Cleverick D. Johnson

The misdiagnosis of temporomandibular disorders in lateral pharyngeal space infections--two case reports.

Two cases of lateral pharyngeal space infections which were initially misdiagnosed as temporomandibular disorders (TMD) are presented and discussed. Such symptomatology as chronic facial pain, trismus and decreased inter-incisal opening provide many viable different diagnoses. It is important for the clinician to evaluate these different diagnoses in a logical manner. Conservative therapy is advised in the initial treatment of many TMDs, therefore other diagnoses with a greater potential for morbidity should be ruled in or out before the diagnosis of TMD is considered. The symptomatology of lateral space infections and the relevance of this entity to clinical dentistry are discussed.

A peripheral giant cell granuloma with extensive osseous metaplasia or a hybrid peripheral giant cell granuloma-peripheral ossifying fibroma: A case report

IntroductionPeripheral giant cell granuloma and peripheral ossifying fibroma are clinicopathologically distinct gingival lesions. Both are included in clinical differential diagnoses of common benign and reactive gingival epulides in humans. It is often impossible to make a clinical distinction between the two entities, thereby making definitive diagnosis dependent on histopathologic features. While our search of the English literature revealed several reports of peripheral giant cell granuloma with ‘bone formation’, we were unable to identify any reports of hybrid peripheral ossifying fibroma-peripheral giant cell granulomas.Case presentationWe report a case of a 44-year-old Caucasian man presenting with a three-month history of swelling of his right posterior mandible, related to an area of previous dental implant restoration. A clinical examination revealed modest extraoral facial swelling of his right posterior mandible, while an intraoral examination showed a 45×25×15mm sessile, lobular soft tissue mass of the right posterior mandibular gingiva. The mucosal covering of the lesion exhibited focal surface ulceration. A panoramic radiograph showed two implants at the vicinity of the lesion with no other significant findings. An excisional biopsy of the lesion followed by histopathologic examination of the biopsy specimen revealed salient and distinctive features of peripheral giant cell granuloma and of peripheral ossifying fibroma, estimated at near equal proportions. This raises the possibility of a hybrid odontogenic lesion.ConclusionThe presentation of this lesion, with areas of peripheral giant cell granuloma along with a distinct area of extensive osseous formation and stroma reminiscent of a peripheral ossifying fibroma, justifies consideration of this as a possible hybrid lesion. Although the biologic behavior of a combined lesion is not anticipated to deviate significantly from that of either of the single entities, this case resurrects an enduring debate as to whether peripheral giant cell granuloma and peripheral ossifying fibroma are simply parts of a disease spectrum, or whether some of these lesions represent true hybrid lesions. It is therefore recommended that more cases with histopathologic features similar to the lesion in our case be reported in the literature to further elucidate the histogenesis of these lesions.

Large Draining Focal Fibrous Hyperplasia Secondary to Periapical Granuloma

Periapical granuloma is a pathological diagnosis associated clinically and radiographically with a nonvital tooth and a periapical radiolucency, respectively. It is frequently seen as a sequela of long-standing pulpal necrosis. Often times, a draining fistula is observed near the nonvital tooth. We report an unusual case of a large draining focal fibrous hyperplasia in association with a large periapical granuloma treated at our clinic. The diagnosis was made by the clinical presentation, radiologic and histopathologic findings.

Proteomic Profiling and Differential Messenger RNA Expression Correlate HSP27 and Serpin Family B Member 1 to Apical Periodontitis Outcomes

Introduction Understanding protein expression profiles of apical periodontitis may contribute to the discovery of novel diagnostic or therapeutic molecular targets. Methods Periapical tissue samples (n = 5) of patients with lesions characterized as nonhealing were submitted for proteomic analysis. Two differentially expressed proteins (heat shock protein 27 [HSP27] and serpin family B member 1 [SERPINB1]) were selected for characterization, localization by immunofluorescence, and association with known biomarkers of acute inflammatory response in human apical periodontitis (n = 110) and healthy periodontal ligaments (n = 26). Apical periodontitis samples were categorized as stable/inactive (n = 70) or progressive/active (n = 40) based on the ratio of expression of receptor activator of nuclear factor kappa‐B ligand (RANKL)/osteoprotegerin (OPG). Next, the expression of HSP27, SERPINB1, C‐X‐C motif Chemokine Receptor 1 (CXCR1), matrix metalloproteinase 8 (MMP8), myeloperoxidase (MPO), and cathepsin G (CTSG) messenger RNA was evaluated using real‐time polymerase chain reaction. Data analysis was performed using the Shapiro‐Wilk test, analysis of variance, and the Pearson test. P values <.05 were considered statistically significant. Results Proteomic analysis revealed 48 proteins as differentially expressed in apical periodontitis compared with a healthy periodontium, with 30 of these proteins found to be expressed in all 4 lesions. The expression of HSP27 and SERPINB1 was ˜2‐fold higher in apical periodontitis. Next, an increased expression of HSP27 was detected in epithelial cells, whereas SERPINB1 expression was noted in neutrophils and epithelial cells. HSP27 and SERPINB1 transcripts were highly expressed in stable/inactive lesions (P < .05). Significant negative correlations were found between the expression of HSP27 and SERPINB1 with biomarkers of acute inflammation including CXCR1, MPO, and CTSG. Conclusions Our data suggest HSP27 and SERPINB1 as potential regulators of the inflammatory response in apical periodontitis. Additional functional studies should be performed to further characterize the role of these molecules during the development/progression of apical periodontitis. HighlightsHSP27 was detected in epithelial cells, whereas SERPINB1 was noted in neutrophils and epithelial cells.HSP27 and SERPINB1 are potential regulators of the inflammatory response in apical periodontitis.

A soldering index made with 4-META adhesive resin

Soldering indexes are most often made of fast-setting impression plaster or autopolymerizing resin. Lack of adhesive bonding between these materials and the casting requires the use of a bulky index to support the fixed partial denture components. The advent of adhesive resins improves the quality of the index and simplifies the procedure. A procedure for making a soldering index with 4-META adhesive resin is described that involves direct bonding of the resin to the metal castings. This procedure is accurate, simple, and time-saving. It can be used inside or outside the mouth, in prosthodontic or implant dentistry.