The Use of TADs in the Mandibular Arch to Prevent Proclination of the Lower Incisors during the Use of the Mini Scope Herbst Appliance.

Class II malocclusions are the most frequent within the Italian population. Normally, these malocclusions are caused by a reduction in a mandibular component whose functional stimulus is still very much cause for debate. The negative effect of all types of Class II functional appliances is in the proclination of the lower incisors, which, in subjects whose incisors are already labially inclined, must be checked at all times to avoid serious consequences to these elements. In this case study, a girl aged 14 years and 5 months presented with Class II malocclusion, 2nd division with a convex profile and a visibly retruded chin. The lower incisors presented a marked proclination (-1/Go-Gn ini = 107.7°) in a brachyfacial patient. To avoid further inclination of the lower incisors a Herbst appliance was mounted in two separate sittings. The first part of the appliance including the tubes was mounted to the upper jaw allowing the vestibularisation of the upper incisors in order to increase the overjet. Once this was obtained the lower part of the appliance was mounted together with the telescopic arms associated with two temporary anchorage devices (TADs) in positions 36-37 and 46-47, and an anterior section 33-43 with distal loop to which two double metallic ligatures were anchored at the TADs to contrast the negative effect of the appliance. At the end of the first functional phase, the treatment was refined using MBK fixed therapy to finish the case. The orthodontic therapy led to a visible improvement of the profile and the achievement of a first-class dental-skeletal result on both sides. From the cephalometric evaluation carried out immediately after the Herbst appliance treatment at time T1 and at the end of the orthodontic therapy T2 it was possible to verify a slight increase in the inclination of the lower incisors (-1/Go-Gn fin = 108°). In conclusion, it can be said that the use of the skeletal anchorage avoided, in this case, the proclination effect in the lower incisors due to the use of a Herbst appliance.

Severe, Treatment-Refractory Periodontitis and Vitamin D Deficiency: A Multidisciplinary Case Report.

Introduction: Vitamin D deficiency and periodontitis are common diseases among people. These conditions interact with each other and worsen the patient's health. Modern dentistry aims to rehabilitate oral health and bring it back to the original state or even improve aesthetics. Without analysing the general health conditions of patients and without a multidisciplinary approach, it is sometimes not possible to solve a case such as we describe. This study shows how a vitamin D deficit can influence the choice of dental treatment. The patient, a 40-year-old woman, in generally good health, came to our observation complaining about pain during mastication, and profuse bleeding during home hygiene maneuvers. She wished to solve this situation. Materials and Methods: Since the patient did not respond well to the initial periodontal therapy, we carried out some accurate research concerning the patient's previous clinical history, and as we suspected that a vitamin D deficit might be involved, a chemical test for vitamin D was carried out and the results confirmed our suspicions. The team programmed the following therapeutical plan: Phase 1-rehabilitation of normal values of vitamin D with the support of an endocrinologist; Phase 2-full mouth disinfection; Phase 3-periodontal surgical restorative therapy; and Phase 4-orthodontic therapy and fixed prosthetics rehabilitation. Results: The results for this clinical case were extremely satisfying; we were able to bring the periodontal illness under control; resolve the orthodontic problems; and rehabilitate the patient both functionally and aesthetically. Conclusion: Thanks to the collaboration and communication between specialists from different sectors of medicine and dentistry, the clinical case was solved with absolutely satisfactory results.

10-Year Evaluation of the First Root Analogue Implant on Humans, Made Using a CT Scan, CAD/CAM and DMLS.

Ten years ago, for the first time in humans, thanks to the DLMS (direct metal laser sintering) technique, we designed, built and inserted an immediate post-extraction custom-made root-analogue implant in Ti-6Al-4v with platform switching. The implant was inserted into the post-extraction socket, respecting the biological width. After 10 years, we wanted to evaluate the dimensional stability of the implant and the eventual crestal bone resorption. The evaluation was performed clinically with periodontal parameters and radiographically by means of an intraoral X-ray with the parallel technique measuring the distance between the base of the bone crest and the implant shoulder. It appears that the implant has maintained dimensional stability of the peri-implant soft tissues, and the crestal resorption is 0 mm. This could represent a step forward to make this experimental method a valid alternative to the current immediate post-extraction implant procedures in use.

A Simplified Digital Approach to the Treatment of a Postpuberty Patient with a Class III Malocclusion and Bilateral Crossbite.

Monolateral and bilateral crossbites are amongst the most frequent forms of malocclusion in the world population. The lack of early correction of this type of malocclusion leads to the partial or total ossification of the sutures which then require surgical treatment in adult patients. In recent years, devices on minipalatal screws have noticeably increased the time window in which it is possible to correct these types of alterations. In this case report, we show how it is possible to correct a third-class skeletal malocclusion associated with a posterior bilateral crossbite in a young woman using a rapid expander on miniscrews and fixed orthodontic device to finalise the process. The procedure for the insertion of the palatal screws was aided by the use of a digitally printed surgical guide, and the appliance was applied in the same sitting thanks to the use of a digital flow software and a systematic easy driver. The CBCT scans show how the orthopaedic expansion of the upper maxilla was obtained without any important alterations that damaged the permanent teeth. This case report wishes to demonstrate how easy and predictable it can be to resolve cases of this type with optimal aesthetic and functional results even when body growth has ended.

Can Orthodontic Treatment Be Stable 20 Years after the End of the Treatment Scheme? Treatment of a Class 2, Division 1 Malocclusion with Severe Skeletal Discrepancy and Its 20-Year Follow-Up.

Class II malocclusions, after class I malocclusions, are the most frequent in the juvenile Italian population. They are most often skeletal in origin and due to mandibular retrusion. Functional devices seem to have a beneficial effect on the growth of the jaw. Long-term maintenance of the achieved results is essential for therapeutic success in any orthodontic treatment; moreover, the retention phase should last as long as possible, especially in the lower anterior sector. A female patient aged 10 years and 3 months presented a visibly convex profile and a severe mandibular retrusion. The anamnesis brought to light the habit of oral breathing and lower-lip sucking. The cephalometric analysis showed a normodivergent skeletal class II. The first treatment phase involved the use of a Bass type for 12 months at the end of the functional treatment; the second phase of fixed therapy was carried out following the principles of bioprogressive techniques. The photos at the end of treatment show an important improvement in the profile; a full class I ratio of molar and canine teeth was achieved with an excellent interarch relationship and a correction of the V-shaped upper arch. The result is occlusally and profilometrically stable after 2, 4, 5, 10, 14, and 20 years. The maintenance of a stable orthodontic result over time is the result not only of a correct and physiological occlusion but also and above all of a correct diagnosis and correct identification of problems that can cause the malocclusion itself. Flawed habits such as interposition of the lower lip and oral breathing must be intercepted and corrected early in order to correct them and not affect the long-term result of orthodontic treatment. In this case, a functional device associated with an orthodontic fixed finishing and a correct retention phase were necessary to correctly treat a second-class mandibular retrusion whose result remained stable 20 years after the end of therapy.

Change of Outpatient Oral Surgery during the COVID-19 Pandemic: Experience of an Italian Center.

COVID-19, which appeared to originate in China in December 2019, has spread worldwide in a pandemic way. The aim of this work is to present a protocol to standardize the outpatient oral surgery activities through remote triage, diagnostic tests, protections, and precautions that allow to provide care while minimizing risk for both patients and surgeons. This article summarizes the clinical and surgical experience of the Oral Surgery Unit of the "Mater Domini" Hospital (Magna Graecia University of Catanzaro, Italy) during the COVID-19 pandemic. The application of a scrupulous triage protocol, the use of remote consultations to limit patients' access to the clinic, and the correct use of PPE prevented transmission of the virus between patients and staff members.

Primary Stability of Three Different Osteotomy Techniques in Medullary Bone: An in Vitro Study.

BACKGROUND: The aim of this in vitro study was to analyse the primary stability of 20 implants placed with Twist drills (TD) versus 20 implants placed with Summers osteotomes (SO) and 20 implants placed with B&B bone compactors (BC) in medullary bone (quality type III and type IV). METHODS: The implants were placed in 10 fresh pig ribs fixed on a bench vice in order to avoid micro-movements during surgical procedures and measure recording. Peak insertion torque (PIT) and Peak removal torque (PRT) were recorded with MGT-12 digital torque gauge and ISQ was recorded through OSSTELL ISQ™ device by an independent operator. RESULTS: Comparing our data (Tukey test p = 0.05), it was evidenced a statistically significant difference in the PIT between TD and BC groups (p = 0.01). Analysing ISQ data, there was a statistically significant difference between the TD and BC groups (p = 0.0001) and between the SO and BC groups (p = 0.014). The analysis of PRT evidenced a statistically significant difference between the TD and BC groups (p = 0.038). CONCLUSIONS: This study evidenced that bone compactor preparation can positively influence primary implant stability (PS), however further in vivo studies and a larger sample are necessary to assess the usefulness in several clinical settings.

The Replanting of a 1.1 from an Ectopic Position during the Course of Orthodontic Therapy: Follow-Up at 8 Years.

The case that is reported here describes the replanting of a 1.1 from an ectopic position during orthodontic therapy. The 9-year-old patient suffered from class 2 type malocclusion with the upper maxilla contracted, right-left posterior cross-bite. The clinical case presented the following details: in the upper incisor group, the 1.1 was overlapping the 1.2 and was distalised and completely vestibularised, whilst in the place of the 1.1, a 1.1 supernumerary persisted in occlusion. Following several medical investigations, such as OPT and, most importantly, TC cone beam investigation, the dangerous position of the dental element became clear. This did not present vestibular cortical bone but only gingival mucosa. Following these investigations, the difficulty in bringing the dental element into its natural position through orthodontic treatment became obvious since the natural position was without sufficient bone support. From this, it became obvious that surgery and replanting of the 1.1 immediately after the extraction of the supernumerary 1.1 was the only choice available.

A direct metal laser sintering (DMLS) root analogue implant placed in the anterior maxilla. Case report.

BACKGROUND: Modern cone beam computed tomography (CBCT) acquisition and three-dimensional (3D) image processing, combined with direct metal laser sintering (DMLS), allows custom-made, root-analogue implants (RAIs). PURPOSE: To demonstrate how DMLS permits customized titanium RAI production, with immediate insertion and restoration in a fresh extraction socket of the anterior maxilla. MATERIALS AND METHODS: A titanium RAI perfect copy of the radicular unit needed for replacement was created by customized DMLS, and inserted into a fresh extraction socket of the esthetic area of the anterior maxilla. RESULTS: Follow-up after 1 year: the DMLS RAI implant showed a satisfactory functional and esthetic integration, with no bone resorption or soft tissue recessions. CONCLUSIONS: The production of customized DMLS RAIs opens new interesting perspectives for immediate implantation. KEY WORDS: Direct metal laser sintering, Root analogue implant.

Antisense Oligonucleotide: Basic Concepts and Therapeutic Application in Inflammatory Bowel Disease.

Several molecular technologies aimed at regulating gene expression that have been recently developed as a strategy to combat inflammatory and neoplastic diseases. Among these, antisense technology is a specific, rapid, and potentially high-throughput approach for inhibiting gene expression through recognition of cellular RNAs. Advances in the understanding of the molecular mechanisms that drive tissue damage in different inflammatory diseases, including Crohn's disease (CD) and ulcerative colitis (UC), the two major inflammatory bowel diseases (IBDs) in humans, have facilitated the identification of novel druggable targets and offered interesting therapeutic perspectives for the treatment of patients. This short review provides a comprehensive understanding of the basic concepts underlying the mechanism of action of the oligonucleotide therapeutics, and summarizes the available pre-clinical and clinical data for oligonucleotide-based therapy in IBD.

Neutrophil Extracellular Traps Sustain Inflammatory Signals in Ulcerative Colitis.

BACKGROUND AND AIMS: In ulcerative colitis [UC], mucosal damage occurs in areas that are infiltrated with neutrophils. The antimicrobial function of neutrophils relies in part on the formation of extracellular web-like structures, named neutrophil extracellular traps [NETs]. The formation and/or clearance of aberrant NETs have been associated with several immune diseases. Here we investigated the role of NETs in UC-related inflammation. METHODS: The expression of NET-associated proteins was evaluated in colonic biopsies of patients with Crohn's disease [CD], UC and in normal controls [NC] by Western blotting, immunofluorescence and immunohistochemistry. Colonic biopsies of UC patients were analysed before and after anti-tumour necrosis factor α [anti-TNF-α] treatment. The capacity of neutrophils to produce NETs upon activation was tested in vitro. UC lamina propria mononuclear cells [LPMCs] were cultured with NETs in the presence or absence of an extracellular signal-regulated kinase-1/2 [ERK1/2] inhibitor and inflammatory cytokine induction was assessed by real-time polymerase chain reaction and enzyme-linked immunosorbent assay. We also characterized the contribution of NETs in dextran sodium sulfate [DSS]-induced colitis. RESULTS: NET-associated proteins were over-expressed in inflamed colon of UC patients as compared to CD patients and NC. Circulating neutrophils of UC patients produced NETs in response to TNF-α stimulation, and reduced expression of NET-related proteins and diminished NET formation were seen in patients receiving successful treatment with anti-TNF-α. Treatment of UC LPMCs with NETs activated ERK1/2, thus enhancing TNF-α and interleukin-1ß [IL-1ß] production. NETs were induced in mice with DSS-colitis and in vivo inhibition of NET release attenuated colitis. CONCLUSIONS: Our data show that NET release occurs in UC and suggest a role for NETs in sustaining mucosal inflammation in this disorder.

Minimally invasive surgical management of impacted maxillary canines.

AIM: Combined surgical-orthodontic treatment of impacted maxillary canines has developed significantly in the last few years, regarding management of both hard and soft tissues and forces of traction. The aim of this report is to describe a combined surgical-orthodontic approach used to treat an impacted maxillary canine and to value the functional and esthetic results after 5 years of followup. MATERIALS AND METHODS: A 13-year-old boy had been seen by surgeons in the Operative Unit of Orthodontics of Policlinico Tor Vergata in Rome. Radiographic images showed intraosseous impaction of teeth 1.3 and 2.3 in a late mixed dentition, and the patient was scheduled for the combined surgical-orthodontic treatment. RESULTS: After the five-year follow-up, the patient had a good occlusal stability. The maxillary canine that had been orthodontically repositioned showed an adequate width of attached gingiva, which was well keratinized, and the margin of free gingiva that followed the course of the cement-enamel junction. Bleeding was absent on probing, the periodontal pocket depth was < 4 mm, and there was no radiographically evident bone loss. CONCLUSIONS: The combined surgical-orthodontic technique used in this case (closed eruption towards the center of the alveolar ridge associated with conservative periodontal surgery, the adhesive technique, and controlled orthodontic traction) simulates physiological tooth eruption and results in proper alignment with good periodontal results. It should be considered as the treatment of choice for impacted teeth whose eruption is not precluded by the position of the tooth and/or the presence of ankyloses. KEY WORDS: Mucoperiosteal flap, Surgical tecnique.

Can Autofluorescence Guide Surgeons in the Treatment of Medication-Related Osteonecrosis of the Jaw? A Prospective Feasibility Study.

PURPOSE: The main limitation of surgical treatment of medication-related osteonecrosis of the jaw (MRONJ) is difficulty in defining resection margins. The aim of this study was to compare the efficacy of the surgeon's experience and autofluorescence-guided bone surgery to delimit resection margins for necrotic bone. MATERIALS AND METHODS: MRONJ requiring surgical treatment was classified according to American Association of Oral and Maxillofacial Surgeons staging. To detect vital bone and resection margins, patients of each stage were randomly assigned to 1 of 2 surgical groups: an autofluorescence-guided surgery (AF) group and a conventional surgery (non-AF) group based on the surgeon's experience. Bone samples from the 2 groups were analyzed histopathologically. The main outcomes were defined as the absence of bone exposure or infection at the time of evaluation. Infection was defined as the presence of swelling, pain, or numbness in the area. Measurements were collected preoperatively and 1 week, 1 month, 6 months, and 1 year after surgery. Statistical analysis included descriptive statistics and the Fisher exact test to evaluate eventual differences between the 2 surgical protocols. RESULTS: The 36 patients (21 women and 15 men) included in this study were equally divided into 2 groups according to the surgical protocol: 18 patients in the non-AF group and 18 in the AF group. Thirty-nine lesions were included in this analysis: 20 lesions in the non-AF group and 19 in the AF group. Histopathologic examination confirmed the necrotic nature of all bone samples. Statistical analysis showed no differences in necrotic bone exposure or signs of infections between the 2 surgical protocols at different times (P > .05). CONCLUSIONS: Although the VELscope appears to be useful in guiding bone resection margins in patients with MRONJ, autofluorescence does not appear to be superior to conventional surgical techniques in mucosal healing and quality of life.

Biomimetic hydroxyapatite used in the treatment of periodontal intrabony pockets: clinical and radiological analysis.

AIM: Hydroxyapatite (PA) has a chemical composition and physical structure very similar to natural bone and therefore it has been considered to be the ideal biomaterial able to ensure a biomimetic scaffold to use in bone tissue engineering. The aim of this study is to clinically test hydroxyapatite used as osteoconductive biomaterial in the treatment of periodontal bone defects. Clinical and radiological evaluations were conducted at 6, 12 and 18 months after the surgery. MATERIALS AND METHODS: Forty patients with 2- and 3-wall intrabony pockets were enrolled in this study. PPD, CAL, radiographic depth (RD) and angular defects were preoperatively measured. After surgery, patients were re-evaluated every 6 months for 18 months. Statistical analyses were also performed to investigate any differences between preoperative and postoperative measurements. RESULTS: Paired t-test samples conducted on the data obtained at baseline and 18 months after, showed significant (p<0.01) differences in each measurement performed. The role of preoperative RD was demonstrated to be a significant key factor (p<0.01). A relevant correlation between preoperative PPD and CAL gain was also found. CONCLUSIONS: Within the limitations of this study, the absence of anatomical variables, except the morphology of the bone defect, emphasizes the importance of the proper surgical approach and the graft material used.

Periodontal Treatment Elevates Carotid Wall Shear Stress in the Medium Term.

Periodontal disease is associated with endothelial dysfunction of the brachial artery and hemodynamic alterations of the common carotid artery. Periodontal therapy improves endothelial function. It is not known if it is able also to improve the hemodynamics of the carotid artery. The aim of the current study was to evaluate the efficacy of 2 different periodontal treatments on carotid hemodynamics: scaling and root planing (SRP) alone or together with low-level laser therapy (LLLT). Forty patients were recruited and randomly treated with SRP (n = 20) or SRP + LLLT (n = 20). Periodontal indices (plaque, gingival, and probing depth indices) were measured before and 5 months after treatment. Blood viscosity, common carotid wall shear stress, circumferential wall tension, and Peterson elastic modulus were evaluated before, soon after and 5 months after treatment. It was found that the periodontal indices improved in both groups, but significantly more so for SRP + LLLT than for SRP (decrease in gingival index 69.3% versus 45.4%, respectively, P = 0.04). In the SRP + LLLT group, after a transient reduction by 5% immediately after therapy, shear stress increased by 11% after 5 months. In SRP only group, however, shear stress variations were less marked. No significant changes were found for the other hemodynamic parameters in either of the groups. Periodontal disease treatment by SRP + LLLT can therefore be said to improve common carotid wall shear stress. This suggests a possible mechanism by which the treatment of periodontal disease has beneficial effects on the cardiovascular system.

Effectiveness of a diode laser in addition to non-surgical periodontal therapy: study of intervention.

BACKGROUND: Chronic periodontitis affects 47% of adult population over the age of 30. The first phase of periodontal treatment is always represented by scaling and root planning (SRP), that is a causal, non-surgical therapy that recognizes as primary aims the control of bacterial infection and the reduction of periodontal plaque-associated inflammation. Yet, another innovative causal therapy is represented by the irradiation of periodontal pockets with laser. AIM: To evaluate the effect of a 940-nm diode laser as an adjunct to SRP in patients affected by periodontitis. MATERIALS AND METHODS: Sixty-eight adult patients with moderate-to-severe periodontitis were sequentially enrolled and undergone to periodontal examination (V1) in order to detect gingival index (GI), plaque index (PI) and probing depth (PD). The patients were randomly divided into two groups: the first (n=34) received SRP treatment alone, the control group (n=34) received SRP and 940-nm diode laser therapy. RESULTS: Data were analyzed by Student's t-test, with two tails; for all clinical parameters, both groups reported statistically significant differences compared to basal values (p<0.0001). Both procedures were effective in improving GI, PI and PD, but the use of diode laser was associated with more evident results. CONCLUSIONS: Considered the better clinical outcomes, diode laser can be routinely associated with SRP in the treatment of periodontal pockets of patients with moderate-to-severe periodontitis.

Postextractive implants in aesthetic areas: evaluation of perimplant bone remodeling over time.

AIM: The aim of this research was to assess peri-implant bone remodeling of post-extractive implants over 2 years. MATERIAL AND METHODS: 30 patients meeting pre-established inclusion criteria were enrolled for the study. One implant for each patient was inserted in the post-extraction sockets according to a defined surgical protocol (atramautic extraction, curettage of extraction socket, implant insertion, grafting with collagenated cortico-cancellous porcine bone, and a trimmed collagen membrane to completely cover the socket, suture). A temporary adhesive bridge, with an adequate profile, was bonded to the adjacent teeth. X-ray evaluation with a standardized stent was carried out at different times. Measurements were obtained from the implant edge to the bone peak. The values obtained at time 0 and at 2 years were compared by t-student test. RESULT: Our results showed that after one year 73% of patient had 0 mm of bone reabsorption, 20% of patient had 0 mm ≤ x ≤ 0.5mm, 7% of patient had 0.5 mm ≤ x ≤ 2 mm of bone reabsorption. After two years 62% of patient had 0 mm of bone reabsorption, 24% had 0 mm ≤ x ≤ 0.5mm, 14% had 0.5 mm ≤ x ≤ 2 mm. CONCLUSIONS: The results showed no significant differences in bone reabsorption in most patients over 2 years.

Histological evaluation of a biomimetic material in bone regeneration after one year from graft.

AIM: The use of substitute materials is one of the solutions used in periodontology for the reconstruction of intrabony defects. Advances in scientific research gave rise to a new generation of biomaterials of synthetic origin stoichiometrically unstable and therefore really absorbable. Our research is directed precisely towards a biomaterial synthesis, Engipore® (Finceramica, Faenza, Italy) which is a bone substitute of the latest hydroxyapatite-based generation, that possesses chemical and morphological properties similar to those of natural bone in the treatment of infrabony periodontal defects. Aim of this study was to evaluate the efficacy of Engipore® in the treatment of intrabony periodontal defects. METHODS: The study was conducted on 100 parodontopatics patients, which had gingival pockets of at least infrabonies 8/10 mm. The histological evaluation was performed with samples after one year from the graft. RESULTS: The histological samples collected after one year showed an abundant new bone formation, with mature lamellar bone tissue surrounding the residual particles of Engipore® that appear completely osteointegrated. The surrounding connective tissue shows no signs of inflammation. CONCLUSIONS: The results obtained in our research demonstrated that, after a proper selection of patients and lesions, and applying an adequate surgical technique, this type of biomaterial in the treatment of periodontal defects acts in an optimal manner as a filler inducing the formation of new bone as evidenced by histological examinations.

IL-21 as a therapeutic target in inflammatory disorders.

INTRODUCTION: IL-21, a cytokine produced by activated CD4(+) cells, activated natural killer T cells and T helper cells in the germinal centers, is involved in the control of the function of both immune and parenchymal cells. AREAS COVERED: IL-21 is overproduced in many chronic inflammatory disorders, including inflammatory bowel diseases, psoriasis, rheumatoid arthritis, type I diabetes and systemic lupus erythematosus, and studies in experimental models indicate that IL-21 plays an important role in sustaining tissue-damaging immune responses in such pathologies. However, genetic deficiency of IL-21 associates with inflammatory bowel diseases and blockade of IL-21 in the early phases exacerbates the disease progression in some models of rheumatoid arthritis and systemic lupus erythematosus, thus suggesting a dual role of IL-21 in the control of immune-mediated diseases. IL-21 can exert additional protective functions for the host as it promotes cytotoxic responses against tumors and viruses. EXPERT OPINION: We here review the available data on the role of IL-21 in chronic inflammatory diseases and discuss the therapeutic benefit of IL-21 inhibitors in such diseases as well as the potential risks of such treatments.