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Adult sporadic Burkitt lymphoma is a rare and highly aggressive malignancy, accounting for approximately 1-2% of adult lymphomas in Western countries, and exclusively intra-oral localization is very uncommon. We describe a rare case of a moderately painful sporadic Burkitt lymphoma localized in the posterior third of the left mandibular bone, initially misdiagnosed as osteomyelitis-like lesion, in a patient Epstein-Barr virus infection-negative with unknown human immunodeficiency virus (HIV) positivity and acquired immunodeficiency syndrome. A 52-year-old man was referred to our Department complaining of persistent moderate pain localized in the left mandibular arch. According to clinical and radiological features, a diagnosis of post-extraction osteomyelitis was made and a surgical revision, including soft and hard tissue biopsy, was performed. Histopathology revealed the presence of a diffuse proliferation of lymphoid cells, exhibiting the typical 'starry-sky' appearance that was consistent with the diagnosis of B-type non-Hodgkin lymphoma. Unexpectedly, HIV seropositivity was also found, but the patient was unaware of this, and the history did not reveal any particular risk factor for HIV infection. Positron-emission tomography showed a highly (18)F-fluorodeoxyglucose-avid mass in the left maxillofacial region and extensive disease in bone marrow and mediastinum. Thus, the patient was referred to our onco-hematological team for final assessment and care. In conclusion, sporadic Burkitt lymphoma is an aggressive malignancy, which rarely affects adults with initial intra-oral manifestations. In the presence of abnormal gingival or alveolar lesions, a non-odontogenic disease should be suspected and the appropriate diagnostic test should be performed., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

The biological interaction between the jaw bones and dental implant is fundamental for the long-term success of dental implant placement. Nevertheless, the insufficient bone volume remains a major clinical problem, especially in case of immediate dental implant. Using a canine model, the present study proves the regenerative potential of adipose- derived stem cells (ADSCs) to repair peri-implant bone defects occurring in immediate dental implant placement. In six labradors, all mandibular premolars and the first molars were extracted bilaterally and three months later dental implants were installed with a marginal gap. The marginal defects were filled with hydroxyapatite (HA)-based scaffolds previously seeded with ADSCs. After one month of healing, specimens were prepared for histological and histomorphometric evaluations. Histological analyses of ground sections show that ADSCs significantly increase bone regeneration. Several new vessels, osteoblasts and new bone matrix were detected. By contrast, no inflammatory cells have been revealed. ADSCs could be used to accelerate bone healing in peri- implant defects in case of immediate dental implant placement.

Bone defects are often secondary to alveolar disease removal. Creating a bone lid with piezosurgery is a valid method to preserve the alveolar bone. A careful and precise osteotomy associated with a firm placement of the bone lid in its original position enables better bone healing, thus allowing for the delayed insertion of dental implants at the operated site with no need for any bone augmentation procedures. The aim of this technical note is to present the application of the bone lid surgery in the posterior mandible before dental implant rehabilitation., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Hereditary angioedema (HAE) is a rare disease, little known to medical and dental practitioners, but with an increasing hospitalization rate over the years. HAE is due to a C1 esterase inhibitor deficiency/dysfunction that leads to an increased vascular permeability. The airways are the most affected, and life-threatening laryngeal swelling may occur. Episodes of HAE have no clear cause, but they can be triggered by anxiety, invasive procedures, and trauma. HAE is an important issue in oral and maxillofacial surgery, otorhinolaryngology, endoscopy, emergency medicine, and anesthesiology because even simple procedures may cause laryngeal edema. Recommendations on the management of HAE include long- and short-term prophylaxis, and treatment for acute attacks, but the importance of controlling anxiety is underestimated. Here, we report on the perioperative management of nine HAE patients scheduled for oral surgery, with a brief review of the literature on this topic.

Computed tomography and magnetic resonance imaging detected an isolated adrenal lesion in an elderly man with high-risk prostate cancer who was undergoing radiotherapy (RT) and hormonal therapy (HT). When prostate-specific antigen (PSA) was 31.66 ng/mL, the lesion was not identified as a metastasis by 18F-choline positron emission tomography/computed tomography (18F-choline-PET/CT). When PSA was over 100 ng/mL, 18F-choline-PET/CT diagnosed the malignancy. After adrenalectomy, PSA returned to normal, and stable disease remission was obtained. This case suggests that atypical metastasis may be underdiagnosed.

Dental pulp tissue supports the vitality of the tooth, but it is particularly vulnerable to external insults, such as mechanical trauma, chemical irritation or microbial invasion, which can lead to tissue necrosis. In the present work, we present an endodontic regeneration method based on the use of a tridimensional (3D) hyaluronan scaffold and human dental pulp stem cells (DPSCs) to produce a functional dental pulp-like tissue in vitro. An enriched population of DPSCs was seeded onto hyaluronan-based non-woven meshes in the presence of differentiation factors to induce the commitment of stem cells to neuronal, glial, endothelial and osteogenic phenotypes. In vitro experiments, among which were gene expression profiling and immunofluorescence (IF) staining, proved the commitment of DPSCs to the main components of dental pulp tissue. In particular, the hyaluronan-DPSCs construct showed a dental pulp-like morphology consisting of several specialized cells growing inside the hyaluronan fibers. Furthermore, these constructs were implanted into rat calvarial critical-size defects. Histological analyses and gene expression profiling performed on hyaluronan-DPSCs grafts showed the regeneration of osteodentin-like tissue. Altogether, these data suggest the regenerative potential of the hyaluronan-DPSC engineered tissue.

Objectives: The clinical efficacy of a wearable pulsed electromagnetic field (PEMF) therapy device was assessed in terms of pain and quality of healing after tooth extraction., Study Design: This randomized, parallel design, placebo-controlled study involved 120 patients undergoing unilateral mandibular third molar extraction and assigned to three groups after surgery. Test and placebo patients wore enabled or disabled PEMF devices, respectively, and controls wore no device. Patients recorded pain (on the visual analog scale) and analgesic use for a week, after which healing complications were assessed., Results: Test patients had only slightly lower visual analog scale scores and analgesic use, but significantly fewer cases of dehiscence than placebo patients., Conclusions: PEMF therapy delivered by a wearable device improved soft tissue healing and may be a useful adjunct for pain management after oral surgery., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: To report a case of canalicular adenoma (CA) and discuss the use of immunohistochemistry to better address the diagnosis given some unusual characteristics in this patient., Background: CA is an uncommon benign neoplasm that can develop in minor salivary gland duct tissues throughout the oral cavity. At histology, it shares several features with other salivary tumors. Immunohistochemistry can be useful in the differential diagnosis., Materials and Methods: The clinical presentation consisted in a nodule on the left upper lip of an 85-year-old man. The patient's main complaint was upper denture instability secondary to soft tissue changes. The nodule was excised under local anesthesia and underwent histological and immunohistochemical examination to rule out any malignancy., Results: Histological findings, cytokeratin positivity and the absence of any reactivity to specific markers of myoepithelial differentiation confirmed the epithelial nature of the lesion., Conclusion: The histological diagnosis of benign salivary tumors such as CA can be confirmed by immunohistochemistry., (© 2013 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.)

Objectives: To evaluate the influence on osseointegration of Deproteinized bovine bone mineral (DBBM) particles used to fill defects of at least 1 mm around implants having no primary contact with bone., Material and Methods: Premolars and first molars were extracted bilaterally from the mandible of six Labrador dogs. After 3 months of healing, mucoperiosteal full-thickness flaps were elevated, and one recipient site was prepared in the molar region of each hemi-mandible to place implants. These were installed with a deliberate circumferential and periapical space to the bone walls of 1.2 mm. All implants were stabilized with passive fixation plates to maintain the implants in situ and without any contact with the implant bed. The control sites were left to be filled with coagulum, while at the test sites, the residual gap was filled with DBBM. After 3 months of submerged healing, the animals were sacrificed. Ground sections were prepared and analyzed histomorphometrically., Results: Mineralized bone-to-implant contact was 4.0% and 3.9% for control and test sites, respectively. The width of the residual defects was 0.48 mm and 0.88 mm at the control and test sites, respectively. The percentage of implant surface covered by a layer of dense connective tissue of 0.12 mm of width on average was 84.9% and 88.5% at the control and test sites, respectively., Conclusion: A minor and not predictable degree of contact or distance osteogenesis was obtained on the implant surface when primary contact of the implant surface with the implant bed had deliberately been avoided. DBBM grafting of the artificial gap did not favor osseointegration. Neither did it enhance the ability to bridge the gap with newly formed bone in an artificial defect wider than 1 mm., (© 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.)

Injury to peripheral nerves can occur as a result of various surgical procedures, including oral and maxillofacial surgery. In the case of nerve transaction, the gold standard treatment is the end-to-end reconnection of the two nerve stumps. When it cannot be performed, the actual strategies consist of the positioning of a nerve graft between the two stumps. Guided nerve regeneration using nano-structured scaffolds is a promising strategy to promote axon regeneration. Biodegradable electrospun conduits composed of aligned nanofibers is a new class of devices used to improve neurite extension and axon outgrowth. Self assembled peptide nanofibrous scaffolds (SAPNSs) demonstrated promising results in animal models for central nervous system injuries, and, more recently, for peripheral nerve injury. Aims of this work are (1) to review electrospun and self-assembled nanofibrous scaffolds use in vitro and in vivo for peripheral nerve regeneration; and (2) its application in peripheral nerve injuries treatment. The review focused on nanofibrous scaffolds with a diameter of less than approximately 250 nm. The conjugation in a nano scale of a natural bioactive factor with a resorbable synthetic or natural material may represent the best compromise providing both biological and mechanical cues for guided nerve regeneration. Injured peripheral nerves, such as trigeminal and facial, may benefit from these treatments.

This report demonstrates the association between the development of a nasopalatine duct cyst and implant surgery, involving 2 implants positioned 4 years after teeth extraction at a site unaffected by any prior local endodontic disease or radiolucency. The cyst was removed and the residual void was filled with deproteinized bovine bone. Two-year follow-up showed no cyst recurrence, the normal anatomy was partly restored, and one of the implants showed clinical signs of re-osseointegration.

Osteonecrosis of the jaw (ONJ) is a rare but serious lesion of the jaw characterized by exposed necrotic bone and is related to several drugs usually used for treating patients with advanced malignancies. Common therapies inducing ONJ are nitrogen-containing bisphosphonates (BPs), the human monoclonal antibody to the receptor activator of nuclear factor-kappa B ligand denosumab and some anti-angiogenic drugs, alone or in combination with BPs. The real incidence of ONJ is unknown. Several cases of ONJ in patients with cancer who underwent denosumab therapy have been reported and it seems that the overall incidence of denosumab-related ONJ is similar to that for BP-related in this population, ranging between 1-2%. The cell-surface vascular endothelial growth factor (VEGF) receptor plays a major role in cancer progression and can be targeted by drugs inhibiting the tyrosine kinase activator or other second messengers. Most angiogenesis inhibitors, such as the monoclonal antibody bevacizumab and the kinase inhibitor sunitinib, target the VEGF signaling pathway. Unfortunately, cases of bevacizumab-induced ONJ have been reported, especially in patients treated with bevacizumab and BPs in combination. There are only few studies reporting sunitinib-related ONJs. In patients with advanced cancer and malignancy-associated hypercalcemia undergoing BP, denosumab or bevacizumab therapy, enquiry into current dental health and dental examination is mandatory. Good oral hygiene, limiting of alcohol intake and stopping smoking should be suggested for all patients requiring such treatments.

The features of implant devices and the reactions of bone-derived cells to foreign surfaces determine implant success during osseointegration. In an attempt to better understand the mechanisms underlying osteoblasts attachment and spreading, in this study adhesive peptides containing the fibronectin sequence motif for integrin binding (Arg-Gly-Asp, RGD) or mapping the human vitronectin protein (HVP) were grafted on glass and titanium surfaces with or without chemically induced controlled immobilization. As shown by total internal reflection fluorescence microscopy, human osteoblasts develop adhesion patches only on specifically immobilized peptides. Indeed, cells quickly develop focal adhesions on RGD-grafted surfaces, while HVP peptide promotes filopodia, structures involved in cellular spreading. As indicated by immunocytochemistry and quantitative polymerase chain reaction, focal adhesions kinase activation is delayed on HVP peptides with respect to RGD while an osteogenic phenotypic response appears within 24h on osteoblasts cultured on both peptides. Cellular pathways underlying osteoblasts attachment are, however, different. As demonstrated by adhesion blocking assays, integrins are mainly involved in osteoblast adhesion to RGD peptide, while HVP selects osteoblasts for attachment through proteoglycan-mediated interactions. Thus an interfacial layer of an endosseous device grafted with specifically immobilized HVP peptide not only selects the attachment and supports differentiation of osteoblasts but also promotes cellular migration., (Copyright © 2012 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.)

Background: The aim of this retrospective study is to investigate the medium- to long-term prognosis of short implants in partially and totally edentulous patients with mandibular bone atrophy., Methods: The study involved 109 patients with 280 implants placed in the mandible. The implants were 7 or 8.5 mm long and 3.75 or 4 mm in diameter. The implant surfaces were machined (M; n = 176) or rough (R; n = 104). Patients were asked to attend a radiographic and clinical follow-up, and their previous clinical records and radiographs were assessed. Implant-related and prosthetic failures and complications were recorded., Results: The mean follow-up was 9 years (range of 5 to 16 years). The survival rate (SSR) and success rate (SR) were calculated using life-table analysis for both M and R short implants. The M implants had a 16-year SSR of 95.7% and a corresponding SR of 93.9%, whereas the 16-year SSR and SR for the R implants were 97.2% and 95.2%, respectively. The mean ± SD bone resorption for all implants was 1.37 ± 0.5 mm. For marginal bone loss, there was no statistically significant difference between the two implant lengths (P = 0.38) or diameters (P = 0.34) or between the M and R implant surfaces (P = 0.47)., Conclusions: Different implant lengths, diameters, and surface treatments do not appear to influence the prognosis of the implant. Within the limitation that most of the short implants were splinted to longer implants, the reduced length of the fixtures did not worsen the long-term survival of the implant-supported fixed prostheses.

Stem cells (SCs) are undifferentiated cells responsible for the growth, homeostasis and repair of many tissues. The maintenance and survival of SCs is strongly influenced by several stimuli from the local microenvironment. The majority of signaling molecules interact with SCs at the nanoscale level. Therefore, scaffolds with surface nanostructures have potential applications for SCs and in the field of regenerative medicine. Although some strategies have already reached the field of cell biology, strategies based on modification at nanoscale level are new players in the fields of SCs and tissue regeneration. The introduction of the possibility to perform such modifications to these fields is probably due to increasing improvements in nanomaterials for biomedical applications, as well as new insights into SC biology. The aim of the present review is to exhibit the most recent applications of nanostructured materials that drive the commitment of adult SCs for potential clinical applications.

Aim: To evaluate the influence of implant positioning into extraction sockets on bone formation at buccal alveolar dehiscence defects., Material and Methods: In six Labrador dogs the pulp tissue of the mesial roots of (4) P(4) was removed and the root canals were filled. Flaps were elevated bilaterally, the premolars hemi-sectioned and the distal roots removed. The implants were placed in contact with either the buccal (test site) or with the lingual (control site) bony wall of the extraction sockets. Healing abutments were affixed and triangular buccal bony dehiscence defects, about 2.7 mm deep and 3.5 mm wide, were then prepared. No regenerative procedures were done and a non-submerged healing was allowed. After 4 months of healing, block sections of the implant sites were obtained for histological processing and peri-implant tissue assessment., Results: After 4 months of healing, the bony crest and the coronal border of osseointegration at the test sites were located 1.71 ± 1.20 and 2.50 ± 1.21 mm apically to the implant shoulder, respectively. At the control sites, the corresponding values were 0.68 ± 0.63 and 1.69 ± 0.99 mm, respectively. The differences between test and control reached statistical significance (P < 0.05). Residual marginal bone defects were found both at the test and control sites. A statistically significant difference between test and control sites was only found at the lingual aspects (depth 2.09 ± 1.01 and 1.01 ± 0.48 mm, respectively). Similar heights of the buccal biological width were observed at both sites (about 5.1 mm)., Conclusions: The placement of implants in a lingual position of the extraction sockets allowed a higher degree of bone formation at buccal alveolar dehiscence defects compared with a buccal positioning., (© 2012 John Wiley & Sons A/S.)

The structural and functional fusion of the surface of the dental implant with the surrounding bone (osseointegration) is crucial for the short and long term outcome of the device. In recent years, the enhancement of bone formation at the bone-implant interface has been achieved through the modulation of osteoblasts adhesion and spreading, induced by structural modifications of the implant surface, particularly at the nanoscale level. In this context, traditional chemical and physical processes find new applications to achieve the best dental implant technology. This review provides an overview of the most common manufacture techniques and the related cells-surface interactions and modulation. A Medline and a hand search were conducted to identify studies concerning nanostructuration of implant surface and their related biological interaction. In this paper, we stressed the importance of the modifications on dental implant surfaces at the nanometric level. Nowadays, there is still little evidence of the long-term benefits of nanofeatures, as the promising results achieved in vitro and in animals have still to be confirmed in humans. However, the increasing interest in nanotechnology is undoubted and more research is going to be published in the coming years.

Aim: The aims of this study were to assess the age limit for infiltration anaesthesia as an effective technique in treating carious lesions of first permanent molars in the paediatric age and if differences exist between males and females., Materials and Methods: A total of 51 teeth from 48 different patients aged between 6 and 14 years were included in the study. The anaesthetic solution used was 1.8 ml of 2% mepivacaine with 1:100000 epinephrine. The effectiveness of anaesthesia was assessed by electrical pulp test after 3, 5, 7 and 10 minutes., Results: In 56.9% of the treated cases a single mandibular infiltration was sufficient to induce complete pulpal anaesthesia of the tooth to be treated. Under 10 years of age, the infiltration technique was effective in 85.2% of cases. The success rate of anaesthesia also decreased significantly and not linearly in function of age. The success of infiltration anaesthesia was not related to gender., Conclusion: Mandibular infiltration anaesthesia is a successful technique for most patients under 10 years (success rate: 85.2%) especially for the younger ones, with no differences between males and females. After this age that success rate dramatically drops.

Objective: The aim of this cross-sectional study was to determine the clinical outcome and patient satisfaction in subjects treated with mandibular overdentures supported by two implants., Material and Methods: One hundred and fifty-nine patients, who received restorative therapy in the edentulous mandible consisting of a bar-retained overdenture supported by two osseointegrated implants in a private clinic in Italy, were recalled for a clinical and radiographic examination. One hundred and forty-one subjects with 280 implants attended the examination. The average follow-up time was 3.9 years. The radiographic examination included assessments of the distance between the implant margin and the most coronal position of bone-to-implant contact at the mesial and distal aspects of each implant. A questionnaire regarding comfort, satisfaction with the treatment, aesthetics, speaking capacity and efficiency in chewing was obtained from each subject. Biological and technical complications were recorded and the number of visits due to complications between the delivery of the prostheses and the re-examination was determined., Results: The results from the examination revealed that the number of lost implants was small and the average marginal bone level around the implants was 0.67 mm apical of the implant margin. The most frequently observed complication was hyperplasia of the mucosal tissue under the bar construction. Few patients experienced loosening of retention. The vast majority of patients reported to be satisfied in relation to the restorative therapy from both functional and aesthetic points of view., Conclusion: Patients with edentulous mandibles may be successfully rehabilitated by means of two implants supporting a bar-retained overdenture., (© 2011 John Wiley & Sons A/S.)

Aim: The purpose of this study is to compare, by means of mechanical tests, the resistance of two types of dental restoration in the uncomplicated crown fracture of human permanent maxillary central incisor: rebonding of the fractured tooth fragment and application of ceramic veneers., Materials and Methods: Thirty human maxillary central incisors were divided into three groups of ten teeth each. The teeth of the first group (Group A) were kept intact and used as controls, while the remaining teeth were sectioned, in order to simulate a crown fracture, and restored respectively with either the rebonding of the fragment (Group B) or with the use of ceramic veneers (Group C). All samples underwent mechanical tests by means of a universal test machine., Results: The mean resistance to fracture recorded is respectively 425.2N for Group A, 233.3N for Group B, and 347.3N for Group C. One-way ANOVA analysis demonstrates statistical significance for at least one couple of values (Group B compared to Group A). The group of restorations with rebonding of fractured fragments has a mean value of resistance to fracture that is lower than both intact teeth and teeth restored with ceramic veneers. The resistance of teeth with rebonded restorations is 54.9% of that of, intact teeth, and resistance increases for teeth restored with ceramic veneers (81.8% of that of intact teeth)., Conclusion: Ceramic veneers showed a higher resistance than rebonding and resulted to be more reliable in case of further trauma.

Aim: To evaluate the healing at implants with a moderately rough surface placed and stabilized in recipient sites of dimensions deeper and larger than that of the implants to avoid any contact between parent bone and the implant., Material & Methods: In six Labrador dogs, premolars and first molars were extracted bilaterally in the mandible. After 3 months of healing, mucoperiosteal full-thickness flaps were elevated and the premolar area of the alveolar bony crest was selected. Three recipient sites were prepared to place three implants. One implant was used as control. The other two were placed in recipient sites which left a circumferentially and periapical prepared defect of 0.7 mm (small) and 1.2 mm (large), respectively. All implants were stabilized with passive fixation plates to maintain the implants stable and without any contact with the implant bed. After 3 months of submerged healing, the animals were sacrificed. Ground sections were prepared and analyzed histomorphometrically., Results: The BIC% was 5.3% and 0.3% for implants placed in small and large defect sites, respectively, whereas it was 46.1% for control implants. The differences were statistically significant. The width of the residual defects was 0.4 and 0.5 mm at the small and large defects, respectively. An approximately 0.09 mm layer of dense connective tissue (DCT) rich in fibers and fibroblast-like cells was observed adherent to the implant surfaces. The percentage of implant surface covered by DCT was 92.8% and 95.6% at the small and large defects, respectively., Conclusion: Osseointegration was observed at the test sites, and the dimensions of the defects influenced the outcomes. However, the degree of osseointegration at both small and large defects was very low compared with the control sites., (© 2012 John Wiley & Sons A/S.)

A 62-year-old man presented with a 2-month history of increasing pain in the left hip. Magnetic resonance imaging (MRI) showed bone marrow edema (BME) of the left femur, dual energy X-ray absorptiometry (DXA) showed osteopenia at the same level, whereas pelvis X-rays failed to show any objective findings. After ruling out other possible causes of BME such as aseptic osteonecrosis, infectious arthritis, primary or metastatic malignancy, tuberculosis, osteomyelitis, rheumatoid arthritis, and seronegative spondyloarthropathies, a diagnosis of transient osteoporosis of the hip (TOH) was made, and treatment with teriparatide at a daily dose of 20 μg was started and continued for 4 weeks. Disappearance of the symptoms and normalization of MRI were obtained.

Aim: To evaluate the effect of implant length (6 mm vs.11 mm) on osseointegration (bone-to-implant contact) of implants installed into sockets immediately after tooth extraction., Material and Methods: In six Labrador dogs, the pulp tissue of the mesial roots of (3) P(3) was removed and the root canals were filled. Flaps were elevated bilaterally, the premolars hemi-sectioned and the distal roots removed. Recipient sites were prepared in the distal alveolus and a 6 mm or an 11 mm long implant was installed at the test and control sites, respectively. Non-submerged healing was allowed. After 4 months of healing, block sections of the implant sites were obtained for histological processing and peri-implant tissue assessment., Results: No statistically significant differences were found between test and control sites both for hard and soft tissue parameters. The bone-to-implant contact evaluated at the apical region of the implants was similar as well. Although not statistically significant, the location of the top of the bony crest at the buccal aspect was more apical in relation to the implant shoulder at the test compared with the control sites (2.0 ± 1.4 and 1.2 ± 1.1 mm, respectively)., Conclusions: Shorter implants (6 mm) present with equal osseointegration than do longer implants (11 mm)., (© 2012 John Wiley & Sons A/S.)

Background: Destructive membranous periodontal disease, or ligneous gingivitis, is a rare condition involving nodular gingival enlargement with ulceration and periodontal tissue destruction. This review gives a brief account of the cases reported in the literature. An effort is also made to define the periodontal disease caused by plasminogen deficiency with a view to its potential inclusion in the classification of periodontal diseases., Methods: A MEDLINE/PubMed and manual search was conducted to find papers describing ≥1 case of ligneous disease involving the oral mucosa., Results: We identified 23 articles reporting 35 cases. For each patient, we analyzed various characteristics, including age, sex, age of onset, oral symptoms, histologic features, plasminogen levels (functional activity, plasma antigen), genetic features, treatment, and results of treatment during the reported follow-up., Conclusions: Ligneous gingivitis is a rare periodontal disorder closely associated with ligneous conjunctivitis and plasminogen deficiency. Its diagnosis may be supported by the finding of genetic mutations responsible for the condition. Research is focusing on the future development of an effective therapy capable of arresting the destructive evolution of the disease. Additional studies, investigating features such as probing depth and attachment loss, are needed for the appropriate classification of this periodontal disease.

In the field of tissue engineering, adult stem cells are increasingly recognized as an important tool for in vitro reconstructed tissue-engineered grafts. In the world of cell therapies, undoubtedly, mesenchymal stem cells from bone marrow or adipose tissue are the most promising progenitors for tissue engineering applications. In this setting, adipose-derived stem cells (ASCs) are generally similar to those derived from bone marrow and are most conveniently extracted from tissue removed by elective cosmetic liposuction procedures; they also show a great potential for endothelization. The aim of the present work was to investigate how the cocommitment into a vascular and bone phenotype of ASCs could be a useful tool for improving the in vitro and in vivo reconstruction of a vascularized bone graft. Human ASCs obtained from abdominoplasty procedures were loaded in a hydroxyapatite clinical-grade scaffold, codifferentiated, and tested for proliferation, cell distribution, and osteogenic and vasculogenic gene expression. The chromosomal stability of the cultures was investigated using the comparative genomic hybridization array for 3D cultures. ASC adhesion, distribution, proliferation, and gene expression not only demonstrated a full osteogenic and vasculogenic commitment in vitro and in vivo, but also showed that endothelization strongly improves their osteogenic commitment. In the end, genetic analyses confirmed that no genomical alteration in long-term in vitro culture of ASCs in 3D scaffolds occurs.

Adipose tissue pathologies and defects have always represented a reconstructive challenge for plastic surgeons. In more recent years, several allogenic and alloplastic materials have been developed and used as fillers for soft tissue defects. However, their clinical use has been limited by further documented complications, such as foreign-body reactions potentially affecting function, degradation over time, and the risk for immunogenicity. Tissue-engineering strategies are thus being investigated to develop methods for generating adipose tissue. This paper will discuss the current state of the art in adipose tissue engineering techniques, exploring the biomaterials used, stem cells application, culture strategies, and current regulatory framework that are in use are here described and discussed.

Bone tissue engineering strategies are emerging as attractive alternatives to autografts and allografts in bone tissue reconstruction, in particular thanks to their association with nanotechnologies. Nanostructured biomaterials, indeed, mimic the extracellular matrix (ECM) of the natural bone, creating an artificial microenvironment that promotes cell adhesion, proliferation and differentiation. At the same time, the possibility to easily isolate mesenchymal stem cells (MSCs) from different adult tissues together with their multi-lineage differentiation potential makes them an interesting tool in the field of bone tissue engineering. This review gives an overview of the most promising nanostructured biomaterials, used alone or in combination with MSCs, which could in future be employed as bone substitutes. Recent works indicate that composite scaffolds made of ceramics/metals or ceramics/polymers are undoubtedly more effective than the single counterparts in terms of osteoconductivity, osteogenicity and osteoinductivity. A better understanding of the interactions between MSCs and nanostructured biomaterials will surely contribute to the progress of bone tissue engineering.

The aim of the present work is to study how biological properties, such as proliferation and commitment ability, of human adult dental pulp stem cells (DPSCs) relate to the age of the donor. Human dental pulps were extracted from molars of healthy adult subjects aged 16 to >66 years. DPSCs were isolated and cultured in the presence of osteogenic, neurogenic, or vasculogenic differentiation medium. Proliferation ability was evaluated by determining doubling time, and commitment ability was evaluated by gene expression and morphological analyses for tissue-specific markers. The results confirm a well-defined proliferative ability for each donor age group at an early in vitro passage (p2). DPSCs from younger donors (up to 35 years) maintain this ability in long-term cultures (p8). Stem cells of all age donor groups maintain their commitment ability during in vitro culture. In vivo tests on the critical size defect repair process confirmed that DPSCs of all donor ages are a potent tool for bone tissue regeneration when mixed with 3D nanostructured scaffolds.

Objective: To retrospectively analyze 14 consecutively treated cases of dental implants placed along with sinus lift procedures in patients with severe bone atrophy (residual bone height of 2 to 5 mm)., Method and Materials: Thirty-one implants were placed with a lateral window sinus lift in 14 patients using deproteinized bovine bone alone (no membrane) for the graft. The implants were monitored for a mean 43.20 ± 9.30 months (minimum, 25.00 months; maximum, 53.00 months) after placement and 32.40 ± 11.10 months (minimum, 11.40 months; maximum, 41.60 months) after fitting of the prostheses. The outcome measures evaluated were implant success, radiographic measurements (original alveolar bone height, peri-implant marginal bone loss, and relationship of implant apex to graft), implant-related probing pocket depth (PPD), Bleeding Index (BI), and prosthesis sucess., Results: The implant success rate was 93.3%. The mean real alveolar bone height was 3.05 ± 0.87 mm, and there was evidence of peri-implant marginal bone loss (mean, 1.02 ± 1.40 mm). The relationship of implant apex to graft remained stable during follow-up. PPD was < 5 mm in 91.6% of implants. The BI was 11.6%. The prosthetic success rate was 100%., Discussion: These findings indicate that dental implants can be employed successfully, even in conditions of severe bone atrophy, using only heterologous bone, provided suitable methods and materials are used (eg, site preparation, rough implant surfaces, and self-tapping screw implants)., Conclusion: The treatment described appears to afford acceptable results, with lower overall costs and treatment time.

Aim: Bispectral Index Score (BIS) is an objective tool to assess sedation depth. Benzodiazepines have different pharmacological profiles and diazepam may be safer than midazolam in this setting. The aim of this study was to compare BIS values observed during anxiolysis after diazepam versus sedation after midazolam., Methods: Thirty-six patients were randomly assigned to 3 groups: group 1 was treated with i.v. diazepam, groups 2 and 3 with iv midazolam 1 and 3 mg, respectively. Sedation was monitored clinically and by means of BIS. BIS values were evaluated as area under the curve (AUC) and compared by variance analysis. The statistical comparison of other data was performed by variance analysis or, alternatively, the χ2 according to Yates. The statistical significance was indicated by P values <0.05., Results: AUC values were significantly lower after midazolam when compared to AUC values registered in diazepam treated patients; 22.6% of the group 3 patients showed BIS values <80, versus 0.4% of group 1 patients., Conclusion: Diazepam has a safer profile, with BIS values and clinical conditions according to the definition of minimal and/or moderate sedation. Diazepam represents the safer drug for anxiety management in dentistry, because regularly produces a state of sedation during which verbal contact with the patient is maintained and carry a margin of safety wide enough to render loss of consciousness unlikely.

Purpose: The aim of the present study was to compare piezoelectric surgery and conventional rotatory osteotomy for mandibular third molar germ extraction to determine the 2 methods' suitability and the postoperative outcomes., Patients and Methods: Mandibular third molar germectomy was performed bilaterally, randomly choosing 1 side for rotatory osteotomy (rotatory group) and the other for piezoelectric surgery (piezo group). The predictor variable was the duration of the surgical procedure. The outcome variables were the suitability of the method used, bleeding, and the postoperative parameters (ie, mouth opening range, clinical appearance of soft tissues, exudate, abscess, wound dehiscence, locoregional lymphadenopathy, pain on palpation at the extraction site, persistent edema) at 7 and 30 days postoperatively. The patients recorded their subjective postoperative pain daily for 7 days using a visual analog scale. The Wilcoxon rank-sum test and stepwise logistic regression model with binary variables were used for statistical analysis., Results: A total of 26 patients (mean age 15.4 ± 1.29 years) were enrolled in the present study. The time needed to complete the osteotomy and extraction was significantly greater for the piezo group (15.77 ± 6.56 minutes) than for the rotatory group (11.77 ± 6.24 minutes; P = .028). No statistically significant differences emerged between the 2 methods for the other outcome variables considered., Conclusions: Piezoelectric osteotomy proved comparable to the rotatory method in terms of the surgeon's perception of the suitability of the 2 methods and the related postoperative sequelae. However, piezoelectric osteotomy took longer to complete than the rotatory method., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

The purpose of this paper was to report the case of a 2-year-old Caucasian female who was referred with a presumed diagnosis of pediatric rheumatoid arthritis. The patient presented widespread gingival swelling with bleeding, sharp pain, and halitosis. The patient also presented pain and swelling of the right knee joint, and psychomotor restlessness associated with muscular frailty. Little compliance on the part of both the patient and parents was also noted. Oral manifestations, together with an accurate medical history, led to the diagnosis of infantile scurvy, caused by an inadequate dietary supply of vitamin C. Administering 250 mg of ascorbic acid orally twice a day led to the remission of gingival swelling and of the other symptoms. The parents were advised to feed the child appropriate foods. Nutritional problems are traditionally linked to an insufficient availability of food, but can also be associated with child- or family-related psychological problems.

Aim: Female patients on estroprogestinic therapy undergoing extraction of the third lower molar have a higher incidence of postoperative complications (dry socket -DS- pain). The purpose of this study is to verify such data and analyse if there are risk factors for the appearance of other postoperative complications., Methods: One hundred eighteen non-smoking healthy patients were included who underwent extraction of the impacted third lower molar (38 on oral contraceptives, OC, 80 as control). After the extraction, patients were prescribed with a pharmacological therapy, consisting of a per os antibiotic and antiseptic rinse. Each patient was examined after 7 days following surgery to verify the state of tissues. In addition subjective postoperative pain (VAS - Visual Analogue Scale) and intake of analgesic drugs were recorded., Results: One case of DS (2.64%) occurred in the OC group, and 1 case of DS occurred in control-patients group (1.25%) (P=0.4436). The postoperative pain proved significantly higher in OC compared to control (first and fifth postoperation day). In OC a predisposition to dehiscence of the wound (86.84% P=0.0021) and emergence of laterocervical lymphadenitis (81.57% P=0.0010) was found, while no cases of postextractive abscesses and trismus of the masseter were found., Conclusion: Although no correlation between DS and estroprogestinic therapy has been found, a more difficult healing of tissues has been observed as well as a significantly higher subjective pain index in the postoperative days considered in OC patients.

Aim: The aim of this study was to evaluate the efficacy of Electronic Dental Anaesthesia (EDA) for third molar surgery., Methods: Third molar extraction under regional anaesthesia (inferior alveolar and buccal nerve blocks) was performed in 2 groups of 30 patients each: group 1 = controls, group 2 = EDA treatment. Anxiety and pain level were reported by means of Visual Analogue Scale, postoperative pain description with the McGill Pain Questionnaire. A postoperative phone interview to all patients was made. Computerized randomization was performed; values expressed as mean+/-SD, data comparison evaluated by means of ANOVA and chi squared, statistical significance indicated by P values <0.05., Results: Features of the patients and surgical interventions were similar. EDA has determined lower pain level; moreover, the control patients has shown higher values of blood pressure and heart frequency. Phone interview has reported no amnesia about the perioperative events. A smaller number of EDA treated patients has reported pain during needle prick and/or intraoperatively; 80% of the EDA treated patients has reported a good opinion about the treatment, 93% of the patients would repeat the treatment, if needed., Conclusion: EDA is a complementary analgesic technique for dental surgery. Cardiovascular changes, frequently observed during third molar extraction, were not present in the EDA treated patients. These data confirm that EDA is able to modify the physiologic responses to stressful events, blunting the adrenergic upset, maybe by means of an analgesic action on A, fiber and an increase of endorphins' central level. These results underline that the complementary use of EDA in the third molar extraction may be better than regional anaesthesia alone.

In this work an ultrasound device was used to perform an ostectomy for the removal of blade implants in order to save as much bone tissue as possible, so that root form implants might later be inserted. Two patients underwent surgery for the removal of two blade implants (one maxillary, the other mandibular) that were no longer functional. The peri-implant ostectomy was carried out with a piezoelectric surgery device. The instrument demonstrated to be effective and precise during ostectomy, providing an extremely thin cutting line. During the course of the operation and at controls after 7 and 30 days, patients did not show any relevant complications and both still had sufficient alveolar bone to be treated with root form implants. The piezosurgery device proved to be an effective instrument in interventions requiring a significant saving of bone tissue, extreme precision in cutting, and respect of soft tissues.

The aims of this study were to determine the microbiological and particle size characteristics of particulate bone collected with a piezosurgery device and bone trap, and to reduce bacterial contamination after treatment of debris with rifamycin SV. Samples were taken from 10 patients who underwent surgical extraction of their third lower molars. The ostectomy was performed with a piezosurgery device, and the debris was collected with a surgical aspiration set equipped with a bone trap. Two aliquots were taken from each sample, one of which was treated with rifamycin SV. The second aliquot, used as a control, was treated with a physiological solution. In the samples immersed in antibiotic solution, there was a statistically significant (P<0.005) reduction in bacterial contamination. The stringent protocol followed in this study has proved valid for collection of material, and treatment with rifamycin SV was found to reduce bacterial contamination in collected material.

Aim: The aim of this study was to evaluate the effects of sedation with benzodiazepines in a large population of patients undergoing oral surgery and age-related implications., Methods: A group of 1 179 consecutive patients undergoing oral surgery in the Dental Clinic of the University of Padua between 2001 and 2003 was evaluated by analysing their anaesthesiological records. The patients were divided into 5 age groups. All were pre-sedated with chlordemethyldiazepam per os, while induction of maximum subjective tranquillity was obtained with fractionated doses of intravenous diazepam. Arterial pressure (AP), heart rate (HR), anxiety level, pathologies, drugs taken, types of intervention, techniques of loco-regional anaesthesia, immediately preoperative AP and HR and tranquillity, intraoperative AP and HR, data regarding postoperative psychomotor recovery, complications and drugs used for the treatment of perioperative pain, were evaluated in each group., Results: Most of the patients (679) were in the 45-64 year-old group. Cardiovascular, respiratory and digestive pathologies proved to be age-dependent. Control AP and HR respectively increased and decreased with age. The doses of chlordemethyldiazepam used induced age-dependent preoperative tranquillity levels. The doses of i.v. diazepam necessary to obtain maximal preoperative subjective tranquillity fell as a function of age. The AP and HR values respectively increased during intervention and decreased in the first hour of intervention. Normal psychomotor recovery was less evident in older patients. The most significant corrective intraoperative interventions consisted of the administration of sublingual hypotensive drugs and in the immediate treatment of some cases of orthostatic hypotension and vaso-vagal syncope., Conclusions: The sedation technique and the antistress procedures employed proved safe and the intra- or postoperative complications almost non-existent. The variations observed in the parameters considered are compatible with the greater age of the treated subjects.

Purpose: The purpose of this study was to investigate the added value of co-registered fusion imaging using a hybrid system in patients with lymphoma., Methods: Twenty-four lymphoma patients underwent (67)Ga-SPECT/CT using a hybrid tomograph consisting of a dual-head, variable-angle gamma camera and a low-dose X-ray tube. Results were compared with those of SPECT alone., Results: Forty-five lesions were identified by SPECT alone, while 49 were detected by SPECT/CT. Forty out of the 45 lesions observed on SPECT were confirmed as lymphoma, but five were due to other causes (thoracic aorta blood pool activity, sialoadenitis in the submandibular gland, bowel activity, rib fracture and bone marrow activation due to radiotherapy). SPECT/CT identified nine more neoplastic lesions compared with SPECT alone: four areas of radiopharmaceutical accumulation were observed in para-aortic lymph nodes, three in the spleen, one in the liver and one in para-iliac lymph nodes. In five cases, SPECT/CT provided additional anatomical information over SPECT alone. In four patients, four large areas of (67)Ga uptake (one mediastinal, two supraclavicular and one para-aortic) were better characterised; in one subject uptake was localised in the seventh thoracic vertebra only by SPECT/CT. Hybrid imaging provided additional data in 13 patients (54.2%), thus inducing oncologists to reconsider the therapeutic approach in eight subjects (33.2%): unnecessary treatment was avoided in four (16.6%) while therapy was altered in another four (16.6%)., Conclusion: SPECT/CT hybrid system is able to provide information not obtained by SPECT alone. It allows the anatomical localisation of lymphoma and physiological radiopharmaceutical uptake, facilitates the diagnosis of tumours located in the abdomen (subdiaphragmatic lesions) and provides information that may cause a change in therapeutic strategy.

Background: This study investigated odontostomatologic signs and symptoms associated with Anorexia Nervosa and Bulimia Nervosa (Eating Disorders, ED)., Methods: The authors have examined the following conditions in a group of 14 female subjects (average age: 23.5 +/-4.8) suffering for ED, compared to a control group of 12 female subjects (average age: 22.58 +/-1.83) negative for ED diagnostic criteria: temporo-mandibular joint status, salivary pH, periodontal indexes (plaque index, bleeding index, pockets presence, gingival recession presence), dental indexes (DMF-T, DMF-S; dental erosion or perymolisis), salivary glands swelling, oral hygiene habits (related to vomiting behavior)., Results: The results obtained revealed a greater prevalence of gingival recession, diffuse marginal gingivitis, perymolysis, salivary glands involvement, lower salivary pH in the Eating Disorders (ED) group when compared with a non-ED control group. The results, obtained for the first time from a group of Italian subjects resident in a mediterranean country, agree with those obtained by authors working in an anglo-saxon area., Conclusions: Since odontostomatologic pathologies may be the only detectable sign of Anorexia Nervosa and/or Bulimia Nervosa,the data presented in this study could facilitate the early identification of these patients and provide guidelines for the evaluation of oral pathologies in anorexic and bulimic patients.

The authors report a case of tinea barbae which initially presented clinical and microscopic symptoms that led to the suspected diagnosis of a rapidly developing malignant tumour. A more detailed diagnosis and multi-specialist collaboration enabled the pathology to be correctly diagnosed and treated.