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The aim of the present study was to develop a method to study the healing process after gingival grafting and to observe the histologic results after use of the modified edentulous ridge expansion technique. A 47-year-old nonsmoking woman with a noncontributory past medical history affected by edentulism associated with a horizontal alveolar ridge defect was referred to the authors for surgical correction of the deficit to improve implant support and the final esthetics of an implant-borne prosthesis. At the 4-month follow-up visit, a biopsy was performed by a punch technique in the same sites of healing abutment connection. The tissue was elevated from the attached gingival. Clinically, the grafted tissues seemed to be attached to the bone surfaces. The histologic findings revealed dense grafted tissues, providing long-term stability to the area. No ligament or bone, characteristic for periodontal regeneration, were observed. The presence of thick attached keratinized tissue around implants may constitute a protective factor against marginal inflammation or trauma.

Bone is the third common site of distant metastases in cancer patients. Bone metastases may have implications for prognosis, quality of life, and local and systemic therapy. Numerous imaging modalities may be used to detect bone metastases. The two main anatomical modalities are computed tomography (CT) and magnetic resonance imaging (MRI), with many variants proposed for the MRI procedure, including diffusion-weighted imaging. The two main functional modalities are scintigraphy and PET/CT, also with many variants in the radiopharmaceuticals. Aim of our paper is to review the most important radio-compounds that can be successfully used to detect and/or characterize bone metastases.

In this review it is discussed the role of mild traumatic brain injury as a cause of Virchow-Robin spaces (VRS) pathological enlargement. Anatomy and physiology of normal VRS, and their immunological role are described. Special attention is given to magnetic resonance imaging findings of both normal and enlarged perivascular spaces.

Bone is one of the most common metastasis sites from solid tumors. Bone pain due to metastatic neoplastic growth is due to tumor infiltration and expansion of bone membranes. Treatment of acute and chronic pain represents one of the greatest problems in clinical oncology, requiring a multidisciplinary approach. This review focuses on the effectiveness of conventional diagnostic radiology and nuclear medicine for the detection, management and treatment of pain from bone metastasis.

Purpose: The purpose of this study was to assess the variation of rotational freedom at the implant interface of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) ceramic abutments with internal-hexagon connections before and after artificial aging and after porcelain sintering., Materials and Methods: Thirty Y-TZP ceramic abutments with internal-hex connections were used in this study. Three groups of 10 abutments each were created. Group C was made up of abutments in the as-received condition, group A abutments went through 1 hour of autoclaving at 134°C to simulate the effect of 3 to 4 years of aging in vivo, and group P abutments went through porcelain sintering procedures. Measurements of rotational freedom were compared between groups. The quantitative differences between groups were assessed using multivariate analysis of variance. Statistical testing was carried out at the 5% significance level., Results: A mean rotational freedom of 115.34 ± 1.42 minutes was found for group C abutments; the values for group A and group P abutments were 115.35 ± 1.73 minutes and 115.37 ± 1.54 minutes, respectively. None of these differences were statistically significant between the three groups., Conclusion: Misfit of the Y-TZP ceramic abutment on the internal-hex connection of implants may be implicated in screw joint loosening. The results of this report suggested that, if all laboratory steps are followed carefully, changes will not occur at the implant/Y-TZP ceramic abutment interface. Maintenance of the original features of the abutment may reduce the risk of screw loosening.

Aim: The aim of this paper was to evaluate the role of net-enhancement (NE) of benign salivary glands with multiphase multidetector row CT (MDCT)., Methods: Forty-eight patients (M=27, F=21), aged 35-76 years old (mean =57) with benign parotid neoplasms were examinated with 4 MDCT, at 20'', 40'', 70'' e 9' after intravenous administration of contrast medium. NE was calculated after subtracting precontrast phase to postcontrast phases. Final data were compared to the histopathology., Results: Thirty-six cases were pleomorphic adenomas (PA), 24 Warthin (WT). PA had a medium NE values of 23 HU, 74 HU, 53 HU e 34 HU at 20'', 40'', 70'' e 9' respectively. WT had a medium NE of 52 HU, 54 HU, 40 HU e 39 HU respectively at the same times. After subtracting precontrast phase to the delayed phase, with NE at 9' and cut-off of 34 HU, we have differenziate PA from WT and normal gland with specifity (SP) 87%, sensibility (SE) 60%, positive predictive value (PPV) and negative predictive value (NPV) of 75% and 59%; with NE at 20'' and cut-off of 54HU we have distingueshed WT from AP with SP 83%, SE 50%, PPV 75% and NPV 63%., Conclusion: The study of NE can allow the characterization of benign parotid gland tumors.

Unlabelled: INTRODUCTION. Edentulous ridge in the posterior maxilla is often compromised by reduced bone volume. This anatomical condition limits the implant placement of 10 mm in length without sinus augmentation. The use of shorter implants with osteotome technique minimizes the need of more extensive sinus floor elevation, thus reducing the duration and morbidity of the treatment. MATERIALS AND METHODS. A prospective study was conducted of all patients treated between Nov 2007 and Nov 2008 who received endosseous implants that were less than 10 mm in length. Patient age, gender, height bone residual of posterior maxilla, location of implants, number and type of implants and Albrektsson criteria for success were assessed., Results: A total of 25 implants of 8 mm in length were placed with primary stability in 11 patients. Cumulative survival rates for implants were 100%. CONCLUSION. This simplified treatment modality can make implant rehabilitation of the atrophic posterior maxilla more accessible.

Background: Improving facial aesthetics has been shown to be a strong motivating factor in patients who decide to undergo orthognathic surgery. The nasolabial region is a keystone of facial aesthetics and thus is of central importance in planning and execution of orthognathic surgery. This article was performed to study modifications of nasolabial area after maxillary advancement., Methods: Forty-two patients undergoing orthognathic surgery were considered. In those patients, after Le Fort I osteotomy, only maxillary advancement was performed., Results: For each patient, several points in the nasolabial area were marked, and the distances between these landmarks were measured before and 6 months after surgery., Conclusions: The outcomes of this study show a general trend in the widening of the alar base with an associated shortening of the columellar length and lengthening of the base of the nose.

This case report is focused on the possibility of treating atrophic ridge with a reduced number of surgical procedures and a reduced healing time. A 43-year-old female patient affected by edentulism associated with horizontal resorption of the ridge was treated by means of a sagittal osteotomy and expansion of the ridge with the new modified edentulous ridge expansion (MERE) technique to obtain a wider bony base for ideal implant placement. In the same procedure 2 implants were placed and connective tissue graft, covering the bony wound, was placed to achieve keratinized mucosa. The implants were placed immediately after the split crest of the ridge and covered by a connective tissue graft. Postoperative recovery was uneventful. Within the limits of this case report, the MERE technique appeared to be reliable and simple, and it reduced morbidity compared with other techniques such as autogenous bone grafts and guided bone regeneration.

All Le Fort I osteotomies have the potential to alter the dimensions of the alar base, and widen it. Surgical techniques to control this lateralisation of the base of the nose, including those of cinch suturing of the alar base, have been widely described and modified. We have compared two techniques of cinch suturing to try and prevent widening of the base of the nose after Le Fort I osteotomy. We studied 40 patients with skeletal class III facial deformities treated by orthognathic operations by the same surgeon. They were randomly divided into two groups of 20 each, one of which was treated with a classic cinch suture and the other by a modified technique. The distances between the nasofacial skinfold at the left alar bases, the columella, and the right nasofacial skinfold were recorded before and six months after operation. The results of the modified technique were more stable than those after classic suturing. In only 3/20 patients in the classic group did the suture prevent nasal widening, whereas in the modified group the number was 14/20., (Copyright 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Aim: The guided bone regeneration (GBR) procedure allows the regeneration of bone in implant surgery. A variety of GBR procedures to provide the bony-support for implant placement have been described and a variety of devices to perform this procedures have been used. The authors have carried out a retrospective study on the use of ostheosynthesis plates, screws, xenogenic bone grafting material and resorbable barriers for implant and preimplant surgery., Methods: Fourteen partially edentulous patients were treated by a single surgeon in a private dental clinic in Italy. Patients age ranged between 28 and 52 years old. Every patients was treated with GBR technique performed with the use of ostheosynthesis plate and screws, xenogenic bone grafting material and resorbable barriers in staged or simultaneous implant placement., Results: Twenty-one implants were placed and no-one failed, all planned prostheses were delivered. In all the cases a complete bone regeneration was obtained., Conclusion: The outcomes of the study allow to state that the GBR technique performed with ostheosynthesis plates, screws, xenogenic graft and resorbable barriers is a safe alternative to the others well established GBR procedure.

Ameloblastomas are benign odontogenic tumors but are locally aggressive, most commonly occurring in the mandible and in the third to fifth decade of life. The male-to-female ratio is approximately equal. Recurrence of ameloblastoma due to inadequate treatment is often described. Recurrences in the temporal area are very rare and are related to the type of primary treatment. The authors describe a case of ameloblastoma recurrence in the temporal area and review the literature regarding recurrence and treatment.

Edentulous ridges in the posterior maxilla are often compromised by reduced bone volume. This anatomic condition often limits dental implant placement of 10 mm in length without prior or simultaneous sinus augmentation. The osteotome technique is an alternative and conservative technique for sinus floor augmentation and immediate implant placement in the posterior region of the maxillary jaw. According to the relevant literature, the osteotome technique appears to be a predictable and safe method for augmenting bone at the sinus floor and to improve bone density and quality of the implant site sufficiently so that immediate loading is possible. A 46-year-old male patient was referred to the authors to replace the single upper premolar with an implant-supported crown restoration without interfering with the integrity and topography of the adjacent gingival tissues. Only one clinical study analyzed minimally invasive implant and sinus lift surgery with immediate loading. In that case report, the osteotomy was widened to its final diameter using a series of incrementally larger twist drills. In our clinical case, a series of incrementally larger diameter osteotomes improved bone density. This simplified treatment modality can make single tooth implant rehabilitation of the atrophic premolar maxilla region more accessible, and immediate loading is facilitated by improved bone density.

Chondroid syringoma is a rare tumor arising from the major and minor salivary glands. The incidence of chondroid syringoma is reported to be <0.01% among the primary skin tumors. Eighty percent of the chondroid syringomas are seen in older patients , commonly on head and neck region and mostly on the cheek and nose. The authors report a case discussing the surgical management of a chondroid syringoma and pointing out the importance of including this tumor in the differential diagnosis of small subcutaneous nodules in the head and neck region, in middle-age male patients.

The use of botulinum toxin (BoNT) is well established in medical practice. The application of BoNT extends over many indications such as strabismus, blepharospasm, hemifacial spasm, and others. Another indication for the use of BoNT type A is the masseteric muscle hypertrophy to obtain a lower facial contouring. Authors report the treatment of 5 patients with intramuscular injection of BoNT. A high degree of patient and physician satisfaction was noted after the treatment. Authors concluded that BoNT type A can safely be considered as a noninvasive drug treatment for patients with MMH.

Improving facial aesthetics has been shown to be a strong motivational factor in patients who decide to undergo orthognathic surgery. The nose is a keystone of facial aesthetics and is thus of central importance in planning and executing orthognathic surgery. Authors present their way to forecast the tip projection in anterior advancement of the maxilla. In the sample, only patients who, after Le Fort I, needed an advancement of the maxilla (56 patients) were considered. For each patient, the upturning angle was measured before and 6 months after surgery. In all the cases, a good aesthetic and functional result was reached; there were no big complications. From this study, it is possible to note that the upturning angle decreased by 0.6 to 0.8 degree each millimeter of maxillary advancement.

In the last 50 years cocaine usage has had a growing incidence worldwide. Chronic nasal abuse of this drug can cause extensive oromaxillofacial destructive process as oronasal perforation. To author's knowledge the only type of oronasal fistula in cocaine abusers that has been reported to date has been perforation of the hard palate; a case of oronasal fistulas involving another region of oral cavity, the anterior gingival sulcus, has been reported only once. In this article authors present the first case of oronasal fistula involving hard palate and the right supero-lateral vestible induced by prolonged cocaine snort described in literature, review about the better surgical management for this lesion and the relationship between chronic cocaine abuse and elevated serum levels of c-ANCA.

Atrophic edentulous jaws can pose a significant challenge to successful oral rehabilitation with endosseous dental implants. Although ridge augmentation can help to restore ridge volume, grafting procedures can significantly increase patient morbidity, costs, and treatment time, depending on the case, before dental implants can be placed. This article reports on an alternative technique used in 3 patients to expand ridge volume and place dental implants in a single procedure. A partial-thickness flap was elevated to expose the alveolar crest, and conventional implant osteotomies were partially prepared. Along the crest of the ridge, a furrow with terminal vertical releases 1 to 3 mm deep were created, and a bone chisel was used to deepen the furrow. Osteotomes were used to complete preparation of the implant receptor sites, and the implants were placed. Bony plates were stabilized through the use of resorbable sutures. Furrows more than 2 mm deep between the plates were augmented with a xenograft. Collegen membranes were placed over the sites, and soft tissue was sutured. Healing was unremarkable, and all implants were successfully restored. For these patients, the ridge expansion technique resulted in substantial bone reconstruction with little or no grafting. Long-term, prospective studies on this procedure are required before definitive conclusions can be drawn.

Maxillary alveolar atrophy often limits the placement of dental implants. The bone splitting and bone widening by osteotome technique is a more obvious method for the immediate placement of implants in those cases in which the dimensions of the residual ridge are reduced by only a small degree. Few studies have been performed that are aimed at the radiographic results shown after the osteotome technique by a low-dose computed tomography scan and assessment of objective improvement of the bone density using Misch's classification. The aim of this clinical case was to analyze the radiographic data of the osteotome technique on the change of bone density and to demonstrate efficacy of the ridge expansion crest to bypass bone fenestrations of the buccal plate in the esthetic zone. The advantages of this technique for patients include less surgical trauma and a shorter treatment time.

Aim: Oral carcinoma is a form of neoplasia with well-known clinical and morphologic features. This study presents the difference of incidence and behaviour in relation to the time of onset of oral carcinoma, and describes the experience made at the Department of Oral and Maxillofacial Surgery of the Second University of Naples., Methods: In this study 118 patients are analysed. They are divided into 3 groups according to age: group A up to 40 years; group B, from 41 to 75 years; group C from 75 years onwards., Results: No patient of group A showed a carcinoma of verrucous type. This histologic type was found in group B, (14 patients: 14,1%) and in group C (6 patients: 46,1%)., Conclusions: The results of this study underline the importance of the time of onset in the behaviour of oral carcinoma and the age of patients.

Background: To examine to what extent physicians follow a regional guidelines for the diagnosis, staging, treatment and follow-up of patients with squamous cell carcinoma of the lower and upper lip., Design: retrospective analysis of data from the medical records of 42 patients diagnosed with squamous cell carcinoma of the lower and upper lip during the period 1990-2000., Setting: Department of head and neck pathology, oral cavity and audio-verbal communication of Naples University., Participants: the data were collected by this Department., Results: In accordance with the TNM system, the 50% of cases was in stage T1, 33% in T2, 14% in T3. In few cases (3%) the lesion was in stage T4. All cases were in M0 and only 8% of cases presented nodal disease at diagnosis (N1). The type of treatment in relation to age was in agreement with the guidelines in 34% of cases. Of the 42 surgically-treated patients, only 4 showed, after 12 months, a local recurrence., Conclusions: Prognosis is good if squamous carcinoma is diagnosed early.

Study Objective: To evaluate whether tibolone modifies the effectiveness of gonadotropin-releasing hormone (GnRH) analog administered before laparoscopic myomectomy., Design: Prospective, randomized, open, placebo-controlled clinical trial (Canadian Task Force classification I)., Setting: University-affiliated hospital., Patients: Sixty-six women with symptomatic leiomyomas., Interventions: Patients received 2 months of treatment with GnRH analog and iron plus tibolone (group A) or placebo (group B); group C received only iron. Laparoscopic myomectomy was performed after medical treatment., Measurements and Main Results: Uterine volume, number and volume of leiomyomas, echogenicity and volume of the largest leiomyomas, hematologic values, and myoma-related symptoms were evaluated at baseline, 1 week before, and 1 week after surgery. We observed significant (p <0.05) reductions in uterine and leiomyomata volume, myoma-related symptoms, and improvement in hematologic values before surgery in groups A and B, without significant difference between groups compared with baseline values and group C. Operating time and blood loss were significantly (p <0.05) lower in groups A and B, without significant difference compared with group C. After surgery, significant numbers of women in group C had worsening of hematologic values (p <0.05)., Conclusion: Adding tibolone to the GnRH analog regimen before laparoscopic myomectomy does not modify the effectiveness of GnRH analog administered alone.

In this study the authors, making use of a non-surgical therapeutic method like extracorporeal shock wave lithotripsy, aim to show the advantages of this method compared with surgery, in the therapy of lithiasis of the salivary glands. Seven patients suffering from calculi of the salivary glands were treated. The authors obtained the best result in each patient and in 5 of these obtained the complete disappearance of sialolithiasis. The authors, considering that there is an ever higher number of requests for this treatment, put extracorporeal lithotripsy in the foreground in the therapy of sialolithiasis.

The goal of this study is to analyze the importance of circulating biomarkers association in the management of patients affected by oral cancer. In this study a survey is made of the international experience from 1980 to 1990 based on the presence of CEA, LASA, SCC Ag, TPA, ferritina, CA-50 and others in patients affected by oral cancer and the sensitivity and specificity of these circulating biomarkers association are assessed. In patients with active disease, the results obtained at the time of diagnosis of oral cancer are not satisfactory due to poor specificity of these circulating biomarkers association. The conclusions is drawn that the circulating biomarkers association (especially CEA, SCC Ag, LASA, ferritin, TPA and CA-50) appears to be useful in the prognosis and staging of oral cancer, while their presence is not significative for the diagnosis.

The authors carry out a review of the international literature on an alternative methodology to surgical therapy of lithiasis of the salivary glands, indicating information, limitations and possible complications. More than fifty papers by international authors were analysed regarding their experience on the use of electro-magnetic waves in the treatment of salivary gland lithiasis. It was observed that extracorporeal lithotripsy is an alternative and valid method to surgery, considering that the complications are negligible. Considering the expectations and the relationship between cost and advantage, extracorporeal lithotripsy can be considered as first treatment with surgery as second therapeutic choice.

A case of angioleiomyoma localized at the level of the soft palate is reported. The 31-year-old patient presented a non-pathognomonic clinical picture and the anamnestic finding of the relatively slow growth of the neoformation raised problems of differential diagnosis in relation to benign growth and lesion of a non-neoplastic nature. The differential diagnosis was only obtained with histological examination of biopsy material.

A rare case of primary malignant melanoma of the oral cavity is reported and a literature review of etiopathogenesis, biological bases and prognosis is made. The hypotheses to explain the very severe prognosis of malignant melanoma of the oral cavity with respect to that of skin are discussed. The therapeutic approaches are described as well as the frequent difficulty to perform them in relation to the anatomical region and the wide extension of the tumoral lesion.