The neuropathic origin of a case of unilateral burning mouth syndrome, previously diagnosed as psychogenic, was ascertained by intra-oral mucosa biopsy, which showed a severe sensory fibers damage, probably caused by maxillary anesthetic block and dental surgery.

Minor salivary glands can be found in the ventral and anterior part of the tongue (Blandin-Nuhn glands). Rarely, these glands can develop a mucocele which appears as an exophytic, sometimes pedunculated, lesion: this feature of the mucocele is due to the absence of a capsule, thus glands are right beneath the mucosa and over the muscle tissue. A 12-year-old healthy Caucasian boy was referred to our Department for the evaluation of an exophitic lesion of the anterior and ventral part of the tongue: the lesion appeared light pink in color, elastic, mobile on the underneath planes, no bleeding and no pain; excisional biopsy of the lesion together with the underneath salivary gland revealed a mucocele of Blandin-Nuhn gland. Anatomy, pathology, clinical features and therapy of Blandin-Nuhn gland mucoceles are discussed: Blandin-Nuhn gland mucoceles, due to uncommon clinical appearance, are often difficult to diagnose. Excisional biopsy is mandatory and, at the same time, diagnostic and therapeutic. A careful removal of the underlining salivary gland is necessary to avoid relapses.

Brain abscesses are rare, life-threatening infections: odontogenic origin is rarely advocate as the cause of these infections. Neurological manifestation which depend on the involved site (i.e. epilepsy, hemiparesis, hemiparesthesia, aphasia, depressed consciousness) are accompained by systemic symptoms such malaise and fever; mortality rate is high (almost 50%). The identification of causal organism can be difficult and the odontogenic origin is often an exclusion diagnosis. Therapy should be started as soon as possible in order to prevent the rapid diffusion to the rest of the brain: recovery might happen with mild-moderate residual neurological deficit. We present two new cases of brain abscesses; Case 1: a 9-year-old boy with a frontal abscess presented multiple dental foci; a CT scan demonstrated the diffusion to the brain through maxillary and ethmoidal sinuses. Case 2: a 60-year-old female presented with cerebral brain abscess: she was under steroid therapy for reumatoid artritis; a panorex revealed numerous dental foci. No other foci were found in both patients. Due to their rarity, brain abscesses of odontogenic origin are difficult to diagnose: a thorough oro-maxillofacial investigation should always be performed in order to exclude this origin.

BACKGROUND: Calcium glucarate (CGT) is a promising chemopreventive agent. This study evaluated the in vivo efficacy of CGT in preventing 7,12-dimethylbenz(alpha) anthracene (DMBA)-induced oral carcinogenesis in the hamster. Matherials and Methods: Seventy-six Syrian hamsters were used, divided into four groups: group 1, untreated animals; 2, CGT controls; 3, DMBA-treated; 4, DMBA- and CGT-treated. Hamsters were painted three times weekly with 0.5% solution of DMBA and were fed a diet supplemented with CGT (64 mmol/kg, 2%). Animals were sacrificed at week 9 and 12 and pathology and histomorphometric analyses were performed. RESULTS: At week 9, four dysplastic lesions and six carcinomas were identified in group 3 while only three dysplasias and five carcinomas were detected in group 4. At week 12, five animals of group 3 displayed a dysplasia, which was only detected in one animal of group 4. Squamous carcinomas were identified in all animals of both group 3 and 4. However, in group 3 four of the animals displayed multifocal lesions and carcinomas displayed histological features indicative of increased aggressiveness. CONCLUSION: The results obtained suggest that CGT can exert an inhibitory effect on oral carcinogenesis in tha hamster and that further studies are warranted to evaluate its potential use as a chemopreventive agent in humans.

Aim: Familial Tumoral Calcinosis (FTC) is a rare autosomal recessive disorder characterized by ectopic calcifications in periarticular location. The hip, shoulder and elbow are common locations. The foot, leg, Knee and hand are involved less frequently. FTC can be due to mutations in GALNT3 gene encoding for glycosyltransferase, a protein that helps to regulate phosphate levels, or Fibroblast Growth Factor 23 gene (FGF 23). This is secreted by bone cells and acts at the kidney to regulate phosphate reabsorption and vitamin D3 production. The aim of our work is to describe a case of FTC with dental anomalies and bisphosphonates therapy undergone to orthodontic and surgical treatment. Materials and Metods: A 13 years-old boy with FTC was referred to our observation and he underwent a complete clinical examination and biochemical, radiological, genetic testing : to intraoral examination teeth are smaller than normal with enamel hypoplasia, panoramic radiographs revealed unerupted 1.3, 2.3, 3.3, 4.3 and tooth anomalies ( short bulbous teeth with obliteration of the pulp chamber and root canal), x-ray pelvis showed calcified areas around of both hip joints. Laboratory tests showed hyperphosphatemia, normocalcemia, elevated level of parathyroid hormone and normal level of 1,25 vitamin D3 and DNA sequencing identified a mutation in GALNT 3 gene. After cephalometric analysis of lateral teleradiographs of the skull an orthodontic treatment with rapid maxillary expansion and subsequent alignment was performed. Results: Orthodontic treatment has solved the malocclusion with the correction of skeletal relationship and dental class. Discussion: Considering the characteristics of the disease which has an alteration of bone metabolism, the assumption of biphosphates which reduce dental movement and the presence of teeth with anomolous roots in a short and stocky form, it has been thought convenient to proceed with an orthodontic treatment using light force (.012, .014, .016 N.T. wires) even though the application of the E.R.P. has given excellent results with the opening of the medial palatine suture.Conclusion: Literature doesn't describe cases of patients having FTC orhodontic and orhtopaedic treatment. Our experience shows that timely management of orthodontic forces allows reaching positive results which remain stable in time (2 year follow-up).

Objective: Cri du Chat Syndrome (CCS) is a rare chromosomal disorder resulting from deletion of the short arm of chromosome 5, characterized by distinctive catlike cry since born due to typical larynx (small and narrow) and epiglottis anomalies. We report on still unreported clinic-pathological features CCS: diffuse Gingival Fibromatosis (GF) with Confocal Laser Scanning Microscopic (CLSM) examination.Case Presentation: A 21-year-old female, affected by CCS showed diffuse GF on the palatal gingiva in the molar region (linked to dental dislocation and malocclusion), which was surgically removed by Diode Laser, formalin-fixed, stained with hematoxylin-eosin and picrosirius red and analyzed at CLSM Nikon E-600 with double Laser inducing fluorescence (green and red).Results: Microscopically, the lesion consisted in large parallel collagenous fibers, abundant blood vessels with plump endothelial cells and chronic inflammatory reaction, and large polygonal cells in the vascular interstitial spaces, with large nuclei, resembling undifferentiated totipotent mesenchymal cells (stem-like cells). At CLSM large and variably oriented collagenous fibers displayed intense fluorescence due to cross-linking between such fibers, which generally characterize fibromatosis, and the vascular structures. The latter showed lower fluorescence intensity, and were surrounded by loose collagenous fibers and trapezoidal large mesenchymal cells.Conclusions: GF seems a characteristic feature of CCS, with typical fluorescent pattern at CLSM, in which purported totipotent mesenchymal cells may play a pathogenetic role.

Obiettivo Le malattie Rare sono condizioni morbose poco conosciute, gravi e invalidanti prive di terapia specifica che colpiscono un numero limitato di individui. Sono definite tali sulla base di una bassa prevalenza nella popolazione che per l’Italia è compresa da 1:20.000 a 1: 200.000. Il loro numero è stimato dall’O.M.S. intorno a 5.000. Queste patologie, in genere geneticamente determinate, possono presentare manifestazioni nel distretto oro-facciale quali anomalie dentarie, scheletriche, lesioni mucose che in alcuni casi possono costituire il primo segno di manifestazione della malattia.Lo scopo del lavoro è fornire i dati relativi all’attività degli ultimi 5 anni del C.I.R. (Bollettino Ufficiale della Regione Puglia n.36 del 05/03/2008) svolta dal reparto di pedodonzia che si occupa dello studio delle malattie rare al fine di stabilire dei criteri di diagnosi e dei protocolli di trattamento e di riabilitazione. MATERIALI E METODI Nel periodo compreso dal 2005 al 2010 sono stati trattati 400 pazienti affetti da malattie rare per prestazioni ambulatoriali e trattamenti in sedazione conscia e narcosi. RISUTATI I pazienti sono stati curati avvalendosi di tecnologie innovative e di nuove metodiche ortodontiche. CONCLUSIONI I percorsi diagnostici – terapeutici delle malattie rare richiedono un’assistenza ultraspecialistica e pluridisciplinare e presentano difficoltà per l’esiguo numero di pazienti arruolabili nei trial clinici, per la scarsa disponibilità di conoscenze scientifiche e di opzione terapeutiche valide. L’attività del C.I.R. (Centro Interregionale di Riferimento) è quella di inquadrare opportunamente tali patologie e di stabilire l’iter diagnostico e terapeutico individuale in relazione alla differente espressività fenotipica della malattia.

Abstract AIM: The aim of this study was to assess the correlation between osteogenesis imperfecta (OI) and dentinogenesis imperfecta (DI) from both a clinical and histological point of view, particularly clarifying the structural and ultrastructural dentine changes. DESIGN: Sixteen children (6-12 years aged) with diagnosis of OI were examined for dental alterations referable to DI. For each patient, the OI type (I, III, or IV) was recorded. Extracted or normally exfoliated primary teeth were subjected to a histological examination (to both optical microscopy and confocal laser-scanning microscopy). RESULTS: A total of ten patients had abnormal discolourations referable to DI: four patients were affected by OI type I, three patients by OI type III, and three patients by OI type IV. The discolourations, yellow/brown or opalescent grey, could not be related to the different types of OI. Histological exam of primary teeth showed severe pathological change in the dentin, structured into four different layers. A collagen defect due to odontoblast dysfunction was theorized to be on the base of the histological changes. CONCLUSIONS: There is no correlation between the type of OI and the type of discolouration. The underlying dentinal defect seems to be related to an odontoblast dysfunction.

Hereditary haemorrhagic telangiectasia (HHT) is rare, and characterised by vascular dysplasia that leads to various symptoms including visceral arteriovenous malformations and mucocutaneous telangiectatic lesions. Our aim was to describe the clinical features and options for the treatment of multiple oral lesions, and to illustrate the efficacy of the diode laser in the treatment of early (<2mm) and advanced lesions (2mm or more). We report 24 patients with 1200 oral telangiectatic lesions, which were often associated with regular bleeding (from monthly to daily), superinfection, pain, and swelling, and treated with multiple sessions of laser according to the number and size of the lesions. Early lesions were treated with a single laser impulse in ultrapulsed mode, and advanced lesions with repeated laser impulses in pulsed mode (t-on 200ms/t-off 500ms), at a power of 8W. Early lesions healed completely after laser photocoagulation with no operative or postoperative complications, while advanced lesions improved with a remarkable reduction in size but more discomfort. Protective occlusal plates were sometimes used to reduce the incidence of new lesions caused by dental trauma. The treatment of oral telangiectatic lesions is still being debated, and it is important to improve quality of life for patients. Diode laser surgery could be an effective treatment for oral lesions in those with hereditary haemorrhagic telangiectasia.

Epidermal nevus syndrome (ENS) is a rare disease characterized by the association of epidermal nevi with abnormalities in other organs and districts affecting prevalently pediatric patients1. The first descriptions of an association of epidermal nevi, neurologic disorders and mental retardation were made by Schimmelpenning in 19572 and extensively reviewed in 1975 by Solomon and Esterly. Central nervous system (cortical atrophy, mental retardation, cerebrovascular malformations and neoplasias), skeletal system (bone cysts, scoliosis syndactyly, polydactyly, chinodacctyly) and eyes (choristomas, bilateral cataracts, colobomas) are most commonly involved while endocrine (hypophosphatemic rickets and precocious puberty), cardio-vascular (aneurysms and malformations), urogenital (testicular adenomas, double ureters), oral and skin lesion other than epidermal nevi were also reported1. It has been determined that there is not just one category of ENS, distinguished from each other by their clinical features and genetic pattern. In 1995, Happle defined six types of ENS but, for the polymorphism showed by the syndrome, different association of anomalies may be present. Sebaceous nevus syndrome, nevus comedonicus syndrome, Becker nevus syndrome, Proteus syndrome, CHILD syndrome are only some examples of the clinical features showed by ENS3. We reported a case of a patients affected by epidermal nevus syndrome with the concomitant presence of oral papillomatosis and cutaneous anomalies including nevi, basal cell carcinoma and siryngocystadenoma without systemic involvement. A concise analysis of the principal epithelial, oral and other lesions associated with ENS and a discussion of the possible relationship between our findings and ENS was performed.

The objective was to compare toluidine blue (TB) and autofluorescence (AF) for the detection of oral dysplasia and squamous cell carcinoma (OSCC) in clinically suspicious lesions according to conventional examination. Fifty-six clinically suspicious lesions were subjected to AF and TB examination. Data were compared using two different scenarios: in the first, mild dysplasia was considered as positive, while in the second, it was considered as negative. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), accuracy, and concordance were calculated. AF sensitivity and specificity were 70.0 and 57.7%, respectively, while TB showed a sensitivity of 80% and a specificity of 61.5%. The sensitivity increased in the second scenario in both AF (76.5%) and TB (88.2%). The specificity decreased in AF and TB, showing the same value (51.3%). PPV was higher in TB than in AF (70.6 versus 65.6%) and similarly for NPV (72.7 versus 62.5%). In the second scenario, TB PPV was 44.1% and NPV was 90.9%; AF PPV was 40.6% and NPV was 83.3%. TB showed greater accuracy than AF in the first scenario (62.5 versus 58.9%). AF and TB are both sensitive but not specific in OSCC and dysplasia diagnosis.

Objectives. Mucous Membrane Pemphigoid (MMP) is the clinical phenotype of a group of rare autoimmune blistering diseases characterized by autoantibodies directed against different structural proteins in epithelial basement membranes. Diagnoses of MMP is routinely verified by direct immunofluorescence (DIF) of oral mucosa biopsy tissue. ELISA detection of autoantibodies in serum is now employed for the diagnosis of pemphigoid and for monitoring the disease activity. The aim of this study was to evaluate ELISA sensitivity, specificity, PPV, NPV in oral MMP patients. Methods. Patients with oral lesions compatible with MMP, were enrolled. Two different specimens were obtained during the surgical biopsy: one for the histopathological assessment and the other for the DIF. ELISA plates, precoated with recombinant ectodomains of the epitope NC16a of the BP180 antigen and carboxy-terminal domains of BP230 antigen were used. All ELISAs were performed according to the manufacturer’s instructions. Values greater than 8,7 U/ml were considered positive. Histopathological and DIF results were considered as the gold standard. Global validation of the test results was established by calculating the sensitivity, specificity and both the positive and negative predictive values. Results. Sixty-four patients were enrolled (M:F=1:4). Ages ranged from 40 to 82 years (mean 61 years). There were 30 patients with MMP, 16 patients with OLP, 14 affected by PV, 3 lichenoid dysplasia and 1 erythema multiforme. ELISA sensitivity and specificity was respectively 47 and 79%. PPV percentage was 67% while NPV was 63%. Conclusions. In suspected oral MPP, both ELISA tests and histopathological + DIF have to be performed because of ELISA low sensitivity. Although BP180 and BP230 are the major target antigens in patients with MMP limited to the oral cavity, they are not the only. This aspect may explain the low sensitivity rate of ELISA in oral MMP when used as the sole diagnostic support.

Introduction: We report on the clinic-pathological features of Familial Tumoral Calcinosis (FTC), a rare disease of early childhood and adulthood, caused by mutations in fibroblast growth factor 23 and GalNAc transferase 3. It is a bone metabolism disorder with abnormal phosphate and calcium (calcinosis) deposits around the joints, in visceral and soft tissues. Case Presentation: A 17 year-old girl complaining for long-standing night leg pain, resistant to FANS therapy, had been diagnosed with osteogenesis imperfecta and was therefore undergoing bisphosphonates therapy. She was referred to our Dental Clinic for diffuse dental anomalies (short and irregular roots, dental chambers anomalies, teeth inclusions) and maxillary hypoplasia and underwent combined surgical and orthodontic treatment. The surgical samples were used for conventional and Confocal Laser Scanning Microscopic (Nikon E-600) (CLSM) examination. Results and conclusions: Microscopically several metaplastic micro and macro-calcificationin soft and periodontal tissue location were detected, along with a typical islands of homogenous, non tubular, dentino-osteoid calcified structures in dentinal tissues. Also, dentinal dysplasia with osteoid-like material, without incremental lines but with strong basophilia, intermingled with remnants of mature mucous connective tissue, was demonstrated. The diagnosis of FTC was confirmed by genetic analysis. CLSM helps to demonstrate distinct odontoblast and osteoblast anomalies in FTC that lead to the accumulation of atypical calcified tissues, responsible for the several clinical signs detected in the patient and formerly attributed to osteogenesis imperfecta.

Objective: We report on the clinic-pathological features of Familial Tumoral Calcinosis (FTC), a rare disease of early childhood and adulthood, caused by mutations in fibroblast growth factor 23 and GalNAc transferase 3. It is a bone metabolism disorder with abnormal phosphate and calcium (calcinosis) deposits around the joints, in visceral and soft tissues. Case Presentation: A 17 year-old girl complaining for long-standing night leg pain, resistant to FANS therapy, had been diagnosed with osteogenesis imperfecta and was therefore undergoing bisphosphonates therapy. She was referred to our Dental Clinic for diffuse dental anomalies, maxillary hypoplasia and tooth roots inclusions and underwent combined surgical and orthodontic treatment. The surgical samples were used for conventional and Confocal Laser Scanning Microscopic (Nikon E-600) (CLSM) examination. Results: Microscopically several metaplastic micro and macro-calcificationin soft and periodontal tissue location were detected, along with a typical islands of homogenous, non tubular, dentino-osteoid calcified structures in dentinal tissues. Also, dentinal dysplasia with osteoid-like material, without incremental lines but with strong basophilia, intermingled with remnants of mature mucous connective tissue, was demonstrated. The diagnosis of FTC was confirmed by genetic analysis. Conclusions: CLSM helps to demonstrate distinct odontoblast and osteoblast anomalies in FTC that lead to the accumulation of atypical calcified tissues, responsible for the several clinical signs detected in the patient and formerly attributed to osteogenesis imperfecta.

Introduzione Il fibroma ossificante periferico (P.O.F.) è una lesione gengivale a partenza dalla papilla interdentale con un’incidenza pari al 9,6% delle lesioni gengivali. Può essere peduncolato o sessile, di colore rosso o roseo, talvolta ulcerato. Interessa più frequentemente la 2a decade di vita tra i 25 e i 35 anni e particolarmente il sesso femminile con un rapporto 2:1 ; il 50% delle lesioni si evidenziano in corrispondenza delle papille interdentali degli incisivi nella regione anteriore del mascellare superiore . L’eziologia e la patogenesi del P.O.F. rimane sconosciuta. Alcuni autori ritengono che si tratti di un processo neoplastico, altri di un processo reattivo favorito da fattori locali irritanti (accumulo di placca, tartaro, restauri incongrui) o da un trauma locale, e che la lesione abbia origine dalle cellule del legamento parodontale causando spesso un progressivo riassorbimento dell’osso con migrazione dei denti vicini. Case report Si presenta il caso di un pz. maschio di aa 18 in terapia ortodontica fissa con ampia lesione sessile al colletto palatale dell’incisivo laterale superiore di sx e profonda tasca parodontale. L’escissione chirurgica della lesione è stata effettuata con trattamento laser a diodi e l’esame istologico ha diagnosticato un P.O.F. Discussione e conclusioni A distanza di 24 mesi non son comparse recidive e il parodonto ha presentato una ottima restitutio ad integrum.

To compare the performance, by scanning electron microscopic analysis, of the interface between tooth and four commercial restorative composite resins in Class I cavities following exposure to acidified artificial solution, pH 4.5, with a background electrolyte composition similar to saliva, 600 teeth were divided into 4 groups. The first group was treated with microfilled light-cured Heliomolar; the second group with Durafill; the third group with the microfilled self-cured Isomolar; and the fourth group was treated using the hybrid self-cured Miradapt. All teeth of each group were randomly divided into two sub-groups: A) a control group that was immersed in artificial saliva (pH 7); B) a study group that was immersed in artificial saliva acidified with phosphoric acid (pH 4.5) in order to obtain artificial caries. The samples were examined by scanning electron microscopy. Data were analyzed using Pearson’s Chi-squared test (χ2) with R statistical software. The statistical analyses demonstrated significant differences in the two sub-groups A and B when considered for the light-cured composites whereas no difference was monitored for self-cured composites. Statistical analysis (p minore di 0.001) also demonstrated that the type of composite strongly influenced the infiltration grade. Our results demonstrate that incremental layering techniques might improve the marginal adaptation for light-cured composites, while self-cured show a marked polymerization contraction which can cause marginal breakdown.

Objectives To examine the vascular anomalies most frequently found in dental practice. Vascular anomalies are diseases characterized by functional and/or morpho-structural alterations of various nature, severity and extension which can affect every type of vessel (arterial, venous or lymphatic) of any caliber or anatomical region. Generally they are congenital and benign though they may cause complications such as ulceration, bleeding, superinfection, functional, and/or aesthetic deficit. Materials and methods Currently, the reference classification is the one adopted by the International Society for the Study of Vascular Anomalies (ISSVA), which distinguishes vascular or vasoproliferative neoplasms, including hemangiomas, from vascular malformations, these latter being further subdivided into low-flow and high bloodstream malformations. The diagnosis of vascular anomalies can not be separated by pathological history and clinical examination of the patient, even if for a certain diagnosis it is necessary to perform instrumental examinations including the echo color doppler ultrasound, a rapid examination, which is repeatable and devoid of ionizing radiation. The treatment involves different techniques, depending on the type of vascular lesion diagnosed; in particular, laser therapy is the most suitable for low-flow anomalies. This technique presents three different approaches: the excisional biopsy being indicated for suspicious lesions which need a histological examination; the transmucousal thermophotocoagulation (TMT) which involves the use of laser in “no contact” mode; and the intralesional photocoagulation (ILP) which uses the laser fiber inside the lesion and is suitable for deepest vascular anomalies. Results and conclusions . According to recent literature and clinical experience, we can say that vascular anomalies are a heterogeneous group of diseases for which treatment is necessary to perform a correct diagnostic clinical-instrumental approach; laser devices, with a wavelength similar to the oxidized hemoglobin, are the gold standard for the treatment of low flow blood abnormalities, both for ease of use and the excellent haemostatic effects.

Dental implants placement in the anterior mandible with flap or flapless technique is a routine procedure and is considered to be safe. However, serious life-threatening complications may occur. We report the first case of massive lingual and sublingual haematoma following postextractive implant placement in the anterior mandible with flapless technique. A 45-year-old female patient underwent placement of four immediately postextractive implants in the anterior mandible using flapless technique. During the procedure, the patient referred intense acute pain and worsening sign of airway obstruction, dysphagia, dyspnea, and speech difficulties. Bimanual compression of the mouth floor, lingual surface of the mandible, and submental skin was maintained for approximately 25 minutes in order to stop the bleeding. Computerized tomography highlighted the massive lingual and sublingual haematoma. The symptoms and signs had almost completely resolved in the next 48 hours. The prevention of these complications is mandatory with clinical and CT analyses, in order to highlight mandibular atrophy and to select carefully the correct length and angulation of bone drilling and to keep more attention to the flapless technique considering the elevation of a lingual mucoperiosteal flap to access the mandibular contour intraoperatively and to protect the sublingual soft tissues and vasculature in high risk cases.

BACKGROUND: Many authors have considered dental implants to be unrelated to increased risk of medication-related osteonecrosis of the jaw (MRONJ). Nevertheless, more recently, more cases of peri-implant MRONJ (PI-MRONJ) have been described, thus becoming a challenging health problem. Also, metastatic cancer deposits are not infrequently found at peri-implant sites and this may represent an additional complication for such treatments. We present the case of a breast cancer patient with PI-MRONJ, presenting a clinically and radiologically undetected metastasis within the necrotic bone, and highlight the necessity of an accurate histopathological analysis. CASE REPORT: A 66-year-old female patient, who had received intravenous bisphosphonates for bone breast cancer metastases, came to our attention for a non-implant surgery-triggered PI-MRONJ. After surgical resection of the necrotic bone, conventional and immunohistochemical examinations were performed, which showed breast cancer deposits within the necrotic bone. CONCLUSIONS: Cancer patients with metastatic disease, who are undergoing bisphosphonate treatment, may develop unusual complications, including MRONJ, which is a site at risk for hosting additional metastatic deposits that may be clinically and radiologically overlooked. Such risk is increased by previous or concomitant implant procedures. Consequently, clinicians should be prudent when performing implant surgery in cancer patients with advanced-stage disease and consider the possible occurrence of peri-implant metastases while planning adequate treatments in such patients.

Melanomas of the oral cavity are extremely rare. Their rarity and their independence on exposure to UV radiation make them particularly interesting. The authors analyzed an oral multiphasic melanoma composed by a nodular nonpigmented ulcerated central region, a nodular ulcerated pigmented area, a pigmented nonulcerated region, and an area similar to a dysplastic nevus. They determined the expression of some genes involved in the differentiation and cellular transformation in morphologically different regions of melanoma. All these areas were also analyzed by electron microscopy. The various regions composing the melanoma expressed genes involved in melanogenesis and melanoma progression in a different manner. Electron microscopy observation of ultrathin sections of each region evidenced ultrastructural differences, being the cellular architecture more compromised in the most aggressive parts of the neoplasm. This pilot study identified morphological, molecular, and ultrastructural differences that characterize each region of the multiphasic melanoma.

OBJECTIVE: To present a retrospective analysis of multicentre case series of oral syphilis and a review of relevant literature. SUBJECTS AND METHODS: A PUBMED search was carried out from 1950 to 2011. Clinical records of patients with exclusive/prevalent oral manifestations of syphilis were collected and examined in three independent hospitals. RESULTS: Of 23 reports describing 34 patients were detected through the review (35% primary, 56% secondary, and 9% tertiary disease), describing unspecific ulcers (59%), mucosal patches (23%), keratosis (6%), pseudomembranes (3%), and gumma (9%). Multicentre case series revealed 12 patients with oral syphilis, of which 17%, 58%, and 25% with, respectively, primary, secondary, and tertiary lesions. Clinically, patients showed white patches (17%), blistering mucositis (8%), chronic unspecific ulcers with/without skin lesions (50%), gumma (17%), and necrosis of the dorsum of the tongue (8%). Oral bullae and tongue necrosis are never described in the current review. CONCLUSIONS: Diagnosis of syphilis remains a challenge because of the multiform and polymorphous clinical pattern at onset and its ability to imitate different diseases. It is mandatory to include syphilis in the differential diagnosis of unusual oral lesions. Diagnosis of oral lesions of syphilis is often difficult, and biopsy is required in controversial cases.

Hereditary Haemorrhagic Telangiectasia (HHT) is a muco-cutaneous inherited disease. Symptoms are epistaxis, visceral arterio-venous malformations, multiple muco-cutaneous telangiectasia with the risk of number increasing enlargement, bleeding, and super-infection. The aim of this work is to show the dual Diode Laser efficacy in preventive treatment of Early Lesions (EL < 2mm) and therapeutic treatment of Advanced Lesions (AL > 2mm). 21 patients affected by HHT with 822 muco-cutaneous telangiectatic nodules have been treated in several sessions with local anaesthesia and cooling of treated sites. EL preventive treatment consists of single Laser impulse (fibre 320) in ultrapulsed mode (2 mm single point spot). AL therapeutic treatment consists of repeated Laser impulses in pulsed mode (on 200ms / off 400ms). According to the results, Diode Laser used in pulsed and ultra-pulsed mode is very effective as noninvasive treatment both in early and advanced oral and perioral telangiectasia. © 2014 Copyright SPIE

Lymphatic Malformation (LM) according to ISSVA Classification, is a rare benign disorder with unknown aetiology. LM may grow slowly over years or develop rapidly over the course of days becoming a bulky lump, infected or bleeding. We propose our three steps Diode Laser protocol for LM management, based on its persistent vascular blood component. 1. Histological and cytological examination, to evaluate the vascular blood component (10-40%), shows mature lymphocytes with red blood cells and endothelial cells. 2. Diode Laser Photocoagulation (DLP) in pulsed mode (on 100ms / off 400ms) at 10W and 800nm with a 300μm fibre kept 2-3mm from the tissues, to reduce the lesion. 3. Diode Laser surgical excision in pulsed mode (on 50ms / off 200ms) at 8W and 800nm with a 300 μm fibre in close contact with tissues, and histological intraoperative margins control on frozen sections. Even if it has inconstant results (lesions decreasing rate is 10% to 40% proportionally to vascular blood component), DLP simplifies the last and the most important step. Use of Diode Laser also in surgical excision reduces intra and postoperatory complications.

Introduction and objectives. Lymphangioma, or Lymphatic Malformation (LM) according to ISSVA Classification, is a rare benign disorder with unknown etiology. LM may grow slowly over years or develop rapidly over the course of days becoming a bulky lump, infected or bleeding. Surgical excision is the gold standard treatment for adult LM with 10-15% recurrence rate and 15-30%complication rate. Other treatment modalities have also been proposed: simple aspiration with high risk for recurrence; sclerotherapy (alcohol, steroids, bleomycin or interferon) without results but only complications like fever, pain or lesion enlargement. The aim of this study is to show our three steps Laser protocol for LM management, based on its persistent vascular blood component. Methods. We select 11 patients aged between 12 and 60 years with clinical diagnosis of LM of tongue, lower lip and cheek divided in circumscriptum (&lt;3x3cm) and major lesions (&gt;3x3cm). LM are fluctuant and mobile suggesting a differential diagnosis from hemangioma, metastatic lesions and lymphoma. LM laser protocol includes three steps: 1. Histological and cytological examination, to evaluate the vascular blood component (10-40%), shows mature lymphocytes with red blood cells and endothelial cells. 2. Diode Laser Photocoagulation (DLP) in pulsed mode (on 190-250ms / off 250-450ms) at 14-20W and 800nm, to reduce the lesion. 3. Diode Laser surgical excision with histological intraoperative margins control on frozen sections. Results and conclusions. Histological analysis, highlighting the vascular blood component in all LM, validates photocoagulation and surgical combined approach with Diode Laser. Even if it has inconstant results (lesions decreasing rate is 10% to 40% proportionally to vascular blood component), DLP simplifies the last and the most important step. Use of Diode Laser also in surgical excision resets bleeding, infection and lymphorrhea to zero, accelerates healing time and improves aesthetic results.

BACKGROUND: Bisphosphonates (BPs) are currently the chief drugs for the prevention/treatment of osteoporosis; one of their adverse effects is the osteonecrosis of the jaw (BRONJ). The primary endpoints of this multi-center cross-sectional study are: i) an observation of the clinical features of BRONJ in 87 osteoporotic, non-cancer patients; and ii) an evaluation of their demographic variables and comorbidities. METHODS: 87 BRONJ patients in therapy for osteoporosis with BPs from 8 participating clinical Italian centers were consecutively identified and studied. After BRONJ diagnosis and staging, comorbidities and data relating to local and drug-related risk factors for BRONJ were collected. RESULTS: 77/87 (88.5%) patients in our sample used alendronate as a BP type; the duration of bisphosphonate therapy ranged from 2 to 200 months, and 51.7% of patients were in treatment for ≤ 38 months (median value). No comorbidities or local risk factors were observed in 17 (19.5%) patients, indicating the absence of cases belonging to BRONJ forms triggered by surgery. BRONJ localization was significantly associated with age: an increased risk of mandible localization (p=0.002; OR=6.36, 95%CI=[1.89; 21.54]) was observed for those over 72 yrs. At multivariate analysis, the increased risk of BRONJ in the mandible for people over 72 yrs (OR'=6.87, 95%CI=[2.13; 2.21]) was confirmed for a BP administration >56 months (OR'=4.82, 95%CI=[2.13; 22.21]). CONCLUSION: Our study confirms the fundamental necessity of applying protocols of prevention in order to reduce the incidence of BRONJ in osteoporotic, non-cancer patients in the presence of comorbidities and/or local risk factor as well as, less frequently, in their absence.

INTRODUCTION: The acronym PHACES describes the association of posterior fossa malformations, facial hemangiomas, arterial anomalies (cardiovascular or cerebrovascular), coarctation of the aorta and cardiac defects, eye abnormalities, and sternal or ventral defects. In this study we report on 6 patients affected by the PHACES syndrome and showing 34 intraoral hemangiomas (IH), treated by diode laser photocoagulation (DLP). CASE PRESENTATION: IH appeared as red-bluish soft masses, smooth or lobulated, from a few millimetre to several centimetres in size, covered by intact mucosa and blanching on pressure. IHs were treated by DLP with 320μm fibres at a wavelength of 800±10nm. The diode laser techniques applied were: Transmucosal DLP (DLTP), a no-contact technique in which laser energy is delivered by a flexible optic quartz fiber, which is kept 2-3mm apart from the lesion, and Intralesional DLP (DLIP), in which the fibre is introduced into the lesion through a transmucosal access. DLTP was used for 20 flat, superficial IHs and, after a variable number of laser sessions (average=3) depending on the size of the lesion, 65% completely regressed, while in the remaining 35% shrinkage of the lesion was achieved with minor and few complications. The remaining 14 deep/multi-lobulated IHs were treated by DLIP, resulting in complete regression of 79% of them. CONCLUSIONS: DLP techniques are an effective and minimally invasive procedure for IH in patients with PHACES, in consideration of the multiple lesions to treat, of the necessity of multiple interventions and the higher compliance of the patients.

INTRODUCTION: PHACES is an acronym which refers to a syndrome charachterized by Posterior cranial fossa malformation, Hemangiomas of the head, Arterial abnormalities, Cardiac abnormalities, Eye abnormalities, Sternal clefting. The syndrome shows a female to male predilection of 9:1. There is no definitive evidence of a familial tendency although an X chromosome linked dominant single gene etiology has been suggested with lethality in males. The diagnosis of PHACES syndrome requires the presence of a segmental hemangioma &gt;5 cm in diameter of the head plus 1 major criterion or 2 minor criteria. There are many treatment options, one of the mainstay therapies is laser photocoagulation. The aim of this work is to show the differential diode laser treatment of intraoral hemangiomas (IH) and perioral hemangiomas (PH) in patients with PHACES syndrome. METHODS: We report the cases of 4 patients (age median 21 years) affected by the syndrome, showing 26 IH and 15 PH. Diagnostic protocol consist on: appropriate clinical exam (highlighting prominent reddish purple plaque-like lesions on lips, tongue, cheek, palate, mouth floor), echocardiogram, ophtalmologic and endocrinologic exams, MRI of the head and MRA of head and neck. Patients were treated with multiple laser sessions. A different approach depending on the site of the lesions was used: repeated diode laser impulses in pulsed mode at the power of 14-20W and the wavelength of 800 nm for IH and lower power for PH, preceded by treated site cooling to avoid the tissue damage. RESULTS and CONCLUSIONS: IH totally healed after 1 or 2 sessions. In each session only a limited area of the PH was treated, obtaining a progressive improvement of the lesions. Both in IH and PH slight post-operatory pain, bleeding and edema was proved, with a low incidence of complications such as ulceration and super-infection. Diode laser has been proved to be very effective as non-invasive treatment for IH and PH in PHACES syndrome patients.

OBJECTIVES: Hashimoto's thyroiditis as well as lichen planus has been associated to a number of disorders, generally of auto-immune origin. A novel possible association between oral lichen planus (OLP) and Hashimoto's thyroiditis (HT) is here proposed on the basis of a cross-sectional survey. MATERIALS AND METHODS: One hundred and five unrelated OLP patients were considered. Diagnosis of HT was based on positive serum anti-TPO, anti-Tg, TSH levels and the typical ultrasound pattern of the thyroid gland. RESULTS: In the present survey, the prevalence of HT in the OLP group was 14.3 % whereas the prevalence of HT-related hypothyroidism in the general population was reported to be equal to 1 %. By Fisher's exact test, it was revealed that the difference between our data and historical prevalence of HT was found statistically significant. CONCLUSION: Actually, there is no definitive hypothesis that could explain the coexistence of OLP and HT. However, considering the onset timing of HT followed by OLP in 93.3 % of our series, we suspected a causal or predisposing role for HT. Specifically, we believe that in HT patients, circulating thyroid antibodies could contribute to trigger an organ-specific auto-immune response also in the oral mucosa or skin, leading to the development of LP lesions. CLINICAL RELEVANCE: Because of the large number of cases of asymptomatic chronic auto-immune thyroiditis, it would be useful that women over 40 years of age affected by OLP were screened for thyroid dysfunction, particularly HT.

This study was designed to evaluate whether a sterile gel formulation of sodium hyaluronate and amino acids Gly-Pro-Leu-Lys (AMINOGAM®) is effective in accelerating post-surgical and pre-implantar bone defects regeneration in pediatric patients. We evaluated different healing in 28 bone defects, divided in 2 groups: test group treated with intracavitary intraoperative filling of gel and control group without gel. Outcomes were evaluated by clinical and radiographic follow-up through grey scale densitometry. Defects treatment after bone healing in both groups was completed with histological pre-implantar examination through trephine drill and insertion of implants. Clinical and radiographic evaluations of the implants were performed at 12 months after functional loading. Soft tissues outcomes in test group show immediate haemostatic effect, pain and swelling decrease and infective complication dejection (0%) compared to control group (6%). Gel reduces removing stitches time at 6 days in test group compared to 14 days in control group. Hard tissues outcomes show faster healing time: 30% difference between ossification level in test and control group at 2 months. The difference decrease in following months until 3% at 12 months. Pre-implantar bone specimen get with 2,5mm trephine drill shows a more dense and mature lamellar bone with twisted fiber and different calcification level allowing early implant insertion at 30-45 days in test group compared to 60 days in control group.

Objective: This study was designed to evaluate whether a sterile gel formulation of sodium hyaluronate and amino acids Gly-Pro-Leu-Lys (AMINOGAM®) is effective in accelerating post-surgical bone defects regeneration, implant rehabilitation and complication management. Materials and Methods: We selected 56 patients aged between 16 and 64 years and we evaluated different healing in 80 bone defects divided in 2 groups: - Test group: 40 defects treated with intracavitary intraoperative filling of gel and application 4 times/die upon the stitches till the complete mucosal healing (sandwich technique). - Control group: 40 untreated defects. Each group was divided in two subgroups: minor (&lt;1cm2) and major defects (&gt;1cm2). Outcomes were evaluated by clinical and radiographic follow-up with OPT rx and CT scan through densitometric analysis. Defects treatment after bone healing in both groups was completed with histological pre-implantar examination and insertion of 52 implants in test group and 49 implants in control group. Clinical and radiographic examinations of implants were performed at 12 months after functional loading. Gel preparation enhances angiogenesis, fibroblast and osteoblast proliferation, collagen biosynthesis, production of growth factors as evidenced by MTT test and alkaline phosphatase histochemical staining. In vivo and in vitro studies suggested that hyaluronic acid plays important roles in bone wound healing by enhancement of osteoblast differentiation through the down-regulation of BMP-2 antagonists. Lysine and proline are important metabolic factors regulating collagen matrix synthesis during osteogenesis. Results: Soft tissues outcomes in test group show similar results in both subgroups with immediate haemostatic effect, pain and swelling decrease and infective complication dejection (0%) compared to control group (6%). Gel preparation reduces the removing stitches and wound complete healing time at 6 days in minors defects and 14 days in major ones of test group compared to 14 and 23 days of control group. Hard tissues outcomes show faster healing time: 20% difference between ossification level in test and control group at 2 months. The difference decrease in following months until 3% at 12 months. Pre-implantar bone specimen get with 2,5mm trephine drill shows a more dense and mature lamellar bone with twisted fiber and different calcification level also evaluated through densitometic analysis, allowing implant insertion at 30-45 days in minor defects and at 60 days in major ones of test group compared to 60 and 90 days of control group. Osseointegration rate in regenerated defects is 100%. Conclusions: Sterile gel based on sodium hyaluronate and amino acids is a new cheap and useful medical device able in resetting post-surgical morbidity to zero. It allows a quickly bone defects healing time with an earlier implant insertion and a faster osseointegration thanks to more quality bone evaluated by histological analysis and grey scale densitometry. Therefore the whole rehabilitation treatment is considerably shortened and free from complication.

INTRODUCTION: Pyogenic granuloma (PG) is a relatively common benign mucocutaneous lesion. The term is a misnomer as the lesion does not contain pus nor it is granulomatous. Etiology of the lesions is unknown, but predisposing factors that have been reported include pregnancy, trauma, vascular malformation and chronic inflammation. PG are usually solitary lesions. The most common intraoral site is marginal gingiva, but lesions have been reported on palate, buccal mucosa, tongue, and lips. Extraoral sites commonly involve the skin of face, neck, upper and lower extremities, and mucous membrane of nose and eyelids. In this report, we seek to highlight the therapeutic advantages achieved with diode laser in intraoral PG treatment compared with surgical excision. MATERIAL AND METHODS: We report the cases of 85 patients presenting intraoral dull red, sessile, or pedunculated smooth surfaced nodule that may easily bleed, crust, or ulcerate. 62 were treated with surgical excision and 23 with diode laser treatment. The laser session consisted in diode laser photocoagulation ensued by diode laser excision of the lesion, preceded by treated areas cooling to avoid the tissue demage. According to the literature were used the following specification: wavelength 808nm, 10W power. Histological evaluation showed hyperplastic stratified squamous epithelium with stroma consisted of a large number of budding and dilateted capillaries and a dens chronic inflammatory cell infiltrate. Diagnosis of PG was confirmed. RESULTS AND CONCLUSION: Rapid healing can be observed within a few days of treatment, and as blood vessels are sealed, there is an improvement of haemostasis and coagulation compared with surgical excision. Post-operative pain discomfort, edema and bleeding are notably reduced. In conclusion, the use of diode laser offers a new tool that can change the way in which existing treatments are performed.

Mucormycosis is an uncommon but severe fungal infection, typically observed in immunocompromized patients. We report a case of acute lymphoblastic leukemia complicated by rhino-oculo-cerebral mucormycosis in a pediatric patient. Combination lipid polyeneechinocandin therapy, along with surgical debridement appeared to be effective. Nevertheless, a severe relapse occurred during posaconazole prophylaxis; antifungal therapy, hemimaxillectomy and suspension of chemotherapy were performed. Although mucormycosis is a frequently lethal infection, prompt diagnosis and aggressive treatment can be successful even in cases of relapse.

PURPOSE: The aim of this study was to evaluate the results of the surgical treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in a large cohort. MATERIALS AND METHODS: A retrospective cohort multicenter study was designed. Patients were enrolled if they were diagnosed with BRONJ and received operative treatment. Data on demographic, health status, perioperative, and surgical factors were collected retrospectively. The primary outcome variable was a change in BRONJ staging (improvement, worsening, or no change). Interventions were grouped by local debridement and resective surgery. Data were collected for other variables as cofactors. Univariate analysis and logistic regressions were then performed. RESULTS: Of the 347 BRONJ-affected subjects, 59% showed improvement, 30% showed no change, and 11% showed worsening. Improvement was observed in 49% of cases treated with local debridement and 68% of cases treated with resective surgery. Multivariate analysis indicated that maxillary location, resective surgery, and no additional corticosteroid treatment were associated with a positive outcome. CONCLUSIONS: Surgical treatment of BRONJ appeared to be more effective when resective procedures were performed. Nonetheless, other factors, such as the absence of symptoms and the types of drug administration, should be taken into account before clinical decisions are made.

Management of osteonecrosis of the jaw associated with antiresorptive agents is challenging, and outcomes are unpredictable. The severity of disease is the main guide to management, and can help to predict prognosis. Most available staging systems for osteonecrosis, including the widely-used American Association of Oral and Maxillofacial Surgeons (AAOMS) system, classify severity on the basis of clinical and radiographic findings. However, clinical inspection and radiography are limited in their ability to identify the extent of necrotic bone disease compared with computed tomography (CT). We have organised a large multicentre retrospective study (known as MISSION) to investigate the agreement between the AAOMS staging system and the extent of osteonecrosis of the jaw (focal compared with diffuse involvement of bone) as detected on CT. We studied 799 patients with detailed clinical phenotyping who had CT images taken. Features of diffuse bone disease were identified on CT within all AAOMS stages (20%, 8%, 48%, and 24% of patients in stages 0, 1, 2, and 3, respectively). Of the patients classified as stage 0, 110/192 (57%) had diffuse disease on CT, and about 1 in 3 with CT evidence of diffuse bone disease was misclassified by the AAOMS system as having stages 0 and 1 osteonecrosis. In addition, more than a third of patients with AAOMS stage 2 (142/405, 35%) had focal bone disease on CT. We conclude that the AAOMS staging system does not correctly identify the extent of bony disease in patients with osteonecrosis of the jaw.

Objectives: The aim of this study was to carry out clinical and radiographic outcomes of bone healing using a new medical device, a sterile gel formulation of sodium hyaluronate and amino acids Gly-Leu-Pro-Lys (AMINOGAM®) in treatment of third stage bisphosphonates-related osteonecrosis of the jaws (BRONJ). Materials and methods: We selected 32 third stage BRONJ patients divided in two groups according to systemic pathology: - Neoplatic diseases group that includes 21 patients; - Non-neoplastic diseases group of 11 patients. According to AAOMS guidelines, all patients suspended biphosphonate therapy three-six months before the surgery and were subjected to antibiotic therapy: three courses of 1g ceftriaxone intramuscular injection/die and 250mg metronidazolo oral tablet two times/die for 8 days with 10 days rest between each course. Surgical treatment provides local anesthesia without vasoconstrictor, segmental resection, Piezosurgery osteoplasty, intracavitary intraoperative use of gel to fill up residual bone defect and a first application upon the stitches (sandwich technique). Our procedure includes using of gel 4 times/die till to complete mucosal healing. Finally a clinical and radiographic follow-up by orthopantomograph and CT examinations at 3, 6, 12 and 24 months was carried out. Results: Clinical outcomes showed complete hard and soft tissue healing in all post-surgical sites, with a difference between two groups: neoplastic deseases group needed a longer soft wound healing time of 5 days compared to non-neoplastic diseases group. Radiographic outcomes show radiolucent areas decreasing due to gel direct osteoinductive effect with a faster osteoregeneration time in non-neoplastic deseases group: 15% difference between ossification level at 3 and 6 months. Gel preparation of sodium hyaluronate and amino acids enhances angiogenesis, fibroblast and osteoblast proliferation, collagen biosynthesis and production of growth factors as evidenced by MTT test and alkaline phosphatase histochemical staining. In vivo and in vitro studies have suggested that hyaluronic acid plays important roles in bone wound healing by enhancement of osteoblast differentiation through the down-regulation of BMP-2 antagonists. Lysine and proline regulate collagen matrix synthesis during osteogenesis. Conclusions: Sodium hyaluronate and amino acids gel formulation decreases postoperative pain, swelling and infective complications after surgery by surgical wound mechanical protectection. This new medical device is biocompatible, extremely cheap, safe and useful in all surgical procedure in order to obtain a faster healing of oral hard and soft tissues, specially in BRONJ that are often prone to difficult, slow and complicate recovery.

Invasive local procedures are often reported in clinical history of patients suffering from Bisphosphonates-Related Osteonecrosis of the Jaws (BRONJ) but over 40% of spontaneous forms have been also described in literature. We compared age, gender, underlying bone disorders, bisphosphonate therapy, clinical features and surgical outcome of 205 cases (36.2%) of BRONJ non surgery-triggered (group 1) with 362 (63.8%) cases of surgery-triggered forms (group 2). Differences between group 1 and 2 were analysed using Mann-Whitney U and χ(2) tests. Statistical analysis was performed using STATA 8. Zoledronate was the most used type of bisphosphonate (63.4% versus 69.0%) and the mandible was the most frequently involved site (63.9% versus 63.4%) in both groups. BRONJ in group 1 was more frequently multicentric (9.3% versus 5%, p<0.05), had a lower clinical stage (45.9% versus 13.8% in stage 1, p<0.01) and had a better outcome after surgical therapy (improvement in 74.1% versus 58.6%, p<0.05). The high prevalence of non surgery-triggered forms of BRONJ should be considered by oncologists, haematologists and general physicians who are advised to inform their patients regarding the importance of preventive dental protocols to control the possible causes of osteonecrosis not related to dental invasive procedures.

Psoriasis is a chronic, remitting and relapsing inflammatory disorder, involving the skin, nails, scalp and mucous membranes, that impairs patients' quality of life to varying degrees. Psoriatic arthritis is a chronic seronegative, inflammatory arthritis, usually preceded by psoriasis. Temporomandibular disorders is a generic term referred to clinical conditions involving the jaw muscles and temporomandibular joint. The aim of this study was to assess symptoms and signs of temporomandibular disorders in psoriasis patients with and without psoriatic arthritis.

Cervico-facial actinomycosis is an infectious, suppurative, and granulomatous disease due to Actinomyces species. Usually, the diagnosis is confirmed by microbiological cultures; however, the need for careful anaerobic handling of specimens often makes it difficult to obtain an effective microbial growth. Therefore, we conducted a retrospective study on biopsy samples from patients with a clinical suspicion of cervico-facial actinomycosis, in order to determine whether accurate histopathological examination could reliably confirm the diagnosis. A retrospective revision of formalin-fixed, paraffin-embedded archival material from 68 cases of cervico-facial lesions, with negative culture for anaerobic/microaerophilic microorganisms, was performed. Twelve serial sections for each case were cut from the paraffin blocks, individually collected on positively charged slides to obtain good section-to-slide adhesion, and stained with hematoxylin and eosin (H&amp;E) and periodic acid-Schiff (PAS). Histopathological examination of the serial sections allowed the identification of bacterial colonies consistent with actinomycetes in 22 cases (32 %). The proposed histopathological examination allowed the retrospective diagnosis of cervical actinomycosis in one-third of clinical specimens that remained misdiagnosed following traditional H&amp;E examination.

Bone is a specialized connective tissue, most prominently characterized by its mineralized organic matrix that imparts the physical properties that allow bone tissue to resist load, to support functional organs, and to protect highly sensitive body parts. Bone loss and bone damage may occur as a result of genetic conditions, infectious diseases, tumours, and trauma. Bone healing and repair, involves integrative activity of native tissues and living cells, and lends itself to the incorporation of naturally derived or biocompatible synthetic scaffolds, aimed at replacing missing or damaged osseous tissues. There are several modalities of bone regeneration including tissue engineering, guided bone regeneration, distraction ontogenesis, and bone grafting. This book concentrates on such procedures that may well be counted among the recent outstanding breakthroughs in bone regenerative therapy.

Objective: We report on a case of Tuberous Sclerosis (TS) with gingival angiofibromatosis (GA), diagnosed by histopathological analysis with Confocal Laser Scanning Microscopy (CLSM) and treated with High-Power Diode Laser gingivectomy. Case presentation: The patient underwent gingivectomy and gingivoplasty with High-Power Diode Laser in pulsed modality and the surgical sample was formalin-fixed, paraffin-embedded and stained with hematoxylin-eosin and Pricrosirius red. Results: Microscopically, thickened acanthotic epithelium with elongated rete ridges, densely packed, whorly collagen fibers, fibroblasts, variably sized vascular structures, and a few chronic inflammatory cells were detected. At CLSM examination, (Nikon Eclipse E-600 with green/red Laser inducing fluorescence) the collagen fibers, showing intense fluorescence, also manifested variable spatial orientation, due to cross-links among the bundles, ad typical of fibromatosis. Also, variably sized blood vessels and large and polygonal interstitial cells displayed fluorescence of lower intensity. The vascular component consisted of small groups of venous-like structures, frequently showing dilated lumina, thin walls and plump endothelial lining. Conclusions: The histopathological analysis with CLSM of GA occurring in TS highlightes distinctive features, such as low fluorescence areas and a typical vascular component which may represent distinctive features of such lesion.