[Osteochemonecrosis of the jaws and bisphosphonates: a case report and literature review]. / Ostéochimionécrose maxillo-mandibulaire et bisphosphonates. A propos d'un cas et revue de la littérature.

Jaws osteonecrosis were, in most cases, caused by external irradiation. It was otherwise a rare occurrence. However, bisphosphonates have recently been associated with osteonecrosis of the mandible or the maxilla. Bisphosphonates are widely used in the treatment of osteoporosis, multiple myeloma and osteolytic bone metastases. They inhibit bone resorption by osteoclasts and disrupt the bone turnover. The so-caused bone expositions are painful and prone to surinfection. Even after cessation of the bisphosphonates, the results of medical and surgical treatment are very inconsistent. A thorough dental check-up is recommended before initiating a course of bisphosphonates.

[Avascular mandibular necrosis]. / Nécrose avasculaire de la mandibule.

INTRODUCTION: Jaw osteonecrosis is, in most cases, caused by external irradiation. It is otherwise a rare occurrence. OBSERVATION: A 52-year-old patient was referred to this hospital for several tooth extractions. In the procedure follow-up, the external aspect of the mandible was more and more exposed. This led to the spontaneous loss of a voluminous bone fragment. The patient had never undergone radiotherapy or a course of bisphosphonates but had a long-term cardio-vascular history. He had undergone endarterectomy of both carotids, an ilio-femoral by-pass, and a coronary dilatation. The diagnosis of bone infarction on a chronic osteomyelitis was made. DISCUSSION: Blood coagulation disorders are responsible for most cases of bone infarction. Other risk factors include local trauma, chemotherapy, corticoids, and bisphosphonates. Necrosis of the jawbones is rare even though these are prone to trauma and infections. Symptoms are not specific and imaging is contributive late in the evolution. The results of medical treatment (antibiotherapy, vasodilators, and hyperbaric oxygenotherapy) and surgical debridement are very inconsistent.

[Oral verrucous carcinoma]. / Le carcinome verruqueux oral.

Verrucous carcinoma is a rare, low-grade, well-differentiated form of squamous cell carcinoma seen on skin and mucosa. It is a slow-growing and locally aggressive tumor whose standard treatment is surgery. A case of strongly invasive oral verrucous carcinoma is presented with the medical history. The differential diagnosis of this neoplasm is difficult and requires clinic and pathologic data confrontation. In this paper, the importance of knowing the malignant potential of this lesion is stressed. Indeed, in 20% of verrucous carcinoma, foci of squamous cell carcinoma can be found. A review of literature and a differential diagnosis of verrucous carcinoma are presented.

[Prevention of postoperative bleeding in patients taking oral anticoagulants. Effects of tranexamic acid]. / Prévention des saignements postopératoires chez des patients sous anticoagulants oraux. Effets de l'acide tranexamique.

INTRODUCTION: We present a prospective clinical study on use of tranexamic acid mouthwashes in patients taking oral anticoagulants and who have to undergo minor ambulatory oral surgery, without modifying their anticoagulant therapy. MATERIAL AND METHODS: Forty patients (18 men and 22 females) aged from 42 to 81 were studied from April 2000 to December 2002. All patients were under the same anticoagulant, vitamin K antagonist, (Sintrom) for different pathologies. The anticoagulant therapy was not modified neither before nor after surgery. More than 70 oral procedures were carried out under local anesthesia. The International Normalized Ratio of prothrombin time (INR) was<=4. Tranexamic acid 5% (Exacyl) mouthwashes were prescribed during and after surgery. RESULTS: All the patients were followed up during 2 weeks after surgery. There were no postoperative bleedings. DISCUSSION: Use of tranexamic acid mouthwashes under a specific protocol is an efficient, reliable and economic method in preventing postoperative bleeding in patients under oral anticoagulant therapy.

S100A8 and S100A9 calcium-binding proteins: localization within normal and cyclosporin A-induced overgrowth gingiva.

S100A8 and S100A9, also called myeloid related protein (MRP) 8 and 14, are calcium-binding proteins highly expressed in neutrophils, in which they play a key role in the inflammatory progression. In this study, we looked at the expression of S100A8/A9 within gingiva from normal and Cyclosporin A (CsA)-induced overgrowth gingiva. In gingiva from the CsA group, several positive S100A8/A9 cells were seen within the connective tissue, whereas in normal gingiva very few positive S100A8/A9 cells were detected. These cells correspond either to activated macrophages or to neutrophils, reflecting the well-known gingival inflammatory status associated with the CsA-treated group. In addition, in both the normal and drug-treated group, the gingival epithelia appeared S100A8/A9 immunopositive. More specifically, S100A8/A9 appeared in the majority within the spino-cellular layer and located extracellularly within the desmosomes. In addition, S100A8/A9 also appeared sporadically intracellularly, located within the cytoplasm and the nuclei, reflecting S100A8/A9 translocations.

[The stomatology and maxillo-facial surgery department]. / Le Service de Stomatologie et de Chirurgie Maxillo-Faciale.

Initially devoted to emergencies, the Department of Oral and Maxillofacial Surgery has grown considerably since 1979. The department now consists of a Maxillofacial Surgery Unit supplemented by several specialised Units in charge of oncology, orthodontics and orthognathic surgery, implantology and all dental specialities. The main themes of research developed in the department include the healing process of oral tissues, the teratogenic effects of various compounds on the cranio-facial region, the study of apoptosis, the role of heat shock proteins, and the management of craniofacial dysmorphosis. These studies have a direct impact on patient management.

Clinical and radiographic evaluation of the papilla level adjacent to single-tooth dental implants. A retrospective study in the maxillary anterior region.

BACKGROUND: The regeneration of gingival papillae after single-implant treatment is an area of current investigation. This study was designed to determine: 1) whether the distance from the base of the contact point to the crest of the bone would correlate with the presence or absence of interproximal papillae adjacent to single-tooth implants, and 2) whether the surgical technique at uncovering influences the outcome. METHODS: A clinical and radiographic retrospective evaluation of the papilla level around single dental implants and their adjacent teeth was performed in the anterior maxilla in 26 patients restored with 27 implants. Six months after insertion, 17 implants were uncovered with a standard technique, while 10 implants were uncovered with a technique designed to generate papilla-like formation around dental implants. Fifty-two papillae were available for clinical and radiographic evaluation. The presence or absence of papillae was determined, and the effects of the following variables were analyzed: the influence of the 2 surgical techniques; the vertical relation between the papilla height and the crest of bone between the implant and adjacent teeth; the vertical relation between the papilla level and the contact point between the crowns of the teeth and the implant; and the distance from the contact point to the crest of bone. RESULTS: When the measurement from the contact point to the crest of bone was 5 mm or less, the papilla was present almost 100% of the time. When the distance was > or = 6 mm, the papilla was present 50% of the time or less. The mean distance between the crest of bone and the most coronal papilla level (interproximal soft tissue height) was 3.85 mm (SD = 1.04). When comparing the conventional and modified surgical technique, the relation shifted from 3.77 mm (SD = 1.01) to 4.01 mm (SD = 1.10), respectively. CONCLUSIONS: These results clearly show the influence of the bone crest on the presence or absence of papillae between implants and adjacent teeth. The data also show a positive influence for the modified surgical technique, aimed at reconstructing papillae at the implant uncovering.

Anterior esthetic rehabilitation on teeth and dental implants optimized with Procera technology: a case report.

With the latest developments of the Procera system, all-ceramic crowns have become an attractive solution to provide functional and esthetic rehabilitation on teeth and dental implants. The Procera AllCeram crown and Procera Abutment embrace the concept of computer-assisted design and computer-assisted machining (CAD/CAM) and can be used together for optimal esthetic result. The purpose of this case report was to illustrate the advantages of these new components for complex anterior rehabilitation. Three natural teeth and a Procera Abutment were restored using four Procera AllCeram crowns. Treatment planning and esthetic benefits are discussed.

Prolactin up-regulates cathepsin B and D expression in minor salivary glands of patients with Sjögren's syndrome.

Various proteases are expressed in the minor salivary glands (MSG) of patients with Sjögren's syndrome (SS), and as we have already shown, prolactin is neosynthesized in the acinar cells of patients with SS. The present study aims to characterize the influence of PRL on the expression of cathepsin B and D in the MSG of patients with SS. Cathepsin B and D expression was investigated immunohistochemically in MSG of 30 patients with SS and 15 healthy volunteers. The presence of cathepsin B and D mRNAs was checked in three SS patients and three control subjects by means of reverse transcription-polymerase chain reaction (RT-PCR). The specificity of the anti-cathepsin B and D antibodies used for the immunohistochemistry was checked by means of western blotting analysis. The influence of prolactin on the immunohistochemical expression of cathepsin B and D was quantitatively assayed by computer-assisted microscopy at three different doses (5, 50, and 500 ng/ml) on eight MSGs (four control subjects and four patients with SS) maintained ex vivo under organotypic cultures. This influence was also investigated at the mRNA level. Whereas cathepsin B immunopositivity was absent from glandular epithelial cells of healthy subjects and only slightly present in SS patients, cathepsin D immunoreactivity was considerably greater (p < 0.0001) in both the acini and the ducts of patients with SS as compared with control subjects. Cathepsin B, but not D, was also expressed in about 20% of infiltrating mononuclear cells of SS patients. Treatment of both healthy and SS minor salivary glands with PRL significantly (p < 0.05 top < 0.0001) enhanced cathepsin B and D expression in acinar and ductal cells at both protein and mRNA levels. PRL produced locally in MSGs of SS patients, but not those of healthy subjects, could play a role in the pathogenesis of Sjogren's syndrome, if only through the activation of proteolytic activity on the part of cathepsins B and D.

Chaperones in the parotid gland: localization of heat shock proteins in human adult salivary glands.

Heat shock proteins (HSPs) are expressed or increased in response to various biological stresses. Moreover, these 'stress proteins' seem to be expressed by some cells living in physiological conditions. From then on, they could play an important physiological role in normal cell functioning. The best-known physiological role of these HSP proteins is to act as 'molecular chaperones'. In this context, we have investigated the immunohistochemical expression of HSP27, HSP70, HSP90 and HSP110 in 10 human adult salivary glands. To highlight the presence of RNAm encoding HSP70, an in situ hybridization was performed. In our material, HSP27 was strongly expressed in the cytoplasm of striated duct cells and in some myoepithelial cells. The same localization was less stained for HSP70 and HSP90. The immunocytochemical reaction was weak or negative for HSP110 in striated ducts. HSPs were not expressed in acinic cells. In situ hybridization gave a positive signal in striated ducts with a probe encoding HSP70. Epithelial cells of the striated ducts and myoepithelial cells expressed HSP27, HSP70 and HSP90. These HSPs probably act in part as molecular chaperones for protein synthesis, transport and for several interactions between HSPs and different proteins.

[Expression of heat shock proteins in salivary gland tumors. Immunohistochemical study of HSP27, HSP70, HSP90, and HSP110: apropos of 50 cases]. / Expression des protéines de choc thermique dans les tumeurs des glandes salivaires.

Heat shock proteins (HSPs) are known to be increased in response to biological stress. Recently some authors described their presence in tumors. Our immunohistochemical investigations revealed the expression of HSP27, HSP70, HSP90 and HSP110 in most of benign tumors of salivary glands (33 cases). In the malignant tumors, the reaction was immunopositive for HSP70 and HSP90 in 13/17 cases; but HSP27 and HSP110 were only expressed in 5/17 cases. In conclusion HSPs were expressed less in malignant than in benign cells. These results suggest that the loss of some HSPs may be a possible sign of malignancy.

Palatal sliding strip flap: soft tissue management to restore maxillary anterior esthetics at stage 2 surgery: a clinical report.

A new soft tissue flap design technique, called "the palatal sliding strip flap" (PSSF), has been developed to improve the soft tissue surgical results at stage 2 implant surgery. The purpose of this flap design is to help form papillae between implants and between natural teeth in the anterior area of the maxilla. The flap is designed and managed so that the palatal attached mucosa slides in a labial direction to create papillae and at the same time augment the labial ridge. This surgical approach is valid, predictable, and has a low risk-to-benefit ratio. This new flap design is indicated for a variety of clinical situations, especially for the problematic maxillary soft tissue reconstruction around teeth and implants.

Myxomatous odontogenic tumor of the maxilla. An unusual case with squamous and mucoproducing epithelial component.

A tumor attached to the amelo-cemental junction of a third molar impacted in the maxillary tuberosity, consisted histologically of a myxomatous stroma, in which multicystic cavities lined by a columnar epithelium and mucoproducing cells, together with an aggressive squamous epithelial component were present. Although the diagnosis of polyp of the maxillary sinus cannot be excluded, this lesion most likely constitutes an unusual presentation for an odontogenic myxoma of the maxilla, in which an aggressive squamous epithelial component is present, along with a mucosecreting glandular component.

Autologous bone graft to augment the maxillary sinus in conjunction with immediate endosseous implants: a retrospective study up to 5 years.

This study reports the successful use of osseointegrated implants to replace posterior teeth combined with the autogenous bone graft technique in the sinus. Preliminary data (1 to 6 years experience) of this one-stage procedure are presented. A total of 33 patients were treated--44 sinus grafts were augmented with bone from the anterior iliac crest. Reconstruction was completed with ceramic fixed partial dentures, and there was a follow-up of 3 to 80 months (mean 40.2 months) after loading. None of the 44 sinus grafts was lost. Of the 121 implants placed, eight failed, resulting in a failure rate of 6.6% and a cumulative failure rate of 6.8%. Of the 44 prostheses placed in the 44 sinuses, one failed, resulting in a prosthesis stability of 97.7%. Complications were encountered in three patients (three sinuses, eight implants); treatments were administered, symptoms subsided, and the implants integrated in two patients (two sinuses, six implants). One patient lost the two implants and the prosthesis, but the graft integrated. No other complications have since occurred. The results compare favorably with previous reports in terms of implant survival and stability. The implant survival rate approached that of implants placed in uncompromised maxillary bone.

Marginal bone levels at Brånemark system implants used for single tooth restoration. The influence of implant design and anatomical region.

In this retrospective study of Brånemark system oral implants, 75 consecutive patients were treated with 84 implants for single-tooth replacement from 1988 to 1993. Two implants were lost and not replaced: the first one before the abutment connection, the latter during the first year in function. The cumulative failure rate reached 2.4% during the 5-year period. Seventy-one percent of the implants were located in the incisor/canine region of both jaws. Twenty-six per cent of the implants were inserted in special presurgical or surgical conditions. The mean annual bone loss as scored on radiograph, was 0.8 mm during the first year and 0.1 mm the following years. Different implant designs were used, a more pronounced bone loss was observed for the conical implant. The present data shows that the cumulative failure rate for single Brånemark implants and radiographic bone loss is similar to that found around implants used for the treatment of complete and partial edentulism.

Noma: clinical and evolutive aspect.

Noma is a gangrenous stomatitis affecting children from developing countries. It may leave dreadful mutilations around the mouth, leading to esthetic disabling sequels and permanent trismus. Iconography of the acute stage and of sequels is presented in this paper, and pathogenesis of the disease is discussed.

Acute Sjögren-like syndrome as the first manifestation of a generalized CMV infection in a patient with AIDS.

We report the first case of generalized cytomegalovirus (CMV) disease in an AIDS patient who presented with an acute Sjögren-like syndrome and was diagnosed by parotid gland biopsy. All symptoms disappeared after a few days of intravenous ganciclovir therapy.

[Sebaceous carcinoma. Apropos of an extra-ocular location]. / Les carcinomes sébacés. A propos d'une localisation extra-oculaire.

Sebaceous carcinomas of the skin are rare tumors. They most often occur on the skin of the head and neck. Their clinical diagnosis is difficult and the evolution is unpredictable. Recurrence and metastasis are not rare. Treatment of choice is large surgical excision. Opinions are divided regarding the use of chemotherapy and radiotherapy. A case of cutaneous sebaceous carcinoma on the right side of the nose that occurred on a previously irradiated skin is described, with rapid metastasis to the right paramandibular region.

[Maxillofacial dysmorphosis and myasthenia. Orthodontic and surgical treatment of a case]. / Dysmorphose maxillo-faciale et myasthénie. Traitement orthodontique et chirurgical d'un cas.

Case report of a patient with myasthenia and dysmorphic facial features. Pluridisciplinary treatments approach.