Mauro Bonanini

Early Surgical Laser-Assisted Management of Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ): A Retrospective Analysis of 101 Treated Sites with Long-Term Follow-Up

BACKGROUND DATA The management of bisphosphonate-related osteonecrosis of the jaws (BRONJ) is still controversial. OBJECTIVE The purpose of this study was to compare surgical and nonsurgical approaches to the treatment of BRONJ and the possible usefulness of Nd:YAG and Er:YAG lasers. METHODS One hundred and twenty-eight patients (33 males, 95 females; 52 with diagnosis of multiple myeloma, 53 with diagnosis of bone metastasis, and 23 with diagnosis of osteoporosis) affected by BRONJ were evaluated at the Unit of Oral Pathology and Medicine and Laser-Assisted Surgery of the University of Parma, Italy, between January 2004 and July 2009. Overall number of BRONJ sites was 151, and number of treated sites was 101. In order to assess the efficacy of different treatments, sites were subclassified as follows: Group 1 (G1): 12 sites treated with medical therapy; Group 2 (G2): 27 sites treated with medical therapy associated with low level laser therapy (LLLT); Group 3 (G3): 17 sites treated with a combination of medical and surgical therapy; Group 4 (G4): 45 sites treated with a combination of medical therapy, surgical (including laser-assisted) therapy, and LLLT. Outcome of treatment was assessed using the staging system proposed by Ruggiero et al. Transition from a higher stage to a lower one for at least 6 months was considered as clinical improvement and suggestive of a successful treatment. RESULTS Clinical improvement was achieved in 3 out of 12 (25%) BRONJ sites in G1. Sites if G2 with an improvement were 18 out of 27 (66%). Nine out 17 BRONJ sites (53%) in G3 had a transition to a lower stage after treatment. For sites in G4, a clinical improvement was recorded in 40 out of 45 cases (89%). CONCLUSIONS In our experience, the percentage of success obtained with a combined approach based on medical therapy, surgical (including laser-assisted) therapy, and LLLT (G4) is significantly higher than the percentage of improvement obtained in G1, G2, and G3.

Welding in the dental office by fiber-delivered laser: a new technique.

OBJECTIVE The aim of this study is to demonstrate the ability of dentists to weld different metals during daily practice using a fiber-delivered laser normally used for dental surgery, and to evaluate the possibilities offered by this new technique. BACKGROUND DATA Laser welding is a common technique that has long been used in dental technician laboratories. It has many advantages over conventional techniques: it may be applied directly to master casts, and it avoids damage to the acrylic or ceramic portions close to the welded area. In addition, it may be applied on different types of metallic alloys, and it may provide a stronger attachment than other more traditional techniques. The cost, size, and limited flexibility of laser transmission systems using fixed lenses have restricted their use to dental technician laboratories. MATERIALS AND METHODS The authors detail their experience with welding using an Nd:YAG fiberoptic-delivered laser that is normally used for dental therapy. RESULTS This work describes some clinical cases that demonstrate the ease of use of this technique to weld broken appliances for both prosthetic and orthodontic therapy. CONCLUSION Dentists using this technique can carry out immediate restoration of metallic fixed, removable, and orthodontic broken prostheses in their own offices, thus reducing the time needed for such repairs.

Intra-oral laser welding: an in vitro evaluation of thermal increase

The neodymium:yttrium–aluminium–garnet (Nd:YAG) laser is currently used in dental laboratories to weld metals on dental prostheses. Recently, the use of Nd:YAG has been suggested so that dentists themselves can repair broken fixed, removable and orthodontic prostheses by welding metals directly in the mouth. This work aimed to evaluate, through a four k-type thermocouple system on calf jaws, the thermal increase in the biological structures close to the metal parts during laser welding. We put two hemispherical metal plates onto mandibular molars and then laser welded them at three points with a four k-thermocouple system to determine the thermal rise in the pulp chamber, sulcus, root and bone. This procedure was carried out on 12 samples, and the results were processed. The highest values of thermal increase were found in the pulp chamber, 1.5°C; sulcus, 0.7°C; root, 0.3°C; and bone, 0.3°C. This study showed that thermal increases in pulp chamber, sulcus, root and bone were biologically compatible and that intra-oral laser welding, at the parameters used in this work, seems to be harmless to the biological structures close to the welding and thermally affected zones.

Medication-Related Osteonecrosis of the Jaw Around Dental Implants: Implant Surgery-Triggered or Implant Presence-Triggered Osteonecrosis?

Introduction: Dentoalveolar surgery including tooth extractions and dental implants placement is considered the major risk factor for developing medication-related osteonecrosis of the jaw (MRONJ). In this study, a patient series of MRONJ around dental implants were carefully analyzed to describe the findings and to assess the possible risk factors. Methods: Fifteen patients with peri-implant bone osteonecrosis were selected out of a group of 250 patients (6%). Patients were divided into 2 groups according to the temporal relationship. Group 1 (G1)—necrosis immediately after implant placement (from 2 to 10 months) and defined as “implant surgery-triggered” MRONJ. Group 2—necrosis distant (from 1 to 15 years) from implant placement and defined as “implant presence-triggered” MRONJ. Epidemiological and pharmacological variables were recorded as well as specific data about osteonecrosis and dental implants. Results: G1 included 6 patients: 5 (83.4%) treated with oral bisphosphonates (BPs) for osteoporosis and 1 (16.6%) with intravenous BPs for breast cancer. Mean duration of BP therapy (BPT) was 83.7 months. G2 included 9 patients: 8 patients (88.89%) treated with intravenous BPs for malignant disease and 1 (11.11%) with oral BPs for osteoporosis. Conclusions: Data confirms that not only surgical insertion of dental implants is a potential risk factor for the development of osteonecrosis but also the presence itself of the implant into the bone can be associated with this disease. Therefore, it is necessary to inform of the increased risk for MRONJ also the patients who have already osteointegrated implants and are going to start the BPT. The risk is lower for patients receiving oral BPs but it exists and seems to be higher if the implant is located in the posterior areas, if the duration of BPT is more than 3 years and if the patient is under corticosteroid therapy.

Quantic molecular resonance scalpel and its potential applications in oral surgery

Quantic molecular resonance is a new technique that applies high frequency waves suitable for many surgical fields. It is a remarkable advance from conventional electrosurgery, and consists of non-traumatic cutting of tissue and gentle coagulation. The cut is achieved by the explosion of infracellular and intracellular liquids, that resonate with a special frequency. The temperature of the cut area and surrounding tissues is less than 45 degrees C, so no thermal injury results. Coagulation is by denaturation of fibrinogen at 63 degrees C, and not at (conventional) higher temperatures. The result is the elimination of scar tissue or keloid, with considerable aesthetic benefits and reduction in postoperative swelling and pain. The quantic molecular resonance scalpel is a device that is suitable for oromaxillofacial surgery and related specialist areas (such as periodontology, implantology, and paediatric oral surgery). Other specialties (such as ear, nose, and throat, dermatology, aesthetic surgery, and veterinary surgery) could also benefit from this new technique.

Odontogenic myxofibroma: a concise review of the literature with emphasis on the surgical approach.

Purpose: The aim of this work is to report a review of the literature concerning epidemiology, clinical and radiographic features as well as treatment of odontogenic myxofibroma (MF). Methods: The PubMed database was searched using the following keywords: “odontogenic myxofibroma”, “odontogenic fibromyxoma”, “myxofibroma of the jaw” and “fibromyxoma of the jaw”. Results: Fifteen articles reporting the experience with 24 patients were identified. Male/female ratio was 1:1.4 and the average age was 29.5 years. The most frequent location was the mandible. In 66.7% of the cases the radiographic appearance was a multilocular radiolucency. Swelling was observed in 13 patients (92.86%), varying degrees of pain in 5 (35.71%) and paresthesia in only one patient (7.14%). Six out of 24 patients (26.09%) were treated with radical surgery and 17 (73.91%) with a conservative approach. In two out of 21 cases (9.52%) a recurrence was reported. Conclusions: MF is an extremely rare tumor and no agreement exists on the causes of its development. According to the present review, the choice of treatment should depend on variables such as localization, presence of a primary or of a recurrent lesion, age, general medical conditions and aesthetic needs of the patient. Key words:Odontogenic myxofibroma, myxofibroma of the jaw, odontogenic tumors, oral surgery, oral pathology.

Central incisor loss after delayed replantation following avulsion: a contemporary restorative and adjunctive orthodontic management approach

Delayed replantation of an avulsed tooth may result in rapid root resorption or, more frequently, dental ankylosis with subsequent bone substitution. If this process develop slowly, it is possible to observe that tooth loss is characterized by a well conserved alveolus with regard to bone preservation, particularly in vertical dimension. This clinical case reports a dental trauma of a central incisor in a young boy characterized by tooth avulsion and its delayed replantation. After 10 years, dental ankylosis of the incisor was recorded and the patient underwent a prosthetic-orthodontic rehabilitation using CAD-CAM technology and no-prep veneers.

Therapeutic management for post-traumatic treatment of the anterior dental region: a case report with long-term follow up

The treatment plan represents the final step in every diagnostic procedure and is the result of a series of assessments based on information gathered from a detailed clinical history. This clinical case reports the replacement of two central incisors that were lost because of a trauma. The advantages and disadvantages of the two treatment options (i.e. implantology or prosthetic restoration) were carefully evaluated in relation to the case in hand. Patient compliance and aesthetic requirements had been also considered. In this case, a conventional prosthetic restoration was performed using a metal-ceramic bridge, utilising full crowns between the right and left maxillary lateral incisors associated with minimal canine preparation. By this strategy, the treatment plan allows for a future implant restoration, should this become necessary.

Erratum to: Advantages of new technologies in oral mucosal surgery: an intraoperative comparison among Nd:YAG laser, quantic molecular resonance scalpel, and cold blade.

The aim of this study is to evaluate the possible intraoperative advantages of Nd:YAG laser and quantic molecular resonance (QMR) scalpel in oral soft tissue surgery. One hundred sixty-three interventions were evaluated. Group 1 (G1) included 77 interventions performed with Nd:YAG laser, group 2 (G2) 45 with QMR scalpel, and group 3 (G3) 41 with cold blade. Parameters analyzed were as follows: speed of incision, time of intervention, intraoperative bleeding, number of stitches, patient compliance, and operator comfort. Data were analyzed using software STATA 12 (StataCorp LP, College Station, TX, USA). Mean speed of incision was 0.54 mm/s in G1, 2.83 mm/s in G2, and 1.58 mm/s in G3, Nd:YAG laser being the slowest. However, no significant differences among times of intervention were found. In particular, interventions in G1 (221.15 ± 220.89 s) have a mean duration lower than G2 (280.56 ± 248.31 s) and G3 (316.10 ± 248.69 s). Intraoperative bleeding occurred in 29.9 % (n = 23/77) of interventions in G1, 97.8 % (n = 44/45) in G2, and 97.6 % (n = 40/41) in G3 (p < 0.0001). Mean number of stitches in G1 was statistically lower (G1, 0.10; G2, 2.07; G3, 2.29; p < 0.0001). No differences with regard to patient compliance were detected. Operator comfort was higher in G1 (p < 0.0003). Nd:YAG laser and QMR scalpel give several advantages in oral mucosal surgery: Nd:YAG laser cuts tissue slowly, but it provides a good visibility and excellent hemostasis. QMR scalpel allows a very rapid cutting with no considerable temperature increase, but there is major risk of bleeding and need for sutures with lower operator comfort.

Laser welding by dental Nd:YAG device

Welding laser was introduced in jewellery during years 70 and, just after, was successfully used also by dental technicians. Welding laser gives a great number of advantages, versus traditional welding and, for this reason, this procedure had a great diffusion in the technician laboratories and stimulated the companies to put in the market more and more evolutes appliances. Some aspects, such great dimensions, high costs and delivery system today still characterize these machines by fixed lenses, which have strictly limited its use only to technician laboratories. The aim of this study is to demonstrate the possibility, by using a fibber‐delivered laser normally utilized in the dental office, to make, by dentist himself in his office, welding on different metals and to evaluate advantages and possibilities of this new technique.