Oral papilloma lesions may appear as a result of HPV infection, or not, and only special molecular methods could differentiate them. Low-risk and high-risk HPV types could induce oral HPV papillomatosis with different natural evolution, clearance and persistence mechanisms. The pathogenic mechanisms are based on the crosstalk between the oral epithelial and immune cells and this very efficient virus. HPV acts as a direct inducer in the process of transforming a benign lesion into a malignant one, the cancerization process being also debated in this paper. According to the degree of malignity, three types of papillomatous lesions can be described in the oral cavity: benign lesions, potential malign disorders and malignant lesions. The precise molecular diagnostic is important to identify the presence of various virus types and also the virus products responsible for its oncogenicity. An accurate diagnostic of oral papilloma can be established through a good knowledge of etiological and epidemiological factors, clinical examination and laboratory tests. This review intends to update the pathogenic mechanisms driving the macroscopic and histological features of oral papillomatosis having HPV infection as the main etiological factor, focusing on its interreference in the local immunity. In the absence of an accurate molecular diagnostic and knowledge of local immunological conditions, the therapeutic strategy could be difficult to decide.

Medication-related osteonecrosis of the jaw (MRONJ) is a major complication of bisphosphonate treatment in cancer patients, and its etiology is not completely clarified. The study’s goal is to find connections between the clinical and histopathological characteristics of osteonecrosis and bisphosphonates in a cohort of cancer patients who had osteonecrosis treated surgically. The retrospective study includes 51 patients of both sexes, aged 46 to 85 years, who underwent surgical treatment for MRONJ in two oral and maxillofacial surgery clinics (Craiova and Constanța). Demographic, clinical, and imaging data from the records of patients with osteonecrosis were analyzed. The surgical treatment removed the necrotic bone, and the harvested fragments were analyzed from a histopathological perspective. The histopathological examination data were evaluated and statistically processed to look for viable bone, granulation tissue, bacterial colonies, and inflammatory infiltrate. In the study groups, MRONJ was found particularly in the posterior regions of the mandible. Tooth extraction, but also periapical or periodontal infections, represented the trigger factors in most of the cases. The surgical therapy consisted of sequestrectomy or bone resection, and the histopathological examination of the fragments revealed osteonecrosis-specific features, such as the lack of bone cells, the development of an inflammatory infiltrate, and the existence of bacterial colonies. MRONJ in cancer patients receiving zoledronic acid is a severe complication that significantly lowers quality of life. Since these patients are not usually monitored by the dentist, they are identified in advanced stages of MRONJ. For these patients, thorough dental monitoring could reduce the incidence of osteonecrosis and its related complications.

MRONJ (Medication-Related Osteonecrosis of the Jaw) is a condition observed in a subset of cancer patients who have undergone treatment with zoledronic acid in order to either prevent or treat bone metastases. The primary aim of this research was to establish the importance of risk factors in the development of medication-related osteonecrosis of the jaw in cancer patients receiving zoledronic acid therapy for bone metastases. The present study is an observational retrospective investigation conducted at two university centers, namely, Craiova and Constanța, and included cancer patients treated with zoledronic acid. The medical records of the patients were obtained over a four-year timeframe spanning from June 2018 to June 2022. The data analysis was carried out between January 2021 and October 2022. Patients were treated for cancer, bone metastases, and MRONJ according to the international guidelines. The research investigated a cohort of 174 cancer patients (109 females and 65 males) aged between 22 and 84 years (with a mean age 64.65 ± 10.72 years) seeking treatment at oncology clinics situated in Craiova and Constanța. The study conducted a binomial logistic regression to analyze ten predictor variables, namely, gender, age, smoking status, treatment duration, chemotherapy, radiotherapy, endocrine therapy, presence of diabetes mellitus (DM), obesity, and hypertension (HT). The results of the analysis revealed that only five of the ten predictor variables were statistically significant for MRONJ occurrence: duration of treatment (p < 0.005), chemotherapy (p = 0.007), and hypertension (p = 0.002) as risk factors, and endocrine therapy (p = 0.001) and obesity (p = 0.024) as protective factors.

Impairment of the immune response in MRONJ (medication-related osteonecrosis of the jaws) is one of the still unclear etiopathogenic mechanisms of this condition encountered in cancer patients treated with bisphosphonates, with negative effects on the patient’s quality of life. The aim of the present study was to correlate the immune response with etiopathogenic factors via immunohistochemical evaluation of the maxillary tissues in zoledronic acid osteonecrosis. The retrospective study included a group of 51 patients with various types of cancers, diagnosed with stage 2 or 3 MRONJ at zoledronic acid and treated surgically. Immunohistochemical expressions of αSMA, CD3, CD4, CD8, CD20, CD79α, CD68, CD204, and tryptase were evaluated. Immunohistochemical markers expressions were statistically analyzed according to the duration of the treatment, the trigger factor, the location of the MRONJ, and the healing status. Analysis of the immune response included T lymphocytes, B lymphocytes, plasma cells, macrophages, and mast cells. The duration of treatment significantly influenced the immunohistochemical expression of most markers (p < 0.05). For an increasing trend in treatment duration, a decreasing trend in marker score was observed, suggesting an inverse correlation. The expression of the markers was different depending on the trigger factor, on MRONJ localization (maxilla/mandible), and the healing status, being more intense in patients cured per primam compared to those who had relapses. The patient’s immune response was negatively influenced by the duration of the treatment, the trigger factor, the location of the lesion in the mandible, and the recurrence of MRONJ.

Artificial intelligence (AI) is rapidly transforming the medical oncology, by providing new tools for early diagnosis and personalized treatment planning. In mandibular oncology, where malignant transformation and metastatic progression can drastically alter prognosis, AI-driven systems show great promise in enhancing clinical decision-making. Convolutional neural networks and deep learning algorithms have already demonstrated high accuracy in analyzing imaging datasets, including CT scans and histopathological slides, for the detection of subtle changes that may indicate malignant transformation of initially benign lesions. These tools also aid in identifying early metastatic spread, allowing for timely intervention. One of the most aggressive head and neck cancers, oral squamous cell carcinoma (OSCC) usually affects the mandible and causes extensive anatomical disruption, neurological impairments, and functional deficits in speech, mastication, and facial symmetry. This article presents clinical and histopathological data on malignant lesions of the mandibular bone, primarily oral squamous cell carcinoma (OSCC). Tumours primarily affected the mandibular body and ramus, often causing facial asymmetry, tooth mobility, and bone loss. Histologically, keratin pearls and spindle-shaped atypical cells were typical characteristics. Neurological involvement from perineural invasion frequently led to pain, numbness, and impaired oral function. In addition to the complex consequences of mandibular cancers, such as their anatomical, functional, and psychological effects, the study underscores the importance of multidisciplinary treatment and rehabilitation. Our paper presents how new methods for improving the precision and effectiveness of oral oncology diagnosis have been made possible by developments in artificial intelligence (AI), especially deep learning approaches. By recognising both cellular and structural atypia, convolutional neural networks (CNNs) have shown excellent performance in the classification of histopathological images. The distinction between benign, dysplastic, and malignant oral lesions is further enhanced by hybrid techniques that blend deep and texture-based features. AI-assisted radiomics has shown promise in diagnostic imaging by detecting high-dimensional, subtle characteristics in CT, MRI, and ultrasound scans that are frequently impossible to interpret visually. According to analysed studies, these techniques can improve the identification of lymph node metastases and offer accurate risk assessment for oral malignancies. Further encouraging their inclusion into the oral oncology workflow, machine learning models have attained diagnostic accuracies that surpass standard radiological assessments by merging image texture analysis with clinical data. A triadic viewpoint is provided by integrating AI into mandibular oncology: (1) imaging-based tumour growth and metastasis detection, (2) histopathological evaluation of malignant potential, and (3) assessment of neurological outcomes following surgery. Also, this article presents a case study from the University of Craiova, guide surgical excision, and assess both histological progression and postoperative functional impact. AI technologies' ability to support individualized treatment plans, enable earlier diagnoses, and enhance clinical judgment is becoming more and more clear as they develop—especially in anatomically and neurologically complex areas like the mandible. In conclusion, AI represents a powerful ally in mandibular oncology, bridging imaging, histopathology, and neurological evaluation, and paving the way for more precise, patient-centered care.

Background: Osseointegration is the main factor that ensures the long-term success of implant-prosthetic therapy, but besides this, there are other important factors, such as the quality of the alveolar bone and the time of placement of dental implants. The study aimed to analyze changes in the alveolar bone following tooth extraction, comparing natural healing with immediate implant placement, using fractal analysis on OPG images. Methods: This retrospective study included OPG images obtained before tooth extraction and 3 months after surgery in 91 patients who underwent maxillary and mandibular molar extractions and opted for either natural healing or immediate dental implant placement. Fractal analysis of OPG images was performed using Image J software, and the resulting measurements were subsequently statistically analyzed. Results: Most extractions were performed in the maxilla, and most were at the level of the first molar. The study group showed a faster healing process following immediate placement of dental implants, regardless of location, and a similar distribution of bone resorption and healing, with clear differences in location: the mandible had a faster healing process than the maxilla. Conclusions: Fractal analysis showed a better and quicker bone healing of the alveolar bone in immediate implant placement in molar areas compared with post-extraction natural healing, especially in the lower jaw.