[Reliability of fine needle aspiration cytology for salivary gland lesions]

Fine needle aspiration [FNA] cytology is a safe, reliable, minimally invasive and cost-effective technique for the diagnosis of salivary gland lesions. This study aimed to assess the accuracy, reliability and diagnostic value of FNA cytology in Iran. A total of 200 records of patients with a history of biopsy or surgical excision of salivary gland lesions along with their histological and cytological examination results were retrieved and evaluated in the Pathology Department of Amir Alam Hospital during 2007-2013. The results of cytological diagnosis were divided into 4 groups of unfavorable, benign, suspicious and malignant. The cytological results were compared with histological data. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of FNA cytology were calculated using SPSS version 16.00. Of the specimens chosen for the study, 173 were from the period, 22 from the submandibular and 5 from the minor salivary glands. FNA cytological diagnosis was benign in 161 cases, suspicious for malignancy in 4 cases, and malignancy in 35 cases. Of 161 cases diagnosed as benign by FNA cytology, 25 were malignant and the frequency of false positive results was 15.5%. The accuracy, sensitivity, specificity, positive and negative predictive values of the FNA test were 82, 53, 93, 72 and 84%, respectively. A good agreement exists between the FNA results and final histopathological diagnosis of salivary gland tumors. Also, this study showed that FNA cytology, 25 were malignant and the frequency of false positive results was 15.5%. The accuracy, sensitivity, specificity, positive and negative predictive values of the FNA test were 82, 53, 93, 72 and 84%, respectively. A good agreement exists between the FNA results and final histopathological diagnosis of salivary gland tumors. Also, this study showed that FNA cytology has moderate accuracy and relative diagnostic value for diagnosis of salivary gland lesions

[Retrospective evaluation of endodontic procedural errors by under- and post-graduate dental students using two radiographic systems]

Recognition of factors that cause procedural errors in dental practice and their prevention increase the success rate of endodontic treatment. This study aimed to evaluate the rate of procedural errors in a clinical training setting using conventional and digital radiography systems. In this study, digital and conventional radiographs available in the archives of the Department of Endodontics, Shahed School of Dentistry were used, including 684 conventional radiographs of 171 patients [treated by the 5[th] and 6[th] year under-graduate dental students and the 1[st] and 2[nd] year postgraduate students] and 852 digital radiographs of 213 patients [treated by the 5[th] and 6[th] year undergraduate dental students and the 1[st], 2[nd], and 3[rd] year postgraduate students]. The errors investigated in this study included missing a canal, canal transportation, ledge formation, apical perforation, furcal perforation, strip perforation, overfilling, under-filling, poor obturation and broken instrument. Radiographs were examined by 3 observers in terms of type of error during endodontic treatment. Once examined, cases that were agreed upon by at least two observers were accepted. In the under-graduate student group, the most frequent errors found in conventional radiographs were poor obturation and under-filling with 8.13% prevalence rate. The most frequent error in post-graduate student group was poor obturation as well with 10.58% frequency. In digital radiographs, in both under-graduate and post-graduate groups, the most frequent error was poor obturation, as well [11.86% in undergraduate and 9.47% in post-graduate groups]. The number of error-free anterior teeth [82.05%] was significantly more than that of posterior teeth [65.29%] [P<0.05]. Also, 11,96% of anterior teeth had problems in terms of length and quality of filling, while in these respects, 23.5% of posterior teeth were unacceptable, and there was a significant difference in the frequency of these procedural errors between the anterior and posterior teeth [P<0.05]. It appears that the educational system in the Department of Endodontics at Shahed School of Dentistry must place a stronger emphasis on the internal anatomy and principles of root canal treatment of the posterior teeth, as well as on the final stage of endodontic treatment [canal filling] for all teeth. It should be noted that an inappropriate canal filling might be secondary to improper canal preparation

Cementoblastoma: report of a case with a long-term pain

Cementoblastoma is a rare benign neoplasm of cementoblastic origin which is usually represented with marked swelling and severe pain. In this article, the mechanism of pain generation and definite diagnosis of a cementoblastoma related to the first mandibular molar with a long-lasting dull pain have been discussed

Eosinophilic granuloma: report of a misconstrued case

Eosinophilic granuloma [EG] is the mildest and localized form of a group of diseases named Histiocytosis X. It is a destructive osseous lesion characterized by presence of a vast number of eosinophils and histiocytes. It has a neoplastic nature especially in the chronic forms. Based on the site of the lesion, three types are elucidated: 1- intraosseous 2- alveolar 3- mixed. In the last two types, extensive alveolar involvement and loosening of the teeth clinically may resemble aggressive periodontitis [AP]. We report a case of EG which was initially diagnosed and treated as AP. The rapid progress, diagnostic problems, etiologic factors and the consequences of late diagnosis and treatment of eosinophilic granuloma are discussed. This explicates why dentists need to know the differential diagnosis of EG with AP for early diagnosis and treatment

[In vitro comparison of microleakage of four different luting cements for cementation of stainless steel crowns in the primary teeth]

Statement of Problem: One of the complications in reconstruction of the primary teeth with stainless steel crowns [SSC] is microleakage at the crowns' margins. Luting cement that can seal the margins can reduce the microleakage

Purpose: This research was performed to compare the ability of four adhesive cements for reducing microleakage at the SSC margins

Methods and Material: In this experimental study, standard preparation was performed on 60 primary molar teeth for SSC restorations. After adjusting SSC, the samples were randomly divided into 5 groups, each containing 12 teeth. Then, the SSCs were cemented in each group with different cements. These groups contained Zincphosphate [Elite, ZP], Polycarboxylate [Durelon, PC], Glass ionomer [Ketac cem, GI], Resin-modified glass ionomer [Rely X luting 2,RMGI], and Resin-modified glass ionomer with bonding agent [[Single Bond,SB]. After thermocycling and using dye penetration [methylen blue 1%], the samples were evaluated under a digital microscope. For comparison of the microleakages among the groups, t-test, ANOVA and LSD tests were used

Result: Microleakage in the adhesive cement groups [GIC, RMGIC, RMGIC+BA] was significantly lower than that in the non-adhesive [ZP, PC] groups [p <0.05]. Comparison of the cements revealed a statistically significant difference among all the groups [p <0.001]. RMGI+SB had the lowest microleakage followed by RMGI, GI, ZP. PC cement showed the greatest microleakage

Conclusion: Adhesive cements were more effective in reducing the microleakage in cementation of SSC than non-adhesive cements. The use of bonding agents with RMGI cement showed more acceptable results in comparison with RMGI cement

[Evaluation of vessels density and the clinicopathological features of oral pyogenic granuloma and its histopathologic subtypes]

Statement of Problem: Due to the clinicopathologic similarity of pyogenic granuloma to some neoplastic or hamartomatouse lesion, vascular density can represent some biological behaviors of this lesion

Purpose: This study aimed to evaluate the density of the vessels and the clinicopathological features of oral pyogenic granuloma [PG] and its histopathologic subtypes

Materials and Methods: Information about age, sex, site, size, duration and the presence of surface ulceration in total and in two histopathologic subtypes [lobular and non-lobular] were collected From 94 PG files in the archives and were compared. Vessel counting was performed on Hand E slides and the density of the vessels was compared in two subtypes, two genders and ulcerated and non-ulcerated groups using Independent Samples T- test

Results: Pyogenic granuloma comprised 4.5 percent of all the lesions. The male to female ratio was 1:1.7. The mean age of the patients was 27.99 years and the most frequent involved site was the gingiva [84%]. The Non-LCH lesions were more than LCH. Post- mandibular gingiva in the LCH group and the anterior portion of the maxillary gingiva were the most locations of involvement. The mean duration of the presence of the lesion in Non-LCH was more than that in LCH. Surface ulceration in Non-LCH [89.4%] was more than LCH [78.6%]. Although the mean density of the vessels was equal in both males and females; there was a significant difference in the lesions with or without surface ulcerations [p =0.01]. However there was no significant difference between the lobular and nonlobular groups

Conclusion: The site of the lesion, duration, and the lower cases with surface ulceration in the LCH form can be in contrast with reactive nature of this subtype, showing similarity to tumoral or developmental lesions. Gender does not influence the density of blood vessels in PG but surface ulceration can influence it

[Evaluation of relationship between probability rate of malignant transformation in oral leukoplakia with respect to risk factors of age, sex, smoking habit of patients, clinical appearance and site of the oral lesions]

Leukoplakia, is considered as the most common precancerous oral lesion. Numerous researches have shown that the effect of various risk factors in malignancy of leukoplakia differs in different societies. Being so, this study was desighned to evaluate the probability rate of malignant transformation of oral leukoplakic lesions in relation to risk factors of age, sex, smoking habit of patients, clinical appearance and site of the oral lesions in Shiraz from 1368 to 1388. This retrospective analytical-descriptive research was performed by collecting all leukoplakia from the Shiraz Nemazi and Khalili Hospitals as well as Oral Medicine and Oral Pathology Departments of Shiraz Dental School from 1368 to 1388 were selected according to their files. Patients with malignant transformation considered as the target group and those without such transformation named control group. Risk factors such as age, sex, smoking habit, clinical appearance and site of the lesions, as independent factors were evaluated in relation to their effect in malignant transformation of the oral leukoplakia through recording of necessary data via filling of special questionnaires. Chance rate in both groups was also evaluated. Data were analyzed by Excell, SPSS and Epi statistical software. Malignant transformation rate of oral leukoplakia was 40.8%. This rate showed increase with age increase specially after, forty years. The malignancy rate in females after the age of forty was higher than males. Although smoking will increase the chance of oral leukoplakia, most malignant transformations, were seen in non-smokers. Tongue was the most site and lips were the least common site for malignant transformation and white and red lesions [erythroplakic lesions] have the highest rate of malignant transformation in both sexes. Data, showed that factors such as age, sex, smoking habit, clinical appearance and site of oral lesions were in direct relation to malignant transformation of oral lesions of leukoplakia

[Evaluation of the agreement rate of clinical and histopathologic diagnosis in patients referring to oral pathology department of Shiraz dental school, 2001-2006]

A correct diagnosis is the first step of treatment. The correspondence of clinical and histopathologic diagnosis is an indicator of the correct opinion of the surgeons and pathologists in diagnosis. This study aimed to evaluate the agreement rate of clinical diagnosis and histopathologic reports of the patients referring to oral pathology department of Shiraz dental school from 2001-2006. in an analytic, retrospective study on 613 files of patients from the archive of oral pathology department, data on the age, site and surgeon were collected and analyzed by SPSS software using Chi-square test. Eighty one percent of the clinical diagnoses were confirmed with the pathologic reports. The greatest concordance was observed in the 8[th] decade and the lowest, in the first decade of life. The highest percentage of correct diagnosis was found in the vestibular mucosa, and the lowest in the palate. The highest percentage of agreement was observed for the mucocele and reactive soft tissue lesions, and the lowest for the benign nonodontogenic tumors and epithelial lesions. According to these results, more effective education, the exact clinical examination of the patients and more surgeon-pathologist correlations are necessary

[ descriptive-clinical study of 134 cases of odontogenic cysts during a 10 year period]

Odontogenic cysts [OC] are relatively common lesions that can behave aggressively and attain large sizes. This study has been conducted to evaluate the prevalence of OCs and their clinical features in three centers in Shiraz which receive most of the oral biopsy specimen in Fars province. In this retrospective study, the histopathologic reports from the archives of the department of pathology of Shiraz Dental School, Khalili and Namazi Hospitals pertaining to a 10 year interval [1375-1385] were reviewed. All odontogenic cysts were listed and their clinical features including sex, age and location were registered and classified according to the latest classification of World Health Organization [WHO] in OCs the results were than descriptively analyzed. Among a total of 110,000 files, 179 were retrieved as OCs after excluding 45 cases of OCs that were non-specifically reported as infected odontogenic cyst. The remainder consisted of 44 cases of radicular syst [32.83%], 42 cases of Dentigerous cyst [31.34%] and 35 cases of Odontogenic keratocyst [26.12%], respectively. OCs was more prevalent in male gender, the posterior mandible and 2nd decade of life. The most frequent OCs, in the studying population were radicular cyst and dentigerous cyst, respectively

Head and neck posttransplant lymphoproliferative disorders [PTLD]: a literature review

Nowadays transplantation is widely used to manage end organ failure, the way that saves patient's lives and increases their survival rate. But it has some complications such as posttransplant malignancies; one of them is posttransplant lymphoproliferative disorder [PTLD]. PTLD is more prevalent in children than in adults and it occurs from months to years after transplantation with the peak of 3-7 months. The incidence of PTLD after heart-lung transplantation is the most [9.4%] and after kidney transplantation is the least [1%]. The common sites of PTLD involvement include abdominal region [32%], bone marrow [25%] and other sites including head and neck [43%]. PTLD is related with immunosuppression caused by administration of immunosuppressive agents and is mostly accompanied by the proliferation of Epstein-Barr virus. Clinical presentation of PTLD varies from a self limiting mononucleosis to a generalized lymphoid infiltration or even a lymphoma. Management of PTLD includes reduction of immunosuppression, using anti CD20 antibody, antiviral drugs, chemothrapy and radiotherapy which are not so efficient. It's prognosis is poor and has 54% mortality rate. Clinical features of PTLD in head and neck region are cervical lymphadenopathy, generalized gingival hyperplasia with erythema, swelling, cyanotic foci and chronic mucosal ulcers; so this neccessitizes referring of a patient with such signs and symptoms or other suspicious conditions in the head and neck to a dentist for early diagnosis and biopsy. This article reviews PTLD with emphasis on oral manifestations and head and neck involvement