Effect of two different parts of CGF on post-extractive alveolar ridge preservation: a preliminary histomorphometric analysis in a Split-Mouth design.

Tooth extraction produces alveolar bone resorption and soft tissue remodelling, so identification of adequate technique for alveolar ridge preservation after tooth extraction is fundamental for all specific cases. Among the several biomaterials, CGF can represent an ideal alternative considering its and its mechanical and biological properties. In this preliminary study we compared the effectiveness of the use of two different parts of CGF (WP-White Part and BC-Buffy Coat) versus natural healing (CTR) by a split-mouth randomized clinical design. Four healthy patients who needed extraction of three teeth were selected. Post-extractive alveolar sockets were filled randomly with CGF-WP, CGF-BC or nothing for CTR. After 60 days, before implant placement, a biopsy for each alveola was obtained for quantitative histomorphometric analysis. The data obtained showed that the use of CGF-WP could achieve good regenerative results, supporting the use of this part for the preservation of the post-extractive alveolar socket.

Concentrated growth factors gel activated with ozone for facial aesthetics purpose after granuloma removal: a case report.

The aim of this case report was to present the management of the aesthetic consequences of the treatment for granuloma removal in the zygomatic region, with concentrated growth factors (CGF) activated by medical ozone. A 54-year-old woman presented with bilateral lesion in the zygomatic region, caused by treatment with hyaluronidase and laser for removal of a granuloma, developed after infiltration with hyaluronate. The lesion was treated by local application of platelet-rich plasma obtained with CGF centrifuge, and containing CD34+ cells, mixed and activated by ozone in a 1:1 proportion, at a concentration of 40 mg/ml for 30 sec, in a syringe. Five consecutive bilateral infiltrations were made at 3-week intervals. Lesion volume was measured, and patient's quality of life was assessed with PGWBI (Psychological General Well Being Index) questionnaire. After the third infiltration of CGF-ozone, a consistent reduction of the lesion was observed, until disappearance at the end of the treatment. The result was maintained after 4-year follow-up. Considerable improvement of patient's well-being was reported. This case report showed that CGF-ozone combined therapy may promote dermal regeneration, achieving excellent facial esthetics outcomes. This result needs to be confirmed by further studies with a larger sample size.

Management of large perforations of the sinus mucosa with PRGF-Endoret® platelet concentrate.

The aim of the present study is to describe a new technique through which it is possible to complete the maxillary sinus lift procedure even in case of severe damage or complete removal of the sinus mucosa using the PRGF-Endoret® platelet concentrate. Eighteen patients (ratio F:M=4:5; average age: 58.2 years; DS: 8.85 years) with severe perforation (more than 10 millimetres of diameter) of the sinus mucosa during the maxillary sinus lift procedure were selected. Normally the procedure is interrupted due to impossible stabilization of the graft material inside the subantral cavity. On the contrary, our protocol foreseen the sealing of the perforation using the PRGF autologous gel membranes or the creation of a new sinus pseudomembrane through which the graft material was covered. The PRGF-Endoret were obtained according to the protocol developed by BTI (Biotechnology Institute - Vitoria, Spain). In 14 cases out of 18 implant fixtures were concurrently inserted while in 4 cases the fixture insertion was postponed after 6 months: 37 fixtures were inserted (27 at the same time and 10 after 6 months). 2 months after surgery the CBCT showed a correct pneumatization of the maxillary sinus in 16 patients out of 18 (89% of cases), while after 12 months the radiological normalization of the maxillary sinus was present in 17 patients out of 18, bringing the healing rate to 94% of cases. Regarding implant healing, 2 out of 37 implants inserted were lost in the first month after the surgical phase, whereas 12 months after prosthesis application the other 35 implants were perfectly osteointegrated with a healing rate equal to 94.6% of the fixtures. 36 months after the surgery all the fixtures were osteointegrated (35 of 37 implants with a percentage of 94.6% of success). We may conclude that the use of PRGF allowed to complete the sinus lift even in case of severe perforation of the sinus mucosa or its total removal thanks to its capability to stabilize the graft, its antibacterial and antifungal activity and its anabolic effect and favouring bone regeneration.

Analysis of the foot load in subjects with prevalent unilateral chewing.

The relationship between occlusion and posture has been and is still strongly debated. This study examines 40 male and female healthy subjects, (11 males and 29 females, average age: 26.27 years, st dv: 3.03) aged between 21 and 32. The baropodometric evaluation was performed with the subject in rest position and in usual centric occlusion. The results obtained were analyzed using a baropodometric platform and Freesteps software (Sensor Medica srl, Rome - Italy) analyzing the podalic load, the foot axis and the foot angles. The values reported show that 80% of subjects in rest position (p-value 0.01) and 70% of subjects in centric occlusion (p-value 0.05) have a greater foot load in the contralateral foot compared to the chewing side; moreover, the foot axis values are statistically significant because 77% of subjects in rest position and 72% in centric occlusion have a foot axis more open on the same side than the chewing one. The foot angles values are not significant. These results could be understood analyzing the activation of the body muscular chains: on the chewing side there is an increase of the activity of the flexion chain with side bending of the trunk. This induces a change of the body barycenter compensated by an outer rotation of the homolateral leg and foot; moreover, the body bending creates a false short leg on the same side, explaining the excess of podalic load on the other side. These values show that the hypothesis of a correlation appears to be likely, although obviously it still needs confirmation and further analysis.

Evaluation of Arthrocentesis with hyaluronic acid injections for management of temporomandibular disorders: a systematic review and case series.

Although arthrocentesis is an accepted safe treatment modality for the management of temporomandibular disorders (TMD) in symptomatic patients, the benefit of hyaluronic acid (HA) injections remains uncertain. The aim of this study was to evaluate whether intra-articular HA injections adjunctive to arthrocentesis can be more effective than other medications for the improvement of TMD associated symptoms. Additionally, the impact of HA injections on quality of life of TMD patients was assessed with SF-36® questionnaire in a cohort of patients. An electronic search of Medline, Scopus and Cochrane databases was performed up to March 2020. The following search terms were used: "arthrocentesis", "hyaluronic acid", "intra-articular injections", "visco-supplementation", "temporomandibular disorders". Prospective and retrospective studies that reported the application of HA injections compared to other intra-articular drugs for the treatment of temporomandibular disorders were included. Systematic or narrative reviews and pre-clinical studies were excluded. Additionally, a retrospective clinical study was performed for evaluation of changes in quality of life before and after arthrocentesis with HA injections. In the systematic review, the initial search yielded 1327 articles. After screening of the titles, abstracts, and full texts, 29 studies were selected (26 randomized studies, 2 controlled clinical trials, 1 retrospective report). In the clinical study, 12 patients were included. Intra-articular injections of HA and other medications together with arthrocentesis seemed to be beneficial for improvement of functional symptoms of TMD and pain. The case series also supported the efficacy of HA injections showing an improvement of quality of life of these patients. However, from literature review, it was impossible to identify an optimum drug or a protocol for predictably improving the pain and/or functional symptoms of temporomandibular problems, due to different etiologies, diversity of treatment modalities and conflicting results. In conclusion, there is no consensus in the literature that HA injections shows better results in comparison with other treatment modalities. According to the results of the present clinical study, HA injections with/without arthrocentesis seems to be beneficial in terms of clinical symptoms and quality of life of the TMD patients.

Dental implant survival rate in irradiated and non-radiated patients: a systematic review and meta-analysis.

Radiotherapy to head and neck has always been considered as a risk factor for rehabilitation with dental implants. Nevertheless, recent data suggest that overall, 5-year implant survival in irradiated patients can be greater than 90%. The purpose of this review was to compare the implant survival rates of irradiated and non-radiated head and neck cancer sites, and discuss the outcomes, through a systematic review approach of prospective and retrospective studies. Electronic searches were performed in the EMBASE, Cochrane, and PubMed/Medline databases up to 2019 Dec, to identify retrospective and prospective clinical studies addressing the subject. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary variables collected from the studies were the site of tumor, age and sex of the patient, site of implant placement, radiation dosage, frequency and duration of radiotherapy, follow-up duration, implant survival and stability, hard and soft tissue changes after implant placement, any type of biological and mechanical complication, and oral health quality of life (QOL). Fifteen studies including 1097 patients and a total of 4637 implants placed in irradiated and non-irradiated sites, with a follow up duration varying from 6 to 120 months, were selected for the systematic review. The results of the quantitative synthesis suggested statistically significantly better survival rate of implants placed in nonradiated sites, as compared to irradiated sites (p<0.00001). However, the cumulative survival rates over a period of 7-10 years were reported to be comparable. Quality of life (QOL) after implant rehabilitation was not found to be significantly different between the compared groups. Due to the limited number of information, insufficient data was available to draw conclusion on peri-implant complication rate. No relationship was found between age, gender, and implant survival rates. Implant placement in irradiated sites is challenging and often warrants protocol modifications. Although statistically the survival rates at irradiated sites were lower in comparison to non-radiated sites, a strict inclusion criterion in patient selection, timing of implant placement after radiotherapy, radiation dosage and regular oral hygiene maintenance could minimize the chances of implant failure in irradiated patients.

Facial Mask and Plexiglass Box: a critical overview on the current strategies to protect patients from COVID-19 infection.

The route of transmission of SARS-CoV-2 has been understood thanks to the knowledge of previously identified human coronaviruses. According to these studies, the transmission of the virus occurs mainly between humans at close range, through respiratory droplets produced during conversation or coughing, as well as through direct contact of the hands then placed on the mucous membranes or mouth. From the final analysis of studies carried out on protective systems, the validity of plexiglass as a material to be used for the construction of protective devices could be affirmed. The plexiglass, in fact, would seem able to isolate the diffusion of aerosol particles dispersed by infected subjects and in different environments.

Taste sensitivity in healthy adults: gustatory test validation and observational study.

Gustatory sensitivity has important biological functions and taste disorders are generally difficult to diagnose and treat. The aim of this study was to investigate taste sensitivity on a sample of adult healthy patients through the validation and administration of a gustatory test, to describe a possible baseline of reference. A gustatory test was performed following a standardized protocol, using primary flavors solutions at 4 known increasing concentrations for a total of 16 sapid solutions. Taste sensitivity was investigated considering (a) the threshold of the flavor identification and (b) the intensity of stimulus perception. Seventy-one healthy patients were included in the study. Reliability measures were evaluated, supporting the validity of the test itself. Sweet, bitter, and salty flavors could be identified within the first concentration, sour flavor was detected within the second concentration in the majority of cases (p<0.05). Sour flavor showed the lowest value of perceived intensity for the less concentrated solution, sweet flavor showed the highest value. Regarding the most concentrated solution, bitter flavor showed the highest intensity value, while sour remained the lowest one. Both gender-based and age-based differences regarding threshold and intensity of perception were not statistically significant. However mean threshold averagely increased along with age. Within its limitations, this study validates a useful, easy-to-use tool for assessing taste function and it provides a possible baseline for perception of primary flavors in a healthy adult population, which can be used as a reference for future studies considering specific cohorts of patients.

Long-term clinical outcome of dental implants: A retrospective clinical study with a minimum follow-up between 9.5 and 17.7 years.

The aim of this retrospective case series was to evaluate the clinical and radiographic outcomes of the patients that underwent implant surgery in all indication classes, with a follow-up of at least 9 years. 121 healthy patients in need for oral rehabilitation with dental implants were included in this study. 196 implants (160 conical, 73 cylindric design implants) were inserted. The implant survival rate was the primary outcome. Intra- and postoperative complications were additional criteria for success. The mean follow-up of the patients was 12.29 years (SD 1.39). Mean age of the study population was 51.0 years (SD 12.7). The mean bone loss around implants after at least 9 years of loading was measured as 2.0 mm (SD 0.73 mm). Intra-operative complications were seen in 5 patients. Post-operative complications included: 5 mucositis,1 dehiscence, 2 screw loosening, 1 infection at site and 1 nonintegrated implant. Two implants were lost in two patients. The overall implant survival rate was 99.1%. As a conclusion, oral rehabilitation with dental implant-supported prostheses can be accepted as a safe procedure with relevantly high survival rates of oral implants and successful aesthetic and functional outcomes.

Role of probiotics in adjunct to non-surgical periodontal therapy in patients with chronic periodontitis: a systematic review and meta-analysis.

The objective of this study was to establish the significance of probiotic usage, both as a preventive as well as a therapeutic strategy for the management of periodontal disease. It also substantiates the existing studies of single/combined bacterial strain for exhibiting variable ecological impact on oral bacteria. Data sources included literature searches of PubMed (MEDLINE), Scopus, Embase, CENTRAL and Web of science databases for placebo controlled randomized clinical trials of SRP with orally administered probiotics in any form as an adjunct. Data extraction was conducted and information from the included studies was tabulated according to the study designs, form of drug delivery, main outcomes, and clinical parameters. Data collected were based on the focused question outlined for the present systematic review. The reviewers cross-checked all extracted data. CAL and PD were assessed as the primary outcome to compare the effectiveness of adjunctive probiotic therapy in addition to SRP. Fourteen clinical studies were included and demonstrated efficacy in reducing periodontal probing depth (PPD) and gaining clinical attachment level (CAL), between probiotics and SRP/placebo. Adjunctive probiotic therapy in addition to SRP leads to decrease in probing depth and clinical attachment gain in chronic periodontitis patients. However, further high-quality randomized clinical trials with microbiological outcomes are required to fortify the conclusion.

Clinical efficacy of grape seed extract as an adjuvant to scaling and root planing in treatment of periodontal pockets.

Grape seed extract (GSE), a naturally producing polyphenolic compound, is found to be a potent hostmodulatory agent and considered for management of periodontal disease. Its anti-bacterial, antioxidant, and anti-inflammatory property may aid in achieving periodontal health. To assess the clinical efficacy of GSE in adjunct to scaling and root planing (SRP) in healing of periodontal pockets. The present study was a longitudinal, parallel design, randomized clinical trial. Seventy-two patients (mean age 39.2±8.6 years) with periodontal pockets were randomly divided into two groups; Test group received intra-pocket delivery of GSE with SRP and Control group received SRP alone. The clinical parameters like Plaque Index (PI), Gingival Index (GI), Probing Depth (PD) and Relative Attachment Level (RAL) were recorded at baseline and 3 months. 64 patients completed the study. Test group at the end of 3 months had statistically significant reduced PD (p=0.002) and RAL (p=0.01). No significant difference was observed for PI and GI at the end of 3 months. Intra-pocket application of GSE with SRP could be beneficial in management of periodontal pockets.

Knowledge, practices and perceptions regarding oral health preventive measures among Mexican dental students: a cross-sectional survey study.

Although oral diseases are mostly preventable, they remain a global public health problem. Thus, there is a need for trained personnel to actively intervene in promoting oral health, to prevent and timeously detect oral diseases, and, in turn, to provide comprehensive quality healthcare. The main objective of the study was to evaluate the knowledge, practices and perceptions regarding oral health preventive measures amongst undergraduate dental students. This cross-sectional study was conducted between the period October 2017 and January 2018. The subjects included were undergraduate students of the dental science program at the School of Dentistry, in Leon Guanajuato, Mexico. A validated questionnaire was used to identify knowledge of preventive dentistry and the frequency of oral health preventive actions in the dental school clinics. Besides, perception towards prevention in dentistry was assessed. A total of N=232 undergraduate students participated of whom 65.9% (N=153) were women. More than half of the students 59.5%, (N=138) rated their knowledge on the prevention of oral diseases as good, followed by 32.8% (N=75) of students who rated it as regular. 49% (N=97) of the students performed frequently preventive treatments in their daily clinical practice. 90% (N=217) think that the main reason of low practice of prevention in dentistry is the lack of commitment of the dentist. 72.8% (N=169) mention that there should be professionals dedicated exclusively to preventive dentistry. Students of second grade demonstrated better prevention knowledge and tended to engage more frequently in preventive activities (p<0.05). In conclusion, our study found that, second-year students perform preventive practices more frequently and these practices decrease as their studies progress. It should be sought to create positive attitudes towards prevention not only in the year in preventive dentistry, but also throughout the entire career. This enables students to become trained professionals that can deliver preventive services to their patients.

Clinical evaluation of efficacy and tolerance of a skin reconditioning compound for anti-aging.

Facial aging involves all facial structures located at different levels: bones soft tissues and skin with a reduction of the extracellular matrix. The aim of the study was to evaluate the efficacy of the injectable solution antiaging complex composed by non-reticulated hyaluronic acid (HA) and amino acids vitamins and antioxidants conveyed with mesotherapy technique in subjects with different expressions of aging. 114 patients with different expressions of aging were enrolled in this study with mean age (49±6). HA and amino acids vitamins and antioxidants complex solution Neofound (Love Cosmedical, Castagneto, Italy) was injected on the dermal plane or superficial subdermal plane. Among the various imperfections, fine roughness surface irregularities skin firmness brightness/discoloration cutaneous hydration were those with the greatest response to therapy. The clinical data showed that the medical device Neofound is effective and safe to treat various skin signs of chrono and photoaging thanks to its ability to protect tissues from oxidative stress and hydrate the skin.

Clinical effectiveness of Lactobacillus reuteri in the treatment of peri-implant diseases: a systematic review and meta-analysis.

In the last decades, the presence of peri-implant diseases (PD) has increased. One of the therapies currently used is probiotics with Lactobacillus reuteri (LR). The aim of this article is to determinate, through a systematic review and meta-analysis, the clinical effectiveness of LR in the treatment of PD. We searched the literature until January 2021, in the biomedical databases: Pubmed, Embase, Scielo, Science Direct, Scopus, SIGLE, LILACS, Google Scholar and Cochrane Central Registry of Clinical Trials. The selection criteria of the studies were: randomized controlled clinical trials, without language and time restriction, reporting the clinical effects (depth to probing, plaque index and bleeding index) of the LR in the PD treatment. The risk of study bias was analyzed through the Cochrane tool for randomized studies using Review Manager software. The search strategy resulted in 6 articles of which four investigated peri-implantitis and three peri-implant mucositis. All studies reported that there was a difference in the depth of the probing in the treatment of PD, in favor of the group using LR, though not always achieving significance. The use of LR can be clinically effective in terms of pocket depth reduction in the treatment of PD.

Early postextraction implants may achieve osseointegration in the absence of primary stability. A pilot study.

This pilot study aimed at investigating if implants without primary stability may osseointegrate and support functional prosthesis. Patients received one Trabecular Metal implant each in posterior sockets two months after tooth extraction, combined with xenograft and a resorbable membrane. Implants were divided in three groups, based on the primary stability assessed by resonance frequency analysis. Implant stability quotient (ISQ) was measured at placement, and re-assessed five months later (at uncovering), and after 6 months of function. Marginal bone loss was radiographically evaluated. After checking normality of the distributions, Student's t-test was used for statistical comparisons. Twenty-five consecutive patients were included. At placement, mean ISQ significantly differed among groups, being undetectable (n=8 implants), 65.00±4.25 (standard deviation, n=6) and 77.95±3.13 (n=11) in the very low, medium and good primary stability groups, respectively. After five months of healing, mean ISQ had increased to >70 in all groups. All implants successfully osseointegrated and were restored as planned. Six months after loading, no significant difference in mean ISQ (range 79.19-81.92), and in mean marginal bone level change (range 0.21 to 0.28 mm) was observed among the three groups. Rehabilitation of wide postextraction defects may achieve successful outcomes even in the absence of primary stability.

Cortical bone lamina approach for mandibular large cystic defect: a case report.

This study evaluated the bone healing of the residual cavity after enucleation of mandibular inflammatory cyst by using only a coverage with cortical bone barrier. This study was conducted at the dental clinic of the Medical, Oral and Biotechnology Sciences Department of Chieti in February 2015. A 36-year-old male patient, D.G.M., had a mandibular inflammatory cyst (with a diameter of about 33.9x20.3mm) treated by surgical enucleation, subsequent apicectomy of the elements involved (4.1, 3.1, 3.2, 3.3, 3.4) and coverage of residual defect with a porcine cortical bone barrier (Bone Lamina). Postoperative clinical and radiographic examinations were performed at 3 and 9 months (panoramic radiographs) and at 12 and 24 months (CBCT Dental scan) respectively after cystic enucleation surgery. Uneventful healing and filling of the residual cavity was carried out. The computed analysis of the postoperative radiographs showed bone regeneration of cortical in terms of thickness increase at 12 and 24 months and showed mean values of reduction in size of the residual cavity of 92.1% after 12 months and 96.53% after 24 months. The volume of residual cavity (3123 mm3 in 2015) was seen to decrease (243.6mm3 at 12 months and 108.5 mm3 at 24 months). In this case report the Bone Lamina prevented tissue collapse within the defect and could maintain structural integrity throughout the period required for bone regeneration; it also has the advantage of resorbable membranes, avoiding a second surgery for its removal.

In vitro interface changes of two vs three narrow-diameter dental implants for screw-retained bar under fatigue loading test.

The mechanical failure of a dental implant is clinically related to a prosthetic overload dissipated on the fixture/abutment complex. The aim of this investigation was to evaluate the fracture strength of two vs three narrow-diameter dental implant configurations for screw-retained bars. Different configurations of screw-retained bars on two narrow-diameter dental implants (Group I) and screw-retained bars on three narrow-diameter dental implants (Group II) were tested under a static fracture loading. A total of 20 specimens, 10 for each group were evaluated. The fracture loading point was significatively higher in Group I (p<0.05). The experimental groups reported high levels of fracture strength under loading that encourages the clinical application of screw-retained bars supported by multiple narrow-diameter implants.

Soft tissue augmentation by means of silicon expanders prior to bone volume increase: a case series.

In guided bone regeneration (GBR) interventions, the incorrect manipulation of the soft tissues may lead to exposure of graft due to insufficient amount of tissue needed for a free-tension flap closure. The aim of this investigation was to evaluate the clinical and radiographical effectiveness of soft tissue augmentation in aesthetic areas. A total of 6 patients were treated in the Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio" of Chieti-Pescara, with a radiographical follow-up at 1 year from the loading. At the follow up, no soft tissue dehiscence was observed This study presented an innovative approach for soft tissue augmentation prior to bone regeneration in aesthetic areas. Augmentation of soft tissue with a silicon expander device before bone regeneration is a simple technique and also allows to obtain greater bone tissue in selective cases.

PRGF® endoret injections for temporomandibular joint osteoarthritis treatment: a one-year follow-up.

This clinical trial investigates the efficacy of PRGF-Endoret® injections for the treatment of temporomandibular joint osteoarthritis by providing patient evaluations at a one-year follow-up. Fifty-two patients with a diagnosis of osteoarthritis according to the American Society of Temporomandibular Joint Surgeons' guidelines underwent a cycle of 3 injections (1 per month) of platelet-derived growth factors (PRFG). Two clinical parameters, pain at rest and maximum non-assisted mouth opening, were assessed by the same blinded operator at the time of the diagnosis (baseline), at each appointment during the treatment and at a 1-year follow-up visit. Both the parameters showed improvements that were maintained over time. Statistical analyses evidenced significant changes within the first two injections. Data from the present investigation support findings from studies on other joints, which show the efficacy of PRGF-Endoret injections to reduce symptoms of osteoarthritis and to maintain improvements over time.

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.