Aggressive type of central giant cell granuloma in a woman on hormone replacement therapy: a histopathological insight.

Quite a few lesions of the oral cavity specifically of the gingiva have a greater inclination towards women and mostly occur during the first four decades of life, the cause of which may be credited to the changing levels of sex hormones. Out of all such lesions, one lesion whose aetiology is still unclear and which originats from the periosteum or periodontal ligament is central giant cell granuloma. Repeatedly, it is has been described as a reactive lesion, the cause of which may be secondary to local irritants or trauma, specifically plaque or calculus, which is not considered to be a true neoplasm. Here we present a case of a 51-year-old female patient with aggressive gingival growth within 10-13 months of hormonal replacement therapy. The aetiology, histological features and appropriate treatment are discussed in the light of current literature.

Oral and dental findings in Bardet-Biedl syndrome: A case report.

Bardet-Biedl syndrome (BBS) is a rare autosomal recessive genetic disorder. This syndrome is associated with 19 genes present, and 80% of the cases are determined as a clinical diagnosis result. A 15-year-old female presented with a complaint of gingival bleeding during brushing. As a result of received detailed history and the intraoral-extraoral examinations; retinal dystrophy, obesity, polydactyly, and renal defects of Caucasian female consistent with BBS were reported. Oral and dental findings were high-arched palate, crowding, and missing tooth. As dentists, we should know the diagnostic criteria of this syndrome. In addition, we should have a high index of suspicion so as to enhance the timely recognition of this condition. Dentists should also be familiar with the management protocol that includes a multidisciplinary approach to alleviate the existing conditions.

Ossifying epulis in pseudohypo-parathyroidism: a case-based therapeutic approach.

BACKGROUND: The term Pseudohypoparathiroidism indicates a group of rare conditions characterised by end-organ resistance to the action of parathyroid hormone (PTH). Ossifying epulis (OE) is a exophytic gingival lesion characterised by spontaneous bone formation beneath the mucosa, which may affect children and adults: the exophytic, calcified outgrowths can occur in any bone and generally have favorable prognosis. Drug therapy may normalise calcium serum levels, but not completely avoid the occurrence of peripheral ossifying epulis. CASE REPORT: We report a representative case of a peripheral ossifying epulis in the mouth of a patient following a drug treatment protocol for her pseudohypoparathyroidism and to optimise serum markers. An 11-year-old girl was referred to our department, showing a bulky neoformation on the gingival margin of 0.6 mm diameter with sharp margins. The mass was completely excised. Histological analysis revealed distinctive features of a chronic and acute inflammatory microenvironment with plasma cells (positivity for CD38, MUM1, Lambda and Kappa chains) and bone tissue fragments with remodeling aspects referable to flogistic osteolysis. The biopsy result leads to hypothese a change in the patient's drug therapy. Multidisciplinary screening and individualised pharmacological treatment are strongly recommended in the clinical practice in order to improve the therapeutic results.

Local Injection of Hyaluronic Acid Filler Improves Open Gingival Embrasure: Validation Through a Rat Model.

BACKGROUND: The open gingival embrasure, the so-called black triangle, is one of the unsolved dilemmas in adult dentistry. Although various techniques have been introduced to improve black triangles, the lack of reproducible experimental models has prevented development of successful protocols to regenerate or to compensate loss of the interdental papilla. Therefore, the objective of this study is first to develop a reliable animal model of open gingival embrasure and then to validate a minimally invasive injection technique using hyaluronic acid (HA) filler to augment the interdental papilla. METHODS: To reproduce open gingival embrasure in rats, rapid space opening was induced between the mandibular incisors by attachment of a compression spring. Loss of interdental papilla height was morphologically evaluated and calculated using standardized serial photographs, microcomputed tomography, and histologic sections. Afterward, HA fillers or phosphate-buffered saline (PBS) was locally injected, and changes in the interdental papilla were evaluated. RESULTS: After 7 days of space opening, the margin of the interdental papilla between the mandibular incisors gradually became irregular and flat, indicating a condition similar to the open gingival embrasure (P <0.05). Local injection of HA filler induced an augmentation effect of the interdental papilla compared with injection of PBS (P <0.05). Interdental papilla became convex, and inner granules containing HA were detected within the submucosal layer after its injection. CONCLUSIONS: Open gingival embrasure was reproduced reliably in vivo. Local injection of HA filler was validated as a meaningful minimally invasive procedure to improve open gingival embrasure.

A Rare Case of Gingival Cyst in a Child.

Gingival cysts, which are more frequently reported as gingival cysts of adults (GCA), are soft tissue cystic lesions of odontogenic origin that are infrequently seen, especially in children. These lesions usually appear as localized firm elevations on the facial gingiva in the anterior segment of the mandible. The purpose of this paper is to present a rare case of a gingival cyst discovered on the palatal aspect of the posterior maxilla in a four-year-old child. The lesion was treated with excisional biopsy.

Measurement of Reduced Gingival Melanosis after Smoking Cessation: A Novel Analysis of Gingival Pigmentation Using Clinical Oral Photographs.

BACKGROUND: Due to moisture and the anatomical complexity of the oral mucosa, it is difficult to measure the extent of gingival melanosis in an optical manner. Therefore, we developed a new quantitative method using clinical oral photographs and compared the extent of gingival melanosis before and after smoking cessation. METHODS: A new analysis method, which we named the gingival melanosis record (GMR), is a quantitative analysis method using clinical oral photographs. We obtained 659 clinical photographs from 263 patients from 16 general dental offices in Japan. Standardized measuring sites were automatically spotted on the screen, and the presence of gingival melanosis was determined at the measuring sites. We assessed the validity of the GMR with the previously reported Hedin's classification using Spearman's rank correlation and intraclass correlation coefficients. RESULTS: The GMR showed a significant association with Hedin's classification (p < 0.01, correlation coefficient = 0.94). The GMR also showed excellent reproducibility of the substantial repeated agreement intraclass correlation coefficients (ICC) (1,1) and ICC (2,1), p > 0.61). The longitudinal loss of gingival melanosis was confirmed by a change in the GMR among patients who successfully achieved smoking cessation for a mean of 4.5 years. CONCLUSION: The GMR is an effective method to assess gingival melanosis. The loss of gingival melanosis after smoking cessation can be objectively confirmed with the use of the GMR.

The Pathogenesis of Implant-Related Reactive Lesions: A Clinical, Histologic and Polarized Light Microscopy Study.

BACKGROUND: Peri-implant soft tissue reactive lesions (I-RLs) may jeopardize implant success and survival. To the best of the authors' knowledge, its pathogenesis is unknown. The objective of this study is to conduct a clinicopathologic and polarized light microscopy (PLM) analysis of 14 new I-RLs and compare them with comparable tooth-associated cases (T-RLs) to better understand I-RL pathogenesis. METHODS: Fifty-eight new cases of I-RL and T-RL were retrieved from the pathology department archives of Rambam Health Care Campus, Haifa, Israel. Retrospective analysis of histopathologic and clinical features was conducted, documented, and then compared for: 1) I-RL (n = 14), 2) peri-implant pyogenic granuloma (I-PG) (n = 5), 3) peri-implant peripheral giant cell granuloma (I-PGCG) (n = 9), 4) T-RL (n = 44), 5) tooth-associated pyogenic granuloma (T-PG) (n = 21), and 6) tooth-associated peripheral giant cell granuloma (T-PGCG) (n = 23). Presence of foreign bodies was assessed using PLM. RESULTS: Foreign bodies were found more commonly in I-RLs (n = 13/14; 93%) when compared with T-RLs (n = 18/44; 41%), which was a statistically significant difference (P = 0.01) with an odds ratio of 7.9. Microscopically, I-PGCG was associated with: 1) lower multinucleated giant cell count (P = 0.04); 2) lower density of mesenchymal cells (P = 0.05); and 3) more diffuse, non-lobulated stromal morphology (P = 0.001). Clinically, I-RLs were found in patients who were older, and all cases were located in the posterior region: mandible (n = 12/14; 86%) and maxilla (n = 2/14; 14%). CONCLUSIONS: In cases of implant failure, implantation of foreign bodies may play a role with subsequent development of I-PG and I-PGCG-like lesions. Clinicians should be aware of this risk so they can implement measures to minimize adverse implant outcomes.

Effect of buccal gap distance on alveolar ridge alteration after immediate implant placement: a microcomputed tomographic and morphometric analysis in dogs.

INTRODUCTION: The buccal bone resorption and the deformation of soft tissue contour are major problems of immediate implant treatment. This study aims to examine the changes of alveolar bone and soft tissue after immediate implant placement in different buccal gap distances. MATERIALS AND METHODS: Eight implants were placed randomly in the mandibular premolar sockets of 6 hybrid dogs with 1, 2, and 3 mm buccal gap distances. The dogs were killed after 2 or 4 months for morphometric and microcomputed tomography analyses. DISCUSSION: After 2 months, the 3-mm group had the highest buccal bone volume (BV), buccal bone/soft tissue thickness, and the lowest bone resorption. The wider the buccal gap, the more buccal bone and soft tissue were formed in this experimental setting. After 4 months, the buccal BV had decreased significantly in the 1-mm and the 2-mm groups, whereas the 3-mm group resisted to buccal bone resorption. This difference was more pronounced at the crest. CONCLUSION: The 3 mm is the optimal gap distance among the groups examined, which drastically influences the healing of bone and soft tissue surrounding the implants.

The usefulness of three-dimensional imaging in the diagnosis and treatment of clinically ambiguous gingival swelling.

We evaluated and treated a 54-year-old woman with gingival swelling. Conventional intraoral and panoramic radiography did not provide sufficient information for either determining the cause of gingival swelling or planning treatment of clinical symptoms. The 3D Accuitomo XYZ Slice View Tomograph (3DX) is a compact dental computed tomography device that allowed for accurate identification and optimal treatment of the causes of gingival swelling. At four years after treatment, 3DX radiographs showed no abnormalities in treated teeth or healing of surrounding structures. We conclude that high-resolution 3D images obtained with 3DX promise to be very effective for diagnosing oral diseases and determining effective treatment.

[Osteoporosis, bisphosphonates and jaws osteochemonecrosis]. / Ostéoporose, bisphosphonates et ostéochimionécrose maxillo-mandibulaire.

Bisphosphonates are widely used in the treatment of nonmalignant bone disease like osteoporosis, Paget's disease and malignant disease like malignant hypercalcemia, osteolytic metastasis from breast and prostate cancer and multiple myeloma. Jaws osteonecrosis is described since 2003 and is more often associated with the intraveinous use than oral use. Higher risk of osteonecrosis is noted after 3 years of osteoporosis treatment. The precipitating event is often a tooth extraction or other invasive procedure. There is no effective treatment for this pathology. Careful oral examination is necessary before prescribing bisphosphonates and dental treatment must be achieved before the initiation of treatment.

Pathosis associated with radiographically normal follicular tissues in third molar impactions: a clinicopathological study.

BACKGROUND: The follicular tissue around impacted third molars has a potential to develop pathosis. However, it is generally assumed that the absence of abnormal radiolucency indicates the presence of a normal follicle. AIMS: The aim of this study was to investigate abnormalities associated with radiographically normal follicular tissue of third molar impactions. MATERIALS AND METHODS: One hundred eighty-five impacted third molars from 170 patients with no signs of abnormal radiolucency (follicular space < 3 mm) were used for this study. Follicular tissues of the relevant teeth were collected. Specimens were fixed in 10% formalin and stained routinely with hematoxilin and eosin to be independently examined by two pathologists. A diagnosis was registered only when the results from both pathologists were in concordance. Clinical details for each patient were registered in WHO standard forms to undergo chi-square statistical analysis. RESULTS: Fifty-three per cent of the specimens had developed pathosis. The incidence of pathosis was higher in the age group of 20-30 years, in men compared to women and in the mandible compared to the maxilla. CONCLUSION: The findings of this study suggest that radiographic appearance may not be reliable in the diagnosis of pathosis in follicular tissue as a surprisingly high rate of pathosis was found in the absence of any radiographically detectable sign.

Pyogenic granuloma, peripheral giant cell granuloma and peripheral ossifying fibroma: retrospective analysis of 138 cases.

AIM: The present study examined retrospectively the clinical and radiographic characteristics of pyogenic granuloma (PG), peripheral giant cell granuloma (PGCG) and peripheral ossifying fibroma (POF), located in the gingiva and alveolar ridge. METHODS: Biopsy records of the Stomatology Service of São Lucas Hospital-PUCRS were reviewed between 1980 and 2006. The medical charts of patients with histopathologic diagnosis of PG, PGCG and POF were selected. The data obtained were evaluated by means of descriptive statistics, analysis of variance (ANOVA), and the chi-squared test (chi-squared), considering the 5% level of significance. RESULTS: Of the 138 cases analyzed, 57.2% corresponded to PG, 22.5% to PGCG and 20.3% to POF. PG and POF exhibited a predilection for females and PGCG for males. PG occurred in younger individuals and showed a greater tendency for bleeding (P=0.018). PG showed a greater frequency of reddish color (P<0.001), PGCG purplish (P<0.001) and POF pinkish (P<0.001). In the radiographic examination, the presence of radiopaque foci was greater in POF (P<0.001), and resorption of the subjacent alveolar bone was found more often in PGCG (P<0.001). POF exhibited a longer evolution. There was no difference in lesions with respect to local irritating factors, ulceration, size, site and recurrence. Pregnancy was a factor linked to PG. CONCLUSION: Despite the lesions investigated exhibit similar clinical characteristics, the present study demonstrated that aspects such as age of the patient and evolution, color, bleeding and radiographic characteristics can help in the differential diagnosis of these lesions.

Odontogenic keratocyst with a misleading clinical and radiologic appearance.

This report describes the case of an 82-year-old woman who presented with the chief complaint of a mild pain and gingival swelling of 2-months' duration in the buccal aspect of her mandibular left premolar region. The condition was initially diagnosed as a periodontal abscess and was treated as such by the referring clinician. The initial periapical radiograph provided by the clinician demonstrated horizontal alveolar bone resorption associated with active periodontal disease, which appeared to be more severe between the 2 premolars adjacent to the swelling. After more detailed clinical evaluation of the area and examination of the adjacent teeth, including vitality testing, it was concluded that the condition was not related to dental or periodontal disease. Consequently, a biopsy specimen was taken, and the histopathologic examination of the lesion proved it to be an odontogenic keratocyst. The case is reported because of the unusual clinical and radiographic findings associated with this lesion. Early diagnosis and appropriate treatment of odontogenic keratocyst can reduce the possibility of recurrence. However, misinterpretation of such a condition as endodontic or periodontal disease may lead to incorrect treatment planning and possibly unnecessary complications.

Peripheral ameloblastoma of the gingiva: the importance of diagnosis.

BACKGROUND: Peripheral ameloblastoma is an extremely rare epithelial odontogenic tumor, limited to the soft tissues of the gums or oral mucosa. Although the lesion is benign, it may be locally aggressive. METHODS: The present study describes the case of a 31-year-old male presenting a firm, symptomless tumor mass of irregular appearance and measuring approximately 12 mm in diameter, located in the distal zone of 4.7. RESULTS: An excision biopsy was performed. The lesion was covered with hyperplastic squamous epithelium, with islets of epithelial cells located at subepithelial level. The cells in the peripheral zone adopted a palisade distribution, and presented the appearance of a lax reticulum at central level. A fibroblastic stroma was observed between the islets. The diagnosis was peripheral ameloblastoma. CONCLUSIONS: Although the origin of the lesion remains unclear, it is able to recur and undergo malignant transformation. Consequently, peripheral ameloblastoma should not be viewed as a harmless mass.