"Diagnostic ability in oral pathology among different population clusters".

OBJECTIVES: To assess the diagnostic ability in detecting oral lesions among dentists, dental hygienists, dentistry students, oral hygiene students, and non-healthcare subjects. MATERIALS AND METHODS: Participants were invited to classify 30 images of oral lesions in "benign" or "suspected malignant" only based on the visual appearance of the lesion. Diagnostic accuracy was assessed by calculating sensitivity and specificity with 95% confidence intervals and stratified by population group and image features (color, shape, and size of the lesions). RESULTS: A total of 16,590 examinations by 553 subjects were analyzed. Overall sensitivity and specificity were 57% (95% confidence interval 56%-58%) and 64% (95% confidence interval 63%-65%). Diagnostic accuracy varied among population groups, with experienced dentists showing the lowest sensitivity (52%) and the highest specificity (71%). Red lesions, flat lesions, and large lesions had the lowest sensitivity (42%, 36%, 57%) but the highest specificity (70%, 75%, 76%). CONCLUSIONS: We found worrying low ability to detect suspected malignant oral lesions by both healthcare workers and non-healthcare subjects. Lesion-specific characteristics may lead to differences in recognition. Specific courses and more adequate teaching methods should be proposed to increase identification of oral lesions.

Single session of laser photobiomodulation for symptom management of oral lichen planus: a retrospective study.

This study aimed to evaluate the effectiveness of a single session of laser photobiomodulation (PBM) with flat top handpiece in reducing painful symptoms in patients with Oral Lichen Planus (OLP). The clinical charts of 20 patients of the Dental Clinic of University of Padua (Italy) who underwent a single laser PBM to manage OLP symptomatology were retrospectively analyzed. A 980 nm diode laser and a flat top handpiece with a 1-cm2 spot area were employed to perform the PBM with a single session protocol. VAS pain scores were assessed before and after the laser PBM, the day after, and on the 7th and 30th days after the treatment. No adverse effects occurred within 30 days after treatment. The mean VAS-pain score was 3.8 (SD 2.3) before PBM; 2.6 (SD 2.0) after PBM; 1.9 (SD 2.2) on day 1; 2.0 (SD 2.3) on day 7; and 1.5 (SD 2.2) on day 30. VAS pain decreased significantly over time (p < 0.0001). A single session of laser PBM may be safe and effective in reducing pain for symptomatic OLP patients. Further investigations are required to include placebo or topical corticosteroids as comparators.

A retrospective study on the incidence of medication-related osteonecrosis of the jaws (MRONJ) associated with different preventive dental care modalities.

PURPOSE: To assess the efficacy of different preventive dental visits and treatments in reducing the risk of medication-related osteonecrosis of the jaws (MRONJ). METHODS: In this retrospective study, patients diagnosed with MRONJ were divided into 5 groups based on available data: no preventive dental visits (group 0); dental visits and compliance with recommended treatments, at the university hospital's dental clinic (group 1) or maxillofacial surgery unit (group 2), or at a private dentist's (group 3); dental visits at one of the above and noncompliance with proposed treatments (group 4); patients judged eligible by the oncologist on panoramic radiography (group 5). Patients were classified on severity of MRONJ according to the Italian SIPMO/SICMF 2.0 staging system. A descriptive analysis was performed on the results. Fisher's exact test was applied (p < 0.05). RESULTS: Ninety-three patients diagnosed with MRONJ were considered for the study, but 22 were excluded due to a lack of data, leaving a sample of 71 cases. MRONJ staging was only 0 for some patients (26.92%) in group 0. In all groups, the majority of patients had stage 2 MRONJ. The proportions of cases in stage 3 were 7.69% in group 0, 18.18% in group 3, and 43.48% in group 5. Groups 0 and 3 were somewhat similar as regard MRONJ staging. Most patients in group 5 had MRONJ stage 2 or 3. No statistically significant differences emerged between the groups. CONCLUSIONS: Preventive dental care can reduce the risk of MRONJ providing patients comply with the specialist's recommendations.

Diode laser to treat small oral vascular malformations: A prospective case series study.

OBJECTIVE: The current work examined a consecutive series of patients presenting vascular malformations (VMs) and venous lakes (VLs) of the lip and oral mucosa who were treated with transmucosal diode laser applications and assessed over a 1 year period. STUDY DESIGN AND METHODS: Fifty-nine patients (31 males and 28 females) presenting low-flow VMs or VLs of the oral cavity were treated transmucosally using a diode laser (with an 830 nm operating wavelength and 1.6 W output power) with a 320 µm diameter flexible fiber. All the lesions were assessed 7 days, 30 days, and 1 year after the laser treatment, and the lesion reduction percentage was scored on a one to five scale. The patients were also asked to assess their pain perception daily during the 7 days following the treatment using a visual analog scale (VAS). RESULTS: There were no procedure-related intra- or post-operative complications; only modest pain intensity was reported. Thirty days after the treatment, lesion reduction was described as excellent or good in 52 cases; it was fair or poor in 7. Six patients (F:M ratio 2:4) required a second diode laser application. At the 1 year follow-up, volume reduction was complete in 48 out of 59 patients; there were five recurrences (F:M ratio 3:2). No relevant gender-related differences were noted. CONCLUSION: The use of diode laser application to treat small oral VMs and VLs was associated to shorter operating times and fewer postoperative complications with respect to the scapel surgery approach. More than one session may nevertheless be required if the anomaly is larger than 10 mm. Lasers Surg. Med. 50:111-116, 2018. © 2017 Wiley Periodicals, Inc.

Influence of Root Canal Posts on the Reattachment of Fragments to Endodontically Treated Fractured Incisors: An in vitro Experimental Comparison.

OBJECTIVE: The aim of this study was to establish the benefits of inserting a fiberglass post when bonding tooth fragments after complicated coronal fractures. METHODS: Thirty bovine incisors were randomly assigned to three groups: a control group of intact teeth (A), and two experimental groups (B and C). Coronal fragments were cut from the teeth in groups B and C, which then underwent root canal treatment, inserting posts in the teeth in group C. The coronal fragments were bonded to the teeth in both experimental groups using the same materials and technique, then the specimens were submitted to mechanical loading until fracture. RESULTS: The specimens in the experimental groups had a lower resistance to mechanical loading than the intact teeth. The mean failure load was: 352.77 (SD ± 62.22) N in group A, 151.04 (SD ± 45.76) N in group B, and 168.61 (SD ± 33.59) N in group C. The difference between group A and the other two groups was statistically significant (analysis of variance test: p < 0.0001), whereas there was no statistically significant difference in the force needed to fracture the teeth in groups B and C (Tukey's test: p = 0.34). When the failure mode under loading was examined, the fractures in group C never involved new tooth substance beneath the adhesion interface, whereas in group B, this was only true in one in two cases. CONCLUSIONS: Inserting a post does not significantly improve the strength of restored teeth, but it may result in a more favorable fracture mode. CLINICAL SIGNIFICANCE: Within the limitations of this in vitro study, reattaching the fragment of a fractured tooth does not seem to restore the tooth to its original load resistance. The findings of this study indicate that inserting a fiberglass post for reinforcement purposes in fractured teeth undergoing root canal treatment is unable to significantly improve their load-bearing capacity by comparison with teeth repaired without inserting a post. However, the results of the present study suggest that inserting a post may result in a more favorable fracture mode in the event of further trauma.

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.

Impairment of Hypnosis by Nocebo Response and Related Neurovegetative Changes: A Case Report in Oral Surgery.

This article presents the third molar removal in a highly hypnotizable patient, who had been successfully submitted to oral surgery with hypnosis as stand-alone anesthesia in previous sessions. Unexpectedly, hypnosis initially failed, as a result of a nocebo response due to a previous dentist's bad communication; two complaints made by the patient were associated with increased sympathetic activity (as defined by increased heart rate and electrodermal activity and decreased heart rate variability). After deepening of hypnosis, the patient achieved a full hypnotic analgesia allowing for a successful conclusion of the intervention, an event associated with decreased heart rate, electrodermal activity, and increased heart rate variability. Hence, the initial failure was paralleled by a decreased parasympathetic activity and increased sympathetic activity, while hypnotic analgesia was associated with the opposite pattern. The patient's postoperative report indicated that the initial failure of hypnosis depended on a strong nocebo effect because of a previous dentist distrusting hypnosis and persuading her that it was not enough to face a third molar removal.

Antibiotic-Prescribing Habits in Dentistry: A Questionnaire-Based Study.

The problem of antibiotic resistance is becoming increasingly serious worldwide due to uncontrolled prescription. Dentists are among the groups that prescribe the most antibiotics, often to delay urgent treatment. The purpose of the present study is to investigate the prescribing protocols adopted by dentists for prophylaxis and antibiotic therapy in major clinical surgical indications. METHODS: A ten-question survey was administered to a group of Italian dentists. The participants were asked about their preferences for antibiotic administration for the prevention of infective endocarditis, the administration of antibiotics to patients allergic to penicillin, the insertion of implants, and the extraction of third molars. The retrieved data were screened and analyzed. RESULTS: A total of 298 surveys were filled out. The most-prescribed antibiotic was amoxicillin or amoxicillin with clavulanic acid or macrolides for allergic patients. The administration of two grams of amoxicillin one hour before surgery was the most widely used prescriptive protocol for prophylaxis. International guidelines on antibiotic prophylaxis for infective endocarditis were only partially followed. The most heterogeneous results emerged for prophylaxis associated with dental implants or provided prior to surgical third-molar extraction. CONCLUSIONS: The present study shows widespread antibiotic prescriptive heterogeneity among the sample of dentists analyzed, especially in conditions where international guidelines are lacking. An evidence-based consensus on prescriptive modalities in dentistry would be desirable in the near future.

Psychophysiological wellbeing in a class of dental students attending dental school: anxiety, burnout, post work executive performance and a 24 hours physiological investigation during a working day.

Aim: To the best of our knowledge, dental school students have never been evaluated for stress, anxiety, burnout, physiological indexes during a 24-h working day, and executive function performance post-work and post-work after returning from vacation; therefore, this research has been conducted. Methods: Data were acquired at the Dental School of the University of Padua on 16 students in their 4th year, far from the exam session. While performing clinical activity on the dental chair and during a working day, electrodermal activity (EDA), heart rate variability (HRV), and heart rate (HR) were recorded. Participants' stress was measured with the Perceived Stress Scale (PSS-10 scale) and anxiety with the General Anxiety Disorder Questionnaire (GAD-7) and State-Trait Anxiety Inventory (STAI-Y-2), while burnout with the Maslach Burnout Inventory (MBI-HSS). Executive functions were evaluated using the Tower of London test (TOL-R). Results: Three students (2F/1M) had a GAD-7 score ≥ 10. Five students (4F/1M) showed trait anxiety. Moderate levels of perceived stress were reported in 85% of participants. MBI-HSS showed that 7 participants scored high on emotional exhaustion and 7 on depersonalization. TOL-R performance (M = 15.85, SD = 4.01) was below the normative value p < 0.00001. A second test, after the holidays, showed normal values. EDA was higher during children's treatment (p < 0.05), ANOVA showed high HR during working time (p < 0.001), and HRV was higher in males (p < 0.001). Conclusion: Based on the sample size evaluated, it is reported that being a dental student has a moderate impact on stress, anxiety, and burnout while a strong impact on executive functions buffered by rest.

One Piece CAD/CAM Abutment for Screw-Retained Single-Tooth Restorations: A 5-Year Prospective Cohort Study.

BACKGROUND: The use of ceramic-coated patient-specific CAD/CAM titanium abutments represents a therapeutic option for the rehabilitation of single tooth. The utilization of highly customized abutments enables the accurate three-dimensional positioning of the prosthetic emergence. This study evaluates the clinical performance of implant-prosthetic rehabilitations carried out using ceramic-coated CAD/CAM titanium abutments. MATERIALS AND METHODS: Thirty implants were placed in thirty patients and rehabilitated with thirty single crowns attached to CAD/CAM titanium abutments. A conventional procedure was applied, with implant placement after post-extraction socket healing and prosthetic restoration after implant healing. Implants of lengths ranging from 6-15 mm and widths of 3.6, 4.2, and 4.8 mm were used in this study. At the time of prosthesis delivery (T0), after two years (T1), and after five years (T2), plaque (PI) and bleeding (BoP) indices, probing depths (PPD), marginal bone levels (MBL), and PES/WES were evaluated for each implant. RESULTS: No patient dropped out of the study during the follow-up period. All thirty implants were clinically successful at five years post-prosthesis delivery (survival rate: 100%) and showed no signs of peri-implant infection. Peri-implant soft tissues were in good health (BoP at T2: 0% in 73% of patients; 25% in 13% of patients; 50% in 10% of patients; and 75% in 3% of patients). The mean PPD was 2.05±0.56 mm at T0, 1.992±0.6 mm at T1, and 1.867±0.439 mm at T2. The mean MBL at T0 was 0.413±0.440 mm, at T1 was 0.306±0.388 mm, and at T2 was 0.263±0.368 mm. The mean PES, WES, and PES/WES indices, 7.43±1.04, 7.57±0.82, and 15.00±1.17, respectively, indicate good integration of soft tissues, satisfactory aesthetics, and an overall positive outcome. CONCLUSIONS: The success rates, maintenance of marginal bone levels, and periodontal and aesthetic indices suggest the validity of implant-prosthetic rehabilitations with CAD/CAM abutments in cases of single crowns.

Bleeding Disorders and Dental Implants: Review and Clinical Indications.

BACKGROUND: Bleeding disorders can be divided into three categories: congenital coagulation disorders (CCDs), antiplatelet-induced bleeding disorders (APBDs) and anticoagulant-induced bleeding disorders (ACBDs). Implant placement can be challenging in these kinds of patients. The aim of this study is to provide evidence on implant surgery in patients with bleeding disorders and to generate some practical recommendations for clinicians. MATERIAL AND METHODS: Pubmed/MEDLINE, Scopus, Web of Science and Cochrane Library databases were screened. The latest search was performed in July 2022. Case reports, case series, cohort studies, cross-sectional studies, case control studies, reviews, consensus reports, surveys and animal studies were included in the analysis. RESULTS: Seventeen articles on CCDs were found, fourteen on APBDs and twenty-six on ACBDs. Most of these articles were case reports or case series. Patients with CCDs can be treated after the infusion of the missing coagulation factor. Patients with APBDs can be treated without withdrawing the therapy. Patients with ACBDs should be treated depending on the anticoagulative medication. CONCLUSION: Despite the low level of evidence, dental implants can be safely placed in patients with bleeding disorders. However, careful preoperative evaluation and the adoption of local and post-operative bleeding control measures are mandatory.

Anxiety in a regular day of work: A 24 hour psychophysiological investigation in young dentists with gender comparison.

Introduction and aim: Dentistry is a highly demanding profession with a strong mental and physical involvement, possibly generating anxiety. Very few studies assessed psychophysiological activity in dentists, while none tried to relate it with gender during a routine working day. This study aims at evaluating correlations between gender, psychophysiological indexes, and psychological variables. Materials and methods: Data were acquired at the Dental Clinic of the University of Padua on 20 healthy young dentists (10 M-10F) during a 24 h period of a working day. Physiological variables (measured with E4 Empatica) were electrodermal activity (EDA), heart rate variability (HRV) and heart rate (HR). Participants anxiety was measured through a self-reported scale on patient-relationship anxiety and through the Generalized Anxiety Disorder-7 Questionnaire (GAD-7). Results: 5 (3F, 2 M) participants over 20 had a GAD-7 score ≥ 10. Female gender, in comparison to Male, was associated with higher perceived patient relationship anxiety (p = 0.002) and lower HRV (p-adj = 0.022). The gender Male, although being associated with lower level of self-reported anxiety (p = 0.002), showed an equal number of subjects with a GAD-7 score ≥ 10 (p = 0.371). No interaction between gender and EDA was found, nor an effect of GAD score on EDA, HRV and HR values. Higher values of EDA were found during sleep time; a difference between sleep time and working time EDA (p = 0.037) and a difference between sleep time and daytime (p = 0.0045). A different HR between sleep and all daytime (p < 0.001) was also highlighted. Conclusion: 25% of dentists fell within generalized anxiety disorder diagnosis, compared to a maximum of 8.6% in the general population. A possible general biomarker of excessive stress response was measured: a shift of circadian sympathetic activity was found in dentists; a higher activity during sleep in comparison to working time and daytime. The Female gender was associated with higher perceived patient-approach anxiety, lower parasympathetic activity, and a comparable sympathetic activity to the Male gender, thus fostering a possible vulnerability to excessive stress. This study underlines the need to empower the psychological approach to stress and patient-relationship in dentistry.

The Follow-Up Necessity in Human Papilloma Virus-Positive vs. Human Papilloma Virus-Negative Oral Mucosal Lesions: A Retrospective Study.

Human papilloma virus (HPV) is known as the main cause of cervical cancer. Data also indicate its role in head-neck cancer, especially oropharyngeal cancer. The correlation between high-risk HPV and oral cancer is still controversial. HPV-related lesions of the oral cavity are frequent and, in most cases, benign. The primary aim of this study was to establish if there is a different follow-up necessity between HPV-positive compared to HPV-negative oral lesions. The secondary aim was to evaluate the recurrence of HPV-related lesions. All patients who underwent a surgical procedure of oral biopsy between 2018 and 2022, with ulterior histopathological examination and HPV typing, were examined. A total of 230 patients were included: 75 received traumatic fibroma as diagnosis, 131 HPV-related lesions, 9 proliferative verrucous leukoplakia, and 15 leukoplakia. The frequency and period of follow-up varied in relation to HPV positivity and diagnosis. This study confirms what has already been reported by other authors regarding the absence of recommendations of follow-up necessity in patients with oral mucosal lesions. However, the data demonstrate that there was a statistically significant difference in the sample analyzed regarding the follow-up of HPV-positive vs. HPV-negative patients. It also confirms the low recurrence frequency of HPV-related oral lesions.

Effectiveness of Dupilumab in the Treatment of Adult and Older Adult Patients with Severe, Uncontrolled CRSwNP.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial disease that significantly impacts patients' quality of life. New therapeutic strategies and in particular biologic treatments are now available for these patients. It has been demonstrated that Dupilumab (an anti IL-4/IL-13 biologic drug) is effective in reducing the size of nasal polyps and in improving patients' symptoms and thus, quality of life. No real-world studies examining Dupilamab's efficacy in the elderly with respect to other adult age groups have as yet been carried out. The aim of this multicentric study was to evaluate Dupilumab's efficacy in young-middle adults as opposed to an older adult population affected by severe, uncontrolled CRSwNP. Of the 96 patients included in the study, 22 were 65 years old or older. Significant improvements were observed in all the parameters considered in both age groups after treatment was begun (T0 mean values for SNOT-22 = 58.5 ± 20.3, VAS NO = 7.6 ± 2.2, VAS smell = 8.6 ± 2.1, NPS = 5.6 ± 1.4, PNIF = 101.6 ± 59.4, S'S = 5.1 ± 3.1), T4 mean values for SNOT-22 = 15.1 ± 12.7, VAS NO = 1.7 ± 1.8, VAS smell = 2.4 ± 3, NPS = 1.7 ± 1.7, PNIF = 162.4 ± 43.2, S'S = 10.4 ± 3.7) (p < 0.0001). No differences in the variables considered were observed between the two age groups during the study, with the exception of the Peak Nasal Inspiratory Flow (PNIF), which was marginally higher; this was also the case according to multivariate analyses (p = 0.008) in the young-middle adult group with respect to the elderly one (p = 0.07). At multivariate analyses, asthma and the female sex negatively influenced the PNIF values (p = 0.001 and p = 0.012, respectively). Age negatively influenced the Visual Analog Scale (VAS) for nasal obstruction (p = 0.0032) and Endoscopic Sinus Surgery (ESS) negatively influenced the patents' olfactory performance (p = 0.028) to the same degree in both groups. Dupilumab was found to be effective to the same degree in both age groups. It can be considered a safe and reliable option for the treatment of elderly patients with severe, uncontrolled CRSwNP.

Systemic Diseases and Biological Dental Implant Complications: A Narrative Review.

The relationship between periodontitis and such systemic disorders as diabetes, cardiovascular disease and obesity has been extensively investigated. There is less scientific evidence available, however, regarding the influence of systemic diseases on the risk of late failure of dental implant rehabilitation due to peri-implantitis. The aim of the present study was to review the literature on the role of several common systemic disorders (diabetes, obesity, cardiovascular disease, hypertension and osteoporosis) in the onset of peri-implantitis. A database search initially yielded 2787 studies of potential interest published up to 1 March 2022 (993 in PubMed; 908 in Web of Science; and 886 in Scopus). After removing 1190 duplicate articles and checking the titles, abstracts and full texts for relevance, 70 articles were selected for the present analysis. Only cohort, case-control studies and clinical case series were considered. Most of the literature concludes for no association between diabetes, cardiovascular disease, hypertension or osteoporosis and the risk of peri-implantitis. On the other hand, almost all the studies that investigated obesity as a risk factor for implant rehabilitation found a positive association between the two. Further longitudinal studies are needed to better understand the effects of systemic diseases on rehabilitation with dental implants.

Bioelectrical Impedance Analysis of Oral Cavity Mucosa in Patients with Lichen Planus and Healthy Controls.

Objectives: Oral lichen planus (OLP) is an inflammatory disease. Bioelectrical impedance analysis (BIA) is a method for assessing tissue composition. Based on a combination of reactance and resistance data, a phase angle is calculated that may range from 90° to 0°, and that correlates with body cell mass. There is evidence to suggest that neoplastic tissue has a lower phase angle than normal tissue. The aim of the present experimental study was to establish whether OLP patients have a different tissue phase angle from healthy controls. Materials and Methods: Bioelectrical impedance measurements were obtained for the buccal mucosa, tongue, hard palate and upper anterior gums using an ad hoc device in a sample of 57 consecutive patients with OLP and 60 healthy controls, and their phase angles were calculated. Results: The mean resistance, reactance, and phase angle of the hard palate and gums were higher in the OLP group than in the controls, and the differences were statically significant. The resistance and reactance recorded for the adherent gingiva and hard palate were always higher in the OLP group (p = 0.044; p = 0.020; p = 0.054), and so was the phase angle for the adherent gingiva. No statistically significant differences emerged for the other areas of the oral cavity (p < 0.05). Conclusion: These findings confirm differences between the bioelectrical impedance of OLP lesions and that of healthy oral tissues. Clinical relevance: Bioelectrical impedance analysis could be useful in the diagnosis of OLP.

Oral Hygiene in Adolescence: A Questionnaire-Based Study.

Oral health is fundamental to our well-being, especially in adolescence. The aim of this study is to investigate oral hygiene knowledge through a questionnaire in a sample of adolescents, paying particular attention to those wearing orthodontic braces. The study was designed as a descriptive report of a local survey. An anonymous questionnaire was distributed to individuals born between 2000 and 2005, both on paper and online. Among 213 adolescents answering the questionnaire, 206 went to the dentist at least once (most of them between 5 and 9 years old), and 144 experienced at least one session of professional oral hygiene. Approximately 83% of the sample brushed their teeth at least twice a day, while only 7% used dental floss daily. Only 54% of respondents wearing orthodontic braces were advised to undergo professional oral hygiene during their orthodontic treatment. Education on oral hygiene at home came only from their parents for 61% of the whole sample. Most respondents had their first visit to the dentist apparently too late. Flossing was rare, whether the adolescents wore orthodontic braces or not. In many cases, professional oral hygiene was not common during orthodontic treatment. Adolescents did not learn about oral hygiene from a dental specialist.

Odontogenic Chronic Rhinosinusitis: Structured Histopathology Evidence in Different Patho-Physiological Mechanisms.

An increased odontogenic chronic rhinosinusitis (oCRS) occurrence rate has quite recently been reported, likely due to an intensification of conservative dental surgery and implantology. The main aim of the study was to report for the first time the structured histopathological characteristics of the surgical specimens of oCRS. Possible associations between histopathological features and oCRS patho-physiological mechanisms were also evaluated. Structured histopathology features were investigated in the sinonasal mucosa tissue of 42 consecutive oCRS patients.Mean tissue eosinophil counts were significantly different between oCRS with radicular cysts, dental implants, or other dental diseases (p =0.0118): mean tissue eosinophil count was higher in oCRS with dental implants. Sub-epithelial edema score and squamous metaplasia presence were significantly different when comparing the above-mentioned sub-cohorts of oCRS (p =0.0099 and p =0.0258). In particular, squamous metaplasia was more present in oCRS cases with radicular cysts than in those with a dental implant (p =0.0423). Fibrosis presence was significantly different comparing the three sub-cohorts of oCRS (p =0.0408), too. This preliminary evidence supports the hypothesis that: (i) structural histopathology can become a useful tool for clinic-pathological practice in diagnostic, therapeutic, and prognostic terms in CRS; (ii) that oCRS, as CRS in general, is a histo-pathologically heterogeneous disease; (iii) oCRS resulting from dental implants disorders can frequently be characterized as a CRS with a rich tissue eosinophilic component.

Safety of dental implant surgery in patients undergoing anticoagulation therapy: a prospective case-control study.

OBJECTIVES: Several studies have described oral surgical procedures in patients receiving anticoagulant therapy, but no prospective studies on dental implant surgery during anticoagulant treatment are currently available, and only a limited number of case reports refer to endosseous dental implant treatment in these patients. In the setting of oral surgery, it has been suggested that anticoagulant treatment is not required when the International Normalized Ratio (INR) is <4 and local haemostatic measures are applied. The purpose of this preliminary study was to evaluate the incidence of bleeding complications following surgical implant therapy in a group of 50 consecutive patients receiving oral anticoagulant therapy (warfarin) without interruption or modifications to their therapy (group A). MATERIALS AND METHODS: One hundred and nine otherwise healthy patients comparable for age, sex, extent and site of the implant surgical procedure formed the control group (group B). In both groups, a standard protocol of local haemostasis, including non-reabsorbable sutures and compressive gauzes soaked with tranexamic acid, was applied. Surgeons, blind to the group allocation, performed all the procedures in an outpatient setting. RESULTS: Two and three late-bleeding complications were reported in group A and group B, respectively, without significant difference in the bleeding risk (relative risk = 1.45; P= 0.65; 95% confidence interval 0.2506-8.4271). These complications were managed using a compressive gauze soaked with tranexamic acid at the site of the surgical wound. CONCLUSION: According to our preliminary results, local haemostasis in dental implant surgery is able to prevent bleeding complications in patients on oral anticoagulants, allowing these surgical procedures to be performed on an outpatient basis.

Intra-oral bone harvesting: two methods compared using histological and histomorphometric assessments.

AIM: This study used morphometric analyses to compare two methods for the intra-oral harvesting of particulate bone: Mectron Piezosurgery® and the Meta Micross®. MATERIALS AND METHODS: Twenty patients requiring bilateral germectomy of the lower third molars for orthodontic reasons were selected and a sample was harvested from each patient from a standardised donor site (the cortical bone in the area of the retromolar triangle). Ten samples were obtained for each method. The particulate collected were subjected to a histological examination and the samples were analysed considering the following parameters: the mean surface area of fragments, the mean surface area considered vital and the mean surface area considered non-vital, the mean percentage of area considered vital and the mean percentage of area considered non-vital, the mean number of normal osteocytes and the mean number of osteocytes with morphological changes identified per unit area (600,000 µm(2)). The results were analysed, calculating the mean and the corresponding standard deviations, and testing their significance using Student's t-test, and plotted in graphs. RESULTS: Mectron Piezosurgery® produced significantly larger particles (P<0.05) than the Meta Micross®, with a larger mean surface area considered vital and a significantly larger (P<0.05) surface area considered non-vital. Mectron Piezosurgery® also produced a smaller mean percentage of area considered vital (64.83%) and a larger mean percentage of area considered non-vital (35.17%) by comparison with the Meta Micross® (75.34% and 24.66%, respectively). The data also showed that the two methods produce a similar quantity of empty lacunae, and that the Mectron Piezosurgery® produces a larger quantity of osteocytes. CONCLUSIONS: The analyses conducted demonstrated that the particulate collected with the Meta Micross® had a smaller mean surface area of the fragments and a smaller surface area of bone considered non-vital than in the particulate collected using Mectron Piezosurgery®.