Immunoexpression of RANK, RANKL and OPG in sporadic odontogenic keratocysts and their potential association with recurrence.

BACKGROUND: Odontogenic keratocysts (OKCs) are clinically aggressive lesions with relatively high recurrence rates. Dysregulation of functional equilibrium in the RANK/RANKL/OPG system is responsible for osteolysis associated with the development of OKCs. Previously published findings imply that immunoexpression of these 3 proteins may correlate with bone resorption activity in OKCs. OBJECTIVES: The rationale behind this study was to assess the potential for receptor activator of nuclear factor kappa-B (RANK), receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG) expression, as well as RANKL/OPG expression ratio, to serve as prognostic indicators for OKC recurrence. MATERIAL AND METHODS: We investigated the immunoexpression patterns of RANK, RANKL and OPG, and their correlation with recurrence rates, in 41 patients with OKCs treated with enucleation. RESULTS: We found no statistically significant differences between recurrent and non-recurrent cysts in terms of either: epithelial (p = 0.404) and stromal (p = 0.469) immunoreactivity of RANK; epithelial (p = 0.649) and stromal (p = 0.198) immunoreactivity of RANKL; or epithelial (p = 1) and stromal (p = 0.604) immunoreactivity of OPG. We also did not find significant differences in the distribution of cases with respect to ratios of RANKL/OPG immunostaining scores between recurrent and non-recurrent OKCs, both in the epithelium and in the connective tissue (p = 1 and p = 0.237, respectively). CONCLUSIONS: Our results suggest that immunoexpression levels of RANK, RANKL and OPG at the time of pathological diagnosis, as well as the RANKL/OPG ratio, are not useful as prognostic markers for OKC recurrence.

CBCT for estimation of the cemento-enamel junction and crestal bone of anterior teeth.

The aim of the study is to evaluate the usefulness of cone-beam computed tomography (CBCT) in the assessment of the relationship between the cemento-enamel junction (CEJ) and bone crest of the anterior mandibular cortex. The study population comprised 39 males and 61 females, aged 18-71. A GENDEX GXCB-500 machine, i-CAT Vision and CorelDraw 9 software were used. The distances between the CEJ and bone crest at buccal and lingual sides of six anterior mandibular teeth were measured. Descriptive statistical methods, Student's t-test and ANOVA were used. The mean distance between the bone crest and CEJ was 2.32 mm ± 0.78 mm at the buccal and 2.52 mm ± 0.85 mm at the lingual side. It was found that in males aged over 50 years, the mean distance at the buccal side was 2.84 mm ± 0.79 mm and was significantly higher than in males aged 49 and less - 2.08 mm ± 0.41 mm. The mean distance at the lingual side was 3.28 mm ± 1.08 mm and was significantly lower in the age group of 49 years and less - 2.10 mm ± 0.41 mm. CBCT allows determining the distance between the CEJ and crestal bone margin at buccal and lingual sides. The data provide crucial information for planning orthodontic treatment, implant placement and periodontal therapy.

Investigation of clinicopathological parameters and expression of COX-2, bcl-2, PCNA, and p53 in primary and recurrent sporadic odontogenic keratocysts.

OBJECTIVES: Odontogenic keratocyst (OKC) presents considerable variation in aggressiveness and propensity for recurrence, yet hitherto, no explicit clinicopathological features have been determined to clearly demonstrate the potential for relapse. This retrospective study aims to investigate the prognostic relevance of various clinicopathological features as well as immunoexpression of COX-2, bcl-2, PCNA, and p53 in sporadic OKC. MATERIALS AND METHODS: Among 41 patients with OKC treated by enucleation, the frequency of recurrence for various clinicopathological features as well as immunoexpression for COX-2, bcl-2, PCNA, and p53 was evaluated. RESULTS: The mean follow-up was 8.49 years, and recurrences were ascertained in 29.27% of cases. We found significant differences between recurrent and non-recurrent cysts in terms of multilocularity (P = 0.029), cortical perforation (P = 0.001), and lesion size (P < 0.001). Hazard risk for the recurrence was 3.362 (95% CI 1.066-10.598) for multilocular cysts, 7.801 (95% CI 2.1-28.985) for evidence of cortical perforation, and 1.004 (1.002-1.006) for 1 mm2 of lesion size on panoramic radiographs. We also found that immunoexpression of PCNA significantly correlates with the radiographic evidence of cortical perforation (P = 0.048) and that there is significant positive correlation between expression of COX-2 and bcl-2 (P = 0.001) as well as significant negative correlation between immunoexpression of COX-2 and age (P = 0.002). None of the other analyzed factors were associated with the recurrence. CONCLUSIONS: Larger size, multilocularity, and cortical perforation in sporadic OKC may be correlated with the relapse. CLINICAL RELEVANCE: Immunohistochemical analyses of COX-2, bcl-2, PCNA, and p53 lack prognostic utility in sporadic OKC.

Relationship between anterior mandibular bone thickness and the angulation of incisors and canines-a CBCT study.

OBJECTIVES: The morphology of the maxillary and mandibular alveolar cortex plays an important role in the planning of orthodontic treatment. Cone-beam computed tomography (CBCT) provides a precise demonstration of anatomical structures. Therefore, the aim of this paper was to evaluate what influence the position of incisors and canines have on the dimensions of the cortical and spongious bone of the anterior mandibular alveolar process. MATERIALS AND METHODS: The material consisted of 100 CBCT volumes (61 females and 39 males, aged 18-71 years) obtained by means of a Gendex GXCB-500 machine and analysed using i-CAT Vision and CorelDRAW 9 software. Several linear and angular measurements were taken of cortical and spongious mandibular, vestibular and lingual alveolar bone. RESULTS: The thickness of the vestibular spongious bone increased around lateral incisors and canines together with dental axis inclination, as did the thickness of the lingual spongious bone around central incisors and canines with greater angles of vestibular cortex curvature. In all teeth, the thickness of lingual cancellous bone decreased along with increase of the angle of tooth inclination. In the case of almost all groups of teeth, the thickness of lingual cancellous bone around teeth declined as the angle of curvature of the cortical bone decreased. The rotation of mandibular incisors and canines did not affect the thickness of the surrounding bone. CONCLUSIONS: The position of teeth has little influence on vestibular bone thickness and is only significant around central incisors. In the case of almost all groups of teeth, the thickness of lingual spongious bone around teeth declined as the angle of curvature of the cortical bone decreased. CLINICAL RELEVANCE: CBCT is a diagnostic tool that provides detailed information on the dimensions of the anterior dentate mandibular alveolar process.

An evaluation of selected oral health indicators and cariogenic bacteria titer in patients with Helicobacter pylori.

BACKGROUND: Studies based on polymerase chain reaction (PCR) techniques indicate that Helicobacter pylori can be constantly or temporarily present in the oral cavity in virulent or non-virulent form. Streptococcus mutans exerts a strong inhibitory effect on H. pylori. OBJECTIVES: The aim of the present study was to investigate the prevalence and virulence of H. pylori in the oral cavity and the correlation of these factors with oral health and cariogenic bacteria titer. MATERIAL AND METHODS: The study involved 108 adults who were positive in urease tests for H. pylori presence in the gastric mucosa. Group I consisted of 50 patients with positive saliva tests using PCR for the presence of H. pylori DNA, while group II comprised 58 patients with negative tests. The research material consisted of saliva and dental plaque. To determine the density of S. mutans and Lactobacillus, commercially available S. mutans and LB sets were used. RESULTS: H. pylori DNA was found in the oral cavities of 46% of the patients who had tested positive in urease tests for the presence of these bacteria in the stomach. Among those who tested positive for the presence of H. pylori in the oral cavity, virulent strains were identified in 16% of the patients. Approximal plaque index (API) and bleeding on probing (BOP) were found to be significantly higher in patients with confirmed H. pylori in the oral cavity. This group also had a smaller number of S. mutans colonies. CONCLUSIONS: H. pylori is found more often in patients with poor oral hygiene. Oral sanitation and hygiene instructions should be considered relevant as a complement to eradication therapy.

Intraosseous Lipoma of the Mandibula: A Case Report and Review of the Literature.

Lipoma is a benign tumour originating from mature adipose tissue. It can occur in any place in the body where adipose tissue is located. Intraosseous lipoma is a very rare bone tumour. The authors present an infrequent case involving intraosseous lipoma of the mandible in a 32-year old man and provide a review of case studies documented earlier in the literature.

Maxillary fibrous dysplasia associated with McCune-Albright syndrome. A case study.

McCune Albright syndrome (MCA) is a rare complication of genetic origin. The authors present a case study of a patient with MCA diagnosed with multifocal fibrous dysplasia in his limb and craniofacial bones. The symptoms of the disease in the patient's facial and oral tissue and the treatment administered have been described.

Canine transmigration accompanying mandibular retrognathism secondary to osteitis.

Transmigration is a tooth pathology in which the migrating tooth bud passes the median plane. METHODS: This study is a presentation of the diagnostic and therapeutic outcomes in the cases of 4 stomach teeth transmigrations diagnosed in 3 patients with mandibular retrognathia which was a complication after osteitis in the postnatal period and infancy. RESULTS: Extending imaging diagnostics to include CT, most preferably CBCT, makes it possible to precisely evaluate a transmigrated canine's position and to plan a course of treatment. CONCLUSIONS: Planning of the treatment of teeth in transmigration in patients with temporomandibular ankylosis should be done by a team consisting of an orthodontist and a surgeon.

Use of the piezosurgery technique for cutting bones in the autotransplantation of unerupted third molars.

Autotransplantation is a well-known method used in oral surgery. However, risk of failure, most commonly resulting from root resorption of the transplanted tooth or ankylosis, is quite high. Piezosurgery with specific device tip vibration frequencies enables selective tissue cutting, and therefore, tooth buds or teeth can easily be removed from bones with little injury to periodontal fibers or bud follicles.

A radiographic assessment of the regeneration process in post-operative alveolar bone defects in patients with different IL-1B-511 genotypes.

BACKGROUND: IL-1 is the main regulator of inflammatory reactions. This cytokine also plays an important role in bone tissue remodeling processes. The IL-1α-coding gene and the IL-1ß-coding gene are located on the long arm of chromosome 2. These genes contain polymorphic sites. Polymorphic modifications in IL-1-coding genes determine the level of IL-1 release, which can affect bone tissue regeneration. OBJECTIVES: The objective of the present study was to assess the correlation between IL-1B-511 genetic polymorphism and the regeneration of the alveolar ridge bone. MATERIAL AND METHODS: The study was carried out at the Department of Oral Surgery in Bytom, Poland, which is part of the Silesian Medical University of Katowice. The study population comprised 92 patients with mandibular or maxillary alveolar bone defects which had developed following the surgical removal of tooth roots or the enucleation of impacted teeth or cysts. Genetic material was obtained from the epithelial cells of the inner buccal surface. The IL-1B-511 genotype was determined in each patient by means of the phenol-chloroform technique, in order to enable DNA isolation, as well as by the PCR-RFLP method. Once this had been achieved the patients could be classified into 3 groups according to the following genotypes: IL-1B-511 1/1, IL-1B-511 1/2 and IL-1B-511 2/2. Bone regeneration was assessed radiographically using Digora 2.5 software. A comparison was made over a 6-month follow-up period of post-operative bone loss regeneration observed in patients with different types of the IL-1B-511 gene (alleles 1/1, 1/2, 2/2). RESULTS: A careful analysis of the X-ray images showed that the average increase in the optical density of post-operative bone defects was statistically lower in patients with the IL-1B-511 2/2 genotype than in those possessing the IL-1B-511 1/1 or IL-1B-511 1/2 genotypes. The results indicate that alveolar bone regeneration proceeds more slowly in patients with the IL-1B-511 2/2 genotype compared to those with alleles 1/1 and 1/2.

A comparative clinical study on human tooth extractions: flap vs flapless buccal surgery.

This study assessed the viability of bone and soft tissue healing at the wound extraction site, when the wound was both covered and not covered with a mucoperiosteal flap. In total, 40 patients were enrolled in the clinical study and were randomly allocated to each treatment cohort group.

Comparison of cryotherapy and photodynamic therapy in treatment of oral leukoplakia.

Oral leukoplakia is a pre-malignant lesion of the oral mucosa. The aim of this study is to compare the curative effects of photodynamic therapy and cryotherapy in the treatment of oral leukoplakia. The first group, treated by photodynamic therapy (δ-aminolevulinic acid (ALA), 630-635 nm wavelength), consisted of 48 patients suffering from leukoplakia. The second group consisted of 37 patients treated using cryotherapy. Analyses and comparisons of the complete responses, recurrences, numbers of procedures and adverse effects after both PDT and cryotherapy were obtained. In the first group, a complete response was obtained in 35 patients (72.9%), with thirteen recurrences observed (27.1%) over a six-month period. In the second group, a complete response was obtained in 33 patients (89.2%), and recurrence was observed in nine patients (24.3%). Photodynamic therapy and cryotherapy appear to be comparative methods of treatment that may both serve as alternatives for the traditional surgical treatment of oral leukoplakia. The advantages of PDT are connected with minimally invasive and localized character of the treatment and with not damage of collagenous tissue structures, therefore normal cells will repopulate these arrangements. PDT is more convenient for patients, less painful, and more esthetic.

The role of autofluorescence diagnostics in the oral mucosa diseases.

BACKGROUND: Laser-induced fluorescence diagnostics (LIFE) can be used as an imaging system of precancerous and neoplasmatic lesions of oral mucosa. LIFE system utilizes healthy and neoplasmatically changed tissue in autofluorescence, without using any fluorescence substances. Neoplasmatic lesions are visible in pseudo colors, healthy tissue as a shade of green color and abnormal tissue as a shade of red color. All visible colors have different intensity. Color intensity is relevant to the grade of dysplasia, carcinoma progress and is called numerical color value (NCV). AIM: The aim of our study was to find correlation between autofluorescence diagnostics with NCV assessment and type of histopathological diagnostics of specimen biopsy. PATIENTS AND METHODS: Fourteen patients participated in our study. Lesions were located in different intraoral areas. The most common location was: buccal, gingival and mandibular mucosa. Patients were examined using laser induced fluorescence diagnostics (400-750 nm wavelength) with NCV using OncoLIFE system. Then the specimen biopsy from the lesion was taken and histopathological examination was performed. RESULTS: We have noted different NCV and dependence of NCV on histopathological grade. CONCLUSION: Diagnostics using white-light imaging with LIFE imaging is not only a significant faster method and a better diagnostics of preneoplasmatic and neoplasmatic lesions, but also there is a correlation between NCV and histopathological grade. The farther investigations are necessary to prove these preliminary findings.

[A rare case of neurilemmoma of the floor of the mouth]. / Neurilemmoma--rzadki przypadek nerwiaka oslonkowego dna jamy ustnej.

Neurilemmoma is a benign neoplasm of neuroectodermal origin. The authors present a rare case of this lesion localized in the oral cavity. Clinical symptoms, histologic structure of the tumor, methods of treatment and differential diagnosis are described.

[Complications after alcoholization of mental nerve]. / Powiklanie po alkoholizacji nerwu bródkowego.

Trigeminal neuralgia (TN) is a syndrome affecting usually one half of the face and consisting of severe pains within one or more branches of the nerve. One of the methods for conservative treatment is using anesthetic drugs in the form of perineural sensory branch blockades n. V. If these are found ineffective, alcoholic blockades are used in some cases although complications like necrosis, tissue fibrosis or risk of developing a neuroma may occur. The paper describes a case of complication after alcoholic blockade into left mental nerve, namely oral tissue necrosis.

[Comparison of analgetic effect of magnetic and laser stimulation before oral surgery procedures]. / Porównanie efektu przeciwbólowego lasero- i magnetostymulacji przed chirurgicznymi zabiegami stomatologicznymi.

Oral surgery procedures are often the cause of painful sensations because of their tissue invasiveness. To avoid these sensations a wide use of nonsteroid antiinflammatory drugs is usually accepted. Because of plenty side effects of these drugs alternative antipain agents are desired. The goal of this study was to assess antipain effect of laser stimulation and alternating magnetic field in oral surgery procedures. Pain sensations in patients during: local anesthetics application, surgical procedure and after it were assessed according to VAS scale. Level of stomatological fear was assessed with the use of Corah's scale. Achieved results were analyzed statistically. Conclusion of this analysis is that laser stimulation and alternating magnetic field applied directly before oral surgery procedure are effective antipain agents that decrease intra and postoperative sensations. It was observed that patients with high level of stomatological fear had more pain sensations but even in this group laser and magnetic stimulation significantly lowered these complaints.