Efficacy of Topical Treatments for the Management of Symptomatic Oral Lichen Planus: A Systematic Review

Oral lichen planus (OLP) is a chronic mucosal inflammatory disease associated with T-cell-mediated immunological dysfunction. Symptomatic OLP is a painful condition, and complete healing is often not achieved. The aim of this systematic review was to assess the effectiveness of topical drugs, medications, and other interventions compared to placebo or to other treatments in pain reduction and clinical resolution in adult patients with symptomatic OLP. A detailed electronic literature search was performed through the MEDLINE (PubMed) database between 1 January 2005 and 30 September 2022. Eligible studies were selected based on the inclusion criteria, and a quality assessment was conducted. From 649 titles, 121 articles were selected as abstracts, 75 papers were assessed as full text, along with 15 other papers obtained through a manual search. A total of 15 RCTs were finally included in the review process. Because of the significant heterogeneity in the study design of the included studies, no meta-analysis of the data could be performed. Topical corticosteroids represent the first-line treatment in the management of symptomatic OLP due to their efficacy and minimal adverse effects. Calcineurin inhibitors seem to be equally effective and are indicated in recalcitrant cases, extensive lesions, patients susceptible to oral candidiasis, or cases unresponsive to corticosteroids. Other treatments, such as aloe vera, chamomile, isotretinoin, ozone, and laser therapy, could be beneficial as adjunct therapies in association with first-line treatments.

Student Evaluation of Distance Learning during the COVID-19 Pandemic: A Cross-Sectional Survey on Medical, Dental, and Healthcare Students at Sapienza University of Rome

The COVID-19 pandemic has had a deep impact on university education, necessitating an abrupt shift from face-to-face learning to distance learning (DL). This has created new challenges, especially for those courses in which practical activities and internships are integral parts of the education program. The aim of this study was to assess the impact of DL on the study progress of a population of pregraduate students of medicine, dentistry, and healthcare professions. The survey was administered through an anonymous questionnaire by sharing a Google Forms link. Demographic data and educational background information were collected to obtain a profile of the participants. Different aspects of DL were investigated, including availability of digital devices, quality of connection, and environmental conditions; other questions focused on the effects of DL on students' progress and professional maturation. Measures of association were also calculated using the chi-squared test, Cramer V, and Somers D. Among the 372 who participated, the results showed that students had a positive attitude toward online classroom and that DL did not substantially affect their progress. Most of the associations were statistically significant, also highlighting the effect of the degree course on the responses. Some critical issues clearly emerged, however, including the lack of adequate devices and environmental conditions due to economic disparity, poor relationships, suspension of internship programs, and clinical training. The results suggest that DL cannot be considered as a substitute for classroom-based medical education outside an emergency context.

Autologous Dentin Graft after Impacted Mandibular Third Molar Extraction to Prevent Periodontal Pocket Formation-A Split-Mouth Pilot Study

This preliminary study aims to evaluate the efficacy of an autologous dentin graft in preventing periodontal defects after impacted or semi-impacted lower third molars’ (M3) surgical extraction. For this purpose, radiographic and periodontal evaluation of post-extractive sockets were performed. Ten patients were enrolled in the study: twenty M3 extraction sockets were treated with a split-mouth modality. After tooth extraction, the experimental sites were filled with autologous dentin graft obtained by the extracted M3, while the control sites were filled with blood clot alone. Flaps were closed by first intention to ensure the stability of the wounds. Post-extractive sites were monitored at days 15, 90 and 180. The healing was not affected by any complications associated with the use of the autologous dentine graft in all cases. The measurements recorded at six months showed a reduction of the probing pocket depth distal to the second lower molar (M2) at both surgical sites, with a greater reduction observed at the experimental sites. Radiographic evaluation also showed a greater amount of bone gain at the grafted sites compared to the control sites. The results of this preliminary study suggest that autologous dentin grafts can be useful in preventing the formation of periodontal defects distal to M2 after M3 surgical extraction.

Efficacy of Combined Mechanical and Chemical Decontamination Treatments on Smooth and Rough Titanium Surfaces and Their Effects on Osteoconduction: An Ex Vivo Study

PURPOSE

The aim of this ex vivo study was to assess the ability to remove oral biofilm by different combinations of mechanical and chemical treatments on smooth and rough titanium surfaces, as well as their impact on osteoconduction.

MATERIALS AND METHODS

Forty-eight sandblasted acid-etched (SLA) and 48 machined titanium disks were contaminated with oral bacterial biofilm and exposed to the following treatments: (1) titanium brush (TB), (2) TB + 40% citric acid (CA), (3) TB + 5.25% sodium hypochlorite (NaOCl), (4) air polishing with glycine powder (AP), (5) AP + 40% CA, and (6) AP + 5.25% NaOCl. Residual bacteria and chemical contamination were assessed using viable bacterial count assay, scanning electron microscopy (SEM), and x-ray spectroscopy (XPS). Human primary osteoblast (hOB) adhesion and osteocalcin (OC) release were also evaluated.

RESULTS

The microbiologic, SEM, and XPS analysis indicate a higher biofilm removal efficiency of combined mechanical-chemical treatments compared with exclusively mechanical approaches, especially on SLA surfaces. SEM analysis revealed significant alterations of surface microtopography on the disks treated with TB, while no changes were observed after AP treatment. OC release by hOBs was mainly decreased on disks treated with CA and NaOCl.

CONCLUSION

The combination of mechanical and chemical treatments provides effective oral biofilm removal on both SLA and machined implant surfaces. NaOCl and CA may have a negative effect on osteoblasts cultured on SLA samples.

Antibiotics to Prevent Surgical Site Infection (SSI) in Oral Surgery: Survey among Italian Dentists

The benefit of an antibiotic prophylaxis for most oral surgical procedures is controversial. The aim of this study was to collect information on the prescribing habits of a sample of Italian dentists with respect to the role of antibiotic prophylaxis in preventing surgical site infections (SSI). An anonymous questionnaire was prepared and made accessible online by sharing a Google Forms link. General anagraphic data and educational background information were collected to obtain a profile of the participants. Different clinical scenarios were then proposed, with the participants asked to choose whether they would prescribe an antibiotic prophylaxis and with which dosage regimens. In total, 169 dentists participated in the questionnaire and the obtained data were assessed through a percentage report. The results showed a substantial agreement in antibiotics prescription, but only in a limited number of clinical scenarios, such as deciduous teeth extraction or simple extractions in healthy adult patients. Discordant responses were found for several clinical cases, particularly for cases of comorbidities, surgical or multiple extractions, implant placement and abscess drainage. The answers obtained from the survey sample were notably heterogeneous, indicating that the choice to prescribe an antibiotic prophylaxis to prevent SSIs is often discretionary. Moreover, the dosage regimen of prophylaxis is also controversial. The results of this study demonstrate the need for specific guidelines on antibiotics in dentistry and, specifically, on antibiotic prophylaxis in oral surgery. Such guidelines would help to avoid unnecessary prescriptions.

Management of Medication-Related Osteonecrosis of the Jaw (MRONJ) Using Leukocyte- and Platelet-Rich Fibrin (L-PRF) and Photobiomodulation: A Retrospective Study

Background. The aim of this study was to compare retrospectively the effect of three different treatment protocols on the healing outcome in patients with established medication-related osteonecrosis of the jaw (MRONJ). Methods. A total of 34 MRONJ patients were recruited from the Department database and were divided according to the treatment protocols in a study group (G1) and two control groups (G2 and G3). G1 was treated with antibiotic therapy, surgery, leukocyte- and platelet-rich fibrin (L-PRF), and photobiomodulation; G2 was treated with antibiotic therapy and surgery; G3 was treated with antibiotic therapy and photobiomodulation. Various clinical variables and treatment protocols were analyzed to determine their correlation with the healing outcome at three and six months of follow-up. Results. There was a significant association between the different treatment protocols and the outcomes at both three and six months follow-up (p = 0.001 and p = 0.002, respectively). No significant association was observed between the outcomes and MRONJ localization, MRONJ stage, duration of drug treatment, gender, diabetes, corticosteroid therapy, smoking habits, underlying disease, and history of chemotherapy at both three and six months follow-up. Conclusions. Our results show that the combination of antibiotic therapy, surgery, L-PRF, and photobiomodulation may effectively contribute to MRONJ management.

The Prevention of Implant Surface Alterations in the Treatment of Peri-Implantitis: Comparison of Three Different Mechanical and Physical Treatments

The surgical treatment of peri-implantitis is currently based on the removal of biofilms from the implant surface by primary means of mechanical and physical treatments. However, such approaches often determine some alterations of the implant surface with detrimental effects on re-osseointegration. This study aims to evaluate the effects of four different mechanical and physical treatments on titanium samples with moderately rough surface. Air powder abrasion (AP) with glycine powder, a titanium brush (TB) and a diode laser at 3 W (L3) and 4 W (L4) were tested. Surface morphology, roughness and chemical composition were then assessed by scanning electron microscope (SEM), white light interferometer and X-ray photoelectron spectroscopy (XPS), respectively. The microscopic analysis revealed significant alterations in surface morphology on TB samples, while AP and L3 had only a minor or null impact. L4 samples revealed signs of overheating due to the excessive power. Nevertheless, the overall roughness of the samples was not significantly altered in terms of roughness parameters. Similarly, surface chemical composition was not significantly affected by the treatments. Among the treatments tested in this study, air powder abrasion with glycine powder and 3 W diode laser had the lowest impact on surface physicochemical properties.

Microbiological and FE-SEM Assessment of d-PTFE Membrane Exposed to Oral Environment after Alveolar Socket Preservation Managed with Granular nc-HA

AIM

The aim of this study was to analyze, by the aid of microbiological analysis and the field emission scanning electron microscopical (FE-SEM) analysis, the role of high-density polytetrafluoroethylene (d-PTFE) membranes in avoiding the microbial colonization of a nanocrystalline hydroxyapatite (nc-HA) bone graft and the involvement of this colonization in the healing process.

MATERIALS AND METHODS

Six patients underwent extraction of unrecoverable teeth, and a socket preservation technique was carried out with nc-HA synthetic bone graft and then covered with a d-PTFE membrane. After 28 days from surgery, FE-SEM analysis and BioTimer assay technique to assess the microbiological count of streptococci species were carried out. Data were collected and analyzed by the Student's t test (confidence interval: 95%).

RESULTS

The mean amount of bacteria measured on the upper side of the membrane was 6.52 ± 0.50 CFU, while on the lower side, it was 6.59 ± 0.40 CFU. Significant differences were not found between the two sides of the membrane or between the different sectors (p > 0.05). The FE-SEM analysis revealed structured biofilms on both sides of the membrane: species of cocci, bacilli, and fusobacteria were recognizable in occasional settled vegetations.

CONCLUSION

Since the amount of bacteria found was low, the improved impermeability of the d-PTFE membrane permitted the healing process to proceed uneventful and without signs of infection or inflammation.

CLINICAL RELEVANCE

The infection of the graft site could lead to a failure of the socket preservation technique which could delay or compromise the rehabilitation following procedures. The use of d-PTFE can improve the bone regeneration thanks to its antimicrobial properties.

Reosseointegration after the surgical treatment of induced peri-implantitis: systematic review on current evidence and translation from the animal to the human model

INTRODUCTION

The aim of this study was to review the histologic evidence of reosseointegration and related influencing factors in experimental induced peri-implantitis.

EVIDENCE ACQUISITION

An electronic search was performed on Medline for animal studies that included a histometric evaluation of the amount of regenerated bone in contact with an implant surface. Questions raised in the study focused on the role of implant surfaces, bone regeneration and decontamination treatments in achieving reosseointegration. A detailed electronic search was then conducted on MEDLINE (PubMed) up to July 2017.

EVIDENCE SYNTHESIS

One hundred and one articles were selected as abstract, thirty-seven articles assessed as full-text and sixteen finally included in the study. Reported measurements of reosseointegration varied significantly in the study, from 0 to 3.37 mm. There is histological evidence that reosseointegration can occur after treatment of ligature-induced peri-implantitis. However regenerated bone in contact with bone is generally restricted to the most apical portion of the peri-implant defect.

CONCLUSIONS

Animal studies of induced peri-implantitis seem to indicate that rough surfaces can enhance reosseointegration as compared to smooth surfaces. With regard to bone regeneration techniques and materials, submerged healing and barrier membranes have shown a positive effect on reosseointegration. No evidence exists, however, about the specific role of different bone substitutes and their ability to improve bone formation. Growth factors have been shown to improve reosseointegration in animal models, though additional study is required to confirm the data. Several decontamination treatments have been shown to promote reosseointegration compared to control; however no specific procedure has proven superior to others in achieving reosseointegration.

Immediate or delayed retrieval of the displaced third molar: A review

Background

The displacement of a third molar is a rare occurrence, but it could lead to serious and/or life threatening complication. Aim of this review is to understand the most correlated causes of displacement and the possible solutions proposed in literature to avoid and solve this complication for maxillary and mandibular third molars at the appropriate time.

Material and Methods

A search for “third molar displacement” was performed by using Pubmed database. Articles referred to soft tissues displacement, from 1957 to 2018, were included in the review. The references lists of all eligible articles were examined and additional studies were added to the review only if indexed on Pubmed. All the articles on maxillary sinus displacement and the dislocation of dental fragments or surgical equipment were excluded.

Results

From a total of 134 results, 68 articles were examined for satisfying inclusion criteria. 18 articles were excluded because not inherent with the topic; 19 articles on infratemporal space, 11 on sublingual space, 9 on submandibular space, 11 on lateral pharyngeal space displacement were considered congruent for the review and included.

Conclusions

The displacement of the third molar in deeper tissues could be avoided by the use of proper surgical procedures and instrumentarium. If displacement occurs, and the operator could not reach the tooth in safe conditions, the patient should be immediately referred to a maxillo-facial surgeon, because of the possibility of further displacement or the onset of hazardous or potentially fatal infections in vital regions.

Key words:Third molar, wisdom tooth, maxillary, mandibular, displacement.

Physical Profile and Impact of a Calcium-Incorporated Implant Surface on Preosteoblastic Cell Morphologic and Differentiation Parameters: A Comparative Analysis

PURPOSE

To assess and compare topographic features and preosteoblastic cell responses of a new hydrothermally treated, calcium-incorporated surface against other commercially available implant surfaces.

MATERIALS AND METHODS

Four different surfaces were the subject of comparison in this study: machined (MC), resorbable blast media (RBM), sandblasted/large-grit/acid-etched (SLA), and calcium-incorporated SLA (Ca-SLA). Surface morphology and roughness were first characterized by scanning electron microscope (SEM) and white light interferometer, respectively. Preosteoblastic MC3T3-E1 cells were then cultured on the titanium surfaces. Cell morphology was observed at 24 hours, 48 hours, 7 days, and 15 days by SEM; differentiation was assessed at 7, 11, and 15 days by assaying alkaline phosphatase (ALP) activity and osteocalcin (OCN) levels.

RESULTS

Surface characterization revealed nanotopographic features on Ca-SLA. At topographic analysis, SLA and Ca-SLA showed similar roughness values. Significant differences in cell differentiation parameters were found only at 15 days between the SLA surfaces (both Ca-incorporated and nonincorporated) and MC.

CONCLUSION

Collectively, this study demonstrated that hydrothermal treatment determines the formation of nanotopography without altering the SLA microtopography. Moreover, Ca-SLA and SLA induce MC3T3-E1 cell differentiation at comparable levels.

Identification of possible factors influencing temperatures elevation during implant site preparation with piezoelectric technique

BACKGROUND

Overheating during implant site preparation negatively affects the osseointegration process as well the final outcome of implant rehabilitations. Piezoelectric techniques seem to provide to a gentle implant preparation although few scientific reports have investigated the heat generation and its underlying factors.

PURPOSE

To investigate, through a proper methodological approach, the main factors influencing temperature rise during piezoelectric implant site preparation.

MATERIALS AND METHODS

Different piezoelectric tips (IM1s, IM2, P2-3, IM3, Mectron Medical Technology, Carasco, Italy) have been tested. The experimental set-up consisted in a mechanical positioning device equipped with a load cell and a fluoroptic thermometer.

RESULTS

The first tip of the sequence (IM1s) generated the highest temperature increasing (ΔT). The diamond tips (IM1s and P2-3) determined higher ΔT values than the smooth tips (IM2 and IM3). Further tests with IM1s suggested that the temperature elevation during the first thirty seconds may be predictive of the maximal temperature as well as of the overall thermal impact.

CONCLUSIONS

Working load, working movements management and bone features resulted to be the main factors influencing temperature rise during piezoelectric implant site preparation. Irrigant temperature and clogging effect may also synergically contribute to the heat generation.