Cone Beam-CT-Based Bone Volume Assessments of Alveolar Synthetic Bone Graft GlassBONE™ in Cleft Lip and Palate Patients: A Retrospective Study.

Background: Clefts of the lip and palate (CLP) are facial deformities that require multiple surgical procedures during childhood. One of these steps consists of filling the alveolar space with bone graft, traditionally removed from the iliac crest. However, this procedure could be invasive in children. Aim: Here, we aimed to evaluate the outcomes of GlassBONE™ graft, a bioactive glass used as a bone substitute, as an alternative to the deleterious autologous bone graft in children. Materials & methods: Retrospective monocentric study with 17 children aged 7.5 ± 2.2 yo [3.8-13.3 yo] carrying CLP. This technique has been established at La Timone Children hospital (Assistance Publique - Hôpitaux de Marseille) since 2011. Clinical (scar, graft rejection and periodontal status) and radiological (both panoramic radiographs and cone beam-CT) follow-up was conducted one year after the graft. The primary outcome was the reduction of the cleft volume, and secondary was the eruption of the adjacent tooth through the graft. Results: GlassBONE™ permitted a significant reduction in the cleft volume by 42.4 ± 27.7% [0.6-81.1%] (p < 0.0001), corresponding to a filling of 57.6 ± 27.7% of the alveolar cleft. GlassBONE™ is well tolerated, ensuring satifactory clinical results (improvement in both scar and periodontal coverage), as well as the physiological evolution of the germs through the biomaterial. GlassBONE™ appears particularly suitable for small volumes, and we were able to determine a minimum volume of approximtely 0.259 + / - 0.155 cc required for a successful bone fusion. Conclusion: The bioactive glass GlassBONE™ could be safely used in children with small CLP cases, providing satisfactory clinical and radiological results.

Implant Therapy in the Rehabilitation of Treated Mandibular Arteriovenous Malformations.

Mandibular arteriovenous malformations are rare congenital malformations that require multidisciplinary care. Implant-supported rehabilitation of significant bone defect after embolization and resection is poorly described in the literature. We present the case of a 24-year-old patient with a right-sided mandibular arteriovenous malformation diagnosed after massive hemorrhage and treated by embolization and resection surgery. Implant rehabilitation was carried out 9 years later with a prior bone graft through iliac extraction and 3 short implants. Implant survival rate and patient satisfaction were evaluated at 3 years postplacement. Arteriovenous malformations treatments frequently result in bone defects that are difficult to reconstruct because of probable unstable vascularization due to embolization. The presence of osteosynthesis material and artifacts at the radiological level complicates implant planning due to the lack of visualization of the inferior alveolar nerve or artery and necessitates the placement of low-height implants. Osteointegration in contact with embolization products should be monitored. The creation of a case series could be of interest in order to better understand implant treatment for patients with a history of arteriovenous malformations.

French Otorhinolaryngology Society (SFORL) good practice guidelines for dental implant surgery close to the maxillary sinus.

OBJECTIVES: To draw up guidelines for ENT management associated with dental implant surgery with or without sinus lift. MATERIALS AND METHODS: The methodology followed the rules of laid down by the French Health Authority (HAS): "Methodological bases for drawing up professional recommendations by formalized consensus". The chosen method was the RAND/UCLA "RAND appropriateness method" (short version). RESULTS: In the pre-implantation check-up, it is recommended to systematically screen for sinonasal pathology on medical interview and to favor 3D CT or cone-beam imaging. It is recommended that imaging include the entire maxillary sinus when the patient does not have sinonasal history or functional signs on interview. Otherwise, examination of all sinonasal cavities is recommended. This attitude enables simultaneous analysis of maxillary infrastructure for pre-implantation work-up and assessment of sinonasal cavity status. Sinus mucosal incidentalomas are very common in the healthy population and must be assessed with reference to the clinical, endoscopic and radiological context. CONCLUSION: This formalized expert consensus establishes a common base of knowledge, to clarify the issues and clinical situations and to standardize practices.

Angina bullosa haemorrhagica: a systematic review and proposal for diagnostic criteria.

The aim of this study was to perform a critical review of published data on the epidemiological, aetiological, clinical, histological, biological, and therapeutic characteristics of patients with angina bullosa haemorrhagica (ABH). A literature search was conducted in the PubMed, Science Direct, Web of Science, and Cochrane Library databases. All publications fulfilling the selection criteria were included in the eligibility assessment according to the PRISMA statement. The full texts of 54 retrieved articles were screened. Forty articles published between 1985 and 2016 describing 225 cases of ABH were finally selected. The mean age of the patients was 55.4 years; the male to female ratio was 0.7. The predominant localization was the palate (66%). A third of patients had no medical history. When specified, a triggering event or promoting factor was frequently found (82%). Biological tests were normal. A biopsy was performed on 35% of the patients. Treatment was symptomatic with a favourable outcome. Recurrences were frequent (62%). In conclusion, ABH is poorly documented and only by studies of low-level evidence. This review did not allow any aetiopathogenic association to be made with a general pathology or treatment. On the basis of this systematic review of the literature, diagnostic criteria aiming to improve the care of patients presenting with ABH are proposed.

Endodontic-related inferior alveolar nerve injuries: A review and a therapeutic flow chart.

INTRODUCTION: Inferior alveolar nerve (IAN) lesions related to endodontic treatments can be explained by the anatomical proximity between the apices of the mandibular posterior teeth and the mandibular canal. The aim of this article is to review the management of inferior alveolar nerve lesions due to endodontic treatments and to establish a therapeutic flow chart. METHODS: A review of publications reporting IAN damage related to endodontic treatment over the past 20 years has been conducted, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist; it combines an electronic search of the Pubmed® and Google Scholar® databasis. Forty-two full-text articles corresponding to 115 clinical cases have been selected. Two personal clinical cases were additionally reported. RESULTS: IAN lesions due to endodontic treatments require urgent management. Early surgical removal of the excess of endodontic material, in contact with the nerve allows the best recovery prognosis (72h). Beyond this delay, irreversible nervous lesions prevail and a medical symptomatic treatment, most of the time with pregabalin, must be/can be carried out. A delayed surgical procedure shows some good benefits for patients. However, the healing prognosis remains poorly predictable.

Clear cell odontogenic carcinoma. A review.

INTRODUCTION: Clear cell odontogenic carcinoma (CCOC) is described as an exceptional and hard to diagnose malignant tumor which was first reported by Hansen in 1985. The purpose of this review article is to show that CCOC is a not that rare entity and to discuss its various aspects in order to enhance the diagnosis. MATERIAL AND METHODS: A search in the English language literature was performed using the Scopus, ScienceDirect, PubMed and Medline databases between 1985 and 2016. Data were collected on epidemiologic, clinical, radiographic, histological, immunohistochemistrical, cytogenetic, management, follow-up and prognosis features of CCOC. RESULTS: Sixty-five studies from which a total of 95 case reports were included in the review. CCOC was generally seen in the fifth decade and the most common site was mandibular. The most frequently found symptoms were swelling, tooth mobility and pain. Radiologically, the image was radiolucent and could look like a cyst or a periodontal lesion. In situ hybridization techniques frequently expressed a gene fission of EWSR1. The treatment was mostly a radical surgical excision of the tumor with or without adjuvant radiotherapy or chemotherapy. CCOC showed high rates of recurrence and mortality related with the presence of distance metastasis. DISCUSSION: Fission of EWSR1 gene could be the main element it the diagnosis of CCOC. A multidisciplinary approach, including a radiologist, pathologist and an oral & maxillofacial surgeon may be helpful in the evaluation and management of these lesions. With 95 reports found in English literature, we cannot say that CCOC is extremely rare anymore.

Clear cell odontogenic carcinoma, diagnostic difficulties. A case report.

INTRODUCTION: Clear cell odontogenic carcinoma (COCC) is a rare tumor described by Hansen et al. in 1985. The clinical and radiological manifestations are multiple and the diagnosis is histological. OBSERVATION: A 64-year-old patient consulted us for a right mandibular osteolytic lesion associated to a homolateral labial hypoesthesia. A biopsy was performed under local anesthesia. Histology was consistent with a metastatic lesion of clear kidney cell carcinoma, COCC, or odontogenic squamous tumor. Additional tests eliminated a metastatic lesion. A wide excision of the lesion by hemi-mandibulectomy associated with lymph node dissection and reconstruction by a fibula osteoseptocutaneous flap was performed. Presence of a fission of the EWSR1 gene on the histological examination of the surgical specimen made the diagnosis of COCC. DISCUSSION: Our observation illustrates the difficulty of diagnosing COCC. The new contribution of the cytogenetic techniques such as FISH-type techniques makes possible the improvement of the diagnosis.

[Proliferative verrucous leukoplakia: Three cases and literature review]. / Leucoplasie verruqueuse proliférative : trois observations et revue de la littérature.

BACKGROUND: The aim of this study was to collect epidemiological, aetiopathogenic, clinical, histological and therapeutic data concerning proliferative verrucous leucoplakia (PVL) and to report three new cases. PATIENTS AND METHODS: A literature review performed using the Medline database enabled us to collate 39 studies involving 607 cases. Three new cases were added. RESULTS: PVL is a rare disease characterized by extensive and multifocal oral leucoplakic lesions. Its histological pattern depends on the stage of the disease: hyperkeratosis, verrucous hyperplasia, verrucous carcinoma and squamous cell carcinoma. The aetiopathogenesis of PVL is poorly understood and there is no clear consensus concerning therapy. Malignant transformation occurs in over 50 % of cases. DISCUSSION: Diagnosis of PVL is difficult because of the presenting signs, which can be mistaken for those of other diseases. Management may be complicated and long-term follow-up is essential.

[Autotransplantation of an immature tooth]. / Autotransplantation de dent immature.

Autogenous tooth transplantation is indicated in young people treated by orthodontology, especially when they present with damaged first molars requiring extraction. This therapeutic alternative with a favourable prognosis is an elegant solution after a single tooth loss.