Alessandro Del Vecchio

Bone damage induced by different cutting instruments: an in vitro study

The aim of this study was to compare the peripheral bone damage induced by different cutting systems. Four devices were tested: Er:YAG laser (2.94 mm), Piezosurgery, high-speed drill and low-speed drill. Forty-five bone sections, divided into 9 groups according to different parameters, were taken from pig mandibles within 1 h post mortem. Specimens were fixed in 10% buffered formalin, decalcified and cut in thin sections. Four different parameters were analyzed: cut precision, depth of incision, peripheral carbonization and presence of bone fragments. For statistical analysis, the Kruskal-Wallis test was applied to assess equality of sample medians among groups. All sections obtained with the Er:YAG laser showed poor peripheral carbonization. The edges of the incisions were always well-shaped and regular, no melting was observed. Piezosurgery specimens revealed superficial incisions without thermal damage but with irregular edges. The sections obtained by traditional drilling showed poor peripheral carbonization, especially if obtained at lower speed. There was statistically significant differences (p<0.01) among the cutting systems for all analyzed parameters. Er:YAG laser, gave poor peripheral carbonization, and may be considered an effective method in oral bone biopsies and permits to obtain clear and readable tissue specimens.

Observation of Pain Control in Patients with Bisphosphonate-Induced Osteonecrosis Using Low Level Laser Therapy: Preliminary Results

BACKGROUND Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is an adverse side effect associated with bisphosphonate (BP) therapy, especially when parenteral BP administration is used. Patients affected by BRONJ present wide areas of exposed necrotic bone, particularly after surgical oral procedures. The main symptom is pain that is poorly controlled by common analgesic drugs. Recently, many studies have pointed to the beneficial effect of low-level laser therapy (LLLT) in pain reduction for many pathological conditions. The purpose of this study is to investigate whether LLLT could be helpful in managing BRONJ by reducing the problems associated with this condition and the use of analgesic drugs. METHODS Twelve patients affected by BRONJ were monitored at the Complex Operative Unit of Oral Pathology. Among these patients, only seven referred to pain in necrotic areas and were recruited for LLLT. Laser applications were performed with a double diode laser simultaneously emitting at two different wavelengths (λ = 650 nm and λ = 904-910 nm, spot size = 8 mm). All of the patients were irradiated with a fluence of 0.053 J/cm(2) for 15 min five times over a period of 2 weeks, in a non-contact mode, ∼1 mm from the pathologic area. The patients maximum and minimum pain was recorded using a numeric rating scale (NRS) evaluation before and after the treatment. Statistical analysis was performed using the Kruskal-Wallis test. RESULTS Six patients showed significant pain reduction, and only one patient indicated a worsening of the symptoms, which was probably related to a reinfection of the BRONJ site, which occurred during the study. A statistically significant difference (p < 0.05) was found between the NRS rates before and after the protocol. CONCLUSIONS This pilot study suggests that LLLT may be a valid technique to support the treatment of BRONJ-related pain, even though the low number of cases in this study does not permit any conclusive consideration.

Excision of oral mucocele by different wavelength lasers

BACKGROUND Mucocele is a common benign neoplasm of oral soft tissues and the most common after fibroma. It generally occurs in the lower lip and its treatment includes excision of cyst and the responsible salivary gland, in order to prevent recurrences. AIMS To evaluate the capability of three different lasers in performing the excision of labial mucocele with two different techniques. MATERIALS AND METHODS In the presented cases, excision was performed using two different techniques (circumferential incision technique and mucosal preservation technique) and three different laser wavelengths (Er,Cr:YSGG 2780 nm, diode 808 nm, and KTP 532 nm). RESULTS All the tested lasers, regardless of wavelength, showed many advantages (bloodless surgical field, no postoperative pain, relative speed, and easy execution). The most useful surgical technique depends on clinical features of the lesion. CONCLUSION Tested lasers, with both techniques, are helpful in the management of labial mucocele.

Effectiveness of KTP laser versus 980 nm diode laser to kill Enterococcus faecalis in biofilms developed in experimentally infected root canals

This study aimed to evaluate the antibacterial action of KTP (potassium-titanyl-phosphate) laser irradiations (compared with 980 nm diode laser), associated with conventional endodontic procedures, on Enterococcus faecalis biofilms. Fifty-six dental roots with single canals were prepared with Ni-Ti rotary instruments, autoclaved, inoculated with an E. faecalis suspension and incubated for 72 h. They were randomly allocated to control and treatment groups. Laser parameters were as follows: power 2.5 W, Ton 35 ms, Toff 50 ms (KTP laser); power 2.5 W, Ton 30 ms, Toff 30 ms (980 nm diode laser). To evaluate the residual bacterial load, BioTimer Assay was employed. The chemo-mechanical treatment together with laser irradiations (KTP and 980 nm diode lasers) achieved a considerable reduction of bacterial load (higher than 96% and 93%, respectively). Regarding both laser systems, comparisons with conventional endodontic procedures (mortality rate of about 67%) revealed statistically highly significant differences (P ≤ 0.01). This study confirms that laser systems can provide an additional aid in endodontic disinfection.

Biopsy of Different Oral Soft Tissues Lesions by KTP and Diode Laser: Histological Evaluation

Introduction. Oral biopsy aims to obtain clear and safe diagnosis; it can be performed by scalpel or laser. The controversy in this latter application is the thermal alteration due to tissue heating. The aim of this study is the histological evaluation of margins of “in vivo” biopsies collected by diode and KTP lasers. Material and Methods. 17 oral benign lesions biopsies were made by diode 808 nm (SOL, DenMatItalia, Italy) and KTP 532 nm (SmartLite, DEKA, Italy). Samples were observed at OM LEICA DM 2000; margin alterations were evaluated through Leica Application Suite 3.4. Results. Epithelial and connective damages were assessed for each pathology with an average of 0.245 mm and a standard deviation of ±0.162 mm in mucoceles, 0.382 mm ± 0.149 mm in fibromas, 0.336 mm ± 0.106 mm in hyperkeratosis, 0.473 mm ± 0.105 mm in squamous hyperplasia, 0.182 mm in giant cell granuloma, and 0.149 mm in melanotic macula. Discussion. The histologic aspect of lesions influenced the response to laser, whereas the greater inflammation and cellularity were linked with the higher thermal signs. Many artifacts were also associated to histologic procedures. Conclusion. Both tested lasers permitted sure histologic diagnosis. However, it is suggested to enlarge biopsies of about 0.5 mm, to avoid thermal alterations, especially in inflammatory lesions like oral lichen planus.

Color-Doppler US features of a pyogenic granuloma of the upper dorsum tongue

The diagnosis of oral lesions is based on clinical history, clinical examination and imaging exams. Different imaging modalities are available for the diagnosis and follow-up of these lesions such as computed tomography, magnetic resonance imaging, color-Doppler ultrasound, angiography and positron emission tomography. To date, color-Doppler ultrasound is considered the first-line imaging approach since it provides a non-invasive, cost-effective, real-time evaluation of oral anomalies. It provides both morphological and vascular information which are useful to determine the best therapeutic options. Differential diagnosis of a bleeding lobular mass of the tongue is, however, not always easy and includes several vascular and non-vascular lesions. We present herein a case of pyogenic granuloma of the tongue that at Color-Doppler US appeared as hypervascular lesion.SommarioLa diagnosi delle lesioni orali si basa sulla storia clinica, l’esame obiettivo e gli esami radiologici. Sono disponibili diverse modalità di esame radiologico per la diagnosi e il follow-up di tali lesioni, come la TC, la Risonanza Magnetica, l’eco-color-Doppler, l’angiografia e la PET. Al momento, l’eco-color-Doppler risulta l’analisi di scelta in quanto consente una valutazione delle anomalie orali immediata, non invasiva, con ottimo rapporto costo/beneficio. Fornisce infatti informazioni morfologiche e vascolari utili per determinare le migliori opzioni terapeutiche. Tuttavia la diagnosi differenziale di una massa lobulare sanguinante della lingua non sempre risulta semplice e include numerose lesioni vascolari e non vascolari. In questo articolo presentiamo il caso di un granuloma piogenico della lingua che all’analisi con eco-color-Doppler è stato identificato come lesione ipervascolarizzata.

Focal epithelial hyperplasia in a human immuno-deficiency virus patient treated with laser surgery.

Focal epithelial hyperplasia (FEH), or Hecks disease, is a rare disease of the oral mucosa; it is mostly found in children or young adults who are immunosuppressed and who live in regions with low socioeconomic status. It is characterized by asymptomatic papules on the oral mucosa, gingiva, tongue, and lips. Healing can be spontaneous, and treatment is indicated if there are aesthetic or functional complications. Human papillomavirus, especially genotypes 13 and 32, has been associated with FEH and is detected in the majority of lesions. Histopathologically, FEH is characterized by parakeratosis, epithelial hyperplasia, focal acanthosis, and fusion and horizontal outgrowth of epithelial ridges. A 37-year-old male patient was referred to the Department of Oral and Maxillofacial Sciences at the Sapienza University of Rome, complaining of numerous exophytic lesions in his mouth. He stated that the lesions were not painful but he had experienced occasional bleeding after incidental masticatory trauma. He had received no previous treatment for the oral lesions. His medical history revealed that he was human immuno-deficiency virus positive and was a smoker with numerous, asymptomatic oral papules clinically and histologically corresponding to FEH. The labial and buccal mucosa were especially affected by lesions. Surgical treatment was performed using a 532-nm potassium titanyl phosphate laser (SmartLite, Deka, Florence, Italy) in continuous mode with a 300 μm fiber and power of 1.4 W (power density 1980.22 W/cm(2)). After anesthesia without vasoconstrictors, the lesions were tractioned with sutures or an Allis clamp and then completely excised. The lesions were preserved in 10% formalin for histological examination, which confirmed the clinical diagnosis of FEH. In this case, the laser allowed excellent control of bleeding, without postoperative sutures, and optimal wound healing.