Healing of human critical-size alveolar bone defects secondary to cyst enucleation: a randomized pilot study with 12 months follow-up.

BACKGROUND: Alveolar bone cyst enucleation can give rise to critical-size defects whose healing may be incomplete due to the loss of periosteum or bone walls and there is a paucity of studies investigating the use of immediate bone grafts. The aim of this study was to compare spontaneous healing versus a deproteinized bovine bone graft. METHODS: In this prospective randomized clinical pilot study, twenty patients requiring the removal of a cyst ≥20 mm in maximum diameter were randomly assigned to one of two groups: deproteinized bovine bone grafting (test) or spontaneous healing (control). Computed tomographies were obtained preoperatively and 12 months after surgery and the radiolucent volumes were compared. Residual radiological morphology and clinical outcomes at 7 days and 1, 6 and 12 months after surgery were also assessed. RESULTS: The median percentage reduction in the volume of the defect was 98% in the test group and 73% in the control group (P=0.001) with an evidence of soft tissue invagination in the latter. There were no differences in the clinical parameters between the two groups. CONCLUSIONS: Within the limitations of this pilot study, the healing of critical-size alveolar bone defects is incomplete at 1 year observation and the use of deproteinized bovine bone graft did not influence the clinical outcomes.

An Observational Cohort Study on Delayed-Onset Infections after Mandibular Third-Molar Extractions.

OBJECTIVES: The purpose of the present study was to investigate the occurrence and clinical features of delayed-onset infections after mandibular third-molar extractions. METHOD AND MATERIALS: An observational cohort study was conducted on 179 patients undergoing mandibular third-molar extraction between January 2013 and December 2015, for a total of 217 extractions. Data were recorded at the time of extraction (T0), on suture removal seven days later (T1), and 30 days after the extraction, when patients were contacted and asked about their healing process (T2). The statistical analysis was performed with nonparametric tests. A p value lower than 0.05 was considered statistically significant. RESULTS: Eight delayed-onset infections were recorded, amounting to 3.7% of all extractions. The median time elapsing from the extraction to the delayed-onset infection was 35 days (IQR 28-40; min 24-max 49). Younger age and longer surgical procedures seemed to be more often associated with this complication. CONCLUSION: Delayed-onset infections after third-molar extractions are relatively rare postoperative complications characterized by a swelling, usually with a purulent discharge. Patients should be informed of this possibility, which might develop even several weeks after the extraction.

Rehabilitation With Implants After Bone Lid Surgery in the Posterior Mandible.

Bone defects are often secondary to alveolar disease removal. Creating a bone lid with piezosurgery is a valid method to preserve the alveolar bone. A careful and precise osteotomy associated with a firm placement of the bone lid in its original position enables better bone healing, thus allowing for the delayed insertion of dental implants at the operated site with no need for any bone augmentation procedures. The aim of this technical note is to present the application of the bone lid surgery in the posterior mandible before dental implant rehabilitation.

Managing dentoalveolar surgical procedures in patients taking new oral anticoagulants.

The development of new orally administered anticoagulants, such as dabigatran, rivaroxaban, and apixaban, in the past few years has focused on avoiding some of the drawbacks associated with warfarin. This work aims to illustrate the main features of the most commonly used new oral anticoagulants, reviewing the current literature on the management of patients taking these drugs and needing oral and implant surgery, and discussing the currently proposed related guidelines.

Pulsed electromagnetic fields for postoperative pain: a randomized controlled clinical trial in patients undergoing mandibular third molar extraction.

OBJECTIVES: The clinical efficacy of a wearable pulsed electromagnetic field (PEMF) therapy device was assessed in terms of pain and quality of healing after tooth extraction. STUDY DESIGN: This randomized, parallel design, placebo-controlled study involved 120 patients undergoing unilateral mandibular third molar extraction and assigned to three groups after surgery. Test and placebo patients wore enabled or disabled PEMF devices, respectively, and controls wore no device. Patients recorded pain (on the visual analog scale) and analgesic use for a week, after which healing complications were assessed. RESULTS: Test patients had only slightly lower visual analog scale scores and analgesic use, but significantly fewer cases of dehiscence than placebo patients. CONCLUSIONS: PEMF therapy delivered by a wearable device improved soft tissue healing and may be a useful adjunct for pain management after oral surgery.

Canalicular adenoma immunoprofile: a case report.

OBJECTIVES: To report a case of canalicular adenoma (CA) and discuss the use of immunohistochemistry to better address the diagnosis given some unusual characteristics in this patient. BACKGROUND: CA is an uncommon benign neoplasm that can develop in minor salivary gland duct tissues throughout the oral cavity. At histology, it shares several features with other salivary tumors. Immunohistochemistry can be useful in the differential diagnosis. MATERIALS AND METHODS: The clinical presentation consisted in a nodule on the left upper lip of an 85-year-old man. The patient's main complaint was upper denture instability secondary to soft tissue changes. The nodule was excised under local anesthesia and underwent histological and immunohistochemical examination to rule out any malignancy. RESULTS: Histological findings, cytokeratin positivity and the absence of any reactivity to specific markers of myoepithelial differentiation confirmed the epithelial nature of the lesion. CONCLUSION: The histological diagnosis of benign salivary tumors such as CA can be confirmed by immunohistochemistry.

Destructive membranous periodontal disease (ligneous gingivitis): a literature review.

BACKGROUND: Destructive membranous periodontal disease, or ligneous gingivitis, is a rare condition involving nodular gingival enlargement with ulceration and periodontal tissue destruction. This review gives a brief account of the cases reported in the literature. An effort is also made to define the periodontal disease caused by plasminogen deficiency with a view to its potential inclusion in the classification of periodontal diseases. METHODS: A MEDLINE/PubMed and manual search was conducted to find papers describing ≥1 case of ligneous disease involving the oral mucosa. RESULTS: We identified 23 articles reporting 35 cases. For each patient, we analyzed various characteristics, including age, sex, age of onset, oral symptoms, histologic features, plasminogen levels (functional activity, plasma antigen), genetic features, treatment, and results of treatment during the reported follow-up. CONCLUSIONS: Ligneous gingivitis is a rare periodontal disorder closely associated with ligneous conjunctivitis and plasminogen deficiency. Its diagnosis may be supported by the finding of genetic mutations responsible for the condition. Research is focusing on the future development of an effective therapy capable of arresting the destructive evolution of the disease. Additional studies, investigating features such as probing depth and attachment loss, are needed for the appropriate classification of this periodontal disease.