Piezosurgery is a relatively new technique of bone surgery that is recently gaining popularity in implantology, periodontics and oral surgery. The piezosurgery device produces specific ultrasound frequency modulation (22 000–35 000 Hz). The unit provides extreme precision and safety as well as micrometric cutting, thus allowing one to selectively section the mineralized bone structures. Moreover, the device causes less bleeding during and after the operation and the healing process is shorter. Due to the aforementioned advantages, an ultrasound device could be utilized in a wide range of surgical procedures, e.g. impacted tooth extraction, elevation of the Schneiderian membrane, bone splitting or expansion of the ridge, preparing bone bed and bone sampling, and corticotomy, not to menton cystectomy.
Among many substances used in clinical diagnosis, such as peripheral blood, gum homogenate, saliva and gingival pocket fluid, it is the latter that seems to bean extremely valuable diagnostic and research material. Identification of mediators in gingival crevicular fluid, both in the healthy gingival fissure, as well as in pathological periodontal pockets can be a valuable supplement to the initial diagnosis and describe the mechanism of gumorperiodontal diseases. Changes in the concentration of individual components in the gingival crevicular fluid may be used to assess the severity of periodontal disease. There are numerous methods for collecting fluid from the sulcus described: Micro-capillary drainage, micropipette drainage, rinsing pocket or drainage with the use of methylcellulose strips and then reading with Periotron. Gingival fluid is composed mainly of blood electrolytes and organic molecules, i.e. albumins, globulins, lipoproteins or fibrinogen and cellular components as well as peptides, bacteria and enzymes. Therefore gingival crevicular fluid (GCF) is treated as a window for noninvasive analysis of periodontitis, taking into account indicators and markers of connective tissue and bone destruction.
In the period of pregnancy in females, a sequence of physiological changes takes place that result above all from the appreciable increase of the concentration of the steroidal sex hormone in the blood serum and to a lesser degree, in saliva. In this study, a case of rare pregnancy granuloma is presented. A course of disease and procedures are described.
Periodontal disease is an inflammatory disease of multifactorial etiology. In order for it to appear there must come to an imbalance between the effects of pathogens and host defense mechanisms. As a result of its course the destruction of structures supporting the teeth appears (periodontium, cement, bone), and consequently leads to teeth loosening and loss. In recent years, the participation of RANKL/RANK/OPG in bone remodeling process was highligted. At the molecular level the bone resorption is regulated through the interaction of the ligand receptor activator of nuclear NF-kappa B (RANKL) and osteoprotegerin (OPG), which is a system of two proteins belonging to the protein tumor necrosis factor (TNF). Recent findings about the RANKL protein and OPG have shed new light on the previously unexplained phenomenon of the basis of bone resorption. Research has shown that both protein OPG and RANKL can be detected in gingival crevicular fluid, which has become a window of opportunity in the analysis of non-invasive markers of periodontal tissues, confirming elevated levels of RANKL protein in periodontal disease, and decreased levels of OPG protein. Bone resorption is initiated by the binding of the RANKL protein to receptors RANK present on the surface of mature osteoclasts, and their precursors, which leads to the differentiation and activation of osteoclasts. OPG, being RANKL’s inhibitor, has, in turn, opposite characteristics to RANKL, resulting in the reduction of osteoclastogenesis process. Despite all this, the exact mechanism of bone resorption has not yet been elucidated.
Paranasal sinus mucoceles are chronic, benign, mucous filled cystic lesions caused by obstruction of sinus ostia. Mucoceles are usually seen in the frontoethmoidal region. Maxillary sinus retention cysts are rare amongst paranasal sinus mucoceles. We present one such case of a 63-year-old woman, whose maxillary sinus mucocele revealed during radiological examination, was treated with the use of piezosurgery. In this article we also present the beneficial aspects of the ultrasound unit, that allows for precise removal of bone with minimal risk of injury to underlying soft tissues. It allows more successful and more complication-free surgical result for a less experienced surgeon that could be especially beneficial for preparation of the Schneider's membrane. Furthermore, it gives minimal operative invasion as well as provides less bleeding intra-and postoperative.
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