Treatment of a peri-implantitis defect using a mini-invasive surgical approach (MISA) and deproteinized bovine bone mineral with 10% collagen: a case series.

This pilot study evaluates the effectiveness of the Mini-Invasive Surgical Approach (MISA) in the treatment of peri-implantitis defect. MISA is based on the use of the deproteinized bovine bone mineral with 10% collagen in combination with a minimal flap. The main principle is the elevation of a flap to access to the peri-implantitis defect only on one side (palatal aspect), leaving the opposite site intact. The study was designed as a non-controlled, non-randomized pilot study. In 10 consecutive subjects, 10 implants with diagnosis of perimplantitis were selected. In all the treated sites, primary closure was obtained at completion of the surgical procedure. No relevant pain, edema and hematoma were noted. The reported surgical approach resulted in significant clinical and radiographic improvements while limiting patient morbidity. After 1-year follow-up minimal mucosal recession, probing depth reduction and radiographic bone gain were noted.

White cell and platelet content affects the release of bioactive factors in different blood-derived scaffolds.

Platelet-derived factors are biomaterials that might accelerate healing process in oral, maxillofacial, and several other applications. Release of specific factors by platelet concentrates is critical to achieving a successful outcome. Here, we have shown that platelet-rich fibrin (PRF) clots were beneficial sources of leukocytes, which may directly affect the release of chemokines and growth factors. When compared with the standard leukocyte-PRF (L-PRF), the experimental low-force modified procedure [defined as advanced-PRF (A-PRF)] entrapped the same content of viable leukocytes, released a similar amount of inflammatory cytokines, but secreted 3-, 1.6-, 3-, and 1.2-fold higher levels of Eotaxin, CCL5, platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF), respectively. A leukocyte-free scaffold, such as plasma rich in growth factors (PRGF), released only platelet-specific factors and, in particular, the F3 fraction, the richest in growth factors, secreted higher amount of CCL5 and PDGF compared to F1 and F2 fractions. In conclusion, different procedures and leukocyte content affect cytokine, chemokines, and growth factor release from platelet derivatives, which may be helpful in different clinical settings.

Extraction of mandibular third molars: proposal of a new scale of difficulty.

We evaluated the accuracy of a new scale of surgical difficulty for the extraction of impacted mandibular third molars, which includes consideration of previously underestimated variables. Two hundred patients with impacted third molars were enrolled, and a preoperative clinical and radiographic assessment of difficulty was made by an oral surgeon using the new index. Five oral surgeons with similar degrees of experience then evaluated the surgical difficulty during operation. The kappa test and weighted kappa were used to evaluate the level of agreement between the preoperative and postoperative evaluations. This was 0.73, which indicated a substantial concordance between the preoperative and postoperative assessments of difficulty indicated by the new scale. The linear weight of kappa was 0.8 and the quadratic weight 0.87. We recommend this new scale of surgical difficulty for the extraction of impacted third molars for use in clinical practice.

The platform switching approach to optimize split crest technique.

The split crest technique is a reliable procedure used simultaneously in the implant positioning. In the literature some authors describe a secondary bone resorption as postoperative complication. The authors show how platform switching can be able to avoid secondary resorption as complication of split crest technique.