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Dental trauma is a frequent occurrence in children and adolescent and a correct diagnosis and treatment are essential for a favourable long-term prognosis. The present Guidelines aim to formulate evidence-based recommendations to assist dentists, paediatricians, surgeons, teachers, school and sport staff, parents in the prevention and first aid of dental trauma in children and to provide a careful assessment of the medico-legal implications, reviewing the first draft of the guidelines published in 2012. A multidisciplinary panel on the behalf of the Italian Ministry of Health and in collaboration with the WHO Collaborating Centre for Epidemiology and Community Dentistry of Milan, developed this document. The following four queries were postulated: 1) Which kind of precautions the health personnel, parents, sports and educational personnel must activate in order to prevent the dental trauma damage? 2) How an orofacial trauma in paediatric patients should be managed either in the Emergency Care Unit and/or in private dental office? 3) What criteria should be adopted by a dentist private practitioner to fill in a certificate in cases of dental and/or tempomandibular joint trauma occurring in children and adolescents? 4) What are the elements that should lead clinicians to suspect a non-accidental dental trauma? A systematic review and analysis of the scientific literature published in English, Italian and French from 2007 to 2017 regarding dental trauma in children and adolescents aged 0-18 years was performed, and about 100 papers were analysed and included. The following four domains were analysed and discussed: Dental Trauma Prevention Strategies and Health Education, First aid in orofacial and dental trauma, Certificate of the dental trauma, Oral and dental signs of child abuse and neglect. Twenty-eight recommendations were draw up and codified by the panel according to the Methodological handbook, produced by the Istituto Superiore di Sanità, in order to guide physicians in the prevention and first aid of dental trauma in children and adolescents. In addition, a careful assessment of the medico-legal implications is reported in this document.

By definition, osseointegration means close contact between bone and implant. Bone response is related to implant surface properties. Various surfaces have been studied and applied to improve the biological properties of the implant and thereby favor the mechanism of osseointegration. This strategy aims to promote osseointegration by means of a faster and stronger bone formation, improving stability during the healing process, and thus allowing for earlier loading of the implant. Dental implant osseointegration has so far been studied in various animal models. The development of a method based on tissue engineering for assessing the osseointegration process in vitro could prove a valid biomimetic alternative to sacrificing animals. In this study, flat cylindrical dental implants with moderately rough surfaces and machined implants were set in bovine bone blocks. Then, adipose-derived stem cells (ADSCs) were three dimensionally cultured onto these blocks in osteo-endothelial medium for up to 30 days to mimic the osseointegration process in vitro. Scanning electron microscopy (SEM) and gene expression were used to examine stem cell commitment. Mechanical pull-out tests were also performed. SEM analysis identified cells with an osteoblast morphology adhering to the surface of the implants after their removal. Gene expression analysis showed that ADSCs seeded onto the bone blocks were able to express osteoblast and endothelial markers. The implants with the moderately rough surface generated higher pull-out strengths when compared with the machined implants. Nevertheless, the pull-out test values were higher for implants placed in bone blocks with ADSCs than for those set in scaffolds without stem cells. Our results demonstrate the validity of the method adopted and its potential for use in the in vitro assessment of the biological behavior of dental implant surfaces.

Purpose: To assess in vitro, using an infrared (IR) thermometer, temperature changes generated at implant sites by osteotomies involving two different drilling methods (with multiple drills versus only one) and to measure the influence of irrigation on the temperature variation., Materials and Methods: Forty bone samples (from bovine rib) were divided into two groups of 20. Osteotomies were performed in group A with four drills, using the standard method (Leone Dental Implant System, final diameter 3.5 mm), and in group B with a single drill (Zero1 Drill, Leone Dental Implant System 3.5 mm diameter). In each group, half of the osteotomies were performed with irrigation (subgroups A1 and B1) and the other half without irrigation (subgroups A2 and B2). Two osteotomies were performed on each sample, using four different-sized drills according to the standard technique on one side and using a single drill on the other side. The starting temperature (T0 ) and the maximum temperature (Tmax ) reached in the bone were measured. Comparisons of ΔT were drawn between subgroups A1 and B1 and between subgroups A2 and B2. The data were analyzed using Student's t-test (with 95% confidence interval)., Results: The mean difference identified between the temperature produced with the last drill used in the traditional technique and that produced with the single drill was 0.3150 ± 1.0194°C when irrigation was used (group A1 vs group B1; not statistically significant). The mean difference between the temperature produced with the last drill of the traditional technique and that produced with the single drill was -0.3526 ± 0.5232°C when irrigation was not used (group A2 vs group B2; statistically significant)., Conclusions: The single-drill method induced a significantly greater variation in temperature than the traditional method, but only when irrigation was used; without any irrigation, the difference in the temperature variation generated by the two methods was not statistically significant. In any case, bone heating during the osteotomy never exceeded 2°C and was clinically irrelevant, as thermal damage to bone has only been reported in the literature for temperatures beyond 47°C persisting for more than one minute., (© 2014 Wiley Periodicals, Inc.)

Peripheral Ameloblastoma (PA) is the rarest variant of ameloblastoma. It differs from the other subtypes of ameloblastoma in its localization: it arises in the soft tissues of the oral cavity coating the tooth bearing bones. Generally, it manifests nonaggressive behavior and it can be treated with complete removal by local conservative excision. In this study we report a case of PA of the maxilla in a 78-year-old female patient and we describe the four different histopathological patterns revealed by histological examination. After local excision and diagnosis, we planned a long term follow-up: in one year no recurrence had been reported. The choice of treatment is illustrated in Discussion.

The development of new orally administered anticoagulants, such as dabigatran, rivaroxaban, and apixaban, in the past few years has focused on avoiding some of the drawbacks associated with warfarin. This work aims to illustrate the main features of the most commonly used new oral anticoagulants, reviewing the current literature on the management of patients taking these drugs and needing oral and implant surgery, and discussing the currently proposed related guidelines.

Bone defects are often secondary to alveolar disease removal. Creating a bone lid with piezosurgery is a valid method to preserve the alveolar bone. A careful and precise osteotomy associated with a firm placement of the bone lid in its original position enables better bone healing, thus allowing for the delayed insertion of dental implants at the operated site with no need for any bone augmentation procedures. The aim of this technical note is to present the application of the bone lid surgery in the posterior mandible before dental implant rehabilitation., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Dental pulp tissue supports the vitality of the tooth, but it is particularly vulnerable to external insults, such as mechanical trauma, chemical irritation or microbial invasion, which can lead to tissue necrosis. In the present work, we present an endodontic regeneration method based on the use of a tridimensional (3D) hyaluronan scaffold and human dental pulp stem cells (DPSCs) to produce a functional dental pulp-like tissue in vitro. An enriched population of DPSCs was seeded onto hyaluronan-based non-woven meshes in the presence of differentiation factors to induce the commitment of stem cells to neuronal, glial, endothelial and osteogenic phenotypes. In vitro experiments, among which were gene expression profiling and immunofluorescence (IF) staining, proved the commitment of DPSCs to the main components of dental pulp tissue. In particular, the hyaluronan-DPSCs construct showed a dental pulp-like morphology consisting of several specialized cells growing inside the hyaluronan fibers. Furthermore, these constructs were implanted into rat calvarial critical-size defects. Histological analyses and gene expression profiling performed on hyaluronan-DPSCs grafts showed the regeneration of osteodentin-like tissue. Altogether, these data suggest the regenerative potential of the hyaluronan-DPSC engineered tissue.

Objective: The dentist has a fundamental role in the early diagnosis of lesions of the oral cavity. The aim of this study was to establish the rate of erroneous clinical diagnoses and whether a clinical diagnosis is enough. The study was conducted to ascertain the overall accuracy of clinical diagnoses established by dentists., Study Design: The biopsy reports of 1,566 samples taken from 1,406 patients and examined at the Dental Outpatients Department of the University of Padua from 1 January 2006 to 30 June 2012 were analyzed in order to compare the presumptive clinical diagnosis with the fi nal diagnosis based on histology., Results: Overall, the dentists' clinical diagnoses were erroneous in 31.5% of cases. These diagnostic errors pertained to 23.8% of the benign neoplasms, 78.9% of the malignant neoplasms, and 17% of precancerous lesions., Conclusion: The present report should not be interpreted as a criticism of the clinicians making diagnostic errors but rather a confirmation of the policy to submit excised tissues for histologic examination.

Aim: Dental caries in pits and fissures of molars is still very common in young people, despite a gradual reduction in their incidence and prevalence. Prevention with the aid of dental fissure sealants can help to reduce the onset of decay. In vitro tests were conducted to compare the bond strength to enamel of self-etching sealants versus those applied using the conventional procedure., Methods: The lingual surface of 40 extracted, caries-free, mandibular third molars was milled to make them flat. The prepared teeth were randomly divided into two groups of 20 teeth each: those in Group A were treated with Clinpro (3M ESPE, St. Paul, MN, USA); those in Group B with Quick Seal (BJM Laboratories Ltd, Or-Yehuda, Israel). Cylinders of sealant were attached to the enamel of the flat surfaces of the samples using a polymerisation process treating the surfaces involved according to the type of material. All samples underwent load testing by means of a universal test machine., Results: The results of the load testing, measured in MPa, were analysed using the Student's t-test for independent samples and the differences proved significant, indicating that the traditionally- applied sealant (mean strength 21.06 MPa) assured a significantly stronger bond (p <.05) than the self-etching sealant (mean strength 10.43 MPa) under our experimental conditions. CONCLUSION Conventional sealants generally provide a considerably higher bond strength than self-etching sealants.

Background: The aim of this retrospective study is to investigate the medium- to long-term prognosis of short implants in partially and totally edentulous patients with mandibular bone atrophy., Methods: The study involved 109 patients with 280 implants placed in the mandible. The implants were 7 or 8.5 mm long and 3.75 or 4 mm in diameter. The implant surfaces were machined (M; n = 176) or rough (R; n = 104). Patients were asked to attend a radiographic and clinical follow-up, and their previous clinical records and radiographs were assessed. Implant-related and prosthetic failures and complications were recorded., Results: The mean follow-up was 9 years (range of 5 to 16 years). The survival rate (SSR) and success rate (SR) were calculated using life-table analysis for both M and R short implants. The M implants had a 16-year SSR of 95.7% and a corresponding SR of 93.9%, whereas the 16-year SSR and SR for the R implants were 97.2% and 95.2%, respectively. The mean ± SD bone resorption for all implants was 1.37 ± 0.5 mm. For marginal bone loss, there was no statistically significant difference between the two implant lengths (P = 0.38) or diameters (P = 0.34) or between the M and R implant surfaces (P = 0.47)., Conclusions: Different implant lengths, diameters, and surface treatments do not appear to influence the prognosis of the implant. Within the limitation that most of the short implants were splinted to longer implants, the reduced length of the fixtures did not worsen the long-term survival of the implant-supported fixed prostheses.

Background: Destructive membranous periodontal disease, or ligneous gingivitis, is a rare condition involving nodular gingival enlargement with ulceration and periodontal tissue destruction. This review gives a brief account of the cases reported in the literature. An effort is also made to define the periodontal disease caused by plasminogen deficiency with a view to its potential inclusion in the classification of periodontal diseases., Methods: A MEDLINE/PubMed and manual search was conducted to find papers describing ≥1 case of ligneous disease involving the oral mucosa., Results: We identified 23 articles reporting 35 cases. For each patient, we analyzed various characteristics, including age, sex, age of onset, oral symptoms, histologic features, plasminogen levels (functional activity, plasma antigen), genetic features, treatment, and results of treatment during the reported follow-up., Conclusions: Ligneous gingivitis is a rare periodontal disorder closely associated with ligneous conjunctivitis and plasminogen deficiency. Its diagnosis may be supported by the finding of genetic mutations responsible for the condition. Research is focusing on the future development of an effective therapy capable of arresting the destructive evolution of the disease. Additional studies, investigating features such as probing depth and attachment loss, are needed for the appropriate classification of this periodontal disease.

Objective: To retrospectively analyze 14 consecutively treated cases of dental implants placed along with sinus lift procedures in patients with severe bone atrophy (residual bone height of 2 to 5 mm)., Method and Materials: Thirty-one implants were placed with a lateral window sinus lift in 14 patients using deproteinized bovine bone alone (no membrane) for the graft. The implants were monitored for a mean 43.20 ± 9.30 months (minimum, 25.00 months; maximum, 53.00 months) after placement and 32.40 ± 11.10 months (minimum, 11.40 months; maximum, 41.60 months) after fitting of the prostheses. The outcome measures evaluated were implant success, radiographic measurements (original alveolar bone height, peri-implant marginal bone loss, and relationship of implant apex to graft), implant-related probing pocket depth (PPD), Bleeding Index (BI), and prosthesis sucess., Results: The implant success rate was 93.3%. The mean real alveolar bone height was 3.05 ± 0.87 mm, and there was evidence of peri-implant marginal bone loss (mean, 1.02 ± 1.40 mm). The relationship of implant apex to graft remained stable during follow-up. PPD was < 5 mm in 91.6% of implants. The BI was 11.6%. The prosthetic success rate was 100%., Discussion: These findings indicate that dental implants can be employed successfully, even in conditions of severe bone atrophy, using only heterologous bone, provided suitable methods and materials are used (eg, site preparation, rough implant surfaces, and self-tapping screw implants)., Conclusion: The treatment described appears to afford acceptable results, with lower overall costs and treatment time.

Aim: Bispectral Index Score (BIS) is an objective tool to assess sedation depth. Benzodiazepines have different pharmacological profiles and diazepam may be safer than midazolam in this setting. The aim of this study was to compare BIS values observed during anxiolysis after diazepam versus sedation after midazolam., Methods: Thirty-six patients were randomly assigned to 3 groups: group 1 was treated with i.v. diazepam, groups 2 and 3 with iv midazolam 1 and 3 mg, respectively. Sedation was monitored clinically and by means of BIS. BIS values were evaluated as area under the curve (AUC) and compared by variance analysis. The statistical comparison of other data was performed by variance analysis or, alternatively, the χ2 according to Yates. The statistical significance was indicated by P values <0.05., Results: AUC values were significantly lower after midazolam when compared to AUC values registered in diazepam treated patients; 22.6% of the group 3 patients showed BIS values <80, versus 0.4% of group 1 patients., Conclusion: Diazepam has a safer profile, with BIS values and clinical conditions according to the definition of minimal and/or moderate sedation. Diazepam represents the safer drug for anxiety management in dentistry, because regularly produces a state of sedation during which verbal contact with the patient is maintained and carry a margin of safety wide enough to render loss of consciousness unlikely.

Aim: This study used morphometric analyses to compare two methods for the intra-oral harvesting of particulate bone: Mectron Piezosurgery® and the Meta Micross®., Materials and Methods: Twenty patients requiring bilateral germectomy of the lower third molars for orthodontic reasons were selected and a sample was harvested from each patient from a standardised donor site (the cortical bone in the area of the retromolar triangle). Ten samples were obtained for each method. The particulate collected were subjected to a histological examination and the samples were analysed considering the following parameters: the mean surface area of fragments, the mean surface area considered vital and the mean surface area considered non-vital, the mean percentage of area considered vital and the mean percentage of area considered non-vital, the mean number of normal osteocytes and the mean number of osteocytes with morphological changes identified per unit area (600,000 μm(2)). The results were analysed, calculating the mean and the corresponding standard deviations, and testing their significance using Student's t-test, and plotted in graphs., Results: Mectron Piezosurgery® produced significantly larger particles (P<0.05) than the Meta Micross®, with a larger mean surface area considered vital and a significantly larger (P<0.05) surface area considered non-vital. Mectron Piezosurgery® also produced a smaller mean percentage of area considered vital (64.83%) and a larger mean percentage of area considered non-vital (35.17%) by comparison with the Meta Micross® (75.34% and 24.66%, respectively). The data also showed that the two methods produce a similar quantity of empty lacunae, and that the Mectron Piezosurgery® produces a larger quantity of osteocytes., Conclusions: The analyses conducted demonstrated that the particulate collected with the Meta Micross® had a smaller mean surface area of the fragments and a smaller surface area of bone considered non-vital than in the particulate collected using Mectron Piezosurgery®., (© 2010 John Wiley & Sons A/S.)

Purpose: The aim of the present study was to compare piezoelectric surgery and conventional rotatory osteotomy for mandibular third molar germ extraction to determine the 2 methods' suitability and the postoperative outcomes., Patients and Methods: Mandibular third molar germectomy was performed bilaterally, randomly choosing 1 side for rotatory osteotomy (rotatory group) and the other for piezoelectric surgery (piezo group). The predictor variable was the duration of the surgical procedure. The outcome variables were the suitability of the method used, bleeding, and the postoperative parameters (ie, mouth opening range, clinical appearance of soft tissues, exudate, abscess, wound dehiscence, locoregional lymphadenopathy, pain on palpation at the extraction site, persistent edema) at 7 and 30 days postoperatively. The patients recorded their subjective postoperative pain daily for 7 days using a visual analog scale. The Wilcoxon rank-sum test and stepwise logistic regression model with binary variables were used for statistical analysis., Results: A total of 26 patients (mean age 15.4 ± 1.29 years) were enrolled in the present study. The time needed to complete the osteotomy and extraction was significantly greater for the piezo group (15.77 ± 6.56 minutes) than for the rotatory group (11.77 ± 6.24 minutes; P = .028). No statistically significant differences emerged between the 2 methods for the other outcome variables considered., Conclusions: Piezoelectric osteotomy proved comparable to the rotatory method in terms of the surgeon's perception of the suitability of the 2 methods and the related postoperative sequelae. However, piezoelectric osteotomy took longer to complete than the rotatory method., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objectives: Several studies have described oral surgical procedures in patients receiving anticoagulant therapy, but no prospective studies on dental implant surgery during anticoagulant treatment are currently available, and only a limited number of case reports refer to endosseous dental implant treatment in these patients. In the setting of oral surgery, it has been suggested that anticoagulant treatment is not required when the International Normalized Ratio (INR) is <4 and local haemostatic measures are applied. The purpose of this preliminary study was to evaluate the incidence of bleeding complications following surgical implant therapy in a group of 50 consecutive patients receiving oral anticoagulant therapy (warfarin) without interruption or modifications to their therapy (group A)., Materials and Methods: One hundred and nine otherwise healthy patients comparable for age, sex, extent and site of the implant surgical procedure formed the control group (group B). In both groups, a standard protocol of local haemostasis, including non-reabsorbable sutures and compressive gauzes soaked with tranexamic acid, was applied. Surgeons, blind to the group allocation, performed all the procedures in an outpatient setting., Results: Two and three late-bleeding complications were reported in group A and group B, respectively, without significant difference in the bleeding risk (relative risk = 1.45; P= 0.65; 95% confidence interval 0.2506-8.4271). These complications were managed using a compressive gauze soaked with tranexamic acid at the site of the surgical wound., Conclusion: According to our preliminary results, local haemostasis in dental implant surgery is able to prevent bleeding complications in patients on oral anticoagulants, allowing these surgical procedures to be performed on an outpatient basis., (© 2010 John Wiley & Sons A/S.)

The aim of this study was to assess the efficacy of Normast 300 mg in reducing swelling and pain after the surgical extraction of impacted lower third molars. Materials and Methods. A randomized, split-mouth, single-blind study was conducted on 30 patients between 18 and 30 years of age requiring lower third molar extraction. Patients underwent bilateral extractions in a randomized sequence, one extraction being performed under Normast treatment. The Normast treatment involved 2 tablets a day for 15 days. The parameters assessed at each procedure were trismus, swelling, pain, NSAID consumption, postoperative complications, drug tolerability, and safety. The results obtained were processed using repeated measures analysis of variance. Results. Perceived postoperative pain was reportedly significantly milder on Normast treatment than control. The trend of the means differed over time (P < .0001) and between the two extraction groups (P < .0221). On the other hand, for edema and trismus, the trend differed over time for both groups but did not differ between the two groups. Discussion. Our analyses indicate that patients experienced significantly less postoperative pain when they were treated with Normast. Conclusions. Administering Normast improves the postoperative course-in terms of pain-after lower third molar extraction.

Following favourable results from a previous study, a large, multicentre, prospective, case-control study was performed to further assess the incidence of bleeding complications after dental extraction in patients taking oral anticoagulant therapy (OAT). Four hundred fifty-one patients being treated with warfarin who required dental extraction were compared with a control group of 449 non-anticoagulated subjects undergoing the same procedure. In the warfarin-treated group, the oral anticoagulant regimen was maintained unchanged, such that the patients had an International Normalised Ratio ranging between 1.8 and 4, and local haemostatic measures (i.e. fibrin sponges, silk sutures and gauzes saturated with tranexamic acid) were adopted. All the procedures were performed in an outpatient setting. Seven bleeding complications occurred in the OAT group and four in the control group; the difference in the number of bleeding events between the two groups was not statistically significant (OR=1.754; 95% CI 0.510 - 6.034; p=0.3727). No post-operative late bleeds requiring hospitalisation and/or blood transfusions were recorded, and the adjunctive local haemostatic measures were adequate to stop the bleeding. The results of our protocol applied in this large, multicenter study show that dental extractions can be performed easily and safely in anticoagulated outpatients without any modification of the ongoing anticoagulant therapy, thus minimising costs and reducing discomfort for patients.

The purpose of this paper was to report the case of a 2-year-old Caucasian female who was referred with a presumed diagnosis of pediatric rheumatoid arthritis. The patient presented widespread gingival swelling with bleeding, sharp pain, and halitosis. The patient also presented pain and swelling of the right knee joint, and psychomotor restlessness associated with muscular frailty. Little compliance on the part of both the patient and parents was also noted. Oral manifestations, together with an accurate medical history, led to the diagnosis of infantile scurvy, caused by an inadequate dietary supply of vitamin C. Administering 250 mg of ascorbic acid orally twice a day led to the remission of gingival swelling and of the other symptoms. The parents were advised to feed the child appropriate foods. Nutritional problems are traditionally linked to an insufficient availability of food, but can also be associated with child- or family-related psychological problems.

Aim: Female patients on estroprogestinic therapy undergoing extraction of the third lower molar have a higher incidence of postoperative complications (dry socket -DS- pain). The purpose of this study is to verify such data and analyse if there are risk factors for the appearance of other postoperative complications., Methods: One hundred eighteen non-smoking healthy patients were included who underwent extraction of the impacted third lower molar (38 on oral contraceptives, OC, 80 as control). After the extraction, patients were prescribed with a pharmacological therapy, consisting of a per os antibiotic and antiseptic rinse. Each patient was examined after 7 days following surgery to verify the state of tissues. In addition subjective postoperative pain (VAS - Visual Analogue Scale) and intake of analgesic drugs were recorded., Results: One case of DS (2.64%) occurred in the OC group, and 1 case of DS occurred in control-patients group (1.25%) (P=0.4436). The postoperative pain proved significantly higher in OC compared to control (first and fifth postoperation day). In OC a predisposition to dehiscence of the wound (86.84% P=0.0021) and emergence of laterocervical lymphadenitis (81.57% P=0.0010) was found, while no cases of postextractive abscesses and trismus of the masseter were found., Conclusion: Although no correlation between DS and estroprogestinic therapy has been found, a more difficult healing of tissues has been observed as well as a significantly higher subjective pain index in the postoperative days considered in OC patients.

Aim: The aim of this study was to evaluate the efficacy of Electronic Dental Anaesthesia (EDA) for third molar surgery., Methods: Third molar extraction under regional anaesthesia (inferior alveolar and buccal nerve blocks) was performed in 2 groups of 30 patients each: group 1 = controls, group 2 = EDA treatment. Anxiety and pain level were reported by means of Visual Analogue Scale, postoperative pain description with the McGill Pain Questionnaire. A postoperative phone interview to all patients was made. Computerized randomization was performed; values expressed as mean+/-SD, data comparison evaluated by means of ANOVA and chi squared, statistical significance indicated by P values <0.05., Results: Features of the patients and surgical interventions were similar. EDA has determined lower pain level; moreover, the control patients has shown higher values of blood pressure and heart frequency. Phone interview has reported no amnesia about the perioperative events. A smaller number of EDA treated patients has reported pain during needle prick and/or intraoperatively; 80% of the EDA treated patients has reported a good opinion about the treatment, 93% of the patients would repeat the treatment, if needed., Conclusion: EDA is a complementary analgesic technique for dental surgery. Cardiovascular changes, frequently observed during third molar extraction, were not present in the EDA treated patients. These data confirm that EDA is able to modify the physiologic responses to stressful events, blunting the adrenergic upset, maybe by means of an analgesic action on A, fiber and an increase of endorphins' central level. These results underline that the complementary use of EDA in the third molar extraction may be better than regional anaesthesia alone.

Aim: Aim of this study was to assess by clinical evaluation and by Bispectral Index (BIS) the tranquillizing properties of diazepam injected intravenously, and midazolam by intranasal route according to the body weight in dental patients., Methods: A group of 34 patients undergoing implantology were divided at random into 2 groups of 17. They were evaluated physically, clinically and psychologically. The psychomotor activity was measured by the Newman's test. Preoperative anxiety was treated with chlordemethyldiazepam (CHDDZ) per os, administered before induction of conscious sedation. In the first group, conscious sedation was accomplished by induction with titrated doses of i.v. diazepam, and in the second group with 0.1 mg/kg of intranasal midazolam. BIS values were analysed as Area Under the Curve (AUC)., Results: The AUC BIS values after CHDDZ presedation were overlapping in both groups. AUC after midazolam decreased after induction of the conscious sedation (P<0.05), during anesthesia (P<0.01) and during intervention (P<0.01) compared to the diazepam treatment. In the midazolam group the BIS values were on average lower than 90, while in the diazepam group they were on average higher than 95 (P<0.01). The psychomotor recovery was more impaired after midazolam., Conclusions: The study shows that nasal route ensures the quick absorption of midazolam as revealed during the first 3 min from drug administration. The depressant effect of midazolam increased as a function of time, reaching the highest levels during intervention. The results suggest that midazolam is endowed with sedative effects which may compromise the state of consciousness of the patient and be incompatible with the definition of conscious sedation in dentistry.

In this work an ultrasound device was used to perform an ostectomy for the removal of blade implants in order to save as much bone tissue as possible, so that root form implants might later be inserted. Two patients underwent surgery for the removal of two blade implants (one maxillary, the other mandibular) that were no longer functional. The peri-implant ostectomy was carried out with a piezoelectric surgery device. The instrument demonstrated to be effective and precise during ostectomy, providing an extremely thin cutting line. During the course of the operation and at controls after 7 and 30 days, patients did not show any relevant complications and both still had sufficient alveolar bone to be treated with root form implants. The piezosurgery device proved to be an effective instrument in interventions requiring a significant saving of bone tissue, extreme precision in cutting, and respect of soft tissues.

The aims of this study were to determine the microbiological and particle size characteristics of particulate bone collected with a piezosurgery device and bone trap, and to reduce bacterial contamination after treatment of debris with rifamycin SV. Samples were taken from 10 patients who underwent surgical extraction of their third lower molars. The ostectomy was performed with a piezosurgery device, and the debris was collected with a surgical aspiration set equipped with a bone trap. Two aliquots were taken from each sample, one of which was treated with rifamycin SV. The second aliquot, used as a control, was treated with a physiological solution. In the samples immersed in antibiotic solution, there was a statistically significant (P<0.005) reduction in bacterial contamination. The stringent protocol followed in this study has proved valid for collection of material, and treatment with rifamycin SV was found to reduce bacterial contamination in collected material.

Aim: Many studies proposing the use of autologous bone to correct bony defects of the oral district have been published, and numerous protocols have been proposed to simplify the harvesting of particulate bone. However, no qualitative evaluation of the harvested bone has been reported. The study provides a qualitative evaluation of autologous bone harvested by 9 methods: the harvested bone was analysed through microphotography and histomorphometric analysis, measuring the surface area of bone fragments and the percentages of vital and necrotic bone., Methods: Nine harvesting methods were employed: round bur on low-speed hand-piece (40000 rpm), bur on high-speed hand-piece, spiral implant bur on low-speed hand-piece (1000 rpm), safe scraper, Rhodes' back-action chisel, rongeur pliers, gouge shaped bone chisel, mectron piezosurgery. Ten bone harvests were taken from the retromolar bone using the 9 methods, during extraction of embedded wisdom teeth (indication to extraction was for orthodontic reasons). The histocytological preparations were analysed with microphotography and histomorphometric analysis, evaluating particle size, percentage of vital bone and number of osteocytes per unit of surface area., Results: Histomorphometric analysis showed that non-vital bone accounted for 100% of harvested bone, with a complete absence of osteocytes, in specimens harvested with burs and safe scraper. Percentage of non-vital bone was intermediate, with a low number of cells, in specimens harvested with back-action, gouge shaped bone chisel, spiral bur and piezosurgery. The best results were achieved with rongeur pliers and by en bloc harvesting., Conclusions: The results show that the best methods to harvest vital bone are: gouge shaped bone chisel, back-action, en bloc harvesting, rongeur pliers and piezosurgery, although the latter method leaves some empty gaps in the tissue. The bone harvested with round bur on low-speed hand-piece, bur on high-speed hand-piece, spiral implant bur, or safe scraper are not suitable for grafting as indicated by the absence of osteocytes and the predominance of non-vital bone.

Aim: The aim of this study was to evaluate the effects of sedation with benzodiazepines in a large population of patients undergoing oral surgery and age-related implications., Methods: A group of 1 179 consecutive patients undergoing oral surgery in the Dental Clinic of the University of Padua between 2001 and 2003 was evaluated by analysing their anaesthesiological records. The patients were divided into 5 age groups. All were pre-sedated with chlordemethyldiazepam per os, while induction of maximum subjective tranquillity was obtained with fractionated doses of intravenous diazepam. Arterial pressure (AP), heart rate (HR), anxiety level, pathologies, drugs taken, types of intervention, techniques of loco-regional anaesthesia, immediately preoperative AP and HR and tranquillity, intraoperative AP and HR, data regarding postoperative psychomotor recovery, complications and drugs used for the treatment of perioperative pain, were evaluated in each group., Results: Most of the patients (679) were in the 45-64 year-old group. Cardiovascular, respiratory and digestive pathologies proved to be age-dependent. Control AP and HR respectively increased and decreased with age. The doses of chlordemethyldiazepam used induced age-dependent preoperative tranquillity levels. The doses of i.v. diazepam necessary to obtain maximal preoperative subjective tranquillity fell as a function of age. The AP and HR values respectively increased during intervention and decreased in the first hour of intervention. Normal psychomotor recovery was less evident in older patients. The most significant corrective intraoperative interventions consisted of the administration of sublingual hypotensive drugs and in the immediate treatment of some cases of orthostatic hypotension and vaso-vagal syncope., Conclusions: The sedation technique and the antistress procedures employed proved safe and the intra- or postoperative complications almost non-existent. The variations observed in the parameters considered are compatible with the greater age of the treated subjects.

Aim: A dental composite resin, Ariston pHc, has been described as having a cariostatic effect by buffering acid saliva and preventing decalcification and infiltration of restorations. The buffering effect has been reported due to the release of OH- originated from the alkaline glass embedded in the resin. The release would occur only in the presence of low salivary pH values. The aim of this in vitro investigation was to evaluate pH variations induced by Ariston pHc and 2 other composite resins (P60 and Z100)., Methods: Eighteen samples were prepared for each composite and 5 specimens of each brand were embedded in artificial saliva according to Brugirar and Mazille, at 3 different pH values. A 1(st) group of 5 specimens of each tested resin was immersed in neutral artificial saliva at pH 7.7, a 2(nd) group in acidified artificial saliva at pH 5.45 and a 3(rd) group in alkalised saliva at pH 9.25. Three other samples of each resin were immersed in tubes containing distilled water at pH 7.23 and served as controls. Twelve tubes were filled only with neutral, alkalised and acidified artificial saliva and distilled water at the above mentioned pH values. Measurements of pH modifications were taken after 1, 3, 9, 14, 31 days. RESULTS. Ariston pHc raised the pH of distilled water up to 9.59 after 1 day, and to 8.42 after 31 days. This pH modification shown by Ariston pHc in distilled water, compared to those of the other 2 composites were statistically highly significant, with p<0.001, while the pH variations of saliva containing the 3 resins were negligible, except for acidified saliva with Ariston pHc, where a slight pH enhancement with some statistical significance (p=0.04) was found. However, acidified saliva without any resin embedded was found to shift to neutrality as well., Conclusion: These results strongly suggest that none of the 3 tested materials can achieve an effective buffering action in vitro on low salivary pH values. However, the ability of Ariston pHc to raise the pH in distilled water, and to a lesser degree in acidified saliva, suggests that an in vivo buffering effect cannot be excluded.

Temporary discontinuation of high-intensity oral anticoagulant treatment is not recommended in patients undergoing dental surgery. This policy is not based on solid data from randomized clinical trials but on expert consensus. The alternative, i.e., to continue treatment and treat patients with tranexamic acid mouthwash, often is not applicable. A prospective cohort study was carried out to evaluate bleeding and thromboembolic complications in patients bearing prosthetic heart valves and registering International Normalized Ratio (INR) values between 2.0 and 4.5, who underwent dental procedures after a 2-day suspension of warfarin treatment. One hundred four consecutive patients receiving high-intensity anticoagulation underwent 123 dental procedures after 2 days' warfarin withdrawal. No major bleeding complications occurred in the week after the procedure; minor bleeding requiring local measures occurred in two patients. No thromboembolic events and no cases of bacterial endocarditis were recorded in the 3 months after the procedure. A mean decrease in INR by approximately 1.0 U (from 2.95+/-0,59 to 1.87+/-0,46) occurred after 2 days' warfarin suspension. Seven days after reinitiation of warfarin, INR values returned to the therapeutic range in 90% of cases. The calculated average time spent at INR less than 2.0 (critical value) was 28 hours. Two days' warfarin suspension is a simple and safe policy for patients with prosthetic heart valves undergoing dental surgery.

Background: The use of intramarrow penetration in combination with osseous reconstructive surgery has been recommended in various periodontal and oral surgical applications. The purpose of this pilot study was to evaluate the effect of intramarrow penetration on the rate of bone neogenesis in protected spaces created on the calvarial bone using occlusive titanium domes in 16 adult white rabbits., Methods: In each rabbit, 2 standardized circular 1 mm deep slits were prepared in the bone, one on each side of the midline using a trephine. Within the perimeter of one of the slits, the external cortical surface of the skull bone was mechanically perforated using a carbide round bur (experimental site), while the bone surface within the other slit (control site) was left intact. Subsequently, 2 prefabricated titanium domes with an inner diameter of 4.8 mm and an inner height of 3.0 mm were anchored in the prepared slits. The animals were divided into 4 groups of 4 rabbits each and were sacrificed at 10, 21, 42, and 60 days. The specimens were assessed for the percentage bone fill and density of the newly formed bone within the boundaries of the domes., Results: Histomorphometric analysis showed significantly increased bone neogenesis within the experimental domes at 10, 21, 42, and 60 days. A mean total area of 29% newly formed bone was demonstrated in the experimental sites at 21 days, while negligible bone formation (9%) occurred with the control domes at the same evaluation interval. Bone density was consistently higher in experimental domes at all healing intervals., Conclusions: Within the limits of this study, the results demonstrate that intramarrow penetration accelerates initial bone neogenesis and results in increased bone fill and density, suggesting that its use can be beneficial in bone regenerative procedures.