Removal of Supernumerary Teeth Utilizing a Computer-Aided Design/Computer-Aided Manufacturing Surgical Guide

Publication date: Available online 12 November 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Chanwoo Jo, Doohwan Bae, Byungho Choi, Jihun Kim
Supernumerary teeth need to be removed because they may cause various complications. Caution is needed because their removal may cause damage to the permanent teeth or tooth germs in the local vicinity. Surgical guides have recently been used in maxillofacial surgery. Because surgical guides are designed through preoperative analysis by computer-aided design software, and are fabricated by using a three-dimensional printer applying computer-aided manufacturing technology, they increase the accuracy and predictability of surgery. We report two cases of removal of mesiodens—one from a child and one from an adolescent—by utilizing a surgical guide; they would have been difficult to remove with conventional surgical methods.



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What is the evidence for genetics in chronic rhinosinusitis?.

Purpose of review: To perform analysis of evidence in current literature on the topic of genetics and chronic rhinosinusitis (CRS), with a particular focus on recent findings in the cystic fibrosis transmembrane regulator (CFTR), genes associated with primary ciliary dyskinesia, and taste receptor T2R38. Other genes that have been found to have association with CRS are also presented and discussed. Recent findings: Recent studies in CFTR and CRS research have investigated possible CFTR-potentiators for treatment of refractory CRS. The T2R38 gene has been shown to be applicable in the clinical setting with a testable phenotype and may have a role in the prognosis and influencing management strategies of CRS patients. Many genes of the immune system have been studied, with genome-wide association studies and candidate-gene approaches identifying new associations that will need replication and further elucidation. Summary: CRS is a multifactorial disease, with strong evidence of a genetic component in its pathophysiology for some cases. Currently, there are over 70 genes that have been genetically associated with CRS in the past 15 years. Future investigations into genetic causes and predispositions of CRS may allow for improved prognostication and development of disease-prevention strategies as well as novel therapeutic targets. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Sinonasal methicillin-resistant Staphylococcus aureus: updates on treatment.

Purpose of review: Over the past two decades, the management of methicillin-resistant Staphylococcus aureus (MRSA) in chronic rhinosinusitis has posed significant challenges. This document reviews current management techniques and novel treatment modalities for sinonasal MRSA infections. Recent findings: Topical antibiotic therapy, that is, drops (ofloxacin) and ointments (mupirocin) as off-label use for the management of MRSA chronic sinusitis, has shown beneficial results. Other more recently trialed nonantibiotic modalities such as antimicrobial photodynamic therapy and colloidal silver irrigation are also showing promise. Summary: Sinonasal MRSA is considered to be associated with recalcitrant chronic sinusitis. Advancements in systemic and local antibiotics in its management have been slow and unsatisfactory. Attention is shifting to the use of nonantibiotic antibacterial treatments. Knowledge of these options is critical to improve the overall management of these chronic patients. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Comprehensive management of hereditary hemorrhagic telangiectasia.

Purpose of review: Hereditary hemorrhagic telangiectasia (HHT), or Osler Weber-Rendu disease, is a rare inherited disorder of fibrovascular tissue affecting various organs. Epistaxis is the most common symptom of HHT but as the disease affects multiple organs, a multisystem and multidisciplinary approach to management is required. The purpose of this article is to provide an overview of the multidisciplinary approach to HHT for the otolaryngologist and to discuss the current pharmacologic and procedural treatment options available for HHT-related epistaxis. Recent findings: Multidisciplinary expert guidelines have better defined what screening tests are advised for the multisystem evaluation of the HHT patient. New pharmacologic therapies including bevacizumab (Avastin) used submucosally or topically have shown promise as in-office treatment modalities. Sclerotherapy of telangiectasia, including in-office applications, has recently proven safe and effective. Summary: HHT remains a difficult disease to treat. Being aware of the common organ systems involved by the disease will help the practicing otolaryngologist to ensure the patient receives appropriate multidisciplinary care. For HHT-related epistaxis, new medical and surgical options allow for a wider range of treatments than were previously available. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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The evidence for olfactory training in treating patients with olfactory loss.

Purpose of review: The purpose of this review is to go over the only therapy for olfactory loss supported by level 1a evidence that is currently available, which is olfactory training. This therapy is widely underutilized and has the potential to help many patients with olfactory dysfunction who are otherwise offered no management options. Recent findings: We will review the rationale, clinical studies, and quality of the evidence regarding olfactory training, specifically the olfactory system's inherent ability to regenerate, the plasticity of the system, and the multiple protocols and modifications of protocols present in the literature. Summary: Olfactory training is an effective therapy for some patients suffering from olfactory loss, and, while we do not yet know the optimal duration or number of odorants or exact patient population it may be most beneficial for, as an extremely easy, self-driven therapy with no significant side-effects, it should be consistently offered to this patient population. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Systematic review and individual patient data analysis of pediatric head and neck squamous cell carcinoma: An analysis of 217 cases

Publication date: Available online 12 November 2016
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): V. Bhanu Prasad, Supriya Mallick, Ashish Dutt Upadhyay, G.K. Rath
IntroductionPediatric head and neck Squamous cell carcinoma (PHNSCC) is a rare disease. The optimum treatment and outcome remains poorly understood because of rarity.MethodsWe conducted an individual patient data analysis of PHNSCC. Two authors independently searched PubMed, google search, and Cochrane library for eligible studies using following search words: Pediatric Head and neck squamous cell carcinoma, Head and neck squamous cell carcinoma under age of 20, Head and neck squamous cell carcinoma in young, PHNSCC till June 1, 2016 published in English language.ResultsTotal of 217 patients of PHNSCC were found in the literature. Median age among the cohort was 15 years (Range: 0–20 years) with a clear male preponderance. Oral cavity tumors were commonest 75 (70%) followed by laryngeal neoplasms 16(15%). Median disease free survival was 9 months (Range: 0–216 months). Median overall survival was 48 months (Range: 1–216 months). In univariate analysis treatment modality had significant impact on disease free survival (DFS). Whereas, patients treated with Surgery, Laryngeal primary had significantly better OS. Patients with associated fanconis anemia had significantly worse overall survival (OS).ConclusionPHNSCC is a rare disease with poorer outcome. Associated DNA defects leads to poorer OS. Patients treated with surgery alone or surgery followed by adjuvant radiation had better DFS and OS. Molecular profiling and personalized therapy may improve survival with limited toxicity.



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A pearl in the ear: Intracranial complications of pediatric cholesteatomas

Publication date: Available online 12 November 2016
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Krystyne Basa, Jessica R. Levi, Erin Field, Robert C. O'Reilly
A nine-year-old male had a cholesteatoma of the mastoid and middle ear found incidentally after myringotomy tube placement. Associated asymptomatic sigmoid plate dehiscence with sinus invasion or thrombosis and ossicular chain destruction complicated his case. He had canal wall down tympanomastoidectomy and was followed for 4.5 years. Disease recurrence necessitated revision. Our case highlights an unusual clinical presentation, possible complications, and the aggressive quality of a benign lesion common in the pediatric population. To our knowledge, this is the first report of an asymptomatic lateral sinus obstruction secondary to an invasive cholesteatoma in this population.



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A review of acute postoperative sialadenitis in children

Publication date: Available online 12 November 2016
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Michael T. Yim, Yi-Chun C. Liu, Julina Ongkasuwan
ObjectiveAcute postoperative sialadenitis is a previously described rare entity that has occurred following general anesthesia and has also been associated with prolonged neurosurgical procedures. We aim to better characterize this entity while performing a literature review regarding potential etiologies, diagnosis, airway management and treatment options.MethodsA retrospective chart review was performed at a pediatric tertiary care center from 2000 to 2014. Charts were selected for the study utilizing an ICD-9 diagnosis of sialadenitis occurring within two weeks of a surgical procedure. Data including age, gender, medical history, preoperative diagnosis, operation length, time to symptom onset, and subsequent management were collected. An additional literature review was performed focusing on reports of post-operative acute sialadenitis involving airway compromise.Result244 charts were reviewed and 4 patients met inclusion criteria. The average time to symptom onset was 4.3 days (range 1 h–12 days) following conclusion of the surgical procedure. Symptoms ranged from mild inflammation of the parotid gland to rapid swelling of the neck necessitating intubation. All patients were treated with standard sialadenitis treatment including hydration, antibiotics, and airway management as needed.ConclusionTo our knowledge this is the first case series reviewing this entity specifically within the pediatric population. There appears to be two distinct categories of postoperative sialadenitis; one of which presents very acutely and results in massive neck swelling and airway compromise. It is important for practicing Otolaryngologists to be aware of this potentially life-threatening complication in the immediate postoperative period.



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Tooth loss early in life suppresses neurogenesis and synaptophysin expression in the hippocampus and impairs learning in mice

Publication date: February 2017
Source:Archives of Oral Biology, Volume 74
Author(s): Kin-ya Kubo, Chika Murabayashi, Mika Kotachi, Ayumi Suzuki, Daisuke Mori, Yuichi Sato, Minoru Onozuka, Kagaku Azuma, Mitsuo Iinuma
ObjectiveTooth loss induced neurological alterations through activation of a stress hormone, corticosterone. Age-related hippocampal morphological and functional changes were accelerated by early tooth loss in senescence-accelerated mouse prone 8 (SAMP8). In order to explore the mechanism underlying the impaired hippocampal function resulting from early masticatory dysfunction due to tooth loss, we investigated the effects of early tooth loss on plasma corticosterone levels, learning ability, neurogenesis, and synaptophysin expression in the hippocampus later in life of SAMP8 mice.DesignWe examined the effects of tooth loss soon after tooth eruption (1 month of age) on plasma corticosterone levels, learning ability in the Morris water maze, newborn cell proliferation, survival and differentiation in the hippocampal dentate gyrus, and synaptophysin expression in the hippocampus of aged (8 months of age) SAMP8 mice.ResultsAged mice with early tooth loss exhibited increased plasma corticosterone levels, hippocampus-dependent learning deficits in the Morris water maze, decreased cell proliferation, and cell survival in the dentate gyrus, and suppressed synaptophysin expression in the hippocampus. Newborn cell differentiation in the hippocampal dentate gyrus, however, was not affected by early tooth loss.ConclusionThese findings suggest that learning deficits in aged SAMP8 mice with tooth loss soon after tooth eruption are associated with suppressed neurogenesis and decreased synaptophysin expression resulting from increased plasma corticosterone levels, and that long-term tooth loss leads to impaired cognitive function in older age.



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Tooth loss early in life suppresses neurogenesis and synaptophysin expression in the hippocampus and impairs learning in mice

Publication date: February 2017
Source:Archives of Oral Biology, Volume 74
Author(s): Kin-ya Kubo, Chika Murabayashi, Mika Kotachi, Ayumi Suzuki, Daisuke Mori, Yuichi Sato, Minoru Onozuka, Kagaku Azuma, Mitsuo Iinuma
ObjectiveTooth loss induced neurological alterations through activation of a stress hormone, corticosterone. Age-related hippocampal morphological and functional changes were accelerated by early tooth loss in senescence-accelerated mouse prone 8 (SAMP8). In order to explore the mechanism underlying the impaired hippocampal function resulting from early masticatory dysfunction due to tooth loss, we investigated the effects of early tooth loss on plasma corticosterone levels, learning ability, neurogenesis, and synaptophysin expression in the hippocampus later in life of SAMP8 mice.DesignWe examined the effects of tooth loss soon after tooth eruption (1 month of age) on plasma corticosterone levels, learning ability in the Morris water maze, newborn cell proliferation, survival and differentiation in the hippocampal dentate gyrus, and synaptophysin expression in the hippocampus of aged (8 months of age) SAMP8 mice.ResultsAged mice with early tooth loss exhibited increased plasma corticosterone levels, hippocampus-dependent learning deficits in the Morris water maze, decreased cell proliferation, and cell survival in the dentate gyrus, and suppressed synaptophysin expression in the hippocampus. Newborn cell differentiation in the hippocampal dentate gyrus, however, was not affected by early tooth loss.ConclusionThese findings suggest that learning deficits in aged SAMP8 mice with tooth loss soon after tooth eruption are associated with suppressed neurogenesis and decreased synaptophysin expression resulting from increased plasma corticosterone levels, and that long-term tooth loss leads to impaired cognitive function in older age.



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Mitotic rate correlates with sentinel lymph node status and outcome in cutaneous melanoma greater than 1 millimeter in thickness: A multi-institutional study of 1524 cases

The 7th edition of the TNM American Joint Committee on Cancer classification incorporates mitotic rate (MR) only for primary cutaneous melanoma (PCM) with Breslow thickness (BT) ≤1 mm.

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Influence of bioactive particles on the chemical-mechanical properties of experimental enamel resin infiltrants

Abstract

Objective

This study aimed at evaluating the chemophysical properties of experimental resin infiltrants (ERIs) doped with different bioactive particles.

Methods

A control resin infiltrant (CR) was formulated using triethylene glycol dimethacrylate (TEGDMA) and ethoxylated bisphenol A dimethacrylate (BisEMA). Moreover, five experimental ERIs were also created by incorporating the following bioactive fillers (10 wt%) into the CR: hydroxyapatite (Hap), amorphous calcium phosphate (ACP), zinc-polycarboxylated bioactive glass (BAG-Zn), bioactive glass 45S5 (BAG 45S5), and calcium silicate modified with beta tricalcium phosphate (β-TCP). ICON® resin infiltrant was also used as control. All the ERIs used in this study were assessed for degree of conversion (DC), Knoop microhardness (KHN), softening ratio (SR), tensile cohesive strength (TCS), modulus of elasticity (E-modulus), water sorption (WS), and solubility (SL). Data were subjected to ANOVA and Tukey's test (α = 5%).

Results

ICON® presented the lowest DC, KHN, TCS, E-modulus, and SR. Incorporation of bioactive fillers into CR caused significant increase in the KHN. Conversely, no significant effect was observed on DC, TCS, and E-modulus. The resin infiltrant containing Hap showed a significant increase in softening ratio, while, ICON® presented the highest WS and SL. The WS of ACP-doped resin infiltrant was significantly higher than that of the Hap-doped infiltrant. The SL of the ACP-doped infiltrant was higher than CR BAG-Zn or BAG 45S5.

Conclusion

The incorporation of bioactive particles into experimental resin infiltrants can improve the chemomechanical properties and reduce water sorption and solubility.

Clinical relevance

Resin infiltrants doped with bioactive particles may improve the long-term performance of the treatment of white-spot lesions.

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Premature exposure of dental implant cover screws. A retrospective evaluation of risk factors and influence on marginal peri-implant bone level changes

Abstract

Objectives

The objectives of this study were to identify risk factors associated with the premature cover screw exposure (pCSE) at dental implants and to evaluate the influence of a pCSE on peri-implant marginal bone level (MBL) change compared to non-exposed implants.

Materials and methods

Retrospective data assessment from 165 patients (mean age = 54.0 ± 14.4 years) who received 395 submerged implants included demographic, health-related, and therapeutic variables which were analyzed for their respective impact. MBL change was detected at digital radiographs obtained from first- and second-stage surgeries.

Results

pCSE were detected in 43 patients (26.1%) and 53 implants (13.4%). An increased frequency of exposure was significantly associated with (I) male gender (p = 0.012) at patient level and (II) the posterior region of the jaws (p = 0.005), implant systems with platform-matching cover screws, and a vertical distance of ≥0.5 mm between bone crest and the implant platform (both p < 0.001) at implant level. The decrease in mesial, distal, and total MBL differed significantly (mean total = 0.8 ± 0.7 vs. 0.3 ± 0.5; mean mesial = 0.8 ± 0.8 vs. 0.3 ± 0.6; mean distal = 0.8 ± 0.8 vs. 0.3 ± 0.6 mm; p < 0.001) between non-exposed and pCSE implants.

Conclusions

Male patients, implants with platform-matched cover screws, or when placed supracrestally or in posterior sites revealed significantly more pCSE, resulting in significantly decreased peri-implant MBL compared with non-exposed implants.

Clinical relevance

Patients with an enhanced risk of pCSE should follow frequent regular recalls during the healing period to enable for early diagnosis and intervention.

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Evaluation of peri-implant bone metabolism under immediate loading using high-resolution Na 18 F-PET

Abstract

Objective

This study aimed to examine the influence of immediate loading on the dynamic changes of bone metabolism around dental implants using a high-resolution semiconductor sodium ¹⁸F-fluoride (Na¹⁸F)-PET.

Methods

Tibiae of 12 adult male rats were divided into 4 groups: immediate loading (IL), no loading (NL), bone defect (BD), and control (CTR). For the IL group, a 4.0-N load was applied continuously by two closed-coil springs attached between two implants in tibia. Each rat received an intravenous injection of Na¹⁸F and was scanned by high-resolution Na¹⁸F-PET at day 1 and then at weeks 1, 2, 3, 4, 5, 6, and 8 after surgery. Bone metabolism around the implant was evaluated by standardized uptake value (SUV), which indicates the outcome of Na¹⁸F accumulation. CT scanning was also performed, and PET and CT images were superposed to determine the anatomical orientation in PET images.

Results

Bone metabolism peaked at 7 days after surgery and then gradually decreased in all three test groups (IL, NL, and BD). SUVs of all three test groups were significantly higher than the baseline at 1, 2, 3, and 4 weeks after surgery, with SUVs in the IL group returning to baseline levels earlier than those in the NL and BD groups.

Conclusions

Fluorine integrates preferentially with the initial low-calcified bone; thus, our results suggest that immediate loading promotes the calcification of the bone tissue in the early stage on peri-implant bone formation.

Clinical relevance

Na¹⁸F-PET allows for an estimate of bone metabolism change around the implant.

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Axiographic results of CAD/CAM-assisted microvascular, fibular free flap reconstruction of the mandible: A prospective study of 21 consecutive cases

Virtual planning and guided reconstruction of the mandible following ablative surgery have become standard procedures in reconstructive surgery. Many advantages regarding operation time, morphology, bony fit, and consolidation have been described, but analyses of the functional outcome of virtually planned mandibular reconstructions are lacking. We prospectively analyzed 21 consecutive cases of mandibular reconstructions using CAD/CAM-assisted microvascular, fibular free flaps in operations between July 2014 and January 2016 at a single center.

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Uncovering potential key genes associated with the pathogenesis of asthma: A microarray analysis of asthma-relevant tissues

Publication date: Available online 11 November 2016
Source:Allergologia et Immunopathologia
Author(s): Y. Guan, X. Jin, X. Liu, Y. Huang, M. Wang, X. Li
BackgroundThe present study aimed to discover more potential genes associated with the pathogenesis of asthma.MethodsThe microarray data of GSE67940 was downloaded from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were identified in bronchial alveolar lavage cells from patients with mild-moderate asthma (notSA) and severe asthma (SA) compared with normal controls (NC), respectively. Functional and pathway enrichment analysis, protein–protein interaction (PPI) network analysis were performed upon the identified up- and down-regulated DEGs. Besides, the gene association network based on the common up-regulated and down-regulated genes was generated and transcriptional regulatory pairs of overlapping DEGs in the PPI network were identified.ResultsA total of 104 DEGs (30 up- and 74 down-regulated genes) were identified in notSA vs. NC. Additionally, 2796 DEGs were screened out in SA vs. NC group, including 320 up-regulated DEGs, and 135 down-regulated DEGs. Specially, 41 overlapping DEGs were screened out in notSA vs. NC and SA vs. NC, including 16 common up-regulated genes and 25 common down-regulated genes. No pathways were enriched by the DEGs in notSA vs. NC. DEGs in SA vs. NC were associated with cytokine–cytokine receptor interaction. VEGFA was a hub protein in both the PPI networks of DEGs in notSA vs. NC and SA vs. NC. Gene association network showed that signalling pathways and cytokine–cytokine receptor interaction were involved in. The overlapping VEGFA, and IFRD1, and ZNF331 were regulated by more TFs.ConclusionGenes such as VEGFA, and IFRD1, and ZNF331 may be associated with pathogenesis of asthma.



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Analysis of debrided and non-debrided invasive squamous cell carcinoma skin lesions by in vivo reflectance confocal microscopy before and after therapy

Abstract

Hyperkeratosis hinders the application of reflectance confocal microscopy (RCM) to image squamous cell carcinoma (SCC). Not all lesions with SCC show hyperkeratosis, and these lesions can be directly imaged. However, lesions with hyperkeratosis can be treated by debriding the hyperkeratotic surface for further imaging. RCM was used to investigate patients with suspected SCC. Lesions without obvious keratosis underwent direct RCM examinations. Lesions with obvious keratosis were treated by debriding the hyperkeratotic surface. The following main RCM criteria were used to diagnose invasive SCC: atypical keratinocytes arranged in nests, islands, and disarrangement patterns; an atypical honeycomb pattern; the absence of a cobblestone pattern; and non-edged dermal papillae. Other characteristics of invasive SCC observed by confocal microscopy included keratin pearl structures, hyperkeratosis, and inflammatory cell infiltration. During the follow-up period after treatment, both the cobblestone pattern and edged dermal papillae were as important as the typical honeycomb pattern in suggesting a normal skin structure. Our findings indicate RCM is a valuable tool to noninvasively examine the histology of invasive SCC before and after therapy.

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Editorial Board

Publication date: December 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 122, Issue 6





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Information for Readers

Publication date: December 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 122, Issue 6





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Society Page

Publication date: December 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 122, Issue 6





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Tradition vs Evolution

Publication date: December 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 122, Issue 6
Author(s): Pedro Franco




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Contents

Publication date: December 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 122, Issue 6





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Tooth autotransplantation in the anterior maxilla and mandible: retrospective results in young patients

Publication date: December 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 122, Issue 6
Author(s): Marjolijn Gilijamse, Jacobus A. Baart, Jan Wolff, George K. Sándor, Tymour Forouzanfar
ObjectiveThis retrospective study evaluated survival rates, prognosis, and overall success of autotransplanted teeth in young patients missing anterior teeth as a result of trauma, agenesis, or developmental disturbances.Study DesignRetrospective data were collected from the medical records of patients who had undergone tooth autotransplantations to anterior sites between January 2001 and December 2012. Clinical variables, such as gender, age, surgical indications, donor and recipient sites, type of anesthetics, bone augmentation, and complications during follow-up, were assessed.ResultsA total of 59 donor teeth in 46 patients (30 boys and 16 girls; average age 12.15 years) were autotransplanted to the anterior region of the maxilla and mandible. After a mean follow-up period of 17.35 months (range 10-61 months), all of the transplanted teeth remained in situ with no complications.ConclusionsThis study supports the autotransplantation of teeth to the anterior alveolus as a viable option suitable in growing patients with missing anterior teeth.



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Effect of length, diameter, intraoral location on implant stability

Publication date: December 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 122, Issue 6
Author(s): Kyle Shiffler, David Lee, Mark Rowan, Tara Aghaloo, Joan Pi-Anfruns, Peter K. Moy
ObjectivesTo quantitatively compare stability of dental implants with varying lengths, diameters, and intraoral locations.Study DesignRetrospectively, 200 consecutive NobelReplace Tapered Groovy implants of varying lengths and diameters were evaluated via implant stability quotient readings at placement (T1) and follow-up (T2). Data were analyzed by analysis of variance and simple linear regression tests.ResultsIntraoral location was statistically significant at T1 and T2. Although implant diameter was not statistically significant, implant length resulted in T1 (P = .08) and T2 (P = .09), which may have a clinically relevant effect on implant stability. An overall implant survival rate of 98% was achieved. Gender and age did not seem to affect implant stability quotient values at placement, follow-up, or implant survival.ConclusionsIntraoral location is an important factor in implant stability, with implants placed in the mandible being more stable than implants placed in the maxilla both at T1 and T2. Length may have a clinically relevant effect on implant stability.



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AAOM Clinical Practice Statement

Publication date: December 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 122, Issue 6





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Acknowledgment of Reviewers

Publication date: December 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 122, Issue 6





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Hypoxia-induced epithelial-mesenchymal transition is regulated by phosphorylation of GSK3-β via PI3 K/Akt signaling in oral squamous cell carcinoma

Publication date: December 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 122, Issue 6
Author(s): Takeshi Kaneko, Hironari Dehari, Takanori Sasaki, Tomohiro Igarashi, Kazuhiro Ogi, Jun-ya Okamoto, Mayumi Kawata, Jun-ichi Kobayashi, Akihiro Miyazaki, Kenji Nakamori, Hiroyoshi Hiratsuka
ObjectiveEpithelial–mesenchymal transition (EMT) plays an important role in cancer invasion and metastasis induced by hypoxia. Here, we examined whether phosphorylation of GSK3-β via phosphoinositide 3-kinase (PI3 K)/Akt signaling is involved in enhancing the hypoxia-induced EMT in oral squamous cell carcinoma (OSCC).Study DesignExperiments were performed in OSCC cell lines (HSC-2, HSC-3, HSC-4, SAS, and HO-1-U-1) under normoxic or hypoxic conditions. The EMT was assessed by Matrigel invasion assays and wound healing assays. OSCC cell lines (HSC-2 and HSC-4) overexpressing hypoxia-inducible factor (HIF)-1α were established to examine the effects of HIF-1α on EMT-related factors. Immunohistochemical staining was performed to examine phosphorylation of GSK3-β in 33 cases of tongue squamous cell carcinoma.ResultsUnder hypoxic conditions, OSCC cell lines exhibited HIF-1α expression and showed evidence of the EMT. In cells overexpressing HIF-1α, the levels of phospho-Akt and phospho-GSK3-β were increased, resulting in induction of the EMT. Inhibition of GSK3-β phosphorylation suppressed these effects. Moreover, the intensity of pGSK3-β staining was significantly increased with cN stage and cTNM stage in patients with tongue squamous cell carcinoma.ConclusionsOur data showed that the hypoxia-induced EMT in OSCC was enhanced by GSK3-β phosphorylation, suggesting that GSK3-β may be important in the invasion and metastasis of OSCC.



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Cytogenetic and immunohistochemical characterization of mammary analogue secretory carcinoma of salivary glands

Publication date: December 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 122, Issue 6
Author(s): Syed A. Khurram, Jemel Sultan-Khan, Neil Atkey, Paul M. Speight
ObjectivesMammary analogue secretory carcinoma (MASC), initially considered a subset of acinic cell carcinoma (ACC), harbors an ETV6 translocation [t(12:15)(p13:25 q)] and is now regarded as a distinct entity. Several putative markers to differentiate MASC from ACC have been reported; however, the immunohistochemical profile is still being explored and updated. The purpose of this study was to further explore the cytogenetic and immunohistochemical profile of MASC.Study DesignCases were analyzed for ETV6 translocation using fluorescent in situ hybridization and stained for CK8, amylase, mammaglobin, GCDFP-15, MUC1, MUC4, STAT5a, Ki-67 (n = 37), CK7, Cam5.2, CK14, SMA, p63, S100, vimentin and DOG1 (n = 42). Histochemical stains for mucins were also performed and data collected for age, sex, and site.ResultsFluorescent in situ hybridization showed 9 cases with ETV6 rearrangement and 2 with increased ETV6 copies. These 11 cases showed an absence of PAS-D–resistant granules, with 10 of 11 showing strong S100, mammaglobin, and STAT5a staining. All ACCs showed diffuse DOG1 staining, whereas 8/11 MASCs were negative and 3 showed only focal DOG1 staining.ConclusionDOG1 can be used in conjunction with PAS-D, S100, and mammaglobin to identify MASCs. Cases with increased ETV6 copies are a novel finding with a similar immunostaining profile and should be considered as MASCs.



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Sclerosing odontogenic carcinoma presenting on the hard palate of a 43-year-old female: a case report

Publication date: December 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 122, Issue 6
Author(s): Andrew Wood, Fiona Young, James Morrison, Brendon I. Conn
We present a case of sclerosing odontogenic carcinoma (SOC) occurring on the hard palate of a 43-year-old female. The tumor presented as an asymptomatic firm swelling and histopathologically was characterized by widely dispersed nests and cords of bland cells infiltrating between hyalinized collagen fibers. Prominent perineural and intraneural invasion and erosion of bone was noted. The tumor cells showed staining with antibodies to pan-cytokeratin (PanCK), cytokeratin 19 (CK19), cytokeratin 5/6 (CK5/6), cytokeratin 14 (CK14), p63 and E-cadherin, but no staining with antibodies to carcinoembryonic antigen (CEA), cytokeratin 7 (CK7), cytokeratin 20 (CK20), estrogen receptor (ER), progesterone receptor (PR) or S100. Staining for mucin with alcian blue/periodic acid–Schiff with diastase was equivocal, with no definite evidence of mucin or muciphages. An initial diagnosis of adenocarcinoma NOS was made upon incisional biopsy, with the prominent filing pattern and cytoplasmic vacuolization prompting consideration of metastatic breast cancer in the first instance. The true nature of the tumor became clear after staging investigations and surgical resection. The patient was treated by surgery alone and is disease-free after 17 months.



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Efficacy and toxicity of rechallenge with combination immune checkpoint blockade in metastatic melanoma: a case series

Abstract

Background

The efficacy and potential toxicity of rechallenge with combination ipilimumab and nivolumab has not been described. Retreatment of patients with immune checkpoint inhibitors in the setting of prior significant toxicity lacks evidence-based guidance.

Methods

We present the first three, consecutive patients who received re-treatment with combination ipilimumab and nivolumab for metastatic melanoma managed at our institution.

Results

Rechallenge with combination ipilimumab and nivolumab in the setting of prior grade 3 toxicity with initial combination therapy is feasible, and responses are seen. We highlight the fact that grade 3 toxicity is likely to recur, but if so, can be manageable.

Conclusions

Retreatment with ipi + nivo may be considered an option in carefully selected, well-informed patients. More research is required to delineate the benefits and risks with this approach.

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The effect of modified surgical flap design for removal of lower third molars on lingual nerve injury

Abstract

Aim

The objective of this study was to evaluate a modified flap design for removal of lower third molars with avoidance of lingual flap elevation and its effect on postsurgical lingual nerve sensory impairment.

Materials and methods

The patients included in this prospective study were those referred for removal of symptomatic lower third molars at two Oral and Maxillofacial Surgery clinics. Different patterns of impaction were included regarding the angulation and depth of the lower third molar. Patients were reviewed 1 day after surgery, then after 1 week. Each patient was examined at each recall visit for any sensory alterations of the lingual nerve. The data collected was correlated to several variables including the age, gender, side of operation, state of eruption, angulation, depth of impaction, and tooth division.

Results

A number of 53 patients (23 males and 30 females), at ages ranging from 16 to 43 years, underwent surgical removal of 66 fully or partially impacted lower third molars under local anesthesia using a modified flap design. The modified flap design provided adequate exposure for removal of the lower third molar for all patterns of impactions included, regarding the state of eruption, angulation, and depth of the tooth.

Conclusion

This study showed that the investigated flap design can be safely used to remove lower third molars for different patterns of impaction without jeopardizing the lingual tissues thus providing optimum protection for the lingual nerve since it provided adequate exposure to remove the tooth without the reflection of a lingual flap.

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Molecular detection of bacteria associated to caries activity in dentinal lesions

Abstract

Objectives

This study aimed at identifying and quantifying Actinomyces naeslundii, Bifidobacterium spp., Streptococcus mitis group, Lactobacillus acidophilus, Lactobacillus casei group, Streptococcus gordonii, and Streptococcus mutans in active and inactive carious dentine lesions of children with early childhood caries by using quantitative polymerase chain reaction.

Material and methods

Fifty-six dentin lesion samples, classified as active (n = 39) or inactive (n = 17), were collected from children aged from 2 to 5 years old. Dentinal-cavitated lesions were evaluated by Nyvad criteria for the assessment of caries lesion activity.

Results

Relative quantification revealed that Bifidobacterium spp. and the L. casei group were significantly more abundant in active dentin lesions (p < 0.05). Concentrations of A. naeslundii, S. mitis group, and S. gordonii were not significantly different when comparing dentin lesion activity. The relative proportion of S. mutans was significantly greater in inactive than in active lesions (p < 0.05). Bifidobacterium spp. and L. casei group demonstrated a positive correlation (p = 0.001) in active lesions. The positive detection of L. acidophilus (odds ratio = 15.1) and S. gordonii (odds ratio = 7.7) was significantly associated to the active lesions.

Conclusions

The data indicate that higher detection levels of Bifidobacterium spp. and the L. casei group may be linked to dentin lesion activity. Additionally, the presence of L. acidophilus and S. gordonii was associated with lesion activity.

Clinical relevance

Considering that information about the oral microbiota related to dentin caries activity status is relevant, this study provides insights to better understand the differences in the microbiotas between active and arrested dentin cavities.

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Allergies – A T cells perspective in the era beyond the TH1/TH2 paradigm

Publication date: Available online 12 November 2016
Source:Clinical Immunology
Author(s): Moritz Berker, Larissa Johanna Frank, Anja Lidwina Geßner, Niklas Grassl, Anne Verena Holtermann, Stefanie Höppner, Christian Kraef, Martin Dominik Leclaire, Pia Maier, David Alexander Christian Messerer, Lino Möhrmann, Jan Philipp Nieke, Diana Schoch, Dominik Soll, Christina Marianne Paulina Woopen
Allergic diseases have emerged as a major health care burden, especially in the western hemisphere. They are defined by overshooting reactions of an aberrant immune system to harmless exogenous stimuli. The TH1/TH2 paradigm assumes that a dominance of TH2 cell activation and an inadequate TH1 cell response are responsible for the development of allergies. However, the characterization of additional T helper cell subpopulations such as TH9, TH17, TH22, THGM-CSF and their interplay with regulatory T cells suggest further layers of complexity. This review summarizes state-of-the-art knowledge on T cell diversity and their induction, while revisiting the TH1/TH2 paradigm. With respect to these numerous contributors, it offers a new perspective on the pathogenesis of asthma, allergic rhinitis (AR) and atopic dermatitis (AD) incorporating recent discoveries in the field of T cell plasticity.



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Comparison of cone-beam computed tomography and osteometric examination in preoperative assessment of the proximity of the mandibular canal to the apices of the teeth

Publication date: Available online 11 November 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Sadaf Adibi, Maryam Paknahad
The risk of postoperative neurosensory impairment after extraction of a third molar will be greater if the inferior alveolar nerve is in close proximity to the apices of the root. Precise preoperative evaluation of the relative positions of the nerve and the mandibular apices is important to protect the nerve from mechanical irritation. The aim of this study was to assess the accuracy of cone-beam computed tomography (CT) in the identification of the positional relations of the mandibular third molar and the inferior alveolar canal using Rood's criteria.Panoramic images of 10 dry hemimandibles were obtained, and 20 teeth each with one of Rood's criteria indicating close relations to the mandibular canal were selected. Cone-beam CT images of the selected points were obtained. The closest distance between the apex of the root and the inferior alveolar canal was measured on cross-sectional cone-beam CT images. The same measurements were made on the corresponding osteometric sections with digital callipers. The intra-class correlation coefficient (ICC) was used to measure the consistency between the two measurements as the reference method, and showed that there was a high level of inter-rater agreement (r>0.90). The mean (SD) deviation of cone-beam CT measurements from the gold standard osteometric measurements was small at 0.30 (0.24). There were lmost perfect matches between cone-beam CT and gold standard measurements. Cone-beam CT is an accurate technique to measure the proximity of the mandibular apices to the alveolar nerve.



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