Immediate Implant Placement After Removal of Maxillary Impacted Canine Teeth: A Technical Note.

Impacted maxillary canine teeth commonly occur in the general population. The traditional therapeutic approach comprises fenestration and orthodontic traction; however, if traction is not feasible or the patient refuses orthodontic treatment, an alternative solution is to remove the impacted tooth and immediately place an implant. This technical note describes a novel surgical approach to rehabilitation after impacted canine tooth removal, entailing immediate placement of a long implant in combination with regenerative materials and a barrier. Of note, this procedure preserves the apical ridge bone crest, allowing implant anchorage and primary stability to be achieved.

Tooth extraction in patients taking intravenous bisphosphonates: a preventive protocol and case series.

PURPOSE: To test the efficacy of a protocol in preventing the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ) after tooth extraction. PATIENTS AND METHODS: In this prospective case series, consecutive subjects treated with intravenous bisphosphonates who needed tooth extraction underwent a protocol aimed at reducing the risk of BRONJ, based on local and systemic infection control by means of mechanical and chemical reduction of the local bacterial load plus antibiotic prophylaxis. RESULTS: We performed 38 extractions in 23 patients treated with intravenous bisphosphonates, mainly zoledronate, for a mean of 17.5 months (range, 3-36 months). Five patients already had signs of BRONJ caused by tooth extractions performed elsewhere. The mean follow-up was 229.5 days (range, 14-965 days), and no case of BRONJ was recorded. CONCLUSIONS: Despite the methodologic limitations of the study design, the proposed preventive protocol appears to reduce the risk of BRONJ after tooth extraction in a group of subjects treated with intravenous bisphosphonates.

Mucoceles of the oral cavity: a large case series (1994-2008) and a literature review.

OBJECTIVES: Evaluating data of patients affected by oral mucoceles, examined at the Unit of Oral Medicine and Pathology of the University of Milan between January 1994 and December 2008. STUDY DESIGN: Concise review on oral mucoceles and analysis of the clinical files of patients who underwent excisional biopsy (patient age, medical history, diagnosis, date and site of the biopsy, histopathological diagnosis and recurrences if any). RESULTS: During the period June 1994-December 2008, 158 mucoceles were observed (93 males and 65 females), with the most frequent site being the lower lip (53%) (p=0.001 by Fisher's test). The mean age of the patients was 31.9 years, with a peak of occurrence in the first four decades of life (75%). CONCLUSIONS: Mucoceles are lesions commonly seen in an oral medicine service, mainly affecting young people and lower lips.

Localised maxillary ridge expansion with simultaneous implant placement: a case series.

The placement of implants in edentulous areas is often compromised by a thin alveolar crest, which widens the space between the two cortical bones; this offers advantages from aesthetic, biomechanical, and functional points of view. We present our results using the osteotome technique for the creation of a site for an implant, followed by immediate placement of the implant in thin edentulous maxillae, and the stability of the bony expansion over time. Twenty-three patients (six men and seventeen women) with partial edentulism associated with horizontal resorption of the ridges were treated by this technique to obtain a wider bony base for better placement of the implants. At the same time, 36 endosseous titanium implants were inserted. Three to four months later, the patients were rehabilitated with implant-supported prostheses. All implants were successfully osseointegrated and loading began after 61-197 days. All implants inserted were 4.1 mm in diameter, and between 10 and 15 mm long. All the implant-supported prostheses functioned acceptably, with no signs or symptoms such as paraesthesiae, dysaesthesiae, or pain. Within the limits of this study this technique seems to be reliable and simple with little morbidity, and rehabilitation was as good as that after other techniques such as autogenous bone grafts or guided bone regeneration. Survival and the success of implants placed were consistent with those placed in non-reconstructed bone.

Hypericum perforatum extract in burning mouth syndrome: a randomized placebo-controlled study.

Burning mouth syndrome (BMS) or stomatodynia is characterized by a spontaneous burning pain in the oral mucosa without known cause or recognized treatment. This double-blind, randomized, placebo-controlled, single-center study evaluated the effects of systemic Hypericum perforatum extract in patients with BMS. Forty-three patients participated, of whom 39 (35 women, four men, aged 64.9 +/- 4.7 years) completed the study. The patients took indistinguishable 300-mg capsules containing either H. perforatum extract (hypericin 0.31% and hyperforin 3.0%) or placebo three times a day for 12 weeks. The intensity of burning pain was evaluated using a 10-cm visual analog scale (VAS) before the first dose and at visits after 4, 8, and 12 weeks. Furthermore, we also recorded the number of oral mucosa sites with reported burning symptoms and the self-reported descriptions of the patient's condition before and after the treatment. Pain, measured using the VAS, was similar at the beginning of the study and even though a slightly better performance in the test group, the difference was not statistically significant (P = 0.2216). The results failed to demonstrate that 300 mg of H. perforatum extract taken three times a day for 12 weeks improved the pain of BMS patients, although the general reduction in the number of sites with reported burning sensation, a less accurate and objective score, was significant.

Accuracy of referrals to a specialist oral medicine unit by general medical and dental practitioners and the educational implications.

In this study we investigated the accuracy of diagnoses of oral mucosal diseases made by family physicians (without a dental degree), other categories of physicians, and general dental practitioners prior to referring patients to a university oral medicine unit. Over a three-year period, we compared the diagnoses proposed in referral letters with the definitive histological diagnoses made by the specialist unit. Only 305 of 678 (45 percent) of the referral letters included a clinical diagnosis. Eighty-six patients (86/305, 28 percent) were referred by general dental practitioners (GDPs) who had graduated in dentistry; seventy-six (76/305, 25 percent) were sent by GDPs who had graduated in medicine with a postgraduate degree in dentistry; and 143 (143/305, 47 percent) were referred by other categories of physicians. More than 50 percent of the referring professionals were not able to make a clinical diagnosis of oral mucosal diseases. Only 40 percent of the provisional diagnoses (122/305) coincided with the diagnosis made at the specialist unit. The proportion of correct diagnoses was 40 percent for GDPs who had graduated in dentistry, 33 percent for other categories of physicians, and 27 percent for GDPs who had graduated in medicine with a postgraduate degree in dentistry. These findings suggest that Italian dental and medical practitioners have limited knowledge in the field of oral medicine. Consequently, there is a need for better education in the diagnosis and treatment of oral diseases and for improvement in total oral health training.

Primary small cell carcinoma of the nasal cavity with an unusual oral manifestation.

Small cell carcinoma (SCC) is a malignancy that mainly occurs in the lung, with primary lesions in the head and neck being very rare. This neoplasm has an aggressive growth pattern, high recurrence rate, and tendency to metastasize to other sites via the lymphatics and bloodstream. The prognosis of patients with SCC is poor, as the 5-year survival is only 13%. Treatment options include surgical excision, multiple-agent chemotherapy, and radiation therapy. We report a rare case of primary SCC of the nasal cavity presenting as a lesion of the hard palate and describe its clinical, histologic, and immunohistochemical features.

Causative or precipitating aspects of burning mouth syndrome: a case-control study.

BACKGROUND: On causative or precipitating causes of burning mouth syndrome (BMS), there is a lack of consensus. In this prospective case-control study, we compared clinical features and laboratory aspects to evaluate the association of the proposed causative/precipitating factors of BMS. METHODS: A total of 61 BMS patients and 54 control subjects underwent several evaluations: rest and stimulated salivary flow rates measurements, laboratory tests, isolation of Candida species, assessment of parafunctional activities, detection of anxiety and depression by means of the Hospital Anxiety and Depression Scale. Odds ratio and 95% confidence interval were calculated to compare the variables. RESULTS: No statistically significant differences were found with regard to the tested variables except for anxiety and depression. CONCLUSIONS: The results of this study seem not to support a role for the usually reported causative or precipitating factors of BMS and efforts should be addressed towards different aetiologies including possible neuropathic mechanisms of BMS.

Oral malignancies following HSCT: graft versus host disease and other risk factors.

Allogenic hematopoietic stem cell transplantation (HSCT), a procedure that is widely used in the treatment of a large number of malignant and non-malignant hematological diseases, is still associated with a wide range of complications, one of the most important of which is graft versus host disease (GVHD). The patients undergoing allogenic HSCT are also at high risk of developing secondary neoplasms, particularly leukemias and lymphomas. Solid tumors are less frequent, and the incidence appears to increase over time; the most frequent solid tumors are squamous cell carcinomas. We found that almost all studies of solid cancers occurring after transplantation are based on relatively small numbers of cases which have been monitored for short periods, and little information is available on individual cancers. In particular, reports of oral cancers in HSCT are very few. Potential risk factors associated with the development of secondary solid cancers after HSCT have been well described. They include graft versus host disease (GVHD), preoperative regimens, with either radio-chemotherapy or chemotherapy alone, conditioning regimes, immunosuppressive GVHD prophylaxis, viral infection and chronic stimulation as a result of viral antigens, antigenic stimulation from histocompatibility differences between recipient and donor, primary diagnosis, interaction of any of these factors with genetic predisposition, and other factors such as sex and age. All patients treated with HSCT should therefore be closely followed over the long term with the aim of identifying the onset of secondary tumors as early as possible.

Squamous cell carcinoma of the oral cavity associated with graft versus host disease: report of a case and review of the literature.

Allogenic peripheral stem cell transplantation (HSCT), a procedure that is widely used in the treatment of a large number of malignant and nonmalignant hematological diseases, is still associated with a wide range of complications, one of the most important of which is graft-versus-host disease (GVHD). The patients undergoing allogeneic HSCT are at high risk of developing secondary neoplasms, particularly leukemias and lymphomas. Solid tumors are less frequent, but their incidence seems to be higher in the patients who develop GVHD; the most frequent solid tumors are squamous cell carcinomas. We here describe the clinical course and histopathologic aspects of a squamous cell carcinoma arising on GVHD-induced oral lesions in a 53-year-old woman with non-Hodgkin's lymphoma undergoing allogeneic HSCT. Immediately after the transplantation, the patient developed GVHD involving the gastroenteric tract, skin, joints, and oral cavity, which was treated with cyclosporin, prednisone, azathioprine, colchicine, and photophereses. In addition to the sporadic reports of similar pictures published in the literature (16 cases of squamous cell carcinoma owing to oral GVHD in patients undergoing allogeneic HSCT), our case underlines the susceptibility of HSCT patients with oral GVHD to carcinoma of the oral cavity. All patients treated with allogeneic HSCT (particularly those who have developed GVHD) should therefore undergo a careful examination of the oral mucosa and be closely followed up over the long term with the aim of identifying the onset of secondary tumors as early as possible.

Gingival lesions in a patient with chronic oral graft-versus-host disease: a case report.

BACKGROUND: The patient reported in this study was diagnosed with acute nonlymphocytic leukemia and underwent an allogenic bone marrow transplantation. She was referred for persisting oral ulceration and pain associated with the transplant procedure. AIM: To present an unusual involvement of gingival tissues during a case of oral chronic graft-versus-host-disease. CONCLUSION: This is one of the very few reports in the dental literature of a case of oral chronic graft-versus-host disease that includes the unusual manifestation of prominent gingival lesions.

Systematic review of randomized trials for the treatment of oral leukoplakia.

Oral leukoplakia is a relatively common oral lesion that, in a varying proportion of cases, undergoes malignant transformation. The aim of this review was to assess the effectiveness of treatments for leukoplakia. Randomized controlled trials (RCTs) enrolling patients with a diagnosis of oral leukoplakia were identified by searching biomedical databases, hand-searching relevant oral medicine journals, and contacting oral medicine experts through a European mailing list. The methodological quality of included studies was assessed on the basis of the method of allocation concealment, blindness of the study, and loss of participants. Data were analyzed by calculating relative risk. Malignant transformation of leukoplakia, demonstrated by histopathological examination, was the main outcome considered. Secondary outcomes included clinical resolution of the lesion and variation in dysplasia severity. Six RCTs were included in the review. Vitamin A and retinoids were tested in four RCTs; the other agents tested were bleomycin, mixed tea, and beta carotene. Malignant transformation was recorded in just two studies: none of the treatments tested showed a benefit when compared with placebo. Treatment with beta carotene and vitamin A or retinoids was associated with better rates of clinical remission, compared with placebo or absence of treatment. Whenever reported, a high rate of relapse was a common finding. Side effects of variable severity were often described; however, interventions were well accepted by patients since drop-out rates were similar between treatment and control groups. It is noteworthy that the possible effectiveness of surgical interventions, including laser therapy and cryotherapy, has apparently never been studied by means of an RCT. To date, in conclusion, there is no evidence of effective treatment in preventing malignant transformation of leukoplakia. Treatments may be effective in the resolution of lesion; however, relapses and adverse effects are common.