Comparison between the Flapless Surgical Approach and a Novel Single Incision Access in Terms of Recovery Time and Comfort after Extraction of Impacted Inferior Third Molars: A Randomised, Blinded, Split-Mouth Controlled Clinical Trial.

The recent attention to quality of life and oral health care procedures reflects a renewed 'patient-based' approach to dealing with non-life-threatening conditions. In the current study, we proposed a novel surgical approach to the extraction of impacted inferior third molars (iMs3) through a randomised, blinded, split-mouth controlled clinical trial following the CONSORT guidelines. The novel surgical procedure, hereinafter referred to as single incision access (SIA), will be compared with our previously described flapless surgical approach (FSA). The predictor variable was the novel SIA approach, involving access through a single incision without removal of soft tissue, on the impacted iMs3. The primary endpoint was the acceleration of the iMs3 extraction healing time. The secondary endpoints were the incidences of pain and oedema as well as gum health (pocket probing depth and attached gingiva). The study was carried out on 84 teeth of 42 patients with both iMs3 impacted. The cohort was composed of 42% Caucasian males and 58% Caucasian females, aged 23.8 ± 7.9 (17-49) years. We observed faster recovery/wound-healing on the SIA side (33.6 ± 4.3 days) than at the FSA side (42.1 ± 5.4 days; p < 0.05). The FSA approach confirmed the evidence previously detected concerning early post-surgery improvement in terms of attached gingiva and reduced oedema and pain, with respect to the traditional envelope flap. The novel SIA approach follows the early positive post-surgery FSA results.

Free Gingival-Bone Graft in the Anterior Maxilla: A Clinical Case Report.

AIM: To present the healing, development, and long-term clinical results after a combined gingival-bone graft as an alternative treatment for the management of critical extraction sites in the esthetic zone. BACKGROUND: To enhance the knowledge of in vivo soft and hard tissue remodeling, in this case report, we observed the healing, development, and long-term clinical results after a case of a combined gingival-bone graft as an alternative treatment for the management of critical extraction sites. CASE DESCRIPTION: Autogenous grafts of gingival and bone tissue were placed in a 56-year-old female patient, where a hopeless upper left central incisor with an evident loss of both the buccal and the palatal bony plates and with endodontic problems was due for extraction. In order to obtain enough autogenous tissue for filling the defect, a cylindrical free gingival and bone graft was retrieved from the retromolar area with a trephine drill, to obtain hard and soft tissues for grafting the postextraction defect. After 6 months, following soft tissue maturation and once esthetic and natural gingival contours were achieved, the surgical site was prosthetically restored with a porcelain fused to a metal bridge and scheduled for regular follow-up. CONCLUSION: No complications were observed either from the donor site or from the recipient site. The post-treatment result was esthetically pleasing, based upon successful architectural stability of both hard and soft tissues. Although more studies are needed to confirm the beneficial use of this approach, the procedure can be considered a viable option in the management of soft and hard tissue remodeling in esthetically compromised cases. CLINICAL SIGNIFICANCE: The gingival-bone graft may be considered as an alternative treatment for the management of critical extraction sites in the esthetic area. How to cite this article: Signore A, Stepanov M, Angelis ND, et al. Free Gingival-Bone Graft in the Anterior Maxilla: A Clinical Case Report. J Contemp Dent Pract 2021;22(5):568-571.

Mitochondrial Bioenergetic, Photobiomodulation and Trigeminal Branches Nerve Damage, What's the Connection? A Review.

BACKGROUND: Injury of the trigeminal nerve in oral and maxillofacial surgery can occur. Schwann cell mitochondria are regulators in the development, maintenance and regeneration of peripheral nerve axons. Evidence shows that after the nerve injury, mitochondrial bioenergetic dysfunction occurs and is associated with pain, neuropathy and nerve regeneration deficit. A challenge for research is to individuate new therapies able to normalise mitochondrial and energetic metabolism to aid nerve recovery after damage. Photobiomodulation therapy can be an interesting candidate, because it is a technique involving cell manipulation through the photonic energy of a non-ionising light source (visible and NIR light), which produces a nonthermal therapeutic effect on the stressed tissue. METHODS: The review was based on the following questions: (1) Can photo-biomodulation by red and NIR light affect mitochondrial bioenergetics? (2) Can photobiomodulation support damage to the trigeminal nerve branches? (preclinical and clinical studies), and, if yes, (3) What is the best photobiomodulatory therapy for the recovery of the trigeminal nerve branches? The papers were searched using the PubMed, Scopus and Cochrane databases. This review followed the ARRIVE-2.0, PRISMA and Cochrane RoB-2 guidelines. RESULTS AND CONCLUSIONS: The reliability of photobiomodulatory event strongly bases on biological and physical-chemical evidence. Its principal player is the mitochondrion, whether its cytochromes are directly involved as a photoacceptor or indirectly through a vibrational and energetic variation of bound water: water as the photoacceptor. The 808-nm and 100 J/cm2 (0.07 W; 2.5 W/cm2; pulsed 50 Hz; 27 J per point; 80 s) on rats and 800-nm and 0.2 W/cm2 (0.2 W; 12 J/cm2; 12 J per point; 60 s, CW) on humans resulted as trustworthy therapies, which could be supported by extensive studies.

Photobiomodulation and Oxidative Stress: 980 nm Diode Laser Light Regulates Mitochondrial Activity and Reactive Oxygen Species Production.

Photobiomodulation with 808 nm laser light electively stimulates Complexes III and IV of the mitochondrial respiratory chain, while Complexes I and II are not affected. At the wavelength of 1064 nm, Complexes I, III, and IV are excited, while Complex II and some mitochondrial matrix enzymes seem to be not receptive to photons at that wavelength. Complex IV was also activated by 633 nm. The mechanism of action of wavelengths in the range 900-1000 nm on mitochondria is less understood or not described. Oxidative stress from reactive oxygen species (ROS) generated by mitochondrial activity is an inescapable consequence of aerobic metabolism. The antioxidant enzyme system for ROS scavenging can keep them under control. However, alterations in mitochondrial activity can cause an increment of ROS production. ROS and ATP can play a role in cell death, cell proliferation, and cell cycle arrest. In our work, bovine liver isolated mitochondria were irradiated for 60 sec, in continuous wave mode with 980 nm and powers from 0.1 to 1.4 W (0.1 W increment at every step) to generate energies from 6 to 84 J, fluences from 7.7 to 107.7 J/cm2, power densities from 0.13 to 1.79 W/cm2, and spot size 0.78 cm2. The control was equal to 0 W. The activity of the mitochondria's complexes, Krebs cycle enzymes, ATP production, oxygen consumption, generation of ROS, and oxidative stress were detected. Lower powers (0.1-0.2 W) showed an inhibitory effect; those that were intermediate (0.3-0.7 W) did not display an effect, and the higher powers (0.8-1.1 W) induced an increment of ATP synthesis. Increasing the power (1.2-1.4 W) recovered the ATP production to the control level. The interaction occurred on Complexes III and IV, as well as ATP production and oxygen consumption. Results showed that 0.1 W uncoupled the respiratory chain and induced higher oxidative stress and drastic inhibition of ATP production. Conversely, 0.8 W kept mitochondria coupled and induced an increase of ATP production by increments of Complex III and IV activities. An augmentation of oxidative stress was also observed, probably as a consequence of the increased oxygen consumption and mitochondrial isolation experimental conditions. No effect was observed using 0.5 W, and no effect was observed on the enzymes of the Krebs cycle.

Xerostomia and hyposalivation in patients with obstructive sleep apnoea.

OBJECTIVE: (a) To report the xerostomia prevalence and severity in patients with obstructive sleep apnoea (OSA). (b) To assess the saliva pH in patients with OSA. DESIGN: Simultaneous cohort observational clinical study. SETTING: In Sleep Medicine Centre at Lomonosov Moscow State University from March to June 2019. PARTICIPANTS: The study was conducted on 30 patients with OSA aged from 35 to 65 years. MAIN OUTCOMES MEASURES: The diagnosis of sleep apnoea was made after standard polysomnography using the Domino programme. The severity of OSA was indicated using the Apnoea-Hypopnea Index. Xerostomia was evaluated using Fox's test. Hyposalivation was evaluated by measurement of salivary flow rate. Determination of the saliva pH was carried out with a pH metre. Statistical analysis was performed by one-way ANOVA and Tukey-Kramer multi-comparison test. RESULTS: Twenty-two out of 30 (73.3%) patients were diagnosed with "dry mouth". Hyposalivation was observed in 6 out of 30 (20%). Dry mouth on awakening was observed in 60.0%, 72.7% and 88.9% of patients with mild, moderate and severe OSA, respectively. The average salivary flow rate was 0.28 mL/min, 0.24 mL/min and 0.14 mL/min, respectively. The average pH value in patients with mild, moderate and severe apnoea was 6.40 ± 0.017, 6.15 ± 0.27 and 5.87 ± 0.24, respectively. CONCLUSIONS: In patient with mild and moderate OSA, the saliva amount and rate are similar (P > .05). With the increase of OSA severity, both these parameters change (P < .001). The acidity of the saliva was correlated with the level of OSA, and it statistically increased with the increment of the OSA severity (P < .05-P < .001).

Simultaneous photoablative and photodynamic 810-nm diode laser therapy as an adjunct to non-surgical periodontal treatment: an in-vitro study.

BACKGROUND: The use of lasers at different wavelengths has been proposed in combination with conventional non-surgical periodontal treatment in order to improve the clinical outcome of periodontal disease. However, the clinical use of laser photonic energy is still the subject of research and debate because the antibacterial activity of the laser is dependent upon method, laser parameters, quantity of bacteria, species selected and photosensitizers used. METHODS: We evaluated the in-vitro bactericidal activity of 810 nm diode-laser irradiation in simultaneous photoablative and photodynamic mode against the major pathogenic bacterial organisms associated with periodontal inflammation and disease. We used indocyanine green as photosensitizer and the high-energy density of 161.7 J/cm2 or 215.0 J/cm2 for the photoablative-photodynamic irradiation. RESULTS: The bacteria were drastically affected by the 215.0 J/cm2 irradiation in the presence of indocyanine green. In fact, the number of Porphyromonas gingivalis and Prevotella intermedia was reduced by 99.9% (P<0.001), while the number of Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, Tannerella forsythia and Actinomyces viscosus decremented by 83.3% (P<0.01), 86.8% (P<0.05), 75% (P<0.01) and 78.7% (P<0.001), respectively. P. gingivalis and P. intermedia were the only bacteria that were sensitive to the treatment with indocyanine green dye and 161.7 J/cm2 of laser irradiation (P<0.001). CONCLUSIONS: Our preliminary in-vitro data suggest that simultaneous photoablative-photodynamic irradiation could be a promising therapy against a wide range of bacteria involved in periodontal disease. We believe that further additional in-vivo investigation is necessary, to enable a more complete picture of effectiveness within a clinical setting to be established. In addition, the use of a simultaneous photoablative-photodynamic therapy is suggested to reduce treatment time, without compromising the efficacy against the periodontal pathogens.

Guided periodontal surgery: a novel approach for the treatment of gummy smile. A case report.

An excessive gingival display, which commonly influences the appearance of the smile and the social behavior of patients, can be the result of various factors, including vertical maxillary excess, alterated passive eruption (APE), and a short or hyperactive upper lip. Surgical stents and guides have been used more frequently in clinical crown lengthening procedures during recent years to promote a higher level of precision and more predictable results. The aim of this article is to describe a novel approach for treating patients with APE who have high esthetic demands.

1064 nm Nd:YAG laser light affects transmembrane mitochondria respiratory chain complexes.

Photobiomodulation (PBM) is a non-plant-cell manipulation through a transfer of energy by means of light sources at the non-ablative or thermal intensity. Authors showed that cytochrome-c-oxidase (complex IV) is the specific chromophore's target of PBM at the red (600-700 nm) and NIR (760-900 nm) wavelength regions. Recently, it was suggested that the infrared region of the spectrum could influence other chromospheres, despite the interaction by wavelengths higher than 900 nm with mitochondrial chromophores was not clearly demonstrated. We characterized the interaction between mitochondria respiratory chain, malate dehydrogenase, a key enzyme of Krebs cycle, and 3-hydroxyacyl-CoA dehydrogenase, an enzyme involved in the ß-oxidation (two mitochondrial matrix enzymes) with the 1064 nm Nd:YAG (100mps and 10 Hz frequency mode) irradiated at the average power density of 0.50, 0.75, 1.00, 1.25 and 1.50 W/cm2 to generate the respective fluences of 30, 45, 60, 75 and 90 J/cm2 . Our results show the effect of laser light on the transmembrane mitochondrial complexes I, III, IV and V (adenosine triphosphate synthase) (window effects), but not on the extrinsic mitochondrial membrane complex II and mitochondria matrix enzymes. The effect is not due to macroscopical thermal change. An interaction of this wavelength with the Fe-S proteins and Cu-centers of respiratory complexes and with the water molecules could be supposed.

Expansion of the Zone of Keratinized Tissue for Healthy Implant Abutment Interface Using De-epithelialized Amnion/Chorion Allograft.

Keratinized tissue around implants is beneficial for soft tissue stability and esthetics. The aim of this investigation is to show the use of amnion/chorion membrane to increase the keratinized tissue. Fifteen patients were grafted with the allograft at the first or second stage of implant surgery. The mean values of keratinized tissue were 1.27 ± 0.46 mm, 2.00 ± 0.38 mm, 2.80 ± 0.78 mm, and 3.27 ± 0.80 mm at the initial evaluation and 7, 15, and 60 days postsurgery (prosthetic delivery was at day 60), respectively (P < .001). Most increase occurred between 7 days up to the prosthetic delivery. Use of the amnion/chorion membrane seems to improve keratinized-tissue expansion.

Clinical and surgical management of odontoma.

OBJECTIVE AND BACKGROUND: Odontomas are hamartomatous developmental malformations of the dental tissues. We present a retrospective study of recent clinical experience using erbium-doped yttrium aluminum garnet (Er:YAG) (wavelength 2940 nm) and chromium-doped yttrium scandium gallium garnet lasers (Er,Cr:YSSG) (wavelength 2780 nm) for the surgical treatment of these lesions, and score postsurgical pain. MATERIALS AND METHODS: This retrospective study comprised 35 odontomas treated at the Department of Oral Pathology and Laser-Assisted Surgery, San Martino Hospital, University of Genoa, Italy. Of 35 Caucasian patients (23 male, 12 female; ages 8-35; odontomas localized at various oral subsites) those in Group 1 (n=25) had odontomas excised by laser (Er:YAG laser operating at 2940 nm, pulse width 100 msec, curved handpiece, truncated cone HPX tip, 400 µm with energy output 250-400 mJ per pulse, frequency 15 Hz; and Er, Cr: YSGG laser, power 3.5 W, frequency 20 Hz, 55% air/45% water spray, H (hard tissue) mode, pulse width 190-750 µsec variable). In Group 2 (n=10) odontomas were excised by conventional surgery. Pain was assessed using a visual analog scale (VAS). Clinical outcome was determined at 6-12 months. RESULTS: Complete responses were achieved in 100% of the laser-treated odontomas, which compares favorably with reported results of conventional surgery. A statistically significant difference in VAS score was found between patients treated with traditional scalpel surgery (median=4.00) and those who underwent laser surgery (median=3.00). CONCLUSIONS: In treating odontomas, a laser surgery protocol effectively minimizes pain, maintains an excellent clinical outcome, and requires minimal additional treatment time compared with conventional surgery.

Apicoectomies with the erbium laser: a complementary technique for retrograde endodontic treatment.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of erbium lasers for retrograde endodontic treatment, in terms of clinical outcome and therapeutic success. BACKGROUND DATA: Apicoectomy with retrograde filling is a well-established surgical procedure to treat teeth affected by persistent periapical lesions. The apical root end is generally removed with burs, and the adjacent periapical tissue curetted, or alternatively treated with ultrasound or laser. METHODS: Between 2000 and 2010, 65 apicoectomies were performed on necrotic teeth that presented apical lesions (29 men, 36 women). The lasers used in the study were the erbium:yttrium-aluminum-garnet (Er:YAG) laser, wavelength 2940 nm, and the erbium,chromium-doped:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser, wavelength 2780 nm. RESULTS: Of the 65 teeth in the study, failure only occurred in 9 CASES, MANIFESTING AFTER DIFFERENT TIMES. THE REMAINING PATIENTS, 86.15%, experienced no complications, and their treatment followed a positive course. CONCLUSIONS: Laser-assisted surgery increases the range of therapeutic approaches in the sphere of retrograde endodontic treatment. The results of this study show that the erbium laser, used for apicoectomy, results in a high success rate with considerable benefit in terms of clinical outcome and therapeutic success.

Hemangiopericytoma/Solitary fibrous tumor of the oral cavity.

Hemangiopericytoma/solitary fibrous tumor is a very rare tumor of uncertain malignant potential. About 300 such cases have been reported since 1942, when Stout and Murray described these tumors as "vascular tumors arising from Zimmerman's pericytes". Under the World Health Organization (WHO) classification, hemangiopericytomas and solitary fibrous tumors of the soft tissues are regarded as features of the same entity in the soft tissue fascicle. We report the case of a 54-year-old woman who presented with a painless right-side cheek mass of 2 cm maximum diameter. The lesion was completely removed by wide surgical resection. Histologically, the tumour had staghorn-like vasculature and immunohistochemistry for Calponin, CD68 KP1, AE1-AE3, smooth muscle actin and P63, S-100 was negative; that for CD34 was positive. A diagnosis of hemangiopericytoma/solitary fibrous tumor was rendered. The patient had a normal postoperative course of healing, and 24 months later remains asymptomatic, without signs of recurrence or metastasis. Because of the rarity and unpredictable biological behavior of these tumors, long-term follow-up is necessary even after radical resection because recurrence or development of metastasis may be delayed by many years.