Evaluation of wound healing and postoperative pain after oral mucosa laser biopsy with the aid of compound with chlorhexidine and sodium hyaluronate: a randomized double blind clinical trial.

OBJECTIVES: The aim of this study is to evaluate secondary intention healing process and postoperative pain of oral soft tissues after laser surgery with the use of a compound containing chlorhexidine and sodium hyaluronate. MATERIALS AND METHODS: This double-blind, randomized clinical study included 56 patients affected by benign oral lesions and subjected to excisional biopsy with diode laser and randomly divided into three groups. Study group (SG) received 0.2% chlorhexidine digluconate and 0.2% sodium hyaluronate treatment; control group (CG) received 0.2% chlorhexidine digluconate; and placebo group (PG) followed the same protocol, taking a neutral solution having the same organoleptic characteristics. Wound healing was evaluated using percentage healing index (PHI). Numeric rating scale (NRS) was used to evaluate postoperative pain. RESULTS: PHI (T1 = 7 days) was 67.25% for SG, 58.67% for CG, and 54.55% for PG. PHI (T2 = 14 days) was 94.35% for SG, 77.79% for CG, and 78.98% for PG. A statistically significant difference was between the groups for PHI at T2 p = 0.001. No difference was detectable for pain index. CONCLUSIONS: A solution containing sodium hyaluronate and chlorhexidine is a good support to increase wound healing by secondary intention after laser biopsy, but no differences were in postoperative perception of pain. CLINICAL RELEVANCE: The use of the tested solution can be recommended after laser oral biopsies, to achieve a healing without suture. About the postoperative pain, the compound has not showed the same results and did not have measurable effects.

Short vs. Standard Laser-Microgrooved Implants Supporting Single and Splinted Crowns: A Prospective Study with 3 Years Follow-Up.

PURPOSE: The aim of this study was to compare survival rates, marginal bone loss (MBL), and peri-implant soft tissue parameters between short and standard laser-microgrooved implants supporting single or splinted crowns 3 years after loading. MATERIALS AND METHODS: 30 subjects received 1 short ( ≤ 7 mm ) and 1 standard length ( ≥ 9 mm ) laser-microgrooved implant in adjacent sites of the premolar and molar regions of the mandible or maxilla. Peri-implant soft tissue parameters and intraoral radiographs were recorded at the delivery of definitive crowns (baseline) and 3 years later. Cumulative survival rate (CSR) and marginal bone loss (MBL) in relation to crown/implant (C/I) ratio, implant length, location, type of antagonist, and type of prosthetic design (single or splinted), were evaluated. RESULTS: CSR of short implants was 98%, compared to 100% for standard implants, without significant statistical difference. MBL was not significantly different over the observation period, with an average of 0.23 ± 0.6 mm and 0.27 ± 0.3 mm for short and standard implants, respectively. No statistical differences were found between short and standard implants regarding plaque (14.7% vs. 15.7%), number of sites BOP (8.3% vs. 5.9%), probing depth (1.13 ± 0.6 mm vs. 1.04 ± 0.8 mm), and mean mucosal recession (0.18 ± 0.3 mm vs. 0.22 ± 0.3 mm). Analyzing MBL in relation to the C/I ratio, implant length, location, type of antagonist, and type of prosthetic design, no statistically significant differences were found. CONCLUSION: Regardless of C/I ratio, implant length, location, type of antagonist, and type of prosthetic design, short and standard laser-microgrooved implants had similar survival rates, MBL, and peri-implant soft tissue conditions over the observation period of 3 years.

Laser treatment of 13 benign oral vascular lesions by three different surgical techniques.

OBJECTIVES: Benign Oral Vascular Lesions (BOVLs) are a group of vascular diseases characterized by congenital, inflammatory or neoplastic vascular dilations clinically evidenced as more or less wide masses of commonly dark bluish color. If traumatized BOVLs are characterized by a great risk of hemorrhage and their treatment usually requires great caution to prevent massive bleeding. In the last decades lasers have dramatically changed the way of treatment of BOVLs permitting the application of even peculiar techniques that gave interesting advantages in their management reducing hemorrhage risks. The aim of this study was to evaluate the capabilities and disadvantages of three laser assisted techniques in the management of BOVLs. STUDY DESIGN: In this study 13 BOVLs were treated by three different laser techniques: the traditional excisional biopsy (EB), and two less invasive techniques, the transmucosal thermocoagulation (TMT) and the intralesional photocoagulation (ILP). Two different laser devices were adopted in the study: a KTP laser (DEKA, Florence, Italy, 532 nm) and a GaAlAs laser (Laser Innovation, Castelgandolfo, Italy, 808 nm) selected since their great effectiveness on hemoglobin. RESULTS: In each case, lasers permitted safe treatments of BOVLs without hemorrhages, both during the intervention and in the post-operative period. The minimally invasive techniques (TMT and ILP) permitted even the safe resolution of big lesions without tissue loss. CONCLUSIONS: Laser devices confirm to be the gold standard in BOVLs treatment, permitting even the introduction of minimal invasive surgery principles and reducing the risks of hemorrhage typical of these neoplasms. As usual in laser surgery, it is necessary a clear knowledge of the devices and of the laser-tissue interaction to optimize the results reducing risks and disadvantages.

Evaluation of the efficacy of a new low-level laser therapy home protocol in the treatment of temporomandibular joint disorder-related pain: A randomized, double-blind, placebo-controlled clinical trial.

Objective: This study analyzed a home, low-level laser therapy (LLLT) protocol to manage temporomandibular joint disorders (TMJDs)-related pain.Methods: Ninety TMJD patients (12M, 78F) between 18 and 73 years were randomly subdivided into three groups. Study group (SG) received 1-week home protocol LLLT by B-cure Dental Pro: 808 nm, 5 J/min, 250 mW, 15 KHz for 8', 40 J each, over pain area, twice daily. Placebo group (PG) followed the same protocol using sham devices. Drugs group (DG) received conventional drugs. Pain was evaluated by visual analog scale (VAS) before and after therapy.Results: Statistical analysis showed that treatment was effective (F(2,83) = 4.882; p = .010). Bonferroni post-hoc analysis indicated a lower pain decrease in PG. SG registered a 34-point decrease per patient, while in PG and DG, the reduction was 25.6 and 35.3, respectively.Conclusion: The study supports the efficacy of home LLLT management of TMJD related pain.

Influence of restorative margins position on one-stage laser-microgrooved implants-supported single screwed crowns: A clinical, biochemical, and microbiological analysis.

AIM: To clinically, biochemically, and microbiologically evaluate the influence of crown margins position on one-stage laser-microgrooved implants. MATERIALS AND METHODS: Twenty-one-stage titanium implants with a laser-microgrooved collar surface, supporting screwed, single crown restorations, were placed in 20 partially edentulous patients and evaluated. Clinical parameters included modified plaque index, modified gingival index, peri-implant probing pocket depth, bleeding on probing, and distance between implant shoulder and mucosal margin. The parameters were recorded at baseline (crowns delivery) and at every 6-month recall visit, until the end of the 3 years follow-up period. At the same time intervals, radiographic marginal bone levels were assessed at the mesial and distal aspect of the implant sites. For biochemical analysis, the volume of the peri-implant sulcus fluid, and its levels of interleukin-1beta (IL-1ß), interleukin-6 (IL-6), and of tumor necrosis factor-α, were utilized to evaluate the peri-implant health conditions at the end of the 3-year follow-up period. At the same time, microbiological analysis, including the concentration of five putative periodontal pathogens (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Treponema denticola, and Tannerella forsythensis), were assessed. The crown margins positions were classified into four groups (A = intracrevicular position >2 mm, B = intracrevicular position ≤2 mm/<1 mm, C = intracrevicular position ≤1 mm/<0 mm, and D = extracrevicular position), and the biochemical, and microbiological parameters were evaluated at 3 years. RESULTS: No statistical differences of clinical and biochemical parameters were found between the four groups. In group A, compared to groups B, C, and D, a statistically significant higher concentration of putative periodontal pathogens was found. CONCLUSIONS: Results showed that the intracrevicular deeper position of the restoration margin does not influence the clinical and biochemical peri-implant parameters. The deeper position of the crown margin is associated with a greater amount of putative periodontal pathogenic microflora colonization.

Implant-Gingival Unit Stability Around One-Stage Implant with Laser-Microgrooved Collar: Three-Year Result of a Prospective Study.

The aim of the present prospective study was to evaluate the stability of peri-implant soft tissue and the stability of the implant-gingival unit (IGU) around one-stage titanium implants with a laser-microgrooved collar surface following 3 years of loading. Thirty one-stage titanium implants with a laser-microgrooved collar surface were placed in 30 partially edentulous patients. Clinical and radiographic examinations were carried out at implant placement, after a period of 4 to 6 months free of masticatory loading, and after 3 years of function. Plaque Index (PI), modified sulcus bleeding index (SBI), probing depth (PD), distance between the implant coronal margin and the mucosal margin (DIM), clinical attachment level (CAL), and keratinized tissue width (KTW) and thickness (KTT) were recorded. Radiographic marginal bone levels (MBL) were assessed at the mesial (MI) and distal (DI) aspects of implant sites. In addition, the influence of KTT on IGU stability was investigated. No implants failed during the follow-up period. Compared to baseline, PI, BPI, PD, DIM, CAL, KTW, MBL, and IGU showed differences that were not statistically significant (P > .05). Moreover, IGU didn't show a statistical correlation with KTT. Within the limitations of the present study, it can be concluded that around one-stage implants with laser-microgrooved collar, the peri-implant tissues and IGU remain stable over the three evaluation periods.

Classification and cyclic fatigue evaluation of new kinematics for endodontic instruments.

This study evaluated the effect of new motions of the motor TriAuto ZX2 on the cyclic fatigue of endodontic instruments. Vortex Blue 35.06 instruments were divided into four groups (n = 10) and tested for fatigue in a curved artificial canal (90° and 2 mm radius) using the following motions: continuous rotation (CR), Optimum Torque Reverse (OTR) set at 180° and the Optimum Glide Path (OGP), which was tested at 90° and 240°. The time to fracture (TTF) and the lengths of the fractured fragments were recorded. The mean TTF was significantly different among the groups (anova, P < 0.05): OGP 90° (213.39 ± 27.45), OTR 180° (121.24 ± 17.03), OGP 240° (45.24 ± 5.61) and CR (8.43 ± 1.27). Weibull analysis confirmed the shortest life expectancy for CR and the longest survival for OGP at 90°. The resistance to fatigue was affected by motions and pre-set angles. The proprietary movements that are currently available for endodontic instruments were classified according to their kinematics.

One-stage laser-microtextured implants immediately placed in the inter-radicular septum of molar fresh extraction sockets associated with GBR technique. A case series study.

BACKGROUND: The outcome of one-stage trans-mucosal immediate implants with simultaneous guided bone regeneration (GBR) technique has become highly predictable. Furthermore, when this approach is performed to place one-stage implants into the inter-radicular septum of fresh extraction sockets in the molar region, the risk of incorrect emergence profile and off-angle loading is reduced. The aim of the present study was to clinically evaluate the horizontal hard and soft tissue changes, and radiographically the vertical socket walls remodeling, and the early peri-implant marginal bone loss (EMBL) following the placement of immediate one-stage implants in the inter-radicular septum of molar fresh extraction sockets, associated with a collagen membrane. MATERIAL AND METHODS: Twenty patients were selected to receive a one-stage implant with laser-microtextured collar surface into the inter-radicular septum of a fresh molar extraction sockets, associated with a simultaneous placement of a collagen membrane. Intraoral radiographs and model casts were used for the evaluation. Correlation between the amount of the keratinized tissue thickness (KTT) with EMBL was also analyzed. RESULTS: After 4 months, the vertical radiographic mesial and distal EMBL around implants was of 0.06 ±0.01 mm and 0.04±0.02 mm, respectively, with no statistically significant difference between T0 and T1 (P >0.05). No statistical differences were found also for each radiographic measure used for the examination of implant sites vertical bone changes (p >0.05). Clinically, horizontal changes of the bucco-lingual central width were found statistically significant (p<0.05), whereas no statistical differences were found for bucco-lingual mesial and distal width changes (p >0.05). In addition, no statistically significant correlation between EMBL and the amount of KTT was found (P >0.05). CONCLUSIONS: Results suggest that the immediate placement of one-stage laser-microtextured implants could provide advantages in preserving the extraction socket's hard and soft tissue remodeling, and the peri-implant marginal bone level before the prosthetic loading. Key words:One-stage implant, laser-microtextured collar surface, GBR, collagen membrane.

Cone-beam computed tomography in the assessment of periapical lesions in endodontically treated teeth.

Objective: This study aimed to evaluate the relationship between the quality of the coronal restoration and the root canal filling on the periapical status of endodontically treated teeth using CBCT. Materials and Methods: CBCT data were obtained from the records of patients who deny any dental treatment in the 2 years prior to the CBCT examination. CBCT images (90 kVp and 7 mA, exposure time of 23 s, and a voxel size of 0.2 mm, with a field of view of 13 cm × 13 cm) of 1011 endodontically treated teeth were observed. A score was given to the quality of the root filling and the quality of the coronal restoration. Statistical Analysis Used: Data were statistically analyzed to correlate the periapical status with gender, dental group. and quality of endodontic treatment and restoration (Chi-square test with a significance level of P < 0.001). Results: Absence of periapical periodontitis was found in 54.9% of the cases. The periapical outcome was not related to gender or dental group (P > 0.05). A statistically significant factor (Chi-square test, P < 0.0001) resulted when different qualities of sealing were compared. Conclusions: CBCT showed that high-quality root canal treatments followed by an adequate coronal sealing restoration avoid the presence of periapical periodontitis in time.

Retrospective Study on Laser Treatment of Oral Vascular Lesions Using the "Leopard Technique": The Multiple Spot Irradiation Technique with a Single-Pulsed Wave.

OBJECTIVE: This study aimed to retrospectively evaluate the efficacy and safety of laser treatment of oral vascular lesions using the multiple spot irradiation technique with a single-pulsed wave. BACKGROUND DATA: In laser therapy for vascular lesions, heat accumulation induced by excessive irradiation can cause adverse events postoperatively, including ulcer formation, resultant scarring, and severe pain. To prevent heat accumulation and side effects, we have applied a multiple pulsed spot irradiation technique, the so-called "leopard technique" (LT) to oral vascular lesions. This approach was originally proposed for laser treatment of nevi. It can avoid thermal concentration at the same spot and spare the epithelium, which promotes smooth healing. The goal of the study was to evaluate this procedure and treatment outcomes. PATIENTS AND METHODS: The subjects were 46 patients with 47 oral vascular lesions treated with the LT using a Nd:YAG laser (1064 nm), including 24 thick lesions treated using a combination of the LT and intralesional photocoagulation. RESULTS: All treatment outcomes were satisfactory without serious complications such as deep ulcer formation, scarring, bleeding, or severe swelling. CONCLUSIONS: Laser therapy with the LT is a promising less-invasive treatment for oral vascular lesions.

Oral features in patients with psoriasis: an observational study.

BACKGROUND: The aim of this study was to investigate and compare the prevalence of oral mucosal lesions in a group of psoriatic patients and healthy subjects. METHODS: 120 psoriatic patients were enrolled in this observational study. Clinical examination, panoramic X-ray, magnetic nuclear resonance of temporo-mandibular joint, parodontal evaluation, oropharyngeal buffer and incisional biopsies by scalpel, as applicable, were done in order to value the patients. The control group was formed by 201 non-psoriatic patients attending the hospital for dental conditions. Oral clinical evaluation of these patients was performed, to assess the presence of any oral manifestation that can be related to psoriasis: fissured tongue, geographic tongue, parodontitis, temporo-mandibular joint disorders and oral candidiasis. After the observational analysis, a statistical examination was conducted using the chi-square test (2-sided). RESULTS: A percentage of 78.34% of patients belonging to the case group presented oral manifestations, while in the control group the 35.3% of the individuals presented any oral lesions. Especially geographic and fissured tongue showed a strong correlation with psoriasis. CONCLUSIONS: Some oral mucosal lesions, such as geographic and fissured tongue, are strongly associated with psoriasis. Although these lesions are non-pathognomonic to psoriasis, their precise relationship needs to be clarified and further investigated.

In vitro resistance to fracture of two nickel-titanium rotary instruments made with different thermal treatments.

AIM: Aim of the study was to evaluate effectiveness of different heat treatments in improving Ni-Ti endodontic rotary instruments' resistance to fracture. METHODS: 24 new NiTi instruments similar in length and shape: 12 M3 instruments, tip size 25 and .06 taper (United Dental, Shanghai, China), and 12 M3 Pro Gold instruments tip size 25 and .06 taper (United Dental, Shanghai, China), were tested in a 60° curved artificial root canal. Each group received a different heat treatment. Cycles to fracture were calculated for each instrument. Differences among groups were evaluated with an analysis of variance test (significance level was set at P<0.05.). RESULTS: Statistical analysis found significant differences (p<0.0213) between groups. The M3 Pro Gold instruments were significantly more resistant to fatigue (mean values = 1012, SD +/- 77) than M3 instruments (mean values = 748, SD +/- 62). No statistically significant differences were found between fragments' lengths (p>0,05). CONCLUSIONS: An increased flexibility and the reduction of internal defects produced by heat treatments during or after manufacturing processes, may be responsible for improving resistance to cyclic fatigue and flexural stresses.

Detection of Bone Defects Using CBCT Exam in an Italian Population.

BACKGROUND: The aim of this study was to evaluate the in vivo incidence and the location of fenestrations in a young Italian population by using CBCT. MATERIALS AND METHODS: Fifty patients who had previously performed CBCT for planning third molar extraction or orthodontic therapy were selected for the study. No previous dental treatment had been performed on these patients. Overall, 1,395 teeth were evaluated. Root fenestrations were identified according to the definition of Davies and the American Association of Endodontists. Data was collected and statistically analyzed. RESULTS: Fenestrations were observed in 159 teeth out of 1,395 (11% of teeth). In the lower jaw, we found 68 fenestrations (5%) and 91 in the maxilla (6,5%). Incisors were the teeth with the highest incidence of fenestrations. CONCLUSION: The relative common finding (11%) of fenestration supports the need for CBCT exams before any surgical/implant treatment to avoid complications related to the initial presence of fenestrations. CBCT was found to be an effective and convenient tool for diagnosing fenestration.

Oral soft tissue wound healing after laser surgery with or without a pool of amino acids and sodium hyaluronate: a randomized clinical study.

OBJECTIVE: The purpose of this study was to compare secondary intention healing of oral soft tissues after laser surgery with and without the use of a compound containing amino acids and sodium hyaluronate. BACKGROUND DATA: Sodium hyaluronate has been successfully used in medicine to promote healing. It has not been studied in the healing of laser-produced wounds. MATERIALS AND METHODS: Excisional biopsy was performed in oral soft tissues with a potassium-titanyl-phosphate (KTP) laser (532 nm, SmartLite, DEKA, Florence, Italy) in 49 patients divided into two groups. In the study group (SG), 31 patients received a compound gel containing four amino acids and sodium hyaluronate (Aminogam(®), Errekappa, Italy) after laser surgery; in the control group (CG), 18 subjects received no treatment involving a drug or gel. Numeric rating scale (NRS) was used to evaluate pain experienced after surgery [pain index (PI)]. Using a grid as a benchmark and computer software, the lesion area was measured after surgery (T0) and after 7 days (T1). A percentage healing index (PHI) was calculated indicating healing extension in 7 days. RESULTS: SG cases showed an average PHI of 64.38±26.50, whereas the average PHI in the CG was 47.88%±27.84. Mean PI was 2.67±0.96 for SG and 2.75±0.86 for CG. A statistically significant difference was detected between the groups for PHI (p=0.0447), whereas no difference was detectable for PI (p=0.77). CONCLUSIONS: The use of a gel containing amino acids and sodium hyaluronate can promote faster healing via secondary intention in laser-induced wounds, although it does not seem to affect pain perception.

Excision of an oral angiolipoma by KTP laser: a case report.

MATERIALS AND METHODS: A 66 year old woman was referred to our observation, since the presence of a painless swelling located on the right cheek mucosa. A surgical approach with KTP laser was performed with the mucosal preservation technique. RESULTS: Follow up after seven days, sixty days and four months did not showed any complication and the histological examination reported the diagnosis of AL. DISCUSSION: AL is a relatively rare tumor of the head and neck region, although it occurs more commonly in the extremities and the trunk. This tumor has been rarely reported in the oral cavity and when seen in this area, it involves in the lip, cheek, tongue, mandible, and palate. ALs are also intraosseous in the mandible and intramuscular in the pterygoid fossa. KTP laser excision showed to be resolutive and avoid of complications. CONCLUSIONS: AL of the cheek is a very rare patology, but when it appears, it requires a surgical excision.

Laser treatment of 13 benign oral vascular lesions by three different surgical techniques

Objectives: Benign Oral Vascular Lesions (BOVLs) are a group of vascular diseases characterized by congenital, inflammatory or neoplastic vascular dilations clinically evidenced as more or less wide masses of commonly dark bluish color. If traumatized BOVLs are characterized by a great risk of hemorrhage and their treatment usually requires great caution to prevent massive bleeding. In the last decades lasers have dramatically changed the way of treatment of BOVLs permitting the application of even peculiar techniques that gave interesting advantages in their management reducing hemorrhage risks. The aim of this study was to evaluate the capabilities and disadvantages of three laser assisted techniques in the management of BOVLs. Study design: In this study 13 BOVLs were treated by three different laser techniques: the traditional excisional biopsy (EB), and two less invasive techniques, the transmucosal thermocoagulation (TMT) and the intralesional photocoagulation (ILP). Two different laser devices were adopted in the study: a KTP laser (DEKA, Florence, Italy, 532nm) and a GaAlAs laser (Laser Innovation, Castelgandolfo, Italy, 808nm) selected since their great effectiveness on hemoglobin. Results: In each case, lasers permitted safe treatments of BOVLs without hemorrhages, both during the intervention and in the post-operative period. The minimally invasive techniques (TMT and ILP) permitted even the safe resolution of big lesions without tissue loss. Conclusions: Laser devices confirm to be the gold standard in BOVLs treatment, permitting even the introduction of minimal invasive surgery principles and reducing the risks of hemorrhage typical of these neoplasms. As usual in laser surgery, it is necessary a clear knowledge of the devices and of the laser-tissue interaction to optimize the results reducing risks and disadvantages (AU)