Glucagon-Like Peptide-1 Receptor Agonist Liraglutide Ameliorates the Development of Periodontitis

Periodontitis is one of the diabetic complications due to its high morbidity and severity in patients with diabetes. The prevention of periodontitis is especially important in diabetic patients because the relationship between diabetes and periodontitis is bidirectional. Here, we evaluated the impacts of glucagon-like peptide-1 (GLP-1) receptor agonist liraglutide on the amelioration of periodontitis. Five-wk-old Male Sprague-Dawley (SD) rats (n = 30) were divided into 3 groups: normal, periodontitis, and periodontitis with liraglutide treatment groups. Periodontitis was induced by ligature around the maxillary second molar in SD rats. Half of the rats were administered liraglutide for 2 weeks. Periodontitis was evaluated by histological staining, gene expressions of inflammatory cytokines in gingiva, and microcomputed tomography. Periodontitis increased inflammatory cell infiltration, macrophage accumulation, and gene expressions of tumor necrosis factor-α and inducible nitric oxide synthase in the gingiva, all of which were ameliorated by liraglutide. Liraglutide decreased M1 macrophages but did not affect M2 macrophages in periodontitis. Moreover, ligature-induced alveolar bone resorption was ameliorated by liraglutide. Liraglutide treatment also reduced osteoclasts on the alveolar bone surface. These results highlight the beyond glucose-lowering effects of liraglutide on the treatment of periodontitis.

Central Giant Cell Granuloma Treated with Intralesional Corticosteroid Injections and Bisphosphonates: A Long-Term Follow-Up Case Study

Central giant cell granuloma (CGCG) is a benign intraosseous lesion of the head and neck with potential for aggressive and locally destructive behaviour. Lesions of the maxilla tend to expand more than those of the mandible due to the thinner cortices and spongy tissue of this location. Surgical removal is the most common treatment; however, it may be disfiguring in aggressive cases, especially for lesions located in the maxilla. Alternative treatments, such as intralesional corticosteroid injections, have been performed with satisfactory results. We report a case of a 12-year-old female patient with a CGCG of the left maxilla that was treated with 40 doses of intralesional triamcinolone acetonide infiltrations combined with alendronate sodium and calcium carbonate. Clinical and imaging follow-up over 12 years demonstrates improvement in the patient's condition.

Effect of Rapid Maxillary Expansion on Condyle-fossa Relationship in Growing Patients

AIM

This study tests whether rapid maxillary expansion (RME) exerts long term effects on interglenoid fossa distance and condyle fossa relationship.

MATERIALS AND METHODS

Consecutive growing patients aged 8 to 13 years were allocated either to the RME group or control group. Cone-beam computed tomography was performed at baseline and at 6 months. Specific software was used to determine fixed landmarks. Multivariate Analysis of Covariance (MANCOVA) models were used, with time by group interaction, using age as a covariate.

RESULTS

Twenty-seven patients with a mean age of 11.4 ± 1.5 years were included. There was an overall significant group by time interaction (p = 0.012, effect size 0.59). Change in the lateral position of the glenoid fossa, the primary outcome, was reached (p = 0.008, effect size 0.258). Change in the laterolateral position of the center of the condyle, and the co-primary outcome was also significant (p = 0.011, effect size = 0.24). Nasal cavity width increased (p = 0.065, effect size = 0.14). There was an initial asymmetry in the horizontal position of the condyles that was carried on with no effect of RME.

CONCLUSION

Rapid maxillary expansion (RME) produces a significant increase in the interglenoid fossa distance and displacement of the mandibular condyles at 6 months in growing patients compared to a control group.

CLINICAL SIGNIFICANCE

The current study shows that RME is effective during growth, widening the interglenoid fossa distance and the lateral positions of the condyles and eventually enlarging the nasal cavity, without causing asymmetry.

The use of platelet-rich fibrin as a hemostatic material in oral soft tissues

The control of postoperative bleeding represents one of the main intercurrent events associated with soft tissue surgical procedures in the oral cavity. In this context, platelet-rich fibrin (PRF) membranes are materials with great potential for optimizing soft tissue healing and induction of hemostasis. This interventional case series describes the treatment of 10 patients with excisional biopsy of benign oral cavity lesions, following a screening sequence at the surgery clinic of a Brazilian dental school between the years of 2015 and 2017. After treatment with PRF, patients presented mean time for postoperative hemostasis of 10.3 ± 2.5 s, requiring the average use of three membranes to cover the surgical area. The results suggest that the use of platelet-rich fibrin membranes may represent a feasible alternative hemostatic material for the treatment of oral lesions.

Cholesterol granuloma of the maxilla

Intra-osseous cholesterol granuloma (CG) is a rare and benign lesion. Very few cases of CG of the jaws have been described in the literature. CG of the jaws seems to be due to the accumulation of cholesterol of hematogenous origin in odontogenic cysts. We report on one case of CG of the maxilla treated by surgical enucleation in a 46-year-old man who presented an asymptomatic swelling of the maxilla.

Prevalence of odontogenic lesions among the Kanpur population: an institutional study

BACKGROUND

The frequency and incidence of odontogenic cysts and tumors are controversial and depends in the geographic location. These lesions have great clinical and histopathological diversity, and reflect a need for epidemiological profile to be considered when these lesions are studied.

AIM

The purpose of this study was to determine the prevalence of odontogenic cysts and tumors over a period of 10 years and to compare with other data reported around the world.

MATERIALS AND METHODS

Data for the study were obtained from the archives of the Department of Oral and Maxillofacial Pathology, diagnosed as the cases of Odontogenic cysts and tumors histopathologically, reported from January 2007 to March 2016. Case records of the patients that fit the histological classification of the World Health Organization (2005) were included in the study and the variables analyzed were: Age, sex, anatomical location, and histological type.

RESULTS

In a total of 1319 biopsies reported, 112 were odontogenic in nature. Of these 112 odontogenic lesions reported, Odontogenic Cysts accounted for 54.4% and odontogenic tumors of 45.53%. Of them 61.60% of the patients were males. Common age of occurrence was 21-50 years and mandibular posterior was the most common site of occurrence. Most common odontogenic cyst and tumor reported was dentigerous cyst and ameloblastoma respectively.

CONCLUSION

This study provides epidemiological information on odontogenic cyst and tumors at an institutional level. The relative frequency of these cysts and tumors can be analyzed at a global level to understand their prevalence, incidence, biological behaviour, and distribution.

Brown tumor: clinical findings of secondary hyperparathyroidism in patients with renal osteodystrophy

A brown tumor, or osteoclastoma, is a nonneoplastic bony lesion associated with hyperparathyroidism and directly related to increased levels of parathyroid hormone. These tumors result from excessive osteoclastic activity. This article presents 3 cases of brown tumor localized in facial bones. The lesions were the result of secondary hyperparathyroidism associated with chronic renal failure. The patients were two 42-year-old men and a 39-year-old woman. All patients had been treated systemically by hemodialysis for more than 10 years. This article highlights the importance of proper diagnosis and management of dental patients presenting with a brown tumor.

Dentigerous cyst associated with ectopically impacted maxillary second premolar

Dentigerous cysts are benign odontogenic cysts that are accompanying with the crown of permanent teeth. They are typically single in incidence and are situated in the mandible. They are usually associated with impacted mandibular third molar and maxillary canines. Here we report a very rare presentation of dentigerous cyst in anterior maxilla accompanying with ectopically impacted maxillary second premolar. The cyst was enucleated along with extraction of premolar.

Inflammatory pseudotumour of the maxilla

Inflammatory pseudotumour (IP), also known as inflammatory myofibroblastic tumour (IMT), is a rare lesion of the maxillofacial skeleton and a diagnosis by exclusion. We describe three cases which affected the maxilla, two women and one man of ages 67, 56 and 70 years at presentation. All showed the typical, rather non-specific histopathological features. IgG4-positive plasma cells varied greatly in prominence, and none of the three lesions expressed ALK-1. Both women responded to steroids and radiotherapy, though one also required azathioprine. Despite maxillectomy, radiotherapy, steroids and cyclophosphamide, the man suffered intracranial spread and succumbed to persistent disease. The cases described here demonstrate the clinicopathological difficulties presented by this entity and its aggressive, unpredictable behaviour.

[THE ROLE OF ANTIHYPOXANTS AND ANTIOXIDANT IN TREATMENT OF ODONTOGENIC OF MAXILLOFACIAL AREA]

The aim of this work is the systematization of the literature data for the most clearly defined directions of study of the effectiveness of antioxidant and antihypoxant drugs in complex treatment of patients with purulent inflammatory diseases of the maxillofacial area. The authors attempt to analyze the results of the use of antioxidant and antihypoxant therapy at pyoinflammatory pro- cesses of different localization. Areas of research of the impact of antioxidant and antihypoxants therapy on physical and biochemical parameters of the maxillofacial area and the organism of the patient as a whole are defined.

The residual radicular cyst

The existence of a true residual radicular cyst has been called into question. When observed, it probably represents, with rare exceptions, a resolving radicular cyst--a "work in progress".

Paranasal bone: the prime factor affecting the decision to use transsinus vs zygomatic implants for biomechanical support for immediate function in maxillary dental implant reconstruction

Paranasal bone affects the decision-making process for placement of implants for immediate function in the highly resorbed maxilla. The most important bone for apical fixation of implants in this setting is the lateral nasal bone mass. Maximum available bone mass found at the pyriform above the nasal fossa, designated M point, can most often engage two implants placed at 30-degree angles. The second most important area of paranasal bone mass is the subnasal bone of the premaxilla, which is required to engage an angled implant at the alveolar crest. However, only 4 to 5 mm in height is needed when implants are angled posterior to engage M point. The third most important paranasal bone site for implant fixation is the midline nasal crest extending upward to the vomer. This site, which is usually type 1/2 bone, can engage implants apically and provide enough fixation for immediate function even if implants are short. These anatomical bone sites enable placement of implants to obtain a 12- to 15-mm anterior-posterior spread, which is favorable for immediate function.

Treatment of craniofacial fibrous dysplasia: a case report

The concept of "fibro-osseous lesions" of bone has evolved over the last several years and now includes two mayor entities: the fibrous dysplasia (FD) and the cement-ossifying fibroma (COF). Fibrous dysplasia is considered to be a developmental, tumor-like (hamartomatous), fibro-osseous disease of unknown etiology. There is a maxillary predominance when craniofacial FD occurs in the jaws and the maxillary sinus is commonly involved. Differentiation of OF from FD is important because of differences in treatment and behaviour. This article report a case of 60-year-old female with a history of painless unilateral palatal swelling.

Nasopalatine duct cyst as a complication of dental implant placement: a case report

This report demonstrates the association between the development of a nasopalatine duct cyst and implant surgery, involving 2 implants positioned 4 years after teeth extraction at a site unaffected by any prior local endodontic disease or radiolucency. The cyst was removed and the residual void was filled with deproteinized bovine bone. Two-year follow-up showed no cyst recurrence, the normal anatomy was partly restored, and one of the implants showed clinical signs of re-osseointegration.

Peripheral cementifying fibroma: a clinical diagnostic dilemma

The peripheral ossifying fibroma (POF) is a reactive gingival overgrowth occurring frequently in the anterior maxilla. It originates in the cells of the periodontal ligament and is more common in children and young adults. In the current article a case of gingival over growth, which was thought to be puberty-induced gingivitis was seen in the lower anterior maxillary gingiva. Histology of the excised tissue showed cellular, fibrous connective tissue stroma with calcified osseous calcifications indicative of POF. The definitive diagnosis is established only by histological examination, which revealed the presence of highly cellular connective tissue with focal calcifications. Surgery is the treatment of choice, though the recurrence rate can reach 20% in case of POF. After histological confirmation the recall and clinical evaluation protocol of POF varies due to its increased recurrence rate, which the general dentist should be aware of.

Large, expansile odontogenic cyst with bilateral maxillary sinus involvement

Residual cysts are common odontogenic lesions of the tooth-bearing areas of the jaws. A case of an unusually large residual cyst that crosses the maxillary midline and occupies portions of the maxillary sinuses is being reported. Investigations included a panoramic radiograph, CT scan and a biopsy. The differential diagnoses were common odontogenic lesions, including cysts and benign tumors. The value of advanced imaging modalities is stressed when determining the presence and extent of lesions in complex structures such as the maxilla. The need to visualize the entire lesion beyond what may be seen on intraoral views, as well as panoramic radiographs, is discussed.

Globulomaxillary cysts--do they really exist?

OBJECTIVES

The so-called "globulomaxillary cyst", described as a fissural cyst, caused by entrapped epithelium between the nasal and maxillary process, is no longer considered for its own entity. Nevertheless, cystic lesions, which correspond to the previous image of globulomaxillary cysts, do still occur in daily practice. This raises the question to which entities pathological processes in this particular region actually belong to.

MATERIALS AND METHODS

In a retrospective study, 17 cases (12 men and 5 women, 12-59 years old) of primarily diagnosed globulomaxillary cysts are analysed according to clinical, radiological and histological aspects, catamnestic processed and assigned to a new entity. The results are compared with the international literature and draws conclusions on the diagnostic and therapeutic procedure.

RESULTS

Seven lateral periodontal cysts, four radicular cysts, two keratocystic odontogenic tumours, one adenomatoid odontogenic tumour, one periapical granuloma, one residual cyst and one undefined jaw cyst were determined.

CONCLUSIONS

According to the results of our study and the data from the international literature, the entity globulomaxillary cyst is no longer justified.

A clinico-pathologic correlation

A 66-year-old female was referred to our department for evaluation of exposed bone in the hard palate. She was asymptomatic at the time of her initial consultation; however, she was concerned about a non-healing lesion that had been present for five months. The patient reported having injured her hard palate while eating sometime in November 2011. Subsequently she was followed by her general dentist, who had noticed improvement of the area. Approximately three months later, she noticed worsening of the lesion along with discomfort. She was conservatively managed at that point with penicillin and chlorhexidine mouth rinse without any improvement of her condition.

Idiopathic synchronous central giant cell granulomas involving both the maxilla and mandible: a case report

The central giant cell granuloma is a well-defined lesion of the jaws and reports of multiple lesions are very uncommon. The authors report the case of a patient with idiopathic synchronous multiple central giant cell granulomas involving both the maxilla and the mandible. Surgical curettage of the lesions was performed. At the end of the 24 months follow-up, no recurrence was detected.

Keratocystic odontogenic tumour (KCOT)--a cyst to a tumour

PURPOSE

The World Health Organization (WHO) has reclassified 'odontogenic keratocyst' (OKC) to 'keratocystic odontogenic tumour' (KCOT) in 2005. Currently, this tumour is classified as a benign neoplasm of odontogenic origin and not as a cyst. This article reviews and discusses history, classification scheme, aetiology and pathogenesis, molecular and genetic basis, incidence, epidemiology and site, clinical features, imaging, histopathology, immunohistochemistry, treatment options, prognosis, recurrence and malignant transformation of KCOT, with emphasis on understanding the basis of reclassification as 'keratocystic odontogenic tumour'.

METHODS

A systematic search and review of the literature was carried out in the online database of the United States National Library of Medicine to identify eligible titles for the study.

RESULTS

Current evidence suggests that the scientific community still continues to use the term 'odontogenic keratocyst' more favourably than 'keratocystic odontogenic tumour'.

CONCLUSION

The online database search indicates that the scientific community still continues to use the term 'odontogenic keratocyst' more favourably than 'keratocystic odontogenic tumour'. At this juncture, where the terminology has changed from a cyst to a tumour, a thorough review of literature on KCOT is presented.

Platelet gel in oral and maxillofacial surgery: a single-centre experience

BACKGROUND

Platelet gel is a blood product intended for non-transfusion, therapeutic purposes; it is produced by combining platelet concentrate with cryoprecipitate. Platelet gel stimulates tissue growth and is a key player in tissue regeneration. As an allogeneic product, platelet gel is obtained from the blood of a common type O blood donor, with a platelet count >200×10(3)/μL. Most of the beneficial effects of this product are due to the numerous growth factors (PDGF, TGF-β, IGF-1 and IGF-2, EGF, VEGF and FGF) contained in the alpha-granules of platelets. The aim of this study was to confirm that platelet gel is a valuable aid for the surgical repair of alveolar bone loss.

MATERIALS AND METHODS

Our study was carried out on 87 patients with inflammatory or dysembryoplastic osteolytic lesions >2 cm in diameter in jaw bones. For most patients the platelet gel was collected into a 450 mL bag and kept frozen at -40 °C until, whereas for a small group of patients the gel was prepared and activated in the sterile field of the operating theatre.

RESULTS

All of our patients reported a decrease in painful symptoms immediately after surgery. Follow-up showed considerable acceleration of the healing processes in soft tissues and faster bone regeneration.

CONCLUSION

Multicentre studies are needed in order to standardise the methods for producing platelet gel and the clinical use of this product. Furthermore, for research purposes in vitro studies are needed to increase knowledge on the functional network and platelet growth factors and also to investigate the biochemical and molecular mechanisms involved.

Basal cell carcinoma arising in association with a maxillary keratocyst in a patient with Gorlin-Goltz syndrome. Report of a case

INTRODUCTION

Gorlin-Goltz syndrome, also known as nevoid basal cell carcinoma syndrome, is an autosomal dominant inherited disorder which is characterized by the presence of multiple basal cell carcinomas, maxillary keratocysts, and musculoskeletal anomalies.

CASE REPORT

We present a case of a patient suffering from Gorlin-Goltz syndrome who developed an intraosseous basal cell carcinoma associated with a recurrent maxillary keratocyst. To our knowledge, this is the first case of malignant transformation of a keratocyst into a basal cell carcinoma described in the literature.

CONCLUSION

This case highlights the importance of careful histologic examination of keratocysts excised in patients suffering from Gorlin-Goltz syndrome.

Primary tuberculosis: an unusual finding in the oral cavity

The unusual involvement of the oral cavity in tuberculosis and the non-specific nature of its presentations mean that diagnosis of tuberculosis is often delayed and is an unexpected finding. The aim of this paper is to present a case of primary tuberculosis and discuss the implications of the manifestations and diagnosis of oral tuberculosis. This paper presents an unusual case of a painless, papillary, erythematous lesion in the anterior region of a maxillary edentulous ridge. When the patient concerned was first seen by the author, the lesion had been present for six months. There was cervical lymphadenopathy and it was diagnosed initially as a malignant lesion. Eventually, after biopsy and ultrasound examination, the diagnosis of primary oral tuberculosis was reached. The patient was managed solely by anti-tubercular drug therapy.

Chloroquine-induced hyperpigmentation of the hard palate

This article reports a rare case of extensive palatal pigmentation secondary to long-term chloroquine treatment. Chloroquine was originally used as an antimalarial agent, but it is now widely used as an adjunct in the treatment of autoimmune diseases. Adverse effects of chloroquine usually include skin changes such as bullous pemphigoid, exacerbation of psoriasis, and pigmentation of the skin and mucous membranes as well as retinopathy, gastrointestinal alterations, and neuromuscular disorders. Extensive oral pigmentation is an uncommon feature of an adverse drug effect, and diagnosis should be based on clinicopathological findings.

A case series of odontogenic keratocysts from a New Zealand population over a 20-year period

PURPOSE

To report on the clinicopathological aspects of odontogenic keratocysts (OKC)/keratocystic odontogenic tumours (KCOT) presenting in a New Zealand population.

METHODS

Information on defined areas--including age at presentation, gender, anatomical sub-location, presenting features, histological subtype and the recurrence pattern--were extracted from the histopathological data available in the Oral Pathology database of the University of Otago School of Dentistry.

RESULTS

Two hundred and twenty three cases of OKC/ KCOT were identified over the period ranging from 1987 to 2008. Mean age at presentation was 37.0 years (males 38.6 years, females 34.4 years), with 61.0% of cases being male. The mandible was the dominant jaw affected, with 65.9% of lesions, with the angle of mandible being the commonest anatomical sub-location (with 32.4% of lesions). One-fifth of the cases were asymptomatic incidental findings, while the majority of problems were related to the third molar tooth and/or pain and swelling. The overall recurrence rate was 18.3%, with the majority (62.2%) in the mandible and more males (67.5%) affected. Recurrence was highest in the first 5 years of follow-up, and decreased sharply thereafter.

CONCLUSION

This study is the first to describe the frequency, distribution, presentation and recurrence rates of OKC/KCOT in New Zealand and shows that these are similar to those reported from other populations.

Nasolabial cyst: 18.5 year experience in a pathology laboratory

AIM

This paper offers a survey of nasolabial cysts diagnosed at the Pathology Laboratory of the Universidade Federal dos Vales do Jequitinhonha e Mucuri (Brazil) over a period of 18.5 years, and a case report.

METHODS

A retrospective study was carried out on biopsies performed at the Pathology Laboratory of the UFVJM School of Dentistry between January 1992 and July 2010.

RESULTS

Among a total of 2730 histopathological exams of biopsies performed at the UFVJM Pathology Laboratory, 288 (10.54%) were different types of cysts, The prevalence of NLC was 0.29% (8 cases) in relation to the overall sample and 2.43% among all cysts. NLC only occurred in the female gender in the age group spanning from 25 to 62 years (mean: 40.00 years; standard deviation (SD): 13.48 years). The duration of evolution ranged from six to 18 months (mean: 12 months; SD: 3.79 months). The cysts were asymptomatic in 62.5% of cases. Cyst size ranged from 10 to 30 mm (mean: 16.86; SD: 8.00 mm). In six cases (75%), the radiographic exams were consistent with the final diagnosis, whereas there were no records of radiographic images in two cases (25%). Surgical excision was the treatment of choice for all cases.

CONCLUSION

The characteristics of NLC, such as location, elevation of the nasal wing, disappearance of the nasolabial sulcus, nasal obstruction, floatation of the cyst and the presence of cystic liquid in the interior, are enough to suggest the diagnosis of this cyst. However, the confirmation of the diagnosis is performed through biopsy and histopathological analysis.

Trabecular juvenile ossifying fibroma with aneurysmal bone cyst: a rare presentation

Juvenile ossifying fibroma is an uncommon, benign, bone-forming neoplasm that is distinguished from other fibro-osseous lesions primarily by its age of onset, clinical presentation, and potential behavior. It mainly occurs in juveniles and has a slight male predilection and more aggressive behavior than a common ossifying fibroma. There are 2 distinct histopathological variants of this lesion: (1) psammomatoid pattern and (2) trabecular pattern. An aneurysmal bone cyst may occur in association with other bone lesions, such as fibrous dysplasia, ossifying fibroma, and giant cell lesion. The clinical management and prognosis of juvenile ossifying fibroma is somewhat uncertain, and this tumor has high rates of recurrence. Such behavior may be related to younger patient age and the concurrent development of aneurysmal bone cyst. The purpose of this paper was to report a case of trabecular juvenile ossifying fibroma in a 9-year-old girl associated with an aneurysmal bone cyst, presenting an aggressive behavior, and causing significant facial asymmetry.

Microcomputed and histologic evaluation of calvarial bone grafts: a pilot study in humans

Two evaluation techniques (histology and microcomputed tomography [micro-CT]) were synergistically applied to calvarial bone graft to verify whether additional bone information can be obtained for the assessment of bone grafts. Ten extensive bone defects in the anterior and posterior maxilla or mandible involving crestal bone were treated by grafted blocks and chips of autogenous calvarial bone. The grafts were fixed with lag screws and left to heal for 4 months. No complications were observed. At surgical reentry for implant placement, a cylindric bone biopsy of both graft and native bone was retrieved and analyzed with both micro-CT and standard histology. Two- and three-dimensional (2D, 3D) micro-CT analyses allowed bone connectivity indices to be evaluated. This is useful for estimating bone strength and observing bone structure. The integration of the grafted calvarial bone with the residual bone of the recipient site was considered satisfactory. Histologic analysis allowed observations to be made at a higher resolution. Calvarial bone grafts seem to have positive effects when used as grafting materials. The application of both histologic and micro-CT techniques allows a better evaluation of grafted bone by concurrently allowing 2D and 3D visual and morphometric analysis of bone vitality, structure, turnover, and strength.

Surgical management of primary chronic osteomyelitis of the jaws in children: a prospective analysis of five cases and review of the literature

INTRODUCTION

Primary chronic osteomyelitis (PCO) of the jaws is an uncommon non-suppurative inflammatory disease of unknown origin. Although the disease is not age-specific, only sparse cases with onset during childhood or adolescence have been reported in the literature.

PURPOSE

This study seeks to present five cases of maxillofacial PCO in children and to evaluate the effectiveness of the applied therapeutic protocol. A review of the literature concerning diagnosis and treatment of PCO with special emphasis on surgical therapy is also performed.

PATIENTS AND METHODS

Demographic data, clinical, radiographic and histopathologic findings, blood tests results, and the treatment protocol applied to five young patients suffering from PCO and referred to the Department of Oral and Maxillofacial Surgery at "A. & P. Kyriakou Children's Hospital" over the past 5 years are presented. Decortication and contouring of the affected bone were performed; antibiotics were administered for a short period of time and the patients remained under follow-up evaluation.

RESULTS

The posterior mandible was affected in four cases and the maxilla-zygomatic bone in one case. All patients showed remission of signs and symptoms after surgical treatment. The postsurgical clinical course was uneventful in all cases. However, recurrences have been noted, as reported in the literature.

CONCLUSION

PCO of the jaws is a complex clinical entity, presenting both a diagnostic and therapeutic challenge, especially in young patients. Surgical treatment in conjunction with antibiotics and non-steroid anti-inflammatory drugs proved to be beneficial and to improve considerably the patients' quality of life. Nevertheless, exacerbation of the disease may appear and regular follow-up of the patients is required.

Synchronous Paget disease of bone and hyperparathyroidism: report of a case with extensive craniofacial involvement

Paget disease of bone (PDB) and hyperparathyroidism (HPT) are metabolic osseous disorders which affect ≥2% of the population. As these diseases may share clinical, radiographic, biochemical, and histopathologic features, knowledge of their phenotypic overlap may provide diagnostic utility and improve clinical outcome. Scant information is available in the dental literature regarding patients concurrently affected with both pathologies. We present an unusual case report of a 63-year-old woman coaffected with primary HPT, attributed to a functional oxyphilic parathyroid adenoma, and PDB. Bone scintigraphy revealed pagetoid lesions of the skull, humeral head, spine, sacrum, and hemipelvis. Salient craniofacial features noted were bony involvement of the calvarium and midface, resulting in extensive maxillary overgrowth, hearing loss, telecanthus and consequent visual impairment, nasal deformity, and leontiasis ossea. The patient underwent a partial parathyroidectomy and bisphosphonate administration was to be initiated upon extraction of the remaining dentition.

[Giant cell in maxillary pseudotumors]

A research on lesions apparently tumorous that appear on jawbones and are not exactly tumors is developed. These lesions are clinically silent, although they produce deformity and, perhaps because of that, an early diagnosis with biopsy or other procedures is needed. The image research can be very characteristic or otherwise, it can be very complex, non specific and not provide everything expected to make the diagnosis. The difference between radiolucent and radiopaque images that produce the querubism-fibrous displasia, prove both extremes in which the diagnosis judgment made by image can or cannot be significant. We have to highlight the presence of giant cells with an osteoclastic nature in most of these pseudo tumorous lesions.

Overexpression of matrix metalloproteinase (MMP)-1 and -9 in central giant cell lesions of the jaws: implications for clinical behavior

OBJECTIVE

The aim of this study was to investigate the relationship between the immunohistochemical expression of MMP-1 and MMP-9 with the clinical behavior of central giant cell lesions (CGCLs) of the jaws.

STUDY DESIGN

Paraffin-embedded tissue from 30 aggressive and 12 nonaggressive CGCLs was assessed for the expression of MMP-1 and MMP-9 using immunohistochemistry.

RESULTS

Although cellular immunolocalization patterns of MMP-1 and MMP-9 were similar, mean values of expression estimation/SID scores of each protease were significantly higher in aggressive CGCLs in comparison with nonaggressive lesions. Moreover, linear regression analysis showed that there was a reasonably good correlation not only between the expression estimation but also among SID scores of the 2 proteolytic enzymes.

CONCLUSION

The findings of this study suggest a role for MMP-1 and MMP-9 in the resorptive activity of different cellular groups in CGCLs and indicate that differences in immunoreactivity of these 2 proteolytic enzymes may underlie the distinct clinical behavior.

[Extensive odontogenic cysts of varying histological structure in an x-ray film]

As of now, a dental surgeon and a maxillofacial surgeon face a problem in choosing the optimal treatment of extensive cavitary masses in the maxillary bones. A detailed study of the characteristic x-ray manifestations of large jaw bone cavities makes it possible to give an insight into the pattern and extension rate of a destructive process, to choose the most optimal surgical treatment, and to yield more predictable results. The aim of this investigation was to analyze the morphological characteristics of large odontogenic cysts in the jaw bones and to reveal the main specific features of their x-ray picture in relation to their histological structure. An x-ray study determines the location, sizes, shape, and structure of the shadow of a cavity, its relation to the adjacent anatomic masses, as well as bone swelling, and preserved cortical laminae and facilitates the most correct presumptive diagnosis.

[A case of breast cancer with extensive osteonecrosis of maxilla induced by a bisphosphonate]

Here, we report a case of extensive osteonecrosis of the maxilla associated with a history of bisphosphonate (BP) therapy for management of bone metastases from breast cancer. A 66-year-old woman was referred to our hospital because of a fistulation on the right side of the maxilla in May 2005 by her dentist. The patient had a medical history of breast cancer with bone metastasis that was treated by chemotherapy with 45 mg pamidronate in 2 weekly courses for 16 months. We suspected that this rare case of osteonecrosis was caused by chemotherapy with BPs. Palliative treatments, including antibiotic therapy and local irrigation, were administered. Finally, extensive osteonecrosis of the maxilla occurred.

Initial speech problems in patients treated with multiple zygomatic implants

PURPOSE

The aim of this study was to investigate the speech ability of patients treated with multiple zygomatic implants. This technique can be used in patients with severe atrophy of the maxilla when there is insufficient residual bone in the anterior region for placement of conventional implants.

MATERIALS AND METHODS

Between 2004 and 2008, audio recordings were performed in patients treated with fixed dental prostheses (FDP) supported by multiple zygomatic implants. Patients with extensive resorption of the basal bone of the maxilla (Cawood and Howell Class VI) were included in the study. No bone grafts were used. Audio recordings were conducted before treatment (pretreatment), within 1 week after the FDP was inserted (1 week posttreatment), and then again after 4 months (4 months posttreatment). Perceptual evaluations of the recordings were performed by a panel of speech and language pathologists (n = 3), and the patients' subjective views of speech quality were investigated on the three different occasions.

RESULTS

Seven consecutive patients were treated with a total of 28 zygomatic implants and five conventional implants. All patients received a FDP. According to the evaluations by professionals, five of the seven patients, all of whom wore a removable conventional denture prior to treatment, had normal speech before treatment. One patient could not be evaluated by the professionals because of medical impairment. In five of the six remaining patients, a mild deterioration in articulation was registered at 1 week posttreatment, and these problems remained after 4 months. Patients' subjective views reflected a dramatic improvement in speech at 1 week posttreatment for the two patients presenting with the highest degree of maxillary bone resorption. The three patients who reported completely normal speech before treatment all experienced a drop in their ability at 1 week posttreatment. Four patients displayed a similar pattern after treatment according to the professionals' opinions and the patients' subjective reports.

CONCLUSION

A mild deterioration in speech can be anticipated in patients subjected to treatment with a FDP supported by multiple zygomatic implants.

[Clinical immunological peculiarities of complicated course of odontogenic phlegmons of maxillofacial region]

Based upon clinical immunological checkup of 76 patients with common phlegmons of maxillofacial region, their complications and analysis of general phlogogenic activity the variants of hyperergic inflammation process flow were determined, that allowed to diagnose its activity and forecast possibility of its further development and its outcome.

[Periapical osseous dysplasia of the anterior maxilla--a case presentation]

Osseous dysplasias (formerly cemento-osseous dysplasias/ CODs) represent a specific clinico-pathologic spectrum of related, non-neoplastic benign fibro-osseous lesions. The most recent WHO classification (2005) defines them as bone-related lesions (9262/0). The controversial presence of cementum was solved by complete removal of the term "cemento" in the revised classification of tumors. Normal bone architecture is replaced by fibroblasts and collagen fibers containing variable amounts of mineralized material. Osseous dysplasias are often identified as an incidental finding on standard dental radiographs of adults. They usually cause no specific symptoms or obvious clinical findings. Four different types of ODs can be distinguished: the periapical osseous dysplasia (POD), the focal osseous dysplasia (FocOD), the florid osseous dysplasia (FOD) and the familial gigantiform cementoma. This case report presents an unusual localization of a periapical osseous dysplasia (POD) in the anterior maxillary bone in a 33-year old female patient of Caucasian origin. Radiological, clinical and histopathological characteristics of the POD and similar benign lesions are defined and discussed.

Calcified maxillary cyst secondary to a foreign-body reaction at the site of a remote tooth extraction

Unilateral sinus disease has a wide differential diagnosis. When a patient has a history of maxillary dental work on the same side as the sinusitis, a foreign entity introduced during or subsequent to the dental manipulation must be considered. We present a case of calcified maxillary cyst that was discovered at the site of a remote tooth extraction. Pathologic analysis revealed the presence of vegetable matter within the cyst. To the best of our knowledge, no case of a maxillary cyst secondary to vegetable matter has been previously reported in the literature.

Aging quantification on alveolar bone loss

Objectives were to measure labial alveolar resorption using Lamendin's method; to correlate the measured values of resorption with age at death; to determine whether age influences alveolar resorption, and if so, to quantify this impact. The study was performed during the 1992-1995 period in identified war casualties in Bosnia and Herzegovina. Data on the date, month and year of birth, and on the month and year of death were known in all cases. Measurements were carried out in 845 anterior monoradicular maxillary and mandibular teeth from male bodies (n=198) aged 23-69, divided into five age groups of 23-29, 30-39, 40-49, 50-59 and 60-69 years. Teeth with macroscopic pathologic lesions were excluded from analysis. Lamendin's method was used to measure the alveolar bone level on the labial aspect of the extracted teeth. Results are presented in tables. Regression analysis was used to determine the alveolar resorption increase with age. Results are also presented by the factor of alveolar resorption, where the youngest age group was divided by older age groups. In the total sample of 845 teeth, alveolar bone level of up to 3.49 mm was recorded in 740 (87.76%), of 3.50-5.99 mm in 99 (11.79%), and of > 6.00 mm in 6 (0.71%) teeth. In anterior monoradicular teeth, labial alveolar resorption increased with age and showed a regular age dependent pattern toward older age groups in mandibular but not in maxillary teeth. A > 6-mm pocket was very rarely recorded. Study results contribute to clinical practice, demonstrating that periodontology is a preventive discipline in dental medicine.