Alice E. Curran

Periapical Microsurgery: An In Vivo Evaluation of Endodontic Root-End Filling Materials

The purpose of this study was to assess the healing of periapical tissues using three different materials (IRM [L.D. Caulk Inc, Dentsply International Inc, Milford, DE], Geristore [Den-Mat, Santa Maria, CA], and MTA [ProRoot MTA; Dentsply Tulsa Dental Specialties, Tulsa, OK]) after endodontic microsurgery in an animal model. Using beagle dogs as a study model, 48 bicuspids were accessed, instrumented, and intentionally infected. The surgical procedures were performed after 30 days following the radiographic confirmation of periapical radiolucencies. The root canals were still infected and had no disinfection procedure carried out. The root ends were resected, retrograde preparations were completed, and the experimental materials were placed under surgical operating microscopy. After a period of 6 months, digital radiographic images of the periradicular areas were taken. The samples were prepared for histologic evaluation. Although Geristore showed no radiographic difference when compared with the other groups, it showed the least favorable healing in the histologic evaluation. Our histologic and radiographic results showed no statistical difference between MTA and IRM.

Clinical and histological findings of denture stomatitis as related to intraoral colonization patterns of Candida albicans, salivary flow, and dry mouth.

PURPOSE Multifactorial etiological factors contribute to denture stomatitis (DS), a type of oral candidiasis; however, unlike other oral candidiasis, DS can occur in a healthy person wearing a denture. In this study, we therefore attempt to explore the association between candida, denture, and mucosal tissue using (1) exfoliative cytology, (2) the candidal levels present in saliva, on mucosal tissues and on denture surfaces, and (3) the salivary flow rate and xerostomic symptoms. MATERIALS AND METHODS A cross-sectional study enrolled 32 edentulous participants, 17 without DS as controls and 15 with DS (Newtons classification type II and III). Participants with systemic or other known oral conditions were excluded. Participants completed a xerostomia questionnaire, and salivary flow rates were measured. Samples of unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) were collected. UWS was used for fungal culturing. Periodic acid-Schiff (PAS) stain and quantitative exfoliative cytology were performed on samples from affected and unaffected mucosa from each participant. Levels of Candida species (albicans and non-albicans) were determined in salivary samples (expressed as colony-forming units, CFU), as well as from swab samples obtained from denture fitting surfaces, in addition to affected and unaffected mucosa. RESULTS There were no significant differences in salivary flow rates, mucosal wetness, or frequency of reported dry mouth comparing participants with and without DS. Exfoliative cytology of mucosal smears demonstrated significantly higher (p= 0.02) inflammatory cell counts in DS patients, as compared with smears of healthy denture-wearers. Candida albicans was significantly more prevalent in saliva (p= 0.03) and on denture surfaces (p= 0.002) of DS participants, whereas mucosal candidal counts and the presence of cytological hyphae did not show significant difference comparing DS to healthy participants. CONCLUSIONS In this investigation, we presented a unique group of healthy edentulous patients. This population may reflect the general DS population without systemic or other oral diseases. The prominent etiological factor for DS in this population is the presence of candida in denture and saliva. We found that other factors such as saliva flow/xerostomia, fitting of the denture, and the presence of candida in the mucosa, are less important in this population. Therefore, DS treatments in healthy patients should first focus on sanitization of an existing denture and/or fabrication of a new denture.

Topical Application of a Mucoadhesive Freeze-Dried Black Raspberry Gel Induces Clinical and Histologic Regression and Reduces Loss of Heterozygosity Events in Premalignant Oral Intraepithelial Lesions: Results from a Multicentered, Placebo-Controlled Clinical Trial

Purpose: Approximately 30% higher grade premalignant oral intraepithelial neoplasia (OIN) lesions will progress to oral cancer. Although surgery is the OIN treatment mainstay, many OIN lesions recur, which is highly problematic for both surgeons and patients. This clinical trial assessed the chemopreventive efficacy of a natural product-based bioadhesive gel on OIN lesions. Experimental Design: This placebo-controlled multicenter study investigated the effects of topical application of bioadhesive gels that contained either 10% w/w freeze-dried black raspberries (BRB) or an identical formulation devoid of BRB placebo to biopsy-confirmed OIN lesions (0.5 g × q.i.d., 12 weeks). Baseline evaluative parameters (size, histologic grade, LOH events) were comparable in the randomly assigned BRB (n = 22) and placebo (n = 18) gel cohorts. Evaluative parameters were: histologic grade, clinical size, and LOH. Results: Topical application of the BRB gel to OIN lesions resulted in statistically significant reductions in lesional sizes, histologic grades, and LOH events. In contrast, placebo gel lesions demonstrated a significant increase in lesional size and no significant effects on histologic grade or LOH events. Collectively, these data strongly support BRBs chemopreventive impact. A cohort of very BRB-responsive patients, as demonstrated by high therapeutic efficacy, was identified. Corresponding protein profiling studies, which demonstrated higher pretreatment levels of BRB metabolic and keratinocyte differentiation enzymes in BRB-responsive lesions, reinforce the importance of local metabolism and differentiation competency. Conclusions: Results from this trial substantiate the LOH reductions identified in the pilot BRB gel study and extend therapeutic effects to significant improvements in histologic grade and lesional size. Clin Cancer Res; 20(7); 1910–24. ©2014 AACR.

Effect of intracanal corticosteroids on healing of replanted dog teeth after extended dry times.

This study investigated the effect of potent intracanal corticosteroids on periodontal healing of replanted avulsed teeth and evaluated the systemic absorption of these corticosteroids. Sixty-seven extracted dog premolar roots were randomly assigned to one of the following groups: groups 1-3 filled with gutta-percha and replanted immediately and after 40 and 60 minutes, respectively; groups 4 and 5 filled with 0.05% clobetasol; and groups 6 and 7 filled with 0.05 % fluocinonide. Groups 4 and 6 were replanted after 40 minutes and groups 5 and 7 after 60 minutes. After 4 months, roots were evaluated histologically for signs of periodontal healing. Roots treated with clobetasol and fluocinonide healed more favorably than roots filled with gutta-percha and were different from each other at 60 minutes. No change in the systemic corticosteroid blood concentration was observed in any group. Corticosteroids were efficacious in the beagle model as intracanal medicaments for promoting favorable postavulsion periodontal healing.

Distinctive Pattern of Glial Fibrillary Acidic Protein Immunoreactivity Useful in Distinguishing Fragmented Pleomorphic Adenoma, Canalicular Adenoma and Polymorphous Low Grade Adenocarcinoma of Minor Salivary Glands

Objectives Immunohistochemistry (IHC) can be helpful in the diagnosis of minor salivary gland neoplasms including those that have been incisionally biopsied or fragmented during surgery that do not contain key diagnostic features on hematoxylin and eosin sections. IHC has been used as an adjunct to distinguish among many salivary gland neoplasms using both qualitative and quantitative methods. The objective of this study was to determine whether a distinctive immunoreactivity staining pattern to GFAP can be consistently observed among three selected minor salivary gland neoplasms and thus serve as a diagnostic adjunctive procedure. Study Design Glial fibrillary acidic protein (GFAP) reactivity was examined among 78 minor salivary gland neoplasms: 27 canalicular adenomas (CAA), 21 pleomorphic adenomas (PA) and 30 polymorphous low grade adenocarcinomas (PLGA). Each case was evaluated by two oral and maxillofacial pathologists (OMP) blinded to the diagnosis. Consensus was reached on the pattern of GFAP reactivity among the neoplastic cells and on the similarities and differences among the cases. Results Ninety-six percent (96%) of CAAs demonstrated a distinctive linear immunoreactive pattern among cells in proximity to connective tissue interface. All (100%) PAs demonstrated diffuse immunopositivity within tumor cells. All (100%) PLGAs showed little or no intralesional reactivity and no peripheral linear immunoreactivity. Additional challenge cases were examined by outside OMPs to demonstrate the utility of these findings. Conclusions This study demonstrates that the pattern of GFAP immunoreactivity may be an adjunct to diagnosis among PA, CAA and PLGA. The pattern of distinctly linear GFAP immunoreactivity at the tumor/connective tissue interface in CAA has not been reported previously. This distinctive feature may permit the pathologist to differentiate among CAA, PA and PLGA when an incisional biopsy and/or fragmentation cause key diagnostic features to be absent. Because each of these neoplasms requires a different treatment approach, this can be of major significance.

Randomized controlled trials: what are they and who needs them?

Dentistry is rapidly entering a new era of evidence-based practice, and society is demanding prevention and treatment that has been proven to be effective in terms of meaningful health outcomes. Practitioners, individual patients and the public need randomized controlled trials because they provide the highest level of scientific evidence to change clinical practice and inform public health policy. Well-designed randomized controlled trials are conceptually simple but deceptively complex to design, implement and translate into clinical practice. Randomized controlled trials are fundamentally different from observational clinical research because they randomly assign volunteers to receive test or control interventions, they are prospective and the success of the test intervention is based on a meaningful clinical outcome that is specified before the trial begins. To be successful, randomized controlled trials must be carefully designed and powered to answer a specific question that will be generalizable to the population under study. Randomized controlled trials can be designed to evaluate efficacy, effectiveness, superiority, equivalence or noninferiority. Prominent issues and challenges in designing and conducting randomized controlled trials include carefully defining enrollment criteria, establishing an organizational infrastructure, use of a data-coordinating center, developing a manual of procedures, obtaining informed consent, recruiting and ensuring the safety of volunteer subjects, ensuring data quality, analysis and publication of trial outcomes, and translating results into clinical practice.

Peripheral Desmoplastic Ameloblastoma : Report of a Rare Case

position. Common complications include malpositioned teeth, delayed eruption of teeth, and resorption of surrounding teeth. With long-term review, dentigerous cysts have been found to be associated with 11% of all mesiodens, and movement of the mesiodens has also been reported. Although reports of nasal deformity due to mesiodens have been reported, there are few reports of mesiodens causing facial sinuses. There are reports, however, of ectopic supernumerary teeth in the soft tissue of the jaws. There are some controversies regarding the management of patients with mesiodens. Although some authors promote the early removal of mesiodens to minimize complications, other authors advise a more cautious approach to treatment planning the removal of these teeth. In the current case report, the patient had been given the option of removal of the mesiodens 3 years before her current presentation, when the tooth was asymptomatic. Early removal of this tooth may have prevented some of the soft tissue sequelae now affecting the patient.

Molar root-incisor malformation: considerations of diverse developmental and etiologic factors

OBJECTIVE The objective of this study was to evaluate the variation in the condition referred to as molar root-incisor malformation (MRIM) and elucidate the distribution of affected teeth. This study further aimed to identify associated environmental stressors. STUDY DESIGN Individuals were identified through retrospective review of dental radiographs and through referral to the investigators. Histologic evaluation included examination of mineralized and decalcified sections of affected first permanent molar teeth. RESULTS Thirty cases of MRIM were identified, with all having affected first permanent molars with dysplastic root formation. The primary second molars were affected in 57% of the cases, with permanent anterior teeth being involved in 40% of the cases. A variety of medical conditions were associated with MRIM, the most common being neurologic. Several affected individuals reported no significant past medical history or environmental stressors. CONCLUSIONS The etiology of MRIM remains unclear, and this unique developmental defect of the first permanent molar roots appears to occur in populations throughout the world. Clinicians identifying the MRIM phenotype should carefully evaluate the permanent incisors for associated developmental defects that could result in pulpal necrosis.

Considerations in the diagnosis of oral hairy leukoplakia—an institutional experience

OBJECTIVE We report here the 10-year experience with oral hairy leukoplakia (OHL) at the Division of Oral and Maxillofacial Pathology at the University of North Carolina at Chapel Hill, NC, USA. STUDY DESIGN All the associated hematoxylin and eosin and Epstein-Barr virus encoding region in situ hybridization slides of OHL cases between January 1, 2008, and February 1, 2017, were retrieved and reviewed. Collected demographic characteristics, clinical presentation, medical and social histories were reviewed and reported. RESULTS Six OHL cases with confirmed in situ hybridization showed predilection for the lateral tongue. The study included 3 females and 3 males (mean age 50.5 years; age range 29-70 years). One patient had known HIV-positive status before biopsy was performed. Three patients had reported a history of heavy smoking. Other medical conditions reported were history of breast cancer, a long history of corticosteroid inhaler use for asthma treatment, high cholesterol, diabetes, and hypertension. CONCLUSIONS The findings of this study indicate the need to include OHL as a potential entity in the differential diagnosis of leukoplakic tongue lesions, regardless of the patients HIV status. In addition, the presence of OHL in the patient requires investigation of various explanations for EBV infection, including immunosuppression caused by HIV infection or chronic steroid use.