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Aim of the study The use of nitrous oxide/oxygen conscious sedation in American Society of Anesthesiologists (ASA) II dental patients has been regarded as controversial. The aim of this study was to investigate cardiovascular effects of nitrous oxide-oxygen mixture conscious sedation in ASA II patients undergoing tooth extraction. Material and methods The purpose of this study was to determine differences in heart rate (HR) and blood pressure (BP), comparing nitrous oxide/oxygen with no sedation in a sample of ASA II patients. Physiologic parameters measured were heart and respiratory rate, systolic and diastolic blood pressure and oxygen saturation. Categorical data are summarized as percentages, and differences between groups were tested using Stata/IC 16 software (StataCorp). Ethical approval from the local institutional ethics comitee was obtained for this study. Results Results did not indicated differences for any physiologic parameters, including heart rate and diastolic blood pressure. Significant differences across procedures were found for systolic blood pressure. Conclusions Although the effects of nitrous oxide/oxygen may not be statistically significant, generally it produces an attenuation in physiological responses as measured under the conditions of this study in ASA II patients.

Aim of the study Patients with comorbidities have often difficulties tolerating in-office dental treatment; therefore, they often require sedation to facilitate dental treatment. When deciding on dental treatment under sedation, the plan should be carefully determined because compared to general patients, ASA Class II patients are more likely to experience complications because of their underlying medical conditions and potential drug interactions. The purpose of this study was to evaluate the Ramsay Sedation Score on nitrous oxide-oxygen mixture conscious sedation in a sample of ASA II patient’s. Material and methods 114 ASA II patients scheduled for elective tooth extraction under local anesthesia were enrolled in this randomized controlled trial. The patients were divided into two groups: the Study group – patients that agreed to receive nitrous oxide/oxygen inhalation sedation (n = 54) and the Control group (n = 60) that included patients unwilling to be sedated. Ramsay sedation scale was used to assess adequacy of sedation. Categorical data are summarized as percentages, and differences between groups were tested using Stata/IC16 software (StataCorp). Ethical approval from the local institutional ethics comitee was obtained for this study. Results There was significant difference after surgery between patients exposed to nitrous oxide/oxygen inhalation sedation and the control group. Conclusions The results of this study show that nitrous oxide/oxygen sedation is a useful method for ASA Class II dental patients, who needs lower doses of sedative to obtain an adequate level of sedation.

Aim of the study Oral anticoagulants are effective therapies for reduction of stroke risk in patients with atrial fibrillation. However, blocking elements of the clotting cascade carries an inherent risk of bleeding. Also, anticoagulated patients sometimes require tooth extractions and other invasive procedures. The purpose of the present study was to compare the relationship between the risk factors and postoperative hemorrhage among dental patients with atrial fibrillation receiving acenocumarolum versus new oral anticoagulants users. Material and methods A sample of consecutive patients exposed to oral anticoagulants who required tooth extraction at our institution were retrospectively reviewed. Categorical data are summarized as percentages, and differences between groups were tested using Stata/IC 16 software (StataCorp). Ethical approval from the local institutional ethics comitee was obtained for this study. Results The overall bleeding rate was higher in new anticoagulant users than in acenocumarolum users (26.72% vs 12%, p = 0.03) and similar (17.8% vs 14.1%, p = 0.129) between the two groups. There were no significant differences between atrial fibrillation patients and non-atrial fibrillation patients regarding bleeding rate. The highest rates were observed in patients with congestive cardiac failure exposed to new oral anticoagulants. Conclusions According to the results of our study, patients exposed to new oral anticoagulants had higher rates of overall bleeding events than chronic acenocumarolul users.

Aim of the study Oral anticoagulants have been used to prevent first or recurrent stroke, especially among patients with arterial fibrillation and y atherosclerotic disease. Despite the widespread use in dental patients, safety of anticoagulants are controversial. The uncertainty is due to the lack of definitive clinical data. In the present review, we have attempted to compare the relationship between the risk factors and postoperative hemorrhage after tooth extraction among patients with recent stroke receiving acenocumarolum versus new oral anticoagulants users. Material and methods This is a retrospective study of all patients exposed to oral anticoagulants who required tooth extraction treated in Clinic of Oral and Maxillofacial Surgery, Carol Davila University Bucharest – Hospital of Oral and Maxillofacial Surgery from 2019 to 2020. Clinical and operative records of all patients were retrieved and reviewed from the hospital’s medical records. All data were analyzed using Stata/IC 16 software (StataCorp). Ethical approval from the local institutional ethics comitee was obtained for this study. Results In our study, there were no significant differences between continuous oral anticoagulation use prescribd for antecedents of stroke and bleeding rate (32.14% vs. 20.92%, p > 0,05). Additionally, post-extraction bleeding was statistically significant associated with the type of anticoagulant used among concomitant diabetes patients. Conclusions In patients with prior cerebrovascular accident, concomitant use of new oral anticoagulants was associated with increased risk of postoperative bleeding. Concomitant diabetes contribute to the risk of bleeding.

Background and Objectives: The aim of this study was to evaluate and compare the effects of two different anti-inflammatory drugs (ketoprofen and prednisone) combined with an antibiotic (amoxicillin + clavulanic acid) and periodontal surgery on dental and periodontal parameters in patients with severe chronic periodontitis. In addition, salivary stress expressed by cortisol levels was assessed. Materials and Methods: An interventional study was performed on 22 periodontal subjects and 19 clinical healthy controls. The patients were divided in four groups, depending on treatment planning, as follows: eight patients received prednisone and antibiotherapy, associated with surgical periodontal therapy; seven patients received ketoprofen and antibiotherapy, associated with surgical periodontal therapy (group II); seven patients received only prednisone. Periodontal healthy patients underwent routine scaling and polishing. Bleeding on probing (BOP), dental mobility and salivary cortisol (ng/mL) were assessed before and after treatment. The means and standard deviations for the salivary cortisol levels (SCLs), dental and periodontal parameters were calculated for all groups using each patient as a unit of analysis. Results: Data analyses showed that the two different anti-inflammatory drugs associated with or without surgical therapy were efficient on inflammation periodontal parameters (BOP, dental mobility). Prednisone treatment alone was associated with a significant decrease of SCLs between pretreatment and post-treatment. Conclusions: In the present study, the effects of either of the anti-inflammatory drugs on inflammation evolution and salivary stress were comparable in patients undergoing antibiotherapy and surgical periodontal therapy.

Introduction. The clinical use of bioactive materials for bone augmentation has remained a challenge because of predictability and effectiveness concerns, as well as increased costs. The purpose of this study was to analyse the ability to integrate bone substitutes by evaluating the immunohistochemical expression of the platelet endothelial cell adhesion molecules, vascular endothelial growth factor, collagen IV, laminin, and osteonectin, in the vicinity of bone grafts, enabling tissue revascularization and appearance of bone lamellae. There is a lack of in vivo studies of inflammatory-driven angiogenesis in bone engineering using various grafts. Methods. The study was performed in animal experimental model on the standardized monocortical defects in the tibia of 20 New Zealand rabbits. The defects were augmented with three types of bone substituents. The used bone substituents were beta-tricalcium phosphate, bovine hydroxyapatite, and bioactive glasses. After a period of 6 months, bone fragments were harvested for histopathologic examination. Endothelial cell analysis was done by analysing vascularization with PECAM/CD31 and VEGF and fibrosis with collagen IV, laminin, and osteonectin stains. Statistical analysis was realized by descriptive analysis which was completed with the kurtosis and skewness as well as the Kruskal-Wallis and Mann-Whitney statistical tests. Results. The discoveries show that the amount of bone that is formed around beta-tricalcium phosphate and bovine hydroxyapatite is clearly superior to the bioactive glasses. Both the lumen diameter and the number of vessels were slightly increased in favor of beta-tricalcium phosphate. Conclusion. We can conclude that bone substitutes as bovine bone and beta-tricalcium phosphate have significant increased angiogenesis (and subsequent improved osteogenesis) compared to the bioactive glass. In our study, significant angiogenesis is linked with a greater tissue formation, indicating that in bone engineering with the allografts we used, inflammation has more benefic effects, the catabolic action being exceeded by the tissue formation.

Sebaceous adenoma is an extremely rare tumor located in the parotid gland. In the English literature, less than 10 cases have been reported. Sebaceous adenoma represents 0.5% of all monomorphic adenomas. The authors are presenting a case of sebaceous adenoma of the parotid gland in a 65-year-old female who presented a mass on the left parotid area that had been gradually enlarging for one year without symptoms of pain. On imaging (ultrasound), a well-defined mass lesion in the left parotid area was seen. Histopathological findings were consistent with sebaceous adenoma. Surgical excision is curative. The prognosis is excellent, with a low recurrence rate. The present case report will increase the awareness and possibility of this rare tumor occurring at an unusual site, thereby avoiding any chance of misdiagnosis.

Abstract Waning of the immune response upon vaccination in SARS-CoV-2 infection is an important subject of evaluation in this pandemic, mostly in healthcare workers (HCW) that are constantly in contact with infected samples and patients. Therefore, our study aimed to establish the specific humoral response of specific IgG and IgA antibodies upon vaccination, during the second year of pandemic and evaluating the booster shot with the same vaccine type. A group of 103 HCW with documented exposure to the virus were monitored for specific IgG and IgA levels prior to vaccination, after the first vaccination round, during the following 8 months and after the booster shot with the same vaccine type. After 8 months post-vaccination the humoral response in both IgG and IgA decreased, 2.4 times for IgG, and 2.7 times for IgA. Although the antibodies levels significantly decreased, no documented infection was registered in the group. After the booster shot, the entire group, displayed IgG increased levels, immediately after booster followed by the increase in specific IgA. IgG levels post-second round of vaccination are statistically higher compared to the first round, while IgA is restored at the same levels. Within the vaccination or booster routine for a multiple waves’ pandemic that is generating new virus variants, populational immunity remains an important issue for future implementation of prevention/control measures.

The aim of this study is to evaluate the long-term changes of sinus lift material. Materials and methods: We included a total number of 35 patients (20 men and 15 women), between 32 and 80 years old, evaluated on a timeframe of up to 11.6 years. Diverse biomaterials were used (allograft, xenograft, alloplastic, combinations of them), with autologous bone in some cases. Results: The appearance of the top plane of the bone over time took a large dome shape (36% of cases), a linear shape (32% of cases), an irregular shape (23% of cases), or had micro domes above the implants (7%). No significant differences were found between the groups regarding age. The radiological density of the biomaterial tended to equalize that of the native bone. The final vertical dimensions seemed to be independent of the initial native bone height but seemed to be correlated with the amount of applied biomaterial. For the study group, the biomaterial contracted on average by 10% for the maximum height (H max) and 20% for the minimum height (H min), which can explain the tendency of the upper border of the biomaterial to curve. The annual H max contraction ranged from −0.09 to +0.18 with a mean value of 2.67% (SD = 0.04, CI: [0.011, 0.041]). The median value was 1.8%. The annual H min contraction ranged from −0.24 to +0.24, with a mean value of 4.33% (SD = 0.07, CI: [0.021, 0.065]). The median value was 3.59%. There were no statistically significant gender differences (Mann–Whitney U, p = 0.483, p = 0.642). The additional application of biomaterial together with the implants seemed to have a beneficial effect on the final vertical dimension of the bio-transformed material.

Dental extraction is followed by decreases in alveolar volume, vertically and horizontally. This retrospective study measured vertical alveolar resorption after insertion of immediate implants, using OPG, without CBCT or additional radiographs. Patients were randomly split in two groups A (57 implants) and B (47 implants). Measurements were made by two independent observers. The types of implants were: Exacta (Biaggini Medical Devices), Nova, Dentix Millenium and Surcam. The method was based on the size of the implant and another common element of the two radiographs. It used an optimal radiologic exposure. It can be generalized to other studies. Similar results measured in the two groups showed that alveolar remodeling does not depend on the type of the implant. Half of the alveoli did not have any resorption. Another quarter showed barely perceptible clinical resorption (1-2 mm). In the last quarter were registered all the notable resorptions that were associated with various factors (temporary mobile prosthesis, surgical flap, medication and some health problems, smoking, etc.) showing real situations, not ideal conditions. Maximum resorption was unique (7.63 mm).

Aim of the study Glycemic control is vital in the care of diabetes mellitus and is significantly associated with the incidence of clinical complications. This study was conducted to evaluate the glycemic response to local anesthesia with various local anesthetics in patients undergoing tooth extractions. Material and methods A total of 60 patients with diabetes mellitus undergoing tooth extractions were included in this prospective, randomized clinical study. First 30 patients were given 4% articaine HCl with 1:200,000 epinephrine and other 30 patients were given 3% mepivacaine HCl, to carry out tooth extractions. Blood glucose estimations were done at definite intervals (before and after the administration of local anesthetic). Results There were no statistically significant differences in the parameters evaluated in this study. Both groups demonstrated a decrease in blood glucose levels over time. Conclusions According to the results of our study, plexal anesthesia with articaine 4% with epinephrine 1:200,000 was comparably as safe as local anesthetic with standard concentrations of plain 3% mepivacaine in diabetes melitus patients.

Aim of the study The aim of this study is to compare glycemic variability of 2% plain lidocaine to 4% articaine with epinephrine 1:200,000 during tooth extraction. Material and methods This prospective study was carried out in 60 diabetes melitus patients who presented at the Clinic of Oral and Maxillofacial Surgery, Carol Davila University, OMFS Hospital, Bucharest, from 2019 to 2020 for tooth extraction. Patients were randomly allocated to two groups (30 patients in each group) according to the type of anaesthetic solution employed. Group 1 had tooth extraction done under 4% articaine with 1:200,000 epinephrine while group 2 had tooth extraction done under plain 2% lidocaine. One tooth was extracted from each patient. Blood glucose level was recorded before surgery, after local anaesthetic injection and one hour after the administration of anesthetic agent. Results There was no statistically significant difference between the glycemic response in the two groups after administration of regional block anaesthesia. However the highest alteration in parameters was observed one hour after procedure in the two groups. Conclusions The glycemic changes induced by injecting 4% articaine with epinephrine in patients with controlled diabetes melitus during tooth extraction is within normal range and is not different from that induced by plain 2% lidocaine. The general preference given to local anesthetics without vasoconstrictor in diabetics is not supported by the present study

Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive drugs – Bisphosphonates (BPs) and RANKL inhibitor (denosumab) – prescribed for treatment of bone malignancies and severe osteoporosis. Non-surgical treatment may be a valid option for MRONJ in patients ineligible for surgery. Published observational studies have demonstrated that a common purine derivative – pentoxifylline in combination with tocopherol are potentially useful in the nonsurgical management of MRONJ. The aim of this study was to assess the therapeutic impact and possible side effects of treatment with pentoxifylline in combination with tocopherol in patients with MRONJ. Patients were subdivided into two groups: the test group, comprising of 20 patients, underwent treatment with 800 mg pentoxifylline in combination with 1000 IU of tocopherol, whereas the other patients formed the control group. After the 6-month treatment course, the statistically significant results of our study show that treatment with pentoxifylline in association with tocopherol is efficacious for managing MRONJ nonsurgically. However, larger clinical studies are needed to optimize dose and duration. No serious adverse effects occurred.

Wound healing is a complex biologic process evolving in three phases: inflammation, proliferation, and tissue remodeling controlled by numerous growth factors and cytokines. Oral mucosa wounds heal with significantly less important scars with less numerous macrophages and mast cells and more numerous myofibroblasts than cutaneous counterparts. We analyzed 32 cutaneous and 32 oral mucosa scars for TGFbeta1, TGFbeta2, TGFbeta3, TNFalpha, PDGF BB and FGF1 expression in mesenchymal cells, endothelial cells, macrophages, and multinucleated giant cells. We identified differences in the expression of profibrotic and antifibrotic factors in oral mucosa and skin scars; TGFbeta2 was positive in cutaneous multinucleated giant cells, TNFalpha was positive in cutaneous macrophages, and both were negative in oral mucosa while TGFbeta3 was positive in oral macrophages and mostly negative in cutaneous ones. PDGF BB and FGF1 were positive in oral endothelial cells and oral macrophages and negative in macrophages with opposite positivity pattern in cutaneous scars. Based on these findings, macrophage seems to be the key player in modulating pro- and antifibrotic processes in wound regeneration.

Medication related osteonecrosis of the jaw is a heterogeneous clinical entity with common pathology features and their diagnosis and management remains a dilemma for many clinicians. During the current SARS-CoV-2 virus pandemic, an extensive therapeutic arsenal is being used that includes traditional immunosuppressive and repurposed drugs, so it is important to understand their possible adverse effects. We describe the diagnosis, clinical course, and management of a 65-year-old female patient undergoing previously intravenous bisphosphonates (BPs) therapy and recently was treated with corticosteroid for the prevention of multi-inflammatory syndrome during the course of COVID-19. In this context, possible pathophysiological links between osteonecrosis of the jaw and medication used to treat non-severe COVID-19 infection are discussed. It should be underlined that osteonecrosis of the jaw unrelated to BPs may be a rare complication associated with concomitant corticotherapy. This case highlights the need for rapid dissemination of clinical information related to the multidisciplinary care of patients with COVID-19 who were managed by corticosteroids.