Ultrasonic osteotomy and regeneration with A-PRF+ for periapical surgery of a mandibular molar with root cyst perforating the lingual osseous cortex: A case report.

Background: Periapical surgery is a complex dental procedure that remains a considerable challenge in clinical practice. The use of APRF+ membranes and piezoelectric osteotomy help to improve outcomes and increase the efficiency and speed of recovery. Material and Methods: This case report describes a 20 years-old man with a periapical lesion which perforated the lingual cortex in a lower mandibular molar. A periapical surgery was performed with endoscope magnification and ultrasonic osteotomy. Apicectomy and retrograde cavities were performed using a piezoelectric scalpel and sealed using a bioceramic sealer. The osteolytic defect was filled with A-PRF+ membranes and the bone cortex was repositioned trough a micro-screw. Results: The histological analysis concluded an inflammatory odontogenic cyst. The postoperative period was uneventful with pain and mild oedema until the fourth day. Short-term follow-up showed the beginnings of bone regeneration and correct healing of the surgery without periodontal defects. Two-year follow-up showed favorable results and regeneration of the bone defect. Conclusions: Periapical surgery with magnification, ultrasonic osteotomy repositioning and application of A-PRF+ membranes as an adjuvant proved to be an effective approach for the regeneration of the osteolytic process, allowing the preservation of the tooth. Promising short and long-term results were shown for this case report. Key words:Periapical surgery, osteotomy, ultrasound, A-PRF+.

La calidad de vida, relacionada con la salud oral, en el Centro del Adulto Mayor de San Isidro, Lima / Quality of life, related to oral healthcare, in the Elderly Center de San Isidro, Lima

Introducción: El mantenimiento de la calidad de vida es uno de los resultados más importantes de los servicios de atención. Varios planes respaldan la importancia de realizar su medición en los adultos mayores. Objetivo: Evaluar la calidad de vida, relacionada con la salud oral, en los miembros de un centro del adulto mayor en Lima, Perú. Métodos: Se realizó un estudio descriptivo transversal en una población de 1800 adultos mayores. La muestra estuvo conformada por 184 participantes. El instrumento perfil de impacto de salud oral (OHIP14sp) se utilizó para medir la calidad de vida en relación con la salud oral. La validez de contenido se realizó mediante un grupo de evaluadores y la consistencia del cuestionario se evaluó con la prueba alfa de Cronbach. Se resumió la información en porcentajes y se utilizaron pruebas de hipótesis de Fisher y chi cuadrado para identificar la relación de la calidad de vida con el sexo y la edad, y la regresión de Poisson. Resultados: La calidad de vida de los adultos mayores fue mala en el 9,8 por ciento, buena en el 23,4 por ciento, y excelente en el 66,8 por ciento. Las mujeres (71 por ciento) tuvieron mejor calidad de vida que los hombres (58 por ciento). Se observó que a menor edad mejor es la calidad de vida. La mayoría de los adultos podían realizar sus actividades diarias salvo un 7,1 por ciento. La salud bucal no tuvo un impacto negativo en la calidad de vida de los adultos mayores en términos de malestar psicológico, limitación funcional y minusvalía, solo en un 61 por ciento, 49 por ciento y 17 por ciento, respectivamente. Conclusiones: El impacto en la salud oral en Lima identificó como excelente o regular la calidad de vida en relación con la salud bucal de los adultos mayores concurrentes al Centro del Adulto Mayor de San Isidro(AU)

Introduction: Maintaining quality of life is one of the most important results of care services. Several plans support the importance of measuring it in older adults. Objective: To assess oral health-related quality of life in members of a senior center in Lima, Peru. Methods: A descriptive cross-sectional study was carried out in a population of 1800 older adults. The sample consisted of 184 participants. The oral health impact profile instrument (OHIP14sp) was used to measure quality of life in relation to oral health. Content validity was performed by a group of evaluators and the consistency of the questionnaire was evaluated with Cronbach's alpha test. The information was summarized in percentages and Fisher's and chi-square hypothesis tests were used to identify the relationship of quality of life with gender and age, and Poisson regression. Results: The quality of life of older adults was poor in 9.8 percent, good in 23.4 percent, and excellent in 66.8 percent. Women (71 percent) had a better quality of life than men (58 percent). It was observed that the younger the age, the better the quality of life. Most of the adults were able to perform their daily activities except for 7.1 percent. Oral health did not have a negative impact on the quality of life of older adults in terms of psychological discomfort, functional limitation and handicap, only 61 percent, 49 percent and 17 percent, respectively. Conclusions: The impact on oral health in Lima identified as excellent or regular the quality of life in relation to oral health of older adults attending the San Isidro Senior Center(AU)

The study of bone healing after endodontic microsurgery using cone beam computed tomography: A retrospective cohort study.

Background: The main aims of this study were to evaluate mean volume reduction, radiographic healing rate and healing outcome two years after endodontic microsurgery. The effects of certain preoperative clinical factors upon preoperative volume, volumetric changes and healing outcome were also studied. Material and Methods: A clinical database was searched for patients who had undergone endodontic microsurgery and with the availability of a cone beam computed tomography (CBCT) scan preoperatively and after a control period. Volumetric analysis of the periapical area was made to assess volumetric reduction. The modified Penn 3D criteria were applied. The relationship between preoperative volume, volumetric reduction and healing outcome and certain preoperative factors was also studied. Results: Fifty-seven cases were evaluated. Initially, the bone cavities had a median volume of 163.2 mm3, and this volume decreased by 147.7 mm3 after treatment, with a radiographic healing rate of 6.2 mm3 per month. After applying the modified Penn 3D Criteria, 53 cases were classified as successful healing (93%). Regarding the influence of the different preoperative factors, patient age and sex, dental arch and cortical bone significantly influenced preoperative volume, while only the dental arch exerted a significant influence upon volumetric changes and preoperative symptoms on healing outcome. Conclusions: The CBCT data evidenced a significant volume reduction of 79.1%, with a monthly volume reduction rate of 6.2 mm3. The success rate obtained was 93%. Patient age and sex, dental arch and cortical bone influenced preoperative volume, tooth type had an impact upon the volumetric changes, and the preoperative symptoms influenced healing outcome. Key words:Cone beam computed tomography, endodontic microsurgery, healing, lesion volume, prognostic factors.

Endoscopic findings in periapical surgery. A cross-sectional study of 206 roots

Background: A study is made of the findings of high-magnification rigid endoscopy at the root end surface following apicoectomy of teeth subjected to periapical surgery.Material and Methods: A cross-sectional study was made of patients subjected to periapical surgery at the Unitof Oral Surgery and Implantology (University of Valencia, Valencia, Spain) between 2011 and 2019. Followingapicoectomy, the root end surfaces were inspected, with the evaluation of untreated canals, isthmuses, craze lines,crack lines, opaque dentin and gaps. Likewise, an analysis was made of the association between patient age andthe tooth type and restoration and the presence of craze lines, cracks, opaque dentin and gaps.Results: The final sample consisted of 168 patients subjected to periapical surgery, with 177 operated teeth and206 roots. Untreated canals were observed in 14 roots (6.8%). Isthmuses were identified in 74 roots (35.9%),particularly in the mesial root of the lower first molar (94.1%). In turn, craze lines were identified in 8.3% of theroots, cracks in 3.9%, and gaps in 53.4%. The prevalence of opaque dentin was 78.3%, with a greater presence inposterior teeth (90.3% in premolars and 86.2% in molars) than in anterior teeth (50.6%) (p<0.001). Patient age andtooth restoration showed no correlation to the studied parameters.Conclusions: Craze lines and crack lines were observed in less than 10% of the roots, though opaque dentin wasidentified in 73% of the roots, particularly in posterior teeth, and gaps were found in over half of the canals. (AU)

Influence of root width and dentin wall thickness evaluatedby endoscopy upon the outcome of periapical surgery. A cohort study

Background: An analysis was made of the correlation between root width, the thickness of the remaining dentinalwall as determined by endoscopy, and the outcome of periapical surgery.Material and Methods: A retrospective cohort study was carried out involving patients subjected to periapicalsurgery between 2017 and 2019 at the University of Valencia (Valencia, Spain).One year after surgery, cone-beam computed tomography (CBCT) was used to evaluate healing against the preoperative volumes. The maximum root width was measured on the postoperative CBCT scan at the apical section ofthe treated root. This measurement was transferred to the intraoperative endoscopic image, where the minimumroot width, peripheral dentin thickness, and minimum dentin thickness were recorded. Root measurements, andthe position (maxillary or mandibular) and type of tooth (roots of incisors, canines, premolars or molars) werefurther correlated to periapical surgery outcome.Results: A total of 51 patients, comprising 52 teeth and 62 roots, were included in the study. The mean measurements were: maximum root width (4.13±0.84 mm), minimum root width (2.46±0.72 mm), peripheral dentin thickness (0.77±0.2 mm) and minimum dentin thickness (0.4±0.2 mm). The success rate was 82.2%. Premolar roots showed a greater minimum dentin thickness (0.58±0.25 mm) (p<0.003) than incisor roots. No significant association was found between the different measurements and the healing rate at one year, though the roots that failed to heal showed smaller minimum dentin thickness values than the roots that healed correctly. The position and type oftooth did not influence healing outcome.Conclusions: The root width and thickness of the remaining dentin wall did not significantly influence healing.However, the roots that failed to heal showed smaller minimum dentin thickness values than the roots that healed correctly. (AU)

Intraoral onlay block bone grafts versus cortical tenting technique on alveolar ridge augmentations: a systematic review

Background : To review systematically the bone gain and superficial resorption rate of the onlay block bone grafts versus the cortical tenting technique, as well as secondarily study the postoperative complications, implant survival and success rates, and peri-implant marginal bone loss. Material and Methods: Following the recommended methods for systematic reviews and meta-analyses (PRISMA), an electronic search was performed in the PubMed (MEDLINE), EMBASE and the Cochrane Library of the Cochrane Collaboration (CENTRAL) databases to identify all relevant articles published up to March 2021 on onlay block bone grafts and cortical tenting technique. Results: Eighteen papers complied with the inclusion criteria. In onlay grafts, the vertical bone gain mean was 4.24 mm, and resorption 20.91%; and 4.29 mm in the horizontal augmentation with a resorption of 10.28%. The complication rate was 14.8%. The implant survival and success rates were 100% and 92%; and the mean peri-implant bone loss ranged from 0.6 to 1.26 mm. In cortical tenting technique, the vertical bone gain mean was 6.17 mm and the resorption of 9.99%; and 5.55 mm in the horizontal augmentation with a 6.12% of resorption. The complication rate was 24.6%. The implant survival and success rates were 96.63% and 100%; and the mean peri-implant bone loss ranged from 0.27 to 0.77mm. Conclusions: Despite the limitations, both techniques offer a predicTable way to reconstruct atrophic alveolar ridges, though the cortical tenting technique seems to achieve a greater bone gain and a lower surface resorption. Current evidence is still limited due to the inadequate follow-up, lack of information referred to methodological quality and sample attrition.(AU)

Is periapical surgery follow-up with only two-dimensional radiographs reliable? A retrospective cohort type sensitivity study / ¿El seguimiento de la cirugía periapical se realiza únicamente con radiografías bidimensionales confiable? Un estudio retrospectivo de sensibilidad de tipo cohorte

Background: Two-dimensional (2D) radiographic techniques are commonly used for assessing lesion prognosisafter endodontic surgery. The present retrospective cohort study analyzes the sensitivity and ability of differentradiographic techniques in obtaining area and volume measurements of periapical lesions.Material and Methods: Preoperative and follow-up (6-48 months) periapical and panoramic radiographs (indextest) and cone-beam computed tomography (CBCT) images (reference standard) were selected from an endodonticmicrosurgery database. Sensitivity was analyzed independently by two examiners. The areas of the 2D radio-graphic images and CBCT volumes were studied using Itk-Snap software and Romexis viewer.Results: The sample comprised 105 patients and 105 teeth, with a mean follow-up of 21 months (range 6-48). Preop-eratively, CBCT detected all the periapical areas, periapical radiography detected 67, and panoramic radiographydetected 60. Postoperatively, of the 52 cases in which CBCT detected remains of the periapical area, periapical ra-diography detected 22, and panoramic radiography detected 17. The measurements of the areas obtained by the 2Dmethods, and the volumes obtained by CBCT, had to be transformed into linear measures for comparison purpos-es. The measurements were found to be significantly different in both the preoperative and the follow-up images. Conclusions: Periapical radiography showed greater sensitivity than panoramic radiography, both preoperatively andat follow-up. The lesions measured with CBCT were larger, with significant differences than as evidenced by theperiapical and panoramic radiographs.(AU)

Comparison of the diagnostic efficacy of 2D radiography and cone beam computed tomography in persistent apical periodontal disease: A PRISMA-DTA systematic review and meta-analysis.

OBJECTIVE: The objective of this study was to answer the question: Do conventional radiographs (periapical/panoramic) afford better diagnostic outcomes than cone beam computed tomography (CBCT) as a complement for clinical diagnosis of apical lesions with persistent apical periodontitis or disease after root canal treatment? STUDY DESIGN: Five electronic databases were searched and provided information to enable construction of a table to determine primary diagnostic measures and secondary parameters. The evidence was appraised with the Quality Assessment of Diagnostic Accuracy Studies tool and GRADEpro software. RESULTS: Twenty-seven articles (9903 diagnostic images) were included. The pooled sensitivity, specificity, area under the receiver operating characteristic curve (AUCROC), positive predictive value, negative predictive value, negative likelihood ratio, and accuracy were 0.58, 1, 0.77, 1, 0.68, 0.45, and 0.79, respectively. CONCLUSIONS: Moderate certainty evidence suggested that conventional radiographs showed poor sensitivity and excellent specificity but good diagnostic performance in terms of AUCROC and accuracy. Sensitivity, AUCROC, and negative likelihood ratio values could be reduced if the time elapsed to diagnosis after root canal treatment exceeded 5 years. The use of CBCT with a reduced field of view or a 2D radiographic technique should be weighed considering patient-specific and indication-oriented criteria as taking precedence over the therapeutic goal.

Low-speed drilling without irrigation versus conventional drilling for dental implant osteotomy preparation: a systematic review.

PURPOSE: This paper aims to review the evidence comparing low-speed drilling without irrigation versus conventional drilling for dental implant osteotomy preparation. MATERIALS AND METHODS: A systematic review was carried out based on the PRISMA statement. Four databases and gray literature were searched up to November 2020. In vitro, animal, and clinical studies were included. The variables were temperature change, drilling time, quantity of harvested bone, osteotomy precision, marginal bone loss, implant success rate, osseointegration, and the histomorphologic characteristics and cellularity of the osteotomy and of the harvested bone. Different tools for the assessment of bias were applied for each study design. RESULTS: A total of 626 articles were identified, of which 13 were included. Both low-speed drilling without irrigation (test group) and conventional drilling (control group) maintained temperatures below the critical temperature of 47 °C. The test group yielded a greater quantity and more beneficial cellular and histomorphologic properties of harvested bone, with a longer drilling time and greater osteotomy precision (p < 0.05). No significant results were obtained regarding drill wear, osseointegration, marginal bone loss, implant success rate, and histomorphology of the dental implant osteotomy (p > 0.05). The results, in particular on the osteotomy precision and quantity of harvested bone chips, should be interpreted with caution because outcomes are based in only one in vitro study. CONCLUSIONS: Low-speed drilling without irrigation seems to be comparable to conventional drilling in preparing dental implant osteotomies. In some situations, low-speed drilling without irrigation might offer advantages over conventional drilling. The results should be interpreted with caution due to the low percentage of clinical human studies. Accordingly, more clinical studies are needed to improve the scientific evidence on this topic. CLINICAL RELEVANCE: The low-speed drilling without irrigation is a valid technique for dental implant osteotomy preparation. Its higher quantity and quality of harvested autologous bone might be particularly beneficial in cases of dental implant placement with minor simultaneous bone regeneration.

Facial alveolar bone thickness and modifying factors of anterior maxillary teeth: a systematic review and meta-analysis of cone-beam computed tomography studies.

BACKGROUND: Understanding the anatomy of the facial alveolar bone (FAB), provides a prognostic tool for estimating the degree of dimensional ridge alterations after tooth extraction. This systematic review and meta-analysis aims to determine the FAB thickness and modifying factors of anterior maxillary teeth measured by CBCT scans. A secondary objective was to assess the facial distance from the cementoenamel junction (CEJ) to the bone crest. METHODS: An electronic search was made of Medline, Embase, Web of Science, Cochrane Library and Google Scholar up to December 2019. Studies that analyze and quantitatively compare FAB thickness at maxillary teeth by CBCT scans were included. The methodological quality of the included studies was appraised using the ROBINS-I tool and the overall meta-evidence certainty using the GRADE approach. A single means random-effects meta-analysis was performed to obtain the weighted mean for 95% confidence interval. A meta-regression of covariates and subgroup analysis was conducted. The nullity Qh test and I2 index for heterogeneity was estimated. RESULTS: 2560 potentially relevant articles were recorded from which 29 studies were selected for the qualitative analysis, including 17,321 teeth. Seventeen studies considered the facial bone crest, and 12 the CEJ as a reference point for their measurements. Mean FAB thickness was ≤ 1 mm in maxillary incisors and canines (0.75-1.05 mm) and 1-2 mm in premolars. Patients over 50 years of age, females and thin gingival phenotype was associated with thinner FAB at some apico-coronal locations of maxillary incisors and canines. The geographical setting was an effect modifier that could explain up to 87% of the heterogeneity in FAB thickness, being Asian populations that showed the lowest FAB thickness values. The CEJ-bone crest distance was 2-2.5 mm in all teeth analyzed. Population over 50 years of age exhibited greater CEJ-bone crest distances, and males also showed a trend for greater distance. Evidence certainty has shown moderate quality in most analysis subsets. CONCLUSIONS: Facial alveolar bone at anterior maxillary teeth is thin, heterogeneous in width along its apico-coronal dimensions, and increases in thickness in maxillary premolars. The CEJ-bone crest distance presented homogeneous and similar values in all teeth analyzed.

Socket seal surgery techniques in the esthetic zone: a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials.

BACKGROUND: The socket seal surgery (SSS) technique is a common alternative for the management of the post-extraction sockets that requires a primary closure of the wound to promote proper regeneration and ridge preservation. OBJECTIVE: To learn about the effect of different SSS techniques on alveolar ridge preservation MATERIAL AND METHODS: Two independent and calibrated reviewers conducted an electronic search in PubMed, Cochrane, and Web of Science for randomized clinical trials (RCT) published up to June 2020. The evaluation of the risk of bias in the included studies was carried out following the Cochrane manual for interventions of systematic reviews, version 5.1.0. A meta-analysis of ridge width changes at - 1, - 3, and - 5 mm cutoff points from bone crest was conducted using a random-effects model. The risk of types I and II errors against accrued data was appraised obtaining the required information size using a trial sequential analysis package (TSA). RESULTS: A total of 135 sockets located in the esthetic zone were evaluated with a minimum of a 3-month follow-up after tooth extraction in 6 RCTs. The evaluated SSS techniques were free gingival graft (FGG), collagen matrix (CM), collagen sponge (CS), acellular dermal matrix (ADM), and polytetrafluoroethylene membrane (PTFEm). The FGG in sockets without bone filling showed significant results in preserving both buccal and lingual bone height (- 1.42 mm in the experimental group versus - 0.01 in the control group). The comparison of CM and FGG with bone filling did not show clinical differences in terms of dimensional bone changes. No clinical differences were found in either width or gingival thickness when comparing CM and CS. The meta-analyses of RW changes comparing CM versus FGG showed no significant differences, but a trend for lessening horizontal reduction at - 1, - 3, and - 5 mm in favor of FGG. The TSA showed that accrued data did not reach the required information size, and more evidence is required for clinical significance inferences. CONCLUSIONS: There are several predictable SSS techniques to improve clinical results in ridge preservation. More clinical studies in the form of clinical trials are required to demonstrate the superiority of one technique over another.

Does enamel matrix derivative application provide additional clinical benefits in the treatment of maxillary Miller class I and II gingival recession? A systematic review and meta-analysis.

OBJECTIVE: This review aimed to evaluate the effects of enamel matrix derivative (EMD) in association with coronally advanced flap (CAF) or CAF + connective tissue graft (CTG) when compared with CAF alone or CAF + CTG for the treatment of gingival recessions (GR) in maxillary teeth. METHODS: Five databases and gray literature were searched up to April 2020, to find randomized clinical trials comparing the clinical effects of CAF + EMD versus CAF alone (first group) or CAF + CTG + EMD versus CAF + CTG (second group) in the treatment of Miller class I and II or Cairo type I gingival recessions (GR). Random effects model of mean differences was used to determine the GR reduction, gain in keratinized tissue width (KTW), and gain in clinical attachment level (CAL). The trial sequential analysis (TSA) was implemented to determine the optimal information size (OIS) and imprecision using the GRADE approach. Bayes factors were calculated as complementary statistical evidence of p value. RESULTS: From 1349 titles identified, 9 trials representing 336 GR were included. The meta-analysis showed a statistically significant difference for GR reduction and CAL gain in favor CAF + EMD (p ≤ 0.05). The additional effect of EMD showed a statistically significant difference in GR reduction in favor CAF + CTG + EMD (p ≤ 0.05). The differences in KTW gain proved to be not statistically significant in both comparison groups. The OIS were not met among meta-analyses. Evidence certainty according the GRADE approach proved to be moderate for GR reduction and gain in CAL, but very low for gain in KTW. CONCLUSION: The adjunctive application of EMD in the treatment of GR in maxillary teeth either with CAF or CTG provided moderate certainty evidence in favor of their use for reduction in GR and gain in CAL at 6 and 12 months. However, their effect on the increase in keratinized tissue band height showed very low evidence certainty for its use. CLINICAL RELEVANCE: To know if EMD could improve the results for root coverage.

Regenerated Traumatic Bone Cyst With Platelet-Rich Fibrin in the Mandible: A Case Report.

INTRODUCTION: Traumatic bone cyst is a pseudocyst which is characterized as an asymptomatic unilocular single lesion with an empty cavity without epithelial lining. Its etiology is still debated, it is more frequent among young people and it is often localized in the posterior mandible zone. A case report is described about diagnosis and conservative treatment of a traumatic bone cyst in anterior zone of lower mandible. CASE PRESENTATION: The report describes a 22-year-old female with a traumatic bone cyst in anterior mandible as accidental discovery from a routine orthopantomography. A conservative approach was conducted to treat the lesion through a submarginal incision, an osteotomy with ultrasound, a filling of the cavity with advanced platelet-rich fibrin membranes, and repositioning of the cortical bone. The radiological follow-up to 6 months confirmed the healing of the lesion. CONCLUSION: The conservative approach through submarginal incision, osteotomy with ultrasound, filling with A-PRF+ membranes and repositioning of cortical bone ensures optimal bone healing and avoids gingival recessions at six months follow-up, showing to be a good alternative for satisfactory defect resolution in similar clinical cases.

Treatment of apicomarginal defect with periapical surgery: A case report.

An apicomarginal defect can be explained as a total loss of buccal alveolus extending from the original crestal bone to the apex of the tooth. This study presents a case of an apicomarginal defect in a first left molar subjected to periapical surgery with vestibular cortex block replacement and A-PRF + membrane coating approximately one year ago. One-year clinical follow-up was performed, with no evidence of recurrence. This case report discusses periapical surgical treatment and the importance of an interdisciplinary approach to the management of teeth with apicomarginal defects. Key words:Periapical surgery, apicomarginal defect, A-PRF+, bone graft.

The use of the endoscope in endodontic surgery: A systematic review.

BACKGROUND: A systematic review of clinical studies with at least one year of follow-up was done to assess the success rate of endodontic surgery including endoscopy for magnification and illumination. MATERIAL AND METHODS: Five electronic databases were searched, including MEDLINE (via PubMed), Embase, Web of Science, Scopus and the Cochrane Library of the Cochrane Collabora-tion (CENTRAL). There were no language restrictions, and the search covered the period up to October 2019. The risk of bias was evaluated with the Cochrane Collaboration tool for randomized clinical trials and the ROBINS-I tool for non-randomized studies of inter-ventions. RESULTS: From the 278 initially identified titles, finally 2 randomized controlled trials and 3 non-randomized studies met the inclusion criteria. All the included studies analyzed the success rate of endodontic surgery performed with the help of endoscope for magnifica-tion and illumination. The risk of bias was high for allocation sequence concealment and blinding of participants and personnel in the randomized controlled trials. The nonran-domized studies showed limitations in terms of confounding bias and blinding of outcome assessment. Endodontic surgery with the help of an endoscope is associated with high success rates (88.9-94.9%). CONCLUSIONS: The endoscope was associated with high success rates of endodontic sur-gery in the included studies. Future studies on this topic are warranted, due to the meth-odological issues and the scarce number of randomized clinical trials. Key words:Endodontic surgery, magnification, endoscope, success.

Hemostatic agents in endodontic surgery of maxillary molars: A randomized controlled pilot study of polytetrafluoroethylene (PTFE) strips as an adjunct to epinephrine impregnated gauze versus aluminum chloride

BACKGROUND: Hemostasis is of critical importance in endodontic surgery. Studies on bleeding control in maxillary molars are scarce. The present study compares the efficacy of two hemostatic techniques in controlling bleeding in endodontic surgery. MATERIAL AND METHODS: A randomized two-arm pilot study involving 30 patients with peri-radicular lesions in maxillary molars (first and second molars) was carried out including the following hemostatic agents: polytetrafluoroethylene (PTFE) strips as an adjunct to epinephrine impregnated gauze (test group; n = 15) and aluminum chloride (Expasyl(TM)) (control; n = 15). Bleeding control was independently assessed by the surgeon and by two blinded observers before and after application of the hemostatic agent, and was classified as either adequate (complete bleeding control) or inadequate (incomplete bleeding control). RESULTS: Bleeding control was similar in both groups. Simple binary logistic regression analysis failed to identify variables affecting bleeding control. Only the height of the keratinized mucosal band (≥ 2 mm) suggested a decreased risk of inadequate bleeding control of up to 89% (OR = 0.11; p = 0.06). CONCLUSIONS: No difference in the efficacy of bleeding control was observed between PTFE strips as an adjunct to epinephrine impregnated gauze and aluminum chloride in maxillary molars

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Sequential healing of the elevated sinus floor with different size of antrostomy: a histomorphometric study in rabbits.

PURPOSE: To study the influence of the access window dimensions on the healing at the antrostomy and within the augmented maxillary sinus. MATERIAL AND METHODS: A maxillary sinus augmentation was performed in twenty-four albino New Zealand rabbits. Antrostomies of 3 × 6 mm (small) or 5 × 6 mm (large) in dimensions were randomly prepared in each animal. A collagenated cortico-cancellous porcine bone was used to fill the elevated region, and an equine collagen membrane was placed on the antrostomies. Three different groups were formed, based on the time of euthanasia, i.e., 2, 4, and 8 weeks from surgery. RESULTS: No relevant changes of the height of the augmented sinus were detected over time. Mineralized bone increased between 2 and 4 weeks of healing while remained stable between 4 and 8 weeks. The highest amounts of new bone were found close to the sinus bone walls. No antrostomies were found healed with an even layer of corticalized bone, while large amounts of connective tissue were occupying the antrostomy in both groups. CONCLUSION: Antrostomies of different dimensions resulted in similar outcome in bone formation both in the antrostomy regions and within the elevated sinus.

Influence of the use of autogenous bone particles to close the access window after maxillary sinus floor augmentation: an experimental study in rabbits.

AIM: To study the influence on the healing of the placement of particulate autogenous bone in the antrostomy and in the subjacent region after maxillary sinus elevation. MATERIAL AND METHODS: Sixteen New Zealand rabbits were undergone to bilateral maxillary sinus floor augmentation with 4 × 4 mm antrostomy dimension. The sinus mucosa was elevated, and the space obtained was filled with xenograft. In the test site (treated sites), autogenous bone was harvested from the tibia and was placed either in the antrostomy and the subjacent region while the control site was left untreated. Antrostomy was covered bilaterally with collagen membranes. Animals were euthanized after 1 and 8 weeks of healing, with 8 rabbits in each group. Histomorphometric evaluations were done. The Wilcoxon test is used for statistical analysis, for a 5% statistical significance. RESULTS: After 1 week of healing, the new bone proportion in the antrostomy was 7.7 ± 11.2% and 6.1 ± 6.4% in the treated and untreated sites, respectively. In the subjacent region (close-to-window region), hardly any new bone was assessed. In the elevated region, 2.7-2.8% of total new bone was found in both sites. In the antrostomy region, after 8 weeks of healing, 35.5 ± 20.9% of new bone in the treated sites, and 28.6 ± 24.1% in the untreated sites was observed (p = 0.499). In the close-to-window region, the respective proportions were 25.8 ± 16.1% and 17.6 ± 16.3% (p = 0.018). In the elevated region, the total new bone reached fractions of 27.9 ± 12.9% and 23.6 ± 15.2% in the treated and untreated sites, respectively (p = 0.128). CONCLUSIONS: The placement of autogenous bone in the antrostomy and the subjacent region after maxillary sinus elevation, slightly enhanced bone formation compared with sites only grafted with xenograft. Though, only the subjacent close-to-window region showed a statistical significance at 8 weeks of healing. Despite the limitations of the present study, due to its preclinical nature, findings should be extrapolated to humans with caution.

Patient morbidity after impacted third molar extraction with different flap designs. A systematic review and meta-analysis

BACKGROUND: To review the literature on the effect of different surgical flaps upon patient morbidity (pain perception, trismus, swelling and osteitis) after impacted third molar extraction. MATERIAL AND METHODS: An electronic and complementary search of main databases and grey literature was performed up to January 2019 to retrieve randomized clinical trials. The Cochrane risk of bias assessment tool was used for methodological appraisal. A random-effects meta-analysis was conducted of pain perception and trismus. RESULTS: From the initially 1314 screened studies, only 11 were included in the qualitative synthesis, and 5 in the meta-analysis. There were no statistically significant differences in pain between the envelope and triangular flap designs over time, except on the sixth postoperative day, when the envelope flap proved more painful. Regarding trismus, statistically significant differences were observed on the seventh postoperative day, with greater mouth opening in the envelope flap group than in the triangular flap group. There were no clear differences in swelling and osteitis among the flap designs. CONCLUSIONS: Despite its limitations, the present meta-analysis found no clear differences in patient morbidity between the different flap designs

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Influence of Facial Bone Thickness After Implant Placement into the Healed Ridges on the Remodeled Facial Bone and Considering Soft Tissue Recession: A Systematic Review.

PURPOSE: A systematic review was performed of the dimensional changes in facial cortical bone following implant placement into healed ridges, with the aim of establishing a minimum bone thickness that limits such changes. The influence of such bone remodeling upon the soft tissues and implant survival was also evaluated. MATERIALS AND METHODS: A search was done of two electronic databases (MEDLINE via PubMed and CENTRAL), complemented by a manual search and lists of references. The risk of bias and methodological quality were assessed using the Cochrane Collaboration tool, the Methodological Index for Non-randomized Studies (MINORS), and the Quality Appraisal Checklist for Case Series. RESULTS: The search yielded 536 publications, of which 11 (four randomized clinical trials, two non-randomized clinical trials, and five case series) were entered in the review. All the included studies reported vertical and horizontal implant facial bone resorption. Decreased facial bone thickness was correlated with increased vertical bone resorption, which in turn was associated with slight soft tissue retraction. A meta-analysis could not be performed, due to the heterogeneity of the study designs and measurement sites. CONCLUSION: No minimum facial bone thickness was seen that would completely avoid peri-implant bone loss and maintain soft tissue stability. However, a thickness of approximately 2 mm was associated with diminished vertical bone resorption and less peri-implant mucosal recession.