Solitary fibrous tumor with entrapment of minor salivary gland tissue: an unusual presentation that requires exclusion of pleomorphic adenoma.

We report two unusual cases of solitary fibrous tumor (SFT) of minor salivary glands that microscopically mimicked pleomorphic adenoma. One of these lesions presented in the retromolar region and the other in the buccal mucosa. The microscopic features of these two tumors and their intimate relationship with regional mucous minor salivary glands posed a diagnostic challenge. Awareness of the morphological diversity of SFT coupled to a judicious use of appropriate immunohistochemical probes should prove valuable to accurately segregate SFT from pleomorphic adenoma.

Full-mouth rehabilitation with single-tooth implant restorations. Overview and report of case.

The purpose of this study was to report a case of full-arch rehabilitation with single-tooth endosseous implant restorations. Secondly, the investigators aimed to review the literature systematically regarding full-mouth rehabilitation of the edentulous patient with single-tooth implant restorations. The investigators searched the databases PubMed, EMBASE Drugs and Pharmacology, the Cochrane library, and clinicaltrials.gov for relevant literature regarding full-mouth fixed rehabilitation of the edentulous patient with dental implants. In addition, the investigators provide a clinical case of full-mouth rehabilitation of an edentulous patient using single-tooth implant restorations. The literature search revealed 60 citations that addressed the topic at large. None of the papers reported full-mouth rehabilitation with single-tooth implant restorations; therefore, papers reporting full-arch rehabilitation with a full-arch fixed prosthesis were compared to the single-implant restoration protocol described herein. Although there are similarities between our protocol and those proposed in the past, differences include potentially higher patient satisfaction because of the close similarity between the final restorations and the patient's prior natural dentition. While the proposed treatment may not be within the financial means of most patients, because of its anecdotal advantages over conventional splinted fixed restorations, the investigators believe this is the next step in the evolution of the restorative management of the completely edentulous patient.

Building on the proceedings of the McGill conference: implant-retained overdentures in an area of South America.

PURPOSE: Since the McGill consensus conference, numerous reports have proposed the advantages of the 2-implant-retained overdenture over the conventional denture in the restorative management of the edentulous mandible. The purpose of this article was to demonstrate the use of the 2-implant-retained overdenture in the restorative management of patients with edentulous mandibles in an impoverished population. MATERIALS: To address the study's purpose, the investigators initiated a retrospective cohort study and enrolled a sample of subjects who had mandibular 2-implant overdenture treatment using the protocol described within. The primary predictor variable was whether the patient had mandibular 2-implant overdenture treatment. The primary outcome variable was survival of mandibular 2-implantoverdenture treatment as defined within. RESULTS: The study sample included 35 patients each of whom had 2 mandibular implants placed for a total of 70 implants inserted with the purpose of retaining a mandibular overdenture. The mean clinical follow-up time was 74.7 months, during which there were no incidences of implant failure. Therefore, analytical and survival analyses could not be performed. CONCLUSION: Given the increase in quality of life and ease in implementation, clinicians should now be suggesting the mandibular 2-implant overdenture as the treatment of choice in the management of the edentulous mandible.

Modified channel retractor for the sagittal split ramus osteotomy: a technical note.

The authors describe a modification of the commonly used inferior border channel retractor for the sagittal split osteotomy of the mandible. We modified this instrument by hollowing out the shank and working surface allowing improved access during the vertical cut through the inferior border of the mandible. Advantages of this modification over the original design include less dulling of the cutting instrument, less damage to the channel retractor, less debris in the surgical wound, and most importantly, less damage to the surrounding soft tissue. In our experience with this instrument, there have been no incidences of excessive blood loss requiring transfusion, avascular necrosis, bony nonunion or permanent nerve injury. We believe this modification improves manouverability during orthognathic surgery thereby decreasing morbidity and operating time, thereby making a successful outcome more likely.

Morbidity associated with oral mucosa harvest for urological reconstruction: an overview.

PURPOSE: To present a systematic review of the literature regarding complications associated with the donor site following oral mucosa harvest for urethral reconstruction. MATERIALS AND METHODS: The authors conducted a database search for relevant literature during the time period January 1966 through January 1, 2007, regarding complications associated with oral mucosa graft harvest for use in urethral transplantation. Bibliographies of database hits were searched for pertinent papers. RESULTS: The most common harvest sites were the buccal and mandibular labial mucosa. The most frequent complications at both mucosal harvest sites were scarring and contracture. These 2 complications limit jaw opening and have been found to last for as long as 4 weeks. Labial mucosa harvest is associated with the additional morbidity of perioral neurosensory defect because of the procedure's proximity to the mental nerve. When nerve damage occurs, it usually subsides within 10 months postsurgery. Patients report relatively the same quality of life following harvest from both donor sites, although buccal mucosa harvest was associated with less postoperative discomfort, less neurosensory defect, and less salivary flow change. Following oral mucosa harvest, patients should be able to ingest oral fluids within 24 hours, solid foods within 2 days, and return to a normal dietary regimen within 1 week of harvest. CONCLUSION: When harvesting oral mucosa for urethral reconstruction, sound surgical principles will ensure the patient the best chance of avoiding postoperative complications at the donor site. Oral and maxillofacial surgeons should advise both urologists and their patients of the potential complications associated with both oral mucosa harvesting sites.

The oral mucosa graft: a systematic review.

PURPOSE: We provide the reader with a critical, nonbiased, systematic review of current and precedent literature regarding the use of oral mucosa in the reconstruction of urethral defects associated with stricture and hypospadias/epispadias. MATERIALS AND METHODS: We reviewed pertinent English literature from January 1966 through August 1, 2006 via the databases MEDLINE/PubMed, the Cochrane Library, and EMBASE Drugs and Pharmacology regarding the use of oral mucosa graft urethroplasty in the reconstruction of urethral defects associated with stricture and hypospadias/epispadias. Bibliographies of pertinent articles were explored for additional important literature. RESULTS: Data were stratified among studies that only used oral mucosa graft urethroplasty in the reconstruction of urethral defects associated with stricture, and those that used oral mucosa graft urethroplasty in the reconstruction of urethral defects associated with hypospadias/epispadias. Recipient site success in the reconstruction of defects associated with stricture was significantly associated with the location of graft placement (ventral vs dorsal, p <0.001) when an onlay graft was used. Hypospadias/epispadias recipient site success was significantly associated with the type of graft used (tube vs onlay, p <0.001), and by the site of oral mucosa harvest (labial vs buccal, p <0.001). Other perioperative and patient oriented variables were not significantly associated with success at the recipient site. CONCLUSIONS: The oral mucosa is a viable source of donor tissue displaying many characteristics of the ideal urethral graft. There are numerous variations of the oral mucosa graft urethroplasty technique. Herein comparisons are made.

Draining orocutaneous fistula associated with a failing subperiosteal implant: report of a case.

The use of mandibular subperiosteal implants was first reported by Dahl in the 1940s. It was followed by a more comprehensive report by Goldberg and Gershkoff, who published the first case series in the United States. We describe a case of an orocutaneous fistula that developed secondary to a chronic infection attributed to a failing subperiosteal implant. Elemental analysis of the metal framework revealed an implant composed of mainly a cobalt-chromium alloy. Cobalt, which was frequently used in subperiosteal implant manufacturing, is associated with a higher corrosion rate than other metals and is no longer used to fabricate subperiosteal implants. The strength of subperiosteal implants is their ability to be used in a mandible with an atrophic alveolar ridge. Unfortunately, this feature of the hardware is also its weakness in that reconstructive procedures after their removal are difficult. The failing subperiosteal implant in our patient was subsequently removed, and primary closure of the intraoral wound and extraoral fistula as well as resolution of the patient's symptoms was obtained with no lasting complications.

Nicotine induced proliferation and cytokine release in osteoblastic cells.

Smoking has deleterious effects on osteoporosis and periodontitis both characterized by bone loss. Smoking also interferes with the protective effect that hormone replacement therapy (HRT) has on bone loss. Our study investigated two mechanisms by which smoking may affect bone metabolism: nicotine-induced proliferation and nicotine-induced cytokine secretion in osteoblasts. Two osteoblastic cell models were used: mouse osteoblasts derived from mouse calvaria and human osteoblasts. Thymidine incorporation and immunoassays were used to evaluate proliferation, interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) secretion. Parametric and nonparametric statistical analyses were used for comparisons. The results showed that nicotine induced stimulation and inhibition of proliferation in both osteoblastic cell models. In human osteoblasts, the proliferative and inhibitory effects were also donor dependent. Il-6 secretion showed different patterns in mouse and human osteoblasts. In mouse osteoblasts, nicotine significantly increased IL-6 secretion and estradiol significantly inhibited the nicotine-induced IL-6 release. In human osteoblasts, cells derived from one subject did not respond to nicotine. However, in the second sample, nicotine increased secretion of Il-6 but estradiol did not oppose this effect. In human osteoblasts, nicotine also induced an increase in the TNF-alpha secretion and estradiol opposed this increase. These results suggest that nicotine affects bone metabolism by modulating proliferation, and Il-6 and TNF-alpha secretion. These studies provide a possible explanation for differences in bone loss among subjects who smoke and offer a possible mechanism for the oppositional effect of smoking on HRT in subjects with bone loss.

Cavernous hemangioma of the palate. A review of etiology, pathogenesis and treatment options.

Cavernous hemangiomas of the palate are a rare but not infrequent sighting in the oral and maxillofacial region. The etiology and pathogenesis of these lesions are not definitively understood and are currently being explored. Treatment options usually include, but are not limited to, surgical excision of the lesion. Alternative management paradigms should be considered when dealing with this type of lesion. Precaution should be taken before any surgical intervention.

Bisphosphonate-associated osteonecrosis of the jaws: a review of current knowledge.

BACKGROUND: Increasing numbers of dental patients are taking bisphosphonate medications for a variety of indications. These drugs may be associated with poor healing, spontaneous intraoral ulceration and bone necrosis in the oral and maxillofacial region. CASE DESCRIPTION: The authors describe a case of osteonecroSis of the jaws in a patient receiving long-term bisphosphonate therapy for cancer. They offer recommendations for management and prevention of oral complications. CONCLUSION AND CLINICAL IMPLICATIONS: It is important that clinicians are aware of the association between bisphosphonate treatment and delayed wound healing and osteonecrosis of the jaws. They should consider referring patients in this population to specialists for even the most routine oral surgery. Clinicians should perform a thorough oral examination in patients before they begin any chemotherapy regimen.

Engineering a bioactive matrix by modifications of calcium sulfate.

The goal of this study was to define the conditions for the fabrication of a bioactive matrix that induces and supports cell proliferation and tissue regeneration. The proposed hypothesis was that a composite graft could be engineered by the absorption of platelet-rich plasma (PRP) onto calcium sulfate (CS). Evaluation of the biological activity of the engineered grafts was based on osteoblast proliferation studies and scanning electron microscopy (SEM) analyses. Graft samples were created in a standard size and shape so that the surface available for attachment and cell proliferation was always identical. Proliferation data were expressed as counts per minute per group and differences among groups were statistically analyzed by analysis of variance followed by the Scheffé test (alpha = 0.1). SEM analysis showed that the combination of CS and PRP presents a preserved crystalline structure well integrated by organic matrix. This combination showed the highest cell proliferation levels (p < 0.001). Further evaluations demonstrated that PRP is activated when combined with CS. When tested as a possible carrier for biologically active molecules such as platelet-derived growth factor (PDGF), CS showed increased cell proliferation (p < 0.001). SEM revealed adherent osteoblasts with broad flattened edges on CS-PRP. This study proposes CS as an efficient carrier for PRP or PDGF and supports the use of these combinations as bioactive matrices in clinical or laboratory applications.