1,720,994 research outputs found
Diode laser photocoagulation of sublingual varices in 706 patients on antithrombotic therapy without drug discontinuation
Full text linkSeveral conditions such as age, gender, systemic diseases, smoking, consuming vitamin rich foods, denture wearing may play a role in aetiology of sublingual varices. However, few studies investigating these associations. Nevertheless, prevention of potential bleeding of sublingual varices especially in patients in antithrombotic therapy should led clinicians to treat them by diode laser, since it allows a minimally invasive treatment of photocoagulation. We report on a large sample of patients (706) showing single or multiple SVs on antithrombotic therapy, highlighting the possibility to treat lesions without drug discontinuation and without intra- and post -operative complications. KEY WORDS: Antithrombotic therapy, Bleeding, Diode laser photocoagulation, Sublingual varices
The Effectiveness of Ropivacaine and Mepivacaine in the Postoperative Pain after Third Lower Molar Surgery
Full text linkAIM:To compare the efficacy of 0.75% ropivacaine with 3% mepivacaine for pain control in the first 24 hours after surgical removal of lower third molars, using a quantitative measurement such as VAS. The secondary objective involved rescue analgesia.
METHODS:
Forty-five patients, 21 females and 24 males, mean age 23,2 ± 3 years, underwent surgical removal of third molars in two separate sessions. A split-mouth design was chosen, so each patient underwent both the first and second surgeries, having for each extraction a different anesthetic. The second extraction was carried out 1 month later. Parameters evaluated were: onset of anesthesia, duration of surgery, lip numbness, timing of pain appearance and first analgesic intake.
RESULTS:
No significant differences about onset of anesthesia, duration of surgical procedures, and timing of first analgesic intake were found. Lower lip numbness, on the other hand, was more prolonged after using ropivacaine (p < 0.0001) and the onset of postoperative pain was more delayed after anesthesia with ropivacaine (p=0.0048). Pain scores at 1 and 2 hours after surgery were 3.5 ± 2.0 and 4.1 ± 1.3 after injection of mepivacaine, and 2.7 ± 2.2 and 2.9 ± 2.4 after ropivacaine (p value =0.006 for both time points). No significant differences in pain score were recorded between the two anesthetics at 12 and 24 hours post surgery.
CONCLUSIONS:
With the use of ropivacaine, the discomfort caused by prolonged lip numbness is counterbalanced by less postoperative discomfort after surgery. In addition, when compared with other long-acting anesthetics, ropivacaine ensures a safer anesthetic profile for medically complex patients
Temporomandibular disorders in psoriasis patients with and without psoriatic arthritis: an observational study.
No full textTemporomandibular disorders in psoriasis patients with and without psoriatic arthritis:an observational study. Aim. Psoriasis is a chronic, remitting and relapsing inflammatory disorder, involving the skin, nails, scalp and mucous membranes, that impairs patients’ quality of life to varying degrees. Psoriatic arthritis (PsA) is a chronic seronegative, inflammatory arthritis, usually preceded by psoriasis. Temporomandibular disorders (TMD) is a generic term referred to clinical conditions involving the jaw muscles and temporomandibular joint (TMJ). The aim of this study was to assess symptoms and signs of TMD in psoriasis patients with and without PsA. Methods. The study group included 112 patients (56 men, 56 women; median age 49.7±12 years) with psoriasis; 25 of them were affected by PsA. A group of 112 subjects without psoriasis (56 men, 56 women; median age 47.7±17 years) served as controls. Signs and symptoms of TMD were evaluated according to the standardized Research Diagnostic Criteria for Temporomandibular
Disorders (RDC/TMD). Psoriasis patients were subgrouped according to the presence/absence of PsA and also by gender, to assess the prevalence of traditional TMD symptoms and signs.
Results. Patients with psoriasis, and to an even greater extent those with PsA, were more frequently affected by TMD symptoms and signs, including an internal TMJ opening derangement (OD) than healthy subjects. A statistically significant increase in TMDs, OD, bruxism (BRUX) and temporomandibular joint sounds (TMJS) was found in patients with PsA as compared with psoriasis patients without arthritis and controls. Conclusion. Psoriasis seems to play a role in TMJ disorders, causing an increase in orofacial pain and an altered chewing function
Keratocystic odontogenic tumors as first clinical manifestation of nevoid basal cell carcinoma syndrome in pediatric age: our microinvasive surgical approach.
Full text linkKeratocystic odontogenic tumors as first clinical manifestation of nevoid basal cell carcinoma syndrome in pediatric age: our microinvasive surgical approach.
Aim. Nevoid Basal Cell Carcinoma Syndrome (NBCCS) is a rare genetic condition involving multiple organs; Keratocystic Odontogenic Tumors (KCOTs) are often the first clinical manifestation in pediatric age. The aim of this study was to describe the clinical and histopathological features of KCOTs as first clinical sign of NBCCS in pediatric patients allowing an early diagnosis, and their treatment with conservative microinvasive piezosurgery. Methods. Twenty pediatric patients affected by NBCCS showing 60 KCOTs came to our attention at the Complex Operating Unit of Odontostomatology, Policlinic of Bari, from 1996 to 2014. After clinical examination, OPT and computed tomography analysis, all patients underwent conservative micro-invasive surgical treatment under general anesthesia, consisting in enucleation of KCOTs, cavity ostectomy and osteoplasty with conventional rotative instruments and piezoelectric tools in order to remove damaged bone, epithelial remnants and satellite cysts with maximal teeth preservation in consideration of the young age of the patients, and to possibly minimize the recurrence risk. A sterile gel formulation of sodium hyaluronate and amino acids (Gly-Pro-Leu-Lys) was put into the bone defect, allowing for faster bone regeneration and healing of the surgical site. All the surgical specimens were sent for histopathological examination. The patients underwent clinical and radiological (OPT) follow-up after 7, 15 and 30 days, 2, 3, 6 and 12 months, and, then, once a year. The followup time ranged from 18 months to 8 years. Results. There were 10 males and 10 females, with an average age of 10,6 years. At the initial evaluation, 13 patients showed swelling, teeth agenesis, and dental inclusions or dislocations as first clinical manifestation of their disease; in the remaining cases, KCOTs were asymptomatic. Among the 20 patients, 11 had been previously diagnosed with NBCCS because of familiarity or presence of characteristic features of the syndrome, while KCOTs were the first clinical sign of NBCCS for the remaining 9 patients without familial history of the syndrome; subsequently, the genetic analysis showing PTCH1 mutations confirmed the diagnosis. 60 KCOTs were totally identified: 39 lesions were located in the mandible and 21 lesions were located on the upper jaw. The histopathological analyses highlighted thin connective tissue walls covered by para- and orthokeratotic stratified squamous epithelium, usually about 5-8 cell layers thick, around cystic lumens filled with desquamated keratin, thus confirming the diagnosis of KCOT. The epithelial lining included a well-defined, palisading basal layer of cuboidal to small columnar cells and a superficial layer with corrugated appearance. Satellite cysts could also be seen due to tissue budding of the basal cell layers into the adjacent connective tissue. The clinico-radiological follow-up of 53 lesions showed progressively decreased radiolucent areas up to complete healing within 12 months from the surgical treatment. Differently, OPT disclosed lack of decreasing radiolucency of 7 lesions after 12 months suggesting KCOTs recurrence, that is more frequent in syndromic KCOTs than in sporadic ones due to their higher dimensions and to the involvement of nobile structures such as teeth which should be preserved in these young patients as much as possible.
Conclusion. KCOTs in pediatric patients require conservative approaches for permanent teeth preservation. While conventional enucleation leads up to 60% recurrence rates, cavity ostectomy with piezoelectric tools significantly reduced the recurrence risk allowing the preservation of permanent teeth
Medication-Related Osteonecrosis of the Jaws: Considerations on a New Antiresorptive Therapy (Denosumab) and Treatment Outcome after a 13-Year Experience
Full text linkMedication-related osteonecrosis of the jaw (MRONJ) is a serious complication in patients receiving antiresorptive therapies for bone neoplastic localizations and osteoporosis. The aim of this study was to evaluate the clinicopathological features of MRONJ in a cohort of patients treated by new antiresorptive drugs (denosumab) and the corresponding outcome after 13-year maximum follow-up. Overall, 244 patients affected by MRONJ were treated from 2003 to 2015. After clinical and radiological examinations, all lesions were staged according to a dimensional staging system and then surgically treated. All the denosumab-related lesions were classified as stage II or III, thus requiring a more or less invasive surgical approach, despite the results of many recent studies, which suggested a conservative medical approach with early resolution for MRONJ in patients on denosumab. In the current series, 86.9% of treated lesions showed complete clinical and radiological healing, while 13.1% recurred; all recurrences were detected in patients who could not interrupt chemotherapy, steroids, and/or antiresorptive drugs administration due to their general conditions. In conclusion, all oral specialists should be aware of the MRONJ risk among patients taking new antiresorptive drugs; moreover, our protocol based on surgical treatment guided by dimensional staging could be considered effective in view of the low recurrence rate
Diode laser treatment of venous lake of the lip
Full text linkKey Clinical Message: The diode laser promotes regression of the small venous lake of the lip by forced dehydration with induced photocoagulation of the lesions, with an uneventful postoperative course and anesthetic sequelae
Peri-Implant Metastasis as First Manifestation of an Unknown Lung Cancer: Literature Review and Two New Cases
No full textMetastases around dental implants are extremely rare. They usually represent a secondary localization of a multiorgan metastatic neoplasm but also are, exceptionally, recognized as the first clinical manifestation of a still unknown cancer of whatever organ. Metastases usually manifest as rapidly growing lesions of hard and soft tissues and always represent a true diagnostic/therapeutic dilemma both for clinicians in choosing the more appropriate treatment and for pathologists in recognizing the primary tumor when still undiagnosed. We report 2 distinct cases of metastasis occurring around dental implants in the maxilla and mimicking peri-implantitis at the onset; more precisely, in one case, the lesion involved exclusively the alveolar bone, where an implant were previously inserted, while in the other case, a neoplasm caused bone destruction around the fixture with an impressive and rapid exophytic growth. In both cases, maxillary lesions were the first metastatic manifestation of an unknown adenocarcinoma of the lung
Oral Intravascular Papillary Endothelial Hyperplasia (IPEH): Analysis by Confocal Laser Scanning Microscopy in Two Cases
No full textIntravascular papillary endothelial hyperplasia (IPEH) was
first described in 1923 as Masson’s tumour and is currently
believed to be a relatively uncommon benign, non-neoplastic
vascular lesion. We report two cases of IPEH occurred on the
mouth floor in female patients, presenting as slightly elevated
great lesions with oval form, firm consistency, and red-bluish
colour. FNAB was performed and the surgical samples were fixed
in formaline, stained with Haematoxylin-eosin and Picrosirius
red, and analyzed at Confocal Laser Scanning Microscope
(CLSM). The histological examination showed an exuberant
intravascular endothelial proliferation comprising papillary formations
and anastomosing cavernous-like vascular channels.
CLSM highlighted a well-defined lesion consisting of cystic
spaces with blood content rounded by elongated irregular
papillae, and vascular connective stroma. Thus, diagnosis of
IPEH was made. Achieving a correct diagnosis is essential to
avoid subjecting a patient to unnecessarily aggressive therapy.
We performed Diode Laser excision and patients had no evidence
of recurrences
Metastatic breast cancer in medication-related osteonecrosis around mandibular implants
No full textBACKGROUND:
Many authors have considered dental implants to be unrelated to increased risk of medication-related osteonecrosis of the jaw (MRONJ). Nevertheless, more recently, more cases of peri-implant MRONJ (PI-MRONJ) have been described, thus becoming a challenging health problem. Also, metastatic cancer deposits are not infrequently found at peri-implant sites and this may represent an additional complication for such treatments. We present the case of a breast cancer patient with PI-MRONJ, presenting a clinically and radiologically undetected metastasis within the necrotic bone, and highlight the necessity of an accurate histopathological analysis.
CASE REPORT:
A 66-year-old female patient, who had received intravenous bisphosphonates for bone breast cancer metastases, came to our attention for a non-implant surgery-triggered PI-MRONJ. After surgical resection of the necrotic bone, conventional and immunohistochemical examinations were performed, which showed breast cancer deposits within the necrotic bone.
CONCLUSIONS:
Cancer patients with metastatic disease, who are undergoing bisphosphonate treatment, may develop unusual complications, including MRONJ, which is a site at risk for hosting additional metastatic deposits that may be clinically and radiologically overlooked. Such risk is increased by previous or concomitant implant procedures. Consequently, clinicians should be prudent when performing implant surgery in cancer patients with advanced-stage disease and consider the possible occurrence of peri-implant metastases while planning adequate treatments in such patients
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