A Comparative Immunohistochemical Study of Presence and Distribution Pattern of Stromal Myofibroblast in Oral Dysplasia and in Different Grades of Oral Squamous Cell Carcinoma.

AIMS AND OBJECTIVES: Squamous cell carcinoma (SCC) is a common oral malignancy with a poor survival rate. Early tumorigenesis is marked by transdifferentiation of fibroblasts to myofibroblasts (MFs), which is supported by growth factors and cytokines expressed by tumor cells. The expression of alpha-smooth muscle actin (αSMA) marker correlates with the activation of MFs. This study was undertaken to compare the frequency and distribution of αSMA immunoexpression in oral epithelial dysplasia (OED) and OSCC. MATERIALS AND METHODS: This study was conducted on samples collected from patients with oral epithelial dysplasia and oral SCC who visited Rajarajeswari Dental College and Hospital, Bengaluru. Tissue sections were subjected to Immunohistochemistry using αSMA marker, and cells were counted. The obtained data was subjected to Kruskal-Wallis test and Mann-Whitney U-test. RESULTS: On performing Kruskal-Wallis test and Mann-Whitney U-test between the three groups (normal oral mucosa, OED, and OSCC) statistically significant result was found in the frequency between OED and OSCC and between normal tissue and OSCC. On comparing the distribution pattern, statistically significant result was found between OED and OSCC and between normal tissue and OSCC. CONCLUSION: The expression of MFs increases as the disease progresses from high-grade epithelial dysplasia to invasive OSCC. Poorly differentiated SCC showed more attendance of positive MFs in the stroma than other grades of OSCC. The rise in the number of αSMA-positive MFs and change in distribution pattern in OSCC can be associated with tumor invasive characteristics. Thus, the proliferation of MFs may be used as a stromal marker of premalignancy and malignancy.

Forensic photography: Prospect through the lens.

Forensic photography is an indispensable tool in modern forensic odontological protocol which aids in investigative procedures, maintenance of archival data, and to provide evidence that can supplement medico legal issues in court. Proper selection and implementation of the appropriate photography and computer equipment combined with necessary training and correct workflow patterns make incorporating photography into the field of forensics, an easily obtainable goal. The role of the forensic photographer is crucial, as a good skill in photography with updated knowledge of the mechanics and techniques involved is required for proper documentation of evidence. This paper aims to shed light on the various aspects of forensic photography with emphasis on its diverse applications and advancements.

Rapid tissue processing technique: A novel method using methyl salicylate.

INTRODUCTION: Tissue processing involves transition of the biopsy tissue in graded concentration of various chemicals to make the tissue amiable for sectioning. The entire process takes 2-3 working days before a microscopic slide is ready for diagnosis. In order to shorten the turnaround time, rapid tissue processing method using methyl salicylate was developed. AIM: The aim of this study is to develop a rapid tissue processing technique using methyl salicylate as a clearing agent and to compare it with routine tissue processing technique. MATERIALS AND METHODS: A total of 70 tissue specimens were cut into two equal halves. One each was processed by routine processing technique (RoPT) and rapid processing technique (RaPT). Tissue specimens were measured before and after processing. Quality of staining and cellular-level shrinkage were observed and scored for specimens. Statistical analysis using Welch's unequal variances t-test was performed. Costs of chemicals in both the techniques were compared to see the cost-effectiveness of RaPT. RESULTS AND CONCLUSION: Outcomes of both the processing techniques were comparable with statistically not significant P values for all the parameters. Hence, the results of RaPT technique are satisfactory, and the use of this technique may prove beneficial to pathology laboratories.

Gender determination by odontometric method.

CONTEXT: Gender determination is central in establishing personal identification from human skeletal remains. The study was conducted to find out the accuracy with which gender can be determined by odontometric methods. AIMS: To investigate the mesiodistal (MD) and buccolingual (BL) dimensions of all the teeth of permanent dentition to find new parameters to differentiate between male and female teeth and to assess whether each type of linear measurement can be used independently in odontometric sex differentiation. MATERIALS AND METHODS: The study was conducted at a dental college on a composite group of 500 individuals comprising 250 males and 250 females. Impressions of upper and lower jaws were made with alginate impression material and casts prepared with dental stone. A digital Vernier calliper was used to measure the BL and MD dimensions of all the upper teeth except the third molars. STATISTICAL ANALYSIS USED: The results were subjected to statistical analysis using univariate analysis and linear stepwise discriminant function analysis to find the variables which discriminate gender significantly. RESULTS: The MD and BL dimensions between males and females were statistically significant. The predicted value for correct classification of gender was also statistically significant. CONCLUSIONS: The ability to differentiate gender in the population using stepwise discriminant functions was found to be very high with 99.8% accuracy with males showing statistically larger teeth than females. This is similar to the near 100% success in gender determination using pelvic and skull bones.

Concurrent central odontogenic fibroma and dentigerous cyst in the maxilla: A rare case report.

Central odontogenic fibroma (COF) represents a rare group of benign odontogenic tumor, while dentigerous cyst (DC), on the other hand, is the odontogenic cyst that encloses the crown of an unerupted tooth. A combination of COF and DC is rare and not reported in literature till date. The aim of this paper is to report a case of COF occurring concurrently with DC. The simultaneous occurrence of COF and DC raises the question of whether it is a collision tumor or their simultaneous occurrence is just a coincidence. In our case, the probable cause of simultaneous occurrence might be that COF would have displaced 23 resulting in the formation of DC.

Stereomicroscopic study on unsectioned extracted teeth.

INTRODUCTION: Age has been considered as a reliable marker for establishing the identity of a person in the field of forensic medicine. Teeth are useful skeletal indicators of age at death since it can survive for decades. Nondestructive methods ensure the evident preservation of dental hard tissues that reflect age changes from the cradle to the grave. Therefore, an attempt was made for estimating the age using the nondestructive method. AIMS AND OBJECTIVES: The aim of this study to assess whether physiological changes of the teeth allow possible correlation for accurate age estimation and to establish a graduation standard by microscopic observation for a better age correlation. MATERIALS AND METHODS: The study was carried on 209 teeth samples extracted for orthodontic treatment or periodontal diseases comprised both maxillary and mandibular teeth across different age groups. The assessment of these changes was carried out by well-established standard methods with some proposed modifications. RESULTS: Pearson correlation analyses revealed root dentin translucency with the highest correlation (r = 0.97) followed by periodontal ligament attachment (r = 0.95), root dentin color (r = 0.95), and attrition being the least correlated (r = 0.90). All the parameters taken for the study contributed to stepwise linear regression analysis (R = 0.98; P < 0.01) indicating a strongly positive relationship between age and the changes observed. A regression formula was obtained with mean error age difference ±1.0 years. CONCLUSION: The present study showed that extracted tooth is highly significant in identifying the age without being sectioned or further processed and also signifies the use of microscope for observation of these changes, thus reducing the errors of calibrating the age.

Quantification and Correlation of Angiogenesis with Macrophages by Histomorphometric Method in Central and Peripheral Giant Cell Granuloma: An Immunohistochemical Analysis.

INTRODUCTION: Angiogenesis is a fundamental process that affects physiologic reactions and pathological processes such as tumour development and metastasis. It is the process of formation of new microvessel from the preexisting vessels. AIM: The purpose of this study was to evaluate angiogenesis, macrophage index and correlate the impact of macrophages on angiogenesis in the central and peripheral giant cell granulomas by evaluating immunohistochemically microvessel density, microvessel perimeter and macrophage index. MATERIALS AND METHODS: Immunohistochemical analysis was carried on 20 cases of central and peripheral giant cell granulomas each for CD34 and CD68 proteins expression. Inferential statistical analysis was performed using Independent student t-test to assess the microvessel density, microvessel perimeter and macrophage index on continuous scale between Group I and Group II. Level of significance was determined at 5%. Further bivariate analysis using Pearson correlation test was carried out to see the relationship between microvessel density and macrophage index in each group. RESULTS: Microvessel density, micro vessel perimeter and macrophage index was higher in central giant cell granuloma compared to that of peripheral giant cell granuloma. Correlation between microvessel density and macrophage index among these two lesions was statistically insignificant. CONCLUSION: Angiogenesis as well as the number of macrophages appeared to increase in Central Giant Cell Granuloma in present study. These findings suggest that macrophages may up regulate the angiogenesis in these giant cell granulomas and angiogenesis do have a role in clinical behaviour. However, we could not establish a positive correlation between microvessel density and macrophage index as the values were statistically insignificant. This insignificance may be presumed due to fewer samples taken for study.

Prognostic potential of AgNORs in oral submucous fibrosis.

AIM AND OBJECTIVE: The role of prognosis cannot be stressed enough, especially when it comes to potentially malignant lesions. The argyrophilic nucleolar organizer regions (AgNORs), which is simple and cost-effective has been used in diagnostic and prognostic pathologies. This study seeks to identify the nucleolar organizer regions (NORs) in oral submucous fibrosis (OSMF), to correlate the AgNOR count with the histologic grade of OSMF, and to evaluate the prognostic potential of AgNOR. MATERIALS AND METHODS: The sample size consisted of archival paraffin blocks of 35 cases of varying grades of OSMF and 10 cases of squamous cell carcinoma. Normal mucosa samples served as controls for the study. AgNOR staining in accordance with the method of Smith and Crocker was performed and Student's t-test was used for statistical analysis. RESULTS: The results showed an increase in AgNOR counts with corresponding grades of OSMF, the count being least in normal mucosa and also an increase in AgNOR count with corresponding decrease in differentiation of oral squamous cell carcinoma. CONCLUSION: AgNOR staining is a rapid and inexpensive procedure representing cellular proliferation that can be used to assess the nature of the lesion and therefore, the prognosis.

Neural crest: The fourth germ layer.

The neural crest cells (NCCs), a transient group of cells that emerges from the dorsal aspect of the neural tube during early vertebrate development has been a fascinating group of cells because of its multipotency, long range migration through embryo and its capacity to generate a prodigious number of differentiated cell types. For these reasons, although derived from the ectoderm, the neural crest (NC) has been called the fourth germ layer. The non neural ectoderm, the neural plate and the underlying mesoderm are needed for the induction and formation of NC cells. Once formed, NC cells start migrating as a wave of cells, moving away from the neuroepithelium and quickly splitting into distinct streams. These migrating NCCs home in to different regions and give rise to plethora of tissues. Umpteen number of signaling molecules are essential for formation, epithelial mesenchymal transition, delamination, migration and localization of NCC. Authors believe that a clear understanding of steps and signals involved in NC formation, migration, etc., may help in understanding the pathogenesis behind cancer metastasis and many other diseases. Hence, we have taken this review to discuss the various aspects of the NC cells.

Pseudoepitheliomatous Hyperplasia in Oral Lesions: A Review.

Pseudoepitheliomatous hyperplasia (PEH) is a histopathological reaction pattern to various stimuli, which includes trauma, infection, inflammation, neoplasia. It is seen as tongue like epithelial proliferation invading the connective tissue and should not be mistaken for squamous cell carcinoma (SCC). This review enlists oral lesions which exhibit PEH with a note on how to differentiate SCC from PEH.

Age estimation using annulations in root cementum of human teeth: A comparison between longitudinal and cross sections.

BACKGROUND: Age estimation is an important factor in the identification of an individual in forensic science. Research indicates that cemental annulations may be used more reliably than other morphological or histological traits of human skeleton for age estimation. MATERIALS AND METHODS: Twenty-five teeth were sectioned longitudinally, and twenty-five teeth were cross-sectioned at the mid portion of the root. Sections were ground, mounted and viewed under a bright light microscope. The area selected for counting was photographed under ×10 objective, magnified 5 times; cemental lines were counted and added to the eruption age of that patient, to obtain the chronological age. The statistical software SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0 and R environment ver.2.11.1 were used for the analysis of the data. RESULTS: The P value comparing actual age and calculated age using longitudinal sections is moderately significant and the P value comparing actual age and calculated age in the age group of <30 years is significant. INTERPRETATION AND CONCLUSION: The middle third of tooth root was most suitable to count annulations. The cross sections are easier to count but longitudinal sections give more appropriate results on age estimation. Though the procedure predicts under assessment of age in the younger age group and over assessment of age in the older age group, it provides a close estimate of the actual age of an individual. It can be correlated with other age estimation methods for better reliability.

Lip prints and inheritance of cleft lip and cleft palate.

BACKGROUND: Labial mucosa has elevations and depressions forming a pattern called 'Lip Prints'. Parents of patients with cleft lip &/or palate are known to have a particular lip print pattern. OBJECTIVES: Analysis of lip prints and relationship between Cheiloscopy and inheritance of cleft lip &/or cleft palate. METHODOLOGY: The study included 100 subjects [study groupparents with children having cleft lip &/or cleft palate, 50 fathers and 50 mothers) and 50 subjects (control group-parents having children without cleft lip &/or cleft palate, 25 fathers and 25 mothers. The lip prints of the subjects were obtained using the cellophane method and analysed using Suzuki & Tsuchihashi classification of lip prints. The data was subjected to Chi- Square test, Fisher Exact test and Student t-test [two tailed, independent]. RESULTS: A new whorl pattern was present in the study group. The groove count was higher in the fathers' than in the mothers' prints in the upper lip and vice versa in the lower lip. CONCLUSION: The new pattern was present in the study group in a significant number of cases. The groove count was significantly high in the study group. These two parameters can be of significant value to similar future studies.

Risk of tumor cell seeding through biopsy and aspiration cytology.

Cancer cells, besides reproducing uncontrollably, lose cohesiveness and orderliness of normal tissue, invade and get detached from the primary tumor to travel and set up colonies elsewhere. Dislodging neoplastically altered cells from a tumor during biopsy or surgical intervention or during simple procedure like needle aspiration is a possibility because they lack cohesiveness, and they attain the capacity to migrate and colonize. Considering the fact that, every tumor cell, is bathed in interstitial fluid, which drains into the lymphatic system and has an individualized arterial blood supply and venous drainage like any other normal cell in our body, inserting a needle or a knife into a tumor, there is a jeopardy of dislodging a loose tumor cell into either the circulation or into the tissue fluid. Tumor cells are easier to dislodge due to lower cell-to-cell adhesion. This theory with the possibility of seeding of tumor cells is supported by several case studies that have shown that after diagnostic biopsy of a tumor, many patients developed cancer at multiple sites and showed the presence of circulating cancer cells in the blood stream on examination. In this review, we evaluate the risk of exposure to seeding of tumor cells by biopsy and aspiration cytology and provide some suggested practices to prevent tumor cell seeding.

Expression of CD34 and CD68 in peripheral giant cell granuloma and central giant cell granuloma: An immunohistochemical analysis.

BACKGROUND: Central and Peripheral giant cell granulomas of jaws are uncommon, benign, reactive disorders that are characterized by the presence of numerous multinucleated giant cells and mononuclear cells within a stroma. The origin of the multinucleated giant cells is controversial; probably originating from fusion of histiocytes, endothelial cells and fibroblasts. OBJECTIVE: To assess the expression of CD34 and CD68 in central and peripheral giant cell granulomas to understand the origin of these multinucleated giant cells. MATERIALS AND METHODS: Twenty cases of Central and Peripheral giant cell granulomas were evaluated immunohistochemically for CD34 and CD68 proteins expression. RESULTS: Immunopositivity for CD34 was seen only in cytoplasm of endothelial cells of blood vessels; whereas, consistent cytoplasmic immunopositivity for CD68 was seen in few stromal cells. Statistical significance was seen in mean number of multinucleated giant cells, mean number of nuclei in multinucleated giant cells, CD68 expression and ratio of macrophages to multinucleated giant cells among two lesions. CONCLUSION: Although the central giant cell granulomas share some clinical and histopathological similarities with peripheral giant cell granulomas, differences in mean number of nuclei in multinucleated giant cells and CD68 immunoreactivity may underlie the distinct clinical behavior.

Ameloglyphics and predilection of dental caries.

BACKGROUND: Dental caries is an infectious disease of microbiologic origin resulting in destruction and loss of tooth structure and is related to every speciality of dentistry. Many studies have been carried out to identify the causative factors, methods of prevention, and treatment of dental caries. Ameloglyphics is the study of enamel rod end patterns. These patterns have been found to be unique to individual teeth of the same individual and also to different individuals. A possible correlation between the type of enamel rod end pattern and the occurrence of dental caries might help in predicting caries susceptibility of an individual and implementation of preventive measures. This is a simple and easy method cutting short elaborate methods currently in use and can be invaluable in caries prevention. OBJECTIVE: This study is aimed at ascertaining the possibility of a correlation between enamel rod end patterns and occurrence of dental caries, which might help in identifying predisposition to dental caries. MATERIALS AND METHODS: Thirty carious and 30 noncarious teeth were used to obtain enamel rod end patterns. Occurrence of any particular pattern in either of the study groups, which might affect the predisposition of teeth to dental caries was analyzed. RESULTS: No particular rod end pattern was found in teeth affected by dental caries. Also, no particular pattern was found to be unique to teeth not affected by dental caries.

Flowable composite an alternative orthodontic bonding adhesive: an in vitro study.

OBJECTIVE: To determine the clinical applicability of Ormocer based fowable adhesive (Admira fow) in comparison with BisGMA based adhesive (Transbond XT) and Ormocer based packable adhesive (Admira). MATERIALS AND METHODS: Sixty human premolars, divided into group I (n = 20) Transbond XT, group II (n = 20) Admira and group III (n = 20) Admira fow were bonded with metal brackets using adhesives. Brackets were debonded in shear on an Instron universal testing machine with a crosshead speed of 1 mm per minute. The mode of bond failure was determined by modifed ARI index. RESULTS: The results obtained from SBS evaluation and modifed ARI showed highest shear bond strength for Transbond XT (SD 11.64) 3.68 followed by Admira fow (SD 11.0) 2.87 and least for Admira (SD 9.42) 2.21. However, the difference was not statistically signifcant, but an intergroup comparison done using Independent student 't' test, showed statically signifcant difference between Transbond XT and Admira. Kaplan-Meier survival analysis showed least survival median value for Admira, but the survival median value is not statistically signifcant among the three groups. All groups had modifed ARI score of three (60-70%), suggestive of cohesive type of failure. CONCLUSION: The in vitro study showed that fowable Ormocer can be an good alternative to commonly used BisGMA based adhesive but the its effcacy needs clinical assessment through a survival analysis. CLINICAL SIGNIFCANCE: Admire fow can defnitely be considered as an alternative bonding system due to their comparable bond strength and debonding characters and reported properties of biocompatibility.