Gingival plasma cell granuloma.

Plasma cell granulomas (pseudotumors) are rare benign, tumor-like proliferations composed chiefly of plasma cells that manifest primarily in the lungs, but may occur in various anatomic locations. We report this case of a 54-year-old male who presented with an unusual maxillary anterior gingival overgrowth treated by excisional biopsy. Histological examination revealed a dense inflammatory cell infiltrate containing mainly plasma cells. Immunohistochemistry for kappa and lambda light chains showed a polyclonal staining pattern confirming a diagnosis of plasma cell granuloma. Intraoral plasma cell granuloma is exceedingly rare, although case reports documenting such lesions have been reported. This case highlights the need to biopsy unusual lesions to rule out potential neoplasms.

The osteoinductive potential of demineralized freeze-dried bone allograft in human non-orthotopic sites: a pilot study.

BACKGROUND: The use of demineralized freeze-dried bone allograft (DFDBA) in periodontal therapy is widely accepted. In addition to histologic studies demonstrating its role in regenerating the attachment apparatus, its recognized ability to exhibit osteoinduction in small laboratory mammals has prompted many clinicians to regard it as osteoinductive when utilized in periodontal therapy. Despite such a theoretical deduction, evaluating and establishing the osteoinductive potential of DFDBA in humans has been problematic. The purpose of this study was to investigate, through the use of a novel implantation/recovery model, the potential of DFDBA to induce new bone formation at sites not normally considered capable of de novo osteogenic activity. METHODS: Seven patients scheduled to undergo periodontal therapy utilizing non-absorbable membranes agreed to have sterile polypropylene mesh capsules placed adjacent to the primary surgical site for the purpose of this investigation. One capsule was left empty while the second capsule contained DFDBA. At the appropriate time interval for removal of the therapeutic membrane, the capsules were removed and submitted for histologic analysis. Five of the subjects had procedures directed at regenerating bone within molar furcations (guided tissue regeneration) and had the membranes and associated capsules removed between 6 and 8 weeks. The 2 remaining patients had procedures directed toward ridge augmentation (guided bone regeneration) and had the membranes removed either at 8 or 9 months, respectively. In addition, one of the 2 long-term membrane patients had liberal cortical penetration performed directly beneath the implanted capsule. RESULTS: Histologic analysis of all recovered capsules by 2 independent oral and maxillofacial pathologists could not confirm the presence of either osteoblastic or osteoclastic activity associated with the DFDBA particles, although the 2 longer-term specimens clearly exhibited trace amounts of vital bone non-contiguous with the implanted material. CONCLUSIONS: The results of this pilot study do not support the osteoinductive potential of DFDBA when utilized in quantities normally associated with periodontal bone grafting, although they do support the use of this implantation/recovery model to study other preparations and mechanisms of bone formation.

Myospherulosis complicating cortical block grafting: a case report.

BACKGROUND: Myospherulosis of the oral cavity is an inflammatory, granulomatous lesion historically associated with the use of petrolatum-based antibiotic ointment placed in third molar extraction sites to prevent postoperative infection. METHODS: A case of bilateral myospherulosis is presented, in which large lesions complicated the procurement of a cortical block graft used to prepare a mandibular molar edentulous space for implant placement. By obtaining the block graft from a more lateral location on the mandible, an adequate graft was procured and was successfully grafted into an atrophic edentulous ridge. RESULTS: The cortical block graft was successfully incorporated by the recipient site, which received a wide-body, threaded dental implant 6 months later. Healing was uncomplicated, and a functional implant-supported restoration was successfully achieved. CONCLUSIONS: Myospherulosis, though rare today, may present a significant obstacle to the procurement of cortical block grafts. In this case, thorough debridement of the material resulted in subsequent healing of the myospherulosis defect, but prevented procurement of the cortical graft from the planned site. The dimension and volume of the neighboring cortical bone were adequate, and the augmented edentulous space was subsequently restored with a functional endosseous implant. The success seen in these 2 sites would seem to confirm the assumption that size and location of myospherulosis defects are critical factors in obtaining a successful clinical result in implant patients.

Endodontic considerations of the nasopalatine duct region.

Although rare, anomalies of the nasopalatine region have been reported in the literature mimicking pathoses of endodontic origin. The purpose of this article is to present a case of a patent nasopalatine duct that was originally diagnosed as a sinus tract and referred for endodontic therapy. A review of the anatomy of the nasopalatine region is also discussed.

Experimental evaluation of expanded polytetrafluoroethylene for reconstruction of orbital floor defects.

OBJECTIVE: This study evaluates the efficacy of a medical grade expanded polytetrafluoroethylene (e-PTFE) sheet for reconstruction of the orbital floor. MATERIALS AND METHODS: Orbital floor defects were created in 10 domestic sheep and reconstructed with the 1-mm thick e-PTFE sheet. The surgical sites were evaluated for the development of enophthalmos and biocompatibility at 2 weeks, and at 1-, 2-, 4-, and 6-months intervals. RESULTS: The results of this indicate that the e-PTFE material has excellent handling characteristics, provides stability to correct surgically created enophthalmos, and causes essentially no foreign body reaction. CONCLUSION: Expanded polytetrafluoroethylene proved to be an excellent alloplastic material for the repair of orbital floor defects in this experimental study.

Autologous calvarial and iliac onlay bone grafts in miniature swine.

Calvarial bone has been reported to be superior to iliac bone for onlay bone grafting due to decreased resorption. This study evaluated the physical, histologic, and radiographic characteristics of calvarial and corticocancellous iliac onlay bone grafts in nine Pitman-Moore miniature swine at 2 weeks, and at 1-, 2-, 4-, 6-, 7-, 8-, 10-, and 12-month intervals. Compared with iliac grafts, the calvarial onlay grafts had more than a twofold greater radiographic density. Statistical analysis of the mature grafts using the standard of estimated means of the bone graft volumes revealed 85% retention of the calvarial grafts compared with 34% retention of the grafted iliac bone. There was no subjective difference in the rate or degree of revascularization between the two grafted materials.

Candida and candidosis. Epidemiology, diagnosis and therapeutic management.

Infections caused by Candida species comprise one of the most common oral disease conditions encountered in the practice of dentistry. Gradual changes in population demographics have been accompanied by an increased incidence in candidal and related opportunistic infection rates. Candida albicans and other candidal species traditionally have been recognized as opportunistic pathogens. Recent advances in both the scientific basis for and the clinical significance of candidal organisms, however, have demonstrated these fungi to be distributed widely and to be important contributors to a broad range of mucosal and systemic disease conditions. These factors have allowed for a better understanding of fungal pathogenesis as it affects human oral disease through improvements in clinical and laboratory diagnosis and the therapeutic management of candidosis.

Oral candidosis. Clinical, historical, and therapeutic features of 100 cases.

Oral candidosis is an increasingly important disease that affects a significant percentage of the population. Traditionally known as an opportunistic pathogen, the broader clinical scope of oropharyngeal candidal infections is now being recognized. The clinical and historical features of 100 patients referred for diagnosis and management of candidosis have been reviewed. The age, gender, chief complaint, medical history, medications, and clinical findings have been noted. A wide range of clinical signs and symptoms, and the rationale behind the topical and systemic antifungal therapies provided to this patient population, are discussed.

Radiographic support in highly mobile operations.

A lightweight radiographic package is described for use in highly mobile operations, especially light units. Weight, volume, and power requirements of the current medical field x-ray machine create a situation in which radiographic support is impractical if not possible in the early phase of high mobility medical operations. A method for immediate utilization of the dental field x-ray unit to overcome the limitations of the standard field x-ray machine (GX-111) is described.