Oral bisphosphonate-induced osteonecrosis complications in patients undergoing tooth extraction: a systematic review and literature updates.

OBJECTIVE: Bisphosphonates, the most common anti-resorptive medications, are internalized by osteoclasts, where they inhibit the macrophage colony-stimulating factor (M-CSF) pathway, preventing their differentiation, inhibiting anchorage to the cell membrane, and inducing apoptosis. In patients undergoing oral bisphosphonate therapy, oral surgery involves a high risk of developing drug-related osteonecrosis of the jaws (BRONJ/MRONJ), among the possible complications. MATERIALS AND METHODS: A systematic search was carried out on the PubMed, Scopus and Cochrane Library search engines, using the keywords "oral bisphosphonates AND tooth extraction", "third molar extraction AND oral bisphosphonates". In addition, we manually evaluated the articles included in references from other sources and an analysis of the Gray Literature was performed. A secondary outcome was to evaluate the assessment of pharmacological (antibiotics) use in the BRONJ/MRONJ management. The revision protocol followed the indications of the Cochrane Handbook, and was registered in the INPLASY database, while the drafting of the manuscript was based on PRISMA. RESULTS: The results of the systematic review, after the study identification and selection process, included a total of 7 studies: 4 retrospective studies, 2 prospective studies and 1 case report. The main complication was represented by osteonecrosis of the jaws, which appears to be related to the duration of treatment with bisphosphonates; in addition, data regarding the anatomical location of post-extraction sites, the sex and age of patients, comorbidities and various systemic risk factors were extrapolated. The most frequent post-extraction complication in patients treated with oral bisphosphonates is osteonecrosis of the jaws, with a significant prevalence in the posterior region of the mandible. In some cases, delayed healing of the surgical wound was also found; moreover, the duration of exposure to oral bisphosphonates influences the onset of complications. CONCLUSIONS: Ongoing studies continue to unravel the role of the oral environment response in alveolar bone homeostasis and how it might contribute to the induction of BRONJ/MRONJ. Approaching the problem from this perspective could provide new directions for the prevention of BRONJ/MRONJ and expand our understanding of the unique oral microenvironment.

The integumentary system and its microbiota between health and disease.

The aim of the present investigation was to evaluate the essential physiological functions of the skin microbiota in human health and diseases. The main characteristics of the normal microbiota in the different anatomical sites have been reported in relation to the main factors, such as the effect of age, on its composition and stability for the eubiosis condition. Moreover, the present overview analyzed the functions and composition and the correct functionality of the skin microbiota in the light of current knowledge. According to several evidence is important preserving the eubiosis of the commensal microbes of the microecosystem (symbiotic and pathogenic), and probiotics are able to counteract the conditions of dysbiosis. Also, it has been shown that there is a crosstalk between gut and skin microbiota that affects human health and is still being studied, and its relationship to the current pandemic SARS-CoV-2.

Correlation between occlusal trauma and oral microbiota: a microbiological investigation.

The occlusal trauma has been defined as an injury to the periodontium resulting from occlusal forces that exceeds the reparative capacity of the attachment apparatus. Currently, the effects of occlusal trauma on tooth support tissues, the onset and the progression of periodontal disease are still debated. In fact, researchers started evaluating the possible effects of occlusal discrepancies on incidence, progression, and treatment outcomes of periodontitis, but all the results underlined the more significant role played by microbiological flora. The results of this study show that after 60 days of treating the occlusal trauma, a significant reduction was achieved in the periodontal bacterial flora.

Focus on the cariogenic process: microbial and biochemical interactions with teeth and oral environment.

This paper aims to describe the biochemical interactions between teeth and the oral environment that occur during the caries process, hence it covers all the steps related to physico-chemical reactions, including the most up-to-date theoretical basis in the clinical application for the prevention and treatment of caries. The terms 'demineralization' and 'remineralization' that characterise this process were analysed, as well as the role of the microbiota in its interaction with the hard surface of the teeth. The biochemical mechanisms that lead to the onset of carious lesions and those that occur during the healing and repair of such lesions are listed.

Stemness genes expression in naïve vs. osteodifferentiated human dental-derived stem cells.

OBJECTIVE: Mesenchymal stem cells (MSCs) have been deeply investigated in regenerative medicine because of their crucial role in tissue healing, such as tissue regeneration. Dental-derived stem cells (d-DSCs) are easily available from dental tissues, which can be isolated from all age patients with minimal discomfort. PATIENTS AND METHODS: Normal unerupted third molars tooth buds were collected from adolescents' patients underwent to extractions for orthodontic reasons. The expression of the genes Kruppel-like factor 4 (Klf-4), octamer-binding transcription factor 4 (Oct-4), homeobox transcription factor Nanog (NANOG) was investigated in d-DSCs obtained from dental bud (DBSCs), differentiated toward osteoblastic phenotype and not. RESULTS: Our results showed that DBSCs expressed Oct-4, Nanog, and Klf-4 in undifferentiated conditions and interestingly the expression of such genes increased when the cells were kept in osteogenic medium. CONCLUSIONS: These attractive stemness properties, together with the effortlessly isolation, during common oral and maxillofacial surgical procedures, from undifferentiated tissues such as dental bud, make this kind of d-DSCs a promising tool in regenerative medicine, having the potential for clinical applications, and reinforcing the present challenge to develop new preventive and healing strategies in tissue regeneration.

Familial X;Y translocation with distinct phenotypic consequences: Characterization using FISH and array CGH.

X;Y translocation is a relatively rare event in humans. Analyzed cytogenetically, the majority of these aberrations have breakpoints at Xp22 and Yq11. Females with t(X;Y)(p22;q11) are phenotypically normal except for short stature, while the males may have abnormalities. Aberrations that lead to nullisomy of the deleted region and complete loss of the respective genes have been recognized as a cause of variable contiguous gene syndromes in males. The phenotype depends on the extent and position of the deletion showing the variable association of apparently unrelated clinical manifestations such as ichthyosis, chondrodysplasia punctata, hypogonadotropic hypogonadism with anosmia, ocular albinism, short stature, and mental retardation. In addition, some patients have been reported with symptoms of attention deficit hyperactivity disorder. The extent of terminal Xp deletions is limited by the presence of male lethal genes in Xp22.2 at about 10-11 Mb from the telomere. The deletions in the majority of viable reported male patients extend to the STS ( approximately 7.0 Mb) or to the KAL1 ( approximately 8.5 Mb) loci. We present a clinical, cytogenetic, FISH, and array CGH study of a family with an Xp;Yq translocation. The chromosomal status is also discussed in the light of their phenotypic traits. The final karyotypes of the patients were designated as: Patient 1: 46,Y,der(X),t(X;Y)(p22;q12).ish der(X)(Xpter-,DXZ1+,Xqter+)mat.arr cgh Xp22.31p22.33(RP11-60P14 --> RP13-391G2)x0;arr cgh Yq11.221qter (RP11-235I1 --> RP11-270H4)x2.Patient 2: 46,X,der(X),t(X;Y)(p22;q12).ish der(X)(Xpter-,DXZ1+,Xqter+)mat.arr cgh Xp22.31p22.33(RP11-60P14 --> RP13-391G2)x1;arr cgh Yq11.221qter (RP11-235I1 --> RP11-270H4)x1.

[Primary and secondary prevention procedures of temporo-mandibular joint disease in the evolutive age]. / Procedure di prevenzione primaria e secondaria delle disfunzioni dell'articolazione temporo mandibolare in età evolutiva.

In the last years prevention of temporomandiboular joint (TMJ) disease had acquired great importance. According to the neuro-occlusal rehabilitation (RNO) it is possible to say that TMJ disease starts since first years of life. So it is important both for dentist and for pediatric know what are the conditions and the atypical functions which predispose to this pathology. The aim of this work was to show how it is possible to intercept since primary teeth and the correct norms of primary and secondary prevention.

El ameloblastoma del hueso maxilar y mandibular: un estudio clínico basado en nuestra experiencia / Ameloblastoma of the jaw and maxillary bone: clinical study and report of our experiencea

Mediante una serie de casos de ameloblastomas, tumores odontogénicos de origen epitelial, valoraremos los hallazgos histológicos y radiográficos más comunes, su sintomatología más frecuente, y estimaremos la variación de su prevalencia en función de la edad del paciente, sexo, localización de la lesión, etc. A su vez destacaremos los principales factores de riesgo y clasificaremos los distintos tratamientos en función de su histología, clínica y tipo de lesión (AU)

In order to ameloblastoma´s cases series, benign tumour of epithelial origin, we will value the histological and radiographic common findings, its frequent symptomatology, and we will estimate the prevalence variation according to the age, gender, lesion localization, etc. In the other hand, we will emphasize the principal risk factors and we will classify the different treatment according to its histology, clinic and type of lesion (AU)

Granuloma periférico de células gigantes: análisis inmunohistoquímico de la población celular en tres casos clínicos / Peripheral giant cell granuloma: immunohistochemical analysis of different markers. Study of three cases

El granuloma periférico de células gigantes (GPCG) es una lesión de tejido blando no neoplásica ocasionada por una reacción hiperplásica a consecuencia de un traumatismo o inflamación. Es una lesión reactiva del tejido blando que se desarrolla exclusivamente en la cavidad oral y con una ligera predilección en el sexo femenino. La localización habitual de GPCG es en la región de los premolares y la mucosa de la cresta alveolar edéntula. Se presentan tres casos con GPCG (dos hombres y una mujer) con una edad comprendida entre los 25 y 35años. Todos los pacientes se trataron con resección quirúrgica y ninguno sufrió recidivas. Con el propósito de determinar el posible origen de las células estromales mononucleares y de las células gigantes multinucleares, las muestras de cada caso se estudiaron mediante inmunohistoquímica (marcadores CD-68, CD-34 y α-1antitripsina) con el fin de evaluar la expresión del linaje endotelial y del linaje monocito/macrófago. Los resultados inmunohistoquímicos mostraron una marcada positividad difusa de CD-68 en las células estromales mononucleares y en las células gigantes multinucleadas. Estas últimas resultaron ser inmunonegativas para CD-34 y sólo puntualmente positivas para α-1 antitripsina. Estos resultados sugieren que las células gigantes multinucleares poseen un fenotipo osteoclástico, proviniendo del linaje monocito/macrófago, y que no derivan del linaje de las células endoteliales de los capilares. Se establece la importancia de un exhaustivo diagnóstico y de una exéresis quirúrgica completa de la lesión (curetaje óseo) con el propósito de evitar la reabsorción del diente y hueso adyacente (AU)

Peripheral giant cell granuloma (PGCG) is a non-neoplastic lesion representing a local hyperplastic reaction to injury or inflammation. It is known to be a reactive soft tissue lesion that develops only within the oral cavity, with a slightly predilection for female sex. The usual localization for PGCG is the premolar region and the crest of the edentulous ridge. This study presents three cases of PGCG, including 2 male and 1 female, with an age comprised between 25 and 35 years. All patients were treated with resection biopsy and no one relapsed. With the aim of determine the probable origin of stromal mononuclear cells and multinuclear giant cells, each case was then studied by immunohistochemistry to evaluate the expression of endothelial and monocyte/macrophage lineage. Immunohistochemical results showed a strong diffuse positivity for CD-68 in round mononuclear stromal cells and in multinucleate giant cells. These latter were immunonegative for CD-34 and only focally positive for α-1 antitrypsin. These results suggest that multinucleated giant cell shows an osteoclast phenotype and that probably derive from monocyte/macrophage lineage and that do not derive from the endothelial cells of the capillary. In second instance, we underlined the importance of an exhaustive dia (AU)

Oral squamous cell carcinoma and biological markers: an update on the molecules mainly involved in oral carcinogenesis.

Squamous cell carcinoma (SCC) is one of the most common malignant cancer of the oral cavity encompassing at least 92.8% of all oral malignancies. Despite improved diagnostic and therapeutic methods over the 20 last years, this tumour is still characterized by a high rate of mortality. The latest advances of molecular biological methods have contributed to better understand the mechanisms involved in the oral carcinogenetic process. Deregulation of cell cycle, apoptosis and cell-cell/cell-matrix adhesions are considered the pathways mainly influencing this multistage event and scientific researches over the last decade have been performed in order to investigate the biological diagnostic and prognostic parameters related to these events (i.e. tumour growth markers, markers of tumour suppression and anti-tumour response, angiogenesis markers, markers of tumour invasion and metastatic potential, cell surface markers, intracellular markers, markers derived from arachidonic acid, and enzymatic markers). The aim of the present review was to outline the current knowledge on the role of some of these tumour biological markers in carcinogenesis of oral SCC.

Cocaine-related syndrome and palatal reconstruction: report of a series of cases.

Intranasal cocaine abuse may cause significant local ischaemic necrosis and destruction of the nasal and midfacial bones and soft tissue, leading to development of a cocaine-induced midline destructive lesion. Review of the English-language literature reveals only a few case reports describing hard and/or soft palatal perforation related to cocaine inhalation. To date, among the reconstructive techniques of the palate, different surgical options have been reported such as local, regional and free flaps. Common prosthetic obturators have also been used. Presented here are six cases of cocaine abuse showing different types of cocaine-related palatal lesions treated with different surgical approaches including local and free flaps. Mean follow-up was 3 years. A surgical variation of Marshall's classic technique for insetting a free flap in such lesions is proposed.

Treatment of severe bilateral temporomandibular joint ankylosis in adults: our protocol.

AIM: In order to evaluate the reliability of interpositional gap arthroplasty with temporalis myofascial flap the authors retrospectively analysed the data of 5 patients suffering from bilateral temporomandibular ankylosis operated on with this technique. METHODS: The preoperative assessment included evaluation of pain during function, interference with eating and the maximal interincisal distance. All patients received bony ankylosis removal, interposition of a finger-shaped temporalis myofascial flap in the articular gap and coverage with temporoparietal fascial flap as a new capsule. In the postoperative period an aggressive physiotherapy was carried on for at least 6 months. RESULTS: All cases experimented release of pain (evaluated by a Visual Analogue Scale method), a return to a normal diet and a stable improvement in mouth opening during the follow-up period. CONCLUSIONS: This technique should be considered a reliable method to avoid relapse of ankylosis and to stabilize postoperative results.

Fibrolipoma gigante de la mejilla: a propósito de un caso / Giant fibrolipoma of the cheek: report of a case

El fibrolipoma es una neoplasia de origen mesenquimal, rara en la cavidad oral, representando el 1% de todos los tumores benignos orales. Es una variante histológica del lipoma simple, que normalmente se manifiesta a nivel de la mucosa oral, suelo de la boca, lengua y labios. La etiología suele ser traumática cuando afecta localizaciones extraorales, mientras se considera idiopática al manifestarse a nivel bucal. En este artículo se presenta un caso raro de fibrolipoma de mejilla, y se discuten los aspectos diagnósticos, histo-patológicos y de tratamiento de acuerdo a la literatura (AU)

Lipomas are common soft tissue mesenchymal neoplasms, rare in the oral cavity, representing 1% of all benign oral tumors. Fibrolipoma is a histopathological variant of the classic lipoma which normally affects buccal mucosa, floor of the mouth, tongue and lips. In this article is presented a rare case of fibrolipoma of the cheek and are discussed all the aspects of diagnosis, histology and surgical treatment, according to literature data (AU)

Síndrome de Rendu-Osler-Weber o Telangiectasia Hemorrágica Hereditaria (HHT): descripción de dos casos y revisión de la literatura / Rendu-Osler-Weber Syndrome or Hereditary Hemorrhagic Telangiectasia (HHT): report of two cases and review of literature

El síndrome de Rendu-Osler-Weber, también conocido como Telangiectasia Hemorrágica Hereditaria, es un desorden vascular cuya prevalencia se estima que afecta a uno de cada 5-8.000 individuos. Se trata de una alteración vascular displásica multisistémica de carácter autosómico dominante, asociada a dos genes, HHT1 y HHT2, que determinan mutaciones en el gen endoglina (ENG), localizado en el cromosoma 9, y por mutaciones en el gen ALK1, localizado en el cromosoma 12. El 95% de los afectados presentan epitaxis recurrentes, con edad media de comienzo a los 12 años e incremento progresivo del sangrado nasal en frecuencia y severidad. Generalmente se presenta asociado a malformaciones arteriovenosas pulmonares y/o múltiples telangiectasias en sistema gastrointestinal, manos, cara, cavidad oral y afectación de otras vísceras. El diagnóstico inicial de HHT continúa basándose en la presencia de signos clínicos compatibles junto con la historia familiar. Para el diagnóstico molecular es necesario secuenciar las regiones codificantes completas de los genes ALK1 y ENG. El test genético no es positivo en el 100% de los pacientes con diagnóstico clínico de HHT, siendo posible no encontrar en un mismo grupo familiar la mutación común. Se revisa la literatura y se presentan dos casos con manifestaciones orales en lengua y labio inferior, sin otras lesiones sistémicas asociadas, tratada en nuestro departamento por problemas odontológicos (AU)

Rendu-Osler-Weber syndrome, also known as Hereditary Hemorrhagic Telangiectasia (HHT), is a vascular disorder with a prevalence estimated in one in 5-8.000 individuals. It is a dominant autosomic transmission determining multisystemic vascular dysplasia, which has been mapped to two genes, HHT1 and HHT2, determined by mutations of the endoglin (ENG) gene, localized to the chromosome 9, and by mutations of the activin receptor like kinase 1 (ALK1) gene, localized on the chromosome 12. The 95% of affected present recurrent epistaxis, with a mean age of first event at about 12 years, generally the nosebleed frequency and severity increase with age and usually it is associated with pulmonary AVM and/or multiple telangiectases of gastrointestinal apparatus, of the hands, face, and oral cavity and others visceral involvement. The first diagnosis of HHT is still based on the presence of clinical signs and family history; for the molecular diagnosis of HHT is necessary sequencing the entire coding regions of the ALK1 and ENG genes. The genetic test is positive not in the 100% of all patients with clinical diagnosis of HHT, but it is also possible not find in the same family group the common mutation. We review the litterature and report 2 cases with oral manifestation, on the tongue and on the inferior lip, without others systemic HHT lesions, treated in our Department for general odontoiatric problems (AU)