Oral rehabilitation of edentulous jaws with one-piece implants: a case series.

The popularity of one piece implants has increased considerably between patients and dentists. The advantages of one-piece immediate loading for rehabilitation of edentulous mandibles is to reduce the number of interventions and timing of prosthetic. These parameters can be better controlled with a one-piece implant. Twenty-one patients with one-piece implants inserted in totally edentulous mandibles were considered for this retrospective study. Inclusion criteria were: Good oral hygiene, absence of lesions of the oral mucosa, no smoking or smoking less than 20 cigarettes a day, drinking less than 2 glasses of wine a day, good general health no pregnancy. Twenty-one (12 females 9 males) patients were enrolled in this retrospective study. The mean follow-up was 1 years. A total 84 one-piece implants (Biohorizon, Italy) were inserted in edentulous mandible. Implants diameter was 3.0 mm in all fixtures. Implants length was equal and longer than 12 mm in 44 and 40 fixtures respectively. 48 were inserted in females 36 in males (range 33-67; mean age 58.3). One-piece immediate loading implants has no difference in survival rate respect to two-piece implant and delayed loading for rehabilitation of totally edentulous mandibles. In conclusion one-piece immediate loading implant is a reliable device for mandible rehabilitation.

Complications in sinus lift.

Prosthetic rehabilitation of atrophic maxillary implants often requires grafting owing to vertical and transversal bone deficiency. The use of this procedure in order to insert implants was introduced by Tatum and published as a clinical study by Boyne and James. It can be performed via a lateral or crestal approach. This surgery is now widespread, with good results in terms of bone augmentation and implant osseointegration. Nevertheless, there is a small proportion of patients who have infectious complications with an incidence ranging from 3.5% to 10.5%. We observe that maxillary sinus augmentation is a successful preprosthetic technique for augmentation of the edentulous posterior maxilla. Preoperative assessment of the anatomy of the sinus reduces the rate of complications considerably.

Silica solutions (SL) is efficacy in the treatment of chronic periodontitis: a case control study.

AIM: The objective of this study was to compare the efficacy of supportive periodontal therapy (i.e. scaling and rooth planning, SRP) alone versus a chemical device silica dioxide (SiO2) colloidal solutions (SL) used in association with SRP in the treatment of chronic periodontitis in adult patients. MATERIALS AND METHODS: A total of 20 patients with a diagnosis of chronic periodontitis (40 localized chronic periodontitis sites) in the age group of 35 to 55 were selected. None of these patients have previously received any surgical or non-surgical periodontal therapy and demonstrated radiographic evidence of moderate bone loss. Two non-adjacent sites in separate quadrants were selected in each patient to monitorize treatment efficacy (split mouth design). Clinical pocket depth (PD) and microbial analysis (MA) were analyzed at baseline and 15th day. SPSS program and paired simple statistic T-test were used to detect significant differences. RESULTS: Total bacteria loading, Tannerella Forsitia and Treponema Denticola loading were statistically reduced when SiO2 is locally delivered. CONCLUSIONS: SL gel is an adiuvant therapy which should be added to SRP in the management of moderate to severe chronic periodontitis.

Evaluation of effectiveness of photobiostimulation in alleviating side effects after dental implant surgery. A randomized clinical trial.

BACKGROUND: To assess if photobiostimulation (PBS) alleviates pain intensity/duration and swelling after implant surgery. MATERIAL AND METHODS: Sixty subjects (27 male and 33 female, with a mean age of 47,13 8.05 years) were included and randomly assigned to experimental group (implant surgery and photobiostimulation), placebo group (implant surgery and simulated photobiostimulation) and control group (implant surgery only). INCLUSION CRITERIA: subjects older than 20 years, with a healthy oral mucosa and requiring implant surgery. EXCLUSION CRITERIA: pregnancy, history of implant failure, light sensitivity, metabolic deseases, consumption of antibiotics or corticosteroids in the last two weeks, smokers and alcohol drinkers. Patients reported the pain experienced by using a numeric rating scale (NRS) at 2 hours, 6 hours, 12 hours, 24 hours and from day 2 to 7. Swelling score was assessed by linear measurements and type and number of analgesic drugs within each time-point were recorded on a spreadsheet. Data of pain and amount of swelling were compared among the three groups by using the Kruskal-Wallis H Test and post-hoc comparisons tests. RESULTS: Pain in the experimental group was less compared to controls and placebo group, at each time intervals (p < 0.001) as well as the maximum pain score (experimental group: median = 2, interquartile range 2-3; control group: median = 8, interquartile range 3,75-9; placebo group: median = 8, interquartile range 6,25-9). Swelling was almost insignificant in the experimental group (maximum value = 1, interquartile range 0-2,75, at 24 hours) compared with control (maximum value = 6, interquartile range 5-8,75, at 24 hours) and placebo (maximum value = 6, interquartile range 5-8, at 24 hours). Subjects in the experimental group assumed less analgesics compared to both controls and placebo groups. CONCLUSIONS: Photobiostimulation is an effective method to reduce pain intensity/duration and swelling after implant surgery.

Bleeding control with calcium sulphate after oral surgery in anticoagulant therapy patients.

Control of bleeding after oral surgery, is mandatory in patients taking anticoagulants. There are different haemostatic measure to prevent post-surgical bleeding. The aim of our study is to use a homeostatic agent, Calcium sulphate (P30, Ghimas, Bologna, Italy) for controlling post-surgical bleeding in a group of patients treated with warfarin therapy for thromboembolic states. Twenty teeth (12 mandibular molars, 8 maxillary molars) in 20 patients (14 men and 6 woman) with a mean age of 54.3 years (± 10.3 years) were included in the study. The patients were divided in 2 group; in 10 patients of the study group was used Calcium sulphate (P30, Ghimas, Bologna, Italy) in layers to fill the socket after extraction, while in control group was recommended to put a gauze with tranexamic acid in the extraction site immediately after extraction, and half an hour after extraction. The outcome was bleeding in subsequent days. Bleeding at post operative day 1 was significant in 5 patients of control group, otherwise in study group treated with calcium sulfate there was no bleeding in any patient (p. value 0.0055). CaS demonstrated to be a good hemostatic agent for controlling bleeding after oral surgery in patients taking anticoagulants.

Intra and extra oral clinical manifestations of Rendu-Osler-Weber syndrome: case report and literature review.

Hereditary Hemorrhagic Telangiectasia or Rendu-Osler-Weber syndrome is an incomplete penetrance dominant autosomal transmission disease which determines microcirculatory beds alterations (capillary and venules), caused by the loss of the support tissues that usually enclose blood vessels, and hemorrhage potentially in every organ. The syndrome clinical manifestations are multiple telangiectasia of small proportions on the skin or on the mucous membranes (e.g. of the gastrointestinal tract or other organs), in association with recurring bleedings of the affected areas and external and internal melena. The treatment is a supportive one so to prevent complications. This study reports a case of a patient affected by this syndrome in need of a dental implant following the fracture of a tooth. Furthermore, a bibliographical review of etiopathogenesis, clinical manifestations and therapy options has been made.

Low-level laser therapy protocols in dental movement acceleration and in pain management during orthodontic treatment.

In recent years various studies about the biostimulatory effects of the laser therapy in orthodontics have been carried out. This study investigates the potential advantages obtainable using the Low-level Laser Therapy during orthodontic treatment and the most efficient clinical protocols. Recently published randomized controlled trials (RCTs) have been obtained through a search on electronic databases (Cochrane Library and Pubmed). Clinical studies in humans in which Low-level Laser Therapy was applied during orthodontic treatment were included. In conclusion, 14 relevant clinical studies were identified. This study shows the possibility to obtain an increase in tooth movement between 31% and 100% depending on the laser therapy considered and the time interval for measuring the value. In addition, there is a potential impact in reducing orthodontic pain limited to the day following the application of laser therapy when orthodontic therapy includes canine retraction, and during a period not exceeding five days from the placement of fixed orthodontic appliances in the others clinical cases.Low-level Laser Therapy is considered effective both to increase the movement of the dental elements and to reduce pain during orthodontic therapy. Different clinical protocols have been identified depending on the orthodontic cases considered. Both an LED device and an AlGaAs diode device can be used. In the future paying more attention to the therapeutic possibilities offered by laser devices with greater power is recommended. A greater energy density directed to the target tissues has been proven to provoke more significant therapeutic effects.

Role of mesenchymal stem cells in osteotomy sinus graft healing: a case report and a literature review.

Prosthetic rehabilitation of the edentulous posterior maxilla with implant-supported prostheses frequently presents a challenge for the oral surgeon because of the lack of bone due to alveolar ridge resorption or maxillary sinus pneumatization. To overcome these problems, different solutions were proposed over the years. Maxillary sinus membrane elevation is a common surgical technique for increasing bone height in the posterior maxilla prior to dental implant placement. However, the biological nature of bone regeneration in maxillary sinus membrane remains largely unidentified. The authors present a clinical case and literature review to understand the fundamental of bone formation in osteotomy sinus floor elevation.

The use of a new collagen matrix to support the regeneration of peri-implant soft tissue laser-assisted: case report.

Several factors compete for both the achievement and the long-term maintenance of osseointegration; among these, of importance is the width and integrity of the peri-implant soft tissue. Many authors already underlined the importance for implant-prosthesis procedures to maintain a good biological seal together with a low bacterial cell surface charge (this is also valid for a natural tooth with an undamaged periodontium). The aim of this work is to present, through a clinical case, a new technique that focuses on the regeneration of soft tissue around a post-extractive implant. For the case reported, a post-extractive implant surgery of an inferior molar of the fourth quadrant with a buccal bone resorption of 3mm in the mesial section of the root, three dimensional collagen matrices (Bioteck) and a blend of equine spongy bone granules (OX Bioteck) were used, combined with aPDT without dye (Rey Protocol). With an easy and not invasive surgery, this technique allows the recreation of new gingiva around the implant.

Evaluation of the degree of differentiation of human mesenchimal stem cells on different titanium superfaces: a pilot study.

The aim of our study was to evaluate the properties of a laser-modified titanium surface, specifically the promotion of a faster differentiation of human Mesenchymal Stem Cells (hMSCs) into osteoblasts and a more stable connection between differentiated cells and titanium, compared to machined and sand-blasted surfaces. Furthermore, we wanted to assess if the titanium alone could be a sufficient factor in the induction of the differentiation towards the osteogenic lineage. MATERIALS AND METHODS: we harvested stem cells from an individual (under his consensus) and cultivated them into dishes containing titanium disks presenting three different surfaces: machined (M), sand-blasted (S) and laser-modified (L). In the test group, cells were cultivated in an osteogenic medium, while in the control group, cells were seeded in a standard DMEM. Evaluations of the degree of differentiation were made with Alizarin coloration after 28, 38, 42, 49, 56 and 63 days from induction. RESULTS: no signs of differentiation were evident in the control group, while in the test group there was a statistically significant differentiation, evident since the fourth week. Laser-modified and sand-blasted surfaces showed similar values, higher than the machined surface. DISCUSSION: on the laser-modified surface the differentiation reached its peak on the sixth week, while on the seventh week for the other two surfaces. After the peak, the differentiation showed a slow decrease for the laser-modified surface and a rapid decrease for the other two. CONCLUSIONS: titanium alone can't be considered enough to induce differentiation of human Mesenchymal Stem Cells into osteoblasts. Still, the laser-modified once induced a faster differentiation of stem cells and a more stable connection between osteoblasts and titanium.

One-piece implants: an alternative rehabilitation of edentuluos jaws.

The popularity of one-piece implants has increased considerably between patients and dentists. The advantages of one-piece immediate loading for rehabilitation of edentulous mandibles are to reduce the number of interventions and timing of prosthetic. These parameters can be better controlled with a one-piece implant. Twenty-one patients with one-piece implants inserted in totally edentulous mandibles were considered for this retrospective study. Inclusion criteria were: Good oral hygiene, absence of lesions of the oral mucosa, no smoking or smoking less than 20 cigarettes a day, drinking less than 2 glasses of wine a day, good general health no pregnancy. Twenty-one (12 female 9 males) patients were enrolled in this retrospective study. The mean follow-up was 1 year. A total 84 one-piece implants (Biohorizon, Italy) were inserted in edentulous mandible. Implants diameter was 3,0 mm in all fixtures. Implant's length was equal and longer than 12 mm in 44 and 40 fixtures respectively. 48 were inserted in females 36 in males (range 33-67; mean age 58,3). One-piece immediate loading implants has non-difference in survival rate respect to two-piece implant and delayed loading for rehabilitation of totally edentulous mandibles. In conclusion one-piece immediate loading implant is a reliable device for mandible rehabilitation.

First analysis of ancient burned human skeletal remains probed by neutron and optical vibrational spectroscopy.

Burned skeletal remains are abundant in archaeological and paleontological sites, the result of fire or of ancient funerary practices. In the burning process, the bone matrix suffers structural and dimensional changes that interfere with the reliability of available osteometric methods. Recent studies showed that these macroscopic changes are accompanied by microscopic variations are reflected in vibrational spectra. An innovative integrated approach to the study of archaeological combusted skeletal remains is reported here, where the application of complementary vibrational spectroscopic techniques-INS (inelastic neutron scattering), FTIR (Fourier transform infrared), and micro-Raman-enables access to the complete vibrational profile and constitutes the first application of neutron spectroscopy to ancient bones. Comparison with data from modern human bones that were subjected to controlled burning allowed identification of specific heating conditions. This pioneering study provides archaeologists and anthropologists with relevant information on past civilizations, including regarding funerary, burial, and cooking practices and environmental settings.

A new chemical device for the treatment of chronic periodontitis: a case control study.

The objective of this study was to compare the efficacy of supportive periodontal therapy (i.e. scaling and root planning, SRP) alone, versus a chemical device silica dioxide (SiO2) colloidal solutions (SDCS) used in association with SRP in the treatment of chronic periodontitis in adult patients. A total of 20 patients with a diagnosis of chronic periodontitis (40 localized chronic periodontitis sites) in the age group of 35 to 55 were selected. None of these patients have previously received any surgical or non-surgical periodontal therapy and demonstrated radiographic evidence of moderate bone loss. Two non-adjacent sites in separate quadrants were selected in each patient to monitor treatment efficacy (split mouth design). Clinical pocket depth (PD) and microbial analysis (MA) were analyzed at baseline day 15. SPSS program and paired simple statistic T-test were used to detect significant differences. Total bacteria loading, Tannerella forsitia and Treponema denticola loading were statistically reduced when SiO2 is locally delivered. SDCS gel is an adjuvant therapy which should be added to SRP in the management of moderate to severe chronic periodontitis.

Effects of laser biostimulation on the epithelial tissue for keratinized layer differentiation: an in vitro study.

Gingival augmentation techniques proposed in the international literature do not exclude a surgical component, which determines consequent post-surgical discomfort and results are not always predictable. In recent years, the introduction of laser biostimulation has led to a less invasive approach, particularly in the treatment of periodontally compromised patients, limiting the surgical phase to seriously compromised cases, with regeneration techniques for the restoration of a correct periodontal tissue anatomy. The aim of this in vitro study is to establish the validity of laser biostimulation in order to develop the epithelial keratinized layer of the tissue by stimulating fibroblasts-keratinocytes organotypic cultures and fibroblasts and keratinocytes mono-cultures. We created two groups (test and control), each one composed of 3 fibroblast cultures, 3 keratinocyte cultures and 3 organotypic cultures. We performed laser irradiation of test group with Wiser Doctor Smile Lambda, Flat Top Handpiece, at 50 J/cm2 of fluency with one application every 40 h for a total of 5 applications. Forty-eight h after the last laser application, we investigated the presence and amount of keratins 5 and 8 with citofluorymetric and western blotting analyses. Analyses showed an increase in keratin synthesis in test group cultures, showing a remarkable increase in production of keratin 8 in co-cultures test. Laser biostimulation can considerably enhance keratin synthesis when applied with high energy doses and repeated applications to keratinocytes-fibroblasts co-cultures.

Treatment of craniofacial fibrous dysplasia: a case report.

The concept of "fibro-osseous lesions" of bone has evolved over the last several years and now includes two mayor entities: the fibrous dysplasia (FD) and the cement-ossifying fibroma (COF). Fibrous dysplasia is considered to be a developmental, tumor-like (hamartomatous), fibro-osseous disease of unknown etiology. There is a maxillary predominance when craniofacial FD occurs in the jaws and the maxillary sinus is commonly involved. Differentiation of OF from FD is important because of differences in treatment and behaviour. This article report a case of 60-year-old female with a history of painless unilateral palatal swelling.

Piezolelectric surgery in dentistry: a review.

In the last ten years was observed a significant increase of publications about piezoelectric bone surgery. The purpose of this review was to define the state of art and to realize a comparison between piezoelectric devices and manual or rotating traditional techniques, analyzing advantages and disadvantages from a clinical and histological point of view for various dental procedures. The literature review has been carried out using medical databases on line: MEDLINE and COCHRANE LIBRARY. The authors selected 37 publications about dental field and consistent with inclusion criteria established. From the clinical point of view, the analysis of selected publications concerning procedures such as maxillary sinus lift, alveolar ridge expansion, samples of autologous bone, etc, showed surgical trauma reduction, especially towards to soft and nervous tissues, surgical mini-invasiveness, cut precision and selectivity and speed of learning guaranteed by piezoelectric devices compared to traditional ones. Histologically, however, the study of biology and postintervention bone tissue healing showed a lower loss of bone with piezoelectric instruments than with conventional devices, as well as a better healing quality by reducing patient's postsurgery morbidity. The use of piezoelectric devices seems thus to simplify different sinus lift surgical procedures and to allow greater predictability, although some studies reveal that there are not substantial differences in comparison of long-term results between conventional and piezoelectric instruments and also criticize their increase in operation time.

Effects of low-level laser irradiation on proliferation and osteoblastic differentiation of human mesenchymal stem cells seeded on a three-dimensional biomatrix: in vitro pilot study.

Mesenchymal stem cells (MSCs) from bone marrow are a recent source for tissue engineering. Several studies have shown that low-level laser irradiation has numerous biostimulating effects. The purpose of this trial was to evaluate the effects of Nd:Yag laser irradiation on proliferation and differentiation of MSCs induced into the osteoblastic lineage. MSCs were collected from adult human bone marrow, isolated, and cultured in complete medium (α-MEM). Subsequently, they were treated with osteogenic medium, seeded in three-dimensional collagen scaffolds, and incubated. We used six scaffolds, equally divided into three groups: two of these were irradiated with Nd:Yag laser at different power levels (15 Hz, 100 mJ, 1.5 W, and one with a power level of 15 Hz, 150 mJ, 2.25 W), and one was left untreated (control group). Evaluations with specific staining were performed at 7 and 14 days. After 7 days, proliferation was significantly increased in scaffolds treated with laser, compared with the control scaffold. After 14 days, however, laser irradiation did not appear to have any further effect on cell proliferation. As concerns differentiation, an exponential increase was observed after 14 days of laser irradiation, with respect to the control group. However, this was a pilot study with very limited sample size, we conclude, that low-level laser irradiation might lead to a reduction in healing times and potentially reduces risks of failure.