ObjectivesOdontogenic keratocyst (OKC) presents considerable variation in aggressiveness and propensity for recurrence, yet hitherto, no explicit clinicopathological features have been determined to clearly demonstrate the potential for relapse. This retrospective study aims to investigate the prognostic relevance of various clinicopathological features as well as immunoexpression of COX-2, bcl-2, PCNA, and p53 in sporadic OKC.Materials and methodsAmong 41 patients with OKC treated by enucleation, the frequency of recurrence for various clinicopathological features as well as immunoexpression for COX-2, bcl-2, PCNA, and p53 was evaluated.ResultsThe mean follow-up was 8.49 years, and recurrences were ascertained in 29.27% of cases. We found significant differences between recurrent and non-recurrent cysts in terms of multilocularity (P = 0.029), cortical perforation (P = 0.001), and lesion size (P < 0.001). Hazard risk for the recurrence was 3.362 (95% CI 1.066–10.598) for multilocular cysts, 7.801 (95% CI 2.1–28.985) for evidence of cortical perforation, and 1.004 (1.002–1.006) for 1 mm2 of lesion size on panoramic radiographs. We also found that immunoexpression of PCNA significantly correlates with the radiographic evidence of cortical perforation (P = 0.048) and that there is significant positive correlation between expression of COX-2 and bcl-2 (P = 0.001) as well as significant negative correlation between immunoexpression of COX-2 and age (P = 0.002). None of the other analyzed factors were associated with the recurrence.ConclusionsLarger size, multilocularity, and cortical perforation in sporadic OKC may be correlated with the relapse.Clinical relevanceImmunohistochemical analyses of COX-2, bcl-2, PCNA, and p53 lack prognostic utility in sporadic OKC.

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We report the history of a 59-year old patient with systemic AL amyloidosis of intraoral manifestation. The patient first presented with complaints about dysphagia and remarkable enlargement of the tongue with highly reduced mobility, as well as bilateral submucosal thickenings on the cheeks. Histopathological examination of the incisional biopsy of the buccal mucosa and underlying tissues revealed AL amyloidosis. The microscopic presentation was, however, unique, as the amyloid deposits were present intracellularly in the striated muscles. The subsequent bone marrow biopsy confirmed the diagnosis of primary amyloidosis/multiple myeloma-associated amyloidosis.

Background. Odontogenic keratocysts (OKCs) are clinically aggressive lesions with relatively high recurrence rates. Dysregulation of functional equilibrium in the RANK/RANKL/OPG system is responsible for osteolysis associated with the development of OKCs. Previously published findings imply that immunoexpression of these 3 proteins may correlate with bone resorption activity in OKCs.Objectives. The rationale behind this study was to assess the potential for receptor activator of nuclear factor kappa-B (RANK), receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG) expression, as well as RANKL/OPG expression ratio, to serve as prognostic indicators for OKC recurrence. Materials and methods.We investigated the immunoexpression patterns of RANK, RANKL and OPG, and their correlation with recurrence rates, in 41 patients with OKCs treated with enucleation.Results. We found no statistically significant differences between recurrent and non-recurrent cysts in terms of either: epithelial (p = 0.404) and stromal (p = 0.469) immunoreactivity of RANK; epithelial (p = 0.649) and stromal (p = 0. 198) immunoreactivity of RANKL; or epithelial (p = 1) and stromal (p = 0.604) immunoreactivity of OPG. We also did not find significant differences in the distribution of cases with respect to ratios of RANKL/OPG immunostaining scores between recurrent and non-recurrent OKCs, both in the epithelium and in the connective tissue (p = 1 and p = 0.237, respectively). Conclusions.Our results suggest that immunoexpression levels of RANK, RANKL and OPG at the time of pathological diagnosis, as well as the RANKL/OPG ratio, are not useful as prognostic markers for OKC recurrence.

Introduction: Standard local anaesthetics do not guarantee complete absence of pain during endodontic debridement of the in lamed pulp. We investigated whether the addition of mg of morphine to local articaine anaesthesia as compared to articaine alone could reduce pain sensations during endodontic debridement and within h after the procedure. Materials and methods: Thirty-two patients with pain attributed to irreversible pulpitis of the irst upper molar participated in this randomized, double-blind trial. Patients were randomly assigned either to the study group (patients receiving periapical injection of modi ied local anaesthetic solution with morphine, n = ) or to the control group (patients receiving standard anaesthetic solution without morphine, n = ). The pain intensity was assessed using the visual analogue scale and verbal score before and directly after endodontic debridement, as well as at , , , , and h after the procedure. Results:Neither the visual analogue scale nor verbal score differed between both groups before or during the endodontic debridement, as well as during -hour follow-up. However, there was an insigni icant tendency for greater pain relief in patients treated with articaine and morphine at h after endodontic debridement (p = . ). The study was funded by a Jagiellonian University in Poland (JU) grant, and was registered with the JU Ethical Committee No. /K/ZDS/ . Conclusions: The addition of morphine to local articaine anaesthesia does not in luence pain intensity in patients undergoing endodontic debridement in contrast to the previously described pain-relief effect in patients after oral surgery. However, future studies are needed to evaluate the role of opioids in local anaesthesia in endodontic procedures. Keywords: pulpitis; endodontic debridement; articaine; morphine; pain. ABSTRAKT Wstęp: Standardowe znieczulenie miejscowe nie gwarantuje całkowitego ustąpienia bólu podczas zabiegu endodontycznego usuwania miazgi w stanie nieodwracalnego zapalenia. Celem pracy było sprawdzenie, czy miejscowe znieczulenie za pomocą mor iny w dawce mg dodanej do standardowego znieczulenia za pomocą artykainy w porównaniu z samą artykainą zmniejszy odczuwanie bólu w czasie godz. po zabiegu endodontycznym. Materiały i metody: W podwójnie ślepej próbie klinicznej uczestniczyły osoby, które miały nieodwracalne zapalenie miazgi pierwszego zęba trzonowego szczęki. Uczestnicy badania byli zrandomizowani do dwóch grup: grupy badawczej, która otrzymywała artykainę i mor inę (n = ), oraz grupy kontrolnej, która otrzymywała tylko artykainę (n = ). Nasilenie bólu badano za pomocą numerycznej skali oceny bólu oraz skali wzrokowo--analogowej przed zabiegiem oraz , , , , i godz. po zabiegu.Wyniki: Nie stwierdzono istotnych różnic nasilenia bólu między dwoma grupami w obu skalach oceny bólu we wszystkich kolejnych punktach oceny aż do godz. po zabiegu. Stwierdzono jedynie nieistotne statystycznie mniejsze odczuwanie bólu po godz. u chorych leczonych mor iną i artykainą (p = , ). Badanie było inansowane z ...

Introduction: Impacted upper central incisors are a big aesthetic, developmental and social problem for patients. One of the causes of tooth eruption is dilaceration, which is the angulation of the tooth root in relation to its crown. The prognosis regarding the possibility of introducing teeth with dilaceration to the dental arch is uncertain and is characterized by a large number of failures. The aim of the study was to conduct a systematic review of the literature discussing the subject of impacted upper central incisors with confirmed dilaceration and illustrate this problem with the presentation of our own clinical case. Objectives: The aim of the study was to conduct a systematic review of the literature discussing the subject of impacted maxillary central incisors with confirmed dilaceration and to illustrate this problem with the presentation of a clinical case. Material and methods: A systematic review of the literature was conducted by searching the medical databases of PubMed and Scopus. The search was carried out by entering the following keywords: dilaceration, impacted tooth, impacted maxillary central incisors. Non-systematic reviews of the literature were excluded from the analysis. Results: The result of searching the databases was a total of 706 articles. Twenty-nine articles corresponding to the objectives of the study were included in the analysis. Among them were original papers, meta-analyses and case reports. The problem of impacted upper central incisors with the diagnosed dilaceration is illustrated by the description of the orthodontic and surgical treatment of the case. Conclusions: Patients with diagnosed impacted tooth with dilaceration require detailed diagnostics to plan orthodontic treatment. The implementation of a comprehensive orthodontic and surgical treatment at an early stage of tooth development gives the best prognosis to introduce a tooth with dilaceration to the dental arch.

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