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Type of impaction and site of nerve are important risk factors of neurological damage following the lower third molar removal. The purpose of this study was to evaluate the peripheral damage of lingual and lower alveolar nerves in relation to tooth angulation and radiographic proximity to the alveolar canal.Sixty-seven consecutive patients (41 women and 26 men, mean age 29.97+/-14.35 years) underwent lower wisdom teeth extraction and were clinically evaluated over a one year period, checking any evidence of peripheral damage of the lower alveolar or lingual nerves. Tooth angulation and presence or absence of spongy bone between the mandibular canal and the root apex were considered; so, the patients were assigned twice to two groups: G1A (third molar in axis); G2A (third molar angulated); G1B (third molar apex adjacent to the mandibular canal); G2B (spongy bone between root apex and canal). The extraction was carried out according to a standardised technique without raising and retracting of a lingual flap. The follow-up checks were at one week, 1, 3, 6, 12 months and until any problem was solved. Statistical analysis was carried out using chi2 test.A total of two cases of temporary damage to the lingual nerve (1 case in G1A and 1 in G2A; 2 cases in G2B) and 3 cases to the lower alveolar nerve (3 cases in G2A; 1 in G1B and 2 in G2B) were discovered. No statistical differences were found. Symptoms cleared up within a maximum period of 5 months.Tooth angulation and proximity to lower alveolar canal were not related to alveolar or lingual damage; the conservative surgical technique seems to be an important factor in preventing neurological complications.

Trismus may represent an external sign of masticatory or lateral pharyngeal abscess that in rare cases is the consequence of pathogen action by micro-organisms introduced in deep tissues after inferior alveolar block. The case presented shows a buccal-masseteric mycotic abscess following restorative procedure involving inferior alveolar anesthesia on the same side. A 49-year-old woman was referred to the Dental Clinic (University of Trieste) complaining of a progressive inability to open her mouth since one week associated to a hemifacial edema in the right parotid region. The symptoms initially started one week before. Infection developed after restorative procedures performed 10 days before on the same side. Based on clinical signs and cultural exam findings, a buccal-masseteric mycotic abscess was found and magnetic resonance (MR) was performed to assess its localization and extension. Initial pharmacological therapy with piperacillin/tazobactam administered intravenously, was replaced by appropriate antimycotic therapy on the basis of sensitivity test to antibiotics. Infection resolution was obtained but complete absence of facial asymmetry occurred after 5 months only. Introduction of micro-organisms during anesthetic alveolar block is a documented source of infection and may occur after dental procedure involving inferior alveolar anesthesia. Complete medical history, cultural exam with sensitivity test to antibiotics and RM or computed tomography (CT) images, are necessary to perform an adequate treatment plan and to administer a correct therapy. Presence of trismus, accompanied by pain or facial edema after dental procedure or during dental or perioral infections has to be carefully considered by clinician to diagnose as soon as possible a deep spaces infection and to avoid serious or life-threatening complications.

Objectives To evaluate the level of knowledge of pregnant women and puerpers about oral health and prevention during and after gestation. Methods One hundred women aged 18–49 years (mean age 33±6 years) were included in this cross-sectional study. An anonymous questionnaire with 24 items related to oral health has been administered during or just after pregnancy. Firstly, answers have been analyzed on the full population and then subdividing the sample on the base of age ranges (G1: 18–25 years, G2: 26–35 years and G3: >35 years) and number of pregnancies (FP: first pregnancy; SP: second or more pregnancies). Parametric tests have been chosen for the statistical analysis; in particular, Anova test for independent samples was used to evaluate differences of baseline demographic characteristics among subgroups G1, G2, G3 while chi-square test was used for FP and SP subgroups. Anova test was also used to intercept differences on answers given to the questionnaire among G1, G2 and G3 group; for FP and SP group was used t-test. Results Level of information and knowledge of the full sample was medium-low and no significant differences have been observed between groups regarding awareness of the own level of the oral hygiene and knowledge of oral care. Conclusions Results of this survey underline the high necessity of educational programs regarding oral care in pregnant and puerpers women. A strict collaboration between medical figures (dentist, oral hygienist, gynecologist and obstetric) is strongly encouraged to spread the concept of prevention.

Purpose. Recent advances show that ultrasonic implant site osteotomy is related to a decreased trauma and a better postoperative healing of the surgical site when compared to traditional drilling techniques. The micrometric bone cutting control and the operative advantages related to the piezoelectric approach are also characterized by a learning curve for the clinician in surgical practice and an increased operative duration of the procedure. The aim of this investigation is to compare the operative time, the postoperative pain, and the amount of painkillers taken by the patient during the healing period. Methods. A total of 65 patients were treated at the Unit of Oral Surgery (Department of Medical Sciences, Surgery and Health, University of Trieste, Italy) using a split mouth model: 75 drill-inserted implants (G1) and 75 piezoelectric device-inserted implants (G2) were placed. The Visual Analogue Scale (VAS) was performed to evaluate the postoperative pain at 15 days from surgery. The operative time and frequency of intake of painkillers were measured. Results. The G1 and G2 groups showed a significant difference with a higher use of painkillers observed for G1. The G2 patients showed a lower level of pain (VAS) at all experimental times between 8 hours to 7 days (p<0.01) postsurgery. At 15 days, the pain levels were similar for both groups. No differences were found in site preparation duration between the study groups. Conclusions. The evidence supports the application of the piezoelectric approach compared to the drill’s osteotomy as a useful technique for implant site preparation. This trial is registered with NCT03978923.

The authors describe four cases of suicide by hara-kiri. This very painful form of suicide consists of self-inflicting a wound in the abdomen using a sharp instrument. It was first reported in 988 A.D. in the East but has now become rare in both the East and West. These four cases occurred over a 40-year period in the Trieste and Bari medicolegal area. In two of our cases the victims were afflicted with mental illness, whereas the other two suffered from depression. In cases of death by hara-kiri, it is important to establish a differential diagnosis between suicide and homicide; the presence of trial wounds (inflicted by the victim as a form of practice to overcome any hesitation before stabbing the abdomen with the cutting weapon) can prove very helpful.

Objective To evaluate postextractive neurological complications after third molar extraction under general anesthesia and to identify correlations between the surgical procedure, the third molar-related pathology, and neurological involvement. Study design The clinical records of 183 patients were analyzed for a total of 408 third molars extracted at the Dental Clinic of Trieste (Italy). Individual effects of clinical data on the presence of paresthesia were evaluated by a logistic regression model. Results Neurological involvement was observed in 13 patients (6.1%). No permanent inferior alveolar nerve damage was found (0%) and only 1 patient presented a permanent lesion of the ipsilateral lingual nerve (0.3%). Pell and Gregory classification and surgical difficulty were not associated with the incidence or gravity of neurological lesions (P = NS). Among the pathologies associated with third molars, only the variable “abscess” presented a significant correlation with paresthesia (OR 6.86; 95% CI 1.21-38.8; P = .029). Conclusion The percentage of nerve injuries agrees with the literature data, inclusion class, and surgical technique seem not to influence paresthesia risk. Further studies are necessary to evaluate the role of infectious pathologies as a cofactor in the development of neurological lesions after oral surgery.

The authors describe 3 cases of dismemberment. Numerous methods of hiding a body and thus erasing proof of murder have been devised. Those most frequently described in the literature include: burial of the body in an unusual or impervious place such as a wood, grotto or mountain; charring the body by wrapping it in a tire, for example, to fuel the fire until all traces of the crime have been erased and identification of the victim is difficult; and dropping the weighted-down body in the open sea or in a well in the hope that it will never be found. Dismemberment is in reality a relatively rare method whereby, after killing the victim, the murderer uses a very sharp cutting weapon (a saw, axe, etc.) to sever the limbs and cut the body into small pieces. The operation is generally carried out immediately after the crime, although more rarely a long time may pass between the 2 events. © 2006 Lippincott Williams & Wilkins, Inc.