Roberto Pippi

Piezosurgery for the lingual split technique in mandibular third molar removal: a suggestion.

BackgroundThe lingual split technique is a surgical procedure for extraction of impacted mandibular third molar throughout a lingual approach. The main disadvantage of this technique is the high rate of temporary lingual nerve injury mainly because of the trauma induced by the lingual flap retraction. The purpose of this paper is to suggest the use of piezosurgery in performing the lingual cortical plate osteotomy of the third molar alveolar process. MethodsSurgical procedure was performed under general anesthesia, and it lasted approximately 60 minutes. After the buccal and lingual full-thickness flaps were incised and elevated, a piezosurgical device was used for osteotomy. A well-defined bony window was then removed, and it allowed the entire tooth was extracted in a lingual direction. The patient did not show any neurological postoperative complication. Lingual and inferior alveolar nerve functionality was normal before as well as after surgery. ConclusionsThe use of piezoelectric surgery seems to be a good option in removing lower third molars when a lingual access is clearly indicated. The only disadvantage of this technique can be represented by an operating time lengthening possibly because of a lower power cut of the piezoelectric device, to the high mineralization of the mandibular cortical bone and to the use of inserts with a low degree of sharpening.

Odontomas and Supernumerary Teeth: Is There a Common Origin?

The aim of the present work is to analyze all scientific evidence to verify whether similarities supporting a unified explanation for odontomas and supernumerary teeth exist. A literature search was first conducted for epidemiologic studies indexed by PubMed, to verify their worldwide incidence. The analysis of the literature data shows some interesting similarities between odontomas and supernumerary teeth concerning their topographic distribution and pathologic manifestations. There is also some indication of common genetic and immuno-histochemical factors. Although from a nosological point of view, odontomas and supernumeraries are classified as distinct entities, they seem to be the expression of the same pathologic process, either malformative or hamartomatous.

The effectiveness of a new method using an extra-alveolar hemostatic agent after dental extractions in older patients on oral anticoagulation treatment: an intrapatient study

OBJECTIVE The present study aimed to evaluate the effectiveness of a new adhesive agent, HemCon Dental Dressing (HDD), in patients receiving oral anticoagulant treatment (OAT), who were undergoing nonsurgical tooth extractions without interruption or reduction of OAT, compared with that of a common local hemostatic agent. STUDY DESIGN Twenty patients on OAT with an international normalized ratio (INR) ranging between 1.6 and 3.5 were recruited. In the same session, each patient was subjected to the extraction of two teeth: In the test site the HDD was applied, and in the control site, a common hemostatic sponge (CollaPlug, Zimmer Dental) was used. RESULTS The mean application time was significantly lower in the test group than in the control group, and this difference is statistically significant. The mean postoperative pain was significantly lower in the test group than in the control group the morning after surgery and at the time of suture removal. Post-extraction socket healing was significantly better in the test group than in the control group. CONCLUSIONS Tooth extraction in patients receiving OAT and have an INR lower than 3.5 is a safe procedure without discontinuation of the OA regimen. The HDD seems to reduce postoperative side effects and obtain rapid soft tissue healing.

The central odontogenic fibroma: How difficult can be making a preliminary diagnosis.

Central odontogenic fibroma (COF) is a rare benign odontogenic tumor derived from the dental ectomesenchymal tissues. A 16-year-old Caucasian female patient was referred by her dentist for a radiolucent asymptomatic area associated with the crown of the impacted lower right third molar. A preliminary diagnosis of a follicular cyst was supposed. The lesion was surgically removed under general anesthesia together with the impacted tooth. The microscopic diagnosis of the excised tissue revealed an odontogenic fibroma. No clinical or radiographic signs of recurrence were found five years after surgical excision. Despite the various differential diagnoses of homogeneous unilocular and well delimited radiolucencies of the jaws, enucleation with peripheral curettage, without any other pre-operative imaging exams or biopsies, can be considered as the treatment of choice. Key words:Differential diagnosis, impacted third molar, radiographic imaging, microscopic diagnosis, odontogenic fibroma.

Prevention of Mandibular Fractures Caused by Difficult Surgical Extractions: Report of a Borderline Case

Intra- and postoperative mandibular fracture is one ofthe major complications associated with difficult sur-gical extractions in the lower arch.Adult age, male gender, deep inclusion, tooth an-kylosis, and associated cystic or other pathologicallesions are usually considered predisposing factors ofmandibular fracture related to surgery.The aim of the present article was to report anddiscuss a case in which a miniplate was used toprevent such a serious complication.

Post-Surgical Clinical Monitoring of Soft Tissue Wound Healing in Periodontal and Implant Surgery

Clinical features of surgical soft tissue wound healing in dentistry have been rarely discussed in the international literature. The aim of the present paper is to highlight both the main clinical findings of surgical wound healing, especially in periodontal and implant dentistry, and the wound healing monitoring procedures which should be followed. Wound inspection after careful food and plaque debridement is the essential part of wound healing monitoring. Periodontal and peri-implant probing should be performed only after tissue healing has been completed and not on a weekly basis in peri-implant tissue monitoring. Telephone follow-up and patient self-assessment scales can also be used the days following surgery to monitor the most common surgical complications such as pain, swelling, bleeding, and bruising. Wound healing monitoring is an important concern in all surgical procedures since it allows to identify signs or/and symptoms possibly related to surgical complications.

The Use of a Chitosan-Derived Hemostatic Agent for Postextraction Bleeding Control in Patients on Antiplatelet Treatment

PURPOSE The current approach for tooth extraction in patients receiving antiplatelet treatment requires the use of local hemostatic agents without previous thromboembolic treatment interruption. The aim of the present study was to evaluate the effectiveness of an extra-alveolar hemostatic agent, the HemCon Dental Dressing (HDD), in controlling postsurgical bleeding. MATERIALS AND METHODS Routine, atraumatic tooth extractions were performed in a single session under local anesthesia without a vasoconstrictor and without interruption of antiplatelet therapy. All patients underwent extraction of 2 teeth in the same session, with each in a different dental hemi-arch, and the hemostatic method to be used was randomly chosen: in the test site, the HDD was applied, whereas in the control site, a common hemostatic sponge (CollaPlug, Zimmer Dental) was applied and stabilized in situ with a suture. For each surgery, 2 different times were measured: the time required for hemostatic agent application and the time required for hemostasis achievement. Postoperative pain and healing quality also were evaluated. RESULTS Twenty outpatients were enrolled. The mean application time was considerably shorter in the test group than in the control group; the mean bleeding time in the control group was considerably shorter than in the test group; pain values were lower in the test group than in the control group, especially at suture removal; and postextraction socket healing was better in the test group than in the control group. CONCLUSION HDD seems to be a valid and safe alternative in treating postextraction sockets in outpatients under single-drug antiplatelet treatment in the absence of surgical wound lacerations.

Accuracy of cone-beam computed tomography in defining spatial relationships between third molar roots and inferior alveolar nerve

Objective: Cone-beam computed tomography (CBCT) has been proposed in surgical planning of lower third molar extraction. The aim of the present study was to assess the reliability of CBCT in defining third molar root morphology and its spatial relationships with the inferior alveolar nerve (IAN). Materials and Methods: Intraoperative and radiographic variables of 74 lower third molars were retrospectively analyzed. Intraoperative variables included IAN exposure, number of roots, root morphology of extracted third molars, and presence/absence of IAN impression on the root surface. Radiographic variables included presence/absence of the cortex separating IAN from the third molar roots on CBCT examination, number of roots and root morphology on both orthopantomography (OPG) and CBCT. The statistical association between variables was evaluated using the Fishers exact test. Results: In all cases of intraoperative IAN exposure, the cortex appeared discontinuous on CBCT images. All cases, in which the cortical bone was continuous on CBCT images, showed no association with nerve exposure. In all cases in which nerve impression was identified on the root surface, the IAN cortex showed interruptions on CBCT images. No nerve impression was identified in any of the cases, in which the cortex appeared continuous on CBCT images. CBCT also highlighted accessory roots and apical anomalies/curvatures, not visible on the OPG. Conclusions: CBCT seems to provide reliable and accurate information about the third molar root morphology and its relationship with the IAN.

Intrasinus Bone Gain with the Osteotome Sinus Floor Elevation Technique: A Review of the Literature

PURPOSE To evaluate the mean amount of intrasinus bone obtainable with the osteotome technique for transcrestal maxillary sinus elevation combined with simultaneous implant insertion, with and without the use of grafting materials. MATERIALS AND METHODS A review was conducted on PubMed, Scopus, and Cochrane central databases. Only human studies in which implant placement was contextual to the sinus elevation procedure, without additional crestal regenerative procedures and with a minimum 1-year follow-up, were selected. Seventeen studies were found to meet the selection criteria. RESULTS No statistically significant difference between the two procedures was detected. The mean intrasinus bone gain at 3 years after surgery was 2.99 mm in cases where no grafting material was used and 4.24 mm in cases in which grafting materials were used. The mean percentage of crestal height increase at the implant site at 3 years after surgery, referring to a selection of studies with initial bone height > 4 mm, was 47.28% in procedures without grafting material and 62.68% in procedures with grafting material. A different dimensional behavior of the newly formed bone during the first 3 years after surgery was found: a slight volumetric shrinkage in grafting procedures and a slight bone increase in procedures without grafting material. No statistically significant difference in implant survival rate was found. CONCLUSION Both osteotome transcrestal sinus elevation procedures seem to guarantee predictable short- and medium-term results with reference to the intrasinus bone gain. However, the use of grafting materials, compared with their nonuse, does not seem to have substantial advantages in the short and medium term as far as mean intrasinus bone gain is concerned.

How much do Italian patients in supportive periodontal therapy know about the role of smoking in oral health and what is their lifestyle

Objective: The level of awareness of patients receiving supportive periodontal therapy (SPT) concerning the role of smoking as a risk factor for oral health was investigated. Materials and Methods: A questionnaire was administered to 158 patients previously treated for periodontitis in four periodontally oriented private dental offices in Rome. The generalized linear model was used to test the simultaneous effect of questions posed to all patients. Fishers exact test was used to verify significant associations among qualitative variables. Results: Only 53.79% of the total sample referred having been informed by the dentist/hygienist about smoking as an oral health risk factor. About 40% of patients did not know that oral cancer exists and only 36.08% of them reported being informed about it by their own dentist/hygienist. Females are significantly less frequent among ex-smokers than among smokers. Nonsmokers were on periodontal supportive therapy for a longer period than smokers. Patients who started smoking later found harder to quit smoking than those who started earlier. Conclusion: Awareness of patients in SPT about health risks related to smoking does not assume a change in their harmful behavior. Among oral health professionals, there is not yet a widespread awareness of the importance of their role in increasing patients motivation to quit.