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We report a case of a patient with EBA, who developed ONJ after Rituximab treatment.

Objectives. The aim of the present study is to investigate the presence of proteomic signatures of Oral Squamous Cell Carcinoma (OSCC) in saliva and their use as potential biomarkers for early and non-invasive diagnosis, as well as prognostication. Methods. Saliva from 45 OSCC patients and 30 healthy controls was analysed by SELDI-TOF mass spectrometry and ProteinChip® technology. Proteomic profiles were tested with differential expression analysis and fold change of protein peaks, principal component analysis, Spearman rank correlation test and hierarchical clustering in order to identify a list of peaks of interest representative of controls, N- and N+ cases. Those peaks were used in a supervised artificial neural network in order to classify samples according to the following conditions: controls vs OSCC, controls vs N-, and controls vs N+. Results. When compared with controls, four peaks (i.e. 6913, 11948, 13287 and 27280 m/z) were significantly altered in both N- group and N+ group; four peaks (i.e. 3353, 3433, 3482 and 4136 m/z) were selectively altered in Ngroup; eight peaks were selectively altered in N+ group (i.e. 4038, 7133, 11755, 13746, 13841, 14264, 16807, 17127 m/z). Those peaks were capable to classify 100% of cases and controls, thus being potential diagnostic and prognostic biomarkers for OSCC

Congenital anomalies (CA) are one of the major cause of infant mortality and childhood morbitity, affecting 2-3% of all babies. Approximately 1% of these newborns have syndromes or multiple anomalies; Cranio-facial anomalies are often a component part of these pathologies. Several newborns with cranio-facial anomalies are affected by syndromes composed of multiple malformations thought to be etiologically and/ or pathogenetically related. One of the most frequent sign of these syndromes is the cleft lip and/or cleft palate. It is estimated that 30% of cleft cases are syndromic and conversely, therefore, approximately 70% are non-syndromic. Oral clefts are among the most widely known and common craniofacial anomalies, occurring in approximately 1 in every 700 live births. Craniofacial anomalies include jaw deformities, malformed or missing teeth, defects in the ossification of facial or cranial bones, and facial asymmetries. Many factors contribute to cleft conditions, among them being heredity, pre-natal nutrition, drug exposure, and other environmental factors (WHO, 2002). The present study was aimed at evaluating the incidence of fetal oro-facial malformations in a tertiary center hospital of Southern Italy.

Aim. Bisphosphonate Related OsteoNecrosis of the Jaw (BRONJ) is described as an adverse event related to amino-bisphosphonate (NBP) therapy, occurring as a result of reduced bone resorption and bone turnover. One of the most significant risk factor associated with the onset of BRONJ is tooth extraction even if not yet supported by definitive scientific evidences. The aim of this study is to propose a simple surgical/medical protocol to carry out dental extractions in patients in therapy with NBPs in order to minimize the BRONJ risk. Materials and methods. Eighty-eight patients currently or previously treated with NBPs were selected for extractions of compromised teeth. Patients were divided into two groups on the basis of the risk of BRONJ. Patients were subdivided in high risk (HR) group (i.v. NBPs administration) and in low risk (LR) group (i.m./oral NBPs administration >36 months or oral NBPs < 36 month plus other risk factors). Tooth extractions were carried out using the following surgical-pharmacological protocol: 1) exposure of the alveolar bone through the creation of surgical edges; 2) nontraumatic avulsion, courettage of the area, irrigation of the alveolus with a local antibiotic and 3) closure by primary intention. Furthermore, all patients received a pre- and post-operative pharmacological therapy. The antibiotic systemic therapy was different for HR and LR patients. For HR, the antibiotic systemic therapy based on administration of ampicillin and sulbactam by i.v. and metronidazole per os (1 day pre-operative and 7 days post-operative); for LR patients, amoxicillin and clavulanic acid and metronidazole per os (1 day pre-operative and 7 days post- operative). For both groups, the use of antiseptic (chlorexidine 0,2% mouthwashes 7 days pre-operatively and 15 days post-operatively) and sodium-hyaluronate (post-operative local application for 15 days) were also prescribed. A follow-up of at least 4 months was needed. Data were included in Microsoft Excel® spreadsheet. A descriptive statistical analysis was performed. Results. Sixteen (18.2%) of eighty-eight were treated with i.v. NBPs, twelve (13.6 %) with intramuscular NBPs and fifty-nine (67.1%) with oral NBPs. One patient was treated with either oral and intramuscular NBPs. After two hundred thirty-one tooth extractions performed, there was no evidence of BRONJ in eighty-two (93,18%) patients treated at follow-up (225 tooth extractions; 97.4%). In six (6.81%) patients of HR group, it has been diagnosed BRONJ according to Bedogni et al: five of these patients were treated with endovenous NBPs for at least 6 months (mean±SD: 27.6±13.14) and one patient with oral NBPs for 36 months. Neither of these patients reported other systemic risk factors. Conclusions. The proposed surgical-medical protocol obtained the complete healing of wound and the absence of radiological signs of BRONJ in more than 90% of patients after tooth extractions. It appears to be a valid choice for patients treated with NBPs who need tooth extraction, in terms of prevention of BRONJ.

Aim. Oral squamous cell carcinoma (OSCC) is the most common malignant tumor of the oral cavity and is a neoplasia characterized by a poor prognosis. In fact, the estimated survival rate is 44% after 5 years from the diagnosis. The prognosis of the disease is significantly related to the stage in which the disease is diagnosed. Moreover the therapies are not very efficient and are so invasive, disfiguring and debilitating that in the survivors the quality of life is poor. Nowadays there is not a reliable and non-invasive method for early diagnosis of oral squamous cell carcinoma and the simple visual examination of the oral cavity is characterized by a low sensitivity and specificity, also because in a significant number of patients the early stages of oral carcinogenesis are not associated with clearly evident clinical abnormalities. The aim of the study was to determine the potential biomarkers of early and non-invasive diagnosis and to use a test that was less subject to the clinical experience of the examiner. Furthermore, we tried to use the saliva as a biological matrix to make a rapid, simple and economic diagnosis. Materials and methods. In the current study, we analysed 65 saliva samples of patients with OSCC (25 stage I and II, 40 stage III and IV) and 34 healthy controls (HS). Stage I and II OSCC patients were classified as Early Stage OSCC (ES-OSCC), while stage III and IV patients were classified as Late Stage OSCC (LS-OSCC). All samples were collected and processed for proteomics research. Each sample has undergone an ethanol frozen precipitation to be purified and then was made a 2D-PAGE electrophoresis. Separated proteins were eluted for SELDI-TOF mass spectrometry analysis. Protein profiles of all samples were analysed using BIORAD DataManagerTM software (Ver 3.5). Results. From this analysis we identified a list of differently expressed mass peaks (clusters). We noted the presence of protein spots in gel of samples ES-OSCC. No spots were found in LS-OSCC and HS samples. After a passive elution of spots, we identified the same peaks more expressed in ES-OSCC: 13512, 13509, 14168, 14041, 14040, 13649, 13652, 13,493, 10899 and 10895 m/z. The same peaks were more expressed in ES-OSCC rather than in LS-OSCC. Conclusions. Overall, our data confirm that the salivary proteome of patients with OSCC seems to be different in each stage of oral cancer progression. These data also indicate a strong association between the levels of salivary marker of 13512, 13509, 14168, 14041, 14040, 13649, 13652, 13,493, 10899 and 10895 m/z and the OSCC. For this reason, if confirmed on large series of patients, these biomarkers can be useful for a rapid and non-invasive diagnosis of the disease.

Objectives. Oral mucositis is the most severe complication of anticancer therapy. It occurs in 40-85% of patients during chemotherapy and radiotherapy but also in patients who have undergone hematopoietic stem cell transplantation. The symptoms for oral mucositis are burning and severe pain oral, spontaneous bleeding, dysphagia, dysarthria and odynophagia; especially pain and burning sensation on swallowing contribute to decreased quality of life for oncologic patients and, in severe cases, may also force the patient to feed parenterally (1). Furthermore, if the mucositis is severe it can lead to partial or complete interruption of radiotherapy before completion of the treatment protocol with consequent worsening of the prognosis (2, 3). Dentists must be familiar with the necessary intervents, in order to help the patient during the course of the treatment and prevent the interruption. Certain measures may help minimize the symptoms associated with oral mucositis; however, further research is required, focusing on lesion prevention prior to treatment initiation. To this end, it has been investigated the salivary proteome of cancer patients who developed oral mucositis, post chemotherapy and/or radiotherapy. In addition, we compared the salivary proteome of the same subjects before developing oral mucositis and immediately after the treatment for the mucositis. The analysis was made with SELDI technology. Methods. In the current study, 55 saliva samples of patients suffering from different types of cancer were analyzed. The saliva was collected in three times: before the development of mucositis, when it was diagnosed and after the resolution of this pathology. All samples were analyzed by SELDI-TOF/MS analysis. It was possible to create cluster peaks in spectra obtained using BIORAD DataManagerTM software (Ver 3.5). Results. From this analysis we identified a list of differently expressed mass peaks (clusters). We have selected some significant peaks in a range of values between 3000 m/z 15000 m/z. In particular, five were found to be differentially expressed: 3343, 3486, 3732, 4132 and 4786 m/z. The analysis of the cluster, we evaluated different patterns of peaks in the three groups; some of these were up regulated, as the peak 3732 m/z in samples pre mucositis, and down regulated, such as the 7101 m/z in the samples pre mucositis. It is noted, moreover, an important increase of the peak 4132 m/z in samples of mucositis. Conclusions. Oral mucositis is one of the most frequent complications of cancer therapies. It is, therefore, extremely important that the mucositis is prevented whenever possible, or at least treated to reduce its severity and possible complications. Knowing the salivary proteome and its variations in a state of pre mucositis, mucositis and post mucositis can be useful in order to intervene with preventive tools and better therapies. The association of the peaks 3343, 3486, 3732, 4132 and 4786 m / z, in particular the increase in expression of the peak 4132 m / z in samples of mucositis makes us think that it can be used as biomarker of this condition. Therefore, if these data will be confirmed on a larger series of patients could identify these proteins and study of targeted therapies. Furthermore, it would be helpful to understand whether these variations are associated with a particular chemotherapy and evaluate longer available cancer therapies replacement.

Background. Several options can be taken into account to treat hemangiomas; the most considered is the surgical excision, although total removal is not always possible, especially for large lesions, since vital structures can be involved. Another treatment includes the diode laser therapy. Objectives. The aim of this study was to report a clinical case of micro-invasive treatment of a large oral hemangioma in the buccal mucosa using a 900 nm diode laser. Case report. A 49-year-old female patient was referred to our sector of oral medicine reporting difficult chewing, swelling, and occasionally bleeding, from a congenital neoformation. Clinical examination revealed a dark blue and multiglobular (size 5x3 cm) lesion of the right buccal mucosa. After diascopy, loss of normal coloration in the place of the lesion was observed. After the eco-doppler evaluation, a diagnosis of congenital haemangioma was formulated, and the patient was treated by photocoagulation by diode laser at 900 nm wavelenght, and 2.5 W of power, in continuous wave mode for 90 s. Irradiation was delivered by means of a flexible quartz fiber that was kept 2-3 mm away from the lesion. Treatment was performed without topical, local, or general anesthesia, in six-monthly-sessions. All stages of treatment and healing were photographically documented. After the treatment, the lesion was blanched and visibile shrinkaged. No adverse effects (atrophy, scars, hyper- or hypopigmentation) were observed after the treatment. No intra and postoperative pain was reported by the patients. On 3-months follow-up, no recurrence was observed. Conclusions. Likewise reported by other studies, diode laser photocoagulation treatment proved to be an useful method for the treatment of oral hemangiomas. For the safety of use and the absence of intra and postoperative discomfort for patients, it would be considered a valuable tool in the treatment of large hemangiomas.

The purpose of this case is describing the treatment of a fibrous epulis (FE), the most common type of localized gingival overgrowths, with a Diode Laser. FE management involves causal periodontal treatment, surgical excision, usually performed with scalpel, and often the extraction of adjacent teeth. The Laser surgery has been proposed as a less invasive method based on the following advantages: better control of intra/post-operative pain and bleeding by coagulation, resulting in a bloodless surgical field, an excellent intra-operative visibility for the operator and an increase in surgical accuracy. A male patient of 78 years, anamnestically not reporting systemic diseases, drugs and smoke/alcohol assumption, was observed at Sector of Oral Medicine for a firm, pink and painless mass (> 1 cm) at the interdental papillae between 1.2–1.3. Clinical examination reveals a poor oral hygiene state and severe mobility of 1.2. The treatment plan consisted of extraction of 1.2, excision of the lesion and causal periodontal therapy. After superficial desensitization with application of a lidocaine 2.5% + prilocaine 2.5% cream (EMLA®), excision was performed with Diode Laser 915nm (900 LASEmaR, Eufoton, TS, Italy) according to the manufacturer’s protocols (C.M. continues, 1.5 W, 300 μm). Surgical wound healing occurred by secondary epithelialization. Excised tissue was submitted for histological examination, confirming the diagnosis. The treatment protocol showed the following advantages: a) reduced administration of anesthetic, despite the considerable lesion size, without any intraoperative pain; b) absence of significant complication (e.g hemorrhage-pain-edema-swelling-infection) in the post-operative period with complete healing process in 20 days without scaring; c) complete removal of lesion, without any recurrence at 1 year follow-up. Given the intrinsic features of Diode Laser, it is reasonable assuming that it may be an advantageous device in the surgery of soft oral tissues.

Backgroung. PG or granuloma pyogenicum is a common tumor like growth of the oral cavity that is considered to be of non-neoplastic nature, arising commonly as a result of constant low grade trauma and poor oral hygiene and in few instances because of hormonal disturbances. Since it is a benign lesion, choice of treatment is surgical excision with removal of underlying cause if any. A newer treatment modality using laser has been reported. Case report. A 16-year-old male patient reported to our sector of oral medicine with the chief complaint of intra-oral painless growth since four months. Past history and medical history did not reveal any relevant information. He was taking no medication and had no history of known drug allergy. On intra-oral examination smooth surfaced and lobulated growth of approximately 1.5 × 1 × 0.5 cm in size was present in the palate. The lesion was pedunculated and was freely movable over peduncle. The surface of the lesion showed non-omogenous red color whereas in certain area was covered by yellowish plaque like material. On palpation, growth was non-tender, nonfluctuant, hard and fibrous in consistency. Treatment plan comprising of excisional biopsy of the lesion using an Er, Cr: YSGG laser. An elliptical incision was made around the peduncle, the lesion was lifted along with the underlying periosteum from the bone surface and removed. Hemostasis was achieved with the same laser and healing was obtained for second intention. Excised specimen was preserved and sent for histopathological examination. At 7 days recall, the gingival tissues were healthy with successful healing. Conclusion. Excisional surgery is the treatment of choice for PG. The use of laser may be a valid approach for the excision of this lesion, as it is minimally invasive and offers many clinical advantages (minimal intra-operative bleeding,hemostasis, reduced times of healing).

Background. Bulkiness and unsightly scarring are very common complaints after oral cancer surgical treatment. The scar of cheek can give complications such as: reduced mouth opening or interference with mastication. Both of these complications are particularly sources of discomfort for patient and may cause additional trauma to the treated mucosa.There are several ways to reduce these complications: the most widely used is surgical excision of the scar but this treatment often requires more invasive surgery. Case report. A 58-year-old male patient, treated surgically for a carcinoma in situ in the right cheek, reported to our oral medicine sector after this excision. The patient manifested the presence of some scars in the buccal side of the cheek with reduced mouth opening, reduced mobility of the tongue and interference of scars with mastication. A laser Er, Cr:YSGG was used to reduce the effects of scars by releasing adhesions. It was used a power of 1.5 watts with a pulse duration of 740 ms, an energy of 50 mJ with a frequency of 30 pulses per second. It took three different interventions, although minor, in order to assess the actual improvement in symptoms. In none of the interventions was necessary to give stitches because haemostasis was achieved with the same laser. No drug treatment is needed, as no post-operative pain symptoms was complaining. The complete resolution of symptoms was achieved at the end of treatment. The mouth opening of the patient varied from 26 mm to 36 mm after the treatment. Conclusion. The use of laser Er,CR: YSGG may be a valid approach for the excision of scars of cheek’s mucosa, as it is minimally invasive and offers many clinical advantages (minimal intra-operative bleeding, haemostasis, reduced times of healing).

Delay in diagnosing oral squamous cell carcinoma (OSCC) can be still identified as a major cause of its high morbidity and mortality. To date, the early diagnosis for OSCC is mainly based on clinical oral examination and there is an urgent need for reliable markers; thus, advancements in molecular technologies has set the stage for investigating new markers, as well as new diagnostic matrices. The aim of the present study is to investigate the presence of proteomic signatures of OSCC in saliva and their use as potential biomarkers for early and non-invasive diagnosis. Saliva from 45 OSCC patients and 30 healthy controls was analysed by SELDI-TOF mass spectrometry and ProteinChip® technology. A supervised multivariate statistical analysis (Classification and Regression Tree - CART) was used to build models for discriminating between OSCC and controls, and between early (ES-OSCC) and late stage (LS-OSCC) cancers. The peptide with 8041 Da mass was 22-fold more expressed in OSCC, thus being a suitable potential biomarker. Classification and regression analysis allowed to build a model that was capable of correctly classifying all cancers and controls in an independent testing set, using the 8041 m/z peak as splitter. Eleven peaks were also differently expressed between ES-OSCC and LS-OSCC, but, basing on these differences, it was not possible to build an algorithm to predict tumour staging. These findings confirm that saliva proteome in OSCC patients is different from healthy controls and these variations might reflect different stages of disease progression and are worthy of further validation as diagnostic and prognostic biomarkers.

The objective of this study was to evaluate the potential role of newly developed, advanced magnetic resonance (MR) imaging techniques (spectroscopy, diffusion and perfusion imaging) in diagnosing brain gliomas, with special reference to histological typing and grading, treatment planning and posttreatment follow-up. Conventional MR imaging enables the detection and localisation of neoplastic lesions, as well as providing, in typical cases, some indication about their nature. However, it has limited sensitivity and specificity in evaluating histological type and grade, delineating margins and differentiating oedema, tumour and treatment side-effects. These limitations can be overcome by supplementing the morphological data obtained with conventional MR imaging with the metabolic, structural and perfusional information provided by new MR techniques that are increasingly becoming an integral part of routine MR studies. Incorporation of such new MR techniques can lead to more comprehensive and precise diagnoses that can better assist surgeons in determining prognosis and planning treatment strategies. In addition, the recent development of new, more effective, treatments for cerebral glioma strongly relies on morphofunctional MR imaging with its ability to provide a biological interpretation of these characteristically heterogeneous tumours. © 2009 Springer-Verlag Italia.

Several recent medical reports have focused attention on the possible application of skeletal scintigraphy imaging in odontostomatology. The aim of the present report was to assess the influence of a new implant surface on peri-implant osteoblastic activity through bone scintigraphy.Implants were placed in one healthy subject. A nuclear medicine investigation with single-photon emission-computed tomography (SPECT) was performed at 30 and 90 days after implant placement. The study was completed with acquisition of planar images of the skull in an anterior view and the use of regions of interest (ROIs) of the same size in the area corresponding to new surfaces implants and in the opposite maxilla (at the control sites). Count density ratios (counts/pixel) obtained from each ROI were used for a quantitative/relative assessment. Tomographic images were evaluated with a qualitative method.Routine planar methodology provided a direct measure of cellular activity of the examined areas. The difference in count density ratio registered from the same ROI between the first and the second scintigraphy revealed the course of peri-implant osteoblastic activity, which was very high in the first month and then declined during subsequent months.In spite of the small number of involved patients, the results obtained from this pilot study suggest that nuclear medicine investigation held advantages in oral implantology to clarify those aspects still unknown dealing with osteoblastic activity.