A 6-month histological analysis on maxillary sinus augmentation with and without use of collagen membranes over the osteotomy window: randomized clinical trial.

INTRODUCTION: Over the years, several modifications have been made to the sinus augmentation technique and to the materials used. However, there is still controversy about the need for using a barrier concurrently with a graft in sinus augmentation procedures. On this basis, the aim of this randomized clinical study was to investigate the effect of resorbable collagen membrane over the osteotomy window on maxillary sinus augmentation healing. MATERIALS AND METHODS: Patients who required maxillary sinus augmentation were evaluated and selected to enter the study. After maxillary sinus grafting, each patient was randomly assigned to control (membrane over the osteotomy window) or test (no membrane) group. After 6 months, one bone biopsy was harvested from the lateral window and sent to the histology laboratory. The Mann-Whitney nonparametric test was used for comparing the two groups. P-value was set at 5%. RESULTS: Eighteen patients entered the study and were randomly allocated in control (nine patients) or test group (nine patients). The histomorphometric measurements revealed that newly formed bone was 30.7% ± 15.5% of the total volume from the membrane group (control). The average percentage of connective tissue was 50.6% ± 18.7% and residual graft percentage was 18.4% ± 20.3%. On the other hand, data regarding the nonmembrane group (test) showed that the percentage of newly formed bone was 28.1% ± 19.4%. The mean percentage of connective tissues was 59.3% ± 15.4% and 12.6% ± 12.4% for the residual graft particles. No significant difference was detected in the histomorphometrical evaluation between the two groups. DISCUSSION: Our results showed that, compared with sites not covered, the use of the membrane did not substantially increase the amount of vital bone over a period of 6 months. On the other hand, the use of membrane seems to reduce the proliferation of the connective tissue and the graft re-absorption rate. It is plausible that blood supply of maxillary sinus can play a role in such a result. Further studies are needed to explore whether the use of membrane could really be advantageous for the sinus augmentation procedure and to evaluate what influence this method can have on the amount and quality of reconstructed bone.

Gastroesophageal reflux disease and dental erosion. A case report and review of the literature.

The term gastroesophageal reflux refers to the regurgitation of gastric material into the oesophagus. When the reflux is accompanied by inflammation of the oesophageal mucosa and extra-oesophageal symptoms the complaint is classified as a pathological condition called gastroesophageal reflux disease (GERD). GERD is caused by backward expulsion of the gastric content into the oesophagus. It is characterized by a complex clinical picture that may include lesions of the oesophageal mucosa and lesions of a different nature and severity of the respiratory and stomatognathic apparatus. GERD is considered to be a proteiform complaint induced by many different pathogenetic mechanisms resulting in a wide spectrum of clinical and morphological manifestations secondary to the reflux. Among extra-oesophageal manifestations, those affecting the dental structures are particularly important, owing to their aesthetic and functional implications on the stomatognathic apparatus. The Authors present a recently observed and treated case of GERD with associated severe aesthetic lesions of the frontal teeth. The currently available treatment options for the primary disease are examined, as well as the possible forms of conservative treatment of the affected teeth.

Local delivery of antimicrobial drugs in the treatment of chronic adult periodontitis.

AIM: The aim of this study was to evaluate the clinical and microbiologic results of local delivery of adjunctive antimicrobials in the treatment and management of patients with periodontitis. METHODS: The study population included 33 patients (age range, 37-49 years), with chronic adult periodontitis. Eleven of 33 received local treatment with 10% doxycycline injected directly into the periodontal pocket; 11 received local treatment with a chlorhexidine-based gel (1.5%) in situ; 11 received mechanical treatment with scaling and root planing. The crevicular fluid of the doxycycline-treated group was analyzed using high performance liquid chromatography over a period of 1 month. RESULTS: In the 11 patients treated with an antibiotic we observed a reduction in attachment loss and a reduction in probing depth of 1.4 mm; in the 11 chlorhexidine-treated patients we observed a reduction in attachment loss and a reduction in probing depth of 0.9 mm; in the remaining 11 patients the reduction in attachment loss and probing depth was less than those measured in the other two treatment groups. CONCLUSIONS: Our results suggest that direct delivery of antimicrobial agents to the infection site may be a useful adjunctive to conventional periodontal treatment.

Drugs in oral surgery. Brief guidelines for adult patients.

Drugs administrable in oral surgery for adult patients are antiseptics-antibiotics, antiinflammatory-analgesics and sedative-hypnotics. Such drugs can be administered before, during or after oral surgery. Sedative-hypnotics can be administered before or during oral surgery in order to control the patient's anxiety. Anti-inflammatory-analgesics, on the other hand, can be administered before or after oral surgery to lower edema and pain. For this purpose, FANS are the most commonly used drugs but, in more traumatic oral surgery, the administration of a single pre-surgery dose of corticosteroids is suitable. As regards, antibiotics have to be given from 15 min to 1 h before oral surgery and continued or otherwise for 24-48 h depending on the dosage. post-surgery infection onset, in fact, is higher within 3 h after oral surgery.

[Antibacterial effect of Nd:YAG laser in periodontal pockets decontamination: a in vivo study]. / Effetto antibatterico del laser Nd:YAG nella decontaminazione delle tasche parodontali. Uno studio in vivo.

AIM: Tha aim of this paper is to assess the effects in vivo of the Nd: Yag laser on gingival microflora in patients periodontally at risk. METHODS: An investigation has been carried out on 5 patients suffering from serious periodontal disease, with a sub-gingival check-up a week after the treatment. The selected patients presented either a relapse after the raising of a traditional flap, or showed acute phenomena and were, therefore, treated with a laser with the propedeutic intention of surgery; or they refused traditional surgical therapy or presented systematic pathologies that could not be included in the appropriate protocol. Pockets were chosen that had a probe depth of between 5-8 mm, an optic fibre probe was pushed as far as possible into the probe depth, for about 1 minute per site, 5 times, at 30 second intervals. The samples, taken in order to calculate bacteria colonies, were carried out before using the laser, immediately after and, again, 1 week later. RESULTS: All the sites showed a slight reduction in the quantity of colonies forming immediately after the Nd:Yag laser application, while a week later, only if clinical inflammation appeared to be resolved, the bacteria forming colonies seemed to be reduced. CONCLUSION: From this study it can be concluded that the use of the Nd:Yad laser represents, in mild and average periodontitis, a therapeutic aid to scaling and root planing and, in the same way, in serious periodontitis for traditional surgical therapy.