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.

Growth-promoting action and growth factor release by different platelet derivatives.

Abstract Platelet derivatives are commonly used in wound healing and tissue regeneration. Different procedures of platelet preparation may differentially affect growth factor release and cell growth. Preparation of platelet-rich fibrin (PRF) is accompanied by release of growth factors, including platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF) and transforming growth factor ß1 (TGFß1), and several cytokines. When compared with the standard procedure for platelet-rich plasma (PRP), PRF released 2-fold less PDGF, but >15-fold and >2-fold VEGF and TGFß1, respectively. Also, the release of several cytokines (IL-4, IL-6, IL-8, IL-10, IFNγ, MIP-1α, MIP-1ß and TNFα) was significantly increased in PRF-conditioned medium (CM), compared to PRP-CM. Incubation of both human skin fibroblasts and human umbilical vein endothelial cells (HUVECs) with PRF-derived membrane (mPRF) or with PRF-CM enhanced cell proliferation by >2-fold (p<0.05). Interestingly, PRP elicited fibroblast growth at a higher extent compared to PRF. At variance, PRF effect on HUVEC growth was significantly greater than that of PRP, consistent with a higher concentration of VEGF in the PRF-CM. Thus, the procedure of PRP preparation leads to a larger release of PDGF, as a possible result of platelet degranulation, while PRF enhances the release of proangiogenic factors.

Adverse reaction to irrigation with povidone-iodine after deep-impacted, lower third molar extraction.

Povidone-iodine is most commonly used worldwide because of its germicidal activity, relatively low irritancy or toxicity and low cost. Frequently, povidone-iodine is used as a topical antiseptic for treating and preventing wound infection. In rare cases skin irritation or iododerma-like eruption could represent possible adverse effects due to the oxidative effects of iodine and allergic hypersensitivity reaction. In this report we describe a case of a massive adverse reaction to the irrigation of surgical wound dehiscence with 10 percent povidone-iodine solution after deep-impacted, lower third molar extraction. This reaction was related to a central neurotrophic reflex involving three trigeminal branches and probably due to peripheral chemical insult of mandible nerve. This adverse reaction determined a severe edema and diffuse skin lesions, involving the whole left side of the face mimicking an iododerma-like eruption. These violent symptoms were solved after 60 days. Furthermore, we report a small permanent skin scar in the zygomatic area and transient alterations of facial sensitivity on the affected side which completely disappeared in 6 months.

Use of piezosurgery device in management of oral surgery complications: clincal case and clinical experience report.

The root displacement into the maxillary sinus could be a complication of oral surgery in the upper jaw. In these cases, the root removal is needed in order to avoid the occurrence of sinus pathologies. Piezosurgery techniques could assure a safer management of such complications, because of the clear surgical visibility and the selective ability of cut. The aim of this article is to present a case of oral surgery complication (root displacement in the right maxillary sinus), in which piezosurgery technique helped for a correct and safe clinical management, allowing to reduce the soft tissue damage.

In vitro comparative study on the mechanical behavior of Zirconia and Polyetheretherketone in applied dental sciences.

OBJECTIVE: Recently, Zirconia and polyaryletherketone (PEEK) have attracted increasing interest as reliable and safe materials in dental applications, mainly because of their good biomechanical characteristics. The aim of this study was to investigate the response to different loads by prosthetic frameworks for supported fixed partial dentures (FPDs), thus simulating osseointegrated implants. MATERIALS AND METHODS: The specimens were divided into two groups (n= 5 each). Group A: FDPs in zirconia-ceramic; Group B: FDPs in PEEK-composite. These 2 groups were subjected to vertical loads so to evaluate structural deformation; then, they have been analyzed by scanning electron microscopy (SEM) at different magnifications. RESULTS: In tested samples, different types of mechanical failures have been observed. In Zirconia-specimens, chipping is the main failure noticed in this study, mostly in distal margins of the structure. Also, peek-specimens show failure and fracture. CONCLUSIONS: Zirconia and PEEK could be considered both good materials, but several investigations are needed to use these materials as an alternative to metals for fixed partial dentures.

Frenulectomy: proposal of a new surgical approach and case report.

The frenula of the oral cavity represent the insertion of perioral muscles in jaws, consisting of a fold of the triangular fibro-connective tissue covered with mucous membrane and usually inserted at the mucogingival line. The purpose of this work, after a review of literature, was to provide the clinical signs above the median frenum removal order for the orthodontic closure of a interincisor diastema and to present a new surgical technique.

Tooth replantation as an alternative to dental implantology in adolescent patients.

BACKGROUND: A 16-years old female patient was referred to our observation in July 2006, 14 days after an accident, with traumatic intrusive luxation of the right upper central incisor that caused the nasal floor and buccal cortical bone fracture. While the extraoral examination showed the traumatic lesions of the upper lip, the intraoral examination revealed intrusive luxation, pain and high mobility of the tooth, and bleeding of the adjacent oral tissue. The treatment protocol consisted in surgical buccal bone removal, tooth extraction, retrograde root-canal filling, and tooth repositioning in occlusion with a resilient splinting. After 8 weeks the splinting was removed, and clinical and radiological examinations were taken 3, 6, 9, 12, and 24 months after surgery. At the 24 months follow-up the root showed no radiographic signs of inflammation, resorption or ankylosis, and the function of the replanted tooth was fully maintained. Tooth replantation can be considered an effective alternative to dental implant, when the latter is contraindicated in young patient with incomplete skeletal development. The long-term success of the procedure will likely require a multidisciplinary approach.

Treatment of a post surgery defect of the lower lip: a case report.

We present the clinical case of a patient, CT of 35 years who came to our observation for the appearance of a recurrent mucocele on the lower lip. The mucocele or retention cyst is a benign lesion of minor salivary glands characterized by swelling, which can vary from a few millimeters to several centimeters, as determined by retention of secretion due to partial or total obstruction of an excretory duct. Current thinking is that the mucocele is formed due to traumatic events or inflammatory, malformation of the excretory duct or parenchyma of the minor salivary glands. Once framed the patient from a clinical point of view we performed surgery, which provides complete enucleation of the lesion by about 7 mm. The clinical suspicion was confirmed by histological diagnosis as extraductal mucocele. After about six months after surgery, at complete healing, resulted a residual imperfections with a loss of substance in the area. To eliminate this defect, poorly tolerated by the patient, we decided to use a filler of hyaluronic acid, which, although it is an absorbable material, results in an excellent appearance and does not expose to complications like the use of inducible permanent.

[Mouthwash solutions containing microencapsulated natural extracts: Clinical results on dental plaque and gingivitis]. / Bains de bouche aux extraits naturels microencapsulés : résultats cliniques sur la plaque dentaire et la gingivite.

INTRODUCTION: New mouthwash solutions containing microencapsulated natural extracts have been developed. Besides antiseptic activity, these solutions have antioxidant and immunoregulatory properties on oral tissues. The objective of this preliminary clinical study was to assess the efficiency of a mouthwash containing microencapsulated natural extracts (GingiNat, LoB5 Foundation, Paris, France) on gingivitis. PATIENTS AND METHODS: Twenty volunteers (37 + or - 2 years) with significant gingivitis (bleeding when tooth-brushing) used a 6% GingiNat mouthwash solution, two to three times per day (according to oral hygiene habits) for 21 days in addition to their usual oral care. Each volunteer was examined at day 0, 4, 7 and 21. The Löe and Silness Plaque Index, the Russel Periodontal Index, a breath index (halitosis), and oral tissue tolerance were assessed. Finally, each volunteer filled in a daily follow-up form and answered a questionnaire on tolerance and acceptability. RESULTS: A significant decrease of the dental plaque index was observed on day 4, 7, and 21, in respectively 29, 48 and 71% of volunteers. This decrease reached 18% on day 4 (p=0.014), 32% on day 7 (p=0.002), and 47% on day 21 (p<0.001). A significant decrease of the periodental index was observed on day 4, 7 and 21, in respectively 52, 81 and 95% of volunteers. This decrease reached 30% (p=0.001) on day 4, 49% (p<0.001) on day 7, and 78% (p<0.001) on day 21. A significant improvement of the breath index was noted on day 4, 7, and 21, in respectively 43, 52 and 48% of volunteers. This improvement reached 29% (p=0.004) on day 4, 35% (p=0.001) on day 7, and 32% (p=0.002) on day 21. The mouthwash was well tolerated. The patients liked its effectiveness and organoleptic properties. All patients expressed the wish to continue using this solution. DISCUSSION: The GingiNat mouthwash solution at 6% had a significant efficiency on plaque, gingivitis, and halitosis after 21 days of use. This makes it a good complementary treatment for gingivitis. Tolerance and acceptability were good despite the long and repeated use. Further studies are needed to have a detailed analysis of its efficiency in the long run and on patients presenting with various forms of periodontitis.

[Mouthwash solutions containing microencapsuled natural extracts: In vitro evaluation of antioxidant properties (dental plaque and gingivitis)]. / Bains de bouche aux extraits naturels microencapsulés : évaluation in vitro des propriétés antioxydantes (plaque dentaire et gingivite).

INTRODUCTION: New mouthwash solutions containing microencapsulated natural extracts were developed to provide both antiseptic activity and in depth treatment of oral tissues, due to their antioxidant and immunoregulatory properties. The objective of this study was to quantify the antioxidant action of the GingiNat solution (LoB5 Foundation, Paris, France) in an in vitro cell model. MATERIALS AND METHODS: Diluted GingNat solutions (0.12%, 0.06% and 0.012%) were put in contact with Jurkat type human lymphoid cells in basal radical state (cells at rest) and in provoked oxidative stress conditions (after an UVA+UVB irradiation). The lipid peroxidation was quantified by flow cytometry using a fluorescent probe. RESULTS: The diluted GingNat solutions at 0.12%, 0.06%, and 0.012% showed a significant antioxidant effect with respectively 122.9%, 117.8% and 119.3% on average. The difference was statistically significant compared to controls for the three concentrations without any significant difference among them. This antioxidant effect was even more significant when cells were in oxidative stress with respectively 155.3%, 139.3%, and 132.5% on average. There was a significant difference between the tested concentrations (p<0.01). DISCUSSION: These first in vitro results confirmed the antioxidant properties of the GingiNat solution. These antioxidant properties are significantly higher at stronger concentrations. Further studies are required to analyze the influence of microencapsulation on these results. Clinical trials are needed to confirm these antioxidant properties.

[Mouthwash solutions with microencapsuled natural extracts: Efficiency for dental plaque and gingivitis]. / Bains de bouche aux extraits naturels microencapsulés : effets sur la plaquedentaire et la gingivite.

Mouthwash solutions are mainly used for their antiseptic properties. They currently include synthetic agents (chlorhexidine, triclosan, etc.) or essential oils (especially Listerine). Many natural extracts may also be used. These associate both antiseptic effects and direct action on host response, due to their antioxidant, immunoregulatory, analgesic, buffering, or healing properties. The best known are avocado oil, manuka oil, propolis oil, grapefruit seed extract, pycnogenol, aloe vera, Q10 coenzyme, green tea, and megamin. The development of new technologies, such as microencapsulation (GingiNat concept), may allow an in situ slow release of active ingredients during several hours, and open new perspectives for mouthwash solutions.

Microbiological and biochemical effectiveness of an antiseptic gel on the bacterial contamination of the inner space of dental implants: a 3-month human longitudinal study.

Microbial penetration inside the implants internal cavity produces a bacterial reservoir that is associated with an area of inflamed connective tissue facing the fixture-abutment junction. The aim of this clinical trial is to evaluate the effectiveness of a 1 percent chlorhexidine gel on the internal bacterial contamination of implants with screw-retained abutments and on the level of AST secreted in peri-implant crevicular fluid. Twenty-five patients (aged 29 to 58 years) each received one implant. Three months after the end of the restorative treatment, and immediately after a clinical and radiographic examination and the abutment removal, microbiological samples were obtained from the internal part of each fixture and biochemical samples were collected by peri-implant sulci. The patients were then divided into two groups: the control (CG; n=10) and test (TG; n=15) groups. The CG had the abutment screwed into place and the crown cemented without any further intervention. In contrast, before the abutment placement and screw tightening, the TG had the internal part of the fixture filled with a 1 percent chlorhexidine gel. Three months later, the same clinical, microbiological and biochemical procedures were repeated in both groups. Total bacterial count, specific pathogens and AST activity were detected. The clinical parameters remained stable throughout the study. From baseline to the 3-month examination, the total bacterial counts underwent a significant reduction only in the TG. In contrast, the AST activity showed a significant increase in the CG. The administration of a 1% chlorhexidine gel appears to be an effective method for the reduction of bacterial colonization of the implant cavity and for safeguarding the health status of peri-implant tissue over a 3-month administration period.

Clinical difficulties in diagnosis: a rare case of lipoma of the floor of the mouth.

Lipomas are soft tissue mesenchymal neoplasms that rarely occur in the oral and maxillofacial region. Their incidence in the floor of the mouth is very low. The authors present the case of a lipoma of the floor of the mouth, the diagnosis of this lesion was challenging as many clinical signs mimicked the appearance of a common ranula. Also the ultrasound imaging findings were not decisive and only during the operation the yellowish, solid and lobulated aspect of the lesion directed the surgeon to the correct treatment: a block resection of the mass was performed under local anesthesia with no complications. The patient remained asymptomatic with no evidence of recurrences in the postoperative follow-up period of 24 months. Histopathologically, the lesion was classified as a lipoma, a diagnosis based on the presence of mature adipose tissue with no cytologic atypia, subdivided by rare and thin septa of fibrous tissue with the presence of few blood vessels. The case reported highlights the difficulties in diagnosing lesions in the floor of the mouth and the necessity of including rare conditions like lipoma in the differential diagnosis.

A pilot study of human mesenchymal stem cells from visceral and sub-cutaneous fat tissue and their differentiation to osteogenic phenotype.

OBJECTIVE: To evaluate the different behavior of two different human adult adipocytes derived stem cells (hASCs) during proliferation and osteogenic differentiation. PATIENTS AND METHODS: Human adult adipocytes stem cells (hAT-SCs) from visceral (hAV-SCs) and subcutaneous (hAS-SCs) sites were obtained after surgery procedures of seven patients. All samples were fully investigated and the different proliferation rates were evaluated. All MSCs clusters were cultured with an osteogenic and adipogenic differentiation medium. Homogeneous pools of Mesenchymal Stem Cells (MSCs) were confirmed by Flow-Cytometry Analysis (FACS) and Spectrophotometric Assay. The differentiated cells were eventually assessed for the expression of Alkaline Phosphatase (ALP), Alizarin Red (AR) and Oil Red-O (OR-O) detection, and analyzed by the Spectrophotometric Assay. After osteogenic differentiation, the cell clusters were incubated and analyzed with Real Time-Polymerase Chain Reaction (qRT-PCR) and fluorescence microscopy. RESULTS: The FACS analysis performed on hAT-SCs confirmed the homogenous presence of MSCs in all samples. The ALP, AR stain confirmed the osteogenic differentiation capacity of MSCs towards osteoblast-like-cells. The colorimetric cell metabolic activity (MTS) assay showed an increase in the proliferation rate with different values in both sets hAS-SCs vs. hAV-SCs. CONCLUSIONS: These in vitro findings of both hAS-SCs and hAV-SCs suggested an important role of these stem cells for future clinical use in bone regeneration. Indeed, the final outcomes suggested a better performance of cells coming from subcutaneous adipose tissue vs. those from visceral fat tissue.

The usefulness of 111indium-oxine autologous platelet gel graft imaging to evaluate osteoinduction in patients undergoing surgery of jaw bone defects.

Autologous platelet gel (AGP) is a source of concentrated growth factors contained in the platelet granules used to enhance bone quality and, especially, quicken bone formation in regeneration techniques, and also ameliorate the haemostasis in anti-coagulated patient management. The purpose of this study is to describe a technique to perform labelling of autologous platelet-gel with 111In -Oxine and to evaluate its usefulness, as a marker of bone osteoinduction by means of scintigraphy, after in vivo application in patients with jaw bone defects following cystic lesion enucleation and the extraction of deeply impacted lower third molar. All patients included in the study presented mandible bone defects following cyst enucleation or deeply impacted lower third molar extraction. In sterile conditions, 111In-Oxine AGP was added during the bone-milling phase of the graft preparation and then applied to the bone defects. The scintigraphy was performed 2 hours after the application of labelled AGP (early scan) and at 24, 48, 72, 384 hours (delayed scan). At early scan all the patients presented a high concentration of 111In-Oxine AGP, which was easily recognized at the level of jaw defect. Limited diffusion of AGP was seen in the tissue surrounding the bone defect; this activity was attributed to the presence, in the PRP, of a quote of autologous granulocytes, as marker of inflammatory process, which was labelled with 111In-Oxine. In order to demonstrate the persistence and stability of labelling AGP, abdominal scintigraphies were performed to assess the presence of activity in the liver, spleen and bone marrow. None of the patients presented appreciable activity in these organs. The labelled AGP topically applied showed high uptake values, without statistically significant activity in the surrounding tissues or in critical organs during the early phase, as well as in delayed controls, and confirmed a very low grade of loss of 111In-Oxine from the bone defect. The scintigraphy represents a useful method of assessing the success of surgical procedure for jaw bone defects performed with autogenous grafts. It is well accepted by the patients, offering at the same time a sensitive method of studying uptake of topically applied AGP and to follow up kinetics of AGP in order to correlate quantitative data of the platelet gel life span with evolution of the bone remodelling process. Finally, the labelled granulocytes around the bone defect allow to assess the inflammatory process evolution derived from the surgical technique.

Effect of a subgingival chlorhexidine chip on the clinical parameters and the levels of alkaline phosphatase activity in gingival crevicular fluid during the non-surgical treatment of periodontitis.

The main therapeutic approaches for inflammatory periodontal diseases include the mechanical treatment of root surfaces. Multi-center clinical trials have demonstrated that the adjunctive use of a chlorhexidine (CHX) chip is effective in improving clinical results compared to scaling and root planing (SRP) alone. However, some recent studies failed to confirm these clinical results, nor have any data been reported regarding the capability of the CHX chip in affecting the activity of alkaline phosphatase (ALP) in the gingival crevicular fluid (GCF). This enzyme has been related to a condition of destructive activity of periodontitis. The aim of this study is to provide further data on the clinical and biochemical effects of CHX chips when used as an adjunct to SRP. Eighty-two systemically healthy patients, aged 31-63, with moderate and advanced periodontitis were recruited from the departments of Periodontology of the University of Chieti. In each patient 2 experimental sites, located in two symmetric quadrants, were chosen with a probing depth of > or = 5 mm and bleeding on probing. The 2 sites were selected randomly at the split-mouth level; control sites received SRP alone, and test sites SRP plus 1 CHX chip. Clinical indices, including probing depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and the ALP activity in GCF were evaluated at baseline and after 6 months. Alkaline phosphatase activity was assayed spectrophotometrically. The PPD and CAL were significantly lower at 6 months as compared to the baseline scores in both treatments (p less than 0.01). The PPD reduction was 2.7 mm in the CHX+SRP group and 1.9 mm in the SRP alone group. The CHX+SRP group showed a significantly greater gain of clinical attachment (mean: 1.4 mm) in comparison with the SRP group (mean: 0.9; p less than 0.05). No differences were observed in the decrease of the percent of BOP-positive sites between the experimental groups. Conversely, the CHX+SRP group underwent a significantly greater decrease (p less than 0.01) of the GCF-ALP activity 6 months after treatment in comparison with the SRP alone group. The adjunctive use of the CHX chip resulted in a significant improvement of pocket reduction and clinical attachment gain as compared with SRP alone. These results were concomitant with a significantly greater reduction of the GCF-ALP activity levels.

Analysis of the occlusal stress transmitted to the inferior alveolar nerve by an osseointegrated threaded fixture.

BACKGROUND: Altered sensation can occur after the placement or loading of mandibular implants. Limited evidence exists with regard to the proper distance between the implant and the mandibular nerve to ensure the nerve's integrity and physiologic activity. The proper distance should come from evaluation of clinical data as well as from biomechanical analyses. METHODS: A numeric mandibular model based on the boundary element method was created to simulate a mandibular segment containing a threaded fixture so that the pressure on the trigeminal nerve, as induced by the occlusal loads, could be assessed. Such pressure distributions were evaluated with different distances of the fixture from the mandibular canal and considering different bone densities. Although all simulations considered a canal that was orthogonal to the implant axis, in one case, the effects of an inclined canal were analyzed. RESULTS: The nerve pressure increased rapidly with a bone density decrease. A low mandibular cortical bone density caused a major nerve pressure increase. CONCLUSION: Our study suggested a distance of 1.5 mm to prevent implant damage to the underlying inferior alveolar nerve when biomechanical loading was taken into consideration.

Nanohybrids for controlled antibiotic release in topical applications.

New polymeric composite materials containing a nanohybrid to be used for the controlled release of an antibiotic molecule, chloramphenicol succinate, have been formulated, prepared and characterised. The nanohybrid consists of a layered double hydroxide of Mg-Al hydrotalcite-type, in which the nitrate anions present in the host galleries were replaced with chloramphenicol succinate anions (CFS(-)) by a simple ion-exchange reaction. Different amounts of the hybrid material were incorporated in polycaprolactone and processed as films of 0.15mm thickness. The composite materials were analysed by X-ray diffractometry and thermogravimetry and their mechanical properties were determined. They showed properties even better than those of the pristine polymer. The release process of the antibiotic molecules was found to be very interesting and promising for tuneable drug delivery. It consists of two stages: an initial stage of a very rapid burst, in which a small fraction of drug is released; and a second stage that is much slower, extending for a longer and longer time. This behaviour is profoundly different and much slower than that of a sample in which the antibiotic molecule is directly incorporated into the polymeric matrix. The parameters influencing drug release have been individuated and discussed.

Effectiveness of a new decisional algorithm in managing mandibular ameloblastomas: a 10-years experience.

We present a new treatment algorithm aimed to assist surgeons to develop a rational diagnostic protocol and establish effective conservative surgical management in patients with mandibular ameloblastoma. Fifteen consecutive cases treated by conservative management were reviewed. Data collected included age, sex, symptoms and signs at diagnosis, anatomical distribution of the lesions, numbers and types of operations, number of recurrences, and duration of follow-up post-operatively. Curettage was the first operation for all patients and they were closely followed-up post-operatively. During the follow-up period (4-10 years), small recurrences were diagnosed early in 7 patients who were treated by radical surgery including marginal or "box" resection. No further recurrences were observed after the second operation. When detected early, recurrences are small and surrounded by a large amount of uninvolved normal bone so it is possible to manage them with a radical resection, so lowering the risk of further recurrence and avoiding severe cosmetic and functional problems.