Atraumatic vertical tooth extraction: a proof of principle clinical study of a novel system.

OBJECTIVE: The aim of this study was to evaluate the applicability and limitations of a novel atraumatic extraction system. STUDY DESIGN: Seventy-two patients with severely decayed teeth or root remnants not suitable for forceps extraction were consecutively recruited and had 111 teeth extracted with the use of a novel atraumatic vertical extraction system (Benex). Various patient, tooth, and procedure data were recorded and analyzed. RESULTS: Overall, 92 out of 111 teeth (83%) were successfully extracted. The success rate was higher in single-rooted teeth (89%) and lower in multirooted teeth (43%), with a risk ratio for failure of multirooted versus single-rooted teeth of 5.2 (95% confidence interval 2.5-10.7). The majority of failures were characterized by insufficient retention of the screw and/or root fracture, which mainly occurred as a result of caries in the root canal, misplacement/misalignment of the screw by the surgeon, or a fracture of the root in response to drilling and/or moderate input of traction force. CONCLUSIONS: The Benex extractor system may be successfully used for atraumatic tooth extraction. The system has a higher success rate with single-rooted teeth compared with multirooted teeth. Extraction failure is mostly associated with insufficient retention or misplacement of the screw and root fracture.

The salivary tip of the p53 mutagenesis iceberg: novel insights.

Salivary malignancies are rare, heterogeneous, unpredictable in their clinical behavior and seldom studied. This study focused on examining the expression of mutated p53, the most prevalent mutated gene related to human cancer, in a rather large cohort of salivary malignancies (n = 70) and for a prolonged period (20 years). P53 was found to be a most powerful predictor for poor survival and more so when the tumor concurrently expressed TUNEL and heparanase markers, dramatically dropping the survival probability of the patients to 0! Survival probability at 6 years for patients with tumors stained negatively vs. positively for p53, TUNEL and heparanase was 100% vs. 49% while at 18 years this probability dropped to 67% vs. 0%, respectively (p = 0.023). Significant correlation rates were found between age and poor survival, age and p53, and p53 and other co-existing malignancies. These findings support mutated p53 as a prognostic predictor and a pivotal player in salivary carcinogenesis. Significantly more extensive therapy applied to salivary p53-positive patients did not improve mortality rate, questioning the justification for such extensive therapy and emphasizing the need to understand p53, TUNEL and heparanase biological pathways and develop additional therapeutic tools for fighting salivary cancer.