Treatment Outcome of Posterior Composite Indirect Restorations: A Retrospective 20-Year Analysis of 525 Cases with a Mean Follow-up of 87 Months.

The purpose of this study was to evaluate the survival of 525 composite indirect restorations in premolars and molars after a follow-up of 20 years. For each patient, the following variables were recorded and analyzed: age, sex, smoking status, presence of plaque according to O'Leary index, and presence of bruxism. For each restoration, the following variables were collected: restoration class, tooth type (premolar or molar), and restoration material. Mean 20-year survival rate of composite restorations was 57%, ranging from 44% to 75%. The Kaplan-Meier method demonstrated a probability of survival at 10 years of 80% and 90%. Surviving restorations kept their clinical characteristics extremely well, as assessed on the basis of the United States Public Health Service criteria. The results of this study demonstrate the efficacy of indirect composite restorations, confirming their reliability as a posterior prosthetic clinical option.

Medication-related osteonecrosis of the jaw: risk factors in patients under biphosphonate versus patients under antiresorptive-antiangiogenic drugs.

BACKGROUND: Biphosphonate-related osteonecrosis of the jaw (BRONJ) is a potential side effect associated with the administration of bisphosphonates; the aim of this work is to highlight the possible epidemiological differences between two groups of patients affected by medication related osteonecrosis of the jaw (MRONJ) treated at the Center of Oral Medicine, Pathology and Laser Surgery of the Academic Hospital at the University of Parma, Italy, between January 2004 and June 2016. METHODS: Medical charts of 303 patients (214 females and 89 males, mean age: 67 years old) treated at the Center of Oral Medicine, Pathology and Laser Surgery of the Academic Hospital at the University of Parma, between January 2004 and June 2016, were retrospectively analyzed. Patients were divided in 2 groups according to drugs therapy they underwent: group 1 (G1) including patients treated with bisphosphonates alone and group 2 (G2) including patients receiving antiresorptive-antiangiogenic drugs in association with bisphosphonates or antiresorptive-antiangiogenic drugs alone. Than 269 MRONJ sites treated with 5 different therapeutical approaches were analyzed. RESULTS: Results showed G1 consisting mainly in female patients undergoing bisphosphonates for oncologic disease, stage II was most frequently diagnosed and MRONJ developed mainly after dental extraction or bone surgery. G2 consisted mainly in males patients, whom took antiresorptive-antiangiogenic drugs in association with bisphosphonate or antiresorptive-antiangiogenic drugs alone for oncologic disease. Stage II was most frequently diagnosed and MRONJ developed most frequently "spontaneous". CONCLUSIONS: This study showed how a new population affected by MRONJ is emerging. Men affected by kidney cancer treated with new antiresorptive-antiangiogenic drugs will represent a growing portion of the pool of patients at risk. In our experience, a strict follow-up is of outmost importance to early detect MRONJ also in patients with spontaneous cases. When MRONJ occurs, surgical laser treatment with Er:YAG seems to represent the option with highest percentage of success; for patients with contraindication to surgery, LLLT helps to improve outcomes of the medical therapy.

Medication-Related Osteonecrosis of the Jaw Around Dental Implants: Implant Surgery-Triggered or Implant Presence-Triggered Osteonecrosis?

INTRODUCTION: Dentoalveolar surgery including tooth extractions and dental implants placement is considered the major risk factor for developing medication-related osteonecrosis of the jaw (MRONJ).In this study, a patient series of MRONJ around dental implants were carefully analyzed to describe the findings and to assess the possible risk factors. METHODS: Fifteen patients with peri-implant bone osteonecrosis were selected out of a group of 250 patients (6%). Patients were divided into 2 groups according to the temporal relationship. Group 1 (G1)-necrosis immediately after implant placement (from 2 to 10 months) and defined as "implant surgery-triggered" MRONJ. Group 2-necrosis distant (from 1 to 15 years) from implant placement and defined as "implant presence-triggered" MRONJ. Epidemiological and pharmacological variables were recorded as well as specific data about osteonecrosis and dental implants. RESULTS: G1 included 6 patients: 5 (83.4%) treated with oral bisphosphonates (BPs) for osteoporosis and 1 (16.6%) with intravenous BPs for breast cancer. Mean duration of BP therapy (BPT) was 83.7 months. G2 included 9 patients: 8 patients (88.89%) treated with intravenous BPs for malignant disease and 1 (11.11%) with oral BPs for osteoporosis. CONCLUSIONS: Data confirms that not only surgical insertion of dental implants is a potential risk factor for the development of osteonecrosis but also the presence itself of the implant into the bone can be associated with this disease. Therefore, it is necessary to inform of the increased risk for MRONJ also the patients who have already osteointegrated implants and are going to start the BPT.The risk is lower for patients receiving oral BPs but it exists and seems to be higher if the implant is located in the posterior areas, if the duration of BPT is more than 3 years and if the patient is under corticosteroid therapy.

Odontogenic myxofibroma: a concise review of the literature with emphasis on the surgical approach.

PURPOSE: The aim of this work is to report a review of the literature concerning epidemiology, clinical and radiographic features as well as treatment of odontogenic myxofibroma (MF). METHODS: The PubMed database was searched using the following keywords: "odontogenic myxofibroma", "odontogenic fibromyxoma", "myxofibroma of the jaw" and "fibromyxoma of the jaw". RESULTS: Fifteen articles reporting the experience with 24 patients were identified. Male/female ratio was 1:1.4 and the average age 29.5 years. The most frequent location was the mandible. In 66.7% of the cases the radiographic appearance was a multilocular radiolucency. Swelling was observed in 13 patients (92.86%), varying degrees of pain in 5 (35.71%) and paresthesia in only one patient (7.14%). Six out of 24 patients (26.09%) were treated with radical surgery and 17 out of 24 (73.91%) with a conservative approach. In two out of 21 cases (9.52%) a recurrence was reported. CONCLUSIONS: MF is an extremely rare tumour and no agreement exist on the causes of its development. According to the present review, the choice of treatment should depend on variables such as localization, presence of a primary or of a recurrent lesion, age, general medical conditions and aesthetic needs of the patient.

Massive mandibular destruction and alveolar nerve infiltration without lower lip paresthesia in primary intraosseous carcinoma: report of two cases and critical appraisal of diagnostic criteria.

OBJECTIVE: To report two cases of solid type primary intraosseous carcinoma (PIOC) with a critical appraisal of one of the WHO diagnostic criteria. SUMMARY: Both patients had radiographic and histopathologic findings showing massive mandibular destruction as well as the involvement of the inferior alveolar nerve, without lip or chin paresthesia. Patients were treated through hemimandibulectomy followed by reconstruction through fibula free flap and forearm flap. CONCLUSION: Lip and/ or chin paresthesia are rather frequent in metastatic and salivary gland tumors but not in primary tumors of the jaws. Reasons for such a discrepancy are mostly unknown. A few hypotheses are put forward here. It is the opinion of the authors that most of the diagnostic criteria for solid type PIOC are acceptable. However, the criterion "absence of ulcer formation on the overlying mucosa" mainly depends on the dimension of the tumor at diagnosis.

Different laser wavelengths comparison in the second-stage implant surgery: an ex vivo study.

The implant surgery consists of two distinct techniques, the transmucosal, also known as "one-stage" and the "two-stage" technique. Lasers represent a possible aid in implant dentistry, especially in the two-stage technique and its main characteristics are represented by a decreased trauma to bone and soft tissues, a reduction of pain as well as a reduction of the risk of postoperative infections. The aim of this study was to analyze in an animal model the thermal elevation induced by four different laser wavelengths (diode, Nd:YAG, Er:YAG, KTP) during the implant uncovering. Four pig jaws were used to carry out this study. Five implants were placed in each anatomical specimen for a total of 20 fixtures. Four wavelengths (532, 810, 1,064 and 2,940 nm) were used to uncover the implants. Two thermocouples were used to measure temperature changes during laser irradiation at bone level, peri-implant tissues and on the fixture surface The thermocouples were connected with two probes of 1.5 mm in diameter, in order to simultaneously recording two temperature variations. Surface temperature was also checked during all procedures with a thermal camera (Thermovision A 800, Flyr Systems, Stockolm, Sweden) connected to a PC. The mean temperatures of each specimen (five fixtures) were calculated (TM1, mean temperature at the beginning; TM2, mean peak temperature). Furthermore, a record of the temperature at 1 min after the end of the surgical procedure was taken (mean: TM3). All the recorded values were statistically evaluated by one-way analysis of variance (ANOVA). The thermocouples recorded a lower increase in temperature for Er:YAG and KTP laser; Nd:YAG and diode laser produced similar increases characterized by higher values. The thermo-camera pointed out the lower increase for Er:YAG and higher for diode laser. KTP laser resulted faster in uncovering implants and diode laser was the one that needed more time. This ex vivo study showed that laser utilization with the recommended parameters gives no risks of dangerous thermal elevation to the tissues and implants.

The effect of age, gender, and insertion site on marginal bone loss around endosseous implants: results from a 3-year trial with premium implant system.

OBJECTIVES: The goal of this study was to evaluate bone changes around endosseous implants in partially edentulous patients. MATERIALS AND METHODS: A total of 632 two-stage implants were placed in 252 patients. The implants had straight emergence profile, ZirTi surface, 3.3 to 5 mm diameter, and 8.5 to 13 mm length. Bone levels were assessed on orthopantomography immediately after surgery and after 36 months and marginal bone loss (MBL) was calculated from their difference. RESULTS: Cumulative survival rate was 98.73%. Overall MBL was 0.8 mm ± 0.03 (mean ± SEM). Higher MBL was observed around implants in the maxilla than in the mandible (P < 0.007). A relation between implant diameter and MBL (P < 0.0001) was observed in male and, more limitedly, female patients. Older patients had higher MBL in the maxilla, but not in the mandible (P < 0.0001). MBL progressively increased with age in male patients, but reached a peak already in the 50-60 years age group in the female subset (P < 0.001). CONCLUSIONS: The overall MBL is consistent with the available literature. Site difference and patient age and gender appear to significantly affect MBL, representing important factors to be considered during implant placement.

Correlation between density and resorption of fresh-frozen and autogenous bone grafts.

TRIAL DESIGN: This analysis compared the outcome of fresh-frozen versus autologous bone block grafts for horizontal ridge augmentation in patients with Cawood and Howell class IV atrophies. METHODS: Seventeen patients received autologous grafts and 21 patients received fresh-frozen bone grafts. Patients underwent CT scans 1 week and 6 months after surgery for graft volume and density analysis. RESULTS: Two autologous and 3 fresh-frozen grafts failed. Autologous and fresh-frozen grafts lost, respectively, 28% and 46% of their initial volume (P = 0.028). It is noteworthy that less dense fresh-frozen blocks lost more volume than denser grafts (61% versus 16%). CONCLUSIONS: According to these 6-month results, only denser fresh-frozen bone graft may be an acceptable alternative to autologous bone for horizontal ridge augmentation. Further studies are needed to investigate its behaviour at longer time points.

Early surgical laser-assisted management of bisphosphonate-related osteonecrosis of the jaws (BRONJ): a retrospective analysis of 101 treated sites with long-term follow-up.

BACKGROUND DATA: The management of bisphosphonate-related osteonecrosis of the jaws (BRONJ) is still controversial. OBJECTIVE: The purpose of this study was to compare surgical and nonsurgical approaches to the treatment of BRONJ and the possible usefulness of Nd:YAG and Er:YAG lasers. METHODS: One hundred and twenty-eight patients (33 males, 95 females; 52 with diagnosis of multiple myeloma, 53 with diagnosis of bone metastasis, and 23 with diagnosis of osteoporosis) affected by BRONJ were evaluated at the Unit of Oral Pathology and Medicine and Laser-Assisted Surgery of the University of Parma, Italy, between January 2004 and July 2009. Overall number of BRONJ sites was 151, and number of treated sites was 101. In order to assess the efficacy of different treatments, sites were subclassified as follows: Group 1 (G1): 12 sites treated with medical therapy; Group 2 (G2): 27 sites treated with medical therapy associated with low level laser therapy (LLLT); Group 3 (G3): 17 sites treated with a combination of medical and surgical therapy; Group 4 (G4): 45 sites treated with a combination of medical therapy, surgical (including laser-assisted) therapy, and LLLT. Outcome of treatment was assessed using the staging system proposed by Ruggiero et al. Transition from a higher stage to a lower one for at least 6 months was considered as clinical improvement and suggestive of a successful treatment. RESULTS: Clinical improvement was achieved in 3 out of 12 (25%) BRONJ sites in G1. Sites if G2 with an improvement were 18 out of 27 (66%). Nine out 17 BRONJ sites (53%) in G3 had a transition to a lower stage after treatment. For sites in G4, a clinical improvement was recorded in 40 out of 45 cases (89%). CONCLUSIONS: In our experience, the percentage of success obtained with a combined approach based on medical therapy, surgical (including laser-assisted) therapy, and LLLT (G4) is significantly higher than the percentage of improvement obtained in G1, G2, and G3.

Nd:YAG laser versus traditional scalpel. A preliminary histological analysis of specimens from the human oral mucosa.

Hyperplastic fibro-epithelial lesions are the most common tumor-like swellings in the mouth. The neodymium yttrium aluminium garnet (Nd:YAG) laser appears to be useful for the surgical treatment of these lesions. Some controversies of laser surgery concern the accuracy of pathological diagnosis as well as the control of thermal damage on the target tissue. The aim of this study was to establish if the thermal changes induced by the Nd:YAG laser may affect the histopathological diagnosis and the evaluation of the resection margins. Furthermore, we compared the histological features of oral benign fibro-epithelial lesions excised through Nd:YAG laser and traditional scalpel. Twenty-six benign fibro-epithelial oral lesions from 26 patients, localized in the same oral subsites (cheek and buccal mucosa), were collected at the Unit of Oral Pathology and Oral Laser-assisted Surgery of the Academic Hospital of the University of Parma, Italy. Specimens were subclassified into three groups according to the tool used for the surgical excision. Group 1 included six specimens excised through Nd:YAG laser with an output power of 3.5 W and a frequency of 60 Hz (power density 488,281 W/cm2); Group 2 included nine specimens excised through Nd:YAG laser with an output power of 5 W and a frequency of 30 Hz; Group 3 included 11 specimens excised through a Bard-Parker scalpel blade no. 15c. Epithelial changes, connective tissue modifications, presence of vascular modifications, incision morphology and the overall width of tissue modification were evaluated. Differences between specimens removed with two different parameters of Nd:YAG laser were not significant with regard to stromal changes (p=0.4828) and vascular stasis (p=0.2104). Analysis of regularity of incision revealed a difference which was not statistically significant (p=1.000) between group 1 and group 2. Epithelial and stromal changes were significantly more frequent in specimens with a mean size less than 7 mm (p<0.0001). Nd:YAG laser induced serious thermal effects in small specimens (mean size less than 7 mm) independently from the frequency and power employed. The quality of incision was better and the width of overall tissue injuries was less in the specimens obtained with higher frequency and lower power (group 1: Nd:YAG laser at 3.5 W and 60 Hz).

[Surgical treatment of maxillary osteonecrosis due to bisphosphonates using an Er:YAG (2940 nm) laser. Discussion of 17 clinical cases]. / Traitement chirurgical des ostéonécroses maxillaires sous bisphosphonates à l'aide du laser Er:YAG (2940 nm). Discussion de 17 cas cliniques.

Reports of cases of ONJ are significantly increased during the last five years as a iatrogenic complication of therapy with bisphosphonates (BPT). The aim of this work is to present the advantages of surgery using Er:YAG laser for treatment of ONJ. Er:YAG laser can gradually reach the healthy bone without causing any heating damage of tissues. This device results very versatile and gives the possibility of choose among different surgical techniques depending by the case (e.g.: vaporization or ostectomy). Moreover, different studies have demonstrated the presence of both bactericidal and biomodulating effect on bone and surrounding tissues, with biostimulation of microcirculation and neoangiogenesis. Seventeen sites of ONJ, classified according to the staging system developed by Ruggiero and observed in 12 patients with multiple myeloma (9 patients), bone metastases (2 patients) and osteoporosis (1 patient), were treated with Er:YAG laser (Fidelis Plus, Fotona-Slovenia). Laser device was used in non-contact or near-contact way (VSP, 300 m3 30 Hz, Fluence 60 J/cm2) on 17 sites (4 Stage I and 13 Stage II) on 3 different types of surgery: sequestrectomy + debridement, sequestrectomy + corticotomy and vaporization. For an average follow-up of 9 months (SD +/- 6 months), complete healing of ONJ (Stage 0) was obtained for 13 sites (76.5%) and resolution of symptoms was obtained (Stage 1) for 3 sites (17.5%). For one site at Stage II (6%), recovery was obtained but this result was not maintained over 3 months. Positive results were independent by the anatomical area (mandible or maxilla), primary disease (osteoporosis, multiple myelomas or metastasis) and discontinuation of BPT before surgery. Er:YAG laser (2940 nm), in our experience, represents a valid therapeutic option for ONJ-BP related, especially in early stages of the disease.

Welding in the dental office by fiber-delivered laser: a new technique.

OBJECTIVE: The aim of this study is to demonstrate the ability of dentists to weld different metals during daily practice using a fiber-delivered laser normally used for dental surgery, and to evaluate the possibilities offered by this new technique. BACKGROUND DATA: Laser welding is a common technique that has long been used in dental technician laboratories. It has many advantages over conventional techniques: it may be applied directly to master casts, and it avoids damage to the acrylic or ceramic portions close to the welded area. In addition, it may be applied on different types of metallic alloys, and it may provide a stronger attachment than other more traditional techniques. The cost, size, and limited flexibility of laser transmission systems using fixed lenses have restricted their use to dental technician laboratories. MATERIALS AND METHODS: The authors detail their experience with welding using an Nd:YAG fiberoptic-delivered laser that is normally used for dental therapy. RESULTS: This work describes some clinical cases that demonstrate the ease of use of this technique to weld broken appliances for both prosthetic and orthodontic therapy. CONCLUSION: Dentists using this technique can carry out immediate restoration of metallic fixed, removable, and orthodontic broken prostheses in their own offices, thus reducing the time needed for such repairs.

[Oral health conditions and systemic diseases prevalence in long term institutionalizated elderly. A cross sectional study in Parma province]. / Condizioni orali e prevalenza di patologie sistemiche nel soggetto anziano istituzionalizzato. Indagine nella provincia di Parma.

People aging 74 years and more are in Parma province about 11,5% of residents. Disability conditions and familiar ties loss frequently let the elderly to recovery in long term home care where quality of care became synonymous of quality of life. To best evaluate oral health conditions in institutionalized elderly and their needs of care, we conducted, between August 2002 and July 2003 a cross-sectional study with clinical oral examinations in 200 long-term patients. Number of teeth, tooth remnants, mucosal findings, edentulousness, level of dental hygiene, needs for operative treatment and prevalence of systemic disease associated were evaluated. Subjects' mean age was 84,4 years (interval 57 _ 105); 59% were edentulous. As reported by several authors, a correlation between edentulousness and cardiovascular disease was found even after controlling for confounding variables (age, sex, smoking habit and Alzheimer disease).

Quantic molecular resonance scalpel and its potential applications in oral surgery.

Quantic molecular resonance is a new technique that applies high frequency waves suitable for many surgical fields. It is a remarkable advance from conventional electrosurgery, and consists of non-traumatic cutting of tissue and gentle coagulation. The cut is achieved by the explosion of infracellular and intracellular liquids, that resonate with a special frequency. The temperature of the cut area and surrounding tissues is less than 45 degrees C, so no thermal injury results. Coagulation is by denaturation of fibrinogen at 63 degrees C, and not at (conventional) higher temperatures. The result is the elimination of scar tissue or keloid, with considerable aesthetic benefits and reduction in postoperative swelling and pain. The quantic molecular resonance scalpel is a device that is suitable for oromaxillofacial surgery and related specialist areas (such as periodontology, implantology, and paediatric oral surgery). Other specialties (such as ear, nose, and throat, dermatology, aesthetic surgery, and veterinary surgery) could also benefit from this new technique.

Nd:YAG laser biostimulation in the treatment of bisphosphonate-associated osteonecrosis of the jaw: clinical experience in 28 cases.

OBJECTIVE: To research an efficient treatment for the management of bisphosphonate-associated osteonecrosis. BACKGROUND DATA: Necrosis of the jawbone has recently been described in association with systemic bisphosphonate therapy with drugs including zoledronic acid, pamidronate, and alendronate. The extent and clinical characteristics of bisphosphonate-associated osteonecrosis (BON) of the jaw are extremely variable, and range from the presence of fistulae in the oral mucosa or orofacial tissues, to large exposed areas of necrotic bone within the oral cavity. Clinical signs and symptoms commonly reported include pain, swelling, the presence of pus, loose teeth, ill-fitting dentures, and paresthesias of the inferior alveolar nerve when the necrosis affects the mandible. Fractures have also been reported. The treatment of BON of the jaw is still controversial since no therapy has proven to be efficacious as shown by the literature on the subject. MATERIALS AND METHODS: In this study we report results achieved with 28 patients affected by BON of the jaw, who received treatment with the Nd:YAG laser alone or in combination with conventional medical or surgical treatment. Clinical variables such as severity of symptoms, presence of pus, and closure of mucosal flaps before and after therapy were evaluated to establish the effectiveness of laser irradiation. The 28 patients with BON were subdivided into four groups: eight patients were treated with medical therapy only (antibiotics with or without antimycotics and/or antiseptic rinses), six patients were treated with medical and surgical therapy (necrotic bone removal and bone curettage), six patients were treated with medical therapy associated with laser biostimulation, and eight patients were treated with medical therapy associated with both surgical therapy and laser biostimulation. RESULTS: Of the 14 patients who underwent laser biostimulation, nine reported complete clinical success (no pain, symptoms of infection, or exposed bone or draining fistulas), and three improved their symptomatology only, with a follow-up of between 4 and 7 mo. CONCLUSIONS: While the results reported in this study are not conclusive, they indicate that laser therapy has potential to improve management of BON.