Ivan Dojcinovic

Occurrence of a Pyogenic Granuloma in Relation to a Dental Implant

Pyogenic granuloma is an inflammatory vascular hyperplasia often occurring in the oral cavity. It appears in response to various stimuli such as low-grade local irritation, trauma, or female steroid hormones. A 32-year-old man sought care for a tender and bleeding lesion of the left posterior maxillary gingiva. The intraoral examination showed an exophytic ulcerated nodule measuring 1.0 cm, related to a dental implant placed in the upper left second premolar position. Radiographic examination showed an oversized healing cap. A provisional diagnosis of reactive inflammatory hyperplasia was made, and the lesion was excised and submitted for histologic examination. On microscopy, the surgical specimen showed an ulcerated nodule consisting of a delicate connective tissue stroma containing numerous blood vessels with plump endothelial cells, intermingled with abundant polymorphonuclear lymphocytes. A diagnosis of pyogenic granuloma associated with a dental implant was made. In this case it was the result of an inappropriate choice of a healing cap, thus allowing an accumulation of dental plaque and sustained chronic inflammation of the peri-implant tissue. A conservative excision and replacement of the healing cap were sufficient for definitive treatment.

Osteonecrosis of the jaw after treatment with bisphosphonates: is irreversible, so the focus must be on prevention.

New generation bisphosphonates such as zolendronic acid, pamidronate, and alendronic acid have various indications in medicine. Initially, their use was restricted to patients with metastatic bone malignancy secondary to breast cancer, lung cancer, prostate cancer, or multiple myeloma. Their benefit in these conditions led to wider application for other bone pathologies, such as osteoporosis and Pagets disease.1 Their main effect is to inhibit osteoclast activity; however, they also seem to have antiangiogenic effects, …

Mucormycoses: serious complication of high-dose corticosteroid therapy for traumatic optic neuropathy

Mucormycosis is harmless to a healthy person, but can cause opportunistic infections in immunocompromised patients, and once it has invaded internal organs is frequently fatal. Traumatic optic neuropathy is a rare complication of maxillofacial trauma. Management is controversial, and there are no treatment guidelines in the literature. The main methods of treatment of this condition employed today are high-dose corticosteroids and surgical optic nerve decompression, either alone or in combination. In this case, the patient was in good health, but received high-dose corticosteroids for 2 weeks, which temporarily diminished immune response and permitted the development of mucormycosis.

Techniques de couverture lors d'alveoloplasties secondaires: comparaison de deux types de lambeaux

Introduction Ce travail a compare deux techniques chirurgicales de couverture lors d’alveoloplasties secondaires chez des sujets porteurs de fentes labio-maxillo-palatines (FLMP) : le lambeau de glissement muco-perioste et le lambeau vestibulaire de rotation. Materiel et methode Ce travail s’appuyait sur l’etude clinique retrospective de 52 alveoloplasties secondaires. Quatre parametres cliniques ont ete etudies pour chaque type de lambeau de couverture : les dehiscences postoperatoires, la recidive de la fistule oronasale, l’eruption de la canine a travers le greffon et les besoins en chirurgie parodontale secondaire. Le recul moyen a ete de 5 ans. Resultats La technique de lambeau par glissement perioste a montre moins de dehiscences postoperatoires mais plus de recidives de la fistule, et a necessite moins de chirurgie parodontale secondaire que le lambeau vestibulaire de rotation. Discussion En correlation aux donnees de la litterature, le lambeau de glissement perioste est prefere a la technique de lambeau muqueux de rotation par son apport tissulaire de meilleure qualite. L’eruption de la canine n’est pas influencee par le type de lambeau. Une mauvaise hygiene bucco-dentaire, la presence d’une canine ayant deja fait son eruption et l’âge avance du patient augmentent les risques de complications de l’alveoloplastie secondaire.

Osteonecrosis of the jaws: maxillofacial recommendations for bisphosphonate prescribers

Dear Sir, New generation bisphosphonates (NGB) are widely used in oncology and other bone ailments such as osteoporosis or Paget’s disease [1]. These drugs have been introduced some 15 years ago and the clinical experience reaches back for almost 10 years [2, 3]. Depending on the clinical situation and patients requirements NGB are applied either orally or intravenously. The beneficial mechanism of NGBs is inhibition of osteoclast activity, but they also have antiangiogenic effects and once incorporated into the bone they are barely degraded [4]. NGB have proved efficacious in oncologic patients with bone affection and there is no doubt about their contribution in improving the life quality in patients with metastatic cancer spread. Concerning osteoporosis patients, there are rising evidences that early and widespread NGB prescription considerably lowers fracture risk and thus medical costs and morbidity [2, 5].

Osteonecrosis of the jaw after treatment with bisphosphonates is irreversible, so the focus must be on prevention

Primary Dental Care • January 2007 36 BMJ Editorial

Abcès sous condylien : complication rare d’une anesthésie locale

Introduction Quatre-vingt-dix pour cent des infections bucco-faciales sont d’origine dentaire. Les 10 % restants sont la consequence de problemes oro-pharynges, cutanes ou iatrogenes, comme le cas presente. Observation Un jeune homme de 24 ans a consulte aux urgences pour une tumefaction mandibulaire gauche, accompagnee d’un trismus. Quatre jours auparavant, il avait beneficie de l’extraction de la 38 sous anesthesie tronculaire au niveau de l’epine de Spix. Un premier drainage par voie vestibulaire a ete effectue en urgence sous anesthesie generale. En l’absence d’amelioration clinique, un scanner a ete realise. Il montrait un abces a la base du condyle, englobant le bord posterieur de la mandibule, tres au-dessus de l’epine de Spix. Une seconde intervention a permis de solutionner le probleme. Discussion La localisation d’un abces tres au-dessus de l’epine de Spix, autour du col du condyle, est une complication rarement rapportee dans la litterature. Elle est surement la complication d’une anesthesie locale avec vasoconstricteur. L’evolution inhabituelle apres le premier geste chirurgical et malgre une antibiotherapie adequate a motive un scanner cervico-facial, aide precieuse au diagnostic definitif.