Gianfranco Gaimari

Laser treatment of 13 benign oral vascular lesions by three different surgical techniques

Objectives: Benign Oral Vascular Lesions (BOVLs) are a group of vascular diseases characterized by congenital, inflammatory or neoplastic vascular dilations clinically evidenced as more or less wide masses of commonly dark bluish color. If traumatized BOVLs are characterized by a great risk of hemorrhage and their treatment usually requires great caution to prevent massive bleeding. In the last decades lasers have dramatically changed the way of treatment of BOVLs permitting the application of even peculiar techniques that gave interesting advantages in their management reducing hemorrhage risks. The aim of this study was to evaluate the capabilities and disadvantages of three laser assisted techniques in the management of BOVLs. Study design: In this study 13 BOVLs were treated by three different laser techniques: the traditional excisional biopsy (EB), and two less invasive techniques, the transmucosal thermocoagulation (TMT) and the intralesional photocoagulation (ILP). Two different laser devices were adopted in the study: a KTP laser (DEKA, Florence, Italy, 532nm) and a GaAlAs laser (Laser Innovation, Castelgandolfo, Italy, 808nm) selected since their great effectiveness on hemoglobin. Results: In each case, lasers permitted safe treatments of BOVLs without hemorrhages, both during the intervention and in the post-operative period. The minimally invasive techniques (TMT and ILP) permitted even the safe resolution of big lesions without tissue loss. Conclusions: Laser devices confirm to be the gold standard in BOVLs treatment, permitting even the introduction of minimal invasive surgery principles and reducing the risks of hemorrhage typical of these neoplasms. As usual in laser surgery, it is necessary a clear knowledge of the devices and of the laser-tissue interaction to optimize the results reducing risks and disadvantages. Key words:Oral vascular diseases, laser, photocoagulation.

Cone-beam computed tomography in the assessment of periapical lesions in endodontically treated teeth

Objective: This study aimed to evaluate the relationship between the quality of the coronal restoration and the root canal filling on the periapical status of endodontically treated teeth using CBCT. Materials and Methods: CBCT data were obtained from the records of patients who deny any dental treatment in the 2 years prior to the CBCT examination. CBCT images (90 kVp and 7 mA, exposure time of 23 s, and a voxel size of 0.2 mm, with a field of view of 13 cm × 13 cm) of 1011 endodontically treated teeth were observed. A score was given to the quality of the root filling and the quality of the coronal restoration. Statistical Analysis Used: Data were statistically analyzed to correlate the periapical status with gender, dental group. and quality of endodontic treatment and restoration (Chi-square test with a significance level of P < 0.001). Results: Absence of periapical periodontitis was found in 54.9% of the cases. The periapical outcome was not related to gender or dental group (P > 0.05). A statistically significant factor (Chi-square test, P < 0.0001) resulted when different qualities of sealing were compared. Conclusions: CBCT showed that high-quality root canal treatments followed by an adequate coronal sealing restoration avoid the presence of periapical periodontitis in time.

Le anomalie vascolari dei tessuti molli del cavo orale

Riassunto Obiettivi Esaminare le anomalie vascolari di piu frequente riscontro nella pratica odontoiatrica. Le anomalie vascolari possono interessare ogni tipo di vaso (arterioso, venoso o linfatico) di qualunque calibro o distretto anatomico e sono patologie caratterizzate da alterazioni funzionali e/o morfo-strutturali di varia natura, gravita ed estensione. Generalmente sono forme congenite e benigne, sebbene possano essere causa di complicanze quali ulcerazione, sanguinamento, sovrainfezione, deficit funzionale e/o estetico. Materiali e metodi Attualmente, la classificazione di riferimento e quella adottata dalla Societa Internazionale per lo Studio delle Anomalie Vascolari (International Society for the Study of Vascular Anomalies, ISSVA), che distingue le neoplasie vascolari o vasoproliferative, tra cui gli emangiomi, dalle malformazioni vascolari; queste ultime sono ulteriormente suddivise in malformazioni a basso e ad alto flusso sanguigno. La diagnosi delle anomalie vascolari non deve prescindere dall’anamnesi patologica prossima e dall’esame clinico del paziente, anche se per la diagnosi di certezza e necessario eseguire indagini strumentali tra cui l’ecocolor-Doppler, che e un esame rapido, ripetibile e privo di radiazioni ionizzanti. Il trattamento prevede diverse tecniche, in relazione alla tipologia di lesione vascolare diagnosticata; tra queste, quella maggiormente indicata per le anomalie a basso flusso e la laserterapia. Questa tecnica prevede tre distinti approcci terapeutici: la biopsia escissionale, che e indicata per lesioni sospette e per cui si renda necessario un esame istologico; la termofotocoagulazione transmucosa, che prevede l’utilizzo del laser in modalita “no contact”; la fotocoagulazione intralesionale, che utilizza la fibra laser internamente alla lesione ed e indicata per le anomalie vascolari piu profonde. Risultati e conclusioni Alla luce della letteratura recente e dell’esperienza clinica e possibile affermare che le anomalie vascolari sono un gruppo eterogeneo di patologie per il cui trattamento e necessario seguire un corretto approccio diagnostico clinico-strumentale; le apparecchiature laser con lunghezza d’onda affine per l’emoglobina ossidata costituiscono il “gold standard” nel trattamento delle anomalie a basso flusso sanguigno, sia per la semplicita d’uso sia per l’ottimo controllo dell’emostasi.

Short vs. Standard Laser-Microgrooved Implants Supporting Single and Splinted Crowns: A Prospective Study with 3 Years Follow-Up: Effectiveness of Short Implants

PURPOSE The aim of this study was to compare survival rates, marginal bone loss (MBL), and peri-implant soft tissue parameters between short and standard laser-microgrooved implants supporting single or splinted crowns 3 years after loading. MATERIALS AND METHODS 30 subjects received 1 short ( ≤ 7 mm ) and 1 standard length ( ≥ 9 mm ) laser-microgrooved implant in adjacent sites of the premolar and molar regions of the mandible or maxilla. Peri-implant soft tissue parameters and intraoral radiographs were recorded at the delivery of definitive crowns (baseline) and 3 years later. Cumulative survival rate (CSR) and marginal bone loss (MBL) in relation to crown/implant (C/I) ratio, implant length, location, type of antagonist, and type of prosthetic design (single or splinted), were evaluated. RESULTS CSR of short implants was 98%, compared to 100% for standard implants, without significant statistical difference. MBL was not significantly different over the observation period, with an average of 0.23 ± 0.6 mm and 0.27 ± 0.3 mm for short and standard implants, respectively. No statistical differences were found between short and standard implants regarding plaque (14.7% vs. 15.7%), number of sites BOP (8.3% vs. 5.9%), probing depth (1.13 ± 0.6 mm vs. 1.04 ± 0.8 mm), and mean mucosal recession (0.18 ± 0.3 mm vs. 0.22 ± 0.3 mm). Analyzing MBL in relation to the C/I ratio, implant length, location, type of antagonist, and type of prosthetic design, no statistically significant differences were found. CONCLUSION Regardless of C/I ratio, implant length, location, type of antagonist, and type of prosthetic design, short and standard laser-microgrooved implants had similar survival rates, MBL, and peri-implant soft tissue conditions over the observation period of 3 years.

One-stage laser-microtextured implants immediately placed in the inter-radicular septum of molar fresh extraction sockets associated with GBR technique. A case series study

Background The outcome of one-stage trans-mucosal immediate implants with simultaneous guided bone regeneration (GBR) technique has become highly predictable. Furthermore, when this approach is performed to place one-stage implants into the inter-radicular septum of fresh extraction sockets in the molar region, the risk of incorrect emergence profile and off-angle loading is reduced. The aim of the present study was to clinically evaluate the horizontal hard and soft tissue changes, and radiographically the vertical socket walls remodeling, and the early peri-implant marginal bone loss (EMBL) following the placement of immediate one-stage implants in the inter-radicular septum of molar fresh extraction sockets, associated with a collagen membrane. Material and Methods Twenty patients were selected to receive a one-stage implant with laser-microtextured collar surface into the inter-radicular septum of a fresh molar extraction sockets, associated with a simultaneous placement of a collagen membrane. Intraoral radiographs and model casts were used for the evaluation. Correlation between the amount of the keratinized tissue thickness (KTT) with EMBL was also analyzed. Results After 4 months, the vertical radiographic mesial and distal EMBL around implants was of 0.06 ±0.01 mm and 0.04±0.02 mm, respectively, with no statistically significant difference between T0 and T1 (P >0.05). No statistical differences were found also for each radiographic measure used for the examination of implant sites vertical bone changes (p >0.05). Clinically, horizontal changes of the bucco-lingual central width were found statistically significant (p<0.05), whereas no statistical differences were found for bucco-lingual mesial and distal width changes (p >0.05). In addition, no statistically significant correlation between EMBL and the amount of KTT was found (P >0.05). Conclusions Results suggest that the immediate placement of one-stage laser-microtextured implants could provide advantages in preserving the extraction socket’s hard and soft tissue remodeling, and the peri-implant marginal bone level before the prosthetic loading. Key words:One-stage implant, laser-microtextured collar surface, GBR, collagen membrane.

Detection of Bone Defects Using CBCT Exam in an Italian Population

Background The aim of this study was to evaluate the in vivo incidence and the location of fenestrations in a young Italian population by using CBCT. Materials and Methods Fifty patients who had previously performed CBCT for planning third molar extraction or orthodontic therapy were selected for the study. No previous dental treatment had been performed on these patients. Overall, 1,395 teeth were evaluated. Root fenestrations were identified according to the definition of Davies and the American Association of Endodontists. Data was collected and statistically analyzed. Results Fenestrations were observed in 159 teeth out of 1,395 (11% of teeth). In the lower jaw, we found 68 fenestrations (5%) and 91 in the maxilla (6,5%). Incisors were the teeth with the highest incidence of fenestrations. Conclusion The relative common finding (11%) of fenestration supports the need for CBCT exams before any surgical/implant treatment to avoid complications related to the initial presence of fenestrations. CBCT was found to be an effective and convenient tool for diagnosing fenestration.

Photodynamic therapy in the treatment of epithelial potentially malignant disorders of the mouth: advantages and disadvantages

Introduction: Leukoplakia is a potentially malignant epithelial lesion with carcinomatous percentages transformation comprehended between 1% and 7% for the homogeneous forms and from 4% to 15% for the non-homogeneous ones. Their removal can be performed by scalpel or laser surgery (excision or vaporization). Photodynamic therapy (PDT) is a bloodless treatment option, based on the involvement of three elements: light, photosensitizer and oxygen. When the molecules of the photosensitizer are activated by a low power laser, energy is transferred to molecular oxygen creating highly reactive radicals of oxygen, that have a cytotoxic effect on target cells. Aim of the study: According to several studies in Literature, it has been decided to evaluate through an initial clinical trial, the efficacy of PDT using topical aminolevulinic acid (5-ALA) activated by a laser diode (λ = 635 nm) to treat potentially oral malignant lesions and to illustrate the advantages and disadvantages derived from the use of this technique. Materials and Methods: Five patients, affected by oral leukoplakia (OL) and oral verrucous leukoplakia (OVL) on the mucosal cheeks, labial commissure, fornix and retromolar areas, have been treated using the PDT. Irradiation time with Diode laser: 1000s. Irradiation mode: Scanning. 5 cycles of 3 minute + final cycle of 100 seconds. Each cycle has been interrupted by pauses of 3 minutes. Results and conclusion: PDT results to be effective in the treatment of OL, especially on OVL. In fact, OVL, due to its irregularity, has got an area of increased retention for the gel that is more difficult to be removed by salivary flow. This could explain the better results obtained in this case rather than in those ones of OL. Furthermore, the advantages have been represented by: less invasivity, high sensitivity for altered tissues, minimal scar tissue, less side effects and no pain during and after operation. In contrast to this, the disadvantages were: longer treatment duration and the high cost.

Treatments of the oral leukoplakia by laser

Oral leukoplakia is catalogued under the group of “potentially malignant disorders”. In daily practice, the World Health Organization definition “white patch or plaque that cannot be characterized clinically or histologically as any other disease” is completed by including the observation that it cannot be removed by simple scraping, thereby distinguishing it from pseudo-membranous candidiasis. The aim of this study is to find a definitive treatment of oral leukoplakia, because of its recurrence and its potentiality to the malignant transformation. There are currently different approaches to oral leukoplakia: scalpel surgery, systemic therapy (carotenoids, vitamins, etc.), electro-cauterization, cryotherapy and the use of the laser. In every lesion, biopsy and histological analysis has been performed to identify the stage and classification of the oral leukoplakia. Laser can be used for the complete excision of the lesion (which is more effective, but also more invasive), for the photodynamic therapy (non-invasive procedure, which requires several applications) or for the vaporization of the lesion (very precise treatment and relatively easy to perform). Laser treatments have shown better healing, less soft tissues retraction and less post-operative pain, comparing with traditional surgery. The use of systemic therapies and smoking habit interruption (where present) has been also useful to reduce the lesions before the clinical treatments. The treatment has always to be supported by histological analysis to identify the risk and consequently planning the clinical approach.