Maxillary Area Research Articles

Techniques and Graft Materials Used in Maxillary Sinus Lift Procedure for Dental Implant Placement

Posterior quadrant of the maxilla consider as special challenges for use of implant active prostheses to restore dental function. Placement of Implant in the posterior part of maxilla influence hesitation due to the lack of sufficient alveolar bone height. This occurs due to the proximity of alveolar crest to the maxillary sinus because of sinus pneumatization, along with resorption of bone of the alveolar ridge secondary to tooth extraction, pathological lesion or trauma. Sinus lifting to augment atrophic maxillary posterior area to create space for implantation has been progressively widespread in latest years. In literatures 2 approaches have been designated for sinus lifting: the direct approach called also lateral approach and the indirect approach called also crestal approach.

Clinical Comparison of the Volumetric Changes in Single Pontic Site Development through Connective Tissue Grafting Using Modified Pouch Technique versus Pouch Technique in the Maxillary Esthetic Zone: A Randomized Controlled Clinical Trial.

The aim is to compare the volumetric changes between pouch technique versus the modified pouch technique in pontic site development using connective tissue graft in patients that have Seibert class I ridge defects in the maxillary esthetic zone. Methodology. This randomized, controlled, double-blinded, parallel-grouped clinical trial included sixteen patients with a single pontic site in the maxillary esthetic area presenting Seibert Class I ridge defects. Patients were randomly assigned into two equal groups: test group (n: 8) received soft tissue augmentation with connective tissue graft using the modified pouch technique and control group (n: 8) received soft tissue augmentation with connective tissue graft using pouch technique. The volumetric evaluation was carried out by taking impressions at baseline, 3 and 6 months after the surgery. Keratinized tissue thickness was also measured at baseline, 3 and 6 months after the surgery. Visual analogue scale (VAS) was recorded by the patients at day 3, day 7, and day 14 after the surgery. The test group had more increase in soft tissue volume than the control group at baseline, 3 months, and 6 months. The keratinized tissue width at baseline in the test group had a higher value than that of the control group. At 3 months, both groups had the same mean value, while at 6 months, the test group had a higher value than the control group. Regarding postoperative pain, the visual analogue scale shown at day 3 in the test group had a higher value than that of the control group, while at day 7, the control group had a higher value than the test group. At day 14, both groups had the same mean value. Soft tissue augmentation using both the traditional pouch technique and the modified pouch technique led to successful soft tissue volume augmentation in pontic site development in Seibert Class I ridge defects with no statistically significant difference between the two techniques.

Treatment of multiple adjacent RT 1 gingival recessions with the modified coronally advanced tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: 9-year results of a split-mouth randomized clinical trial

ObjectivesTo evaluate the long-term outcomes following treatment of RT 1 multiple adjacent gingival recessions (MAGR) using the modified coronally advanced tunnel (MCAT) with either a collagen matrix CM or a connective tissue graft (CTG).Material and methodsSixteen of the original 22 subjects included in a randomized, controlled split-mouth clinical trial were available for the 9-year follow-up (114 sites). Recessions were randomly treated by means of MCAT + CM (test) or MCAT + CTG (control). Complete root coverage (CRC), mean root coverage (MRC), gingival recession depth (GRD), probing pocket depth (PD), keratinized tissue width (KTW), and thickness (KGT) were compared with baseline values and with the 12-month results.ResultsAfter 9 years, CRC was observed in 2 patients, one in each group. At 9 years, MRC was 23.0 ± 44.5% in the test and 39.7 ± 35.1% in the control group (p = 0.179). The MRC reduction compared to 12 months was − 50.1 ± 47.0% and − 48.3 ± 37.7%, respectively. The upper jaw obtained 31.92 ± 43.0% of MRC for the test and 51.1 ± 27.8% for the control group (p = 0.111) compared to the lower jaw with 8.3 ± 46.9% and 20.7 ± 40.3%. KTW and KGT increased for both CM and CTG together from 2.0 ± 0.7 to 3.1 ± 1.0 mm (< 0.0001). There were no statistically significant changes in PD.ConclusionThe present results indicate that (a) treatment of MAGR using MCAT in conjunction with either CM or CTG is likely to show a relapse over a period of 9 years, and (b) the outcomes obtained in maxillary areas seem to be more stable compared to the mandibular ones.Clinical relevanceThe mean root coverage at 12 months could not be fully maintained over 9 years. On a long-term basis, the results seem to be less stable in the mandible as compared to maxillary areas.

Outcomes Following Hydraulic Pressure Indirect Sinus Lift in Cases of Simultaneous Implant Placement With Platelet-Rich Fibrin.

BackgroundTo achieve a better long-term prognosis in the posterior maxilla with poor quality of bone, the sinus lift must ensure bone regeneration till the apex of the dental implant for osseointegration. An indirect sinus lift is a minimally invasive procedure where simultaneous bone condensation is achieved. During the sinus lift procedures, different graft materials are used to gain the height of the bone in the sinus. The present study aimed to evaluate the outcomes of indirect sinus lift with hydraulic pressure and the simultaneous placement of implant using platelet-rich fibrin (PRF).MethodologyIn total, 24 subjects aged 18-74 years with missing maxillary premolars and first and second molars who opted for dental implants placed with indirect sinus lift with hydraulic pressure and had low sinus with less residual ridge height, bone density, and bone height were assessed at one day, one week, one month, three months, and six months.ResultsThe average mean height preoperatively was 5.573 ± 0.66 mm which showed a significant increase postoperatively to 9.603 ± 0.78 mm (p < 0.001). Mean sinus membrane lift was 4.8 ± 2.2 mm at six months. The implant stability quotient increased significantly at six months postoperatively from 69.07 ± 3.39 at the immediate postoperative time to 72.92 ± 2.714 at six months postoperatively (p < 0.001).ConclusionsThe current study suggests that minimally invasive indirect sinus lift with bone augmentation utilizing PRF increased residual alveolar ridge height and implant stability with fewer problems than previous sinus lift procedures in the posterior maxillary area.

Double Transcrestal Sinus Lift Procedure with Collagen as Bone Void Filler Alone in Atrophic Maxilla: 5 Years Retrospective Radiological Study

Objectives: The present study aimed to investigate the effectiveness of transcrestal double-elevation of the maxillary sinus (TSFE) with an implant placement during the second-stage surgery in the maxillary areas with a residual alveolar bone less than 3mm. Materials and Methods: Patients with long-standing edentulous areas underwent double TSFE surgery involving a first transcrestal maxillary sinus floor augmentation with a collagen sponge to fill the intrabony cavity and a second osteotome-mediated sinus floor elevation by using an electromagnetic device and immediate implant placement. The radiographic changes in bone heightwere measured and compared during the different time intervals by nonparametric statistics with p &lt; 0.01. Results: Twenty-eight patients were retrospectively selected for the study. A total of 42 implants were positioned in 28 augmented sinuses. After the first TSFE surgery, no minor swelling of gingival mucosa, no mucositis, or flap dehiscence with suppuration was found. After three months a second TSFE with simultaneous implant placement was performed; four patients experienced minor nasal bleeding. Significant increases in the bone height had been respectively reported for the first (from 2.3±0.2 to 9.5 ± 0.3 mm) and second surgeries with p-values less than 0.0001 and an overall bone height measured 5 years after the first surgery of 12.2±0.3 mm. Conclusion: The present study suggested to clinicians the possibility of osteotome double sinus lifting and grafting with highly absorbable collagen material, generally used as a haemostatic agent alone in case of residual bone height less than 3 mm.

Favorable Transverse Maxillary Development after Covering the Lateral Raw Surfaces with Buccal Fat Flaps in Modified Furlow Palatoplasty: A Three-Dimensional Imaging-Assisted Long-Term Comparative Outcome Study.

The pedicled buccal fat flap has recently been applied to cover the lateral raw surfaces during palatoplasty as an attempt to mitigate scar-induced transverse maxillary constriction during growth, but with no formal long-term comparative analysis. This three-dimensional imaging-assisted study assessed its impact on posterior transverse maxillary development. Cone beam computed tomographic scans from patients with unilateral cleft lip, alveolus, and palate who received buccal fat flap (buccal fat group; n = 22) or Surgicel (Surgicel group; n = 32) for covering lateral raw surfaces during modified Furlow palatoplasty at 9 to 10 months of age and had reached the age of 9 years were retrieved for analysis. Patients with unilateral cleft lip and alveolus (nonpalatoplasty group; n = 24) were also included for comparison. Using three-dimensional maxillary image models, linear (U6T-MSP and U6J-MSP) and area measurements were calculated for cleft and noncleft posterior maxillary sides and for total posterior transverse maxillary dimension. The buccal fat group had significantly (all p < 0.05) wider dimensions compared with the Surgicel group for all transverse maxillary measurements on both the cleft and noncleft sides, except for U6J-MSP and posterior palatal area parameters on the cleft side ( p > 0.05). The buccal fat group had significantly (all p < 0.05) wider total transverse maxillary dimensions compared with the Surgicel and nonpalatoplasty groups. Covering the lateral raw surfaces with buccal fat flaps resulted in less posterior transverse maxillary constriction compared with the Surgicel-based covering procedure. Therapeutic, III.

Long-Term Treatment Outcomes of Implant Prostheses in Partially and Totally Edentulous Patients.

Implant dental therapy is a clinical procedure used for treating patients with tooth loss with known clinical success. This clinical study aimed to evaluate the long-term clinical outcomes of dental implants in partially and totally edentulous patients. A total of 544 Microdent (Microdent SU, Implant Microdent System®, Santa Eulàlia de Ronçana Barcelona, Spain) screw implants were placed in 111 patients using a two-stage surgical technique and a conventional loading protocol (lasting 3 months). Implant and prosthetic clinical findings were evaluated during a 15-year follow-up. A total of 6 implants were lost during the healing period, and 124 prostheses were placed over the 538 implants that remained: 20 single crowns, 52 partially fixed bridges, 45 full-arch fixed restorations, and 7 overdentures. A total of 20 of these were lost during the follow-up period. The cumulative survival rate for all implants was 96.4%. The data underwent statistical analysis (significance level: p < 0.05). The mean marginal bone loss was 1.82 ± 0.54 mm, ranging from 1.2 to 3.1 mm. The most frequent complications were mechanical prosthodontic complications (16.2%). In all, 11.8% of implants showed periimplantitis as the primary biological complication. Dental implants inserted in both the maxillary and mandibular areas produce long-term favorable outcomes and stable tissue conditions when a delayed loading protocol is followed.

A prospective cohort study of immediate implantation and delayed implantation for a labial bony dehiscence defect in the maxillary aesthetic area

A prospective cohort study of immediate implantation and delayed implantation for a labial bony dehiscence defect in the maxillary aesthetic area

Difference in the alveolar bone remodeling between the adolescents and adults during upper incisor retraction: a retrospective study

The purpose of this study was to compare the difference of alveolar bone remodeling between the adolescents and adults in the maxillary incisor area during retraction. This retrospective study included 72 female patients who needed moderate anchorage to correct the bimaxillary protrusion. Subjects were further divided into the minor group (n = 36, 11–16 years old) and adult group (n = 36, 18–35 years old). Digital lateral cephalography and cone beam CT scanning were taken in each patient before (T0) and after treatment (T1). Cephalometry was conducted to assess incisor retraction, while alveolar bone thickness (ABT), alveolar bone distance (ABD), and alveolar bone area (ABA) were detected to assess changes in the alveolar bone. No difference in the inclination of upper incisors was observed at both T0 and T1 between two groups. Changes in the alveolar bone showed a similar tendency with bone apposition on the labial side and bone resorption on the palatal side in both groups. Less increase in the labial ABT (T1–T0) and more decrease in the palatal ABT (T1–T0) was found in the adult group, leading to less total ABT in the adult group. Higher reduction in ABD (T1–T0) was found in the adult group. Moreover, more decrease in the ABA (T1–T0) was found in the adult group. Adult patients have less alveolar bone support after treatment when compared with young adolescents. Orthodontists should take the age into consideration to reduce the potential periodontal risks during the treatment planning.

“One day visit”: a predictable clinical procedure.

The present clinical case aims to introduce a cluster of techniques based on a digital and biological basis, to be used at intrasurgical time, in order to achieve a predictable clinical outcome. In fact, the possibility of merging data could allow a single-step procedure, introducing concepts like ‘one day visit’ with Socket shield (SS), implant and provisional crown, same-day delivery. This procedure is well accepted by the patient as reducing surgery sessions and prosthetic time. A CBCT and a digital impression were used for initial diagnosis, obtaining data about tooth anatomy, bone quality, and bundle bone extension. Surgical planning and relative stent, allowed a careful position of implant inter-radicularly to achieve best primary stability, required for an immediate load on the mandibular molar area. It was first performed an SS on molar #46, with a seagull wing configuration (i.e., maintaining a small septum area between vestibular roots laminae. The implant was positioned in the inter-radicular area using a safe surgical stent: IT, IT curve and the implant stability quotient (ISQ (>70) were measured establishing criteria for immediate loading. An intra surgical impression scan was taken using a T-Base system allowing the planning of an immediate digital provisional crown in 40 minutes. Meanwhile, the SS shoulder was reduced, root spaces were filled with bone chips mixed with Fibrin glue and covered with platelet-rich-fibrin (PRF) A large healing cap was inserted on waiting time. The provisional crown fit was excellent requiring minor adjustment, and was immediately positioned. Seven months later a digital crown copy on disilicate was inserted. SS proved to maintain marginal gingiva and bundle bone. A novel intrasurgical action allows the implant stability measurement and immediate digital impression, picking high-quality prosthetic data.(time 0 concept. Follow-up shows crown stability and maintenance of both soft and hard tissue volume over 3 years. This is a proof of principle clinical case. Hardware & Software technologies were used to improve the predictability of outcome and stability over time of soft and hard tissue. Several activities were done at intra-surgical time and allowed to achieve unique data for prosthetic planning. The SS typically used on an anterior maxillary area was here used on posterior region and it is a fundamental step on ‘single day visit’ approach. The technique is operator sensitive and may not be applicable in any single case. More studies and clinical confirmation are therefore required.

Comparison of Temperature and Pain Changes between the Drip and Topical Methods of Administering the Transnasal Sphenopalatine Ganglion Block.

The objective of this study was to compare facial temperatures and the visual analogue scale (VAS) between the drip method and the topical method of transnasal sphenopalatine ganglion block (SPGB). The transnasal SPGB is administered to patients with facial or head and neck pain. In the transnasal approach, the drip and topical methods are frequently used. We compared facial temperatures and VAS after transnasal SPGB. Medical records of 74 patients who visited the pain clinic and underwent transnasal SPGB were retrospectively reviewed. A total of 156 transnasal SPGB were performed. The patients were divided into the drip-method and topical-method groups. Facial temperatures were measured in six areas of the right and left forehead, maxilla, and mandible before and 30 min after completion of the transnasal SPGB. Temperatures were compared before and 30 min after SPGB in each group and between the two groups. VAS scores were compared at the same times of SPGB in each group and between the two groups. In the drip-method group, there were significant increases at four areas of the face in temperature changes at 30 min after SPGB. In the topical-method group, there was no significant difference in the temperature changes at 30 min after SPGB. There were statistically significant differences in the facial temperature changes between the two groups in the right forehead (p = 0.001), left forehead (p = 0.015), and right maxillary area (p = 0.046). In herpes zoster, there were statistically significant differences in the VAS scores between before and 30 min after SPGB in both groups (p < 0.001, p = 0.008) and between two groups (p < 0.001). In migraine, there were statistically significant differences in VAS scores between before and 30 min after SPGB in both groups (p < 0.001, p = 0.004) and between two groups (p = 0.014). Transnasal SPGB using two methods showed different temperature changes and VAS scores.

Variations in the bony architecture of the greater palatine canal: An anatomical report

IntroductionThe greater palatine canal route has been well‐described in adults for the purposes of anesthetizing the branches of the maxillary division of trigeminal nerve for the relief of sphenopalatine neuralgia [11]. The canal also provides direct access to the contents of the PPF [12]. A complex array of vascular and neural structures characterizes this posterior maxillary region where the GPC is located. Its surgical anatomy can get further complicated by any anatomic variations and identification of vital structures becomes difficult, especially when bleeding during surgery obscures the region. Accurate knowledge of normal anatomy and common anatomical variations therefore remain crucial in minimizing intraoperative and postoperative complications associated with invasive microsurgical approaches to this region. The aim of this study was to explore the architecture of the GPC for any anatomic variations.Material &amp; MethodIn total, 30 adult dried and intact skull specimens were selected. The selection criteria included an intact hard palate with erupted 3rd molars and an intact lateral nasal wall on both sides. The exclusion criteria included any major craniofacial deformities, excessive bone resorption, very old specimens. The bony walls of the GPC were observed by passing a black wire.Findings4 out of 30 specimens showed marked variations in the bony medial wall of the greater palatine canal (GPC). Partial to complete malfusion between the posterior surface of the maxilla and the perpendicular plate of palatine bone was observed. This might be the result of embryological malformation.ConclusionThe present study provided information regarding the existence of some degree of anatomical variation in the bony architecture of greater palatine canal.SignificanceThis might help surgeons visualize over the possibility of the existence of any such variation while performing any surgical procedure in the posterior maxillary area. In order to establish the embryological basis of these findings, investigation on a larger number of specimens is highly suggested by the authors.

Farklı Maloklüzyonların Ortodontik Tedavisinde Maksiller Sinüs Boyutlarındaki Değişimin Belirlenmesi

Background: Craniofacial growth-development has a complex and multifactorial structure. According to functional matrix theory, soft tissues change the development direction of hard tissues and affect the sinus cavities within the cranial structure. The objective of this study is to determine the change in the maxillary sinus dimensions after orthodontic treatments according to malocclusion groups. Methods: Our study comprises 51 individuals who have met the admission criteria. Our study was carried out retrospectively. The individuals included in the study have been analyzed in terms of malocclusion groups by comparing their maxillary sinus dimensions on panoramic films. Results: The intended base length, planar length of the maxillary sinus, and the area measurements of the maxillary sinus have been found to be different at pre-treatment and post-treatment in terms of malocclusion. In Class I, the post-treatment maxillary sinus indentation base length has decreased, and the average planar base length and the maxillary sinus area has increased, and in Class II, the post-treatment maxillary sinus indentation base length and the average planar base length has increased, the maxillary sinus area has decreased, and in Class III, The post-treatment maxillary sinus indentation base length and the average planar base length has decreased, and the maxillary sinus area has increased compared to the pre-treatment. Conclusion: There have been changes in the sinus dimensions of Class I, II, and Class III patients who have received orthodontic treatment compared to the pre-treatment. The changes in the possible craniofacial structures before orthodontic treatments should be taken into consideration carefully, and the dental treatments to be applied should be decided after such considerations.

Screw-and-cement–retained prosthesis versus cement-retained prosthesis: Which is more appropriate for the upper premolar area?

Background/purposeThe narrow alveolar ridge in the maxillary premolars area limits the angle of implant placement and the shape of the prosthesis. The aim of this study was to evaluate which implant prosthesis, screw-and-cement-retained prosthesis (SCRP) or cement-retained prosthesis (CRP), was more suitable for the maxillary premolar area. Materials and methodsWe conducted virtual implantation on 58 implant images from 47 patients obtained using cone beam computed tomography (CBCT). The width and buccal inclination of the alveolar bone, the angulation of the implant fixture, and the angulation of abutment were measured and calculated. ResultsWe determined that SCRP was feasible in 52% and 78.8% of first and second premolar areas, respectively. There was a positive relationship between the feasibility of SCRP and the premolar region in general (P = 0.031), although SCRP was more likely to be a possibility in the second premolar area. On multiple logistic regression analysis, the difference in the angle between the axis of the prosthesis and the axis of the alveolar bone (RA) was significantly associated with the type of prosthesis (P = 0.001). The RA was significantly higher for CRP implants (OR = 1.885; 95% CI: 1.31 to 2.70). ConclusionSCRP is not always feasible in the maxillary premolar area, especially in the first premolar area. If the difference between the angle of the axis of the prosthesis and the axis of the alveolar bone is large, it may be necessary for the clinician to consider CRP in the treatment planning stage.

Management of Fibrous Epulis of Anterior Maxillary Teeth: A Case Report of a 1.5-Year-Old Lesion

Background: Epulis is a gingival hyperplasia (tumor-like) that originates from periodontal connective tissue. It can be caused by many factors such as a chronic local irritation. Epulis that grows on the anterior maxilla area can be inconvenient because it disrupts the aesthetics and also the function of the teeth. Therefore, it has to be completely removed by surgery.&#x0D; Objective: To correct the condition of epulis by excision and gingival contouring for aesthetic need.&#x0D; Case Report: A 30-year-old female patient presented with a complaint of a mass on the gum of the anterior teeth on her upper jaw that made her unconfident to smile. The mass had been there for 1.5 years.&#x0D; Conclusion: The condition of epulis can be corrected by excision procedure and by removing the cause of the epulis (sub-gingival calculus). The aesthetic result can be obtained by gingival contouring after the excision.&#x0D; Keywords: epulis, fibrous epulis, gingival hyperplasia, excision, gingival contouring, gingival biopsy

Three-dimensional analysis of the maxillary sinus according to sex, age, skin color, and nutritional status: A study with live Brazilian subjects using cone-beam computed tomography

ObjectiveTo perform three-dimensional measurements (volume and area) of the maxillary sinus, from cone-beam computed tomography (CBCT) images, and to assess potential differences between the left and right sides and a correlation of the measurements to sex, age, skin color, and nutritional status. DesignCBCT images of 161 living Brazilian subjects of both sexes (89 women and 72 men) were used, and three-dimensional measurements of volume and area were made with the beta version of the DDS-Pro™ 2.14.2_2022 software (DPP Systems, Czestochowa, Poland). The inter- and intra-examiner reproducibility of measurements was evaluated with TEM, rTEM, and R. ResultsBoth maxillary sinus volume and area did not show significant differences between the left and right sides and between the sexes. Volume and area were significantly lower in the age group from 6 to 11 years than in the other two groups (p < 0.05). The measurements obtained for maxillary sinus volume and area were significantly higher in white individuals (p < 0.05), but they did not show significant differences (p > 0.05) regarding nutritional status (considering the body mass index - BMI). ConclusionThere were no statistically significant differences between the sexes, which does not allow recommending the use of maxillary sinus volume and area measurements to analyze sexual dimorphism, and the same occurs for BMI. However, such measures can help to estimate the age and skin color of individuals.

Assessment of Maxillary Molars Interradicular Septum Morphological Characteristics as Criteria for Ideal Immediate Implant Placement-The Advantages of Cone Beam Computed Tomography Analysis.

The aim of this study was to evaluate the interradicular septum bone morphometric characteristics using cone beam computed tomography (CBCT) images, as well as to establish quantitative shortcuts to allow clinicians to make a faster and more reliable plan for immediate implant placement in the maxillary molars area. This retrospective quantitative study was conducted on CBCT images obtained from 100 patients. The morphometric analysis of the maxillary molars region was based on the parameters obtained on the sagittal and axial slices. The analysis performed on sagittal slices showed that the first maxillary molars had a wider interradicular septum when compared to the second molars, but the septum height in the first molars was significantly below the height in the second maxillary molars. The axial CBCT slices analysis showed that both interradicular septum perimeter and surface area were significantly more pronounced in the first than in the second maxillary molars. The interradicular furcation angle significantly correlated with the surface area (positively) and septum height (negatively) for both molars. The results of this study may recommend CBCT image analysis as a useful tool in predefining the circumstances that can allow for substantially better planning of immediate implant placement procedures in the region of maxillary molars.

Oncocytic Lesion or an Atypical Epithelioid Vascular Tumor of Unknown Biologic Potential: A Rare Diagnostic Dilemma

<h3>Introduction</h3> Oncocytomas are rare benign tumors found in many different organs, including but not limited to the kidneys, thyroid, parathyroid and salivary glands. Oncocytomas arising in the minor salivary glands are rare. These tumors represent 1 to 2% of all salivary gland neoplasms. <h3>Materials and Methods</h3> We report a case of a 16 year old female patient who was referred to an oral surgeon due to an incidental finding of a soft palatal mass while evaluating for pain in the maxillary area. The soft palatal mass was asymptomatic. The patients past medical history was non-pertinent. <h3>Results</h3> PET scan failed to identify the clinically observed palatal mass. Microscopically, there was a proliferation of large polygonal epithelioid cells forming loosely cohesive, vaguely organoid structures associated with promi- nent dilated and convoluted vascular spaces and demonstrated an infiltrative growth pattern in some areas. These cells showed abundant granular cytoplasm and an eccentrically placed nuclei, including nuclear pseudoinclusions. Mitotic activity or necrosis was not seen. Histologically, the morphology also somewhat mimicked a rhabdoid tumor but rhabdoid tumors are not usually so prominently vascular and are aggressive but in our case Ki-67 proliferation index was scant, besides INI 1 or SMARCB1 expression was not lost on IHC ruling out the possibility of SMARCB1 negative tumors. ERG stain was negative in the tumor cells but delineated the vascular lobules encompassing the polygonal cells. PTAH was diffusely positive in the polygonal epithelioid appearing cells suggestive of a mitochon- drial (oncocytic) component characterizing the cellular proliferation. The tumor cells exhibited a strong positivity for Vimentin and were moderately reactive for Pancytokeratin which necessitated the need to rule out metastatic carcinoma. <h3>Conclusion</h3> Our case showed a propensity towards rhabdoid cytomorphology but without loss of SMARCB1/INI1 protein expression emphasizing the clinical efficacy of INI1 IHC in discerning these tumors in the differential.

A new diagnostic paradigm for Erythromelanosis Follicularis Faciei et Colli: Dermoscopic and reflectance confocal microscopic features

Introduction: Erythromelanosis Follicularis Faciei et Colli is a rare variant of Kerastosis pilaris, characterized by a clinical triad of erythema, hyperpigmentation and follicular papules involving bilaterally cheeks, preauricular and maxillary areas of young male or, more rarely, female patients Case presentation: A 21-year-old Caucasian woman presented symmetrical patches of hyperpigmentation, erythema with microscopic telangiectasias and tiny follicular papules involving cheeks, preauricular and maxillary areas, forehead, pinna and neck since childhood. Lesions were asymptomatic but caused profound cosmetic disfigurement and had a negative impact on her social life. The patient underwent a non-invasive diagnostic procedure with epiluminescence and confocal microscopy. Dermoscopic examination revealed prominent yellowwhitish follicular keratotic plugging over a reddish background with short fine telangiectasia in the perifollicular and interfollicular areas. Furthermore, RCM features displayed the presence of enlarged the presence of enlarged follicular openings, absence of demodex mites within the follicles and slight infundibular hyperkeratosis. At the level of the epidermal-dermal junction hyperpigmentation of the epithelial basal cell layer and dilation of dermal capillaries inside dermal papillae were observed, correlating to typical histological features of EFFC. Our patient benefited from the topical use of tretinoin 0.05% cream, with attenuation of the instrumental pictures. Conclusion: Characteristic plugging over a reddish background and morphological features revealed by RCM may be helpful for assessment and monitoring in patients with EFFC. Starting from the observation of this case we would like to underline the importance of a noninvasive diagnostic procedure and an effective therapy for such a rare condition. Keywords: Erythromelanosis Follicularis Faciei et Colli; Erythromelanosis Follicularis Faciei diagnosis; Dermoscopy; In vivo reflectance confocal microscopy.

Causes of Emergency Bleeding after Nonsurgical Periodontal Therapy in Adult Periodontitis Patients: A Retrospective Analysis.

Background Emergency gingival uncontrollable bleeding after nonsurgical periodontal therapy (NSPT) could be caused by a variety of factors; local oral factors are the main cause of gingival bleeding in most patients. Because the doctor will do a good job of evaluating the patient's physical condition before nonsurgical periodontal therapy. This study is subjected to evaluate the possible factors associated with emergency uncontrollable bleeding within 24-48 hours after NSPT. Material and Methods. A total of fifty-eight patients with emergency bleeding after NSPT in the past four years were enrolled. The related factors in patients, such as age, gender, clotting function, systemic diseases, and baseline periodontitis severity, were analyzed. The site-related factors, such as tooth type, tooth distribution, and alveolar bone resorption at the bleeding site, were compared. The possible relationship of the parameters to the causes of emergency bleeding with NSPT was also evaluated. Results Gingival bleeding after NSPT was registered. In this retrospective study, a total of 58 patients were selected. There were 29 males and 29 females, aged from 20 to 67 years old, with an average age of 35.21 ± 10.09 years. Among them, 8.6% were over 50 years old, and 91.4% were under 50 years old. Completed evaluations were performed in 15.5% gingivitis and 84.5% periodontitis. The causes of emergency bleeding after nonsurgical periodontal therapy in this study were residual subgingival calculus or granulation tissue in 63.79% of cases: severe gingival inflammation, 29.32%; gum trauma, 3.45%; and poor compliance, 3.45%. The therapy method before bleeding includes supragingival scaling accounted for 72.4% and subgingival scaling accounted for 27.6%. 23 cases of horizontal absorption at the bleeding site accounted for 39.66%, and 35 cases of angular absorption accounted for 60.34%. Bleeding of maxillary posterior teeth accounted for 34.48%; mandibular anterior teeth accounted for 15.52%; mandibular anterior teeth accounted for 8.62%; and mandibular posterior teeth accounted for 18.97%; multiple sites accounted for 22.41%; eliminating residual subgingival calculus and granulation tissue were the main and most effective hemostatic methods, 86.21%. Conclusion Residual subgingival calculus or granulation tissue and severe gingival inflammation were the main causes of emergency gingival bleeding after nonsurgical periodontal therapy. Severe gingival inflammation causing emergency bleeding was more common in maxillary posterior teeth areas. Angular alveolar bone resorption was more likely to cause bleeding than horizontal resorption. Careful debridement of residual subgingival calculus and granulation tissue was the main hemostatic method.