Thirteen Synchronous Multifocal Calcifying Epithelial Odontogenic Tumors (CEOT): Case Report and Review of the Literature.

BACKGROUND: Calcifying epithelial odontogenic tumor (CEOT, Pindborg tumor) is a rare, benign, locally aggressive neoplasm of the jaws that accounts for approximately 1% of all odontogenic tumors. It was first defined by Pindborg in 1955 and has been reported approximately 350 times in the literature; 7 reported multiple (up to 4) synchronous lesions. MATERIALS AND METHODS: We report an individual with the largest number of CEOTs reported to date and provide a literature review of multifocal CEOT cases. RESULTS: A 30-year-old male presented to the Oral and Maxillofacial Surgery Department of the West Virginia University School of Dentistry (WVU SoD) to extract multiple impacted teeth previous to construction of a complete denture. A pantograph showed 15 impacted teeth, almost all associated with well-demarcated cyst-like radiolucencies, some with small, ill-defined radiopaque flecks. Microscopically, the lesions showed sheets and strands of polygonal epithelial cells with eosinophilic cytoplasm. Spread throughout the epithelium and connective tissue were small, spherical, amorphous, pale purplish calcifications. Each lesion was similar and consistent with a diagnosis of CEOT. CONCLUSION: We report a patient with 13 independent CEOTs scattered throughout all quadrants. This case represents the largest number of Pindborg tumors or any other type of odontogenic tumor yet reported in a single individual.

Symmetrical palatal fibromatosis: Five new cases and a review of the literature.

OBJECTIVE: To present five cases of symmetrical palatal fibromatosis (SPF), a lesion reported very rarely in the English language literature, under more than a dozen different names, and to recommend the most appropriate name. METHODS: Five SPF cases are characterized with a literature review. RESULTS: Three females and two males, aged 20-39 years, presented with bilateral, symmetrical, asymptomatic, sessile, moderately firm, or soft (n = 2) masses of the lateral posterior hard palate; two were isolated to the tuberosities. All masses were normal in color, with smooth, non-ulcerated surfaces and occasional surface nodularity. Underlying bone was radiographically normal, and adjacent teeth were asymptomatic. All masses originated from supra-periosteal tissues over palatal bone, only secondarily extending to gingivae and/or crestal tuberosity. Cases were present between 4 months and 15 years, with no familial or environmental etiologies identified. Histopathologically, masses were comprised of dense, avascular fibrous tissue with scattered thick bands of collagen. Surface epithelium showed occasional long, thin, sometimes pointed rete processes, and subepithelial stroma contained scattered large, angular fibroblasts. Conservative surgical excision appeared curative in all cases. CONCLUSIONS: The present investigators propose SPF as the most accurate name for this rare entity.

Is preexisting inflamed jaw marrow a "hidden" co-morbidity affecting outcomes of COVID-19 infections? - Clinical comparative study.

Introduction: Exceedingly high levels of the chemokine CCL5/RANTES have been found in fatty degenerated osteonecrotic alveolar bone cavities (FDOJ) and aseptic ischemic osteolysis of the jaw (AIOJ) from toothless regions. Because CCL5/RANTES seems to have a prominent role in creating the COVID-19 "cytokine storm", some researchers have used the monoclonal antibody Leronlimab to block the CCR5 on inflammatory cells.Objective: Is preexisting FDOJ/AIOJ jaw marrow pathology a "hidden" co-morbidity affecting some COVID-19 infections? To what extent does the chronic CCL5/RANTES expression from preexisting FDOJ/AIOJ areas contribute to the progression of the acute cytokine storm in COVID-19 patients?Methods: Authors report on reducing the COVID-19 "cytokine storm" by treating infected patients through targeting the chemokine receptor 5 (CCR5) with Leronlimab and interrupting the activation of CCR5 by high CCL5/RANTES signaling, thus dysregulating the inflammatory phase of the viremia. Surgical removal of FDOJ/AIOJ lesions with high CCL5/RANTES from patients with inflammatory diseases may be classified as a co-morbid disease.Results: Both multiplex analysis of 249 FDOJ/AIOJ bone tissue samples as well as serum levels of CCL5/RANTES displayed exceedingly high levels in both specimens.Discussion: By the results the authors hypothesize that chronic CCL5/RANTES induction from FDOJ/AIOJ areas may sensitize CCR5 throughout the immune system, thus, enabling it to amplify its response when confronted with the virus. As conventional intraoral radiography does little to assess the quality of the alveolar bone, ultrasonography units are available to help dentists locate the FDOJ/AIOJ lesions in an office setting.Conclusion: The authors propose a new approach to containment of the COVID-19 cytokine storm by a prophylactic focus for future viral-related pandemics, which may be early surgical clean-up of CCL5/RANTES expression sources in the FDOJ/AIOJ areas, thus diminishing a possible pre-sensitization of CCR5. A more complete dental examination includes trans-alveolar ultrasono-graphy (TAU) for hidden FDOJ/AIOJ lesions.

Accelerated osteogenic orthodontics technique: a 1-stage surgically facilitated rapid orthodontic technique with alveolar augmentation.

PURPOSE: Demineralization of a thin layer of bone over a root prominence after corticotomy surgery can optimize the response to applied orthodontic forces. This physiologic response is consistent with the regional acceleratory phenomenon process. When combined with alveolar augmentation, one is no longer strictly at the mercy of the original alveolar volume and osseous dehiscences, and fenestrations can be corrected over vital root surfaces. This is substantiated with computerized tomographic and histologic evaluations. Two case reports are presented that demonstrate the usefulness of the accelerated osteogenic orthodontics technique in de-crowding and space closing for the correction of dental malocclusions. MATERIALS AND METHODS: Orthodontics is combined with full-thickness flap reflection, selective alveolar decortication, ostectomy, and bone grafting to accomplish complete orthodontic treatment. RESULTS: Rapid tooth movement was demonstrated in both cases and stability up to 8 years of retention. CONCLUSION: The accelerated osteogenic orthodontics technique provides for efficient and stable orthodontic tooth movement. Frequently, the teeth can be moved further in one third to one fourth the time required for traditional orthodontics alone. This is a physiologically based treatment consistent with a regional acceleratory phenomenon and maintaining an adequate blood supply is essential.

The use of digital volume tomography in imaging an unusually large composite odontoma in the mandible.

The odontoma is the most common of all odontogenic tumors. Digital volume tomography (DVT) provides a major advantage of decreased radiation and cost-effectiveness, as compared to a conventional computed tomography. There is no known published report utilizing this DVT analysis for assessing and localizing on odontomo. The purpose of this case report was to document the use of digital volume tomography to assess an unusually large composite odontoma in the mondible. Tomographic sections revealed expansion of the buccol cortex and occasional thinning of both the buccol and lingual cortical plates, although there was no pronounced clinically detectable cortical expansion. The sections further demonstrated enomel ond dentin in on irregular mass bearing no morphologic similority to rudimentary teeth. This case highlights the importance of early diagnosis and intervention for treating on odontoma while demonstrating the value of tomographic imaging as on aid to diagnosis.

The pararadicular radiolucency with vital pulp: Clinicopathologic features of 21 cemental tears.

OBJECTIVE: The investigation was conducted to better characterize the clinical, radiographic, and histopathologic features of cemental tears from a review of 21 cases. STUDY DESIGN: This was a retrospective review of consecutive cases collected from patient records of the investigators. RESULTS: Twenty-one cases were identified during an 8-year period. Maxillary incisors were most often affected (47.6%). All lesions presented with pain. They occurred as radiolucencies along the root of a vital or endodontically treated tooth and were classified as D-shaped (38.1%), thin-vertical-line (23.8%), thick-vertical-line (14.3%), J-shaped (19.0%), or periapical radiolucencies (4.8%). All lesions showed focal destruction of the lamina dura, with 66.7% exhibiting extension into the medullary bone. Histopathologic diagnoses included intramedullary fibrous scar (28.6%) and chronic fibrosing osteomyelitis (71.4%), all associated with embedded cemental fragments. Five associated teeth were also examined: All showed tears beneath the remaining cementum. Four cases were successfully treated with curettage without tooth extraction; endodontic therapy was performed, probably mistakenly, in 8 cases. CONCLUSIONS: Cemental tears produced symptomatic, localized chronic inflammation characterized usually by a vertical radiolucency adjacent to a root. These lesions may not be as rare as previously thought and extraction may not be the best treatment.

Assessment of risk factors for oral leukoplakia in West Virginia.

OBJECTIVE: To assess risk factors associated with oral leukoplakia in a US population with high use of smoked tobacco and smokeless tobacco. METHODS: The RJ Gorlin Leukoplakia Tissue Registry was used to identify individuals with oral leukoplakia in West Virginia, USA. This case-control study consisted of 90 cases with oral leukoplakia and 78 controls with periapical cysts. Univariate-univariable (one dependent variable and one independent variable) and univariate-multivariable (one dependent variable and multiple independent variables) logistic regression modeling quantified the association between oral leukoplakia and potential explanatory variables. RESULTS: Unadjusted measures of association indicate that those with oral leukoplakia were more likely to be older [odds ratio of crude: OR(Crude) = 2.72; 95% confidence interval (CI): 1.45-5.11], more likely to currently use smokeless tobacco (OR(Crude) = 3.16; 95% CI: 1.10-9.07), and more likely to currently use snuff (OR(Crude) = 8.32; 95% CI: 1.83-37.80). Individuals currently using smokeless tobacco or currently using snuff were more likely to have oral leukoplakia [adjusted odds ratio, OR(Adj) = 9.21 and 30.08; 95% CI: 1.49-57.00 and 2.67-338.48, respectively], after simultaneously adjusting for age, gender, currently using smoked tobacco, currently using alcohol daily, and dental prostheses use. CONCLUSIONS: Generalizability is an issue when studying risk factors associated with oral leukoplakia because of geographical variations in the composition of smokeless tobacco (i.e. betel, lime, ash, and N-nitrosamines) and cultural variations in the use of tobacco (i.e. reverse smoking). Snuff was the main smokeless tobacco product currently used in West Virginia, and was strongly associated with oral leukoplakia, after adjusting for potential explanatory variables.

Full-thickness flap/subepithelial connective tissue grafting with intramarrow penetrations: three case reports of lingual root coverage.

Three case reports are presented that demonstrate the use of full-thickness flap/subepithelial connective tissue grafting for root coverage on the lingual surfaces of the mandibular anterior teeth. This is accomplished using an envelope full-thickness flap technique with intramarrow penetrations at the recipient site. Miller Class I, II, and III gingival recession defects and gingival perforation defects were treated. Complete root coverage was achieved in two Miller Class I gingival recession defects, in one Miller Class II gingival recession defect, and in two gingival perforation defects in areas that exhibited no radiographic evidence of bone loss. Partial root coverage was achieved in two Miller Class III gingival recession defects in an area that exhibited radiographic evidence of bone loss. Although the majority of the exposed root surface was covered in these two Miller Class III defects, about 1 mm of root surface remained exposed, which seemed to closely correspond to the amount of bone loss that was noted radiographically. A grafting technique has been presented that can be used to restore the functional properties of the lingual gingiva of the mandibular anterior teeth by repairing gingival defects and re-establishing the continuity and integrity of the zone of keratinized gingiva. Our clinical impression is that this has made it easier for the three patients presented in this report to maintain the lingual surfaces of the mandibular anterior teeth with routine oral hygiene measures.

Focal osteoporotic marrow defect: report of 100 new cases with ultrasonography scans.

Focal osteoporotic marrow defect (FOMD) may be the earliest detectable form of the ischemic marrow disorders. The exact cause is unknown, but three theories have been proposed in the literature. A fourth is presented in this paper. In this study, 100 biopsies were examined histologically and were diagnosed as FOMD, based upon consistent histological characteristics. Until recently, the only diagnostic criteria were radiographic evaluation and incisional biopsy. In February 2002, a through-transmission alveolar ultrasonic test (Cavitat 4000, Cavitat Medical Technologies, Inc., Aurora, CO) was approved by the US Food and Drug Administration and by Health Canada for detection of low bone density and bone desiccation, both features of FOMD and chronic ischemic bone disease. Within this article, the diagnostic criteria and pathological findings of FOMD will be presented. The three current theories concerning its etiology will be briefly presented and a fourth theory will be proposed.

Charlatans in dentistry: ethics of the NICO wars.

The scientific and diagnostic status of neuralgia-inducing cavitational osteonecrosis, NICO, has not been definitively established. A case is presented in favor of this diagnosis based on published literature. It is argued that the case against NICO has been made largely based on personal experiences, by innuendo, and through personal attacks rather than in scientific debate.