Critical Overview on Pure Chitosan-based Scaffolds for Bone Tissue Engineering: Clinical insights in Dentistry.

Bone Tissue Engineering (BTE) is a field of regenerative medicine continuously improving, thanks to the development of new biomaterials used as grafts or scaffolds for repairing bone defects. In recent years, chitosan, a natural biopolymer extracted mainly from crustacean shells, has demonstrated unique and desirable characteristics for BTE applications, such as: biocompatibility, biodegradability, and osteoconductive behavior. Additionally, the presence of numerous active amine groups in its chemical structure allows it to be easily modified. Data suggest that chitosan scaffolds are highly biomimetic, and show an interesting bioactivity, and antibacterial behavior. We have demonstrated, in a critical overview, how chitosan-based scaffolds may hold great interest for BTE applications in medical and dental applications. Future research should be focused on the use of chitosan-scaffolds combined with other biomaterials or bioactive molecules, to increase their overall regenerative potential, also in critical-sized defects. In conclusion, chitosan can be considered a promising biomaterial in BTE and clinical dentistry.

Comparative in vitro study on biomechanical behavior of zirconia and polyetheretherketone biomaterials exposed to experimental loading conditions in a prototypal simulator.

Zirconia and polyetheretherketone (PEEK) are two biomaterials widely investigated as substitute for metals in oral prosthetic rehabilitation. To achieve a proper biomechanical behavior, the prosthetic biomaterials must ensure a good resistance to loads, as this is a crucial characteristic enabling their use in dental applications. The aim of this study was to investigate differences in the fracture resistance of different biomaterials in an experimental environment: fixed partial dentures (FPDs) screwed in a prototype of biomimetic mandible. 10 Samples of FPDs were allocated in 2 groups (A and B): Group A (n=5) involved FPDs in zirconia-ceramic, and Group B (n=5) involved FPDs in PEEK-composite. The samples were loaded by means of a three-point bending mechanical test, and the load to fracture has been evaluated generating a point-by-point graphics (speed/load and time/deformation). The samples were further analyzed by micro-computed tomography (micro-CT) and described under experimental loading conditions. Zirconia-ceramic FDPs were the samples reporting the worst results, showing a lower value of vertical displacement with respect to PEEK-based samples. The micro-CT results have further confirmed the preliminary results previously described. This in vitro study aims to give analytic data on the reliability of PEEK as a reliable and strong biomaterial for prosthetic treatments.

Influence of crestal and sub-crestal implant position on development of peri-implant diseases: a 5-year retrospective analysis.

OBJECTIVES: The aim of the present study was to evaluate the influence of crestal and subcrestal implant position on development of peri-implant diseases. MATERIALS AND METHODS: The study was designed as a retrospective clinical and radiographic analysis. Implant-supported fixed dental prostheses were allocated in two groups: with the shoulder (i) placed in sub-crestal level and (ii) placed at bone level. For each patient, the following clinical variables were assessed: FMPS, FMBS, PlI, BOP, and PD. After prothesis delivery, an intraoral radiograph was obtained; this exam was performed also at 5 years of observation period. RESULTS: No statistically significant difference was found in terms of FMPS and FMBS at baseline and after 5 years follow-up (P < 0.05). A statistically significant difference was assessed between PD of control group and test group (P = 0.042). Patient-based analysis showed a 25.6% of peri-implant mucositis and 32.6% of peri-implantitis for implants placed with the shoulder in crestal position, while for implants inserted in sub-crestal position the percentage of peri-implant-mucositis and peri-implantitis were 19%; no statistically significant difference was found between groups after 5 years (P < 0.05). CONCLUSIONS: Within the limitation of the present study, the clinical and radiographic outcomes showed that the percentage of peri-implant mucositis and peri-implantitis was not statistically significant for both groups after 5 years follow-up. CLINICAL RELEVANCE: The outcomes of present study clinically demonstrated that a deep position of implant shoulder did not provide any benefits. On the contrary, it may be considered a possible risk indicator for implant diseases.

The use of self-report questionnaires in an analysis of the multidimensional aspects of pain and a correlation with the psychological profile and quality of life in patients with burning mouth syndrome: A case-control study.

BACKGROUND: The symptomatology in Burning Mouth Syndrome (BMS) is complex and it should be considered in accordance with a biopsychosocial model. OBJECTIVES: To evaluate the multidimensional aspects of pain with a complete battery of tests and to analyse its relationship with potential predictors such as mood disorders, sleep and quality of life. METHODS: Forty patients with BMS versus an equal number of age and sex-matched healthy controls were enrolled. The VAS, SF-MPQ, BPI, PD-Q, BDI-II, STAI, PSQI, ESS, SF-36 and OHIP-14 were administered. RESULTS: The scores of the VAS, SF-MPQ, BPI, PD-Q, BDI-II, STAI, PSQI, SF-36 and OHIP-14 were statistically significantly higher in the BMS patients than the controls (p < .001**). A strongly linear correlation between pain (VAS, SF-MPQ, BPI and PD-Q) and disease onset (STAI, BDI-II, PSQI and sub-items of SF-36 and OHIP-14) was found. In the multiple regression analysis, the contributions of the BDI-II and OHIP-14 were found to be statistically significant with the SF-MPQ, PD-Q and BPI in terms of severity and interference, while the contributions of the STAI and sleep were found to be statistically significant with the SF-MPQ and BPI in terms of severity and interference, respectively. CONCLUSIONS: Pain tests are differently correlated with mood and quality of life. Therefore, a complete analysis of the patient requires several tools to better understand the multidimensional aspects of pain in BMS.

The role of cognitive and non-cognitive factors in dental anxiety: A mediation model.

Dental anxiety is a crucial problem for dentistry because it may represent a significant risk to oral health. Different factors, whether non-cognitive (e.g., traumatic dental events) or cognitive (e.g., the patient's subjective perceptions), may cause dental anxiety. However, previous studies have assessed these factors as independent predictors of dental anxiety, without providing any exploration of potential mediational pathways. The current study assessed the role of certain cognitive dimensions (i.e., the dentist's perceived professionalism and communicational attitudes, and the patient's perceived lack of control) as mediators between traumatic dental events and dental anxiety. The sample comprised 253 patients who had accessed a public university hospital dental surgery. The mediation analysis used a structural equation modeling. Traumatic dental events were positively associated with dental anxiety but, among the cognitive factors, only lack of control was. Furthermore, lack of control mediated the relationship between traumatic dental events and dental anxiety, although this mediation was only partial. This study sheds light on the mechanisms through which non-cognitive and cognitive factors may affect dental anxiety. The clinical implications for dental practice, in terms of improving the psychological well-being of patients, are discussed.

Assessment of oral health-related quality of life, measured by OHIP-14 and GOHAI, and psychological profiling in burning mouth syndrome: A case-control clinical study.

OBJECTIVES: To evaluate the oral health-related quality of life (OHRQoL) of patients with burning mouth syndrome (BMS) by comparing the Oral Health Impact Profile-14 (OHIP-14) and Geriatric Oral Health Assessment Index (GOHAI) tests, assessing their dependence with pain, anxiety and depression and, secondly, to analyse the changes in time after treatment with psychotropic drugs. METHODS: Twenty-six patients and 26 controls were included. The GOHAI, OHIP-14, visual analogue scale (VAS) and the Hamilton Rating Scales for Depression and Anxiety (HAM-D and HAM-A) were performed at baseline (time 0) and after 6 months of treatment (time 1). Descriptive statistics, the Mann-Whitney non-parametric test for two independent samples and the Wilcoxon non-parametric test for two paired samples were used. RESULTS: The scores from all outcome measurements were statistically significantly different between the cases and controls (P < .001) with a strong correlation between the GOHAI and the OHIP-14 (P < .001). The BMS patients showed a statistically significant improvement in the VAS, HAM-D and HAM-A scores from time 0 to time 1 (P < 0.001), and in the OHIP-14 scores (P < .004**) after the treatment, but no statistically significant difference in the GOHAI score (.464). CONCLUSIONS: Burning mouth syndrome patients showed poorer scores on all scales compared to the healthy subjects with a lower OHRQoL. OHIP-14 gives a greater weight to psychological and behavioural outcomes in evaluating oral health than GOHAI, and therefore, it is a more effective questionnaire in terms of the evaluation of the treatment response. The management of BMS can improve pain, anxiety and depression and the OHRQoL.

Prosthetic Rehabilitation of the Posterior Atrophic Maxilla, Short (≤6 mm) or Long (≥10 mm) Dental Implants? A Systematic Review, Meta-analysis, and Trial Sequential Analysis: Naples Consensus Report Working Group A.

PURPOSE: To compare the clinical and patient-reported outcomes of ≤6-mm implants with those of ≥10-mm implants placed after both lateral and transcrestal sinus floor elevation. MATERIALS AND METHODS: Using PubMed (MEDLINE), EMBASE, and Cochrane, a literature search for randomized controlled trials was performed. All the outcome variables were evaluated through a quantitative meta-analysis, and the influence of other clinical covariates were determined with a metaregression. For the survival outcomes, trial sequential analysis (TSA) was performed to adjust results for type I and II errors and to analyze the power of the available evidence. RESULTS: After full-text reading, 12 studies were included in the analyses. No statistically significant difference was found after 3 years between the 2 study groups (P = 0.36). Short implants displayed fewer biological complications (P = 0.05), less marginal bone loss (MBL) from implant placement (P < 0.01), and reduced surgical time and treatment cost. However, long implants showed a statistically significant smaller number of prosthetic complications (P = 0.03). TSA confirmed the results of the meta-analysis, revealing that additional studies are needed due to low statistical power of the available evidence. CONCLUSION: The placement of short implants is a predictable option in treating patients with maxillary atrophy up to a 3-year follow-up. Studies with a longer observational period are needed to study the long-term performance of these implants.

Periodontal care as a fundamental step for an active and healthy ageing.

In the industrialized part of the world, an increasing number of people live the old age without too many restrictions due to illness or physiological impairment. This group is known as the young elderly. On the contrary, a consistent part of seniors develops a greater number of medical conditions and become more and more dependent, these are the old elderly. The first cause of tooth lost in industrialized word is periodontitis that generally strikes people older than 40 years and determines serious detriment of the stomatognatic organ. Smoking and stress are risk factors for periodontitis that are common and shared between young, adult, and older age. Diabetes mellitus, obesity, and osteoporosis are very frequent pathological situations in older age. They have been identified as cofactors in the progression of periodontitis. Many dental associations recognize the importance of continued research on oral fluids diagnostics and welcome the development of rapid point-of-care tests providing accurate measurements of clinically validated biomarkers. At present, well-studied molecules associated with host response factors and with derived tissue destruction mediators have been proposed as diagnostic biomarkers for periodontitis detected in the oral fluids.

Soft and hard tissues healing at immediate transmucosal implants placed into molar extraction sites with collagen membrane uncovered: a 12-month prospective study.

PURPOSE: To assess soft and hard tissues healing at immediate transmucosal implants placed into maxillary molar region with collagen membranes uncovered. MATERIALS AND METHODS: Twenty subjects received 20 immediate transmucosal implants placed in maxillary molar extraction sockets. Periimplant marginal defects were treated according to the principles of guided bone regeneration by means of deproteinized bovine bone mineral particles in conjunction with collagen membrane. Flaps were repositioned and sutured, allowing nonsubmerged, transmucosal soft tissues healing. The collagen membranes adapted around implant neck were uncovered. RESULTS: No implants were lost during the 1-year observation period yielding a survival rate of 100%. No postsurgical wound healing complications were observed. No degranulation of grafting material was reported. CONCLUSIONS: The results of this 12-month prospective study showed that the exposure of collagen membrane at time of the flap suturing does not represent a limitation for the soft and hard tissues healing at immediate transmucosal implants placed into maxillary molar extraction sites.

Unlocking the Potential of Dental-Derived Mesenchymal Stem Cells in Regenerative Medicine.

Over the past few decades, life expectancy has been increasing in several countries [...].

Local delivery of the hemostatic agent tranexamic acid in chronically anticoagulated patients.

In oral surgery, the management of patients on anticoagulant therapy is still challenging because of the risks of uncontrolled bleeding and, if the therapy is discontinued, the possibility of undesired thromboembolic complications. The use of local hemostatic agents may be a viable alternative to overcome these issues. Along these lines, the aim of this work was to evaluate the use of newly developed swelling matrices loaded with tranexanic acid in preventing postextractive bleeding in patients with no modification of oral anticoagulant therapy. The matrices are made up of cellulose and are able to fit the tridimensional postextractive alveolar cavity, thus assuring also a mechanical contribution to homeostasis. The potential of this new therapeutic approach in reducing hospitalization, removing the risk of infections, and lowering the number of hemorrhagic complications was demonstrated.

Implant mandibular rehabilitation postoncologic segmental resection: a clinical report.

In cases of reconstruction of a discontinuity defect of the mandible, the surgeon has a major responsibility to maximize function as well as cosmetics and to preserve quality of life, restoring mastication, speech, and appearance. Treatment of mandibular discontinuity defects is a complex process and, among other methods, includes the use of free vascularized flaps. A variety of donor sites have been used for this purpose, including the iliac crest, radius, scapula, and fibula.At this time, the iliac crest free flap represents a versatile reconstruction method after mandibular ablation. This article reports a clinical case using the iliac crest free flap for comprehensive reconstruction of discontinuity defects in the mandible after resections of an aggressive odontogenic tumor. The immediate implant positioning reduced the number of surgical procedures and the rehabilitation time.

Effectiveness of surgical procedures in the acceleration of orthodontic tooth movement: Findings from systematic reviews and meta-analyses.

The current overview aimed to summarise the findings provided by systematic reviews (SRs) on the effect of surgical procedures in the acceleration of tooth movement and to assess the methodological quality of the included SRs. Three electronic databases have been explored. SRs addressing the effects of surgical procedures on the acceleration of tooth movement were included. The methodological quality of the included SRs was assessed using the updated version of "A Measurement Tool to Assess Systematic Review" (AMSTAR-2). Twenty-eight (28) SRs were included. The methodological quality of the included reviews ranged between critically low (6 studies) and high (12 studies). The most common critical weakness in the included reviews was the absence of clearly a-prior established review methods and any significant deviations from the protocol. The most studied surgical procedure was corticotomy, followed by micro-osteoperforation, piezocision and periodontally accelerated osteogenic orthodontics. The majority of the included SRs supported short-term favourable effects of corticotomy on treatment time and tooth movement rate, in the short-term. However, the authors of the included SRs reported that results were based on weak quality evidence. Conflicting results arise from the existent SRs with regards to the effectiveness of piezocision and micro-osteoperforation. Few SRs summarised complications and side effects of surgical techniques, supporting absence of loss of tooth vitality, periodontal problems, or severe root resorption. The current overview of SRs highlighted the need of high quality SRs comparing different surgical approaches for tooth movement acceleration though network meta-analysis, in order to determine the most efficient instrument for orthodontic movement acceleration.

Influence of the Antithrombotic Therapy in the Healing of Simple Post-Extraction Sockets: A Randomized Clinical Trial.

Background: An adequate blood supply plays a leading role in the healing process of the post-extractive socket; its coagulation leads to fibrin clot formation, which acts as a physical barrier able to prevent postoperative bleeding and microbial infection. The purpose of this study was to evaluate the effectiveness of antiaggregant drugs in healing post-extraction sockets compared to natural wound healing. Methods: This was a single-center prospective clinical trial. Extraction sockets allocated in healthy patients and in patients assuming antiplatelet drugs were considered. Thirty consecutive patients under (treated with/in treatment with) oral antiplatelet treatment were enrolled in the test group. In order to provide a control group, 30 consecutive patients meeting all the exclusion and inclusion criteria were enrolled. The extraction of the mono-radicular tooth was atraumatically performed without gingivoplasty or osteotomy procedures that could influence the healing process. Photographs were obtained before and immediately after surgery and at 3-, 7-, 14- and 28-days follow-up. Results: All patients assumed the prescribed therapy and their post-operative recovery was uneventful without any kind of post-extractive complications. The results of inter-group comparison show that on the third and seventh days of follow-up, the antiplatelet group expressed a statistically significant higher level of healing compared to the control group (p < 0.05), while no statistically significant differences were recorded at 14- and 28-days follow-up. Conclusions: Patients treated with antiplatelet agents seemed to show that this therapy can positively affect the healing process after tooth extractions.

The effect of the COVID-19 outbreak on the periodontal status of patients with periodontitis in supportive therapy: a retrospective study.

OBJECTIVE: The aim of this study was to assess the impact of lockdown due to the coronavirus COVID-19 pandemic on the periodontal status of patients with periodontitis in supportive periodontal therapy. METHOD AND MATERIALS: A retrospective analysis of patients affected by periodontitis stage III-IV-grade A, B, and C, who had their supportive periodontal therapy to September 2020, after a period of 6 months from the planned maintenance recall (March 2020) was performed. Clinical parameters full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), and probing depth (PD) were evaluated. Patients were assigned to three groups: A (nonsmokers); B (< 10 cigarettes/day); and C (> 10 cigarettes/day). Statistical analysis was used to compare intra-group and inter-group differences. RESULTS: In total, 55 subjects with the mean age of 47.7 ± 7.0 years were enrolled. The number of participants in group A and group B decreased, respectively, from 25 (45.5%) to 20 (36.4%) and from 17 (30.9%) to 13 (23.6%). The C group increased from 13 (23.6%) to 22 (40.0%). A statistically significant increase in mean FMPS was recorded in group A (from 22.5 ± 3.5 to 30.0 ± 28.3; P < .0001); group B (from 22.5 ± 12.7 to 42.5 ± 3.5; P < .0001); and group C (from 22.5 ± 25.5 to 42.5 ± 10.6; P < .0001). A statistically significant increase in mean FMBS was recorded in group A (from 15.0 ± 7.1 to 25.0 ± 21.2; P < .0001); group B (from 15.0 ± 0.0 to 37.5 ± 3.5; P < .001); and group C (from 12.5 ± 3.5 to 30.0 ± 7.1; P < .0001). A statistically significant increase in mean PD was recorded in group A (from 4.48 ± 0.5 to 5.25 ± 1.2; P < .001); in group B (from 4.71 ± 0.7 to 5.38 ± 1.31; P < .0001); and group C (from 6.00 ± 0.0 to 7.09 ± 1.1; P < .0001). CONCLUSIONS: Within the limitations of this study the results showed that the pandemic period resulted in an increase in probing depth for the patients in regular SPT, possibly due to increased tobacco consumption.

Narrow-diameter versus standard-diameter implants placed in horizontally regenerated bone in the rehabilitation of partially and completely edentulous patients: A systematic review.

PURPOSE: The present systematic review and meta-analysis aimed to investigate the available evidence in the literature to answer the following focused question: In partially edentulous arches with reduced bone width, do implants placed after horizontal bone augmentation exhibit differences in survival and success rate compared to narrow-diameter implants placed in native bone? MATERIALS AND METHODS: A population, intervention, comparison and outcome question was defined and an electronic search was conducted using the MEDLINE (via PubMed) and Cochrane Oral Health Group databases to identify all studies analysing the use of standard-diameter implants inserted in regenerated bone or narrow-diameter implants for the rehabilitation of partially or completely edentulous atrophic maxillae and mandibles. Inclusion criteria and quality assessments were established, and studies were selected on this basis. RESULTS: Twenty-four studies met the inclusion criteria and were analysed cumulatively. A comparative meta-analysis was not possible due to the lack of studies directly comparing the two rehabilitation methods in question. A cumulative implant survival rate of 97.80% (1246/1274; pooled proportion 0.984, 95% confidence interval 0.977-0.991) was reported for the narrow implants placed in atrophic ridges, while similar results were obtained for the standard-diameter implants placed in regenerated bone, with a cumulative implant survival rate of 97.94% (1332/1360; pooled proportion 0.983, 95% confidence interval 0.976-0.990). CONCLUSIONS: The present systematic review found high and comparable survival rates between narrow- and standard-diameter implants placed in regenerated bone; however, well-designed randomised controlled trials are required to support the hypothesis that both treatment strategies are successful in comparable circumstances.

Implant therapy in irradiated patients.

In this multicenter study, submerged implants were prospectively followed to evaluate their long-term prognosis in irradiated patients. In a total of 77 patients treated for oral or neck cancer, 188 implants were consecutively placed. After a healing period, the successfully integrated implants were restored with 69 removable and 38 fixed restorations. The implants cumulative survival and success rates were evaluated over a period of at least 36 months. In addition, cumulative success rates were calculated for implant subgroups divided per implant site (mandible or maxilla), radiation dosage, and the time interval between the last irradiation and implant placement. During the healing period, 20 implants did not successfully integrate, whereas 168 implants were classified as success (including both survival and success rates). The analysis of implant subgroups showed slightly more favorable cumulative success rate for mandibular implants (98.4%) compared with maxillary implants (57.1%) and clearly better success rate for a radiation dosage minor of 50-Gy doses. A time greater than 12 months as interval between last irradiation and implant placement seems not to promote better clinical results.

Alternative transoral approach for intranasal tooth extraction.

Intranasal ectopic eruption is an uncommon condition. Even if an intranasal tooth can be completely asymptomatic, sometimes a variety of nasal signs and symptoms may be associated, ranging from mild nasal congestion to recurrent epistaxis and purulent rhinorrhea. As a consequence, surgical removal is often required. Endoscopic extraction of the intranasal tooth has been reported to present several advantages with respect to traditional surgical approaches and thus recommended as routine treatment in such cases. However, when a tooth is impacted next to the nasal floor, an alternative approach could be needed. We suggest an alternative transoral approach to perform extraction of intranasal teeth, aimed at avoiding excessive bone removal to reach the nasal floor area and preventing the complications related to traditional intraoral buccal or palatal approach. It could represent a reliable alternative to traditional removal in the Oral Surgery Department.

Effect of Implant Surface Roughness and Macro- and Micro-Structural Composition on Wear and Metal Particles Released.

BACKGROUND: Considerations about implant surface wear and metal particles released during implant placement have been reported. However, little is known about implant surface macro- and microstructural components, which can influence these events. The aim of this research was to investigate accurately the surface morphology and chemical composition of commercially available dental implants, by means of multivariate and multidimensional statistical analysis, in order to predict their effect on wear onset and particle release during implant placement. METHODS: The implant surface characterization (roughness, texture) was carried out through Confocal Microscopy and SEM-EDS analysis; the quantitative surface quality variables (amplitude and hybrid roughness parameters) were statistically analyzed through post hoc Bonferroni's test for pair comparisons. RESULTS: The parameters used by discriminant analysis evidenced several differences in terms of implant surface roughness between the examined fixtures. In relation to the observed surface quality, some of the investigated implants showed the presence of residuals due to the industrial surface treatments. CONCLUSIONS: Many structural components of the dental implant surface can influence the wear onset and particles released during the implant placement.

Predictive Periodontitis: The Most Promising Salivary Biomarkers for Early Diagnosis of Periodontitis.

The primary cause of tooth loss in the industrialized world is periodontitis, a bacterial anaerobic infection whose pathogenesis is characterized by composite immune response. At present, the diagnose of periodontitis is made by a complete status check of the patient's periodontal health; full-mouth plaque score, full-mouth bleeding score, probing depth, clinical attachment level, bleeding on probing, recessions, mobility, and migration are evaluated in order to provides a clear picture of the periodontal conditions of a single patient. Chair-side diagnostic tests based on whole saliva could be routinely used by periodontists for a very early diagnosis of periodontitis, monitoring, prognosis, and management of periodontal patients by biomarker detection, whose diagnostic validity is related to sensitivity and specificity. Recent paper reviews and meta-analyses have focused on five promising host derived biomarkers as candidate for early diagnosis of periodontitis: MMP-8 (Metalloproteinase-8), MIP-1α (Macrophage inflammatory protein-1 alpha), IL-1 ß (Interleukin-1 beta), IL-6 (Interleukin-6), and HB (Hemoglobin), and their combinations. Chair-side Lab-on-a-chip (LOC) technology may soon become an important part of efforts to detect such biomarkers in saliva medium to improve worldwide periodontal health in developed nations as well as in underserved communities and poor countries. Their applications in preventive and predictive medicine is now fundamental, and is aimed at the early detection of risk factors or the presence or evolution of the disease, and in personalized medicine, which aims to identify tailor-made treatments for individual patients. The aim of the present paper is to be informative about host derived periodontal biomarkers and, in particular, we intend to report information about the most important immune response derived biomarkers and Hemoglobin as candidates to be routinely utilized in order to obtain a chair-side early diagnosis of periodontal disease.