A randomized controlled trial comparing surgical excisional biopsies using CO2 laser, Er: YAG laser and scalpel

This randomized controlled trial (RCT) (ClinicalTrials.gov ID: NCT03001791) compared excisional biopsies of fibrous hyperplasia performed using a CO2 laser (140Hz, 400μs, 33mJ), Er:YAG laser (35Hz, 297μs, 200mJ, air-water cooling), or scalpel (15c blade). Clinical parameters recorded were duration of the intervention, intraoperative bleeding, need for electrocauterization and/or suturing, postoperative side effects, complications, pain, and intake of analgesics. Histopathological linear measurements of the thermal damage zone were performed on the laser biopsies. Results showed that the duration of the intervention was significantly shorter for both lasers compared to the scalpel (P<0.001). Intraoperative bleeding occurred less frequently with the CO2 laser (P<0.001). Additional electrocautery was used in 92% of Er:YAG laser interventions (P<0.001). Postsurgical complications, pain, and the intake of analgesics did not differ between the groups. The measured thermal damage zones differed significantly between the CO2 laser (median of 72.6μm) and Er:YAG laser (30.9μm) (P<0.001). This RCT showed that CO2 laser, Er:YAG laser, and scalpel are all adequate for excisional biopsies of small lesions in the oral mucosa. While patient postoperative morbidity is similar, the ideal instrument can be selected according to the surgical advantages preferred for the individual situation.status: publishe

Risk factors for external root resorption of maxillary second molars due to impacted third molars as evaluated using cone beam computed tomography

The purpose of this retrospective study was to evaluate risk factors for external root resorption (ERR) on maxillary second molars (MxM2) in association with impacted third molars (MxM3) using cone beam computed tomography (CBCT) scans. The angles between the axes of MxM2/MxM3 (inclination) were measured. Further, ERR on MxM2 was classified as absent, slight, moderate, or severe. Contact location between MxM3 and MxM2, the size of the dental follicle, type of impaction, root formation, and patient demographic characteristics were also assessed. Half of the 84 MxM2 showed ERR (slight 36.9%, moderate 6.0%, severe 7.1%). Patient age was a significant factor for the presence of ERR (P = 0.03). The inclination was also a relevant factor, with transverse MxM3 exhibiting the highest risk of ERR (P = 0.02). The cervical third (28.6%) showed a significantly lower risk percentage of ERR compared to the apical (73.7%) and middle thirds (60.6%) of the root (P = 0.004). Based on these findings, clinicians assessing the need for surgical removal should be able to selectively identify impacted MxM3 at risk of causing ERR on MxM2 early on, especially when the MxM3 is located in close contact with the apical and middle thirds of the MxM2 roots and has a transverse inclination.status: publishe

Is there a difference in frequency and type of maxillary sinus septa between dentate and edentulous posterior maxillae?

Background and Objectives: To evaluate and compare the frequency, type and origin of maxillary sinus septa in patients with a dentate and an edentulous posterior maxilla using cone-beam computed tomography (CBCT) imaging. Methods: The study included 100 maxillary sinuses – 50 from patients with a dentate and 50 from patients with an edentulous posterior maxilla – to evaluate the frequency, morphology and location of maxillary sinus septa in axial, sagittal and coronal CBCT images. Differences regarding age, gender, side, septa location and type of dentition (dentate/edentulous posterior maxilla) were analysed. Findings: The mean age of the patients was 58.3 years. A total of 60 sinus septa were found in exactly half of the evaluated sinuses. Most of the septa were located on the floor of the maxillary sinus (n = 34; 56.7%). Of these, the majority was found in the region of the second maxillary molars (n = 27; 79.4%). Regarding the distribution of sinus septa, septa were present in 26 (52%) dentate and in 24 (48%) edentulous regions. Thus, for a potential influence of the status of the dentition in the posterior maxilla on the frequency of sinus septa, no significant impact was found (P = 0.69). Conclusions: Sinus septa are equally often found in patients with a dentate and an edentulous posterior maxilla. As sinus septa are reported to be an important reason for surgical complications during sinus floor elevation procedures, a three-dimensional radiographic examination using CBCT prior to surgery might be helpful for diagnosis and treatment planning. Copyright © 2017 Published by Elsevier Ltd

Patent nasopalatine ducts: an update of the literature and a series of new cases

PURPOSE The objective of this review is to present an update and summary of clinical findings of cases with a patent nasopalatine duct (NPD) reported in the literature from 1881 to 2016. METHODS Previous articles and reviews about patent NPDs were studied and copies of all original publications were obtained for data verification. Furthermore, a literature search was conducted. In addition, the study sample was complemented with four cases recently seen in our institution. RESULTS Ten out of 67 published cases were to be excluded for this analysis due to misinterpretation or misreporting in previous articles. Overall, 57 cases with NPD patency could be analyzed. Males outnumbered females in a ratio of 2:1. The mean age (when this information was available) was 34.1 ± 17.6 years (range 6-69 years). NPDs were located bilaterally (60%), unilaterally (20%) or centrally (20%). Complete or partial patency was reported in 73.9 and 26.1%, respectively. 74.1% of patients presented a variety of clinical signs and symptoms. The ability of the patient to produce a squeaky or whistling sound was the most frequent clinical finding (23.8%). CONCLUSIONS Caution must be exercised when reading review articles about NPD patency since wrong data have been copied in several subsequent publications. Since epidemiological data are missing with regard to patent NPDs, age and gender predilections are not warranted. Bilateral occurrence and full patency were prevailing features in the evaluated case reports of patent NPDs