Giorgia Capocasale

Endodontic Re-treatment of a Tooth with a Floor Perforation in a Patient inTreatment with Oral Bisphosphonate

Prevention of bisphosphonate related osteonecrosis of the jaws (BRONJ) represents an important challenge for clinicians. Dent alveolar surgery is usually performed to reduce the risk local and systemic complications, In fact, removing the tooth that is the source of the infectious outbreak, brings to the removal of the infected tissue and determines a correct healing of the disease. However, in patients are undergoing bisphosphonate this procedure expose patients to an increased risk of BRONJ. However, in patients who are in treatment with systemic bisphosphonates, this procedure exposes them to an increased risk of BRONJ. When possible, avoid the surgical interventions in favors of endodontic treatment could be an important clinical options in reducing the possibility of BRONJ occurrence. In this paper, we report a case of endodontic re-treatment in a tooth with a floor perforation in a patient was assuming oral alendronate. Limits and advantages of performing endodontic retreatment for the prevention of BRONJ development have still not well elucidated. Due to the very low power of this study, no conclusions should be made to perform an endodontic retreatment instead of performing a tooth extraction. However, this case report support the execution of future studies related to the calculation of BRONJ incidence after surgical extraction vs endodontic retreatment.

In vivo optical coherence tomography imaging in a case of mucous membrane pemphigoid and a negative Nikolsky's sign

There is currently a growing interest in new diagnostic tools of the oral cavity and mucosa which are non‐invasive, repeatable and reliable. A diagnosis of a suspected, autoimmune pathology was made regarding a 57‐year‐old patient with desquamative gingivitis. However, a negative Nikolskys sign did not seem to indicate a diagnosis of mucous membrane pemphigoid neither was there any indication as to the optimum location for an incisional biopsy. As an imaging method, the use of optical coherence tomography (OCT) has enabled the obtaining of tomographic (cross‐sectional) scans of tissue. Such images are acquired prior to and after verifying Nikolskys sign, thereby enabling the clinician to identify the presence (or not) of subepithelial bullae. Thereafter, an assessment of changes in the subepithelium (the split) can be performed, even in the absence of a suitable clinical picture, such as, for example, a negative Nikolskys sign. Histological analysis and the use of indirect immunofluorescence have facilitated a diagnosis of mucous membrane pemphigoid, an autoimmune pathology, which can be confirmed with the appearance of subepithelial bullae. OCT was found to be a valid, non‐invasive, auxiliary diagnostic device, capable of revealing in vivo and real‐time bullae, which were hitherto clinically undetectable.