A technique for the treatment of maxillary sinus membrane perforations occurred during endodontic surgery: a prospective comparative evaluation

Abstract Objectives The aim of this study was to evaluate the use of PRGF in endodontic surgery to treat sinus membrane perforation. Materials and methods A total of 20 patients (ten per group) were included. In the control group the lesion of the sinusal membrane was treated with collagen sponge. In the test group PRGF was used to close the communication with the sinus cavity. Results and conclusions The use of PRGF resulted in better postoperative quality of life parameters if compared to the negative control group. Perceived pain was significantly lower in the test group than in the control one for the first six days after intervention

Diagnostic issues dealing with the management of teeth with vertical root fractures: a narrative review

Abstract Aim The objectives of this study were to review the existing literature of vertical root fractures (VRFs) dealing with its management and to describe a classification for the bone defects resulting after extraction. Methodology An electronic search was performed on biomedical databases using a combination of appropriated search terms combined through the use of Boolean operators. A classification of the bone defects associated with vertical root fracture (VRF) was also proposed. Results Outcomes data extracted from the selected articles were summarized. Conventional radiography could fail in directly detecting the presence of VRF but can allow finding bone resorption areas which are related to the fracture itself. Tridimensional radiography (CBCT) may allow a better visualization of such bone defects. The bone defects associated to VRF could be classified on the basis of the number of walls affected and of the depth (in apico-coronal direction). Conclusions The diagnosis of VRF is a challenging process that includes both clinical and radiographic examination. In most cases, when postextraction implant was placed, guided bone regeneration is required to compensate the bone defect caused by VRF. A deep knowledge of the characteristics of the associated bone defect may allow an immediate and predictable substitution with dental implants, when tooth extraction is the only option

Tooth as graft material: Histologic study.

BACKGROUND An effective regenerative protocol is key to reestablish and maintain the hard and soft tissue dimensions over time. The choice of the graft material and its properties also could have an impact on the results. To prevent alveolar ridge dimensional changes, since numerous graft materials have been suggested and in the past years, a growing interest in teeth material has been observed as a valuable alternative to synthetic biomaterials. AIM The aim of the study was to explore the histomorphometric outcomes of tooth derivative materials as used as bone substitute material in socket preservation procedure. METHODS After alveolar socket preservation (ASP) procedures using autologous demineralized tooth as graft material prepared by means of an innovative device, was evaluated. A total of 101 histological samples, from 96 subjects, were analyzed by evaluating the total amount of bone (BV), residual tooth material (residual graft, TT), and vital bone (VB). The section from each sample was then split in nine subsections, resulting in 909 subsections, to allow statistical comparison between the different areas. RESULTS It was not noticed a statistically significant difference between maxillary and mandibular sites, being the amount of VB in upper jaw sites 37.9 ± 21.9% and 38.0 ± 22.0% in lower jaw sites and the amount of TT was 7.7 ± 12.2% in maxilla and 7.0 ± 11.1% in mandibles. None of the other considered parameters, including defect type and section position, were statistically correlated to the results of the histomorphometric analysis. CONCLUSIONS ASP procedure using demineralized autologous tooth-derived biomaterial may be a predictable procedure to produce new vital bone potentially capable to support dental implant rehabilitation

Nonsurgical Treatment of Peri-Implantitis: Case Series

Peri-implantitis is one of the most important biological complication of dental implants. It has inflammatory nature, proved association with plaque accumulation in peri-implant tissues, and can be progressive on background of several factors, like comorbidity factors and bad habits. The prophylaxis and different methods of treatment were discussed during last 30 years, and surgical and nonsurgical techniques have their foes, benefits, and disadvantages. In this article, we describe the case series of various nonsurgical treatments of peri-implantitis with the use of protocols based on the application of local antibiotics (doxycycline, lincomycin, and erythromycin), mechanical and chemical debridement of dental implant surface, and mini-invasive regenerative technique with injections of bovine collagen. All these three cases demonstrated good results with the maintenance of bone level and absence of clinical signs of inflammation for at least a year according to the X-ray imaging (bone defect volume) and clinic assessments (probing depth, bleeding or suppuration, mucosa color, and pain presence)

Surgically-oriented anatomical study of mandibular premolars : a CBCT study

The knowledge of root canal anatomy and of the anatomical relationship should be considered mandatory when planning surgical endodontics. The aim of the study was to investigate the anatomical features of mandibular premolars, evaluating their relationship with mental nerve. CBCT scans were evaluated recording the number of roots, root canal configuration and the relationship with mental nerve of 100 mandibular premolars. After simulating a resection of 3 mm of the root, the shape and the number of canals, and the distance to the buccal and lingual bone plate and to the mental foramen was evaluated. The one root - one canal configuration was the most common configuration. The mental foramen was located at the level of MSPs in 40% cases, and it was between MSP and MFP in 46% of cases. The distance between the apex and the vestibular plate was lower than the distance to the lingual one. We found a significant heterogeneity in the anatomy of mandibular premolars. CBCT could be considered important when planning surgical endodontics in this region

Osteotome-Mediated Sinus Lift without Grafting Material: A Review of Literature and a Technique Proposal

Implant rehabilitation of the edentulous posterior maxilla may be a challenging procedure in the presence of insufficient bone volume for implant placement. Maxillary sinus augmentation with or without using grafting materials aims to provide adequate bone volume. The aim of the present study was to systematically review the existing literature on transalveolar maxillary sinus augmentation without grafting materials and to propose and describe an osteotome-mediated approach in postextraction sites in combination with platelet derivative. The systematic review showed that high implant survival rate (more than 96% after 5 years) can be achieved even without grafting the site, with a low rate of complications. Available alveolar bone height before surgery was not correlated to survival rate. In the described case report, three implants were placed in posterior maxilla after extraction of two teeth. An osteotome-mediated sinus lifting technique was performed with the use of platelet derivative (PRGF); a synthetic bone substitute was used to fill the gaps between implant and socket walls. No complications occurred, and implants were successfully in site after 1 year from prosthetic loading. The presented technique might represent a viable alternative for the treatment of edentulous posterior maxilla with atrophy of the alveolar bone though it needs to be validated by studies with a large sample size

Comparison of Antimicrobial Substantivity of Six Root Canal Irrigants against Enterococcus faecalis

Introduction: The antimicrobial substantivity of Mixture of Doxycycline, Citric acid, and Tween 80 (MTAD), Tetraclean, Tetraclean NA, Q-Mix, 2% Chlorhexidine (CHX) and Octenisept was assessed in human root dentine blocks infected with Enterococcus (E.) faecalis. Methods and Materials: A total of 170 dentine tubes were prepared from human maxillary incisors. After crown and apical third removal, cementum was abraded. The remaining center-holed pieces were cut into 4-mm blocks, infected with E. faecalis in Brain Heart Infusion (BHI) broth for 28 days, then randomly divided into 6 experimental groups (n=25) and 2 controls (n=10). At 0, 7, 14, 21 and 28 days, dentine chips were removed from the canals, with sequential round burs with increasing diameters, and collected into freshly prepared BHI broth. After culturing, growing colonies were counted as colony forming units (CFU). Conventional non-parametric tests (Kruskal-Wallis and Mann-Whitney tests) were used to assess intra-group (at different time frames) and inter-group (at each experimental time) differences (P=0.05). Results: Tetraclean yielded the lowest CFU counts (P<0.001) at each observation time. Tetraclean NA and Q-Mix showed better (P<0.001) substantivity than 2% CHX and MTAD (except for Q-Mix versus MTAD at 14 days, P=0.21). Conclusions: In this in vitro study, Tetraclean NA and Q-Mix displayed the best antimicrobial substantivity against E. faecalis after Tetraclean in infected human root dentine. Considering the findings of our study and potential drawbacks of antibiotic-based irrigants, free-antibiotic irrigants may represent viable alternative for final rinse in root canal treatment.Keywords: Antimicrobial Substantivity; Enterococcus faecalis; MTAD; Qmix; Tetraclea

Computerized Tomography Technique for the Investigation of the Maxillary First Molar Mesiobuccal Root

The aim of this paper was to review the literature about the use of computerized tomography to evaluate the presence and characteristics of the second mesiobuccal canal in the maxillary first molar. An electronic search was performed. Frequencies of the presence of second mesiobuccal canal and root anatomy characteristics were extracted from the selected studies. Pooled frequencies were calculated as weighted means. Seven articles were included. A second mesiobuccal canal was present in 59.32% of the teeth, and it was noncommunicating in 58.45% of teeth presenting the canal itself. The most common root canal morphology was single canal or two separated canals. The present paper showed that cone beam CT is a viable radiologic device for the evaluation of the mesiobuccal root of maxillary first molars. In fact, it was observed that the frequency of second mesiobuccal canal detection is similar to those presented by clinical studies or micro-CT evaluations

Prevalence of Peri-Implantitis: A Multi-Centered Cross-Sectional Study on 248 Patients

The aim of this multicenter cross-sectional study was to determine the prevalence of peri-implantitis and to assess its association with several patient- and implant-related factors. Patients with at least one implant, who came for a recall visit to one of the four centers over a period of five months, were enrolled. Presence of peri-implantitis (defined as bleeding on probing, exudate/suppuration, bone loss > 0.2 mm/year and increased pocket depth) and several other variables (e.g., smoking habits, history of periodontitis, diabetes) were recorded. Out of 248 enrolled patients (1162 implants), 10 patients had at least one implant with peri-implantitis (4.03%); a total of 14 implants were affected (1.20%). A statistically significant association between peri-implantitis and diabetes was found (OR 8.65; CI: 1.94–38.57). Smoking more than 10 cigarettes per day (OR: 0.53; CI 0.03–9.45) and history of periodontitis (OR: 2.42; CI: 0.49–11.89) were not found to be statistically associated with peri-implantitis. Even if implant therapy is a consolidated treatment, biological complications do happen. Strict supportive therapy recalls could lead to lower rates of peri-implantitis and earlier diagnosis

Il posizionamento di impianti in siti infetti come alternativa al trattamento endodontico secondario : revisione della letteratura

RiassuntoObiettiviValutare e discutere i risultati clinici di riabilitazioni supportate da impianti posizionati in siti infetti per ragioni di tipo endodontico.Materiali e metodiÈ stata effettuata una ricerca su Medline™ ed EMBASE™ su articoli pubblicati dal 1966 ad aprile 2011 riportanti un follow-up minimo di 6 mesi.RisultatiL'inserimento immediato di impianti dopo l'estrazione di elementi con infezione di origine endodontica, dopo attenta revisione dell'alveolo, può essere considerata una tecnica valida, con percentuali di successo che sono paragonabili a quelle del trattamento endodontico secondario.ConclusioniDal momento che gli studi clinici su questo argomento sono scarsi, il livello di evidenza è basso, il periodo di follow-up è limitato e sono quindi necessari altri studi al fine di valutare la pertinenza di questa alternativa di trattamento.SummaryObjectivesTo perform a literature review in order to evaluate the clinical outcomes of restorations supported by implants placed immediately after extraction in endodontically infected sockets.Materials and methodsA Medline™ and EMBASE™ search was performed on articles published from 1966 to April 2009. A minimum of 6 month follow-up was required.ResultsImmediate implant placement after extraction of teeth with endodontic infection, performed after careful socket debridement, can be considered a viable technique. The reported survival rates are similar to those reported for secondary endodontic treatment.ConclusionsSince the clinical reports on this topic are scarce, the level of evidence is low and the follow-up period is limited, more well-designed studies are required in order to assess relevance of this treatment alternative