Paolo Difalco

Traditional Endodontic Surgery Versus Modern Technique: A 5-Year Controlled Clinical Trial

AbstractIn this study, we compared outcomes of traditional apicoectomy versus modern apicoectomy, by means of a controlled clinical trial with a 5-year follow-up. The study investigated 938 teeth in 843 patients. On the basis of the procedure performed, the teeth were grouped in 3 groups. Differences between the groups were the method of osteotomy (type of instruments used), type of preparation of retrograde cavity (different apicoectomy angles and instruments used for root-end preparation), and root-end filling material used (gray mineral trioxide aggregate or silver amalgam).Outcome (tooth healing) was estimated after 1 and 5 years, postoperatively. Clinical success rates after 1 year were 67% (306 teeth), 90% (186 teeth), and 94% (256 teeth) according to traditional apicoectomy (group 1), modern microsurgical apicoectomy using burns for osteotomy (group 2) or using piezo-osteotomy (group 3), respectively. After 1 year, group comparison results were statistically significant (P < 0.0001). Linear trend test was also statistically significant (P < 0.0001), pointing out larger healing from group 1 to group 3. After 5 years, teeth were classified into 2 groups on the basis of root-end filling material used. Clinical success was 90.8% (197 teeth) in the silver amalgam group versus 96% (309 teeth) in the mineral trioxide aggregate group (P < 0.00214). Multiple logistic regression analysis found that surgical technique was independently associated to tooth healing. In conclusion, modern apicoectomy resulted in a probability of success more than 5 times higher (odds ratio, 5.20 [95% confidence interval, 3.94–6.92]; P < 0.001) compared with the traditional technique.

Maxillary bone necrosis following the use of formaldehyde containing paste: management and case series

Paraformaldehyde is used both as a disinfectant and to devitalise inflamed pulps when local anaesthesia is ineffective. Despite the clinical benefits, paraformaldehyde is not confined to the pulp, but penetrates the dentine and is gradually released as formaldehyde. This case series describes the effects on periodontal and bone tissues of paraformaldehyde used as a devitalising or disinfectant agent.

Juvenile central ossifying fibroma of the mandible: a case report

Central ossifying fibroma is a rare fibro-osseous neoplasm in young children. It is highly aggressive and has a strong tendency to recur. We describe an 11-year-old girl with juvenile central ossifying fibromas of the mandible that caused obstruction of tooth eruption of the lower left second premolar. Oral examination revealed the presence of the primary lower left second molar and a small bony hard swelling over the left side of the mandibular body. After a computed tomographic scan, an incisional biopsy was performed, and the lesion proved to be a juvenile ossifying fibroma. Although this tumor often recurs early, and many authors suggest radical en bloc resection, we performed a more conservative procedure to avoid damage to the mandibular nerve. There has been no evidence of recurrence 1 year later.