Flapless Versus Traditional Dental Implant Surgery: Long-Term Evaluation of Crestal Bone Resorption.

PURPOSE: The literature reports that flapless compared with traditional implant surgery can be associated with several advantages, including the maintenance of peri-implant hard tissues. This study investigated vertical bone resorption during long-term follow-up after implant placement with flapless versus traditional surgery. MATERIAL AND METHODS: In this prospective, randomized controlled clinical trial, 40 patients underwent implant placement at the Maxillofacial Department Surgery of the Istituto Stomatologico Italiano Hospital in Milan, Italy. Patients were randomly assigned to the control or experimental group. The control group had implants placed with open flap surgery (traditional surgery), whereas the experimental group had implants placed with flapless surgery. The distance between the first implant thread and the marginal crestal bone level was measured at the basal, loading, and long-term control points. The basal recording was performed just after implant placement. The loading measurement was recorded at the time of implant loading, after 2 months of healing for the lower jaw and after 3 months of healing for the upper jaw, and the long-term control record was registered 36 months after implant placement. Statistical analysis was performed using mean values and standard deviations based on bone resorption in the 2 groups. To detect statistical differences, the Student t test was applied. Differences were considered significant if P values were less than .05. RESULTS: The control group (open flap surgery) was comprised of 19 patients, and the experimental group (flapless surgery) was comprised of 21 patients. No statistical differences were found in peri-implant bone resorption between the 2 groups at the basal, implant loading, and 3-year control recordings. CONCLUSION: According to this study, the approach to implant surgery does not seem to influence peri-implant bone resorption in humans, at least for the period measured in this study.

Management of symptomatic florid cemento-osseous dysplasia: Literature review and a case report.

INTRODUCTION: Cemento-osseous dysplasia is a jaw disorder characterized by a reactive process in which normal bone is replaced by connective tissue matrix. There are different Cemento-osseous dysplasia entities. The treatment of these lesions, once diagnosed by radiology, is not required because generally they are asymptomatic. The localization is in the tooth-bearing areas of the jaws and its distribution is symmetric. CASE REPORTS: In this case report, a 57-year-old Caucasian female patient was referred to our attention complaining of painful inflammatory events localized in the right angle of the jaw. The radiographic appearance, the distribution of several lesions and the positive vitality test of the involved teeth, supported the diagnosis of Florid Cemento-osseous dysplasia. Because of the symptomatology, the patient was submitted to surgery and the lesion and the second inferior right molar were removed. The histological examination of the specimens confirmed the diagnosis. DISCUSSION: Many lesions that may exhibit a similar sclerotic appearance on conventional radiographs have to be differentiated and dental imaging can be used to discriminate between Florid COD and other lesions. Diagnosis of Florid Cemento-osseous dysplasia can be made with accurate clinical and radiographic assessment. In asymptomatic cases no treatment is required and the patient should have regular follow-up, but in this symptomatic case it was necessary to proceed with surgical intervention. The surgery treatment in the symptomatic case had a favourable prognosis and the two years follow-up has shown a complete healing. Given the abow, it is concluded that the choice of treatment must be selective according to the disease sites. Key words:Cemento-ossifying dysplasia, fibro-osseous lesions, florid cemento-osseous dysplasia, cementoma.

Sinus lift: 3 years follow up comparing autogenous bone block versus autogenous particulated grafts.

BACKGROUND/PURPOSE: The aim of this prospective randomized controlled clinical trial was to compare vertical bone gain and bone resorption after sinus graft procedures performed either with particulate or with autogenous bone block. MATERIAL AND METHODS: Forty-one patients underwent sinus graft procedures with autogenous bone. They were randomly assigned to one group. The first group of 22 patients was treated with autogenous bone block with or without particulated bone, while in the second group of 19 patients sinus floor elevation was performed only with particulated autogenous bone. Linear measurements were recorded before surgery with a computed tomography scan at surgery and at 36 months after sinus lift grafting with a second computed tomography scan. To detect statistical differences Student t test was applied. Differences were considered significant if P values were < 0.05. RESULTS: There was a statistically significant difference in bone gain for the group treated with bone block grafts. CONCLUSION: As a general clinical guideline the clinician should prefer, wherever feasible, en-block bone grafts for sinus floor augmentation procedures.

[Piezoelectric surgery. An alternative method of minimally invasive surgery]. / Piezoelektrische Chirurgie. Eine alternative Methode für die schonende Chirurgie.

The piezoelectric surgery is an ultrasonic surgery which represents a novel and alternative method to the conventional hard and soft tissue management with rotating instruments in the oral district. The innovation of this technique is mainly due to three major characteristics: a) a micrometric cut of 60 mu to 200 mu, b) a selective cut which works on hard tissues but not on soft tissues, c) a relative blood free surgical field due to the air-water cavitation effect of the ultrasonic device. The final result of these characteristics is a definite clinical advantage with regard to the cut precision, the sparing of vital nervous soft tissues, the better visualisation of the surgical area. The present work shows through a series of case reports the possible use of the piezoelectric surgery in the oral district, presenting observed advantages and disadvantages over a time lag of 18 months. The entire clinical work was performed with the Piezosurgery device Mectron (Mectron Medical Technology, I-16042 Carasco).

Therapeutic efficacy of bromelain in impacted third molar surgery: a randomized controlled clinical study.

OBJECTIVE: Bromelain is the name given to a family of proteolytic enzymes obtained from Ananas comosus, the pineapple plant. It is considered a potent anti-inflammatory and antiedematous substance. Surgery of impacted third molars in the outpatient setting is one of the procedures most often associated with postoperative pain and swelling. The aim of this study was to evaluate the efficacy of bromelain in reducing postoperative pain and swelling. METHOD AND MATERIALS: 80 patients were recruited to the study from patients attending the Maxillofacial Surgery Unit of the Istituto Stomatologico Italiano, Milan, Italy, for impacted third molar surgery. At time 0 when surgery was performed, patients started simultaneous antibiotic and analgesic therapy. On the following day, patients were divided into two groups. Patients in group 1 were prescribed bromelain. Patients in group 2 were prescribed only the analgesic if required. Three parameters were evaluated: pain, edema, and erythema. The first evaluation visit was performed 3 hours after surgery, the second 48 hours after surgery, and the final evaluation 7 days after surgery. RESULTS: Postoperative pain, edema, and erythema were significantly lower in the study group than in the control group. Analgesic consumption, both in terms of days of treatment and number of tablets taken, was slightly lower in the study group. Only one adverse event was recorded, which occurred in a patient in the control group. CONCLUSION: The present study demonstrates an important anti-inflammatory and anti-edematous effect of bromelain. Statistical analysis shows that in the group treated with bromelain the inflammatory response was significantly less than in the control group.