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

Evaluation of wound healing and postoperative pain after oral mucosa laser biopsy with the aid of compound with chlorhexidine and sodium hyaluronate: a randomized double blind clinical trial

OBJECTIVES: The aim of this study is to evaluate secondary intention healing process and postoperative pain of oral soft tissues after laser surgery with the use of a compound containing chlorhexidine and sodium hyaluronate. MATERIALS AND METHODS: This double-blind, randomized clinical study included 56 patients affected by benign oral lesions and subjected to excisional biopsy with diode laser and randomly divided into three groups. Study group (SG) received 0.2% chlorhexidine digluconate and 0.2% sodium hyaluronate treatment; control group (CG) received 0.2% chlorhexidine digluconate; and placebo group (PG) followed the same protocol, taking a neutral solution having the same organoleptic characteristics. Wound healing was evaluated using percentage healing index (PHI). Numeric rating scale (NRS) was used to evaluate postoperative pain. RESULTS: PHI (T1 = 7 days) was 67.25% for SG, 58.67% for CG, and 54.55% for PG. PHI (T2 = 14 days) was 94.35% for SG, 77.79% for CG, and 78.98% for PG. A statistically significant difference was between the groups for PHI at T2 p = 0.001. No difference was detectable for pain index. CONCLUSIONS: A solution containing sodium hyaluronate and chlorhexidine is a good support to increase wound healing by secondary intention after laser biopsy, but no differences were in postoperative perception of pain. CLINICAL RELEVANCE: The use of the tested solution can be recommended after laser oral biopsies, to achieve a healing without suture. About the postoperative pain, the compound has not showed the same results and did not have measurable effects

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

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. 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. 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 (p0.05). In addition, no statistically significant correlation between EMBL and the amount of KTT was found (P >0.05). 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

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

Use of systemic and in situ lactoferrin in MRONJ surgical management: proposal for a therapeutic solution

Aim: Lactoferrin (Lf) is an antimicrobial and iron chelator glycoprotein contained in exocrine secretion, including saliva, and in secondary granules of neutrophil granulocytes. Lf performs its antibacterial and antiviral action through two pathways: the first deprives bacteria of the iron they need for their reproduction and for biofilm formation; the second contributes to restore the inflammatory homeostasis which is essential for tissue health modulating the level of cytokines, like IL-6. The study intends to propose the use of systemic and in situ Lf effectiveness in the healing of oral mucosa and bone tissue affected by medication-related ostenecrosis of the jaw (MRONJ), after surgical excision or spontaneous elimination of necrotic bone

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 disadvantage

Evaluation of photodynamic therapy using a diode laser 635 nm as an adjunct to conventional chemo-mechanical edodontic procedures against enterococcus faecalis biofilm: ex-vivo study

The study aimed to evaluate the antimicrobial effect of photodynamic therapy (PDT) with the use of Toluidine Blue (TB) on extracted teeth infected with biofilms of Enterococcus faecalis. Fifty-four extracted teeth with single-roots and single canals were mechanically shaped, autoclaved, and contaminated with E. faecalis. They were randomly divided into six groups: two groups were negative and positive control groups, two groups were subjected to mechanical instrumentation and PDT with different pre-irradiation times and irradiation times, and two groups were subjected to chemo-mechanical endodontic treatment and PDT with different pre-irradiation times and irradiation times. In PDT groups, after the application of TB, the canals were irradiated with a diode laser of wavelength 635 nm, with a fiber diameter of 200 μm and 100 mW of power in continuous mode. The bacterial load was evaluated using a BioTimer Assay protocol. The greatest reduction of bacterial load was observed in groups of combined PDT with chemo-mechanical treatment. The reductions of bacterial load in groups of combined PDT with chemo-mechanical treatment, and in the positive control group, were significant (p < 0.01) when compared to that of the negative control group. Photodynamic therapy as an adjunctive modality may improve the disinfection capacity of conventional endodontic treatment against E. faecalis