Leucoplachia verrucosa proliferativa. Analisi retrospettiva di 12 casi

Objectives

Proliferative verrucous leukoplakia (PVL) is a potentially malignant disorder characterized by highly aggressive behavior and a marked tendency to neoplastic transformation. In this retrospective study, we analyzed the epidemiologic, clinical and histopathological features of 12 cases of PVL with particular emphasis on the type and outcome of treatment.

Materials and methods

Using the original diagnostic criteria proposed by Hansen, we selected 12 patients with PVL who were referred to the Unit of Oral Medicine and Oral Pathology (Odontostomatology Department) of the University Hospital of Parma between January 1993 and January 2010.

Results

Ten patients (83.3%) were females; the mean age of the total group was 70.1 years. The buccal mucosa, tongue, and adherent gingiva were the most frequently involved oral sites. Eight patients (60.0%) developed an oral carcinoma during the follow-up. The mean interval between the first visit and the diagnosis of malignancy was 33.8 months. The cancers involved the tongue (3 cases), buccal mucosa (2 cases), gingiva (2 cases), and hard palate (1 case). Different therapeutic approaches were utilized: medical therapy with topical retinois or topical clobetasol, surgical removal of the lesions with traditional cold-blade technique, quantic molecular resonance scalpel, Nd:YAG laser, and Er:YAG laser vaporization. Only one patient was disease-free at the last follow-up visit.

Conclusions

This experience confirms the high rate of malignant transformation and recurrence associated with PVL. None of the therapeutic approaches proved to be completely effective. Therefore, patients with PVL need close follow-up (every 3-4 months) to insure early detection of malignant lesions.     

Malignant transformation of oral leukoplakia in a well‐defined cohort of 144 patients

Objectives

Oral leukoplakia is a potentially malignant disorder of the oral mucosa. The aim of this retrospective study was to identify the factors that possibly predict malignant transformation in a well‐defined cohort of patients with a long‐term follow‐up. All leukoplakias were staged according to a clinicopathological classification and staging system. Furthermore, a certainty factor has been used with which the diagnosis has been established.

Material and methods

The group consisted of 144 patients. The size, presence and degree of epithelial dysplasia were incorporated into a clinicopathological classification and staging system. Initial management consisted of surgical excision, CO₂ laser vaporisation or observation only. The mean follow‐up period was 51.2 months (s.d. = 39.33, range 12–179 months).

Results

In 16 of 144 patients (11%), malignant transformation occurred between 20 and 94 months (mean 57.0 months) after the first visit, the annual malignant transformation rate being approximately 2.6%. A large size of the lesion (≥ 4 cm) showed to be the only statistically significant predictor of malignant transformation (P = 0.034).

Conclusion

A size of ≥ 4 cm showed to be the only significant predicting factor of malignant transformation in oral leukoplakia. No other epidemiological, aetiological, clinical or histopathological parameters were of statistical significance.     

Recurrence patterns of oral leukoplakia after curative surgical resection: important factors that predict the risk of recurrence and malignancy

J Oral Pathol Med (2012) 41 : 682–688 Background: Oral leukoplakia can be treated using a variety of treatment procedures; however, the lesions recur in many cases irrespective of the treatment procedure used. The rate of recurrence was from 7.7% to 38.1%. This study aims to identify the important factors that can lower the risk of recurrence of oral leukoplakia treated by curative surgical resection. Methods: The clinical records of 52 patients with oral leukoplakia (53 lesions) who underwent curative surgical resection between 2004 and 2009 were retrospectively analyzed for the rate of recurrence, clinical outcome, epithelial dysplasia, lesion location, and resection margins. Results: The recurrence rate following curative surgical resection was 15.1%, with the most common site being the gingiva. Malignant transformation occurred in a single patient (1.9%). Minimal resection margins (<3 mm) were observed in many patients with recurrent disease, and recurrence was more likely in cases with positive margins (epithelial abnormalities at the resection margins) than in those with negative margins. There was no significant association between recurrence and the degree of epithelial dysplasia. Conclusions: Our data suggest that surgical resection of oral leukoplakia is curative only if all areas of epithelial abnormalities are identified and resected. Moreover, an adequate resection margin may reduce the risk of recurrence.     

Diffusion-weighted magnetic resonance imaging in oral and maxillofacial lesions: preliminary study on diagnostic ability of apparent diffusion coefficient maps

Objectives

The aim of this study was to investigate the usefulness of diffusion-weighted magnetic resonance imaging (DWI) in oral and maxillofacial lesions, especially the utility of apparent diffusion coefficient (ADC) maps for differential diagnosis of these lesions.

Methods

Fifty-seven patients who underwent magnetic resonance imaging for diagnosis of oral and maxillofacial lesions were included in this prospective study. DWI was performed on a 1.5 T unit with b-factors of 0 and 800 s/mm², and ADC maps were generated. ADC values were measured for all 57 oral and maxillofacial lesions (19 squamous cell carcinoma, 10 medication-related osteonecrosis of the jaw, 6 odontogenic abscess, 4 ranula, 4 osteoradionecrosis, 4 hemangioma, 3 pleomorphic adenoma, 3 odontogenic keratocyst, 2 nasopalatine duct cyst, 1 malignant melanoma, and 1 basal cell carcinoma).

Results

The mean ADC values for ranula (2.69 ± 0.59 × 10^?3 mm²/s) and nasopalatine duct cyst (2.34 ± 0.12 × 10^?3 mm²/s) were significantly higher than those for the other oral and maxillofacial lesions (p = 0.000). In contrast, the mean ADC value for odontogenic abscess (0.67 ± 0.36 × 10^?3 mm²/s) was significantly lower than those for the other oral and maxillofacial lesions (p = 0.000).

Conclusions

The present study suggests the usefulness of DWI in oral and maxillofacial lesions, especially the utility of ADC maps for differential diagnosis of these lesions.

     

Excision of Oral Leukoplakia by CO2 Lasers Versus Traditional Scalpel: A Comparative Study

Purpose

Laser surgery has shown to exhibit several advantages over scalpel for many procedures. Some of these advantages include hemostasis, decreased scarring, and ability to perform certain procedures without anaesthesia. It has been postulated that laser surgery results in less post-operative pain. However this can be a difficult parameter to measure. This study sought to determine if there was a difference in the intensity and frequency of pain following excision with scalpel when compared to excision done with a CO₂ laser.

Aims and Objective

(1) Hemostasis intra operatively and (2) pain, swelling and scarring post-operatively.

Materials and Methods

Thirty patients with bilateral (60 lesions) were selected for the entire proposed research. Group A: carbon dioxide laser excision (experimental group). Group B: scalpel excision (control group).

Result

(1) Intra operative bleeding is significantly higher in scalpel side compared to laser side treatment. (2) Percentage change (gained) in facial edema is significantly higher in scalpel side compared to laser side treatment. (3) Distribution of level of pain is approximately similar in both the treatments. (4) Distribution of scarring after 1 month post-operative pain is significantly higher in scalpel side compared to laser side treatment.

Conclusion

Through this study we can infer that CO₂ laser supersedes conventional scalpel in terms of better intra-operative and reduced scarring. Post-operative pain and swelling after laser excision did not show any significant difference from that of scalpel.     

Immunohistochemical expression of DNA methyltransferases 1, 3a and 3b in oral leukoplakias and squamous cell carcinomas

Over-expression of DNA methyltransferases DNMT1, DNMT3a and DNMT3b has been reported in various cancers and precancerous lesions.

Objective

To investigate DNMT1, DNMT3a and DNMT3b enzymes in oral squamous cell carcinoma (SCC) and leukoplakia, and their relationship with histopathologic/clinical parameters.

Study design

Immunohistochemistry was carried out to evaluate the three DNMTs in 60 samples of oral SCC and 37 samples of oral leukoplakia.

Results

DNMT3a immunoreactivity in the three groups of oral SCC (39.8%) was significantly higher than in control (22.6%) (ANOVA, Student–Newman–Keuls test, P < 0.05), but not when compared to oral leukoplakia groups (28.2%). For DNMT1 and DNMT3b, there were no statistically significant differences between oral SCC groups (65% and 74.7%), oral leukoplakia groups (68.3% and 70.9%) and control (65.4% and 76.5%). There was a significantly higher mean percentage of DNMT1 immunoreactivity in non-smokers (ANOVA, P = 0.048), and a higher DNMT3a immunoreactivity in alcohol users (ANOVA, P = 0.01).

Conclusions

Higher DNMT3a immunopositivity may be associated with oral SCC and alcohol use, whilst lower levels of DNMT1 may be related with smoking habit. However, there was a significantly higher mean percentage of DNMT1 immunoreactivity in non-smokers (ANOVA, P = 0.048), and a higher DNMT3a immunoreactivity in alcohol users (ANOVA, P = 0.010).     

Topical Steroids and CO2 Laser in the Treatment of Refractory Oral Lichenoid Drug Reaction and Lichenoid Contact Lesion: a Case Report

A 54-year-old female presented with severe pain on the gingiva and buccal mucosa. Oral findings revealed generalized fiery red gingiva, ulcerative with white striae covered by pseudo-membranes on both buccal mucosae. She had hypertension, dyslipidemia, subclinical hypothyroidism and arthritis. She was treated with atorvastatin, hydrochlorothiazide, valsartan, levothyroxine and non-steroidal anti-inflammatory drug (NSAIDs). Her oral lesions were a slight improvement from a previous treatment with pimecrolimus cream, triamcinolone acetonide 0.1% orabase and injection. After diclofenac was replaced with tenoxicam and oral lesions were treated with various topical steroids, the lesions showed marked improvement. The biopsy from the buccal mucosa revealed oral lichen planus. Patch test showed positivity to mercury, gold sodium thiosulfate and palladium. One year later the left buccal mucosa showed red, round papillomatous-like lesions. The histopathological report showed a non-specific ulcer with chronic inflammation. The lesions flared up after replacing amalgam with crowns. After CO₂ laser treatment, the lesions showed some improvement. Direct and indirect immunofluorescence of the lesions proved to be negative. This first case report showed that the palliative treatment of refractory oral lichenoid lesions with potent topical steroids for 7 years had no side-effects. CO₂ laser can be an alternative treatment of refractory lesion in this case.KEYWORDS: CO₂ laser, clobetasone propionate, oral lichenoid, fluocinolone acetonide     

Quantification of root surface plaque using a new 3-D laser scanning method

Abstract. There are no published reports in the literature objectively quantifying thickness of plaque on teeth. The aim of this study was to quantify plaque on a tooth surface and assess if this quantification correlates with a clinical index of plaque from each of 51 patients. Patients were instructed not to perform any oral hygiene on the day of the assessment. The Silness and Löe plaque index was scored and replicas were scanned using a co-ordinate measuring machine (CMM) and laser scanning probe. A replica was obtained from this surface before and after toothbrushing. Plaque adjacent to the gingival margin had a mean thickness of 0.106±0.118 mm (mean±SD) whilst mean plaque thickness 250 μm from the gingival margin was 0.053±0.052 mm (mean±SD). There was a significant correlation between the plaque index and the plaque thickness (p≤0.002). The finding that plaque is present in the greatest amount adjacent to the gingival margin supports a previously reported hypothesis that primary root carious lesions (PRCL's) may initiate adjacent to the gingival margin. This method quantifies plaque thickness on exposed root surfaces which correlates with the plaque index as well as illustrating how the morphological characteristics of teeth, gingivae and plaque can be studied in vivo from replicas recorded.     

Scientific Abstracts of 40th Annual Conference of Association of Oral and Maxillofacial Surgeons of India

Introduction

Bone marrow (BM) derived pleuripotent undifferentiated stem cells represent a promising population for supporting new concepts in cellular therapy.

Aim

The aim of this study is to evaluate the versatility of pleuripotent undifferentiated stem cells derived from BM aspiration and its applications in oral and maxillofacial surgical procedures.

Materials and Methods

A total of 30 patients out of which 15 were with hard tissue defects (cystic lesions n = 6, post surgical alveolar defects n = 4, peri implant defects n = 3, alveolar clefts n = 2) and 15 soft tissue lesions (leukoplakia and lichen planus n = 6, oral submucous fibrosis n = 7, post traumatic soft tissue loss n = 2) were included in the study on randomized clinical basis. The patients received autologous BM derived mononuclear cells which were being locally delivered into the lesion and followed up. The parameters used were (1) To compare and evaluate the bone regeneration by radiographic assessment at the end of 3rd and 6th month postoperatively. (2) Duration of the procedure. (3) Clinical improvement in the management of soft tissue lesions. (4) Assessment of wound healing by Vancouver burn scar assessment of wound. (5) Safety, postoperative infections and complications.

Results

For hard tissue lesions CT scans and OPG revealed adequate regenerated bone, bridging the defect after 3 months. Hounsfield units of regenerated bone after 6 months were more or less similar to native bone which was statistically significant (unpaired t test = p < 0.05). For soft tissue lesions (1) 7 cases of OSMF showed adequate clinical mouth opening (one way anova test = p < 0.05), reduction in burning sensation and blanching of mucosa, (2) 6 cases of leukoplakia and lichen planus and 2 cases of post traumatic soft tissue defects showed good clinical improvement by Vancouver burn scar assessment of wound index.

Conclusion

The study shows that there is a definite beneficial effect in bone regeneration and soft tissue wound healing with the use of BM-derived mononuclear cells.

     

Influence of orthognathic surgery on periodontal tissues

Objective

The present prospective study aimed at evaluating the influence of orthognathic surgery on mucogingival tissues and the subgingival microflora.

Patients and methods

Fifteen consecutively-treated patients with a mean age of 24.9±7.7?years were included in this study. The surgical interventions comprised the Le Fort?I osteotomy of the maxilla and/or sagittal split osteotomy of the mandible. The following periodontal and microbial parameters were measured preoperatively (T₀) as well as 1?week (T₁) and 6?weeks (T₂) postoperatively: pocket probing depth?(PPD), gingival recession?(GR), clinical attachment level?(CAL), bleeding on probing?(BOP), plaque index?(PI), and changes in the subgingival microflora. Periodontal parameters were calculated for all sites as well as for buccal and oral sites separately. For statistical analysis, the general linear model and paired t test were applied (level of significance: p<0.05).

Results

PPD readings increased significantly on oral tooth sites when T₀ values were compared to T₁ (p=0.009) and T₂ values (p=0.042). GR increased significantly on buccal sites from 0.10±0.16?mm at baseline to 0.21±0.23?mm at T₁ (p=0.013) and 0.31±0.31?mm at T₂ (p=0.001). Furthermore, we noted significant changes in the CAL (oral sites) and PI (buccal and oral sites). We observed no significant differences in BOP and periodontopathogenetic bacteria.

Conclusion

Orthognathic surgery has a statistically significant effect on the development of gingival recessions. However, this effect may not necessarily clinically impair the esthetic appearance.     

Salivary 8-hydroxy-2-deoxyguanosine,malondialdehyde, vitamin C,and vitamin E in oral pre-cancer and cancer: diagnostic value and free radical mechanism of action

Objectives

The objectives of this study are to analyze oxidative DNA and lipid damage using salivary 8-hydroxy-2-deoxyguanosine (8-OHdG), malondialdehyde (MDA), and vitamins C and E in oral lichen planus lesions, oral leukoplakia, oral submucous fibrosis, oral squamous cell carcinoma (SCC), and controls and to determine the value of salivary biomarkers in the diagnosis of oral pre-cancer and cancer patients.

Materials and methods

Unstimulated saliva was collected from a group of patients diagnosed with 40 oral squamous cell carcinoma (OSCC), 40 oral lichen planus lesions, 40 oral leukoplakia, 40 oral submucous fibrosis, and from a control group of healthy age- and gender-matched individuals. Salivary 8-OHdG, MDA, and vitamins C and E were measured.

Results

Squamous cell carcinoma and pre-cancer patients showed significantly higher levels of salivary 8-OHdG and MDA and lower levels of vitamins C and E when compared to levels in healthy normal subjects. The specificity and sensitivity of the combination of 8-OHdG, MDA, vitamin C, and vitamin E are high for the diagnosis of oral pre-cancer and SCC compared to an individual biomarker approach using either 8-OHdG, MDA, or vitamin C and vitamin E independently.

Conclusions

This study indicates the presence of oxidative DNA and lipid damage in pre-cancerous and SCC patients. It is postulated that the mechanism may have a significant link to carcinogenesis in oral cancer. Detection of salivary 8-OHdG, MDA, vitamin C, and vitamin E can act as suitable diagnostic biomarkers of oral pre-cancer and cancer.

Clinical relevance

Of clinical importance is that salivary 8-OHdG, MDA, vitamin C, and vitamin E could play a significant role in oral cancer and pre-cancer patients and could therefore be useful for diagnosis in patients with oral lichen planus lesions, oral leukoplakia, oral submucous fibrosis, and oral squamous cell carcinoma.

     

Malignant transformation of oral proliferative verrucous leukoplakia: a series of 48 patients with suggestions for management

Proliferative verrucous leukoplakia (PVL) is a rare and refractory form of oral mucosal leukoplakia of unknown origin, characterized by high rates of malignant transformation. Different diagnostic criteria, terminologies, and therapeutic approaches have been proposed since the first report in 1985. There remains no general agreement regarding the clinical and histological diagnosis, prevention, and correct management of this disease. This retrospective study investigated 48 patients affected by PVL showing at least one malignant transformation and followed up at 2-month intervals. Twenty-five were female (52.1%) and 23 (47.9%) were male; their median age was 67 years (range 40–93 years). Follow-up ranged from 18 to 240 months. Clinical examination included the use of Lugol’s solution to prevent clinical underestimation of the margins and toluidine blue for suspicious areas. Surgical excision by scalpel was the preferred treatment for suspicious lesions, with only five carcinomas surgically removed by diode laser and two by CO₂ laser. All specimens were accurately mapped after formalin fixation. Fifteen patients (31.3%; 10 female, five male) developed one oral carcinoma, while 33 (68.7%) developed two or more primary tumours (range 3–12). Only four patients (8.3%), who developed between 2 and 8 oral squamous cell carcinomas (OSCCs), died of tumour-related causes. The pre-surgical clinical workup, subsequent surgical treatment, and follow-up are key to success for patients affected by PVL with malignant transformation into stage 1 OSCC and/or verrucous carcinoma, leading to a high overall survival rate.     

Impact of oral potentially malignant disorders on quality of life

Background

Oral potentially malignant disorders (OPMDs) could have a significant psychological impact on patients, principally because of the unknown risk of malignant transformation, while the physical and functional impairments could differ. This study aimed to assess the impact of three different OPMDs and their disease stages on the quality of life (QoL) of affected patients.

Methods

Oral leukoplakia (OL), oral lichen planus (OLP) and oral submucous fibrosis (OSF) patients who were undergoing treatment at an oral medicine clinic of a dental teaching hospital in India were the study population. All subjects completed the recently developed OPMDQoL questionnaire and a short form 12 item (version 2) health survey questionnaire (SF‐12v2). OPMDQoL questionnaire consists of 20 items over four dimensions. A higher score denotes poor OHRQoL. SF‐12v2 has two components, a Physical Component Summary (PCS) and Mental Component Summary (MCS).

Results

A total of 150 subjects (50 each of OL, OLP and OSF) participated. OL patients (37.7 ± 7.9) reported significantly better OPMDQoL scores than OLP (47.3 ± 5.8) and OSF (45.4 ± 9.2) patients. OLP patients reported significant problems in obtaining a clear diagnosis for their condition, more so than the other OPMDs. OL patients reported fewer problems for the dimension, “physical impairment and functional limitations” than the OLP and OSF patients. A significant trend was observed with the overall OPMDQoL and MCS, deteriorating as the disease stage increased.

Conclusions

OLP and OSF have a significant impact on the QoL of affected individuals: OL less so. Increasing stage of the disease is associated with worsening QoL.     

CO2, ER:YAG AND ND:YAG LASERS IN ENDODONTIC SURGERY

Objectives:

CO₂, Er:YAG and Nd:YAG lasers have been used in endodontic surgery. This in vitro study evaluated 1% Rhodamine B dye penetration using computer-assisted morphometry (ImageTool Software®) of 108 endodontically treated human permanent canines.

Material and methods:

Teeth were divided into 9 groups according to the technique used: A: 90-degree apicoectomy with bur, root-end cavity preparation with ultrasound and filled with MTA; B: 90-degree apicoectomy with bur, root-end cavity prepared with ultrasound and filled with MTA, and treatment of apical surface with CO₂ laser (1 W, CW/CW); C: 90-degree apicoectomy with bur, and treatment of apical surface with Nd:YAG laser (150 mJ, 10 Hz); D: 90-degree apicoectomy with bur, and treatment of apical surface with CO₂ laser (1 W, CW/CW); E: apicoectomy with Er:YAG laser (400 mJ, 10 Hz), root-end cavity prepared with ultrasound and filled with MTA; F: apicoectomy with Er:YAG laser (400 mJ, 10 Hz) and treatment of apical surface with Nd:YAG laser (150 mJ, 10Hz); G: apicoectomy with CO₂ laser (5W, CW/SP), root-end cavity prepared with ultrasound and filled with MTA; H: irradiation of apical end with CO₂ laser (1 W, CW/CW); I: irradiation of apical end with Nd:YAG laser (150 mJ, 10 Hz).

Results:

Dye penetration was found in all specimens at different rates, the lowest penetration occurring in groups C (16.20%), B (17.24%) and F (17.84%).

Conclusions:

Groups B, C and F represent the best technical sequences to perform endodontic surgery.     

An Immunohistochemical Analysis of Cell Cycle Markers in Oral Mucosal Dysplastic Lesions Treated by Laser Therapy. A Pilot Study

Introduction  

Over the past 15 years, dysplastic oral mucosal lesions have been treated by laser ablation with variable success. A recent study have shown that the type of laser utilized may be important for patient outcome, however, it may also be changes at a cellular level that could be an important factor in determining recurrence outcome. The aims of this study were to assess cellular markers related to oral dysplastic lesions treated by two different laser types.     

Chemometric analysis of the consumption of oral rinse chlorite (ClO2 −) by human salivary biomolecules

Objectives

Oral rinse formulations containing chlorite anion (ClO₂ ^?) as an active agent exert a range of valuable oral healthcare activities. However, salivary biomolecules which chemically react with this oxidant can, at least in principle, serve as potentially significant barriers to these therapeutic properties in the oral environment. Therefore, in this investigation, we have explored the extent of ClO₂ ^? consumption by biomolecules which scavenge this agent in human salivary supernatants (HSSs) in vitro.

Materials and methods

HSS samples were equilibrated with oral rinse formulations containing this active agent (30 s at 35 °C in order to mimic oral rinsing episodes). Differential spectrophotometric and ion-pair reversed-phase high-performance liquid chromatographic analyses were employed to determine residual ClO₂ ^? in these admixtures.

Results

Bioanalytical data acquired revealed the rapid consumption of ClO₂ ^? by biomolecular electron donors and/or antioxidants present in HSS samples. Mean?±?95 % confidence interval (CI) consumption levels of 7.14?±?0.69 and 5.34?±?0.69 % of the total ClO₂ ^? available were found for oral rinse products containing 0.10 and 0.40 % (w/v) ClO₂ ^?, respectively. A mixed model analysis-of-variance performed on experimental data acquired demonstrated highly-significant differences between oral rinse ClO₂ ^? contents (p?<?0.0001), trial participants (p?<?0.001) and sampling days–within-participants (p?<?0.001), and also revealed non-additive ClO₂ ^?-scavenging responses of participants’ HSSs to increases in the oral rinse content of this oxidant (p?<?0.0001). A slower, second phase of the reaction process (t _1/2?=?1.7–2.8 h) involved the oxidative consumption of salivary urate.

Conclusions

These data clearly demonstrate that for recommended 30 s oral rinsing episodes performed at physiological temperature, <10 % of the total oral rinse ClO₂ ^? available is chemically and/or reductively consumed by HSS biomolecules for both oral rinse formulations investigated.

Clinical relevance

These observations are of much clinical significance in view of the retention of these products’ active agent, i.e. <10 % of ClO₂ ^? is consumed by HSS biomolecules within recommended 30 s oral rinsing episodes, and hence, the bulk of this oxyhalogen oxidant (>90 %) may effectively exert its essential microbicidal, anti-periodontal and oral malodour-neutralising actions.     

Nested PCR for detection of HSV-1 in oral mucosa

Background

It has been estimated that 15%-20% of human tumours are driven by infection and inflammation, and viral infections play an important role in malignant transformation. The evidence that herpes simplex virus type 1 (HSV-1) could be involved in the aetiology of oral cancer varies from weak to persuasive. This study aimed to investigate by nested PCR (NPCR) the prevalence of HSV-1 in samples from normal oral mucosa, oral leukoplakia, and oral squamous cell carcinoma (OSCC).

Material and Methods

We investigated the prevalence of HSV-1 in biopsies obtained from 26 fresh, normal oral mucosa from healthy volunteers as well as 53 oral leukoplakia and 27 OSCC paraffin-embedded samples. DNA was extracted from the specimens and investigated for the presence of HSV-1 by nested polymerase chain reaction (NPCR) and DNA sequencing.

Results

HSV-1 was detected in 14 (54%) of the healthy samples, in 19 (36%) of the oral leukoplakia samples, and in 14 (52%) of the OSCC samples. The differences were not statistically significant.

Conclusions

We observed a high incidence of HSV-1 in healthy oral mucosa, oral leukoplakia, and OSCC tissues. Thus, no connection between OSCC development and presence of HSV-1 was detected. Key words:HSV-1, nested PCR, PCR.     

Il ruolo dell’igienista dentale nel trattamento laser dell’ipersensibilità dentinale

Objectives

The aim of the study is to assess and compare the desensitizing effects of Er:Yag laser and CO₂ laser with fluoride gel in the treatment of dentine hypersensitivity.

Materials and methods

The 15 patients selected are affected by hypersensitivity in the upper premolar; they have been treated randomly with Er:Yag laser, CO₂ laser, fluoride gel, and placebo. The pain was evaluated before the treatment by using the Visual Analogue Scale (VAS) and by air emission from a standard air-water syringe.

Results

There were statistically significant differences between the group treated with lasers and fluoride gel versus the group treated with placebo. There were no statistically significant differences between the groups treated with Er:Yag and CO₂ laser and the groups treated with fluoride gel and placebo.

Conclusions

Er:Yag and CO₂ lasers together with fluoride gel are useful in the treatment of dentine hypersensitivity.     

Maxillary distraction osteogenesis at Le Fort-I level induces bone apposition at infraorbital rim

Objective

The aim of this study is to evaluate whether there is any remodeling of bone at infraorbital rim following maxillary distraction osteogenesis (DO) at Le Fort-I level.

Materials and methods

Twelve adult subjects in the age range of 17–21 years with complete unilateral cleft lip and palate underwent advancement of the maxilla by DO. The effect of maxillary DO on the infraorbital rim remodeling was evaluated from lateral cephalograms recorded prior to the DO (T₀), at the end of DO (T₁), and at least 2-years after the DO (T₂) by Walker’s analysis. The ANOVA and two-tailed t test were used and probability value (P value) 0.05 was considered as statistically significant level.

Results

There was anterior movement of maxilla by 9.22?±?3.27 mm and 7.67?±?3.99 mm at the end of immediate (T₁) and long-term (T₂) follow-up of maxillary DO, respectively. The Walker’s analysis showed 1.49?±?1.22 mm and 2.31?±?1.81 mm anterior movement of the infraorbital margin (Orbitale point) at the end of T₁ and T₂, respectively (P?Conclusion The advancement of maxilla by distraction osteogenesis at Le Fort-I level induced significant bone apposition at infraorbital rim.

Clinical relevance

Patients with mild midface hypoplasia who would otherwise may be candidates for osteotomy at Le Fort-II or Le Fort-III level may benefit from maxillary distraction at Le Fort-I level.