Early periodontal wound healing after chlorhexidine rinsing: a randomized clinical trial.

OBJECTIVES: This single-center randomized, parallel design, clinical trial with a 2-week follow-up involved patients affected by periodontitis undergoing periodontal surgery. The aim was to evaluate periodontal surgical wound healing with the use of chlorhexidine-based mouth rinses versus an untreated control group. MATERIALS AND METHODS: Periodontal surgery was performed following a standardized protocol. Patients were randomly prescribed i) chlorhexidine (CHX) + anti-discoloration system (ADS) + hyaluronic acid (HA), ii) CHX + ADS or iii) no treatment (control group). Plaque score, gingival inflammation, and Early Healing Index (EHI), assessing the degree of wound closure and the presence of fibrin and necrosis, were evaluated at 3, 7 and 14 days after surgery. RESULTS: In total, 33 patients were enrolled. Patients were comparable at baseline for all measured clinical parameters. At 3-days wound healing was significantly improved in all patients treated with CHX + ADS-based mouth rinses with a lower EHI score at the interdental papillae compared with control group (p < 0.01). CHX + ADS + HA group presented improved healing across all time points in terms of EHI, plaque containment, and gingival inflammation when compared to control group (p < 0.01). CONCLUSIONS: The usage of CHX-ADS following periodontal surgery improved early wound healing, reduced plaque accumulation and gingival inflammation. During the early post-operative period the adjunct of HA further improved soft tissue closure. CLINICAL RELEVANCE: This study aims at evaluating the response of gingival tissues to mouth rinsing with chlorhexidine and anti-discoloration system (CHX + ADS) or CHX + ADS + hyaluronic acid (CHX + ADS + HA) versus no rinse in terms of healing of the periodontal surgical wound. CHX + ADS mouth rinses enhanced early soft tissue closure after periodontal surgery and contributed to the reduction in plaque accumulation and gingival inflammation. The adjunct of HA may be beneficial especially in the early post-operative period. CHX + ADS administration following periodontal surgery may improve soft tissue healing in the first two post-operative weeks.

Complications and treatment errors in nonsurgical periodontal therapy.

Nonsurgical periodontal therapy can be subject to iatrogenesis, which includes all the complications directly or indirectly related to a treatment. These complications include both operator-dependent harms and errors and the consequences and adverse effects of the therapeutic procedures. The complications arising following nonsurgical periodontal treatment can be categorized as intraoperative and postoperative and can affect both soft and hard tissues at an intra-oral and extraoral level. Soft-tissues damage or damage to teeth and restorations can occur while performing the procedure. In the majority of cases, the risk of bleeding associated with nonsurgical therapy is reported to be low and easily controlled by means of local hemostatic measures, even in medicated subjects. Cervicofacial subcutaneous emphysema is not a frequent extraoral intraoperative complication, occurring during the use of air polishing. Moreover, side effects such as pain, fever, and dentine hypersensitivity are frequently reported as a consequence of nonsurgical periodontal therapy and can have a major impact on a patient's perception of the treatment provided. The level of intraoperative pain could be influenced by the types of instruments employed, the characteristics of tips, and the individual level of tolerance of the patient. Unexpected damage to teeth or restorations can also occur as a consequence of procedural errors.

Ultra-High Frequency Ultrasound in Melanoma Management: A New Combined Ultrasonographic-Histopathological Approach.

OBJECTIVES: The main aim of this study is to evaluate the correspondence between the ultrasonographic thickness and the Breslow thickness in melanoma using ultra-high frequency ultrasound and the intra- and inter-operator repeatability in the ultrasonographic measurements of melanoma depth. Moreover, we propose a new protocol based on a combined ultrasonographic-histopathological approach. METHODS: We analyzed 27 melanomas in a population consisted of 27 patients (mean age 57.6 years, 51.8% males), who came at the Department of Dermatology (University of Pisa, Pisa, Italy) from April 2016 to March 2018 and had an ultrasonographic examination of a suspected lesion before the surgical removal using ultra-high frequency ultrasound (Vevo®MD, Fujifilm, Visualsonics, Toronto, Canada; 70 MHz probe). B-mode images were analyzed by two skilled and blinded operators, and the maximum depth of the lesions was measured using a dedicated graphical user interface developed in Matlab R2016b (MathWorks Inc., Natick, MA), to obtain repetitive measurements. RESULTS: All melanomas appeared as band-like or oval/fusiform shaped hypoechoic inhomogeneous lesions. We observed an excellent agreement between the Breslow thickness of melanomas and the ultrasonographic thickness, as well as a reduced intra- and inter-operator variability in the ultrasonographic measurements of melanoma depth. CONCLUSIONS: We propose a ultrasonographic-histopathological protocol which may help clinicians to reduce the diagnostic delay, improve prognosis and survival rates, perform a surgical excision with negative margins, and reduce the variability in the assessment of Breslow thickness.

Impact of rehabilitation versus edentulism on systemic health and quality of life in patients affected by periodontitis: A systematic review and meta-analysis.

AIM: To investigate the effect of rehabilitation in fully/partially edentulous patients with stage IV periodontitis on oral-health-related quality of life (OHRQoL) and systemic health. MATERIALS AND METHODS: A systematic electronic and manual search was conducted. Three authors independently reviewed, selected, and extracted the data. Outcomes were OHRQoL (Oral Health Impact Profile 14 [OHIP-14] and OHIP-49, General Oral Health Assessment Index [GOHAI], visual analogue scale, symptoms registration) and systemic health-related outcomes (incidence and prevalence of systemic diseases, values of systemic disease indicators). Qualitative data were synthesized for OHRQoL and systemic health-related outcomes. Meta-analysis was conducted on available quantitative data. RESULTS: The search identified 59 articles (6724 subjects in total). OHRQoL improved across all the studies, irrespective of the number of missing teeth, their location, or treatment modality. Meta-analysis showed significant improvement of OHIP-49 (36.86, p < .01) in manuscripts including subjects affected by periodontitis, consistently with the remaining literature (reduction of score points post rehabilitation: OHIP-14 = 10.52, OHIP-49 = 56.02, GOHAI = 5.40, p < .01 for all). Non-rehabilitated subjects exhibited inferior cognitive status, higher medication intake, and frailty. However, our data are limited and should be interpreted with caution. CONCLUSIONS: Oral rehabilitation improves OHRQoL and, potentially, systemic health in edentulous patients. It is unclear whether these findings may be extrapolated to patients with stage IV periodontitis.

Medication-Related Osteonecrosis of the Jaw Associated in a Patient Treated With Etanercept.

ABSTRACT: Medication-related osteonecrosis of the jaws (MRONJ) is defined as a pathologic condition affecting the maxillary and mandibular bones arising subsequently to pharmacological treatment with antiresorptive and antiangiogenic drugs.In this case report, the occurrence of MRONJ is described in a 66-year-old female patient affected by rheumatoid arthritis and treated with Etanercept, a Tumor Necrosis Factor (TNF)-a inhibitor. The patient developed a mandibular MRONJ following the extraction of teeth 3.4 and 3.5. The patient was then treated with conservative surgery of the necrotic bone. At 12-month follow-up complete resolution was observed. According to the data presented, the evaluation of the effects of new immunosuppressive biological therapies on the oral cavity appears of utmost importance in preventing the development of MRONJ. Although the risk related to TNF-a inhibitors has not been quantified yet, the clinician should be aware of the potential adverse effects on the oral cavity.

Oral Mucosal Melanoma.

PURPOSE: Primary oral mucosal melanoma (OMM) is a rare neoplasm accounting for the 0.2% to 0.8% of all melanomas. The aim of the present manuscript is (1) to describe 2 cases of primary OMM treated at our department, and (2) to perform a systematic literature review on primary OMM occurrence and treatment. METHODS: Two cases of primary OMM were described. A systematic review is presented in order to assess the treatment options, recurrence, metastasis development, and survival rate of primary OMM. RESULTS: Two patients were referred for the development of a lesion of the hard palate and the maxillary gingival mucosa, respectively. An incisional biopsy was performed in both patients, followed by extensive surgical resection after a thorough consideration of patient history and systemic involvement. The literature search retrieved 447 primary OMM cases. In the 30% of cases, distant metastases were already present at the time of diagnosis. The management of primary OMM most frequently involved surgical treatment and adjuvant radiotherapy. CONCLUSIONS: Primary OMM still represents a challenge for the clinician, as the diagnosis is often performed when metastases have already developed. The prognosis is generally poor, thus highlighting the need for further investigations to improve early diagnosis.

Interdental plaque reduction after the use of different devices in patients with periodontitis and interdental recession: A randomized clinical trial.

OBJECTIVES: To determine the efficacy of four different oral hygiene protocols involving adjunctive interdental devices in terms of plaque and bleeding scores in periodontitis-affected patients. MATERIAL AND METHODS: This was a randomized clinical trial with a 5-week follow-up, including previously treated periodontitis patients not undergoing any supportive care. Patients were randomly allocated to 4 groups: manual toothbrush (group TB); toothbrush plus dental floss (group TB/F); toothbrush plus interdental brushes (group TB/IDB) and toothbrush plus rubber interdental picks (group TB/RIDB). Oral hygiene instructions (OHI) were provided at baseline (T-7) and at T0 (1-week) then bi-weekly (T14/T28). At T0, supragingival professional cleaning was delivered. Plaque and bleeding indexes were taken at all timepoints by a single calibrated examiner, blind to group allocation. RESULTS: At T-7, patients were comparable for age, body mass index (BMI) and all clinical parameters, exceptions for the Interdental Angulated Bleeding Index. At T28, significant reductions of plaque and gingival inflammation were noted in all groups (p < 0.001) and within the expected ranges. Intergroup comparisons identified that group TB/IDB and group TB/RIDB achieved lower levels of plaque and inflammation than group TB (p < 0.05). Group TB/IDB and group TB/RIDB showed lower levels of plaque and lower inflammation as measured by angulated bleeding index than group TB/RIDB (p < 0.05). CONCLUSION: Interdental brushes and rubber interdental picks were more efficient than toothbrushing alone and toothbrushing and floss in reducing plaque and gingival inflammation measured in a periodontitis-affected population.

Ultra-high frequency ultrasonography (UHFUS)-guided minor salivary gland biopsy: A promising procedure to optimize labial salivary gland biopsy in Sjögren's syndrome.

BACKGROUND: Sjögren's syndrome (SS) is an autoimmune disease characterized by an inflammatory infiltrate of exocrine salivary and lachrymal glands. Diagnosis is complex, and minor salivary gland biopsy and subsequent focus score (FS) calculation appear of extreme importance in the diagnostic work-up of the disease. Ultra-high frequency ultrasonography (UHFUS) is a recently introduced diagnostic technique, which is gaining an increasingly important role in intraoral imaging. This study aims at exploring the usefulness of UHFUS for obtaining valuable labial salivary gland samples to assess the histopathological features of SS patients. METHODS: Patients with clinical suspect of SS and eligible for minor salivary gland biopsy were enrolled. UHFUS scan of the lower lip was performed. Glandular echostructure was classified according to Outcome Measures in Rheumatology (OMERACT) scoring system. The glands to be sampled were selected on the basis of UHFUS evaluation and biopsied. The areas of the samples were recorded and compared with those obtained without UHFUS guidance. The correlation between UHFUS grade and labial gland FS was also assessed. RESULTS: The areas of the samples obtained with UHFUS guidance were significantly higher (7.25 ± 3.98 mm2 ) than those obtained by conventional procedures (5.79 ± 3.49 mm2 , P = .02). UHFUS correlated significantly with the salivary gland FS (r = .532, P = .001). CONCLUSION: UHFUS seems a promising tool in SS diagnostic algorithm, being able to provide a valuable support to the biopsy procedure. Further studies are mandatory to confirm the role of UHFUS in SS.

A perspective on dental activity during COVID-19: The Italian survey.

OBJECTIVES: During the months of March and April 2020, Italy saw an exponential outbreak of COVID-19 epidemic. Dental practitioners were particularly limited in their routine activity, and the sole performance of urgent treatments was strongly encouraged during the peak of the epidemic. A survey among dental professionals was performed between 6th and 13th of April, in order to evaluate the status of dental practice during COVID-19 in Italy. MATERIALS AND METHODS: An online anonymous questionnaire was administered to retrieve data on the dental procedures performed, the preventive measures adopted, and the predictions on the future changes in dentistry following the pandemic. RESULTS: The survey was completed by 3,254 respondents and, according to the results obtained, dental activity was reduced by the 95% and limited to urgent treatments. The majority of the surveyed dentists employed additional personal protective equipment compared to normal routine, although in a non-negligible number of cases difficulty in retrieving the necessary equipment was reported. CONCLUSIONS: The survey provided a snapshot of dental activity during the SARS-CoV-2 outbreak. Overall, following the peak of the epidemic, it is probable that dental activities will undergo some relevant changes prior to fully restart.

Ultra-high frequency ultrasound in the differential diagnosis of oral pemphigus and pemphigoid: An explorative study.

OBJECTIVES: Intraoral ultra-high frequency ultrasound (UHFUS) is an emerging technique in oral medicine, due to its possibility to provide submillimeter resolution imaging of superficial mucosal structures. In this study, the potential role of UHFUS in the diagnosis of oral pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP) is assessed. MATERIALS AND METHODS: Consecutive patients with suspected oral PV or MMP were enrolled. All patients underwent clinical examination, laboratory tests, intraoral UHFUS scan, and biopsy. Histology and direct immunofluorescence were set as benchmark for diagnosis confirmation. The sensitivity and specificity of UHFUS compared to histology were assessed. Mann-Whitney test was performed to evaluate the presence of differences in the echogenicity of PV and MMP. P-value was set at P < 0.05. RESULTS: Twenty-five patients were included. Thirteen patients were diagnosed with PV, and twelve with MMP. The UHFUS features of PV and MMP lesions were described. Image analysis showed statistically significant differences between the echogenicity of PV and MMP lesions (P < 0.05). Good concordance between UHFUS and histology was found. UHFUS showed 75% sensitivity in the diagnosis of PV and 66.7% in the diagnosis of MMP. CONCLUSIONS: UHFUS appears a valuable tool in the diagnosis of PV and MMP. Although histology and immunofluorescence remain the gold standard, UHFUS role in the diagnostic algorithm of PV and MMP seems promising as a chair-side tool consistently enhancing clinical evaluation of oral bullous lesions.

Ultra-high-frequency ultrasound monitoring of plaque psoriasis during ixekizumab treatment.

BACKGROUND: High-frequency ultrasound (HFUS) is a non-invasive method that detects superficial skin features. Ultra-high frequencies (50-100 MHz) can reveal epidermis and dermis structures. OBJECTIVES: In this study, we describe the psoriatic plaque using a new device equipped with a 70 MHz probe (VEVO® MD, Fujifilm, VisualSonics) and we assess the lesion before and after ixekizumab. METHODS: We examined the superficial hyperechoic band, the subepidermal hypoechoic band (SLEB), and the vascularization of the plaque in ten patients affected by plaque psoriasis. RESULTS: The average superficial hyperechoic band thickness was 0.2157 mm before treatment, 0.1611 mm after 15 days, and 0.1354 mm (P < .05) after 30 days. The SLEB thickness was 0.7535 mm at baseline, 0.3300 mm after 15 days (P < .05), and 0.2007 mm (P < .05) after 30 days. The average percentage vascularization was 50.21% at baseline, 13.15% after 15 days (P < .05), and 5.97% after 30 days. UHFUS assessment highlighted the rapid action of the drug in terms of the decrease in vascularization after 15 days. It revealed a statistically significant reduction in SLEB thickness after 15 days and a significant reduction in the hyperechoic superficial band after 30 days. CONCLUSIONS: VEVO® MD provides physicians with high-resolution details of the psoriatic plaque, thus enabling tailored-made treatments.

Ultra-High Frequency Ultrasound, A Promising Diagnostic Technique: Review of the Literature and Single-Center Experience.

OBJECTIVES: Ultra-high frequency ultrasonography (UHFUS) is a recently introduced diagnostic technique which finds several applications in diverse clinical fields. The range of frequencies between 30 and 100 MHz allows for high spatial resolution imaging of superficial structures, making this technique suitable for the imaging of skin, blood vessels, musculoskeletal anatomy, oral mucosa, and small parts. However, the current clinical applications of UHFUS have never been analyzed in a consistent multidisciplinary manner. The aim of this study is to revise and discuss the current applications of UHFUS in different aspects of research and clinical practice, as well as to provide some examples of the current work-in-progress carried out in our center. MATERIALS AND METHODS: A literature search was performed in order to retrieve articles reporting the applications of UHFUS both in research and in clinical settings. Inclusion criteria were the use of frequencies above 30 MHz and study design conducted in vivo on human subjects. RESULTS: In total 66 articles were retrieved. The majority of the articles focused on dermatological and vascular applications, although musculoskeletal and intraoral applications are emerging fields of use. We also describe our experience in the use of UHFUS as a valuable diagnostic support in the fields of dermatology, rheumatology, oral medicine, and musculoskeletal anatomy. CONCLUSION: Ultra-high frequency ultrasonography application involves an increasing number of medical fields. The high spatial resolution and the superb image quality achievable allow to foresee a wider use of this novel technique, which has the potential to bring innovation in diagnostic imaging.

Total area of inflammatory infiltrate and percentage of inflammatory infiltrate identify different clinical-serological subsets of primary Sjögren's syndrome better than traditional histopathological parameters.

OBJECTIVES: Recently, the total area of the inflammatory infiltrate and the percentage of inflammatory infiltrate have been proposed as novel histopathological parameters to improve the stratification of patients with Sjögren's syndrome (SS) in clinical trials. Both these parameters provide a more accurate assessment of the extent of the infiltrate in minor salivary gland biopsies (MSGBs) and may overcome the bias related to the Focus score (FS). To date, however, only few studies have investigated their clinical value and feasibility. In this study we revised consecutive MSGBs obtained routinely in a real-life clinical setting and correlated the total area of the inflammatory infiltrate and the percentage of inflammatory infiltrate both with the other MSGB histopathological parameters and with patients' clinical features in order to explore their usefulness in SS diagnostic work-up. METHODS: We assessed the area of the inflammatory infiltrate and the percentage of the inflammatory infiltrate in consecutive MSGBs and correlated these parameters with the number of foci, the FS and the presence of ectopic lymphoid structures (ELS). We also correlated these additional parameters with patients' clinical and biological data. RESULTS: We revised 69 MSGB samples: 46 from patients with a diagnosis of SS and 23 from subjects with no SS. The total area of inflammatory infiltrate and the percentage of inflammatory infiltrate appeared significantly higher in patients fulfilling the ACR/EULAR classification criteria for SS and correlated significantly with both the number of foci (p<0.001) and the FS (p<0.001). Particularly, they correlated better with the ELS in MSGBs than the number of foci and the FS. When we limited the analysis to the 32/69 patients with a FS<1, both the total area of the inflammatory infiltrate (p=0.02) and the percentage of the inflammatory infiltrate (p=0.03), but not the number of foci (p=0.12) remained significantly higher in the 10/32 anti-Ro/SSA positive patients fulfilling the ACR/EULAR classification criteria. Finally, the total area of inflammatory infiltrate and the percentage of inflammatory infiltrate correlated significantly with several biological and haematological SS-related abnormalities including hypergammaglobulinaemia, C4 levels, total number of white blood cells and the number of circulating lymphocytes. CONCLUSIONS: The total area of the inflammatory infiltrate and the percentage of the inflammatory infiltrate in SS referral centres, and particularly for selected cases, may maximise the information on disease activity at tissue level, ultimately improving SS patients' assessment.

Ultra-high frequency ultrasonography of labial glands is a highly sensitive tool for the diagnosis of Sjögren's syndrome: a preliminary study.

OBJECTIVES: Ultra-high frequency ultrasonography (UHFUS) has been recently introduced in oral medicine due to its ability to image small anatomical structures including labial salivary glands (LSG). To date no ultrasonography morphological studies of labial salivary glands (LSG) have been carried out in SS. In this pilot study we aimed at analysing the distribution of UHFUS findings in LSG of patients with suspected SS, focusing in particular on the association with patients' oral dysfunction, antibody profiles and histopathology. METHODS: Consecutive patients undergoing a LSG biopsy for clinically suspected SS were included in this study between January 2018 and January 2020. Intraoral UHFUS scan of the lip mucosa was performed with Vevo MD equipment, using a 70 MHz probe with a standardised protocol. LSG were assessed by using a four-grade semiquantitative scoring system (0-3), similar to the OMERACT scoring system used for major salivary glands. The distribution of UHFUS grades was compared in patients stratified according their final diagnosis, patients antibody profiles and LSG histopathology. RESULTS: We included 128 patients with suspected SS: out of them, 54 (42.2%) received a final diagnosis of SS, made according to the ACR 2016 criteria and 74 (57.8%) were diagnosed as no-SS sicca controls. We found that LSG inhomogeneity was significantly greater in patients with SS than in no-SS subjects (p<0.0001). We also found that higher UHFUS pattern of inhomogeneity (i.e. grade 2 and 3) were significantly more frequent in both SSA+/SSB- and SSA+/SSB+ patients (p=0.001). A normal UHFUS pattern, by contrast, was significantly more common in SSA-/SSB- subjects (i.e. 15/83 (18.1%) vs. 1/33 (3%) vs. 0/12 (0%), p=0.001). Finally, LSG inhomogeneity was significantly associated with both the number of foci (p<0.001) and focus score (p<0.001). Particularly, we found that both the number of foci and the FS were significantly higher in patients presenting a UHFUS grading of 2 and 3 with respect to those presenting a UHFUS grading of 0 and 1 (p=0.01). CONCLUSIONS: This preliminary study demonstrates the optimal feasibility of UHFUS and its high sensitivity in identifying negative patients on subsequent lip biopsy, thus avoiding invasive procedures in selected cases. Further studies are in progress to define the clinical and predictive role of the various patterns observed and their added value with respect to traditional salivary gland ultrasonography.

Intraoral Ultra-High Frequency Ultrasound study of oral lichen planus: A pictorial review.

BACKGROUND: Ultra-High Frequency Ultrasound (UHFUS) is a recently introduced diagnostic technique involving the use of higher frequencies compared to conventional ultrasound. Among the several fields of application, intraoral usage of UHFUS appears still limited. We report the intraoral evaluation of Oral Lichen Planus (OLP) by means of UHFUS and describe typical UHFUS aspect of different forms of presentation of OLP. MATERIALS AND METHODS: Patients with clinical and histological diagnosis of OLP were enrolled in the study. OLP lesions were evaluated by means of intraoral UHFUS performed at 70 MHz, using B-mode and C-mode, in order to characterize the echostructure of each form of presentation. RESULTS: Fifty patients in total were enrolled, and UHFUS features were described for different OLP forms. All the lesions showed a thick, hypoechoic superficial layer in the mucosal stratum, suggesting that such UHFUS alteration can be pathognomonic of OLP. CONCLUSION: Ultra-High Frequency Ultrasound was able to differentiate superficial alterations of the oral mucosa, giving insight on possible applications of UHFUS in the study of OLP beyond clinical and histological investigations. Due to a limited study sample, we cannot draw firm conclusions. However, it is reasonable to think that UHFUS evaluation of OLP may provide useful information to the clinician.

Advanced evaluation of hidradenitis suppurativa with ultra-high frequency ultrasound: A promising tool for the diagnosis and monitoring of disease progression.

BACKGROUND: Hidradenitis suppurativa is a chronic inflammatory skin disease. An ultrasound staging (SOS-HS) using frequencies from 7 to 18 MHz has been proposed to evaluate the severity of the disease. MATERIALS AND METHODS: We retrospectively evaluated the most significant lesions in 50 patients with hidradenitis suppurativa (32 females and 18 males, aged from 12 to 68 years old), who had undergone high-frequency ultrasound (HFUS) (18-22 MHz) and ultra-high frequency ultrasound (UHFUS) (48 and 70 MHz). A MyLab™ Touch system (Esaote) equipped with a 18-22 MHz linear probe was used for the HFUS, and a Vevo® MD (VisualSonics) was used for the UHFUS, equipped with two linear probes (70 and 48 MHz). RESULTS: A total of 116 lesions were observed, of which 66 were fluid collections, 32 were tunnels, 6 pseudocysts, 5 bridge scars, 5 tombstone comedones, and 2 granulation tissues. Structures that had already been described with HFUS were then observed with UHFUS but with a better definition. In addition, structures that had not been detected by HFUS were also observed with UHFUS such as drop-shaped hair follicles, micro-tunnels, and microcysts. CONCLUSION: Ultra-high frequency ultrasound provides a better understanding of hidradenitis suppurativa. Patients can be monitored more effectively thereby preventing the most severe changes.

Renal Cell Carcinoma Metastases to the Oral Cavity: Report of 2 Cases and Review of Literature.

The localization of renal cell carcinoma (RCC) metastases in the oral cavity has been reported, accounting for about 15% of patients with metastasizing renal disease. In this work, we report 2 cases of oral metastases of renal carcinoma and provide a review of the current literature on the occurrence of oral metastases of renal origin. The first patient (a 61-year-old man) presented with a tumefaction of the body of the tongue. The second patient (a 71-year-old man) showed a large mass localized in the buccal mucosa. In both patients, incisional biopsy was performed to better characterize the nature of the lesions. Histologic evaluation showed the metastatic origin of the 2 lesions, which were distant metastases of clear cell RCC. After systemic evaluation, a second surgical procedure was performed to obtain a wider resection of the mass to reduce the development of complications and improve the patients' quality-of-life. After the second surgical treatment, both patients showed an improvement in symptoms, and no further complications and/or signs of recurrence were detected. At present, 132 cases of oral metastases of RCC have been described in the literature. This article reviews and discusses the clinical, diagnostic, and pathologic features and the treatment options reported in the literature. Localization of renal metastases to the tongue was the most frequently described localization in the literature. In general, surgical treatment appears to be effective in controlling metastasis development and associated symptoms. Although relatively rare, renal metastases to the oral cavity should be taken into account when creating the differential diagnosis of oral lesions of unknown origin.

Surgical Management of Medication-Related Osteonecrosis of the Jaw Patients Related to Dental Implants.

OBJECTIVES: The aim of the present study is to report a case series of patients with peri-implant medication-related osteonecrosis of the jaw (MRONJ), in particular describing the onset of the condition and surgical treatment outcome. MATERIAL AND METHODS: Fifteen consecutive patients with clinical diagnosis of peri-implant MRONJ were retrospectively included in the study. The sample was stratified on the base of oral, pharmacological, and general health variables. The number of affected implants was recorded in all patients, and MRONJ staging applied. Surgical treatment was performed with a standardized operative protocol, involving implant removal, sequestrectomy, debridement of soft tissue, and bone curettage. Follow-up evaluating surgical outcome was performed at twelve months after surgery. RESULTS: in our study sample, patients were almost equally distributed in terms of underlying diseases in osteoporotic and oncologic patients. All MRONJ lesions were symptomatic, and in 6 patients bone exposure was detected. 40 implants in total were evaluated, with MRONJ being present around 29 implants. 12 patients were diagnosed with Stage III MRONJ, and 3 patients with Stage II MRONJ. Surgical treatment leads to complete healing in 86.7% of cases, with 100% success for maxillary MRONJ. CONCLUSIONS: Surgical treatment seems to have a positive impact on MRONJ treatment also in cases of peri-implant involvement. However, monitoring and prevention are fundamental in patients under pharmacological treatment with anti-resorptive/antiangiogenic drugs, as peri-implant MRONJ can develop also in absence of specific traumatic events.

Feasibility of intraoral ultrasonography in the diagnosis of oral soft tissue lesions: a preclinical assessment on an ex vivo specimen.

OBJECTIVES: The early detection of oral soft tissue lesions is an important prognostic factor, and the possibility of using ultrasonography (US) as a diagnostic tool may improve the diagnosis and characterization of tissue alterations at an early stage. This study aims to evaluate the feasibility of intraoral US by performing a preclinical assessment of an ex vivo specimen in which focal lesions were simulated. MATERIALS AND METHODS: Fourteen lesions were simulated on a freshly extracted calf tongue, by introducing in the tongue different materials mimicking the appearance of various focal lesions. The specimen was scanned with a 8 MHz US probe and computed tomography (CT) was performed to compare the two imaging techniques. Later, the specimen was dissected to set a benchmark for size assessment. RESULTS: US was able to identify all the simulated lesions within the tongue, resulting in one case more accurate than CT. Statistical analysis demonstrated high correlation between the measurements of the simulated lesions performed on the US images and the real size of the materials introduced in the tongue (p < 0.05). CONCLUSIONS: This preclinical study proves that US performs well in the detection and characterization of simulated lesions of the tongue. These findings suggest that US could be effectively used in clinical applications. However, further research is mandatory to assess the reliability of in vivo US in the detection and characterization of tongue lesions as well as of other oral soft tissue alterations.