A pragmatic window of opportunity to minimise the risk of MRONJ development in individuals with osteoporosis on Denosumab therapy: a hypothesis

Abstract Denosumab is associated with the development of medication-related osteonecrosis of the jaw (MRONJ), an uncommon but severe oral side effect with a higher prevalence in metastatic cancer patients than in patients with metabolic bone fragility. Although several oral triggers can initiate MRONJ, invasive oral treatments and tooth extraction still remain the most common precipitating event. In general, tooth extraction and oral surgery should be avoided in patients at increased risk of MRONJ, while extraction of non-restorable teeth should be performed based on specific risk reduction protocols to eliminate dental/periodontal infections, still protecting from MRONJ onset. Based on th…

Gingival displacement using diode laser or retraction cords: A comparative clinical study.

PURPOSE: To compare two systems used for conditioning the gingival sulcus and exposing the finish line before the final impression for a fixed denture: retraction cords and diode laser. METHODS: All subjects participating in the study had healthy gingival and periodontal status before intervention for fixed prosthesis. 74 abutments for complete crown restoration were randomly divided into two groups for displacing the gingival sulcus before the final impression: gingival retraction cords (RC) and diode laser (DL). The height of the clinical crowns was measured by a blinded examiner in three points of the buccal surface (mesial, midline and distal) at four different times: after tooth prepar…

Analysis of immune-phenotype in squamous cells carcinoma of the tongue

Overexpression of Nicotinamide n-Methyl- transferase in HSC-2 OSCC cell line: effect on apoptosis and cell proliferation

Bioactive Scaffolds Based on Amine-Functionalized Gellan Gum for the Osteogenic Differentiation of Gingival Mesenchymal Stem Cells

With the aim to produce a cellularized construct for the guided bone regeneration of dento-alveolar defects, here we produce a porous scaffold using an amine derivative of gellan gum to host gingival mesenchymal stem cells (GMSCs) and allow their osteochondral differentiation. Three derivatives were produced by using the same synthetic procedure, and the viscoelastic properties of their aqueous dispersions were investigated and compared to those of the native polysaccharide to choose the derivative with suitable properties for the scaffold production. Freeze-drying was used to obtain a porous sponge that can be rehydrated with the cells’ suspension to produce an implantable cell containing …

The patient-doctor relationship: new insights in light of the current Ministerial recommendations regarding Phase 2 of the COVID-19 pandemic

Following the publication of the italian Ministerial recommendations relating to dentistry in Phase 2 of the coViD-19 pandemic (focusing on operational protocols for all dental staff), we believe that the patient/dentist relationship should increasingly take into account the heightened fears and anxious thoughts of patients. this particularly regards patients who are about to undergo dental work. Moreover, dentists should also pay close attention to recent events, which have determined the new recommendations regarding SarS-coV-2 biocontainment. Furthermore, the authors of this paper consider it appropriate to make suggestions and develop interventionist techniques regarding the interface w…

Neoformazione esofitica mandibolare in una giovane paziente

Una donna caucasica di 18 anni si presentava all’osservazione presso il Settore di Medicina Orale (Università degli Studi di Palermo) data la comparsa di una neoformazione localizzata in zona trigono retromolare destro. L’anamnesi patologica non evidenziava la presenza di patologie sistemiche attuali o pregresse. La paziente era in buone condizioni di salute, riferiva di non assumere farmaci e di non avere subito alcun intervento chirurgico; dichiarava di non avere mai fumato. La paziente riferiva un lento e progressivo accrescimento della lesione, in assenza di sintomatologia algica. L’esame obiettivo extra-orale non evidenziava linfoadenopatie latero-cervicali o altre anomalie. All’esame …

Simplifying the dental/periodontal management of patients with metabolic bone fragility receiving treatment with denosumab

Denosumab (DNB) is a bone-targeted medication used to preserve structural integrity and minimise the risk of fragility fractures in metastatic cancer and metabolic bone disorders. DNB targets and binds RANK Ligand, inhibiting osteoclast maturation, function, and survival. In contrast with nitrogen-containing bisphosphonates (N-BPs), DNB does not bind to hydroxyapatite and incorporate into bone; thus, bone cellular remodelling recovers rapidly after drug suspension. Denosumab has benn linked to the occurrence of osteonecrosis of the jaw (MRONJ), a uncommon but severe oral side effect with a higher prevalence in metastatic cancer patients than in patients with metabolic bone fragility. Althou…

Paresthesia of the lip caused by a large osteoma of the mandible treated with a conservative approach: a case report.”

Prevenzione e management odontoiatrico dei pazienti oncologici a rischio di osteonecrosi delle ossa mascellari da farmaci.

non disponibile

Proceedings of the Closed Round Table and Italian Consensus on the Medication-Related Osteonecrosis of Jaws (MRONJ) at the Symposium of Italian Society of Oral Pathology and Medicine (SIPMO) Ancona, 20 October 2018 - Part III

Salivary Biomarkers for Oral Squamous Cell Carcinoma Diagnosis and Follow-Up: Current Status and Perspectives.

Oral cancer is the sixth most common cancer type in the world, and 90% of it is represented by oral squamous cell carcinoma (OSCC). Despite progress in preventive and therapeutic strategies, delay in OSCC diagnosis remains one of the major causes of high morbidity and mortality; indeed the majority of OSCC has been lately identified in the advanced clinical stage (i.e., III or IV). Moreover, after primary treatment, recurrences and/or metastases are found in more than half of the patients (80% of cases within the first 2 years) and the 5-year survival rate is still lower than 50%, resulting in a serious issue for public health. Currently, histological investigation represents the “gold stan…

In vivo diagnosis of oral squamous cell carcinoma using optical coherence tomography: three cases reports

Mucosal healing following PRP (Platelet-Rich Plasma) application in post-extraction socket in patients treated with aminobisphosphonates

Predicting Death in Patients with Squamous Cell Carcinoma of the Tongue

Tongue squamous cell carcinoma (TSCC) accounts for 40% of all squamous cell carcinoma involving the mucosal surface of the oral cavity. TSCC is highly invasive and aggressive and, nowadays, TNM staging system is considered the gold standard in predicting patients’ outcomes. [...]

Oral Surgical Management of Bone and Soft Tissues in MRONJ Treatment: A Decisional Tree.

Background: The aim of the present work was to analyze a 10-year retrospective series of surgically treated medication-related osteonecrosis of the jaws (MRONJ) cases, reporting the clinical outcome and success rate for each adopted procedure in order to draw a treatment algorithm that is able to standardize clinical decision making and maximize the success of oral surgical treatment of MRONJ. Methods: Different surgical approaches were categorized taking into consideration two variables a) hard tissue management (defined as debridement, saucerization or marginal resective surgery of maxillary necrotic bone) and b) soft tissue management (defined as type of flap design and related modality …

Review of: "Teriparatide Promotes Bone Healing in Medication-Related Osteonecrosis of the Jaw: A Placebo-Controlled, Randomized Trial"

In Vitro and in Vivo investigation on stem cells isolated from pulp and gingival tissues from periodontally compromised teeth.

In vivo investigation on stem cells isolated from dental pulp and gingival tissues from periodontally compromised teeth

The role of antibiotic prophylaxis in reducing bacterial contamination of autologous bone graft collected from implant site

The aim of this study was to evaluate if antibiotic prophylaxis reduces the bacterial contamination of bone particles collected directly from the burs used for implant site preparation. Thirty-four patients underwent the surgical procedures for a total of 34 implant sites. One 1 gr. tablet of amoxicillin + clavulanic acid was given to the test group 12 hours and 1 hour before the surgery. The control group did not take antibiotic prophylaxis. Bone particles were collected and centrifuged. The suspensions were subjected to serial dilutions and each dilution was examined twice using a spatulation technique in Trypticase Soy Agar (TSA), in Sabouraud Dextrose Agar, and in Mitis Salivarius Agar …

Conservative treatment of a Riga-Fede disease: a case report

Riga-Fede disease (RFD) is clinically characterized by the presence of a traumatic ulceration on the ventral surface of the tongue in newborns and infants. It is frequentely associated with prematurely erupting primary teeth, but may also occur after the eruption of primary lower incisors in older infants with repetitive tongue thrusting habits and children with familiar dysautonomia (insensitivity to pain).

The Treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Systematic Review with a Pooled Analysis of Only Surgery versus Combined Protocols

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents, and it is also a potentially painful and debilitating condition. To date, no specific studies have prospectively evaluated the efficacy of its treatment and no robust standard of care has been established. Therefore, a systematic review (2007–2020) with a pooled analysis was performed in order to compare MRONJ surgical techniques (conservative or aggressive) versus combined surgical procedures (surgery plus a non-invasive procedure), where 1137 patients were included in the pooled analysis. A statistically significant difference in the 6-month improvement rate, comp…

Additional file 2: Table S1. of Mesenchymal stem cells derived from inflamed dental pulpal and gingival tissue: a potential application for bone formation

The expression values of putative mesenchymal surface stem cells markers. (DOC 31 kb)

Low Frequency of Human Papillomavirus in Strictly Site-Coded Oral Squamous Cell Carcinomas, Using the Latest NHI/SEER-ICD Systems: A Pilot Observational Study and Critical Review.

Simple Summary The incidence of oropharyngeal squamous cell carcinomas (OPSCCs) has increased in the last decades, and this seems to be correlated to the infectious epidemiological trend of human papillomavirus (HPV). The prevalence of HPV-positive OPSCCs is approximately 70%, with involvement mainly of the tonsillar area. On the role of HPV in oral squamous cell carcinoma (OSCC), very few studies have investigated the prevalence of HPV in strictly site-codified OSCC, excluding the base of the tongue as distinct oropharyngeal entity. As a result, an inappropriate estimation of HPV infection in OSCC has been observed. We investigated HPV status, using a combination of detection methods, in a…

Porphyromonas gingivalis, Periodontal and Systemic Implications: A Systematic Review

In recent scientific literature, oral infections and systemic manifestations, or correlations between oral health and systemic diseases are a topic of discussion. Porphyromonas gingivalis is one of the bacteria implicated in the biofilm formation of bacterial plaque, and plays an important role in the progression of periodontal disease. In this systematic review authors have evaluated the literature of the last 10 years on P. gingivalis and all the systemic implications proven. This study therefore evaluates all the districts of the organism in which this bacterium may have implications. From the results it emerges that P. gingivalis has implications in the onset of different systemic patho…

Use of porcine collagen matrix (Mucograft®) to promote the wound healing in the oral cavity

The aim of this study was to evaluate the use of a new collagen matrix (Mucograft®; Geistlich Pharma AG, Wol- husen, Switzerland) in the soft tissue reconstruction after excisional biopsy. The healing of soft tissues after bioptical excision tends to heal by secondary intention. To avoid this, the soft tissue grafts can be harvested from the palate, retromolar pad, or (if available) edentulous site. Disadvantages of harvesting the graft from the retromolar pad and edentulous site are minimal amount of tissue availability and thinner grafts are obtained. The use of collagen matrix is also reported in literature and could represent an optimal solution in the future. Mucograft® is a pure colla…

Commonalities between ENT Specialists and Oral Medicine Experts: Old HPV Diseases and New Oral HPV-Cancer along the Borders

A human papillomavirus (HPV) infection is globally one of the most common causes of sexually transmitted infections of the mucous membranes (genital, anal and oral). Over the last decade, an increasing number of young patients have been infected due to the changes in sexual habits in the general population. The majority of the lesions are benign; however, substantial scientific evidence has suggested a role for the HPV family in the carcinogenesis of squamous cell carcinoma (SCC). It is proposed that dentists, in addition to ENT specialists, should apply standardized management protocols in order to construct a well-defined pathway in terms of diagnosis, which is based on a PCR diagnostic t…

Growth and Osteogenic Differentiation of Discarded Gingiva-Derived Mesenchymal Stem Cells on a Commercial Scaffold

Background In periodontal patients with jawbone resorption, the autologous bone graft is considered a "gold standard" procedure for the placing of dental prosthesis; however, this procedure is a costly intervention and poses the risk of clinical complications. Thanks to the use of adult mesenchymal stem cells, smart biomaterials, and active biomolecules, regenerative medicine and bone tissue engineering represent a valid alternative to the traditional procedures. Aims In the past, mesenchymal stem cells isolated from periodontally compromised gingiva were considered a biological waste and discarded during surgical procedures. This study aims to test the osteoconductive activity of FISIOGRAF…

RE: MEDICATION-RELATED OSTEONECROSIS OF THE JAW (MRONJ)

Evidence of field cancerization of oral squamous cell carcinoma: a case report

Objectives. From 1953 (1) the term “field cancerization” has been used to describe an “increased risk of cancer de- velopment in the entire upper aerodigestive tract due to multiple genetic abnormalities in the whole region after pro- longed exposure to carcinogen” (2). This phenomenon implies the occurrence of multiple primary tumors/potentially malignant disorders as results of cell-molecular aberrations in different independent sites (polyclonal theory) or from the same site through widespread expansion or later spread across the mucosa (monoclonal theory). Case report. A 63-year-old female patient referred in June of 2014 for exophytic/ulcerative lesion in the hard palate. At the same t…

Proceedings of the Closed Round Table and Italian Consensus on the Medication-Related Osteonecrosis of Jaws (MRONJ) at the Symposium of Italian Society of Oral Pathology and Medicine (SIPMO) Ancona, 20 October 2018 - Part I.

On 20 October 2018 a Closed Round Table brought together a wide range of stakeholders from several medical disciplines, including academic experts, dentists, oncologists, maxillo-facial surgeons, oral surgeons, radiologists, under the technical and scientific coordination of Giuseppina Campisi (for SIPMO) and Giacomo Oteri (for Italian Society of Oral Surgery- SIdCO).

Application of Ozone Therapy in the Conservative Surgical Treatment of Osteonecrosis of the Jaw: Preliminary Results

The main goals of the management of osteonecrosis of the jaw (ONJ) are to slow the progressionof the disease and, when it is achievable, to remove all the necrotic bone promoting the tissues’healing [...]

Oral Health Status in Subjects with Amnestic Mild Cognitive Impairment and Alzheimer’s Disease: Data from the Zabút Aging Project

Background: The relationship between Alzheimer’s disease (AD) and periodontitis has been recently investigated with heterogenous results. Objective: This study aims to evaluate the oral health status and its relationship with cognitive impairment of participants, enrolled in the Zabút Aging Project, a community-based cohort study performed in a rural community in Sicily, Italy. Methods: A case-control study (20 subjects with AD, 20 with amnestic mild cognitive impairment [aMCI], and 20 controls) was conducted. The protocol included a comprehensive medical and cognitive-behavioral examination. Full-mouth evaluation, microbial analysis of subgingival plaque samples (by RT-PCR analysis), and o…

The preventive care of medication-related osteonecrosis of the jaw (MRONJ): a position paper by Italian experts for dental hygienists

Abstract Purpose The prevention and early diagnosis of medication-related osteonecrosis of the jaw (MRONJ) is fundamental to reducing the incidence and progression of MRONJ. Many in the field believe that dental hygienists should play an integral role in primary and secondary MRONJ prevention. However, to date, very few publications in the literature have proposed standardised MRONJ protocols, which are dedicated to dental hygienists. The aim of this study was to provide guidance to the health care providers managing MRONJ. Methods The expert opinion in this study was developed by dental hygienists from the main Italian technical-scientific associations (Italian Dental Hygienists Associatio…

Can radium 223 be a conservative non-surgical management of medication-related osteonecrosis of the jaw?

AbstractOsteonecrosis of the jaw (ONJ) is a rare and severe necrotic bone disease reflecting a compromise in the body's osseous healing mechanisms and unique to the craniofacial region. Radium 223 dichloride (Ra223) is the only targeted alpha therapy able to extend survival in patients with bone metastases from prostate cancer. Mechanism of action and data currently available focused mainly on osteoblastic metastases from prostate cancer. In 2018, a Caucasian 54-year-old woman presented to our institution for a breast cancer with bone metastases. Since the patient refused any treatment and taking into account the bone disease, our multidisciplinary team evaluated a supplementary strategy wi…

Human exfoliated deciduous teeth and oral mucosa: promising applications in tissue regeneration

In the last three decades, the constantly increasing need for therapies, efficiently preventing and/or treating human diseases, has raised the interest in Regenerative Medicine (RM). RM is based on employing mesenchymal stem cells (MSCs), that showed to have great proliferation, self-renewal and multilineage differentiation potential, in vitro as well as in vivo. The opportunity of an accessible, painless and low-cost reservoir of MSCs constitutes the first important step of a successful regenerative therapy to include in the current clinical practice. Oral cavity has recently demonstrated to contain different MSCs niches: dental pulp from permanent and deciduous teeth, periodontal ligament…

Dental pulp stem cells for bone tissue engineering: a review of the current literature and a look to the future.

The aim of this narrative review is to investigate the implication of mesenchymal stem cells harvested from human dental pulp in in vivo bone tissue regeneration. We focused on studies related to roles of human dental pulp stem cells in in vivo bone regeneration. A total of 1021 studies were identified; after the assessment of eligibility, only 39 studies were included in the review. The evaluated information of the studies regards the experimental strategies (e.g., the isolation method, the scaffold, the in vivo animal models). The overall main evidences highlighted from the analysis are that dental pulp stem cells and human-exfoliated deciduous teeth stem cells supported by a suitable sc…

Oral Squamous Cell Carcinoma Mimicking Medication-Related Osteonecrosis of the Jaws (MRONJ): A Case Series

(1) Background: Medication-related osteonecrosis of the jaw (MRONJ) is a potential adverse drug reaction of antiresorptive and/or antiangiogenic treatment. MRONJ is mostly diagnosed by anamnestic data, clinical examination and radiological findings, with signs and symptoms often unspecific. On the other hand, oral squamous cell carcinoma (OSCC) is characteristic for its pleomorphic appearance (e.g., ulcer, mucous dehiscence, non-healing post-extractive socket). We report three cases where OSCC mimicked MRONJ lesions. (2) Patients: Three patients undergoing amino-bisphosphonate treatment for osteoporosis presented with areas of intraorally exposed jawbone and unspecific radiological signs co…

Medication-Related Osteonecrosis of Jaws (MRONJ) Prevention and Diagnosis: Italian Consensus Update 2020

The Medication-Related Osteonecrosis of Jaws (MRONJ) diagnosis process and its prevention play a role of great and rising importance, not only on the Quality of Life (QoL) of patients, but also on the decision-making process by the majority of dentists and oral surgeons involved in MRONJ prevention (primary and secondary). The present paper reports the update of the conclusions from the Consensus Conference—held at the Symposium of the Italian Society of Oral Pathology and Medicine (SIPMO) (20 October 2018, Ancona, Italy)—after the newest recommendations (2020) on MRONJ were published by two scientific societies (Italian Societies of Maxillofacial Surgery and Oral Pathology and Medicine, SI…

Onset of MRONJ in Breast Cancer Patients after Switching from Low to High Dose of Bone Modifying Agents Due to Bone Metastases Development: A Single Center Retrospective Cohort Study

Background: Medication-Related Osteonecrosis of the Jaw (MRONJ) is an adverse drug reaction mainly associated to bone modifying agents (BMAs). Breast cancer (BC) is the most frequent cancer worldwide. Its therapy can cause cancer treatment-induced bone loss (CTIBL), commonly treated with BMAs. The aims of this retrospective study are: to describe characteristics of BC patients under BMAs for CTIBL; to record any switch to high-dose BMAs; to assess MRONJ onset and to identify any factors associated with it. Patients: Authors included patients referred for MRONJ prevention to the Unit of Oral Medicine (University Hospital of Palermo). Results: Fourteen female BC patients under low-dose BMAs f…

Early onset ONJ in patient treated with denosumab and bevacizumab: case report

Umanizzazione delle cure in odontostomatologia. Una tendenza emergente

OBIETTIVI Scopo del presente lavoro è fornire agli specialisti della salute orale la descrizione delle caratteristiche del colloquio narrativo, inteso come differente dalla tradizionale anamnesi e in grado di rilevare l’universo del paziente, alla base del processo di umaniz-zazione delle cure in odontostomatologia, e illustrare un modello di umanizzazione di cure odontoiatriche. METODI Nell’articolo vengono descritti i punti chiave del processo di umanizzazione delle cure e come tale pratica sia stata integrata nella U.O. di Medicina Orale, A.O.U. P. Giaccone di Palermo per l’approccio al paziente fragile. La comunità scientifica ha già messo in discussione il tradizionale approccio medico…

A SIMPLE SURGICAL-MEDICAL PROTOCOL TO CARRY OUT DENTAL EXTRACTIONS IN PATIENTS IN THERAPY WITH BISPHOSPHONATES: OUR EXPERIENCE

Aim. Bisphosphonate Related OsteoNecrosis of the Jaw (BRONJ) is described as an adverse event related to amino-bisphosphonate (NBP) therapy, occurring as a result of reduced bone resorption and bone turnover. One of the most significant risk factor associated with the onset of BRONJ is tooth extraction even if not yet supported by definitive scientific evidences. The aim of this study is to propose a simple surgical/medical protocol to carry out dental extractions in patients in therapy with NBPs in order to minimize the BRONJ risk. Materials and methods. Eighty-eight patients currently or previously treated with NBPs were selected for extractions of compromised teeth. Patients were divided…

Development of a Multifunctional Bioerodible Nanocomposite Containing Metronidazole and Curcumin to Apply on L-PRF Clot to Promote Tissue Regeneration in Dentistry

Teeth extractions are often followed by alveolar bone reabsorption, although an adequate level of bone is required for reliable rehabilitations by dental implants. Leukocyte and platelet-rich fibrin (L-PRF) has been widely applied in regenerative procedures and with antibiotic and antioxidant agents could play an essential role in hard and soft tissue healing. In this work, a nanocomposite (Sponge-C-MTR) consisting of a hyaluronate-based sponge loaded with metronidazole (MTR) and nanostructured lipid carriers containing curcumin (CUR-NLC) was designed to be wrapped in the L-PRF&trade

Leucocyte- and Platelet-Rich Fibrin Block: Its Use for the Treatment of a Large Cyst with Implant-Based Rehabilitation

The management of critical-size bone defects is still demanding. Recently, autologous platelet concentrates in combination with bone substitute have been applied and reported in a few studies. Our aim is to report the healing of a critical-size alveolar bone defect treated with a new bone regeneration technique by means of L-PRF and L-PRF blocks. A 45-year-old woman presented a large cystic lesion; the extraction of three teeth, a cyst removal procedure, and bone regeneration procedures with L-PRF and L-PRF blocks were planned. The L-PRF block was prepared by mixing a bone substitute with a piece of L-PRF membrane and liquid fibrinogen. Additionally, after bone healing an implant-based reha…

Salivary Microbiota Composition in Patients with Oral Squamous Cell Carcinoma: A Systematic Review.

Background: Oral squamous cell carcinoma (OSCC) is one of the most prevalent cancers worldwide. Despite recent advances in diagnosis and treatment, in recent years, an increase in the incidence of OSCC has been registered, and the mortality rate is still high. This systematic review aims to identify a potential association between the composition of salivary microbiota and OSCC. Materials and Methods: The protocol for this study was designed following the PRISMA guidelines. Records were identified using different search engines (e.g., Medline/PubMed). Observational studies, in human subjects with histological diagnosis of OSCC, concerning the analysis of salivary microbiota, were selected. …

Diagnostic delay of oral squamous cell carcinoma and the fear of diagnosis: A scoping review.

The mortality rate of patients affected with oral squamous cell carcinoma (OSCC) has been stable in recent decades due to several factors, especially diagnostic delay, which is often associated with a late stage diagnosis and poor prognosis. The aims of this paper were to: analyze diagnostic delay in OSCC and to discuss the various psychological factors of patients with OSCC, with particular attention to the patient’s fear of receiving news regarding their health; and the professional dynamics related to the decision-making processes in cases of suspected OSCC. A preliminary review of literature focusing on OSCC diagnostic delay was performed. Seven articles were included with the diagnosti…

Oral lesions as primary manifestations of acute agranulocytosis related to metamizole: a case report

Adenoid Cystic Carcinoma of Salivary Gland: An Immunohistochemical Study

Mucocutaneous Leishmaniasis Mimicking Squamous Cell Carcinoma

Leishmaniasis is a parasitic infectious disease caused by protozoan species belonging to the [...]

Medication-related osteonecrosis of the jaw in a cancer patient receiving lenvatinib.

Medication-related osteonecrosis of the jaw (MRONJ) is an adverse drug reaction that affects the mandible and maxilla of patients exposed to bone-targeting agents such as anti-resorptive and anti-angiogenic agents. Several MRONJ cases have been reported after dental extractions in patients under treatment with anti-angiogenic agents, including receptor activator of nuclear factor κB ligand (RANKL) inhibitor, anti-vascular endothelial growth factor (anti-VEGF) monoclonal antibody, mammalian target of rapamycin (mTOR) inhibitors, and tyrosine kinase inhibitors (TKIs). The aim of this article was to describe an original case of lenvatinib-related osteonecrosis of the jaw in a patient affected …

Mesenchymal stem cells derived from inflamed dental pulpal and gingival tissue: a potential application for bone formation

Background Chronic periodontal disease is an infectious disease consisting of prolonged inflammation of the supporting tooth tissue and resulting in bone loss. Guided bone regeneration procedures have become common and safe treatments in dentistry, and in this context dental stem cells would represent the ideal solution as autologous cells. In this study, we verified the ability of dental pulp mesenchymal stem cells (DPSCs) and gingival mesenchymal stem cells (GMSCs) harvested from periodontally affected teeth to produce new mineralized bone tissue in vitro, and compared this to cells from healthy teeth. Methods To characterize DPSCs and GMSCs, we assessed colony-forming assay, immunophenot…

Site-Coded Oral Squamous Cell Carcinoma Evaluation by Optical Coherence Tomography (OCT): A Descriptive Pilot Study

Optical Coherence Tomography (OCT) is an emerging non-invasive method for oral diagnostics, proving to be a practicable device for epithelial and subepithelial evaluation. The potential validity of OCT in oral cancer assessment has been explored but, to date, there are very few investigations conducted with a systematic comparison between clinical/histological and OCT parameters, especially in strict reference to the anatomical site-codification of the oral mucosa. In this regard, our study performed a two-steps evaluation (in vivo OCT and histological investigations) of suspected OSCCs, progressively recruited, using as references the OCT images of the same site-coded healthy mucosa, to pr…

Use of Optical Coherence Tomography in Patients with Desquamative Gingivitis: A Case Series

A Cemento-ossifying fibroma of the mandible in an 18 years old female patient: a case report

CD34 and CD105 Microvessels in Resected Bone Specimen May Implicate Wound Healing in MRONJ

Clinical treatment outcome of MRONJ (medication-related osteonecrosis of the jaw) surgery despite radical osseous removal and primary closure healing still shows differences in terms of outcome and disease recurrence. The study aims to assess the rate of angiogenesis of MRONJ lesions in order to understand the impact of angiogenesis and neoangiogenesis status on MRONJ surgical treatment outcome. This is the first study correlating microvessel density with prognosis in MRONJ surgically-treated patients. The immunohistochemical expression of CD34 and CD105 in MRONJ specimens obtained from surgically-treated patients was evaluated. The most vascularized areas detected by CD34 and CD105 were se…

Strategie preventive e management odontoiatrico nel paziente a rischio di osteonecrosi delle ossa mascellari associata a farmaco

Osteonecrosis of the jaw (ONJ) drug related is an uncommon but serious and debilitating disease, whose epidemiology and pathogenesis are still unclear. However, in the recent years, knowledge regarding ONJ risk factors has lead to substantial progress in ONJ prevention. Anti-resorptive medicines (e.g. bisphosphonates, denosumab) and anti-angiogenic medicines (e.g bevacizumab, sunitinib) are being used in the treatment of various cancers and in the treatment of several non-oncological conditions, mainly for the osteoporosis. Despite the higher frequencies of ONJ cases in cancer patients, ONJ is becoming more frequent in everyday practice in osteometabolic patients. This due to the higher num…

MRONJ in breast cancer patients under bone modifying agents for cancer treatment-induced bone loss (CTIBL): a multi-hospital-based case series

Abstract Background Cancer treatment-induced bone loss (CTIBL) is the most common adverse event experienced by patients affected by breast cancer (BC) patients, without bone metastases. Bone modifying agents (BMAs) therapy is prescribed for the prevention of CTIBL, but it exposes patients to the risk of MRONJ. Methods This multicentre hospital-based retrospective study included consecutive non-metastatic BC patients affected by MRONJ related to exposure to low-dose BMAs for CTIBL prevention. Patients’ data were retrospectively collected from the clinical charts of seven recruiting Italian centres. Results MRONJ lesions were found in fifteen females (mean age 67.5 years), mainly in the mandi…

The surgical treatment of mandibular peripheral calcifying epithelial odontogenic tumour (pindborg tumor) with Er,Cr:YSGG laser: a case report.”

Bilateral palatal swelling as frst sign of recurrence of a mantle cell lymphoma: a case report

Proceedings of the Closed Round Table and Italian Consensus on the Medication-Related Osteonecrosis of Jaws (MRONJ) at the Symposium of Italian Society of Oral Pathology and Medicine (SIPMO) Ancona, 20 October 2018 - Part II

On 20 October 2018 a Closed Round Table brought together a wide range of stakeholders from several medical disciplines, including academic experts, dentists, oncologists, maxillo-facial surgeons, oral surgeons, radiologists, under the technical and scientific coordination of Giuseppina Campisi (for SIPMO) and Giacomo Oteri (for Italian Society of Oral Surgery- SIdCO)

Optical coherence tomography as a simple and non invasive tool for the diagnosis of oral disease: a case report

Introduction. Optical Coherence Tomography (OCT) is a new biomedical imaging modality that provides high reso- lution cross-sectional images of tissue. Conceptually, it has been compared with ultrasound scanning but it uses in- frared light and records reflections below the surface to produce a cross-sectional architectural image of the tissue. OCT has been applied in ophthalmology and recently in dermatology; several studies have shown the validity of the use of OCT in ex vivo oral lesions but, to date, it does not exist a bank of normative and pathological OCT data of the oral tissues to consent identification of cellular structures of normal and pathological processes. We report a case o…

A case of osteonecrosis of the jaws in epidermolysis bullosa patient treated with rituximab.

We report a case of a patient with EBA, who developed ONJ after Rituximab treatment.

Hydrophilic Sponges loaded with Curcumin solid lipid nanoparticles and Metronidazole applied on L-PRF clot to promote tissue regeneration in dentistry

Leukocyte-and platelet-rich fibrin (L-PRF) technology allows for the preparation of strong fibrin membranes enriched with cells (activated platelets, leukocytes, circulating cells) and platelet growth factors [1]. In dentistry, the use of this autologous platelet concentrates such as L-PRF, also in association with Metronidazole (MTR), seems an innovative approach for vestibular bone grafting on the alveolar ridges [2]. In addition, Curcumin (CUR), a natural polyphenol derived from the rhizome of the Curcuma longa, could be effectiveness on tissue regeneration due to its well-known antioxidant and anti-inflammatory properties [3]. The aim of the present work was the development of bioerodib…

Platelet-Rich Plasma (PRP) in Dental Extraction of Patients at Risk of Bisphosphonate-Related Osteonecrosis of the Jaws: A Two-Year Longitudinal Study

: Dental extraction has often been described as the main trigger event of osteonecrosis of the jaws (ONJ). This longitudinal hospital-based study aimed to evaluate the outcome at 2 years of a standardized medical-surgical protocol for dental extraction, combined with platelet rich-plasma (PRP) application, compared with conventional protocol not combined with PRP or any other autologous platelet concentrate in cancer (ONC) and osteometabolic (OST) patients, at risk of bisphosphonate (BP)-related ONJ. Twenty patients were consecutively recruited: six received BPs for cancer skeletal-related events (34.17 &plusmn

Protein Cargo of Salivary Small Extracellular Vesicles as Potential Functional Signature of Oral Squamous Cell Carcinoma

The early diagnosis of oral squamous cell carcinoma (OSCC) is still an investigative challenge. Saliva has been proposed as an ideal diagnostic medium for biomarker detection by mean of liquid biopsy technique. The aim of this pilot study was to apply proteomic and bioinformatic strategies to determine the potential use of saliva small extracellular vesicles (S/SEVs) as a potential tumor biomarker source. Among the twenty-three enrolled patients, 5 were free from diseases (OSCC_FREE), 6 were with OSCC without lymph node metastasis (OSCC_NLNM), and 12 were with OSCC and lymph node metastasis (OSCC_LNM). The S/SEVs from patients of each group were pooled and properly characterized before perf…

Clinical Validation of 13-gene DNA Methylation Analysis from Oral Brushing: A Non Invasive Sampling Procedure for Early Detection of Oral Squamous Cell Carcinoma. A Multicentric Study

In a recent study our research group described a non-invasive sampling procedure based on [...]

The dental management of patients at risk of medication-related osteonecrosis of the jaw: New paradigm of primary prevention

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents; it is a potentially painful and debilitating condition that can considerably affect the quality of life of patients. Furthermore, even if its epidemiology and pathogenesis have still not been fully clarified, several risk factors related to MRONJ have been recognized in prevention protocols. Three main risk factors are as follows: (i) the type of ONJ-related medications: antiresorptive (e.g., Bisphosphonates, Denosumab) and antiangiogenic drugs (e.g., Bevacizumab, Sunitinib); (ii) the category of patient at MRONJ risk: cancer versus non-cancer patient; (iii) the typ…

Painful oral aphthous-like lesions in patient with kidney cancer after target therapy and bisphosphonate administration: a case report of adverse drug reaction.

Aim. Tyrosine kinase inhibitors (TKIs) targeting tu- mor angiogenesis and mammalian target of rapamycin inhibitors (mTOR) are indicated for the management of several cancer types, as for renal cell carcinoma (RCC). Oral ulcerations are reported as common adverse drug reactions of mTOR inhibitors and are currently classified as mTOR inhibitor associated stomatitis (mIAS). Interestingly, these lesions appear as aphthous-like stoma- titis rather than the mucositis seen with chemotherapy agent. Case report. A 49 years old male patient underwent to the left radical nephrectomy in May 2014 for clear RCC. From July to October 2014 he was treated with Pazopanib, a tyrosine kinase inhibitor. In Dece…

Preliminary study about the efficiency of diode laser compared with retraction cords used for exposing the finishing lines of dental abutments before the optic impression

The Humanization of Health Care: In-Depth Knowledge Regarding the Ethics of Dental Care in Oncological Patients

This chapter provides an illuminating insight into the processes of the humanization of care in order to increase specialist knowledge regarding the nature of the doctor-patient relationship. It will deal with the notion of care and its various aspects, including the existential dimension of the process of caregiving by means of a narrative (storytelling) interview. After a brief analysis of the changes which have affected medical science in past centuries, the focus of the paper will be directed to the remarkable transformation which clinical practice has undergone, by virtue of which the concept of the taking care of the patient has gained increasing attention. Thus, care can be provided …

Optical coherence tomography in oral medicine: preliminary in vivo study

To introduce an OCT (Optical Coherence Tomography) in vivo database of oral diseases, by means of the VivoSight! OCT (Michelson diagnosis) scanner.

Histological findings of osteonecrosis spotted prior to tooth extractions. Should we consider tooth extraction still the main trigger event?

Osteonecrosis of the jaw (ONJ) is an adverse drug reaction described as the progressive destruction and death of bone that affects the mandible and maxilla of patients exposed to the treatment with medications known to increase the risk of disease, in the absence of a previous radiation treatment. Tooth extraction often precedes the manifestation of ONJ; indeed, it is sometimes called trigger event and it have also been considered as risk factors for the onset of ONJ. As a consequence, some of the guidelines recommend avoiding tooth extractions in patients at risk of ONJ; however, a growing body of evidence indicates that dental/periodontal infection prior to extraction, rather than dental …

L-PRF application in extraction sockets of bisphosphonate-treated patients: preliminary results

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a severe adverse event related to bisphosphonates (BPs) therapy; tooth extraction has been described as the main trigger. Autologous platelet concentrates, such Leukocyte-Platelet Rich Fibrin (L-PRF, Intraspin !) are designed to release platelet growth factors, improving the tissue healing in oral surgery. The aim of this study was to evaluate the efficacy and safety of our dental extraction protocol applied in BPs patients.

Oral squamous cell carcinoma mimicking osteonecrosis of the jaw: a case report

Osteonecrosis of the jaw (ONJ) is a well-known adverse drug reaction to bisphosphonate (BP) treatment. ONJ diagnosis is usually based on the patient’s medical/medication histories and on the clinical/radiological features of necrotic bone (frequently exposed). Furthermore, in case of mandibular involvement, patients may present pain and/or hypesthesia of the inferior alveolar nerve. There are no pathognomonic clinical and radiological signs of ONJ, and in doubtful cases, the histologic examination is recommended. We report a case of a woman attending to our sector of Oral Medicine (AOUP “P. Giaccone” Palermo, Italy) with a mandibular bone exposure after implants loss and a medical history o…

Oral verruciform xanthoma and erythroplakia associated with chronic graft-versus-host disease: A rare case report and review of the literature

Abstract Background Oral verruciform xanthoma is an uncommon benign lesion. Although oral verruciform xanthoma occurs in healthy individuals, it has been also reported in association with some inflammatory conditions. The aim of this study is to report a case of oral verruciform xanthoma associated with chronic graft-versus-host disease and to review the literature on this topic. Case presentation A 47-year-old Caucasian male presented to the Sector of Oral Medicine “V. Margiotta”, University Policlinic “P. Giaccone” of Palermo complaining of a mass on the gingiva. He first noticed the painless mass 1 year ago. He reported to have undergone allogenic hematopoietic stem cell transplantation …

Development of OloHealth, a teledentistry program for the enhancement of oral health in Sicilian policemen: preliminary reports

Advance on Resveratrol Application in Bone Regeneration: Progress and Perspectives for Use in Oral and Maxillofacial Surgery

The natural polyphenol Resveratrol (RSV) claims numerous positive effects on health due to the well documented biological effects demonstrating its potential as a disease-preventing agent and as adjuvant for treatment of a wide variety of chronic diseases. Since several studies, both in vitro and in vivo, have highlighted the protective bone aptitude of RSV both as promoter of osteoblasts’ proliferation and antagonist of osteoclasts’ differentiation, they could be interesting in view of applications in the field of dentistry and maxillofacial surgery. This review has brought together experimental findings on the use of RSV in the regeneration of bone tissue comprising also its application a…

Clinical validation of 13-gene DNA methylation analysis in oral brushing samples for detection of oral carcinoma: an Italian multicenter study

Background The aim of this Italian multicenter study was to evaluate the diagnostic performance of a minimally invasive method for the detection of oral squamous cell carcinoma (OSCC) based on 13-gene DNA methylation analysis in oral brushing samples. Methods Oral brushing specimens were collected in 11 oral medicine centers across Italy. Twenty brushing specimens were collected by each center, 10 from patients with OSCC, and 10 from healthy volunteers. DNA methylation analysis was performed in blindness, and each sample was determined as positive or negative based on a predefined cutoff value. Results DNA amplification failed in 4 of 220 (1.8%) samples. Of the specimens derived from patien…

Idiopathic osteonecrosis of the mandible in a 49 healthy male patient: a rare and interesting case report

Hastening of wound healing of mucosa by means of aminoacids combined to sodium hyaluronate after oral biopsy: an open trial.

Sodium hyaluronate has been widely used in order to promote wound healing in oral cavity for its anti-inflammatory effects. Aim of this clinical trial was to evaluate the efficacy of aminoacids added to topical sodium hyaluronate, in minor oral surgery. After surgery by means of Quantic molecular resonance scalpel, in 27 patients a gel with sodium hyaluronate has been applied directly on the surgical wound, in order to favorite healing by secondary intention. Furthermore, gel has been applied 3-4times/day, after meals and oral hygiene. Hemostatic effect, edema and pain symptoms by VAS (Visual Analogue Scale;0-100), and clinical healing (full, partial, absent) have been evaluated at T#1(2hrs…

Finite Element Method and Von Mises Investigation on Bone Response to Dynamic Stress with a Novel Conical Dental Implant Connection

The bioengineering and medical and biomedical fields are ever closer, and they manage to obtain surprising results for the development of new devices. The field of simulations and studies in silica has undergone considerable development in recent years, favoring the advancement of medicine. In this manuscript, a study was carried out to evaluate the force distribution on the implant components (In-Kone® Universal) and on the peri-implant tissues subjected to loading. With the finite element analysis and the Von Mises method, it was possible to evaluate this distribution of forces both at 0 degrees (occlusal force) and at 30 degrees; the applied force was 800 N. The obtained results on this …

Ozone Infiltration for Osteonecrosis of the Jaw Therapy: A Case Series

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction, mainly due to bone-modifying agents (BMA), and it is a potentially painful and debilitating condition. To date, the literature has reported a 90% rate of successful outcomes for MRONJ patients undergoing surgical treatment. Particularly for patients with advanced disease stages who are unsuitable for surgery, prolonged medical treatment is required, with a consequent risk of the overuse of antibiotics and antibiotic resistance. The aim of this study is to evaluate the efficiency and safety of ozone, via oral mucosal infiltrations, in seven cancer patients with MRONJ, who are not eligible for surgery. The prot…

Comment on “Medication-Related Osteonecrosis of the Jaw (MRONJ)” by Elie M. Ferneini in the Section “Simply Put: JOMS Information for Patients”

We read with great interest the contribute to the section “Simply Put: JOMS Information for Patients” named “Medication-Related Osteonecrosis of the Jaw (MRONJ)” by Elie M. Ferneini.

Peri-implantitis-like medication-related osteonecrosis of the jaw: Clinical considerations and histological evaluation with confocal laser scanning microscope

Objective: In the recent years, an increasing number of peri-implant medication-related osteonecrosis of the jaw (PI-MRONJ) have been reported in literature, both in oncologic and osteoporotic patients. The aim of this study is to describe 19 cases of patients previously diagnosed as affected by peri-implantitis, who were treated for PI-MRONJ, with consideration on clinical and histopathological features. Materials and Methods: Patients included were affected by postmenopausal osteoporosis and were administered with different antiresorptive drugs. Due to the presence of clinical and radiological signs of peri-implantitis not healed after non-surgical periodontal treatment, they were referre…

Conservative Surgical Treatment of Bisphosphonate-Related Osteonecrosis of the Jaw with Er,Cr:YSGG Laser and Platelet-Rich Plasma: A Longitudinal Study

Introduction. The management of bisphosphonate-related osteonecrosis of the jaw (BRONJ), with no evidence-based guidelines, remains controversial. We aimed to evaluate the efficiency of a conservative surgical treatment combining Er,Cr:YSGG laser and platelet-rich plasma (PRP) for the treatment of BRONJ in cancer patients. Methods. We performed a longitudinal cohort study. Inclusion criteria were (1) age ≥ 18 years; (2) cancer diagnosis; (3) treatment with NBP because of the underlying cancer. Results. We consecutively recruited ten patients diagnosed with BRONJ in stage I or II. These patients underwent a surgical laser-assisted therapy together with autologous PRP. At the latest follow-up…

Additional file 1: Figure S1. of Mesenchymal stem cells derived from inflamed dental pulpal and gingival tissue: a potential application for bone formation

A) Bar graph represents the MTT absorbance mean values ± SD of P-DPSCs and P-GMSCs vs. their healthy control. The differences were not significant. B) The histograms represent the comparison of DT. Mean values ± SD are based on three independent experiments. n.s = not significant (p value > 0.05). C) Each field shows a cell cycle analysis representative of each sample investigated. (TIF 11728 kb)

Additional file 3: Figure S2. of Mesenchymal stem cells derived from inflamed dental pulpal and gingival tissue: a potential application for bone formation

A, B) Basal gene expression of IL-1β and TNF-α receptors in P-DPSCs, H-DPSCs, P-GMSCs, and H-GMSCs. C, D) Gene expression of IL-1β and TNF-α receptors under cytokine stimulation at 24, 48, and 72 h (cytokine treatment: 20 ng/ml IL-1β + 40 ng/ml TNF-α). *p value 

Oral squamous cell carcinoma mimicking osteonecrosis of the jaw: a case report