Postoperative discomfort in oral soft tissue surgery: a comparative perspective evaluation of Nd:YAG Laser, quantic molecular resonance scalpel and cold blade.

AIM: The aim of this paper was to compare pain, health-related quality of life (HRQoL) and need for painkillers during the postoperative course of oral soft tissue surgery performed with neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, quantic molecular resonance (QMR) scalpel and cold blade. METHODS: One-hundred and sixty-three similar surgical interventions were subclassified as follows: group 1 (G1), 77 cases performed with Nd:YAG laser; group 2 (G2), 45 cases performed with QMR scalpel and group 3 (G3), 41 cases performed with cold blade. Pain was evaluated using a Visual Analogue Scale (VAS), a Numeric Rating Scale (NRS) and a Verbal Rating Scale-6 (VRS-6) on the same day of surgery (day 0), and at 1, 3 and 7 days after surgery. The HRQoL was evaluated on day 7 using a 0-45 score range questionnaire. On day 7, painkillers taken were recorded. RESULTS: No statistically significant differences could be highlighted in the VAS and NRS scores at day 1, 3 and 7. A trend toward significance at day 0 was evident, with a VAS and NRS average scores lower in G1 than G2 and G3. With regard to VRS-6, the scores resulted statistically lower in G1 than G2 and G3 at day 1 and 3. The HRQoL in G1 was statistically lower than G3. CONCLUSION: Our study demonstrates that the use of new technologies in oral soft tissue surgery is associated to a reduction of postoperative discomfort. The better HRQoL and the lower postoperative pain observed in laser-treated patients may be associated to the possible bio-modulating effect of the laser.

Pharmacological GSK-3beta inhibition improves osteoblast differentiation on titanium surfaces.

Rough titanium surfaces enhance the activation of Wnt canonical signaling, a pathway required for osteoblast differentiation. The present study investigated the effects of GSK3b-inhibitor (2'Z,3'E)- 6-Bromoindirubin-3'-oxime (BIO) on osteoblastic differentiation on titanium surfaces with different topography and wettability. C2C12 cells were plated on pickled, acid-etched/sand-blasted (SLA), modified hydrophilic SLA titanium discs (modSLA) and stimulated with increasing doses of BIO. Activation of Wnt canonical signaling was measured with a reporter system. Gene expression was measured in the same cell system by Real Time PCR. Osteoblastic MC3T3 cells were then plated on discs with or without BIO and the expression of osteoblast specific genes was assessed by Real Time PCR. One mM BIO activated Wnt canonical signaling in C2C12 cells on all surfaces, and the highest effect was on rough surfaces. BIO markedly increased the expression of Osteoprotegerin and Osteocalcin in MC3T3 cells on rough surfaces at the concentration of 100 nM, and on all surfaces at the concentration of 1 mM. BIO enhances Wnt signaling activation and the expression of osteoblastic genes on rough surfaces and could be a viable approach to improve cell response to implant surfaces.

Intra-oral laser welding: an in vitro evaluation of thermal increase.

The neodymium:yttrium-aluminium-garnet (Nd:YAG) laser is currently used in dental laboratories to weld metals on dental prostheses. Recently, the use of Nd:YAG has been suggested so that dentists themselves can repair broken fixed, removable and orthodontic prostheses by welding metals directly in the mouth. This work aimed to evaluate, through a four k-type thermocouple system on calf jaws, the thermal increase in the biological structures close to the metal parts during laser welding. We put two hemispherical metal plates onto mandibular molars and then laser welded them at three points with a four k-thermocouple system to determine the thermal rise in the pulp chamber, sulcus, root and bone. This procedure was carried out on 12 samples, and the results were processed. The highest values of thermal increase were found in the pulp chamber, 1.5 degrees C; sulcus, 0.7 degrees C; root, 0.3 degrees C; and bone, 0.3 degrees C. This study showed that thermal increases in pulp chamber, sulcus, root and bone were biologically compatible and that intra-oral laser welding, at the parameters used in this work, seems to be harmless to the biological structures close to the welding and thermally affected zones.

Polymerization shrinkage of microfilled composites determined by laser beam scanning.

An He-Ne scanning laser beam was used to measure for the first time the linear shrinkage of light-cured microfilled composites. A low-power beam, which has a wavelength (632.8 nm) different from the polymerization wavelength (approximately 450 nm), was used. In these conditions no shrinkage is induced by the laser light. This method of measurement makes it possible to analyse small samples with a very low error (1.1 microns). Five different materials were tested using 10-20 mg specimens, and the shrinkage process was examined in detail over 2 days. All these materials showed shrinkage of more than 50% of their original length after 1 min of irradiation and approximately 99% of the total shrinkage occurred 4 h after irradiation.

Motor-evoked potentials in masseter muscle by electrical and magnetic stimulation in intact alert man.

The electromyographic responses of the masseter after different types of transcranial stimulation were recorded with surface and needle electrodes. Magnetic stimulation at 4 cm lateral to the vertex on the biauricular line elicited MEPs in the contralateral masseter (latency 6.9 ms) due to activation of motor cortex or adjacent elements along the cortico-nuclear pathway. The ipsilateral responses to the same stimuli and to more lateral ones had shorter latencies and were ascribed to direct stimulation of the trigeminal nerve, probably its intracisternal portion. This was also the probable origin of the ipsilateral MEPs after both anodic and cathodic bipolar electrical stimulation at 7 and 11 cm lateral to the vertex on the biauricular line.

Nevoid basal cell carcinoma syndrome: a review of the literature.

The nevoid basal cell carcinoma syndrome (NBCCS) or Gorlin-Goltz Syndrome is an autosomal dominant disorder principally characterized by cutaneous basal cell carcinomas, multiple keratocysts, and skeletal anomalies. The present report reviews current knowledge of this disorder that has profound relevance to specialists in Oral and Maxillo-Facial Surgery, Oral Medicine and Radiology.

[Neoplastic transformation of oral lichen planus. I: Review of the literature]. / La cancerizzazione del lichen planus orale. I: Revisione della letteratura.

Lichen planus is described like a well-characterized dermatological condition affecting the skin and the oral and genital mucosa. Over the years, different authors have expressed the possible oral lichen planus premalignant nature, but this is still controversial. This criticism is due to the insufficiency of the clinical and histopathological data to support the initial diagnosis of oral lichen planus, the occurrence of some wrong diagnostic criteria for this pathology, the contemporary presence in the same region of the oral lichen planus lesions and of neoplasia. The malignant transformation of oral lichen planus rate varies, according to authors, from 0.4 to 3.7%. The aim of this study is to review the literature from 1910 to 1999, focusing on the suggested possible premalignant nature of oral lichen planus.

[Neoplastic transformation of oral lichen planus. II: association with risk co-factors]. / La cancerizzazione del lichen planus orale. II: Associazione con co-fattori di rischio.

The possible malignant transformation of oral lichen planus is still controversial. It is not clear if this is in fact due to the premalignant nature of oral lichen planus or to the presence of some risk-factors in patients with this pathology. The risk co-factors that may he involved in this malignant transformation are numerous. Some authors suggested a correlation between oral lichen planus and HCV or HGV, or with the presence of some oncogenic viruses (EBV, HSV, HPV). Cases of this malignant transformation on oral and genital mucosa with lichen are reported, hut none on the skin lesions. The aim of this study is to investigate, through the literature, these correlations that may have a role in the malignant transformation of oral lichen planus.

[Pathogenesis of cyclosporine induced gingival overgrowth]. / Patogenesi degli aumenti di volume gengivale causati da ciclosporina.

Several studies, during the last 20 years, tried to explain the pathogenetic mechanisms of the cyclosporine (CS) induced gingival overgrowth (and in general, of the drugs induced gingival overgrowth), but they are still poorly understood. The relationship between the drug and the different pharmacokinetic variables (dosage, duration of therapy, plasmatic and salivary Cs concentration) is still on discussion. It is accepted that a threshold concentration is necessary, in the gingival tissues, to begin or to enhance the morphostructural changes of the gums, but the total Cs weight, from the beginning of the therapy to the time of clinical examinations, has to be evaluated. The pharmacokinetic variables are associated with many other factors (first of all the oral hygiene score) that are probably connected with the developing of the gingival lesions. Gingival inflammation could be very important in the pathogenesis of gingival overgrowth. It has been shown by several cross-sectional studies a strong association between plaque and gingival lesions, but it is not yet clear if plaque accumulation is a causal factor or a consequence of the morphological gums changes. It would seem that the morphological alterations, in drug-induced gingival overgrowth, could be started by the plaque induced inflammation, and this would lead to an hyperemic and edematous gingival tissue. Oral hygiene (professional and at home) is more difficult and represents an irritation factor that makes the pathological cycle to go on. Other factors, probably connected with the cyclosporine induced gingival overgrowth, are represented by age, gender, genetic predisposition, alterations of gingival connective homeostasis and metabolism, inflammatory alterations, interactions with the growth factors and protective or synergic effects of other drugs.

[Burning mouth syndrome. Clinical experience with 75 patients]. / Burning mouth syndrome. Esperienza clinica in 75 pazienti.

The burning mouth syndrome (BMS) is a very common disorder frequently seen in practical dentistry. It is a particular condition with a complex of strange burning sensation localized in the oral mucosa which is clinically normal. It is very important for the dentist to recognize and classify this particular syndrome in order to exclude other factors which can cause the same symptoms. On the basis of personal experience on 75 patients, the complex management of this particular group of patients has been evaluated to make a right diagnosis and a correct treatment.

[Gorlin-Goltz syndrome]. / Sindrome di Gorlin-Goltz.

The Nevoid Basal Cell Carcinoma Syndrome (NBCCS) or Gorlin-Goltz syndrome, principally characterized by basal cell carcinomas, multiple jaw cysts and skeletal anomalies, is an interesting pathology for the dentist who is often the first clinician involved in the diagnosis of this syndrome. Because of the multisystem involvement and variable expressivity of NBCCS, patients affected by this syndrome must be evaluated by many medical and dental specialists in order to properly sequence their treatment.

[Temporal muscle fatigue studied via muscle conduction velocity technics and spectral analysis of the electromyographic signal]. / La fatica nel muscolo temporale tramite tecniche di velocità di conduzione muscolare e di analisi spettrale del segnale elettromiografico.

We examined 6 normal volunteers (3 males and 3 females, age 26-30). They were requested to clench as hard as they could until they felt pain. The experiment was repeated one hour later. Emg was recorded during the fatiguing exercise and the recovery period. We couldn't determine the muscle conduction velocity, probably because of the anatomy of the temporal muscle. The mean of the power spectrum showed wide variability and proved unsuitable for clinical applications, both for diagnosis and follow-up.

[11 cases of erythema multiforme. The etiological correlations and therapy]. / Undici casi di eritema multiforme. Correlazioni etiologiche e terapia.

Erythema multiforme (EM) is characterised by a polymorphous eruptive complex which many involve the cutis and oral, genital and conjunctival mucous. Its etiopathogenesis is unclear: it is thought to be associated with various viral or bacterial infective agents (herpes virus, Coxsackie virus, mycoplasmas, etc.), numerous drugs, physical therapy, systemic pathologies of various types. The authors report their experience in relation to 11 patients suffering from EM; the clinical characteristics of each case are reported, together with the course of disease, and the diagnostic and therapeutic protocol adopted. The discussion examines the possible cause of disease: in 5 patients the etiology was traced back to viral infections (4 herpes and 1 coxsackie) and to the administration of drugs in the remaining cases (4 in relation to anti-phlogistic agents and 2 regarding antibiotics).

[Electromyographic evaluation of silent periods in the elevator muscles of the mandible in dysfunctional pathology of the temporo-mandibular joint]. / Valutazione elettromiografica dei periodi inibitori nei muscoli elevatori della mandibola in corso di patologia disfunzionale dell'articolazione temporo-mandibolare.

After a brief review of the features and physiology of the silent period, its modifications in painful temporomandibular dysfunction are assessed with particular reference to their reliability in practical diagnosis. Six patients with the classic signs and symptoms as well as 7 healthy volunteers acting as controls were examined. In view of the results obtained as well as the discrepancies reported in the literature and the numerous variations in the methods used in stimulating, recording and measuring the silent period, it is concluded that this study can play no more than a supporting role in the diagnosis of the syndrome despite its value in experimental research.

[Masseteric responses following electrical stimulation of the scalp]. / Risposte masseterine seguenti stimolazioni elettriche allo scalpo.

Electromyographic responses of the masseter muscles following electric transcranial stimulations by a conventional constant current stimulator were recorded with surface and needle electrodes. Ipsilateral motor evoked responses following both anodic and cathodic bipolar electrical stimulations performed at 7 and 11 cm laterally to the vertex on the biauricular line were recorded, with latencies ranging from 2 to 3.6 ms. Contralateral responses were not elicited. The ipsilateral responses to stimuli were ascribed to direct stimulation of the trigeminal nerve, probably its intracisternal portion.

[Magnetic stimulation of the scalp: the responses of the masseter muscles. I]. / Stimolazione magnetica allo scalpo: risposte nei masseteri. Parte I.

Magnetic stimulation of nervous elements is a new neurophysiological technique. It easily succeeds in stimulating the brain motor cortex. We applied this technique to the trigeminal motor system, recording responses in masseter muscles. The magnetic stimulations at 4 cm laterally to the vertex on the biauricular line elicited responses in the contralateral masseter due to activation of motor cortex or adjacent elements along the cortico-nuclear pathway. The ipsilateral responses to the same stimuli and to more lateral ones presented shorter latencies and they were ascribed to direct stimulation of the trigeminal nerve, probably its intracisternal portion. The latency values were 6.9 +/- 0.71 ms and 3.6 +/- 0.3 ms respectively.

[Magnetic stimulation of the scalp: the responses of the masseter muscles. II]. / Stimolazione magnetica allo scalpo: risposte nei masseteri. Parte II.

Magnetic stimulation of nervous elements is a new technique of investigation in intact alert man. Electromyographic responses of the masseter muscles were recorded in normal volunteers and in two patients with hemispheric or capsular lesions, both by surface and needle electrodes. In the patients "cortical" responses were absent when stimulating the affected hemisphere and present when stimulating the unaffected one. These findings suggest that the direct facilitating cortico-nuclear projections for the masseter muscle are mainly crossed. Nevertheless the presence of clear ipsilateral responses after stimulation of the unaffected hemisphere demonstrates the existence of uncrossed projections; in fact only the ipsilateral motor cortex can be the site of origin of the responses in these patients.

[Headaches and craniofacial pains with dental involvement in the classification of the International Headache Society (1988)]. / Cefalee e algie cranio-facciali di interesse stomatologico nella classificazione della International Headache Society (1988).

Facial pain often presents complex diagnosis, requiring other specialists' consultation. The use of different terminology and protocols can affect the information exchange negatively. These problems in the field of headache, cranial neuralgias and facial pain lead the International Headache Society to introduce a new classification in 1988. The chief difference with the previous ones is the presence of strictly codified diagnostic principles. Its target is research, but it can help the general practice as well. We discuss the most interesting points to the stomatologist.