A rare case of melanosis of the hard palate mucosa in a patient with chronic myeloid leukemia

Imatinib Mesylate, also known as Gleevec or ST1-571, is a tyrosine-kinase inhibitor used as the gold standard medication for the chronic myeloid leukemia (CML); Imatinib has indeed deeply revolutionized the CML therapy allowing most patients to have a good quality of life. Despite its beneficial effects, Imatinib has significant side effects such as mucosal pigmentation. A 72-year-old female having an Imatinib induced mucosal pigmentation is presented: she has been treated with Imatinib since 2003 and only in 2014 discovered, during a routine dental visit, having a pigmented lesion on her hard palate mucosa. Histopathologically, the lesion shows the deposition of fine dark brown spherical bodies within the lamina propria and cloaked in between the collagen fibers. There was no sign of inflammation, hyperplasia, or hemorrhage in the tissu

Classification review of dental adhesive systems: from the IV generation to the universal type

Adhesive dentistry has undergone great progress in the last decades. In light of minimal-invasive dentistry, this new approach promotes a more conservative cavity design, which relies on the effectiveness of current enamel-dentine adhesives. Adhesive dentistry began in 1955 by Buonocore on the benefits of acid etching. With changing technologies, dental adhesives have evolved from no-etch to total-etch (4th and 5th generation) to self-etch (6th, 7th and 8th generation) systems. Currently, bonding to dental substrates is based on three different strategies: 1) etch-and-rinse, 2) self-etch and 3) resin-modified glass-ionomer approach as possessing the unique properties of self-adherence to the tooth tissue. More recently, a new family of dentin adhesives has been introduced (universal or multi-mode adhesives), which may be used either as etch-and-rinse or as self-etch adhesives. The purpose of this article is to review the literature on the current knowledge for each adhesive system according to their classification that have been advocated by many authorities in most operative/restorative procedures. As noted by several valuable studies that have contributed to understanding of bonding to various substrates helps clinicians to choose the appropriate dentin bonding agents for optimal clinical outcomes

Subcutaneous emphysema during root canal therapy: endodontic accident by sodium hypoclorite

Cervicofacial subcutaneous emphysema is defined as the abnormal introduction of air in the subcutaneous tissues of the head and neck. It is mainly caused by trauma, head and neck surgery, general anesthesia, and coughing or habitual performance of Valsalva manoeuvre. The occurrence of subcutaneous emphysema after dental treatment is rare, and diffusion of gas into the mediastinum is much rarer, especially when the procedure is a nonsurgical treatment. Presented here is a case of subcutaneous emphysema that occurred after sodium hypochlorite irrigation during endodontic treatment, and the description of its etiologies and prevention during nonsurgical endodontic treatment. Endodontic success can be essentially achieved via good debridement of a root canal, and an ideal endodontic irrigant is effective in removing the smear layer, opening the dentinal tubules, and producing a clean surface for closer obturation

Er:YAG laser, piezosurgery, and surgical drill for bone decortication during orthodontic mini-implant insertion: primary stability analysis-an animal study

It is important to identify factors that affect primary stability of orthodontic mini-implants because it determines the success of treatment. We assessed mini-implant primary stability (initial mechanical engagement with the bone) placed in pig jaws. We also assessed mini-implant insertion failure rate (mini-implant fracture, mini-implants to root contact). A total of 80 taper-shaped mini-implants (Absoanchor® Model SH1312-6; Dentos Inc., Daegu, Korea) 6 mm long with a diameter of 1.1 mm were used. Bone decortication was made before mini-implant insertion by means of three different methods: Group G1: Er:YAG laser (LiteTouch®, Light Instruments, Yokneam, Israel) at energy of 300 mJ, frequency 25 Hz, fluence 38.2 J/cm2, cooling 14 ml/min, tip 1.0 × 17 mm, distance 1 mm, time of irradiation 6 s; Group G2: drill (Hager & Meisinger GmbH, Hansemannstr, Germany); Group G3: piezosurgery (Piezotom Solo, Acteon, NJ, USA). In G4 group (control), mini-implants were driven by a self-drilling method. The primary stability of mini-implants was assessed by measuring damping characteristics between the implant and the tapping head of Periotest device (Gulden-Medizinteknik, Eschenweg, Modautal, Germany). The results in range between − 8 to + 9 allowed immediate loading. Significantly lower Periotest value was found in the control group (mean 0.59 ± 1.57, 95% CI 0.7, 2.4) as compared with Er:YAG laser (mean 4.44 ± 1.64, 95% CI 3.6, 5.3), piezosurgery (mean 17.92 ± 2.73, 95% CI 16.5, 19.3), and a drill (mean 5.91 ± 1.52, 95% CI 5.2, 6.6) (p < 0.05). The highest failure rate (33.3%) during mini-implant insertion was noted for self-drilling method (G4) as compared with G1, G2, and G3 groups (p < 0.05). The small diameter decortication by Er:YAG laser appeared to provide better primary stability as compared to drill and piezosurgery. Decortication of the cortical bone before mini-implant insertion resulted in reduced risk of implant fracture or injury of adjacent teeth. The high initial stability with a smaller diameter of the mini-implant resulted in increased risk of fracture, especially for a self-drilling metho

Er:YAG laser, piezosurgery, and surgical drill for bone decortication during orthodontic mini-implant insertion: primary stability analysis-an animal study

It is important to identify factors that affect primary stability of orthodontic mini-implants because it determines the success of treatment. We assessed mini-implant primary stability (initial mechanical engagement with the bone) placed in pig jaws. We also assessed mini-implant insertion failure rate (mini-implant fracture, mini-implants to root contact). A total of 80 taper-shaped mini-implants (Absoanchor® Model SH1312-6; Dentos Inc., Daegu, Korea) 6 mm long with a diameter of 1.1 mm were used. Bone decortication was made before mini-implant insertion by means of three different methods: Group G1: Er:YAG laser (LiteTouch®, Light Instruments, Yokneam, Israel) at energy of 300 mJ, frequency 25 Hz, fluence 38.2 J/cm2, cooling 14 ml/min, tip 1.0 × 17 mm, distance 1 mm, time of irradiation 6 s; Group G2: drill (Hager & Meisinger GmbH, Hansemannstr, Germany); Group G3: piezosurgery (Piezotom Solo, Acteon, NJ, USA). In G4 group (control), mini-implants were driven by a self-drilling method. The primary stability of mini-implants was assessed by measuring damping characteristics between the implant and the tapping head of Periotest device (Gulden-Medizinteknik, Eschenweg, Modautal, Germany). The results in range between − 8 to + 9 allowed immediate loading. Significantly lower Periotest value was found in the control group (mean 0.59 ± 1.57, 95% CI 0.7, 2.4) as compared with Er:YAG laser (mean 4.44 ± 1.64, 95% CI 3.6, 5.3), piezosurgery (mean 17.92 ± 2.73, 95% CI 16.5, 19.3), and a drill (mean 5.91 ± 1.52, 95% CI 5.2, 6.6) (p < 0.05). The highest failure rate (33.3%) during mini-implant insertion was noted for self-drilling method (G4) as compared with G1, G2, and G3 groups (p < 0.05). The small diameter decortication by Er:YAG laser appeared to provide better primary stability as compared to drill and piezosurgery. Decortication of the cortical bone before mini-implant insertion resulted in reduced risk of implant fracture or injury of adjacent teeth. The high initial stability with a smaller diameter of the mini-implant resulted in increased risk of fracture, especially for a self-drilling metho

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

Gingival reactive lesions in orally rehabilitated patients by free revascularized flap

The aim is to discuss four cases of gingival reactive hyperplastic lesions in patients with a history of excision of oral neoplastic lesions and rehabilitation by a free revascularized flap of the iliac crest. One female and 3 male patients were referred due to the presence of exophytic lesions at the rehabilitated sites. The clinical examination revealed that the poor oral hygiene was the common trigger factor in all the cases, in addition to trauma from the upper left second molar in the first case, pericoronitis related to a partially erupted lower right third molar in the third case, and poor stability of an upper removable partial denture in the fourth case. All the cases were subjected to elimination of these suspected triggering factors, exclusion of dysplasia, excisional biopsy by CO2 laser, and five follow-up visits. The histological examination of all the cases confirmed the diagnosis of pyogenic granuloma. These presented cases suggest that the limitations in oral functions and maintaining the oral hygiene measures following the free revascularized flap reconstruction surgery probably played a role in the development of gingival reactive hyperplastic lesions with presence of trigger factors such as local trauma, chronic infection, or inadequate prosthesis

Исследование в области химии производных карбазола

A biopsy is a surgical procedure performed to establish a clear diagnosis of a lesion in order to clarify a clinical diagnostic suspicion. During a biopsy procedure it is fundamental to maintain safe and readable cut margins in order to permit histological visualization of possible marginal infiltrations or malignant transformation of a lesion. The aim of this study was to evaluate the histological peripheral damage caused by application of a KTP (potassium titanium phosphate) laser during oral soft tissue biopsy procedures. A KTP laser (λ 532 nm) at different power settings and fluences was used to obtain 45 samples from pig cadaver tongues. The samples were then subdivided into five groups of nine samples each. A final specimen was taken by scalpel as a control. All samples were put into test tubes containing 10% buffered formalin solution, and were examined separately under an optical microscope by two pathologists to evaluate the peripheral thermal damage induced by the laser. In all specimens the cut edges of the incision were free from histological artefacts, especially when lower settings were applied. Statistical analysis showed no differences among the groups. The KTP laser demonstrated surgical effectiveness and caused little peripheral damage to the cut edges, and therefore would always allow a safe histological diagnosis to be obtained. © Springer-Verlag London Ltd 2010

Could the super-pulsed CO2 laser be used for oral excisional biopsies?

Background. The main purpose of a biopsy is microscopic examination and diagnosis. Keeping the margins of specimens safe and readable is always fundamental to detecting marginal infiltrations or malignant transformation. Numerous options and tools have been introduced for biopsy procedures. Lasers are one of these options that provide many enhancements to clinical and surgical biopsy procedures in comparison to scalpels. Objectives. The aim of the present study is to quantify the thermal artefacts in histological specimens obtained using a CO2 laser from different oral mucosal lesions and to evaluate if the resulting thermal effect hinders the histological examination. This aim is accomplished through quantitatively and qualitatively assessing the thermal effect in both the epithelium and connective tissue. Material and methods. A super-pulsed CO2 laser (10,600 nm) was used to obtain 10 excision biopsy samples. The parameters were a power of 4.2 W in focused mode and a frequency of 80 Hz in super-pulse mode. The histological analysis was performed with an optical microscope. Computerized imaging software was utilized to quantitatively evaluate the thermal effect in both the epithelium and connective tissue expressed in microns. Results. The thermal effect of the CO2 laser was limited to the surgical resection margins in all the specimens and did not hinder the histological analysis. Thermal artefacts were observed in 3 specimens. The range of thermal effects in the epithelial tissue was between 184 μm and 2,292 μm, while in the connective tissue it was between 133 μm and 2,958 μm. Conclusions. The resulting thermal effects of using a CO2 laser did not hamper the histological evaluation. Utilizing a laser in biopsy procedures should be tailored. Not only should laser parameters and safety margins be taken into consideration but also the working time, clinical accessibility, and the nature and water content of the tissue

Bone damage induced by different cutting instruments: an in vitro study

The aim of this study was to compare the peripheral bone damage induced by different cutting systems. Four devices were tested: Er:YAG laser (2.94 mm), Piezosurgery, high-speed drill and low-speed drill. Forty-five bone sections, divided into 9 groups according to different parameters, were taken from pig mandibles within 1 h post mortem. Specimens were fixed in 10% buffered formalin, decalcified and cut in thin sections. Four different parameters were analyzed: cut precision, depth of incision, peripheral carbonization and presence of bone fragments. For statistical analysis, the Kruskal-Wallis test was applied to assess equality of sample medians among groups. All sections obtained with the Er:YAG laser showed poor peripheral carbonization. The edges of the incisions were always well-shaped and regular, no melting was observed. Piezosurgery specimens revealed superficial incisions without thermal damage but with irregular edges. The sections obtained by traditional drilling showed poor peripheral carbonization, especially if obtained at lower speed. There was statistically significant differences (p<0.01) among the cutting systems for all analyzed parameters. Er:YAG laser, gave poor peripheral carbonization, and may be considered an effective method in oral bone biopsies and permits to obtain clear and readable tissue specimens