Effect of pre-operatory low-level laser therapy on pain, swelling, and trismus associated with third-molar surgery.

BACKGROUND: The extraction of impacted third molars is commonly associated to pain, edema, trismus, limited jaw opening and movements. The aim of this retrospective study is to verify if pre-surgical low-level laser therapy (LLLT) associated with the extraction of impacted lower third molars could add benefits to the postoperative symptoms respect LLLT performed only after surgery. MATERIAL AND METHODS: Data from 45 patients subjected to a surgical extraction of lower third molars were pooled and divided into three groups. Patients that received only routine management were inserted in the control group. Group 1, were patients that received LLLT immediately after surgery and at 24 hours. In group 2 were included patients treated with LLLT immediately before the extraction and immediately after the end of the procedure. Data were analyzed using linear regression and descriptive statistics. RESULTS: Both laser-treated groups were characterized by minor events of post-surgery complications of pain, edema, trismus. The use of NSAIDs in the first 24 hours was significantly inferior in Group 2. CONCLUSIONS: Pre-surgical LLLT treatment seems to increase the analgesic effect of LLLT. However, trismus and edema were reduced in both laser treated groups, independently from the period of irradiation.

Thermal analysis of laser-softened gutta-percha.

The aim of this work is to examine the behaviour of laser treated gutta-percha (a–b) after heating, to test the validity of a new obturation technique. Samples of laser- and no laser- treated gutta-percha have been examined by the thermal/thermogravimetric analysis and compared. All samples have been submitted to four runs of heating from the temperature of 25–130 C, followed by spontaneous cooling. It was found that some samples have shown the typical behaviour of the alpha-gutta-percha; others have shown characteristics similar to the conventional beta-gutta-percha. The laser treated gutta-percha has shown a significant mass loss after the first run of heating, while the mass tends to stabilize after the third run. It has been demonstrated that the 980 nm diode laser used with cited parameters does not alters thermal behaviour of gutta-percha cones.

Micromorphometrical and histological analyses using two different oscillating osteotomy techniques compared with conventional rotary osteotomy.

The recently introduced ultrasonic osteotome procedure is an alternative to conventional rotatory burs. The aim of this study was to establish the differences between two ultrasonic osteotomes and conventional rotatory burs, in order to perform micromorphological and histological analyses of osteotomized bone surfaces. Bony samples were taken from adult bovine ribs including both the cortical and marrow bone. Soft tissues have been removed and the bone pieces were divided into four groups, to test four devices: a conventional osteotomy round bur, a Lindeman bur and piezoelectric osteotomes ES007 and the T-Black. Each device performed cuts that were examined via scanning electron microscope (SEM) and light microscopy (LM) to check respectively cut precision and bone architecture all along the defect borders. SEM analysis of specimens showed that burs created defects of greater width and with irregular edges while those produced by ultrasonic osteotomes were narrow and had mostly smooth cutting surfaces. The edges of incisions made by drills were full of bone fragments while less bone chips were observed on piezoincision’s ones. Dimensions of fragments were wider if cuts were made by burs too. LM analysis of samples showed focally, delicate bony trabecules crushed and pressed into the bone marrow in cutting made by burs. Samples cut by ultrasonic devices showed small or no smear layer and only partial or no crushed trabecules. Osteocytes seemed to be intact all along the cutting surface in all samples observed. In the present study, according to literature, ultrasonic surgery validity is confirmed. As a matter of fact, the greater the number of bone chips products, the greater the magnitude of the inflammatory process induced, as well as the possibility of a greater bone loss and delay in wound healing near the osteotomized area.

Subjective pain response to two anesthetic systems in dental surgery: traditional syringe vs. a computer controlled delivery system.

The present study was conducted to evaluate human pain perception at different phases of dental surgery using a computer controlled device, the Single Tooth Anesthesia System (STA System), versus the traditional syringe technique. One hundred healthy patients participated in this single-blind split-mouth design study. Individuals provided pain ratings at needle insertion, delivery of anesthetic solution and tooth extraction via a numeric visual rating scale or NVRS. The anterior middle superior alveolar, or AMSA, injection was compared with traditional syringe injections in maxillary quadrants. NVRS scores for AMSA were significantly lower for the STA System when compared to traditional syringe technique at needle insertion, delivery of anesthetic solution (p less than 0.0001) and also during tooth extractions (p=0.0002). A higher percentage of patients (23 percent) required a second injection after the traditional syringe technique. Subjects reported having less clinical pain with AMSA injection at every step of the dental surgery. The STA System combines an anesthetic pathway and controlled flow rate resulting in virtually imperceptible needle insertion and injection, and a rapid onset of profound anesthesia. NVRS scoring system facilitated patient comprehension in assessing pain value and intensity experienced. The two anesthetic delivery techniques were therapeutically equivalent for maxillary injections but AMSA/computer controlled protocol significantly minimizes subjective pain perception at needle insertion, anesthetic delivery and during tooth extraction.

Comparative evaluation among laser-treated, machined, and sandblasted/acid-etched implant surfaces: an in vivo histologic analysis on sheep.

PURPOSE: The aim of the present in vivo analysis was to evaluate the osseointegration process of titanium implants with three different surfaces (machined, sandblasted and acid-etched, and laser-treated) after 15 and 30 days of healing period. MATERIALS AND METHODS: Thirty-six implants with different surfaces were placed in the iliac crest of four Bergamasca sheep. The implant surfaces tested were sandblasted and acid-etched (group A), laser-treated (group B), and fully machined (group C). Two animals were sacrificed after 15 days while the other two after 30 days. Histological and histomorphometric analyses were performed. RESULTS: After 30 days, the bone tissue layer onto implant groups A and B appeared almost continuous with small marrow spaces interruption, while on the machined surface (group C), larger spaces with marrow tissue alternated with the bony trabeculae onto the titanium surface. Implants in groups A and B showed significantly higher implant contact percentage (BIC%) value than group C (P < 0.05). Moreover, it was observed a BIC% increase in both groups A and B between 15 and 30 days while in the machined group (group C), the BIC% decreased. CONCLUSION: Results from the present in vivo analysis revealed that both sandblasted/acid-etched and laser-treated titanium implants, compared to the machined ones, have higher values of osseointegration in less healing time.

Clodronate combined with a surfactant (Tween 20) does not improve osseointegration: a rabbit immunohistomorphometric study.

Biphosphonates are compounds that inhibit bone reabsorption mediated by osteoclasts or the progression of periodontal disease independent on the host response to pathogenic bacteria that colonize the tooth surface. The use of biphosphonates in oral implantology is still in the experimental stage. The aim of this study is to evaluate the efficacy of a non-aminobiphosphonate combined with a surfactant to increase the ability of the drug to link to the implant and bone surfaces in the development of osseointegration in rabbits. Smooth titanium implants were devised to be used on rabbit femurs. A topical administration of clodronate combined with the surfactant (Tween 20) at different concentrations was made on the implant surface and in the implant site to increase the bone and implant adhesiveness. Placebo was given to the control group. New Zealand rabbits were used and sacrificed by CO2 after 8 weeks from the implantations. A histologic and histomorphometric analysis was carried out. Results did not show significant difference between the tests and the placebo groups. Our data are different from other similar studies obtaining statistically significant differences. These differences could depend on the efficacy of the drug used and on the procedure of application of the drug on the implant. This study demonstrates poor efficacy of clodronate applied topically to the implant and implant site during surgery to increase the percentage of osseointegration in the implant. Further studies using different fixation techniques of the drug may be necessary to confirm the present data.

In vitro evaluation of the efficacy of a new laser surface implant: cellular adhesion and alkaline phosphatase production tests.

Bone tissue reacts in different ways to implant surfaces with different patterns. The aim of this study is to understand which laser generated surface pattern produces the best cell adhesion in vitro, evaluating both the activity of the alkaline phosphatase and the cells adhering to titanium samples. Tests were carried out on titanium samples with sandblasted surfaces with laser-produced holes with diameters of 5, 10, and 20 microm, and on sandblasted titanium cylinders without holes as controls. The samples were inserted into culture medium containing SaOS-2 cells for 3, 7 and 10 days. The results showed that at days 3 and 7 the laser surfaces stimulated a higher production of alkaline phosphatase (ALP) compared to the data from the control group. At day 10 there were no significant differences between the test group and the control group.

Recurrence of pleomorphic adenoma of the palate after sixteen years: case report and an analysis of the literature.

Pleomorphic adenoma or mixed tumour (MT) is a benign neoplasia of slow growth and epithelial histogenesis. We report a particular case of recurring MT of the hard palate. A 39-year-old man came to us with a swelling of the hard half-palate. The patient, 19 years earlier, had had a small formation in the same place that, over a period of three years had slowly grown. Histology showed that it was an MT and it was promptly removed. Sixteen years after the operation, a small recurrence reappeared, reaching a diameter of 12 mm. The patient underwent a new excision. The case reported is of particular interest due to many aspects: the outbreak from the minor salivary glands; the male sex; the young age of the patient at the first sign of the tumour; the appearance of a recurrence after 16 years, not contemplated in literature; and finally, the rapid growth of the second appearance.

Sinus augmentation procedure of the jaw sinus in patients with mucocele.

The sinus augmentation procedure of the jaw sinus (SAP) is a surgical technique which permits the prosthetic rehabilitation of the edentulous saddles by the insertion of dental implants where unfavourable conditions exist for their application. Nevertheless, apart from malignant tumors, benign pathologies exist, such as mucocele or radicular cysts, which can complicate the SAP, causing sinusal disturbances. In this study we describe our experience of SAP in patients with mucocele of the jaw sinus, and describe our surgical technique without the preventive emptying of the mucocele. Based on our experience, the SAP operation can be carried out without complications if the distance between the top of the mucocele with SAP and the osteomeatal complex (OMC) is 22 mm, or for mucocele no larger than 18 mm. In fact, these parameters guarantee that, because of the lifting of the sinusal membrane, the antral drainage (AD) duct does not alter or become obstructed.

N-3 polyunsaturated fatty acid effect in periodontal disease: state of art and possible mechanisms involved.

Anti-inflammatory properties have been widely reported for n-3 polyunsaturated fatty acids (PUFAs) and some studies have been focalized on their possible role in the modulation of gingivitis and alveolar bone resorption in periodontal disease (PD). Increased formation of arachidonic acid-derived inflammatory eicosanoids and augmented oxidative stress are two molecular mechanisms pathogenetically involved in the progression of PD and known to be inhibited by n-3 PUFAs in PD setting. The present review will focus also on other molecular pathways and factors known to be altered in the development of PD and known to be subject to n-3 PUFA modulation in other pathological settings different from PD. Overall, the available findings strongly encourage further experimental studies on animals subject to experimental PD and treated with n-3 PUFAs, long term n-3 PUFA intervention studies on PD patients and molecular studies to identify additional potential molecular routes of n-3 PUFA action in PD.

Evaluation of a new laser surface implant: scanning electron microscopy/energy dispersive X-ray and X-ray photoelectron spectroscopy analyses.

The roughness and the purity of implant surfaces are key points in the osteointegration process. The surfaces obtained by classic methods present irregular non-reproducible patterns and furthermore contaminate the implant surface with materials other than titanium which interfere with the process of osteointegration. The aim of the present study is to evaluate, by SEM/EDX and XPS analyses, the surface microstructure and the purity of new laser-treated implant surfaces. The laser treatment of the surface allows to set parameters to determine the roughness in order to obtain a regular and repeatable surface. Furthermore, there being no contact between the implant and the machine, there is no surface contamination with elements other than titanium. In this study we used a diode-pumped solid state laser (DPSS) with Nd:YAG source operating in Q-Switching mode on titanium samples. The resulting samples were analysed by SEM/EDX and XPS to evaluate morphology and purity of the surface. The results show surfaces with very regular roughness and a total absence of contamination.

Bone and maxillofacial abnormalities in thalassemia: a review of the literature.

Thalassemia is an inherited blood disorder due to an imbalanced globin chain synthesis leading to anaemia that requires regular blood transfusions and iron-chelating therapy. Of all organ failures secondary to iron deposit, and all the complications, heart failure still represents the first cause of death. Osteopenia and osteoporosis can be considered important causes of morbidity in a population whose lifespan is getting longer, with a strong impact on their quality of life. Authors have reported mainly bone, oral and maxillofacial abnormalities and relative complications, especially in terms of traumatic risk, in patients affected by thalassemia. As examples, this study reports bone modifications in three clinical cases; one of these was also complicated with a femoral fracture, surgically treated with the same criteria of metastatic femoral bone disease. More research on this topic is necessary for the prevention of several complications caused by this disease, and to carefully plan dental or traumatologic operations.

Effect of a subgingival chlorhexidine chip on the clinical parameters and the levels of alkaline phosphatase activity in gingival crevicular fluid during the non-surgical treatment of periodontitis.

The main therapeutic approaches for inflammatory periodontal diseases include the mechanical treatment of root surfaces. Multi-center clinical trials have demonstrated that the adjunctive use of a chlorhexidine (CHX) chip is effective in improving clinical results compared to scaling and root planing (SRP) alone. However, some recent studies failed to confirm these clinical results, nor have any data been reported regarding the capability of the CHX chip in affecting the activity of alkaline phosphatase (ALP) in the gingival crevicular fluid (GCF). This enzyme has been related to a condition of destructive activity of periodontitis. The aim of this study is to provide further data on the clinical and biochemical effects of CHX chips when used as an adjunct to SRP. Eighty-two systemically healthy patients, aged 31-63, with moderate and advanced periodontitis were recruited from the departments of Periodontology of the University of Chieti. In each patient 2 experimental sites, located in two symmetric quadrants, were chosen with a probing depth of > or = 5 mm and bleeding on probing. The 2 sites were selected randomly at the split-mouth level; control sites received SRP alone, and test sites SRP plus 1 CHX chip. Clinical indices, including probing depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and the ALP activity in GCF were evaluated at baseline and after 6 months. Alkaline phosphatase activity was assayed spectrophotometrically. The PPD and CAL were significantly lower at 6 months as compared to the baseline scores in both treatments (p less than 0.01). The PPD reduction was 2.7 mm in the CHX+SRP group and 1.9 mm in the SRP alone group. The CHX+SRP group showed a significantly greater gain of clinical attachment (mean: 1.4 mm) in comparison with the SRP group (mean: 0.9; p less than 0.05). No differences were observed in the decrease of the percent of BOP-positive sites between the experimental groups. Conversely, the CHX+SRP group underwent a significantly greater decrease (p less than 0.01) of the GCF-ALP activity 6 months after treatment in comparison with the SRP alone group. The adjunctive use of the CHX chip resulted in a significant improvement of pocket reduction and clinical attachment gain as compared with SRP alone. These results were concomitant with a significantly greater reduction of the GCF-ALP activity levels.

Pharmacologic modulation of clodronate in local therapy of periodontal and implant inflammation.

Bisphosphonates are drugs used in the treatment of a variety of osteometabolic diseases. Recently they have been the object of research and studies on their potential application in dentistry and orthopedics. In particular, clodronate (non-aminobisphosphonates) has been studied, due to its reversible activity in comparison to apoptotic osteoclasts, the intrinsic action which stimulates the differentiation and activity of the osteoblasts, their antinflammatory activity, antipain and antioxidant action, represent the rational to estimate their clinical efficacy, for local use in dentistry, implatology, orthopaedic, rheumatology, oncology and dermatology.

Potential applications of biphosphonates in dental surgical implants.

Biphosphonates are largely used for their unquestionable properties of inhibiting bone resorption by osteoclasts in the treatment of various osteometabolic illnesses such as osteoporosis, multiple myeloma, tumors which metastasize to the bone and malignant hypercalcemia. In this literature review the physico-chemical properties, biologic activities and the mechanisms of action of biphosphonates are described. The use of these drugs is discussed, analyzing the quantity of results which have emerged through in vitro and in vivo experiments on animal models. In this study the efficiency of these drugs is demonstrated in contrasting the osteolitic processes of the alveolar bone, in promoting the neoformation and in bettering the quality of bone implants. However, it is important to draw attention to a worrying correlation which has emerged during the last 3-4 years, between osteonecrosis of the jaw (ONJ) and the systemic administration of aminobiphosphonates. This collateral effect did not emerge following the use of non-aminobiphosphonates. The aim of this review is to identify the guidelines for the use of biphosphonates in oral implant surgery.

Multiple chemical sensitivity: current concepts.

Multiple Chemical Sensitivity (MS) is characterized by a wide range of symptoms when affected patients come into contact with several chemical products. Very little is known of either the diagnosis or the suitable treatment. In this study we report the case of a 38-year-old woman, previously diagnosed as suffering from MCS, who was referred for an oral health evaluation. After removing all the existing restorations and extracting the diseased teeth, a removable partial denture without metal structure was made after testing her hypersensitivity to these materials. The one year follow-up of the patient did not show any remarkable reaction, confirming the reduction of a large number of MCS symptoms and the increase in her quality of life.

Biological considerations on the use of zirconia for dental devices.

Zirconium oxide, known as zirconia, is a ceramic material with optimal esthetical and mechanical properties. Zirconia stabilized with yttrium oxide has the best properties for medical uses. A stress on ZrO2 surface creates a crystalline modification that opposes to propagation of cracks. Zirconia core for fixed partial dentures (FPD) on anterior and posterior teeth and on implants are now available. Clinical evaluations after 3 years report good percentage of success for zirconia fixed partial denture. Zirconia biocompatibility was studied in vivo and in vitro by orthopedic research; no adverse responses were reported on insertion of ZrO2 samples in bone or muscle. In vitro experimentation showed absence of mutation and a good viability of cells cultured on this material.

Evaluation of non-specific tissue alkaline phosphatase on bone samples from traditional and piezoelectric osteotomy.

The aim of this study is to test the response of bone during cutting actions in dental procedures by sampling alkaline phosphatase (ALP) as a biological reference marker. ALP is found abundantly in bone tissue. In the first series of experiments a temporal-minimum quantity of ALP enzyme response was recorded, the observed period was 40 minutes. The ALP samples treated with piezoelectric surgery showed a rapid increase, with peak at 30 min, and then declined rapidly within the next 10 minutes. A second experiment was performed to evaluate 4 cutting instruments: drill bits high speed turbine (T1); drill bits contra-angle (T2) Piezoelectric insertions (T3), and manual instruments (controls). This second experiment was to evaluate the ALP activity at 30 min. The T1 samples produced the highest results (3,66499 +- 0,51394); control groups had a lower response (0,72793 +- 0,22353), while the T2 group produced statistically significant higher results (2,77793 +- 0,40553) than T3 (1,16608 +- 0,32676). The different values obtained for ALP in these two experiments for a short period of time (30 min) cannot be interpreted as a response of bone tissue regeneration subjected to surgical trauma. The MINIMUM trauma caused by the surgical piezoelectric instruments, in respect to conventional surgical instruments is clearly evident from the phosphatase inflammatory activity.

Extraoral extraction: a very rare surgical approach to tooth impaction. A case report.

Extraoral route of access is usually not considered in surgical extraction of teeth because of technical difficulties and above all because of scar resulting from surgical skin wound healing. Some specific conditions, however, should suggest the use of this kind of access. A case of an impacted transmigrated right mandibular canine in an 18-year-old girl is reported. A CT examination has been carried out to evaluate the anatomy of the impacted toot as well as its relationship with the neighbouring structures. Extraoral surgical technique is then detaily described: skin incision, muscular dissection, ostectomy, tooth extraction and suture. Esthetical result was also reevaluated after 10 years. Advantages and drawbacks of intraoral and extraoral routes of access to mandibular tooth impaction are discussed and all anatomic and topographic factors related to the present impacted canine are examined. In conclusion, it is possible to confirm that extraoral access is indicated when a tooth is superficially impacted, in the molar-premolar region, toward the lingual aspect and near the lower border of the mandible.

Cyclic Amp phosphodiesterase activity in normal and inflamed human dental pulp.

Cyclic AMP phosphodiesterase (cAMP PDE) seems to be important in pulp tissues. High levels of cAMP PDE have been demonstrated to be in dental pulp cells. In the present study cAMP PDE activity was analyzed in normal healthy human dental pulps, in reversible pulpitis and in irreversible pulpitis. Enzymatic cAMP PDE control values for normal healthy pulps were 12.14 +/- 3.74 nmols/mg of proteins. In reversible pulpitis the cAMP PDE activity increased almost 2.5 times. In irreversible pulpitis specimens the values increased 4.5 times compared with normal healthy pulps activity. The differences between the groups (control vs. reversible pulpitis and vs. irreversible pulpitis) were statistically significant. These results could point to a role of cAMP PDE in the initial pulp response after injury.