Oral microbiota in human health and disease: A perspective

The evolution of medical knowledge about oral microbiota has increased awareness of its important role for the entire human body health. A wide range of microbial species colonizing the oral cavity interact both with each other and with their host through complex pathways. Usually, these interactions lead to a harmonious coexistence (i.e. eubiosis). However, several factors - including diet, poor oral hygiene, tobacco smoking, and certain medications, among others - can disrupt this weak homeostatic balance (i.e. dysbiosis) with potential implications on both oral (i.e. development of caries and periodontal disease) and systemic health. This article is thus aimed at providing an overview on the importance of oral microbiota in mediating several physiological and pathological conditions affecting human health. In this context, strategies based on oral hygiene and diet as well as the role of probiotics supplementation are discussed.

The Effect of Diabetes and Hyperglycemia on Horizontal Guided Bone Regeneration: A Clinical Prospective Analysis

Guided bone regeneration (GBR) is a reconstructive procedure for treating atrophic alveolar ridges. This study aims to assess the correlation between different glycemic control levels and clinical findings in patients undergoing horizontal GBR before implant placement. The study population consisted of all patients requiring horizontal GBR. Patients were divided into three groups based on HbA1c levels: non-diabetic normoglycemic patients (HbA1c < 5.7%), non-diabetic hyperglycaemic patients (HbA1c < 6.5%), and patients with controlled diabetes (HbA1c < 7%). The primary outcomes were the horizontal (mm) and vertical (mm) dimensional changes of the alveolar ridge 6 months after the procedure. The study sample consisted of 54 patients. Sixty-eight implants (95.8%) were classified as "successful," meaning the possibility of inserting a standard-sized implant following the GBR (diameter ≥ 4 mm). There was a statistically significant difference between the three groups in terms of horizontal gain at 6 months: in particular, there was a statistically significant difference between group 1 and group 2 (p = 0.026) and between group 1 and group 3 (p = 0.030). The present investigation showed that patients with HbA1c levels below 7% could undergo GBR and obtain a statistically significant horizontal bone gain.

Odontogenic Sinusitis from Classical Complications and Its Treatment: Our Experience

Odontogenic sinusitis (ODS) refers to the maxillary sinus infection, which is secondary to either adjacent infectious dental pathologies or procedures. The aim of this retrospective study is to report the experiences of the department of integrated therapies in otolaryngology (Campus Bio-Medico Foundation, Rome, Italy) in classifying and treating patients that are affected by odontogenic sinusitis derived from "classic complications". A total of 68 patients responding to the criteria and to the definition as a classical odontogenic complication were included. The surgical therapy consisted of a combined oral and nasal simultaneous approach for 28 patients (43%), a combined non-simultaneous approach for 4 patients (6%), a nasal only approach for 14 patients (21%), and an oral only approach for 20 patients (30%). All the patients presented a complete resolution of the symptoms. The choice of performing a nasal, oral, or combined approach is based on the presence of anatomical elements that facilitate sinusitis and reinfection occurrence, such as deviated nasal septum, concha bullosa, or obstructed osteo-meatal complex. The correct use of validated classification, the pre-operative CT scan, a multidisciplinary approach, and an appropriate presurgical examination are the necessary elements to obtain a good success rate.

Subversion of the Oral Microbiota and Induction of Immune-Mediated Systemic Inflammation with Special Reference to Periodontitis. Current Knowledge and Perspectives

BACKGROUND

Under steady state circumstances, the oral microbiota is in equilibrium with host tissues, thus contributing to local and systemic health. Any interruption of such equilibrium leads to a condition of dysbiosis with proliferation of oral pathogens able to cause gingivitis and periodontal disease. Dysbiosis-related disease: The mechanisms of periodontitis will be described, mostly emphasizing the noxious effects exerted by oral pathogens on the periodontium either directly or indirectly via release of an array of mediators, even including pro-inflammatory cytokines, chemokines, and enzymes. The persistence of local inflammation ultimately leads to a systemic inflammation and, therefore, the link between periodontitis and obesity, diabetes and cardiovascular disease will be elucidated. Treatment with natural products: Some natural compounds, such as polyphenols, prebiotics and probiotics will be discussed for their ability to exert anti-inflammatory and anti-oxidant activities in the context of the inflamed buccal cavity and systemically, as well as for their modulation of the altered gum-gut microbiota.

The Effect of an Optimized Diet as an Adjunct to Non-Surgical Periodontal Therapy in Subjects with Periodontitis: A Prospective Study

Diet and nutrition are generally categorized as modifiable lifestyle risk factors for the development of periodontal disease because diet may influence a person’s inflammatory status. This study aimed to evaluate the efficacy of the application of a diet plan focused on reducing inflammation and oxidative stress in treating periodontitis. Subjects suffering from periodontitis were divided into two groups. Both groups underwent non-surgical periodontal therapy, and in the optimized diet (OD) group, this treatment was associated with a diet plan. The sample consisted of 60 subjects; 32 (53%) were treated in the non-optimized diet group (ND group) and 28 (47%) in the OD group. In both groups, the periodontal treatment significantly improved the recorded periodontal outcomes between T0 and T1 (FMPS, FMBS, CAL, PPD). Inter-group differences were not statistically significant (p < 0.05). The linear regression models showed that the optimized diet was associated with a higher reduction in PPD and FMBS after the treatment, while patients who had higher LDL levels (over 100 mg/mL) had a less favorable improvement of PPD. The application of an improved diet plan can increase the reduction in PPD and FMBS after non-surgical periodontal therapy when compared with periodontal treatment alone.

The Effects of Wearing a Removable-Partial-Denture on the Bite Forces: A Cross-Sectional Study

Background: Removable partial dentures are a frequently used prosthetic treatment in the elderly population, but different types or RPDs might guarantee different chewing capabilities. In many studies, the relationship between chewing and aging has been reported and it has been shown that efficient chewing can improve the overall quality of life. Objectives: In the present study, the relationship between maximum bite force (MBF) and RPDs was studied. A relationship between the body mass index (BMI) and the type of prosthesis was also analyzed. Methods: 240 elderly patients, 120 males and 120 females, with bilateral posterior edentulism (class 1 of Kennedy classification) who had been wearing an RPD for at least a year, were recruited. Patients were divided into two groups: Group 1: male (n = 60) and female (n = 60) patients with bilateral edentulous areas located posterior to the remaining natural teeth and natural teeth in the opposite dental arch. Group 2: male (n = 60) and female (n = 60) patients with maxillary and mandibular bilateral edentulous areas located posterior to the remaining natural teeth. Their Body Mass Index (BMI) and Maximum bite force (MBF) were measured and compared according to the material and design of their RPD. Results: In both Groups, patients wearing cobalt-chrome alloy RPDs (Co-Cr-RPD) (Group 1: 20.25 ± 6.7 MBF, p < 0.001; Group 2: 16.0 ± 5.7 MBF, p < 0.001) had an increased MBF when compared to polymethylmethacrylate RPD (PMMA-RPD) (Group 1: 12.9 ± 3.36 MBF; Group 2: 10.4 + 2.8 MBF), and Valplast RPD (V-RPD) (Group 1: 14.3 ± 4.7 MBF; Group 2: 11.3 ± 3.4 MBF) users. There were no significant differences in bite force between patients wearing PMMA-RPD and V- RPD in both Groups. Patients in Group 2 showed a lower MBF than those in Group 1 (Group 1: 16.05 ± 6.13 MBF; Group 2: 12.6 ± 4.84 MBF; p < 0.001). Conclusions: A reduction in chewing force can lead to choosing softer foods for nutrition, which can lead to an increase in BMI. Our results show that only CoCr-RPD wearers were able to chew consistent food, whereas PMMA- RPD and V-RPD, due to the properties of the materials, their instability, and the possibility of causing pain during mastication, determined a limitation in the choice of food for many of the participants.

Local/Topical Antibiotics for Peri-Implantitis Treatment: A Systematic Review

Most studies indicate that the mechanical removal of the bacterial biofilm from the implant surface is the central goal of peri-implantitis therapy. However, controversial results in the treatment of peri-implantitis have led to the consideration of additional strategies that include surgical approaches and chemical adjuvants. Local/topical antibiotics, such as minocycline, azithromycin, tetracycline, amoxicillin, doxycycline, and metronidazole, may improve the efficacy of the definitive treatment of the disease, but the lack of conclusive findings prevents their use in clinical practice. This systematic review aimed to evaluate the effect of local/topical antibiotics for peri-implantitis treatment. Randomised controlled studies (RCT) on patients with peri-implantitis and comparing the efficacy of local/topical antibiotics vs. placebo or mechanical debridement were included. A systematic search strategy was carried out using three registered databases (PubMed, Web of Science, and Scopus). RoB2 was used to assess risk of bias. Five RCTs were identified (n = 250 patients and 333 implants). Contrast results emerged among the included studies, and a high heterogeneity level was observed. Risk of bias revealed some concerns for three studies out of five, while one study was judged at high risk. Only one study analysed the limitations of its findings. Overall, local antibiotic use can be considered a valid approach in the treatment of peri-implantitis. Therefore, future long-term clinical trials with standardised protocols and antibiotics with similar biological activity profiles should be tested to achieve a valid and definitive conclusion.

The Treatment of Peri-Implant Diseases: A New Approach Using HYBENX® as a Decontaminant for Implant Surface and Oral Tissues

Background: Peri-implantitis is a pathological condition characterized by an inflammatory process involving soft and hard tissues surrounding dental implants. The management of peri-implant disease has several protocols, among which is the chemical method HYBENX^®. The aim of this study is to demonstrate the efficacy of HYBENX^® in the treatment of peri-implantitis and to compare HYBENX^® with other chemical agents used in the surgical treatment of peri-implantitis. Methods: The present study included a population of ten subjects with severe peri-implantitis. The procedure used in the study involves the application of HYBENX^® after open-flap debridement. Each patient has been followed for 12 months after a single application of the decontaminant agent. Clinical and radiographical parameters were recorded at baseline, 3 months, and 12 months after treatment completion. Results: At baseline, a mean pocket probing depth (PPD) of 7.3 ± 0.5 mm and a mean clinical attachment level (CAL) of 8.8 ± 0.8 mm was recorded. An average residual PPD of 4.2 ± 0.5 mm and a mean CAL of 5.2 ± 0.8 mm were observed after 1 year. Additionally, the average of bone gain was about 3.4 mm, with a mean marginal bone level (MBL) change from 5.8 mm (baseline) to 2.4 mm (12 months). In total, 90% of the treated implants reached the success rate after the 1-year follow-up. Only in one case out of ten treated implants was resolution of the disease not achieved. Conclusion: Clinical improvements highlight that the procedure of open-flap debridement (OFD) + HYBENX^® may be considered an effective technique in the treatment of peri-implantitis. From the results obtained, it can be concluded that the use of HYBENX^® in the surgical treatment of peri-implantitis is promising. Overall, this protocol demands further studies to better understand the role and potential benefits of HYBENX^® in the treatment of peri-implantitis.

Microbiological Profiles of Dental Implants in Metabolic Syndrome Patients: A Case-Control Study

There is a lack of knowledge on the possible influence of systemic conditions on peri-implantitis. The aim of this case-control study is to evaluate the difference in terms of oral pathogens' concentrations in the peri-implant sulcus of a group of patients affected by metabolic syndrome (Mets) compared to healthy subjects. For each patient, peri-implant sulcular biofilm samples were obtained by inserting two sterile endodontic paper points in the deepest aspect of the peri-implant sulcus for 30 s. The quantitative real-time polymerase chain reaction was performed to evaluate total bacterial counts of six pathogens. Patients were screened for peri-implant diseases and clinical and radiographic parameters were recorded. A total of 50 patients was enrolled in the study, 25 affected by Mets and 25 healthy. Significantly higher bacterial counts were discovered for Aggregatibacter actinomycetemcomitans (p = 0.0008), Prevotella intermedia (p = 0.0477) and Staphylococcus aureus (p = 0.034) in MetS patients compared to healthy subjects. Performing a sub-group analysis, considering peri-implant status and dividing patients by MetS diagnosis, no statistically significant (p < 0.05) differences were found. For the first time, a correlation between MetS presence and a greater prevalence of some bacterial species in the peri-implant sulcus was reported, irrespectively from peri-implant status (health vs. disease).

Study of cellular toxicity in vitro of two resins for orthodontic use

OBJECTIVE

The objective of this work is to compare cellular toxicity in vitro of two resins for orthodontic use: an auto-polymerizable composite and a photo-polymerizable composite.

MATERIALS AND METHODS

Samples were obtained by joining a couple of steel orthodontic brackets by using auto-polymerizing or photo-polymerizing resin. We used a halogen lamp, a mini LED lamp and a fast LED lamp used for orthodontics cure for 40 seconds. The 3T3 Swiss cellular line of fibroblasts was used. The samples obtained were used to determine the cellular toxicity in vitro using the Neutral Red Up-take (NRU) and the 3-(4,5-dimethylthiazol-2-Yl)-2,5-diphenyltetrazolium bromide (MTT) assay.

RESULTS

Toxicity of the extract appraised at a low level at MTT and NRU assays. There were statistically relevant differences between the toxicity induced by the auto-polymerizing material and the toxicity induced by the photo-polymerizing composite material, polymerized with the blue-light lamp (p < 0.001) and with the mini LED lamp (p < 0.05).

CONCLUSIONS

From the data collected in this study, we can conclude that both resins show a low level of cytotoxicity that, in the case of photochemical polymerizing resin, depends on the characteristics of the lamp.

Clinical comparison of a xenogeneic collagen matrix versus subepithelial autogenous connective tissue graft for augmentation of soft tissue around implants

Dental implant placement is a predictable therapy for replacing teeth. Nevertheless, mechanical, biological, and aesthetic complications frequently occur. The aim of this study was to compare the clinical outcomes of a xenogeneic collagen matrix (XCM) used at the time of implant placement as an alternative to a subepithelial connective tissue graft (SCTG), for soft tissue augmentation. This was a prospective clinical trial with 12 months of follow-up. In the control group, soft tissue augmentation at the time of implant placement was performed with a SCTG, while in the test group, a XCM was employed. At 12 months postoperative, all xenografts showed no postoperative complications. In both groups, a significantly greater thickness was observed on the buccal and occlusal sides from preoperative to 3 months postoperative (P<0.05). No statistically significant difference in pink aesthetic score (P=0.379, 6 months postoperative) or marginal bone loss (P=0.449 at 3 months postoperative, P=0.778 at 6 months postoperative) was observed between the groups. Statistically significant differences in pain perceived by the patients (P<0.0001) and the time to complete the surgical procedure (P=0.0008) were detected. At 12 months after surgery, XCM provided similar clinical results in terms of soft tissue augmentation on the buccal and occlusal sides as compared with the SCTG.

Special features of SARS-CoV-2 in daily practice

The severe acute respiratory syndrome-coronavirus-2 (commonly known as SARS-CoV-2) is a novel coronavirus (designated as 2019-nCoV), which was isolated for the first time after the Chinese health authorities reported a cluster of pneumonia cases in Wuhan, China in December 2019. Optimal management of the Coronavirus Disease-2019 disease is evolving quickly and treatment guidelines, based on scientific evidence and experts' opinions with clinical experience, are constantly being updated. On January 30, 2020, the World Health Organization declared the SARS-CoV-2 outbreak as a "Public Health Emergency of International Concern". The total lack of immune protection brought about a severe spread of the contagion all over the world. For this reason, diagnostic tools, patient management and therapeutic approaches have been tested along the way, in the desperate race to break free from the widespread infection and its fatal respiratory complications. Current medical knowledge and research on severe and critical patients' management and experimental treatments are still evolving, but several protocols on minimizing risk of infection among the general population, patients and healthcare workers have been approved and diffused by International Health Authorities.

Epidemiology of odontogenic sinusitis: an old, underestimated disease, even today. A narrative literature review

Odontogenic sinusitis is an inflammatory condition of the paranasal sinuses resulting from dental pathology. The aim of this study is to provide an overview of the current literature on the dimensions of the phenomenon, quality of life, economic considerations, and approaches to odontogenic sinusitis. A narrative review was conducted following the methodology proposed by Green et al. (2006). There appears to have been an increase in the incidence over the last decade. Nowadays, evidence in the literature reports that 10-12% up to 40% of all sinusitis cases are associated with odontogenic infections. The iatrogenia was by far the leading cause of odontogenic sinusitis (55.97%) while the first and second molars were the most affected teeth with an incidence of 35.6% and 22%. If not properly diagnosed and treated, these infections may lead to a rapid spread, giving rise to potentially life-threatening complications with a significant general health-related Quality of Life detriment. The proper management of patients in a pre-implant logical setting leads to substantial savings, ranging from €38 million to €152 million, for the Italian National Health Service. Odontogenic sinusitis management should involve shared decisionmaking between the otolaryngologist, dental provider, and patient, where the benefits and risks of dental treatment and endoscopic sinus surgery are discussed.

Photodynamic therapy (PDT) in non-surgical treatment of periodontitis

Periodontitis represents a major problem for patients, since it is not possible to eliminate the bacteria that are responsible for this pathology with a pharmacological treatment. The present study included forty-four patients with periodontitis, who had undergone disinfection via photodynamic therapy (PDT) using a laser source having a 635 nm wavelength associated with a photoactivable substance (methylene blue). Clinical assessment of plaque index (PI), bleeding on probing (BOP), probing depth (PD), calculus index (CI), gingival recession (REC) and clinical attachment level (CAL) were recorded at base line, 1 month (4 weeks) after treatment and again 3 months (12 weeks) after treatment, while site radiography (RX) and microbiological test (MT) were recorded at base line and 3 months (12 weeks) after treatment. The outcomes show a good efficacy of the PDT in the elimination of the periodontal pathogenic microflora and in the improvement of the clinical parameters considered: from the base line to the final check after 12 weeks it has been observed a reduction in REC of about 16.9%, a reduction of CAL of about 17.85%, a reduction of the BoP of about 93.3%, a reduction of the PD of about 17%, a reduction of the CI of about 66.3%, a reduction of PI of about 44%, and microbiologically a reduction of the total amount of bacteria with proven parodontopathic properties (red complex bacteria) of about 58.74%. Within the limits of the present study, PDT can be reasonably considered as a good carrier that leads to significant improvements in the parameters (clinical and microbiological) considered.

Evaluation of the periodontal healing of the second mandibular molar distal site following insertion of PRF in the third molar post extraction alveolus

The aim of this study was to evaluate the periodontal healing of the distal sites of the mandibular second molars, comparing the extraction therapy of the third molar with and without PRF adjunct into the postextraction alveolus. The study sample was composed by 40 consecutive patients who underwent extraction of mandibular third molars. Patients were divided in two groups: the last 20 participants who have only been subjected to extraction (spontaneous healing group, SHG) and the first 20 patients who had PRF adjunct (PRF group, PG). Healing was evaluated by analyzing the variations in terms of PPD (Probing Pocket Depth), REC (Recession), CAL (Level of Clinical Attachment), BoP (Bleeding on Probing) and GI (Gingival Index) from Baseline to further follow-ups at 1 month and 3 months. The disto-vestibular (DV) and disto-lingual (DL) PPD values of the second mandibular molar were measured at Baseline and after three months in the two groups. Patients of the PG group showed lower PPD values at 1 month and 3 months postoperatively: DV: 3.6±1.09 - DL: 3.5±1.15 and DV: 2.5±0.83 - DL: 2.6±1.09, respectively. Patients belonging to the SHG also showed lower PPD values, reporting respectively the following DV values after 3 months: 2.7±0.86 - DL: 2.75±0. 85. However, there was no statistically significant difference comparing the results obtained in PG and SHG groups at 1 and 3 months (p>0.05). The insertion of PRF inside the post-extraction alveolus of the mandibular third molar leads to limited improvement in terms of periodontal healing, compared to extraction therapy only.

Antimicrobial efficacy of photodynamic therapy (PDT) in periodontitis and peri-implantitis: A systematic review

To systematically review the literature regarding the antimicrobial effects of photodynamic therapy (PDT) on multi-bacterial species in periodontitis and peri-implantitis disease. The addressed focused question was: "Does PDT show antimicrobial efficacy against multi-bacterial species colonization in periodontal pockets and on the surface of dental implants?" Electronic databases including MEDLINE and EMBASE up to and including December 2018 were searched. Of the ninety studied analyzed, seven were included, four for the study of PDT in peri-implantitis disease and three for periodontal disease. All studies reported the multibacterial species outcomes after the application of antimicrobial PDT. All studies showed a significant reduction in the bacterial load, both in studies based on periodontal and peri-implantary disease, with an average reduction of the total amount of bacterial load of 99.3%. Moreover, the change in clinical parameters is equally important, with an average reduction of PPD of 1.01 mm (from 4.92 to 3.49 ± SD with a percentage reduction of 29%); of BoP of 50%; of RCAL of 1.19 mm (from 9.93 to 8.74, with an average percentage reduction of 12%); of PI of 0.3 (from 1 to 0.7 with a percentage reduction of 30%) and of GI of 1.2 (from 1.8 to 0.6 with a percentage reduction of 66.6%). This review demonstrated significant reduction in the bacterial load in periodontal pocket and dental implant surface with the use of PDT. The results of this review should be considered preliminary and further studies with standardized laser parameters are needed to obtain strong conclusions.

The efficacy of Barbed Sutures for Anterior Pharyngoplasty: technical aspects and preliminary results

After the first experiences with the Barbed Sutures (BS) in sleep surgery, we present the Modular Barbed Anterior Pharyngoplasty (M.B.A.Ph.), a functional tenso-structural reconstruction of the soft palate, as a surgical solution for Obstructive Sleep Apnea (OSA) due to antero-posterior collapse at the drug induced sleep endoscopy (DISE) for snoring and mild-moderate OSA. The action of the BS is sustained over time by means of solid and stable tissue scarring. M.B.A.Ph. avoids palatal fibromuscular resection and minimize iatrogenic bleeding (bloodless surgery). The technique is described in detail and some preliminary results are presented.

The Coronavirus Disease-19 Infection and the Oral Mucosa

BACKGROUND: The current coronavirus disease (COVID-19) pandemics induced a modification of daily life and clinical practice. Health care workers, particularly dentists and dental hygienists, have been obliged to limit their activity and to establish new operative protocols. AIM: We aimed to discuss an easy protocol for the prevention of cross-infections in dental settings. METHODS: We revised literature data about COVID-19 and oral health to establish how to work safely with dental patients. RESULTS AND CONCLUSION: A few papers are currently available about the effective prevention of COVID-19 during dental procedures. Most of the revised articles report a potential strong effectiveness of povidone-iodine and its safety for both patients and dental professionals.

Taste and smell as chemosensory dysfunctions in COVID-19 infection

PURPOSE

To review the literature on the presence of two clinical manifestations in patients presenting COVID-19 (SARS-CoV-2) infection: loss of taste (ageusia) and loss of smell (anosmia).

METHODS

PubMed and EMBASE were searched and studies were selected starting from November, 2019 until April 2020; also, the references of the selected articles were evaluated for methodological quality.

RESULTS

Of the 19 studies analyzed, five were included to evaluate the presence of ageusia and/or anosmia as symptoms in patients who were tested and resulted positive for the SARS-CoV-2 virus. In a total of 10,818 patients, 8,823 presented ageusia (81.6%; range 5.6%-88%) and 8,088 presented anosmia (74.8%; range 5.1-85.6%). Only one study recorded both symptoms with a percentage of 18.6%.

CLINICAL SIGNIFICANCE

This systematic review demonstrated significant presence of ageusia and anosmia in the patients with COVID-19 infection. These symptoms may be considered as the first manifestation of the infection.

The impact of the COVID-19 infection in dentistry

IMPACT STATEMENT

Dentists have always been taught how to protect themselves and their patients from potential blood-borne pathogens, but the Coronavirus pandemic has brought a new unprecedented challenge to the world of dentistry; we therefore reviewed the literature to provide suggestions on how to accordingly change dental practice prevention.

The Use of a Non-Absorbable Membrane as an Occlusive Barrier for Alveolar Ridge Preservation: A One Year Follow-Up Prospective Cohort Study

：The aims of this study were to obtain preliminary data and test the clinical efficacy of a novel nonporous dense-polytetrafluoroethylene (d-PTFE) membrane (permamem®, botiss) in alveolar ridge preservation (ARP) procedures with a flapless approach. A traumatic extraction was performed in the premolar maxillary area, and a d-PTFE membrane was used to seal the alveolar cavity: no biomaterial was used to graft the socket and the membrane was left intentionally exposed and stabilized with sutures. The membrane was removed after four weeks and dental implants were placed four months after the procedure. The primary outcome variables were defined as the dimensional changes in the ridge width and height after four months. A total of 15 patients were enrolled in this study. The mean width of the alveolar cavity was 8.9 ± 1.1 mm immediately after tooth extraction, while four months later a mean reduction of 1.75 mm was experienced. A mean vertical reduction of 0.9 ± 0.42 mm on the buccal aspect and 0.6 ± 0.23 mm on the palatal aspect were recorded at implant placement. Within the limitations of this study, the d-PTFE membrane proved to be effective in alveolar ridge preservation, with the outcomes of the regeneration not affected by the complete exposure of this biomaterial.

Poor Oral Health as a Determinant of Malnutrition and Sarcopenia

Aging is accompanied by profound changes in many physiological functions, leading to a decreased ability to cope with stressors. Many changes are subtle, but can negatively affect nutrient intake, leading to overt malnutrition. Poor oral health may affect food selection and nutrient intake, leading to malnutrition and, consequently, to frailty and sarcopenia. On the other hand, it has been highlighted that sarcopenia is a whole-body process also affecting muscles dedicated to chewing and swallowing. Hence, muscle decline of these muscle groups may also have a negative impact on nutrient intake, increasing the risk for malnutrition. The interplay between oral diseases and malnutrition with frailty and sarcopenia may be explained through biological and environmental factors that are linked to the common burden of inflammation and oxidative stress. The presence of oral problems, alone or in combination with sarcopenia, may thus represent the biological substratum of the disabling cascade experienced by many frail individuals. A multimodal and multidisciplinary approach, including personalized dietary counselling and oral health care, may thus be helpful to better manage the complexity of older people. Furthermore, preventive strategies applied throughout the lifetime could help to preserve both oral and muscle function later in life. Here, we provide an overview on the relevance of poor oral health as a determinant of malnutrition and sarcopenia.

Clinical and radiographic assessment of implant-supported rehabilitation of partial and complete edentulism: a 2 to 8 years clinical follow-up

OBJECTIVE

The aim of this study was to find out the rates of survival and success of implant rehabilitation, and the influence of some risk indicators on the medium- and long-term prognosis.

PATIENTS AND METHODS

Of the 102 patients eligible for this study rehabilitated with dental implants during the years 2009-2015, 75 patients with 156 implants of different implant systems placed and loaded by the same team were recalled. For each subject, pocket-probing depth, bleeding on probing, plaque buildup, mobility of the fixtures, and the presence/absence of prosthetic complications were recorded. Radiographic evaluation was based on the analysis of bone levels around the fixtures, as shown by intraoral radiographs.

RESULTS

The average follow-up was 4.4 years, ranging from 1.5 to 7.8 years. One hundred and fifty-four of the implants survived, while two implants failed; 98.8% of the prostheses survived, while 75.9% were successful. Success was achieved in 90.4% of implants and in 80% of patients. The sample showed average radiographic bone resorption of 1.09 mm. The average pocket probing depth was 2.79 mm. Bleeding on probing was found in 18% of all sites, and 59.6% of implants showed bleeding on probing in at least one site. Mucositis was found in 90% of patients, and peri-implantitis was found in 16% of patients.

CONCLUSIONS

The rates of success and survival showed the reliability of implant therapy. Plaque accumulation, smoking and upper jaw location, seem to increase the risk of failure of implant-supported rehabilitation.

Oral management of adult patients undergoing hematopoietic stem cell transplantation

Chemotherapy and hematopoietic stem cell transplantation (HSCT) are the current treatments for patients with hematological diseases; they result in myelosuppression, and increase the susceptibility of patients to severe infections. The oral cavity is a potential site of complications in HSCT patients, because it is the entrance for agents that can cause systemic infections; it is one of the most frequent locations for side effects deriving from conditioning therapy. The importance of dental pre-chemotherapy and transplant prescription is often stressed, since both therapies depress the immune system and platelets, making each intervention at this stage a high risk. The aim of this article is to review the potential complications of HSCT, and to extrapolate from the scientific literature the treatments and timeframes in which dental therapies can be performed, avoiding important risks for patients.

Monolithic CAD-CAM lithium disilicate versus monolithic CAD-CAM zirconia for single implant-supported posterior crowns using a digital workflow: A 3-year cross-sectional retrospective study

STATEMENT OF PROBLEM

Dentistry has evolved significantly with the introduction of digital technologies and materials; however, clinical evidence for the performance of the complete digital workflow for single implant-supported posterior crowns is lacking.

PURPOSE

The purpose of this cross-sectional retrospective clinical study was to compare the clinical outcomes of 2 types of implant-supported crown used to replace a single missing posterior tooth in a completely digital workflow: transocclusal screw-retained monolithic lithium disilicate crowns versus transocclusal screw-retained monolithic zirconia crowns.

MATERIAL AND METHODS

A total of 38 participants who had been provided with dental implants and transocclusal screw-retained monolithic lithium disilicate or zirconia single crowns were evaluated in the study. Clinical and esthetic outcomes were recorded after a 3-year follow-up.

RESULTS

Both groups had comparable clinical outcomes with a survival rate of 100%. In the lithium disilicate group, 89% of the participants were free of technical complications, and 95%, in the zirconia group. Only 1 patient experienced minor chipping affecting a lithium disilicate crown. All complications were considered minor and were easily resolved, and none of the participants required replacement of a crown. No biological complications were recorded in either group.

CONCLUSIONS

Within the limitations of this cross-sectional retrospective clinical study, monolithic lithium disilicate and zirconia screw-retained single crowns fabricated using computer-aided design and computer-aided manufacturing (CAD-CAM) and a fully digital workflow were found to be reliable and suitable clinical options for restoring a posterior missing tooth on a dental implant.

Hard and Soft Tissue Evaluation of Different Socket Preservation Procedures Using Leukocyte and Platelet-Rich Fibrin: A Retrospective Clinical and Volumetric Analysis

PURPOSE

The extraction of a tooth is followed by hard and soft tissue changes that can compromise implant placement. The aim of the present retrospective study was to compare the clinical and radiographic outcomes of different ridge preservation procedures based on the use of leukocyte and platelet-rich fibrin (L-PRF).

MATERIALS AND METHODS

The study population consisted of all patients who had undergone surgery from January 1, 2017 to January 1, 2018 for alveolar ridge preservation on single posterior teeth using 3 clinical protocols: L-PRF alone, L-PRF mixed with a bone xenograft, and bone xenograft alone. Clinical and radiographic measures were recorded preoperatively and at 6 months postoperatively to determine the horizontal and vertical ridge resorption.

RESULTS

A total of 45 patients were included in the present study. All the surgeries were performed successfully, and no intraoperative complications developed. The L-PRF group experienced significantly greater horizontal and vertical bone resorption. The L-PRF plus bone xenograft group had less vertical and horizontal bone resorption than the bone xenograft alone group. Statistically significant differences in postoperative pain and wound healing were observed, with the bone xenograft alone group, in particular, having higher values for pain and experiencing delayed wound healing.

CONCLUSIONS

Within the limitations of the present retrospective study, the use of a bone xenograft alone or L-PRF combined with a bone xenograft to perform alveolar ridge preservation procedures significantly limited bone resorption.

Influence of mandibular third molar surgical extraction on the periodontal status of adjacent second molars

BACKGROUND

The periodontal health distal of second molars (M2) is often compromised because of third molar (M3) impactions. The aim of this study was to evaluate healing and periodontal status of mandibular M2 after M3 surgical extraction.

METHODS

Eighty-nine consecutive patients with 89 asymptomatic M3 who needed surgical extraction of one fully- or semi-impacted M3 entered this study. Clinical measurements, probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and bleeding on probing (BOP), were compared for M2 at baseline (T0) and 6-months (T1) postsurgical extraction. Multiple logistic regression analysis assessed different risk factors for postoperative changes of periodontal parameters.

RESULTS

Six-month M2 PPD improved at disto-vestibular (T0-5.2/T1-3.0 mm) and disto-lingual (T0-5.4/T1-3.2 mm) sites. The average attachment gains at T1 were 1.9 and 2 mm, respectively (P < 0.05). BOP, PI, and GI showed significant clinical improvements after extractions. Fifty-three out of 72 (73.6%) M2 presenting a PPD ≥ 4mm at baseline healed at 6 months recall without periodontal pockets. Older age (mean 55 years, SD 16.7; range 26 to 81) and mean distal PPD at baseline of 7 mm was more likely to be associated with PPD ≥ 4 mm 6 months postextraction (P < 0.05). Past history of periodontitis patients were 41 times more likely to present PPD ≥ 4 mm after healing (OR = 41.4; 95% CI = 10.9 to 156.5, P < 0.05).

CONCLUSION

Mandibular M3 extractions seem to improve overall periodontal health distal of M2. History of periodontitis, preoperative deep pockets and older age are independent risk factors for poorer healing and residual pockets after M3 surgical extraction.

Management of Single Uncomplicated Dental Extractions and Postoperative Bleeding Evaluation in Patients With Factor V Deficiency: A Local Antihemorrhagic Approach

PURPOSE

The aim of the present study was to analyze the management of single dental extractions and postoperative bleeding in patients with a diagnosis of factor V deficiency. A careful evaluation of each case will allow the team to categorize the risk and operate safely, minimizing the incidence of intraoperative and postoperative complications. If necessary, the oral-maxillofacial surgeon can choose to do so in collaboration with the hematologist on a case-by-case basis.

PATIENTS AND METHODS

The present retrospective study included 5 patients with mild congenital factor V deficiency who had undergone at least 1 dental extraction. Mouth rinse with tranexamic acid, nonresorbable sutures, and gelatin sponge packed in the alveolar socket were used to obtain hemostasis. No systemic therapies, such as fresh frozen plasma, platelet concentrate, or recombinant activated factor VII, were administered.

RESULTS

Twenty-five teeth were extracted. The factor V plasma levels ranged from 14.1 to 22.4%. Local antihemorrhagic treatments resulted in good hemostasis. No hemorrhagic complications or intraoperative or postoperative major bleeding was observed.

CONCLUSIONS

Dental extractions appear to be safe procedures for patients with mild factor V deficiency when a bleeding risk assessment has been performed in conjunction with a hematologist and an appropriate treatment protocol is followed. Our treatment protocol was found to be effective and well tolerated by all the patients.

Alveolar ridge augmentation with maxillary sinus elevation and split crest: Comparison of 2 surgical procedures

The purpose of this study was to evaluate the clinical and radiological outcomes of 2 piezosurgical split techniques performed in conjunction with the sinus lift.The present retrospective study included 20 patients with edentulism of the posterior maxilla who had undergone the sinus lift and alveolar ridge split treatment separately or the sinus lift combined with the monoblock alveolar ridge split. Differences between these 2 techniques were analyzed.All the surrounding areas successfully produced an adequate bone volume for the insertion of implants. A clinical evaluation showed a mean vertical augmentation of 3.6 ± 0.4 mm in Group A and 3.2 ± 0.7 mm in Group B. With regards to the lateral augmentation, the clinical evaluation gives a mean gain of 5.2 ± 0.3 mm in Group A and 4.9 ± 0.5 mm in Group B. The mean vertical and horizontal bone augmentation recorded for both types of surgical procedures were comparable.The proposed surgical procedures enabled the tridimensional volume of the alveolar ridge to be recreated. This resulted in the creation of a natural contour of hard and soft tissues which enabled a functional and aesthetic rehabilitation of the edentulous posterior maxilla to be obtained.

Orofacial signs and dental abnormalities in patients with Mulvihill-Smith syndrome: A literature review on this rare progeroid pathology

BACKGROUND

Mulvihill-Smith syndrome is a rare sporadic condition that was first recognized in 1975. A total of 11 cases have been described in the literature. The aim of this study was to describe the orofacial signs and dental anomalies, their frequency, and the relationship between Mulvihill-Smith syndrome and other progeroid syndromes via a review of the literature.

METHODS

A systematic PubMed search was performed to retrieve articles published between 1975 and the present day that described patients affected by Mulvihill-Smith syndrome. The search identified 14 articles, and data on 11 patients were extracted from the selected articles.

RESULTS

A total of 7 patients (63.6%) affected by Mulvihill-Smith syndrome were described as having a typical "bird" face. Dental abnormalities, including irregular shape, enamel defects, hypodontia, and taurodontism, were described in 6 patients (54.5%). All patients (100%) had multiple pigmented nevi on the face and a lack or thinning of subcutaneous tissue around the neck and face. Three patients with Mulvihill-Smith syndrome exhibited early onset of tumors of the gastrointestinal tract, including the tongue.

CONCLUSION

Mulvihill-Smith syndrome is a clinically complex disease that may be caused by a single gene mutation. Numerous different tissues of the body are affected. This analysis of the orofacial signs may help clinicians to diagnose this rare pathology.

Management of Surgical Third Lower Molar Extraction and Postoperative Progress in Patients With Factor VII Deficiency: A Clinical Protocol and Focus on This Rare Pathologic Entity

PURPOSE

The purpose of the present study was to analyze the management of surgical third molar extraction and postoperative progress in patients with a diagnosis of factor VII deficiency. Close collaboration between the oral-maxillofacial surgeon and hematologist will allow the team to categorize the risk and operate safely, thereby minimizing the incidence and severity of intraoperative and postoperative complications.

MATERIALS AND METHODS

The present retrospective study included 7 patients with factor VII deficiency who had undergone third lower molar surgery. Their factor VII deficiency ranged from 10.5 to 21.0%. Recombinant activated factor VII (rFVIIa) (coagulation factor VIIa [recombinant]; NovoSeven RT; Novo Nordisk, Bagsvaerd, Denmark) was transfused intravenously in a single dose of 25 μg/kg body weight, 30 minutes before surgical extractions. After the surgery, betamethasone, an analgesic, and an ice pack were administered.

RESULTS

Pretreatment with recombinant activated factor VII resulted in excellent hemostasis. No hemorrhagic complications and no postoperative major bleeding were observed.

CONCLUSIONS

The extraction of the third lower molar appears to be a safe procedure for patients with factor VII deficiency when appropriate prophylaxis with rFVIIa is used.