Use of the natural tooth for soft tissue development: a case series

The achievement of optimal esthetics around anterior dental implants has been a major challenge for many clinicians. The key to an esthetically pleasing appearance lies in the clinician's ability to properly manage the soft tissue profile around dental implants. Hence, the purpose of this case report is to describe a new technique that uses the patient's own natural tooth for the provisional implant restoration to develop soft tissue architecture that is almost identical to the patient's original immediately after tooth extraction. Ten consecutively treated patients were included in this series. Clinical measurements included soft tissue height, papilla appearance, and probing pocket depths. Other parameters such as radiographic bone levels and quality-of-life ratings were also recorded. Results from this study showed that all patients achieved a normal or Class 1 papilla appearance similar to the original appearance of the natural tooth. All patients were very happy with the treatment outcome. This newly suggested approach for restoring an anterior implant can be valuable and esthetically pleasing.     

Oral myoepithelioma of soft tissue origin: report of a new case and literature review

Oral myoepithelioma of soft tissue origin, an entity distinct from myoepithelioma of salivary glands, constitutes an extremely rare benign neoplasm, with only 1 previously published case, affecting the tongue of a 22-year-old woman. Ectomesenchymal chondromyxoid tumour (ECT) also is a very rare benign neoplasm of the oral cavity that has a strong predilection for the anterior dorsum of the tongue. The great similarities in the histologic and immunohistochemical characteristics of soft tissue myoepithelioma (STM) and ECT probably indicate that they refer to the same or closely related pathologic entities. The aim of this paper is to report a new case of STM affecting the dorsal tongue of a 45-year-old man. A review of the relevant literature is made and the relationship between oral STM and ECT discussed.     

Oral infiltrating lipomas

Infiltrating lipomas are unusual benign tumours of mesodermal origin which infiltrate adjacent skeletal muscle and tend to recur after excision. We report three previously unrecorded cases that developed about the mouth, and describe the clinical characteristics of these lesions, together with those of the seven previously reported cases. We have identified a number of differences from oral lipomas that could be of diagnostic value.     

Oral soft tissue trauma: gingival degloving

Abstract Ideally gingival degloving following a traumatic episode should be treated as soon as possible by repositioning the displaced gingivae and mucosa. The cases reported are of de-gloving in die primary and permanent dentition. In both cases immediate assistance was sought from health professionals but no treatment was offered. The delay before attendance at the Dental Hospital meant that it was too late to offer active treatment. Instead supportive measures were1 instigated which resulted in eventual successful healing.     

Oral mucosal melanoma: a series of case reports.

INTRODUCTION: Due to the rarity of oral malignant melanomas case reports are a necessary source of information. Ten new cases are reported with a minimum follow-up of 3 years. PATIENTS AND METHODS: Patients were treated during a period of 10 years. Clinical, demographic and pathologic findings were examined. RESULTS: In 6 males (60%) and 4 females with a mean age of 64.3 years the tumour locations were: hard palate-maxillary gingiva (3 cases), maxillary gingiva (2), lower gingiva (2), tongue (2), hard/soft palate-buccal mucosa (1). Pre-existing melanotic pigmentation had been present in 4 patients. Four patients were in stage I, 5 in stage II, and 1 in stage III. Surgical excision was the primary treatment in 9 cases. Five patients underwent simultaneous neck dissections. All patients received radiation and multimode adjuvant therapies. After a 3-year follow-up 3 patients are still alive (50% (2/4) of those presenting in stage I and 20% (1/5) in stage II). CONCLUSIONS: Due to the rarity of oral melanoma, individual experience is limited. The poor prognosis and the different treatments reflect this situation.     

Oral soft tissue pathology in children.

A guide to etiology, symptoms, and treatment of commonly occurring oral afflictions of infants and children.     

Oral hairy leukoplakia in healthy immunocompetent patients: a small case series

Background

Oral hairy leukoplakia (OHL) is caused by the Epstein-Barr virus (EBV) and usually presents in patients with human immunodeficiency virus (HIV) infection and systemic immunosuppression. It is rarely seen in patients who are immunocompetent. It is clinically characterised as an asymptomatic, soft, white and corrugated lesion that cannot be scraped from the surface it adheres to.

Methods

Immunocompetent patients with OHL attending Bristol Dental Hospital within the last 6 months were identified. EBV infection was demonstrated using EBV in situ hybridization. Clinical features and medical history were determined by reviewing medical records.

Case report

Four cases of OHL in immunocompetent individuals were identified. All lesions were located on the lateral borders of the tongue.

Discussion

OHL should be considered as a differential diagnosis for white patches on the lateral borders of the tongue in apparently healthy immunocompetent patients, even when they do not have a typical corrugated appearance. OHL should no longer be regarded as pathognomonic for HIV infection or systemic immunosuppression.

     

Oral soft tissue alterations in patients with neurofibromatosis

Our aim was to characterize the type and frequency of oral soft tissue alterations in neurofibromatosis. A total of 103 patients with neurofibromatosis 1 (NF1) and three patients with neurofibromatosis 2 (NF2) were clinically evaluated for their oral soft tissue alterations. Disturbing growths were removed from nine patients with NF1 and from one patient with NF2. The specimens were analyzed using routine histological methods and with immunohistochemistry using antibodies to S100, type IV collagen, CD34, neurofilament, and neuron-specific tubulin (TUBB3). Alterations including oral tumors, overgrowths of gingival soft tissue, and enlarged papillae of the tongue were discovered in 74% of NF1 patients. The results showed that three tumors clinically classified as plexiform neurofibromas and five out of six discrete mucosal tumors displayed histology and immunohistology consistent with that of neurofibroma. The histology of one palatal lesion resembled that of a scar, and the lesion removed from the patient with NF2 was classified as an amyloid tumor. To conclude, oral soft tissue growths are common findings in NF1, but most lesions do not require treatment and the patients may even not be aware of these alterations. Collagen IV, S100, and CD34 are useful biomarkers in the analysis of NF1-related oral soft tissue tumors. The clinicians should recognize that oral soft tissue alterations are relatively common in NF1. Some of the growths are disturbing, and plexiform neurofibromas may bear a risk of malignant transformation.     

Hard and soft tissue augmentation in a postorthodontic patient: a case report

A combination of hard and soft tissue grafting is used to augment a thin biotype. A 26-year-old woman with mandibular anterior flaring and Miller Class I and III recessions requested interceptive treatment. Surgery included a full-thickness buccal flap, intramarrow penetrations, bone graft placement, and primary flap closure. Postoperative visits were at 2 and 4 weeks and 2, 3, and 6 months. Stage-two surgery consisted of submerged connective tissue graft placement. Postoperative visits were completed at 2, 4, 6, and 8 weeks and 1 year. Follow-up was completed 3 years after the initial surgery. Interradicular concavities were resolved and gingival biotype was augmented. Soft tissue recession remained at 6 months. Reentry revealed clinical labial plate augmentation; 2 mm was achieved at the lateral incisors and the left central incisor and 3 mm was achieved at the right canine. No bone augmentation was achieved on the left canine and right central incisor. The dehiscence at the right central incisor appeared narrower. Overall, a 2- to 3-mm gain in alveolar bone thickness/height was observed. Two months after stage-two surgery, near complete root coverage was achieved; 1 mm of recession remained on the left central incisor. There was a soft tissue thickness gain of 2 mm without any visual difference in keratinized tissue height. Interradicular concavities were eliminated; the soft tissue was augmented and the gingival biotype was altered. Interdental soft tissue craters remained. One year after connective tissue graft placement, there was near complete root coverage at the left central incisor, which at 2 months experienced residual recession. Interradicular concavities and interdental soft tissue craters were eliminated with soft tissue augmentation, including clinical reestablishment of the mucogingival junction. Clinical stability remained 3 years after the initial surgery, with the patient noting comfort during mastication and routine oral hygiene. A clinical increase in labial plate thickness, in conjunction with soft tissue augmentation, appears to provide for continued stability and decreased potential for future clinical attachment loss.     

Hard and soft tissue augmentation in implant surgery: a case report

Correct pre- and postimplant hard and soft tissue management is prerequisite to achieving optimal esthetic and functional outcomes after implant-prosthesis treatment. Various different methods for preimplant hard tissue augmentation in alveolus maxillary atrophy are described. In some cases, non-resorbable titanium-reinforced membranes are employed for vertical augmentation of the edentulous crest. Also well documented is soft tissue management through mucus-gingival surgery techniques that increase the thickness of peri-implant keratinized gingiva, enhancing soft tissue esthetic and health. These methods also include the use of epithelial-connectival grafts collected from the palate. Here we present a clinical case of severe bone vertical resorption in edentulous areas treated with two vertical ridge augmentations by means of non-resorbable membranes in the retromandibular area and deferred insertion of six implants. Peri-implant plastic surgery techniques to improve the quantity of keratinized mucosa during the second surgery phase are also discussed. Combination of the two techniques resulted in harmonic tissue architecture and adequate presence of keratinized gingiva.     

Oral bisphosphonate-related osteonecrosis of the jaws in dental implant patients: a case series

Bisphosphonates have been associated with a serious adverse reaction known as bisphosphonate-related osteonecrosis of the jaws (BRONJ). The aim of this study was to describe its clinical characteristics in patients with dental implants who were taking bisphosphonates orally. We made a retrospective multicentre study in 3 hospitals in Galicia, Spain. The medical records and clinical and radiological follow-up of the oral cavity were reviewed for those patients given bisphosphonates and diagnosed with BRONJ after the placement of dental implants within the previous 3 years. The series comprised 9 white patients (mean age 66 years). The bisphosphonates were alendronate (n = 6), ibandronate (n = 2), and risedronate (n = 1), and the most common indication was osteoporosis (n = 7). The mean interval between the initiation of treatment and the onset of BRONJ lesions was 60 months. Most of the lesions were located around the mandibular implants (n = 8). The mean interval between placement of dental implants and the onset of BRONJ was 34 (range 1–96) months. After treatment 7/9 patients recovered completely. The prevalence of BRONJ secondary to treatment with bisphosphonates taken orally after placement of dental implants may be higher than expected in a particular geographical region, but to date specific risk factors have not been identified. Clinical characteristics and the outcomes of treatment of lesions are similar to those seen in patients with BRONJ that is unrelated to placement of dental implants.