Minas Leventis

Intraosseous cystic lesions of the jaws in children : A retrospective analysis of 47 consecutive cases

OBJECTIVES The aim was to review the characteristics and treatment approach in 47 cases of intraosseous cystic lesions of the jaws in children. STUDY DESIGN Forty-three patients, 2-14 years old, with 47 cystic lesions of the jaws, were treated during the period 2000-2007. All cysts were surgically removed. No bone grafts were used and the teeth involved were preserved whenever possible. Removed tissues were examined histologically. Follow-up period ranged from 6 months to 7 years. RESULTS In 74.5% of the cases, cysts were enucleated, and in 17.0% they were marsupialized. Most commonly, the cysts were dentigerous (20, 42.6%), followed by eruption cysts, odontogenic keratocysts, and radicular cysts (10.6% each) and buccal bifurcation cysts (8.6%). CONCLUSION Cystic lesions in children were found to be mainly of developmental origin. Treatment was surgical removal without interfering, when possible, with the development of the dentition. Surgical approach was usually enucleation and, to a lesser extent, marsupialization.

Localized jaw enlargement in renal osteodystrophy: Report of a case and review of the literature

Renal osteodystrophy is a common long-term complication of end-stage renal disease. Involvement of the jaws is common and radiographic alterations are often one of the earliest signs of chronic renal disease. However, marked enlargement of the jaws is a rare complication of renal osteodystrophy. A case of localized asymptomatic enlargement of the mandible in a 38-year-old woman with chronic renal failure is presented. The clinical, radiographic, and histological findings were consistent with renal osteodystrophy. To our knowledge, this is the third case of localized mandibular enlargement of renal osteodystrophy reported in the English-language literature.

Effect of autologous platelet-rich plasma in combination with a biphasic synthetic graft material on bone healing in critical-size cranial defects.

Purpose The aim of the study was to investigate the effect of autologous platelet-rich plasma (PRP) on the osteogenic potential of a biphasic synthetic graft material composed of hydroxyapatite and beta-tricalcium phosphate (HA/&bgr;-TCP) in critical-size cranial defects in rabbits. Materials and Methods Three circular bicortical critical-size cranial defects were created in each of 18 rabbits. The first of the defects was grafted with autologous PRP and HA/&bgr;-TCP, the second was grafted with HA/&bgr;-TCP without PRP, and the third was left unfilled as a negative control. Animals were euthanized at 2, 4, and 6 weeks after surgery. Harvested tissue specimens were evaluated histologically and histomorphometrically. Several parameters associated with osteoclastic and osteoblastic activities were measured and calculated. The results were statistically analyzed using the 1-way analysis of variance statistical method. Results Histologic analysis of the samples showed bone tissue formation at all experimental sites including untreated control defects. A statistically significant difference in new bone formation between the defects treated with HA/&bgr;-TCP + PRP and defects treated with HA/&bgr;-TCP alone was not observed. Control untreated defects showed the greatest bone regeneration. Conclusions In this animal model, autologous PRP had no effect on bone healing in addition to a biphasic HA/&bgr;-TCP synthetic graft material after 2, 4, and 6 weeks of implantation.

Oral nodular fasciitis: report of a case of the buccal mucosa.

Nodular fasciitis is a benign, reactive, proliferative spindle-cell lesion, usually located at the subcutaneous tissues or muscle fascia. Clinically, it manifests as a soft-tissue mass with well-defined margins and fixed to the adjacent structures. Because of its rapid growth rate, rich cellularity and relatively high mitotic activity, nodular fasciitis is sometimes misdiagnosed as a sarcoma. Accurate diagnosis is based only on histopathological examination. A rare case of nodular fasciitis of the buccal mucosa in a 50-year-old female patient is presented.

Minimally Invasive Alveolar Ridge Preservation Utilizing an In Situ Hardening β-Tricalcium Phosphate Bone Substitute: A Multicenter Case Series

Ridge preservation measures, which include the filling of extraction sockets with bone substitutes, have been shown to reduce ridge resorption, while methods that do not require primary soft tissue closure minimize patient morbidity and decrease surgical time and cost. In a case series of 10 patients requiring single extraction, in situ hardening beta-tricalcium phosphate (β-TCP) granules coated with poly(lactic-co-glycolic acid) (PLGA) were utilized as a grafting material that does not necessitate primary wound closure. After 4 months, clinical observations revealed excellent soft tissue healing without loss of attached gingiva in all cases. At reentry for implant placement, bone core biopsies were obtained and primary implant stability was measured by final seating torque and resonance frequency analysis. Histological and histomorphometrical analysis revealed pronounced bone regeneration (24.4 ± 7.9% new bone) in parallel to the resorption of the grafting material (12.9 ± 7.7% graft material) while high levels of primary implant stability were recorded. Within the limits of this case series, the results suggest that β-TCP coated with polylactide can support new bone formation at postextraction sockets, while the properties of the material improve the handling and produce a stable and porous bone substitute scaffold in situ, facilitating the application of noninvasive surgical techniques.

Desmoplastic Fibroma of the Mandible in a child presenting with TMJ dysfunction

Abstractbackground: Desmoplastic fibroma of bone is a rare intraosseous benign but locally aggressive tumor of connective tissue origin. The lesion may affect the metaphyses of the long bones but it may also involve the skull bones and more specifically the mandible, with most lesions appearing in the ramus-angle area. Treatment is surgical although additional chemotherapy or radiation has been applied. Case report: A 10-year-old boy initially presented with restriction and deviation of mouth opening. Clinical and radiological examination revealed a tumor-like lesion of the mandible extending into the soft tissues, which on biopsy proved to be a desmoplastic fibroma. Treatment: The surgical treatment included peripheral ostectomy of the mandible, via an intraoral approach, for the removal of the lesion and restoration of the bone defect with an iliac bone autograft. Follow-up: The high recurrence rate of this type of lesion, demands a strict follow-up schedule. In the case presented, 5 years post-operatively, there are no signs of local recurrence. Conclusion: Changes in mouth opening when not attributed to obvious reasons, such as trauma, should make a dentist suspicious and lead to further investigation. In the case presented, a central lesion was revealed in the radiograph and the patient was referred and treated early. Extended surgical removal of the tumor, with wide margins, proved to be the appropriate treatment.

Biological response to β-tricalcium phosphate/calcium sulfate synthetic graft material: an experimental study.

Purpose:The aim of this study was to evaluate the effect of a biphasic synthetic bone graft material composed of &bgr;-tricalcium phosphate (&bgr;-TCP) and calcium sulfate (CS) in 12 New Zealand rabbits. Materials and Methods:A circular bicortical critical-size cranial defect was created in each of 12 rabbits. The defects were grafted with &bgr;-TCP/CS. Animals were euthanized at 3 and 6 weeks. Harvested tissue specimens were evaluated histologically and histomorphometrically. Parameters associated with new bone formation and graft resorption were measured and calculated. The results were statistically analyzed using the Mann-Whitney test. Results:Our data demonstrated the biocompatibility of synthetic &bgr;-TCP/CS, as no inflammatory response was observed, and no fibrosis was developed between the graft particles and the newly formed bone. Moreover, &bgr;-TCP/CS acted as an osteoconductive scaffold that allowed a significant bone regeneration and graft biodegradation with time. Conclusion:In this animal model, synthetic &bgr;-TCP/CS proved to be a biocompatible, osteoconductive, and bioresorbable bone graft substitute.

Intraosseous mandibular venous malformation.

Intraosseous venous malformations are rare benign lesions that account for approximately 0.5% to 1% of all osseous tumors. Involvement of the facial skeleton is rather uncommon, with the mandible and maxilla most frequently involved. In the current study, we report a case of an intraosseous venous malformation in a 52-year-old male patient with a history of mandibular keratocystic odontogenic tumor. The patient presented with an asymptomatic bony lesion in the mandible. Treatment involved surgical excision. Histopathologic examination of the excised specimen revealed an intraosseous venous malformation. Twelve months postoperatively, there was no evidence of recurrence.

Protocol for Bone Augmentation with Simultaneous Early Implant Placement: A Retrospective Multicenter Clinical Study.

Purpose. To present a novel protocol for alveolar bone regeneration in parallel to early implant placement. Methods. 497 patients in need of extraction and early implant placement with simultaneous bone augmentation were treated in a period of 10 years. In all patients the same specific method was followed and grafting was performed utilizing in situ hardening fully resorbable alloplastic grafting materials consisting of β-tricalcium phosphate and calcium sulfate. The protocol involved atraumatic extraction, implant placement after 4 weeks with simultaneous bone augmentation, and loading of the implant 12 weeks after placement and grafting. Follow-up periods ranged from 6 months to 10 years (mean of 4 years). Results. A total of 601 postextraction sites were rehabilitated in 497 patients utilizing the novel protocol. Three implants failed before loading and three implants failed one year after loading, leaving an overall survival rate of 99.0%. Conclusions. This standardized protocol allows successful long-term functional results regarding alveolar bone regeneration and implant rehabilitation. The concept of placing the implant 4 weeks after extraction, augmenting the bone around the implant utilizing fully resorbable, biomechanically stable, alloplastic materials, and loading the implant at 12 weeks seems to offer advantages when compared with traditional treatment modalities.

Alveolar ridge preservation using a novel synthetic grafting material: A case with two-year follow-up

This case report highlights the use of a novel in situ hardening synthetic (alloplastic), resorbable, bone grafting material composed of beta tricalcium phosphate and calcium sulfate, for alveolar ridge preservation. A 35-year-old female patient was referred by her general dentist for extraction of the mandibular right first molar and rehabilitation of the site with a dental implant. The nonrestorable tooth was “atraumatically” extracted without raising a flap, and the socket was immediately grafted with the synthetic biomaterial and covered with a hemostatic fleece. No membrane was used, and the site was left uncovered without obtaining primary closure, in order to heal by secondary intention. After 12 weeks, the architecture of the ridge was preserved, and clinical observation revealed excellent soft tissue healing without loss of attached gingiva. At reentry for placement of the implant, a bone core biopsy was obtained, and primary implant stability was measured by final seating torque and resonance frequency analysis. Histological analysis revealed pronounced bone regeneration while high levels of primary implant stability were recorded. The implant was successfully loaded 12 weeks after placement. Clinical and radiological follow-up examination at two years revealed stable and successful results regarding biological, functional, and esthetic parameters.