Effect of temperature on presepsin pre-analytical stability in biological fluids of preterm and term newborns

OBJECTIVES

Thermostability is one of the pre-requisites for the reliability of analytes in clinical practice and biomedical research. Although presepsin represents a promising new biomarker for the early diagnosis of sepsis in newborns, data on its stability under different storage conditions are lacking. We aimed to investigate presepsin thermostability in blood, urine and saliva samples after thawing at 4 predetermined monitoring time-points in a cohort of preterm and term infants.

METHODS

We conducted an observational study, where each case served as its own control, in 24 preterm and term infants. Blood, urine and saliva samples were stored at -80 °C for 18 months, and presepsin measured in different biological fluids at thawing (T0), 24 (T1), 48 (T2) and at 72 (T3) hours after thawing.

RESULTS

No significant differences (p>0.05, for all) in presepsin levels were observed at T0-T3 in the different biological fluids. Furthermore, no differences at T0-T3 were observed in presepsin levels between blood and saliva fluids, whilst urine levels were significantly higher (p<0.05, for all) than blood and saliva at T0-T3.

CONCLUSIONS

Results on presepsin pre-analytical thermo-stability in different biological fluids after long-term refrigeration support the reliability of this biomarker in the diagnosis and monitoring of perinatal sepsis.

Treatment of Multiple RT1 Gingival Recessions Using a Coronally Advanced Flap Associated with L-PRF or Subgingival Connective Tissue Graft from Maxillary Tuberosity: A Randomized, Controlled Clinical Trial

The goal of plastic periodontal surgery is to obtain complete root coverage, increasing gingival thickness (GT), a positive prognostic factor for gingival margin stability over time. The aim of this study was to compare the effectiveness of the Coronally Advanced Flap (CAF) in RT1 (GR; gingival recession with no loss of interproximal attachment) when associated with a connective tissue graft from the maxillary tuberosity (tCTG) or with leukocyte and platelet-rich fibrin (L-PRF) membranes in obtaining root coverage and increasing the thickness and width of the keratinized tissue, along with aesthetic improvement, taking into account a number of patient-related outcomes. Thirty patients with two adjacent RT1 GRs (GRs with no loss of interproximal attachment) were each treated using CAF associated with tCTG (15 patients) or L-PRF. The main outcome was a GT increase; secondary outcomes were keratinized tissue width (KT), gingival recession (GR), probing depth (PD), clinical attachment level (CAL), root coverage percentage (RC%), complete root coverage (CRC), and root coverage esthetic score (RES). Patient-reported outcomes were discomfort (D), dentine hypersensitivity (DH), patient-related esthetic score (PRES), and overall treatment satisfaction (OTS). After 12 months, clinical and patient-reported parameters did not show significant differences between groups, with the only exception being a GT gain, which was significantly greater in the CAF + tCTG group. Our results showed that both techniques were effective in treating RT1 GRs, with comparable patient-related outcomes. However, the use of tCTG produces significantly thicker tissue, covering the exposed root surface.

New insights on collagen structural organization and spatial distribution around dental implants: a comparison between machined and laser-treated surfaces

BACKGROUND

One of the main factors for the osseointegration of dental implants is the development of an adequate soft tissue barrier, mainly composed by collagen, which protects the implant from bacterial development. The structural features of the peri-implant collagen are influenced by the implant components and, in particular, by the type of the surface. In the clinical practice, healing abutments are characterized by smooth surfaces, named machined. Recently, a new laser technique, Synthegra, has been developed to obtain a topography-controlled surface with micrometric regular pores that seems reducing the risk of peri-implantitis. Based on this background, this study aims investigating the structural organization and spatial distribution of collagen surrounding healing abutments characterized by laser-treated and machined surfaces.

METHODS

Gingiva portions surrounding custom-made healing abutments (HA), characterized by alternated laser-treated and machined surfaces, were collected and analyzed by combining Fourier Transform InfraRed Imaging (FTIRI) spectroscopy, a non-invasive and high-resolution bidimensional analytical technique, with histological and multivariate analyses.

RESULTS

Masson's trichrome staining, specific for collagen, highlighted a massive presence of collagen in all the analyzed samples, evidencing a surface-related spatial distribution. The nature of collagen, investigated by the FTIRI spectroscopy, appeared more abundant close to the laser-treated surface, with a perpendicular disposition of the bundles respect to the HA; conversely, a parallel distribution was observed around the machined surface. A different secondary structure was also found, with a higher amount of triple helices and a lower quantity of random coils in collagen close to the laser treated surfaces.

CONCLUSIONS

FTIRI spectroscopy demonstrates that the use of a laser treated transmucosal surface can improve the morphological organization of the peri-implant collagen, which presents a distribution more similar to that of natural teeth.

TRIAL REGISTRATION

This trial is registered with ClinicalTrials.gov Identifier: (Registration Number: NCT05754970). Registered 06/03/2023, retrospectively registered, https://clinicaltrials.gov/show/NCT05754970 .

Evaluation of Post-Operative Morbidity and Palatal Wound Healing after Implant Uncovering Surgical Procedure Performed with Apically Positioned Flap (APF) and Leukocyte and Platelet-Rich-Fibrin (L-PRF): An Original Technique

Background and Objectives: Dental implants are recognized as an effective treatment in the management of edentulous patients; controversies surround the connection between the sufficiency of keratinized gingiva (KG) and peri-implant health. Maintaining an ample amount of peri-implant KG is crucial for minimizing gingival inflammation, highlighting the need for regular consideration of soft-tissue augmentation. Among the diverse periodontal plastic surgical procedures, the apically positioned flap (APF) is notable for its ability to enhance the width of keratinized tissue while minimizing patient morbidity. The aim of this study was to evaluate the effects of L-PRF on palatal wound healing and patient discomfort after surgery. Materials and Methods: Twenty patients with two adjacent submerged fixtures in the maxilla and buccal keratinized gingiva widths < 2 mm were treated with APF and L-PRF. Clinical evaluations were performed at 1, 2, 3, and 4 weeks post-surgery, focusing on parameters such as complete wound epithelialization (CWE), postoperative discomfort (D), changes in feeding habits (CFH), alteration of sensitivity (AS) around the wound area, and the consumption of analgesics. Results: Our data revealed CWE in 5 patients by the end of the second week, with the remaining 15 achieving CWE by the end of the third week. For D and CHF, a statistically significant improvement was recorded for all cases between the first and second weeks, as well as AS, although less substantial, by the third week. No significant changes were noted for AS over the initial two weeks. Conclusions: These findings suggest that L-PRF may enhance wound healing and decrease patient discomfort following APF for fixture uncovering.

A systematic review on removal of osseointegrated implants: un update

BACKGROUND

Today dental implants represent an effective therapy in case of partial or total edentulism, with an excellent success rate. Despite the results obtained, there may be biological or mechanical complications during the therapy, which lead to the loss of the implant. This systematic review aims to evaluate the current state of the art in the literature on techniques used for the removal of dental implants. Various aspects will be analyzed, such as the success of the technique, any complications, and the advantages and disadvantages of their use.

METHODS

Two reviewers conducted a literature analysis (PubMed, Embase, Web of Science) of the last 20 years (2003-2023). The main criterion analyzed was the success of the technique, while secondary outcomes such as complications and risks of the technique were also analyzed. 258 articles were identified in the various search databases. 42 eligible articles were subsequently identified after an article screening. Only 18 full texts were subsequently included in the review.

RESULTS

A total of 18 articles were selected and 1142 implants and 595 patients were included. The main techniques used were the Counter-Torque Ratchet Technique (CTRT), Piezoelectric bone surgery (PBS), trephine drills, carbide burs, Erbium, Chromium, Yttrium, Scandium, Gallium, Garnett (Er:Cr:YSGG) laser and carbon dioxide (CO2) laser. Combined uses of techniques have been identified such as: PBS and trephine burs or carbide burs, trephine burs with the use of a 3d-printed guide, CTRT and trephine burs. The technique with the highest success rate, less morbidity for the patient, and less removal of bone appears to be the CTRT.

CONCLUSIONS

The use of conservative techniques, especially CTRT, in bone removal is useful to allow for immediate implant placement in the removal area. However, further studies with a high sample size are needed to be performed on all techniques, particularly new randomized controlled trials (RCTs) that allow for the analysis of the success of alternative techniques such as Laser and Piezosurgery, which appear to be very promising.

Long-Term Efficacy of Chlorhexidine Gel in Single-Crown Implant Rehabilitation: A Five-Year Follow-Up Study

Chlorhexidine digluconate (CHX) has shown the ability to significantly reduce inflammation and marginal bone loss (MBL) at the 1-year follow-up but limited data exist regarding its long-term efficacy in peri-implant stability. The objective was to compare the long-term effects (5 years of follow-up) of a placebo gel (16 patients in Group A) or a 0.20% CHX gel (15 patients in Group B) used at each previous surgical and prosthetic stage. Control visits were conducted in 2022, investigating the long-term effects by biological, radiological, and clinical evaluation. The data were statistically analyzed. The research achieved a 96.7% implant success rate over five years, but 41.9% of patients did not attend annual oral hygiene check-ups. The average MBL was 1.04 ± 0.39 mm, with no significant differences between the two groups. Notably, patients who attended regular periodontal check-ups experienced significantly less MBL than those who did not (p < 0.05). At five years, direct effects of CHX were absent, with both groups showing moderate bone loss. However, the results suggest that early disinfection could enhance both short- and long-term outcomes. In fact, patients with initial minor MBL due to use of CHX, preserve this advantage also after 5 years of follow-up. Additionally, the data underscore the importance of annual check-ups in early detection and management of biological complications.

Clinical Applications and Mechanical Properties of CAD-CAM Materials in Restorative and Prosthetic Dentistry: A Systematic Review

Clinical outcomes of dental restorations depend primarily on the choice of materials used, and nowadays, dental CAD-CAM (Computer-Aided Design Computer-Aided Manufacturing) materials have strongly changed daily clinical practice. The aim of this systematic review is to analyze CAD-CAM dental materials according to their mechanical properties and in relation to their clinical applications. A literature review was performed on PubMed, Scopus, Web of Knowledge, and the Cochrane Library. Articles addressing at least one of the following topics regarding dental materials for CAD-CAM systems: manufacturers, mechanical features, materials' composition, optical properties, clinical indications, and/or outcomes were included in the review. A flowchart was performed as described in the PRISMA guidelines. Among the 564 articles found, 63 were analyzed and evaluated. Within the limitations of this systematic review, it can be concluded that CAD-CAM materials present a wide range of clinical applications due to their improved mechanical properties. Specifically, in addition to materials that have been in use for a long time (such as feldspathic ceramics), resin block composites can also be used for permanent restorations.

Impact on peri-implant connective tissue of laser treated versus traditional healing abutments: a human clinical trials

BACKGROUND

Dental implant is the principal treatment for edentulism and the healthiness of the peri-implant tissue has a pivotal role for its longterm success. In addition, it has been shown that also the topography of the healing abutment can influence the outcome of the restoration. The objective of this human clinical trial was to assess the impact of a novel laser-treated healing abutment on peri-implant connective tissue and extracellular matrix proteins compared to the conventional machined surface, which served as the control group.

METHODS

During second surgical stage a customized healing abutment were inserted on 30 single dental implants. Healing abutments were realized with two alternated different surface (two side laser-treated surfaces and two side machined surfaces) in order to be considered both as test and control on the same implant and reduce positioning bias. Following the soft tissue healing period (30 ± 7 days) a 5 mm circular biopsy was retrieved. Immuno-histochemical and quantitative real-time PCR (qPCR) analyses were performed on Collagen, Tenascin C, Fibrillin I, Metalloproteinases (MMPs) and their inhibitor (TIMPs). 15 were processed for qPCR, while the other 15 were processed for immunohistochemical analysis. Paired t-test between the two groups were performed. A value of p < 0.05 was considered statistically significant.

RESULTS

Results revealed that the connective tissue facing the laser-treated surface expressed statistically significant lower amount of MMPs (p < 0.05) and higher level of TIMPs 3 (p < 0.05), compared to the tissue surrounding the machined implant, which, in turn expressed also altered level of extracellular matrix protein (Tenascin C, Fibrillin I (p < 0.05)) and Collagen V, that are known to be altered also in peri-implantitis.

CONCLUSIONS

In conclusion, the laser-treated surface holds promise in positively influencing wound healing of peri-implant connective tissue. Results demonstrated that topographic nature of the healing abutments can positively influence mucosal wound healing and molecular expression. Previous studies have been demonstrated how laser treatment can rightly influence integrity and functionality of the gingiva epithelium and cell adhesion. Regarding connective tissue different molecular expression demonstrated a different inflammatory pattern between laser treated or machined surfaces where laser treated showed better response. Targeted interventions and preventive measures on peri- implant topography could effectively minimize the risk of peri-implant diseases contributing to the long-term success and durability of restoration. However, new studies are mandatory to better understand this phenomenon and the role of this surface in the peri-implantitis process.  TRIAL REGISTRATION: This trial is registered with ClinicalTrials.gov Identifier: (Registration Number: NCT05754970 ). Registered 06/03/2023, retrospectively registered.

Gingival phenotype changes after different periodontal plastic surgical techniques: a single-masked randomized controlled clinical trial

ABSTRACT: OBJECTIVES: Aim of this clinical study was to evaluate the effects on gingival thickness of three surgical techniques for root coverage: the coronally advanced flap (CAF) alone, with a sub-epithelial connective tissue graft (SCTG) or with leukocyte- and platelet-rich fibrin (L-PRF) membranes.

METHODS

Sixty patients with RT1 single maxillary gingival recession were treated with CAF + L-PRF (20 patients), CAF + SCTG (20 patients) or CAF alone (20 patients). At baseline and 6-month after treatment, gingival thickness (GT), keratinized tissue width (KT), gingival recession (GR), clinical attachment level (CAL), probing depth (PD), PROMs, and the aesthetic outcome were recorded.

RESULTS

CAF + SCTG and CAF + L-PRF groups showed a significantly greater mean GT increase than CAF alone (0.31 ± 0.10 mm) with no significant differences between CAF + SCTG (0.99 ± 0.02 mm) and CAF + L-PRF (0.92 ± 0.52 mm) groups (p = 0.55). CAF + SCTG was associated with a significantly greater KT gain (3.85 ± 1.04 mm), while in CAF + L-PRF (2.03 ± 0.53 mm) and CAF (1.50 ± 0.69 mm) groups, KT was not significantly increased. Both GR and CAL showed a significant within groups' improvement, without among-groups differences. No significant among-groups difference for the aesthetic outcome but greater discomfort and pain-killer consumption in CAF + SCTG group was detected.

CONCLUSION

All investigated surgical techniques produced significant GR reduction and CAL gain. GT was similarly augmented by CAF + L-PRF and CAF + SCTG techniques; however, the CAF + SCTG technique produced a more predictable KT and GT increase.

CLINICAL RELEVANCE

The results of our study suggest that the CAF + SCTG technique represents the most predictable method for the clinician to improve the gingival phenotype, an important factor for long term gingival margin stability.

TNFα, IL-6, miR-103a-3p, miR-423-5p, miR-23a-3p, miR-15a-5p and miR-223-3p in the crevicular fluid of periodontopathic patients correlate with each other and at different stages of the disease

Periodontitis is one of the main frequent intraoral diseases. Pathogenesis triggers are the immune responses with pro-inflammatory cytokines production and non-coding RNAs expression. The purpose of the present study was to evaluate the involvement of selected miRNAs in various stages of periodontitis and their relationship with the levels of inflammatory mediators in gingival crevicular fluid (GCF). For this study, 36 subjects (21 with periodontal disease, 15 healthy controls) were selected with an age mean of 59.1 ± 3.7 years. Clinical parameters included plaque index, gingival index, sulcus bleeding index, pocket depth, and clinical attachment level. The GCF samples were taken using capillary paper. The levels of miRNAs in GCF were estimated using a Real-Time PCR and TNFα and IL-6 levels were assessed by enzyme-linked immunosorbent assay (ELISA). The results indicated that the miRNA-103a-3p, miRNA-23a-3p, miRNA-15a-5p, and miRNA-223-3p were significantly upregulated with respect to healthy controls. Significant differences were observed for miRNA-23a-3p, miRNA-103a-3p and miRNA-423-5p levels in accord with the disease stages. Inflammatory mediators evaluated in GCF correlate well with the clinical parameters and the severity of the periodontal disease. miRNAs can represent biomarkers of disease stage and can be investigated as a possible therapeutic target, as well as levels of TNFα and IL-6 may drive the disease progression by acting as prognostic markers.

Lithium disilicate and ZLS glass-ceramics for CAD/CAM dental restorations. Biocompatibility, mechanical and microstructural properties after crystallization.: Microstructure and Properties of Glass Ceramics for CAD/CAM Applications

OBJECTIVES

The objective of this study was to define the impact of heating rate on the crystal growth, the mechanical properties, and the biocompatibility of three different kinds of CAD/CAM glass-ceramics treated with a conventional furnace.

METHODS

Lithium disilicate (IPS EMax-CAD, Ivoclar Vivadent) (LS₂) and two zirconia reinforced lithium silicate (ZLS) ceramics (Vita Suprinity PC, VITA Zahnfabrik; Celtra Duo, Dentsply Sirona) (ZLSS; ZLSC) were used. The mechanical properties and the crystal growth were evaluated on 42 specimens (n=14 per group). The thermal treatments recommended by the manufacturers were carried out. All groups were tested for fracture toughness (Ft) and Vickers hardness (Hv). Scanning electron microscope (SEM) images were taken after a slight surface etching with hydrofluoric acid solution (1% for 20 sec). Differential Thermal Analysis (DTA) was performed and cellular adhesion with human periodontal ligament stem cells (hPDLSCs) culture was qualitatively assayed. Data were analysed with Repeated Measurements ANOVA and ANOVA followed by Tukey post hoc test.

RESULTS

The crystals' mean size (±SD) after heat treatment was 1650.0 (±340.0) nm for LS₂, 854.5 (±155.0) nm for ZLSS and 759.9 (±118.4) nm for ZLSC (p<0.05 among the groups). As consequence of crystallization, the Hv was 6.1±0.3 GPa for LS₂, 7.6±0.7 GPa for ZLSS and 7.1±0.5 GPa for ZLSC (p<0.05 for LS₂ vs ZLSS and ZLSC), while the Ft was 2.2±0.1 MPa m^1/2 for LS₂, 4.7±0.8 MPa m^1/2 for ZLSS and 3.8±0.6 MPa m^1/2 for ZLSC (p<0.05 among the groups). The DTA curves showed a crystallization process for LS₂, ZLSS and ZLSC at a temperature range 810°C to 840°C. The amount of adherent hPDLSCs was superior on LS₂ than on ZLS.

CONCLUSIONS

All the CAD/CAM materials can be properly crystallized if heat treated following the manufacturers' instructions. The crystallization process highly depends on temperature. ZLS glass ceramics show significantly inferior crystals dimensions and higher fracture toughness and Vickers hardness than LS₂ ceramic. hPDLSCs cultured on LS₂ have a superior adhesion than those cultured on ZLS.

CLINICAL SIGNIFICANCE

The clinical interest of this study relies on the demonstration that a proper heat-treatment of CAD/CAM lithium disilicate and ZLS glass ceramics generates products that are suitable for clinical service. The differences highlightable in mechanical properties and biocompatibility behaviour do not affect their successful clinical application.

Multiple Free Flap Reconstruction of a Complex Intraoral Defect after Squamous Cell Carcinoma Excision: A Case Report

Background: Squamous cell carcinoma is the most frequent malignant cancer of the oral cavity. Metastasis involvement is one of the most relevant prognostic factors in terms of survival probability. Patients with oral cancers often undergo extensive en bloc resective surgery of the mandible and maxilla, with or without cervical nodal dissection, based on the presence or occult risk of regional metastases. Several factors affect the choice of flap, to recover aesthetics and function. Case Presentation: The case of a 60-year-old man who underwent maxillectomy with neck dissection as well as a reconstruction with a combination of multiple vascularized free flaps is presented. Conclusions: The excellent integration of the free flaps and the total absence of complications led to a high-quality aesthetic and functional performance of the reconstruction obtained through two different flaps. More specifically, the fibular free flap for bone reconstruction allows a two-team approach and maintains an excellent vascularization, even in case of several osteotomies for the maxillary reconstruction as reported. In addition, the use of free radial forearm flap for soft tissue reconstruction permits to obtain long caliber vessels, thus facilitating surgery without repositioning of the patient during surgery and therefore, consequently reducing surgery times.

The added benefit of L-PRF to autogenous bone grafts in the treatment of degree II furcation involvement in mandibular molars

BACKGROUND

Tissue regeneration within the periodontally involved furcation area is one of the most challenging aspects of periodontal surgery. The aim of this study was to evaluate the additional benefit of leukocyte and platelet-rich fibrin (L-PRF) to autogenous bone grafts (ABGs) in the treatment of mandibular molar degree II furcation involvement, comparing the clinical outcomes with those from open flap debridement (OFD)+ABG and OFD alone treatments.

METHODS

Fifty-four patients, exhibiting one buccal or lingual mandibular molar furcation defect, were randomly assigned to three treatment groups: OFD+ABG+L-PRF(n = 18); OFD+ABG (n = 18); and OFD (n = 18). Clinical [probing pocket depth (PPD), horizontal clinical attachment level (HCAL), vertical clinical attachment level (VCAL), gingival recession (GR)] and radiographic [vertical bone level (VBL)] parameters were evaluated at baseline and 6 months after treatment. HCAL change was the primary outcome.

RESULTS

No significant differences within each group were reported for GR changes, but statistically significant improvements in HCAL, VCAL, PPD and VBL were observed in all groups, except for VBL in the OFD group. At 6 months, the mean HCAL gain was 2.29±0.18 mm in the OFD+ABG+L-PRF group, which was significantly greater than that in the OFD+ABG (1.61±0.18 mm) and OFD (0.86±0.18 mm) groups. Both OFD+ABG+L-PRF and OFD+ABG therapies produced a significantly greater clinical and radiographic improvement than OFD.

CONCLUSION

The addition of L-PRF to ABG produces a significantly greater HCAL gain and PPD reduction as compared to OFD+ABG treatment in mandibular degree II furcation involvements. This article is protected by copyright. All rights reserved.

Efficacy of inorganic bovine bone combined with leukocyte and platelet-rich fibrin or collagen membranes for treating unfavorable periodontal infrabony defects: Randomized non-inferiority trial

BACKGROUND

Growing evidence shows the efficacy of platelet concentrates in periodontal therapy. This study aimed to demonstrate that an inorganic bovine bone graft (IBB) in combination with a leukocyte and platelet rich fibrin (L-PRF) is non-inferior to a combination with a collagen membrane (CM) when managing unfavorable infrabony defects (IBDs).

METHODS

All patients exhibited at least one unfavorable IBD; they were randomly assigned to two groups, 31 treated with L-PRF+IBB and 31 with CM+IBB. A clinical and radiographic examination was performed at baseline and 12 months later. Clinical attachment level (CAL), gingival recession (GR), probing depth (PD), and radiographic defect bone level (DBL) post-therapy changes were compared between the two treatments. A non-inferiority margin = 1 mm was set to determine the efficacy of the test treatment (-1 mm for GR); a second non-inferiority margin = 0.5 mm (-0.5 mm for GR) was chosen for clinical relevance.

RESULTS

Twelve months after surgery a significant improvement of clinical and radiographic parameters was observed at both experimental sites. The 90% confidence intervals of the CM+IBB-L-PRF+IBB mean difference for CAL gain (-0.810 mm [-1.300 to -0.319]) and DBL gain (-0.648 mm [-1.244 to -0.052]) were below the 0.5 mm non-inferiority margin; GR increase (1.284 mm [0.764 to 1.804]) remained above the -0.5 mm, while PD reduction (0.499 mm [0.145 to 0.853]) crossed its 0.5-mm margin.

CONCLUSIONS

The L-PRF+IBB treatment of unfavorable IBDs offers non-inferior efficacy for CAL gain, showing less GR and more DBL gain too, while for PD reduction it is inferior to the CM+IBB treatment.

Prevalence of Obstructive Sleep Apnea Syndrome: A Single-Center Retrospective Study

Obstructive sleep apnea syndrome (OSAS) is a sleep breathing disorder that often remains undiagnosed and untreated. OSAS prevalence is increasing exponentially. Starting on the dentist's role as an epidemiological and diagnostic "sentinel", the purpose of this study was to assess the prevalence of OSAS. The clinical diaries of 4659 patients were reviewed through a single-center retrospective analytic study. Descriptive statistical analysis was performed. Only 0.26% of patients reported to suffer from sleep apnea and were then diagnosed with OSAS. It was found that, out of 4487 patients, 678 suffered from hypertension (14.80%), 188 from gastro-esophageal-reflux-disease (GERD = 4.10%) and 484 from gastritis (10.78%). These results could be related to a difficult diagnosis of OSAS and to the absence of a dedicated section on sleep disorders in medical records. Therefore, the introduction of a question dedicated to sleep disorders, the administration of questionnaires (such as the STOP-BANG questionnaire) for early diagnosis, a multidisciplinary approach and pneumological examination could support the dentist in identifying patients at risk of OSAS.

Water-Airborne-Particle Abrasion as a Pre-Treatment to Improve Bioadhesion and Bond Strength of Glass-Ceramic Restorations: From In Vitro Study to 15-Year Survival Rate

The purposes of this study were to evaluate the efficacy of water-airborne-particle abrasion (WAPA) as pre-etching procedure for tooth surfaces to increase bond strength, and to compare the survival rate of WAPA vs. non-WAPA glass-ceramic restorations with a 15-year follow-up. The occlusal surfaces of 20 human molars were sectioned and flattened. The prepared surfaces areas were subdivided into two parts: one received WAPA treatment (prophy jet handpiece with 50 µm aluminium oxide particles) followed by acid etching (37% phosphoric acid for 20 s/3-step etch-and-rinse); the other one was only acid-etched. In total, 108 specimens were obtained from the teeth, of which 80 were used to measure the micro-tensile bond strength (μTBS) in the WAPA (n = 40) and control (n = 40) groups, while the remaining specimens (n = 28) were investigated via SEM to evaluate the micromorphology and roughness (Ra) before and after the different treatment steps. The survival rate (SR) was performed on 465 glass-ceramic restorations (131 patients) comparing WAPA treatment (n = 183) versus non-WAPA treatment (n = 282). The bond strength was 63.9 ± 7.7 MPa for the WAPA group and 51.7 ± 10.8 MPa for the control group (p < 0.001). The Ra was 98 ± 24 µm for the enamel control group, 150 ± 35 µm for the enamel WAPA group, 102 ± 27 µm for the dentin control group and 160 ± 25 µm for the dentin WAPA group. The Ra increase from the WAPA procedure for enamel and dentin was statistically significant (p < 0.05). Under SEM, resin tags were present in both groups although in the WAPA they appeared to be extended in a 3D arrangement. The SR of the WAPA group (11.4 years) was 94%, while the SR of the non-WAPA group (12.3 years) was 87.6% (p < 0.05). The WAPA treatment using aluminium oxide particles followed by a 3-step etch-and-rinse adhesive system significantly improved bioadhesion with an increased bond strength of 23.6% and provided superior long-term clinical performance of glass-ceramic restorations.

Metabolic Changes in SARS-CoV-2 Infection: Clinical Data and Molecular Hypothesis to Explain Alterations of Lipid Profile and Thyroid Function Observed in COVID-19 Patients

It seems that during SARS-CoV-2 infection, total cholesterol, LDL-C, and HDL-C values decrease and lipids could play a fundamental role in viral replication. Moreover, it has been shown that SARS-CoV-2 infection could influence thyroid function. We performed a retrospective analysis of 118 hospitalized patients with COVID-19, comparing pre-infection lipid profile (53 patients) and thyroid-stimulating hormone (TSH) values (45 patients) to those measured on admission. Our aim was to evaluate whether SARS-CoV-2 infection could be involved in thyroid and lipid profile alterations and study possible correlations with disease severity and clinical outcome. Median baseline values at the admission time were: total cholesterol at 136.89 ± 42.73 mg/dL, LDL-C 81.53 ± 30.35 mg/dL, and HDL-C 32.36 ± 15.13 mg/dL; and triglycerides at 115.00 ± 40.45 mg/dL, non-HDL-C 104.53 ± 32.63 md/dL, and TSH 1.15 ± 1.08 μUI/mL. Median values of pre-infection total cholesterol, HDL-C, and TSH were significantly higher than those measured at the admission time (p value < 0.05). The C-reactive protein (CRP) negatively correlated with LDL-C (p = 0.013) and HDL-C (p = 0.05). Our data underline a possible impact of SARS-CoV-2 infection on thyroid function. Moreover it suggests a possible relation between COVID-19 and the lipid profile with a negative correlation between CRP, LDL-C, and HDL-C values, proposing the hypothesis that lipid lowering could follow the rising of the COVID-19 inflammatory state.

Picture of the Favourable Immune Profile Induced by Anti-SARS-CoV-2 Vaccination

COVID-19 pandemic has hit people’s health, economy, and society worldwide. Great confidence in returning to normality has been placed in the vaccination campaign. The knowledge of individual immune profiles and the time required to achieve immunological protection is crucial to choose the best vaccination strategy. We compared anti-S1 antibody levels produced over time by BNT162b2 and AZD1222 vaccines and evaluated the induction of antigen-specific T-cells. A total of 2569 anti-SARS-CoV-2 IgG determination on dried blood spot samples were carried out, firstly in a cohort of 1181 individuals at random time-points, and subsequently, in an independent cohort of 88 vaccinated subjects, up to the seventeenth week from the first dose administration. Spike-specific T-cells were analysed in seronegative subjects between the two doses. AZD1222 induced lower anti-S1 IgG levels as compared to BNT162b2. Moreover, 40% of AZD1222 vaccinated subjects and 3% of BNT162b2 individuals resulted in seronegative during all the time-points, between the two doses. All these subjects developed antigen-specific T cells, already after the first dose. These results suggest that this test represents an excellent tool for a wide sero-surveillance. Both vaccines induce a favourable immune profile guaranteeing efficacy against severe adverse effects of SARS-CoV-2 infection, already after the first dose administration.

Collagen Fibres Orientation in the Bone Matrix around Dental Implants: Does the Implant's Thread Design Play a Role?

The aim of this study was to analyse the influence of different thread shapes of titanium dental implant on the bone collagen fibre orientation (BCFO) around loaded implants. Twenty titanium dental implants, divided for thread shapes in six groups (A–F) were analysed in the present study. All implants were immediately loaded and left in function for 6 months before retrieval. The parameters evaluated under scanning electron microscope were the thread width, thread depth, top radius of curvature, flank angle, and the inter-thread straight section. Two undecalcified histological sections were prepared from each implant. Birefringence analysis using circularly polarized light microscopy was used to quantitively measure BCFO. For groups A–F, respectively, transverse BCFO was 32.7%, 24.1%, 22.3%, 18.2%, 32.4%, and 21.2%, longitudinal BCFO was 28.2%, 14.5%, 44.9%, 33.1%, 37.7%, and 40.2%. The percentage differences between transverse and longitudinal orientation were 4.50% (A), 9.60% (B), −22.60% (C), −14.90% (D), −5.30% (E), and −19.00% (F). Following loading, the amount of transverse and longitudinal BCFO were significantly influenced by the thread shape. The greater flank angles and narrower inter-thread sections of the “V” shaped and “concave” shaped implant threads of groups A and B, respectively, promoted the predominance of transverse BCFO, compared to groups C-F (p < 0.05). A narrow inter-thread straight section promotes transverse BCFO, as do “V” shaped and “concave” shaped threads, which can thus be considered desirable design for implant threads.

Mechanical Pull-Out Test of a New Hybrid Fixture-Abutment Connection: An In Vitro Study

Implant abutment connection was described among the main causes of peri-implant bone resorption. The aim of this in vitro study was to test the coupling capacity, the surface modification of a new hybrid connection and the influence of repeated connection activations caused during the main clinical and laboratory phases. A total of 40 implant-abutment screw retained systems with 10°-conical and internal hexagon connection were tested. The connection was screwed, fixed to the universal test machine, removed the screw and a pull-out test was performed. Test was repeated five times in succession. Also Scanning Electron Microscopy (SEM) was used to detect microscopically surface modification. Analysis of variance and Tukey tests were used for the statistical analysis. Pull-out test reveals a mean value of 131.35 ± 16.52 Newton Centimeter (N·cm). For each single activation, results from first to fifth were: 113.9 ± 13.02, 126.1 ± 12.81, 138.11 ± 15.15, 138.8 ± 11.90 and 140 ± 12.99 N·cm. A statistically significant difference between the measurements and an increase in the removal force was shown. The collected data supports the use of this new type of connection, resulting in a very strong interface between implant and abutment. Also, repeated activation of connection can promote a better coupling of the implant-abutment interface.

Comparative surface detail reproduction for elastomeric impression materials: Study on reproducibility performance

For dental impression of a prepared tooth, the goal is a void-free negative representation from which an accurate cast of a tooth and its surrounding tissue can be reproduced. This in-vitro study assessed and compared the reproduction accuracies of surface detail obtained with three different dental elastomeric impression materials: vinyl polysiloxane (VPS), vinyl polyether silicone (VPES), and polyether (PE). A stainless-steel model with two abutments was used, with impressions taken 10 times for each material, for 20 abutment impressions per group, using a two-phase, one-step technique (heavy body/light body). The impressions were removed and assessed for numbers of enclosed voids and open voids visible on the surface. The defect frequency was 95% for impressions with the VPS and VPES materials, and 30% for the PE material. No significant differences were seen for number of impressions with defects for VPS versus VPES. Significant differences were seen for VPS and VPES versus the PE material (P <.05). No significant differences were seen for the defect type distributions across these three impression materials. The PE impression material showed better accuracy for reproduction of surface detail of these dental impressions compared to the VPS and VPES impression materials.

Normal breathing releases SARS-CoV-2 into the air

This study tests the release of SARS-CoV-2 RNA into the air during normal breathing, without any sign of possible risk of contagion such as coughing, sneezing or talking. Five patients underwent oropharyngeal, nasopharyngeal and salivary swabs for real-time reverse transcriptase PCR (RT-PCR) detection of SARS-CoV-2 RNA. Direct SARS-CoV-2 release during normal breathing was also investigated by RT-PCR in air samples collected using a microbiological sampler. Viral RNA was detected in air at 1 cm from the mouth of patients whose oropharyngeal, nasopharyngeal and salivary swabs tested positive for SARS-CoV-2 RNA. In contrast, the viral RNA was not identified in the exhaled air from patients with oropharyngeal, nasopharyngeal and salivary swabs that tested negative. Contagion of SARS-CoV-2 is possible by being very close to the mouth of someone who is infected, asymptomatic and simply breathing.

SEM-EDX Analysis of a Submandibular Gland Salivary Calculus: A Case Report

Sialolithiasis or “salivary lithiasis” is a pathological condition that involves the formation of calcified concrements within the gland parenchyma and its ductal system of the main salivary glands of the head and neck area. Various theories of lithogenesis have been reported, but the etiology of sialoliths still remains unclear. The aim of this case report was to evaluate the biochemical composition and the surface morphology of a sialolith using energy dispersion X-ray spectroscopy (EDX) and scanning electron microscopy (SEM). SEM images of the sialolith detected a concentric laminar architecture of the sialolith’s core surrounded by radial structures that are arranged from the center to the periphery of the sialolith. EDX analysis detected a high percentage of carbon in the central area of the sialolith, indicating the abundance of organic materials. Structures corresponding to a foreign body or bacteria were not detected in any area. Thus, the sialolith presented a mixed genesis, and the increased presence of organic substances over inorganic ones suggests its phlogistic nature.

Air and surface measurements of SARS-CoV-2 inside a bus during normal operation

Transmission pathways of SARS-CoV-2 are aerosol, droplet and touching infected material. The diffusion of the virus contagion among people is easier in indoor location, but direct detection of SARS-CoV-2 in air or on surfaces is quite sparse, especially regarding public transport, while it would be important to know how and if it is safe to use them. To answer these questions we analysed the air and the surfaces most usually touched by passengers inside a city bus during normal operation, in order to understand the possible spreading of the virus and the effectiveness of the protective measures. The measurements were carried out across the last week of the lockdown and the first week when, gradually, all the travel restrictions were removed. The air and surface samples were analysed with the RT-PCR for the detection of SARS-CoV-2 virus. After two weeks of measurements and more than 1100 passenger travelling on the bus the virus was never detected both on surfaces and on air, suggesting that the precautions adopted on public transportation are effective in reducing the COVID-19 spreading.

Gingival Response to Dental Implant: Comparison Study on the Effects of New Nanopored Laser-Treated vs. Traditional Healing Abutments

The health of peri-implant soft tissues is important for the long-term success rate of dental implants and the surface topography is pivotal in influencing it. Thus, the aim of this study was to evaluate, in human patients, the inflammatory mucosal microenvironment in the tissue surrounding a new, nanoscale, laser-treated healing abutment characterized by engineered nanopores versus a standard machined-surface. Analyses of anti- and pro-inflammatory markers, cytokeratins, desmosomal proteins and scanning electron microscopy were performed in 30 soft-tissue biopsies retrieved during second-stage surgery. The results demonstrate that the soft tissue surrounding the laser-treated surface was characterized by a lower grade of inflammation than the one facing the machined-surface, which, in turn, showed a disrupted epithelium and altered desmosomes. Moreover, higher adhesion of the epithelial cells on the laser-treated surface was detected compared to the machined one. In conclusion, the laser-treated surface topography seems to play an important role not only in cell adhesion, but also on the inflammatory makers’ expression of the soft tissue microenvironment. Thus, from a clinical point of view, the use of this kind of topography may be of crucial importance not only on healing abutments but also on prosthetic ones.

Influence of Dentine Pre-Treatment by Sandblasting with Aluminum Oxide in Adhesive Restorations. An In Vitro Study

Dentine pretreatment through sandblasting procedures has been widely studied but no curve test results are currently available. Thus, the aim herein was to in vitro compare the adhesive strength in sandblasted or not samples using a universal testing machine. Thirty -two bovine teeth were divided into two groups, namely test (n = 16 bars), sandblasting with aluminum oxide particles (50 µm) was performed before the adhesion procedures), and control (n = 16 bars), where no sandblasting procedure was performed. A bi-material curve test was used to evaluate the characteristics of the dentine pretreatment in terms of tensile stress and fracture strength. A scanning electron microscope (SEM) was used to analyze the fracture topography in the composite, bonding, dentin, and at the relative interfaces. The results demonstrated a statistically significant difference between the two groups in terms of tensile stress at maximum load showing values of 84.300 ± 51.342 MPa and 35.071 ± 16.609 MPa, respectively for test and control groups (p = 0.033). Moreover, a fracture strength test showed values of 18.543 ± 8.145 MPa for test and 8.186 ± 2.833 MPa for control group (p = 0.008). In conclusion, the sandblasting treatment of the dentine significantly influenced the mechanical resistance of the adhesion in this in vitro study.

A 4 Year Human, Randomized, Radiographic Study of Scalloped versus Non-Scalloped Cemented Implants

Marginal bone loss (MBL) is a key factor in long-term implant success rate. Among the different factors that influence MBL, it is the different implant shoulder designs, such as scalloped or non-scalloped, which have been widely studied on screw retained but not on cemented retained implants. Thus, the aim of the present study was to evaluate the MBL around scalloped and non-scalloped cemented retained dental implants after 4 years of loading, in humans. A total of 15 patients were enrolled in the present study. A radiographic and clinical examination was performed after implant placement (T0) and after 4 years from it (T1). The results demonstrated a differential MBL (T1-T0) of 2.436 ± 1.103 mm and 1.923 ± 1.021 mm, respectively for test (scalloped) and control (non-scalloped) groups with a statistically significant difference between them. On the other hand, no statistically significant differences were found between the groups in terms of prosthetic complication and abutment decementation, whilst ceramic crowns chipping was shown in both groups. In conclusion, the use of a scalloped platform did not provide better results on the maintenance of MBL after 4 years follow-up. In this study, this probably was determined by multiple factors, among which was the subcrestal insertion of scalloped implants.

Immunohistochemical Results of Soft tissues Around a New Implant Healing-Abutment Surface: A Human Study

Although, the high success rate of implant rehabilitation treatment, the biological complications such as bone loss and peri-implantitis are still present. The creation of a coronal biological seal between the implant and the oral tissues seems to be a crucial point on preserving dental implants. The objective of this study was to immunohistochemically analyze the behavior of peri-implant soft tissues around a new implant healing-abutment surface on humans. A total of 30 soft tissue biopsies were collected after a healing period of 30 (±7) days, to analyze the expression of inflammatory (cluster of differentiation 63 (CD63), human neutrophil peptides 1-3 (HPN1-3)) and junctional (E-cadherin, occludin, and β-catenin) markers, on soft tissues around laser treated and machined alternated healing abutments. The evaluation demonstrated the whole area of the soft tissues adherent to the laser treated surface with a regular morphology. While several stress hallmarks in correspondence of machined surfaces were shown such as: a) An irregular, disrupted, and discontinued basal membrane with an increased inflammation evident both the epithelial and connective tissues; b) the absence or defective proper keratinization process of the external layer, and c) damages in the cell to cell interaction. In conclusion, the laser treated surface is preferable to maintain the integrity and functionality of the gingiva epithelium.

Penetration of Different Impression Materials into Exposed Dentinal Tubules during the Impression Procedure

Adhesive restorations have been shown to guarantee excellent performance and longevity, although this comes with some disadvantages. Among these, the vulnerability of dentine to different agents has been widely evaluated. The aim of this study was to evaluate the possible penetration of impression materials into freshly cut dentine. Dentine from 27 teeth was impressed with polyether (Impregum Penta L) (nine teeth) and with polyvinyl siloxane (Aquasil Ultra LV) (nine teeth). The surface of nine teeth after the impressions were used as the control. Specifically, the extroflections caused by the imprinting of the dentinal tubules on the impression material, the so-called impression tags, were measured. Furthermore, the presence of the material inside the tubules was examined. Scanning electron microscopy analysis showed material tags for all of the experimental groups. The mean lengths (±SD) were 22.6 (±11.0) µm for polyether, 21.8 (±12.8) µm for polyvinyl siloxane and 11.3 (±7.0) µm for the tooth control, with mean diameters (±SD) of 2.8 (±0.5), 2.4 (±0.7) and 3.1 (±0.7) µm, respectively. Fractal analysis showed fractal dimensions of 1.78 (±0.03), 1.77 (±0.03) and 1.71 (±0.03), respectively. These data demonstrated that the impression materials can remain inside the dentinal tubules, which can adversely affect the adhesive procedures.

The Relationship Between Time of Retightening and Preload Loss of Abutment Screws for Two Different Implant Designs: An In Vitro Study

The loosening of an abutment screw is one of the most frequent complications in implant-prosthetic rehabilitation, especially for single-crown cemented prostheses. This complication is due to several mechanical factors including type of connection, abutment-screw geometry, settling effects, and cyclical load. The purpose of the present in vitro study was to compare and associate different times of retightening with reductions in preload losses. We evaluated 40 internal hexagon dental implants and 40 external hexagon dental implants, with their related abutment screws. The implants were embedded in acrylic resin in cylindrical polyvinyl chloride tubes (26 mm diameter, 20 mm height). The abutments were fixed to the implants with screws to an initial torque of 35 Ncm using a digital torque meter with decimal precision. Two different types of connection were randomly divided in 4 subgroups of 10 samples each. One subgroup was used as control. The test groups underwent retightening to the same initial torque at increasing times from initial torque application for tightening of the abutment screws, to their retightening at 2 minutes, 5 minutes, and 10 minutes. The retightening time of 2 minutes shows significantly reduced preload loss. Randomized clinical trials are strongly required to provide clinicians with a beneficial standardized protocol of retightening that can be applied in routine clinical practice.

AEDG Peptide (Epitalon) Stimulates Gene Expression and Protein Synthesis during Neurogenesis: Possible Epigenetic Mechanism

It was shown that AEDG peptide (Ala-Glu-Asp-Gly, Epitalon) regulates the function of the pineal gland, the retina, and the brain. AEDG peptide increases longevity in animals and decreases experimental cancerogenesis. AEDG peptide induces neuronal cell differentiation in retinal and human periodontal ligament stem cells. The aim of the study was to investigate the influence of AEDG peptide on neurogenic differentiation gene expression and protein synthesis in human gingival mesenchymal stem cells, and to suggest the basis for the epigenetic mechanism of this process. AEDG peptide increased the synthesis of neurogenic differentiation markers: Nestin, GAP43, β Tubulin III, Doublecortin in hGMSCs. AEDG peptide increased Nestin, GAP43, β Tubulin III and Doublecortin mRNA expression by 1.6–1.8 times in hGMSCs. Molecular modelling method showed, that AEDG peptide preferably binds with H1/6 and H1/3 histones in His-Pro-Ser-Tyr-Met-Ala-His-Pro-Ala-Arg-Lys and Tyr-Arg-Lys-Thr-Gln sites, which interact with DNA. These results correspond to previous experimental data. AEDG peptide and histones H1/3, H1/6 binding may be one of the mechanisms which provides an increase of Nestin, GAP43, β Tubulin III, and Doublecortin neuronal differentiation gene transcription. AEDG peptide can epigenetically regulate neuronal differentiation gene expression and protein synthesis in human stem cells.

Curcumin/Liposome Nanotechnology as Delivery Platform for Anti-inflammatory Activities via NFkB/ERK/pERK Pathway in Human Dental Pulp Treated With 2-HydroxyEthyl MethAcrylate (HEMA)

Curcumin, primary component of the spice turmeric extracted from the rhizomes of Curcuma longa, represents the major anti-oxidant and anti-inflammatory substance found in turmeric, acting thought various mechanisms not completely understood. Curcumin modulates cytokines, growth factors, transcription factors, inflammatory molecules and cell signaling pathways. During restorative dentistry practice, free resin monomers of 2-hydroxyethyl methacrylate (HEMA) propagate through dentin micro-channel and pulp into the bloodstream affecting cellular integrity. The study highlights the significance of application of curcumin bioactive component into liposomal formulations (CurLIP) to restore the homeostasis of dental pulp stem cells (hDPSCs) in response to 3 and 5 mmol L^–1 HEMA treatment. Cell proliferation in combination with changes of the morphological features, proinflammatory cytokines secretion as Interleukin (IL) 6, IL8, Monocyte Chemoattractant Protein-1 (MCP1) and Interferon-gamma (IFNγ) were assayed along with the nuclear factor (NF)-kB, an inducible transcription factor involved in the activation of several cell processes associated to extracellular signal-regulated kinases (ERK) and posphorylated (p-) ERK pathway. Our results showed a decreased cell proliferation, morphological changes and upregulation of IL6, IL8, MCP1 and IFNγ in presence of 3 and 5 mmol L^–1 HEMA treatment. CurLIP therapy in hDPSCs provokes an increase in cell proliferation and the block of inflammatory cytokines secretion through the inhibitory regulation of NFkB/ERK and pERK signaling cascade. The natural nanocarrier CurLIP influences numerous biochemical and molecular cascades causing anti-inflammatory properties in response to HEMA treatment in human dental pulp stem cells, representing an innovative endodontic formulation able to improve the quality of dental care with a major human community impact.

Effect of short peptides on neuronal differentiation of stem cells

It has been demonstrated that short peptides play an important role in the transmission of biological information, modulation of transcription, and restoring genetically conditioned alterations occurring with age. Peptidergic regulation of homeostasis occupies an important place in physiological processes, which lead to the aging of cells, tissues, and organs, consisting in the involution of major regulatory systems-the nervous, the endocrine, and the immune. The effect of AED (Ala-Glu-Asp), KED (Lys-Glu-Asp), KE (Lys-Glu), AEDG (Ala-Glu-Asp-Gly) peptides and their compound on neuronal differentiation of human periodontal ligament stem cells (hPDLSCs) was studied by immunofluorescence and western blot analysis. Growth-Associated Protein 43 (GAP43), which implements neurotransmission mechanisms and neuroplasticity, demonstrated an increased expression in hPDLSCs cultured with a compound of all studied peptides and with KED alone. The peptide compound and KED, increase the expression of Nestin (neurofilament protein), expressed in early neuronal precursors in hPDLSCs cultures. Thus, the compound of peptides AEDG, KE, AED, and KED could promote the neuronal differentiation of hPDLSCs and be a promising tool for the study of peptides as a modulator of neurogenesis in neurodegenerative diseases studied in animal models.

A 10-year retrospective comparative human study on screw-retained versus cemented dental implant abutments

The aim of this 10-year retrospective study was to evaluate the long-term reliability, survival rate and mechanical and biological complications of single-crown implant rehabilitations with two different types of fixture-abutment connections: screw-retained abutments (SRAs) with internal hexagonal connection, and cemented retained abutments (CRAs). A total of 300 single implant-supported crowns were analysed, which had been inserted between 2004 and 2007. Patients were classified according to two groups: the SRA group (n = 150) and the CRA group (n = 150). The primary outcome was marginal bone loss (MBL) on peri-apical radiographs. Bleeding on probing (BOP) and probing depth (PD) were also evaluated. Moreover, prosthetic complications were recorded. Analysis of variance (ANOVA) was used to evaluate the differences between the groups. The overall implant failure rate was 4.2%. The overall positive BOP index was 81.9% of the sites under investigation, as 83.4% for SRA and 80.4% for CRA. Moreover, >5 mm PD demonstrated a rate of 21.0% for CRA, and 13.8% for SRA. The primary outcome of mean MBL was 2.09±1.07 mm for SRA and 1.54±1.20 mm for CRA. Analysis of variance of MBL showed statistical significance for the difference between these two groups (P less than 0.001). For the mechanical aspects, an overall 12.5% of complications occurred. No implant or abutment fractures were recorded. Although complications occurred, the results from this 10-year retrospective study show that these two methods have positive long-term follow-up. With MBL significantly greater for the SRA group than the CRA group, the clinical use of CRA is encouraged in terms of the lower bone resorption rate.

Human Gingival Fibroblasts Exposed to Extremely Low-Frequency Electromagnetic Fields: In Vitro Model of Wound-Healing Improvement

Several clinical studies have suggested the impact of sinusoidal and pulsed electromagnetic fields in quickening wound repair processes and tissue regeneration. The clinical use of extremely low-frequency electromagnetic fields could represent a novel frontier in tissue repair and oral health, with an interesting clinical perspective. The present study aimed to evaluate the effect of an extremely low-frequency sinusoidal electromagnetic field (SEMF) and an extremely low-frequency pulsed electromagnetic field (PEMF) with flux densities of 1 mT on a model of oral healing process using gingival fibroblasts. An in vitro mechanical injury was produced to evaluate wound healing, migration, viability, metabolism, and the expression of selected cytokines and protease genes in fibroblasts exposed to or not exposed to the SEMF and the PEMF. Interleukin 6 (IL-6), transforming growth factor beta 1 (TGF-β), metalloproteinase 2 (MMP-2), monocyte chemoattractant protein 1 (MCP-1), inducible nitric oxide synthase (iNOS), and heme oxygenase 1 (HO-1) are involved in wound healing and tissue regeneration, favoring fibroblast proliferation, chemotaxis, and activation. Our results show that the exposure to each type of electromagnetic field increases the early expression of IL-6, TGF-β, and iNOS, driving a shift from an inflammatory to a proliferative phase of wound repair. Additionally, a later induction of MMP-2, MCP-1, and HO-1 was observed after electromagnetic field exposure, which quickened the wound-healing process. Moreover, electromagnetic field exposure influenced the proliferation, migration, and metabolism of human gingival fibroblasts compared to sham-exposed cells. This study suggests that exposure to SEMF and PEMF could be an interesting new non-invasive treatment option for wound healing. However, additional studies are needed to elucidate the best exposure conditions to provide the desired in vivo treatment efficacy.

Comparison of a Novel Ultrasonic Scaler Tip vs. Conventional Design on a Titanium Surface

The aim of this in vitro study was to evaluate the alterations of a titanium surface after treatment with two different types of ultrasonic tips: conventional steel versus an innovative copper alloy silver-plated one. Twenty smooth-surface, grade IV unalloyed titanium discs were divided into two groups. The discs were ultrasonically instrumented and the scaler was connected with a loading machine. The surface morphology was examined using scanning electron microscopy (SEM) and fractal analysis of lacunarity was calculated to highlight the alteration of the surface using the two different tips. The SEM analysis showed different degrees of surface roughness between the two types of scaler tips. Moreover, these observations demonstrated that the new tip showed fewer irregularities on the disc’s surface than the conventional steel tip. The statistical and fractal analysis showed a statistically significant difference between the two groups. Surface alterations of titanium induced by the conventional ultrasonic tips were much greater than those made by copper alloy silver plated tips. The presented results suggest that the use of this new ultrasonic tip may reduce the alterations on the implant surface during its use in dental practice.

Immunohistochemical study of osteopontin in oral squamous cell carcinoma allied to fractal dimension

The aim of the study was to consider a possible correlation between the intensity of expression of osteopontin and grading established by the pathologist. Furthermore, a correlation was investigated between the increase of fractal dimension and osteopontin in order to use this marker as an early and reliable diagnostic tool for the degree of cell transformation in oral squamous carcinoma. Ten histologically healthy oral samples and sixty-four primary oral squamous cell carcinomas specimens were analysed by a single pathologist. Immunohistochemical analysis and Fulgen stain were performed in order to evaluate intensity of expression of osteopontin and fractal dimension. Data obtained were presented as mean and standard deviation and processed for the statistical analysis. Ostepontin expression revealed a statistical significance between groups (P less than 0.001). Fractal dimension in oral squamous cell carcinoma groups vs controls revealed statistically significant differences (P less than 0.001). The fractal dimension value and the osteopontin expression were compared, using two-dimensional scatter. The correlation was relevant in the G3 group. The results demonstrated a correlation between the growths of osteopontin expression and nuclear abnormality measured by fractal dimension. These results support the hypothesis that the level of osteopontin expression might be used as a marker for the evaluation of oral squamous cell carcinoma differentiation. Osteopontin and fractal dimension could support the histological grading to increase the predictability of the diagnosis, choices of treatment procedure and long-term prognosis.

Multimodal-3D imaging based on μMRI and μCT techniques bridges the gap with histology in visualization of the bone regeneration process

Bone repair/regeneration is usually investigated through X-ray computed microtomography (μCT) supported by histology of extracted samples, to analyse biomaterial structure and new bone formation processes. Magnetic resonance imaging (μMRI) shows a richer tissue contrast than μCT, despite at lower resolution, and could be combined with μCT in the perspective of conducting non-destructive 3D investigations of bone. A pipeline designed to combine μMRI and μCT images of bone samples is here described and applied on samples of extracted human jawbone core following bone graft. We optimized the coregistration procedure between μCT and μMRI images to avoid bias due to the different resolutions and contrasts. Furthermore, we used an Adaptive Multivariate Clustering, grouping homologous voxels in the coregistered images, to visualize different tissue types within a fused 3D metastructure. The tissue grouping matched the 2D histology applied only on 1 slice, thus extending the histology labelling in 3D. Specifically, in all samples, we could separate and map 2 types of regenerated bone, calcified tissue, soft tissues, and/or fat and marrow space. Remarkably, μMRI and μCT alone were not able to separate the 2 types of regenerated bone. Finally, we computed volumes of each tissue in the 3D metastructures, which might be exploited by quantitative simulation. The 3D metastructure obtained through our pipeline represents a first step to bridge the gap between the quality of information obtained from 2D optical microscopy and the 3D mapping of the bone tissue heterogeneity and could allow researchers and clinicians to non-destructively characterize and follow-up bone regeneration.

Anti-inflammatory steroid use in impacted third molar surgery: a systematic review

Oral surgery procedures involve traumatization of mucosal and bony tissues, and lengthy interventions can lead to inflammatory post-operative sequelae. In the bony tissues in particular, the inflammatory processes can affect healing. Modern drug therapies provide valid support for lowering the risk of occurrence of post-operative inflammatory signs. The two main types of agents used are nonsteroidal anti-inflammatory drugs and/or corticosteroids, which act on two different molecular pathways in the inflammatiory process. The aim of this systematic review is to examine the different corticosteroids used in oral surgery procedures, their indications for use, and their route of administration, to provide the clinician with a useful scheme for correct pharmacological management of post-operative inflammation. To identify studies eligible for inclusion in this systematic review, we performed a literature search up to April 2017 of the electronic databases, considering published papers from 2007 to 2017. The search terms included steroids, third molar, oral surgery, RCT [randomized controlled trial], human, and clinical trial. Only articles in English language were considered.

Instant loading with intraoral welding technique and PRAMA implants: a new prosthetic approach

When splinting multiple implants passive fit of the framework should be achieved to avoid excessive force distribution on the implants. Recently, a protocol was suggested for immediate loading of multiple implants by welding a titanium bar to implant abutments directly in the oral cavity so as to create a customized, precise and passive metal-reinforced provisional restoration. The intraoral welding technique subsequently proves to be a successful option in the full-arch immediate restorations of the mandible and maxilla. The aim of this article is to present a case report in which a new prosthetic approach, using trans-mucosal implants, is described. Dental implants are instantly loaded with a provisional prosthesis supported by an intraoral welded titanium framework to obtain a precise passive fit of the immediate loaded prosthesis.