Removal Of Granulation Tissue Research Articles

Innovative Approaches in Fistula-In-Ano Management: Evaluating the Role of Fistula Brush - A Case Study

Introduction: Fistula in ano is one of the most common anorectal diseases. The prevalence is greater in men than women, with the rate of 12.3 cases per 100,000 and 5.6 cases per 100,000, respectively. In Ayurvedic Science Ksharasutra ligation is one of the most popular treatment modality for Bhagandara. Ksharasutra is indeed a well-known treatment in Ayurveda, particularly for managing conditions like pilonidal sinus and anal fistulas. However, it does have some limitations. Hence, an innovative technique is adopted by introducing a new Yantra i.e., Fistula brush in the field of Shalya Tantra for minimizing the unit cutting time in fistulous tract. Methodology: The fistulous tract was curetted using the fistula brush in 4-5 strokes followed by primary threading with barbour thread. Follow up thread change was done after curetting the tract using fistula brush until the tract was cut through. (under local anaesthesia). Result: The intervention results indicated a marked improvement in both subjective and objective parameters, demonstrating the intervention's effectiveness in enhancing patient outcomes. Discussion: The treatment of anal fistula through curettage of the tract using a fistula brush has been demonstrated to be a cost-effective and accessible method. This technique facilitates the removal of unhealthy granulation tissue while ensuring adequate drainage with the use of a drainage seton, thereby promoting the formation of healthy granulation tissue. Ultimately, this process encourages fibrosis of the tract and minimizes the risk of sphincter damage. Mechanical debridement plays a pivotal role throughout the stages of wound healing by promoting a clean, healthy wound environment. By alleviating symptoms associated with each stage - such as pain, burning sensation, discharge and local tenderness - it ultimately enhances the healing process and improves patient comfort.

Radiographic evaluation of partial versus complete removal of granulation tissue in modified minimally invasive surgical technique (M-MIST).

Radiographic evaluation of partial versus complete removal of granulation tissue in modified minimally invasive surgical technique (M-MIST).

Partial (incomplete) removal of granulation tissue using modified minimally invasive surgical technique in treatment of infrabony defects (randomized control clinical trial)

AimThis study aims to compare the clinical and radiographic outcomes after complete versus incomplete removal of granulation tissue (GT) during modified minimally invasive surgical technique (M-MIST) for management of periodontitis patients with deep pockets associated with infra-bony defects.MethodologyTen patients with a total of 14 deep non-resolving pockets (≥ 5 mm) associated with a vertical infra-bony defect were recruited for this study. They were randomized into 2 groups; a test group with incomplete removal of GT and a control group with complete removal of GT. Clinical parameters of clinical attachment level (CAL), residual probing depth (rPD) and buccal recession (Rec.) were recorded every 3 months. Radiographic periapicals were taken at baseline, 6 and 9 months. The significance level was set to 0.05.ResultsNone of the results showed statistical significance between the 2 groups (p > 0.05). The test group showed less CAL gain (2 ± 0.87 mm, p = 0.062), more reduction in rPD (3.1 ± 0.96 mm, p = 0.017) and more recession (0.857 ± 0.26 mm, p = 0.017) than control group CAL gain (2.4 ± 0.58 mm, p = 0.009), rPD reduction (2.9 ± 0.3 mm, p = 0.001) and recession (0.5 ± 0.34 mm, p = 0.203) respectively. Control group had linear reduction in depth defect (DD) (0.68 ± 0.287, p = 0.064) compared to an increase in DD in test group (-0.59 ± 0.5, p = 0.914).ConclusionsNo statistical significance were observed in healing parameters between complete removal of GT in M-MIST and incomplete (partial) removal of GT of deep pockets with infra-bony defects both clinically and radiographically. Further studies with larger samples are needed to confirm the results.

Novel use of hot biopsy forceps for removal of tracheobronchial stent-related granulation tissue

Patients with malignant central airway obstruction often present with dyspnea and sometimes with frank respiratory failure. Airway stenting has become a routine modality in the management of these patients. A correctly placed airway stent will give good relief in dyspnea and respiratory failure and will even improve the patient's ECOG (Eastern Cooperative Oncology Group) performance score. The common complications associated with stents are migration, fracture, infection, and obstruction by tumors, granulation tissue, and secretions. These complications are more pronounced with metallic stents. Surveillance bronchoscopy should ideally be done in these patients at least 4–6 weeks post-stent insertion. Removal of granulation tissue has been attempted with modalities like lasers, Argon plasma coagulation, cryotherapy, and snare electrocautery. Here, we present a novel case of post-stent granulation tissue, which was removed and debulked with the help of electrocoagulation bronchoscopy biopsy forceps (hot biopsy forceps).Conclusion Hot biopsy forceps can be safely and easily used for the removal of granulation tissue in patients post-tracheobronchial stent insertion.

Is there an advantage to delayed molar implant placement in those with chronic apical periodontitis?

This paper is a single-centre, double-blinded, prospective randomised control trial, comparing immediate vs delayed implant placement clinically and radiographically in patients with chronic periodontitis, specifically assessing the molar region. Seventy-four patients were recruited to the study over a one-year period, all of whom returned for follow up throughout the study. The study adhered to the principles outlined in the Declaration of Helsinki and obtained ethical approval from the affiliated University Hospital of Qingdao. Written consent was gained from patients in line with the CONSORT guidance. The patients were recruited from the Department of Oral and Maxillofacial Surgery at the University of Qingdao between January 2019 and January 2020. The study included anyone above the age of 18, who had a molar with chronic apical periodontitis and lesions of less than 8 mm. Exclusions included pregnancy, uncontrolled diabetes, smokers, bisphosphonate use, history of head/neck tumours, coagulation disorders, and acute infections of adjacent teeth/tissue. Of the patients who met the inclusion criteria, all were randomly numbered by a stomatologist and placed into either the control group or the experimental group by a computerised system (Microsoft Excel). This study looked at the placement of 74 implants in 74 patients, including 40 female and 34 malepatients in total. The delayed implant placement allowed for healing of 3 months in the mandible and 6 months in the maxilla. The width of the implants placed was 6 mm and the lengths were between 7 mm and 12 mm.The periodontal probing depth, modified sulcus bleeding index, andmodified plaque index were all clinically examined. In terms of other parameters assessed, CBCT was used to look at alveolar bone mass. All surgery and implant placement was carried out by the same surgeon and the clinical measurements were all taken by one dentist. The results showed no significant difference in implant stability quotient immediately and 6 months post-surgery (0.110 and 0.066, respectively), when comparing the experimental and control group. Similarly, there was no significant difference in PD, mSBI or mPI between the groups. On assessment of CBCT scans however there was a significant difference between the two groups in the buccal horizontal marginal bone loss (P = 0.003), lingually there was not. Vertical bone loss also showed no significant difference in comparison. At one-year post-implant placement, there was a survival rate of 100% in both groups assessed. IBM SPSS statistics was used for statistical analysis. Multiple tests including the Shapirowilk test, the student t-test and the Mann-Whitney U-test were carried out on the data and all statistical tests were two tailed. Statistical significance was set at <0.05 throughout study of results. The conclusion of this study suggests that immediate implant placement in chronic periodontitis patients, specifically in the molar region, may be clinically viable. With flap surgery and complete removal of inflammatory granulation tissue, the study suggests no significant disadvantage to alveolar bone healing or osseointegration. The various limiting factors of this study should be taken into consideration, and it must be highlighted that longer and larger studies are necessary to allow for more accurate understanding of the long-term outcomes.

Entire Papilla Preservation Technique with Recombinant Human Fibroblast Growth Factor-2 and Autogenous Bone Grafting in the Treatment of Isolated Non-Contained Intrabony Defect: Case Report of a 5-Year Follow-Up.

Regenerative periodontal surgery is an effective procedure for the treatment of intrabony defects. Various flap designs preserving the defect-associated interdental papilla have been proposed to improve early wound stability. This case report describes the long-term results of a regenerative treatment in severely compromised mandibular canine using entire papilla preservation technique. Surgical access was provided by a single buccal vertical incision without any papilla incision. Combination of autogenous bone harvested from the same surgical site and recombinant human fibroblast growth factor-2 was applied to non-contained intrabony defect following the granulation tissue removal. Surgical site was closed with single interrupted sutures. The clinical outcomes and 5-year stability of pocket closure with no increase in gingival recession show the potential of entire papilla preservation technique with the use of combined biomaterials.

Effectiveness of modified and control protocols for the surgical therapy of combined peri-implantitis-related defects. Aretrospective analysis.

To compare the clinical effectiveness of control and two modified protocols for surgical therapy of combined peri-implantitis-related defects. A total of n=36 patients (n=40 implants) diagnosed with combined supra- and intrabony defects were identified for this retrospective analysis. All protocols considered access flap surgery, granulation tissue removal and implant surface decontamination using a titanium brush. The control combined protocol included implantoplasty at supracrestal/ buccal- and reconstructive therapy at intrabony components using a particulate natural bone mineral + a native collagen membrane (CM) (n=11 patients, n=11 implants, CP). The modified protocols included the augmentation at both supra- and intrabony defect components using either a collagen-stabilized natural bone mineral (BOC) (n=15 patients, n=15 implants, MP1), or BOC mixed with autogenous bone chips + CM (n=10 patients, n=14 implants, MP2). Linear mixed effects analyses were used to assess the changes in clinical parameters (i.e., bleeding on probing - BOP, probing pocket depth - PD, and mucosal recession - MR) over time (i.e., 6 and 12 months) and the impact of the treatment groups (CP, MP1, MP2). At 12 months, median BOP and PD reductions amounted to -58.33% and - 1.16 mm in the MP1, to -62.50% and -1.95 mm in the MP2, and to -66.67% and -0.83 mm in the CP groups, respectively. The associated MR changes ranged between 0.00 and 0.08 mm. The survival rates were 100% in all groups. All treatment protocols were associated with short-term improvements in the clinical parameters investigated.

Improving Surgical Treatment of Skin Burns to Reduce the Incidence of Pathologic Scarring

Background: In some parts of the world, the incidence of postburn pathologic scars reaches 16%. One should understand reconstructive surgery techniques and prioritize scar prevention during burn wound treatment. Inadequate wound management affects scar tissue formation and may cause pathologic scarring. Optimal timing of skin restoration operations reduces the risk of postoperative complications.Objective: To demonstrate that the surgical removal of fibrotic dermis and granulation tissue is feasible to reduce the incidence of pathologic scarring.Materials and methods: We studied treatment results in 57 patients with deep burns who were divided into 2 groups based on surgical treatment types before autologous skin grafting. Group 1 underwent total excision of granulation tissue, removal of fibrotic dermis, and excision of wound edges on day 27–31 after the injury. On day 22–28 postburn, group 2 had tangential excision of granulation tissue, removal of the upper skin layers only (the fibrotic dermis preserved), and then autologous skin grafting. The patients were followed up postoperatively at 1, 6, 12 months. During the examinations we assessed the formed scar tissue and perfusion of the burn injuries. Types and features of the scar tissue were identified by histologic examination of biopsy tissues.Results: We identified statistically significant differences between the analyzed patient groups based on the perfusion values measured by laser Doppler flowmetry and found a relationship between surgical approaches, wound perfusion, and the incidence of pathologic scarring.Conclusions: When early debridement is unfeasible, the preferred surgical approach for deep burns is a staged wound cleansing from necrotic tissue followed by total removal of granulation tissue and fibrotic dermis, and finally autologous skin grafting. This approach prevents pathologic scarring.

Congenital Malformations of the Cricoid Cartilage: Upper Airway Obstruction and Treatment Strategy.

To review treatment and outcomes in patients with congenital cricoid cartilage malformation. Retrospective analysis of patients with diagnosis of congenital cricoid malformation (CCM) treated in a single tertiary pediatric referral center between 1985 and 2022. Patients were grouped according to the morphology of the cricoid cartilage that was diagnosed during endoscopy. We reviewed the treatment strategy(s), decannulation rate, complications, and functional outcomes. Twenty-nine patients were grouped into four morphological subtypes of cricoid cartilage: 10 patients had a hypoplastic cricoid, eight had an elliptic shape, five had severe anterior thickening, and six an accentuated V-shape posterior cricoid plate. Twenty-four patients underwent surgery, and five were closely followed up without surgical treatment. Eight patients had a tracheostomy prior to surgery, and the majority had a hypoplastic cricoid. Most patients (20 out of 24) required additional procedures postoperatively to achieve an age-appropriate airway. Thirteen patients needed endoscopic dilatation(s) and granulation tissue removal; four needed more aggressive treatment, and three patients required revision open surgery. Decannulation was achieved after a median of 4.5 months in all previously tracheostomized patients. Endoscopy at the last follow-up showed an age-appropriate airway in 27 patients; 20 patients had normal oral feeding, and 11 patients had a normal voice. Endoscopy is important to diagnose CCM and most of the time patients would need only watchful waiting. In this report, surgery was required for patients who continued to remain symptomatic and had a compromised airway. The type of surgery depends on the type of cricoid malformation and the grade of stenosis. 4 Laryngoscope, 133:3185-3191, 2023.

Surgical Treatment of Peri-Implantitis Using a Combined Nd: YAG and Er: YAG Laser Approach: Investigation of Clinical and Bone Loss Biomarkers.

The current study aimed to investigate the effect of the combined Nd-Er: YAG laser on the surgical treatment of peri-implantitis by evaluating clinical markers and biomarkers of bone loss (RANKL/OPG). Twenty (20) patients having at least 1 implant diagnosed with peri-implantitis were randomly assigned to two groups for surgical treatment. In the test group (n = 10), Er: YAG laser was used for granulation tissue removal and implant surface decontamination, while Nd: YAG laser was employed for deep tissue decontamination and biomodulation. In the control group (n = 10), an access flap was applied, and mechanical instrumentation of the implant surface was performed by using titanium curettes. The following clinical parameters were evaluated at baseline and six months after treatment: Full-mouth Plaque Score (FMPS), Probing Pocket Depth (PPD), Probing Attachment Levels (PAL), recession (REC), and Bleeding on probing (BoP). Peri-implant crevicular fluid (PICF) was collected at baseline and six months for the evaluation of soluble RANKL and OPG utilizing enzyme-linked immunosorbent assay (ELISA). Baseline clinical values were similar for both groups, with no statistical differences between them. The study results indicated statistically significant improvements in the clinical parameters during the 6-month observation period in both groups. More specifically, PPD, PAL, and REC were improved in the test and control groups with no differences in the between-groups comparisons. However, a greater reduction in the BoP-positive sites was noted for the laser group (Mean change 22.05 ± 33.92 vs. 55.00 ± 30.48, p = 0.037). The baseline and six-month comparisons of sRANKL and OPG revealed no statistically significant differences between the two groups. The combined Nd: YAG-Er: YAG laser surgical therapy of peri-implantitis seemed to lead to more favorable improvements in regard to bleeding on probing six months after treatment compared to the conventional mechanical decontamination of the implant surface. None of the methods was found superior in the modification of bone loss biomarkers (RANKL, OPG) six months after treatment.

Diagnosis and management of allergic fungal sinusitis

Background: Fungal Rhinosinusitis is one of the common diseases affecting the Nose and Paranasal Sinuses. Various fungi cause the disease. These infections are termed as invasive Fungal Infections, when they occur in immunologically compromised individuals, and Diabetics. Objective: To evaluate the use of diagnostic criteria to confirm the fungal rhinosinusitis disease with radiological, pathological and microbiological investigations and their management. Materials and Methods: A prospective observation study has been conducted at, in which 21 patients presenting to the Ear, Nose and Throat (ENT) department of our institution with clinical features of fungal sinusitis. After thorough clinical examination, the patients underwent investigations including hematological tests, radiological tests, diagnostic nasal endoscopy, histopathological examination and microbiological examination. Clinical examination including complete ENT & Head and Neck examination and cranial nerves examination was done to all the 21 patients included in the study. The data collected was imported into excel sheet (Microsoft Excel) for further evaluation in obtaining the results. The frequencies of distribution of various variables of the study were represented in the form of tables. Results: 19 patients presented with nasal obstruction, 18 with nasal discharge, 14 with sneezing, 8 with headache, 11 with anosmia, 8 with nasal allergy, 9 with asthma, 7 with Diabetes mellitus, and 7 with previous history of nasal surgery. On clinical examination, polyps were found in 16 patients. Conclusion: Post-operative use of Systemic and Local Steroids, Antihistamines, Decongestants, Regular nasal douching and Anti-fungal antibiotics wherever necessary, helps in early healing of the cavities and also reduces recurrence. Postoperative regular follow up for endoscopic suction clearance of the debris, crusts, and removal of granulation tissue, helps in identifying early recurrence and gives the surgeon to plan further treatment.

Laser and Its Application in Periodontology: A Review of Literature

Introduction: The use of lasers is an emerging therapy in periodontology, however, controversies regarding its use. Despite the vast amount of literature that is currently available, debates regarding the use of lasers in periodontal therapy continue. This review aims to summarize and clarify the myths surrounding the use of lasers in periodontal therapy, which may offer new hope for the treatment’s future. Methods: A comprehensive computer-based search was done using various databases like PubMed, Medline, and Cochrane Library. Results: Laser therapy has influenced periodontal treatment in many aspects. The advantages of laser over conventional instruments were reported, which include pain relief, inflammation reduction, tissue repair acceleration, wound healing, reduction of scar formation, removal of granulation tissue and epithelial lining, and treatment of periodontal pockets. Today, the laser starts to get more people’s attention. However, an evidence-based approach to using lasers in periodontal treatment must be developed. The potential risks associated with lasers should also be considered. There must be careful and strict safety precautions implemented. Conclusion: Although laser therapy has shown promising results in the treatment of periodontal disease, further research is needed before the clinical use of lasers in evidence-based practice. Further long-term studies and clinical studies in human models are needed to generalize laser therapy in periodontology.

'Combined endo-perio lesions' - what is the best treatment?

Aims To assess the radiographic and periodontal healing of combined endo-perio lesions in anterior teeth treated with orthograde root canal treatment (RCT), with and without guided tissue regeneration (GTR) and bone grafting.Sample selection A total of 120 individuals attending the Dental University Hospital in Riyadh, Saudi Arabia, diagnosed with true combined endo-perio lesions were selected. Inclusion criteria included being between 25 and 55 years old and having a single-rooted non-vital maxillary anterior tooth with a true combined endo-perio lesion, assessed using a cone beam computed tomography (CBCT) scan. Exclusion criteria included uncontrolled systemic disease, a history of oral cancer or sepsis, recent use of antibiotics, the use of bone metabolism modifying drugs and the presence of fractures, resorption or associated pathological cysts. Power calculations were used to set a minimum sample size of 120 teeth.Design A randomised controlled trial involving four treatment arms: root canal treatment (RCT) with gutta percha (GP) obturation; RCT with mineral trioxide aggregate (MTA) obturation; RCT with GP obturation and guided tissue regeneration (GTR); and RCT with MTA obturation and GTR. Participants were randomly assigned using computer software to each treatment arm via block randomisation.Baseline periodontal measurements (gingival phenotype, keratinised tissue width, pocket depth and clinical attachment level) and a CBCT scan to obtain a CBCT periapical index (CBCTPAI) score were taken at visit one. Visit two involved scaling, root planing and a RCT performed using hand files and a thermoplastic obturation technique for the GP obturation arm (Obtura II, Obtura Spartan, USA) and vertical compaction for the MTA obturation arm (ProRoot White, Dentsply, USA). Visit three (for the GTR and bone-grafting arms), one week later, included regenerative periodontal surgery - raising a three-sided buccal flap, removal of granulation tissue, filling the defect with demineralised, freeze-dried bone allograft, coverage with a resorbable collagen membrane and closure with resorbable sutures. Visit two was performed by a single endodontist and visit three, for the GTR and bone grafting arms, was performed by a single periodontist. Previous or future planned treatment was concealed to operators and they were only informed of the treatment to be performed on the day. All teeth received definitive restorations.The follow-up schedule was one, three, six and twelve months post-treatment. CBCT scans were repeated at six and twelve months; clinical periodontal measurements were repeated at three, six and twelve months.Data analysis Descriptive analysis was performed and results were presented as cross-tabulations and a bar chart. Inferential statistics were used; one-way analysis of variance with Tukey's multiple comparison test to compare the mean value of measurements between treatment arms at follow-up visits and Kruskal-Wallis test to compare mean CBCTPAI scores between arms at follow-up visits. The p-value was set at ≤0.05.Results Baseline comparison showed no statistically significant differences between treatment arms. No participants were lost to follow up. At 12 months, GTR showed improved healing, with 98% of cases showing CBCTPAI scores better than 1, compared to 100% cases scoring 1 + D or worse without GTR. Statistically significant differences were found between treatment arms with respect to CBCTPAI score and pocket depth at 12 months.Conclusions GTR may improve radiographically-assessed healing of combined endo-perio lesions. MTA obturation may play a role in the management of combined endo-perio lesions. Study limitations do not allow for more definitive conclusions.

Split Thickness Skin Grafting With and Without Surgical Removal of Granulation Tissue in Granulating Wounds: A Single Blinded, Randomized Controlled Trial

Introduction: Split thickness skin graft (STSG) is a commonly carried out procedure in granulating wounds. The graft may be applied directly on the granulation tissue (without scrapping) or it may be applied after complete removal of the granulation tissue (after scrapping). Surgeons are divided on this issue. Methods: A single blinded, randomized, controlled trial was carried out between November 2017 and December 2018 in the Department of Plastic Surgery and Burns, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The study consisted of 62 patients who were divided into two groups. Group A consisted of patients undergoing removal of granulation tissue and Group B included patients on whom the skin graft was directly applied on the granulation tissue. On the 10th post-operative day, assessment of the graft take was done. Results: There was no statistically significant difference in graft take between group A and group B (p=0.59). The average drop in hemoglobin levels after the surgery was 1.6 gm% in group A and 0.4 gm% in group B and this difference was statistically significant. Also, the drop of serum protein after surgery was 8.6% gm/dl in group A and 1.0 gm/dl in group B and this difference was significant. Conclusion: There was no significant difference in the take of skin graft with or without removal of granulation tissue in our study. However, with lesser blood loss, lesser protein loss and lesser operative time, this study favours skin grafting without the removal of granulation tissue.

Balloon-Assisted Rib Graft Placement in Endoscopic Posterior Cricoid Split Procedure.

View Video S1 Laryngoscope, 132:212–214, 2022

Biportal endoscopic debridement and percutaneous screw fixation technique for spinal tuberculosis: how I do it.

Biportal endoscopy and percutaneous screw fixation are promising techniques that can be applied to treat various degenerative spinal diseases. However, these techniques for spinal tuberculosis have not been reported. Using the biportal endoscopic technique, bilateral decompression, tissue biopsy, and granulation tissue removal were performed using the screw insertion site. Using the percutaneous fixation screw technique, posterior stabilization and sagittal angle restoration were achieved. Paraplegia and radiating pain improved neurologically. Kyphosis was radiologically restored. Spinal tuberculosis (Potts's disease) was histopathologically diagnosed. Minimally invasive endoscopic and percutaneous screw technique can aid the diagnosis and treatment of spinal tuberculosis.

Effect of the Piezoelectric Device on Intraoperative Hemorrhage Control and Quality of Life after Endodontic Microsurgery: A Randomized Clinical Study

IntroductionThe purpose of this study was to evaluate the effect of the piezoelectric device on intraoperative hemorrhage control during surgery and the quality of life of patients after endodontic microsurgery. MethodsA total of 40 patients were randomly divided into the piezo group (n = 20) and the control group (n = 20). In the piezo group, after flap reflection, bone cutting, granulation tissue removal, and root-end resection were performed using the piezoelectric surgical device and surgical carbide burs, and curettes were used in the control group. The quality of life of patients was evaluated daily for 1 week postsurgery for limitations of oral and general functions, pain, and other symptoms. Limitation of functions and other symptoms were recorded by a modified version of the patient’s perception questionnaire using a 5-point Likert scale for mouth opening, chewing, speaking, sleeping, daily routine, missed work, swelling, nausea, and bad taste/breath, and the visual analog scale was adopted for pain. Hemorrhage control during surgery was independently assessed by the surgeon and 2 blinded observers and recorded as 0 (no hemorrhage control), 1 (intermittent control), and 2 (complete control). The chi-square test was used to assess hemorrhage control. For variables related to function and symptoms other than pain and analgesics taken, the Fisher exact test was used. For the assessment of pain between the 2 groups, the Mann-Whitney U test was used. ResultsFor parameters of quality of life, the piezo group showed significantly less swelling on the first, second, and third days and pain on the first and second days compared with the control group (P < .05). Analgesics taken were also significantly less in the piezo group (P < .05). In the piezo group, complete hemorrhage control was achieved in 10 patients, and in the control group, it was achieved only in 1 patient (P < .05). ConclusionsPiezoelectric surgery resulted in improved quality of life of patients in the first week postsurgery with lower levels of pain and swelling as well as the number of analgesics taken and better hemorrhage control during surgery.

Simultaneous Perio-endo Surgery with ER:YAG Laser and Bone Xenograft. A Case Report

Periodontally affected teeth with periapical lesion indicated for periapical surgery have a poor prognosis. Using Er:YAG lasers to perform simultaneous surgery on both defects may increase their survival rate. Preparing a retrograde cavity on affected teeth and obturating it is still a matter of debate among clinicians. The purpose of this case report was to describe the simultaneous use of Erbium-doped Yttrium Aluminium Garnet Er:YAG (2,940 nm) laser in the treatment of periapical granuloma and infraossal defect and the achieved results. The Er:YAG laser was used to perform flap dissection, granulation tissue removal, osteotomy and root-end resection except for initial flap incision and reflection. The cystic cavity was filled with Bio-Oss Collagen® xenograft. Results were followed up for 18 months with the help of radiographic orthopantomographic images. The outcome of this clinical case indicates that the use of Er:YAG laser could be considered a suitable method to perform simultaneous periodontal and endodontic surgery.

Surgiflo® may have a potential impact on the healing process in cricotracheal resection anastomosis.

To evaluate the role of thrombin-based haemostatic agent Surgiflo® (Ethicon) in improving the outcome of cricotracheal resection anastomosis. Randomised controlled clinical trial. Otorhinolaryngology Department, Mansoura University Hospitals, Egypt. This study included 55 patients with grade III and IV subglottic and/or cervical tracheal stenosis, who underwent cricotracheal resection anastomosis. Patients were randomly assigned into two groups: Surgiflo group (n=20) and control group (n=35). In Surgiflo patients, Surgiflo® was applied at the end of surgery over the whole operative field including the line of airway anastomosis with the purpose of adequate haemostasis and enhancing healing of the anastomosis. The success rate and the incidence of complications in both groups were compared. At the end of treatment, decannulation rate was 95% (19/20) in the Surgiflo groups and 82.8% (29/35) in the control group. The overall incidence of complications was significantly lower in the Surgiflo group (P=.021). Need for further surgical airway interventions in the form of repeated dilatation, granulation tissue removal or performing a tracheotomy was reported in 22.9% (8/35) of control group patients, in comparison with 5% (1/20) in Surgiflo group. Direct Surgiflo® application in the operative field enhances the anastomotic healing, decreases the incidence of anastomotic complications and subsequently improves the outcome. It can be recommended as an adjuvant to surgery in patients undergoing cricotracheal resection anastomosis.

Reconstructive surgical treatment of isolated deep intrabony defects with guided tissue regeneration using entire papilla preservation technique: A prospective case series.

The aim of this prospective study is to evaluate the clinical applicability of the entire papilla preservation (EPP) technique in the regenerative treatment of isolated deep intrabony defects using native collagen membrane and bone grafting materials. Fifteen healthy and non-smoker patients (nine males and six females; mean age: 47.73 ± 12.18; range 21 to 63 years) with one isolated deep intrabony defect each (baseline probing depth (PD): 9.03 ± 1.62mm; clinical attachment level (CAL): 11.16 ± 1.81mm) were treated with guided tissue regeneration. Surgical access to the defect was provided by a single buccal vertical incision with an interdental tunneling flap. Following the granulation tissue removal, intrabony defect was filled with bone substitutes. A collagen barrier was trimmed and placed under the intact defect-associated papilla with palatal positioning suture. Microsurgical sutures were used for primary closure. At 1week, healing of the 15 sites was uneventful. During the study, all sites showed 100% primary closure rate. At 1-year follow-up, an average CAL gain of 5.86 ± 1.28mm (P<0.0001), PD reduction of 6.1 ± 1.47mm (P<0.0001), and minimal increase in gingival recession of 0.23 ± 0.62mm (P=0.168) were observed. This novel surgical technique, that keeps the interdental papilla intact, seems promising to provide optimal biomaterial protection and healing conditions, even when a collagen barrier and bone substitutes are applied.