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The present report describes a case of Epstein-Barr virus (EBV)-positive mucocutaneous ulcer (EBVMCU) with an ulcerative lesion on the right tongue. A 69-year-old Japanese woman with awareness of pain in the right lingual margin visited our hospital. The patient had rheumatoid arthritis and had been treated with methotrexate (MTX) for 9 years. Vitiligo was found throughout the oral cavity, and ulceration was found on the right tongue. Under a diagnosis of oral candidiasis and suspected right tongue tumor, treatment for candidiasis and biopsy of the right tongue ulcer were performed. Histopathological results were positive for CD20 and CD30 and negative for CD3 and CD5. EBV-encoded small RNA in situ hybridization confirmed positive results in large, atypical cells, suggesting involvement of EBV. EBVMCU was diagnosed based on the history of MTX use associated with rheumatoid arthritis, blood biochemical findings, and histopathological findings. The ulcer on the right tongue margin resolved spontaneously after treatment for oral candidiasis prior to discontinuation of MTX. No recurrence was seen for 18 months.

This study was conducted to determine the most secure implant positioning on the marginally resected mandible to support a fixed complete denture through finite element analysis. Three or 4 implants were placed at near, middle, or far positions from the resected margin in a simulation model with a symmetrical marginal defect in the mandibular symphysis. The height of the residual bone was 5, 10, or 15 mm. The 4 possible implant patterns for 3 or 4 implants were defined as (1) asymmetrically isolated position 1 to position 2, (2) asymmetrically isolated position 1 to position 3, (3) asymmetrically isolated with greater-length position 1 to position 2, and (4) 2 implants symmetrically positioned on each side of the defect. The von Mises stress in the resected and peri-implant bone with respect to the occlusal force was calculated. Initially, because the peri-implant bone stress around the isolated implant at the near position was greater than at the middle and far positions regardless of the residual bone height, the near position was excluded. Second, the von Mises stress in the resected bone region was >10 MPa when the isolated implant was at the far position, and it increased inversely depending on the bone height. However, the stress was

Mucoceles originating in submandibular gland (SMG) which are extravasation type are extremely rare. Because the extraoral approach with potential risks of facial nerve injury and scar formation is commonly performed, we report endoscopically-assisted intraoral removal of submandibular gland mucocele as minimally invasive surgery. A 28-year-old female was referred to our department with an eight-week history of left submandibular painless swelling. Radiological diagnosis was not plunging ranula but SMG mucocele. The patient underwent endoscopically-assisted intraoral removal of SMG under general anesthesia as minimally invasive surgery. A mucosal incision on the left oral floor was made. After soft tissues surrounding the SMG were dissected bluntly, the mucocele and SMG were exposed more prominently by digital pressure applied beneath the lower border of the mandible by an assistant. The SMG was gripped with forceps after aspiration of mucocele, and pulled up through the incision by gland dissection. Because the facial artery penetrated the SMG, the facial artery was ligated and cut. The SMG with mucocele was removed completely in intraoral approach. Although there was no continuity with SMG and sublingual gland (SLG), the SLG was also removed preventively. The pathological diagnosis was SMG mucocele. Although lingual nerve paresthesia occurred postoperatively, the paresthesia was recovered completely 3 weeks after surgery. There was no recurrence 2.5 years after surgery. Because intraoral removal of SMG can be performed without cervical scar and facial nerve injury, this intraoral approach with endoscopic assistance can be an alternative to transcervical approach.

Vascular anomalies in infants and children were separated into hemangiomas and vascular malformations based on their clinical appearance, histopathologic features, and biologic behavior. Whereas vascular malformations are structural abnormalities of capillary, arterial, venous, or lymphatic elements, vascular tumors are characterized by increased endothelial cell turnover. However, misdiagnoses and misperceptions persist around the use of the term "hemangioma". Although venous malformations arising in the submandibular gland are extremely rare, the most have been diagnosed as “hemangioma”. We report a rare submandibular gland venous malformation with multiple phleboliths. A 54-year-old female visited a private dental clinic for the pain of the right mandibular third molar. Panoramic radiograph showed multiple radiopaque lesions below the right mandibular angle. After the diagnosis of submandibular gland stones, she was referred to our department for the treatment. Ultrasonography showed a heterogeneous, hypoechoic lesion with multiple hyperechoic lesions and blood flow in the right submandibular gland. CT showed a well-circumscribed, heterogenous, low-density lesion with multiple calcifications in the right submandibular gland. MRI showed a lesion with signal intensity similar to that of the muscle in the right submandibular gland had multiple low signal intensity lesions on gadolinium-enhanced T1-weighted images. Radiological diagnosis was submandibular gland venous malformation with multiple phleboliths. She underwent intraoral removal of submandibular gland lesion under general anesthesia. Pathological diagnosis was submandibular gland venous malformation with multiple phleboliths.

Conventional intraoral removal of deeply impacted or ectopic mandibular third molar is challenging for limited surgical access. Because there are potential risks of inferior alveolar nerve (IAN) injury or iatrogenic mandibular fracture, several methods for the removal have been proposed. As minimally invasive and safe surgery, we report image-guided removal of deeply impacted mandibular third molar using navigation system. A 32-year-old male was referred to our department with right mandibular pain and swelling. Panoramic radiograph showed right mandibular third molar was deeply impacted and interrupted the white line of the mandibular canal. Computed tomography (CT) showed deep impacted right mandibular third molar with root projection from the lingual cortical bone, and there was resorption of lingual cortical bone and passing of mandibular nerve between roots. For mandibular navigation surgery, a resin occlusal splint with titanium markers and handle was manufactured to fix reference frame to the mandible. CT was performed preoperatively after the occlusal splint was fixed with patient’s mandibular teeth, and the patient underwent image-guided removal of mandibular third molar with navigation system under general anesthesia. After reference frame was attached to the handle of the occlusal splint fixed with patient’s mandibular teeth, point-based registration was performed. The crown was removed after the sectioning, and the root sectioning with calibrated bur was performed carefully to avoid injury of the IAN under navigational guidance. The roots were completely removed, and the IAN was exposed in the lingual cortical bone defect. Postoperative course was uneventful without paresthesia of the IAN.

We examined blood and protein dynamics potentially influenced by implant threads and hydrophilic/hydrophobic states of implant surfaces.A computational fluid dynamics model was created for a screw-shaped implant with a water contact angle of 70° (hydrophobic surface) and 0° (superhydrophilic surface). Movements and density of blood and fibrinogen as a representative wound healing protein were visualized and quantified during constant blood inflow.Blood plasma did not occupy 40-50% of the implant interface or the inside of threads around hydrophobic implants, whereas such blood voids were nearly completely eliminated around superhydrophilic implants. Whole blood field vectors were disorganized and random within hydrophobic threads but formed vortex nodes surrounded by stable blood streams along the superhydrophilic implant surface. The averaged vector within threads was away from the implant surface for the hydrophobic implant and towards the implant surface for the superhydrophilic implant. Rapid and massive whole blood influx into the thread zone was only seen for the superhydrophilic implant, whereas a line of conflicting vectors formed at the entrance of the thread area of the hydrophobic implant to prevent blood influx. The fibrinogen density was up to 20-times greater at the superhydrophilic implant interface than the hydrophobic one. Fibrinogen density was higher at the interface than outside the threads only for the superhydrophilic implant.Implant threads and surface hydrophilicity have profound effects on vector and distribution of blood and proteins. Critically, implant threads formed significant biological voids at the interface that were negated by superhydrophilicity-induced contact hemodynamics.

The frequency of supernumerary teeth is approximately 1%. The most frequent site is the anterior maxillary region, and supernumerary molars are relatively rare. Regarding the buccolingual position, most supernumerary teeth appear on the lingual side. The majority of cases present with only one supernumerary tooth, and those with multiple supernumerary teeth often have a genetic disorder. The present report describes a rare case of five impacted supernumerary teeth on the buccal side of bilateral upper molars in a healthy subject. Considering the appearance site and current theories on supernumerary teeth, the teeth were presumed to be impacted paramolars.

Objective Intra-oral minor salivary gland tumors are relatively rare. This study aimed to clarify the frequency and distribution of intra-oral minor salivary gland tumors in Japanese patients. Methods We retrospectively analyzed the histopathological records of 131 patients with minor salivary gland tumors that were surgically treated between 1967 and 2017 at a single institution. Results Of the 131 minor salivary gland tumors, 61 (47%) were benign and 70 (53%) were malignant. The male:female ratio was 1:1.8 for benign cases and 1:1 for malignant cases. Most of the tumors occurred in the palate, followed by the floor of the mouth. The most frequent minor salivary gland tumor was pleomorphic adenoma among benign tumors and adenoid cystic carcinoma among malignant tumors. The rarest minor salivary gland tumors were Warthin tumors and basal cell adenocarcinoma, accounting for only 0.8% of all cases. Conclusions The present study determined the incidence rates of these rare tumors.

Objective We previously reported that daily concurrent chemoradiotherapy using retrograde superselective intra-arterial infusion for locally advanced oral cancer provided good local control and overall survival rates. This study was performed to evaluate the therapeutic results of daily concurrent intra-arterial chemoradiotherapy for patients with locally advanced squamous cell carcinoma of the mandibular gingiva. Methods Sixteen patients with T3, 4 mandibular gingiva cancer who refused surgery underwent definitive intra-arterial chemoradiotherapy between August 2006 and July 2014. Treatment consisted of concurrent chemoradiotherapy using retrograde superselective intra-arterial infusion (60 Gy, total dose; 60 mg/m2 for docetaxel and 150 mg/m2 for cisplatin). Results Complete response of the primary site was obtained in 14 patients (87.5%). Five-year local control and survival rates were 73.4%and 81.3%, respectively. Grade 3 or 4 toxicities including mucositis and neutropenia were seen in 13 patients (81.3%) and 6 patients (37.5%), respectively. Grade 3 osteoradionecrosis occurred as a late adverse event in 1 patient (6.3%). Conclusions Retrograde daily concurrent intra-arterial chemoradiotherapy for locally advanced carcinoma of the mandibular gingiva provided good local control and overall survival rates. This method can become one of the therapeutic options for patients with locally advanced carcinoma of the mandibular gingiva.

OBJECTIVES Hydrophilicity/hydrophobicity of titanium surfaces may affect osseointegration. Ordinary titanium surfaces are hydrophobic. Recently, 2 different methods of storing titanium in saline solution or treating it with ultraviolet (UV) light were introduced to generate surface hydrophilicity. This study compared biological and physicochemical properties of 2 different hydrophilic titanium surfaces created by these methods. MATERIALS Acid-etched control, saline-stored, and UV-treated titanium surfaces were assessed by scanning electron microscopy, energy dispersive spectroscopy, and x-ray photoelectron spectroscopy. The attachment, spreading behaviors, mineralization, and gene expression of osteoblasts were examined. RESULTS Similar microroughness was found on control and UV-treated surfaces, whereas foreign deposits were observed on saline-stored surfaces. Control and UV-treated surfaces consisted of Ti, O, and C, whereas saline-stored surfaces showed Na and Cl in addition to these 3 elements. Atomic percentage of surface carbon was higher in order of control, saline-stored, and UV-treated surfaces. Osteoblasts cultured on saline-stored surfaces showed higher levels of calcium deposition and collagen I expression than control. Osteoblasts on UV-treated surfaces showed significantly increased levels for all parameters related to cell attachment, cell spreading, the expression of adhesion and cytoskeletal proteins, mineralization, and gene expression compared with control, outperforming saline-stored surfaces for most parameters. CONCLUSION Despite similar hydrophilicity, saline-stored and UV light-treated surfaces showed substantially different biological effects on osseointegration, associated with different surface chemistry and morphology.

Hemangiopericytoma/solitary fibrous tumor (HPC/SFT) is a perivascular mesenchymal tumor often found unexpectedly on histopathological examination, and occasionally shows malignant behavior. The incidence of intraoral HPC/SFT is extremely rare. We report a case of HPC/SFT located in the buccal mucosa. A 50-year-old woman presented with a 5-year history of a painless mass in the left buccal mucosa. Clinical findings showed the lesion was a well-defined tumor between the cheek skin and buccal mucosa with two feeding arteries, indicating hemangioma. The tumor was completely resected under general anesthesia. Histopathologically, immunostaining for STAT6 revealed results consistent with HPC/SFT, and no findings suggestive of malignancy, such as tumor size greater than 5 cm and high proliferative activity as shown by mitotic index and Ki-67 index. No other distinct primary lesion or distant metastasis was detected on whole-body computed tomography. Dealing with the lesion as a precancerous or potentially malignant tumor, follow-up was performed for 5 years after surgery, but neither recurrence nor metastasis was observed. As recurrence or metastasis may be delayed by many years, follow-up needs to be continued long-term according to risk factors of malignant behavior such as tumor size, cell characteristics and proliferative activity.

Actinomycosis is often considered an affliction of the soft tissues, but in fact, the process spreads to bone in up to 15% of cases. Although Actinomyces -associated lesions in the jaw, such as radicular cyst and osteomyelitis, have been reported by many authors, there are few reports have previously described Actinomyces -associated calcification in the jaw. We report here a rare case of Actinomyces -associated calcifications around an impacted third molar of the mandible. A 76-year-old man with left mandibular pericoronitis was referred to our department. A panoramic radiograph showed alveolar bone resorption caused by severe periodontitis of the left mandibular second molar and multiple small radiopaque spots around the crown of left mandibular third molar in a radiolucent lesion. Computed tomography revealed that the lesion of the left mandibular retromolar lesion was low density, with multiple high density spots surrounding the third molar crown surface. Removal of the lesion and the left mandibular second and third molars were performed and multiple small black pieces of hard tissue were present on the crown surface of the third molar. Histopathological examination of soft tissue specimen around the third molar revealed that collagenous fibroconnective tissue infiltrated by inflammatory cells with squamous epithelium on its surface. Black hard tissue consisted of calcification and conglomerations of Actinomyces which were densely stained by hematoxylin-eosin stain were observed at the margin of the hard tissue surrounding tiny filamentous structures. The postoperative course was uneventful without need for additional antibiotics and there has been no recurrence 22 months after surgery.

Osteomas are benign, slow-growing osteogenic tumors that consist of compact or cancellous bone. They sometimes arise from the craniomaxillofacial region. Among the peripheral, central, and extraskeletal types, peripheral osteomas arise from the periosteum, usually as unilateral, pedunculated, mushroom-like masses. Here, we report an unusual peripheral osteoma arising from the lateral surface of the mandibular ramus. A 57-year-old woman with a mass at the left mandibular ramus was referred to us. The hard and immobile mass had been growing for 15 years, and she had facial asymmetry. She had no trismus, temporomandibular joint dysfunction, previous facial trauma, or infection. Computed tomography showed a mushroom-like lesion (21.1 × 13.4 × 13.1 mm) arising from the lateral surface of the left mandibular ramus. Clinical diagnosis was peripheral osteoma. The lesion was removed using rotary instruments and a chisel through an intraoral approach under general anesthesia. The lesion had intruded into the masseter muscle. Pathological diagnosis was compact osteoma. The postoperative course was uneventful and there has been no recurrence 1.5 years after surgery.

Purpose This study evaluated the usefulness of sentinel lymph node (SLN) biopsy with preoperative computed tomographic lymphography (CTL) and intraoperative indocyanine green (ICG) fluorescence imaging for N0 early tongue cancer. Methods Twenty-seven patients with N0 early oral tongue cancer underwent CTL with a 128-slice multi-detector row CT scanner to detect SLN on the day before resection of primary tumor and SLN biopsy under ICG fluorescence guidance. We identified the location and number of SLNs mapped by CTL and evaluated whether CTL-enhanced SLNs could be identified intraoperatively as ICG fluorescent lymph nodes. Prognosis was also evaluated. Results SLNs were detected by CTL in 26 of 27 patients (96.3%). The total and mean numbers of SLNs were 41 and 1.5, respectively. All SLNs enhanced by CTL could be identified intraoperatively as ICG fluorescent lymph nodes. Two SLNs were found under ICG fluorescent guidance in only one patient without SLN enhanced by CTL. Among the 27 patients, five (18.5%) had SLN with metastasis. Median follow-up was 76 months (range 44–82 months). During follow-up, three of 22 patients without SLN metastasis had occult cervical lymph node metastasis. The 5-year overall survival rate was 100%. Conclusion SLN biopsy with preoperative CTL and intraoperative ICG fluorescence imaging is a feasible and reliable procedure, without radioisotope tracers, for neck management in cases of early tongue cancer.

Purpose: The objective of this study was to compare the rate of implant stability development of as-received and photofunctionalized dental implants in regular and complex cases. Materials and Methods: Forty-nine implants (24 as-received and 25 photofunctionalized) placed in regular or complex cases (simultaneous guided bone regeneration, sinus elevation, or fresh extraction sockets) were studied. Photofunctionalization was performed by ultraviolet (UV) treatment of implants for 15 minutes using a photo device immediately prior to placement, and the generation of superhydrophilicity was confirmed. Implant stability was evaluated by measuring the implant stability quotient (ISQ) at placement (ISQ1) and at stage-two surgery (ISQ2). The rate of implant stability development was evaluated by calculating the osseointegration speed index (OSI), defined as the ISQ increase per month ([ISQ2-ISQ1]/healing time in months). The percentage of innate bone support at placement was evaluated clinically and radiographically. Results: The average OSI was considerably greater for photofunctionalized implants (3.7 ± 2.9) than for as-received implants (0.0 ± 1.0). The OSI in complex cases was 4.2 ± 3.2 for photofunctionalized implants and 0.2 ± 0.9 for as-received implants. The OSI in cases with simultaneous sinus elevation was 5.5 ± 3.5 for photofunctionalized implants and 0.2 ± 1.1 for as-received implants. Photofunctionalized implants showed significantly higher ISQ2 values than as-received implants. Photofunctionalized implant ISQ2 values were greater than 60, regardless of primary stability and innate bone support at placement. In multivariate analysis including the effects of photofunctionalization, age and sex of patients, and diameter and length of implants, photofunctionalization showed the strongest influence on the OSI for both regular and complex cases, while other factors influenced the OSI only in certain conditions. Conclusion: Photofunctionalization accelerated the rate and enhanced the final level of implant stability development compared with as-received implants, particularly for implants placed into poor-quality bone and other complex cases. Photofunctionalization was a stronger determinant of implant stability than all the other tested implant- and host-related factors.

Purpose The straight locking miniplate (SLM) technique is a straightforward method to accurately reposition the maxilla during bimaxillary orthognathic surgery. The present study evaluated the accuracy of the SLM technique in maintaining the condylar position during surgery without the use of a cutting guide. Patients and Methods The present prospective, single-center study was conducted at Yokohama City University between 2016 and 2017 and included patients with skeletal Class III malocclusion. The patients were divided into 2 groups according to the fixation method used for the mandibular segments. The mandibular segments were fixed with miniplates either manually (manual group) or using the SLM technique (SLM group). Computed tomography was performed before and 3 days after surgery to compare the condylar position. The bodily and rotational movements of the condyle were analyzed. Results The subjects were 18 Japanese patients (36 condyles) who had undergone bilateral set back surgery with Le Fort I osteotomy. The amount of bodily movements in the manual and SLM groups were 1.44 and 0.62 mm, respectively. The degree of rotational movement in the sagittal plane in the manual and SLM groups was 3.33° and 0.23°, respectively. The bodily and rotational movements in the SLM group were significantly smaller than those in the manual group (P Conclusions These results suggest that use of the SLM technique reduces the risk of condylar positional changes to less than 1 mm during orthognathic surgery without the use of any complex devices or a cutting guide.

Statement of problem The bonding and biological properties of currently used luting/cementing materials need to be improved. 4-Acryloyloxyethyl trimellitate anhydride/methyl methacrylate-tri-n-butylborane (4-META/MMA-TBB) resin is primarily used for splinting mobile teeth or treating fractured teeth. It undergoes moisture-resistant polymerization and bonds strongly to dentin and metals. Purpose The purpose of this in vitro study was to compare the biological and biochemical properties META/MMA-TBB resin with those of conventional polymethyl methacrylate (PMMA)-MMA resin and other currently used luting materials in order to determine whether it may be a viable dental luting agent. Material and methods The degree of polymerization of 4-META/MMA-TBB resin, PMMA-MMA autopolymerizing resin, 10-methacryloyloxydecyl dihydrogen phosphate-dimethacrylate (MDP-DMA) adhesive resin, and a glass ionomer cement was measured by Fourier-transformed infrared spectroscopy. Free radical production during setting was evaluated by electron spin resonance (ESR) spectroscopy. Rat dental pulp cells cultured on these materials were examined for cell viability, attachment, proliferation, and functional phenotype. Results The degree of polymerization of 4-META/MMA-TBB resin was 82% thirty minutes after preparation, compared to 66% for PMMA-MMA autopolymerizing resin. ESR spectroscopy revealed free radical production from 4-META/MMA-TBB resin and glass ionomer cement was equivalent 24 hours after preparation, with no spike in radical generation observed. In contrast, free radical production from PMMA-MMA and MDP-DMA adhesive resins was rapid and sustained and 10 to 20 times greater than that from 4-META/MMA-TBB. The percentage of viable dental pulp cells 24 hours after seeding was considerably higher on MDP-DMA and 4-META/MMA-TBB resin than on glass ionomer cement. Cell number, proliferation, and alkaline phosphatase activity were highest on 4-META/MMA-TBB resin and lowest on the glass ionomer cement. Conclusions 4-META/MMA-TBB resin is at least as biocompatible, and perhaps even more biocompatible, than other current luting materials, with fast, favorable, and nontoxic polymerization properties. Further in vivo and human studies of 4-META/MMA-TBB resin as a dental luting agent are warranted.

Objectives To evaluate the therapeutic results and rate of organ preservation in patients with squamous cell carcinoma of the tongue treated with retrograde superselective intra-arterial chemoradiotherapy. Materials and methods Between June 2006 and June 2015, 118 patients with tongue cancer were treated with intra-arterial chemoradiotherapy. Treatment consisted of radiotherapy (total 50–70 Gy) and daily concurrent intra-arterial chemotherapy (docetaxel, total 50–70 mg/m2; cisplatin, total 125–175 mg/m2) for 5–7 weeks. Locoregional control and overall survival rates were calculated by the Kaplan-Meier method. Cox’s proportional hazards model was used for both univariate and multivariate analyses. Results The median follow-up for all patients was 38.5 months (range, 3–129 months). After intra-arterial chemoradiotherapy, primary site complete response was achieved in 113 (95.8%) of 118 cases. Three-year locoregional control and overall survival rates were 80.3% and 81.5%, respectively. Grade 3 or 4 toxicities included neutropenia in 16.1% and mucositis in 87.3%. Grade 3 toxicities included anemia in 12.7%, thrombocytopenia in 3.4%, nausea/vomiting in 3.4%, dermatitis in 45.7%, dysphagia in 74.6%, and fever in 2.5% of patients. Late toxicity consisting of grade 3 osteoradionecrosis of the jaw occurred in 4.2% of patients. On univariate analysis, T stage and overall stage were significantly associated with locoregional control, and N stage and overall stage were significantly associated with overall survival. On multivariate analysis, the only significant predictor of overall survival was overall stage classification. Conclusion Retrograde superselective intra-arterial chemoradiotherapy for tongue cancer provided good overall survival and locoregional control.

Cervicofacial subcutaneous emphysema is a rare complication of dental procedures with an air turbine or syringe, and dentists and oral surgeons sometimes encounter mediastinal emphysema following the presentation of extensive subcutaneous emphysema. Most emphysema occurs incidentally during tooth extraction, restorative treatment, or endodontic treatment, with only a few cases reported of cervicofacial subcutaneous emphysema associated with dental laser treatment. We report a case of cervicofacial subcutaneous and mediastinal emphysema caused by the air cooling spray of dental laser during dental treatment in a 76-year-old woman. After she underwent dental laser treatment, cervicofacial swelling was noted and she was referred to our department. Computed tomography showed both cervicofacial subcutaneous emphysema and mediastinal emphysema. Antibiotics were administered prophylactically and the emphysema disappeared 5 days after the dental laser treatment, without any complications.

The aim of this experiment was to evaluate the histological effects of zoledronic acid on the periodontal space in rats. 40 male Wistar rats were divided into three zoledronic acid groups and a control group. Zoledronic acid was injected subcutaneously at doses of 10, 50, or 500 μg/kg once a week for 3 weeks. The rats were killed 1 or 9 weeks after the last injection. Histological examination of the periodontal space around the incisor tooth revealed that zoledronic acid did not inhibit tooth development. In the rats killed 1 week after treatment discontinuation, the periodontal space gradually narrowed in response to increasing zoledronic acid doses, and the changes were statistically significant according to ANOVA but not according to ANOVA with post hoc tests. The changes persisted in the high-dose zoledronic acid group despite zoledronic acid discontinuation, with significant differences identified by ANOVA and ANOVA with post hoc tests. Therefore, although zoledronic acid had an insignificant effect on tooth development, it had a significant effect on the periodontal space when high doses were administered. The results of this experiment may provide useful information for future investigations on the role of zoledronic acid in the osteonecrosis of the jaw.

Purpose: Ultraviolet (UV)-mediated photofunctionalization has earned considerable attention for the enhancement of the biologic capabilities of titanium. The effects of photofunctionalization on bone augmentation and gap closure were examined using titanium implants and mesh in a rat femur model. Materials and Methods: An acid-etched titanium implant (4-mm length, 1-mm diameter) was placed in the gluteal tuberosity that resembles a knife-edge-like edentulous ridge. The lower half of the implant was located in a 2-mm-diameter defect created in the bone without cortical bone support; the upper half was exposed and covered with a titanium mesh to provide augmentation space. After 12 and 24 days of healing, specimens were subjected to microcomputed tomography (micro-CT)- and histology-based bone morphometry in three zones of analysis: augmentation, cortical bone-implant gap, and bone marrow. A biomechanical push-in test was performed to examine the strength of bone-implant integration. Photofunctionalization was performed by treating titanium implants and mesh with UV light for 12 minutes. Results: Photofunctionalized titanium mesh and implants were hydrophilic, whereas untreated controls were hydrophobic. Bone volume was significantly greater in photofunctionalized implants and mesh than in untreated implants in all zones on days 12 and 24. Bone-to-implant contact of photofunctionalized implants was greater than that of untreated implants, not just in the bone marrow but also in the gap and augmented zones. The strength of osseointegration was three times greater for photofunctionalized implants than for untreated implants. Conclusion: Use of photofunctionalized titanium mesh and implants effectively enhanced vertical bone augmentation, cortical bone-implant gap closure, and osseointegration without innate bone support.

Objective To evaluate the therapeutic results and control of occult neck metastasis in patients with T2-4N0 oral tongue squamous cell carcinoma treated with retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy. Study Design Forty-two patients with T2-4N0 tongue cancer (17 with late T2; 13 with T3; and 12 with T4a disease, M0) were treated with intra-arterial chemoradiotherapy. Treatment consisted of retrograde superselective intra-arterial chemotherapy (docetaxel 50-70 mg/m2, cisplatin 125-175 mg/m2) and daily concurrent radiotherapy (50-70 Gy) for 5-7 weeks. Results The median follow-up for all patients was 46.5 months (range, 8-105 months). Primary-site complete response was achieved in 42 of 42 cases (100%). Three-year overall survival, progression-free survival, and local control rates were 85.0%, 77.8%, and 91.7%, respectively. Delayed neck metastasis was detected in 5 of 42 cases (11.9%). Grade 3 or 4 toxic changes included oral mucositis in 92.9%, neutropenia in 21.4%, and thrombocytopenia in 4.8%. Grade 3 toxicities included anemia in 16.7%, radiation dermatitis in 9.5%, nausea in 4.8%, and fever in 2.4%. Conclusions Retrograde superselective intra-arterial chemotherapy for T2-4N0 tongue cancer provided good overall survival and local control rates and was effective for occult neck metastasis.

Objectives This study evaluated the effect of photofunctionalization on osseointegration under the biologically adverse conditions of aging. Materials First of all, bone marrow-derived osteoblastic cells from young (8 weeks old) and aged (15 months old) rats were biologically characterized. Then, the osteoblasts from aged rats were seeded on titanium discs with and without photofunctionalization, and assessed for initial cell attachment and osteoblastic functions. Titanium mini-implants, with and without photofunctionalization, were placed in the femur of aged rats, and the strength of osseointegration was measured at week 2 of healing. Periimplant tissue was examined morphologically and chemically using scanning electron microscopy and energy dispersive x-ray spectroscopy, respectively. Results Cells from the aged rats showed substantially reduced biological capabilities compared with those derived from young rats. The cells from aged rats showed significantly increased cell attachment and the expression of osteoblastic function on photofunctionalized titanium than on untreated titanium. In addition, the strength of osseointegration was increased by 40% in aged rats carrying the photofunctionalized implants. Robust bone formation was observed around the photofunctionalized implants with strong elemental peaks of calcium and phosphorus, whereas the tissue around untreated implants showed weaker calcium and phosphate signals than titanium ones. Conclusion These in vivo and in vitro results corroboratively demonstrate that photofunctionalization is effective for enhancing osseointegration in aged rats.

Statement of problem Despite its clinical benefits, the immediate loading protocol might have a higher risk of implant failure than the regular protocol. Ultraviolet (UV) photofunctionalization is a novel surface enhancement technique for dental implants. However, the effect of photofunctionalization under loading conditions is unclear. Purpose The purpose of this animal study was to evaluate the effect of photofunctionalization on the biomechanical quality and strength of osseointegration under loaded conditions in a rat model. Material and methods Untreated and photofunctionalized, acid-etched titanium implants were placed into rat femurs. The implants were immediately loaded with 0.46 N of constant lateral force. The implant positions were evaluated after 2 weeks of healing. The strength of osseointegration was evaluated by measuring the bone-implant interfacial breakdown point during biomechanical push-in testing. Results Photofunctionalization induced hydrophilic surfaces on the implants. Osseointegration was successful in 28.6% of untreated implants and 100% of photofunctionalized implants. The strength of osseointegration in successful implants was 2.4 times higher in photofunctionalized implants than in untreated implants. The degree of tilt of untreated implants toward the origin of force was twice that of photofunctionalized implants. Conclusions Within the limit of an animal model, photofunctionalization significantly increased the success of osseointegration and prevented implant tilt. Even for the implants that underwent successful osseointegration, the strength of osseointegration was significantly higher for photofunctionalized implants than for untreated implants. Further experiments are warranted to determine the effectiveness of photofunctionalization on immediately loaded dental implants.

This study investigated the bone regeneration properties of titanium fibre mesh as a tissue engineering material. A thin hydroxyapatite (HA) coating on the titanium fibre web was created using the developed molecular precursor method without losing the complex interior structure. HA-coated titanium fibre mesh showed apatite crystal formation in vitro in a human osteoblast culture. Titanium fibre mesh discs with or without a thin HA coating were implanted into rat cranial bone defects, and the animals were killed at 2 and 4 weeks. The in vivo experience revealed that the amount of newly formed bone was significantly higher in the HA-coated titanium fibre mesh than in the non-coated titanium fibre mesh 2 weeks after implantation. These results suggest that thin HA coating enhances osteoblast activity and bone regeneration in the titanium fibre mesh scaffold. Thin HA-coating improved the ability of titanium fibre mesh to act as a bone regeneration scaffold.

Malignancies associated with Behcet's disease (BD) are rare, and surgery for patients with BD frequently results in postoperative complications such as wound dehiscence, postoperative infection, and exacerbation of BD itself. We present a rare case of left tongue carcinoma in a 70-year-old woman with BD. The pathological findings showed moderate-differentiated squamous cell carcinoma with atypical squamous cell infiltrative proliferation. Daily concurrent chemoradiotherapy with docetaxel and cisplatin using superselective intra-arterial infusion via superficial temporal artery and occipital artery was performed. Two indwelling catheters, one from the left occipital artery to the left lingual artery and the other from the left superficial temporal artery to the left facial artery, were inserted to carry out superselective intra-arterial infusion treatment. After completion of all treatments, a biopsy specimen of the primary lesion showed grade III, nonviable tumor cells, suggesting complete response. Superselective intra-arterial chemoradiotherapy was effective for treating the tongue carcinoma associated with BD, and avoided surgical treatment. This method could control the primary lesion and cervical lymph node metastasis clinically without severe side effects. The patient has been disease free for 18 months without the complication of treatment.

Objective To describe vertical distraction osteogenesis of a scapular flap and removable lip support for oral rehabilitation after surgical creation of an ablative defect of the mandible. Case report A 70-year-old man who was diagnosed with squamous cell carcinoma of the left lower gingiva underwent segmental mandibulectomy for tumor ablation and reconstruction with a scapular bone flap. To augment bone height of this flap, vertical distraction osteogenesis was performed. After denture fabrication, a removable lip support was placed between the implant-supported denture and the lower lip. Results The bone height of the scapular bone flap increased by 9 mm. Implants with adequate length could be placed in the distracted bone. The lip support was effective. Two years after masticatory loading, the implants remained stable. Conclusion Vertical distraction osteogenesis of the scapular bone flap was suitable to facilitate postoperative functional and esthetic restoration after tumor resection. A removable lip support was also useful as a supplementary tool for oral rehabilitation.

Malignant melanoma of the oral cavity is uncommon, and the tongue is a particularly rare primary site. We report a case of malignant melanoma of the tongue in a 69-year-old Japanese man, who had undergone lower lobectomy of the right lung 1 year earlier for lung squamous cell carcinoma. The patient had noticed a grey-black pedunculated nodule on the dorsum of the tongue 3 months previously. No other primaries or metastases apart from recurrences of lung squamous cell carcinoma were observed. A palliative approach was adopted comprising chemotherapy and immunotherapy for the tongue tumour, as radical surgery for recurrent lung carcinoma was considered unfeasible. The patient died of lung carcinoma 6 months after completing the therapy. The size of the lingual tumour changed very little over this period, no problems with oral intake were reported, and quality of life was maintained. This report presents details of the case and reviews relevant literature.

Purpose: The aim of this study was to evaluate whether photofunctionalization of titanium mesh enhances its osteoconductive capability. Materials and Methods: The titanium mesh (0.2 mm thickness) used in this study was made of commercially pure grade-2 titanium and had hexagonal apertures (2 mm width). Photofunctionalization was performed by treating titanium mesh with UV light for 12 minutes using a photo device immediately before use. Untreated or photofunctionalized titanium mesh was placed into rat femurs, and bone generation around titanium mesh was profiled using three-dimensional (3D) microcomputed tomography (micro-CT). A set of in vitro experiments was conducted using bone marrow–derived osteoblasts. Results: Photofunctionalized titanium mesh surfaces were characterized by the regenerated hydrophilicity and significantly reduced surface carbon. Bone generation profiling at week 3 of healing showed that the hexagonal apertures in photofunctionalized mesh were 95% filled, but they were only 57% filled in untreated mesh, particularly with the center zone remaining as a gap. Bone profiling in slices parallel to the titanium surface showed that photofunctionalized titanium mesh achieved 90% bone occupancy 0 to 400 μm from the surface, compared with only 35% for untreated mesh. Bone occupancy remained as high as 55% 800 to 1,200 μm from photofunctionalized titanium mesh surfaces, compared with less than 20% for untreated mesh. In vitro, photofunctionalized titanium mesh expedited and enhanced attachment and spread of osteoblasts, and increased ALP activity and the rate of mineralization. Conclusion: This study may provide novel and advanced metrics describing the osteoconductive property of photofunctionalized titanium mesh. Specifically, photofunctionalization not only increased the breadth, but also the 3D range, of osteoconductivity of titanium mesh, enabling space-filling and far-reaching osteoconductivity. Further translational and clinical studies are warranted to establish photofunctionalized titanium mesh as a novel clinical tool for better bone regeneration and augmentation.

Salivary duct carcinoma (SDC) is a distinctive and aggressive neoplasm. The most frequent site of origin is the parotid gland, followed by the submandibular gland. SDC originating in the minor salivary glands, particularly in the ectopic glands within the mandible, is extremely rare. We describe a 62-year-old man with SDC in the mandible, who presented with a painless lump in the right submandibular region (later identified as lymph node metastasis) and ipsilateral mental nerve palsy. Histologic examination after ablative surgery revealed SDC originating in the mandible and cervical nodal metastases spreading to levels I-III. The patient remains alive 59 months after presentation as a result of postoperative full-dose irradiation and regular intensive chemotherapy using TXT, 5-FU, and CDDP. However, the patient has local recurrence and distant metastases to the lung and brain. In this report, we also discuss the specific diagnostic criteria and developmental theories of intraosseous salivary gland tumors.

Purpose: Treatment of titanium with UV light immediately before use, or photofunctionalization, is gaining traction as a simple method to improve the biologic capability and clinical performance of dental implants. The objective of this study was to examine the effect of photofunctionalization on the biologic capability and mechanical anchorage of orthodontic miniscrews. Materials and Methods: Untreated and photofunctionalized Ti-6Al-4V orthodontic miniscrews were placed into rat femurs. Photofunctionalization was performed by treating miniscrews with UV light for 12 minutes using a photo device immediately before placement. After 3 weeks of healing, miniscrews were pushed laterally to measure the resistance against the tipping force. The miniscrews were also evaluated for morphology and chemistry of tissue formed around them using scanning electron microscopy and energy dispersive spectroscopy. Rat bone marrow–derived osteoblasts were cultured on Ti-6Al-4V disks with and without photofunctionalization. The number of osteoblasts attached to the disks and the behaviors, alkaline phosphatase activity, and mineralization capability of osteoblasts were evaluated. Results: Photofunctionalization converted both disk and screw surfaces from hydrophobic to superhydrophilic. In vivo biomechanical testing showed that the displacement of untreated screws was 1.5 to 1.7 times greater than that of photofunctionalized screws when subjected to lateral tipping force. Robust bone formation was observed around photofunctionalized miniscrews with strong elemental peaks of calcium and phosphorus, whereas the tissue around untreated miniscrews appeared thin and showed no clear peak of calcium. The attachment, initial spreading, adhesion, and expression of functional phenotypes of osteoblasts were significantly increased on photofunctionalized Ti-6Al-4V disks. Conclusion: These in vivo and in vitro results comprehensively and consistently demonstrate that photofunctionalization increases the bioactivity of Ti-6Al-4V and improves the anchoring capability of orthodontic miniscrews.

Objective To investigate whether 2-[18 F]fluoro-2-deoxy-D-glucose (FDG) uptake of primary tumor in oral squamous cell carcinoma (OSCC) could predict prognosis. Study Design Sixty-nine patients with OSCC who underwent retrograde superselective intra-arterial chemoradiotherapy were recruited and underwent dual-time-point FDG positron emission tomography twice, before treatment and 4 weeks after treatment. FDG uptake was defined as the standardized uptake value (SUVmax). The retention index (RI) and the percent change in SUV (% change SUV), derived from the dual-time-point scan, were calculated. Results On univariate analysis, patients with high pre-SUV, RI, and percent change SUV values had significantly worse overall survival and disease-free survival compared with patients with low values. On multivariate analysis, high pre-RI (≥20.6%) and high percent change SUV (≥60.0%) (delayed-image) were associated with significantly worse overall survival. High pre-SUV (≥9.6) (delayed-image) and high pre-RI (≥20.6%) were associated with significantly shorter disease-free survival. Conclusions Dual-time-point FDG positron emission tomography in OSCC provided prognostic information and predicted patient outcome.

The desmoplastic ameloblastoma is a histological variant of ameloblastoma. The neoplastic epithelial islands seen in desmoplastic ameloblastoma are small and ameloblastic cells are rare. Basal cell ameloblastoma is also a rare variant of ameloblastoma, in which the tumor is composed of more primitive cells and has even fewer features of peripheral palisading. This report describes the case of a 17-year-old female with an ameloblastoma in the right anterior maxilla. Orthopantomography and computed tomography showed a well-defined lesion in the right maxilla. A partial maxillectomy for tumor resection was performed under general anesthesia. Histologically, ameloblastic tumor cells were seen with dense collagenous stroma and the tumor cells showed primarily basal cell variants of ameloblastoma. After 7 years of follow-up, clinical and radiographic examinations have revealed no evidences of recurrence.

Background: In oral lichen planus (OLP), destruction of the basal cell layer, which is one of the characteristic histological features, is seen and many changes in cell proliferation, cell repair and cell death occur in the injured mucosal epithelium. Methods: We studied mucosal tissues from 19 patients of OLP and 10 controls, with immunohistochemistry for Ki-67, p53, cyclin dependent kinase inhibitors (CDKI) and cyclins. Mitotic count was calculated. TUNEL assay was also performed for evaluation of apoptotic cell death. Results: Mitotic count, Ki-67 and cyclin D1 labeling indices in the basal and parabasal layers of OLP mucosa were elevated in comparison with those of controls. p53, p21Cip1 and TUNEL indices of OLP mucosa were also increased. Conclusions: These complex changes, which concomitantly occur in the injured mucosal epithelium, could contribute to the development and maintenance of characteristic mucosal epithelial architectures seen in OLP.

*Clinical Fellow, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. †Associate Professor, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. ‡Clinical Fellow, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. §Associate Professor, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. Senior Resident, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. ¶Lecturer, Division of Oral and Maxillofacial Surgery, Comprehensive Dentistry, Kanagawa Dental College, Yokohama Clinical Training Center, Yokohama, Japan. #Associate Professor, Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Japan. **Chair and Professor, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. Address correspondence and reprint requests to Dr Adachi: Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan; e-mail: amakoto@yokohamacu.ac.jp © 2011 American Association of Oral and Maxillofacial Surgeons 278-2391/11/6904-0034$36.00/0 oi:10.1016/j.joms.2010.02.056

Dental implant treatment has been applied widely in recent years. However, several complications sometimes have been reported. Although displacement of dental implants into the maxillary sinus commonly occurs during surgery, the migration of dental implants after a period of function, especially several years after dental implant placement, is very rare.We report here removal of migrated dental implants from the maxillary sinus 4 years and 10 months after dental implant placement.

The new technology of photofunctionalization with ultraviolet (UV) light for titanium implants has earned considerable attention. We hypothesized that UV light treatment would enhance bone formation on titanium mesh.We implemented in vitro and in vivo experiments to examine the effectiveness of UV treatment for bone formation on titanium mesh surfaces. Titanium mesh for medical use was prepared as samples, which were autoclaved and stored under dark ambient conditions for 4 weeks. UV treatment was performed for 12 minutes. Carbon contamination, hydrophilicity, and protein adhesion of the titanium mesh surface were examined in an in vitro model. Bone tissue formation around the titanium mesh was observed in a rat femur bone model. The Mann-Whitney U test was used to examine differences between the untreated and UV-treated groups. P values of.05 were considered significant.UV-mediated photofunctionalization reduced carbon contamination rates on the untreated titanium mesh surfaces. The hydrophobic surface of the untreated titanium mesh became superhydrophilic after UV-mediated photofunctionalization (P.01). The amount of protein adsorbed onto the titanium was 1.5 to 3 times greater on the photofunctionalized titanium mesh surfaces than on the untreated titanium mesh surfaces (P.01). In the animal experiment, the newly formed bone on the UV-treated titanium mesh was approximately 2.5 times greater than that on the untreated mesh (P.05).UV-mediated photofunctionalization is effective, as demonstrated by the enhanced bone tissue formation on the titanium mesh. Future studies will focus on bone augmentation using an UV-mediated photofunctionalized titanium implant and mesh.

Purpose Ultraviolet-mediated photofunctionalization is a new technology to improve bone and titanium integration. We hypothesized that photofunctionalization would enhance the stability of titanium screws used for segmental bone defects. Materials and Methods Disks were prepared of a titanium alloy (Ti6Al4V) for an in vitro study to evaluate the attachment, proliferation, and differentiation of osteoblasts. Commercially available Ti6Al4V screws were used in vivo. Segmental bone defects were created in rat femurs as an immediate loading reconstruction model. The defects were reconstructed with commercially available titanium plates and Ti6Al4V screws, with or without photofunctionalization. The screw survival rates and mechanical stability were evaluated at 2 and 4 weeks, and the bone formation around the screws was analyzed. Results Osteoblasts showed greater attachment, proliferation, and differentiation on the photofunctionalized Ti6Al4V disks. Photofunctionalized screws had significantly greater survival rates and mechanical stability at 2 and 4 weeks. The bone formation around the photofunctionalized screws was significantly greater than that around the untreated screws at 4 weeks. Conclusions The results of the present study have demonstrated the efficacy of photofunctionalization on enhancing the survival and stability of Ti6Al4V screws under a loaded condition in the reconstruction of segmental defects. This was associated with increased bioactivity and bone formation around the photofunctionalized Ti6Al4V material.

Objective This paper describes a case of secondary mandibular bone reconstruction performed to place dental implants. Osteosynthesis and simultaneous irregular trifocal distraction osteogenesis were documented. Patient The patient was a 51-year-old man with recurrent ameloblastoma of the mandible. Segmental mandibulectomy for tumor ablation and immediate mandibular reconstruction were performed. Because the volume of reconstructed bone was insufficient to place dental implants, trifocal distraction osteogenesis (vertical and horizontal distraction osteogenesis) was performed. Because the mandible had lost its continuity, osteosynthesis was performed simultaneously. Results Through this procedure, the bone was well augmented. Absorption of the distracted bone was not seen. Adequate-length implants were placed. Conclusion Irregular trifocal distraction osteogenesis synchronized with osteosynthesis shortened the treatment period and produced stable bone augmentation for placement of dental implants. Therefore, this procedure could be indicated for complicated segmental mandibular bone defects.

This report describes mandibular reconstruction using a 2-step bone transport technique in a cancer patient with type 2 diabetes mellitus (DM) who received radiotherapy before ablative surgery. The bone, measuring 90 mm in length with the mandibular curvature and good alveolar form, was regenerated using a plate-guided method. Three implants were placed 21 months after completion of the first distraction and 14 months after the second distraction. These implants integrated successfully and have remained stable more than 2 years after loading. The results suggest that mandibular reconstruction using bone transport is possible after segmental osteotomy in irradiated cancer patients with DM, although a long treatment period is required.

This paper describes a case of vertical distraction osteogenesis of a free vascularized osteocutaneous scapular flap in the reconstructed mandible before implant therapy. The patient was a 67-year-old woman with squamous cell carcinoma of the right lower gingiva. She underwent segmental mandibulectomy for tumor ablation and reconstruction with an osteocutaneous scapular flap. The distraction protocol, clinical course and implant therapy are presented. Through this procedure, the bone height of the scapular graft increased by 10 mm. Implants with adequate length could be placed in the distracted area. Two years after masticatory loading, the condition of these implants was stable. Vertical distraction osteogenesis of the scapular flap was considered effective when performed before implant therapy, to facilitate postoperative functional and esthetic restoration after tumor resection.

n r eratocystic odontogenic tumours are relatively common. In 005 they were reclassified and renamed keratocystic odonogenic tumours in the WHO classification of head and neck umours. Because they are aggressive and have a high potenial for recurrence, complete resection is vital. Causes of ecurrence are incomplete removal of the cystic lining and rowth from small satellite cysts or odontogenic epithelial ests left behind after resection.1,2 Although their treatment emains controversial, conservative or aggressive treatment s selected according to size and location of the tumour, egree of involvement of the soft tissues, and history of revious treatment. Their recurrence depends on the treatent: enucleation has a high recurrence rate because the omplete removal of the thin epithelial lining and daugher cysts is difficult, whereas resection is less likely to esult in recurrence though this can be highly invasive. Less ggressive treatment should therefore be selected for benign umours. Adjunctive measures (mechanical curettage, chemical urettage, or cryosurgery) and enucleation also have impor