Publications by authors named "Ricardo J Padilla"

21 Publications

  • Page 1 of 1

SARS-CoV-2 infection of the oral cavity and saliva.

Nat Med 2021 Mar 25. Epub 2021 Mar 25.

Division of Oral & Craniofacial Health Sciences, University of North Carolina Adams School of Dentistry, Chapel Hill, NC, USA.

Despite signs of infection-including taste loss, dry mouth and mucosal lesions such as ulcerations, enanthema and macules-the involvement of the oral cavity in coronavirus disease 2019 (COVID-19) is poorly understood. To address this, we generated and analyzed two single-cell RNA sequencing datasets of the human minor salivary glands and gingiva (9 samples, 13,824 cells), identifying 50 cell clusters. Using integrated cell normalization and annotation, we classified 34 unique cell subpopulations between glands and gingiva. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral entry factors such as ACE2 and TMPRSS members were broadly enriched in epithelial cells of the glands and oral mucosae. Using orthogonal RNA and protein expression assessments, we confirmed SARS-CoV-2 infection in the glands and mucosae. Saliva from SARS-CoV-2-infected individuals harbored epithelial cells exhibiting ACE2 and TMPRSS expression and sustained SARS-CoV-2 infection. Acellular and cellular salivary fractions from asymptomatic individuals were found to transmit SARS-CoV-2 ex vivo. Matched nasopharyngeal and saliva samples displayed distinct viral shedding dynamics, and salivary viral burden correlated with COVID-19 symptoms, including taste loss. Upon recovery, this asymptomatic cohort exhibited sustained salivary IgG antibodies against SARS-CoV-2. Collectively, these data show that the oral cavity is an important site for SARS-CoV-2 infection and implicate saliva as a potential route of SARS-CoV-2 transmission.
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http://dx.doi.org/10.1038/s41591-021-01296-8DOI Listing
March 2021

CRTC1/MAML2 directs a PGC-1α-IGF-1 circuit that confers vulnerability to PPARγ inhibition.

Cell Rep 2021 Feb;34(8):108768

Division of Oral and Craniofacial Health Sciences, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Cell Biology and Physiology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Biomedical Research Imaging Center, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, Cancer Cell Biology Program, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address:

Mucoepidermoid carcinoma (MEC) is a life-threatening salivary gland cancer that is driven primarily by a transcriptional coactivator fusion composed of cyclic AMP-regulated transcriptional coactivator 1 (CRTC1) and mastermind-like 2 (MAML2). The mechanisms by which the chimeric CRTC1/MAML2 (C1/M2) oncoprotein rewires gene expression programs that promote tumorigenesis remain poorly understood. Here, we show that C1/M2 induces transcriptional activation of the non-canonical peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1α) splice variant PGC-1α4, which regulates peroxisome proliferator-activated receptor gamma (PPARγ)-mediated insulin-like growth factor 1 (IGF-1) expression. This mitogenic transcriptional circuitry is consistent across cell lines and primary tumors. C1/M2-positive tumors exhibit IGF-1 pathway activation, and small-molecule drug screens reveal that tumor cells harboring the fusion gene are selectively sensitive to IGF-1 receptor (IGF-1R) inhibition. Furthermore, this dependence on autocrine regulation of IGF-1 transcription renders MEC cells susceptible to PPARγ inhibition with inverse agonists. These results yield insights into the aberrant coregulatory functions of C1/M2 and identify a specific vulnerability that can be exploited for precision therapy.
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http://dx.doi.org/10.1016/j.celrep.2021.108768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955229PMC
February 2021

Correction: Global deletion of optineurin results in altered type I IFN signaling and abnormal bone remodeling in a model of Paget's disease.

Cell Death Differ 2021 Feb;28(2):825-826

Immunity, Inflammation, and Disease Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, 27709, USA.

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http://dx.doi.org/10.1038/s41418-020-0586-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862615PMC
February 2021

Desmoplastic fibroma associated with tuberous sclerosis: case report and literature review.

Oral Surg Oral Med Oral Pathol Oral Radiol 2019 Aug 16;128(2):e92-e99. Epub 2019 Mar 16.

Assistant Professor, Interim Chief and Residency Program Director, Division of Oral and Maxillofacial Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. Electronic address:

Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder that affects the skin, brain, kidneys, and other organ systems. It may exhibit a wide spectrum of clinical manifestations. Desmoplastic fibroma (DF) of the jaw is a rare benign myofibroblastic neoplasm. Less than 10 cases of DF associated with TSC have been published previously. We report a new case of a maxillary DF in a 12-year-old girl with TSC. The presentation, diagnostic process, and management of this case are discussed, and the literature is reviewed for the additional cases of DF associated with TSC; 7 previously reported cases are summarized. Small sample size limits conclusions, but there may be differences in the presentations of DF of the jaws in patients with TSC vs those in the general population. DF of the jaws may be a manifestation of TSC, and the authors propose surveillance panoramic radiographs every 2 to 3 years in patients with TSC.
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http://dx.doi.org/10.1016/j.oooo.2019.03.008DOI Listing
August 2019

Identification of NSDHL mutations associated with CHILD syndrome in oral verruciform xanthoma.

Oral Surg Oral Med Oral Pathol Oral Radiol 2019 Jul 23;128(1):60-69. Epub 2019 Feb 23.

Departments of Oral and Craniofacial Health Sciences and Dental Ecology, UNC School of Dentistry, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, UNC School of Medicine, Chapel Hill, NC, USA. Electronic address:

Objective: The aim of this study was to perform a systematic analysis of the nicotinamide adenine dinucleotide phosphate (NAD[P])-dependent steroid dehydrogenase-like (NSDHL) gene in cases of oral verruciform xanthoma (VX) and to test for the presence of mutations associated with congenital hemidysplasia with ichthyosiform nevus and limb defects (CHILD) syndrome.

Study Design: DNA was extracted from archived paraffin-embedded tissue of oral VX and control cases. Polymerase chain reaction (PCR) was then used to screen exons 4 and 6 of the NSDHL gene for the presence of 4 known germline mutations associated with CHILD syndrome and 1 somatic mutation previously identified in VX lesions with no known association with CHILD syndrome.

Results: Of the 16 oral VX tissue samples, 8 (50%) had known missense mutations associated with CHILD syndrome. Furthermore, 2 of these 8 tissue samples also had an additional missense mutation previously identified in cutaneous VX lesions. No mutations of exons 4 and 6 were found in the 5 negative control tissue samples.

Conclusions: NSDHL gene mutations associated with CHILD syndrome are common in sporadic oral VX cases, suggesting that these mutations confer a greater risk for the development of epithelial barrier defects that promote recurrent oral VX lesions and the potential for direct germline transmission of oral VX susceptibility.
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http://dx.doi.org/10.1016/j.oooo.2019.02.015DOI Listing
July 2019

Global deletion of Optineurin results in altered type I IFN signaling and abnormal bone remodeling in a model of Paget's disease.

Cell Death Differ 2020 01 10;27(1):71-84. Epub 2019 May 10.

Immunity, Inflammation, and Disease Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, 27709, USA.

Genome-wide association studies (GWAS) have identified Optineurin (OPTN) as genetically linked to Paget's disease of the bone (PDB), a chronic debilitating bone remodeling disorder characterized by localized areas of increased bone resorption and abnormal bone remodeling. However, only ~10% of mouse models with a mutation in Optn develop PDB, thus hindering the mechanistic understanding of the OPTN-PDB axis. Here, we reveal that 100% of aged Optn global knockout (Optn) mice recapitulate the key clinical features observed in PDB patients, including polyostotic osteolytic lesions, mixed-phase lesions, and increased serum levels of alkaline phosphatase (ALP). Differentiation of primary osteoclasts ex vivo revealed that the absence of Optn resulted in an increased osteoclastogenesis. Mechanistically, Optn-deficient osteoclasts displayed a significantly decreased type I interferon (IFN) signature, resulting from both defective production of IFNβ and impaired signaling via the IFNα/βR, which acts as a negative feedback loop for osteoclastogenesis and survival. These data highlight the dual roles of OPTN in the type I IFN response to restrain osteoclast activation and bone resorption, offering a novel therapeutic target for PDB. Therefore, our study describes a novel and essential mouse model for PDB and define a key role for OPTN in osteoclast differentiation.
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http://dx.doi.org/10.1038/s41418-019-0341-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7205997PMC
January 2020

Inter-observer Variability in the Diagnosis of Proliferative Verrucous Leukoplakia: Clinical Implications for Oral and Maxillofacial Surgeon Understanding: A Collaborative Pilot Study.

Head Neck Pathol 2020 Mar 10;14(1):156-165. Epub 2019 Apr 10.

Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, CA, USA.

The use of diverse terminology may lead to inconsistent diagnosis and subsequent mistreatment of lesions within the proliferative verrucous leukoplakia (PVL) spectrum. The objectives of this study were: (a) to measure inter-observer variability between a variety of pathologists diagnosing PVL lesions; and (b) to evaluate the impact of diverse terminologies on understanding, interpretation, and subsequent treatment planning by oral and maxillofacial surgeons (OMFS). Six oral pathologists (OP) and six head and neck pathologists (HNP) reviewed 40 digitally scanned slides of PVL-type lesions. Inter-observer agreement on diagnoses was evaluated by Fleiss' kappa analysis. The most commonly used diagnostic terminologies were sent to ten OMFS to evaluate their resulting interpretations and potential follow-up treatment approaches. The overall means of the surgeons' responses were compared by Student t test. There was poor inter-observer agreement between pathologists on the diagnosis of PVL lesions (κ = 0.270), although there was good agreement (κ = 0.650) when diagnosing frankly malignant lesions. The lowest agreement was in diagnosing verrucous hyperplasia (VH) with/without dysplasia, atypical epithelial proliferation (AEP), and verrucous carcinoma (VC). The OMFS showed the lowest agreement on identical categories of non-malignant diagnoses, specifically VH and AEP. This study demonstrates a lack of standardized terminology and diagnostic criteria for the spectrum of PVL lesions. We recommend adopting standardized criteria and terminology, proposed and established by an expert panel white paper, to assist pathologists and clinicians in uniformly diagnosing and managing PVL spectrum lesions.
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http://dx.doi.org/10.1007/s12105-019-01035-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021885PMC
March 2020

Relationship of infiltrating intraepithelial T lymphocytes in the diagnosis of oral lichen planus versus oral epithelial dysplasia: a pilot study.

Oral Surg Oral Med Oral Pathol Oral Radiol 2019 Jun 13;127(6):e123-e135. Epub 2019 Feb 13.

Kaneda Family Distinguished Associate Professor, Oral and Maxillofacial Pathology, Department of Diagnostic Sciences, University of North Carolina at Chapel Hill, School of Dentistry, 101 Manning Drive, Chapel Hill, NC, USA.

Objective: The aim of this study was to identify the type and distribution of CD4+ and CD8+ T lymphocytes in oral mucosal specimens to potentially distinguish between underlying alterations or patterns in oral epithelial dysplasia and oral lichen planus.

Study Design: This pilot study included 10 archived tissue samples that were received at the University of North Carolina Oral and Maxillofacial Pathology Laboratory and were diagnosed as oral lichen planus and moderate to severe epithelial dysplasia. Dual staining with CD4 and CD8 antibodies was carried out on each case. Slides were scanned in the Aperio ScanScope FL (Leica Biosystems, Wetzlar, Germany) and archived. Histomorphometric analysis was performed to detect inflammatory cells expressing CD4 and CD8 biomarkers in the epithelial and connective tissue regions.

Results: No differences were found in the amount and ratio of CD4+/CD8+ lymphocytes among the 3 groups analyzed; however, the intraepithelial CD8+ lymphocyte distribution was strikingly different between lichen planus and moderate to severe epithelial dysplasia.

Conclusions: The localization of CD8+ cells can be potentially useful as an adjunctive diagnostic procedure to distinguish oral epithelial dysplasia from other inflammatory entities, such as lichen planus.
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http://dx.doi.org/10.1016/j.oooo.2019.02.004DOI Listing
June 2019

Expression of ETS1 and LEF1 in salivary glands of Sjögren syndrome patients.

Oral Dis 2019 Jan 22;25(1):164-173. Epub 2018 Oct 22.

Department of Oral Medicine, Carolinas HealthCare System, Charlotte, North Carolina.

Objective: Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease affecting exocrine glands, thereby causing dry mouth and eyes (sicca). Our objective was to determine the expression of pSS pathogenic biomarker MMP9 and its putative transcription factors ETS1 and LEF1, in labial salivary glands of pSS patients.

Methods: Sicca patients were assigned to three groups based on focus score (FS): non-pSS sicca (i.e., GR1 [FS = 0] and GR2 [0 < FS < 1]) and pSS (i.e., GR3 [FS ≥ 1]). We determined the mRNA and protein expression of MMP9, ETS1, and LEF1 in salivary gland biopsies. Also, ETS1-CD4 and LEF1-CD4 co-expression analyses were performed.

Results: The mRNA expression of MMP9, ETS1, and LEF1 was upregulated in GR3 compared to GR1 (p < 0.01). Most GR3 salivary gland areas had moderate to high MMP9, ETS1, and LEF1 protein expression compared to GR1 and GR2. Further, ETS1-CD4 and LEF1-CD4 dual staining demonstrated that both salivary gland epithelial cells and lymphocytic infiltrates had increased levels of ETS1 and LEF1. Moreover, there was a strong correlation between ETS1(+)-CD4(-) and LEF1(+)-CD4(-) cells.

Conclusion: These results suggest, for the first time, a concerted increase in ETS1 and LEF1 expression in salivary gland epithelial cells of pSS patients that is reflective of the etiopathogenesis of pSS.
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http://dx.doi.org/10.1111/odi.12985DOI Listing
January 2019

Comparing panoramic radiographs and cone beam computed tomography: Impact on radiographic features and differential diagnoses.

Oral Surg Oral Med Oral Pathol Oral Radiol 2018 Apr 17. Epub 2018 Apr 17.

Department of Diagnostic Sciences, University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, NC, USA.

Objectives: The aims of this study were to determine whether lesion features appear differently on panoramic radiography (PAN) and cone beam computed tomography (CBCT), and whether the use of CBCT affects diagnostic accuracy and observers' confidence in comparison with PAN.

Study Design: Three oral and maxillofacial radiologists reviewed 33 sets of PAN images and CBCT volumes of biopsy-proven lesions. They described 12 different lesion features and provided up to 3 ranked differential diagnoses, as well as their confidence with respect to those diagnoses. Their confidence was weighted by the rank at which the correct diagnosis was provided.

Results: Odds ratios (ORs) were statistically significant for border definition (OR = 5.45; P = .004), continuity of border cortication (OR = 0.34; P = .035), effect on neurovascular canals (OR = 6.38; P = .043), expansion (OR = 18.56; P < .001), cortical thinning (OR = 30.22; P < .001), and cortical destruction (OR = 9.80; P < .001). There was no association between the 2 modalities and the rank at which the correct differential diagnoses were made or the observers' weighted confidence.

Conclusions: Before acquiring a CBCT scan to aid in the diagnosis of an intraosseous lesion, clinicians should consider the diagnostic information that is expected to be gained. In this study, although there were differences between PAN and CBCT with respect to some lesion features, CBCT did not help improve diagnostic accuracy.
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http://dx.doi.org/10.1016/j.oooo.2018.03.019DOI Listing
April 2018

Considerations in the diagnosis of oral hairy leukoplakia-an institutional experience.

Oral Surg Oral Med Oral Pathol Oral Radiol 2018 03 15;125(3):232-235. Epub 2017 Nov 15.

Department of Diagnostic Sciences, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Objective: We report here the 10-year experience with oral hairy leukoplakia (OHL) at the Division of Oral and Maxillofacial Pathology at the University of North Carolina at Chapel Hill, NC, USA.

Study Design: All the associated hematoxylin and eosin and Epstein-Barr virus encoding region in situ hybridization slides of OHL cases between January 1, 2008, and February 1, 2017, were retrieved and reviewed. Collected demographic characteristics, clinical presentation, medical and social histories were reviewed and reported.

Results: Six OHL cases with confirmed in situ hybridization showed predilection for the lateral tongue. The study included 3 females and 3 males (mean age 50.5 years; age range 29-70 years). One patient had known HIV-positive status before biopsy was performed. Three patients had reported a history of heavy smoking. Other medical conditions reported were history of breast cancer, a long history of corticosteroid inhaler use for asthma treatment, high cholesterol, diabetes, and hypertension.

Conclusions: The findings of this study indicate the need to include OHL as a potential entity in the differential diagnosis of leukoplakic tongue lesions, regardless of the patient's HIV status. In addition, the presence of OHL in the patient requires investigation of various explanations for EBV infection, including immunosuppression caused by HIV infection or chronic steroid use.
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http://dx.doi.org/10.1016/j.oooo.2017.10.017DOI Listing
March 2018

Massive enlargement of the anterior mandible.

Oral Surg Oral Med Oral Pathol Oral Radiol 2016 Jul 13;122(1):3-9. Epub 2015 Oct 13.

Oral and Maxillofacial Pathology Program Director, Clinical Associate Professor, University of North Carolina at Chapel Hill, NC, USA.

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http://dx.doi.org/10.1016/j.oooo.2015.09.020DOI Listing
July 2016

Carcinoma cuniculatum of the oral mucosa: a potentially underdiagnosed entity in the absence of clinical correlation.

Oral Surg Oral Med Oral Pathol Oral Radiol 2014 Dec 30;118(6):684-93. Epub 2014 Aug 30.

Professor and Chair, Department of Diagnostic Sciences, University of North Carolina School of Dentistry, Chapel Hill, NC, USA.

Objective: To delineate the features of carcinoma cuniculatum (CC), emphasizing potential management errors.

Study Design: A retrospective study examined archival cases of CC. An analysis of clinical, microscopic, and management parameters was performed.

Results: Ten cases were identified, and their clinical and microscopic features were summarized. CC exhibits a sessile pink/red mildly papillary surface. Histologically, CC presents a tortuous invasive component with a more subtle papillary appearance than verrucous carcinoma.

Conclusions: CC is an uncommon variant of squamous cell carcinoma distinct from verrucous carcinoma. Diagnostic delays result from misinterpretation of superficial samples or lack of awareness of the entity. Bland cytology and unusual architecture result in underdiagnosis of CC without clinicopathologic correlation. Clinicians should submit multiple deep samples of lesions displaying a cobblestone-like surface and provide a clinical photograph to the pathologist. Pathologists can avoid underdiagnosis by thorough sampling of biopsies and requesting additional tissue as needed.
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http://dx.doi.org/10.1016/j.oooo.2014.08.011DOI Listing
December 2014

Evaluation of a collagen scaffold for cell-based bone repair.

Int J Oral Maxillofac Implants 2014 Jan-Feb;29(1):e122-9

Purpose: To determine whether a collagen scaffold could provide an environment for mesenchymal stem cell (MSC)-related bone repair of critical-size bone defects in rat calvaria.

Materials And Methods: Craniotomy defects were created in 28 adult Sprague-Dawley rats. Two additional rats were used as MSC donors by means of femoral bone marrow lavage and culture. The rats were randomly divided into four groups: (1) empty/no graft; (2) collagen scaffold (matrix)+saline; (3) matrix+MSCs; (4) matrix+bone morphogenetic protein. The animals were euthanized 28 days after surgery. Microcomputed tomographic reconstructions were obtained to measure bone fill. The specimens were processed for histologic examination, and the total defect and bone fill areas were measured.

Results: Mean bone fill (± standard deviation) of 9.25%±10.82%, 19.07%±17.38%, 44.21%±3.93%, and 66.06%±15.08%, respectively, was observed for the four groups; the differences were statistically significant. Bone repair was statistically significant for groups 3 and 4. No significant difference was seen for bone repair between groups 1 and 2 or between groups 3 and 4. Bone formation differed significantly across the four groups. Statistically significant changes in radiodensity were observed between groups 1 and 3, groups 1 and 4, and groups 2 and 4. Significant differences were not observed between groups 1 and 2, groups 2 and 3, or groups 3 and 4.

Conclusion: After grafting of adult MSCs adherent within a collagen matrix, repair of bone was significant. Expanded three-dimensional collagen represents a radiolucent, resorbable, biocompatible scaffold that is capable of supporting MSC repair of bone.
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http://dx.doi.org/10.11607/jomi.te51DOI Listing
May 2014

Use of archived biopsy specimens to study gene expression in oral mucosa from chemotherapy-treated cancer patients.

Oral Surg Oral Med Oral Pathol Oral Radiol 2013 May 28;115(5):630-7. Epub 2013 Mar 28.

Cannon Research Center, Carolinas Medical Center, Charlotte, NC 28203, USA.

Objectives: Oral mucositis caused by cancer chemotherapy can result in significant clinical complications. There is a strategic need to accelerate the delineation of the pathobiology. This proof-of-principle study was designed to demonstrate the feasibility of studying archived oral mucosal specimens to further delineate oral mucositis pathobiology.

Materials And Methods: Twenty-nine formalin-fixed and paraffin-embedded tissue blocks of 25-year-old oral mucosa autopsy specimens from cancer chemotherapy patients were studied. Standardized technology was utilized, including RNA isolation and amplification, array hybridization, and gene expression analysis.

Results: A predominance of DNA damage in buccal mucosal basal keratinocytes was observed. Data comparing basal cells from buccal vs. gingival mucosa identified differential gene expression of host responses in relation to pathways relevant to oral mucositis pathogenesis, including responses to cancer-associated inflammation.

Conclusions: This proof-of-principle study demonstrated that archived oral mucosal specimens may be a potentially valuable resource for the study of oral mucositis in cancer patients.
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http://dx.doi.org/10.1016/j.oooo.2013.01.003DOI Listing
May 2013

Incidental findings from cone beam computed tomography of the maxillofacial region: a descriptive retrospective study.

Clin Oral Implants Res 2012 Nov 30;23(11):1261-8. Epub 2011 Sep 30.

Division of Oral and Maxillofacial Radiology, Department of Diagnostic Sciences and General Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA.

Objective: To evaluate the type and prevalence of incidental findings from cone beam computed tomography (CBCT) of the maxillofacial region. Findings are divided into those that require (i) intervention/referral, (ii) monitoring, and (iii) no further evaluation.

Methods: Three hundred consecutive CBCT scans conducted in the University of North Carolina School of Dentistry Oral and Maxillofacial Radiology Clinic from January 1 to August 31, 2008 were retrospectively reviewed. Findings were categorized into airway, soft tissue calcifications, bone, temporomandibular joint (TMJ), endodontic, dental developmental, and pathological findings.

Results: A total of 272 scans revealed 881 incidental findings (3.2 findings/scan). The most prevalent was airway findings (35%) followed by soft tissue calcifications (20%), bone (17.5%), TMJ (15.4%), endodontic (11.3%), dental developmental (0.7%), and pathological (0.1%). 16.1% required intervention/referral, 15.6% required monitoring, and the remainder (68.3%) required neither.

Conclusion: This study underscores the need to thoroughly examine all CBCT volumes for clinically significant findings within and beyond the region of interest.
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http://dx.doi.org/10.1111/j.1600-0501.2011.02299.xDOI Listing
November 2012

The spectrum of gnathic osteosarcoma: caveats for the clinician and the pathologist.

Head Neck Pathol 2011 Mar 3;5(1):92-9. Epub 2010 Nov 3.

Division of Oral and Maxillofacial Pathology, Department of Diagnostic Sciences, University of North Carolina, Chapel Hill, NC, USA.

Seven expansile jaw lesions in patients ranging from 7 to 63 years are presented to illustrate diagnostic and management issues pertaining to cases ultimately proven to be gnathic osteosarcoma (GO). Six of the cases in our series were low-grade osteoblastic and one high-grade chondroblastic. None of our cases exhibited the characteristic "sunburst" radiopaque appearance described for GO. All of our cases displayed cortical expansion and one showed development of diastema. Two occurred in the maxilla and five in the mandible. Two of the patients with mandibular lesions presented initially with pain; all other patients were asymptomatic. Lack of pain resulted in a delay in diagnosis due to postponement of consultation or biopsy. Two cases underwent initial shallow non-representative biopsies, requiring a second biopsy for definitive diagnosis, further delaying treatment. Those biopsies were initially interpreted as pyogenic granuloma and peripheral ossifying fibroma, respectively. GO should always be considered in the differential diagnosis of expansile jaw lesions. Bone biopsies of lesions exhibiting pain and expansion of cortical plates should include medullary bone in order to minimize sampling error. In addition, all rapidly growing or painful exophytic bone lesions, and presumed soft tissue lesions that may involve underlying bone, should be examined histopathologically, and receive clinical and radiographic follow-up until complete resolution or healing is evident, regardless of the diagnosis. Based on the positive outcomes of the patients in our series, the prognosis of GO appears to be relatively favorable when compared to other sarcomas and osteosarcomas of long bones.
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http://dx.doi.org/10.1007/s12105-010-0218-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037463PMC
March 2011

Featured topic: contact allergy to dental fillings.

J Esthet Restor Dent 2009 ;21(5):355-6

Department of Operative Dentistry, University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, NC, USA.

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http://dx.doi.org/10.1111/j.1708-8240.2009.00289.xDOI Listing
January 2010

AAOMP Case Challenge: a non-expansile radiolucency of the posterior mandible.

J Contemp Dent Pract 2008 Nov 1;9(7):122-6. Epub 2008 Nov 1.

A 14-year-old Caucasian female was referred by her orthodontist with a non-expansile radiolucent lesion associated with impacted tooth #31.
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November 2008

The effect of hydrofluoric acid treatment of TiO2 grit blasted titanium implants on adherent osteoblast gene expression in vitro and in vivo.

Biomaterials 2007 Dec 14;28(36):5418-25. Epub 2007 Sep 14.

Dental Research Center, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

It is widely accepted that implant surface factors affect the quality of the bone-to-implant interface. Recent additional treatments superimposed on moderately rough cpTitanium surface provide further enhancement of bone-to-implant contact. The aim of this study was to compare osteoinductive and bone-specific gene expression in cells adherent to titanium dioxide-grit blasted (TiO2) versus TiO2 grit blasted and HF treated (TiO2/HF) cpTitanium implant surfaces. MC3T3-E1 cells were grown in osteogenic supplements on the titanium disk surfaces for 1-14 days. Real-time PCR was used to measure RUNX-2, Osterix, and bone sialoprotein (BSP) mRNA levels. Implants were placed in rat tibia and, following harvesting at 1-7 days after placement, real-time PCR was used to measure RUNX-2, alkaline phosphatase (ALP), and BSP mRNA levels in implant adherent cells. In cell culture, RUNX-2 and Osterix levels were significantly increased (p<0.05) on the TiO2/HF surfaces as compared to the TiO2 and smooth surfaces through the cultural period, while BSP expression was elevated on both TiO2 and TiO2/HF surfaces when compared to a machined surface control. In cells adherent to implants retrieved from rat tibia, RUNX-2 mRNA levels were 2-fold and 8-fold greater on the TiO2/HF surfaces at 1-3 and 7 days following implantation. This was paralleled by significantly greater levels of ALP at 3 and 7 days and BSP mRNA at 7 days following implantation. As a marker of osteoinduction, the increased levels of RUNX-2 in cells adherent to the TiO2/HF surfaces suggest that the additional HF treatment of the TiO2 grit blasted surface results in surface properties that support adherent cell osteoinduction. In vivo assessments of implant adherent cell phenotypes provide further insight into the mechanisms affecting alloplast-tissue interactions.
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http://dx.doi.org/10.1016/j.biomaterials.2007.08.032DOI Listing
December 2007

The AAOMP case challenge: painful mandibular mass associated with a molar.

J Contemp Dent Pract 2003 May 15;4(2):87-91. Epub 2003 May 15.

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May 2003