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In oral surgery, the management of patients on anticoagulant therapy is still challenging because of the risks of uncontrolled bleeding and, if the therapy is discontinued, the possibility of undesired thromboembolic complications. The use of local hemostatic agents may be a viable alternative to overcome these issues. Along these lines, the aim of this work was to evaluate the use of newly developed swelling matrices loaded with tranexanic acid in preventing postextractive bleeding in patients with no modification of oral anticoagulant therapy. The matrices are made up of cellulose and are able to fit the tridimensional postextractive alveolar cavity, thus assuring also a mechanical contribution to homeostasis. The potential of this new therapeutic approach in reducing hospitalization, removing the risk of infections, and lowering the number of hemorrhagic complications was demonstrated.

Background:This randomized clinical trial compares the outcomes of combination treatment by autogenous periosteal membranes and bone graft versus guided tissue regeneration (GTR) with collagen membranes or open‐flap debridement (OFD) only in the treatment of intraosseous defects. Methods:Forty‐two patients affected by moderate to severe chronic periodontitis were enrolled. Each patient had one deep intrabony defect (≥6 mm). They were randomly assigned into three groups: patients treated with 1) an OFD procedure alone (OFD group); 2) a GTR procedure with collagen membranes (GTR group); and 3) a combined treatment procedure by autogenous periosteal membranes and autogenous bone chips (aCPRT group). Clinical and intrasurgical examinations including probing depth (PD), clinical attachment level (CAL), gingival recession (GR), and defect bone level (DBL) were performed at baseline and after 1 year. Results:After 1 year, all of the evaluated clinical parameters showed statistically significant changes from baseline within each group (P<0.01). The GTR and aCPRT groups had significantly greater PD reductions (5.2 and 4.4 mm, respectively) and CAL (3.2 and 3.9 mm) and DBL gains (2.4 and 3.1 mm) compared to the OFD group (PD, 2.9 mm; CAL, 1.6 mm; DBL, 1.5 mm); moreover, the aCPRT group showed a significantly smaller GR increase (0.5 mm) and a greater DBL gain (3.1 mm) compared to the GTR group (2 and 2.4 mm, respectively; P<0.05). Conclusions:Both the GTR and aCPRT treatments produce additional clinical benefits over OFD alone. Moreover, the aCPRT technique can minimize post‐surgical GR and produce better defect bone‐level improvement.

Choukroun's platelet‐rich fibrin (PRF) is a fibrin biomaterial with a specific composition, three‐dimensional architecture, and associated biology. This letter highlights some key issues related to the use of this complex material during periodontal surgery. First, a reproducible protocol for the production of PRF membranes must be followed to control the quantity and quality of the fibrin matrix, leukocytes, platelets, and growth factors. Second, its use in periodontology must follow two principles founded on tissue‐engineering basic rules and classical periodontal concepts. Using this two‐principle safe protocol, the use of PRF in periodontal surgery leads to a significant improvement during the early healing phase and to a thick and stable final remodeled gingiva.

Background:The use of locally delivered antibacterials containing chlorhexidine (CHX) was proposed to improve the effectiveness of non‐surgical periodontal treatment. The present multicenter randomized study investigated the effects of a xanthan‐based chlorhexidine (Xan‐CHX) gel used as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. Methods:Ninety‐eight systemically healthy subjects with moderate to advanced periodontitis were recruited in four centers (59 females and 39 males; aged 24 to 58 years). For each subject, two experimental sites located in two symmetric quadrants were chosen with probing depths (PD) ≥5 mm and positive for bleeding on probing (BOP). These two sites were randomized at the split‐mouth level with one receiving a single SRP treatment and the other receiving a single SRP + Xan‐CHX gel treatment. Supragingival plaque, modified gingival index, PD, clinical attachment level (CAL), and BOP were evaluated at baseline (prior to any treatment) and after 3 and 6 months. At the same times, subgingival microbiologic samples and gingival crevicular fluid (GCF) were collected for the analysis of total bacterial counts (TBCs), including the identification of eight putative periodontopathogens, and alkaline phosphatase (ALP) activity, respectively. Results:The Xan‐CHX treatment group showed greater improvements compared to the SRP group for PD and CAL at 3 and 6 months (P<0.001). The differences in PD reduction between the treatments were 0.87 and 0.83 mm at 3 and 6 months, respectively (P<0.001); for CAL, these were 0.94 and 0.90 mm, respectively (P<0.001). Similar behavior was seen when the subgroup of pockets ≥7 mm was considered. The percentage of sites positive for BOP was similar between the treatments at each time point. For the comparisons between the treatment groups, no differences were seen in the TBCs and GCF ALP activity at baseline and 6 months; in contrast, slightly, but significantly, lower scores were recorded for the Xan‐CHX treatment group at 3 months (P= 0.018 and P= 0.045, respectively). Moreover, greater reductions in the percentages of sites positive for the eight putative periodontopathic bacteria were generally seen for the Xan‐CHX treatment group compared to SRP alone. Conclusions:The adjunctive use of Xan‐CHX gel promoted greater PD reductions and CAL gains compared to SRP alone. These results were concomitant with better microbiologic and biochemical outcomes when Xan‐CHX gel use was added to SRP, particularly up to 3 months after treatment.

Background:Extraction of deep‐impacted mandibular third molars may lead to periodontal defects at the distal surface of the adjacent second molar. The purpose of this study was to compare the ability of three regenerative approaches to prevent third molar extraction‐related periodontal defects. Methods:Forty‐five patients with bilateral osseous or soft tissue–impacted lower third molars were selected to participate in the study. Inclusion criteria were the presence of a pocket that was located distally to the mandibular second molar with a probing depth (PD) ≥7 mm and with a probing clinical attachment level (CAL) ≥6 mm. Ninety third molar impactions were used and were randomly assigned to three equal treatment groups (30 each): bovine porous bone mineral (BPBM) alone, BPBM plus collagen membrane (CM), and an untreated control group. Clinical and radiographic measurements were recorded at 3, 6, 9, 12, 18, 24, 36, 48, 60, and 72 months after the surgery. Results:BPBM or BPBM + CM resulted in a significant reduction in PD and gain in CAL compared to the control group at all time points. BPBM + CM had the best outcome for the prevention of a second‐molar periodontal defect. Conclusion:The application of BPBM, with or without a collagen membrane, can be a viable and stable treatment to alleviate the periodontal defects that are often associated with impacted mandibular third molar extractions.

Background:This randomized controlled clinical trial was designed to compare the clinical outcomes of guided tissue regeneration with calcium sulfate graft and membrane (CS) versus guided tissue regeneration with collagen membrane (CM) or open flap debridement (OFD) only in terms of clinical attachment gain in periodontal intrabony defects. Methods:Fifty‐one systemically healthy, non‐smoking subjects affected by moderate to severe chronic periodontitis were recruited. The subjects had one deep intrabony defect with a probing depth (PD) ≥6 mm and were randomly divided into three equal groups (17 subjects per group). Subjects were surgically treated with OFD (OFD group), OFD with CS (CS group), or OFD and CM (CM group). One year after surgical treatment, a complete clinical examination and a surgical reentry were performed. The pre‐ and post‐therapy clinical parameters, including PD, clinical attachment level (CAL), gingival recession (GR), and intrasurgical parameters (defect bone level [DBL]), were compared. Results:After 1 year, the clinical and intrasurgical parameters showed statistically significant changes from baseline within each group for all of the evaluated parameters (PD and CAL, P<0.001; GR and DBL, P<0.05). Differences (PD, CAL, and DBL, P<0.001; GR, P<0.05) were also seen across the three groups. The CM and CS groups had significantly smaller PD, CAL, and DBL values than subjects treated with only OFD. Groups treated with regenerative techniques had a significantly greater PD reduction and CAL and DBL gain compared to the OFD group. No significant differences were seen between CM and CS. Conversely, the CM group showed a significantly greater GR increase compared to OFD and CS. Conclusions:Both regenerative treatments produced additional clinical benefits over OFD alone. Moreover, the use of CS may minimize post‐surgical recession.

Background:Microbial penetration inside an implant's internal cavity results in a bacterial reservoir that has been associated with an area of inflamed connective tissue facing the fixture–abutment junction. The aim of the present clinical trial was to evaluate the effectiveness of a 1% chlorhexidine gel on the internal bacterial contamination of implants with screw‐retained abutments. Methods:Thirty subjects (age range: 27.3 to 54.2 years) underwent single implant restoration. Three months after prosthodontic restoration, the modified sulcus bleeding index, modified plaque index, full‐mouth plaque score, and full‐mouth bleeding score were recorded. Microbiologic samples were also collected from the internal part of each fixture. Subjects were then divided into two equal groups: control and test groups (CG and TG, respectively). The CG had the abutment screwed and the crown cemented without any further intervention. Conversely, the TG had the internal part of the fixture filled with a 1% chlorhexidine gel before the abutment placement and screw tightening. Six months later, microbiologic and clinical procedures were repeated in both groups. Total bacterial count and multiplex polymerase chain analysis were performed to detect specific pathogens. Results:Clinical parameters remained stable throughout the study. From baseline to the 6‐month examination, the total bacterial counts underwent a significant reduction in the TG (P<0.05). Detection of the single pathogen species did not show any significant differences. However, periopathogens were detected more frequently in the CG. Conclusion:The application of a 1% chlorhexidine gel seemed to be an effective method to reduce bacterial colonization of the implant cavity over a 6‐month period.

Ranulas have been managed by various surgical methods, and the optimal treatment is still controversial. The aim of this study was to analyze a group of 124 surgically treated patients with intraoral ranula to assess 3 different methods sublingual gland removal combined with the ranula excision, conventional marsupialization, and a variant of the marsupialization technique usually performed in our departments. Recurrence rate was 0% after radical treatment, 25.8% after marsupialization, and 12% after modified marsupialization. We suggest that conservative methods should always be considered as treatment of superficial oral ranulas. The modification of the conventional marsupialization by suturing the edges of the pseudocyst before unroofing of the lesion was demonstrated to be a useful technical strategy that simplifies and accelerates the surgical procedures and probably contributed to preventing recurrences.

Facial nerve injuries are rare complications after orthognathic surgery. A literature review shows that such damages can develop with various mechanisms and are usually transient. Two cases of delayed facial paralysis after mandibular osteotomy with spontaneous recovery are reported.

Severity of injury resulting from facial firearm wounds varies according to many factors. The correct management of these lesions can be complex, and each can present peculiarities.

Knowing that patients desire reduced duration of local anesthesia, the authors performed a meta-analysis to evaluate the efficacy of phentolamine mesylate (PM) in reducing anesthesia duration and the occurrence of adverse effects.