Interstitial brachytherapy for lip carcinomas: Comparison between Ir-192 low-dose-rate and high-dose-rate treatment.

PURPOSE: Low-dose-rate (LDR) and high-dose-rate (HDR) interstitial brachytherapy are known to be effective in the treatment of lip carcinomas. The aim of this study was to retrospectively compare oncologic and toxicity outcomes between the two techniques. PATIENTS AND METHODS: From 2007 to 2018, patients at the Institut de cancérologie de Lorraine (France) who received exclusive or adjuvant interstitial brachytherapy for lip squamous carcinomas were studied. Two groups were defined: the LDR/PDR group, including patients treated with iridium-192 wires, or pulsed-dose rate technique, and the high-dose-rate group, with patients treated by high-dose-rate technique. The dose ranged between 50Gy and 65Gy (depending on previous surgery) for low-dose-/pulsed-dose rate treatments, and 39Gy for high-dose-rate (twice a day). Early, late toxicity events and oncologic control were reported. RESULTS: Among the 61 patients whose data were analyzed retrospectively, 36 received the low-dose-/pulsed-dose rate treatment (59%) and 25 the high-dose-rate brachytherapy (41%). The median follow-up time was 44 months. At 36 months, the local control rates were 96.3% for LDR/PDR group and 100% for HDR (P=0.180). The regional control rates were 85.9% and 92% without any difference according to the two groups (P=0.179). The specific overall survival rate was 95.5% with no difference between groups. There were more grade 2 or higher mucositis in the HDR group than in LDR/PDR group (40% versus 16.7%, P=0.042). One case of grade 3 mucositis was recorded in each group. No grade 3 late complications were recorded. High-dose-rate brachytherapy reduced the length of hospitalization by 2 days (P<0.001). CONCLUSION: High-dose- or low-dose-/pulsed-dose rate brachytherapy seemed to be as effective and well tolerated in our experience of 61 patients.

Can we predict the cardiac benefit of deep inspiration breath hold for left breast and regional nodal irradiation?

PURPOSE: Deep inspiration breath hold (DIBH) is used to decrease the dose of radiotherapy delivered to the heart. There is a need to define criteria to select patients with the potential to derive a real clinical benefit from DIBH treatment. Our study's main goal was to investigate whether two CT-scan cardiac anatomical parameters, cardiac contact distance in the parasagittal plane (CCDps) and lateral heart-to-chest distance (HCD), were predictive of unmet dosimetric cardiac constraints for left breast and regional nodal irradiation (RNI). MATERIALS AND METHODS: This retrospective single-institution dosimetric study included 62 planning CT scans of women with left-sided breast cancer (BC) from 2016 to 2021. Two independent radiation oncologists measured HCD and CCDps twice to assess inter- and intra-observer reproducibility. Dosimetric constraints to be respected were defined, and dosimetric parameters of interest were collected for each patient. RESULTS: Mean heart dose was 7.9Gy. Inter-rater reproducibility between the two readers was considered excellent. The mean heart dose constraint<8Gy was not achieved in 25 patients (40%) and was achieved in 37 patients (60%). There was a significant correlation between mean heart dose and HCD (rs=-0.25, P=0.050) and between mean heart dose and CCDps (rs=0.25, P=0.047). The correlation between HCD and CCDps and unmet cardiac dosimetric constraints was not statistically significant. CONCLUSION: Our dosimetric analysis did not find that the cardiac anatomical parameters HCD and CCDps were predictive of unmet dosimetric cardiac constraints, nor that they were good predictors for cardiac exposure in left-sided BC radiotherapy comprising RNI.

Update on Actinomucor elegans, a mucormycete infrequently detected in human specimens: how combined microbiological tools contribute efficiently to a more accurate medical care.

Actinomucor elegans is a fungus belonging to mucormycetes and is still probably underdiagnosed due to misidentification. Based on a recent first case of Actinomucor elegans sinusitis in Europe, in an immunocompromised patient under voriconazole treatment, this paper aims to summarize knowledge about A. elegans mucormycoses. Even if the diagnosis of mucormycosis was made using traditional mycology techniques, precise identification of the fungus could only be achieved using molecular tools. In this observation, the galactomannan dosage was positive until the introduction of treatment and surgical debridement. The patient experienced no relapse after one year. By reviewing the four previous A. elegans reported cases and describing the mycological characteristics of this species, we highlight the need to use a combination of tools to improve the diagnostic strategy in such rare and life-threatening clinical situations.

Gingival plasma cell granuloma.

Plasma cell granulomas (pseudotumors) are rare benign, tumor-like proliferations composed chiefly of plasma cells that manifest primarily in the lungs, but may occur in various anatomic locations. We report this case of a 54-year-old male who presented with an unusual maxillary anterior gingival overgrowth treated by excisional biopsy. Histological examination revealed a dense inflammatory cell infiltrate containing mainly plasma cells. Immunohistochemistry for kappa and lambda light chains showed a polyclonal staining pattern confirming a diagnosis of plasma cell granuloma. Intraoral plasma cell granuloma is exceedingly rare, although case reports documenting such lesions have been reported. This case highlights the need to biopsy unusual lesions to rule out potential neoplasms.

The effect of dental implant spacing on peri-implant bone using the rabbit (Oryctolagus cuniculus) tibia model.

PURPOSE: This study investigated the effects of implant proximity on inter-implant bone height, density, and osseointegration using digital radiography and histology. MATERIALS AND METHODS: After a feasibility study, a total of 80 endosteal implants were placed in 20 New Zealand White Rabbit tibias. With the aid of a surgical jig, four 8.5-mm implants were placed in the medial aspect of the tibial crest at inter-implant distances of approximately 1, 1.5, and 3 mm. Standardized digital radiographs using a paralleling device were made immediately after placement of implants. Implants were allowed to osseointegrate for 90 days. After this healing period, the animals were sacrificed, and the standardized radiographs were repeated. The tibias were harvested, processed, and invested in epoxy. Sagittal sections were made from each specimen for histologic evaluation. The initial and postmortem digital radiographs were evaluated for inter-implant distances, vertical bone height changes over time and between implant pairs, and bone density changes over time and between implant pairs using a computer image analysis program and computer statistics program. RESULTS: The actual inter-implant distances were consistent in a range of 0.2 mm. Bone height increased significantly from presurgical levels at all 3 locations (p < .0005). Repeated measures analysis of variance comparing change in bone height at the 3 implant pair distances showed significant differences among the 3 (p = .002). Paired t tests showed that the amount of bone growth at the 1-mm separation site was significantly greater than the 1.5-mm site (p = .026) and the 3-mm site (p = .001), whereas bone growth at the 1.5- and 3-mm sites did not show significant differences (p = .162). A repeated measures analysis of variance comparing change in bone density showed no significant differences (p > .05) among the 3 inter-implant distances for either the 8-mm position (approximately crestal bone height) or the 6-mm position (approximately 2 mm subcrestal). CONCLUSION: Within the limits of this study, it seems placing implants closely together does not adversely affect bone height or density. Conversely, it seems that placing implants closer together may increase bone growth.

Effect of nicotine on fibroblast beta 1 integrin expression and distribution in vitro.

BACKGROUND: Integrins are a family of transmembrane cell surface glycoproteins, and those with the beta 1-subunit function in both cell-to-cell and cell-to-substrate adhesion. The purpose of this study was to determine nicotine's effect on the expression and distribution of the beta 1 integrin subunit on the human gingival fibroblast cell surface. METHODS: Pure nicotine was diluted in medium to the following concentrations: 0 (control), 0.025, 0.05, 0.1, 0.2, and 0.4 microM. Human gingival fibroblasts (HFG) were grown for 24 hours in each concentration and fluorescein-labeled with a mouse monoclonal anti-human beta 1 antibody and secondarily incubated with a urease-labeled anti-mouse IgG antibody. After a final wash, the cells were incubated with urea/bromcresol blue substrate for 15 minutes at 37 degrees C and measured in a microplate reader at 570 nm. RESULTS: The integrin beta 1-subunit was detected on the HGF surface membrane by fluorescence labeling, and cell-enzyme-linked immunosorbent assay testing demonstrated its decreased expression with increasing nicotine concentrations that were statistically different at the concentrations of 0.2 and 0.4 microM versus controls (P < 0.05). CONCLUSIONS: Nicotine concentrations of 0.2 and 0.4 microM significantly decrease beta 1 integrin expression in human gingival fibroblasts that may affect cell-cell and cell-substratum adhesion during wound healing.

Periodontal disease and its association with systemic disease.

Periodontal diseases are oral disorders characterized by inflammation of the supporting tissues of the teeth. Usually, periodontitis is a progressively destructive loss of bone and periodontal ligament (loss of the attachment apparatus of the teeth). Periodontitis has documented risk factors, including but not limited to specific plaque bacteria, smoking, and diabetes mellitus. Initially, the link between systemic disease and periodontal diseases was thought to be unidirectional. Currently, there is increasing evidence that the relationship between these entities may be bidirectional. Recent case-control and cross-sectional studies indicate that periodontitis may confer a 7-fold increase in risk for preterm low birth weight infants and a 2-fold increase in risk for cardiovascular disease. These early reports indicate the potential association between systemic and oral health. Additionally, these studies support the central hypothesis that periodontal disease involves both a local and a systemic host inflammatory response. This knowledge of disease interrelationships may prove vital in intervention strategies to reduce patient risks and prevent systemic disease outcomes. Based on the current evidence of the periodontal-systemic disease connection, the purpose of this report is to help establish the groundwork for closer communication between physicians and periodontists in the military health care setting.

Treatment of gingival recession with collagen membranes.

Periodontal plastic surgical techniques to obtain root coverage traditionally have utilized autogenous soft tissue grafts. Guided tissue regeneration (GTR) increasingly is being used as an alternative to soft tissue grafting in attempting root coverage. Resorbable membranes in GTR therapy prevent the need for a second surgery to harvest donor tissue. GTR membranes composed of collagen are effective barriers that add to the thickness of the overlying gingiva and possess platelet-aggregating properties that may help in early wound healing. The cases presented here demonstrate the treatment of gingival recession with a resorbable collagen membrane.

Periodontal plastic surgical technique for gingival fenestration closure.

Gingival fenestration is an opening through oral keratinized tissue, usually unattached, that is observed in thin gingiva with usually thick subgingival calculus deposits. This lesion is seen infrequently but may be more common than has been reported; lack of symptoms may inhibit patient awareness. Because surgical correction usually is not required, there are very few reports in the literature concerning this lesion. The following report describes a case of gingival fenestration and surgical treatment with a connective tissue/periosteal graft.

Gingival recession treatment using a bilayer collagen membrane.

Traditional periodontal plastic surgery techniques for the management of gingival recession have typically used soft tissue grafts to obtain defect coverage with great clinical success. Clinicians using guided tissue regeneration (GTR) techniques are also enjoying significant success in periodontal plastic surgery procedures. GTR therapy utilizing bioabsorbable membranes offers the advantages of preventing a donor site surgery and a second surgical procedure for barrier removal. A new bioabsorbable bilayer collagen membrane that readily adapts to bone and tooth surfaces by a gel formation of collagen fibers and blood may be stabilized without sutures prior to soft tissue closure. This bioabsorbable membrane has been shown to be effective in guided bone regeneration procedures and in treating periodontal defects. This case demonstrates the treatment of gingival recession with a novel collagen bilayer membrane.

Pluronic polyol effects on human gingival fibroblast attachment and growth.

BACKGROUND: Enhanced speed of human gingival fibroblast (HGF) spreading and attachment, as affected by ionic bonding interactions, may facilitate cell orientation and subsequent collagen synthesis to promote early wound healing. The purpose of this study was to determine the in vitro effects of pluronic polyols, a family of widely used surfactants currently used as drug carriers for antibiotic, anti-inflammatory, and anti-neoplastic agents, on the attachment and growth of human gingival fibroblasts (HGF) to dentin and plastic surfaces using established tissue culture techniques. METHODS: Plastic culture wells containing Eagle's minimal essential media (EMEM) with 10% fetal calf serum and Pluronic F-68 or F-127 in concentrations from 1.2 x 10(-2) to 1.2 x 10(-10) M were incubated with HGF and run in replicates of ten. Attached cells were quantified by measuring the optical density of methylene blue-stained cells. Additional experiments were conducted using human dentin sections as a substrate and Pluronic F-68 or F-127 at a concentration of 1.2 x 10(-8) M. In these experiments, HGF were stained with acridine orange and quantified per unit area of dentin by fluorescence microscopy. RESULTS: Attachment and growth of HGF to both plastic and dentin were significantly increased over serum controls by very low concentrations of Pluronic F-68 and F-127 by 30 minutes, with attachment reaching a plateau at 2 hours. CONCLUSIONS: Pluronic polyols, a family of widely used surfactants, in very low dosages may be beneficial in early postsurgical wound healing by facilitating early attachment and enhancing the growth rate of human gingival fibroblasts.

Non-Hodgkin's lymphoma and periodontitis. A case report.

BACKGROUND: We describe an unusual case of extra-nodal non-Hodgkin's lymphoma that developed in the maxillae associated with localized severe periodontitis in a 64-year-old Caucasian male. The lymphoma was diagnosed less than 2 years following routine periodontal surgery and 8 weeks after the extraction of hopeless teeth in the associated area. METHODS: Two months following the extractions, the patient experienced pain and swelling in the maxillary right edentulous area mimicking an abscess, and reported for emergency care. An expansile lesion measuring 2.0 x 2.5 cm in diameter was noted on radiographic examination to extend into the right maxillary sinus. A definitive biopsy diagnosis of high-grade, small, non-cleaved, diffuse non-Hodgkin's lymphoma of the right posterior maxillae was established. The patient was subsequently treated by a combination of radiation, chemotherapy, and bone marrow transplantation. RESULTS: The maxillary tissues healed uneventfully, and the patient has been closely observed for approximately 5 years without symptoms or recurrence of the lymphoma. CONCLUSIONS: This case highlights the need for careful debridement of extraction sockets associated with severe periodontitis and argues for the routine submission of extracted teeth with adjacent soft tissue for microscopic analysis, to assist in the early diagnosis of potentially life-threatening malignancies.

Surgically assisted rapid palatal expansion: orthodontic preparation for clinical success.

Close root proximity between the maxillary central incisors presents a problem in the surgical management of a maxillary palatal expansion. During the surgical fracture of this interdental area, the possibility exists for a separation to occur between the root surface and the bone. If this does occur, it is paramount that the gingival attachment remain intact. Asymmetric separation places more stress on the mesial gingival attachment because of the anatomy of the gingival fiber apparatus. Gingival detachment results in epithelial downgrowth in an apical direction, which in turn prevents bone apposition in a coronal direction. The resulting osseous defect is difficult to treat with an osseous graft procedure, as there are few if any intrabony walls. Treatment planning should include analysis of a recent periapical radiograph of the incisor roots to determine the need for orthodontic root separation before surgery. A postsurgical periapical radiograph should be taken to determine where the interdental separation has occurred. The expansion schedule should be adjusted depending on the symmetry of the separation and the health of the gingival attachment.

Gingival augmentation with a dermal allograft.

Gingival augmentation surgery with soft tissue autografts long has been the standard for increasing the width of keratinized oral tissue. Acellular dermal allografts, which have been used for several years by reconstructive surgeons, are a novel technique for achieving increased gingival tissue in place of soft tissue autografts. This report describes a case of gingival augmentation via an acellular dermal allograft. Reduced morbidity from donor site grafts and increased patient acceptance, along with highly successful clinical results, are the primary advantages of this acellular dermal allograft.

Estrogenic hormones and dental implant therapy: the effects of estrogen and progesterone levels on osseointegration of dental implants.

Successful rehabilitation of female service members suffering traumatic injuries to the maxillofacial region is both a physiological and a psychological issue. A clinical evaluation to determine if an association exists between sex hormone levels and dental implant success was undertaken. Endosseous dental implants were placed in three patient groups: (1) male controls, (2) females with high estrogen, and (3) females with low estrogen. Female groupings were based on ovulation cycles. Serum estrogen (ng/dl), serum progesterone [ng/dl], and serum interleukin-6 (pg/ml) were determined at time of implant placement. Pre- and postsurgical photographs and vinyl-polysiloxane impressions were taken to evaluate crestal alveolar bone loss. Upon data analysis, the authors concluded that the balance of alveolar osseous wound healing was not influenced by temporal fluctuations in the ovulatory cycle.

Pyogenic granuloma associated with guided tissue regeneration: a case report.

A pyogenic granuloma is an exuberant growth of granulation tissue secondary to irritation. Intraorally, it can present with a wide array of clinical appearances, ranging from a sessile lesion to an elevated mass. Pyogenic granulomas generally are soft, painless, and deep red to reddish-purple in color. They are usually 0.5 to 1.0 cm in diameter, more common in females, and often found on the keratinized tissue. This case is interesting because the pyogenic granuloma was found associated with guided tissue regeneration and the lingual alveolar mucosa. The lesion arose after demineralized freeze dried bone allograft and an expanded polytetrafluoroethylene (ePTFE) membrane were utilized to repair osseous defects. Five weeks after surgery, the patient presented for routine follow-up where suppuration associated with the membrane was noted along with an exophytic growth of the lingual alveolar mucosa. The ePTFE membrane was removed alone with an excisional biopsy of one of the growths. By 10 days after the removal of ePTFE, the lesion spontaneously healed. Histologic evaluation of the tissue was consistent with a pyogenic granuloma. This is the first case in the literature of a pyogenic granuloma associated with a routine guided tissue regenerative surgery using a non-resorbable membrane and allograft.

Maxillary sinus morphology in differential dental diagnosis.

In this case, the shape of the maxillary sinus was misinterpreted as a periapical pathological condition. Based on this anatomic misinterpretation, conventional endodontic therapy had been performed on two teeth. When the suspected lesion did not resolve, an exploratory procedure revealed the unusual morphology of an otherwise normal maxillary sinus. The anatomy and morphology of the maxillary sinus in differential dental diagnosis are discussed, and surgical exploration is demonstrated. A case of healthy sinus anatomy with abnormal morphology is reported.

An in vivo study of dentin sensitivity: the relation of dentin sensitivity and the patency of dentin tubules.

Dentin hypersensitivity can be a major problem for periodontal patients. The relationship between dentin hypersensitivity and the patency of dentin tubules in vivo has been established. Thirteen adult patients with teeth scheduled for extraction were selected and a stent fabricated to confirm location of the root surface being examined. Response to a constant air blast was recorded on a numeric pain rating scale (from 0 to 4) during the course of treatment. The tooth surface was initially treated with 0.5 molar EDTA (pH = 7.4), to remove the smear layer and expose tubules. The region was then treated with either a 3% monopotassium-monohydrogen oxalate solution or a 3% sodium chloride solution, both at pH = 2.4. Solutions were prepared to be indistinguishable to the examiner. Response to air was evaluated before and after EDTA treatment and after treatment with a desensitizing agent. The patient was anesthetized and the treated tooth extracted. Specimens were sectioned, critical point dried, sputter coated with gold, and examined under the scanning electron microscope. Photomicrographs were analyzed by computer assisted digital analysis to evaluate the degree of tubule occlusion. Statistical analysis by repeated measures ANOVA for univariate tests of hypothesis for within subject effects showed the sodium chloride solution was more effective in reducing dentin sensitivity than the potassium oxalate solution. Scanning electron micrographic analysis revealed a mean dentin tubule aperture size of 1.720 square microns following EDTA treatment alone, 0.564 square micron following potassium oxalate treatment, and 0.386 square micron following sodium chloride treatment.(ABSTRACT TRUNCATED AT 250 WORDS)