Nutrient canals and porosity of the bony palate: A basis for the biological plausibility of the anterior middle superior alveolar nerve block.

BACKGROUND: The authors investigated morphologic parameters of the palatal cortex that affect the diffusion of local anesthetic solution in the region of the anterior middle superior alveolar (AMSA) nerve block injection site. METHODS: The authors used computed tomographic (CT) and micro-CT imaging to assess 20 human skulls from an anatomic collection. Analysis of the CT images included frequency, distribution, and width of the nutrient canals in the bony palate, according to to the person's sex and age. Micro-CT analysis involved measuring the thickness and porosity of palatal cortical bone in the area of the AMSA injection site in relation to the thickness and porosity of the opposite buccal cortical bone. RESULTS: There was a statistically significant difference (P = .042) in the location of the nutrient canals between male specimens (> 50% in the border region) and female specimens (> 50% in the palatal process). Furthermore, the female skulls had significantly wider nutrient canal foramina (P = .042) than did the male skulls. Despite greater thickness, the palatal cortex in the area of the AMSA injection site had slightly greater porosity than did the buccal cortex. A significantly greater number of microcanals penetrated the whole cortical thickness in palatal than in buccal cortical bone (P = .001). CONCLUSIONS: The distribution and width of nutrient canals differed between male and female skulls. At the microscopic level, structural characteristics of the palatal cortex provide a good anatomic basis for the potential of a satisfactory AMSA injection success rate. PRACTICAL IMPLICATIONS: The AMSA technique success rate might be increased if the clinician adjusts the injection site to the distribution of nutrient canals, depending on the sex of the patient.

A clinical study on the influence of suturing material on oral wound healing.

BACKGROUND/AIM: Suture materials play an important role in healing, enabling reconstruction and reassembly of tissue separated by the surgical procedure or trauma, and at the same time facilitating and promoting healing and hemostasis. Suture materials are used daily in oral surgery, and are considered to be substances most commonly implanted in human body. The aim of this clinical study was to examine the speed of wound healing and complications incidence, after the use of three different absorbable synthetic suture materials in oral surgery (catgut, Dexon and Vicryl rapide), and to ascertain which one is the most suitable for oral surgery. METHODS: The study was conducted on 96 patients undergoing root resection or surgical extraction of third molars. Each of the suture materials (catgut, Dexon and Vicryl rapide) was used for 8 root resections and 8 surgical third molar extractions in the maxilla, as well as in the mandible (a total of 32 surgical interventions for each suture material). RESULTS: The faster wound healing was obtained with Vicryl rapide compared to other two suturing material tested. There was no significant difference regarding the presence of local reaction in all the three groups of patients on the 21st postoperative day. CONCLUSION: The results of our clinical study point out that Vycril- rapid contributes more than catgut or Dexon to faster healing of human wounds, with fewer incidences of wound dehiscence and milder local reactions.

Influence of suturing material on wound healing - An experimental study on dogs.

BACKGROUND/AIM: The most common materials implanted in the human organism are suture materials that are classified on the basis of several criteria, usually the origin, structure, and properties. The properties of suture materials are related to its absorbability and non-absorbability. When using resorbable materials it is of great importance to determine whether its absorbability and tensile strength help wound healing in function of time. Sutures themselves can become a source of inflammation, that may reduce or compromise the potential of reparation and regeneration. The aim of this experimental study on dogs was to ascertain whether the absorption rate and the degree of local tissue reactions differ from information provided by the manufacturers, whether there are differences between the applied suture materials and which of the used suture materials have better effect on wound healing. METHODS: Experimental testing of the selected suture materials basic characteristics was performed on 6 German Shepherd dogs, which, after induction of general anesthesia, were made 3 identical incisions each in all 4 quadrants (left and right side of the upper and lower jaws), so that 12 horizontal incisions were formed, 10 mm long, 20-25 mm distant from one another, on each animal. Randomly, incisions were stitched up in the following order, starting from back to front: catgut, Dexon®, Vicryl-Rapid®. The experiment was terminated by histopathological examination of tissue samples, taken on postoperative day 3, 7, 14 and 21 in order to identify the effect of healing and the degree of local reaction. RESULTS: The obtained results suggest that catgut has the highest absorption rate, while Dexon® the lowest. Vicryl- Rapid® causes the lowest level of local reactions, while Dexon® the highest. CONCLUSION: There is no ideal suture material because various patient factors also influence the wound healing process.