Acute dental abscess is a frequent and sometimes underestimated disease of the oral cavity. The acute dental abscess usually occurs secondary to caries, trauma, or failed endodontic treatment. After the intact pulp chamber is opened, colonization of the root canals takes place with a variable set of anaerobic bacteria, which colonize the walls of the necrotic root canals forming a specialized mixed anaerobic biofilm. Asymptomatic necrosis is common. However, abscess formation occurs when these bacteria and their toxic products breach into the periapical tissues through the apical foramen and induce acute inflammation and pus formation. The main signs and symptoms of the acute dental abscess (often referred to as a periapical abscess or infection) are pain, swelling, erythema, and suppuration usually localized to the affected tooth, even if the abscess can eventually spread causing a severe odontogenic infection which is characterized by local and systemic involvement culminating in sepsis syndrome. The vast majority of dental abscesses respond to antibiotic treatment, however, in some patients surgical management of the infection may be indicated. In the present work, a retrospective analysis of the patients with dental orofacial infections referred to the Unit of Dentistry and Maxillofacial Surgery of the University of Verona from 1991 to 2011 has been performed.

The objective of this clinical trial was the analysis of 2 methods for engineering of autologous bone grafts for maxillary sinus augmentation with secondary implant placement. Group 1 (8 patients, 12 sinuses): cells of mandibular periosteum were cultured in a good manufacturing practice laboratory (2 weeks) with autologous serum and then transferred onto a collagen matrix. After another week, these composites were transplanted into the sinuses. In group 2A (2 patients, 3 sinuses), cells of maxillary bone were cultivated with autologous serum for 2 weeks, seeded onto natural bone mineral (NBM, diameter [Ø] = 8 mm) blocks, and cultivated for another 1.5 months. These composites were transplanted into the sinuses. Group 2B (control, 3 patients, 5 sinuses) received NBM blocks alone. In the course of implant placement 6 (group 1) and 8 (group 2) months later, core biopsy were taken. Clinical follow-up period was 1 to 2.5 years in group 1 and approximately 7 years in groups 2A and 2B. New vital bone was found in all cases at median densities of 38% (n = 12) in group 1, 32% in group 2A (n = 3), and 25% in group 2B (n = 5). Differences between group 1 and 2B as well as 2A and 2B were statistically significant ( p = 0.025). No adverse effects were seen. All methods described were capable of creating new bone tissue with sufficient stability for successful implant placement.

Oroantral communication (OAC) can be defined as a pathologic space created between the maxillary sinus and the oral cavity.This communication and subsequent formation of a chronic oroantral fistula is a common complication often encountered by oral and maxillofacial surgeons.Although various techniques have been proposed in published studies, long-term successful closure of oroantral fistulas is still one of the most difficult problems confronting the surgeon working in the oral and maxillofacial region.The decision of which treatment modality to use is influenced by many factors, such as the amount and condition of tissue available for repair, the size and location of the defect, the presence of infection, the time to the diagnosis of the fistula. To evaluate an alternative technique for the treatment of oro-antral fistula, using a combined therapeutic ear nose and throat/intraoral approach. Twelve consecutive patients affected by complicated OAC were included in this study.The protocol consisted of: clinical, endoscopic, and radiological preoperative evaluation (panoramic tomogram and computed tomography); systemic antibiotic and steroid therapy for 2 weeks before surgery; one-stage surgical procedure consisting of Functional Endoscopic Sinus Surgery technique associated with the closure of the OAC by a titanium mesh and a mucoperiosteal flap; postoperative antibiotic and cortisone-based therapy.A titanium mesh was used to obtain an optimal support and stabilization of soft tissues.Follow-up consisted of weekly clinical evaluation during the first month, a clinical evaluation at 1, 3, 6, 12, 24 months and a nasal endoscopy at 3, 8, 24 weeks after surgery. A second surgical step took place to remove the mesh, after a period of healing, which went from 6 to 18 months. Samples were harvested from the surgical site after mesh removal for histological analysis. At 1 month follow-up, in 10 patients of 12, the Valsalva manoeuvre was negative, same result at the 3rd month follow-up, although in 11 of 12 patients. In 5 of 12 patients, the mesh was exposed. The histological analysis confirmed the formation of a pseudo-periosteum layer.One patient failed because the mesh lost its stability. The patient was operated again 8 months later and new mesh was fixed into place. The current study showed that one-stage, combined endoscopic and intraoral approach represents a feasible and minimally invasive procedure for the long-term effective treatment of chronic complicated OACs.The main advantage of the use of a titanium mesh to guide the regeneration is that it assures a predictable healing, mechanic scaffold, tissues stability and allows a possible following oral rehabilitation.