Rare incidence of three consecutive primary tumors in the maxillofacial region: retinoblastoma, leiomyosarcoma, and choriocarcinoma: case report

Multiple primary tumors occur more commonly in the region of the head and neck than elsewhere in the body. The chance of this is particularly high in patients treated for retinoblastoma, in part because of a genetic predisposition, and in part because of the possibility of irradiation treatment. However, triple tumors occur in only 0.5% of multiple tumors. A rare case of a triple (metachronous) tumor is reported: 12 years after the treatment of bilateral retinoblastoma (enucleation and irradiation), secondary leiomyosarcoma developed in the maxillofacial region, followed 5 years later by choriocarcinoma. Surgery was performed on all three types of tumor. As a result, the female patient (currently 21 years old) is now free of complaints and has married. It is extremely rare for either leiomyosarcoma or choriocarcinoma (CHC) to appear in the maxillofacial region. The long-term, systematic control of such patients is absolutely necessary, for the multiple tumors tend to develop only after a long latency period of 10 to 20 years.     

Maxillary sinus floor grafting with beta-tricalcium phosphate in humans: density and microarchitecture of the newly formed bone

OBJECTIVES: Graft insertion can effectively enhance the regeneration of debilitated bone. The effects of an alloplastic bone-replacing material, beta-tricalcium phosphate (Cerasorb), and of autogenous bone graft were compared. MATERIALS AND METHODS: In 17 edentulous patients, the maxillary sinus floor was extremely atrophied to such an extent that implant placement was impossible. The Schneiderian membrane was surgically elevated bilaterally by insertion of Cerasorb (experimental side) and autogenous bone graft (control side). After surgery, the recovery was followed clinically and radiologically. After 6 months, 68 bone cylinders were excised from the grafted areas and implants were inserted into their places. The bone samples were embedded into resin, and the osteointegration of the grafts was studied histologically. Trabecular bone volume (TBV) and trabecular bone pattern factor (TBPf) were quantified by histomorphometry. RESULTS: Cerasorb proved to be an effective bone-replacing material with osteoconductivity; it was capable of gradual disintegration, thereby providing space for the regenerating bone. The new bone density was not significantly different on the experimental and control sides (32.4+/-10.9% and 34.7+/-11.9%, respectively). However, the graft biodegradation was significantly slower on the experimental side than the control side. The TBPf value was lower on the control side than on the experimental side (-0.53+/-1.7 and -0.11+/-1.4 mm(-1), respectively), but this difference was not significant. CONCLUSIONS: Six months after insertion of the grafts, the bone of the augmented sinus floor was strong and suitable for anchorage of dental implants, irrespective of whether autogenous bone or Cerasorb particles had been applied.     

Quantitative and qualitative comparison of the maxillary bone regeneration after beta-tricalcium phosphate and autogenous bone implantation

Graft insertion can effectively enhance the regeneration of debilitated bone. The effects of an alloplastic bone-replacing material, beta-tricalcium phosphate (Cerasorb), and of autogenous bone graft were compared. In 17 edentulous patients, the maxillary sinus floor was extremely atrophied to such an extent that implant placement was impossible. The Schneiderian membrane was surgically elevated bilaterally by insertion of Cerasorb (experimental side) and autogenous bone graft (control side). After surgery, the recovery was followed clinically and radiologically. After 6 months, 68 bone cylinders were excised from the grafted areas and implants were inserted into their places. The bone samples were embedded into resin, and the osteointegration of the grafts was studied histologically. Trabecular bone volume (TBV) and trabecular bone pattern factor (TBPf) were quantified by histomorphometry. Cerasorb proved to be an effective bone-replacing material with osteoconductivity; it was capable of gradual disintegration, thereby providing space for the regenerating bone. The new bone density was not significantly different on the experimental and control sides (32.4 +/- 10.9% and 34.7 +/- 11.9%, respectively). However, the graft biodegradation was significantly slower on the experimental side than on the control side. The TBPf value was lower on the control side than on the experimental side (-0.53 +/- 1.7 mm(-1) and -0.11 +/- 1.4 mm(-1), respectively); but this difference was not significant. Six months after insertion of the grafts, the bone of the augmented sinus floor was strong and suitable for anchorage of dental implants, irrespective of whether autogenous bone or Cerasorb particles had been applied.     

An audit of paediatric dental treatments carried out under general anaesthesia in a sample of Spanish patients

OBJECTIVE: To evaluate the success and failure rates of the clinical procedures carried out under general anaesthesia in disabled or medically comprised and healthy children. BASIC RESEARCH DESIGN: Retrospective study included 47 patients who received dental treatment under general anaesthesia, grouped according to whether they were disabled or medically compromised (group A, n = 16) or not (group B, n = 31), and subgrouped according to whether they were under or over 6 years of age. RESULTS: Mean duration of anaesthesia was 2 hours and 25 minutes, with a range of 1 to 4 hours. The percentage of children followed up was 87%. The procedures performed were: 105 preformed metal crowns, 142 restorations, 85 pulpotomies and 166 extractions. The success rate was 93% for preformed metal crowns, 96% for pulpotomies and 90% for restorations. CONCLUSIONS: General anaesthesia is necessary in some children, but should be complemented with a preventive programme, behavioural remodelling and a follow-up schedule to avoid having to repeat the use of general anaesthesia.     

Effect of unilateral carotid occlusion on blood flow in oral tissues of the rat using 86Rb as a tracer

Cardiac output and blood flow to both incisors and the 2 halves of the tongue were estimated by the ⁸⁶Rb isotope-fractionation technique in rats with and without unilateral common carotid ligation. Ligation produced no changes in blood pressure, cardiac output or total peripheral resistance. Ligation: (1) decreased blood perfusion of incisors on the ipsilateral side and increased that of the contralateral incisors; (2) did not change significantly blood flow to the ipsilateral half of the tongue, whereas that for the contralateral side increased.     

Effects of phosphoric acid on bovine enamel bleached with carbamide peroxide

The aim of this study was to measure the demineralization capacity of 37% phosphoric acid on bovine enamel at different time-points after bleaching with 30% carbamide peroxide. Five, 4 × 4-mm sections were obtained from the enamel of 10 bovine incisors. After applying 30% carbamide peroxide (Vivastyle) for 90 min, specimens were stored in artificial saliva for 0, 24, 72 h, or 7 d and then immersed in 37% phosphoric solution. At 15, 30, 60, 90, and 120 s, 5-ml aliquots were extracted. A control group of specimens was not bleached. Ca²⁺ concentrations were measured by atomic absorption spectrophotometry. A larger amount of Ca²⁺ was extracted from enamel by phosphoric acid after the application of 30% carbamide peroxide. Twenty-four hours after bleaching, significantly more Ca²⁺ was extracted from bleached than from control specimens at all time-points, and this greater susceptibility to the action of the acid persisted for at least 1 wk after bleaching.     

Peripheral T-cell subsets in patients with reticular and atrophic-erosive oral lichen planus

OBJECTIVE: Oral lichen planus (OLP) presents with various clinical forms that can be classified into 2 major types: reticular OLP and atrophic-erosive OLP. Our objective was to investigate immunologic differences between these 2 types. STUDY DESIGN: We investigated possible immunologic differences between 26 patients with reticular OLP and 26 patients with atrophic-erosive OLP. RESULTS: No differences were detected in serum Ig levels or complement levels. However, the mean proportions of CD4+CD45RO+ and DR+ lymphocytes were significantly higher in patients with atrophic-erosive OLP than in patients with reticular OLP, whereas the mean proportion of CD8+CD45RA+ lymphocytes was significantly lower in patients with atrophic-erosive OLP. CONCLUSION: These findings suggest that the 2 clinical types of OLP might have different immunopathogenic mechanisms.     

Smear layer influence on the apical seal of four different obturation techniques

The purpose of this study was the in vitro evaluation of four techniques for the obturation of the root canal system in the presence or absence of a smear layer. Ninety-six human upper central incisors were instrumented using the pressureless crown-down technique and irrigated with 5.25% NaOCl. The teeth that had the smear layer removed were irrigated with this solution in combination with 17% EDTA. The teeth were obturated with lateral condensation with an accessory or standardized cone as the main cone, with vertical condensation of warm gutta-percha or with thermoplasticized injectable gutta-percha. Apical leakage was assessed by measuring the linear penetration of methylene blue dye with a stereomicroscope. The results showed no significant differences in the degree of leakage with and without the smear layer when the samples were considered as a whole. However, when the groups were assessed separately, teeth in the lateral condensation with an accessory main cone group and teeth in the thermoplasticized group leaked less with a smear layer present. In contrast teeth with lateral condensation and a standardized main cone leaked more with a smear layer present. In the vertical condensation groups there was no difference attributable to the smear layer.