Diagnosis and management of benign fibro‐osseous lesions of the jaws: a current review for the dental clinician

Benign fibro‐osseous lesions of the maxillofacial skeleton constitute a heterogeneous group of disorders that includes developmental, reactive (dysplastic) and neoplastic lesions. Although their classification has been reviewed multiple times in the past, the most common benign fibro‐osseous lesions are fibrous dysplasia, osseous dysplasia and ossifying fibroma. For the dental clinician, the challenges involve diagnosis and treatment (or lack thereof). A careful correlation of all clinical, radiologic and microscopic features is essential to establish a proper diagnosis and a clear treatment plan. This article aimed to review the clinical, radiologic and histopathologic characteristics of benign fibro‐osseous lesions of the jaws, with emphasis on their differential diagnoses. With a deeper understanding of benign fibro‐osseous lesions, clinicians will be better prepared to manage these lesions in their practice.     

Cherubism: a systematic literature review of clinical and molecular aspects

The purpose of this review was to integrate the clinical, radiological, microscopic, and molecular data of published cherubism cases, in addition to therapeutic approaches, to provide more concise information about the disease. An electronic search was undertaken in September 2019. Eligibility criteria included publications having enough clinical, radiological, and histological information to confirm the diagnosis. A total of 260 publications reporting 513 cherubism cases were included. Familial history was observed in 310/458 cases (67.7%). SH3BP2 mutations were reported in 101/108 cases (93.5%) and mainly occurred at protein residues 415, 418, 419, and 420. Retrospective clinical grading was possible in 175 cases. Advanced clinical grading was associated with tooth agenesis, but not with other clinical, radiological, and genetic features. Specific amino acid substitutions of SH3BP2 mutations were not associated with the clinical grading of the disease. ‘Wait and see’ was the most common therapeutic approach. In a small number of cases, drugs were used in the treatment, with variable response. In conclusion, there is no clear correlation between the genotype and the phenotype of the disease, but additional genomic and gene expression regulation information is necessary for a better understanding of cherubism.     

Fibro‐osseous lesions of the jaws: an analysis of 122 cases in Thailand

J Oral Pathol Med (2010) 39 : 703–708 Background: There are no previously published reports on fibro‐osseous jaw lesions in Thailand. The aims of this study were to determine the relative frequencies and the clinicopathologic features of these lesions in Thailand, and to compare these data with information available in the literature. Methods: A total of 122 cases of fibro‐osseous lesions of the jaws, out of a total of 4808 biopsy specimens, were collected from the files of the Department of Oral Pathology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand, during a 34‐year period from 1973 to 2006. Clinical data and histopathologic diagnoses were reviewed and analyzed. Results: The most common was ossifying fibroma (50.8%), followed by fibrous dysplasia (42.6%). Ossifying fibroma most frequently occurred in the third and fourth decades of life (61.3%) and mostly involved the posterior region of the mandible (41.9%). Fibrous dysplasia was mostly seen in the second decade of life (40.4%). The maxilla was involved far more often than the mandible (53.8% and 6.2%, respectively), most common in the posterior region of the maxilla (28.8%). Both lesions presented as painless swellings (62.9% and 90.4%, respectively). Radiographically, ossifying fibroma mostly was mixed radiolucent–radiopacity (45.2%). Fibrous dysplasia mostly appeared as a radiopaque lesion (34.6%). Conclusions: The relative frequency of osseous dysplasia is underestimated because most lesions are not treated and the patients are kept under long‐term follow‐up without biopsy. The clinicopathologic features of ossifying fibroma and fibrous dysplasia in Thailand are identical to those in the literature.     

Fibrous dysplasia of bone: craniofacial and dental implications

Fibrous dysplasia (FD) is a rare bone disease caused by postzygotic somatic activating mutations in the GNAS gene, which lead to constitutive activation of adenylyl cyclase and elevated levels of cyclic AMP, which act on downstream signaling pathways and cause normal bone to be replaced with fibrous tissue and abnormal (woven) bone. The bone disease may occur in one bone (monostotic), multiple bones (polyostotic), or in combination with hyperfunctioning endocrinopathies and hyperpigmented skin lesions (in the setting of McCune–Albright Syndrome). FD is common in the craniofacial skeleton, causing significant dysmorphic features, bone pain, and dental anomalies. This review summarizes the pathophysiology, clinical findings, and treatment of FD, with an emphasis on the craniofacial and oral manifestations of the disease.     

Segmental odontomaxillary dysplasia: clinical, radiological and histological aspects of four cases

Segmental odontomaxillary dysplasia (SOD) is a rare developmental disorder of the maxilla, primarily involving the posterior part of the maxilla. Clinically, the disorder is often diagnosed in early childhood due to a unilateral buccolingual expansion of the posterior alveolar process, gingival enlargement, absence of one or both premolars in the affected region, delayed eruption of the adjacent teeth and malformations of the primary molars. In this report, four patients with SOD are described. The findings were similar to earlier reports, but for the first time an ipsilateral rough erythema on the skin in two of the subjects is reported.     

Osteoradionecrosis of the jaws: definition,epidemiology, staging and clinical and radiological findings. A concise review

Osteoradionecrosis (ORN) of the jaws is a pernicious complication of radiation therapy for head and neck tumours. This article aims to provide an update on data related to the definition, epidemiology, staging, and clinical and radiological findings of ORN of the jaws. Using certain keywords, an electronic search was conducted spanning the period from January 1922 to April 2014 to identify the available related investigations. Pooled data were then analysed. ORN is described as exposed irradiated bone that fails to heal over a period of 3 months without evidence of persisting or recurrent tumour. The prevalence of ORN varies in the literature. Several staging or scoring systems of ORN have been proposed. Clinical findings include ulceration or necrosis of the mucosa with exposure of necrotic bone. Radiological findings are not evident in the early stages of ORN. Furthermore ORN may not be apparent in imaging even when the disease is advanced. Taking into account the severity of ORN and the difficulties in diagnosing it early and accurately, the clinician should be aware of this complex entity in order to prevent its appearance or the development of more severe complications.     

一种新的放射性颌骨坏死的临床分类分期—120例临床分析

目的:探讨颌骨放射性骨坏死的临床特征、治疗方法、分类及分期。方法:采用BS分类及分期,对我院口腔颌面-头颈肿瘤科2003年1月—2013年1月10 a间收治的120例放射性颌骨坏死患者临床资料进行回顾分析。结果:下颌骨发生骨坏死的病例明显多于上颌骨及上、下颌骨,分别为99例、14例及7例。累计放疗剂量区间为35～148 Gy,中位剂量为68.1 Gy, 69(57.5%)例患者剂量大于60 Gy。大多数患者骨坏死发生在放疗后1～2 a内(64.2%),少数发生在放疗5 a以后(20.0%)。按BS分类,Stage Ⅰ期患者为0例;Stage Ⅱ期患者16(13.3%)例,主要采用单纯死骨刮治及单纯死骨扩大切除术(14例);Stage Ⅲ期患者92(76.7%)例,71例患者采用死骨扩大切除术,其中47例同期行血管化组织瓣修复;Stage Ⅳ期患者12(10.0%)例,主要采用死骨扩大切除联合同期血管化组织瓣修复(10例)。结论:放射性颌骨坏死以单侧下颌骨最多见,并以体部及部分下颌支最为好发,大多数患者骨坏死发生在放疗后1～2 a。死骨扩大切除联合同期血管化组织瓣修复是目前最好的治疗方法。     

A prospective,controlled clinical trial evaluating the clinical and radiological outcome after 3 years of immediately placed implants in sockets exhibiting periapical pathology

Objectives: The aim of the present study was to compare the clinical and radiological outcome of immediately placed implants in sockets with or without periapical pathology 3 years after implant placement. Materials and methods: Twenty‐nine patients with immediate implant placement were clinically and radiologically followed 3 years after implant placement (test group: 16 patients without periapical pathology, control group: 13 patients with periapical pathologies). Clinical (full‐mouth bleeding score, full‐mouth plaque score, clinical attachment level measurements and width of keratinized mucosa buccaly of the implant) and radiological parameters (vertical distance from the implant shoulder to the first bone‐to‐implant contact [IS‐BIC]) were assessed. Both 95% confidence intervals, as well as results of statistical tests (one‐sample, two‐sample and paired t‐test) were provided. Results: The implant survival rate was 100% for all 29 implants after 3 years. The clinical and radiological parameters showed no statistically significant difference between the test and the control group at 3 years (two‐sample t‐test). The IS‐BIC was between 1.54 ± 0.88 mm (mesial, test) and 1.69 ± 0.92 mm (distal, test). Between the 1‐ and 3‐year visit the IS‐BIC increased in both groups significantly on one side of the implant: 0.30 ± 0.37 mm (mesial, test) and 0.33 ± 0.43 mm (distal, control) (one‐sample t‐test). None of the 13 examined radiographs of implants immediately placed in sockets with periapical pathologies revealed retrograde peri‐implantitis after 3 years. Conclusion: It is concluded within the limitations of this study, that after careful debridement of the extraction socket, immediate placement of implants into sites with periapical pathologies can be a successful treatment modality for at least 3 years with no disadvantages in clinical and radiological parameters to immediately placed implants into healthy sockets. To cite this article:
Truninger TC, Philipp AOH, Siegenthaler DW, Roos M, Hämmerle CHF, Jung RE. A prospective, controlled clinical trial evaluating the clinical and radiological outcome after 3 years of immediately placed implants in sockets exhibiting periapical pathology.

Clin. Oral Impl. Res. 22 , 2011; 20–27.
doi: 10.1111/j.1600‐0501.2010.01973.x     

The roles of matrix metalloproteinases-2, -7, -10 and tissue inhibitor of metalloproteinase-1 in the pathogenesis of oral lichen planus

J Oral Pathol Med (2012) 41 : 689–696 Background: The aim of this study was to investigate the roles of Matrix Metalloproteinases (MMP)‐2, Metalloproteinases‐7, Metalloproteinases‐10 and Tissue Inhibitors of Metalloproteinase‐1 (TIMP‐1) in the pathogenesis of oral lichen planus (OLP) disease in same tissue samples. Methods: Thirty‐nine individuals [29 patients with OLP (74%) and 10 healthy control subjects (25%)] were included in our study. The mean age was 48 ± 14.39 with a range of 20–75. Results: MMP‐2 and MMP‐7 expression was significantly different in the patient and control groups in the epithelium and the connective tissue (P < 0. 05). The ratio of MMP‐2/TIMP‐1 and MMP‐7/TIMP‐1 were higher in patient with OLP group than control group. Conclusions: Along with the exposure of the role of MMPs activity on diseases characterized by the tissue destruction, several studies were conducted on the pharmacological control of MMPs activity. However, understanding of the biological functions of MMPs is very important for the development and implementation of MMP inhibitors in the treatment of diseases. According to the results of this study, we suggest that MMP‐2, MMP‐7, and TIMP‐1 may be involved in the formation of OLP lesions. Further studies on MMPs may be useful for understanding and treating the diseases such as OLP.     

Pleomorphic adenoma (benign mixed tumour) of the salivary glands: its diverse clinical, radiological, and histopathological presentation

Pleomorphic adenoma is the single most common salivary gland tumour. It has a diverse histological presentation because of varying proportions of different epithelial and mesenchymal elements, and presents clinically and radiologically in various ways as it occurs at many different sites in the head and neck region. The choice of imaging is influenced by its site and size, and a range of options for treatment includes both operation and radiotherapy. The tumour can also present in various ways if it is not removed or treated successfully.     

Pro‐inflammatory cytokine levels in human apical periodontitis: Correlation with clinical and histological findings

This study aimed to compare the levels of tumour necrosis factor‐alpha (TNF‐α), interleukin‐1 beta (IL‐1β) and interleukin‐6 (IL‐6) between apical periodontitis lesions with different clinical and histological features. Based on clinical data and history of disease, 100 human apical periodontitis lesions were categorised as either asymptomatic or symptomatic lesions. According to histological examination, lesions were divided into periapical granulomas and radicular cysts. Pulp tissues of 25 impacted wisdom teeth were used as controls. Homogenised tissue samples were centrifuged and supernatants were used for the determination of cytokine levels by enzyme‐linked immunosorbent assay. Significantly higher levels of IL‐1β and IL‐6 were found in symptomatic lesions compared with asymptomatic lesions and control tissues (P < 0.001, P < 0.001, respectively). The concentration of IL‐1β was significantly higher in radicular cysts compared with periapical granulomas (P = 0.003). Symptomatic lesions, as judged by high local production of IL‐1β and IL‐6, represent an immunologically active stage of the disease.     

Radiographic evaluation of marginal bone levels during healing period,adjacent to parallel‐screw cylinder implants inserted in the posterior zone of the jaws,placed with flapless surgery

Objective: The purpose of this study was to compare changes at the marginal bone level adjacent to implants placed with flapless surgery and flap surgery during a stress‐free healing period. Material and methods: Seven hundred and eighty‐five implants were placed in 417 patients with a flapless approach and 459 implants were placed in 227 patients using flap techniques. The marginal bone level was determined radiographically, using digitized panoramic radiographs, at two time points: at implant placement (baseline) and after the healing period. Results: The median follow‐up time was 0.5 years (SD, 1.2; range: 0.3–0.7). Implants placed with flapless surgery had a mean crestal bone loss of 0.5 mm (SD, 0.5; range: ?0.7–2.4) and implants placed with flap surgery had a mean bone loss of 0.5 mm (SD, 0.7; range: ?2.0–3.0) after healing. Differences in bone level changes between smokers and non‐smokers were statistically significant for the flapless group (P<0.01). Conclusions: A radiographic evaluation of marginal bone levels adjacent to implants showed comparable results for implants placed with flapless surgery and flap surgery. Appropriate case selection after virtual planning of the implant position and a sound surgical protocol is necessary for flapless surgery. Smoking habits may compromise the efficacy of flapless implant procedures. To cite this article:
Nickenig H‐J, Wichmann M, Schlegel KA, Nkenke E, Eitner S. Radiographic evaluation of marginal bone levels during healing period, adjacent to parallel‐screw cylinder implants inserted in the posterior zone of the jaws, placed with flapless surgery.
Clin. Oral Impl. Res. 21 , 2010; 1386–1393.
doi: 10.1111/j.1600‐0501.2009.01961.x     

Study of histopathological,morphological and immunohistochemical features of recurrent pleomorphic adenoma: an attempt to predict recurrence of pleomorphic adenoma

J Oral Pathol Med (2011) 40 : 352–358 Background: Recurrent pleomorphic adenoma (RPA) is an uncommon and challenging disease. The aim of this study was to review the clinical information obtained by examining RPA patients, to determine its histomorphological features and to verify the expression of the Mcm‐2 markers of cell proliferation and the expression of p‐53 in pleomorphic adenoma (PA), RPA, and RPA with malignant transformation (TRPA). Methods: A total of 10 cases of PA and 29 cases of RPA were examined in detail for the presence of nodules and their histomorphological features. Cell proliferation and expression of p‐53 were detected by the immunohistochemical technique using the antibodies against Mcm‐2 and p‐53. Results: Histopathologically, RPA is very similar to PA; the only difference found was that all the cases of RPA were multinodular. When comparing primary and recurrent tumor, no significant difference was found in terms of cell proliferation and the expression of p‐53; however, in the RPA with areas of malignant transformation there was an increased expression of these proteins. Conclusion: This study showed that recurrences were multinodular, with nodules varying in numbers and sizes. No significant difference in histological features was found between RPA and PA. Moreover, the immunohistochemical study showed a low expression of p‐53 and Mcm‐2 in PA and RPA and an increased expression of these proteins in the RPA with areas of malignant transformation.