Denosumab for the management of central giant cell granuloma of the jaws—a case series

Denosumab has been suggested as a medical treatment for central giant cell granuloma of the jaws. This study included eight patients, seven female and one male, aged between 19 and 32 years, with biopsy-proven central giant cell granuloma of the mandible. The patients were treated with subcutaneous injections of 120 mg of denosumab in a regime consisting of three injections at weekly intervals followed by five injections at monthly intervals over a 6-month period. They were followed up for between 60 and 71 months clinically and radiographically with panoramic radiographs and cone beam computed tomography scans. All of the lesions became calcified radiographically and asymptomatic clinically. They did not reduce in size, but to date only one patient has requested surgical remodeling. There has been no recurrence or regrowth in over 5 years.     

Does invasion of oral squamous cell carcinoma occur into a non-pathological fracture of the mandible?

Although the route of invasion of oral squamous cell carcinoma into the intact mandible is well-documented we know of no reports about whether malignant cells invade through non-pathological fractures. A 68-year-old patient presented with a traumatic fracture of the mandible at the site of an existing carcinoma. He had asegmental resection but histological examination showed no evidence of invasion into the bone.     

Is hard tissue formation in the dental pulp after the death of the primary odontoblasts a regenerative or a reparative process?

Objectives

Conceptually, two types of tertiary dentine may be produced in response to caries and environmental irritations: “reactionary dentine” that is secreted by existing primary odontoblasts and “reparative dentine”, formed after the death of the odontoblasts by proliferation and differentiation of progenitor cells into odontoblast-like cells. Because histologic evidence for tubular dentine generated by newly differentiated odontoblast-like cells is lacking in human teeth, the present study examined pulpal cellular changes associated with caries/restorations, in the presence or absence of pulpal exposures.

Methods

Ninety-six extracted human teeth were histologically processed and serial sectioned for light microscopy: 65 contained untreated enamel/dentine caries; 20 were heavily restored and 11 had carious exposures managed by direct pulp-capping.

Results

Sparsely distributed, irregularly arranged dentinal tubules were identified from the tertiary dentine formed in teeth with unexposed medium/deep caries and in restored teeth; those tubules were continuous with the tubules of secondary dentine; in some cases, tubules were absent. The palisade odontoblast layer was reduced to a single layer of flattened cells. In direct pulp-capping of pulp exposures, the defects were repaired by the deposition of an amorphous dystrophic calcified tissue that resembled pulp stones more than dentine, sometimes entrapping pulpal remnants. This atubular hard tissue was lined by fibroblasts and collagen fibrils.

Conclusions

Histological evidence from the present study indicates that reparative dentinogenesis cannot be considered as a regenerative process since the so-formed hard tissue lacks tubular features characteristic of genuine dentine. Rather, this process represents a repair response that produces calcified scar tissues by pulpal fibroblasts.

Clinical significance

Formation of hard tissue in the dental pulp after the death of the primary odontoblasts has often been regarded by clinicians as regeneration of dentine. If the objective of the clinical procedures involved is to induce healing, reduce dentine hypersensitivity, or minimise future bacteria exposure, such procedures may be regarded as clinical success. However, current clinical treatment procedures are not adept at regenerating physiological dentne because the tissues formed in the dental pulp are more likely the result of repair responses via the formation of calcified scar tissues.     

Squamous cell carcinoma of the mandible – Patterns of metastasis and disease recurrence in dependence of localization and therapy

IntroductionOral squamous cell carcinomas exhibit distinct patterns of disease progression, depending on their localisation. This study aimed to evaluate clinicopathological data in patients with tumors of the mandibular alveolar process, to facilitate risk assessment and therapy planning.Materials and methodsA retrospective cohort study was designed including patients with squamous cell carcinoma of the mandibular gingiva. Clinical and pathological data were collected to determine the rate of cervical metastases and clinical outcomes depending on tumor stage, localization (anterior, intermediate and posterior) and the extent of tumor resection.Results120 patients were included in the analysis. Rate of metastases was 42.6%. Tumors of the anterior part of the mandible exhibited significantly higher rates of bilateral metastases (anterior: 85.7%, intermediate: 15.8%, posterior: 4%, p < 0.001) and local recurrence (anterior: 25%, intermediate: 16.3%, posterior: 5.5%, p = 0.03) compared to posterior malignancies.ConclusionTumors of the anterior segment of the mandible are characterized by high rates of metastases and local recurrence. Therefore, we propose radical segmental resection and bilateral neck dissection in those patients.     

Can recurrence of giant cell tumour occur in an allograft? A report of two cases

Giant cell tumour is a locally aggressive tumour with a high incidence of local recurrence. The choice of treatment remains to be controversial. These tumours are usually managed with extended curettage in the early stage and with resection and replacements in the advance stages. This is an illustration of two case of Giant cell tumour, one of the proximal tibia and another of the distal radius that was treated with wide resection and osteoarticular allograft. Both patients developed recurrence of the disease within the allograft.     

Immunoexpression of TNF-α and TGF-β in central and peripheral giant cell lesions of the jaws

J Oral Pathol Med (2012) 41 : 194–199 Background: Peripheral giant cell lesion (PGCL) is a reactive process associated with a local irritating factor that shows low recurrence after treatment, especially if the irritating factor is eliminated. On the other hand, central giant cell lesion (CGCL) presents a variable clinical behavior ranging from slow and asymptomatic growth without recurrence to rapid, painful and recurrent growth. Our aim was to compare the immunoexpression of tumor necrosis factor‐alpha (TNF‐α) and transforming growth factor‐beta (TGF‐β) in CGCL and PGCL. Methods: Twenty CGCL and 20 PGCL were selected for analysis of the immunoexpression of TNF‐α and TGF‐β in multinucleated giant cells (MGC) and mononucleated cells (MC). Results: The PGCL showed lightly higher expression of TNF‐α than CGCL. In comparison with PGCL, the CGCL showed higher expression of TGF‐β in MC and MGC (P < 0.05) and in total cells (P < 0.05). Significant positive correlation was found between expressions of TGF‐β and TNF‐α in CGCL (P < 0.05). Conclusions: Our results suggest that, in CGCL, coordinated interactions between TGF‐β and TNF‐α may be important for osteoclastogenesis and bone resorption. PGCL occasionally cause bone resorption but to a lower extent, a fact that might be explained by the lower expression of TGF‐β in these lesions.     

Denosumab osteonecrosis of the mandible: A new entity?A case report

In the treatment of osteoporosis, M. Kahler and bone metastases from prostate and breast cancer bisphosphonates play a major role. Not all patients respond well to bisphosphonate treatment. Since a few years adverse effects of these drugs have been reported. A new drug, denosumab, a fully human monoclonal antibody to RANKL, has recently been developed. This case reports a 74-year-old male patient with a medical history of diabetes mellitus, angina pectoris, coronary bypasses, hypertension, and prostate cancer with multiple metastases to lymph nodes, bone and lungs. The prostate cancer was treated according to the protocol. But he was never treated with bisphosphonates. Instead he was included in a phase III randomized double blind multicenter trial, testing the efficacy of denosumab compared to zoledronic acid in the treatment of bone metastases of hormone resistant prostate cancer. Only 7 months after start of denosumab infectious symptoms developed, followed by infestation of the mandible. Despite surgical treatment fistula and exposed bone remained. This case illustrates that use of denosumab can lead to a type of osteonecrosis resembling bisphosphonate related osteonecrosis of the jaws.     

Does preservation of the socket decrease marginal bone loss in the mandible after extraction of first molars?

The quality of the bone plays an important part in marginal bone loss (MBL) around dental implants. The aim of this study was to compare MBL around implants the sockets of which had been preserved with the bone around healed sites in the mandible after extraction of first molars. It was a prospective, cohort study in which subjects were divided into three groups (n = 30 in each): dental implants were placed six months after preservation of the socket in the first group, eight weeks after tooth extraction in the second, and six months after tooth extraction in the third. The changes between the marginal bone level after loading of the implant and 12, 24, and 36 months later were considered to be the MBL. Age and sex were the variables studied, the condition of the bone (healed socket or preservation) was a predictive factor, and MBL was the outcome. Analysis of variance was used to compare MBL and age among groups. There were no differences in the mean MBL among the three groups 12, 24, and 36 months after loading (p = 0.55, p = 0.22, p = 0.38, respectively). Preservation of the socket did not seem to affect MBL of the first molar of the mandible.     

Is there an asymmetry of the condylar and coronoid processes of the mandible in individuals with unilateral crossbite?

Objectives:To evaluate if there is a true skeletal asymmetry of the condylar and coronoid processes of the mandible in growing individuals with unilateral posterior crossbite (UPC) either functional or not.Materials and Methods:This cross-sectional study screened a total of 1120 cone beam computed tomography (CBCT) scans based on inclusion and exclusion criteria. The final sample comprised 20 CBCT images of individuals with UPC and 19 CBCT images of individuals without transverse malocclusion. The lengths of the condylar and coronoid processes were measured to evaluate asymmetry, as well as the magnitude of the mandibular lateral deviation in the UPC group.Results:There was a significant difference between the lengths of the affected and nonaffected sides of the coronoid processes in the UPC group (P < .01). The same was not observed in the condyle in the UPC group (P > .05). There were no significant differences between the groups (P > .05).Conclusions:Although no differences in the condyle were observed, the coronoid process was asymmetric in individuals with UPC. However, this asymmetry was not considered to be clinically significant.