M. De Benedittis

Oro-dental manifestations in Hallopeau-Siemens-type recessive dystrophic epidermolysis bullosa.

Recessive dystrophic epidermolysis bullosa of Hallopeau‐Siemens (RDEB‐HS) is a rare genetic disorder characterized by trauma‐induced blisters, milia, acral pseudosyndactyly, and scarring. RDEB‐HS patients present with a distinct pattern of oral involvement consisting of microstomia, ankyloglossia, vestibule obliteration and dental caries. In this review, we describe the orodental manifestations of RDEB‐HS and present our experience in a cohort of six new cases of RDEB‐HS in children aged 6–10 years, documenting the presence of microstomia, ankyloglossia and vestibule obliteration in childhood. We also show that compared with unaffected control children, RDEB‐HS subjects have a greater risk of developing high caries indices with early onset, both for permanent or deciduous teeth, and a worse oral hygiene index (scored as OHI). Tooth malpositions and the cross‐bite relationship between maxilla and mandible could play a major role in promoting these events. We propose that dental management of RDEB‐HS subjects should commence as soon as tooth eruption begins.

Oral squamous cell carcinoma during long-term treatment with hydroxyurea.

Hydroxyurea (HU) is commonly used for the treatment of chronic myelogenous leukaemia, polycythemia vera and essential thrombocythaemia. Patients receiving HU present a number of side‐effects including skin/mucosa changes and tumours. Mucocutaneous abnormalities include xerosis, ichthyosiform lesions, dark brown pigmentation of skin folds and nails, malleolar ulcers, oral mucositis and oral ulcers. Cutaneous squamous/basal cell carcinomas have also often been reported following long‐term administration of HU. HU‐induced carcinogenesis is due to both the mutagenic potential of this agent and to an impairment of DNA repair mechanisms after damage by external factors such as ultraviolet radiation. Oral cancer following long‐term treatment with HU has been reported only once, in a patient with concomitant multiple skin tumours. We present the unique case of a patient with polycythemia vera who developed oral cancer after 15 years of HU therapy.

Expression and subcellular distribution of Bcl-2 and BAX proteins in serum-starved human keratinocytes and mouth carcinoma epidermoid cultures.

Squamous cell carcinoma (SSC) is the most frequent malignant tumor of the oral cavity. Aberration of programmed cell death is thought to participate in cancer. Using specific antibodies a study of the expression and subcellular distribution of Bcl-2, BAX, caspase-3 and cytochrome c in normal human keratinocytes and mouth carcinoma slowly (HN) and rapidly growing (KB) cells has been carried out. In carcinoma cells depressed expression of BAX, presence in the cytosol of procaspase-3 and absence in this fraction of cytochrome c have been found. PGE2 treatment prevented cell growth depression induced by pro-apoptotic serum starvation both in control and carcinoma cell cultures. It is also shown that PGE2 promoted both in keratinocytes and KB cells expression of Bcl-2, which was accompanied in the first case by increase in its mitochondrial level. These results indicate that in carcinoma cells there is an apparent down regulation of the apoptotic cascade as compared to normal keratinocytes. Thus the possibility that down regulation of apoptosis is associated with promotion of tumor development in the oral mucosa cells seems to be supported by these observations.

Topical, vitamin E acetate for the treatment of cheilitis: a multicentric experience

Treatment of cheilitis is usually difficult and often disappointing. We evaluated the effects of a topical preparation containing vitamin E acetate (VEA® lipogel) in 254 patients (mean age, 29.5) with cheilitis of various nature and etiology, involving the vermilion region and/or the perioral skin. The most frequent form of cheilitis was that induced by oral isotretinoin; other forms were irritant contact dermatitis, atopic cheilitis, and contact allergy. Patients were instructed to apply VEA® lipogel daily; the number of daily applications was modulated on the basis of the severity of symptoms (two or three times a day in the majority of cases). After 4 weeks of treatment, clinical examination showed that the severity of symptoms and signs significantly improved (P<0.001). The response to treatment was reported as particularly rapid by 32% of patients. Patients assessment of overall effectiveness and acceptability was positive in the majority of cases. Treatment was well tolerated; local adverse reactions were observed in 2.75% of patients and were mostly transient and mild. Our experience suggests that VEA® lipogel is an effective and safe approach to cheilitis. The safety of this preparation is also due to the presence of only a few excipients and the absence of fragrances, preservatives and colouring agents.

Use of platelet rich fibrin and Bio-OSS/SINT-Oss for implant-prosthetic rehabilitation in maxillary atrophy with sinus pathology: A 48-month follow-up

The maxillary sinus floor elevation procedure has gained popularity with predictable results, and is a safe, acceptable technique for bone augmentation, providing a base for dental implant treatment. Faint radiopaque lesions at the base of the maxillary sinus are frequent diagnoses on radiographs and must be identified during dental implant planning. The use of autografts, xenografts, allografts, and alloplasts or a combination between them has been demonstrated to be effective for increasing bone height and bone volume in maxillary sinus. The objective of this study was to evaluate the outcome of subjects with considerable sinus membrane pathology (test group) undergoing maxillary sinus floor augmentation using Platelet Rich Fibrin (PRF) as a filling material, in association with the Bio-Oss and Sint-Oss and simultaneous implant placement in a one-stage surgical procedure. All patients reported no pain to percussion, no sign of tissue suffering to the soft peri-implant tissues, the presence of an optimal primary stability of the inserted implants, and the increase in the peri-implant bone density. No complications were encountered during follow-up periods in these patients, including no negative evolution in the sinusitis and all implants are functioning successfully. In conclusion, the use of PRF and Piezosurgery reduced the healing time, favoring optimal bone regeneration and allowing sinus membrane integrity to be maintained during surgical procedures, according to evidence-based dentistry.