Is Laser Therapy an Adjuvant in the Treatment of Peri-Implant Mucositis? A Randomized Clinical Trial.

(1) Background: Early diagnosis and treatment of peri-implant mucositis may reduce inflammatory markers and halt the progression of the condition to peri-implantitis. Adjunctive laser treatment may have therapeutic benefits that are not yet well known. The aim of this study was to determine the advantages and limitations of laser therapy as an adjuvant in the treatment of peri-implant mucositis. (2) Methods: A total of 42 patients with at least 2 implants situated in different hemiarches were included in this study and divided into two groups: G1 (received laser therapy) and G2 (no laser therapy). Periodontal health status indices were recorded at the initial moment (T0), and all patients underwent non-surgical debridement therapy accompanied by oral hygiene training. In patients from group G1, one implant site received adjuvant laser therapy (subgroup IL), and the other one did not receive active laser light (IC). The plaque index (PI), probing pocket depth (PPD), and bleeding on probing (BOP) values recorded after 3 months (T1) and 6 months (T2) were analyzed and compared with those at T0. (3) Results: PI values considerably reduced at moment T1 and T2 for both G1 and G2 (p = 0.0031). PPD was also reduced, but the difference between the groups and the three recording moments was not statistically significant. Statistically significant differences were found when comparing the BOP values between G1 IL and G1 IC for T0/T1 (p = 0.0182) and T1/T2 (p < 0.0001), but there was no significant difference between G2 and G1 IL or G1 IC. (4) Conclusions: Laser therapy as an adjunct to conventional treatment of peri-implant mucositis leads to a statistically significant reduction in bleeding on probing at 3-month and 6-month re-evaluations. Moreover, it leads to an evident reduction in probing depth but with no statistical significance. These results should be interpreted with caution, and more in-depth research should be performed to create a complete laser therapy protocol for peri-implant mucositis.

Effects of Laser Therapy on Periodontal Status in Adult Patients Undergoing Orthodontic Treatment.

Orthodontic treatment with fixed devices should only be indicated in case of a stable, non-active periodontal disease status. Throughout orthodontic treatment, a careful assessment of the periodontal status is advised. Due to its anti-inflammatory and antimicrobial effects, laser therapy is frequently used as an adjunct to classic periodontal therapy. The aim of this study was to evaluate the advantages and limitations of the use of laser therapy on periodontal status during orthodontic treatment. Throughout the 9 months during which this placebo-controlled, single-blind clinical trial was conducted, 32 patients were included in the study, divided into two groups: microscope "+" (patients who observed the bacteria within the dental plaque-sample examination on the screen of a dark-field microscope in real time) and microscope "-" (patients who did not see the oral pathogens using a dark-field microscope). For all patients, using the split-mouth study design, laser therapy was applied to one hemiarch (HL), whereas the other hemiarch received treatment without active light (HC). After one month, by analyzing the main indicators of periodontal health status, we found that the plaque index (PI) and bleeding on probing (BOP) values were significantly decreased after receiving treatment (for PI: HL-p = 0.0005, HC-p = 0.0297; for BOP: HL-p = 0.0121, HC-p = 0.0236), whereas the probing-depth (PD) values remained almost the same as before treatment (HL-p = 1.5143; HC-p = 1.4762). Conclusions: The use of the dark-field microscope proved to be beneficial in sensitizing patients to the presence of bacteria in the oral cavity and motivated them to strictly follow the rules of oral hygiene. Laser treatment can be a valuable aid in periodontal therapy, but only in adjunction with mechanical therapy.

Effects of Laser Application on Alveolar Bone Mesenchymal Stem Cells and Osteoblasts: An In Vitro Study.

Mesenchymal stem cells isolated from the bone marrow have a great differentiation potential, being able to produce many cell lines, including osteoblasts. Osteoblasts have an important role in bone remodeling by actively participating in the maturation and mineralization of the extracellular matrix. The aim of this study was to determine the effect of laser application on the viability and proliferation of osteoblasts. METHODS: Alveolar bone was harvested from 8 patients and placed into a culture medium to induce proliferation of mesenchymal stem cells. These were differentiated into osteoblasts in special conditions. The cells from each patient were split into two groups, one was treated using a 980 nm laser (1W output power, pulsed mode, 20 s, 50 mm distance) (laser "+") and the other one did not receive laser stimulation (laser "-"). RESULTS: Using the confocal microscope, we determined that the cells from the laser "+" group were more active when compared to the laser "-" group. The number of cells in the laser "+" group was significantly greater compared to the laser "-" group as the ImageJ-NIH software showed (p = 0.0072). CONCLUSIONS: Laser application increases the proliferation rate of osteoblasts and intensifies their cellular activity.

Clinical Assessment of the Hyperbaric Oxygen Therapy Efficacy in Mild to Moderate Periodontal Affections: A Simple Randomised Trial.

Background and Objectives: Gum disease represents the condition due to the dental plaque and dental calculus deposition on the surfaces of the teeth, followed by ulterior destruction of the periodontal tissues through the host reaction to the pathogenic microorganisms. The aim of study was to present aspects regarding the efficacy of hyperbaric oxygen therapy (HBOT) as an adjuvant therapy for the treatment of periodontal disease, started from the already certified benefits of HBOT in the general medicine specialties. Materials and Methods: The participant patients in this study (71) required and benefited from specific periodontal disease treatments. All patients included in the trial benefited from the conventional therapy of full-mouth scaling and root planing (SRP) within 24 h. HBOT was performed on the patients of the first group (31), in 20 sessions, of one hour. The patients of the control group (40) did not benefit from HBO therapy. Results: At the end of study, the included patients in HBOT group presented significantly better values of oral health index (OHI-S), sulcus bleeding index (SBI), dental mobility (DM), and periodontal pocket depth (PD) than the patients of the control group. Conclusions: HBOT had beneficial effects on the oral and general health of all patients, because in addition to the positive results in periodontal therapy, some individual symptoms of the patients diminished or disappeared upon completion of this adjuvant therapy.

Evaluation of the Behavior of Two CAD/CAM Fiber-Reinforced Composite Dental Materials by Immersion Tests.

Fiber-reinforced composites are used as restorative materials for prosthetic oral rehabilitation. Gastroesophageal reflux disease (GERD) is an accustomed affection with various oral manifestations. This study aimed to evaluate the behavior of two high-performance CAD/CAM milled reinforced composites (Trinia™, TriLor) in artificial saliva at different pH levels through immersion tests, and to determine if changes in mass or surface morphology at variable pH, specific for patients affected by GERD, appear. After investigating the elemental composition and surface morphology, the specimens were immersed in Carter Brugirard artificial saliva for 21 days at different pH values (5.7, 7.6, and varying the pH from 5.7 to 3). The values of the weighed masses during the immersion tests were statistically processed in terms of mean and standard deviation. Results suggested that irrespective of the medium pH, the two composites presented a similar mass variation in the range of -0.18 (±0.01)-1.82 (±0.02) mg after immersion, suggesting their stability when in contact with artificial saliva, an aspect which was also highlighted by scanning electron microscope (SEM) analysis performed on the immersed surfaces. Novel composite biomaterials can be a proper alternative for metal alloys used for prosthetic frameworks in patients suffering from GERD.

Multiple asymptomatic cutaneous pilar leiomyoma versus spontaneous eruptive keloids - a case report.

Cutaneous piloleiomyoma, angioleiomyoma and genital leiomyoma are variants of superficial cutaneous leiomyoma. The main purpose of this paper was to present clinical, histopathological and immunohistochemical diagnosis criteria for an unusual case of pilar leiomyoma in an 18-year-old male patient. The initial clinical aspect was very similar to spontaneous eruptive keloids: red-violet color, painless, aspect of "crab pincers" of some of the lesions, epidermis atrophy, telangiectasia, located on acneiform zones and compliance with cephalic extremity. The patient had no history of trauma, surgery or acne. Local treatment of one lesion was performed with cryotherapy using liquid nitrogen (-172°C) together with intra-lesion steroid injections, occlusive dressings and silicone gel. Local therapy did not showed notable results, moreover the lesion become painful. Skin biopsy with histological and immunohistochemical analysis revealed the diagnosis of multiple cutaneous pilar leiomyoma without atypia. The particularity of the case stands in the atypical onset followed by explosive increasing of lesions number and the appearance of pathognomonic pain after local therapy.

Necrotizing fasciitis in oro-maxillo-facial area after radiotherapy for squamous cell carcinoma of the soft palate.

The fascia's and subcutaneous adipose tissue's impairment by mono or polymicrobial infection, which also can involve the skin and the muscles, is rarely seen in oro-maxillo-facial area. The present case report is presenting a case of necrotizing fasciitis in a patient who had a history of an invasive squamous cell carcinoma of the soft palate, with surgical treatment and with radiotherapy. He was admitted in our Clinic with malaise and subsequently developed a toxico-septic shock. Clinical symptoms, serological and bacteriological analysis and histopathological examination confirmed the diagnosis of necrotizing fasciitis (NF). The patient subsequently underwent a series of surgical reconstruction and aesthetic treatments because of the complications that had arised in the meantime. Postoperative evolution was favorable towards complete closure of the defect. The prognosis of this disease is generally reserved, the favorable evolution depending on the possibility of wound sterilization and the surgery is required despite its mutilating effect.

Clinical dental adhesive application: the influence on composite-enamel interface morphology.

Although the adhesion phenomenon is crucial in achieving and maintaining a composite building on dental structure, this phenomenon is not completely understood. On the other hand, adhesion is dependent on the interface quality (the interface between enamel and adhesive). In this study, the authors approached the subject of the influence of adhesive clinical application on the composite-enamel interface, which was less investigated by the scientists. On intact extracted human teeth were prepared enamel areas, and then filled with light-curing composite. The teeth were sectioned and prepared for microscopic investigation, at 10×, 100× and 200× magnifications.

Aneurysmal dermatofibroma mimicking both clinical and dermoscopic malignant melanoma and Kaposi's sarcoma.

Aneurysmal dermatofibroma (AD) or aneurysmal fibrous histiocytoma (AFH) is a relatively rare form of histiocytoma representing less than 2% of total cases. It shares many clinical and dermoscopic similarities with skin tumors, especially malignant melanoma and Kaposi's sarcoma, which can make differentiation problematic. We report the case of a 53-year-old man, who presents with a black nodular tumor with increased consistency, edges infiltrated from the surface to depth, spontaneous and sensitive to touch that shows rapid growth in the last three months. Dermoscopically, the central region consists of intricate areas colored in red, violet, blue-white and black. On the periphery stand two rings, centrally white and peripherally pigmented, with an abundance of polymorphic capillaries. To clarify the diagnosis, the lesion was widely excised and histopathological examination was performed, which revealed immunophenotypical tumor cells negative for HMB-45 and S100, and numerous CD68 macrophages between tumor cells. This aneurysmal fibrous histiocytoma shows both clinical and dermoscopically discrete differential criteria, which are not specific and that make it difficult to distinguish from malignant melanoma and Kaposi's sarcoma, and required performing histopathology and immunohistochemistry.

Oral squamous cell carcinoma of the maxilla, a second malignancy after a right ethmoido-maxillary chondrosarcoma.

Squamous cell carcinoma is defined as an invasive epithelial neoplasm, with variable degrees of squamous differentiation, with or without keratinization. It is origins stand at the level of the keratinized stratified squamous epithelium (skin) or non-keratinized (oral mucosa, esophageal mucosa, uterine exocervical mucosa), but it can also be found in squamous metaplasia areas (uterine endocervix or trachea-bronchial tree). This report presents the case of an oral squamous cell carcinoma as a second malignancy in the same anatomical territory, in a patient with prior treatment for chondrosarcoma, both surgical and radiotherapy. The tumor had appeared 5-6 months prior and had undergone a relatively rapid growth, this being the patient's main motive for addressing the doctors. The tumor was greyish, with imprecisely demarcated margins, of firm consistency, bleeding and with local necrotic deposits. The tumor extended from the incisive region to the maxillary tuberosity, towards the cheek mucosa and the soft palate. After a large excision, the histopathological diagnosis was infiltrative keratinizing squamous cell carcinoma, with moderate differentiation, with origins in the oral mucosa, infiltrating the whole of the maxilla and the maxillary sinus mucosa. Approximately three months after the surgery, a new tumor appeared in the oral cavity, on superior and inferior mucosa of the right cheek, extending towards the right buccal commissure, implying a relapse of the primary tumor. Postoperative oncological therapy included standard chemotherapy, which resulted in favorable postoperative evolution. This case is interesting by the association, of two metachronous malignant tumors, of different histological origin: a chondrosarcoma and a squamous cell carcinoma, at an interval of 25 years.

Pagetoid reticulosis Woringer-Kolopp type, a particular variant of mycosis fungoides: a case report.

According to the definition of WHO, pagetoid reticulosis (PR) is characterized by the presence of unique skin lesion in the shape of patches or plaques caused by the proliferation of atypical T-cells in epidermis. We report the case of a 50-year-old female, presenting a 50×65 mm erythematous scaly patch, well-defined, slightly infiltrated, discrete polycyclic, on the right buttock, which appeared and developed in about 6-8 months. The clinical and dermatoscopic aspects suggested a Bowen's disease. A skin biopsy was performed. The histological examination of the pieces confirmed the presence of monoclonal lymphoid infiltrate with obvious phenomena of epidermotropism. Immuno-phenotypically the tumoral cells express intensively CD3 and CD8 and focally CD4. Surgical excision was performed without radiotherapy and chemotherapy. The patient was followed-up for 42 months without local relapses, distant lymph nodes or visceral metastases. Microscopic aspect of the lesion corresponds to stage I-II of mycosis fungoides (MF) (patches or plaques); the diagnosis was PR Woringer-Kolopp type. The most recent classification of skin lymphomas (WHO, 2008) confirms that the immunohistochemical profile of T-cells can be CD4+ and CD8- or CD4- and CD8+, and frequently CD30+, in contrast to the classical versions of MF. Pagetoid reticulosis type Woringer-Kolopp, a rare particular variant of mycosis fungoides, is suspected in cases with unique, distinctive lesion and confirmed only by histological immunohistochemistry. Treatment consists of surgical excision of the lesion with long follow-up.

Giant dermatofibrosarcoma protuberans - rare form of mesenchymal tissue neoplasm: case presentation.

UNLABELLED: Dermatofibrosarcoma protuberans (DFSP), a rare type of mesenchymal neoplasm, is defined by the WHO as a superficial sarcoma with low-grade malignancy that develops in the cutaneous and subcutaneous tissues. The purpose of this paper is to present a case of a giant DFSP, with post-traumatic onset in childhood and a very long evolution. CLINICAL DATA: 51-year-old Caucasian patient presents for 41 years a presternal neoplastic lesion, with onset at 10-year-old, few months after a strong trauma. The patient addressed for a clinic examination, secondary to a spontaneous hemorrhage of the lesion. The local examination reveals the presence of a red-purple polynodular neoplastic lesion of 180×110×30 mm, of firm consistency, adherent to the subcutaneous tissue, painless, with lateral extension at 8 o'clock as an erythematous infiltrated atrophic plaque appearance. One of these nodular masses presents surface ulceration and areas of necrosis. The CT scan did not detect any infiltration into the pectoral muscle or loco-regional metastasis. Under general anesthesia a wide surgical excision with free macroscopic margins of 3 cm was performed. Histopathological diagnosis was DFSP, with evidence of tumoral spindle cells disposed in storiform pattern, embedding small adipocyte panicles, creating a lace-like or honeycomb appearance. Immunohistochemically, the tumor cells express an intense and diffuse CD34 and they are negative for S-100 and SMA. The Ki-67 is focal positive in almost 2-4%. Clinical and paraclinical monitoring at 18 months follow-up does not detect any local recurrences or metastases, and an excellent quality of life.