Local complications in dental implant surgery: prevention and treatment.

There are many detailed articles regarding accidents and local complications in dental implantation. Comparison of the data they report is not always easy because different criteria have been followed in the various classifications and there is confusion between the terms accident and complication. The aim of this paper is to propose a classification that considers the timing of the events and makes a distinction between the two terms. Accidents are events that occur during surgery and complications are all the pathological conditions that appear postoperatively. The proper diagnostic procedures and surgical techniques for complications prevention and treatment are also described.

[Lifting of the maxillary sinus: complementary use of platelet rich plasma, autologous bone deproteinised bovine bone. Case report]. / Rialzo del seno mascellare: uso complementare di plasma arricchito di piastrine, osso autologo e osso bovino deproteinizzato. Caso clinico.

The present paper describes a clinical case in which autologous bone, removed during an operation from the maxillary tuberosity, platelet rich plasma (PRP) and deproteinised bovine bone (Bio-oss, Geistlich) were used as graft material in a bilateral maxillary sinus lift procedure. During the same operating session, it was planned to carry out the lift of the maxillary sinus, employing a "combined" graft (autologous bone, PRP, deproteinised bovine bone), and to insert 6 fixtures at maxillary level, 3 in each quadrant, and 6 fixtures at mandibular level. The use of PRP, or rather of the platelet gel derived from it, represented an improvement compared to standard bone graft techniques. A graft consisting of autologous bone and PRP (with or without deproteinised bovine bone) makes it possible in fact to carry out more demanding operations, such as a major lift of the maxillary sinus, without the need for a block graft, but employing autologous bone particulate, which is easier to find. Furthermore, a "combined" graft is easily malleable and adjustable and can be adapted perfectly to the bone defect in which it is inserted. Finally, it guarantees a better quality of cure both in terms of speed and degree of mineralisation. This is very important if we consider that usually, lifting of the maxillary sinus is carried out precisely to guarantee adequate bone volume in cases where bone has been lost and to permit the insertion of osteointegrated implants.

[Oral cancer]. / Carcinoma orale.

Oral cancer (OC) is a rather frequent pathology representing about 30% of head and neck malignant neoplasms. After many years the incidence of the pathology shows constant values; the male:female ratio is continuously decreasing and at present, it is about of 2:1. The delay in diagnosis is the main cause of unsuccessful treatment and of the high values of poor outcome. OC shows three clinical aspects: exophytic, ulcerative and infiltrative; lips and margins of tongue are the most interested sites. For the diagnosis a correct clinical examination and a biopsy, possibly made with incisional criteria are necessary.

[The principles of tissue engineering: role of growth factors in the bone regeneration]. / Principi d'ingegneria tessutale: fattori di crescita e rigenerazione ossea.

In this article the principles of tissue engineering are analyzed. The growth factors release from platelets, TGF-beta, PDGF, IGF-I and -II, are accurately described and the structure and functions of these growth factors are reported. Then a simple model of bone regeneration is proposed. This model is used every time that bone grafts are used in oral and maxillofacial surgery. On the basis of this model of bone regeneration, the cells and biochemical indicators (pH and pO2) of bone wound where the bone graft is placed, and of surrounding tissues, are described. Then three phases of bone regeneration are analyzed: the beginning, the second (or immature bone), the third or mature bone with lamellar architecture. In each phase the importance of growth factors are evaluated. The conclusion is drawn that factors influence the bone regeneration and that their increased concentration leads to a quick bone formation and quantity. Moreover, the techniques of regeneration in vivo with autogenous bone, are better than those in vitro, since the bone structure, is also the result of the biomechanical environment, where the bone graft grows up.

[Root-end filling materials. Proposal for a meta-analysis study]. / Materiali da otturazione retrograda. Proposta di studio metanalitico.

BACKGROUND: The purpose of this study is to identify a first choice Root-end Filling Material (RFM) as regards the apical sealing ability. METHODS: The method we have used is the so called Metanalysis. It consists of the selection of all experimental studies already existing in literature and of the statistical processing of their results, so that it is possible to achieve a wider statistical sample which could lead to the most conclusive results. In this study we have tried to apply the above mentioned method to scientific articles investigating apical sealing ability through two different experimental methods: the dye penetration method and the fluid filtration method. RESULTS: This study shows that it is not possible to perform all the steps required for the realisation of a metanalytic study. This situation is consequential on the lack of well overlapped studies concerning the experimental protocol. We have tried, however, to outline the characteristics of main Root-end Filling Materials, on the basis of what we had achieved by consulting the single studies found in literature. CONCLUSIONS: It is necessary to carryout experiments consisting of more similar research protocols both to realise their metanalytic comparison and to respect one of the main foundations in scientific research, that is the effective repetition rather than a mere theoretical one.

[Gorlin's syndrome. Case report]. / Sindrome di Gorlin. Presentazione di un caso clinico.

The authors present a case of Gorlin's Syndrome, more satisfactorily defined as nevoid basal cell carcinoma syndrome (NBCS), a rare genetic disorder characterized mainly by multiple basal cell carcinomas and odontogenic keratocysts and other less frequent skeletal, sexual and neurological manifestations. Patient 75 years old, male. Previously treated surgically for multiple cutaneous basal cell carcinomas, comes to our Department to remove a suspected asymptomatic keratocyst. Clinical examination reveals cutaneous alterations of hands and feet (webbed hands and feet), a little progenism and multiple nevi and basal cell carcinomas on the body and the head. The oral cavity is free of alterations or clinical signs. NBCS is probably caused by chromosomal abnormalities of chromosome 5 and 9. The abnormalities seen in the latter are similar to those seen in people exposed for long periods to UV radiation. These abnormalities could determine malignant cutaneous tumors removing anti neoplastic protection. The association with odontogenic keratocysts, however not clearly understood, appears in more than 90% of cases. All the other disorders are less frequent. Juvenile basal cell carcinomas, especially if associated with odontogenic keratocysts suggest, the hypothesis of NBCS; if confirmed, this diagnosis makes further familial investigations necessary, to diagnose other cases, at the time unknown.

[Gardner's syndrome. A case report]. / Sindrome di Gardner. Un caso clinico.

Gardner's syndrome is a congenital condition characterised by diffuse intestinal adenomatous polyposis (IAP) associated with maxillary osteomas, odontomas, hypertrophy of the retinal epithelium and skin tumours. It may affect subjects of all ages with equal frequency in males and females. The fact that diffuse adenomatous polyposis, the most serious clinical aspect of the syndrome, is treated surgically, has led to improved survival in patients and, consequently, an increased incidence in associated lesions, particularly maxillary osteomas. A personal case observed at the Odontostoma-tological Clinic of the University of Rome La Sapienza is reported.

Evaluation of piroxicam-beta-cyclodextrin, piroxicam, paracetamol and placebo in post-operative oral surgery pain.

Two hundred ninety-eight patients with post-operative pain after the surgical removal of an impacted third molar were randomly assigned, on a double-blind basis, to receive a single oral dose of piroxicam 20 mg, or piroxicam-beta-cyclodextrin equivalent to 20 mg piroxicam, or paracetamol 500 mg, or placebo. Using a semi-quantitative self-rating scale, patients rated their pain and its relief at 30-min intervals for the first 2 h, and then hourly for 4 h after treatment administration. All active medications were reported to be significantly superior to placebo. The three active drugs were comparable for the degree of analgesia up to the third hour, after which the effect of paracetamol decreased significantly as compared to piroxicam-beta-cyclodextrin and piroxicam. Piroxicam-beta-cyclodextrin and paracetamol were more rapid than piroxicam in inducing analgesia. The tolerability for the active drugs was comparable to that for placebo.

[Analgesic efficacy and the tolerance for piroxicam-beta-cyclodextrin compared to piroxicam, paracetamol and placebo in the treatment of postextraction dental pain]. / Efficacia analgesica e tollerabilità di piroxicam-beta-ciclodestrina in confronto con piroxicam, paracetamolo e placebo nel trattamento del dolore post-estrattivo dentale.

INTRODUCTION: Acute postoperative pain is a common experience in oral surgery practice. Non-steroidal anti-inflammatory drugs (NSAIDs) are quite effective against mild to moderate pain and they are generally better suited in ambulatory outpatients than narcotic analgesics. The analgesic activity of piroxicam, a well known NSAID has been documented in many pain states. Piroxicam can be administered once daily because of its long half-life, but its absorption in the gastrointestinal tract is slow as it is its onset of action. Piroxicam-beta-cyclodextrin (PBCD) is a new formulation of piroxicam which is the product of supermolecular encapsulation of piroxicam with the cyclic oligosaccharide beta-cyclodextrin. PBCD is absorbed much faster than standard piroxicam, and its action as an analgesic is consequently more rapid. The purpose of this study was to assess the efficacy and the rapidity of action of piroxicam-beta-cyclodextrin in comparison with standard piroxicam, paracetamol and placebo following surgical extraction of impacted third molars. MATERIALS AND METHODS: The study population was composed of 32 patients of both sexes and in good health. To be included into the study, patients must have had third molar removal resulting in acute post-surgical pain of at least moderate intensity. The patients were then randomly assigned to one of four treatment groups. PBCD 20 mg tablets; piroxicam 20 mg capsules; paracetamol 500 mg tablets, or placebo. The study was conducted according to a double-blind, double-dummy design. Pain intensity and pain relief were recorded at 0.5, 1, 1.5, 2, 3, 4 hours after a single dose of the study drugs, by means of a Keele-type rating scale. Rescue analgesics were not allowed before one and a half hour after taking the study drugs. A global evaluation of study drugs was expressed by patients at the end of the observation period. RESULTS: Treatment groups were homogeneous for demographic characteristics of the patients and for pain intensity at the time of medication with study drugs. All patients who received placebo requested supplemental analgesics, while none of the patients treated with the active drugs needed rescue analgesics. PBCD and paracetamol were comparable for their analgesic effect, while the time lag before a significant reduction of pain intensity with piroxicam was longer. Piroxicam and PBCD were superior to paracetamol because they showed a substantial analgesic effect through the 4-hour study duration, while paracetamol did not induce a complete relief from pain. DISCUSSION: One of the most commonly utilized model for the evaluation of analgesics is the third molar extraction pain. Our study clearly differentiated between active drugs and placebo. Furthermore, while PBCD and paracetamol showed a rapid effect, piroxicam was slow in inducing pain relief. The analgesic and anti-inflammatory activity of PBCD and piroxicam brought about the resolution of pain and inflammation consequent to the dental extraction. Paracetamol, a pure analgesic, was not equally active and pain persisted, even if at a low grade, throughout the observation period; probably this was due to local inflammation and edema. The results of our study appear to confirm the pharmacokinetic data on PBCD, which showed that therapeutic blood levels are reached faster with PBCD than with the standard piroxicam formulation. This results should be confirmed in studies with an adequate number of patients.

[Topical infiltration of diclofenac sodium during extraction of impacted lower 3rd molars]. / Infiltrazione topica di diclofenac sodico durante l'estrazione di III molari inf. inclusi.

Somministrations with topical infiltration of a FANS (Diclofenac sodium) based on a new therapeutic scheme, were carried on by the Authors. Reduction of postoperative compliances and no side or general effects were noted.