The Publisher regrets that this article is an accidental duplication of an article that has alrea... more The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/S0011-8524(13)70006-0. The duplicate article has therefore been withdrawn.
BACKGROUND Biphosphonate-related osteonecrosis of the jaw (BRONJ) is a potential side effect asso... more BACKGROUND Biphosphonate-related osteonecrosis of the jaw (BRONJ) is a potential side effect associated with the administration of bisphosphonates; the aim of this work is to highlight the possible epidemiological differences between two groups of patients affected by medication related osteonecrosis of the jaw (MRONJ) treated at the Center of Oral Medicine, Pathology and Laser Surgery of the Academic Hospital at the University of Parma, Italy, between January 2004 and June 2016. METHODS Medical charts of 303 patients (214 females and 89 males, mean age: 67 years old) treated at the Center of Oral Medicine, Pathology and Laser Surgery of the Academic Hospital at the University of Parma, between January 2004 and June 2016, were retrospectively analyzed. Patients were divided in 2 groups according to drugs therapy they underwent: group 1 (G1) including patients treated with bisphosphonates alone and group 2 (G2) including patients receiving antiresorptive-antiangiogenic drugs in association with bisphosphonates or antiresorptive-antiangiogenic drugs alone. Than 269 MRONJ sites treated with 5 different therapeutical approaches were analyzed. RESULTS Results showed G1 consisting mainly in female patients undergoing bisphosphonates for oncologic disease, stage II was most frequently diagnosed and MRONJ developed mainly after dental extraction or bone surgery. G2 consisted mainly in males patients, whom took antiresorptive-antiangiogenic drugs in association with bisphosphonate or antiresorptive-antiangiogenic drugs alone for oncologic disease. Stage II was most frequently diagnosed and MRONJ developed most frequently "spontaneous". CONCLUSIONS This study showed how a new population affected by MRONJ is emerging. Men affected by kidney cancer treated with new antiresorptive-antiangiogenic drugs will represent a growing portion of the pool of patients at risk. In our experience, a strict follow-up is of outmost importance to early detect MRONJ also in patients with spontaneous cases. When MRONJ occurs, surgical laser treatment with Er:YAG seems to represent the option with highest percentage of success; for patients with contraindication to surgery, LLLT helps to improve outcomes of the medical therapy.
Introduction: Dentoalveolar surgery including tooth extractions and dental implants placement is ... more Introduction: Dentoalveolar surgery including tooth extractions and dental implants placement is considered the major risk factor for developing medication-related osteonecrosis of the jaw (MRONJ). In this study, a patient series of MRONJ around dental implants were carefully analyzed to describe the findings and to assess the possible risk factors. Methods: Fifteen patients with peri-implant bone osteonecrosis were selected out of a group of 250 patients (6%). Patients were divided into 2 groups according to the temporal relationship. Group 1 (G1)-necrosis immediately after implant placement (from 2 to 10 months) and defined as ''implant surgery-triggered'' MRONJ. Group 2-necrosis distant (from 1 to 15 years) from implant placement and defined as ''implant presence-triggered'' MRONJ. Epidemiological and pharmacological variables were recorded as well as specific data about osteonecrosis and dental implants. Results: G1 included 6 patients: 5 (83.4%) treated with oral bisphosphonates (BPs) for osteoporosis and 1 (16.6%) with intravenous BPs for breast cancer. Mean duration of BP therapy (BPT) was 83.7 months. G2 included 9 patients: 8 patients (88.89%) treated with intravenous BPs for malignant disease and 1 (11.11%) with oral BPs for osteoporosis. Conclusions: Data confirms that not only surgical insertion of dental implants is a potential risk factor for the development of osteonecrosis but also the presence itself of the implant into the bone can be associated with this disease. Therefore, it is necessary to inform of the increased risk for MRONJ also the patients who have already osteointegrated implants and are going to start the BPT. The risk is lower for patients receiving oral BPs but it exists and seems to be higher if the implant is located in the posterior areas, if the duration of BPT is more than 3 years and if the patient is under corticosteroid therapy.
Medicina Oral Patologia Oral Y Cirugia Bucal, 2015
Objetivo: El objetivo de este trabajo es presentar una revision de la literatura sobre la epidemi... more Objetivo: El objetivo de este trabajo es presentar una revision de la literatura sobre la epidemiologia, las caracteristicas clinicas y radiologicas, asi como el tratamiento del mixofibroma odontogenico (MF). Metodos: Se realizo una busqueda en la base de datos PubMed, usando las siguientes palabras clave: "mixofibroma odontogenico", "fibromixoma odontogenico", "mixofibroma mandibular" y "fibromixoma mandibular". Resultados: Fueron identificados quince articulos relatando la experiencia con 24 pacientes. La proporcion hombre / mujer fue de 1: 1,4 y la media de edad fue de 29,5 anos. La localizacion mas frecuente fue la mandibula. En el 66,7% de los casos la apariencia radiografica fue de radiolucidez multilocular. Se observo tumefaccion en 13 pacientes (92,86%), diferentes grados de dolor en 5 (35,71%) y parestesia en solo un paciente (7,14%). Seis de cada 24 pacientes (26.09%) fueron tratados con cirugia radical y 17 (73,91%), con un enfoque mas conservador. En dos de cada 21 casos (9,52%) se observo una recurrencia. Conclusiones: El MF es un tumor extremadamente raro y no existe un acuerdo sobre las causas de su desarrollo. Esta revision muestra que la eleccion del tratamiento dependera de variables como la localizacion, la presencia de una lesion primaria o de una lesion recurrente, la edad, las condiciones generales medicas y las necesidades esteticas del paciente
ObjectivesTo evaluate the thermal changes and histologic alterations produced in ex vivo and in v... more ObjectivesTo evaluate the thermal changes and histologic alterations produced in ex vivo and in vivo specimens of oral mucosa by the quantum molecular resonance (QMR) scalpel.
Quintessence international (Berlin, Germany : 1985), 2015
To report two cases of solid type primary intraosseous carcinoma (PIOC) with a critical appraisal... more To report two cases of solid type primary intraosseous carcinoma (PIOC) with a critical appraisal of one of the WHO diagnostic criteria. Both patients had radiographic and histopathologic findings showing massive mandibular destruction as well as the involvement of the inferior alveolar nerve, without lip or chin paresthesia. Patients were treated through hemimandibulectomy followed by reconstruction through fibula free flap and forearm flap. Lip and/ or chin paresthesia are rather frequent in metastatic and salivary gland tumors but not in primary tumors of the jaws. Reasons for such a discrepancy are mostly unknown. A few hypotheses are put forward here. It is the opinion of the authors that most of the diagnostic criteria for solid type PIOC are acceptable. However, the criterion "absence of ulcer formation on the overlying mucosa" mainly depends on the dimension of the tumor at diagnosis.
People aging 74 years and more are in Parma province about 11,5% of residents. Disability conditi... more People aging 74 years and more are in Parma province about 11,5% of residents. Disability conditions and familiar ties loss frequently let the elderly to recovery in long term home care where quality of care became synonymous of quality of life. To best evaluate oral health conditions in institutionalized elderly and their needs of care, we conducted, between August 2002 and July 2003 a cross-sectional study with clinical oral examinations in 200 long-term patients. Number of teeth, tooth remnants, mucosal findings, edentulousness, level of dental hygiene, needs for operative treatment and prevalence of systemic disease associated were evaluated. Subjects' mean age was 84,4 years (interval 57 _ 105); 59% were edentulous. As reported by several authors, a correlation between edentulousness and cardiovascular disease was found even after controlling for confounding variables (age, sex, smoking habit and Alzheimer disease).
Several studies, during the last 20 years, tried to explain the pathogenetic mechanisms of the cy... more Several studies, during the last 20 years, tried to explain the pathogenetic mechanisms of the cyclosporine (CS) induced gingival overgrowth (and in general, of the drugs induced gingival overgrowth), but they are still poorly understood. The relationship between the drug and the different pharmacokinetic variables (dosage, duration of therapy, plasmatic and salivary Cs concentration) is still on discussion. It is accepted that a threshold concentration is necessary, in the gingival tissues, to begin or to enhance the morphostructural changes of the gums, but the total Cs weight, from the beginning of the therapy to the time of clinical examinations, has to be evaluated. The pharmacokinetic variables are associated with many other factors (first of all the oral hygiene score) that are probably connected with the developing of the gingival lesions. Gingival inflammation could be very important in the pathogenesis of gingival overgrowth. It has been shown by several cross-sectional st...
We examined 6 normal volunteers (3 males and 3 females, age 26-30). They were requested to clench... more We examined 6 normal volunteers (3 males and 3 females, age 26-30). They were requested to clench as hard as they could until they felt pain. The experiment was repeated one hour later. Emg was recorded during the fatiguing exercise and the recovery period. We couldn't determine the muscle conduction velocity, probably because of the anatomy of the temporal muscle. The mean of the power spectrum showed wide variability and proved unsuitable for clinical applications, both for diagnosis and follow-up.
Acta bio-medica de L'Ateneo parmense : organo della Società di medicina e scienze naturali di Parma, 1989
After a look at the most common functional orthodontic appliances, the Authors suggest a special ... more After a look at the most common functional orthodontic appliances, the Authors suggest a special kind of activator and its own specific indications. They also describe the use of this activator in a case of both dental and skeletal malocclusion.
Facial pain often presents complex diagnosis, requiring other specialists' consultation. The ... more Facial pain often presents complex diagnosis, requiring other specialists' consultation. The use of different terminology and protocols can affect the information exchange negatively. These problems in the field of headache, cranial neuralgias and facial pain lead the International Headache Society to introduce a new classification in 1988. The chief difference with the previous ones is the presence of strictly codified diagnostic principles. Its target is research, but it can help the general practice as well. We discuss the most interesting points to the stomatologist.
The function of the soft palate is complex; it takes part in speech, swallowing, and masticatory ... more The function of the soft palate is complex; it takes part in speech, swallowing, and masticatory mechanisms. Its pathology ranges from morphological deficits to functional ones; these are commonly due to a central nervous system damage. The clinical analysis is based upon examination and instrumental prove, and leads to an optimum choice between surgical and prosthetic solutions. The latter is the best one in terms of quick execution, low costs and future possibilities of improvement.
Background: Extranodal NK/T-cell lymphoma, nasal type is a neoplasm prevalent in native mexican p... more Background: Extranodal NK/T-cell lymphoma, nasal type is a neoplasm prevalent in native mexican population, characterized by vascular damage, necrosis and association with EBV. Most cases display a NK/T phenotype, however, some cases appear to be of cytotoxic T-cell lineage. CD30-positivity in neoplastic cells have been occassionally reported in previous studies in a proportion of 20-40%, frequently associated with large or anaplastic cell morphology, raising the differential diagnosis of anaplastic large cell lymphoma (ALCL). Objective: To analyze the frequency of CD30-positive neoplastic cells in a series of patients with centrofacial lesions diagnosed as Extranodal NK/T cell lymphoma, nasal type. Methods: Twelve cases of Extranodal NK/T cell lymphoma, nasal type were retrieved from consultation files of Surgical Pathology Department at Instituto Nacional de Cancerología. Routine H&E slides were evaluated and immunohistochemical studies with antibodies against CD3, CD4, CD8, CD56, CD57, Granzyme B, TIA-1 and CD30 were performed. Results: All cases demonstrated CD3 positivity (12/12), and were positive for both TIA-1 and Granzyme B (11/11). CD56 was expressed in 5/15 (41%), CD8 in 9/12 (75%) and CD4 in 6/12. None were positive for CD57. An unexpected finding was the presence of numerous neoplastic cells with membranous and Golgi pattern CD30 reactivity. These cases showed either mixed (small and large) and large cell morphology. Conclusions: CD30-positive neoplastic cells in Extranodal NK/T cell lymphoma seems to be more common than previously recognized. No statistical difference in survival was found among the CD30+ and CD30-cases in previous series. However, the high prevalence observed in our study gave rise to need to perform a careful histological evaluation and immunohistochemical interpretation to avoid misdiagnosis of such cases as ALCL. A combined approach, including clinical information will be the most helpful tool to arrive at correct diagnosis.
The Publisher regrets that this article is an accidental duplication of an article that has alrea... more The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/S0011-8524(13)70006-0. The duplicate article has therefore been withdrawn.
BACKGROUND Biphosphonate-related osteonecrosis of the jaw (BRONJ) is a potential side effect asso... more BACKGROUND Biphosphonate-related osteonecrosis of the jaw (BRONJ) is a potential side effect associated with the administration of bisphosphonates; the aim of this work is to highlight the possible epidemiological differences between two groups of patients affected by medication related osteonecrosis of the jaw (MRONJ) treated at the Center of Oral Medicine, Pathology and Laser Surgery of the Academic Hospital at the University of Parma, Italy, between January 2004 and June 2016. METHODS Medical charts of 303 patients (214 females and 89 males, mean age: 67 years old) treated at the Center of Oral Medicine, Pathology and Laser Surgery of the Academic Hospital at the University of Parma, between January 2004 and June 2016, were retrospectively analyzed. Patients were divided in 2 groups according to drugs therapy they underwent: group 1 (G1) including patients treated with bisphosphonates alone and group 2 (G2) including patients receiving antiresorptive-antiangiogenic drugs in association with bisphosphonates or antiresorptive-antiangiogenic drugs alone. Than 269 MRONJ sites treated with 5 different therapeutical approaches were analyzed. RESULTS Results showed G1 consisting mainly in female patients undergoing bisphosphonates for oncologic disease, stage II was most frequently diagnosed and MRONJ developed mainly after dental extraction or bone surgery. G2 consisted mainly in males patients, whom took antiresorptive-antiangiogenic drugs in association with bisphosphonate or antiresorptive-antiangiogenic drugs alone for oncologic disease. Stage II was most frequently diagnosed and MRONJ developed most frequently "spontaneous". CONCLUSIONS This study showed how a new population affected by MRONJ is emerging. Men affected by kidney cancer treated with new antiresorptive-antiangiogenic drugs will represent a growing portion of the pool of patients at risk. In our experience, a strict follow-up is of outmost importance to early detect MRONJ also in patients with spontaneous cases. When MRONJ occurs, surgical laser treatment with Er:YAG seems to represent the option with highest percentage of success; for patients with contraindication to surgery, LLLT helps to improve outcomes of the medical therapy.
Introduction: Dentoalveolar surgery including tooth extractions and dental implants placement is ... more Introduction: Dentoalveolar surgery including tooth extractions and dental implants placement is considered the major risk factor for developing medication-related osteonecrosis of the jaw (MRONJ). In this study, a patient series of MRONJ around dental implants were carefully analyzed to describe the findings and to assess the possible risk factors. Methods: Fifteen patients with peri-implant bone osteonecrosis were selected out of a group of 250 patients (6%). Patients were divided into 2 groups according to the temporal relationship. Group 1 (G1)-necrosis immediately after implant placement (from 2 to 10 months) and defined as ''implant surgery-triggered'' MRONJ. Group 2-necrosis distant (from 1 to 15 years) from implant placement and defined as ''implant presence-triggered'' MRONJ. Epidemiological and pharmacological variables were recorded as well as specific data about osteonecrosis and dental implants. Results: G1 included 6 patients: 5 (83.4%) treated with oral bisphosphonates (BPs) for osteoporosis and 1 (16.6%) with intravenous BPs for breast cancer. Mean duration of BP therapy (BPT) was 83.7 months. G2 included 9 patients: 8 patients (88.89%) treated with intravenous BPs for malignant disease and 1 (11.11%) with oral BPs for osteoporosis. Conclusions: Data confirms that not only surgical insertion of dental implants is a potential risk factor for the development of osteonecrosis but also the presence itself of the implant into the bone can be associated with this disease. Therefore, it is necessary to inform of the increased risk for MRONJ also the patients who have already osteointegrated implants and are going to start the BPT. The risk is lower for patients receiving oral BPs but it exists and seems to be higher if the implant is located in the posterior areas, if the duration of BPT is more than 3 years and if the patient is under corticosteroid therapy.
Medicina Oral Patologia Oral Y Cirugia Bucal, 2015
Objetivo: El objetivo de este trabajo es presentar una revision de la literatura sobre la epidemi... more Objetivo: El objetivo de este trabajo es presentar una revision de la literatura sobre la epidemiologia, las caracteristicas clinicas y radiologicas, asi como el tratamiento del mixofibroma odontogenico (MF). Metodos: Se realizo una busqueda en la base de datos PubMed, usando las siguientes palabras clave: "mixofibroma odontogenico", "fibromixoma odontogenico", "mixofibroma mandibular" y "fibromixoma mandibular". Resultados: Fueron identificados quince articulos relatando la experiencia con 24 pacientes. La proporcion hombre / mujer fue de 1: 1,4 y la media de edad fue de 29,5 anos. La localizacion mas frecuente fue la mandibula. En el 66,7% de los casos la apariencia radiografica fue de radiolucidez multilocular. Se observo tumefaccion en 13 pacientes (92,86%), diferentes grados de dolor en 5 (35,71%) y parestesia en solo un paciente (7,14%). Seis de cada 24 pacientes (26.09%) fueron tratados con cirugia radical y 17 (73,91%), con un enfoque mas conservador. En dos de cada 21 casos (9,52%) se observo una recurrencia. Conclusiones: El MF es un tumor extremadamente raro y no existe un acuerdo sobre las causas de su desarrollo. Esta revision muestra que la eleccion del tratamiento dependera de variables como la localizacion, la presencia de una lesion primaria o de una lesion recurrente, la edad, las condiciones generales medicas y las necesidades esteticas del paciente
ObjectivesTo evaluate the thermal changes and histologic alterations produced in ex vivo and in v... more ObjectivesTo evaluate the thermal changes and histologic alterations produced in ex vivo and in vivo specimens of oral mucosa by the quantum molecular resonance (QMR) scalpel.
Quintessence international (Berlin, Germany : 1985), 2015
To report two cases of solid type primary intraosseous carcinoma (PIOC) with a critical appraisal... more To report two cases of solid type primary intraosseous carcinoma (PIOC) with a critical appraisal of one of the WHO diagnostic criteria. Both patients had radiographic and histopathologic findings showing massive mandibular destruction as well as the involvement of the inferior alveolar nerve, without lip or chin paresthesia. Patients were treated through hemimandibulectomy followed by reconstruction through fibula free flap and forearm flap. Lip and/ or chin paresthesia are rather frequent in metastatic and salivary gland tumors but not in primary tumors of the jaws. Reasons for such a discrepancy are mostly unknown. A few hypotheses are put forward here. It is the opinion of the authors that most of the diagnostic criteria for solid type PIOC are acceptable. However, the criterion "absence of ulcer formation on the overlying mucosa" mainly depends on the dimension of the tumor at diagnosis.
People aging 74 years and more are in Parma province about 11,5% of residents. Disability conditi... more People aging 74 years and more are in Parma province about 11,5% of residents. Disability conditions and familiar ties loss frequently let the elderly to recovery in long term home care where quality of care became synonymous of quality of life. To best evaluate oral health conditions in institutionalized elderly and their needs of care, we conducted, between August 2002 and July 2003 a cross-sectional study with clinical oral examinations in 200 long-term patients. Number of teeth, tooth remnants, mucosal findings, edentulousness, level of dental hygiene, needs for operative treatment and prevalence of systemic disease associated were evaluated. Subjects' mean age was 84,4 years (interval 57 _ 105); 59% were edentulous. As reported by several authors, a correlation between edentulousness and cardiovascular disease was found even after controlling for confounding variables (age, sex, smoking habit and Alzheimer disease).
Several studies, during the last 20 years, tried to explain the pathogenetic mechanisms of the cy... more Several studies, during the last 20 years, tried to explain the pathogenetic mechanisms of the cyclosporine (CS) induced gingival overgrowth (and in general, of the drugs induced gingival overgrowth), but they are still poorly understood. The relationship between the drug and the different pharmacokinetic variables (dosage, duration of therapy, plasmatic and salivary Cs concentration) is still on discussion. It is accepted that a threshold concentration is necessary, in the gingival tissues, to begin or to enhance the morphostructural changes of the gums, but the total Cs weight, from the beginning of the therapy to the time of clinical examinations, has to be evaluated. The pharmacokinetic variables are associated with many other factors (first of all the oral hygiene score) that are probably connected with the developing of the gingival lesions. Gingival inflammation could be very important in the pathogenesis of gingival overgrowth. It has been shown by several cross-sectional st...
We examined 6 normal volunteers (3 males and 3 females, age 26-30). They were requested to clench... more We examined 6 normal volunteers (3 males and 3 females, age 26-30). They were requested to clench as hard as they could until they felt pain. The experiment was repeated one hour later. Emg was recorded during the fatiguing exercise and the recovery period. We couldn't determine the muscle conduction velocity, probably because of the anatomy of the temporal muscle. The mean of the power spectrum showed wide variability and proved unsuitable for clinical applications, both for diagnosis and follow-up.
Acta bio-medica de L'Ateneo parmense : organo della Società di medicina e scienze naturali di Parma, 1989
After a look at the most common functional orthodontic appliances, the Authors suggest a special ... more After a look at the most common functional orthodontic appliances, the Authors suggest a special kind of activator and its own specific indications. They also describe the use of this activator in a case of both dental and skeletal malocclusion.
Facial pain often presents complex diagnosis, requiring other specialists' consultation. The ... more Facial pain often presents complex diagnosis, requiring other specialists' consultation. The use of different terminology and protocols can affect the information exchange negatively. These problems in the field of headache, cranial neuralgias and facial pain lead the International Headache Society to introduce a new classification in 1988. The chief difference with the previous ones is the presence of strictly codified diagnostic principles. Its target is research, but it can help the general practice as well. We discuss the most interesting points to the stomatologist.
The function of the soft palate is complex; it takes part in speech, swallowing, and masticatory ... more The function of the soft palate is complex; it takes part in speech, swallowing, and masticatory mechanisms. Its pathology ranges from morphological deficits to functional ones; these are commonly due to a central nervous system damage. The clinical analysis is based upon examination and instrumental prove, and leads to an optimum choice between surgical and prosthetic solutions. The latter is the best one in terms of quick execution, low costs and future possibilities of improvement.
Background: Extranodal NK/T-cell lymphoma, nasal type is a neoplasm prevalent in native mexican p... more Background: Extranodal NK/T-cell lymphoma, nasal type is a neoplasm prevalent in native mexican population, characterized by vascular damage, necrosis and association with EBV. Most cases display a NK/T phenotype, however, some cases appear to be of cytotoxic T-cell lineage. CD30-positivity in neoplastic cells have been occassionally reported in previous studies in a proportion of 20-40%, frequently associated with large or anaplastic cell morphology, raising the differential diagnosis of anaplastic large cell lymphoma (ALCL). Objective: To analyze the frequency of CD30-positive neoplastic cells in a series of patients with centrofacial lesions diagnosed as Extranodal NK/T cell lymphoma, nasal type. Methods: Twelve cases of Extranodal NK/T cell lymphoma, nasal type were retrieved from consultation files of Surgical Pathology Department at Instituto Nacional de Cancerología. Routine H&E slides were evaluated and immunohistochemical studies with antibodies against CD3, CD4, CD8, CD56, CD57, Granzyme B, TIA-1 and CD30 were performed. Results: All cases demonstrated CD3 positivity (12/12), and were positive for both TIA-1 and Granzyme B (11/11). CD56 was expressed in 5/15 (41%), CD8 in 9/12 (75%) and CD4 in 6/12. None were positive for CD57. An unexpected finding was the presence of numerous neoplastic cells with membranous and Golgi pattern CD30 reactivity. These cases showed either mixed (small and large) and large cell morphology. Conclusions: CD30-positive neoplastic cells in Extranodal NK/T cell lymphoma seems to be more common than previously recognized. No statistical difference in survival was found among the CD30+ and CD30-cases in previous series. However, the high prevalence observed in our study gave rise to need to perform a careful histological evaluation and immunohistochemical interpretation to avoid misdiagnosis of such cases as ALCL. A combined approach, including clinical information will be the most helpful tool to arrive at correct diagnosis.
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