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.

The effects of surgical preparation techniques and implant macro-geometry on primary stability: An in vitro study.

BACKGROUND: The attainment of a good primary stability is a necessary condition to ensure the success of osseointegration in implantology. In type IV cancellous bone, however, it is possible that a reduced primary stability can lead to an increased rate of failure. The aim of this study was therefore to determine, with the help of the resonance frequency (Osstell mentor), which technique of implant site preparation (piezo surgery, conventional, under-preparation, bone compaction, osteodistraction) and macro-geometry is able to improve implant stability in type IV cancellous bone. MATERIAL AND METHODS: 10 pig ribs were prepared with a surgical pre-drilled guide, calibrated for a correct implant positioning. On each rib, 5 implant sites (one for each technique) were prepared. Successively, 50 conical implants (Tekka Global D) were inserted and measured with the resonance frequency to evaluate the primary stability. Data collected were analyzed by analysis of variance (ANOVA) to test whether the Implant Stability Quotient (ISQ) values of the five techniques were significantly different. RESULTS: The results showed that no significant differences among the ISQ values of the five techniques used were found. Also, no significant differences in the macro-geometry of the two types of compared implants were observed. However, the macro-geometry of Tekka implants, characterized by a double condensing thread, seems to provide greater ISQ values than those of single thread implants when using the same technique. CONCLUSIONS: In light of these preliminary data, it is conceivable that in cases of reduced stability, such as those occurring with a type IV bone, all means ameliorating the primary stability and accelerating the osseointegration can be utilized.

DENTAL PULP STEM CELLS AND HUMAN PERIAPICAL CYST MESENCHYMAL STEM CELLS IN BONE TISSUE REGENERATION: COMPARISON OF BASAL AND OSTEOGENIC DIFFERENTIATED GENE EXPRESSION OF A NEWLY DISCOVERED MESENCHYMAL STEM CELL LINEAGE.

Bone regeneration is an interesting field of biomedicine. The most recent studies are aimed to achieve a bone regeneration using mesenchymal stem cells (MSCs) taken from more accessible sites: oral and dental tissues have been widely investigated as a rich accessible source of MSCs. Dental Pulp Stem Cells (DPSCs) and human Periapical Cysts Mesenchymal Stem Cells (hPCy-MSCs) represent the new generation MSCs. The aim of this study is to compare the gene expression of these two innovative cell types to highlight the advantages of their use in bone regeneration. The harvesting, culturing and differentiating of cells isolated from dental pulp as well as from periapical cystic tissue were carried out as described in previously published reports. qRT-PCR analyses were performed on osteogenic genes in undifferentiated and osteogenic differentiated cells of DPSC and hPCy-MSC lineage. Real-time RT-PCR data suggested that both DPSCs and hPCy-MSCs cultured in osteogenic media are able to differentiate into osteoblast/odontoblast-like cells: however, some differences indicated that DPSCs seem to be directed more towards dentinogenesis, while hPCy-MSCs seem to be directed more towards osteogenesis.

Behaviour of dental pulp stem cells on different types of innovative mesoporous and nanoporous silicon scaffolds with different functionalizations of the surfaces.

Dental pulp stem cells (DPSCs) are stem cells found in the dental pulp. The ability of DPSCs to differentiate towards odontoblastic and osteoblastic phenotype was reported first in the literature, then in the following years, numerous studies on odontogenesis were carried out, starting from mesenchymal stem cells isolated from tissues of dental and oral origin. The aim of this research was to evaluate the behaviour of DPSCs grown on silicon nanoporous and mesoporous matrices and differentiated towards the osteogenic phenotype, but also to investigate the use of DPSCs in pilot studies focused on the biological compatibility of innovative dental biomaterials. Twenty-eight silicon samples were created with standardized procedures. These scaffolds were divided into samples made of silicon bulk, nanoporous silicon, mesoporous silicon, nanoporous silicon functionalized with (3-Aminopropyl) Trimethoxysilane (APTMS) and methanol (MeOH), nanoporous silicon functionalized with (3-Aminopropyl) Trimethoxysilane (APTMS)/toluene, mesoporous silicon functionalized with (3-Aminopropyl) Trimethoxysilane (APTMS) and methanol (MeOH) andmesoporous silicon functionalized with (3-Aminopropyl) Trimethoxysilane (APTMS)/toluene. DPSC proliferation on the tested silicon scaffolds was analyzed at 3 and 5 days. The assay showed that DPSCs proliferated better on mesoporous scaffolds functionalized with APTMS/toluene compared to a silicon one. These results show that the functionalization of silicon scaffold with APTMS/toluene supports the growth of DPSCs and could be used for future applications in tissue engineering.

A new aid in temporomandibular joint disorders' therapy: the universal neuromuscular immediate relaxing appliance.

Among the various treatment options currently indicated to deal with temporomandibular joint disorders (TMD) an important role is played by occlusal devices, which can be used in an individualized or universal manner. A new universal occlusal appliance device was designed and patented at the Clinical Gnathology Service of the Sapienza University of Rome. To assess its validity and efficacy a preliminary study on a sample of 50 patients was carried out. Patients were selected from a cohort of 158 according to the RDC-TMD (SPEC) criteria and randomly assigned to two groups, the patient group (PG), treated with the device, and a control group (CG) without any treatment. The two groups were evaluated by comparing four VAS pain scores: muscular, migraine, cervical and temporomandibular joint (TMJ). On the whole, all VAS pain scores in the PG showed a marked and statistically significant improvement after treatment, decreasing to about 50-80 percent, while the control group remained stable. The best improvement was achieved in muscular pain. Age did not affect neither the initial scores, nor the pain response to the treatment. The pain scores tended to slightly increase with time of application (one, two or three months), but this trend was significant only for cervical pain. Overall the results are favourable to the application of this new occlusion device. However, the data should be considered preliminary and require further verification in time and on a higher sample of patients of both sexes.

Use of electrical field for biofilm implant removal.

OBJECTIVE: New methods for biofilm removal are being investigated. A recent new one involves the use of the electric field for biofilm removal. In particular, electrolytic cleaning works on the adhesion forces of the biofilm on the surfaces, with few studies showing promising results in decontamination and implant re-integration in the bone. This study aims at assessing the effect of a new decontamination device that implies the electric field for implant-biofilm removal. MATERIALS AND METHODS: Three implants affected by peri-implantitis were selected for the study. After the treatment, the implants were observed by the Scanning Electron Microscopy. RESULTS: All three samples showed no microbial biofilm in the application area, while the rest of the surface observed was covered with microbial biofilm, with an intensely thickened bacterial population. CONCLUSIONS: Peri-mucositis and peri-implantitis prevention and early treatments are essential for implant maintenance, thus saving the surrounding hard and soft tissues. The technological innovation is providing electrolytic devices which act not only on the microbial population but on the biofilm adhesion to the implant surface, with promising results for a new and valid therapeutic option.

Microleakage and mechanical behavior of conical vs. internal hexagon implant-abutment connection under a cyclic load fatigue test.

OBJECTIVE: The aim of the present investigation was to evaluate, by an in vitro simulation, the mechanical behavior of the conical vs. internal hexagon under cyclic load and the microleakage of the prosthetic connection of the fixture. MATERIALS AND METHODS: A standardized cyclic loading was performed considering the implant with conical connection (diameter 4 mm - length 10 mm) (CS) and internal hexagon connection (diameter 4 mm - length 10 mm) (IH). The toluidine blue infiltration has been evaluated with the paper cone test. RESULTS: After a total of 5x104 loads, the screw has been removed and the abutment appears solid and stable to the implant fixture for CS, while the IH was unstable. There was no infiltration of the toluidine marker in the connection interfaces of CS implants, while the IH was positive to the paper cone test. CONCLUSIONS: The study data showed that the conical connection showed higher stability compared to the internal hexagon connection under the loading and it is able to prevent bacterial microleakage. This effectiveness should be considered for the long-term maintenance of the peri-implant soft and hard tissues around the fixture.

Topical hemostatic agents in oral surgery: a narrative review.

Sufficient hemostasis during oral surgical procedures is crucial for successful outcomes and to reduce healthcare resource utilization. The purpose of this narrative review is to give a rational insight into the management of bleeding in oral and dental practice through modern drugs. A narrative literature review has been performed on the present topic identifying all articles on Pubmed/Medline and Google Scholars. Acceptable hemostasis during oral surgery is also required to improve visibility and provide a dry operational area. Many oral surgeons, in their daily practice, encounter problems in controlling postoperative bleeding and use a topical hemostatic agent to promote platelet activation or aggregation to form a stable clot.

Wettability of mg-ha/Chitosan-based membrane surfaces: blood vs. autologous platelet liquid (APL).

OBJECTIVE: The physical and physical chemistry is able to influence the interaction of the scaffolds and bone substitutes with the body fluid and blood. The aim of the present investigation was to evaluate the wettability properties of an Mg-HA Chitosan-based Gel with blood vs. autologous platelet gel. MATERIALS AND METHODS: A total of 6 study groups were evaluated according to the Mg-HA Chitosan-based Gel thickness (1, 2 and 3 mm) and the fluids (blood vs. autologous platelet gel). The biomaterial wettability was conducted through the sessile drop technique. RESULTS: The study findings showed a significant difference in contact angle between the APL and blood groups (p<0.05). The MG-Ha Chitosan-based membrane thicknesses seem to produce no significant effects on contact angles measurement for all groups (p>0.05). CONCLUSIONS: In the present investigation, a similar MG/Ha gel membranes wettability was reported between APL and blood groups. In addition, a high hydrophilicity of MG/Ha gel membranes was reported with a potential advantage in terms of a more effective osteogenic capability in the clinical practice.

Subjects with temporomandibular joint disc displacement and body posture assessment via rasterstereography: a pilot case-control study.

OBJECTIVE: The possible relationship between temporomandibular disorders (TMDs) and body posture is still controversial. Rasterstereography has been introduced as a radiation-free, reliable and non-invasive method to analyze three-dimensional spinal posture. The aim of this case-control study is to evaluate, through rasterstereography, body posture parameters in a group of patients with reducible unilateral dislocation of the articular disc, compared to healthy volunteers. PATIENTS AND METHODS: Rasterstereographic recordings obtained were compared between the two groups with a paired t-student test. Furthermore, the relationship between Rasterstereographic recordings and clinical data in the TMD group were analyzed by means of multiple regression analysis. RESULTS: Only lateral deviation was statistically significant different between the two groups (rms VPDM Control group 40% > TMD group, p=0.02; 43% control group VPDM max > TMD group, p<0.02). In the TMD group, a significant relationship (p<0.05) was found out between lateral and rotational deviations of the column and muscular pain, therefore suggesting a possible overactivity of the masticatory muscles, especially of lateral pterygoids' bilaterally and the left masseter. CONCLUSIONS: Patients with reducible unilateral disc displacement showed limited postural alterations compared to healthy volunteers, only lateral deviations (VPDM rms and VPDM-max) were statistically significant (Π<0.05) between the two groups.

"All on short" prosthetic-implant supported rehabilitations.

OBJECTIVES: Short implants are increasing their popularity among clinicians who want to fulfill the constant demanding of fixed prosthetic solutions in edentulous jaws. The aim of this report was to propose a new possibility to project and realize an occlusal guided implant cross-arch prosthesis supported by ultra-short implants, describing it presented an edentulous mandible case report. METHODS: A 61-year-old, Caucasian, female patient who attended the dental clinic of the University of L'Aquila presented with edentulous posterior inferior jaw and periodontitis and periimplantitis processes in the anterior mandible. The remaining tooth and the affected implant were removed. Six 4-mm-long implants were placed to support a cross-arch metal-resin prosthesis. RESULTS: At 1-year follow-up clinical and radiological assessment showed a good osseointegration of the fixtures and the patient was satisfied with the prosthesis solution. CONCLUSION: The method, even if it requires further validation, seems to be a valid aid in solving lower edentulous clinical cases, and appears less complex and with more indications of other proposals presented in the current clinical literature. Our case report differs from the current technique All-on-Four, which uses four implants in the mandible to support over-denture prosthesis, assuring a very promising clinical result.

Comparison between PRP, PRGF and PRF: lights and shadows in three similar but different protocols.

OBJECTIVE: The main goal of the modern surgery is to get a low invasiveness and a high rate of clinical healing: in the last years, it has been introduced the concept of a "regenerative surgery", and many techniques has been widely described in the literature. The most used are PRP, PRGF and PRF techniques. Aim of this research is to compare the three protocol of PRP, PRF and PRGF in their essential features, so to suggest to the practitioners the best blood product to use in the regenerative surgery. DISCUSSION AND CONCLUSIONS: Among the advantages that shows the PRF, compared to PRP and PRGF, we can cite a greater simplicity of production for the absence of manipulation that leads to a reduced possibility of alteration of the protocol due to an error of the operator. The special texture of the PRF and its biological features shows clearly an interesting surgical versatility and all the characteristics that can support a faster tissues regeneration and high-quality clinical outcomes.

Implant stability in different techniques of surgical sites preparation: an in vitro study.

OBJECTIVE: In the last few decades the implantology has achieved excellent results in the prosthetic rehabilitation of the partially or totally edentulous patients. The clinicians, given the pressing demand by patients, must deal with the situations in which the lack of the availability and sometimes the low quality of the bone can lead to the treatment failure. Although the manufacturers recommend to follow codified surgical protocols, alternative techniques of preparation, apt to ensure a better primary implant stability, have been developed. The aim of this study was to determine in vitro, by using the resonance frequency (Osstell mentor), which technique of implant site preparation (piezo surgery, conventional, under-preparation, bone compaction, osteodistraction) is able to improve implant stability of type IV cancellous bone. METHODS: 10 pig ribs were prepared, and a surgical pre-drilled and calibrated guide for proper implant placement was used. On each rib, 5 implant sites were prepared, one for each technique. RESULTS: One-way ANOVA did not show statistically significant differences among the "implant stability quotient" (ISQ) values of the 5 techniques utilized. CONCLUSIONS: Thus, in light of these results, in the clinical practice of the type IV bone one technique is replaceable with the others, as none of them improves implant stability. The choice should instead be directed to the technique that accelerates the healing process and the osseointegration.

A new aid in TMD Therapy: the Universal Neuromuscular Immediate Relaxing appliance "UNIRA".

Among the various treatment options currently indicated for the temporomandibular joint disorders (TMD) tackle an important role is played by occlusal devices which can be used in an individualized and or universal.At the Service of Clinical Gnathology of the Head-Neck Department of the Umberto I Polyclinic at the Sapienza University of Rome, has been tested a new universal occlusal appliance, invented and patented by dott. Rampello.To assess the applicability and efficacy was carried out a preliminary study on a sample of 50 patients selected according to the criteria RDC-TMD and divided in random into two groups, the patient group (PG), treated with the device, and a control group (CG) does not undergo any treatment.The two groups were evaluated according to an analysis of segmentation by comparing the clinical data. Were considered some aspects of the application of the device using a self-evaluation questionnaire administered to the PG.CONSIDERATIONS DERIVED FROM THIS INITIAL APPLICATION ARE: none of the 25 patients in the sample PG has worsened the initial situation. 6 patients (24%) were healed and were included in a protocol of regular six-monthly visits. 16 patients (64%) have improved and incorporated into treatment to complete the treatment cycle. 3 patients (12%) were stationary and subjected to a diagnostic reassessment.The patients in the CG have all been included in the multidisciplinary treatment program.The findings of our preliminary study are favorable to this new device occlusion, however, requires further verification in time and on a sample of patients numeroso.

Self bone graft and simultaneous application of implants in upper jawbone.

The implant supported rehabilitation of upper back sectors, sometimes, is conditioned to the pneumatization of the jawbone and so, reducing the possibility to apply the implants when the bone portion is inferior to 4 mm (important condition for the primary stability).The great rise of the jawbone and the simultaneous application of implants is, surely, the condition to have the best success guarantees compared to the only application of filling material.The surgical technologies used in the self bone grafts are various (Ilium crest, calvaria, fibula) and so also for implant applications.In this article we want to put in evidence a new technology in order to reduce at the minimum the invasive surgery of the removal and the patient morbidity.It has been executed a longitudinal study on 21 consecutive cases and illustrated by a clinical one; the success was of 94.5%. The advantages of this technique are: Functional and anatomical recovery of the jaw cavityImmediate application of implants with a thickness of remaining bone in fervor to 4 mm.Reduction of surgical timesReduced morbidity of the patientLocal an anesthesia.