## 4 Discussion  
In the past, several agents including topical liquid and semi-liquid formulations as well as dry traditional dressings have been employed to promote faster wound healing, thus also reducing the risk of complications and increasing the surgical success rate. Aminogam(r) gel has been proposed for the same purpose with an innovative formulation as containing sodium hyaluron with the addition of four synthetic aminoacids (glycine, leucine, proline, lysine) [1, 11]. Figure 4: Histological analysis of the samples obtained from patients of experimental group D (**a,b**) highlights the presence of mature connective tissue, with low vascular density, abundant old collagen without inflammatory cells (**a**) (arrow), as confirmed by the high fluorescence seen by Confocal Laser Scanning Microscopy (**b**) (arrow). In opposition, the histological analysis of the surgical specimens obtained from patients of the control group D shows the presence of young connective tissue (**c**) (arrow), with abundant inflammatory infiltrate, high vascular density, immature collagen and fibroblast characterized by round nuclei, as confirmed by the low auto-fluorescence observable via the Confocal Laser Scanning Microscope (**d**) (arrow). Figure 3: GROUP F: Slow-flow vascular malformations of the tongue in 2 patients (**a,e**) treated by diode laser photo coagulation (**b,f**). Patient receiving Aminogam® gel (**f**). After 5 days, uncompleted healing was observed in the untreated patient (**c**), still showing signs of flogosis and ulceration and following residual pain, all the latter undetectable in the treated patient (**g**). After 12 days, clinical examination showed uncompleted healing of surgical wound untreated by Aminogam® gel (**d**), while a complete resolution was detected in the treated one (**h**). In fact, although it is well documented that during the wound healing process, the hyaluronic acid promotes cell proliferation, differentiation and motility, and moreover that a large availability of aminoacids is necessary because of increased metabolic activity [13; 14], at present, few medical devices exists which contain all of them [11]. These aminoacids are directly involved in tissue repair; in fact, glycine constitutes one-third of collagen molecules, proline/hydroxyproline or lysine/hydroxylyisne represent approximately 23% of collagen chains [15], while leucine residues are important constituents of small leucine-rich repeat proteoglycans and proteins that participate in ECM organization and influence cell behavior [16]. Preliminary in vivo and in vitro studies demonstrated that Aminogam(r) gel promotes angiogenesis and macrophages activity, induces fibroblasts proliferation and the production of fibronectin and collagen I and III. In addition, it stimulates the expression of several cytokines and growth factors, such as vascular endothelial growth factor, interleukin-6 and -8 and transforming growth factor-beta, thus resulting in the acceleration of the wound healing process [1; 11]. Beyond the investigations on the effects of Aminogam(r) on tissue components, clinical studies have been conducted to investigate effectiveness of this gel compound on humans [17; 18]. In 2008, the authors themselves conducted a preliminary clinical study [1] on 120 cases (60 study cases treated with Aminogam(r) and 60 control cases) who underwent oral surgical procedures. The 60 experimental cases were divided into three groups of 20 cases each based on the kind of surgical procedure. Subgroup A patients underwent extraction of molars on both sides of the mandible, but only one side was treated with Aminogam(r) (three applications per day). Subgroup B patients received endosseous implants with flap elevation and were treated with Aminogam(r) (three applications per day) until the complete healing of the gingiva.