Histological and Histomorphometrical Analysis on a Loaded Implant With Platform-Switching and Conical Connection: A Case Report.

The association of Morse taper implant-abutment design with the use of a smaller abutment diameter (platform switching) may improve dental implant success rate and prevent peri-implant bone loss. The aim of the present study was to histologically and histomorphometrically evaluate the behavior of peri-implant tissues around an implant with a conical connection associated with platform switching. A platform-switched Morse-cone connection implant was inserted in the left posterior mandible of a 61-year-old patient. The implant was inserted at the level of the alveolar crest. After 11 months from placement and 6 months of loading, the implant was retrieved for psychological reasons and processed for histological evaluation. The retrieved implant was wholly surrounded by bone tissue, except for a small area in the apical portion. At higher magnification, in the coronal portion of the implant, it was possible to observe bone directly at the implant platform level. No resorption of the coronal bone was present, except for 0.2 mm on the vestibular aspect. Crestally, bone remodeling with areas of newly formed bone was detected; the bone-implant contact was 73.9%. Apposition of bone was detected even upon the platform. Peri-implant crestal bone preservation can be achieved with the combination of Morse taper conical internal implant-abutment connection with the use of a smaller abutment diameter (platform-switching).

Effects of Repeated Screw Tightening on Implant Abutment Interfaces in Terms of Bacterial and Yeast Leakage in Vitro: One-Time Abutment Versus the Multiscrewing Technique.

Screw loosening can damage the interfaces of implant components, resulting in susceptibility to contamination of the internal parts by microorganisms. The aim of this study was to investigate the impact of abutment screw retightening on the leakage of two different types of bacteria, Streptococcus sanguinis and Fusobacterium nucleatum, and of the yeast Candida albicans. Two types of implant-abutment systems with tube-in-tube interfaces were tested. Groups A and B each used a different type of system that consisted of 20 different pieces that were assembled according to the manufacturer's torque recommendations; four samples in each group were closed just one time, four samples three times, four samples five times, four samples seven times, and four samples nine times. The implants of groups A and B were contaminated with 0.1 µL of microbial solution just before being assembled for the last time to minimize the possibility of contamination. Results showed a direct correlation between the number of colony-forming units grown in the plates and the closing/opening cycles of the implant-abutment systems. Within the limitations of this study, the results indicate the possibility that repeated closing/opening cycles of the implant-abutment unit may influence bacterial/yeast leakage, most likely as a consequence of decreased precision of the coupling between the abutment and the internal part of the dental implant. These findings suggest that a one-time abutment technique may avoid microbiologic leakage in cases of implant-abutment systems with tube-in-tube interfaces.

Expression of Pattern Recognition Receptors in Epithelial Cells Around Clinically Healthy Implants and Healthy Teeth.

BACKGROUND: Gingival epithelial cells have a pivotal role in the recognition of microorganisms and damage-associated molecular pattern molecules and in the regulation of the immune response. The investigation of the behavior of Toll-like receptors (TLRs) and nucleotide oligomerization domain (NOD) like receptors (NLRs) around a healthy implant may help to address the first step of periimplantitis pathogenesis. PURPOSE: To investigate by quantitative real-time polymerase chain reaction, the mRNA expressions of TLR2, TLR3, TLR4, TLR5, TLR6, TLR9, NOD1, NOD2, and NLRP3 from gingival epithelial cells of the sulcus around healthy implants and around healthy teeth. MATERIALS AND METHODS: Two types of implant-abutment systems with tube-in-tube interface were tested. After 6 months of implant restoration, gingival epithelial cells were obtained from the gingival sulcus around the implants and around the adjacent teeth of 10 patients. RESULTS: Our results did not reach statistical significance among the mRNA expressions of TLR2, TLR3, TLR4, TLR5, TLR6, TLR9, NOD1, NOD2, and NLRP3 in epithelial cells around the implant versus around natural teeth. CONCLUSION: This study shows that the implant-abutment systems tested did not induce an immune response by the surrounding epithelial cells at 6 months since their positioning, as well as in the adjacent clincally healthy teeth.

Microbiological evaluation of bacterial and mycotic seal in implant systems with different implant-abutment interfaces and closing torque values.

OBJECTIVE: The aim of this study was to evaluate the possible leakage of 3 species of bacteria (Streptococcus sanguinis, Fusobacterium nucleatum, and Actinomyces odontolyticus) and of Candida albicans and Candida glabrata in osseointegrated implants with different implant-abutment interface (IAI) geometry. MATERIALS AND METHODS: Two groups of implants, (1) implant-abutment unit with a tube-in-tube interface and (2) implant-abutment unit with a flat-to-flat interface closed with different torque values, were compared in the study. In the first phase, the implants were assembled and cultured in vitro for 7 days. The implants and abutments were disconnected and samples were taken and cultured. In the second phase, the internal part of each implant was inoculated with 0.1 µL of microbial broth and then connected to the respective abutments. Afterward, medium samples were taken and cultured. RESULTS: The group 1 implants were more resistant to colonization than those of group 2 (P < 0.05). The intragroup difference was significant between the implant-abutment units assembled with the recommended torque values and those with lower torque values (P < 0.01) for both the groups. CONCLUSION: IAI geometry influences both bacterial and yeast colonization inside the implants as well as the torque value used to connect abutments to implants.

Cupping-related skin lesions.

In the outpatient department of the National Institute for Health, Migration and Poverty (NIHMP) in Rome, Italy, and at the Italian Dermatological Hospital in Mekele, Ethiopia, from January 1, 2007, to December 31, 2009, 47 patients, adults, and children showing typical circular skin lesions referable to cupping were observed. The patients (32 men and 15 women) underwent complete dermatological examination, and their case histories were collected with the aid of a cultural mediator from the same linguistic or cultural area of the patient. The clinical picture included blue-red, circular erythematous spots, sometimes covered with crusts, consistent with recent cupping (figure 1 and figure 2). In some cases, particularly in older lesions, atrophic-cicatricial lesions and irregular, normal-color, slate gray, or hypochromic skin surface were observed (figure 3). Lesions were observed on the back, on the presternal region (figure 4), and, in case of pathologies causing abdominal swelling (i.e., kwashiorkor, intestinal parasitosis), on the abdomen (figure 5). The clinical pictures initially diagnosed as dermatophytoses or lesions caused by traumas or violence were later proved to be cupping-related outcomes or complications.

Epidemiology of skin disorders in Ethiopian children and adolescents: an analysis of records from the Italian Dermatological Centre, Mekelle, Tigray, Ethiopia, 2005 to 2009.

Skin disorders are an important problem in children living in developing countries, but only a few epidemiologic investigations on pediatric dermatoses are available in the literature. Our study is an analysis of the range and frequency of skin diseases presenting to the Italian Dermatological Center in a pediatric Ethiopian population. A retrospective analysis was performed on 17,967 medical records of children aged 0 to 18 years attending the Italian Dermatological Centre in Mekele (Ethiopia) from January 2005 to December 2009. Infections and infestations accounted for 47% of the disorders seen; fungal infections were the most common (44.1%), followed by bacterial and parasitic diseases. Dermatitis constituted the second most common diagnostic category (24.7%) of the disorders seen, and contact dermatitis was the most common diagnosis (48.8%). Pigmentary disorders and disorders of skin appendages were more common in girls, whereas fungal and parasitic infections were more common in boys. Bacterial and parasitic infections were more common in children younger than 1 year old, fungal infections in those aged 1 to 5.9, and disorders of skin appendages and pigmentary disorders in those aged 15 to 18. These findings demonstrate that most of the disorders seen could be easily managed in clinical practice with appropriate skill development. It is crucial to ensure that training of medical students and pediatricians focuses on accurate recognition, diagnosis, and management of these common skin diseases and that families, teachers, health workers, and nurses be educated about the most common signs of prevalent skin diseases to help facilitate appropriate care.

Erythema nodosum induced by kerion celsi of the scalp in a woman.

A 35-year-old woman, with a 3-week history of an enlarging erythematous, scaly plaque of the scalp vertex associated with the onset of some painful, subcutaneous nodules on her pretibial regions. Trichophyton mentagrophytes was isolated from the scalp lesion and the histological examination of one of the nodular lesions of the legs showed a septal panniculitis. The diagnosis of erythema nodosum (EN) induced by kerion celsi was made and the patient started therapy with oral terbinafine 250 mg per day for 4 weeks associated with naproxene per os 1 g per day for 2 weeks. Erythema nodosum is considered a reaction pattern to a wide variety of microbial and non-microbial stimuli: dermatophytic infections are rarely associated with EN.

Clinical features and treatment of dermatosis papulosa nigra in migrants to Italy.

Dermatosis papulosa nigra (DPN) is a benign epithelial tumor that is common in dark-skinned people. Although the diagnosis is easily made on medical examination, DPN is characterized by a chronic and worsening course. Therefore, even if DPN is a benign disease, the lesions are unaesthetic and the therapeutic options are quite inefficient. A prospective study was carried out during a period of 24 months (January 2006 to December 2007) at the Department for Preventive Medicine for Migration, Tourism and Tropical Dermatology of San Gallicano Dermatological Institute in Rome. Among 58 patients, 41 (71%) were women and 17 (29%) were men. The mean age was 33.5 years (range, 8-45 years). One pediatric patient was observed. This study is the first in Italy that, in recent years, has observed an important growth of the migration. The classic female predominance, family predisposition, and photodistribution of the lesion were found. DPN is frequently associated with patient discomfort, therefore the education of patients to reduce self-treatment is important.

Role of magnified ileoscopy in the diagnosis of cases of coeliac disease with predominant abdominal symptoms.

OBJECTIVE: Less severe histological changes have sometimes been reported in the terminal ileum (TI) of coeliac patients. The aim of this work was to assess whether magnified ileoscopy and the corresponding biopsy could be used when diagnosing coeliac disease (CD). This would be of clinical value in coeliac patients who show predominant abdominal symptoms and who undergo colonoscopy with ileoscopy as first clinical examination. MATERIAL AND METHODS: All patients underwent conventional and magnified ileoscopy, along with histological examination of macroscopic mucosal abnormalities, if present. Patients whose ileoscopy with biopsy suggested CD underwent a blood test for quantitative determination of anti-transglutaminase antibodies and upper gastrointestinal endoscopy with corresponding duodenal biopsy. RESULTS: Out of 143 patients enrolled, 21 had a TI mucosal lesion, and 10 of these showed villous atrophy at ileoscopy only after magnification. Six showed a count of intra-epithelial lymphocytes (IELs) >25/100 enterocytes and upper intestinal lesions, confirming the diagnosis of CD. Finally, of four patients diagnosed with Crohn's disease, TI mucosal aftoid lesions were seen in two only in magnified view. CONCLUSIONS: Magnified ileoscopy reliably recognizes the presence of mucosal villous subtotal or total atrophy at TI. This finding, even if not specific to CD, can address the diagnosis of CD. Magnification in the course of ileoscopy could also be useful in the diagnosis of Crohn's disease.

A 10-residue peptide from durum wheat promotes a shift from a Th1-type response toward a Th2-type response in celiac disease.

BACKGROUND: Celiac disease (CD) is a Th1-driven autoimmune permanent enteropathy that is triggered by dietary gluten. Molecules able to shift the immune response from a Th1- to a Th2-type response have been suggested as therapeutic agents for Th1 autoimmune diseases. OBJECTIVE: We sought to investigate the possibility that a decapeptide from durum wheat (p10mer, QQPQDAVQPF), which was previously shown to prevent the activation of celiac peripheral lymphocytes, may promote a shift from a Th1- to a Th2-type immune response in gluten-specific intestinal T cells of CD patients. DESIGN: Intestinal T lymphocyte lines derived from 8 children with CD were incubated with gliadin peptides both alone and simultaneously with p10mer. Cell proliferation and the production of interferon-gamma and interleukin-10 by these T cells were measured. RESULTS: The incubation of celiac intestinal T cells with deamidated gliadin peptides resulted in a significant (P < 0.008) increase in cell proliferation and interferon-gamma release, whereas the simultaneous exposure to p10mer totally abolished the cell proliferation and cytokine release. Moreover, incubation with p10mer maintained an elevated release of interleukin-10, whereas exposure of the cells to culture medium only did not. The replacement of the residues of aspartic acid in position 5 or those of alanine in position 6 in the sequence of p10mer resulted in peptides with no activity in the activation experiments. CONCLUSION: In vitro, p10mer showed the ability to shift the pathogenic immune response of a CD patient from a Th1- to a Th2-type response.

Avenins from different cultivars of oats elicit response by coeliac peripheral lymphocytes.

OBJECTIVE: The avoidance of oats in coeliac patients is still controversial. If oats is confirmed to be safe, it would be a valuable component and offer more variation in a gluten-free diet. The aim of this work was to evaluate whether avenins from different varieties of oats show different abilities in the activation of coeliac peripheral lymphocytes. MATERIAL AND METHODS: In order to assess whether the immunogenic effect of oats varies according to the cultivar, peripheral lymphocytes from 10 coeliac children were exposed to avenins from four different oats varieties: Lampton, Astra, Ava and Nave. Lymphocyte proliferation and interferon-gamma (IFN-gamma) release in the culture medium were measured as indexes of immune activation. RESULTS: All the varieties of oats tested were immunogenic, with Lampton and Ava avenins inducing lymphocyte activation similar to that activated by wheat gliadin, while Astra and Nave avenins showed less immunogenicity, but still with a measurable effect. CONCLUSIONS: There are still concerns about the suitability of including oats in a gluten-free diet. Coeliac patients consuming oats-containing food should be carefully monitored, until there is more evidence to show the safety of oats and varieties of low-toxicity oats.