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Osteoradionecrosis is one of the most severe complications of radiotherapy administered for head and neck tumors. We present the first two cases of advanced and refractory mandibular osteoradionecrosis treated by application of a novel autologous cross-linked 3D serum matrix. Patients were followed clinically and radiographically up to 24 months. Complete wound healing and intact mucosal cover were achieved in both cases. At 12 months, the radiographic values showed an almost complete regeneration of the bone defect, which continued a favourable progression increased to the maximum by 24 months after surgery. The use of an autologous serum-derived scaffold proved to be a quick, predictable, cost-effective and safe adjunct to the conservative surgical treatment of this pathology.

Introduction The objective of this study was to investigate the knowledge and capabilities of dentists and dental students in their last year of study in regard to risk factors of medication-related osteonecrosis of the jaw (MRONJ) in Spain. Material and method We conducted a cross-sectional study consisting of a questionnaire survey in Asturias, Spain. The study was divided into three groups: dentists who worked for the public dental health care system (n = 32), dentists who worked exclusively as private health care practitioners (n = 136), and dental students in their last year (year five) of study (n = 38). The quantitative differences in the scores obtained in the resolution of clinical cases between students and dentists were evaluated. Differences between dentists were evaluated depending on number of years in practice, activity (private or public care), and area of specialty. The study tracked the possible differences in the general knowledge of MRONJ among dentists and students and the participants’ adherence to the dental clinic guidelines regarding the MRONJ. Results Students from year five reached a higher score than those dentists with private practice activity (P = 0.01). Significant differences between the students and the public health care dentists were not recognized, nor between the latter and the private health care dentists. The lowest percentage of correct answers among participants was related to implant surgery in patients treated with oral aminobisphosphonates. The dentists with more than 20 years of professional experience obtained significantly lower-than-average scores in the resolution of the clinical cases based on clinical guidelines (P = 0.01). We did not observe any differences in the average test scores obtained by dentists dependent on their area of expertise. Conclusions Knowledge of side effects of antiresorptive drugs decreases with years of professional practice. Training efforts on MRONJ should focus especially on those dentists who practice privately, who have over 20 years of professional experience, and who perform implant surgery on patients at risk of MRONJ.

The aim of this study was to evaluate the bioactivity of Fullcure compared to porous polyethylene implants (Medpor) in rats prior to custom-made scaffold support manufacturing for mandible segmental defects (MSD) reconstruction in sheep.Twelve Fullcure and Medpor laminaes were implanted in the left and right dorsum respectively of six wistar rats. Toxicity was assessed by skin, kidney and liver histopathology three months post-implantation. Computed Tomography (CT) was carried out in order to assess radiological differences between implants. Fullcure containers were subsequently manufactured by CAD/CAM to hold scaffold cylinders for MSD reconstruction in sheep.No statistical differences were observed in tissue response between implants. Fullcure radiodensity was higher than Medpor (P0.05). Fullcure manufactured support was successfully used for mandible repair in sheep. Nevertheless, the manufactured container did not accomplish the goal of guiding new bone formation according to the mandible shape.Fullcure showed similar biocompatibility and stronger radiodensity than Medpor. Despite its cheaper price and endless 3D-printing possibilities as scaffold holder for mandible reconstruction, further animal studies are needed to ensure Fullcure biocompatibility as implantable biomaterial.

Objective The aim of this prospective not randomized observational study was to determine the costs and outcomes of sentinel lymph node biopsy (SNB) vs elective neck dissection (END) among patients with early oral squamous cell carcinoma (OSCC). Materials and methods Seventy-three consecutive patients were divided according to neck staging method. Patients took the decision themselves after receiving detailed information of both suggested treatment tools. False negative (FN) and negative predictive value (NPV) were assessed. Log-rank test was used to compare disease-free survival (DFS) and overall survival (OS). Only direct costs were analysed. Cost information derived from volumes for hospital stay, surgery and neck outcome were obtained from an internal database of tertiary health care center. Results Thirty-two patients underwent SNB and 41 underwent an END (levels I–III). Average follow-up time was 48.2 months (range 7–80). Five neck recurrences were recorded in the SNB group (range 11–21). Seven neck recurrences occurred in the END group (range 9–16). No significant differences were found in DFS or OS. True negative patients in SNB group incurred in 42% less costs than END group. FN regardless of radiotherapy, was also lower in the SNB group. However, pN+ patients generated 23% more costs in the SNB group. Conclusion In this not randomized observational study with an average follow-up period of 48.2 months, SNB appear to confer less cost than END, with similar prognosis.

ResumenObjetivosRevisar de manera sistemática el schwannoma localizado en el suelo oral. Presentar un caso tratado en nuestro departamento.Material y métodoMediante la utilización de motores de búsqueda se identificaron artículos sobre schwannoma localizado en el suelo oral. Los criterios de inclusión fueron: a) diagnóstico definitivo de schwannoma localizado en el suelo oral; b) casos publicados en inglés, español o alemán. Se analizaron variables relacionadas con las características clínicas, diagnósticas y de tratamiento.ResultadosSe identificaron 19 artículos que cumplían los criterios de inclusión. Edad media: 44,3 años (rango 17-77); 42,1% mujeres y 57,8% hombres; tiempo de evolución de 8,7 meses (rango 1-60); tumoración localizada en el lado izquierdo del suelo oral 52,6%, en el lado derecho 42,1%; diámetro mayor medio 38,3mm (rango 10-70); afectación del nervio hipogloso 15,7%, nervio lingual 15,7%, nervio milohioideo 5,2%, no se identificó nervio de origen en el 21,1% de los casos; punción aspiración con aguja fina no diagnóstica en el 31,5% e identificación de tumoración benigna en el 21%. La exéresis quirúrgica se realizó en el 100% de los casos con un tiempo de seguimiento de 34,3 meses (rango 1-120). No se documentaron recurrencias.ConclusionesLos schwannomas localizados en el suelo de la boca son infrecuentes. Se presentan en torno a los 40 años, con leve predominancia por el sexo masculino y del lado izquierdo del suelo oral. El tiempo de evolución se encuentra próximo a los 9 meses. Usualmente asintomático. Los nervios hipogloso y lingual se afectan por igual. En proporción similar, el nervio de origen no puede ser identificado. La punción aspiración con aguja fina no es efectiva. El tratamiento de elección consiste en la enucleación del tumor una vez diagnosticado. No se documentaron recidivas.AbstractObjectiveSystematically review the oral floor schwannoma. Report of a case treated in our department.Material and methodPublished articles about oral floor schwannoma were identified. The inclusion criteria were: a) Final diagnosis of schwannoma located in the oral floor. b) Articles published in English, Spanish or German. The variables were analysed regarding clinical features, diagnosis and treatment.ResultsNineteen articles that met the inclusion criteria. Average age: 44.3 years (range 17-77); 42.1% were females and 57.8% males; time of lesion development was 8.7 months (range 1-60); side of the oral floor location: left side 52.6%, right side 42.1%; average diameter: 38.3mm (range 10-70); hypoglossal nerve involvement: 15.7%, lingual nerve: 15.7%, mylohyoid nerve: 5.2%, nerve not identified in 21.1% of cases; fine needle aspiration biopsy: non diagnostic in 31.5%, benign tumor identified 21%. Surgical excision was performed in 100% of the cases with a follow up of 34.3 months (rank 1-120). No recurrences were reported.ConclusionsSchwannomas located on the floor of the mouth are uncommon. Environment are presented at age 40 with a slight predominance for males and mainly the left. The time evolution is close to 9 months. The hypoglossal and lingual nerves are affected equally. In similar proportion the nerve of origin cannot be identified. Fine needle aspiration biopsy is not efficient. The treatment of choice is enucleation of the tumor 11 diagnosed. No recurrences were observed.

Resumen Introduccion y objetivos Los bisfosfonatos son farmacos con un amplio espectro de indicaciones cuya principal capacidad es la inhibicion de la funcion osteoclastica. En el ano 2003 se ha descrito una complicacion asociada a su empleo, la osteonecrosis de los maxilares por bisfosfonatos (ONMB). Los objetivos del presente estudio son identificar los casos recogidos de ONMB en un hospital de tercer nivel durante 8 anos, evaluando las principales variables en relacion con la enfermedad, el bisfosfonato empleado y los factores de riesgo locales o generales que pudieran actuar como desencadenante en la patogenesis de la ONMB. Material y metodo Se procedio a la seleccion los pacientes diagnosticados de ONMB en un centro de referencia para una poblacion de 1.100.000 habitantes. Las variables analizadas se dividieron en 3 grupos: pacientes, farmaco (incluyendo el analisis de la dosis aplicada y la ponderacion dosis/potencia) y osteonecrosis. Resultados Se recogieron 70 casos (44 mujeres y 26 varones), con una media de 66,8 anos. Dieciocho pacientes habian recibido un aminobisfosfonato oral y 52 por via intravenosa. El tiempo medio de administracion fue de 26,53 meses. En el 67,1% de los pacientes se pudo identificar un factor local desencadenante, siendo el mas frecuente la exodoncia (48,6%). Aunque la exposicion osea estaba presente en el 75,7% de los casos, 8 enfermos padecieron una osteonecrosis sin exposicion, manifestando la presencia de dolor y/o fistula cronica. El 58,6% experimentaron una resolucion completa con un tiempo medio de control de 16,28 meses. Conclusiones El 25% de las ONMB en nuestra serie se relacionaron con la administracion de un bisfosfonato oral, especialmente el alendronato. El acido zoledronico es el agente que menos miligramos precisa para desarrollar la enfermedad. La exposicion osea solitaria fue el dato clinico mas habitual, afectando especialmente a sectores posteriores mandibulares en pacientes con enfermedad metastasica.

Osteonecrosis of the jaws is a clinically significant complication of bisphosphonate (BP) medications. Otherwise, the effects of BPs on oral soft tissue or cells remain unknown. The main objective of the present study was to determine whether the presence of sinus mucosal thickening was significantly related to BP-related osteonecrosis of the jaw (BRONJ). A case-control study was conducted on 32 patients who underwent treatment of BRONJ with conventional radiological investigations (panoramic radiographs) and computed tomography. The results indicated that patients with BRONJ had a 5.57-fold greater probability of presenting sinus mucosal thickening than controls. Although the existence of this thickening was more common in patients with advanced-stage disease or low levels of C-telopeptide-cross-linked type I collagen, no significant difference was observed between cases and controls. While considering the limitations inherent in the design and number of cases analyzed in our study, patients with osteonecrosis of the jaw were found to have a 5.57-fold greater probability of presenting sinus mucosal thickening (>3 mm) than healthy subjects.

AIM The aim of this study was to evaluate effective bone regeneration using an autologous serum scaffold (alone or seeded with autologous bone marrow-mesenchymal stem cells, BM-MSCs), when implanted in a 30 mm length segmental mandibular defect in sheep. MATERIALS AND METHODS The bone defect was filled either with serum scaffold alone (control group; n = 5) or combined with BM-MSCs (experimental group; n = 10). Bone regeneration was determined at 12 (T12; 2 control sheep and 4 experimental sheep) and 32 weeks (T32; 3 control and 6 experimental sheep), as measured by computed and microcomputed tomography and histological examination. RESULTS Two sheep of the Experimental group died after surgery. While complete bone union in the control group was only observed at T32, it was observed both at T12 (1/4 sheep) and T32 (3/4 sheep) in the experimental group. When properties/characteristics of new bone where compared, a better bone quality, similar to native bone, was observed in the scaffold combined with BM-MSCs. CONCLUSIONS Based on these results, we conclude that the serum scaffold can promote efficient repair of large bone defects, but the combination with BM-MSCs accelerates this process, increasing significantly the amount and quality of bone formed.

Background and objectives Bisphosphonates are widely prescribed drugs whose principal capacity is inhibiting the osteoclast function. In 2003 a complication related to their administration, bisphosphonate-related osteonecrosis of the jaw (BRONJ), was described. The objectives of this study were to identify diagnosed cases of BRONJ in a third-level hospital over 8 years, evaluating the main features in relation to the disease, the bisphosphonate and the presence of local or general risk factors that could trigger the BRONJ. Methods Patients diagnosed with BRONJ in a center of reference for a population of 1 100 000 inhabitants were selected. Variables analyzed were classified into 3 groups: patients, bisphosphonate (focusing on dose and weighting dose/potency) and osteonecrosis. Results Seventy cases were studied, 44 women and 26 men, with a mean age of 66.8 years. Eighteen patients received bisphosphonates orally and 52, intravenously. The mean time of administration was 26.53 months. In 67.1% of the patients it was possible to identify a local trigger, with the most common being tooth extraction (48.6%). Bone exposure was present in 89.2% of the cases, while 12 patients developed BRONJ without exposed bone, with only pain and/or chronic sinus tracts. Complete resolution was achieved in 58.6% of the patients, with a mean time of control of 16.28 months. Conclusions 25% of the BRONJ cases were related to the administration of oral bisphosphonates, especially alendronate. Zoledronic acid was the bisphosphonate that required the fewest milligrams to induce osteonecrosis. Single bone exposure was the most common clinical finding, especially in the molar mandibular region in patients with metastatic disease.

Purpose The aims of this study were to quantify bone mineral density (BMD) and trabecular architecture of sequestra in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ) associated with dental implants and to assess if there are differences between trabecular bone in "implant loading-triggered" and "implant surgery-triggered" BRONJ. Materials and methods Bone sequestra of 2 patients diagnosed with BRONJ associated with dental implants were scanned using high-resolution microcomputed tomography (microCT). Images were obtained at a voltage of 50 kV and 800 μA, and the specimens were scanned at 180 degrees with a single rotation step of 0.3, 1-mm aluminum filter, and a pixel size of 12 μm. The morphometric parameters examined were: BMD, ratio of bone volume/tissue volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp), connectivity density (Conn.D, mm), degree of anisotropy, and the structural model index. Results BMD and BV/TV were higher in bone sequestration than in healthy bone. Tb.Sp was lower and Tb.N and Tb.Th were higher in the BRONJ group. Conn.D and Tb.N values were significantly high in implant surgery-triggered sequestrum but substantially low in sequestra caused by loading as compared with those of the control sample. Conclusions MicroCT is useful for assessing bone sequestration of BRONJ associated to dental implants. The necrotic bone is similar to that described in conventional BRONJ.

Purpose: This prospective study evaluated mandibular fracture repair after either maxillomandibular fixation (MMF) or rigid internal fixation (RIF) using the computer-assisted densitometric image analysis (CADIA) system. Patients and Methods: Fifty-two patients, 32 treated by MMF and 20 by RIF, were studied. Five postoperative panoramic radiographs were performed on each patient (immediately postoperatively and at 15, 30, 60, and 90 days) and the changes occurring in the optical density of the bone at and around the fracture line were analyzed. Results: An increase in optic density was observed in both groups at 15 days after treatment. At 30 days, a decrease in optical density was observed in both groups, being significantly greater in the MMF group. In the measurements performed at 60 days, an increased density was found in the RIF group, but the rate of optical density increase was more rapid in the MMF group. During the third month, the rates of optical density increase were similar in the 2 groups. Conclusions: The use of RIF results in more rapid bone mineralization than the use of MMF. © 2000 American Association of Oral and Maxillofacial Surgeons

Sentinel node biopsy (SNB) is considered a feasible neck staging tool in early oral squamous cell carcinoma. The aim of this study was to compare postoperative morbidity in patients who had undergone SNB and elective neck dissection (END). Seventy-three consecutive patients were included between the years 2005 and 2009. The patients were divided into two groups according to neck management: SNB and END groups. Kaplan-Meier survival analysis was used to compare disease-free survival (DFS) and overall survival (OS) between the groups. Shoulder function, length of the surgical scar, and the degree of cervical lymphoedema were assessed. Neck haematoma and the presence of oro-cervical communication were also analyzed. Thirty-two patients underwent SNB and 41 underwent an END (levels I-III). Seven regional recurrences were recorded in the END group. Three neck recurrences occurred in the SNB group. No significant differences were found in DFS or OS between the groups. There were statistically significant differences between the groups in shoulder function and average scar length. However, differences in degree of lymphoedema were not statistically significant. Neck hematomas and oro-cervical communications occurred only in the END group. From this study, it can be concluded that SNB presents less postoperative morbidity than END.

Objectives: The aim of this study is to describe and compare the evolution of recurrent bisphosphonate-related osteonecrosis of the jaws (BRONJ) in patients treated with plasma rich in growth factors or teriparatide. Material and Methods: Two different types of treatments were applied in patients diagnosed of recurrent BRONJ in a referral hospital for 1.100.000 inhabitants. In the group A, plasma rich in growth factors was applied during the surgery. In the group B, the treatment consisted in the subcutaneous administration of teriparatide. All the cases of BRONJ should meet the following conditions: recurrent BRONJ, impossibility of surgery in stage 3 Ruggiero classification and absence of diagnosed neoplastic disease. Clinical and radiographic evolution of the patients from both groups was observed. Results: Nine patients were included, 5 in group A and 4 in group B. All the patients were women on oral bis-phosphonate therapy for primary osteoporosis (5 patients) or osteoporosis-related to the use of corticosteroids (4 patients). Alendronate was the most common oral bisphosphonate associated with BRONJ in our study (four patients in group A and two in group B). The mean age was 72,8 years in the group A and 73,5 years in the group B. All the patients from group A showed a complete resolution of their BRONJ. Only one patient in the group B showed the same evolution. Conclusions: In our series, the plasma rich in growth factors showed better results than the teriparatide in the treatment of recurrent BRONJ. Key words:Osteonecrosis, oral bisphosphonate, treatment, teriparatide, plasma rich in growth factors.

Inflammatory myofibroblastic tumor (IMT) is a rare mass-forming lesion characterized by fibroblastic or myofibroblastic spindle cell proliferation with varying degrees of inflammatory cell infiltration. Although it has been reported in virtually every organ in the body, the lung is the most common site of involvement. Extrapulmonary IMTs, although rare, have been reported and are characterized by different, more aggressive behavior. We report an extremely rare case of maxillary metastases of pulmonary IMT. Lung IMT was initially misdiagnosed, and oral lesion mimicked clinically and radiologically a radicular cyst. On histologic examination, cells exhibited diffuse and intense immunoreactivity forα-smooth muscle actin and vimentin whereas both pulmonary and oral IMTs presented absence of cellular atypia and lack of expressivity of oncogenic determinants. Distant metastases of lung IMT are extremely unusual, and this is the first report to our knowledge with this particular clinical course. Despite the possibility that the present case could also represent a metachronous multifocal IMT, with pulmonary and extrapulmonary lesions, similar histopathological and immunohistochemical patterns in lung and maxillary region suggest a metastatic course.

Merkel cell carcinoma (MCC) was first described in 1972 by Toker, who described five cases of the so-called "trabecular carcinoma of the skin". MCC is a rare, aggressive skin cancer that affects mainly the elderly. Sun exposed areas are mainly affected, specially the head and neck. Immunohistochemical analysis is essential to reach a correct diagnosis. According to the origin of MCC, the tumor expresses both epithelial and neuroendocrine markers. MCC has a propensity for recurrence, regional and distant metastases. Several treatment options are available, such as surgical excision or Moh's surgery, accompanied by neck dissection or radio and chemotherapy in advanced cases. The present study aims to evaluate the clinical behaviour and the evolution of five cases of this disease that were treated at our institution (reference to 1100000 inhabitants) in the last five years. It is stressed on the bad prognosis of this pathology, which presents high rates of locoregional recurrence, even though the recent advances in radio and chemotherapy. © Medicina Oral S. L.

Major salivary gland absence is a rare disorder. The cause of congenital absence of the salivary glands has not been determined, but it may be associated with ectodermal defects of the first and second branchial arches. Isolated absence of a unilateral submandibular gland is an unusual entity with less than ten cases reported in the literature. The etiopathogenesis of isolated absence of a major salivary gland without other developmental anomalies is still unclear. The formation of a sialolith within the remaining Wharton?s duct, associated with isolated aplasia (versus atrophy) of a unilateral submandibular gland has been recently reported. We describe in this work two cases of sialolithiasis within the ipsilateral remaining Wharton´s duct in patients with isolated absence of a unilateral submandibular gland. In the cases reported, absence of the submandibular gland may have been the result of the complete acinar atrophy secondary to an early obstruction of Wharton´s duct.

Osteopetroses represent a heterogeneous group of rare, hereditary bony dysplasias. They range from a devastating neurometabolic disease (including severe malignant infantile osteopetrosis) to 2 more benign conditions principally affecting adults: autosomal dominant osteopetrosis (ADO) type I and type II. The present study describes the maxillofacial manifestations associated with the 2 subgroups of ADO. In this paper, we present the oldest patient described in the literature with ADO type I (76 years old). We also document the first ADO type II patient described in the literature with synchronic osteomyelitis of the mandible and the maxilla.

Merkel cell carcinoma (MCC) is a very aggressive primary cutaneous neoplasm most often occurring on the head and neck of the elderly. Spontaneous regression of MCC was first described in 1986. A 79-year-old woman with MCC on the right cheek underwent spontaneous regression of the malignancy, documented by photographic follow-up, computed tomography, and histologic studies. A review of the literature is presented. Complete clinical and histologic regression of MCC was observed in the present case. Although the literature documents 11 similar cases, only 6 can be regarded as complete spontaneous regressions following exclusive performance of a biopsy (primary complete spontaneous regression). Primary complete spontaneous regression of MCC is infrequent, and most case reports describe this phenomenon in women with MCC on the cheek. The reasons underlying regression are unknown.

Complications of intracranial placement of a nasogastric tube in patients with complex facial and skull base fractures are infrequent, though the associated morbidity and mortality are high. In such situations some authors advocate craniotomy to allow removal of the tube in several linear segments under direct visualization. Others advise tube removal nasally under antibiotic coverage. We present a case of complex craniofacial fracture in which a nasogastric tube was positioned intracranially 48 hours after admission. The tube was quickly removed through the nose, and the patient was discharged without neurologic problems.

1. Little JW, Falace DA: Dental Management of the Medically Compromised Patient (ed 4). St Louis, MO, Mosby-Year Book, 1993, pp 413438 2. Stern NS, Catone GA: Primary fibrinolysis after oral surgery. J Oral Surg 3349, 1975 3. Falace DA, Kelly DE: Disseminated intravascular coagulation and fibrinolysis as a cause of postextraction hemorrhage. Oral Surg 41:718, 1976 4. McKechnie J: Prostatic carcinoma presenting as a haemorrhagic diathesis after dental extraction. Br Dent J 166:295, 1989 5. Chishiro T: A case of disseminated intravascular coagulation thought to be caused by tooth extraction in the hypercoagulable condition due to abdominal aortic aneurysm. Nipp Naika Gakkai Zasshi 78:1777, 1989 6. Marshall DAS, Berry C, Brewer A: Fatal disseminated intravascular coagulation comphcating dental extraction. Br J Oral Maxillofac Surg 31:178, 1993 7. Herold J, Falworth MA: Disseminated intravascular coagulopathy presenting as a bleeding tooth socket. Br Dent J 177:21, 1994 8. Lee GR, Bithell TC, Foerster J, et al: Wintrobe’s Clinical Hematology (ed 9). Philadelphia, PA, Lea & Febiger, 1993, pp 1480-1493 9. Litt MR, Bell WR, Lepor IIA: Disseminated intravascular coagulation in prostatic carcinoma reversed by ketoconazole. JAMA 258:1361,1987 10. Martinez JFT, Redondo MDT, Silva LA, et al: Disseminated intravascular coagulation in prostatic carcinoma reversed by antiandrogenic therapy. JAMA 260:2507, 1988 11. Catrambone R, Pfeffer RC: Significant postoperative hemorrhage following biopsy of a prostate tumor metastatic to the mandibular condyle: Report of a case. J Oral Maxillofac Surg 48:858, 1990 12. Cooper DL, Sandler AB, Wilson LD, et al: Disseminated intravascular coagulation and excessive fibrinolysis in a patient with metastatic prostate cancer. Cancer 70:656, 1991 13. Goldenberg SL, Fenster NH, Perler 2, et al: Disseminated intravascular coagulation in carcinoma of prostate: role of estrogen therapy. Urology 22:130, 1983 14. Roseman B: Disseminated intravascular coagulation: A review. Oral Surg Oral Med Oral Path01 59:551,1985 15. Mehra P, Caiazzo A, Cataudella J: Disseminated intravascular coagulation associated with parotitis: A case report and review. J Oral Maxillofac Surg 55:1478, 1997

Background and objectives: Biocompatibility is a prerequisite for any substance to be used as an implant material, and potential biomaterials need to be characterized by histological evaluation of tissue responses. FullCure is an acrylic photopolymer with transparent appearance, manufactured by the Objet Company, used in 3-Dimensional Printing Systems for the manufacturing of stereolithography prototypes. Methods: The purpose of this study was to evaluate the bioactivity of FullCure compared to porous polyethylene implants (MedporR). To this end, tissue responses to both substances were evaluated in an animal model. Twelve FullCure laminae were applied on the right side of the dorsum of wistar rats (n= 6). In the same animals but in the left half was placed MedporeR. Responses and biocompatibility were assessed by histopathologic and histomorphometric evaluation at 3 months post-implantation. Results: FullCure showed marked biocompatibility. The implants were well integrated into the tissues: newly formed collagen bands were observed inside the implants and no granulomas were detected. FullCure implants showed a low inflammatory cell infiltration, without significative differences with respect to Medpor implants. Conclusions: FullCure is a biocompatible product that can be considered for use as a material implant in maxillofacial region. Further investigation is required to assess its long-term efficacy and safety.

Purpose Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a clinically significant complication of bisphosphonates (BP). The purpose of this study was to investigate whether BP induces alterations in sinus mucosa and concerning clinical symptoms and imaging features may presage development of BRONJ. Material and methods This retrospective study included 32 patients referred to the Maxillofacial Department of the tertiary centre with a diagnosis of BRONJ. The patient had to confirm the definition of BRONJ as defined by the AAOMS (Ruggiero et al., 2009). Indication for bisphosphonate therapy, type, dose, frequency, therapy duration and discontinuation, primary disease, comorbidities, and dental history were collected and analysed along with BRONJ signs, symptoms, location, stage, treatment, evolution and radiographic data. Special notice was given as to whether or not there was any involvement of the maxillary sinus (sinusitis or mucosal thickening) during the disease. All 32 patients with BRONJ underwent orthopantomography and Computed Tomography (CT). Results A total of 32 patients suffering from BRONJ were identified. Ten male and 22 female, and their age ranged from 47 to 89 years (mean: 69.03; 95% CI: 65.3–73.5). Indications of BPs were breast carcinoma (five cases, 15.6%), multiple myeloma (seven cases, 21.9%), prostate cancer (five cases, 15.6%), kidney cancer (two cases, 6.3%), cervix cancer (one case, 3.1%) and osteoporosis (12 cases, 37.5%). Sinus involvement was observed in CT in 20 patients (62.5%). Seven of the 20 patients with sinus involvement had homolateral maxillary BRONJ, but we found a thickening of the mucosa of the maxillary sinus in 13 patients (40.6%) without affecting of the underlying bone. These patients had BRONJ areas in the jaw or contralateral maxilla. Three of them had bilateral sinus involvement with BRONJ located in the left maxilla. Conclusions BRONJ patients have a high percentage of involvement of the mucosa of the maxillary sinuses.

Introduction Oncocytic carcinoma is a rare proliferation of cytomorphologically malignant oncocytes mainly found in glandular tissue, accounting for 0.5% of all epithelial salivary gland malignancies and 0.18% of all epithelial salivary gland tumors. Case presentation We report a case of oncocytic carcinoma arising in the parotid gland of a 65-year-old Caucasian man. Our patient initially underwent left superficial parotidectomy, including the removal of the mass. A close follow-up was made, and four years after first surgery cervical lymph node metastases were confirmed. Therefore, a complete parotidectomy and radical neck dissections were performed. There were no complications and no sign of recurrence after six months of follow-up. Conclusion Oncocytic carcinoma is an extremely rare malignancy in the salivary glands. Prophylactic neck dissection may be indicated for tumors larger than 2 cm in diameter (our patient's tumor was 2.5 cm at its greatest diameter). The clinical course of our patient, with the appearance of cervical lymph node metastases after four years of follow-up, supports this approach. Further investigation of the prognosis and correct treatment of patients with oncocytic carcinoma are required as more cases are reported.