Non-surgical periodontal treatment of peri-implant diseases with the adjunctive use of diode laser: preliminary clinical study.

Peri-implant diseases present in two forms: peri-implant mucositis and peri-implantitis. The prevalence of peri-implant complications is significantly rising. The aim of this study was to compare conventional treatment of inflamed peri-implant tissues with conventional treatment together with diode laser application. Twenty-seven patients (age 36 to 67, 15 women and 12 men, 12 smokers and 15 non-smokers) requiring treatment for mucositis or peri-implantitis were taken into account for this preliminary study. Plaque index (PI), pocket depth (PD), and bleeding on probing (BoP) were recorded at baseline evaluation. Patients in control group (CG) received conventional non-surgical periodontal treatment. Patients in test group received conventional non-surgical periodontal treatment together with diode laser application (810 nm, 30 s, 1 W, 50 Hz, t on = 100 ms, t off = 100 ms, energy density = 24.87 J/cm(2)). Paired t test was used to evaluate the difference in repeated measurements of considered indexes at T 0 and T 1 (1 year) in both groups. A total of 606 sites were taken into account in the test group (TG) and 144 in the CG. PD mean variation in the TG was 2.66 mm ± 1.07, while mean PD variation in the CG was 0.94 ± 1.13 mm. Paired t testing of the variation in PD in CG and TG revealed a statistically significant difference between the two groups (p < 0.0001). A reduction of pathological sites from 89 % (T 0) to 14.35 % (T 1) was achieved in the TG, while reduction obtained in the CG was from 75.69 % (T 0) to 50 % (T 1); BoP scores at time T 1 had fallen below 5 % in the TG and decreased to 59.7 %, in the CG. Within the limitations of this study, diode laser seems to be an additional valuable tool for peri-implant disease treatment.

Is erbium:yttrium-aluminum-garnet laser versus conventional rotary osteotomy better in the postoperative period for lower third molar surgery? Randomized split-mouth clinical study.

PURPOSE: Lasers have been extensively used in dentistry for several applications. We investigated and compared the use of an erbium:yttrium-aluminum-garnet laser and conventional rotary instruments for bone removal in third molar surgery. MATERIALS AND METHODS: We implemented a randomized, split-mouth clinical trial. Patients with bilateral and symmetrical third molar impaction referred to the Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, were enrolled in the study. Each patient was treated once with the erbium:yttrium-aluminum-garnet laser and once with conventional rotary instruments for bone removal during third molar surgery. Pain, swelling, and trismus were taken into account to match the 2 techniques.In addition, the times required to complete osteotomy and for the full operation were recorded. Descriptive and bivariate statistics were computed, and the P value was set at .05. RESULTS: The sample was composed of 15 patients (8 men and 7 women) ranging in age from 18 to 30 years. Pain perceived in the laser-treated group was significantly less than that in the conventional group(P = .0013). This also was true for trismus (P = .0002) and swelling. The operating time for osteotomy was longer in the laser group. CONCLUSIONS: The results of this study suggest that the laser could be an interesting alternative to conventional rotary instruments. Future studies with a larger number of patients are required to confirm the conclusions achieved from this work.

Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System.

Aim. To evaluate the pain experience and behavior during dental injection, using the Wand computerized delivery system versus conventional local anesthesia in children and adolescents. Methods. An observational crossover split mouth study was performed on 67 patients (aged 7 to 15 years), requiring local anesthesia for dental treatments in both sides of the dental arch. Patients received both types of injections in two separate appointments, one with the use of a Computer Delivery System (the Wand STA system) and one with the traditional syringe. The following data were recorded: pain rating; changes in heart rate; level of collaboration; patient satisfaction. The data were analyzed using ANOVA for quantitative outcomes and nonparametric analysis (Kruskal-Wallis) for qualitative parameters. Results. The use of the Wand system determined significantly lower pain ratings and lower increase of heart rate than the traditional syringe. During injection, the number of patients showing a relaxed behavior was higher with the Wand than with the traditional local anesthesia. The patient level of satisfaction was higher with the Wand compared to the conventional local anesthesia. Conclusions. The Wand system may provide a less painful injection when compared to the conventional local anesthesia and it seemed to be better tolerated with respect to a traditional syringe.

Focal epithelial hyperplasia in a human immuno-deficiency virus patient treated with laser surgery.

Focal epithelial hyperplasia (FEH), or Heck's disease, is a rare disease of the oral mucosa; it is mostly found in children or young adults who are immunosuppressed and who live in regions with low socioeconomic status. It is characterized by asymptomatic papules on the oral mucosa, gingiva, tongue, and lips. Healing can be spontaneous, and treatment is indicated if there are aesthetic or functional complications. Human papillomavirus, especially genotypes 13 and 32, has been associated with FEH and is detected in the majority of lesions. Histopathologically, FEH is characterized by parakeratosis, epithelial hyperplasia, focal acanthosis, and fusion and horizontal outgrowth of epithelial ridges. A 37-year-old male patient was referred to the Department of Oral and Maxillofacial Sciences at the Sapienza University of Rome, complaining of numerous exophytic lesions in his mouth. He stated that the lesions were not painful but he had experienced occasional bleeding after incidental masticatory trauma. He had received no previous treatment for the oral lesions. His medical history revealed that he was human immuno-deficiency virus positive and was a smoker with numerous, asymptomatic oral papules clinically and histologically corresponding to FEH. The labial and buccal mucosa were especially affected by lesions. Surgical treatment was performed using a 532-nm potassium titanyl phosphate laser (SmartLite, Deka, Florence, Italy) in continuous mode with a 300 µm fiber and power of 1.4 W (power density 1980.22 W/cm(2)). After anesthesia without vasoconstrictors, the lesions were tractioned with sutures or an Allis clamp and then completely excised. The lesions were preserved in 10% formalin for histological examination, which confirmed the clinical diagnosis of FEH. In this case, the laser allowed excellent control of bleeding, without postoperative sutures, and optimal wound healing.

Er:YAG Laser Dental Treatment of Patients Affected by Epidermolysis Bullosa.

Aim. The purpose of this study was to evaluate the efficacy of Er:YAG laser used for treating hard dental tissue in patients with epidermolysis bullosa (EB). Methods. We report two cases of EB in which an Er:YAG laser was used for conservative treatments. In the first case, the Er:YAG laser (2,940 µm, 265 mJ, 25 Hz) was used to treat caries on a deciduous maxillary canine in an 8-year-old male patient affected by dystrophic EB. In the second case, we treated a 26-year-old female patient, affected by junctional EB, with generalized enamel hypoplasia, and an Er:YAG laser (2,940 µm, 265 mJ, 25 Hz) was used to remove the damaged enamel on maxillary incisors. Results. The use of the Er:YAG laser, with the appropriate energy, was effective in the selective removal of carious tissue and enamel hypoplasia. During dental treatment with the Er:YAG laser, patients required only a few interruptions due to the absence of pain, vibration, and noise. Conclusions. Laser treatment of hard dental tissues is a valuable choice for patients affected by EB since it is less invasive compared to conventional treatment, resulting in improved patient compliance.

Socio-demographic inequalities and teeth extraction in the last 12 months in Italy.

AIMS: Teeth loss represents a major concern for the global oral health status of a population. The aim of this study was to describe the prevalence of teeth extraction among the Italian adult population, analyzing the association between teeth extraction in the last 12 months and socio-demographic characteristics. METHODS: This cross-sectional study is based on the national survey 'Health Conditions and Healthcare Services Use', carried out by the Italian National Centre of Statistics (ISTAT) in 2005. A univariate analysis was performed to investigate the association between the dependent and the independent variables (teeth extraction Vs socio-demographic characteristics). Multiple logistic regression analysis was conducted to assess the influence on the outcome (teeth extraction Yes/No). RESULTS: The present study highlights the relationship between teeth extraction and socio-demographic factors. Out of 128,040 individuals, the sampled population consisted of 124,677 subjects, representing 56,400,323 individuals in the Italian population. The prevalence of teeth extraction in the last 12 months was 8.2%. Subjects who underwent teeth extraction in the last 12 months were prevalent female (8.6%), smokers (10.4%), with a primary education (9.2%), married (9.2%), in poor health conditions (9.3%), age category of 55-64 years (11.1%), from Northeast of Italy (8.5%), with scarce household income (8.4%). The multivariate analysis confirmed most of the results of the univariate analysis. CONCLUSIONS: Inequalities in health among groups of various socioeconomic status constitute one of the main challenges for public health; these inequalities might be reduced by improving educational opportunities, income distribution, health-related behaviour, or accessibility to health care.

Oral soft tissue wound healing after laser surgery with or without a pool of amino acids and sodium hyaluronate: a randomized clinical study.

OBJECTIVE: The purpose of this study was to compare secondary intention healing of oral soft tissues after laser surgery with and without the use of a compound containing amino acids and sodium hyaluronate. BACKGROUND DATA: Sodium hyaluronate has been successfully used in medicine to promote healing. It has not been studied in the healing of laser-produced wounds. MATERIALS AND METHODS: Excisional biopsy was performed in oral soft tissues with a potassium-titanyl-phosphate (KTP) laser (532 nm, SmartLite, DEKA, Florence, Italy) in 49 patients divided into two groups. In the study group (SG), 31 patients received a compound gel containing four amino acids and sodium hyaluronate (Aminogam(®), Errekappa, Italy) after laser surgery; in the control group (CG), 18 subjects received no treatment involving a drug or gel. Numeric rating scale (NRS) was used to evaluate pain experienced after surgery [pain index (PI)]. Using a grid as a benchmark and computer software, the lesion area was measured after surgery (T0) and after 7 days (T1). A percentage healing index (PHI) was calculated indicating healing extension in 7 days. RESULTS: SG cases showed an average PHI of 64.38±26.50, whereas the average PHI in the CG was 47.88%±27.84. Mean PI was 2.67±0.96 for SG and 2.75±0.86 for CG. A statistically significant difference was detected between the groups for PHI (p=0.0447), whereas no difference was detectable for PI (p=0.77). CONCLUSIONS: The use of a gel containing amino acids and sodium hyaluronate can promote faster healing via secondary intention in laser-induced wounds, although it does not seem to affect pain perception.

Subcutaneous emphysema during third molar surgery: a case report.

Extraction of third molars is the most common surgical procedure performed in oral surgery on a daily basis and, despite surgical skills and expertise, complications may occur. Complications observed during or after third molar removal may include pain, swelling, bleeding, infection, sinus perforation and nerve damage. Fortunately, with a proper management and a good surgical technique, the incidence of such events is low. Subcutaneous emphysema associated with dental extraction occurs when the air from the high-speed dental handpiece is forced into the soft tissue through the reflected flap and invades the adjacent tissues, leading to swelling, crepitus on palpation and occasionally spreading through the tissue spaces of the fascial planes. Although rare, iatrogenic subcutaneous emphysema can have serious and potentially life-threatening consequences. Care should be taken when using air-driven handpieces. The access of air into the facial tissues is not limited to tooth extractions, but may also occur through other portals of entrance, such as endodontically treated teeth, periodontium and lacerations of intraoral soft tissues. When subcutaneous emphysema occurs, it must be quickly diagnosed and properly managed to reduce the risk of further complications. This report presents a case of subcutaneous emphysema occurred during extraction of a mandibular third molar extraction with the use of an air turbine handpiece. Case management is described and issues relative to the diagnosis and prevention of this surgical complication are discussed.

Excision of an oral angiolipoma by KTP laser: a case report.

MATERIALS AND METHODS: A 66 year old woman was referred to our observation, since the presence of a painless swelling located on the right cheek mucosa. A surgical approach with KTP laser was performed with the mucosal preservation technique. RESULTS: Follow up after seven days, sixty days and four months did not showed any complication and the histological examination reported the diagnosis of AL. DISCUSSION: AL is a relatively rare tumor of the head and neck region, although it occurs more commonly in the extremities and the trunk. This tumor has been rarely reported in the oral cavity and when seen in this area, it involves in the lip, cheek, tongue, mandible, and palate. ALs are also intraosseous in the mandible and intramuscular in the pterygoid fossa. KTP laser excision showed to be resolutive and avoid of complications. CONCLUSIONS: AL of the cheek is a very rare patology, but when it appears, it requires a surgical excision.

Observation of pain control in patients with bisphosphonate-induced osteonecrosis using low level laser therapy: preliminary results.

BACKGROUND: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is an adverse side effect associated with bisphosphonate (BP) therapy, especially when parenteral BP administration is used. Patients affected by BRONJ present wide areas of exposed necrotic bone, particularly after surgical oral procedures. The main symptom is pain that is poorly controlled by common analgesic drugs. Recently, many studies have pointed to the beneficial effect of low-level laser therapy (LLLT) in pain reduction for many pathological conditions. The purpose of this study is to investigate whether LLLT could be helpful in managing BRONJ by reducing the problems associated with this condition and the use of analgesic drugs. METHODS: Twelve patients affected by BRONJ were monitored at the Complex Operative Unit of Oral Pathology. Among these patients, only seven referred to pain in necrotic areas and were recruited for LLLT. Laser applications were performed with a double diode laser simultaneously emitting at two different wavelengths (λ = 650 nm and λ = 904-910 nm, spot size = 8 mm). All of the patients were irradiated with a fluence of 0.053 J/cm(2) for 15 min five times over a period of 2 weeks, in a non-contact mode, ∼1 mm from the pathologic area. The patient's maximum and minimum pain was recorded using a numeric rating scale (NRS) evaluation before and after the treatment. Statistical analysis was performed using the Kruskal-Wallis test. RESULTS: Six patients showed significant pain reduction, and only one patient indicated a worsening of the symptoms, which was probably related to a reinfection of the BRONJ site, which occurred during the study. A statistically significant difference (p < 0.05) was found between the NRS rates before and after the protocol. CONCLUSIONS: This pilot study suggests that LLLT may be a valid technique to support the treatment of BRONJ-related pain, even though the low number of cases in this study does not permit any conclusive consideration.

Subcutaneous emphysema during third molar surgery: a case report

Extraction of third molars is the most common surgical procedure performed in oral surgery on a daily basis and, despite surgical skills and expertise, complications may occur. Complications observed during or after third molar removal may include pain, swelling, bleeding, infection, sinus perforation and nerve damage. Fortunately, with a proper management and a good surgical technique, the incidence of such events is low. Subcutaneous emphysema associated with dental extraction occurs when the air from the high-speed dental handpiece is forced into the soft tissue through the reflected flap and invades the adjacent tissues, leading to swelling, crepitus on palpation and occasionally spreading through the tissue spaces of the fascial planes. Although rare, iatrogenic subcutaneous emphysema can have serious and potentially life-threatening consequences. Care should be taken when using air-driven handpieces. The access of air into the facial tissues is not limited to tooth extractions, but may also occur through other portals of entrance, such as endodontically treated teeth, periodontium and lacerations of intraoral soft tissues. When subcutaneous emphysema occurs, it must be quickly diagnosed and properly managed to reduce the risk of further complications. This report presents a case of subcutaneous emphysema occurred during extraction of a mandibular third molar extraction with the use of an air turbine handpiece. Case management is described and issues relative to the diagnosis and prevention of this surgical complication are discussed.

A extração de terceiros molares é o procedimento cirúrgico mais comum na prática diária em cirurgia oral, e complicações podem ocorrer a despeito da habilidade e experiência do cirurgião. Complicações observadas durante ou após extração de terceiros molares podem incluir dor, edema, sangramento, infecção, perfuração de seio e dano nervoso. Felizmente, a incidência de tais eventos é baixa quando se emprega conduta adequada e boa técnica cirúrgica. O enfisema subcutâneo associado à extração dentária ocorre quando o ar da turbina de alta rotação é forçado para dentro dos tecidos moles através de um retalho rebatido e invade os tecidos adjacentes, causando edema, crepitação à palpação, e eventualmente espalhando-se pelos espaços teciduais dos planos fasciais. Embora seja raro, o enfisema subcutâneo iatrogênico pode ter conseqüências sérias e com risco de morte. É necessário ter cuidado com o uso de turbinas de alta rotação durante a realização de procedimentos cirúrgicos orais. A penetração de ar nos tecidos faciais não está limitada às extrações dentárias, e pode ocorrer também por outras vias de acesso, tais como dentes tratados endodonticamente, periodonto e lacerações de tecidos moles intraorais. Quando ocorre, o enfisema subcutâneo deve ser diagnosticado rapidamente e tratado adequadamente para diminuir o risco de outras complicações. Este relato apresenta um caso de enfisema subcutâneo ocorrido durante a extração de um terceiro molar inferior com emprego de turbina de alta rotação. O manejo do caso é descrito e os aspectos relacionados ao diagnóstico e à prevenção desta complicação cirúrgica são discutidos.