An integrative approach for comparing microcirculation between normal and alveolar cleft gingiva in children scheduled for secondary bone grafting procedures.

OBJECTIVE: The aim of this study was to compare microcirculatory parameters in normal versus alveolar cleft gingiva in children selected for secondary bone grafting procedures. STUDY DESIGN: This study included 11 consecutive patients with complete unilateral alveolar clefts who required secondary bone grafting procedures. In a split-mouth design, noninvasive real-time simultaneous measurements among tissue oxygen saturation (StO2), hemoglobin level (rHb), and blood flow parameters were obtained from normal and alveolar cleft gingiva using spectrophotometry and laser Doppler flowmetry. Subsequent noninvasive capillary density measurements and tissue microangioarchitecture were assessed using sidestream dark-field imaging. RESULTS: There were no significant differences in StO2 and rHb between normal and alveolar cleft gingiva. Blood flow, blood flow velocity, and capillary density were significantly decreased in alveolar cleft gingiva (P < 0.05). CONCLUSIONS: Alveolar cleft reconstructions alter gingival microperfusion properties, and microvascular changes adapt to conserve peak oxygen saturation.

Use of sidestream dark-field (SDF) imaging for assessing the effects of high-dose melphalan and autologous stem cell transplantation on oral mucosal microcirculation in myeloma patients.

BACKGROUND: Oral mucositis (OM) is a common toxic side effect among patients receiving high-dose chemotherapy (CT) with autologous stem cell transplantation (ASCT) for hematologic malignancies. The aim of this study was to investigate changes in submucosal microcirculation in myeloma patients receiving high-dose CT with ASCT by assessing capillary density and microvascular structural integrity. METHODS: Ten consecutive patients with multiple myeloma who underwent first-time CT treatment with high-dose melphalan (200 mg/m(2)) and ASCT were included in this study. Baseline buccal mucosa capillary density, expressed as the mean number of capillaries +/- SD per mm(2) (cpll/mm(2)), was measured with sidestream dark-field imaging after treatment was performed, after 30 and 60 minutes, and then on days 2, 4, 6, 8, and 14. A linear mixed model was used to examine capillary density over time and a P value of <.05 was considered to be statistically significant. RESULTS: Baseline mucosal capillary density was 19 +/- 2.4 cpll/mm(2). Mucosal capillary density after melphalan infusion after 30 and 60 minutes and on days 2 and 4 showed no statistically significant differences. A decrease in capillary density with statistical significance was observed on days 6 (10 +/- 3.0 cpll/mm(2); P < .01) and 8 (12 +/- 4.9 cpll/mm(2); P < .01). On day 14, capillary density returned to near baseline value. CONCLUSIONS: High-dose CT alters microvascular structural integrity and dysregulates tissue perfusion in the oral mucosa by decreasing the number of perfused submucosal capillaries in the oral mucosa. The findings of this investigation suggest that acute CT toxicity alters oral microcirculation and may be an important mechanism responsible for driving early mucosal barrier disturbances associated with CT-induced OM.

Regression of central giant cell granuloma by a combination of imatinib and interferon: a case report.

Central giant cell granuloma is a benign lesion of the jaws which is sometimes aggressive locally. The most common treatment is curettage,which has a high recurrence rate, particularly in more aggressive lesions. Other treatments such as interferon (IFN) and calcitonin have been described. We report a patient with Stickler syndrome and an aggressive central giant cell granuloma in the mandible. Initial treatment with calcitonin was not successful. A combination of IFN and imatinib, given for 9 months, initiated regression of the lesion that continued after treatment had ceased.

Central giant cell granuloma of the jaw: a review of the literature with emphasis on therapy options.

Central giant cell granuloma (CGCG) is a benign lesion of the jaws with an unknown etiology. Clinically and radiologically, a differentiation between aggressive and non-aggressive lesions can be made. The incidence in the general population is very low and patients are generally younger than 30 years. Histologically identical lesions occur in patients with known genetic defects such as cherubism, Noonan syndrome, or neurofibromatosis type 1. Surgical curettage or, in aggressive lesions, resection, is the most common therapy. However, when using surgical curettage, undesirable damage to the jaw or teeth and tooth germs is often unavoidable and recurrences are frequent. Therefore, alternative therapies such as injection of corticosteroids in the lesion or subcutaneous administration of calcitonin or interferon alpha are described in several case reports with variable success. Unfortunately, randomized clinical trials are very rare or nonexistent. In the future, new and theoretically promising therapy options, such as imatinib and OPG/AMG 162, will be available for these patients.

DNA analysis of the SH3BP2 gene in patients with aggressive central giant cell granuloma.

A mutation of the SH3BP2 gene is known to cause cherubism. As there are clinical and histopathological similarities between central giant cell granuloma and cherubism, we made a constitutional DNA analysis of the SH3BP2 gene in four patients with aggressive giant cell granuloma (having one or more of the following features pain, paraesthesia, rapid growth, or root resorption). We found no mutations in the SH3BP2 gene, which indicates that cherubism is a separate entity. However, a somatic mutation in a specific group of cells could cause the focal lesions in giant cell granuloma. Further DNA analysis of the tissue of giant cell granulomas therefore seems indicated.

A randomized prospective controlled trial of antibiotic prophylaxis in intraoral bone grafting procedures: single-dose clindamycin versus 24-hour clindamycin prophylaxis.

PURPOSE: The objective of this study was to compare the efficacy of a single oral dose of clindamycin with a 24-h protocol of clindamycin administration in local buccal onlay grafting procedures. MATERIAL AND METHODS: A prospective randomized study in 124 patients was performed. Eligible patients were randomized to receive antibiotic prophylaxis either as a single dose (group I) or over a 24-h period (group II). In both groups prophylaxis started with an oral dose of 600 mg clindamycin 1 h before surgery, followed by either placebo or 300 mg clindamycin every 6 h. The primary endpoint of this study was wound infection at the receptor site within 8 weeks after surgery. Secondary outcome measurements included postoperative infections at the donor site and adverse events as a result of antibiotic administration. RESULTS: The mean age of the patients was 35.9+/-10.1 years (range 18-59 years). Infections at the receptor site were seen in two patients (3.2%, 95% CI 0-7.6%) of the single-dose group and in three patients (4.8%, 95% CI 0-10.1%) of the 24-h group. Infection at the donor site occurred in four patients (6.4%, 95% CI 0-12.5%) of the single-dose group and in two patients (3.2%, 95% CI 0-7.6%) of the 24-h group. Postoperative infections were predominantly caused by alpha-hemolytic streptococci sensitive to penicillin. CONCLUSIONS: No statistically significant difference was found between the prophylactic single dose of clindamycin and the 24-h regimen of clindamycin with regard to postoperative infection in patients undergoing local bone augmentation procedures.

A comparative prospective randomized clinical study of MTA and IRM as root-end filling materials in single-rooted teeth in endodontic surgery.

OBJECTIVE: Randomized clinical prospective study to evaluate the application of MTA and IRM as retrograde sealers in surgical endodontics. STUDY DESIGN: One hundred single-rooted teeth were surgically treated. After randomization, MTA or IRM was used as a retrosealer. Radiographs were taken 1 week, 3 months, and 1 year postoperatively. Assessment was performed by 2 independent assessors 1 year after surgery. Both treatment groups were homogeneous in their composition, and clinical features and radiographic findings were classified according to Rud's classification. RESULTS: Complete healing was observed in 64% of the MTA-treated teeth vs 50% of the IRM-treated teeth. Incomplete healing was seen in 28% (MTA) vs 36% (IRM), and unsatisfactory in 6% (MTA) vs 14% (IRM). Only 1 failure was seen (MTA). No statistically significant differences were found between the 2 retrofilling materials. CONCLUSION: As root-end filling materials in this clinical prospective randomized design on single rooted teeth, MTA and IRM had the same clinical effectiveness.

Clinical and radiological features of central giant-cell lesions of the jaw.

OBJECTIVE: The purpose of this study was to evaluate the clinical and radiological features of central giant-cell lesions that were diagnosed in The Netherlands between January 1, 1990, and January 1, 1995. STUDY DESIGN: A population-based retrospective study was carried out, examining all patients with a central giant-cell lesion from this period. RESULTS: In 83 patients there was a central giant-cell granuloma (89 lesions). Aggressive signs and symptoms (pain, paresthesia, or root resorption) were found in 16 (19.3%) patients. Multiple lesions occurred in 3 (3.6%) patients. The overall recurrence rate was 26.3%, and there was a higher recurrence rate in patients who exhibited aggressive signs and symptoms than in patients without these features (RR 1.6). In 5 patients a clinical diagnosis of cherubism or concomitant neurofibromatosis type 1 was made (14 lesions). CONCLUSION: In a general population, large and aggressive lesions are less common than suggested by the literature. Multiple lesions, however, occur more frequently than previously assumed. In patients with aggressive signs and symptoms, surgical curettage is not an effective therapy.

Incidence and disease-free survival after surgical therapy of central giant cell granulomas of the jaw in The Netherlands: 1990-1995.

BACKGROUND: The central giant cell granuloma (CGCG) of the jaw is a rare benign tumor with an unknown etiology. Epidemiologic data on CGCGs in a general population are not available, nor are data on the overall outcome of surgical therapy. In this article, an overview of these aspects in the Dutch population from January 1, 1990, until January 1, 1995, is presented. METHODS: All CGCGs that were diagnosed and surgically treated in The Netherlands from 1990 until 1995 were evaluated. RESULTS: The incidence is 0.00011%, and the disease-free survival after surgical therapy after 5 years is 76.1%. There is a significantly higher recurrence rate in young males, which cannot be explained by clinical signs and symptoms of the lesion. CONCLUSION: The CGCG is a rare affliction with a high recurrence rate after surgical therapy, especially in young males.

A prospective placebo-controlled double-blind trial of antibiotic prophylaxis in intraoral bone grafting procedures: a pilot study.

OBJECTIVE: A pilot study was conducted to assess the efficacy of a single-dose preoperative prophylactic of the penicillin pheneticillin compared with placebo in the antibiotic prophylaxis of surgical wound infections in intra-oral bone grafting procedures. PATIENTS AND METHODS: Twenty patients (age range 20-45 years) underwent an intra-oral buccal onlay graft procedure. After randomization, a placebo or 2 grams of pheneticillin were administered orally one hour before surgery in a double-blind fashion. During three months, the postoperative course was observed according to clinical parameters of infection. Both groups were homogeneous in their composition and established risk factors for surgical wound infection. The frequency of surgical wound infections, as defined by the Centers of Disease control in 1992, were compared and evaluated statistically. RESULTS: Two patients developed a wound infection at the receptor site; two patients developed an infection at both the receptor and donor sites; and one patient developed an infection at the donor site only. All of these patients received a placebo. No infections were seen in the pheneticillin group. There was a statistically significant increased risk of having an infectious complication after an intra-oral bone graft without antibiotic prophylaxis. CONCLUSION: The results of this study support the efficacy of single-dose, preoperative, oral antibiotic administration.

Multiple recurrent and de novo odontogenic keratocysts associated with oral-facial-digital syndrome.

In 1954, Papillon-Leage and Psaume were the first to describe the clinical characteristics of oral-facial-digital syndrome (OFDS). On the basis of their clinical features and the inheritance pattern, 2 variants were initially distinguished, namely OFDS type I (Papillon-Leage and Psaume) and OFDS type II, or Mohr syndrome. At present, 11 types of OFDS have been discovered. OFDS represents a heterogeneous group of disorders characterized by oral manifestations including oral frenula, cleft or lobulated tongue, high arched palate, cleft lip and/or palate, facial anomalies, and digital abnormalities such as syndactyly, polydactyly, brachydactyly, and clinodactyly. Depending on the type of OFDS, abnormalities may be present in other organs, such as the brain and heart. We report a patient with OFDS in whom multiple recurrent and de novo keratocysts were found. Although multiple keratocysts are commonly found in Gorlin-Goltz nevoid basal cell carcinoma syndrome, a relationship between OFDS and multiple keratocysts has not been described.