The flap recovery on the impacted lower third molar surgery comparing 3 different flap designs: a clinical study.

AIM: The purpose of the study was to analyze the healing of the deep and superficial lower first and second molars periodontium, after the surgical extraction of the contiguous impacted third molar, comparing 3 mucoperiosteal flap designs. MATERIALS AND METHODS: 150 patients which had to undergo a impacted lower third molar surgery were enrolled in this study. They were checked from day 0 to day 90, in order to focus on the recovery quality of the soft tissues around the lower second molar, comparing 3 different flap designs. RESULTS: No intraoperatory incident happened. The complete recovery of the periodontium around the second molar has been shown in each patient after 90 days from surgery and each adverse reaction happened within the sixth week after surgery. Only 2 slight gengival recessions 0,5 mm have been find out. CONCLUSIONS: The impacted third molar surgery is an operation that, if rightly programmed and performed, is relatively safe. Besides, the correct handling and management of periodontium around the second molar and the choice of the flap type to be used support a correct recovery on the second molar periodontium, avoiding any long-term damage. CLINICAL SIGNIFICANCE: This study wanted to analyze the healing of the deep and superficial lower second molar periodontium, after the impacted lower third molar surgery. In order to improve the surgical technique used for lower third molar germectomies, we wanted to compare 3 different kind of flap designs.

Graded porous polyurethane foam: a potential scaffold for oro-maxillary bone regeneration.

Bone tissue engineering applications demand for biomaterials offering a substrate for cell adhesion, migration, and proliferation, while inferring suitable mechanical properties to the construct. In the present study, polyurethane (PU) foams were synthesized to develop a graded porous material-characterized by a dense shell and a porous core-for the treatment of oro-maxillary bone defects. Foam was synthesized via a one-pot reaction starting from a polyisocyanate and a biocompatible polyester diol, using water as a foaming agent. Different foaming conditions were examined, with the aim of creating a dense/porous functional graded material that would perform at the same time as an osteoconductive scaffold for bone defect regeneration and as a membrane-barrier to gingival tissue ingrowth. The obtained PU was characterized in terms of morphological and mechanical properties. Biocompatibility assessment was performed in combination with bone-marrow-derived human mesenchymal stromal cells (hBMSCs). Our findings confirm that the material is potentially suitable for guided bone regeneration applications.

Simplified type 3 implant placement, after alveolar ridge preservation: a case study.

Alveolar ridge, after tooth extraction, could reduce its volume up to 50% in buccal-lingual width in the first twelve months and residual dimensions could interfere with correct three dimensional placement of implants and influence negatively treatment outcomes with regard to function and aesthetic aspects. Over the last decades, several approaches have been proposed and tested in order to prevent ridge volumetric contraction and provide maximum bone availability for implant procedure. This article presents a case study with a single anterior tooth replacement, illustrating socket seal technique followed by a type 3 timing implant placement. Immediately after tooth extraction, residual socket was grafted using Deproteinized Bovine Bone Mineral and a free gingival punch harvested from palate. After 3 months, a root-form titanium implant was inserted without additional regenerative procedures. Follow-up examination revealed favourable preservation of soft tissue width and height in the aesthetic area. Socket seal approach maximizes soft tissue healing, preserving ridge envelope and the subsequent implant placement, furthermore, results simplified, as any augmentation techniques are required. Clinical advantages of this method include predictable preservation of the soft tissues, favourable healing features, easy handling of graft materials and a positive benefit-cost ratio.

Piezosurgery vs High Speed Rotary Handpiece: a comparison between the two techniques in the impacted third molar surgery.

OBJECTIVE: The aim of the Study was to compare the impacted third molar surgical technique by means of the high speed rotary handpiece with the piezoelectric one. MATERIALS AND METHODS: 192 patients have been selected among those who had to undergo a third molar surgical extraction. These patients' surgeries have been performed by means of one of the techniques, randomly chosen. Each patient has undergone the same analgesic therapy (paracetamol 1000 mg tablets). Each surgery has been performed by the same surgeon. The patients were asked to fill in a questionnaire concerning the postoperative pain ("happy face pain" rating scale). RESULTS: The average duration of the surgeries performed by means of the high speed rotary handpiece was 32 minutes, while the duration of the ones performed by means of the piezoelectric handpiece was much longer (54 minutes). The postoperative pain values were almost equal. CONCLUSIONS: In conclusion, the osteotomy performed by means of the traditional technique still represents the gold standard in the impacted third molar surgery. The piezoelectric technique may be an effective choice, especially for the less skilled surgeons, in order to guarantee the protection of the delicate locoregional anatomical structures.

Medical waste to energy: experimental study.

OBJECTIVE: Although waste is traditionally assessed as a pollutant which needs to be reduced or lessened, its management is certainly necessary. Nowadays, biological fuel cells, through the direct conversion of organic matter to electricity using biocatalysts, represent a technology able to produce sustainable energy by means of waste treatment. This study aims to propose a mean to generate energy from blood and saliva, that are common risk-infectious medical waste. MATERIALS AND METHODS: Material employed (purchased by Sigma-Aldrich) were: Glucose oxidase (GOx), Nafion perfluorinated resin solution at 5% in a mixture of lower aliphatic alcohols and water, Polyethylene oxide. Stock solutions of D (+) glucose were prepared in a 0.1 M phosphate buffer solution and stored at 4 °C for at least 24 h before use. Carbon cloth electrode ELAT HT 140 E-W with a platinum loading of 5 gm-2 was purchased by E-Tek. Electrospun Nafion fibers were obtained as follows. Scanning electron microscopy was used to characterize the electrode morphologies. RESULTS: In order to develop an effective immobilization strategy of GOx on the electrode surface, Nafion fibers (a fully fluorinated ion conducting polymer used as a membrane material in enzymatic fuel cells - EFC) were selected as immobilizing polymer matrix. In this work, exploiting the nafion fibers capability of being able to cathalize Gox activity, we have tried to produce an enzymatic fuel cell which could produce energy from the blood and the saliva within medical-dental waste. CONCLUSIONS: Medical waste refers to all those materials produced by the interaction among doctor and patient, such as blood and saliva. During our research we will try to complete an EFC prototype able to produce energy from blood and saliva inside the risk-infectious medical waste in order to contribute to the energy requirements of a consulting room.

Podoplanin in the development and progression of oral cavity cancer: a preliminary study.

OBJECTIVE.: Podoplanin is a mucin-like glycoprotein that is important in lymphangiogenesis but not in blood vessel formation. The aim of this preliminary study is to determine the role of podoplanin in the development and progression of head and neck cancer. MATERIAL AND METHODS.: Podoplanin over expression was analyzed in 20 patients with oral cancer, by immunohistochemical analysis. RESULT.: Podoplanin is not expressed in normal oral epithelial cells but was found in some hyperplastic and dysplastic lesions. Podoplanin high expression was found in 9 of 20 patients and was more frequent in cancers with lymph node metastasis, particularly in oral cavity cancers. In our preliminary study, patients who showed high levels of podoplanin had a statistically greater rate of lymph node metastasis (P<0,001); patients with lymph node metastasis and high-level podoplanin showed a shorter disease-specific survival (P = 0,004) than other patients. CONCLUSION.: The results of our preliminary study have provided interesting and encouraging data. We have observed that podoplanin expression increases in the early stages of tumourigenesis and it seems to be associated with a higher risk of head and neck cancer. While in squamous cell carcinoma podoplanin expression diminishes during tumour progression. These data support a role for podoplanin expression in the initiation but not in the progression of cancer. So we can conclude that podoplanin is involved in oral oncogenesis and can be a predictor for lymph node metastasis in asymptomatic patients. Histology and podoplanin analysis can be very useful to predict the risk of development, invasion and metastatic progression of a tumour in patients with oral cancer.

Oral cavity rare lesions: 15 years case histories.

OBJECTIVES.: Oral cavity rare diseases include a various group of uncommon morbid conditions. For this reason they are often called "orphan diseases", as they are not interesting for research and the description of their natural history is not easy. The aim of our study is to analyze the prevalence and the distribution of oral cavity rare diseases in order to increase their knowledge and allow a fast therapeutic approach. METHODS AND MATERIAL.: 3144 patients took part to our study, they were choosen according to specific criteria and included in a experimental program; they all were prepared for oral biopsy surgery at Fatebenefratelli Hospital - Tor Vergata University of Rome. Following the results of the histological diagnosis, patients have been grouped. RESULTS.: From 1996 to 2010, we observed 1635 men and 1509 women, average age was 53 years, higher for women (55y.) and lower for men (52y.). CONCLUSIONS.: Nevertheless the low level of accordance and the difficulty in description of natural history of diseases reported in literature, we can conclude that, according to our study the onset of rare diseases shows a percentage of appearing statistically significant.

Cemento-ossyfying fibroma juvenile of the oral cavity.

OBJECTIVES: Fibro-osseous neoplasm remains somewhat controversial, and differing concept have been advanced regarding their nature and the proper terminology for them. Cemento-ossyfying fibroma juvenile (JOF) is a rare type of fibro-osseous tumor as also been included under the "umbrella" of cemento-ossyfying fibroma. The JOF is most often seen in patients who are between 5 and 15 years of age. With this work we emphasize the importance of a correct diagnostic approach. MATERIAL AND METHODS.: The case describes a form of cemento-ossyfying fibroma hight active and aggressive like JOF. The patient thirteen older showed from 2004 to 2008 three times the palatal lesion, it was performed with a incisional biopsy and excisional biopsy. The tumor were fixed in 10% buffered formalin embedded in paraffin cut into thick sections and stained with ematoxylineosin. RESULTS: The incisional biopsy was inadequate to formulate a correct diagnosis. The histological exams have showed for three times different aspects. CONCLUSION: Some authors in the past have suggested different classification. The COFs show different clinical, histological and radiographical patterns.

The evaluation of disphagic syndrome, in patients with previously acquired brain damages.

Recently clinical studies have proved without doubts that in patients affect by neurological diseases, like stroke, parkinsonism syndromes and others neurodegenerative pathologies, there is a very elevated incidence of swallowing disorders even severe. The disease can show up in a full blown way, with clinical evident signs like suffocation or frequent and sudden cough, at the moment in which the patient tries to feed or to drink; or it can appear in a less clear way, through an unable protection of the low airway and with possible pathologies ab ingestis. The first signals are represented by frequent resulting of cough reflex at nutrition or hydratation. Important is to assess the validity of this reflection, monitoring the amount of food reflux in the mouth after swallowing, which then could be perceived like foreign body and be aspired. The main diagnostic tests are the pHmetry in 24h, ultrasound, esophagography, videofluoroscopy, endoscopic examination and scintigraphy. Through the FEES (Fiberoptic Endoscopic Evaluation of Swallowing) we can then identify the time of swallowing deficit. Early diagnosis of Dysphagia Syndrome is important to improve living condition and survival of patients.

Fragile-X syndrome: genetic aspects and stomatologic evaluations.

AIM OF THE WORK: The fragile-X syndrome is the most common cause of inherited mental retardation and it is associated with the FMR1 gene on X chromosome. The origin of anatomic anomalies of maxillo-facial complex is still discussed in literature. The authors describe the syndrome and report a clinical case. METHODS: Genetical and clinical aspects and the incidence of caries, periodontal disease and occlusal abrasion are reviewed. Occlusal conditions, particularly openbite and crossbite, are considered. RESULTS: The incidence of fragile-X syndrome is 1: 2000 in males and 1:4000 in females, despite this the syndrome is diagnosed with a lot of difficulties yet, because of extreme variability of the phenomenological aspects. Patients often show severe mental retardation, linked to a peculiar profile of cognitive, behavioural, and emotional dysfunction and to distinctive anatomic features, which become more evident after puberty. Concerning oral characteristics, it doesn't seem to be a significant association between the syndrome and the incidence of caries or periodontal diseases, while an ogival shaped palate is peculiar. CONCLUSIONS: Literature review suggests that when male patients with severe mental retardation without well-known cause are visited, the ipothesis of X-fragile syndrome should be considered. Even though the diagnostic hypothesis may arise from the observation of typical somatic features, the diagnosis can be confirmed only by genetical tests.

Suture in oral surgery. A comparative study.

AIM: The aim of the present paper is to continue the previous study, with 52 new additional cases, confronting in vivo the behavior of 4 different suture materials (Ethibond Excel, Monocryl, silk and Vicryl) in oral surgery. METHODS: The clinical aspects have been particularly underlined: the intraoperative easy handling, the estate of the nodes and the resistance of the thread, the plaque accumulation, the tissue response in the short term (within 3 weeks) as well as in the long term (90 days), all estimated with objective parameters. RESULTS: Fifty-two out of a total of 55 new subjects included in the program have been followed throughout all the experimentation. Of the remaining 3, 1 didn't come for the suture removal, the second had a bleeding phenomenon 2 days after surgery and he went to the emergency department where sutures were replaced. The last one refused to come back for the 90 days control. These patients have been excluded from the experimentation. Data regarding the 52 patients are: plaque index recorded on the suture (Visible Plaque Index), number and percentage of sutures lost before 7/10 days, adverse reactions observed on the surgical site (14/20 days), total plaque index, and healing level and dental-periodontal status at 90 days. CONCLUSIONS: The clinical healing at 90 days was the same for all the different threads, differently from what happened in the critical postoperative period (within the 3 weeks).

Bilateral anesthesia into Spix's spine. Ten years' experience.

AIM: This study examines 10.112 cases in 10 years of bilateral block anaesthesia to Spix's spine. The aim of this study is therefore to eliminate any doubt about executing a bilateral anaesthesia to Spix's spine for the extraction, in inclusion and impacted of the inferior wisdom teeth. METHODS: A retrospective study was carried out on 10,112 operations (59% females, 41% males,) regarding the removal of the lower 3 molar teeth undertaken in the past 10 years. Locoregional anaesthesia and standard instruments and protocol were applied to all operations. The anaesthetic used was mepicavina at 2% with epinefrine 1:100,000 with a 4 x 25 mm, 27 Gauge needle. In order to completely anaesthetize the areas subject to surgery a quantity of approximately 3-ml on each side was injected. Local anaesthetics used were the same throughout the study; all the patients were in good health and not undergoing any pharmaceutical treatment. RESULTS: The onset of complications was 3 times less when using local anaesthesia (LA) compared to general anaesthesia (GA). It was also proven that local anaesthesia was advantageous, as the operation time was considerably less (24 min for LA and 46 min for GA). CONCLUSIONS: The paper shows that LA offers a significant reduction in complications, psychological advantages for the patients and facilitation of the operational position too, so that GA is to be preferred only for non-cooperative patients.

[Impacted third molars and facial typology]. / Inclusione dei terzi molari mandibolari e tipologia facciale.

BACKGROUND: The increasingly frequent removal of asymptomatic or pathology free lower third molars raises several questions. In this paper, the relationships between inclusion of impacted third molars and facial typology, in studied in order to have a further evaluation parameter for their removal. METHODS: The study was carried out an 50 cephalometric radiographs. The patients, 25 males and 25 females, have been submitted to surgical treatment at our oral Surgery Department to remove the lower impacted third molarst. RESULTS: Among patients admitted for impacted third molars removal there was a larger percentage of brachyfacial (84% of the males, 71% of the females) in comparison with normofacial (8% of the males, 19% of the females) and dolichofacial (8% of the males, 10% of the females). CONCLUSIONS: The facial type, characterised by a shortened vertical dimension of the lower third of the face and an anticlockwise mandibular growth, presents a greater risk of included wisdom teeth.