Katia Rupel

A systematic review of therapeutical approaches in bisphosphonates-related osteonecrosis of the jaw (BRONJ)

OBJECTIVES The clinical management of bisphosphonate-related osteonecrosis of the jaw (BRONJ) remains controversial. Since universally accepted guidelines have not been released yet, clinicians usually chose the type of treatment according to position papers based on expert opinion, or on empirical experience. The aim of this systematic review is to identify different therapeutical approaches for BRONJ that have been described in literature and to describe their effectiveness. MATERIALS AND METHODS A Medline via Pubmed and Scopus database literature search was conducted and all publications fulfilling the inclusion and exclusion criteria were included in eligibility assessment. The full texts of 146 retrieved articles were then screened and 40 studies were included in the quality assessment process. RESULTS After quality assessment, 22 full text articles were selected for the final review. 14 articles out of 22 were screened for stage-related outcomes. The overall outcome results and results for every disease stage were the highest when patients were treated with extensive surgery or extensive laser assisted surgery.

Gingival crevicular fluid alkaline phosphate activity during the retention phase of maxillary expansion in prepubertal subjects: A split-mouth longitudinal study

INTRODUCTION The aim of this study was to monitor the alveolar bone formation at the tension sites of teeth supporting the appliances for rapid maxillary expansion (RME) during the retention phase according to the local gingival crevicular fluid (GCF) alkaline phosphatase (ALP) activity. METHODS This split-mouth prospective study included 23 prepubertal subjects (15 girls, 8 boys; mean age, 9.0 ± 1.4 years) who had a constricted maxillary arch and were undergoing RME. Periodontal parameters, including probing depth, were recorded at 3 and 6 months after RME. Furthermore, the GCF ALP activity was measured at the tension sites of the supporting test teeth (TT) and at the antagonist control teeth (CT) sites. RESULTS Periodontal parameters were generally similar between the TT and CT sites during the study, with the exception that probing depth underwent a slight increase at the TT sites. At baseline, the GCF ALP activity was similar between the TT and CT sites; however, at both 3 and 6 months, significantly greater enzymatic activity was seen at the TT sites. The overall probing depth changes were not significantly correlated with the corresponding GCF ALP activity changes for either the TT or the CT sites. CONCLUSIONS Alveolar bone formation at the tension sites would last up to 6 months of retention after RME. These results warrant more comprehensive studies to assess whether the GCF ALP activity has potential as a diagnostic tool for bone formation during the retention phase of RME.

Laser surgical treatment of chronic graft-versus-host disease (cGvHD)-induced buccal mucosal sclerosis

Abstract Oral sclerotic chronic graft-versus-host-disease (cGvHD) represents a distinctive phenotype of cGvHD which causes severe disability and morbidity due to impaired oral hygiene and food intake, jaw pain, tightness and discomfort. As it is a rare presentation, there is little published evidence on its management. Here, the case of a patient suffering from stage-2 oral sclerotic cGvHD treated with a bilateral surgical release of fibrous bands performed using a blue light-emitting diode laser (λ=445±5 nm) is presented. This was followed by maintenance of the mouth opening through a specifically designed resin intraoral device. After the laser-assisted surgical procedure, the patient did not experience any bleeding, pain or discomfort, and the mouth opening was increased from 12 mm to 20 mm. Over a 6-month follow-up period, the patient increased and stabilized the mouth opening from 20 mm to 25 mm helping to maintain and improve oral hygiene together with overall comfort and quality of life.

Self-Assembled Nanomicelles as Curcumin Drug Delivery Vehicles: Impact on Solitary Fibrous Tumor Cell Protein Expression and Viability

Solitary fibrous tumors (SFTs) are rare soft tissue sarcomas that rely on several epithelial-mesenchymal transition (EMT) protein regulators for invasion/metastatic progression. Curcumin (CUR) has several pharmacological activities, including anticancer activity and the ability to suppress the EMT process. However, poor absorption, rapid metabolism, and side effects at high doses limit the clinical applications of CUR. Here we present the results obtained by treating SFT cells with free CUR and three different CUR-loaded nanomicelles (NMs), each of which has its surface decorated with different ligands. All CUR-loaded NMs were more efficient in suppressing SFT cell viability and expression of EMT markers than CUR alone. Combined treatments with the pan-histone deacetylase dual inhibitor SAHA revealed a differential ability in inhibiting EMT markers expression and SFT cell invasiveness, depending on the NM-ligand type. Finally, combinations of photodynamic therapy and CUR-loaded NM administrations resulted in almost complete SFT cell viability abrogation 24 h after laser irradiation.

Laser-induced immune modulation inhibits tumor growth in vivo (Conference Presentation)

Photobiomodulation stands as a recommended therapy for oral mucositis induced by oncological therapies. However, its mechanisms of action and, more importantly, its safety in cancer patients, are still unclear. We assessed cancer cell metabolism and proliferation in vitro and in vivo after exposure to different laser protocols. We exploited both ectopic melanoma and a more physiological oral carcinogenesis mouse model, followed by molecular, histological and immunohistochemical characterization. Laser irradiation resulted in a slightly increase in cell metabolism and proliferation in vitro, albeit each protocol exerted a difference response. Of notice, in vivo laser light reduced tumour growth and invasiveness, indicating e beneficial effect on tumor microenvironment. Laser-treated tumors were surrounded and infiltrated by immune cells, mainly lymphocytes and dendritic cells, paralleled by an enhanced secretion of type I interferons. In contrast, the number of pro-angiogenic macrophages was reduced in response to laser irradiation, with consequent normalization of the tumor vasculature. Based on these finding we have also started exploring the effect of photobiomodulation on lymphocyte response in an experimental model of vaccination. Preliminary data indicate that laser light induced antigen-specific CD8+ and CD4+ T cell responses. In conclusion, our data point toward photobiomodulation as an effective strategy to boost the immune response in vivo, with relevant, therapeutic activities in both cancer and vaccination experimental models. These results support the safe use of laser light on cancer patients and open the way to innovative therapeutic opportunities.

Scoring systems for Oral Lichen Planus used by differently experienced raters

Background Scoring systems have been widely used to evaluate the severity and activity of oral lichen planus (OLP). The aim of the present study was to compare two existing (one modified) scoring systems in the evaluation of OLP severity and correlation with pain. Three differently experienced raters were involved. Material and Methods Consecutive patients with OLP were assessed for pain using the Visual Analogue Scale and examined at 10 intraoral sites before starting (T0) and three weeks after (T1) steroid therapy (Clobetasol). Three differently experienced raters evaluated photographs using two scoring systems designated White-Erosive-Atrophic (WEA) modified from an older WEA system (WEA-MOD) and Reticular-erythematous-Ulcerative (REU) systems. WEA-MOD Kendall’s W and interclass correlation coefficient were calculated and correlation between REU/WEA-MOD and pain was calculated using Spearman coefficient. Results Most patients showed lesions on buccal mucosa (85-93,5%) and maxillary/mandibular gingivae (31,8-31,2%), predominantly reticular. At T0, Kendall-W coefficients of 0.89 and 0.74 were obtained for the REU and WEA respectively. At T1, Kendall-W coefficients of 0.83 and 0.58 were obtained for the REU and WEA respectively. Interclass correlation coefficient ranged from 0.87 to 0.90 for REU and from 0.58 to 0.87 for WEA. REU and WEA scores significantly decreased after therapy (p<0.000) as well as VAS (p<0.05). REU score showed correlation with VAS. Conclusions All the raters achieved comparable measures using REU whereas WEA and WEA-MOD seem less reproducible. REU seems to correlate to disease activity and pain. Key words:Oral lichen planus, scoring system, VAS, REU, WEA, rater.

Blue diode laser versus traditional infrared diode laser and quantic molecular resonance scalpel: clinical and histological findings after excisional biopsy of benign oral lesions

Abstract. This study aims to compare the use of the innovative blue diode laser (BLUE group) with two traditional surgical techniques: the infrared diode laser (IR group) and the quantic molecular resonance scalpel (QMR group) in the excision of benign oral lesions. Ninety-three patients underwent surgical excision of a benign oral lesion and were followed up for 30 days for pain (0 to 10 visual analogue scale), bleeding, and painkillers’ assumption (yes/no). A blind pathologist evaluated the thermal damage along the cutting margin. Although referred pain was lowest in the BLUE group from day 7 on (p<0.05), all patients referred minimum discomfort after surgery. The BLUE group reported minimum bleeding and necessity of sutures (p<0.000). The QMR group showed the highest bleeding during surgery (p<0.000), while after 14 and 30 days no patient bled. Most of the patients in all groups did not need painkillers. The lowest thermal damage (p<0.000) was found in the BLUE group (71.3±51.8  μm), whereas the IR group proved the highest (186.8±82.7  μm) compared both with the BLUE and QMR (111.4±55.4  μm) groups. All the techniques allowed correct histological sampling. All the experimented techniques offer interesting advantages, although the blue laser minimizes risk of bleeding with limited thermal damage.

Can laser therapy be the answer for radiodermatitis in anal cancer patients? Two case reports

Abstract Background: Patients suffering from anal cancer have to undergo different anticancer therapies, including radiotherapy. Radiodermatitis represents a debilitating side effect of radiotherapy, often leading to painful lesions and a suspension of the radiotherapy treatment. No widely recognized treatment of radiodermatitis is currently available. Objective: The present report introduces an innovative technique based on the use of laser light to manage radiodermatitis of the anal region in a decisive fashion. Study design: Two cases of radiodermatitis are presented, the occurrence of which followed combined chemoradiotherapy for anal squamous cell carcinoma. Both patients complained about strong pain, severe itch and spontaneous bleeding from the lesions. In addition, they reported limitations in their daily life activities as well as a negative impact on their quality of life. Both patients received laser irradiation therapy by applying two wavelengths simultaneously (970±15 nm and 660±15 nm) for a total of six laser sessions. The chosen treatment parameters were as follows: peak power, 6 W, 50% duty cycle for 360 s; peak power, 6 W in continuous mode for another 120 s resulting in spatially averaged energy fluences of 67.5 J/cm2 and 45 J/cm2, respectively. Results: Complete healing of the lesions and symptoms was achieved within 2 weeks. Remission of the symptoms continued after 2 months with no documented side effects. Both patients managed to complete the radiotherapy sessions and reported maximum satisfaction with the treatment. Conclusions: These cases can prepare the ground to consider class-IV laser therapy, an innovative option to manage radiodermatitis with predictable effectiveness and a consequent improvement in the quality of life of the patients. Patients experiencing radiodermatitis suffer from pain accompanied by limited independence in daily activities, decreased life quality, and reduced self-esteem which often leads to depression. Resolution of radiodermatitis can result in fewer cases of radiotherapy suspension and a better outcome in the oncological treatment as well as an improved quality of life, usually very quickly.

Combined Orofacial Aspergillosis and Mucormycosis: Fatal Complication of a Recurrent Paediatric Glioma—Case Report and Review of Literature

Mucormycosis and aspergillosis are two opportunistic fungal infections, which can evolve into life-threatening complications. They generally affect patients with relevant risk factors such as immunocompromisation or long-term use of antibiotics or corticosteroids. Treatment usually combines medical and surgical approaches, often including extended necrosectomies, although the prognosis of generalized fungal infections is very poor. In this paper, we present the case of a 17-year-old girl affected by combined aspergillosis and mucormycosis, following treatment of a recurrent glioma. The patient was hospitalized for a suspected cellulitis of the right hemi-face, involving frontal maxillary area and the upper airways and was immediately put on intravenous antibiotic therapies; after performing nasal septum and maxillary biopsies, concomitant mucormycosis and aspergillosis were diagnosed and antimycotic therapy with liposomal B-amphotericin was administered. After evaluation by the oral surgeon and otolaryngologist, surgical cranio-facial necrosectomy was suggested, but refused by the parents of the patient. The girl died only few days later, due to a respiratory arrest. Awareness of this pathology with prompt diagnosis and early treatment may improve the outcome of these infections and reduce the mortality.

Processo diagnostico di una lesione orale inusuale

Riassunto Obiettivi Il rabdomiosarcoma e un tumore maligno dei tessuti molli che origina dal muscolo scheletrico; e stato inizialmente descritto nel 1854 e rappresenta piu del 50% dei sarcomi dei tessuti molli nei giovani pazienti. Diagnosticare un rabdomiosarcoma e spesso difficile dato che, clinicamente, non ha caratteristiche patognomoniche e univoche. Materiali e metodi Si riporta il caso di un rabdomiosarcoma facilmente confondibile con una lesione di origine odontogena, diagnosticato a un giovane di 24 anni. Per giungere alla diagnosi finale sono state necessarie piu fasi e tecniche quali l’istopatologia, l’immunoistochimica e l’imaging, in aggiunta all’aspetto clinico. Risultati e conclusioni La diagnosi precoce delle lesioni maligne del cavo orale riveste un ruolo determinante per la prognosi. E necessario adottare un atteggiamento critico e consapevole per non incorrere in errori diagnostici e, conseguentemente, terapeutici. Inoltre e opportuno che i casi sospetti o dubbi siano tempestivamente inviati a strutture specializzate di riferimento per ottimizzare la gestione del piano diagnostico-terapeutico.