Oral Surgery, Oral Medicine, Oral Pathology ,Oral Radiology

Multiple calcifying epithelial odontogenic tumor: case report and review of the literature Publication date: Available online 1 April 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Ana Carolina Hanaoka Ibituruna, Anaíra Ribeiro Guedes Fonseca Costa, Luiz Fernando Barbosa de Paulo, Paulo Rogério de Faria, Sérgio Vitorino Cardoso, Adriano Mota Loyola Abstract Calcifying epithelial odontogenic tumor (CEOT) is a rare benign neoplasm, and few cases of multiple lesions have been published. This article reports the case of a 26-year-old male patient with bilateral gingival lesions near the maxillary canines and a hard tumor on the left side of the mandible. All lesions presented mixed radiographic appearance (radiolucent and radiopaque). Incisional biopsies revealed typical histopathological findings of CEOT. The gingival lesions were removed by curettage, and the mandibular tumor was surgically resected. No recurrence was detected after six years of treatment. Five well-documented cases of multiple CEOT were retrieved from the PubMed database. These patients were slightly older than those with solitary tumors, and none of them presented syndromic features. Three cases had only multiple central tumors while the other two had multiple peripheral lesions, so the present patient is the first to manifest both central and peripheral tumors.

Evaluation of different soft tissue–simulating materials in pixel intensity values in cone beam computed tomography Publication date: April 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 4 Author(s): Gustavo Machado Santaella, Maria Augusta Portella Guedes Visconti, Karina Lopes Devito, Francisco Carlos Groppo, Francisco Haiter-Neto, Luciana Asprino Objective This study aimed to evaluate different materials as soft tissue simulators and the influence of soft tissues in cone beam computed tomography. Study Design Images of 5 piglet heads were acquired with intact soft tissues, with the tissues stripped, and with the use of different soft tissue simulators, following the same acquisition protocol. Four different materials were tested, individually or in combination: acrylic, water, utility wax, and expanded polystyrene (EPS). Pixel intensity values of 8 quadrangular regions, that is, upper and lower teeth and alveolar bone, were obtained. The mean values were used for comparison by analysis of variance (ANOVA; α = 5%). Results No differences were observed for the "No Material," "EPS," "Acrylic," and "EPS and Wax" groups for the lower anterior and posterior teeth, the upper posterior tooth, and the anterior and posterior bone, and for the "No Material," "EPS," and "EPS and Wax," groups for the lower posterior bone. All groups showed statistical differences for the lower anterior bone and the upper anterior tooth. Conclusions Expanded 2-cm thick polystyrene, with or without 1-cm thick utility wax, was effective for most regions, followed by acrylic 0.5 cm. Soft tissues were not of great influence in most regions. Water was not an effective material for any of the regions.

Postprocessing of all-zirconia restorations in digital dental radiographs: a quality assurance predicament Publication date: April 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 4 Author(s): Allison Buchanan, Amelia Orta, Sajitha Kalathingal Objectives The aim of this study was to describe a quality assurance issue, that is, the production of nondiagnostic high-contrast radiographs when imaging teeth restored with all-zirconia crowns on bitewing radiographs. Study Design All-zirconia crowns were imaged with DIGORA Optime photostimulable phosphor (PSP) plates (Soredex/Orion Corp., Helsinki, Finland). To assess the differences in software processing, the PSP plates were scanned into third-party software as well as directly into the twain and native software provided by the manufacturer. Gamma correction, histogram stretch, and scanner resolution settings were adjusted. Vertical bitewings were acquired to increase anatomic coverage. Results Scanning into third-party software or directly into the twain and native software did not improve contrast. Shifting the lower limit of the histogram stretch to 3 with a gamma correction of 2 resolved the problem. Neither scanner resolution setting nor vertical bitewings improved contrast. Conclusions The nondiagnostic high-contrast radiographs result from imaging software not effectively displaying the available gray scale. The software processing error appears to be initiated by the high-attenuation characteristics of zirconia. Consequently, radiographs with a high ratio of zirconia crown to normal anatomy are particularly susceptible.

Multiple superficial mucoceles concomitant with oral lichen planus: a case series Publication date: April 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 4 Author(s): Kejia Lv, Jianhua Liu, Weijia Ye, Guohua Wang, Hua Yao Superficial mucoceles are a relatively rare variant of common mucoceles and have an unclear etiology. Clinically, they are small, translucent, subepithelial vesicles affecting the oral mucosa in the retromolar region, the lower labial and buccal regions, and the bilateral soft palate. Superficial mucocele is easily misdiagnosed as pemphigoid, bullous lichen planus, herpes lesion, or venous lake when it is concomitant with oral lichen planus (OLP) or lichenoid disorders on the basis of the initial impression. An inflammatory mechanism related to OLP has been hypothesized to induce the development of superficial mucoceles. It is essential to be familiar with this entity. This report presents 9 cases of multiple superficial mucoceles that occurred sequentially concomitant with OLP and with consistent clinical and histopathologic features. Relevant studies reported in the literature are also reviewed to provide additional clarification of the etiology, clinicopathologic characteristics, and differential diagnosis.

Twist and E-cadherin deregulation might predict poor prognosis in lower lip squamous cell carcinoma Publication date: April 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 4 Author(s): Everton Freitas de Morais, Hellen Bandeira de Pontes Santos, Israel Leal Cavalcante, Silvia Helena Barem Rabenhorst, Jean Nunes dos Santos, Hébel Cavalcanti Galvão, Roseana de Almeida Freitas Objective The aim of this study was to evaluate the expression of Twist and E-cadherin in lower lip squamous cell carcinoma (LLSCC) and their association with clinicopathologic parameters. Study Design Fifty-nine cases of LLSCC were analyzed by applying immunohistochemistry techniques in a semiquantitative manner. The systems proposed by Bryne etal., Brandwein-Gensler etal., and Almangush etal. were applied for analysis of the histopathologic malignancy grading system. Results Higher E-cadherin expression (general and membrane) was observed in cases presenting with disease-free survival after 5years of follow-up (P < .05). Higher Twist expression was observed in lesions classified as being in advanced stages, displaying recurrence, and having a high degree of malignancy. A significant negative correlation was detected between cytoplasmic Twist expression and membrane E-cadherin expression (P = .028). A statistically significant relationship was detected between high total Twist expression in tumors classified as high risk by Brandwein-Gensler etal., and no significant difference was observed among total, membrane, and cytoplasmic E-cadherin expressions in LLSCC cases and the 3 applied grading systems (P > .05). Conclusions The results of the present study suggest the potential involvement of Twist and E-cadherin in the modulation of events related to worse prognoses in LLSCC cases.

Comparison of fatty acid synthase and cyclooxygenase-2 immunoexpression in embryonal, benign, and malignant odontogenic tissues Publication date: April 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 4 Author(s): Celeste Sánchez-Romero, Adalberto Mosqueda-Taylor, Wilson Delgado-Azañero, Oslei Paes de Almedia, Ronell Bologna-Molina Objectives The aim of this study was to analyze the immunohistochemical expression of fatty acid synthase (FASN) and cyclooxygenase-2 (COX-2) in tooth germ (TG), ameloblastoma (AM), ameloblastic carcinoma (AC), ameloblastic fibroma (AF), and ameloblastic fibrosarcoma (AFS). Study Design Immunohistochemistry for FASN and COX-2 was performed in 10 TG, 44 AM, 10 AC, 9 AF, and 5 AFS specimens. The results were analyzed by using the immunoreactive score (IRS) and Kruskal-Wallis test followed by Dunn's post-test. Results Most TG specimens were strongly positive for FASN, whereas COX-2 was weak or negative. All AM and AC specimens expressed both proteins. In AF specimens, FASN and COX-2 were variably expressed in the epithelium and negative in the mesenchyme. In AFS specimens, FASN was strongly positive in the malignant mesenchyme and variable in the epithelium; COX-2 was focal or weak in both components. FASN expression showed significant differences in the following comparisons: TG vs AC, AM vs AC, and AF vs AFS. Differences in COX-2 were significant when comparing TG specimens with AM, AC, and AF specimens. Conclusions The results suggest that FASN and COX-2 overexpression may have a role in the pathogenesis of AM and AC, whereas in AFS, FASN seems to be mainly involved. Further studies are necessary to clarify these mechanisms and their clinical implications.

Efficacy of curcumin for management of oral submucous fibrosis: a systematic review of randomized clinical trials Publication date: April 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 4 Author(s): Sadeq Ali Al-Maweri Objectives Oral submucous fibrosis (OSF) is a chronic debilitating disease that has a high risk of malignant transformation. Management of OSF is quite challenging, with no definitive cure being available. This systematic review assessed the available evidence for using curcumin for pain alleviation and clinical improvement in patients with OSF. Study Design A comprehensive search of PubMed/Medline, Scopus, and ISI Web of Science databases was conducted to identify all relevant clinical trials comparing patients receiving curcumin treatment to active and/or nonactive controls for the treatment of OSF. Results Six clinical trials comprising 298 patients were included. All studies found curcumin to be effective in the management of OSF. Three studies found significantly higher improvement in burning sensation in the curcumin group compared with controls, whereas 3 other studies found comparable results. With regard to clinical signs, 2 studies showed better improvement in mouth opening in the curcumin group; 3 studies reported no differences in effectiveness; and only 1 study found curcumin to be inferior to conventional therapy. Conclusions The available evidence remains inconclusive but suggests that curcumin is a promising effective treatment option for the management of patients with OSF. Further well-designed clinical trials with large sample sizes and adequate follow-up periods are warranted.

Medication-related osteonecrosis of the jaw unrelated to bisphosphonates and denosumab—a review Publication date: April 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 4 Author(s): Rebecca King, Nikki Tanna, Vinod Patel The link between medication-related osteonecrosis of the jaw (MRONJ) and bone modulating drugs, such as bisphosphonates and denosumab, is well established, and the number of reported cases is increasing. The development of novel medications used in the treatment of cancer, as well as autoimmune and bone conditions, has led to more cases of MRONJ being reported. However, in addition to this group of medications, increasing numbers of new agents in cancer therapy, such as antiangiogenic agents, have also been implicated in the development of MRONJ. As these newer agents with similar mechanisms are routinely used, the numbers of reported cases will likely rise further. This article aims to identify and summarize the drugs implicated in MRONJ, besides bisphosphonates and denosumab. A wide range of medications classified as tyrosine kinase inhibitors, monoclonal antibodies, mammalian target of rapamycin inhibitors, radiopharmaceuticals, selective estrogen receptor modulators, and immunosuppressants have been implicated in MRONJ. It remains crucial that oral health care providers are aware of these new medications and their associated risks to manage their patients appropriately.

How well do we manage the odontogenic keratocyst? A multicenter study Publication date: April 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 4 Author(s): Brian Kinard, Gentry Hansen, Marshall Newman, Peter Dennis, Tyler Haeffs, Sebastian Perez, Aya Hamao-Sakamoto, Martin Steed, Pamela Hughes, Meredith August, Shelly Abramowicz Objective The aim of this study was to answer the following clinical questions: Among patients treated for odontogenic keratocysts (OKCs), what is the overall 5-year disease-free rate, and what factors are associated with disease recurrence? Study Design We implemented a multicenter retrospective cohort study composed of patients presenting for the evaluation and management of previously untreated OKCs. The predictor variables were grouped into demographic, medical, radiographic, and operative categories. The primary outcome variable was time to lesion recurrence. Data analyses were performed by using bivariate analysis and univariate or multivariate Cox proportional hazards models. Results The study sample was composed of 231 OKCs. Of these, 57 (24.7%) were treated with decompression with residual cystectomy, 86 (37.2%) with enucleation without adjuvant therapy, and 78 (33.8%) with enucleation with peripheral ostectomy. There were 44 recurrences (19%), with a median time to recurrence of 26.7 months (range 15.8–49.8). Conclusions This multicenter study is the largest study analyzing disease recurrence after treatment of OKCs by using appropriate statistical analysis for a time-to-event outcome (disease recurrence). The 5-year disease-free estimate was 29%. Mandibular lesions, multilocular lesions, and lesions treated with decompression and residual cystectomy were associated with recurrence.

Dental and craniofacial alterations in long-term survivors of childhood head and neck rhabdomyosarcoma Publication date: April 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 4 Author(s): Valkiria D'Aiuto de Mattos, Sima Ferman, Denise Maria Araújo Magalhães, Héliton Spíndola Antunes, Simone Queiroz Chaves Lourenço Objective Rhabdomyosarcoma (RMS) represents the most common soft tissue sarcoma that affects children. Treatment involves chemoradiotherapy. This study aimed at evaluating the long-term alterations to teeth and cranial bones in children, teenagers, and young adults after oncologic treatment. Study Design We conducted a cross-sectional study of patients undergoing treatment for head and neck RMS between 1988 and 2011. We evaluated demographic, clinical, and treatment data and performed panoramic radiography, cephalometry, and photography. Results We evaluated 27 long-term survivors, most of whom had been treated between ages 0 to 5 years (51.9%). The total radiation dose applied was 50.4 Gy, and the chemotherapy combination included vincristine, actinomycin D, and cyclophosphamide in 51.9% of the cases. We observed 603 dental alterations, among which 377 (62.7%) occurred in patients ages 0 to 5 years, and root shortening was the most frequent alteration observed (24.2%). With regard to facial bones, 74% of the patients had some level of facial asymmetry, 70.4% had reduced facial depth, 48.4% had mandibles of short size, and 77.8% had reduced facial height. Conclusions Children submitted to RMS treatment involving chemotherapy and radiotherapy displayed significant dental and craniofacial alterations, especially when treatment occurred between ages 0 and 5 years.