Ketamine in dentistry: a useful way for non-compliant pediatric patients.

The infant, like the young un-cooperative or odontophobic patient, constitute the most complex type of patient to be treated and it is frequent in modern society. The treatment of these patients is necessary to resolve the infectious-antalgic urgency and subsequently to build the patient/doctor relationship for continuing general dental care. Conscious sedation is the only way to approach this type of patient. Where therapeutic success with traditional sedation techniques is not achieved, as frequently happens in these patients, sedation with ketamine is the extreme ratio for the purpose of effective resolution of the dental problem, obviously carried out within facilities authorized for these anesthesiological modalities such as private outpatient surgery structures where, when necessary, it is possible to carry out the treatments also under general anesthesia as well as with ketamine.

Effects of the sander bite jumping appliance in patients with class ii malocclusion before growth peak.

Sander bite jumping appliance (BJA) is a functional appliance used to correct Class II malocclusion in growing patients. The aim of this study was to identify the dento-skeletal effects in patients treated with BJA before growth peak and to compare these effects with the ones obtained in a similar group treated with the Andresen activator (AA). Twenty subjects with class II relationship of the skeletal bases and cervical vertebrae maturation stage 1 or 2 were enrolled in the study and treated with BJA. This group were compared to 14 subjects treated with AA. Cephalometric analyses were carried out using landmarks derived from the analyses of Pancherz, Ricketts, Tweed and Steiner. After treatment with BJA Pg/OLp increase was 7.40±3.81 mm (P<0.001); Pg/OLp+Co/OLp significantly heightened from T0 to T1 (T0: 82.20±4.65 mm vs T1: 89.62±4.27, P<0.001). Overjet (is/OLp - ii/OLp) significantly decreased from T0 to T1 (T0: 7.40±2.31 mm vs T1: 3.05±1.34 mm, P<0.001). Molar relationship improved passing from 1.46±1.68 mm at T0 to -3.56±2.04 mm at T1 (P<0.001). No statistically significant differences were found between BJA and AA groups at T0 and T1. BJA treatment determined a Class II malocclusion correction in all patients. The correction of molar relationship was mainly due to the increase in mandibular length; the correction of the overjet was due to the increase in mandibular length, to the slight pro-inclination of the lower incisors and the mild retro-inclination of the upper incisors. No significant differences were found in effectiveness between BJA and AA.

Platelet rich plasma grafting technique combined with trans-sinusal post-extractive implants placement in the posterior maxilla: a technical report and brief literature review.

The atrophic posterior ridges are usually characterized by poor bone quality and quantity: this situation requires the use of bone regenerative techniques. Other alternative surgical approaches are investigated. Nowadays the use of trans-sinus implants offers some advantages due to its feasibility. Today, bone grafting may be practical, but depends on many factors, such as the type of bone graft used (autogenous, alloplastic, or xenograft), host response, age of the patient, various complications associated with grafting procedures, infection, and, most importantly, the time spent while the grafted material matures and is taken up by the bone. So, this case report describes the feasibility of an alternative surgical technique associated to PRP (Platelet Rich Plasma).

New trends in adjunctive treatment and diagnosis in medication-related osteonecrosis of the jaw: A 10-year review.

Medication-related osteonecrosis of the jaw (MRONJ) is a major disease under study for over the last twenty years. Different classifications have been proposed and many therapies for the different stages have been applied. The evolution of treatments lead to an increasingly conservative approach. Numerous adjuvant treatments have been proposed in the last decade. All these complementary treatments have been proposed mainly to resolve or reduce the painful stress, predominantly caused by bacterial infection, simplifying the wound healing process and improving patients' compliance. Nowadays "secondary" treatments, such as autologous platelet concentrates (APCs, more specifically PRP, PRGF or PRF), hyperbaric oxygen (HBO), Auto/tetracycline fluorescence-guided bone surgery (AF-GBS/TF-GBS), medical drugs like teriparatide or the combination between pentoxifylline and tocopherol, fluorodeoxyglucose positron emission tomography (FDG-PET), laser and/or low-laser therapy and ozone therapy are more or less well documented and known considering their clinical effectiveness. The aim of the present review is the evaluation of the quantity and quality of scientific studies concerning this specific topic.

The use of computer-guided flapless dental implant surgery (Nobel guide®) and immediate function to support a fixed full-arch prosthesis in fresh frozen homologous bone grafted patients: a retrospective cohort study with 5 to 8-year follow-up.

The introduction of computer-assisted and guided surgery has radically improved the possibility of using all available bone for implant support, reducing the need for extensive grafting procedures and allowing for better implant placement and restoration. Moreover, fresh frozen homologous bone (FFB) grafts have shown good osteoconductive properties and biocompatibility with results comparable to autologous bone patients. The purpose of this retrospective cohort study was to evaluate the survival and the success rate of implants and related fixed full arch prosthesis at the 5 to 8 years follow-up when performed with immediate function using a flapless surgical procedure and computer-aided technology (NobelGuide®, Nobel Biocare® AB, Goteborg, Sweden) in patients previously treated with FFB grafts; treated at the University of Verona with the NobelGuide® system from January 2007 to December 2012 with at least 5 years follow-up were reviewed. Survival implants and survival prosthesis' percentage reached 95% in a 5 to 8-year period. This study indicates that patients previously augmented with FFB graft for maxillary or mandibular bone atrophy can be safely treated with implant supported prosthesis based on the NobelGuide® protocol, with the aid of computer-generated guide.

The rule of hydrogen peroxide long term rinse during a particular alveolar bone healing after ONJ injuries in a patient with periodontal disease: a 4-year radiological follow up report of a mental nerve emergence migration.

Bisphosphonate Related Osteonecrosis of the Jaw (BRONJ) is a pathology initially described in the early 2000s that has become increasingly common in clinical dentistry and maxillofacial practice due to the frequent use of bisphosphonates medical drugs (BPs) to treat various diseases such as osteoporosis, Paget's syndrome, osteomyelitis and in bone metastases secondary to tumors. Supragingival irrigation applied as monotherapy and in combination with root planning or BFs related bone necrosectomy revealed that supragingival irrigation with a variety of agents reduced the gingival microbial load and gingival inflammation. In this 4-year follow-up study we analyze the use of hydrogen peroxide (H2O2) as an antimicrobial agent for maintenance periodontal health, improving the longevity of teeth and oral cavity healing process.

Zygomatic implants supported rehabilitations in atrophic maxilla: sinus complications, radiological, periodontal and prosthodontic evaluations: a one year follow up retrospective longitudinal study.

The rehabilitation of maxillary bone atrophy represents one of the main challenges of modern oral implantology. The use of zygomatic implants in the prosthetic rehabilitation of the patient affected by severe maxillary bone atrophy is another therapeutic alternative, not exempt from complications. The present study included 19 patients with edentulous maxillae who were treated between 2013 to 2015 with at least two zygomatic implants at the Department of Maxillofacial Surgery, Verona, Italy. The purpose of this retrospective longitudinal study was to evaluate sinus complications and radiological, periodontal and prosthetic evaluations of zygomatic implants technique in severe atrophic. Implant-prosthetic rehabilitation of the upper jaw edentulous severely atrophic using zygomatic implants represents one safe and repeatable technique. In terms of implant survival from our study showed an implant CRS (common reporting standard) of 98.5% and a prosthetic CRS 100% with a mean follow-up period of 19.2 months (range). Both recorded data are superimposed on major reported studies in literature.

Evaluation of pain, swelling and trismus after extraction of impacted third molars relative to the use of betamethasone in submucusal infiltration.

The aim of this study was to evaluate the anti-inflammatory effect of a single 4 mg injection of submucosal betamethasone after extraction of impacted third molars. Single-centre, single-blinded, parallel group study; Forty-three patients were submitted to impacted third molar extraction. In this study, 4 mg single-dose submucosal betamethasone was injected in the interventional group, while in the control group nothing was injected. Postoperative measurement included pain via the VAS scale, swelling and trismus with facial measurements and maximum mouth openings, and finally nerve sensitivity. There was a significant difference between the two groups regarding trismic pain and edema. The use of a single 4 mg submucosal betamethasone injection leads to a reduction of oedema, trismus and pain in patients undergoing impacted third molar extraction. .

Efficacy of the Andresen activator before peak growth in class II patients.

Andresen activator (AA) is a functional appliance used to correct Class II malocclusion in growing patients. It corrects the malocclusion stimulating mandibular growth and determining a palatoversion of the upper incisors and a vestibularization of the lower incisors. The aim of this study was to analyze the treatment efficacy of class II malocclusion due to mandibular hypodevelopment before peak growth. Fourteen subjects with class II relationship of the skeletal bases and cervical vertebrae maturation stage 1 or 2 were enrolled in the study. Cephalometric analyses were carried out using landmarks derived from the analyses of Pancherz, Ricketts, Tweed and Steiner. A significant decrease (P less than 0.05) in ANB angle was found (-2.29±3.05°) after treatment, which was expression of an improvement in maxillo-mandibular sagittal skeletal relationships. There was also a significant reduction of OJ after treatment (-4.44±2.36 mm; P less than 0.001), indicating a vestibularization of the mandibular incisors and a palatoversion of the maxillary incisors, and a correction of the molar relationship. The favorable effects of the Andresen activator for the correction of the mandibular defect can be found even prior to peak growth; the achieved class I relationship maintains a correct mandible position in time, ensuring a proper skeletal growth. .

Tooth agenesis: part 2. Orthodontic treatment and prosthetic possibilities.

Dental agenesis has a great clinical significance due to its frequency during daily practice and the therapeutic problems that can arise from it. This paper will explore all the aspects to consider in order creating a proper multidisciplinary treatment plan: in particular, orthodontic, prosthetic and implantologic therapeutic alternatives are described for the rehabilitation of the different areas of the dental arches. In fact, dental agenesis is a problem that often requires the intervention of specialists from the different fields of dentistry and its treatment must meet aesthetics needs, stomatognathic function and patient satisfaction.

Tooth agenesis: part 1. Incidence and diagnosis in orthodontics.

Dental agenesis has a great clinical significance due to its frequency during daily practice and the therapeutic problems that can arise from it. This paper will explore the incidence of dental agenesis, its diagnosis and how this anomaly affects the teeth differently. The second subsequent paper will look at its treatment and management.

Piezoelectric surgery inserts vs conventional burst: a clinical investigation.

Piezosurgery is a new technique that can be used to cut mineralized structures without damaging adjacent soft tissues. This device has a lot of advantages: reduced surgical time, blood loss, and inferior alveolar nerve injury in bimaxillary osteotomy. Fifty patients underwent different surgical operations (orthognathic surgery, traumatic surgery, reconstructive surgery, aesthetic procedures) with 7 different kind of piezosurgery inserts in a period of 8 months. The same two surgeons performed all the procedures. All the procedures were carried out in order to improve the precision of the osteotomy and the comfort of the surgeon. Piezoelectric devices provide an innovative ultrasonic technique for safe and effective osteotomy compared with methods that use rotating instruments. Different inserts have been developed in order to achieve the utmost advantages.

Histological evaluation of periodontal ligament in human after orthodontic treatment with piezosurgery and monolateral tooth dislocation and ligament distraction technique: a first morphologic and histologic evaluation.

Traditional orthodontic tooth movement is based on the concept that application of a protracted force causes alveolar bone remodelling and adaptive changes in periodontal and dental tissues. Thus, if orthodontic tooth movement is described as a biological bone reaction to orthodontic forces mediated by the periodontal ligament (PDL), this event involves a series of sophisticated signal transduction processes that allows the PDL compression with specific histologic and biomolecular modifications. However, the preservation of the integrity of the PDL is generally difficult to achieve when it is associated with a long duration of orthodontic treatment. A total of 20 Caucasian patients with different dental-skeletal were treated using the Monocortical Tooth Dislocation and Ligament Distraction (MTDLD) technique with Piezosurgery associated with morphologic and histological evaluation of the PDL. The histological results obtained, confirm a good clinical outcome with an improvement of the speed on orthodontic treatment without any signs of tissue injury of PDL fiber without areas of hyalinization. The data suggests that MTDLD with Piezosurgery seems to be a valid alternative to the traditional orthodontic movement in adult patients preserving the anatomy and the integrity of PDL.

Rhinorrhea triggered by obturator prosthesis after surgical intervention of partial maxillary resection: a clinical report.

This clinical report describes a case of rhinorrhea that arose after surgical intervention of partial maxillary resection and obturator prosthesis positioning. Ultimately, the diagnosis was that rhinorrhea was induced by mechanical irritation of the nasal mucosa determined by the nasal part of the obturator prosthesis. The differential diagnosis of nasal irritation, vasomotor rhinitis, gustatory rhinorrhea are presented and discussed, as well as the technical notes and measures taken to reach the final diagnosis and a satisfactory functional and aesthetic result for the patient.