Application of piezosurgery in extraction of impacted third molars

Removal of impacted permanent third molars is considered to be one of the most common and routine oral surgical procedures. This intervention is usually performed in the classical way with the use of rotatory instruments and burs. As an alternative to this classical approach, piezosurgery can be used, which is an osteotomy technique based on ultrasonic vibrations. The crucial advantage of piezosurgery is that it is inert to soft tissues. The aim of this study was to compare piezosurgery with the rotatory osteotomy technique, with particular reference to the time required to perform the intervention and the intensity of postoperative sequelae: pain, swelling, and trismus. This paper summarizes published experiences and knowledge of piezosurgery, with special regard to the extraction of mandibular third molars. For the purposes of this research, an automatic detailed search was performed on the electronic database PubMed for the period 2012-2022. Keywords used in the search were: piezosurgery, impacted third molars. The initial filtration resulted in 47 scientific papers, 17 of which met the selection criteria. Of particular interest were papers such as Meta-analyzes and systematic reviews. A review of the literature indicates that although patients undergoing piezosurgery required longer operating times, they had less postoperative pain, swelling, and trismus. Keywords: impacted molar, piezosurgery

Management of patients with cystic fibrosis in oral and maxillofacial surgery

Cystic fibrosis, an autosomal recessive disease, is considered to be the most lethal inherited trait among Caucasians. The median age for the CF patient has significantly increased over the past 60 years. This study will review diagnosis, pathophysiology, and eventual systemic complications of CF and discuss relevant information for management of the CF patient for the oral and maxillofacial surgeon. The aim of this study is to prove the connection between the cystic fibrosis and the oral health of the patient. For this study, five patients with cystic fibrosis were treated at the clinic of oral surgery. They were evaluated thoroughly to prevent future complications. In preoperative assessment, the pulmonary status, nutritional status and blood glucose levels were identified. The usual doses of antibiotics, cardio tonic drugs, bronchodilators etc. were considered where it was necessary into the preoperative period. Depending on the nature, duration, and complications of the surgical procedure, patients were taken care of in the postoperative period. Every patient in our study went through the treatment successfully without specific complications with the appropriate procedures and protocols. With preoperative preparation and premedication, timing of the surgery, monitoring during the intervention and special post-operative care is necessary for creating specific protocol for surgical interventions on patients with cystic fibrosis. Patients with cystic fibrosis require consistent, regular follow-up. Keywords: Cystic fibrosis, premedication, protocol, surgery

Management of the patient with cystic fibrosis in oral and maxillofacial surgery

Cystic fibrosis, an autosomal recessive disease, is considered to be the most lethal inherited trait among Caucasians. The median age for CF patients has significantly increased over the past 60 years. This study will review the diagnosis, pathophysiology, and eventual systemic complications of CF and discuss relevant information for the management of CF patients for the oral and maxillofacial surgeon. The aim of this study is to prove the connection between cystic fibrosis and the oral health of the patient. For this study, five patients with cystic fibrosis were treated at the clinic of oral surgery. They were evaluated thoroughly to prevent future complications. In preoperative assessment, the pulmonary status, nutritional status and blood glucose levels were identified. The usual doses of antibiotics, cardio tonic drugs, bronchodilators etc. were considered where it was necessary into the preoperative period. Depending on the nature, duration, and complications of the surgical procedure, patients were taken care of in the postoperative period. Every patient in our study went through the treatment successfully without specific complications with the appropriate procedures and protocols. With preoperative preparation and premedication, the timing of the surgery, monitoring during the intervention, and special post-operative care are necessary for creating a specific protocol for surgical interventions on patients with cystic fibrosis. Patients with cystic fibrosis require consistent, regular follow-up. Keywords: Cystic fibrosis, premedication, protocol, surgery

Effectiveness of the impact of second-generation platelet-rich fibrin prf in the treatment of localized individual gingival recessions miller I and II (case report)

The muco-gingival surgical modality SCTG + CAF(subepithelial connective tissue graft-SCTG + coronary positioned flap-CAF) in the treatment of Miller I and II gingival recessions is considered the “gold standard” technique for predictive and complete root coverage of the gingival defects, with long-term clinical stability of the results obtained. The counterpart of this type of technique is the relatively young PRF + CAF operating mode, which recently has a large number of supporters, primarily due to the biological characteristics of this autologous platelet concentrate-PRF (angiogenesis, mitogenesis, osteopromotion, immunomodulation and stem cell entrapment). Aim: The aim of this paper is to evaluate the clinical efficiency of the CAF + PRF combined technique in the treatment of localized individual gingival recessions Miller I and II, by comparing the values of periodontal clinical parameters measured preoperatively and 1 month postoperatively, as well as by the obtained immunohistochemical analysis of the biopsy material taken from the recipient site (the area of the grafted gingival defect), 1 month postoperatively. Material and method: Case report: A 37-year- old man was admitted to the Clinic “St. Panteleimon-Skopje, at the Oral Surgery department for surgical treatment of localized maxillary gingival recession Miller II, tooth 31. Preoperative measurements of periodontal clinical parameters were performed: vertical dimension of gingival recession (RD / VGR), depth of periodontal pocket (PPD/PD) keratinized / attached gingival level (CAL), keratinized gingival width (KTW/ KMW) and gingival thickness (GT) all measured in mm, including gingival biotype. CAF + PRF therapeutic modality is used to treat gingival defect. One month postoperatively, re-measurements of the values of the clinical periodontal indices were performed and they were compared with the measurements obtained preoperatively. Results: Significant reduction of RD, PPD and CAL values were determined on the measurements 1 month postoperatively. Conclusion: Insignificant values of KTW and GT were noted one month post.opp. There are no changes in gingival biotype before and postoperatively. PRF as a second generation of autologous concentrate is not only an adjuvant and / or replacement of the SCTG- “gold standard” in the treatment of Miller I and II, but is also a superior alternative in the surgical treatment of this type of superficial mucogingival defects

Clinical effects of using PRF in socket preservation

Introduction: Preservation of the post-extraction socket, as part of guided bone regeneration, is recommended to create the biological foundation for future implant-prosthetic or prosthetic construction. For this purpose, are used many graft materials, alone or in combination. A-PRF as an autologous blood derivative has been increasingly used in recent years due to its properties in angiogenesis, epithelialization and hemostasis. Easy preparation, low cost and no use of anticoagulants and bovine fibrin are advantages for its widespread use. Aim: To evaluate the effectiveness of the two methods used in the preservation of hard and soft tissues volume, bone quality and the impact of A-PRF on postoperative morbidity. Material and method: Two case studies are described, the one using a combination of A-PRF with xenograft, and the other one using solo A-PRF as post-extraction socket preservation methods. Results: Clinical measurements of the height and width of the post-extraction alveolus and the height of the interdental papilla were performed, and the density of the newly formed bone was measured through CBCT, noted in a tabular view. Postoperative morbidity was also evaluated. Conclusion: From the results obtained in the two case reports shown, it can be concluded that A-PRF, is an economical, autologous and simple autologous graft material is recommended for use in the of a post-extraction socket preservation, as a solo graft material, or in combination with a particulate graft. The volume-preserving properties were confirmed, with better quality and architectonics of the de nuovo formed bone, as well as an easier period of postoperative convalescence are confirmed

Simplified surgical extraction planning using cone beam computed tomography

Introduction: An impacted tooth is one that fails to erupt within the dental arch in the expected time and away from its anatomic position. Treatment decision depends on several factors: location of the impaction, prognosis of the intervention on the impacted tooth and adjacent teeth, surgical accessibility, impact of treatment on the final functional occlusion, and possible surgical morbidity. This decision has traditionally been based on planar 2-dimensional (2D) radiography. New imaging techniques like cone-beam computed tomography (CBCT), which has a lower-dose and lower-cost alternative to conventional CT can direct us in proper planning and make it easier. Case presentation: A 43-year-old woman complained of facial pain and headache, with no signs of any disorders but, based on a panoramic radiograph, with the presence of impacted maxillary wisdom teeth. 3D CBCT scans were performed to evaluate the position and direction of the impacted teeth in the maxillary sinus and related teeth. We noticed that the left third maxillar molar lying on the root of the second maxillar molar and the right one located inside the maxillary sinus, were not clearly demonstrated on panoramic radiography. After that, an appropriate and concise treatment plan was set up and successful surgical removal was done. Conclusion: CBCT offers 3-dimensional and multi-planar views for a more accurate diagnosis and easier and more appropriate planning for a minimally possible invasive treatment approach without radiation exposure of conventional computed tomography (CT) scans. Keywords: Ectopic wisdom teeth, Cone Beam Computed Tomography, surgical planning, extractio

Treatment possibilities and postoperative complications at extracapsular fractures of the mandibular condyle

Objective: Mandibular condylar fractures represent 25%–35% of all mandibular fractures. The treatment of mandibular condyle fractures remains controversial despite many studies regarding the subcondylar type of fracture. The aim of this study is to analyze the outcome and recovery rates after open and closed treatment of extracapsular mandibular condyle fractures, regarding postoperative malocclusion, mouth opening, wound healing, pain, and swelling. Materials-Methods: A retrospective cohort study based on 377 condylar fractures and prospective comparative study on a total of 16 patients were implemented, using two study groups – group A, consisted of 8 patients with placed closed vacuum drain, and 8 patients in group B, without closed vacuum drain, measured on 1st and 3rd postoperative days, whereas both the parameters were comparable on the 7th and 15th postoperative days. Results: Evaluation of the early postoperative sequels, showed significantly higher values in group B, while malocclusion was the most frequent long-term complication after open reduction and rigid intermaxillary fixation (ORIF). Conclusion: There was no statistically significant difference in the incidence of pain, mouth opening, swelling, and wound healing in patients with and without closed suction wound drainage after ORIF of condylar fractures. ORIF, using a retromandibular transparotid approach, is the appropriate treatment of choice for extracapsular condylar fractures of the mandible. Keywords: extracapsular fractures, condyle, open reduction, postoperative complication