Conventional Non-surgical Treatment Research Articles

The effects of repeated applications of antimicrobial photodynamic therapy in the treatment of residual periodontal pockets: a systematic review.

The aim of this study was to assess the effects of repeated applications of antimicrobial photodynamic therapy (aPDT) on the non-surgical periodontal treatment of residual pockets. This work was performed and reported according to the Cochrane and PRISMA recommendations, respectively, and registered at the PROSPERO registry (number CRD42017058403). An extensive search of the biomedical literature was conducted on four databases from January 1960 to August 2018, followed by hand searching. Analysis of the quality of the selected studies was based on the risk of bias. Only two randomised controlled clinical trials (RCTs) met the inclusion criteria although they had unclear risk of bias. One study showed that repeated applications of aPDT in association with conventional non-surgical treatment during periodontal maintenance improved all clinical outcomes after 6months. The other study, which assessed the effects of repeated applications of aPDT in association with ultrasound debridement on periodontal pathogens, showed no significant reduction of the main pathogens after 3-6months but reported reductions of probing pocket depth and C-reactive protein after 3 and 6months, respectively, compared to mechanical therapy alone. Concluding, it was not possible to state that repeated applications of aPDT, in association with non-surgical treatment of residual pockets, have effective clinical effects in the periodontal maintenance therapy. Although one can consider that aPDT is a promising adjuvant therapy, it is still necessary to carry out more RCTs with low risk of bias in order to confirm or refute the benefits of multiple applications for residual periodontal pockets.

Infection Control in Teeth with Apical Periodontitis Using a Triple Antibiotic Solution or Calcium Hydroxide with Chlorhexidine: A Randomized Clinical Trial

IntroductionThis randomized clinical study compared the antibacterial effectiveness of treatment protocols using either a triple antibiotic solution (1 mg/mL) or calcium hydroxide/chlorhexidine paste as interappointment medication in infected canals of teeth with primary apical periodontitis. MethodsThe root canals of single-rooted teeth with apical periodontitis were prepared by using a reciprocating single-instrument technique with 2.5% sodium hypochlorite irrigation and then medicated for 1 week with either a triple antibiotic solution (minocycline, metronidazole, and ciprofloxacin) at 1 mg/mL (n = 24) or a calcium hydroxide paste in 2% chlorhexidine gluconate (n = 23). Samples were taken from the canal at the baseline (S1), after chemomechanical preparation (S2), and after intracanal medication (S3). DNA extracts from clinical samples were evaluated for total bacterial reduction using a 16S ribosomal RNA gene-based quantitative polymerase chain reaction assay. ResultsAll S1 samples were positive for the presence of bacteria, and counts were substantially reduced after treatment procedures (P < .01). Bacterial levels in S2 and S3 samples did not significantly differ between groups (P > .05). S2 to S3 reduction was 97% in the antibiotic group and 39% in the calcium hydroxide/chlorhexidine group; only the former reached statistical significance (P < .01). There were significantly more quantitative polymerase chain reaction–negative S3 samples in the antibiotic group than in the calcium hydroxide group (P < .05). ConclusionsInterappointment medication with a triple antibiotic solution at the concentration of 1 mg/mL significantly improved root canal disinfection, and its effects were at least comparable with the calcium hydroxide/chlorhexidine paste. Effectiveness and easy delivery of the antibiotic solution make it an appropriate medicament as part of a disinfecting protocol for conventional nonsurgical endodontic treatment and possibly regenerative endodontic procedures.

The effectiveness and safety of nonsurgical integrative interventions for symptomatic lumbar spinal spondylolisthesis: A randomized controlled multinational, multicenter trial protocol.

Background:Surgery is generally accepted as the main therapeutic option for symptomatic lumbar spondylolisthesis. However, new nonsurgical therapeutic options need to be explored for this population.Objectives:The objective of this study is to assess the effectiveness and safety of a 5-week Mokhuri treatment program compared with conventional nonsurgical treatments for symptomatic lumbar spondylolisthesis.Methods:This is a study protocol for a multinational, multicenter clinical randomized controlled trial comparing the effectiveness and safety of 5 weeks of nonsurgical integrative treatments (a Mokhuri treatment program consisting of Chuna, acupuncture, and patient education) with nonsurgical conventional treatments (drugs for pain relief, epidural steroid injections, and physical therapy). Clinical outcomes including visual analogue scale (VAS) scores ranging from 0 to 100 for low back pain and leg pain, EQ-5D scores, Oswestry disability index (ODI) scores, Roland–Morris Disability Questionnaire (RMDQ) scores, Zurich Claudication Questionnaire (ZCQ) scores, walking duration and distance without leg pain, and a 5-minute treadmill test, and the ratio between the actual duration of participation and the originally scheduled duration in each group, the presence of any additional spondylolisthesis treatments, the types of concomitant treatments during the follow-up period, and adverse events (AEs) will be assessed at 7 weeks, 18 weeks, 30 weeks, 54 weeks, and 102 weeks after the end of the treatments.Conclusion and discussion:The results of this study will provide clinical evidence on nonsurgical integrative interventions for patients with symptomatic lumbar spondylolisthesis.Clinical trial registry:clinicaltrials.gov (NCT03107468)

Investigation of a Novel Predictive Biomarker Profile for the Outcome of Periodontal Treatment.

An ability to predict the response to conventional non-surgical treatment of a periodontal site would be advantageous. However, biomarkers or tests devised to achieve this have lacked sensitivity. The aim of this study is to assess the ability of a novel combination of biomarkers to predict treatment outcome of patients with chronic periodontitis. Gingival crevicular fluid (GCF) and subgingival plaque were collected from 77 patients at three representative sites, one healthy (probing depth [PD] ≤3 mm) and two diseased (PD ≥6 mm), at baseline and at 3 and 6 months after treatment. Patients received standard non-surgical periodontal treatment at each time point as appropriate. The outcome measure was improvement in probing depth of ≥2 mm. Concentrations of active enzymes (matrix metalloproteinase [MMP]-8, elastase, and sialidase) in GCF and subgingival plaque levels of Porphyromonas gingivalis, Tannerella forsythia, and Fusobacterium nucleatum were analyzed for prediction of the outcome measure. Using threshold values of MMP-8 (94 ng/μL), elastase (33 ng/μL), sialidase (23 ng/μL), and levels of P. gingivalis (0.23%) and T. forsythia (0.35%), receiver operating characteristic curves analysis demonstrated that these biomarkers at baseline could differentiate healthy from diseased sites (sensitivity and specificity ≥77%). Furthermore, logistic regression showed that this combination of these biomarkers at baseline provided accurate predictions of treatment outcome (≥92%). The "fingerprint" of GCF enzymes and bacteria described here offers a way to predict the outcome of non-surgical periodontal treatment on a site-specific basis.

Commentary: Is There Clinical Benefit From Using a Diode or Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Periodontitis?

Despite a quarter of a century of laser research, there is a persistent debate regarding the efficacy of dental lasers in the treatment of periodontitis or periodontal maintenance therapy. There are many claims and much hyperbole surrounding the use of lasers, either as a monotherapy or adjunctive to scaling and root planing, to treat periodontitis. There is little evidence that using a diode or neodymium:yttrium-aluminum-garnet laser adds clinical value over and above conventional non-surgical or surgical periodontal treatment. There is a significant need for better designed human clinical trials. Data from such trials should be analyzed according to initial probing depth and characteristics of the treated sites, such as non-molar, molar flat surfaces, and molar furcations, and evaluated for long-term post-treatment results.

Comparative Evaluation of Clinical Changes in Type-2 Diabetic &amp; Non-Diabetic Patients with Chronic Generalized Periodontitis And Metabolic Improvement of Blood HbA1c Level After Conventional Periodontal Treatment

Aim: India leads the world today with largest number of diabetic patients in any given country. One forth of total diabetic population of world is in India, majority of them are of type-2 diabetics. Our aim of present study was that after control over periodontal infection by conventional non-surgical periodontal treatment, to evaluate metabolic control of type-2 diabetes by means of improvement in blood HbA1c level after 3 & 6 months. Material & Methods: Present study was carried out for management of periodontal infection by conventional periodontal treatment – scaling & root planing, in experimental group with type 2 diabetics and control group, non diabetics; both groups with moderate generalized chronic periodontitis. Clinical parameters measured were the plaque index, bleeding on probing index, probing depth & level of clinical attachment and metabolic response in tpe-2 diabetic patients by means of HbA1c at 3 & 6 months. Results: An improvement in all clinical variables was observed, with no statistically significant differences between the groups, with the exception of probing depth (p<0.016) which shows significantly better outcomes for the control group. The improvement observed in blood HbA1c levels confirmed a positive metabolic response to periodontal treatment. Conclusion:With this study, we conclude that,,non surgical conventional periodontal therapy can lead to definitive improvement in HbA1c level of type-2 diabetics.

Efficacy of adjunctive laser in non-surgical periodontal treatment: a systematic review and meta-analysis.

To evaluate the efficacy of the adjunctive laser therapy in conventional non-surgical treatment of chronic periodontitis, an electronic search was performed through the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, MEDLINE, EMBASE, Scopus, Web of Science, China National Knowledge Infrastructure (CNKI), and China Biology Medicine (CBM) Disc, for relevant randomized controlled trials (RCTs) or quasi-RCTs. All the 12 included studies (11 RCTs and 1 quasi-RCT) were qualified for descriptive and quantitative analysis. Outcomes were divided into two groups according to the length of follow-ups (long term and short term). Subgroup analyses were performed based on the mode of laser (inside and outside mode). Among all included researches, reduction in probing depth (PD) and gain in clinical attachment level (CAL) were presented with the mean value and 95% confidence interval, while bleeding on probing (BOP) was assessed descriptively. Meta-analysis suggested that adjunctive laser therapy reduced PD at 3months [mean difference (MD) = -0.26, 95% confidence interval (CI) range = -0.43 to -0.09, p = 0.003] but did not demonstrate significant effect on the CAL at either 3months (MD = -0.03, 95% CI range = -0.25 to 0.19, p = 0.79) or 6months (MD = -0.11, 95% CI range = -0.38 to 0.16, p = 0.43). Subgroup analyses indicated that laser therapy would be more effective when the probes were set up outside the periodontal pockets.

Neuromodulation for Refractory Failed Back Surgery Syndrome Patients

doi: 10.17691/stm2015.7.3.13 Received February 23, 2015I.N. Morozov, Md, dSc, Senior Researcher, Advisory and Rehabilitation department;А.I. Ushakov, Neurosurgeon, department of NeurosurgeryPrivolzhsky Federal Research Medical Center, Ministry of Health of the Russian Federation, 18 Verkhne-Volzhskaya naberezhnaya St., Nizhny Novgorod, 603155, Russian FederationThe aim of the investigation was to assess the capabilities of spinal cord stimulation, and compare it with conventional nonsurgical treatment in failed back syndrome.Materials and Methods. The study involved the patients with at least one anatomically successful lumber disc hernia excision, post-traumatic spinal deformity in their past history, the patients keeping suffering from neuropathic pain.Group 1 patients (n=45) in addition to traditional therapy underwent spinal cord stimulation. Group 2 control patients (n=35) were given medicines, therapeutic blocks, physiotherapy, and psychotherapy.Results. Epidural spinal cord stimulation in chronic pain syndrome treatment enables to improve significantly the patients, condition: it lowers pain level, increases the functionality and improves the quality of life.Conclusion. Being minimally invasive and highly safe, neuromodulation enables to achieve good treatment results in failed back syndrome.Key words: neuromodulation; spinal cord stimulation; SCS; failed back surgery syndrome; FBSS.For contacts: Morozov ivan Nicolaevich, e-mail: ivanmorozov@list.ru

Non-surgical periodontal treatment of peri-implant diseases with the adjunctive use of diode laser: preliminary clinical study.

Peri-implant diseases present in two forms: peri-implant mucositis and peri-implantitis. The prevalence of peri-implant complications is significantly rising. The aim of this study was to compare conventional treatment of inflamed peri-implant tissues with conventional treatment together with diode laser application. Twenty-seven patients (age 36 to 67, 15 women and 12 men, 12 smokers and 15 non-smokers) requiring treatment for mucositis or peri-implantitis were taken into account for this preliminary study. Plaque index (PI), pocket depth (PD), and bleeding on probing (BoP) were recorded at baseline evaluation. Patients in control group (CG) received conventional non-surgical periodontal treatment. Patients in test group received conventional non-surgical periodontal treatment together with diode laser application (810nm, 30s, 1W, 50Hz, t on = 100ms, t off = 100ms, energy density = 24.87J/cm(2)). Paired t test was used to evaluate the difference in repeated measurements of considered indexes at T 0 and T 1 (1year) in both groups. A total of 606 sites were taken into account in the test group (TG) and 144 in the CG. PD mean variation in the TG was 2.66mm ± 1.07, while mean PD variation in the CG was 0.94 ± 1.13mm. Paired t testing of the variation in PD in CG and TG revealed a statistically significant difference between the two groups (p < 0.0001). A reduction of pathological sites from 89% (T 0) to 14.35% (T 1) was achieved in the TG, while reduction obtained in the CG was from 75.69% (T 0) to 50% (T 1); BoP scores at time T 1 had fallen below 5% in the TG and decreased to 59.7%, in the CG. Within the limitations of this study, diode laser seems to be an additional valuable tool for peri-implant disease treatment.

Assessing the obese diabetic patient for bariatric surgery: which candidate do I choose?

The worldwide prevalence of type 2 diabetes is rising in association with an increasing frequency of overweight and obesity. Bariatric-metabolic procedures are considered as additional therapeutic options, allowing improved diabetes control in most patients. Multiple factors play in concert to achieve the improvements in diabetic remission observed after bariatric-metabolic surgery. Several studies have demonstrated that bariatric-metabolic surgery is an effective treatment for type 2 diabetes when compared with conventional nonsurgical medical treatment. Because the best results are achievable in patients with a relatively short history of diabetes and less advanced controlled disease, the surgical option could be considered early, especially in morbid obese subjects (BMI ≥35 kg/m2) after failure of medical treatment. Patients with extensive weight loss are more likely to achieve type 2 diabetes remission after bariatric surgery. At present, Roux-en-Y gastric bypass seems the surgical procedure of choice because it has fewer risks than biliopancreatic diversion, and it is associated with higher weight loss and metabolic improvements compared with adjustable gastric banding. Recent evidences regarding the effectiveness of sleeve gastrectomy in diabetes remission have to be confirmed by controlled trials with longer follow-up.

Role of surgical resection for patients with limited disease-small cell lung cancer.

Although chemotherapy and radiotherapy are recommended for patients with limited disease small cell lung cancer (LD-SCLC), several series have reported favorable survival outcomes even in patients with stages II and III disease who underwent surgical resection. The purpose of this study is to compare the outcomes of the use of surgical resection to the other conventional non-surgical treatments in patients with LD-SCLC with respect to each clinical stage. We retrospectively reviewed 277 patients who received treatment for LD-SCLC and compared the outcomes of the use of surgical resection to the other conventional non-surgical treatments. The clinical stage was stage I in 50 cases (18%), stage II in 53 cases (19%) and stage III in 174 cases (63%). Eighty-eight patients received surgical resection and 189 patients were treated with non-surgical treatment. Surgery was performed in 44 patients (88%) with stage I, 27 patients (52%) with stage II and 17 patients (10%) with stage III disease. The five-year survival rates of the patients according to clinical stage were 58% in stage I, 29% in stage II and 18% in stage III. The five-year survival rates of the patients with and without surgical resection according to clinical stage were as follows: 62% and 25% in stage I (p<0.01), 33% and 24% in stage II (p=0.95), 18% and 18% in stage III (p=0.35), respectively. In 44 propensity score-matched pairs with stages II and III disease, including matching for variables such as age, gender and the PS, the five-year survival rates was better in patients with surgical resection than in those without surgery (p=0.04). Surgical resection is effective for the patients with stage I LD-SCLC and some cases of stage II or III disease.

Volumetric three-dimensional computed tomographic evaluation of the upper airway in patients with obstructive sleep apnoea syndrome treated by maxillomandibular advancement

Obstructive sleep apnoea syndrome is the periodic reduction or cessation of airflow during sleep together with daytime sleepiness. Its diagnosis requires polysomnographic evidence of 5 or more episodes of apnoea or hypopnoea/hour of sleep (apnoea/hypopnoea index, AHI). Volumetric 3-dimensional computed tomographic (CT) reconstruction enables the accurate measurement of the volume of the airway. Nasal continuous positive airway pressure (CPAP) is the conventional non-surgical treatment for patients with severe disease. Operations on the soft tissues that are currently available give success rates of only 40%-60%. Maxillomandibular advancement is currently the most effective craniofacial surgical technique for the treatment of obstructive sleep apnoea in adults. However, the appropriate distance for advancement has not been established. Expansion of the air-flow column volume did not result in an additional reduction in AHI, which raises the important issue of how much the maxillomandibular complex should be advanced to obtain an adequate reduction in AHI while avoiding the risks of overexpansion or underexpansion. We have shown that there is a significant linear relation between increased absolute upper airway volume after advancement and improvement in the AHI (p=0.013). However, increases in upper airway volume of 70% or more achieved no further reduction in the AHI, which suggests that the clinical improvement in AHI reaches a plateau, and renders further expansion unnecessary. This gives a new perspective to treatment based on the prediction of changes in volume, so the amount of sagittal advancement can be tailored in each case, which replaces the current standard of 1cm.

Actonel&amp;lt;sup&amp;gt;&amp;#174;&amp;lt;/sup&amp;gt; (risedronate) therapy for the maintenance of alveolar bone in adult chronic periodontitis

Introduction: The primary objective of this study was to determine whether risedronate sodium (Actonel?) therapy, in conjunction with conventional non-surgical periodontal treatment, reduces the rate of alveolar bone loss. Secondary aims were to compare the incidence of patient dropouts in the risedronate and placebo groups, and to document adverse events. Methods: This double-blind randomized placebo-controlled trial was conducted in 125 patients with moderate to severe periodontitis. At baseline, three, and nine months, standardized vertical bite-wing radiographs were taken and used to measure bone loss. Clinical periodontal examinations were taken at three-month intervals to assess whether or not the patient was experiencing rapid periodontal breakdown, in which case suitable treatment could be planned and delivered. Patients received scaling and root planing at baseline and periodontal maintenance at three-month intervals thereafter. At three months, subjects were randomly assigned to risedronate (35 mg/week by mouth) or placebo in blocks based on the severity of periodontitis (moderate, mean bone loss 2 -4 mm; or severe, mean bone loss >4 mm); smoking; and diabetes. Interval bone loss in millimeters was measured from the radiographs, and analysis of variance (ANOVA) was used to test for differences in bone loss between test and placebo groups. Results: Over the nine-month study duration, the test group exhibited a significantly greater increase in bone height (0.31 ±0.09 mmgain test, 0.08 ±0.09 mmgain placebo, F = 4.94, p gesting the possibility of a patient-noticeable effect. There was no indication of ONJ.

Bariatric surgery versus conventional therapy in obese Korea patients: a multicenter retrospective cohort study

PurposeIn Korea, the results of bariatric surgery have not been compared with those of nonsurgical treatment. The purpose of this study was to evaluate the effectiveness and safety of bariatric surgery vs. conventional nonsurgical treatment in severely obese Koreans.MethodsIn this retrospective cohort study, we reviewed the medical charts of 261 consecutive subjects who underwent bariatric surgery and 224 subjects who were treated with weight control medication and lifestyle modification therapy between January 2008 and February 2011. Measures of clinical effectiveness, including change in weight (%) and comorbid diseases, and occurrence of complications, were investigated for 18 months after bariatric surgery.ResultsBody mass index (BMI) was higher in the surgery group than in the conventionally treated group (mean ± standard deviation, 39.0 ± 6.2 vs. 34.3 ± 3.8). Diabetes was more prevalent in the surgery group than in the conventionally treated group (39.1% vs. 12.9%). The change in weight (%) between baseline and 18 months posttreatment was significantly greater in the surgery group (22.6%) than in the conventional therapy group (6.7%). While 57%, 47%, and 84% of subjects recovered from diabetes, hypertension, and dyslipidemia, respectively, in the surgery group, 10%, 20%, and 24% of subjects recovered from these conditions in the conventional group. Fifty-one subjects (19.5%) in the surgery group reported 61 complications (23.4%).ConclusionBariatric surgery in Korea was significantly more effective than conventional treatment for weight loss and recovery from comorbidities such as diabetes, hypertension, and dyslipidemia, with a reasonable complication rate.

Reduction in HbA1c levels following non-surgical periodontal therapy in type-2 diabetic patients with chronic generalized periodontitis: A periodontist′s role

Background:Aim of the study was to compare the response to non-surgical periodontal therapy between patients with and without type-2 diabetes from clinical and metabolic stand point.Materials and Methods:A comparative clinical study was performed between type 2 diabetics and non-diabetics with moderate generalized chronic periodontitis. The study period was six months. Conventional periodontal scaling and root planing were performed, and the response to this treatment was compared between the groups at three and six months, measuring the plaque index, bleeding index, gingival index, and probing depth. In diabetic patients, the clinical response was related to measurements of HbA1c and glucose in blood at three and six months.Statistical Analysis:Multi Variant Analysis of Variance was used to compare following variables between groups and function of time.Results:Improvement in all clinical variables was observed in both the groups. The improvement observed in blood HbA1c levels in diabetic group confirmed a positive metabolic response to non-surgical periodontal treatment.Conclusion:With this study, we conclude that there is a definite reduction in HbA1c level in diabetic patients after conventional non-surgical periodontal treatment.

Surgical and nonsurgical management of bilateral periapical lesions in the maxillary anterior region

Conventional nonsurgical endodontic treatment has a high degree of clinical success, but in certain cases surgical intervention becomes necessary. This is the case report of a patient presenting with bilaterally separate periapical lesions in the maxillary anterior region. One lesion was managed by periapical surgery using a novel and safe method of separating the soft tissue mass of the periapical lesion which was in proximity to vital and vulnerable anatomical tissues, and the other was managed by long-term intracanal medicament, emphasizing the need of application of treatment in the best interest of the patient.

Psychosocial impact of periodontal disease and its treatment with 24‐h root surface debridement

To assess the impact of periodontal disease and treatment with 24-h root surface debridement on the oral health-related quality of life of patients (OHQoL). Two cohorts were recruited: 20 patients with moderate to advanced periodontal disease and 16 dentally healthy patients. Patients with periodontal disease were treated with 24-h root surface debridement. OHQoL was assessed, using Oral Health Impact Profile-14, during the initial assessment and by a telephonic interview daily for 7 days for both groups. OHQoL was also assessed at review for the treated cohort. The number of impacts each patient experienced "occasionally" or more often was analysed by non-parametric tests. Patients with periodontal disease reported significantly more impacts on their quality of life than dentally healthy patients (p<0.05). After root surface debridement the impact was significantly reduced (p<0.05) and sustained at review (p<0.05); however, the impact on quality of life was still greater than that experienced by the dentally healthy cohort (p<0.05). Patients with periodontal disease have worse OHQoL than healthy patients, but this impact can be partly ameliorated by periodontal treatment. This implies that periodontal disease is not "silent" and that conventional non-surgical treatment provided in a secondary referral centre can be effective from patients' perspectives.

Spinal cord stimulation compared with medical management for failed back surgery syndrome

It has been 40 years since the first report of spinal cord stimulation (SCS) with electrical energy, written by Shealy et al. [1]. The effectiveness of SCS has been studied in many chronic pain states. Pain relief has been demonstrated in back and leg pain, failed back surgery syndrome, chronic regional pain syndrome, peripheral vascular diseases of the lower extremities, multiple sclerosis, and peripheral neuropathy [2]. In SCS, electrodes are placed in the epidural space, which are attached to an implantable neurostimulating generator. The electrodes are positioned over the posterior columns of the spinal cord. State-of-the-art neurostimulating generators are programmable and allow patients to control certain stimulating parameters with a hand-held programmer. In this randomized controlled clinical trial, Kumar et al. studied SCS compared with conventional nonsurgical treatment of neuropathic pain in patients with failed back surgery syndrome. SCS has been the topic of numerous publications [3–5]. However, many of these publications have been case reports or retrospective studies; few have been randomized controlled trials [6,7].

Enhancement of Healing Kinetics of Periapical Lesions in Dogs by the Apexum Procedure

In nonsurgical endodontic procedures, the healing of apical periodontitis is achieved by treatment provided within the root canal system. The new Apexum procedure is based on advancing the debridement one step further by minimally invasive removal of the inflamed periapical tissues through root canal access, thereby enhancing the healing kinetics of periapical lesions. The Apexum procedure uses 2 sequential rotary devices designed to extend beyond the apex and to mince periapical tissues on rotation in a low-speed handpiece, followed by washing out the minced tissue. This initial animal study was conducted to evaluate the efficacy and potential adverse effects of this procedure. Periapical lesions were induced in the lower premolars in dogs by placement of autologous dental plaque and subsequent radiographic verification. Fifty roots with periapical lesions were then subjected to cleaning, shaping and disinfection of their root canals, using a conventional root canal treatment protocol. Teeth in group 1 were subjected to the new Apexum procedure just before obturation, whereas roots in group 2 were subjected to no additional intervention before obturation. Clinical and radiographic follow-ups were carried out for 6 months. Radiographic healing of the periapical lesions in dogs at 3 and 6 months showed significantly enhanced kinetics in the Apexum-treated group compared with the conventional treatment group, at both time points (p <0.01). No noticeable adverse events occurred in either of the groups. This new procedure might significantly enhance healing kinetics of apical periodontitis compared with conventional nonsurgical endodontic treatment.

S236: Advanced Surgical Management of Obstructive Sleep Apnea

The awareness of the deleterious effects of obstructive sleep apnea (OSA) has increased over the past decade. Known symptoms of OSA include hypersomnolence, and cardiovascular and neurological diseases. Increased awareness of these conditions has led to an increase in the diagnosis and treatment options for patients with OSA. Conventional nonsurgical treatment options may be unacceptable or intolerable to some patients. In these situations, surgical management may be a viable option. Phase I surgery for OSA involves the surgical management of upper airway obstruction that does not involve maxillomandibular advancement surgery (phase II). A variety of solitary and combined surgical procedures have been developed to address upper airway obstruction. This lecture will review several commonly used techniques and emphasize, either alone or in combination, the latest advanced OSA surgery techniques, such as nasal reconstruction (internal and external nasal valve reconstruction, septoplasty, etc) hyoid advancement, elliptical genioglossus advancement, soft palate surgery (UPPP, LAUP, etc), and maxillomandibular advancements. Oral and maxillofacial surgeons managing the surgical obstructive sleep apnea patient will learn the latest advanced techniques in upper airway obstruction surgery. Emphasis will be on the correct diagnosis, treatment planning, indications, and latest research in these techniques for the surgical management of OSA.