Bleeding complications following Nd:YAG laser-assisted oral surgery vs conventional treatment in cardiac risk patients: a clinical retrospective comparative study

OBJECTIVE

Thermal Nd:YAG laser energy is well known for the purpose of blood coagulation. However, little is known about the bleeding frequency following laser-assisted oral surgery in patients on coumarin drugs. Therefore, the purpose of this study was to compare retrospectively the frequency of bleeding complications following Nd:YAG laserassisted versus conventional local coagulation of blood in oral surgery.

METHOD AND MATERIALS

In October 2002, minor oral surgical interventions were found to be indicated in a total of 45 cardiac risk patients. In Group 1, blood coagulation was yielded in 24 patients with a Nd:YAG laser system, whereas in Group 2, treatment was performed in 21 patients with conventional means of local hemostasis. All therapies were performed continuing anticoagulant therapy between November 2002 and March 2003. Clinical data were recorded retrospectively from patient charts in May 2007.

RESULTS

In both Groups 1 and 2, a total of two bleeding complications were recorded. However, local re-interventions were sufficient for local hemostasis.

CONCLUSION

These results indicate that Nd:YAG laser-assisted local hemostasis was not able to prevent bleeding complications completely. Within the limitations of this retrospective study it was concluded that in patients with anticoagulant treatment undergoing minor oral surgery, Nd:YAG laser-assisted local hemostasis is not superior to conventional methods of blood coagulation with respect to the frequency of bleeding complications.

Is the Schneiderian membrane thickness affected by periodontal disease? A cone beam computed tomography-based extended case series

OBJECTIVE

The aim was to assess the thickness of Schneiderian membranes (SM) in patients with advanced periodontal disease.

METHODS

17 dentate patients (DG) scheduled for periodontal surgery on maxillary molars were consecutively recruited and cone beam computed tomographies performed for preoperative diagnosis. Twenty-one patients (EG) requiring cone beam computed tomography-based planning of implant placement in the edentulous posterior maxilla served as controls.

RESULTS

Schneiderian membrane thickness measured from cone beam computed tomography was significantly greater in the dentate group compared to the edentulous group, both in the first (p = 0.028) and second (p < 0.001) molar position. In the dentate group, clinical signs of periodontal destruction (increased probing pocket depth or furcation involvement) were not associated with Schneiderian membrane thickness. Additional findings, such as periapical lesions (p = 0.008), and the distance between root tips and maxillary sinus revealed a significant association (p = 0.036) with Schneiderian membrane thickness.

CONCLUSION

In molar regions with periodontal destruction, Schneiderian membrane thickening occurred, particularly in combination with small bone layers above the root tips or periapical lesions.

Evaluation of ozonated olive oil with or without adjunctive application of calcium sodium phosphosilicate on post-surgical root dentin hypersensitivity: a randomized, double-blinded, controlled, clinical trial

AIM

This study was conducted to evaluate the efficacy of ozonated olive oil with or without adjunctive application of mineral wash containing calcium sodium phosphosilicate on the reversal of post-surgical root dentin hypersensitivity.

METHODS

A double-blinded, randomized controlled clinical trial was conducted on 51 participants with root dentin hypersensitivity (RDH). Participants were randomLy assigned to 4 groups: Group A, ozonated olive oil (OZO): Group B, ozonated olive oil and mineral wash: Group C, placebo olive oil (PPO) and mineral wash: Group D, placebo olive oil only. Active treatment was carried out in-clinic and followed by at-home care with a remineralising paste. The response to various pain stimuli was periodically assessed with a visual analogue scale. Additionally, scanning electron microscopic study assessed the dentinal tubule occlusion and change in tubular surface area after treatment.

RESULTS

The group B participants showed a significant decrease in tooth level and global sensitivity over the period (P<0.001). Moreover, the intergroup comparison also revealed a significant result (P<0.001). Similarly, participants of group C also showed a significant reduction in sensitivity over the period (P<0.001). Whereas, no significant (P>0.05) difference was detected between group A and group D for tooth level and global sensitivity analysis. The SEM study result showed a significantly (P<0.001) enhanced tubule occlusion and decreased tubular surface area in group B specimens compared to other group specimens.

CONCLUSION

OZO, as a mono-therapy is not efficient in reducing post-surgical RDH. However, the adjunctive application of mineral wash containing calcium sodium phosphosilicate has positive impact on the reversal of post-surgical root dentin hypersensitivity.

[Autofibroblasts in surgical treatment of periodontal disease]

Effectiveness of periodontal disease surgical treatment using hydroxyapatite with gingival autofibroblasts culture was assessed in the study by clinical and laboratory data.

Reasons for extraction of permanent teeth in general dental practices in Tehran, Iran

OBJECTIVES

The aim of this survey was to investigate the primary reason for extraction of permanent teeth, its correlations with age, gender and education level, as well as identify the important predictors for dental caries in general dental centers in Tehran, Iran.

SUBJECTS AND METHODS

The study was conducted over a period of 6 months; its population consisted of 1,382 patients, aged 9-95 years, who underwent tooth extraction. There were 673 (47.8%) male and 709 (51.3%) female patients. The frequency distribution was calculated using the χ(2) test, ANOVA and t test for differences in mean number of extracted teeth and the logistic regression model to evaluate the variables associated with reasons for tooth extraction.

RESULTS

A total of 2,620 teeth were extracted from the 1,382 patients. The highest rate (36.9%) of extraction occurred for those 41-60 years old. Males comprised 48.7% of patients but had more teeth (1,470, 55.3%) extracted than females (1,150, 43.9%). Nine hundred and thirty-six (67.7%) patients had incomplete secondary education or less. Tooth loss due to caries was 51%; periodontal disease was 14.4%; supernumerary and tooth impaction 13.9%. There was a significant association between patient characteristics (age, gender and education level) and number of teeth extracted.

CONCLUSION

Dental caries and periodontal disease were the main reasons for tooth extraction in Tehran, Iran.

Immediate implant placement and restoration in infected sites

The long-standing assumption that active infection is a contraindication for immediate implant placement has been challenged recently. High implant survival rates have been reported even when implants were placed immediately in infected extraction sockets and provisionalized within 36 hours. To further evaluate the impact of nonocclusal loading on implants placed in cleaned periodontically or endodontically infected extraction sites, this retrospective study examined the results of 77 implants placed in 63 patients and followed for between 3 and 24 months. Initial primary stability was achieved for all implants, and reverse torque testing at 3 and 4 months postoperatively showed 76 of 77 implants (98.7%) to be successfully osseointegrated.

Causes of tooth extraction at a tertiary care centre in Pakistan

OBJECTIVE

To evaluate the frequency of common causes of permanent tooth extraction and severity of dental condition at the time of tooth extraction.

METHODS

The cross-sectional study was conducted at the Department of Oral and Maxillofacial Surgery, Punjab Dental Hospital, Lahore, Pakistan, from February to June 2010, and involved 1026 patients who were referred for the extraction of permanent teeth. The inclusion criteria comprised caries, periodontitis, restoration failure, trauma, and local pathologies, while 3rd Molar impactions, supernumerary tooth extraction and extractions done as part of orthodontic or prosthodontic treatment were excluded. Oral hygiene was recorded using the Simplified Oral Hygiene Index. SPSS version 17 was used for statistical analysis.

RESULTS

The mean age of the study population was 46.60 +/- 11.321 years, and there were 611 (59.6%) males. A total of 1178 teeth were extracted. Advanced dental caries was the leading cause of tooth extraction (n = 743; 63.1%), followed by periodontitis (n = 309; 26.2%) restoration failure (n = 54; 4.6%), trauma (n = 38; 3.2%) and miscellaneous local pathologies (n = 34; 2.9%). More than half of the patients (n = 540; 52.6%) had poor oral hygiene.

CONCLUSION

Advanced dental caries is the most common cause behind tooth extraction.

Treatment of combined endodontic-periodontic lesions using guided tissue regeneration: clinical case and histology

The aim of this case report is to histologically evaluate periapical healing after combined endodontic-periodontic treatment. A maxillary left central incisor was treated with conventional endodontic therapy, followed by periodontal surgery. The facial bony defect was filled with a mixture of autologous bone and Bio-Oss. A resorbable membrane was used. Histology showed the presence of new cementum, ligament, and bone around the apex of the treated tooth. This finding was clinically associated with minimal residual probing depth and maximum attachment gain. This histologic report demonstrates the possibility of true regeneration in a case of severe periodontal attachment loss resulting from an endodontic-periodontic lesion.

Combining perio-restorative protocols to maximize function

This article describes a team approach for periodontal and restorative treatment intended to produce a predictable, biologically sound outcome that preserves more supporting bone and restores carious and broken down teeth. The goal of periodontal treatment, when performed in conjunction with restorative dentistry, is to provide restorative dentists with a high percentage of tooth structure that allows for a supragingival margin. An equally important goal is to ensure that an adequate thickness of connective tissue exists to create an environment more resistant to trauma and inflammation. The team approach consists of a restorative phase and a surgical phase. The restorative phase involves preparation with complete caries removal, adhesive core buildups, and provisionalization. The surgical phase involves biologic shaping of the roots and judicious osseous resection. Case studies are used to demonstrate the team approach.

Advanced reconstructive technologies for periodontal tissue repair

Reconstructive therapies to promote the regeneration of lost periodontal support have been investigated through both preclinical and clinical studies. Advanced regenerative technologies using new barrier-membrane techniques, cell-growth-stimulating proteins or gene-delivery applications have entered the clinical arena. Wound-healing approaches using growth factors to target the restoration of tooth-supporting bone, periodontal ligament and cementum are shown to significantly advance the field of periodontal-regenerative medicine. Topical delivery of growth factors, such as platelet-derived growth factor, fibroblast growth factor or bone morphogenetic proteins, to periodontal wounds has demonstrated promising results. Future directions in the delivery of growth factors or other signaling models involve the development of innovative scaffolding matrices, cell therapy and gene transfer, and these issues are discussed in this paper.

[Impact of Er, Cr: YSGG-laser on the tooth root cement in the treatment of chronic periodontal disease (the results of electron microscopic studies)]

Ten teeth removed because of periodontal disease were irradiated by Er, Cr: YSGG laser (power 1W and 1,5W). Scanning electron microscopy showed the 10-second exposure of the laser beam to remove the tartar from the surface of the tooth root, as well as "smear" layer and infected cement, exposing the dentine tubules and influencing the collagen fibers, forming a rough surface of the tooth root. These data suggest the effectiveness of Er, Cr: YSGG-laser in the treatment of tooth root cement surface by periodontal disease. Er, Cr: YSGG-laser with a power of 1 and 1,5 W can be used as an adjunctive treatment mode by periodontal therapy.

Endodontic surgery

Conventional endodontic therapy is successful approximately 80-85% of the time. Many of these failures will occur after one year. The presence of continued pain, drainage, mobility or an increasing size of a radiolucent area are some of the indications to treat the case surgically. Since many of these cases may have had final restorations placed by the dentist, the salvage of these cases is of importance to the patient. Advances in periapical surgery have included the use of ultrasonic root end preparation. With the use of these piezoelectric devices, a more controlled apical preparation can be achieved. Additionally, isthmus areas between canals can be appropriately prepared and sealed. The precision afforded with these devices reduces the chances for a malpositioned fill and a more successful outcome.