Publications by authors named "Maddalena Manfredi"

62 Publications

Activity of Two Antimicrobial Peptides against in a Model of Biofilm-Mediated Endodontic Infection.

Antibiotics (Basel) 2021 Oct 7;10(10). Epub 2021 Oct 7.

Laboratory of Microbiology and Virology, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.

is a common cause of biofilm-associated opportunistic infections, which are often difficult to treat. The formation of biofilms on the dentinal walls of the root canal is frequently the cause of endodontic treatment failure and secondary apical periodontitis. In a preliminary work, two recognized antifungal peptides, KP and L18R, showed antibacterial activity against planktonic cells at micromolar concentrations. Moreover, L18R proved to reduce the biomass in the early stage of biofilm development on polystyrene plates, while a qualitative biofilm inhibition was demonstrated on hydroxyapatite disks by confocal laser scanning microscopy (CLSM). The aim of this study was to better characterize the effect of both peptides on biofilm. A reduction in metabolic activity after peptide treatment was detected by Alamar Blue assay, while a remarkable impairment in the architecture of biofilms on hydroxyapatite disks, along with a significant reduction in viable bacteria, was caused mostly by L18R, as assessed by CLSM and scanning electron microscopy. The lack of cytotoxicity of the investigated peptides against L929 murine fibroblasts was also determined. Obtained results suggest L18R as a promising candidate for the development of new strategies for endodontic infection control.
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http://dx.doi.org/10.3390/antibiotics10101220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8532894PMC
October 2021

Chronic mechanical trauma/irritation and oral carcinoma: A systematic review showing low evidence to support an association.

Oral Dis 2021 Oct 12. Epub 2021 Oct 12.

Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy.

Background: Chronic trauma of oral mucosa, resulting from repeated and persistent mechanical irritative action of an intraoral injury agent, has repeatedly been reported to be possibly implicated in the development of oral squamous cell carcinoma (OSCC).

Objectives: The present systematic review aimed to assess whether chronic mechanical trauma can be considered a risk factor for OSCC.

Data Sources: PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), Scopus; EMBASE, Web of Science.

Study Eligibility Criteria: Cohort studies comparing OSCC incidence among subjects with/without chronic mechanical trauma or case-control or cross-sectional studies comparing chronic mechanical trauma among subjects with/without OSCC.

Results: Only one prospective case-control study fulfilled the inclusion criteria, but the quality of the evidence provided is not enough to define trauma as a risk factor for OSCC. The main limitation is the presence of only one case-control study at high risk of bias. In the absence of strong evidence supporting the role of trauma in OSCC, a thorough discussion on trauma and carcinogenesis has been performed.

Conclusions: Available evidence does not support an active role for chronic trauma in oral carcinogenesis, neither as promoter nor as progressor factor. Prospective cohort studies able to better assess trauma in OSCC are needed.
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http://dx.doi.org/10.1111/odi.14049DOI Listing
October 2021

Oral lesions postinjection of the first administration of Pfizer-BioNTech SARS-CoV-2 (BNT162b2) vaccine.

Oral Dis 2021 May 12. Epub 2021 May 12.

Dentistry Unit, Department of Medicine and Surgery, Centro Universitario di Odontoiatria, University of Parma, Parma, Italy.

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http://dx.doi.org/10.1111/odi.13912DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242700PMC
May 2021

Antibiotics to prevent complications following tooth extractions.

Cochrane Database Syst Rev 2021 02 24;2:CD003811. Epub 2021 Feb 24.

School of Dentistry, University of Parma, Parma, Italy.

Background: The most frequent indications for tooth extractions, generally performed by general dental practitioners, are dental caries and periodontal infections. Systemic antibiotics may be prescribed to patients undergoing extractions to prevent complications due to infection. This is an update of a review first published in 2012.

Objectives: To determine the effect of systemic antibiotic prophylaxis on the prevention of infectious complications following tooth extractions.

Search Methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health Trials Register (to 16 April 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2020, Issue 3), MEDLINE Ovid (1946 to 16 April 2020), Embase Ovid (1980 to 16 April 2020), and LILACS (1982 to 16 April 2020). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

Selection Criteria: We included randomised, double-blind, placebo-controlled trials of systemic antibiotic prophylaxis in patients undergoing tooth extraction(s) for any indication.

Data Collection And Analysis: At least two review authors independently performed data extraction and 'Risk of bias' assessment for the included studies. We contacted trial authors for further details where these were unclear. For dichotomous outcomes, we calculated risk ratios (RR) and 95% confidence intervals (CI) using random-effects models. For continuous outcomes, we used mean differences (MD) with 95% CI using random-effects models. We examined potential sources of heterogeneity. We assessed the certainty of the body of evidence for key outcomes as high, moderate, low, or very low, using the GRADE approach.

Main Results: We included 23 trials that randomised approximately 3206 participants (2583 analysed) to prophylactic antibiotics or placebo. Although general dentists perform dental extractions because of severe dental caries or periodontal infection, only one of the trials evaluated the role of antibiotic prophylaxis in groups of patients affected by those clinical conditions. We assessed 16 trials as being at high risk of bias, three at low risk, and four as unclear.  Compared to placebo, antibiotics may reduce the risk of postsurgical infectious complications in patients undergoing third molar extractions by approximately 66% (RR 0.34, 95% CI 0.19 to 0.64; 1728 participants; 12 studies; low-certainty evidence), which means that 19 people (95% CI 15 to 34) need to be treated with antibiotics to prevent one infection following extraction of impacted wisdom teeth. Antibiotics may also reduce the risk of dry socket by 34% (RR 0.66, 95% CI 0.45 to 0.97; 1882 participants; 13 studies; low-certainty evidence), which means that 46 people (95% CI 29 to 62) need to take antibiotics to prevent one case of dry socket following extraction of impacted wisdom teeth. The evidence for our other outcomes is uncertain: pain, whether measured dichotomously as presence or absence (RR 0.59, 95% CI 0.31 to 1.12; 675 participants; 3 studies) or continuously using a visual analogue scale (0-to-10-centimetre scale, where 0 is no pain) (MD -0.26, 95% CI -0.59 to 0.07; 422 participants; 4 studies); fever (RR 0.66, 95% CI 0.24 to 1.79; 475 participants; 4 studies); and adverse effects, which were mild and transient (RR 1.46, 95% CI 0.81 to 2.64; 1277 participants; 8 studies) (very low-certainty evidence).  We found no clear evidence that the timing of antibiotic administration (preoperative, postoperative, or both) was important. The included studies enrolled a subset of patients undergoing dental extractions, that is healthy people who had surgical extraction of third molars. Consequently, the results of this review may not be generalisable to all people undergoing tooth extractions.

Authors' Conclusions: The vast majority (21 out of 23) of the trials included in this review included only healthy patients undergoing extraction of impacted third molars, often performed by oral surgeons. None of the studies evaluated tooth extraction in immunocompromised patients. We found low-certainty evidence that prophylactic antibiotics may reduce the risk of infection and dry socket following third molar extraction when compared to placebo, and very low-certainty evidence of no increase in the risk of adverse effects. On average, treating 19 healthy patients with prophylactic antibiotics may stop one person from getting an infection. It is unclear whether the evidence in this review is generalisable to patients with concomitant illnesses or patients at a higher risk of infection. Due to the increasing prevalence of bacteria that are resistant to antibiotic treatment, clinicians should evaluate if and when to prescribe prophylactic antibiotic therapy before a dental extraction for each patient on the basis of the patient's clinical conditions (healthy or affected by systemic pathology) and level of risk from infective complications. Immunocompromised patients, in particular, need an individualised approach in consultation with their treating medical specialist.
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http://dx.doi.org/10.1002/14651858.CD003811.pub3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8094158PMC
February 2021

Interventions for treating oral lichen planus: corticosteroid therapies.

Cochrane Database Syst Rev 2020 02 28;2:CD001168. Epub 2020 Feb 28.

University of Newcastle upon Tyne, Department of Oral Medicine, School of Dental Sciences, Framlington Place, Newcastle upon Tyne, UK, NE2 4BW.

Background: Oral lichen planus (OLP) is a relatively common chronic T cell-mediated disease, which can cause significant pain, particularly in its erosive or ulcerative forms. As pain is the indication for treatment of OLP, pain resolution is the primary outcome for this review. This review is an update of a version last published in 2011, but focuses on the evidence for corticosteroid treatment only. A second review considering non-corticosteroid treatments is in progress.

Objectives: To assess the effects and safety of corticosteroids, in any formulation, for treating people with symptoms of oral lichen planus.

Search Methods: Cochrane Oral Health's Information Specialist searched the following databases to 25 February 2019: Cochrane Oral Health's Trials Register, CENTRAL (2019, Issue 1), MEDLINE Ovid, and Embase Ovid. ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. There were no restrictions on language or date of publication.

Selection Criteria: We considered randomised controlled clinical trials (RCTs) of any local or systemic corticosteroid treatment compared with a placebo, a calcineurin inhibitor, another corticosteroid, any other local or systemic (or both) drug, or the same corticosteroid plus an adjunctive treatment.

Data Collection And Analysis: Three review authors independently scanned the titles and abstracts of all reports identified, and assessed risk of bias using the Cochrane tool and extracted data from included studies. For dichotomous outcomes, we expressed the estimates of effects of an intervention as risk ratios (RR), with 95% confidence intervals (CI). For continuous outcomes, we used mean differences (MD) and 95% CI. The statistical unit of analysis was the participant. We conducted meta-analyses only with studies of similar comparisons reporting the same outcome measures. We assessed the overall certainty of the evidence using GRADE.

Main Results: We included 35 studies (1474 participants) in this review. We assessed seven studies at low risk of bias overall, 11 at unclear and the remaining 17 studies at high risk of bias. We present results for our main outcomes, pain and clinical resolution measured at the end of the treatment course (between one week and six months), and adverse effects. The limited evidence available for comparisons between different corticosteroids, and corticosteroids versus alternative or adjunctive treatments is presented in the full review. Corticosteroids versus placebo Three studies evaluated the effectiveness and safety of topical corticosteroids in an adhesive base compared to placebo. We were able to combine two studies in meta-analyses, one evaluating clobetasol propionate and the other flucinonide. We found low-certainty evidence that pain may be more likely to be resolved when using a topical corticosteroid rather than a placebo (RR 1.91, 95% CI 1.08 to 3.36; 2 studies, 72 participants; I² = 0%). The results for clinical effect of treatment and adverse effects were inconclusive (clinical resolution: RR 6.00, 95% CI 0.76 to 47.58; 2 studies, 72 participants; I² = 0%; very low-certainty evidence; adverse effects RR 1.48, 95% 0.48 to 4.56; 3 studies, 88 participants, I² = 0%, very low-certainty evidence). Corticosteroids versus calcineurin inhibitors Three studies compared topical clobetasol propionate versus topical tacrolimus. We found very low-certainty evidence regarding any difference between tacrolimus and clobetasol for the outcomes pain resolution (RR 0.45, 95% CI 0.24 to 0.88; 2 studies, 100 participants; I² = 80%), clinical resolution (RR 0.61, 95% CI 0.38 to 0.99; 2 studies, 52 participants; I² = 95%) and adverse effects (RR 0.05, 95% CI 0.00 to 0.83; 2 studies, 100 participants; very low-certainty evidence) . One study (39 participants) compared topical clobetasol and ciclosporin, and provided only very low-certainty evidence regarding the rate of clinical resolution with clobetasol (RR 3.16, 95% CI 1.00 to 9.93), pain resolution (RR 2.11, 95% CI 0.76 to 5.86) and adverse effects (RR 6.32, 95% CI 0.84 to 47.69). Two studies (60 participants) that compared triamcinolone and tacrolimus found uncertain evidence regarding the rate of clinical resolution (RR 0.86, 95% CI 0.55 to 1.35; very low-certainty evidence) and that there may be a lower rate of adverse effects in the triamcinolone group (RR 0.47, 95% CI 0.22 to 0.99; low-certainty evidence). These studies did not report on pain resolution.

Authors' Conclusions: Corticosteroids have been first line for the treatment of OLP. This review found that these drugs, delivered topically as adhesive gels or similar preparations, may be more effective than placebo for reducing the pain of symptomatic OLP; however, with the small number of studies and participants, our confidence in the reliability of this finding is low. The results for clinical response were inconclusive, and we are uncertain about adverse effects. Very low-certainty evidence suggests that calcineurin inhibitors, specifically tacrolimus, may be more effective at resolving pain than corticosteroids, although there is some uncertainty about adverse effects and clinical response to tacrolimus showed conflicting results.
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http://dx.doi.org/10.1002/14651858.CD001168.pub3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047223PMC
February 2020

Antimicrobial effect on biofilm by application of different wavelengths and dyes and the synthetic killer decapeptide KP.

Laser Ther 2019 Sep;28(3):180-186

Micoralis Laboratory, Faculty of Dentistry, University of Nice Sophia Antipolis, Nice, France.

The aim of this study was to test the application of different laser wavelengths at a low fluence in combination or not with proper photosensitizing dyes on biofilm with or without a synthetic killer decapeptide (KP). SC5314 was grown on Sabouraud dextrose agar plates at 37°C for 24 h. Cells were suspended in RPMI 1640 buffered with MOPS and cultured directly on the flat bottom of 96-wells plates. The previously described killer decapeptide KP was used in this study. Three different combinations of wavelengths and dyes were applied, laser irradiation has been performed at a fluence of 10 J/cm. The effect on biofilm was evaluated by the XTT assay. Microscopic observations were realized by fluorescence optic microscopy with calcofluor white and propidium iodide. Compared with control, no inhibition of biofilm viability was obtained with application of red, blue and green lasers alone or with any combination of red diode laser, toluidine blue and KP. The combined application of blue diode laser with curcumin and/or KP showed always a very significant inhibition, as curcumin alone and the combination of curcumin and KP did, while combination of blue diode laser and KP gave a less significant inhibition, the same obtained with KP alone. The combined application of green diode laser with erythrosine and/or KP showed always a very significant inhibition, as the combination of erythrosine and KP did, but no difference was observed with respect to the treatment with erythrosine alone. Again, combination of green diode laser and KP gave a significant inhibition, although paradoxically lower than the one obtained with KP alone. Treatment with KP alone, while reducing biofilm viability did not cause death in the adopted experimental conditions. On the contrary, combined treatment with blue laser, curcumin and KP, as well as green laser, erythrosine and KP led to death most cells. The combination of laser light at a fluence of 10 J/cm and the appropriate photosensitizing agent, together with the use of KP, proved to exert differential effects on biofilm.
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http://dx.doi.org/10.5978/islsm.28_19-OR-14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923346PMC
September 2019

Agenesis of a maxillary lateral incisor associated with bilateral canine inclusions: A noninvasive multidisciplinary approach.

J Esthet Restor Dent 2019 11 30;31(6):542-552. Epub 2019 Jul 30.

Private Practice, Torino, Italy.

Objective: The treatment of congenitally missing maxillary lateral incisors is often complex and requires a multidisciplinary approach, which demands continuous collaboration among the different specialists involved in the rehabilitation. In young patients, implant therapy or the preparation of intact teeth for fixed prostheses is not indicated.

Clinical Considerations: Two complex cases of double maxillary canine inclusion were treated with combined surgical, orthodontic, and conservative prosthetic treatments. Orthodontic therapy allowed the creation of the necessary interocclusal space to fabricate the all-ceramic resin-bonded fixed partial dentures without the preparation of the abutment teeth.

Conclusions: Carefully planned and meticulously executed orthodontic and prosthetic therapies allowed for a noninvasive rehabilitation of patients with maxillary lateral incisor agenesis.

Clinical Significance: This article provides clinicians with a noninvasive solution for agenesis of lateral incisors associated with canine inclusions. Indications for the choice of material of all-ceramic resin-bonded fixed partial dentures are discussed and presented.
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http://dx.doi.org/10.1111/jerd.12515DOI Listing
November 2019

World workshop on oral medicine VII: Direct anticoagulant agents management for invasive oral procedures: A systematic review and meta-analysis.

Oral Dis 2019 Jun;25 Suppl 1:157-173

University of North Carolina, Chapel Hill, North Carolina.

Objectives: This systematic review aimed to evaluate the current literature regarding the importance of discontinuing or not discontinuing direct oral anticoagulants (DOACs) before invasive oral procedures, and to establish the frequency and type of postoperative bleeding events in patients.

Material And Methods: We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library up until November 5, 2018. Selection of the studies, extraction of data, qualitative, and bias assessment was performed independently by two authors.

Results: Twenty-one studies were included. No randomized controlled studies were identified. Six studies reported a direct comparison between patients taking DOACs and those who discontinued DOACs. The meta-analysis of these studies resulted in an OR of 0.92 (95% CI = 0.37-2.27, I  = 9%) for postoperative bleeding events for patients taking DOACs. We found that 59/497 (11.8%) postoperative bleeding events occurred in patients who continued DOACs, while 27/200 (13.5%) events were reported for patients who discontinued treatment. All postoperative bleeding events were controlled with local measures.

Conclusion: Results from the included studies did not discern any important differences in postoperative bleeding events in patients who continued versus patients who discontinued DOACs. Furthermore, no thromboembolic events were recorded. However, the low quality of the studies must be considered.
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http://dx.doi.org/10.1111/odi.13086DOI Listing
June 2019

World Workshop on Oral Medicine VII: Platelet count and platelet transfusion for invasive dental procedures in thrombocytopenic patients: A systematic review.

Oral Dis 2019 Jun;25 Suppl 1:174-181

University of North Carolina, Chapel Hill, North Carolina.

Objectives: To evaluate the evidence for a 50,000/μl platelet count threshold for platelet transfusion for invasive dental procedures in thrombocytopenic patients.

Subjects And Methods: We searched in MEDLINE/PubMed, EMBASE, the Cochrane Library (Wiley) and Scopus from 1960 through April 2018 for studies on patients with quantitative platelet disorders not related to medical co-morbidities or medications and undergoing invasive dental procedures. Two reviewers conducted assessments independently.

Results: We found a total of 176 non-duplicate articles, of which 9 cohort studies met our inclusion criteria. The incidence of postoperative bleeding in thrombocytopenic patients was low (4.9%), and we found no difference in bleeding incidence between patients who had platelet transfusion and those who did not. There was no difference in the mean platelet count for patients with and without bleeding. Different modalities are now available to prevent and control bleeding, which may reduce the need for platelet transfusion.

Conclusions: There is no evidence to support the long-standing dogma of a need for a platelet count ≥ 50,000/μl for safe invasive dental procedures. Platelet transfusion effectiveness for haemostasis support could not be determined based on available data. Local measures and antifibrinolytics are the mainstay for the prevention and management of bleeding.
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http://dx.doi.org/10.1111/odi.13082DOI Listing
June 2019

Antimicrobial Photodynamic Therapy Protocols on with Different Combinations of Wavelengths and Photosensitizing Dyes.

Bioengineering (Basel) 2019 May 10;6(2). Epub 2019 May 10.

Laboratoire MICORALIS (MICrobiologie ORALe, Immunothérapie et Santé) EA7354, Université Nice Sophia Antipolis, UFR Odontologie, Avenue des Diables Bleus, 06000 Nice, France.

The aim of the study is to test the application of different laser wavelengths, with and without different photosensitizing dyes on different types of cultures. Laser irradiation was realized on in both solid and liquid culture media in continuous mode at three different fluences (10, 20, and 30 J/cm) with a red diode (650 nm) with toluidine blue dye, a blue-violet diode (405 nm) with curcumin dye, and a green diode (532 nm) with erythrosine dye. Without a photosensitizer, no growth inhibition was obtained with the red diode at any fluence value. Inhibition rates of 40.7% and 40.2% were obtained with the blue diode and green diode. The blue diode laser used with curcumin obtained results in terms of growth inhibition up to 99.26% at a fluence of 30 J/cm. The red diode laser used with toluidine blue obtained results in terms of growth inhibition up to 100% at fluences of 20 and 30 J/cm. The KTP (potassium-titanyl-phosphate) laser used with erythrosine was able to determine a complete growth inhibition (100%) at the different fluence values. The combination of a laser and its proper color may dramatically change the results in terms of bactericidal effect. It will be interesting to confirm these data by further in vivo studies.
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http://dx.doi.org/10.3390/bioengineering6020042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631272PMC
May 2019

Effects of oral healthcare motivation in patients with gingival oral lichen planus: A randomized controlled trial.

Oral Dis 2019 Jul 24;25(5):1335-1343. Epub 2019 Apr 24.

Dipartimento di Medicina e Chirurgia, Centro Universitario di Odontoiatria, Università di Parma, Parma, Italy.

Objectives: The role of dental plaque in gingival lesions caused by oral lichen planus has not been fully defined. The aim of this clinical trial was to evaluate the effects of oral healthcare motivation on clinical variables in patients with gingival oral lichen planus.

Material And Methods: Oral lichen planus patients with symptomatic gingival lesions were randomized in control and intervention groups. The intervention group was instructed to effectively remove bacterial biofilm from dental surfaces, while controls did not receive any advice. The outcome variables were as follows: quality of life (OHIP-14), pain, plaque index and clinical severity of the disease (Escudier index). Outcome variables were assessed at 0, 4 and 20 weeks and analysed using an ANOVA model for factorial design.

Results: Data from 60 patients were collected. Regression analysis showed a significant positive trend of OHIP-14, plaque index and Escudier index in the intervention group compared to controls (p < 0.05). Pain did not prove significantly different (p = 0.408).

Conclusions: Plaque control improved both OHIP-14 and gingival lesion clinical severity. Oral hygienists should be involved in the multidisciplinary management of patients affected by oral lichen planus with gingival lesions.
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http://dx.doi.org/10.1111/odi.13104DOI Listing
July 2019

World Workshop on Oral Medicine VII: Non-opioid pain management of head and neck chemo/radiation-induced mucositis: A systematic review.

Oral Dis 2019 Jun;25 Suppl 1:182-192

University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Objective: To evaluate the current evidence regarding the effectiveness of non-opioid interventions for the therapeutic management of pain in head and neck cancer patients with oral mucositis resulting from radiotherapy only or chemoradiotherapy.

Materials And Methods: A literature search was conducted which included randomised controlled trials that assessed patient-related outcome of pain in patients with oral mucositis associated with radiation therapy only or chemoradiotherapy. Literature searches were conducted in MEDLINE via Pubmed, Embase, Scopus and CINAHL.

Results: The electronic searches identified 846 articles. Screening revealed that six articles met all eligibility inclusion criteria. Interventions showing statistically significant benefits to reduce oral mucositis associated pain compared to placebo included doxepin (p < 0.001, 95% CI -6.7 to -2.1), amitriptyline (p = 0.04), diclofenac (p < 0.01) and benzydamine (p = 0.014).

Conclusions: Non-opioid interventions, including topical doxepin, amitriptyline, diclofenac and benzydamine, were found to provide relief of pain due to mucositis, and when effective may allow for reduction in the use of opioids in pain management.
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http://dx.doi.org/10.1111/odi.13074DOI Listing
June 2019

Direct oral anticoagulant agents: Are they so safe?

Oral Dis 2019 07 14;25(5):1243-1244. Epub 2018 Nov 14.

Dipartimento di Medicina e Chirurgia, Centro di Odontoiatria, Università di Parma, Parma, Italy.

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http://dx.doi.org/10.1111/odi.12999DOI Listing
July 2019

Prevalence of Candida Species in Endodontic Infections: Systematic Review and Meta-analysis.

J Endod 2018 Nov 18;44(11):1616-1625.e9. Epub 2018 Sep 18.

Department of Medicine and Surgery, University Center of Odontology, University of Parma, Parma, Italy.

Introduction: Candida in endodontic infections has been investigated in a large number of studies, but its role as an endodontic pathogen is still debatable. The aim of this study was to systematically review the literature on the prevalence of Candida species in root canal infections.

Methods: Extensive literature research was performed in the most important electronic biomedical databases, and additional studies have been identified from references from relevant articles. Studies were critically appraised using a modified version of the Joanna Briggs Institute Critical Appraisal Checklist.

Results: From 2225 unique records, 2118 were excluded on the basis of title and abstract. Of the remaining 107 studies, 50 were excluded after full-text review, and 57 were included for qualitative and quantitative analysis. The overall prevalence of Candida spp. in root canal infections was 8.20% (95% confidence interval, 5.56%-11.21%). Candida albicans was the most frequently isolated species. Significant heterogeneity among studies was observed (P < .001, I = 86.07%). Subgroup analyses revealed a higher prevalence of Candida spp. from African samples. All studies considered, a high or unclear risk of bias was prevalent regarding 6 out of the 8 items considered in the critical appraisal.

Conclusions: Candida spp. occurred in a small proportion of root canal infections. Further and better designed research is needed to investigate the real contribution of Candida spp. to the microbial ecology in infected root canals.
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http://dx.doi.org/10.1016/j.joen.2018.07.016DOI Listing
November 2018

Erbium Yttrium-Aluminum-Garnet Laser Versus Traditional Bur in the Extraction of Impacted Mandibular Third Molars: Analysis of Intra- and Postoperative Differences.

J Craniofac Surg 2018 Nov;29(8):2282-2286

Department of Medicine and Surgery, Center of Oral Laser Surgery and Pathology, University of Parma.

Introduction: Different osteotomy techniques have been proposed in order to improve postoperative course of impacted third molar extraction. The aim is to evaluate the possible advantages achieved with erbium yttrium-aluminum-garnet (Er:YAG) laser osteotomy compared with traditional burs.

Materials And Methods: Seventy-six extractions were randomly classified into 2 groups according to osteotomy instrument: group 1 (G1)-Er:YAG laser: 35 patients; group 2 (G2)-traditional bur: 41 patients. Intraoperative parameters: total time, stitches number, and patient compliance. Postoperative: pain, health-related quality of life (HR-QoL), need for analgesics, edema, trismus, intra- and extraoral hematoma, and postoperative complications.

Results: Mean time for G1 resulted 1069.4 seconds; for G2 1913.5 seconds (P < 0.0001). Mean number of stitches (P = 0.773) and patient compliance (P = 0.063) were not statistically different. Regarding pain, mean visual analog scale (VAS), and numeric rating scale (NRS) scores were lower in G1 than in G2. Statistically significant differences were highlighted at days 0, 1, and 3 with VAS scale and at days 0, 1, 3, and 7 with NRS scale. The HR-QoL scores resulted lower in G1 than in G2 (P < 0.0001). Mean facial swelling and trismus resulted statistically lower in G1 than in G2 at day 2 (P < 0.0001). Trismus resulted statistically lower in G1 than in G2 at days 2 (P < 0.0001) and 7 (P = 0.004). Two patients (5.71%) of subcutaneous emphysema was recorded in G1 and 2 patients (4.88%) of lip paresthesia in G2.

Conclusion: Data confirm that the use of Er:YAG laser for osteotomy may achieve several advantages both technical and biological.
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http://dx.doi.org/10.1097/SCS.0000000000004574DOI Listing
November 2018

Medication-related osteonecrosis of the jaw: risk factors in patients under biphosphonate versus patients under antiresorptive-antiangiogenic drugs.

Minerva Stomatol 2017 Aug 10;66(4):135-140. Epub 2017 May 10.

Department of Biomedical, Biotechnological and Translational Science, Center of Oral Medicine and Laser Surgery, University of Parma, Parma, Italy.

Background: Biphosphonate-related osteonecrosis of the jaw (BRONJ) is a potential side effect associated with the administration of bisphosphonates; the aim of this work is to highlight the possible epidemiological differences between two groups of patients affected by medication related osteonecrosis of the jaw (MRONJ) treated at the Center of Oral Medicine, Pathology and Laser Surgery of the Academic Hospital at the University of Parma, Italy, between January 2004 and June 2016.

Methods: Medical charts of 303 patients (214 females and 89 males, mean age: 67 years old) treated at the Center of Oral Medicine, Pathology and Laser Surgery of the Academic Hospital at the University of Parma, between January 2004 and June 2016, were retrospectively analyzed. Patients were divided in 2 groups according to drugs therapy they underwent: group 1 (G1) including patients treated with bisphosphonates alone and group 2 (G2) including patients receiving antiresorptive-antiangiogenic drugs in association with bisphosphonates or antiresorptive-antiangiogenic drugs alone. Than 269 MRONJ sites treated with 5 different therapeutical approaches were analyzed.

Results: Results showed G1 consisting mainly in female patients undergoing bisphosphonates for oncologic disease, stage II was most frequently diagnosed and MRONJ developed mainly after dental extraction or bone surgery. G2 consisted mainly in males patients, whom took antiresorptive-antiangiogenic drugs in association with bisphosphonate or antiresorptive-antiangiogenic drugs alone for oncologic disease. Stage II was most frequently diagnosed and MRONJ developed most frequently "spontaneous".

Conclusions: This study showed how a new population affected by MRONJ is emerging. Men affected by kidney cancer treated with new antiresorptive-antiangiogenic drugs will represent a growing portion of the pool of patients at risk. In our experience, a strict follow-up is of outmost importance to early detect MRONJ also in patients with spontaneous cases. When MRONJ occurs, surgical laser treatment with Er:YAG seems to represent the option with highest percentage of success; for patients with contraindication to surgery, LLLT helps to improve outcomes of the medical therapy.
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http://dx.doi.org/10.23736/S0026-4970.17.04056-0DOI Listing
August 2017

Effect of different wavelengths and dyes on Candida albicans: In vivo study using Galleria mellonella as an experimental model.

Photodiagnosis Photodyn Ther 2017 Jun 24;18:34-38. Epub 2017 Jan 24.

Unit of Oral Pathology, Medicine and Laser Surgery, Department of Biomedical, Biotechnological and Translational Sciences (S.Bi.Bi.T.), University of Parma, Parma, Italy.

Background: Studies on photodynamic inactivation against microorganisms had a great development in recent years. The aim of this work was to test the application of different laser wavelengths with or without different photosensitizing dyes on Candida albicans cells in vitro and in photodynamic therapy protocols in vivo in larvae of Galleria mellonella.

Methods: Laser application was realized on C. albicans cells suspended in saline solution or cultured on solid medium for the in vitro study, and in a model of G. mellonella candidal infection for the in vivo study. Three wavelengths (650, 405, and 532nm) were used in continuous mode with different values of applied fluences: 10, 20 and 30J/cm for the in vitro study and 10J/cm for the in vivo study, without and with photosensitizing dyes.

Results: No growth inhibition was obtained on yeast cells in saline solution without photosensitizers. The maximum inhibition of growth (100%) was obtained with 405nm diode laser and curcumin at any used fluence. No growth inhibition was observed for yeast cells cultured on solid medium after laser application without dyes. An inhibition was observed after laser application when curcumin and erythrosine were added to the medium. The survival curves of G. mellonella larvae infected with C. albicans with or without the different dyes and after laser application showed a statistically significant difference (p<0.001) in comparison with the proper control groups.

Conclusions: These results show the efficacy of photodynamic inactivation exploiting a suitable combination of light and dyes against C. albicans and the potential of photodynamic therapy for the treatment of candidal infections.
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http://dx.doi.org/10.1016/j.pdpdt.2017.01.181DOI Listing
June 2017

Single versus multiple visits for endodontic treatment of permanent teeth.

Cochrane Database Syst Rev 2016 12 1;12:CD005296. Epub 2016 Dec 1.

Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1/3, Milan, Italy, 20142.

Background: Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, tooth cracks or chips, or dental trauma. Successful RoCT is characterised by an absence of symptoms (i.e. pain) and clinical signs (i.e. swelling and sinus tract) in teeth without radiographic evidence of periodontal involvement (i.e. normal periodontal ligament). The success of RoCT depends on a number of variables related to the preoperative condition of the tooth, as well as the endodontic procedures. This review updates the previous version published in 2007.

Objectives: To determine whether completion of root canal treatment (RoCT) in a single visit or over two or more visits, with or without medication, makes any difference in term of effectiveness or complications.

Search Methods: We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 14 June 2016), Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 5), MEDLINE Ovid (1946 to 14 June 2016), and Embase Ovid (1980 to 14 June 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 14 June 2016. We did not place any restrictions on the language or date of publication when searching the electronic databases.

Selection Criteria: We included randomised controlled trials (RCTs) and quasi-RCTs of people needing RoCT. We excluded surgical endodontic treatment. The outcomes of interest were tooth extraction for endodontic problems; radiological failure after at least one year, i.e. periapical radiolucency; postoperative pain; swelling or flare-up; painkiller use; sinus track or fistula formation; and complications (composite outcome including any adverse event).

Data Collection And Analysis: We collected data using a specially designed extraction form. We contacted trial authors for further details where these were unclear. We assessed the risk of bias in the studies using the Cochrane tool and we assessed the quality of the body of evidence using GRADE criteria. When valid and relevant data were collected, we undertook a meta-analysis of the data using the random-effects model. For dichotomous outcomes, we calculated risk ratios (RRs) and 95% confidence intervals (CIs). For continuous data, we calculated mean differences (MDs) and 95% CIs. We examined potential sources of heterogeneity. We conducted subgroup analyses for necrotic and vital teeth.

Main Results: We included 25 RCTs in the review, with a total of 3780 participants, of whom we analysed 3751. We judged three studies to be at low risk of bias, 14 at high risk, and eight as unclear.Only one study reported data on tooth extraction due to endodontic problems. This study found no difference between treatment in one visit or treatment over multiple visits (1/117 single-visit participants lost a tooth versus 2/103 multiple-visit participants; odds ratio (OR) 0.44, 95% confidence interval (CI) 0.04 to 4.78; very low-quality evidence).We found no evidence of a difference between single-visit and multiple-visit treatment in terms of radiological failure (risk ratio (RR) 0.91, 95% CI 0.68 to 1.21; 1493 participants, 11 studies, I = 18%; low-quality evidence); immediate postoperative pain (dichotomous outcome) (RR 0.99, 95% CI 0.84 to 1.17; 1560 participants, 9 studies, I = 33%; moderate-quality evidence); swelling or flare-up incidence (RR 1.36, 95% CI 0.66 to 2.81; 281 participants, 4 studies, I = 0%; low-quality evidence); sinus tract or fistula formation (RR 0.98, 95% CI 0.15 to 6.48; 345 participants, 2 studies, I = 0%; low-quality evidence); or complications (RR 0.92, 95% CI 0.77 to 1.11; 1686 participants, 10 studies, I = 18%; moderate-quality evidence).The studies suggested people undergoing RoCT in a single visit may be more likely to experience pain in the first week than those whose RoCT was over multiple visits (RR 1.50, 95% CI 0.99 to 2.28; 1383 participants, 8 studies, I = 54%), though the quality of the evidence for this finding is low.Moderate-quality evidence showed people undergoing RoCT in a single visit were more likely to use painkillers than those receiving treatment over multiple visits (RR 2.35, 95% CI 1.60 to 3.45; 648 participants, 4 studies, I = 0%).

Authors' Conclusions: There is no evidence to suggest that one treatment regimen (single-visit or multiple-visit root canal treatment) is better than the other. Neither can prevent all short- and long-term complications. On the basis of the available evidence, it seems likely that the benefit of a single-visit treatment, in terms of time and convenience, for both patient and dentist, has the cost of a higher frequency of late postoperative pain (and as a consequence, painkiller use).
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http://dx.doi.org/10.1002/14651858.CD005296.pub3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463951PMC
December 2016

Autofluorescence as indicator for detecting the surgical margins of medication-related osteonecrosis of the jaws.

Minerva Stomatol 2016 Aug;65(4):248-52

Center of Oral Pathology and Laser Surgery, Department of Biomedical, Biotechnological and Translational Sciences, University of Parma, Parma, Italy -

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August 2016

Medication-Related Osteonecrosis of the Jaw Around Dental Implants: Implant Surgery-Triggered or Implant Presence-Triggered Osteonecrosis?

J Craniofac Surg 2016 May;27(3):697-701

*Department of Biomedical, Biotechnological and Translational Sciences, Center of Oral Medicine and Laser Surgery, Dental School, University of Parma, Parma†Department of Medical Science, Faculty of Medicine, University of Eastern Piedmont, Novara, Italy.

Introduction: Dentoalveolar surgery including tooth extractions and dental implants placement is considered the major risk factor for developing medication-related osteonecrosis of the jaw (MRONJ).In this study, a patient series of MRONJ around dental implants were carefully analyzed to describe the findings and to assess the possible risk factors.

Methods: Fifteen patients with peri-implant bone osteonecrosis were selected out of a group of 250 patients (6%). Patients were divided into 2 groups according to the temporal relationship. Group 1 (G1)-necrosis immediately after implant placement (from 2 to 10 months) and defined as "implant surgery-triggered" MRONJ. Group 2-necrosis distant (from 1 to 15 years) from implant placement and defined as "implant presence-triggered" MRONJ. Epidemiological and pharmacological variables were recorded as well as specific data about osteonecrosis and dental implants.

Results: G1 included 6 patients: 5 (83.4%) treated with oral bisphosphonates (BPs) for osteoporosis and 1 (16.6%) with intravenous BPs for breast cancer. Mean duration of BP therapy (BPT) was 83.7 months. G2 included 9 patients: 8 patients (88.89%) treated with intravenous BPs for malignant disease and 1 (11.11%) with oral BPs for osteoporosis.

Conclusions: Data confirms that not only surgical insertion of dental implants is a potential risk factor for the development of osteonecrosis but also the presence itself of the implant into the bone can be associated with this disease. Therefore, it is necessary to inform of the increased risk for MRONJ also the patients who have already osteointegrated implants and are going to start the BPT.The risk is lower for patients receiving oral BPs but it exists and seems to be higher if the implant is located in the posterior areas, if the duration of BPT is more than 3 years and if the patient is under corticosteroid therapy.
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http://dx.doi.org/10.1097/SCS.0000000000002564DOI Listing
May 2016

Auto-fluorescence as indicator for detecting the surgical margins of medication-related osteonecrosis of the jaws.

Minerva Stomatol 2016 Mar 24. Epub 2016 Mar 24.

Department of Biomedical, Biotechnological and Translational Sciences, Center of Oral Pathology and Laser Surgery, University of Parma, Italy -

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March 2016

Ultra-Thin Veneers Without Tooth Preparation in Extensive Oligodontia.

Int J Periodontics Restorative Dent 2015 Nov-Dec;35(6):e97-e103

Dental agenesis is the most commonly encountered dental anomaly in humans. Oligodontia, however, is a rare condition that involves the congenital absence of six or more teeth, excluding the third molars. Treatment of oligodontia requires an interdisciplinary approach. The prosthetic treatment plan should carefully consider esthetic and functional rehabilitation but should take a conservative approach. Adhesive techniques, combined with the new ceramic materials, permit functional and esthetic prosthetic restorations that are more conservative in comparison to those used in the past. Ultrathin occlusal veneers without tooth preparations may represent a good esthetic and conservative approach for oral rehabilitation of patients affected by severe hypodontia.
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http://dx.doi.org/10.11607/prd.2399DOI Listing
January 2017

Erratum to: Advantages of new technologies in oral mucosal surgery: an intraoperative comparison among Nd:YAG laser, quantic molecular resonance scalpel, and cold blade.

Lasers Med Sci 2015 Sep;30(7):1911

Department of Biomedical, Biotechnological and Translational Sciences, Center of Oral Laser Surgery and Oral Medicine, Dental School, University of Parma, Via Gramsci, 14-43125, Parma, Italy.

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http://dx.doi.org/10.1007/s10103-015-1793-7DOI Listing
September 2015

Medication-Related Osteonecrosis of the Jaw: An Autofluorescence-Guided Surgical Approach Performed with Er:YAG Laser.

Photomed Laser Surg 2015 Aug;33(8):437-42

1 Department of Biomedical, Biotechnological and Translational Sciences - Center of Oral Laser Surgery and Oral Pathology, Dental School, University of Parma , Parma, Italy .

Objective: The aim of this study was to propose an autofluorescence (AF)-guided surgical approach performed with Er:YAG laser and Nd:YAG low-level laser therapy (LLLT).

Background Data: Medication-related osteonecrosis of the jaw (MRONJ) therapy remains an unresolved problem. The proposed conservative and surgical treatment regimens are associated with contradictory success rates. However, the increased experience with MRONJ management suggests that surgical therapy can halt disease progression, and can allow a histology-based diagnosis of osteonecrosis. Surgical approach with Er:YAG laser is associated with significantly better results compared with medical treatment and traditional surgical approaches. One of the difficulties encountered during surgical removal of a MRONJ is the precise individuation of necrotic bone margins.

Patient And Methods: A case of Stage III maxillary osteonecrosis treated with a new surgical approach is presented.

Results: After 7 months of follow-up, complete mucosal healing was evident, and the patient was free of symptoms. Such a technique allowed a highly accurate and minimally invasive approach through the selective ablation of the non-/hypofluorescent areas.

Conclusions: Taking into account the advantages of laser therapy and the possible effectiveness of AF in highlighting surgical margins, this approach would probably achieve excellent outcomes.
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http://dx.doi.org/10.1089/pho.2015.3927DOI Listing
August 2015

Advantages of new technologies in oral mucosal surgery: an intraoperative comparison among Nd:YAG laser, quantic molecular resonance scalpel, and cold blade.

Lasers Med Sci 2015 Sep 21;30(7):1903-10. Epub 2015 May 21.

Department of Biomedical, Biotechnological and Translational Sciences, Center of Oral Laser Surgery and Oral Medicine, Dental School, University of Parma, Via Gramsci, 14-43125, Parma, Italy.

The aim of this study is to evaluate the possible intraoperative advantages of Nd:YAG laser and quantic molecular resonance (QMR) scalpel in oral soft tissue surgery. One hundred sixty-three interventions were evaluated. Group 1 (G1) included 77 interventions performed with Nd:YAG laser, group 2 (G2) 45 with QMR scalpel, and group 3 (G3) 41 with cold blade. Parameters analyzed were as follows: speed of incision, time of intervention, intraoperative bleeding, number of stitches, patient compliance, and operator comfort. Data were analyzed using software STATA 12 (StataCorp LP, College Station, TX, USA). Mean speed of incision was 0.54 mm/s in G1, 2.83 mm/s in G2, and 1.58 mm/s in G3, Nd:YAG laser being the slowest. However, no significant differences among times of intervention were found. In particular, interventions in G1 (221.15 ± 220.89 s) have a mean duration lower than G2 (280.56 ± 248.31 s) and G3 (316.10 ± 248.69 s). Intraoperative bleeding occurred in 29.9 % (n = 23/77) of interventions in G1, 97.8 % (n = 44/45) in G2, and 97.6 % (n = 40/41) in G3 (p < 0.0001). Mean number of stitches in G1 was statistically lower (G1, 0.10; G2, 2.07; G3, 2.29; p < 0.0001). No differences with regard to patient compliance were detected. Operator comfort was higher in G1 (p < 0.0003). Nd:YAG laser and QMR scalpel give several advantages in oral mucosal surgery: Nd:YAG laser cuts tissue slowly, but it provides a good visibility and excellent hemostasis. QMR scalpel allows a very rapid cutting with no considerable temperature increase, but there is major risk of bleeding and need for sutures with lower operator comfort.
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http://dx.doi.org/10.1007/s10103-015-1769-7DOI Listing
September 2015

Efficacy of LLLT in swelling and pain control after the extraction of lower impacted third molars.

Laser Ther 2015 Mar;24(1):39-46

Unit of Oral Pathology, Medicine and Laser Surgery, Department of Biomedical, Biotechnological and Translational Sciences (S.Bi.Bi.T), University of Parma, Italy.

Introduction And Aim: Low Level Laser Therapy (LLLT) can facilitate wound healing stimulating a more rapid resolution and an earlier start for the proliferation phase. The purpose of this study is to evaluate the effects of LLLT on postoperative pain and oedema following the removal of impacted lower third molars.

Materials And Methods: Fifty-nine patients, who were to undergo surgical removal of their lower third molars, were studied. Patients were randomly allocated to one of three groups: 17 patients LLLT + traditional drug treatment17 patients traditional drug treatment as control group25 patients treated with LLLT only on one side+traditional drug treatment. The laser we have used for this study is a diode laser, GaAs, which delivers both in the infrared band at the wavelength of 910 nanometers (pulsed and superpulsed source), and in the visible (continuous source) at the wavelength of 650 nanometers (red). LLLT was performed just after the intervention and approximately 12 hours after surgery delivering 240 J in 15 minutes with theoretical fluence values of 480 J/cm(2) and 31 J/cm(2) for every minute of irradiation. We considered and signed with a label constant landmarks on both sides of the face of each patient; measurements were taken: before the surgery, after the surgery right after the 1st laser treatment, after approximately 24 hours after the 2(nd) laser treatment.

Results: We collected all the values of the oedema measurements and the VAS reports and performed a statistical analysis by means One-way Analysis of Variance (ANOVA) test: for the evaluated values (X, Y, Z) an extremely significant difference was found with p values of 0.003 for Y at the first evaluation (pre-12 hours) and less than 0.001 for the other evaluations. A significant result was obtained for VAS recorded at hospital discharge (p<0.0001).

Conclusions: This study demonstrates that LLLT is effective on postoperative pain and oedema accelerating healing time and reducing patients distress.
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http://dx.doi.org/10.5978/islsm.15-OR-05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4416144PMC
March 2015

Tooth extractions in high-risk patients under bisphosphonate therapy and previously affected with osteonecrosis of the jaws: surgical protocol supported by low-level laser therapy.

J Craniofac Surg 2015 May;26(3):696-9

*Center of Oral Laser Surgery and Oral Medicine, Dental School, Department of Biomedical, Biotechnological and Translational Sciences, University of Parma, Italy †Université de Liège, Liège, Belgium.

Trauma during dental surgery is a predisposing factor for medication-related osteonecrosis of the jaws (MRONJ). There are no specific guidelines for the management of dental extractions in patients under bisphosphonate therapy (BPT). The authors proposed in 2013 a successful protocol for tooth extractions in patients under BPT supported by Nd:YAG low-level laser therapy (LLLT). The aim of this study was to validate the safety and efficacy of this protocol reporting the data related to its application in a particular category of patients under BPT at high risk for MRONJ and who were previously affected with MRONJ. Eighty-two tooth extractions were performed in 36 patients previously affected with MRONJ. Antibiotic treatment was administered 3 days before and 2 weeks after tooth extractions. Patients were additionally treated with Nd:YAG LLLT, 5 applications of 1 minute each. Patients were evaluated 3 days and once a week for 2 months after the extractions and every time they received LLLT. In a total of 82 extractions, minimal bone exposure was observed in 2 cases, treated with Er:YAG laser vaporization and then completely healed. The data confirmed that laser biostimulation is a reliable technique that can be considered in the surgical protocol for patients under BPT.
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http://dx.doi.org/10.1097/SCS.0000000000001665DOI Listing
May 2015

Massive mandibular destruction and alveolar nerve infiltration without lower lip paresthesia in primary intraosseous carcinoma: report of two cases and critical appraisal of diagnostic criteria.

Quintessence Int 2015 Apr;46(4):329-38

Objective: To report two cases of solid type primary intraosseous carcinoma (PIOC) with a critical appraisal of one of the WHO diagnostic criteria.

Summary: Both patients had radiographic and histopathologic findings showing massive mandibular destruction as well as the involvement of the inferior alveolar nerve, without lip or chin paresthesia. Patients were treated through hemimandibulectomy followed by reconstruction through fibula free flap and forearm flap.

Conclusion: Lip and/ or chin paresthesia are rather frequent in metastatic and salivary gland tumors but not in primary tumors of the jaws. Reasons for such a discrepancy are mostly unknown. A few hypotheses are put forward here. It is the opinion of the authors that most of the diagnostic criteria for solid type PIOC are acceptable. However, the criterion "absence of ulcer formation on the overlying mucosa" mainly depends on the dimension of the tumor at diagnosis.
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http://dx.doi.org/10.3290/j.qi.a33181DOI Listing
April 2015

Effects of 915 nm GaAs diode laser on mitochondria of human dermal fibroblasts: analysis with confocal microscopy.

Lasers Med Sci 2015 Jan 29;30(1):375-81. Epub 2014 Oct 29.

Unit of Anatomy Histology and Embryology-Department of Biomedical, Biotechnological and Translational Sciences (S.Bi.Bi.T), University of Parma, Parma, Italy.

Low-level laser therapy (LLLT) is widely used in tissue regeneration and pain therapy. Mitochondria are supposed to be one of the main cellular targets, due to the presence of cytochrome C oxidase as photo-acceptor. Laser stimulation could influence mitochondria metabolism affecting mainly transmembrane mitochondrial potential (Δψm). The aim of our study is to evaluate "in vitro" the early mitochondrial response after irradiation with a 915 GaAs laser. Since some evidences suggest that cellular response to LLLT can be differently modulated by the mode of irradiation, we would like to evaluate whether there are changes in the mitochondrial potential linked to the use of the laser treatments applied with continuous wave (CW) in respect to those applied with pulsed wave (PW). In this study, we analyzed effects of irradiation with a 915-nm GaAs diode laser on human dermal fibroblast. We compared effects of irradiation applied with either CW or PW at different fluences 45-15-5 J/cm(2) on Δψm. Laser scanning microscopy (LSM) was used in living cells to detect ROS (reactive oxygen species) using calcein AM and real-time changes of and Δψm following distribution of the potentiometric probe tetramethylrhodamine methyl ester (TMRM). At higher doses (45-15 J/cm(2)), fibroblasts showed a dose-dependent decrement of Δψm in either the modalities employed, with higher amplitudes in CW-treated cells. This behavior is transient and not followed by any sign of toxicity, even if reactive oxygen species generation was observed. At 5 J/cm(2), CW irradiation determined a little decrease (5%) of the baseline level of Δψm, while opposite behavior was shown when cells were irradiated with PW, with a 10% increment. Our results suggest that different responses observed at cellular level with low doses of irradiation, could be at the basis of efficacy of LLLT in clinical application, performed with PW rather than CW modalities.
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http://dx.doi.org/10.1007/s10103-014-1651-zDOI Listing
January 2015

Odontogenic myxofibroma: a concise review of the literature with emphasis on the surgical approach.

Med Oral Patol Oral Cir Bucal 2015 Jan 1;20(1):e1-6. Epub 2015 Jan 1.

Center of Oral Laser Surgery and Oral Pathology, Dental School. Department of Biomedical, Biotechnological and Translational Sciences, Via Gramsci, 14, 43100 Parma, Italy,

Purpose: The aim of this work is to report a review of the literature concerning epidemiology, clinical and radiographic features as well as treatment of odontogenic myxofibroma (MF).

Methods: The PubMed database was searched using the following keywords: "odontogenic myxofibroma", "odontogenic fibromyxoma", "myxofibroma of the jaw" and "fibromyxoma of the jaw".

Results: Fifteen articles reporting the experience with 24 patients were identified. Male/female ratio was 1:1.4 and the average age 29.5 years. The most frequent location was the mandible. In 66.7% of the cases the radiographic appearance was a multilocular radiolucency. Swelling was observed in 13 patients (92.86%), varying degrees of pain in 5 (35.71%) and paresthesia in only one patient (7.14%). Six out of 24 patients (26.09%) were treated with radical surgery and 17 out of 24 (73.91%) with a conservative approach. In two out of 21 cases (9.52%) a recurrence was reported.

Conclusions: MF is an extremely rare tumour and no agreement exist on the causes of its development. According to the present review, the choice of treatment should depend on variables such as localization, presence of a primary or of a recurrent lesion, age, general medical conditions and aesthetic needs of the patient.
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http://dx.doi.org/10.4317/medoral.19842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4320411PMC
January 2015
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