Oral verruciform xanthoma in chronic graft-versus-host disease patients.

BACKGROUND: Verruciform xanthoma (VX) is an uncommon benign epithelial lesion which mainly appears in inflamed oral epithelium. In this study, our aim was to present new cases of oral VX (OVX) in chronic graft-versus-host disease (cGVHD) and review the literature. METHODS: We conducted a retrospective chart review of cGVHD patients (2012-2019) to reveal cases of OVX. The demographics, medical background, clinical presentation, treatment provided, and follow-up were obtained. Additionally, Medline was searched using the terms "graft-versus-host disease," "verruciform xanthoma," and "oral." Of the articles, the above-mentioned demographic and clinical features were retrieved. RESULTS: The patient pool included 133 oral cGVHD patients. Three cGVHD patients (males, aged 15-49 years, post-hematologic malignancy) were diagnosed with OVX. All patients had oral mucosal lichenoid lesions, but not in close proximity to the VX lesion. Medline searches revealed 9 cases of OVX in cGVHD patients reported in the literature. Eleven of the 12 patients had oral mucosal lichenoid lesions. Four patients had multiple OVX lesions. All lesions were asymptomatic. Six patients had lesions in the masticatory mucosa (hard palate and gingiva) and 4 patients had lesions in the buccal mucosa. CONCLUSIONS: To the best of our knowledge, this is the largest published OVX in cGVHD series, including 12 patients. It appears that despite the higher prevalence in cGVHD patients relative to the general population, OVXs do not necessarily develop in sites with lichenoid lesions. It is advised that clinicians be familiar with the clinical and histological features in order to consider OVX in the differential diagnosis of oral lesions in cGVHD patients.

Is entire removal of a post-traumatic temporomandibular joint ankylotic site necessary for an optimal outcome?

PURPOSE: Temporomandibular joint (TMJ) ankylosis that occurs after TMJ condylar fracture constitutes a treatment challenge. The purpose of the present study is shed light on an alternative treatment approach for certain such cases where the displaced condylar head or part of it can be detected in computed tomography. The leading principle of this protocol is accurate removal of the ankylotic mass only, leaving the condyle-disc apparatus un-touched. PATIENTS AND METHODS: The study is based on such cases of post trauma ankylosis where the displace condyle was detected. Thirteen cases are reported (10 unilateral and 3 bilateral) age ranged from 8 to 51 years (mean 20). All patients were treated according to the presented protocol that emphasizes the significance of preserving the condyle-disc apparatus while accurately removing the ankylotic mass. To achieve the required precision, 3-dimensional computed tomography was used. An integral part of the treatment plan is intensive guided physiotherapy, which is intended to re-establish normal joint function, the original occlusion and facial symmetry (in growing individuals). RESULTS: The patients were followed up for 6 to more than 60 months. After guided physiotherapy, all patients had significant postoperative improvement in maximal mouth opening from a mean of 18.4 mm (range 8 to 28) to a mean of 41.2 mm (range 35 to 50). All patients had returned to their original occlusion. In all the growing patients, a marked improvement in facial symmetry was observed. CONCLUSIONS: In post trauma ankylosis the displaced head of the condyle and disc should be searched for using computed tomography. If detected we recommend its preservation while accurately remove only the ankylotic mass. Using this approach, in addition to achieving adequate mandibular motion, good occlusion, and normal facial growth, major surgery, with all its inconveniences and potential complications, is avoided.

Tooth autotransplantation in orthodontic patients.

AIM: The aims of this report are to present three cases of autotransplantation along with a review of the indications, selection criteria for patient donor and recipient sites, and the major steps in the surgical procedure. BACKGROUND: Autogenous tooth transplantation, or autotransplantation, is the surgical movement of a tooth from one location in the mouth to another in the same individual. It can be a good treatment option in many cases if the dentist knows the implications, indications, and contraindications. CASE DESCRIPTIONS: Three cases with different treatment indications and plans are presented. All showed autotransplantation of teeth as part of orthodontic treatment. It emphasized the benefits of this treatment modality such as new bone formation and lower costs. One case, a rare example of multiple congenitally missing teeth treated by autotransplantation, also was presented. SUMMARY: As shown in these case reports, there are instances where the autotransplantation of teeth is appropriate and may possibly simplify future planned orthodontic or prosthodontic treatment. CLINICAL SIGNIFICANCE: Tooth autotransplantation is an easy and good treatment option, applicable in a lot of cases, substituting different types of prostheses, including dental implants.

Modification of mandibular ridge splitting technique for horizontal augmentation of atrophic ridges.

PURPOSE: A two stage approach of ridge splitting and lateral expansion in the mandible to achieve enough bone width for the purpose of dental implants is presented. MATERIALS AND METHODS: A total of 13 consecutive patients with 16 long-span edentulous areas of the mandibular ridge were included in this study and 42 dental implants were inserted. Corticotomy of a rectangular buccal segment was carried out followed by 3 weeks of recovery; the mandibular ridge was stretched laterally, leaving the buccal periosteum attached to the lateralized segment. In this modification, there was no need for the use of grafted foreign materials to fill the defect and neither the use of barrier membranes, since it was treated practically as a fresh extraction site. To prevent the undesirable movement of the lateral plate, a small chip (2-3 mm in diameter) of bone spacer was properly fixed. The dental implants were placed 3-5 months later on. RESULTS: Approximately, 86% of the expanded areas were successful in providing an adequate width to accommodate an implant. The average gain in width was 3.22 ± 0.97 mm. All intended implants were inserted. Prosthetic loading with fixed prosthesis was successfully implemented in all cases. CONCLUSION: This modified technique is a simple and short procedure with satisfactory results and minimal morbidity. Of note, this approach is devoid of foreign materials usage and has a low rate cost, therefore, should be employed more often.

Mandibular reconstruction using stereolithographic 3-dimensional printing modeling technology.

Mandibular reconstruction can be challenging for the surgeon wishing to restore its unique geometry. Reconstruction can be achieved with titanium bone plates followed by autogenous bone grafting. Incorporation of the bone graft into the mandible provides continuity and strength required for proper esthetics and function and permitting dental implant rehabilitation at a later stage. Precious time in the operating room is invested in plate contouring to reconstruct the mandible. Rapid prototyping technologies can construct physical models from computer-aided design via 3-dimensional (3D) printers. A prefabricated 3D model is achieved, which assists in accurate contouring of plates and/or planning of bone graft harvest geometry before surgery. The 2 most commonly used rapid prototyping technologies are stereolithography and 3D printing (3DP). Three-dimensional printing is advantageous to stereolithography for better accuracy, quicker printing time, and lower cost. We present 3 clinical cases based on 3DP modeling technology. Models were fabricated before the resection of mandibular ameloblastoma and were used to prepare bridging plates before the first stage of reconstruction. In 1 case, another model was fabricated and used as a template for iliac crest bone graft in the second stage of reconstruction. The 3DP technology provided a precise, fast, and cheap mandibular reconstruction, which aids in shortened operation time (and therefore decreased exposure time to general anesthesia, decreased blood loss, and shorter wound exposure time) and easier surgical procedure.