Objective: To research an efficient treatment for the management of bisphosphonate-associated osteonecrosis. Background Data: Necrosis of the jawbone has recently been described in association with systemic bisphosphonate therapy with drugs including zoledronic acid, pamidronate, and alendronate. The extent and clinical characteristics of bisphosphonate-associated osteonecrosis (BON) of the jaw are extremely variable, and range from the presence of fistulae in the oral mucosa or orofacial tissues, to large exposed areas of necrotic bone within the oral cavity. Clinical signs and symptoms commonly reported include pain, swelling, the presence of pus, loose teeth, ill-fitting dentures, and paresthesias of the inferior alveolar nerve when the necrosis affects the mandible. Fractures have also been reported. The treatment of BON of the jaw is still controversial since no therapy has proven to be efficacious as shown by the literature on the subject. Materials and Methods: In this study we report results achieved with 28 patients affected by BON of the jaw, who received treatment with the Nd:YAG laser alone or in combination with conventional medical or surgical treatment. Clinical variables such as severity of symptoms, presence of pus, and closure of mucosal flaps before and after therapy were evaluated to establish the effectiveness of laser irradiation. The 28 patients with BON were subdivided into four groups: eight patients were treated with medical therapy only (antibiotics with or without antimycotics and/or antiseptic rinses), six patients were treated with medical and surgical therapy (necrotic bone removal and bone curettage), six patients were treated with medical therapy associated with laser biostimulation, and eight patients were treated with medical therapy associated with both surgical therapy and laser biostimulation. Results: Of the 14 patients who underwent laser biostimulation, nine reported complete clinical success (no pain, symptoms of infection, or exposed bone or draining fistulas), and three improved their symptomatology only, with a follow-up of between 4 and 7 mo. Conclusions: While the results reported in this study are not conclusive, they indicate that laser therapy has potential to improve management of BON.

Objective : The aim of this clinical study was to observe and evaluate the surgical management efficiency of soft tissues during orthodontic treatment. Materials and Methods : Thirty-seven young patients were selected and treated by laser-assisted surgery before or during orthodontic treatment and were classified by sex, age, and type of surgical management. Three different wavelengths were used (diode 810 nm, diode 980 nm, and Nd:YAG 1064 nm) in different surgical situations: maxillary vestibular and lingual frenectomies, surgical exposure and alignment of ectopic or retained teeth, and re-contouring gingival overgrowth. Results : In all evaluated patients, the laser treatment was performed without local anesthesia or sutures. Only topical anesthetic was needed. Conclusion : These use of these wavelengths of laser energy was a noticeable aid in the surgical management of soft tissues before or during orthodontic treatment. The benefits of laser treatment include reduced bleeding during surgery with consequent reduced operating time and rapid postoperative hemostasis, thus eliminating the need for sutures. The lack of need for anesthetics and sutures, as well as improved postoperative comfort and healing, make this technique particularly useful for very young patients.

Dental caries is the most common chronic disease of childhood. Cariogram is a well-recognized algorithm-based software program based on different caries-related risk factors and intended to aid clinicians in performing more objective and consistent dental caries risk assessments. This type of approach precedes the diagnosis of caries and allows the dentist to identify at-risk patients and then take appropriate preventive measures before caries develop further. One of the etiological factors favoring the development of dental caries is the mutans streptococci. These acidogenic dental plaque inhabitants can be effectively antagonized by the activity of bacteriocins released by the probiotic Streptococcus salivarius M18 (salivarius M18). Moreover, salivarius M18 after colonizing the human oral mucosa produces the enzymes dextranase and urease that are able to counteract plaque formation and saliva acidity, respectively. Seventy-six subjects at high risk of dental caries were randomized and then either treated or not treated for 90 days with an oral formulation containing the oral probiotic salivarius M18 (Carioblis^®). The results indicate that the use of salivarius M18 increases the chances of avoiding new dental caries development in children, and its application could be proposed as a new tool in the dentist's armory to be adopted in subjects considered at high risk on the basis of their Cariogram outcome.

Objective: Trauma during dental surgery is a predisposing factor for bisphosphonates (BP)-related osteonecrosis of the jaws (BRONJ). However, about 40% of cases of BRONJ are not related to dental invasive procedures, being probably associated to endodontic or periodontal infections. Extraction of non-treatable teeth is considered a reliable choice, to improve symptoms and to reduce the risk of BRONJ. Here we report our experience of tooth extractions in patients under oral or intravenous BP therapy. Study Design: Two-hundred and seventeen patients (38 males, 179 females; mean age 68.72 ± 11.26 years, range 30 to 83 years) under BP therapy received 589 tooth extractions at the Unit of Oral Medicine, Pathology and Laser-assisted Surgery of the University of Parma, Italy, between June 2006 and December 2010. Ninety five patients were under BP therapy for oncological disease (multiple myeloma (MM): 23; bone metastases (BM): 72) and 122 patients for non oncological diseases: 119 osteoporosis (OP), 2 rheumatoid arthritis (RA) and 1 Paget’s disease (PD). The mean duration of BP was of 35 months. Antibiotic treatment was administered three days before and 2 weeks after tooth extractions. Patients were additionally treated with low level laser therapy (LLLT) through Nd:YAG laser (1064 nm – power 1.25 W; frequency 15 Hz; fibre diameter: 320 ?m), 5 application 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. Mean follow-up was 15 months (ranging from 4 to 31 months). Results: In a total of 589 extractions (285 mandibular, 304 maxillary) performed, a minimal bone exposure was observed in 5 cases, treated with Er:YAG laser vaporization and than healed. Conclusions: Our experience supports the hypothesis that the association of antibiotic treatment and LLLT can be effective in preventing ONJ after tooth extractions in patients under BPT.