A Hirshberg

Center For Oral & Maxillofacial Surgery, Georgia, United States

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Publications (99)180.45 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Intraoperative detection of residual disease in oral cancer may reduce the high rate of recurrences. The aim of the present study was to evaluate the detection sensitivity of diffusion reflection (DR) measurements of bioconjugated gold nanorods (GNRs) to cancerous sites in a rat model of oral squamous cell carcinoma. We used hyperspectral spectroscopy and DR measurements of GNRs bioconjugated to slide specimens of rat tongues where squamous carcinoma was induced by 4NQO (4-nitroquinoline-N-oxide). Wistar-derived male rats were used: 6 were sacrificed at wk 32 to 37 following 4NQO administration (experimental rats), as were 2 control rats at wk 32 and 36. The detection results were compared with histopathology: 19 sites of cancerous changes were identified microscopically (11 invasive cancer and 8 carcinoma in situ [CIS]). The GNRs attached selectively to areas of carcinomatous changes with an intensity exceeding 17 intensity units at 780 nm (overall specificity, 97%; overall sensitivity, 87%) when the hyperspectral spectroscopy system was used. The resulting DR slopes of the reflected intensity showed an increase of >80% in areas of invasive cancer and an increase of >30% in the CIS sites. The resulting intensity units of the hyperspectral spectroscopy system in the invasive cancer significantly exceed those of the CIS (t test, p = .0002; Mann-Whitney, p = .0024). The results demonstrate a great potential of the direct DR scanning as a new and simple tool for detecting residual disease intraoperatively.
    Journal of dental research 04/2014; · 3.46 Impact Factor
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    ABSTRACT: This study is a histopathological analysis of lesions clinically diagnosed as peri-implantitis (PI). This retrospective study included microscopic findings in 117 peri-implant biopsies from lesions presenting clinical and radiographic features of peri-implantitis. The study group included 117 biopsies, mean age 55.2 years; 60.9% of biopsies were from failing implants during explantation, the remaining from surviving implants. All cases showed microscopic evidence for inflammation; however, although 41% exhibited only nonspecific inflammation, 29.9% exhibited actinomyces-related inflammation, 18.8% pyogenic granuloma (PG), and 10.3% giant cell granuloma (GCG). Differences in implant failure rates between pathological diagnostic groups were not statistically significant. Lesions with simple inflammation could not be distinguished clinically or radiographically from the potentially destructive lesions. There were no clinical features which could distinguish PI with simple inflammation from potentially destructive lesions mimicking PI, such as GCG, PG, and actinomycosis. However, to control GCG and PG surgical procedures would be recommended, actinomycosis would indicate specific antibiotics, whereas in nonspecific inflammation, these measures may not be indicated. The results of the present study provide evidence for the importance of early microscopic examination of lesions presenting clinically as peri-implantitis, a step toward more accurate diagnosis and improved treatment of PI and lesions mimicking PI.
    Clinical Implant Dentistry and Related Research 08/2013; · 3.82 Impact Factor
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    ABSTRACT: Necrotizing sialometaplasia (NS) is an uncommon reactive lesion involving the minor salivary glands. This study aimed to investigate the expression of hypoxia-inducible factor alpha (HIF-1α), vascular endothelial growth factor (VEGF), and epithelial growth factor receptor (EGFR) in the pathogenesis of NS. Paraffin-embedded tissue sections from 10 cases of NS were immunohistochemically stained for HIF-1α, VEGF, and EGFR. A semiquantitative morphometric analysis was performed and compared with normal palatal salivary glands and traumatic ulcerations. Hypoxia-inducible factor alpha staining was observed in most elements of the affected area, the acini and ducts of the involved salivary glands as well as in the inflammatory infiltrate, the endothelial cells, and stromal cells. HIF-1α was almost absent in the control glands (P < 0.0001). VEGF staining was positive in the stromal capillaries and in the inflammatory infiltrate. The expression was higher in cases of NS compared with the normal salivary glands (P < 0.001). EGFR was expressed in the surface epithelium, the pseudo-epitheliomatous hyperplasia, and the islands of squamous metaplasia. VEGF expression in traumatic ulcerations was lower than that in cases of NS. This study provides molecular evidence to the role of hypoxia in NS; HIF-1α, the main regulator of hypoxia, was expressed in the infarcted salivary glands, EGFR in the metaplastic epithelium and VEGF in the stromal capillaries, all three components are the key factors induced by hypoxia.
    Oral Diseases 06/2013; · 2.38 Impact Factor
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    ABSTRACT: Neurovascular hamartoma (NVH), in particular in the oral cavity, is rarely described in the literature. The low number of cases may reflect a genuine rarity of the lesion, or it may be due to its being unrecognized and/or under-reported. To investigate clinical and microscopic features of oral NVH and to define microscopic diagnostic criteria with emphasis on the differential diagnosis. Archival cases diagnosed as oral NVH between 1999 and 2011 were retrieved; clinical and demographic data were collected, and a paired morphometric analysis was conducted, with each case of NVH a case of fibrous hyperplasia (FH) from the same oral location. The nerve bundle and blood vessel density were quantified in five microscopic fields at ×100 magnification. The study group included 25 oral NVH, 11 men and 14 women, aged 6-76 years, (mean 44). The majority occurred in the tongue (54%), followed by the buccal mucosa and lower lip (17% each), clinically presenting as asymptomatic 0.25-2.5 cm exophytic masses. Microscopic characteristics included poorly circumscribed masses of closely packed nerve bundles and blood vessels in a loose matrix, containing minimal or no inflammation. The mean nerve bundle density was significantly higher in NVH (4.28 ± 1.26) in comparison with FH (0.27 ± 0.27), (P < 0.00001), and mean vessel density was significantly lower (5.98 ± 1.4 vs. 7.8 ± 1.9, respectively), (P < 0.0003). Oral NVH may not be as rare as previously considered. Morphometric analysis demonstrated that NVH presents a separate distinct entity.
    Journal of Oral Pathology and Medicine 11/2011; 41(4):348-53. · 2.06 Impact Factor
  • Cancer Genetics and Cytogenetics - CANCER GENET CYTOGENET. 01/2010; 203(1):90-90.
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    ABSTRACT: To characterize the clinical manifestations of Actinomyces-associated lesions of the oral mucosa and jawbones, and to correlate the clinical course and treatment requirements with the findings of histomorphometric analysis. The study was a 10-year retrospective analysis of archived cases with microscopic identification of Actinomyces infection. Actinomyces colonies were identified, using hematoxylin-eosin, Gram, and periodic acid-Schiff stains, exhibiting filamentous morphology with color variation between center and periphery. Only colonies with adjacent tissue reaction (inflammation, fibrosis) were analyzed. Actinomyces density (AD) was calculated by dividing total number of colonies by tissue surface, Actinomyces relative surface (ARS) was calculated by dividing total bacterial surface by tissue surface. The study included 106 cases (48 male, 58 female; aged 13-84 years, mean 50.5 years). Cases presented a wide clinical spectrum, involving jawbone and/or oral soft tissues. Cases included osteomyelitis associated with bisphosphonates, osteoradionecrosis, osteomyelitis unrelated to radiation or bisphosphonates, periapical lesions, odontogenic cysts, periimplantitis, and lesion mimicking periodontal disease. The AD correlated with median length of antibiotic treatment (R = 0.284; P = .028). Because we were able to identify 106 such cases, the results indicate that Actinomyces-associated lesions may not be as rare as would be expected from the relatively low number of cases in the literature. Actinomyces-associated lesions presented in a wide spectrum of clinical settings and a variety of contributing factors. Quantitative analysis of the number of bacterial colonies (representing bacterial load) could help in evaluating the aggressive potential of the lesion and help in treatment planning.
    Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 09/2009; 108(5):738-46. · 1.50 Impact Factor
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    ABSTRACT: The malignant potential of oral lichen planus (OLP) has been a matter of serious controversy. We aimed to detect chromosomal numerical aberrations in cells of brush samples collected from affected mucosa. The samples were simultaneously analyzed for morphology and fluorescent in situ hybridization (FISH) with chromosomes 2 and 8 centromeric probes. We analyzed 57 persons with OLP and 33 control individuals. A cut-off value of aneuploid cells was determined as 1.1%. Aneuploid cells were found in 16 persons with OLP (28.1%); in 10 individuals (17.5%), over 5% of the cells were aneuploid. Aneuploid cells were also detected in normal-looking mucosa of seven persons with OLP. One person with OLP developed squamous cell carcinoma; 10% of the cells examined were aneuploid. OLP carries an increased risk for chromosomal instability. Identifying aneuploid cells in a brush sample and the combined morphological and FISH analysis can increase the specificity in predicting the malignant potential of OLP.
    Journal of dental research 06/2009; 88(5):427-32. · 3.46 Impact Factor
  • I Kaplan, Y Anavi, A Hirshberg
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    ABSTRACT: The present review analyzes the accumulated data from all cases of glandular odontogenic cyst (GOC) reported in the English language literature. In the 20 years since it was first described, 111 cases have been reported, an incidence of 0.2% of odontogenic cysts. The age range is 14-75, mean 45.7, with a M/F ratio of 1.3:1. GOC has a predilection for the mandible (70%), affecting both anterior and posterior areas. It is typically radiolucent, well defined, either unilocular (53.8%) or multilocular (46.2%). Frequent perforation (61%) and of thinning of cortical plates (24.4%) indicate aggressiveness. Sufficient follow-up indicates that 30% of cases can recur. Treatment by enucleation or curettage carries the highest risk for recurrence, especially in large and multilocular lesions. Peripheral osteoectomy or marginal resection can eliminate the risk. Defined criteria for microscopic diagnosis are described, which in addition to Ki67 and p53 can help in differentiating GOC from lesions with histological similarities (cysts with mucous metaplasia, botryoid and surgical ciliated cysts, low-grade mucoepidermoid carcinoma). Definite diagnosis may not be possible in small incisional biopsies due to the focal presentation of characteristic features required for diagnosis. There is now evidence to support an odontogenic rather than a sialogenic origin.
    Oral Diseases 02/2008; 14(7):575-81. · 2.38 Impact Factor
  • Noam Yarom, Avraham Hirshberg, Amos Buchner
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    ABSTRACT: Oral melanoacanthoma is a rare pigmented lesion characterized by sudden appearance and rapid radial growth, mimicking malignant melanoma. Oral melanoacanthoma may present as a solitary or multifocal lesion; however, the characteristics of these two clinical variants have never been addressed. In this study, we present an unusual case of multifocal oral melanoacanthoma and analyze cases of oral melanoacanthoma reported in the literature, with special emphasis on multifocal lesions. A thorough MEDLINE search of the literature for cases of oral melanoacanthoma was performed. The demographic and clinical data, histologic features, and immunohistochemical findings were extracted from the full-text articles. The literature search yielded 52 patients with 67 lesions. The addition of our case increased this number to 53 patients with 72 lesions, 43 of whom had solitary lesions and 10 of whom had multifocal lesions. There was a female predominance amongst the patients with solitary oral melanoacanthoma (3 : 1), whereas multifocal oral melanoacanthoma showed an equal gender distribution (1 : 1). Multifocal lesions tended to occur more frequently on the palate, and solitary lesions on the buccal mucosa. Multifocal oral melanoacanthoma appears to demonstrate some demographic and clinical variations from the solitary type of lesion.
    International Journal of Dermatology 01/2008; 46(12):1232-6. · 1.34 Impact Factor
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    ABSTRACT: The aim of the study was to characterize the prevalence, diameter and course of intraosseous anastomosis between the posterior superior alveolar artery and the infraorbital artery (bony canal) involved in the sinus floor augmentation procedure. Data from 208 sinuses were analyzed from reconstructed computed tomography (CT) images. The presence of the intraosseous anastomosis in the lateral antral wall was detected using sagittal plane sections, in addition, the intraosseous course and the diameter of the bony canal were examined. The bony canal was identified in 114 (55%) of the 208 maxillary sinuses, with a mean distance of 16.9 mm from the alveolar ridge. From the examined canals, in 7% the diameter was 2-3 mm wide, in 22% 1-2 mm and in 26% it was less than 1 mm wide. Because only in 50% of cases the vessel was large enough to be detected by a CT scan, it is recommended, to place the superior border of the osteotomy up to 15 mm from the alveolar crest in A to C type ridges to avoid penetration of the artery.
    International Journal of Oral and Maxillofacial Surgery 09/2007; 36(8):735-8. · 1.52 Impact Factor
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    ABSTRACT: To assess the effect of topically applied antimicrobial agents on palatal excisional wound in rats. Excisional wounds, 5 mm in diameter, were made in the centre of the palate of 125 Wistar male rats. In four experimental groups, chlorhexidine digluconate (CHX) 0.12% solution, 1% CHX gel, phenolic compounds solution (Listerine), amine/stannous fluoride solution (Meridol) and saline solution as a control group were applied daily for 1 min. The wound area was measured photographically and the epithelialization rate was determined histologically at 3, 7, 14 and 21 days post-surgery. The mean wound area and mean distance between the epithelial margins decreased significantly with time (p<0.001) in experimental and control groups, with the greatest wound area reduction and rate of epithelialization on day 14. A significantly superior rate of wound epithelialization (p=0.03) was presented following use of 1% CHX gel and Listerine and a comparatively inferior one when the Meridol solution was applied. Each tested antimicrobial agent when applied on an excisional wound with epithelial and connective tissue deficiency did not have a negative effect on the rate of wound closure. The best results were achieved with 1%CHX gel and Listerine.
    Journal Of Clinical Periodontology 02/2007; 34(2):164-71. · 3.69 Impact Factor
  • Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology - ORAL SURG ORAL MED ORAL PATHO. 01/2007; 103(6):790-790.
  • Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology - ORAL SURG ORAL MED ORAL PATHO. 01/2007; 103(4).
  • Oral Oncology Supplement 01/2007; 2(1):223-224.
  • I. Kaplan, S. Traves, A. Hirshberg
    Oral Oncology Supplement 01/2007; 2(1):179-179.
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    ABSTRACT: The purpose of this study was to compare the marginal bone loss (MBL), complications, and 12-year survival rates of commercially pure titanium (cpTi) and hydroxyapatite (HA)-coated implants placed in the maxilla. The study group consisted of 120 patients (77 women, 43 men) treated from 1988 to 1997. A total of 388 implants (156 cpTi and 232 HA-coated) were placed in the maxilla. There were 126 immediate (32.5%) and 262 (67.5%) nonimmediate implants. Patients were evaluated annually. Mean follow-up was 60 +/- 32.3 months. MBL was measured on radiographs using the implant threads as the dimensional reference. MBL, complications, and 12-year survival and success rates were correlated with implant coating, time of implantation, implant dimensions, and position in arch. Total mean MBL was 1.07 +/- 2.16 mm. MBL was significantly lower with cpTi implants (0.55 +/- 1.04 mm) compared to HA-coated implants (1.51 +/- 2.71 mm) (P < .001). No statistical difference in regard to MBL was found between immediate and nonimmediate implants (0.86 +/- 1.8 mm vs 1.16 +/- 2.3 mm). The total 12-year survival rate was 91.4%. HA-coated implants had a significantly higher 12-year survival rate than cpTi implants (93.2% vs 89%; P < .03). Nonimmediate implants had a significantly higher failure rate (8.2%) than the immediate implants (1.3%) (P < .009). No correlation was found between type of implant coating and late implant failure. Immediate implants can serve as a predictable option, providing higher survival and success rates. HA-coated implants tended to fail less during the surgical phase, but had higher mean MBL compared to cpTi implants. HA-coated implants had greater MBL than cpTi implants but a higher 12-year survival rate. Immediate implants had a lower failure rate than the nonimmediate implants in this study population.
    The International journal of oral & maxillofacial implants 01/2005; 20(2):238-44. · 1.91 Impact Factor
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    ABSTRACT: Peripheral odontogenic tumours (POT) are rare benign focal overgrowths of the oral soft tissue, usually occurring in the gingiva. Between 1996-2000, 6 out of 406 excised gingival lesions were diagnosed as POT (1.5%). Tumours included peripheral odontogenic fibroma (2 patients), peripheral calcifying odontogenic cyst (2 patients), peripheral ameloblastoma (1 patient), and peripheral calcifying epithelial odontogenic tumour (1 patient). Review of the literature reveals that peripheral odontogenic fibroma and peripheral ameloblastoma were the most common POT. The purpose of this article was to analyse the clinical data of these tumours according to the presented cases and the literature review, to elucidate typical features of each tumour type and enhance easy identification.
    International Journal of Oral and Maxillofacial Surgery 05/2004; 33(3):268-73. · 1.52 Impact Factor
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    M Stein, A Hirshberg, T Gerich
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    ABSTRACT: Because of the intifada, the Israeli-Palestinian conflict has become characterized by violence against civilians on both sides. Since the early 1990s, this conflict has seen directed operations performed by suicide attackers, whose goal is to kill civilians who are not direct participants in the confrontation. For urban and local hospitals this means that they must always be aware of being confronted with limited multiple-casualty incidents. This has required a restructuring of emergency plans at the scene and in the hospital. At the scene the incident is classified according to the number and degree of injury of the victims. The accumulation of such incidents made it necessary in Israel to change views of the system of triage, which has essential differences from the central European system. Apart from changing preclinical and clinical management algorithms, the surgeons specialized in casualties must be prepared for a new quality of injuries. Barotrauma of the lung and multiple, seemingly superficial injuries often only emerge later as life-threatening and lead to the paralysis of intensive care and surgical capacity.
    Der Unfallchirurg 11/2003; 106(10):802-10. · 0.64 Impact Factor
  • Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 09/2003; 96(3):303.

Publication Stats

2k Citations
180.45 Total Impact Points


  • 2013
    • Center For Oral & Maxillofacial Surgery
      Georgia, United States
  • 1988–2013
    • Tel Aviv University
      • • Department of Oral Pathology and Oral Medicine
      • • Department of Oral and Maxillofacial Surgery
      • • School of Dental Medicine
      • • Department of Biomedical Engineering
      Tel Aviv, Tel Aviv, Israel
  • 1990–2009
    • Sheba Medical Center
      • • Cancer Research Center
      • • Department of Pathology
      Gan, Tel Aviv, Israel
  • 2008
    • Rabin Medical Center
      Tell Afif, Tel Aviv, Israel
  • 2001
    • Michael E. DeBakey VA Medical Center
      Houston, Texas, United States
    • Mayo Foundation for Medical Education and Research
      • Department of Transplantation
      Scottsdale, AZ, United States
  • 1993–2001
    • Baylor College of Medicine
      • Department of Surgery
      Houston, Texas, United States
  • 1988–1990
    • University of KwaZulu-Natal
      • Department of Surgery
      Durban, KwaZulu-Natal, South Africa