Use of Implant-Derived Minimally Invasive Sinus Floor Elevation: A Multicenter Clinical Observational Study With 12- to 65-Month Follow-Up.

The aim of this study is to evaluate the performance of implant-derived minimally invasive sinus floor elevation. A multicenter retrospective study was performed in 5 dental clinics. Patients requiring sinus augmentation for single implant placement were recorded and followed up. The dental implant used in this trial was a self-tapping endosseous dental implant that contains an internal channel to allow the introduction of liquids through the implant body into the maxillary sinus; those liquids include saline and a flowable bone grafting material. Overall, 37 implants were installed in 37 patients. The age range of the patients was 37-75 years (mean: 51.2 years). The average residual bone height prior to the procedure was 5.24 ± 1 mm. Of all cases, 25 implants replaced the maxillary first molar and 12 replaced the maxillary second premolar. All surgeries were uneventful with no apparent perforation of the sinus membrane. The mean follow-up time was 24.81 ± 13 months ranging from 12 to 65 months. All implants integrated and showed stable marginal bone level. No adverse events were recorded during the follow-up period. The presented method for transcrestal sinus floor elevation procedure can be accomplished using a specially designed dental implant. Further long-term studies are warranted to reaffirm the results of this study.

[Etiology of maxillofacial trauma--a 10-year survey at the Chaim Sheba Medical Center, Tel-Hashomer].

BACKGROUND: The management of cranio-maxillofacial trauma includes treatment of facial bone fractures, dentoalveolar trauma, and soft tissue injuries. Integration of several specialties is often needed due to the proximity of the cranial bones to important organs such as the eyeballs, the nose, the ears, and the brain. The epidemiology of facial fractures varies in type, severity, and cause depending on the population studied. The differences between populations in the causes of maxillofacial fractures may be the result of risk factors and cultural differences between countries but are more likely to be influenced by the injury severity. Many epidemiologic investigations of maxillofacial fractures have appeared in the scientific literature over the years. Six main causes of injury were identified: motor vehicle accidents, occupational accidents, sport accidents, falls, assaults, and gun shot wounds. However, few reports, representing continuous long-term data on maxillofacial fractures in the state of Israel, are to be found. AIMS: This study was undertaken to provide information regarding gender, age, etiology and diagnosis of patients with maxillofacial fractures, gleaned from our experience in the last 10 years (1996-2005), and to compare this information to the findings from the years 1985-1995, at the Department of Oral and Maxillofacial Surgery in the Chaim Sheba Medical Center, Tel Hashomer. METHOD: The present study reviews retrospectively hospital records of 775 patients. Data regarding the 753 patients treated at the department in the years 1985-1995 was taken from previous publication. The diagnosis was based on radiographic data and clinical examination. The statistical analysis was carried out by the Statistics Department of Tel Aviv University. RESULTS: The majority of patients (74.2%) were males, the average age was 33.4 years, and the largest subgroup of patients (34%) was in the third decade of life. The most common cause of injury was falls (35%), followed by motor vehicle accidents (29%), and assaults (18%). The most frequent fractures in the male group involved the zygomatic complex (23.4%), followed by the subcondylar area (13.5%). In contrast, the most frequent fractures among females involved the subcondylar area (20.4%) followed by the zygomatic complex (18%). The average age of male patients was 31.2 years, whereas the average age of female patients was 39.6 years. In regard to gender, the first five decades were dominated by male patients, the sixth decade showed an equal distribution, and the females dominated the patient group in the seventh to tenth decades. A rise in the number of patients hospitalized due to falls and assaults, and a decrease in patients hospitalized due to motor vehicle accidents was noted during the years 1996-2005 compared to the years 1985-1995. CONCLUSIONS: Data from the world literature is similar to our findings, as regard to gender and age. Major differences between males and females regarding age, etiology, and diagnosis were found in our study. Nevertheless, the two most common fracture sites among males and females are the Zygomatic complex and the subcondylar area. Apparently, the Israeli society is becoming more violent, whereas the technological improvements, especially in the field of motor vehicle passenger safety, may play an important role in the decrease of upper body injuries.

Calcitonin nasal spray for treatment of central giant cell granuloma: clinical, radiological, and histological findings and immunohistochemical expression of calcitonin and glucocorticoid receptors.

OBJECTIVE: To provide clinical, radiological, and histopathologic analyses of 5 patients with central giant cell granuloma (CGCG) treated with calcitonin nasal spray; to compare the results to 11 well-documented cases in the literature; and to evaluate lesions for immunohistochemical expression of calcitonin receptors (CTR) and glucocorticoid receptors (GCR). STUDY DESIGN: Five patients with CGCG were treated with calcitonin nasal spray, 200 to 400 IU/day, for 13 to 64 months. CTR and GCR expression were examined at different treatment times. RESULTS: No lesions showed significant clinical and/or radiological improvement in size. The main benefit was thickening of the cortical plates. All patients eventually underwent curettage and continued calcitonin treatment. Significant radiological improvement was noticed 2 to 4 months postsurgical procedure. Each lesion exhibited a different immunoprofile for CTR and GCR, pretreatment and during treatment. CTR disappeared after long-term calcitonin treatment. GCR exhibited variable changes. CONCLUSION: Long-term nasal spray calcitonin was ineffective for CGCG management compared with calcitonin injections. It is suggested that lesions with an undesirable response should be evaluated for CTR and GCR expression at different treatment times for maximal benefit of calcitonin treatment.

Myofibroblasts in stroma of odontogenic cysts and tumors can contribute to variations in the biological behavior of lesions.

Stromal myofibroblasts (MF) have the potential to facilitate progression of neoplastic epithelial lesions that could contribute to their biological behavior. To assess immunohistochemically the frequency of stromal MF in different odontogenic cysts and tumors and correlate it to their aggressive biological behavior. The study included cases of dentigerous cyst (DC, n = 7), odontogenic keratocyst-parakeratinized type (OKC-P, n = 8), orthokeratinized type (OKC-O, n = 9), ameloblastic fibroma/fibro-odontoma (AMF/O, n = 11), unicystic ameloblastoma (UAM, n = 6), and solid ameloblastoma (SAM, n = 7). Cases of oral squamous cell carcinoma (SCC, n = 5) served as control. Myofibroblast frequency was assessed as the number of alpha smooth muscle actin (alphaSMA)-positive stromal cells in 10 high-power fields, presented as the mean number of positive cells per field. Counts showed that mean number of positive cells in OKC-P (25.7+/-11.4) was significantly higher than in DC (8.7+/-11.6) (p = 0.024) and in SAM (29+/-7) it was significantly higher than in UAM (14.9+/-4.9) and AMF/O (5.6+/-7.5) (p < 0.001). Counts in OKC-P and SAM were not significantly different from SCC (21.3+/-5.3) (p > 0.05). The high frequency of stromal MF in known aggressive odontogenic lesions, such as OKC-P and SAM, implies that MF can contribute to the biological behavior of these odontogenic lesions. Various pharmacological agents that control stromal MF can be used as an aid to reduce extensive and mutilating surgery in cases of remarkably aggressive odontogenic lesions.

Primary non-Hodgkin's lymphoma of the sinonasal tract.

OBJECTIVES: We sought to review the records of patients seen at the Chaim Sheba Medical Center (Tel Hashomer, Israel) during a 10-year period with respect to the presenting features, management, and outcome of extranodal non-Hodgkin's lymphoma (NHL) of the sinonasal region. STUDY DESIGN: Eight patients were diagnosed with NHL of the paranasal sinuses from 1993 to 2003. The data were reviewed, and we noted the patient's age, sex, the presenting signs and symptoms, staging, histology, treatment, and outcome of NHL. RESULTS: The mean age was 61.75 years (range, 24-83 years), with a 1:1 male-to-female ratio. All cases involved the paranasal sinuses, and the most common symptom was nasal obstruction (6 patients). All the patients had large B-cell lymphoma, and all were treated with combined chemotherapy and radiation. Three patients died from the disease, 3 were free of disease after 12 to 36 months of follow-up, and 1 had a recurrence after 60 months. CONCLUSIONS: NHLs of the paranasal sinuses are uncommon. Early diagnosis and combined treatment are essential for achieving an optimal outcome.

Fracture of the genial tubercles associated with a mandibular denture: a clinical report.

Fracture of the genial tubercles without an associated mandibular fracture is uncommon. It occurs mainly in patients wearing a complete mandibular denture when the mandible is atrophied and the genial tubercles are hypertrophied. Only 7 reports have been found in the English-language literature. An additional situation of a 70-year-old woman is presented along with a review of the literature. A conservative approach to treatment is advised with this type of fracture. The use of dental implants should be considered in patients with hypertrophied tubercles to prevent such fracture.

Epidermal growth factor receptor expression in ameloblastoma.

UNLABELLED: Ameloblastoma is a locally aggressive tumor with possible lethal potential. Currently extensive surgery is the most acceptable treatment modality. AIM: To investigate the presence of EGFR in ameloblastoma in order to consider using newly developed anti-EGFR therapeutic agents in cases of unresectable tumors. The study consisted of 58 formalin-fixed, paraffin-embedded specimens of ameloblastoma that were immunohistochemically stained with a monoclonal anti-EGFR antibody (clone 31G7). Positive and negative controls determined specificity of the antibody. A staining score based on the staining intensity and the proportion of stained cells was established, ranging between 0 and 2. All specimens were EGFR positive; 8 (14%) exhibited the maximum score of 2 and 19 (33%) scored between 1 and 2. Since ameloblastomas are EGFR-positive tumors, anti-EGFR agents could be considered to reduce the size of large tumors and to treat unresectable tumors that are in close proximity to vital structures.