Facial Bone Reconstruction Using both Marine or Non-Marine Bone Substitutes: Evaluation of Current Outcomes in a Systematic Literature Review

Demineralized bone matrix for repair and regeneration of maxillofacial defects: A narrative review

OBJECTIVES

Demineralized bone matrix (DBM) is a well-established bone graft material widely accepted by dentists and the public for its favorable osteoconductivity and osteoinductive potential. This article aimed to provide a narrative review of the current therapeutic applications and limitations of DBM in maxillofacial bone defects.

STUDY SELECTION, DATA, AND SOURCES

Randomized controlled trials, prospective or retrospective clinical studies, case series and reports, and systematic reviews. MEDLINE, PubMed, and Google Scholar were searched using keywords.

CONCLUSIONS

Some evidence supported the therapeutic application of DBM in periodontal intrabony defects, maxillary sinus lifts, ridge preservation, ridge augmentation, alveolar cleft repair, orthognathic surgery, and other regional maxillofacial bone defects. However, the limitations of DBM should be considered when using it, including potential low immunogenicity, instability of osteoinductive potential, handling of the graft material, and patient acceptance.

CLINICAL SIGNIFICANCE

With the increasing demand for the treatment of maxillofacial bone defects, DBM is likely to play a greater role as a promising bone graft material. Safe and effective combination treatment strategies and how to maintain a stable osteoinductive potential will be the future challenges of DBM research.

Histological Comparison of Collagenated Cancellous Equine Bone Blocks Used as Inlay or Onlay for Lateral Bone Augmentation in Rabbits

BACKGROUND

The conformation of the recipient site for an inlay graft presents an increased contact with the parent bone compared to an onlay graft. This might favor bone growth within the inlay compared to onlay grafts. Hence, the objective of this study was to compare the bone incorporation and remodeling processes of xenogeneic en bloc grafts placed using two bone grafting techniques, i.e., onlay vs. inlay.

METHODS

In this prospective, randomized, split-mouth study (test and control sides in the same animal), two bone grafting techniques were comparatively evaluated. The lateral aspect of the rabbit mandible was used as the recipient site, bilaterally. On one side of the mandible, the cortical bone was perforated with drills to allow a better bone formation from the bone wound and the marrow spaces. A xenogeneic bone block was fixed in the center of the prepared region, representing the onlay site. On the other side of the mandible, a 7 mm wide and 3 mm deep circumferential defect was prepared using trephines and drills. A xenogeneic bone block was fixed in the center of the defect, representing the inlay site. Two healing periods were applied in the study: 2 and 10 weeks, each represented by 10 rabbits (n = 10 for each period).

RESULTS

After 2 weeks of healing, the mean percentage of new bone was 10.4% and 23.3% at the onlay and inlay grafts, respectively (p = 0.022). After 10 weeks of healing, new bone increased to 13.2% at the onlay sites and 25.4% at the inlay sites (p = 0.080). In the 10-week period, the inlay grafts presented a homogeneous growth of new bone in all regions, while in the onlay grafts, low percentages of new bone were observed in the external regions.

CONCLUSION

The percentage of new bone increased faster and was higher in the inlay grafts than in the onlay grafts. This outcome might be related to the self-contained conformation of the recipient site in the inlay group, which offered more sources for new bone formation compared to the one-wall conformation of the recipient sites in the onlay group. The osteoconductive properties of the biomaterial allowed the newly formed bone to reach the most peripheral regions in both groups. The osteoconductive properties of the biomaterial, together with the protection offered by the collagen membrane, allowed marginal closure of the defects by newly formed bone in the inlay group.

Preparation and evaluation of stingray skin collagen/oyster osteoinductive composite scaffolds

The regeneration of bone defects is a major challenge for clinical orthopaedics. Herein, we designed and prepared a new type of bioactive material, using stingray skin collagen and oyster shell powder (OSP) as raw materials. A stingray skin collagen/oyster osteoinductive composite scaffold (Col-OSP) was prepared for the first time by genipin cross-linking, pore-forming and freeze-drying methods. These scaffolds were characterized by ATR-FTIR, SEM, compression, swelling, cell proliferation, cell adhesion, alkaline phosphatase activity, alizarin red staining and RT-PCR etc. The Col-OSP scaffold had an interconnected three-dimensional porous structure, and the mechanical properties of the Col-OSP composite scaffold were enhanced compared with Col, combining with the appropriate swelling rate and degradation rate, the scaffold was more in line with the requirements of bone tissue engineering scaffolds. The Col-OSP scaffold was non-toxic, promoted the proliferation, adhesion, and differentiation of MC3T3-E1 cells, and stimulated the osteogenesis-related genes expressions of osteocalcin (OCN), collagen type I (COL-I) and RUNX2 of MC3T3-E1 cells.

Collagens from Marine Organisms towards Biomedical Applications

Collagen is the main fibrous structural protein in the extracellular matrix and connective tissue of animals [...]

Compressive Strength of Conventional Glass Ionomer Cement Modified with TiO2 Nano-Powder and Marine-Derived HAp Micro-Powder

The aim of this research was to investigate the compressive strength (CS), breaking strength (BS), and compressive modulus (CM) of conventional glass ionomer cement (GIC) modified with TiO₂ nano particles, marine-derived hydroxyapatite (md-HAp) microparticles (<45 µm), and a combination of TiO₂ NP and md-HAp particles. The materials used in the study were conventional GIC Fuji IX GP Extra (GC Corporation, Tokyo, Japan), TiO₂ powder P25 (Degussa, Essen, Germany), and HAp synthesized from cuttlefish bone and ground in a mortar to obtain md-HAp powder. md-HAp was characterized using FTIR and SEM analysis. There were four groups of GIC samples: (i) Fuji IX control group, (ii) powder modified with 3 wt% TiO2, (iii) powder modified with 3 wt% HAp, and (iv) powder modified with 1.5 wt% TiO2 + 1.5 wt% HAp. Measurements were performed in a universal testing machine, and CS, BS, and CM were calculated. Statistical analysis was performed using ANOVA and Tukey’s tests. CS, BS, and CM differed significantly between the Fuji IX control group and all experimental groups while differences between the experimental groups were not statistically significant. The addition of TiO₂ NP, md-HAp micro-sized particles, and a combination of TiO₂ and md-HAp reduced the CS, BS, and CM of conventional GICs when mixed at the powder/liquid (p/l) ratio recommended by the manufacturer.

Chitosan-Human Bone Composite Granulates for Guided Bone Regeneration

The search for the perfect bone graft material is an important topic in material science and medicine. Despite human bone being the ideal material, due to its composition, morphology, and familiarity with cells, autografts are widely considered demanding and cause additional stress to the patient because of bone harvesting. However, human bone from tissue banks can be used to prepare materials in eligible form for transplantation. Without proteins and fats, the bone becomes a non-immunogenic matrix for human cells to repopulate in the place of implantation. To repair bone losses, the granulate form of the material is easy to apply and forms an interconnected porous structure. A granulate composed of β-tricalcium phosphate, pulverized human bone, and chitosan-a potent biopolymer applied in tissue engineering, regenerative medicine, and biotechnology-has been developed. A commercial encapsulator was used to obtain granulate, using chitosan gelation upon pH increase. The granulate has been proven in vitro to be non-cytotoxic, suitable for MG63 cell growth on its surface, and increasing alkaline phosphatase activity, an important biological marker of bone tissue growth. Moreover, the granulate is suitable for thermal sterilization without losing its form-increasing its convenience for application in surgery for guided bone regeneration in case of minor or non-load bearing voids in bone tissue.

Biomaterials with Potential Use in Bone Tissue Regeneration-Collagen/Chitosan/Silk Fibroin Scaffolds Cross-Linked by EDC/NHS

Blending of different biopolymers, e.g., collagen, chitosan, silk fibroin and cross-linking modifications of these mixtures can lead to new materials with improved physico-chemical properties, compared to single-component scaffolds. Three-dimensional scaffolds based on three-component mixtures of silk fibroin, collagen and chitosan, chemically cross-linked, were prepared and their physico-chemical and biological properties were evaluated. A mixture of EDC (N-(3-dimethylaminopropyl)-N’-ethylcarbodiimide hydrochloride) and NHS (N-hydroxysuccinimide) was used as a cross-linking agent. FTIR was used to observe the position of the peaks characteristic for collagen, chitosan and silk fibroin. The following properties depending on the scaffold structure were studied: swelling behavior, liquid uptake, moisture content, porosity, density, and mechanical parameters. Scanning Electron Microscopy imaging was performed. Additionally, the biological properties of these materials were assessed, by metabolic activity assay. The results showed that the three-component mixtures, cross-linked by EDC/NHS and prepared by lyophilization method, presented porous structures. They were characterized by a high swelling degree. The composition of scaffolds has an influence on mechanical properties. All of the studied materials were cytocompatible with MG-63 osteoblast-like cells.

Three-Dimensional Evaluation on Cortical Bone During Orthodontic Surgical Treatment

Adult patients' severe malocclusions, especially the skeletal ones, cannot be exclusively solved by the orthodontic treatment and therefore a combined orthodontic-surgical treatment is necessary. Today, numerous software allows to plane and to visualize the final treatment results simulating the best therapeutic option. This is a retrospective experimental study that aims to analyze the changes in the buccal cortical bone in patients undergoing orthodontics surgeries and to evaluate the correlation between the dental movement and the changes in the relative bone cortex. The study sample consists of 32 subjects. By applying the CBCT radiographic examinations, the measurements were made in well-defined points of reference. The 3D study of the dental changes of position and the cortical buccal bone related variation, suggests how the determined orthodontic movement of the dental element does not achieve an easily predictable bone variation. Therefore, it also suggests that there is no direct proportionality relationship between the extent of bone apposition/reabsorption and dental movement.

TGF-β Activity of a Demineralized Bone Matrix

Allografts consisting of demineralized bone matrix (DBM) are supposed to retain the growth factors of native bone. However, it is not clear if transforming growth factor β1 (TGF-β1) is maintained in the acid-extracted human bone. To this aim, the aqueous solutions of supernatants and acid lysates of OraGRAFT^® Demineralized Cortical Particulate and OraGRAFT^® Prime were prepared. Exposing fibroblasts to the aqueous solution caused a TGF-β receptor type I kinase-inhibitor SB431542-dependent increase in interleukin 11 (IL11), NADPH oxidase 4 (NOX4), and proteoglycan 4 (PRG4) expression. Interleukin 11 expression and the presence of TGF-β1 in the aqueous solutions were confirmed by immunoassay. Immunofluorescence further confirmed the nuclear translocation of Smad2/3 when fibroblasts were exposed to the aqueous solutions of both allografts. Moreover, allografts released matrix metalloprotease-2 activity and blocking proteases diminished the cellular TGF-β response to the supernatant. These results suggest that TGF-β is preserved upon the processing of OraGRAFT^® and released by proteolytic activity into the aqueous solution.

Reconstruction of Oromandibular Defect After Tumor Resection by Sternomastoid-clavicular Flap

ABSTRACT

The study aims to evaluate sternocleidomastoid-clavicular osteo-myocutaneous flap (SCM-OMCF) for reconstruction of mandibular defects after tumor resection. In the period between 2010 and 2018, thirteen patients with primary mandibular tumors underwent mandibular resection and reconstruction with SCM-OMCF. Patients were followed up for 10 to 66 months. Hospital was 13 ± 4 days. All patients started fluid in the 2nd day. The mean time to start oral fluid was 7.5 ± 0.8 day. Four (30.8%) patients suffered from complications (infection and salivary leak in 1 case due to partial flap loss, donor wound dehiscence in 1 case, deep venous thrombosis in 1 case and chest infection in 1 case). None of our cases experienced motor disability. Two cases (15.9%) underwent reoperations. The overall aesthetic outcome was found excellent in 5 cases, satisfactory in 5 cases and fair in 3 cases. The functional outcomes were satisfactory. Tumor recurrences were detected in 2 (15.9%) patients. Two patients died during follow up within 2 years after 1st surgery due to local and distant recurrences. SCM-OMCF is a versatile, safe and simple technique for reconstructing mandibular defects less than 11 cm.

Treatment of Osseous Defects after Mandibular Third Molar Removal with a Resorbable Alloplastic Grafting Material: A Case Series with 1- to 2-Year Follow-Up

Mandibular third molar (M3) surgical extraction may cause periodontal complications on the distal aspect of the root of the adjacent mandibular second molar (M2). Patients older than 26 years with periodontal pathology on the distal surface of the M2 and a horizontal/mesioangular impacted M3 may benefit from bone regenerative therapy at the time of surgery. In this prospective case series, an alloplastic fully resorbable bone grafting material, consisting of beta-tricalcium phosphate (β-TCP) and calcium sulfate (CS), was used for the treatment of the osseous defects after the removal of horizontal or mesioangular M3s in 4 patients older than 26 years. On presentation, the main radiological finding in all patients, indicating periodontal pathology, was the absence of bone between the crown of the M3 and the distal surface of the root of the M2. To evaluate the treatment outcome, bone gain (BG) was assessed by recording the amount of bone defect (BD) at the time of surgical removal (T0) and at the time of final follow-up (T1) 1 or 2 years post-operatively. The healing in all cases was uneventful, with no complications associated with the use of the alloplastic grafting material. Clinical and radiological examination at T1 revealed that all extraction sites were adequately restored, with significant BG of 6.07 ± 0.28 mm. No residual pathological pockets on the distal surface of the M2 were detected. Pocket depth (PD) at T1 was 2 ± 0.71 mm. Within the limitations of this case series, the results suggest that β-TCP/CS can support new bone formation at M3 post-extraction sites where bone regeneration methods are indicated, thus reducing the risk of having persistent or developing new periodontal problems at the adjacent M2.

Segmentation and Pore Structure Estimation in SEM Images of Tissue Engineering Scaffolds Using Genetic Algorithm

A python computer package is developed to segment and analyze scanning electron microscope (SEM) images of scaffolds for bone tissue engineering. The method requires only a portion of an SEM image to be labeled and used for training. The algorithm is then able to detect the pore characteristics for other SEM images acquired at different ambient conditions from different scaffolds with the same material as the labeled image. The quality of SEM images is first enhanced using histogram equalization. Then, a global thresholding method is used to perform the image analysis. The thresholding values for the SEM images are obtained using genetic algorithm (GA). The image analysis results include pore distributions of pore size, pore elongation and pore orientation. The results agree satisfactorily with the experimental data for the chitosan-alginate porous scaffolds considered. Applications of the method developed for image segmentation is not limited to scaffold pore structure analysis. The method can also be used for any SEM image containing multiple objects such as different types of cells and subcellular components.

Mechanical Properties of Glass Ionomer Cements after Incorporation of Marine Derived Porous Cuttlefish Bone Hydroxyapatite

The purpose of this study was to evaluate the effects of the incorporation of hydroxyapatite (HA) derived from cuttlefish bone on the mechanical properties of glass ionomer cements (GIC). Fuji II LC and Fuji IX GP Extra (GC Corporation, Tokyo, Japan) were used in the study. There were four groups (n = 11–18) for each material: a group without the addition of HA particles and three groups modified by incorporation of 2, 5, and 10 wt% HA. The tests were performed on a universal testing machine (Shimadzu, Duisburg, Germany) and descriptive statistics, two-way analysis of variance (ANOVA) for the comparison of three mechanical properties, and one-way ANOVA for the comparison of different concentrations for each material were performed. Regarding the Fuji IX groups, compressive strength (CS) and flexural strength (FS) were highest in the group without HA particles added. The differences in CS between the Fuji IX group without HA particles and the Fuji IX groups with 2 wt% HA and 10 wt% HA were significant. The Fuji II 5 wt% HA group exhibited higher diametral tensile strength (DTS) and CS than other Fuji II groups, but not significantly. The Fuji II group, modified with 10 wt% HA, exhibited significantly higher FS than the Fuji II group without HA particles (p < 0.05). Porous HA incorporated into the Fuji IX groups had a significant impact on mechanical properties only in the Fuji IX 5 wt% HA group. Fuji II groups modified with 10 wt% HA showed the most favorable results with respect to FS.

Superior CKIP-1 sensitivity of orofacial bone-derived mesenchymal stem cells in proliferation and osteogenic differentiation compared to long bone-derived mesenchymal stem cells

Maxillofacial bone defects caused by multiple factors, including congenital deformations and tumors, have become a research focus in the field of oral medicine. Bone tissue engineering is increasingly regarded as a potential approach for maxillofacial bone repair. Mesenchymal stem cells (MSCs) with different origins display various biological characteristics. The aim of the present study was to investigate the effects of casein kinase‑2 interaction protein‑1 (CKIP‑1) on MSCs, including femoral bone marrow‑derived MSCs (BMMSCs) and orofacial bone‑derived MSCs (OMSCs), isolated from the femoral and orofacial bones of wild‑type (WT) and CKIP‑1 knockout (KO) mice. MSCs were isolated using collagenase II and the main biological characteristics, including proliferation, apoptosis and osteogenic differentiation, were investigated. Subcutaneous transplantation of MSCs in mice was also performed to assess ectopic bone formation. MTT and clone formation assay results indicated that cell proliferation in the KO group was increased compared with the WT group, and OMSCs exhibited significantly increased levels of proliferation compared with BMMSCs. However, the proportion of apoptotic cells was not significantly different between CKIP‑1 KO OMSCs and BMMSCs. Furthermore, it was revealed that osteogenic differentiation was increased in CKIP‑1 KO MSCs compared with WT MSCs, particularly in OMSCs. Consistent with the in vitro results, enhanced ectopic bone formation was observed in CKIP‑1 KO mice compared with WT mice, particularly in OMSCs compared with BMMSCs. In conclusion, the present results indicated that OMSCs may have a superior sensitivity to CKIP‑1 in promoting osteogenesis compared with BMMSCs; therefore, CKIP‑1 KO in OMSCs may serve as an efficient strategy for maxillofacial bone repair.

New Oral Surgery Materials for Bone Reconstruction-A Comparison of Five Bone Substitute Materials for Dentoalveolar Augmentation

This article presents a comparison of bone replacement materials in terms of their ability to produce living bone image at the place of their implantation. Five bone replacement materials are compared (Osteovit-porous collagen, Cerasorb Foam-collagen scaffolding of synthetic β tricalcium phosphate, Osbone-synthetic hydroxyapatite, Endobone-deproteinized bovine-derived cancellous bone hydroxyapatite, and Cerasorb-synthetic β tricalcium phosphate). Intraoral radiographs are taken immediately after implantation and 12 months later. The texture analysis was performed to assess (texture index, TI) the level of structure chaos (entropy) in relation to the presence of longitudinal elements visible in radiographs (run length emphasis moment). The reference ratio of the chaotic trabecular pattern (Entropy) to the number of longitudinal structures, i.e., trabeculae (LngREmph), is 176:100 (i.e., 1.76 ± 0.28). Radiological homogeneity immediately after the implantation procedure is a result of the similar shape of its particles (Osbone, Endobone and Cerasorb) or radiolucency (Osteovit, Cerasorb Foam). The particles visible in radiographs were similar in the LngREmph parameters applied to the reference bone, but not in the co-occurrence matrix features. The TI for Osteovit during a 12-month follow-up period changed from 1.55 ± 0.26 to 1.48 ± 0.26 (p > 0.05), for Cerasorb Foam from 1.82 ± 0.27 to 1.63 ± 0.24 (p < 0.05), for Osbone from 1.97 ± 0.31 to 1.74 ± 0.30 (p < 0.01), and for Endobone from 1.86 ± 0.25 to 1.84 ± 0.25 (p > 0.05), The observed structure in the radiological image of bone substitute materials containing calcium phosphates obtains the characteristics of a living bone image after twelve months.

Periodontal Regeneration Using Recombinant Human Bone Morphogenetic Protein-2 and a Bilayer Collagen Matrix

Previous studies demonstrated that recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered using a collagen sponge could be a candidate for periodontal regeneration therapy. However, there is little evidence related to rhBMP-2 delivered with a bilayer collagen matrix. The aim of this study was to investigate the proper dose of rhBMP-2 using a bilayer collagen matrix for periodontal regeneration in a 1-wall defect. The mandibular first premolars and first molars of 6 beagle dogs were extracted, and an 8-week healing period was allowed. One-wall intrabony defects (4 mm in width and 5 mm in height) were made on the mesial side of the 2nd premolar and/or the distal side of the 4th premolar bilaterally. Subsequently, a bilayer collagen matrix containing 0 μg (C), 200 μg (T1), or 500 μg (T2) of lyophilized rhBMP-2 was randomly applied to the defect area. Calcein and xylenol orange were injected at 4 and 8 weeks following the surgery, respectively, to label periodic bone formation. After a 12-week healing period, the animals were sacrificed for micro-computed tomography and histomorphometric analysis. Bone mineral density and bone volume density showed statistically significant differences between the control group and group T1, while no significant differences were observed between the control group and group T2 or between groups T1 and T2. The bone height in groups T1 and T2 was smaller than that in the control group. Low doses of rhBMP-2 delivered using a bilayer collagen matrix in 1-wall intrabony defects can promote periodontal regeneration compared to no or high doses of rhBMP-2.

Transcortical bone capillary vessels network: implication on the maxillofacial district

INTRODUCTION

The field of medicine takes steps forward every day. Although some aspects of our organism seem clear, scientific discoveries also affect fields such as anatomy. Recently, transcortical vessels (TCVs) have been debated, although it was thought that cortical bones were not interested by these structures. This would upset some concepts of oral surgery, maxillofacial surgery, periodontics and implantology.

EVIDENCE ACQUSITION

In this study an analysis of the literature on this topic was carried out, and it is proposed to understand the possible implications of TCVs to the oral health.

EVIDENCE SYNTHESIS

Being a current topic, the aim of the study is to promote research in this field, leading to the evidence of these anatomical structures in the maxillofacial district. This study is of a prospective type, there are no other results that speak of these vessels in the maxillofacial district, waiting for a histological study.

CONCLUSIONS

The purpose of the study, therefore, is to shed light on this topic, so that the research could move in this direction.

Key points in surgical management of mandibular condylar fractures

Mandibular condylar fractures are among the most common facial fractures and some of the most difficult to manage. Opinions about the management of mandibular condylar fractures differ among surgeons. With the implementation of new technology, an increased understanding of fracture management, and better functional and morphological outcomes reported in the literature, open reduction and internal fixation is becoming many surgeons' preferred choice for the treatment of condylar fractures. Because surgical treatment of such fractures is complex, certain factors must be considered to achieve satisfactory outcomes. In this article, we summarise six key points in the management of mandibular condylar fractures: virtual evaluation of condylar fracture, a suitable surgical approach, good reduction, stable internal fixation, repair of the articular disc, and restoration of the mandibular arch width. We believe that these points will help to improve the prognosis of mandibular condyle fractures.

Spine and TMJ: A Pathophysiology Report

The relationship between posture, spine, and temporomandibular joint (TMJ) is still a hotly debated topic in medicine. TMJ takes part in different physiological functions of the organism, starting from its embryological development, it is possible that it influences different vital functions. There is a strong connection between the respiratory tract and dental/maxillary occlusion or anatomy. The altered physiology of this district leads to pathologies that could affect the whole organism. On the contrary, it is also possible to highlight some symptoms of distant organism districts. Knowing well the pathophysiology of this district and semiotics, it is also possible to diagnose pathologies affecting other organs.

Application of bioengineering devices for stress evaluation in dentistry: the last 10 years FEM parametric analysis of outcomes and current trends

INTRODUCTION

Dentistry, therefore implantology, prosthetics, implant prosthetics or orthodontics in all their variants, are medical and rehabilitative branches that have benefited greatly from these methods of investigation to improve the predictability of rehabilitations. We will examine the Finite Element Method and Finite Element Analysis in detail. This method involves the simulation of mechanical forces from an environment with infinite elements, the real one, to a simulation with finite elements.

EVIDENCE ACQUISITION

The study searched MEDLINE databases from 2008 to 2018. Human use of FEM in vitro studies reported a contribution on oral rehabilitation through the use of FEM analysis. The initial search obtained 296 citations. After a first screening, the present revision considered the English-language works referred to human application of the FEM published in the last 10 years. Finally, 34 full texts were available after screening.

EVIDENCE SYNTHESIS

The ultimate aim of this review is to point out all the progress made in the field of bioengineering and therefore, thanks to this, in the field of medicine. Instrumental investigations such as FEM are an excellent tool that allows the evaluation of anatomical structures and any facilities for rehabilitation before moving on to experimentation on animals, so as to have mechanical characteristics and satisfactory load cycle testing.

CONCLUSIONS

FEM analysis contributes substantially to the development of new technologies and new materials in the biomedical field, being able to perform a large number of simulations without the need for patients or to perform human tests. Thanks to the 3D technology and to the reconstructions of both the anatomical structures and eventually the alloplastic structures used in the rehabilitations it is possible to consider all the mechanical characteristics, so that they can be analyzed in detail and improved where necessary. It is possible thanks to these methods to know what are the ideal characteristics of a material to promote an oral rehabilitation, so we know the characteristics, it remains only to take a step in the field of the industry for the construction of materials close to these characteristics.

Ridge Augmentation Using β-Tricalcium Phosphate and Biphasic Calcium Phosphate Sphere with Collagen Membrane in Chronic Pathologic Extraction Sockets with Dehiscence Defect: A Pilot Study in Beagle Dogs

This study was conducted to comparatively examine spontaneous healing versus ridge augmentation, in surgically-created dehiscence defects, associated with chronic pathology in dogs. Mandibular second, third and fourth premolars (P2, P3 and P4) were hemi-sectioned, and a dehiscence defect was created at the mesial root, while a groove was made on the buccal area from the top of the teeth to the bottom of the defect, exposing the dental pulp. The mesial roots of P2, P3 and P4 were extracted 1 month after the induction of the dehiscence defect with chronic pathology. Three teeth were randomly allocated to these experimental groups: (i) spontaneous healing without any bone graft (Control group: C); (ii) ridge augmentation with β-tricalcium phosphate (β-TCP) granules (Test 1 group: T1); and (iii) ridge augmentation with 60% hydroxyapatite (HA) and 40% β-TCP microspheres (Test 2 group: T2). Postmortem histopathologic examination showed significant between-group differences in C and T1 and C and T2 in bone volume/tissue volume in qualitative micro-computed tomography (CT) analysis, as well as significant intergroup differences in the coronal area at 4 and 12 weeks. The composition of connective tissue and mineralized bone in C and T1 were higher than in T2 at 4 weeks of healing, whereas the composition of mineralized bone was higher in T2 than in T1 at 12 weeks of healing. Biphasic calcium phosphate, composed of 60% HA and 40% β-TCP microsphere (i) potentially prevented marked osteoclastic resorption and (ii) promoted ridge preservation in the extraction socket with the dehiscence defect and chronic pathology.

Oral Health and Molecular Aspects of Malignant Fibrous Histiocytoma Patients: A Systematic Review of the Literature

Malignant fibrous histiocytoma is one of the most common soft tissue sarcomas in adults. It occurs only occasionally in oral soft tissues, and knowledge about its characteristics is based on a limited number of cases reported in the literature. Malignant fibrous histiocytoma belongs to the group of soft tissue sarcomas and makes up less than 10% of soft tissue sarcomas. For therapeutic purposes, complete exeresis of the lesion (macroscopic and microscopic) is performed because they have frequent recurrences. As for complementary therapy in addition to surgery, neither radiotherapy nor chemotherapy have been shown to reduce the risk of death related to the disease. Often patients complain of a swelling that grows in a short period of time. It is quite common for patients to report trauma in the area, which is not the cause, but rather the event that allows diagnosis. The mass usually does not cause pain unless it compresses an adjacent nerve structure. The aim of this study is to systematically review the scientific literature in order to identify the most recent studies concerning malignant fibrous histiocytomas localized in oral soft tissues and report their main data. The main outcomes of this study concern the immunohistochemical, molecular, and clinical aspects of this pathology. A systematic review of articles in the electronic databases pubmed, Scopus, and Web of Science was performed. After the selection process, 11 studies met the inclusion criteria and were included in the review. The mean age of the patients was 50.8 years old. The lesions affected various parts of the oral cavity, showing predominantly storiform-pleomorphic patterns. All cases except one were treated with surgical resection and radiation therapy. Although some data emerged from this review, they remain limited to a few case reports. Further studies are necessary in order to standardize the approach to patients affected by oral malignant fibrous histiocytoma (MFH).

Surgical Outcomes of Intraconal Cavernous Venous Malformation According to Their Location in Four Right-Angled Sectors

The present study evaluated the surgical outcomes of intraconal cavernous venous malformation according to their location in 4 right-angled sectors. Data regarding the surgical method and approach, surgical outcome, and postoperative complications were retrospectively analyzed for 18 patients with intraconal cavernous venous malformations that were surgically treated at the authors' center between March 2006 and May 2017. The lesion location was defined using 2 perpendicular lines connecting the optic disc and the 4 surrounding rectus muscles in the coronal plane, which resulted in the formation of 4 right-angled sectors (upper-outer quadrant, upper-inner quadrant, lower-inner quadrant, and lower-outer quadrant). Accordingly, there were 3, 3, 8, and 4 lesions in the upper-outer, upper-inner, lower-outer, and lower-inner quadrants, respectively. Ten patients received anterior orbitotomy and 8 received lateral orbitotomy. There were no recurrences during the follow-up period. All patients exhibited reduced proptosis after surgery. Vision improved in 4 patients and remained unchanged in 14. Five patients experienced ocular movement limitation (1 permanent and 4 temporary), 1 developed an inferomedial blowout fracture, 2 developed a temporary sensory deficit, and 1 developed temporary ptosis. The authors' findings suggest that intraconal cavernous venous malformations most frequently occur in the lower-outer quadrant. Although most lesions can be removed via anterior orbitotomy, large lesions located near the orbital apex or on the orbital wall require lateral orbitotomy. Ocular movement limitation is a common complication and can become permanent in rare cases, necessitating close monitoring. Lesion location and surgical approach do not seem to influence the postoperative complication rate.

Prosthetic and Mechanical Parameters of the Facial Bone under the Load of Different Dental Implant Shapes: A Parametric Study

In recent years the science of dental materials and implantology have taken many steps forward. In particular, it has tended to optimize the implant design, the implant surface, or the connection between implant and abutment. All these features have been improved or modified to obtain a better response from the body, better biomechanics, increased bone implant contact surface, and better immunological response. The purpose of this article, carried out by a multidisciplinary team, is to evaluate and understand, through the use also of bioengineering tests, the biomechanical aspects, and those induced on the patient's tissues, by dental implants. A comparative analysis on different dental implants of the same manufacturer was carried out to evaluate biomechanical and molecular features. Von Mises analysis has given results regarding the biomechanical behavior of these implants and above all the repercussions on the patient's tissues. Knowing and understanding the biomechanical characteristics with studies of this type could help improve their characteristics in order to have more predictable oral rehabilitations.

A Novel Approach for Horizontal Augmentation of Posterior Maxilla Using Ridge Split Technique

Over the years, there have been a series of innovative approaches to the alveolar bone augmentation techniques. These have led to the modifications of the existing methods and the establishment of more efficient ways to obtain sufficient bone mass that is necessary for the implant procedure. The aim of this paper is to propose a novel augmentation technique, and to investigate its efficacy, particularly during the healing process of the maxillary alveolar bone prior to the implant treatment. During the application of the proposed methodology, first, the ridge-split technique was applied to the posterior maxilla. Then, a horizontal augmentation procedure was performed with an autogenous bone graft. Implants were placed at the second month of the surgery. Prosthetic rehabilitation was completed after the osseointegration of the implants. The technique was compared with the ridge-split method with simultaneous implant placement in 14 patients. The groups were divided into 2, the control group and the experimental group, each containing 7 patients. The aimed success criteria for the status of the endosteal implants were fulfilled and there were not any complications observed in the second year of follow-up.The basic practical innovation offered by the proposed surgical technique is to achieve the required horizontal dimension and to change the quality of the bone conveniently. The press-fit insertion leads to multipoint contact healing of the transported bone and the use of cortical block bone in posterior maxilla, led to a significantly advantageous higher stability level for both the placement and the survival of the implants.

Early Diagnosis on Oral and Potentially Oral Malignant Lesions: A Systematic Review on the VELscope® Fluorescence Method

The fluorescence method is an innovative technique used by pathologists for examining body mucosa, and for the abnormalities tissue screening, potentially leading to the earlier discovery of pre-cancer, cancer or other disease processes. The early detection is one of the best mechanisms for enabling treatment success, increasing survival rates and maintaining a high quality of life. The purpose of this review is to evaluate the clinical efficiency of this diagnostic tool applied to the oral cavity (VELscope^®). A literature systematic review has been performed. The initial research provided 53 results after applying the inclusion and exclusion criteria, and after a manual screening of the abstracts by the authors, only 25 results were eligible for review. The results and data contained in all the researches, no older than 10 years, were manually evaluated, and provided useful information on this diagnostic method. The VELscope^® mean value about sensitivity and specificity resulted of 70.19% and 65.95%, respectively, by results analysis, but despite this some studies disagree about its clinical effectiveness, and this diagnostic method is still much debated in scientific and clinical medical literature. Surely being able to have efficient and effective tools from this point of view could help the clinician in the diagnosis, and also make timelier the pharmacological or surgical therapy, improving the quality of life of the patient, and in some cases guaranteeing a longer survival term.

Elastics Selector Gauge as Orthodontics Device Applied to Inter-Maxillary Traction during Malocclusion Correction

Elastics are the simplest device that can be used during a class correction in orthodontics, and despite the simplicity of a latex band, they are very effective and powerful. The resultant inter-maxillary force affects not only the teeth, but even the mandibular position, and consequently the temporomandibular joints (TMJ). The purpose of our work is to simplify the use of elastics, and to reduce the amount of inventory for orthodontists, because there is a lot of merceology available on the market, and different ways of using the elastics. The use of elastics in clinical practice is based on the force extension values, which are given by the manufacturer for the different sizes of the elastics, generally when they are stretched to three times their lumen size. Various configurations allow for the correction of different malocclusions. We propose a new classification and a new device, the elastic selector gauge, in order to allow clinicians to quickly and easily choose the right elastic in all conditions.

Transversal Maxillary Distraction in Patients with Cleft Lip and Palate

OBJECTIVE

The aim of this study is to describe the importance of osteodistraction with transpalatal distractors for treating transversal maxillary hypoplasia in patients with cleft and lip palate.

METHODS

The participants were 17 patients (9 females and 8 males) with cleft lip and palate. Among these, 10 presented unilateral cleft lip and palate, 4 bilateral cleft lip and palate, and 3 cleft palate only.

RESULTS

All patients experienced a satisfactory palatal expansion and crossbite correction. The mean lengthening was 12.7 mm. The average increase of intercanine distance, intermolar distance, maxillary transverse dimension (MTD), facial transverse dimension (FTD) was 12.16, 8.45, 1.77, and 1.67 mm, respectively. The clinical follow-up was 29.7 months (range: 6-61 months).

CONCLUSION

Palatal distraction is a safe and successful alternative for treating maxillary transversal alterations in patients with cleft lip and palate. This technique facilitates the establishment of an adequate transverse dimension of maxillary, and consequently a proper dental occlusion.

Marine Collagen as A Promising Biomaterial for Biomedical Applications

This review focuses on the expanding role of marine collagen (MC)-based scaffolds for biomedical applications. A scaffold-a three-dimensional (3D) structure fabricated from biomaterials-is a key supporting element for cell attachment, growth, and maintenance in 3D cell culture and tissue engineering. The mechanical and biological properties of the scaffolds influence cell morphology, behavior, and function. MC, collagen derived from marine organisms, offers advantages over mammalian collagen due to its biocompatibility, biodegradability, easy extractability, water solubility, safety, low immunogenicity, and low production costs. In recent years, the use of MC as an increasingly valuable scaffold biomaterial has drawn considerable attention from biomedical researchers. The characteristics, isolation, physical, and biochemical properties of MC are discussed as an understanding of MC in optimizing the subsequent modification and the chemistries behind important tissue engineering applications. The latest technologies behind scaffold processing are assessed and the biomedical applications of MC and MC-based scaffolds, including tissue engineering and regeneration, wound dressing, drug delivery, and therapeutic approach for diseases, especially those associated with metabolic disturbances such as obesity and diabetes, are discussed. Despite all the challenges, MC holds great promise as a biomaterial for developing medical products and therapeutics.

Bone Regeneration Using a Three-Dimensional Hexahedron Channeled BCP Block Combined with Bone Morphogenic Protein-2 in Rat Calvarial Defects

It is important to obtain sufficient bone mass before implant placement on alveolar bone, and synthetic bone such as biphasic calcium phosphate (BCP) has been studied to secure this. This study used a BCP block bone with a specific structure of the three-dimensional (3D) hexahedron channel and coating with recombinant human bone morphogenetic protein-2 (rhBMP-2) impregnated carboxymethyl cellulose (CMC) was used to examine the enhancement of bone regeneration of this biomaterial in rat calvarial defect. After the preparation of critical-size calvarial defects in fifteen rats, defects were divided into three groups and were implanted with the assigned specimen (n = 5): Boneplant (untreated 3D hexahedron channeled BCP block), Boneplant/CMC (3D hexahedron channeled BCP block coated with CMC), and Boneplant/CMC/BMP (3D hexahedron channeled BCP block coated with CMC containing rhBMP-2). After 4 weeks, the volumetric, histologic, and histometric analyses were conducted to measure the newly formed bone. Histologically, defects in the Boneplant/CMC/BMP group were almost completely filled with new bone compared to the Boneplant and Boneplant/CMC groups. The new bone volume (P < 0.05) and area (P < 0.001) in the Boneplant/CMC/BMP group (20.12% ± 2.17, 33.79% ± 3.66) were much greater than those in the Boneplant (10.77% ± 4.8, 16.48% ± 9.11) and Boneplant/CMC (10.72% ± 3.29, 16.57% ± 8.94) groups, respectively. In conclusion, the 3D hexahedron channeled BCP block adapted rhBMP-2 with carrier CMC showed high possibility as an effective bone graft material.

The prevalence of peri-implant diseases in patients with metabolic syndrome: a case-control study on an Italian population sample

BACKGROUND

The correlation of peri-implantitis with systemic diseases is still highly debated and controversial in literature. The objective of this work was to evaluate the possible association between peri-implant diseases and metabolic syndrome.

METHODS

In this case-control study, subjects healthy or affected by metabolic syndrome, with at least one dental implant with >5 years of functional loading were screened to detect peri-implant health or diseases. A complete full mouth periodontal and peri-implant examination at six sites was performed for each implant and standardized periapical X-ray were taken to evaluate marginal bone loss. Diagnostic Criteria of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions were applied. The analysis of variance (ANOVA) was used to compare means of recorded variables between the two groups, with a P<0.05 value considered statistically significant. Sub-group analysis was performed for smoking (smokers vs. non-smokers), sex (males vs. females), implant site (maxillary vs. mandible) and type of prostheses (single crown vs. bridge).

RESULTS

Forty-one patients were enrolled, divided into two groups, for a total of 132 dental implants: 71 in the metabolic syndrome group and 61 in the control group. The overall prevalence of peri-implant diseases (peri-implantitis + mucositis) in the two groups was, respectively, 93% vs. 63%, with an odds ratio (OR) of 7.4462 (95% CI: 2.6092; 21.2496) for the metabolic syndrome group (P<0.001).

CONCLUSIONS

Despite the limited sample, our results showed a statistically significant higher prevalence of peri-implant diseases in patients with metabolic syndrome compared to healthy patients. Further longitudinal studies are needed to verify this relationship.

Chitosan Use in Dentistry: A Systematic Review of Recent Clinical Studies

This study aims to highlight the latest marine-derived technologies in the biomedical field. The dental field, in particular, uses many marine-derived biomaterials, including chitosan. Chitosan that is used in different fields of medicine, is analyzed in this review with the aim of highlighting its uses and advantages in the dental field. A literature search was conducted in scientific search engines, using keywords in order to achieve the highest possible number of results. A review of randomized controlled trials (RCT) was conducted to evaluate and process all the relevant results for chitosan and oral health. After a screening and a careful analysis of the literature, there were only 12 results highlighted. Chitosan performs different functions and it is used in different fields of dentistry in a safe and effective way. Among the uses of chitosan, we report on the remineralizing property of chitosan which hardens tissues of the tooth, and therefore its role as a desensibilizer used in toothpastes. According to our systematic review, the use of chitosan has shown better surgical healing of post-extraction oral wounds. Furthermore, some studies show a reduction in bacterial biofilm when used in dental cements. In addition, it has antibacterial, antifungal, hemostatic and other systemic properties which aid its use for drug delivering.

Chlorhexidine Gel Use in the Oral District: A Systematic Review

Chlorhexidine compounds and their different formulations have been investigated several times, especially in the dentistry field. Chlorhexidine application for mouth rinsing immediately underwent oral contraindications, linked to the possibility of causing pigmentation to the teeth or relating to possible cytotoxic events after oral surgery. The positive effects, however, are considerable and its topical antiseptic action has been widely demonstrated by in vitro and clinical research. That’s the reason for its large application in different fields of dentistry. The aim of this study is to collect all the literature regarding the use of chlorhexidine gel in dentistry and all the numerous applications. The initial search on search engines obtained 232 results; then, following the application of the inclusion criteria there were 24 selected articles. The chlorhexidine gel appliance in the dental daily practice is direct to oral surgery, conservative endodontics, prevention and prophylaxis. The use of chlorhexidine has shown some positive effects, also in the case of systemic diseases prevention. Surely, this topical medicine used both professionally and prescribed for home use, can be considered a great help for the prevention of several oral pathologies with systemic implications too.

Use of Porous Implants for the Prosthetic Rehabilitation of Fibula Free Flap Reconstructed Patients

Vascularized free flaps represent today the gold standard in Maxillo-Facial reconstructive treatment of the upper and lower compromised maxillas.The aim of this study is to perform the advantages and disadvantages of the vascularized fibula free flap and the available rehabilitation options with porous implants.In this study the authors analyzed 45 patients with 211 inserted implants treated and reconstructed with vascularized fibula flaps. The authors compared the use of 103 titanium tapered implants (with micro rough surface) versus 108 tantalum-titanium porous implants to evaluate the bone reabsorption and implant survival. Immediate implant stability, the peri-implant reabsorption, and the survival were evaluated. The follow-up was after 3, 6, 12, and 24 months.The authors found that for the 108 Zimmer TM they had an average bone loss of 1 mm ± 0.2 mm after 1 year of follow-up, compared with the other implants where the average bone loss was 2.27 mm ± 0.4.This study demonstrated that the problems caused by different fibula flaps level, compared with the mandibula or, with adjacent teeth in the maxilla, can be solved using TM porous implants that almost duplicate the fixture surface and guarantees long life prognosis to the authors' prosthetic devices.

Sandblasted and Acid Etched Titanium Dental Implant Surfaces Systematic Review and Confocal Microscopy Evaluation

The field of dental implantology has made progress in recent years, allowing safer and predictable oral rehabilitations. Surely the rehabilitation times have also been reduced, thanks to the advent of the new implant surfaces, which favour the osseointegration phases and allow the clinician to rehabilitate their patients earlier. To carry out this study, a search was conducted in the Pubmed, Embase and Elsevier databases; the articles initially obtained according to the keywords used numbered 283, and then subsequently reduced to 10 once the inclusion and exclusion criteria were applied. The review that has been carried out on this type of surface allows us to fully understand the features and above all to evaluate all the advantages or not related. The study materials also are supported by a manufacturing company, which provided all the indications regarding surface treatment and confocal microscopy scans. In conclusion, we can say that, thanks to these new surfaces, it has been possible to shorten the time necessary to obtain osseointegration and, therefore, secondary stability on the part of implants. The surfaces, therefore, guarantee an improved cellular adhesion and thanks to the excellent wettability all the biological processes that derive from it, such as increases in the exposed implant surface, resulting in an increase in bone-implant contact (BIC).

Concentrated growth factor promotes proliferation, osteogenic differentiation, and angiogenic potential of rabbit periosteum-derived cells in vitro

OBJECTIVE

The aim of this research is to investigate the effects of concentrated growth factor (CGF) on the proliferation, osteogenic differentiation, and angiogenic potential of rabbit periosteum-derived cells (PDCs) in vitro.

METHODS

PDCs were isolated from the femoral and tibial periosteum of rabbits and cultured with or without CGF membranes or CGF conditioned media. Scanning electron microscopy (SEM) was used for the structural characterization. Cell Counting Kit-8 assay was used to measure cell proliferation. Alkaline phosphatase (ALP) activity of PDCs was also measured. Immunohistochemistry was used to detect the expression of CD34. Enzyme-linked immunosorbent assay (ELISA), quantitative real-time PCR (qPCR), and Western blot were used to evaluate the secretion and expression levels of osteogenic differentiation markers (bone morphogenetic protein-2, type I collagen, osteocalcin) and angiogenesis markers (vascular endothelial growth factor, basic fibroblast growth factor) in supernatants and PDCs at days 3, 7, 14, and 21.

RESULTS

The SEM analysis showed a dense three-dimensional fibrin network in CGF, and CGF membranes were covered by PDCs with elongated or polygonal morphological features. Compared with the control group, CGF significantly promoted the proliferation of PDCs during the experimental period (p < 0.05). Immunohistochemistry revealed that PDCs were dispersedly distributed among the CGF substrates, and CD34-positive cells were also present. Moreover, CGF significantly increased the ALP activity and upregulated the expression and secretion of osteogenic differentiation and angiogenesis markers in PDCs at days 3, 7, 14, and 21 (p < 0.05).

CONCLUSION

CGF can increase the proliferation and promote the osteogenic differentiation and angiogenic potential of PDCs in vitro. These results indicate that CGF can be used as a new therapeutic means for biotechnological and clinical applications.

Advances in Antiplatelet Therapy for Dentofacial Surgery Patients: Focus on Past and Present Strategies

BACKGROUND

Nowadays, patients involved in antiplatelet therapy required special attention during oral surgery procedures, due to the antiplatelet drugs assumption. The motivations of the assumption may be different and related to the patient's different systemic condition. For this reason, accordingly to the current international guidelines, different protocols can be followed. The aim of this work is to analyze how the dentist's approach to these patients has changed from the past to the present, evaluating the risk exposure for the patients.

METHODS

This review paper considered different published papers in literature through quoted scientific channels, going in search of "ancient" works in such a way as to highlight the differences in the protocols undertaken. The analyzed manuscripts are in the English language, taking into consideration reviews, case reports, and case series in such a way as to extrapolate a sufficient amount of data and for evaluating the past therapeutic approaches compared to those of today.

RESULTS

Colleagues in the past preferred to subject patients to substitution therapy with low molecular weight anticoagulants, by suspending antiplatelet agents to treatment patients, often for an arbitrary number of days. The new guidelines clarify everything, without highlighting an increased risk of bleeding during simple oral surgery in patients undergoing antiplatelet therapy.

CONCLUSION

Either patients take these medications for different reasons, because of cardiovascular pathologies, recent cardiovascular events, or even for simple prevention, although the latest research shows that there is no decrease of cardiovascular accidents in patients who carry out preventive therapy. Surely, it will be at the expense of the doctor to assess the patient's situation and risk according to the guidelines. For simple oral surgery, it is not necessary to stop therapy with antiplatelet agents because the risk of bleeding has not increased, and is localized to a post-extraction alveolus or to an implant preparation, compared to patients who do not carry out this therapy. From an analysis of the results it emerges that the substitutive therapy should no longer be performed and that it is possible to perform oral surgery safely in patients who take antiplatelet drugs, after a thorough medical history. Furthermore, by suspending therapy, we expose our patients to more serious risks, concerning their main pathology, where present.

Antibiotic Prophylaxis on Third Molar Extraction: Systematic Review of Recent Data

The aim of this paper was to highlight the most widely antibiotic protocols applied to the dental field, especially in the surgical treatment of impacted wisdom teeth. Once these protocols were screened, all the possible advantages or disadvantages for each drug and each posology were recorded in this review. In recent years, the need to use these protocols has been debated in the literature. The data obtained by this review underlined how antibiotic protocols applied to oral surgery treatments only included surgeries performed on patients who did not present other systemic pathologies. The first literature review obtained 140 results, and then after the application of the inclusion criteria, 12 papers were selected. The results showed that the most commonly used protocol involved the use of penicillin and clavulanate, obtaining safe clinical and prophylactic results in the management of infections. This widely used protocol seems to guarantee high predictability and safety. The presented review highlights the current possibility of antibiotic resistance affecting patients due to drug misuse. Further clinical studies are required to state specific guidelines; however, oral surgeons involved in third molar surgery should evaluate the local and general health conditions of the patients before suggesting any drug measures for patients.

Comprehensive Treatment of Facial Deformity Due to Radiotherapy in Rhabdomyosarcoma Patients: Distraction Osteogenesis and Free Flaps Surgical Technique

Radiotherapy is essential for achieving and maintaining local control in head and neck rhabdomyosarcoma patients. However, radiotherapy may cause outgrowth disturbances of facial bone and soft tissue, resulting in facial asymmetry.Several studies have shown that the management of irradiated bones still remains challenging. The possibility of obtaining functional and aesthetic results when managing facial deformities due to radiation therapy with distraction osteogenesis combined with free flaps reconstruction is not common and not well documented in recent literature.In this report, we present the long-term results of distraction osteogenesis and soft tissue reconstruction via microvascular free flap to correct the facial hypoplasia of a young patient who underwent radiation therapy for rhabdomyosarcoma.This is the first presentation of 26 years long-term results in a patient who also underwent free flaps reconstruction as ancillary surgery for esthetic good results.

Oral and Psychological Alterations in Haemophiliac Patients

Haemophiliacs are hereditary coagulopathies whose basic anomaly consists of the quantitative or qualitative alteration of one or more plasma proteins in the coagulation system. The objective of this review is to analyse all risk factors, predispositions and alterations to the oral-maxillofacial district in patients with haemophilia. The broader assessment also includes the psychological aspects that could affect the treatment and maintenance of oral conditions. The study takes into consideration all the works in the literature in the last 10 years. Works that present oral, dental and psychological changes in haemophilia patients have been combined. A total of 16 studies were analysed carefully evaluating and explaining all the alterations and risk factors that this disease provides. The aim of the review is to report all the anomalies reported in the literature for these patients, and to direct and update the clinician in the treatment of haemophilia patients.

Bone Augmentation and Simultaneous Implant Placement with Allogenic Bone Rings and Analysis of Its Purification Success

The main objective of this manuscript was to demonstrate the use of freeze-dried bone allografts (FDBA) by means of a technique of simultaneous bone augmentation and implant placement (“Bone Ring Technique”) in different indications, i.e., ridge reconstruction and sinus floor elevation procedure with a maxillary bone height of less than 4 mm. Moreover, cases with an up to 3-year follow-up were chosen to analyze the techniques of mid-term clinical success. Finally, the purification success of the FDBA was analyzed by means of established scanning electron microscopic (SEM) and histological methods. The FBDA bone ring was applied in three different patients and indications and presented; the healing success was analyzed on the basis of radiographical and clinical images. For analysis of the purification of the allogeneic bone, previously established histological methods and scanning electron microscopy (SEM) were applied. All analyzed patient cases showed that the FDBA-based bone ring was fully integrated into newly built alveolar bone. Furthermore, the observations revealed that the three-dimensional bone reconstructions in maxilla and mandible were stable within the observational period of up to 3 years. Altogether, the present data show that the application of the Bone Ring Technique using the FDBA rings allows for successful regeneration of alveolar bone with a predictable clinical outcome, functionality and esthetics. Moreover, the material analyses showed that the allogeneic bone tissue was free of cells or cell remnants, while the (ultra-) structure of the bone matrix has been retained. Thus, the biological safety of the FDBA has been confirmed.

Surgical Risk on Patients with Coagulopathies: Guidelines on Hemophiliac Patients for Oro-Maxillofacial Surgery

BACKGROUND

Haemophilia is a disease of genetic origin, which causes a defect in blood coagulation. Under normal conditions, in the case of leakage from the blood vessels, the blood forms a clot that reduces or blocks the bleeding. This process involves the activation of several plasma proteins in a cascade-like species. Two of these proteins, produced in the liver, factor VIII and factor IX, are deficient or present a functional defect in people with haemophilia. Because of this deficit, the haemophiliacs easily suffer external and internal bleeding. Surgical treatment of these patients is to be observed, and often their treatment is delayed due to unclear guidelines and risks in treating these patients. The aim is to provide clear guidelines in the case of surgical treatment of these patients.

METHODS

In this study, we have considered all the guidelines that refer to the gold-maxillofacial surgery, focusing on the literature of the last 10 years.

RESULTS

Surely, this collection of guidelines will favor the choice of the clinician towards safer and predictable protocols. This study does not want to create a guideline but evaluates the literature of the last 10 years, and highlights the latest for the treatment of these patients., with the aim of informing the pathology and at the same time making the surgical maneuvers safer.

CONCLUSIONS

Despite the research of literature has produced few results, it was nevertheless possible to draw up a guideline thanks to additional information extrapolated from textbooks and other scientific articles. According to the guidelines, it is possible to proceed to the treatment of these patients, if with appropriate therapy in a safe and risk-free manner.

Molecular Biomarkers Related to Oral Carcinoma: Clinical Trial Outcome Evaluation in a Literature Review

Backgrounds

The objective of the present research was to systematically revise the international literature about the genetic biomarkers related to oral cancer (OC) evaluating the recent findings in clinical studies.

Methods

A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed database. The authors conducted the search of articles in the English language published from 2008 to 2018. The present systematic review included only papers with significant results about correlation between wound healing, genetic alteration, and OC. Prognostic capacity of genetic markers was not evaluated in vivo.

Results

The first analysis with filters recorded about 1884 published papers. Beyond reading and consideration of suitability, only 20 and then 8 papers, with case report exclusion, were recorded for the revision.

Conclusion

All the researches recorded the proteomic and genetic alterations in OC human biopsy cells. The gene modification level in the different studies, compared with samples of healthy tissues, has always been statistically significant, but it is not possible to associate publications with each other because each job is based on the measurement of different biomarkers and gene targets. Further investigations should be required in order to state scientific evidence about a clear advantage of using these biomarkers for diagnostic purpose.

Fresh Frozen Allogeneic Bone Block in Maxillary Sinus Floor Elevation: Histomorphometric Analysis of a Bone Specimen Retrieved 15 Years after Grafting Procedure

Nowadays implant-prosthetic rehabilitations are one of the best solutions for rehabilitating our patients. These allow obtaining rehabilitations with optimal functional and aesthetic performances. Often patients, who undergo implant-prosthetic therapy, have the conditions of edentulias, single or multiple, that have been going on for some time. This, according to the literature, produces resorption of the alveolar bone, a process that is complicated in the posterior area of the upper arch by a pneumatization of the maxillary sinuses. The loss of vertical height, so that the implant fixtures can be inserted, requires a maneuver called maxillary sinus floor elevation. This procedure, now safely performed with piezoelectric instruments, allows increasing bone height through bone grafting. In this study, the tissue obtained from a patient, after 15 years from the intervention, was evaluated by histological and SEM analyses. The bone healing in the patient has led to a perfect integration between the patient’s bone and the fresh frozen allograft used, however still present and detectable after 15 years.

Cell Viability of Porous Poly(d,l-lactic acid)/Vertically Aligned Carbon Nanotubes/Nanohydroxyapatite Scaffolds for Osteochondral Tissue Engineering

Treatment of articular cartilage lesions remains an important challenge. Frequently the bone located below the cartilage is also damaged, resulting in defects known as osteochondral lesions. Tissue engineering has emerged as a potential approach to treat cartilage and osteochondral defects. The principal challenge of osteochondral tissue engineering is to create a scaffold with potential to regenerate both cartilage and the subchondral bone involved, considering the intrinsic properties of each tissue. Recent nanocomposites based on the incorporation of nanoscale fillers into polymer matrix have shown promising results for the treatment of osteochondral defects. In this present study, it was performed using the recently developed methodologies (electrodeposition and immersion in simulated body fluid) to obtain porous superhydrophilic poly(d,l-lactic acid)/vertically aligned carbon nanotubes/nanohydroxyapatite (PDLLA/VACNT-O:nHAp) nanocomposite scaffolds, to analyze cell behavior and gene expression of chondrocytes, and then assess the applicability of this nanobiomaterial for osteochondral regenerative medicine. The results demonstrate that PDLLA/VACNT-O:nHAp nanocomposite supports chondrocytes adhesion and decreases type I Collagen mRNA expression. Therefore, these findings suggest the possibility of novel nanobiomaterial as a scaffold for osteochondral tissue engineering applications.

Collagen of Extracellular Matrix from Marine Invertebrates and Its Medical Applications

The extraction and purification of collagen are of great interest due to its biological function and medicinal applications. Although marine invertebrates are abundant in the animal kingdom, our knowledge of their extracellular matrix (ECM), which mainly contains collagen, is lacking. The functions of collagen isolated from marine invertebrates remain an untouched source of the proteinaceous component in the development of groundbreaking pharmaceuticals. This review will give an overview of currently used collagens and their future applications, as well as the methodological issues of collagens from marine invertebrates for potential drug discovery.

Bioactive Titanium Surfaces: Interactions of Eukaryotic and Prokaryotic Cells of Nano Devices Applied to Dental Practice

Background: In recent years, many advances have been made in the fields of bioengineering and biotechnology. Many methods have been proposed for the in vitro study of anatomical structures and alloplastic structures. Many steps forward have been made in the field of prosthetics and grafts and one of the most debated problems lies in the biomimetics and biocompatibility of the materials used. The contact surfaces between alloplastic material and fabric are under study, and this has meant that the surfaces were significantly improved. To ensure a good contact surface with the cells of our body and be able to respond to an attack by a biofilm or prevent the formation, this is the true gold standard. In the dental field, the study of the surfaces of contact with the bone tissue of the implants is the most debated, starting from the first concepts of osteointegration. Method: The study searched MEDLINE databases from January 2008 to November 2018. We considered all the studies that talk about nanosurface and the biological response of the latter, considering only avant-garde works in this field. Results: The ultimate aim of this study is to point out all the progress made in the field of bioengineering and biotechnologies about nanosurface. Surface studies allow you to have alloplastic materials that integrate better with our body and allow more predictable rehabilitations. Particularly in the field of dental implantology the study of surfaces has allowed us to make huge steps forward in times of rehabilitation. Overcoming this obstacle linked to the time of osseointegration, however, today the real problem seems to be linked to the “pathologies of these surfaces”, or the possible infiltration, and formation of a biofilm, difficult to eliminate, being the implant surface, inert. Conclusions: The results of the present investigation demonstrated how nanotechnologies contribute substantially to the development of new materials in the biomedical field, being able to perform a large number of tests on the surface to advance research. Thanks to 3D technology and to the reconstructions of both the anatomical structures and eventually the alloplastic structures used in rehabilitation it is possible to consider all the mechanical characteristics too. Recent published papers highlighted how the close interaction between cells and the biomaterial applied to the human body is the main objective in the final integration of the device placed to manage pathologies or for rehabilitation after a surgical tumor is removed.

Biomimetic Surfaces Coated with Covalently Immobilized Collagen Type I: An X-Ray Photoelectron Spectroscopy, Atomic Force Microscopy, Micro-CT and Histomorphometrical Study in Rabbits

Background: The process of osseointegration of dental implants is characterized by healing phenomena at the level of the interface between the surface and the bone. Implant surface modification has been introduced in order to increase the level of osseointegration. The purpose of this study is to evaluate the influence of biofunctional coatings for dental implants and the bone healing response in a rabbit model. The implant surface coated with collagen type I was analyzed through X-ray Photoelectron Spectroscopy (XPS), Atomic Force Microscopy (AFM), micro-CT and histologically. Methods: The sandblasted and double acid etched surface coated with collagen type I, and uncoated sandblasted and double acid etched surface were evaluated by X-ray Photoelectron Spectroscopy (XPS) and Atomic Force Microscopy (AFM) analysis in order evaluate the different morphology. In vivo, a total of 36 implants were positioned in rabbit articular femoral knee-joint, 18 fixtures for each surface. Micro-CT scans, histological and histomorphometrical analysis were conducted at 15, 30 and 60 days. Results: A histological statistical differences were evident at 15, 30 and 60 days (p < 0.001). Both implant surfaces showed a close interaction with newly formed bone. Mature bone appeared in close contact with the surface of the fixture. The AFM outcome showed a similar roughness for both surfaces. Conclusion: However, the final results showed that a coating of collagen type I on the implant surface represents a promising procedure able to improve osseointegration, especially in regions with a low bone quality.