Metastatic lymph nodes in the neck of patients with T1 and T2 squamous cell carcinoma of the lower lip detected with lymphoscintigraphy

Aims and backgroundThe aim of our research was to use lymphoscintigraphy as a main method to confirm and detect lymph nodes in the neck, in patients with squamos cell carcinoma of lower lip which were clinically T1, T2 and N0, and to justify the use of selective neck dissection in those patients. MethodsFrom April 2010 to January 2011, 31 patients with T1, T2 and N0 SCC of the lower lip were admitted to our center. To detect sentinel lymph nodes, we performed lymphoscintigraphy (LSG). LSG was performed on the day of surgery after intradermal injection of 37 Mbq of Tc99m-Sn-colloid/ml at four peritumoral sites. The sentinel lymph nodes were then extirpated and sent for biopsy. Results Among the 31 patients, three (9.7%) were female and 28 (90.3%) were male. LSG detected sentinel nodes in the neck in 21 (67.7%) of the patients. Of these, 10 (47.6%) had a positive sentinel node biopsy. Of all 31 patients enrolled in the study, occult metastases were found in 10 (32.3%).  Conclusions Our results indicate that, of the methods used to detect positive lymph nodes, the most accurate is LSG. The results also suggest that further study is needed to optimize the treatment protocol in patients with SCC of the lower lip, especially in those with T2 lesions.

A Rare Case Report of Non-Familial Sporadic Reoccurrence of Cherubism: Difficulties from the Surgeon’s Point of View

Cherubism is a rare bone dysplasia in children characterized by symmetrical bone resorption limited only to the jaws and diagnosed as bone lesions filled with soft fibrous giant cell-rich tissue that can expand and cause severe facial deformity. Most patients have germline mutations in the gene encoding SH3BP2, a signaling adaptor protein involved in adaptive and innate immune responses. Treatment depends on the clinical course of the disease. The current case report presents a young patient with cysts in frontal region of maxilla without family history, that had recurrences of cysts, and is representing a less documented, rare case. Histological finding at that time was indicating a giant cell granuloma and later a grey tumor. Due to the existence of other pathological findings in the jaws with the presence of giant cells, we had difficulties to diagnose cherubism as surgeons

Platelet-Rich Fibrin in Oral Surgery and Endodontic Procedures as a Regenerative Biomaterial: A Review Article

Background: One of the major challenges in clinical research is to incorporate materials and procedures into dentistry that can improve clinical outcomes, increasing percentages of success. Platelet-rich fibrin (PRF) is a surgical, biological additive prepared by manipulation of autologous blood, which stimulates and regulates inflammation during and after oral surgery. This study aims to assess the potential benefits of using PRF in modern oral and endodontic surgery to accelerate radiographic healing and reduce postoperative discomfort. Methods and Results: Electronic literature research was conducted using the biomedical search engine “National Library of Medicine,” PubMed/MEDLINE database from March 2000 to June 2023. To obtain results that involved the whole scope of dentistry and PRF, the keywords used for the search were “PRF,” “PRF in dentistry,” and “PRF on apical surgery.” The articles were selected by reviewing the titles and abstracts of the articles with the word “platelet-rich fibrin (PRF).” Articles related only to clinical applications in general dentistry and its different application fields were hand-searched in applicable, significant journals, and reference lists of included studies were broadcast with no language limitation. The inclusion criteria set for this review were as follows: all case reports, case series, original research papers, review papers, in vitro/in vivo studies, animal studies, and controlled clinical trials on PRF used in dentistry-related studies. Current studies, in vitro and in vivo, have confirmed safe and encouraging results, without opposing outcomes, related to the use of PRF alone or in a mixture with other biomaterials. Currently, the use of PRF treatment has been shown to enhance and promote natural tissue healing support

Evaluation of Spontaneous Bone Healing After Enucleation of Large Residual Cyst in Maxilla without Graft Material Utilization: Case Report

Cistične lezije čeljusti kao što su keratociste (naziv je vraćen i smatra se boljim negoli keratocistični odontogeni tumori, iako su pojmovi i dalje prihvatljivi sinonimi), folikularne i radikularne ciste te rezidualne ciste mogu dosegnuti velike razmjere i uzrokovati znatnu razgradnju kosti. Enukleacija cističnih lezija u čeljusti oštećuje kosti koje se mogu regenerirati spontano ili nakon intervencije korištenjem autogenih koštanih transplantata ili drugih materijala za njihovo nadomještanje. U ovom kliničkom istraživanju opisuje se spontana regeneracija kosti nakon enukleacije rezidualne ciste u distalnom dijelu maksile. Njezin napredak praćen je na temelju kliničkog pregleda, rendgenske procjene i subjektivnih simptoma pacijenta. Regeneracija kosti i smanjenje cistične šupljine dokumentirani su nakon šest mjeseci i poslije jedne godine na panoramskoj rendgenskoj snimci. Fiziološki proces koagulacije osnova je za spontano stvaranje kosti, čak ako je koštani defekt velik, pod uvjetom da je okružen s dovoljno koštanih stijenki.Cystic lesions of the jaws such as keratocysts (scientific community still continues to use the term ‘odontogenic keratocyst’ more favourably than ‘keratocystic odontogenic tumour’ although both terms remain acceptable synonyms), follicular cysts, radicular cysts, and residual cysts may reach large proportions, causing considerable bone destruction. Enucleation of cystic lesions in the jaw produces bone defects, which may recover spontaneously or with assisted healing with the use of autogenous bone graft or other bone substitute materials. This clinical study presents a spontaneous bone regeneration after residual cyst enucleation in the distal part of the maxilla. The progress of recovery is followed by clinical and radiographic examination and subjective data obtained from the patient. Bone regeneration and cystic cavity reduction was observed in the panoramic image after six months and after one year. The physiological process of coagulation provides the basic process for the spontaneous bone formation even if an osseous defect is considerably large, provided that the defect is surrounded by adequate bony walls

Odontogenic tumor

Ameloblastoma is a benign epithelial odontogenic tumor. It is often aggressive and destructive, with the capacity to attain great size, erode bone and invade adjacent structures. Unicystic ameloblastoma are rare odontogenic lesions , with clinical radiographic and gross features of jaw cysts, which histologicaly show typical ameloblasomatous epithelium lining part of the cyst cavity with or without and /or mural tumor growth. It is usually presented in posterior mandibualar ramus region, while it is rare and atypical in posterior maxillary region. We report a case of 16 year old Kosovar boy, Albanian ethnicity, who presented himself due to a swelling presented in right fronto-lateral maxillary region. Clinical examination revealed a painless swelling extending from right central incisor to first molar same side. Panoramic radiographs disclosed a well corticated unilocular radiolucent lesion approximately 5x5 cm in diameter which inferiorly was in a contact with the roots of the teeth present, and superiorly to the maxillary sinus. Canine impaction of the same site was noted and inside the radiolucency the un-erupted secondary incisor was present. Based on the age of the patient, location of the swelling, clinical and radiographic findings, preoperative diagnose of dentogenous cyst was made, but the UA was also taken into consideration. The patient was treated by surgical enucleation of the lesion and extraction of secondary incisor which was present inside the lesion. The excised lesion was sent for histopatological examination and gauze pack which was put intra-operatively was removed periodically for 3 days from the second day post operation. The histopatological examination finding confirmed for UA mural form. Four year after the operation no signs of relapse are detected. Fronto-lateral maxillary region is considered a rare and atypical location for UA. We emphasize the importance of differential diagnosis of an odontogenic lesion with common clinical and radiological features, since this will impact in treatment planning and follow up. As oral health providers we should be aware of the unilocular radiolucencies as this may be UA

Lip Repositioning Surgery: A Simple Smile and Life Transformation Procedure

Excessive display of the gums when smiling, known as gummy smiles, can lead to aesthetic concerns and emotional discomfort for individuals. In recent times, there has been a notable rise in the popularity of gummy smile surgery as a cosmetic procedure aimed at addressing this problem. A novel technique known as lip repositioning has emerged and gained recent popularity, either on its own or in conjunction with other approaches. In specific situations, it offers a simpler, less intricate alternative to more extensive surgical procedures, resulting in a pleasing and satisfactory camouflage effect while reducing postoperative complications. This case report illustrates the effective treatment of a gummy smile in a patient with excessive gum exposure using a lip repositioning technique. The procedure involved the removal of a partial thickness strip of mucosa lining in the maxillary buccal vestibule, without including the labial frenulum, and suturing the lip lining to the gum line. Our aim was to present lip repositioning as an effective method for reducing excessive gum exposure and addressing any unevenness in a minimally invasive manner. We sought a solution that offers long-lasting results over time while minimizing the chances of the issue recurring, with a 14-month follow-up

The Role of the Dental Plaque Streptococci Level in the Prevalence of Caries in Children

The oral cavity contains the greatest variation of micro flora of the whole human body. Bacterial plaque represents a colony of bacteria attached tightly to the surface of the tooth, in which viridans group of streptococci (VGS) represents the biggest population. The majority of oral cavity diseases including caries (which is most frequent microbial diseases of human), starts from dental plaque. The purpose of the study was to determine the level of dental plaque streptococci in the correlation with oral hygiene and to examine the association between them and the caries prevalence in children. The children included in this research (n=90) were of both genders, age 6 to 15 years from Kosova. The study was carried out in the, Department of Pediatric Dentistry in Kosovo in cooperation with the Microbiologic Department. The children were clinically examined and divided into the two groups: caries-free (n=18) and caries lesions (n=72). The classification in these two groups was done based on the new method of determining the dental status:”International Caries Detection and Assessment System”- (ICDAS) index. The evaluation of oral hygiene was done according to Greene-Vermillion OHI-index while the level of streptococci was detrmined in the Microbiologic Department and expressed by CFU/ml (colony-forming-units). The correlation between oral hygiene index and level of dental plaque streptococci was found for both groups: caries-free and caries lesions (P\u3c0.01). A singificantly higher level of streptococci in dental plaque was observed in group of children with caries lesions (19.7%, CFU\u3e10 5; 54.6%, CFU=10 4-5), compered to children of caries free group (12.5%, CFU\u3e10 5; 37.5%, CFU=10 4-5; ), (P\u3e0.05). These results suport the evidence of the association between caries prevalence and the level of streptococci of dental plaque

Challenges during the Dental Care of Children with Disabilities

Management and dental treatment of children with disabilities is a challenge for the dentist, particularly for specialist of pediatric dentistry. Oral health is of great importance in maintaining overall health, especially in children with special needs, including those with chronic systemic diseases. According to WHO A handicapped child is considered a person who is not in full physical or mental condition for participation in normal activities of his peers, including those of a social, recreational, educational and speaking nature”. Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. Disabled children are divided into these disabilities: Mental- delays in mental development with lower IQ intelligence; Physical -birth defects in extremities, muscular dystrophy, cerebral palsy and Medical - chronic systemic diseases which are considered as risk to overall health during dental treatments. For these disorders, dentist should have knowledge about psychological type of the child. In many cases when there is no cooperation with the child, premedication is needed prior to dental treatment. When all possibilities are used, general anesthesia should be initiated after the consent of the physician who follows the overall state of health. The lack of oral health care, or oral hygiene as well as dental treatments, endangers general health in chronic systemic-medical disabilities such as: Cardiovascular diseases, especially heart abnormalities, blood disorders, some endocrine and immunodeficiency diseases. Preventive dental measures, including information about oral hygiene and regular dental visits, have an important role on the overall health protection of these patients

Family Related Non Syndromic Supernumerary Teeth -Case Reports

Hiperdontia is the condition characterized by supernumerary teeth, the teeth that appear in addition to the regular number of teeth. They can appear in any area of the dental arch and can affect any dental organ. We will present case reports of three children of the same family aged, 10, 11, 13 years, who were multidisciplinary treated for supernumerary teeth condition. Follow up is presented with RTG and photos taken during the treatments. Patients with non-syndromic supernumerary teeth might be related to heredity factor, therefore familial history should be carefully examined. For proper treatment of this condition is necessary to establish close cooperation in between Pedodontist, Oral surgeon and Orthodontist

Cherubism

Cherubism is a rare bone dysplasia that is characterized by symmetrical bone resorption limited to the jaws. Bone lesions are filled with soft fibrous giant cell-rich tissue that can expand and cause severe facial deformity. The disorder typically begins in children beteween age 2-7 and continues until puberty; in most cases the lesions regress spontaneously. Most patients with cherubism have germline mutations in the gene encoding SH3BP2, an adapter protein involved in adaptive and innate immune response signaling. There are a small number of pathological findings in jaws with giant cells, and normaly they should be diagnosed very easy. But very often we as surgeons and pathologists have problems in that field. The basic problem is how to differentiate them, because there is a difference in their behavior and also we are treating them in different ways. The presence of multinucleated giant cellsin fibro-osseous lesions of the jaws have led to considerable confusion and the giant cells themselves are of little diagnostic importance. This work present a case, a young patient that came in our department for the first time when she was 8 years old (2003) with cysts in frontal region of maxilla. HP finding at that time was a giant cellgranuloma. With this kind of diagnosis we have justified the operation in maxilla. Than she came back again after 3years, clinically she had characteristics cherubin face. We were confused with high level of parathormon 77.0 (8-74) and we changed our direction of diagnosis-grey tumor and in the same time alkaline phosphat was 694,5 (100-700). After detailed analyses the function of paratiroid glad was normal and with dynamic scintigrafy we concluded no changes in other bones of the body. In close disscusion with the pathologist the case was deeply analised and the final diagnose of HP was Cherubism