Clinical and microbiological efficacy of indocyanine green-based antimicrobial photodynamic therapy as an adjunct to non-surgical treatment of periodontitis: a randomized controlled clinical trial.

OBJECTIVES: The aim of the present randomized clinical trial (RCT) with a parallel arm design was to evaluate the clinical and microbiological efficacy of repeated ICG-aPDT as an adjunct to full-mouth subgingival debridement in the treatment of periodontitis. MATERIALS AND METHODS: Twenty-four periodontitis patients were treated with full-mouth ultrasonic subgingival debridement (FMUD). Initial sites with probing depth (PD) > 4 mm were randomly assigned to receive the test (ICG-aPDT with an 810 nm diode laser) or the control treatment (off-mode aPDT) one and four weeks after FMUD. Clinical parameters were registered after 3 and 6 months. The presence of the main periodontal pathogens in subgingival samples was assessed with real-time PCR. RESULTS: Both treatment modalities resulted in significant clinical improvements at 3 and 6 months. The only significant differences in favour of the test group were found at 6 months for a higher PD reduction in initial deep pockets (PD ≥ 6 mm) and a higher percentage of closed pockets (PD ≤ 4 mm/no bleeding on probing). Limited microbiological changes were observed in both groups after treatment with no inter-group difference, except for a more significant reduction in Aggregatibacter actinomycetemcomitans and Parvimonas micra levels in the test group at 3 months. CONCLUSION: The combination of repeated ICG-aPDT and FMUD provided no benefits except for selective clinical and microbiological improvements compared to FMUD alone. CLINICAL RELEVANCE: Based on the obtained results, only limited adjunctive effects could be found for the combined use of ICG-aPDT and FMUD. Further, well-designed RCT with larger sample sizes are required to confirm these findings. TRIAL REGISTRATION: ClinicalTrials.gov NCT04671394.

Influence of abutment material and modifications on peri-implant soft-tissue attachment: A systematic review and meta-analysis of histological animal studies.

STATEMENT OF PROBLEM: How the properties of the implant-abutment unit may affect the peri-implant soft-tissue seal, whose stability is considered key to safeguarding the implant from bacterial contamination and preserve peri-implant health conditions, is unclear. PURPOSE: The purpose of this systematic review and meta-analysis of animal studies was to investigate whether material and surface properties of transmucosal implant components can influence the peri-implant soft-tissue adhesion at a histological level. MATERIAL AND METHODS: An electronic and hand search was conducted until August 2019. Histological animal studies comparing soft-tissue response to abutment or transmucosal collar with different materials and/or surface characteristics were selected by 2 independent reviewers. Risk of bias in individual studies was evaluated. Histomorphometric data on the dimension of the peri-implant attachment were recorded, and a quantitative synthesis by a meta-analysis was performed. Risk of bias in individual studies was evaluated in accordance with the Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias tool. RESULTS: Eighteen relevant studies out of 1187 were identified, none with a low risk of bias for all domains. Data from only 4 studies could be meta-analyzed. Comparable results in terms of peri-implant attachment dimensions between test and control groups were found, except for a significantly higher apical junctional epithelium to coronal bone to implant (ajE-CBI) distance for chemically modified acid-etched compared with titanium machined surfaces. Non-meta-analyzable and/or qualitative results highlighted some improved properties also for microgrooved and oxidized surfaces. CONCLUSIONS: Limited data from animal studies suggest that some characteristics of the transmucosal implant components may affect peri-implant soft-tissue adhesion and stabilization but do not allow definitive conclusions. Future research should improve study design to increase the availability of comparable and suitable data on this topic.

Periodontitis, Low-Grade Inflammation and Systemic Health: A Scoping Review.

Background and objectives: Periodontitis is a multifactorial chronic inflammatory infectious disease in which an infection is necessary, but not sufficient, for development of the condition. Individual susceptibility strictly linked to the immune and inflammatory response of the organism must also be present. Low-grade inflammation (LGI) is a systemic status of chronic sub-clinical production of inflammatory factors. This condition represents a risk factor for many chronic diseases including diabetes, cardiovascular disease, cerebrovascular disease, neurodegenerative disease and cancer. This scoping review aims to clarify, summarize and disseminate current knowledge on the possible link between periodontitis, LGI and systemic health. Materials and Methods: PRISMA Extension for Scoping Reviews guidelines were followed. An ad-hoc created keyword string was used to search the electronic databases of PubMed/Medline, Embase, The Cochrane Library and ClinicalTrials.gov. A hand search of specialized journals and their reference lists was also performed. Results: 14 studies that respected eligibility criteria were selected and analyzed. There is emerging evidence of strong links between periodontitis, LGI and systemic health. On the one hand, periodontitis influences the systemic status of LGI and on the other hand, the systemic production of inflammatory factors affects periodontitis with a bidirectional connection. Conclusions: LGI and the subsequent onset of a systemic inflammatory phenotype can be considered the common substrate of many chronic inflammatory diseases including periodontitis, with multiple mutual connections between them. Understanding of the biological principles and mechanisms underlying such a complex interrelationship could lead to significant improvements in the field of personalized diagnostics and therapeutic protocols.

The Role of Autologous Platelet Concentrates in Alveolar Socket Preservation: A Systematic Review.

Prevention of alveolar bone resorption after tooth extraction may be useful for implant rehabilitation of the edentulous site minimizing the future need for bone augmentation procedures. A number of studies have investigated the efficacy of autologous platelet concentrates for the preservation of the alveolar bone volume after tooth extraction. Although encouraging results have been published, the available data are still controversial. The aim of the present systematic review was to assess the effect of platelet concentrates on alveolar socket preservation after tooth extraction. A literature search was carried out up to September 2017 for prospective controlled trials in which a test group using exclusively a platelet concentrate was compared with a control group in which extraction sockets were left to heal spontaneously. Seven controlled clinical trials published between 2010 and 2016 were included. A total of 320 extractions (170 tests and 150 controls) in 190 patients was considered. A great heterogeneity was found in terms of study design, methodological aspects, and outcome evaluation. For this reason, a quantitative analysis followed by meta-analysis was not possible, and only a descriptive analysis on the role of platelet concentrates in alveolar socket preservation was carried out. There is growing evidence that platelet concentrates may be advantageously used in postextraction sites, mainly to improve soft tissue healing and to reduce postoperative symptoms. Data about their potential in preserving the alveolar bone volume are still scarce and controversial, although recently encouraging results have been presented using more reliable and accurate evaluation technologies, such as the computed tomography. Further, well-designed and methodologically standardized investigations are strongly demanded to reach a higher level of evidence on this topic.

The Use of Poly-d,l-lactic Acid (PDLLA) Devices for Bone Augmentation Techniques: A Systematic Review.

Poly-d,l-lactic acid (PDLLA) has been proposed in dentistry for regenerative procedures in the form of membranes, screws, and pins. The aim of this review was to evaluate the efficacy of bone augmentation techniques using PDLLA devices. A literature search was carried out by two independent and calibrated reviewers. All interventional and observational studies assessing the efficacy of bone augmentation techniques using PDLLA devices were included. Six studies were included. The relevant variability of design and methods impeded any qualitative or quantitative comparison. Ease of handling, absence of a re-entry phase, moldability of foils, and good soft-tissue response were appreciated characteristics of PDLLA devices. Some drawbacks such as the risk of membrane exposition, a prolonged adsorbability, and a tendency to a fibrous encapsulation of the PDLLA devices have been described, although the clinical significance of these findings is unclear. Clinical data about PDLLA devices for bone regeneration are very scarce and heterogenous. Well-designed randomized controlled trials comparing the use of PDLLA foils and pins with conventional membranes for bone regeneration are strongly encouraged in order to understand the real clinical benefits/drawbacks of this technique.

Bacterial inactivation/sterilization by argon plasma treatment on contaminated titanium implant surfaces: In vitro study.

BACKGROUND: Surface treatment by argon plasma is widely used as the last step of the manufacturing process of titanium implant fixtures before their sterilization by gamma rays. The possibility of using such a technology in the daily clinical practice is particularly fascinating. The aim of the present study was to assess the effects of the argon plasma treatment on different titanium implant surfaces previously exposed in vitro to bacterial contamination. MATERIAL AND METHODS: Sterile c.p. titanium implant discs with turned (T, Sa: 0.8µm), sandblasted/acid-etched (SAE, Sa: 1.3µm) and titanium plasma sprayed (TPS, Sa: 3.0µm) surface were used in this study. A strain of Aggregatibacter actinomycetemcomitans ATCC3718 was grown at 37°C under anaerobic conditions for 24 h and then transferred on six discs for each of the three surface types. After 24 hours, a half of the contaminated discs (control group) were directly used to evaluate the colony forming units (CFUs). The other half of the contaminated discs (test group) were treated in an argon plasma chamber for 12 minutes at room temperature prior to be analyzed for CFU counting. All assays were performed using triplicate samples of each material in 3 different experiments. RESULTS: When the CFU counting was carried out on control discs, a total of 1.50x106±1.4x105, 1.55x106±7.07x104 and 3.15x106±2.12x105 CFU was respectively assessed for T, SAE and TPS discs, without statistically significant differences among the three surfaces. On the contrary, any trace of bacterial contamination was assessed for titanium discs treated in the argon plasma chamber prior to be analyzed, irrespectively to the implant surface tested. CONCLUSIONS: Within the limit of this study, reported data suggested that the argon plasma technology could be efficiently used to decontaminate/sterilize previously infected titanium implant surfaces.

Poly-D-L-Lactic Acid Membranes for Bone Regeneration.

PURPOSE: To histologically and histomorphometrically evaluate the biocompatibility and the biological properties of perforated and nonperforated poly-D-L-lactic acid (PDLLA) resorbable membranes, using a model of calvarial monocortical bone defects in domestic pigs. METHODS: A total of 6 10 × 10 × 10  mm circular calvarial bone defects were prepared in each of the 3 adult female large white domestic pigs and assigned to the following experimental groups: negative control, nonperforated membrane only, perforated membrane only, bone only, bone + nonperforated membrane, and bone + perforated membrane. The PDLLA membranes were fixed by PDLLA pins by means of an ultrasonic device. After 40 days, bone blocks containing the defects were harvested and histologically processed. RESULTS: A close contact between the PDLLA devices and the surrounding bone was found, and no trace of inflammatory tissue or signs of infection were detected. Bone regeneration occurred from the preexisting bone with a centripetal pattern. Incomplete bone filling was found in empty defects, whereas all sites filled with bone showed a complete bone formation, irrespectively of the presence and the type of membrane used. CONCLUSION: PDLLA membranes and pins showed to be highly biocompatible toward bone tissue and to do not interfere with the bone healing process of monocortical calvaria defects in domestic pigs. No adjunctive effect of PDLLA membranes, irrespectively of their perforated/nonperforated structure, could be evidenced in terms of bone regeneration under the present experimental conditions. Further studies are needed to investigate the regenerative potential of such devices in other clinically relevant models.

Clinical Behavior of the Gingival Margin following Conservative "Coronally Dynamic" Restorations in the Presence of Non-Carious Cervical Lesions Associated with Gingival Recession: A Pilot Study.

Gingival recessions (GR) are often associated with the presence of non-carious cervical lesions (NCCL). The latter result in the disappearance of the cement-enamel junction (CEJ), with consequent difficulties both in measuring the recession itself and in performing root coverage techniques. The restoration of cervical lesions is consequently an important aspect in the treatment of GR, with the re-establishment of a "new" CEJ. This pilot study aimed to verify whether restorative therapy alone, with the execution of a restoration that mimics the convexity of the natural CEJ and thanks to a slight horizontal over-contour, can stabilize a clot in the intrasulcular site and consequently is able to change the position of the gingival margin in a coronal direction. In periodontally healthy patients, with a non-thin gingival phenotype, 10 GR-associated NCCL restorations were performed using a protocol inspired by concepts of prosthetic conditioning, with a progressively reduced convexity ("coronally dynamic restoration") and de-epithelialization of the gingival sulcus. We observed that 70% of the treated teeth showed a reduction in crown length after 15 days (-0.267 mm), without an increase in probing depth. While considering the limitations of the sample and the need to evaluate the different parameters that can affect the result, the coronally dynamic restoration of NCCL with GR was able to influence the position of the gingival margin in a coronal direction.

Aesthetic Outcomes and Peri-Implant Health of Angled Screw Retained Implant Restorations Compared with Cement Retained Crowns: Medium Term Follow-Up.

Single tooth implant restorations in the aesthetic area are a demanding challenge. If a complete osseointegration is mandatory, the final result has to result in a higher standard of biomimetic and soft tissue health among natural teeth. This outcome is traditionally pursued by cementing crowns over individualized abutments. However, in recent years, the need for controlling peri-implant health and the preference towards a retrievable solution has led to an increase in screw-retained crowns, which is not always applicable when the implant axis is not ideal. In the aesthetic area, the use of a novel technical solution represented by the angled screw channel (ASC) of the abutment has been proposed in order to match the advantages of the screwed solution with the aesthetic demands. The aim of this study was to compare ASC crowns to cemented crowns (CC) in single implant restorations using the white esthetic score (WES) and pink esthetic score (PES) at the crown delivery and at a follow-up of a minimum of 2 years. Peri-implant health and marginal bone loss (MBL) were also evaluated. The mean follow-up was 44.3 months, with a mean MBL of 0.22 mm in the ASC group and 0.29 mm in the CC group. The total WES/PES score was 16.6 for ASC, compared with 17.3 for CC at baseline, and 16.2 and 17.1, respectively, at follow-up. Both of the groups reached a high WES/PES, and this was maintained over time, without signs of peri-implant diseases or bone loss, regardless of the choice of connection. In conclusion, ASC can be adopted in cases where the implant axis is not ideal, with aesthetic and functional results that are comparable to implants restored by cemented crowns.

Selection of Collagen Membranes for Bone Regeneration: A Literature Review.

Several treatment modalities have been proposed to regenerate bone, including guided bone regeneration (GBR) where barrier membranes play an important role by isolating soft tissue and allowing bone to grow. Not all membranes biologically behave the same way, as they differ from their origin and structure, with reflections on their mechanical properties and on their clinical performance. Collagen membranes have been widely used in medicine and dentistry, because of their high biocompatibility and capability of promoting wound healing. Recently, collagen membranes have been applied in guided bone regeneration with comparable outcomes to non-resorbable membranes. Aim of this work is to provide a review on the main features, application, outcomes, and clinical employment of the different types of collagen membranes. Comparisons with non-resorbable membranes are clarified, characteristics of cross-linked collagen versus native collagen, use of different grafting materials and need for membrane fixation are explored in order to gain awareness of the indications and limits and to be able to choose the right membrane required by the clinical condition.

Do Dietary Supplements and Nutraceuticals Have Effects on Dental Implant Osseointegration? A Scoping Review.

Several factors affect dental implant osseointegration, including surgical issues, bone quality and quantity, and host-related factors, such as patients' nutritional status. Many micronutrients might play a key role in dental implant osseointegration by influencing some alveolar bone parameters, such as healing of the alveolus after tooth extraction. This scoping review aims to summarize the role of dietary supplements in optimizing osseointegration after implant insertion surgery. A technical expert panel (TEP) of 11 medical specialists with expertise in oral surgery, bone metabolism, nutrition, and orthopedic surgery performed the review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) model. The TEP identified micronutrients from the "European Union (EU) Register of nutrition and health claims made on foods" that have a relationship with bone and tooth health, and planned a PubMed search, selecting micronutrients previously identified as MeSH (Medical Subject Headings) terms and adding to each of them the words "dental implants" and "osseointegration". The TEP identified 19 studies concerning vitamin D, magnesium, resveratrol, vitamin C, a mixture of calcium, magnesium, zinc, and vitamin D, and synthetic bone mineral. However, several micronutrients are non-authorized by the "EU Register on nutrition and health claims" for improving bone and/or tooth health. Our scoping review suggests a limited role of nutraceuticals in promoting osseointegration of dental implants, although, in some cases, such as for vitamin D deficiency, there is a clear link among their deficit, reduced osseointegration, and early implant failure, thus requiring an adequate supplementation.

Enamel Matrix Derivative and Autogenous Bone Graft for Periodontal Regeneration of Intrabony Defects in Humans: A Systematic Review and Meta-Analysis.

The combination of enamel matrix derivative (EMD) with an autogenous bone graft in periodontal regeneration has been proposed to improve clinical outcomes, especially in case of deep non-contained periodontal defects, with variable results. The aim of the present systematic review and meta-analysis was to assess the efficacy of EMD in combination with autogenous bone graft compared with the use of EMD alone for the regeneration of periodontal intrabony defects. A literature search in PubMed and in the Cochrane Central Register of Controlled Trials was carried out on February 2019 using an ad-hoc search string created by two independent and calibrated reviewers. All randomized controlled trials (RCTs) comparing a combination of EMD and autogenous bone graft with EMD alone for the treatment of periodontal intrabony defects were included. Studies involving other graft materials were excluded. The requested follow-up was at least 6 months. There was no restriction on age or number of patients. Standard difference in means between test and control groups as well as relative forest plots were calculated for clinical attachment level gain (CALgain), probing depth reduction (PDred), and gingival recession increase (RECinc). Three RCTs reporting on 79 patients and 98 intrabony defects were selected for the analysis. Statistical heterogeneity was detected as significantly high in the analysis of PDred and RECinc (I2 = 85.28%, p = 0.001; I2 = 73.95%, p = 0.022, respectively), but not in the analysis of CALgain (I2 = 59.30%, p = 0.086). Standard difference in means (SDM) for CALgain between test and control groups amounted to -0.34 mm (95% CI -0.77 to 0.09; p = 0.12). SDM for PDred amounted to -0.43 mm (95% CI -0.86 to 0.01; p = 0.06). SDM for RECinc amounted to 0.12 mm (95% CI -0.30 to 0.55. p = 0.57). Within their limits, the obtained results indicate that the combination of enamel matrix derivative and autogenous bone graft may result in non-significant additional clinical improvements in terms of CALgain, PDred, and RECinc compared with those obtained with EMD alone. Several factors, including the surgical protocol used (e.g. supracrestal soft tissue preservation techniques) could have masked the potential additional benefit of the combined approach. Further well-designed randomized controlled trials, with well-defined selection criteria and operative protocols, are needed to draw more definite conclusions.

A New Controlled-Release Material Containing Metronidazole and Doxycycline for the Treatment of Periodontal and Peri-Implant Diseases: Formulation and In Vitro Testing.

BACKGROUND: Several locally administered antimicrobials have been studied in the literature as adjunctive or primary treatments for periodontitis and peri-implantitis with conflicting results. OBJECTIVE: The aim of this study was twofold: (1) the formulation of a controlled-release material containing metronidazole and doxycycline; (2) an in vitro evaluation of its antibacterial properties against planktonic and biofilm species involved in periodontal and peri-implant diseases. METHODS: Doxycycline (10 mg/ml) and metronidazole (20 mg/ml) were incorporated into a hydroxyethylcellulose-polyvinylpyrrolidone-calcium polycarbophil gel. Three milliliters of gel were dialyzed against Dulbecco's phosphate-buffered saline for 13 days. Antibiotics release at 3, 7, 10, and 13 days was determined spectroscopically. The inhibitory activity of the experimental gel was tested against A. actinomycetemcomitans, S. sanguinis, P. micra, and E. corrodens with an agar diffusion test, an inactivation biofilm test, and a confocal laser scanning microscope study (CLSMS) for S. sanguinis up to 20 days. RESULTS: After 13 days, the released doxycycline was 9.7% (at 3 days = 1.2 mg; 7 days = 0.67 mg; 10 days = 0.76 mg; 13 days = 0.29 mg), while metronidazole was 67% (30 mg, 6.8 mg, 2.5 mg, and 0.9 mg at the same intervals). The agar diffusion test highlights that the formulated gel was active against tested microorganisms up to 312 h. Quantitative analysis of biofilm formation for all strains and CLSMS for S. sanguinis showed a high growth reduction up to 13 days. CONCLUSIONS: The in vitro efficacy of the newly formulated gel was confirmed both on planktonic species and on bacterial biofilm over a period of 13 days. The controlled-release gel containing metronidazole and doxycycline had an optimal final viscosity and mucoadhesive properties. It can be argued that its employment could be useful for the treatment of periodontal and peri-implant diseases, where conventional therapy seems not successful.

Use of diode laser 980 nm as adjunctive therapy in the treatment of chronic periodontitis. A randomized controlled clinical trial.

The primary goal of periodontal therapy is the removal of supra and subgingival bacterial deposits by mechanical debridement consisting in scaling and root-planing (SRP) using manual or power-driven instruments. The complete removal of bacteria and their toxins from periodontal pockets is not always achieved with conventional mechanical treatment. The use of lasers as an adjunctive therapy for periodontal disease may improve tissue healing by bactericidal and detoxification effects. The aim of this study was to compare the effectiveness of Diode laser used as adjunctive therapy of SRP to that of SRP alone for non surgical periodontal treatment in patients with chronic periodontitis. Nineteen pairs of teeth with untreated chronic periodontitis were selected in 13 patients and randomly treated by SRP alone (control group) or by SRP + laser irradiation (test group). Clinical measurements (PPD, CAL, BOP, GI, PI) were performed before treatment at baseline (T0) and at T1 (after 4 weeks), T2 (8 weeks), T3 (12 weeks), T4 (6 months). Subgingival plaque samples were taken at baseline and after treatment and examined for 8 periopathogens bacteria using PCR technique. The present study showed that the additional treatment with diode laser may lead to a slightly improvement of clinical parameters, whereas no significant differences between test and control group in reduction of periodontopathogens were found.

Vitamin D modulatory effect on cytokines expression by human gingival fibroblasts and periodontal ligament cells.

BACKGROUND: It has been demonstrated that vitamin D exerts several functions other than those implied in the bone homeostasis. It has been published the vitamin D can act on many cells and tissues behaving also as a modulatory factor in the immune responses. The aim of our study was to evaluate the effect of active vitamin D3 (VD) on the expression of pro-inflammatory and anti-inflammatory cytokines (IL-6, IL-8, IL-10 and IL-12) in human gingival fibroblasts (hGF) and human periodontal ligament cells (hPDLc) triggered by Porphyromonas gingivalis and Streptococcus pyogenes. METHODS: Primary hGF and hPDLc pretreated or not by VD (10-8 mol/L) were exposed to P. gingivalis and S. pyogenes for 24 h. Production of IL-6, IL-8, IL-10 and IL-12 was evaluated by immunoenzymatic assay. mRNA of the same cytokines were evaluated by PCR. RESULTS: IL-6 secretion increased by 25.2% (±2.1) up to 51% (±3.3) in VD treated hGF and hPDLc exposed to P. gingivalis and S. pyogenes, compared to VD not treated cells. IL-8 secretion decreased approximately by 30% in VD-treated hGF and hPDLc compared to VD not-treated cells. IL-12 secretion decreased by 60%. On the contrary, anti-inflammatory cytokine IL-10 increased by approximately 200%. mRNA PCR confirmed these results. CONCLUSIONS: Within the limits of the study, the obtained results support the hypothesis of a modulatory role of VD on periodontal cells exposed to bacterial infection, reducing their inflammatory response and increasing the secretion of anti-inflammatory and modulatory cytokines. Consequently, it could be speculated that vitamin D assessment, and its possible implementation in deficiency cases, could play a role in periodontal treatment.

Vitamin D reduces the inflammatory response by Porphyromonas gingivalis infection by modulating human ß-defensin-3 in human gingival epithelium and periodontal ligament cells.

Periodontitis is a multifactorial polymicrobial infection characterized by a destructive inflammatory process. Porphyromonas gingivalis, a Gram-negative black-pigmented anaerobe, is a major pathogen in the initiation and progression of periodontitis; it produces several virulence factors that stimulate human gingival epithelium (HGE) cells and human periodontal ligament (HPL) cells to produce various inflammatory mediators. A variety of substances, such as vitamin D, have growth-inhibitory effects on some bacterial pathogens and have shown chemo-preventive and anti-inflammatory activity. We used a model with HGE and HPL cells infected with P. gingivalis to determine the influence of vitamin D on P. gingivalis growth and adhesion and the immunomodulatory effect on TNF-α, IL-8, IL-12 and human-ß-defensin 3 production. Our results demonstrated, firstly, the lack of any cytotoxic effect on the HGE and HPL cells when treated with vitamin D; in addition, vitamin D inhibited P. gingivalis adhesion and infectivity in HGE and HPL cells. Our study then showed that vitamin D reduced TNF-α, IL-8, IL-12 production in P. gingivalis-infected HGE and HPL cells. In contrast, a significant upregulation of the human-ß-defensin 3 expression in HGE and HPL cells induced by P. gingivalis was demonstrated. Our results indicate that vitamin D specifically enhances the production of the human-ß-defensin 3 antimicrobial peptide and exerts an inhibitory effect on the pro-inflammatory cytokines, thus suggesting that vitamin D may offer possible therapeutic applications for periodontitis.

Bone augmentation at implant dehiscences and fenestrations. A systematic review of randomised controlled trials.

PURPOSE: To evaluate the efficacy of the bone augmentation procedure at dehiscence or fenestration defects in one-stage implant insertion and to evaluate which is the most effective procedure. MATERIALS AND METHODS: A systematic review of articles selected from MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar was performed. Additional studies handsearched and found in printed versions of the principal dental implant journals were included. Only randomised controlled trials (RCTs) were included. Outcome variables considered were implant failure, complications, aesthetic and functional satisfaction, complete fill of the defect, clinical and radiological bone level variation, and vestibular peri-implant recession. Independent data extraction by two authors using predefined data fields, including study quality indicators, was completed. All pooled analyses were based on random effects models. RESULTS: A total of 65 full-text articles were examined in detail. Forty-six of the 65 articles did not meet the inclusion criteria. Nineteen articles involving 15 trials were identified for inclusion in the review. Only one study was considered to be at a low risk of bias. The included studies involved 396 patients and 535 implants. Comparing the test group using membranes with the control without membranes, a statistically significant difference was obtained for vertical variation of the peri-implant defect; the difference was 1.64 mm (three RCTs, 95% CI from 0.47 to 2.80 mm; P = 0.006, I2 = 0%) favouring the use of a membrane. Non-resorbable polytetrafluoroethylene (ePTFE) membranes obtained a complete clinical fill of defects more frequently than resorbable polylactide/polyglycolide (PLGA) membranes. The odds ratio was 0.15 (two RCTs, 95% CI from 0.04 to 0.64 mm; P = 0.01, I2 = 0%), favouring the use of ePTFE membranes. No differences were observed comparing nonresorbable ePTFE membranes and resorbable collagen membranes. The comparison between crosslinked membranes and collagen native membranes yielded a very high heterogeneity for vertical variation of the peri-implant defect (two RCTs, I2 = 91%, P = 0.001). Dehiscence complications were more frequent using cross-linked membranes but the odds ratio was not significant (three RCTs, odds ratio 0.44, 95% CI from 0.18 to 1.10; P = 0.08, I2 = 4%). CONCLUSIONS: Overall, the evidence is not sufficiently robust to determine if any treatment is needed and which is the best treatment for dehiscence or fenestration defects at one-stage implant placement. Only 15 trials were included and the majority are of limited sample size, have short follow-ups as well as having a high risk of bias. The use of a membrane can contribute to the regeneration of the hard tissue in horizontal one-stage augmentation. The complete fill of the defect was obtained more frequently when a non-resorbable ePTFE membrane was used compared to a resorbable PLGA membrane. No differences were observed comparing non-resorbable ePTFE membranes and resorbable collagen membranes. No substantial differences were obtained using different non-resorbable membranes and grafts, and the results were positive for the variables examined. A high result of heterogeneity was observed in studies dealing with cross-linked membranes.

Block versus particulate/titanium mesh for ridge augmentation for mandibular lateral incisor defects: clinical and histologic analysis.

The purpose of this study was to clinically, histologically, and immunohistochemically evaluate the quantity and quality of newly regenerated bone by means of direct clinical measuring and biopsy specimens of alveolar ridges augmented by autogenous cortical bone or titanium micromesh-both filled with autogenous particulate bone graft in the anterior jaws. For the preliminary study, 10 alveolar bone defects in five partially edentulous patients (two men and three women), between 19 and 35 years old (mean: 25.4, SD: 5.94) were selected. Bone defects were randomly (coin toss) divided into two groups: A (micromesh) and B (bone block). The donor site was the mandibular symphysis in all cases. On the return appointment, operative grafts appeared well incorporated into the native bone, which suggests that good contact and fit between the graft and the recipient site had been obtained during the first surgery. Histologic investigations confirmed excellent integration and revascularization of the graft in both study groups, with formation of new bone tissue without any relevant inflammation.

Human gingival fibroblast functions are stimulated by oxidized nano-structured titanium surfaces.

OBJECTIVES: The aim of this study was to analyze the features of an oxidized titanium implant surface and to evaluate its effects on the response of human gingival fibroblasts. METHODS: 10mm×10mm×1mm turned (control) and oxidized (test) titanium samples (P.H.I. s.r.l., Italy) were examined by scanning electron microscopy and atomic force microscopy and characterized by height, spatial and hybrid roughness parameters. Primary cultures of human gingival fibroblasts were seeded on titanium samples, and cell morphology, adhesion, proliferation and extracellular matrix deposition, in terms of type I collagen synthesis, were evaluated. RESULTS: Control and test surfaces appeared considerably different at the microscopic analyses: turned samples were grooved, whereas oxidized surfaces showed a more complex micro- and nano-scaled texture, as evidenced by roughness parameters. Cell adhesion and proliferation rate, as well as collagen synthesis, were greater on oxidized vs turned surfaces. CONCLUSIONS: Although both control and test samples were in the range of average roughness proper of smooth surfaces, they exhibited significantly different topographic properties in terms of height and, mostly, hybrid parameters. Furthermore, oxidized surfaces enhanced human gingival fibroblast adhesion, proliferation and extracellular matrix deposition, and this could be due to the different structure at micro- and nano-scale levels. CLINICAL SIGNIFICANCE: Oxidized nanostructured titanium surfaces could have a significant clinical utilization in virtue of their affinity for soft tissue attachment at the implant neck and/or at the transmucosal portion of the prosthetic abutment.

Oral angioleiomyoma: a rare pathological entity.

Leiomyomas are uncommon in the oral cavity and rare on gingiva. They account only for 0.42% of all soft tissue lesions in the oral cavity. We present an extremely rare case of leiomyoma localized to the attached gingival, simulating an epulis in a healthy 14-year-old boy. The tumour was described at the clinical and instrumental level; moreover, its histopathological phenotype was depicted. The treatment of the choice was the radical excision. The wound was closed by surgical dressing with 2-0 silk suture.The post-operative course was uneventful. The surgical wound healed in one week with normal scarring. Finally, the problems of differential diagnosis with other tumours of the oral cavity and the most appropriate therapeutic procedures are discussed.