Treatment of Osteoradionecrosis of the Jaw with Ozone in the Form of Oil-based Gel: 1-year follow-up.

AIM: Osteoradionecrosis of the jaws (ORNJs) is aseptic bone necrosis that develops in post-irradiated bone tissue of patients who underwent radiotherapy for head-neck tumors. The present study aims to clinically assess the regenerative ability of the ozone in the form of oil-based gel applied to the exposed bone area in the treatment of ORNJ. MATERIALS AND METHODS: Eight patients who underwent radio- therapy for the treatment of cervical or neck cancer were diagnosed with ORN of the jaws at our Department, for a total of 11 sites of necrotic bone exposure (3 patients were diagnosed with more than one site of osteoradionecrosis). In the therapeutic protocol, the exposed bone lesion and osteomucosal margin were cleaned with manual debridement. Then the ORN lesion was treated with topical applications of ozone delivered as oil suspension (Ozosan® - Sanipan, Clivio, Italy) on the exposed bone for 10 minutes. The application was repeated each week until movement of the necrotic fragment was noted Results: In six patients on 8 (75%) lesions resolved with complete mucosal healing with 3 to 19 ozone applications. Total sequestration of the necrotic bone with spontaneous expulsion was observed. One patient improved his conditions shifting from a stage B2S1 to B1S1 according to He et al. classification. A patient only worsened his conditions with treatment. No toxicity was reported or observed. CONCLUSION: These results showed the efficacy of ozone oil suspensions in the non-invasive treatment of ORN, probably related to its properties of stimulation of local revascularization and antibacterial activity, and the good tolerability of the related protocol used. CLINICAL SIGNIFICANCE: The use of this kind of medication should be included in ORNJ treatments as effective, noninvasive and self-administered.

Evaluation of Surgical Options for Supernumerary Teeth in the Anterior Maxilla.

AIM: The purpose of this study was to evaluate the surgical options for supernumerary teeth (SNT) in the premaxillary region of children. MATERIALS AND METHODS: A total of 69 patients with 82 partially or completely formed SNT in the anterior maxillary region were identified over a 3-year period. All selected patients were assessed for the number, location, and family history of SNT, damage to adjacent roots, and associated symptoms. The surgical approaches used for removal were recorded. Postoperative clinical sequelae (loss of vitality, periodontal problems, pain, bleeding, and enanthema) were evaluated. RESULTS: A total of 43, 30, and 9 SNT were extracted with palatal, buccal, and bicortical approaches respectively. Peri-odontal and vitality assessments revealed no problems in adjacent teeth at 6 months after surgery. Postoperative pain was within acceptable levels in all patients and subsided within 3 to 7 days. Mild postoperative bleeding occurred in eight patients. Enanthema subsided within 10 days in all patients. CONCLUSION: Our results suggest that early diagnosis and appropriate surgical treatment of SNT are important to decrease the risk of clinical complications.How to cite this article: Maddalone M, Rota E, Amosso E, Porcaro G, Mirabelli L. Evaluation of Surgical Options for Supernumerary Teeth in the Anterior Maxilla. Int J Clin Pediatr Dent 2018;11(4):294-298.

Osteoradionecrosis of the Posterior Maxilla: A New Approach Combining Erbium: Yttrium Aluminium Garnet Laser and Bichat Bulla Flap.

Osteoradionecrosis (ORN) of the jaw is a complication of radiation therapy for head and neck cancers. We report a case of ORN of the posterior maxilla treated with Er: YAG laser and a pedicled buccal fat pad (bichat bulla adipose) flap. A 69-year-old man presented complaining of pain on left maxilla. He had received high-dose radiotherapy (90 Gy) for squamous cell carcinoma of the left soft palate 2 years earlier. Clinical and radiographic examinations revealed ORN of the left maxillary molar region and maxillary sinusitis. Daily home care consisted of 0.9% saline irrigation and 0.8% H2O2 gel application. Sequestrectomy and tooth extraction were followed by debridement with Er: YAG laser and repair with a pedicled buccal fat pad flap. Complete resolution of ORN and maxillary sinusitis was established one year postsurgically. The excellent clinical outcome suggests that Er: YAG laser debridement and pedicled buccal fat pad flap are a viable option to treat ORN of the posterior maxilla.

Doxycycline fluorescence-guided Er:YAG laser ablation combined with Nd:YAG/diode laser biostimulation for treating bisphosphonate-related osteonecrosis of the jaw.

Laser therapy and fluorescence-guided surgery are highly reliable and predictable methods, but their combination has not been found to yield useful outcomes. We present a new therapeutic approach combining fluorescence-guided Er:YAG laser ablation with Nd:YAG/diode laser biostimulation for bisphosphonate-related osteonecrosis of the jaw (BRONJ). A woman was treated with zoledronic acid for bone metastasis from clear cell renal cell carcinoma and subsequently developed BRONJ in the left jaw. The management protocol included perioperative medical therapy (1% chlorhexidine gel, rifamycin, and doxycycline for 10 preoperative and 7 postoperative days), Er:YAG laser ablation guided by doxycycline fluorescence in vital bone under UV light, and Nd:YAG/diode laser biostimulation. The lesion regressed from stage 3 to stage 1 and showed nearly complete healing after laser therapy (3 and 23 cycles of ablation and biostimulation, respectively). These preliminary findings suggest the feasibility of the new approach, which is minimally invasive and biostimulative and causes very low morbidity.

Odontogenic maxillary sinusitis with oro-nasal fistula: a case report.

AIM OF THE STUDY: The odontogenic sinusitis has an incidence between 38 and 40.6%. Increased risk of maxillary sinusitis has been reported with the presence of periapical abscesses, periodontal disease, dental trauma, tooth extraction and implant placement when the sinusal membrane is perforated. MATERIALS AND METHODS: A patient with odontogenic maxillary sinusitis associated with oro-nasal fistula was treated. RESULTS: The follow-up at six months showed the complete resolution of maxillary sinusitis, palatal fistula got closed and pain symptoms disappeared. CONCLUSION: This case report describes a rare complication of odontogenic maxillary sinusitis: the oro-nasal fistula.

Bone augmentation with TiMesh. autologous bone versus autologous bone and bone substitutes. A systematic review.

AIM OF THE STUDY: Reconstruction of segmental defects and the atrophic maxilla and mandible is performed using various techniques. Bone substitutes have received a wealth of reports in the literature demonstrating a long-term success when used in alveolar bone augmentation procedures. MATERIALS AND METHODS: We reviewed articles comparing TiMesh GBR technique with different percentage of bone: autogenous bone alone (AB); anorganic bovine bone alone (ABB); 50:50 or 70:30. From an initial pool of 122, we selected 14 studies. ANOVA followed by Tukey HSD test was used for statistical analysis. RESULTS: We present a table analysing fundamental parameters to value a successful GBR therapy. Autogenous bone remains the gold standard in GBR technique with TiMesh; however, the combination between AB/ABB in relation 50:50 and 70:30 allows reducing surgical cost exploiting properties of eterologous bone. CONCLUSION: The use of autologous bone is associated with a height and width gain of bone, which are greater compared to other techniques, with a lower exposure of the mesh and a lower bone resorption. The use of heterologous graft leads to a lower bone earn and to percentage of resorption greater than autologous graft but does not differ from the gain and resorption of the bone of AB/ABB in percentage 50:50 and 70:30.