Histopathological and histomorphometric analysis of glandular odontogenic cyst-A diagnostic aid.

OBJECTIVES: Compare recognized microscopic parameters, including variations in width, plaque-like thickenings, intra-epithelial microcysts, clefts, mucous, hob-nail, ciliated and clear cells, between glandular odontogenic cyst (GOC) and GOC-like cysts, investigate the extent of cyst circumference exhibiting these features, and inflammation. MATERIALS AND METHODS: Archival records of cysts with histological features of GOC evaluated between 2000 and2020 were retrieved. Slides were revised, and the expression of features throughout the cyst wall was analyzed. Cysts with at least 5 features were classified as GOC, cysts with 3-4 features as GOC-like. RESULTS: The study included 74 cysts, 47 males M, 25 females (2 unknown gender), aged 19-81 years, 62 (83.8%) GOC, 12 (16.2%) GOC-like. Mandible was involved in 44 (59.5%), maxilla in 30 (40.5%), 18 (25%) were associated with unerupted teeth. Cyst classified as GOC had significantly higher rates of all parameters investigated, (except ciliated and clear cells), than GOC-like cysts (p ≤ 0.05). 26 (40.6%) cases showed GOC features in >50% of cyst circumference, 21 (32.8%) involved 25-50%, 17 (26.6%) <25%. More than 50% circumference involvement was highly and independently predictive for a diagnosis of GOC, <25% was highly and independently predictive for GOC-like (p = 0.003). Hobnail cells (p = 0.008) and plaque-like thickenings (p = 0.038) were significantly more frequent in inflamed cysts. CONCLUSION: Besides the number and type of histological features, GOC can be characterized by their distribution within the cyst circumference (focal Vs diffuse), and it may serve as a new diagnostic aid. It is suggested that GOC and GOC-like may represent a single spectrum.

Bacterial Growth in Unsealed Bone-grafting Products.

OBJECTIVE: The aim of this study was to simulate reusing an opened package of bone substitute (BS) under typical clinical conditions, by analyzing bacterial growth in samples of resealed packages of alloplast and xenograft BS following different time periods up to a week. MATERIALS AND METHODS: The experiment was performed in 2 stages: dry stage and wet stage. In the dry stage, BS samples were exposed to air for 15 minutes and then were sealed again in their original package. After several "aging" periods [no aging (t0), 24 hours (t1), and 1 week (t7)], BS samples were plated onto brain heart infusion agar and were incubated at 37 °C for 24 hours under aerobic conditions. Bacterial colonies were enumerated and colony forming units per 1 mL was calculated. In the wet stage, the experiment was repeated but BSs were left to age in a brain heart infusion broth to simulate a more supporting humid environment to encourage bacterial growth. RESULTS: In the dry stage of the experiment, no bacterial growth was detected in both xenograft and alloplast samples (colony forming units/mL=0), in any of the time points (t0, t1, t7). In the wet stage, average bacterial growth was 0 for both groups in t0. In t1: 1.14 × 10 4 ±4.16 × 10 3 for the xenograft and 7.73 × 10 5 ± 9.99 × 10 5 for the alloplast. In t7: 1.64 × 10 9 ±1.82 × 10 8 in the xenograft compared with 8.86 × 10 8 ±4.00 × 10 8 for the alloplast. Analysis of variance with repeated measures showed a significant difference in comparison of the 2 BSs for each time group (t1 and t7) ( P <0.005). CONCLUSION: Under dry conditions, in a resealed package, there was no bacterial growth for up to 1 week for both BSs. Once the BSs are introduced to a humid environment, which supports bacterial growth, the xenograft BS allowed more rapid bacterial growth, compared with the alloplastic BS.

Maxillary Tuberosity Fractures Following Third Molar Extraction, Prevalence, and Risk Factors.

OBJECTIVES: The aim of this study was to evaluate the prevalence of maxillary tuberosity fractures in an adult population and to examine the different risk factors associated with these fractures. MATERIALS AND METHODS: This is a retrospective study; data was collected from medical records of patients who underwent a non-surgical extraction of a maxillary third molar tooth between January 2017 and March 2019. All extractions were performed by 2 maxillofacial specialists. RESULTS: A total of 403 extracted maxillary third molar teeth were included in the study. Out of them 73 cases of tuberosity fractures were recorded (18.1%). No significant difference in the number of recorded fractures was found between the 2 surgeons. The mean age of patients was 32.8 ± 11.5. In the age group of 30 years and under a fractures rate of 12.1% was recorded compared to 25.0% in the age group of over 30 (P = 0.001). Divergent or extremely curved root morphology were associated with a higher risk for fractures (30.7%) compared to convergent root morphology (13.1%) ( P < 0.001). Borderline significance ( P = 0.069) was observed for extractions of teeth with caries lesions (21.9%) compared to teeth with no caries lesions (14.6%). CONCLUSIONS: The risk of developing a tuberosity fracture during an extraction of an upper wisdom tooth increases with age by 3.1% per year. Teeth with a caries lesion or teeth with divergent or extremely curved root morphology are associated with a higher risk for tuberosity fractures. Although, distoangular teeth had reduced risk of developing a tuberosity fractures. Data collected in this study may help to evaluate the risk factors associated with tuberosity fractures, and can assist in minimizing complications during extractions.

Oral Solitary Fibrous Tumor: A Retrospective Clinico-Pathological Study and Long-Term Follow-Up.

Background and Objectives: This was a retrospective single-center study to analyze and describe the clinical and histological features of all cases of oral solitary fibrous tumor (SFT). Study design: the study included all consecutive cases of oral SFT diagnosed between 2008-2018 at a single tertiary center. Materials and Methods: Clinical data was retrieved from medical charts. The diagnosis of oral SFT was based upon the morphologic features of the lesions, in routine hematoxylin and eosin (H&E) stained sections and confirmed by immunohistochemical analyses including CD34, CD99, Bcl2, and stains for STAT6. Results: Seven cases of oral SFT were found. Of these, three (42%) were in males and four (58%) in females. The age range was 24-63 years (mean 47 ± 13). Four (58%) lesions were located in the buccal mucosa, two (28%) in the labial mucosa and one (14%) on the floor of the mouth. The diameter ranged between 3-50 mm (mean 22 ± 14 mm). All patients were treated with local excision. Follow-up periods were between 2-74 months (mean 41 ± 27). No recurrences were reported. Conclusions: We present a series of oral SFT, which were all non-aggressive in presentation and did not recur after conservative surgery (local excision) over a relatively long follow-up period.

Does Maxillary Advancement Influence the Nasolabial Angle?

PURPOSE: To know whether there is a correlation between maxillary advancement and the nasolabial angle change allows to preoperatively predict the precise affect a planned maxillary advancement will have over the nasolabial angle. The aim of this study was to determine the relationship between the maxillary advancement and the nasolabial angle. METHODS: The study is a retrospective analysis of 32 patients (12 males and 20 females, mean age 21 ±â€Š3.4 years) who underwent a maxillary advancement. Lateral cephalometric radiographs were taken preoperatively and postoperatively. The lateral cephalograms were traced. Measurements were evaluated statistically using paired sample t-test and Pearson's correlation test. RESULTS: The mean maxillary advancement was 4.81 ±â€Š3.01 mm with a mean vertical change of -0.28 ±â€Š2.80 mm. The nasolabial angle decreased by a mean of 3.78 ±â€Š9.64° with statistical significance of P = 0.03 using a paired sample t-test, however using Pearson's correlation test, no direct correlation between maxillary advancement and the nasolabial angle was found. Furthermore, the study contains a review of the literature from the last 25 years, which shows that in most studies there was no correlation and in some patients even opposite results. CONCLUSION: Maxillary advancement might influence the nasolabial angle; however, preoperatively predicting the influence a maxillary advancement will have over the nasolabial angle is difficult, and further studies need to be conducted.

Can Differences in Vascularity Serve as a Diagnostic Aid in Fibro-Osseous Lesions of the Jaws?

PURPOSE: Different lesions in the fibro-osseous group share microscopic features; thus, establishing a definitive diagnosis based on microscopic features alone can be a challenge. There is a need for additional microscopic tools to aid in differentiating these lesions. This study compared parameters related to vascularity among 3 lesions in the fibro-osseous group: fibrous dysplasia (FD), central ossifying fibroma (COF), and cemento-osseous dysplasia (COD). MATERIALS AND METHODS: This study was a cross-sectional analysis of biopsied lesions retrieved from 3 medical centers over a 14-year period. The primary predictor variables were the vascularity parameters (number, perimeter, and area). The outcome variables were diagnoses of FD, COF, and COD. Diagnosis was based on clinical, microscopic, and radiologic correlations. From each histopathologic slide, 5 representative fields were captured with a computerized digital camera. The number of blood vessels was counted, and the surface area and vascular perimeter were measured by tracing the perimeter of each vessel. Data were statistically analyzed using analysis of variance with logarithmic transformation and a Tukey adjustment. RESULTS: Sixty-six cases were included in the study (26 in FD group, 26 in COF group, and 14 in COD group). The mean number of vessels showed only a tendency to be larger in the FD group compared with the COF and COD groups (5.4 ± 2.6, 3.7 ± 2.3, and 3.6 ± 1.7, respectively), but the results did not reach the threshold for significance. The mean vascular perimeter was 1,385.8 ± 859.2 pixels in the FD group and 742.6 ± 661.8 in COF group after logarithmic transformation (P = .012). The perimeter in the COD group was smaller (941.1 ± 502) compared with that in the FD group, but the difference did not reach the threshold for significance. The mean area was 25,061 ± 24,875.6 in the FD group and 11,773.8 ± 21,734.4 in the COF group after logarithmic transformation (P = .004). The perimeter in the COD group was smaller (13,011.1 ± 8,338.3) compared with the FD group, but the difference did not reach the threshold for significance. CONCLUSION: The vascular content of the FD group was markedly higher than of the COF group. These vascular changes can aid in differentiating these lesions microscopically.

Referral Patterns of General Dental Practitioners for Implant Surgery Procedures.

PURPOSE: The growing demand for implants has led to their implementation by general dental practitioners (GDPs) in clinical practice. The present study assessed referral patterns of GDPs for the surgical phase of implant dental treatment. MATERIALS AND METHODS: One hundred fifty GDPs were asked to fill out a structured questionnaire containing their demographic data and answer six questions characterising their referral patterns for implant dentistry. RESULTS: Forty-one (41%) percent performed the surgical phase, and 87% provided implant restoration. Gender was the only influencing factor for the surgical phase, as 51.4% of male GDPs and 6.5% of female GDPs performed implant surgery themselves. Experience and practice set-up did not influence the referring decision. Fifty-four percent of the practitioners referred 0 to 5 patients per month, and the chosen specialists were: 80% oral and maxillofacial surgeon, 11% periodontist, and 9% selected a specialist depending on the individual case. The major reasons influencing the referral pattern were the complexity of the surgical procedure, followed by systemic medical compromise of the patient. CONCLUSIONS: Most implant surgeries in Israel are still performed by specialists.

The prevalence of bruxism and oral parafunction activities among Israeli juveniles with autism spectrum disorder: A preliminary study during the COVID-19 pandemic.

OBJECTIVE: To evaluate the prevalence of oral habits, bruxism, and Temporomandibular Disorders (TMD) injuvenileswithautisticspectrumdisorder(ASD). METHODS: Data included 165 juveniles diagnosed with ASD, allocated to younger group aged 6 21 (n=86) and older group aged 13-21 (n=79). RESULTS: Sleep bruxism was reported by 26.7% in the younger group and by 5% in the older group. Awake bruxism was reported by 22% and 17.7%, respectively. Oral habits were reported by 43% of all participants, with similar rate in both groups. TMD related p ain was low in both groups (6.3% and 7% respectively). The influence of the COVID 19 pandemic on oral parafunction was moderate in the younger group (17.4%) and mild in the older group (8.6%), influence on bruxism was mild in both groups (5.8% and 2.5%, respectively). CONCLUSION: The prevalence of bruxism and oral parafunctions was similar to the reported in the literature for the general population.

Recurrent aphthous stomatitis: stress, trait anger and anxiety of patients.

In this case-control study, recent stress and trait anger/anxiety of otherwise healtlhy patients with active recurrent aphthous stomatitis were compared to those of dental patients with no history of RAS (controls). RAS group reported more angry/anxious feelings than controls (2.11 +/- 0.38/1.84 +/- 0.30, respectively; p < 0.001), and more recent stress (2.81 +/- 1.36/1.96 +/- 1.02; p < 0.01). Among subjects with high angriness/ anxiety, RAS subjects showed higher stress level (p < 0.005). The study revealed that anger/anxiety level mediates the relationship between stress level and RAS.

Can black extrinsic tooth discoloration predict a lower caries score rate in young adults?

OBJECTIVE: The aim of this study was to examine the association between black extrinsic tooth discoloration and caries prevalence in an adult population. This association has been previously shown in children and adolescents but has never been examined in an adult population. METHOD AND MATERIALS: Young adults, aged 18 to 29 years old, were examined for black extrinsic tooth discoloration and caries prevalence. The study group included 110 young adults with black stain; the control group consisted of 170 young adults without black stain. The decayed, missing, or filled teeth (DMFT) index score was determined for each subject. The mean DMFT score was calculated for both groups and compared between groups (independent t test). Multiple logistic regression analysis was applied to identify independent influences (age, pigmentation, gender, and smoking) on DMFT. RESULTS: Mean DMFT score was 4.2 ± 3.9 for the study group and 5.98 ± 4.8 for the control group, which was statistically significant (P < .001). Mean D score (untreated caries) was 1.6 ± 2.5 (study) and 2.4 ± 3.5 (control) (P < .05). Age had a positive correlation with the DMFT score; however, gender and smoking were negatively correlated. CONCLUSION: The association between black stain and reduced rates of dental caries was demonstrated in a young adult population for the first time.