New biograft solution, growth factors and bone regenerative approaches in neurosurgery, dentistry, and orthopedics: a review.

Bone regeneration following surgery, trauma, or any other condition is an autologous process that can fail, necessitating the requirement of novel procedures and materials. Recently, significant progress has been made in the research related to regenerative medicine. At the same time, biomedical implants in spine surgery, orthopedics, and dentistry are facing many challenges and posing clinical concerns. A PubMed, MEDLINE, and Scopus review was carried out to identify all studies dealing with bone regenerative approaches in dentistry, orthopedics, and neurosurgery from database inception to December 2022. There has been an upsurge in the implication of a multitude of materials in the enhancement of bone regeneration and/or neo-bone formation, including blood-derived growth factors, new biografts, biosynthetic polymers, inorganic compounds, and sea corals, in the very recent years. Stem cells (SCs) have been found to be efficacious and safe modalities in osteogenesis. Furthermore, bone regeneration/formation depends on the host's immune system and metabolic condition. Epidermal growth factors (EGFs) and their receptors (EGFRs) are important in the mechanism of wound repairing and healing through the recruitment of stromal stem cells for epidermal and dermal regeneration. Similarly, biocomposite developed from Silica assembled with calcium and phosphorous has been utilized in the treatment of broken bones. In this review, we summarized the clinical and laboratory evidence of bone regenerative approaches in the field of spine surgery, orthopedics, and dentistry. An accurate pre-operative screening is the key to managing and carefully planning all surgical steps and achieving the final success.

Dental trauma in the anterior sector: an analysis of the predisposing factors in a group of orthodontic patients.

AIM: The aim of this study was to analyze the predisposing factors of upper incisal trauma in children candidates for orthodontic treatment. METHODS: This is a retrospective study involving 102 consecutive patients who requested orthodontic therapy at Pediatric Dentistry Clinic of Bari University's Dental School during the time frame 2012-2019. The distribution of reported dental trauma was analyzed according to gender, type of trauma, etiology, overjet and labial competence. RESULTS: No substantial association between gender and trauma emerged from our study. Patients between the age range of 11-15 years appear to be at increased risk. A statistically significant correlation between increase in overjet and traumatic events was found. A link was discovered between labial incompetence and trauma, since this condition increases the risk of trauma by exposing part of the surface of the upper incisors. A correlation also emerged between Skeletal Class II and the increased risk of traumatic injury. CONCLUSIONS: Dental trauma, especially in the anterior sector, is a fairly frequent occurrence in pediatric and adolescent patients and is linked to several factors. In our study subjects with Skeletal Class II division I malocclusion with elevated overjet are more predisposed to dental trauma. The limitations of our study are the low number of subjects in the examined sample, and the heterogeneity of the trauma presentation.

Proanthocyanidin may improve the shear bond strength at the composites/dentine interface.

TThis study aimed at assessing whether proanthocyanidin, a collagen cross-linker, affects the adhesion strength of resin composites on the dentine surface. Freshly extracted, caries-free, human molars (N=55) were embedded in transparent resin and bisected. The halves were then assigned to either a treated or a non-treated group, where the treatment consisted of a 10 min incubation in a 6.5% proanthocyanidin solution in PBS. A resin composite cylinder was polymerized perpendicularly to the dentinal surfaces and shear tests were made, using an Instron-like machine. The fracture surfaces were characterized by optical (Picro-Sirius Red stain) and electron microscopy (FESEM EDX analysis). Mean bond strength values were 10.73 MPa (SD 3.70) for the treated group and 8.69 MPa (SD 3.20) for the non-treated group (p less than 0.05 Student’s t-test). No constant fracture patterns could be found within the two groups. Proanthocyanidin treatment may improve the adhesion properties of the dentine-bonding interface.

Obstructive site localization in patients with Obstructive Sleep Apnea Syndrome: a comparison between otolaryngologic data and cephalometric values.

PURPOSE: Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory disorder characterized by repeated obstructive episodes affecting upper airways.This study aims at examining the anatomical craniofacial and pharyngeal characteristics of the patient as to identify the obstructive site which triggers the pathologic process.Correlations between otolaryngologic data observed in the patient and the cephalometric ones for the identification of the obstructive site were also highlighted. MATERIALS AND METHODS: We worked on a sample of 16 patients, 12 males and 4 females, attended to at the Otolaryngology Operative Unit of Bari University Hospital.The patients underwent an otolaryngologic (ORL) diagnostic procedure which provided for ApneaGraph (AG) recording, and a dental diagnostic procedure with cephalometric assessment. RESULTS: The statistical analysis highlighted a strict correlation between the otolaryngologic value of AHI and the cephalometric values of the ANB angle, with the distance between the hyoid bone and the mandibular plane and with the distance between the hyoid bone and the plane passing between C3 and Me. CONCLUSIONS: We observed a concurrence between the ORL diagnosis of the obstruction level assessed with AG and the cephalometric values regarding respiratory tracts (IPAS and SAS). More precisely, we observed the correlation between the otolaryngologic value of AHI with cephalometric values of the ANB angle, with the distance between hyoid bone and mandibular plan, and with the distance between the hyoid bone and the plane passing between C3 and Me. Furthermore, the identification of the caudal position of the hyoid bone can be considered an alarm bell in the diagnosis of severe OSAS.

Correlation between parodontal indexes and orthodontic retainers: prospective study in a group of 16 patients.

PURPOSE: Fixed retainers are used to stabilize dental elements after orthodontic treatment. Being it a permanent treatment, it is necessary to instruct patients about a constant and continuous monitoring of their periodontal conditions and a correct oral hygiene. The aim of this study was to highlight the possible adverse effects of bonded retainers on parameters correlated to the health conditions of periodontal tissues. MATERIALS AND METHODS: We selected 16 patients, under treatment in the Orthodontics Department of University of Bari Dental School, who had undergone a lingual retainer insertion at the end of the orthodontic treatment. The patients were then divided into two groups (Control Group and Study Group) and monitored for 3 and 36 months, respectively. The following indexes were taken into consideration: gingival index (GI), plaque index (PI) and the presence of calculus (Calculus Index, CI), the probing depth and the presence of gingival recession on the six inferior frontal dental elements. RESULTS: After the observation was carried out, any of the patients showed periodontal sockets and gingival recession. In the Study Group, only 1 patient had a PI score=3, the 7 left had scores between 0.66 and 2.83. In the Control Group, one patient had score=0, the other ones showed values between 0.5 and 1.66. The mean GI in the Study Group peaked at a score of 2.83, the minimum was 0.66; whereas in the Control Group the maximum value was 2 and the minimum 0.66. The CI in the Group Study was between 1 and 2. In the Control Group it was absent in only 1 patient, whereas in the remaining 7, it had a value between 0.3 and 1. The clinical data were studied by means of the Wilcoxon test. We found a statistically significant difference for what concerns the Plaque Indexes (PI) (P>0.05) and Calculus Indexes (CI) (P>0.1) in both groups, with higher scores in the Study Group, having retainers for 36 months. Any statistically significant difference was calculated for the GI. CONCLUSIONS: We can therefore conclude that patients with lingual retainers need periodontal hygiene and treatment as to prevent, in the course of time, periodontal damages non-detectable in short-term.

Cytokine, Chemokine, and Growth Factor Profile Characterization of Undifferentiated and Osteoinduced Human Adipose-Derived Stem Cells.

Bone is the second most manipulated tissue after blood. Adipose-derived stem cells (ASCs) may become a convenient source of MSC for bone regenerative protocols. Surprisingly, little is known about the most significant biomolecules these cells produce and release after being osteoinduced. Therefore, the present study aimed at dosing 13 candidates chosen among the most representative cytokines, chemokines, and growth factors within the conditioned media of osteodifferentiated and undifferentiated ASCs. Two acknowledged osteoblastic cell models, that is, MG-63 and SaOs-2 cells, were compared. Notably, IL-6, IL-8, MCP-1, and VEGF were highly produced and detectable in ASCs. In addition, while IL-6 and IL-8 seemed to be significantly induced by the osteogenic medium, no such effect was seen for MCP-1 and VEGF. Overall SaOS-2 had a poor expression profile, which may be consistent with the more differentiated phenotype of SaOs-2 compared to ASCs and MG-63. Instead, in maintaining medium, MG-63 displayed a very rich production of IL-12, MCP-1, IP-10, and VEGF, which were significantly reduced in osteogenic conditions, with the only exception of MCP-1. The high expression of MCP-1 and VEGF, even after the osteogenic commitment, may support the usage of ASCs in bone regenerative protocols by recruiting both osteoblasts and osteoclasts of the host.

Early mandibular canine-lateral incisor transposition: case report.

PURPOSE: The main aim of the present study is to present a case of mandibular transposition between lateral incisor and canine in a paediatric patient. MATERIALS AND METHODS: A fixed multibracket orthodontic treatment was performed by means of a modified welded arch as to correct the transposition and obtaining a class I functional and symmetrical occlusion, also thanks to the early diagnosis of the eruption anomaly. RESULTS: Our case report shows that a satisfactory treatment of mandibular transpositions is obtained when detected at an early stage of the tooth development. CONCLUSIONS: The main treatment options to be taken into consideration in case of a mandibular transposition are two: correcting the transposition or aligning it leaving the dental elements in their transposed order; in both cases, the follow-ups show a stable condition, maintained without relapses. Several factors, such as age of the patient, occlusion, aesthetics, patient's collaboration, periodontal support and duration of treatment have to be considered as to prevent potential damage to dental elements and support appliances. The choice between the two treatment approaches for mandibular lateral incisor/canine transpositions mainly depends on the time the anomaly is detected.

Effectiveness of computer-assisted anesthetic delivery system (sta™) in dental implant surgery: a prospective study.

OBJECTIVES: This prospective cohort study aimed to investigate effectiveness of Computerized Local Anesthesia (CLA) on oral implantology through estimation of pain and discomfort and total quantity of injected anesthetic. METHODS: Forty-five consecutive patients whose treatment plan included immediate or late dental implants were included in this study. The main inclusion criteria comprised: previous implant intervention under conventional anesthesia (CA) during the past 3 years and no previous treatment of pain relief. All patients reported on a 0-10 scale on previous experience with CA, and new experience with CLA. The same CLA system, namely Single Tooth Anesthesia (STA) was used for all patients with half of the quantity normally used for CA. Data on quantity of anesthetic and reported ratings were collected and described. Potential associations and determinant variables were analysed through correlation analysis and regression models. RESULTS: Out of 45 patients, 27 received post-extractive implant surgery whereas the rest 18 implant surgery on healed sites. The reported pain from STA (mean 1.6, SD 0.7) showed important difference as compared to CA (7.9, SD 1.2; z=5.873; p<0.0001). The comfort perceived during the STA ranged from 7 to 10 (mean 9.5, SD 0.79). A second injection with half of the initial dose was necessary in three cases only. CONCLUSIONS: STA system proved to be effective during interventions of dental implantology, by markedly reducing patients' pain and discomfort and the total quantity of necessary anesthetic.

Non-surgical periodontal management in scleroderma disease patients.

The aim of the present study is to investigate the periodontal status of people with scleroderma and their response to non-surgical treatment protocol aimed at controlling the evolution of the disease. The response to non-surgical periodontal treatment was tested on patients belonging to a scleroderma group and a control group: the data show an improvement of the periodontal conditions of all these patients in response to treatment. When compared on the same diagram, a slight remission of the periodontal disease was obtained in both scleroderma and healthy patients. This highlights the benefit to soft tissues produced by non-surgical periodontal treatment also in patients affected by systemic diseases.

Correlation between dento-skeletal characteristics and craniomandibular disorders in growing children and adolescent orthodontic patients: retrospective case-control study.

PURPOSE: The aim of this retrospective case-control study was to identify, in a group of growing children and adolescents affected by malocclusion, specific dento-skeletal characteristics which could be correlated to the onset, in the above-mentioned subjects, of craniomandibular disorders (CMD). MATERIALS AND METHODS: Among the patients treated at the Paedodontics and Orthodontics department of Bari Dental School, we recruited a group of patients with malocclusion and symptoms of temporomandibular disorders, as an experimental group. We considered as controls those patients who, match-paired to their skeletal class depending on the ANB angle, did not show any CMD sign or symptom. RESULTS: Of the 128 examined patients, 15 showed signs and/or symptoms of CMD (11.7%). When compared to 15 patients non-affected by CMD, we could not detect statistically significant differences in both skeletal and occlusal characteristics. It is still interesting to notice how in CMD patients, characteristics of skeletal hyperdivergence are often to be found. CONCLUSIONS: The present study seems to confirm that in growing children and adolescents, the presence of signs and/or symptoms of CMD is not associable to a specific vertical skeletal growth pattern or to other specific occlusal characteristics.

Oral hygiene in patients with oral cancer undergoing chemotherapy and/or radiotherapy after prosthesis rehabilitation: protocol proposal.

PURPOSE: This study was aimed at assessing the effectiveness and the importance of an oral hygiene (OH) protocol in patients undergoing radiation therapy and chemotherapy after prosthesis rehabilitation, in order to reduce or minimize oral complications. MATERIALS AND METHODS: This study was carried out at the Department of Dental Science, at the University of Bari-Italy from December 2012 to December 2015 on 34 selected patients with primary oral cancer undergoing chemotherapy and radiotherapy after prosthesis rehabilitation. They were divided into 2 groups according to their age, sex and cancer therapy. Seventeen patients were assigned to the control group and seventeen in the experimental one. In the experimental group (Table 1), patients underwent an oral hygiene protocol whereas in the control group (Table 2) patients received the usual care provided within the clinical setting. All the patients gave written informed consent. It has been asked and obtained the authorisation from the Ethics Committee of the Dental Science and Surgery Department. RESULTS: Results show that in patients undergoing the oral hygiene protocol, the complications and the risks of infection and permanent dental problems have been minimized. Indeed, of the seventeen patients undergoing the OH protocol, 70% obtained positive results and were satisfied with the program outcome. CONCLUSIONS: The role of the health care providers is essential to educate patients to adhere to the prescribed treatments and reinforce their motivation in oral hygiene. The oral hygiene procedures prevent and ameliorate oral complications due to the radiation therapy and chemotherapy.

Cytogenetic genotoxic investigation in peripheral blood lymphocytes of subjects with dental composite restorative filling materials.

Dental composite resins are biomaterials commonly used to aesthetically restore the structure and function of teeth impaired by caries, erosion, or fracture. Residual monomers released from resin restorations as a result of incomplete polymerization processes interact with living oral tissues. The objective of this study was to evaluate the genotoxicity of a common dental composite material (Enamel Plus-HFO), in subjects with average 13 filled teeth with the same material, compared to a control group (subjects having neither amalgam nor composite resin fillings). Genotoxicity assessment of composite materials was carried out in vitro in human peripheral blood leukocytes using sister-chromatid exchange (SCE) and chromosomal aberrations (CA) cytogenetic tests. The results of correlation and multiple regression analyses confirmed the absence of a relationship between SCE/cell, high frequency of SCE(HFC) or CA frequencies and exposure to dental composite materials. These results indicate that composite resins used for dental restorations differ extensively in vivo in their cytotoxic and genotoxic potential and in their ability to affect chromosomal integrity, cell-cycle progression, DNA replication and repair.

Quality of life in fibromyalgia patients with craniomandibular disorders.

Fibromyalgia (FM) is a rheumatic disease which affects fibrous tissues and muscles; it is characterized by chronic pain and it is often associated with craniomandibular disorders (CMD). 31 patients were assessed from March 2012 to October 2012 through the administration of specific questionnaires and following neurologic and gnatologic assessment. A relevant corre-lation between FM and CMD emerges from the present study, as 80.6% of our patients report CMD symptoms with high prevalence of myofascial pain (84%). Multivariate regression analysis revealed that the patients in the present study did not differ in score of quality of life questionnaires from patients with fibromyalgia. The neuropathic pain diagnostic question-naire (DN4) scores were positively affected by belonging to group II of Research Diagnostic Criteria of Temporomandibular Disorders (RDC/ TDM) classification, suggesting the possibility of a neuropathic component in chronic pain in this CMD group, as already speculated in our study on the correlation between burning mouth syndrome and CMD and by other au-thors in studies on chronic low back pain. However, further clinic and instrumental studies are needed in order to test this as-sumption.

[Prosthetic rehabilitation of edentulous patients after stroke]. / Riabilitazione protesica di pazienti edentuli con esiti di stroke.

AIM: Stroke is actually the 3rd cause of death in the world after cardiovascular diseases and cancer. In Italy, every year there are 100000 new cases; 2/3 of them die or become heavily disabled. The greatest part of patients which survive is old-aged and 70% of patients that survive is a removable denture wearer. METHODS: At the Neurological Clinic of the Polyclinic Hospital of Bari we have studied 14 removable denture wearers that had had a stroke. RESULTS: We observed that 85.7 % of removable dentures were inefficient, in 50% there will need a new removable prosthesis; 50% of persons had a bad dental hygiene; 93% of denture wearers with stroke didn't make an odontoiatric control after stroke. CONCLUSIONS: Although the analysis of the orodental status has been carried out on a limited number of patients, the need of a greater motivation and solicitation in dental check-up is underlined. The role of the dentist in oral rehabilitation and in rehabilitation of post stroke dysphagia in stroke survivors is also examined.

Influence of posts and cores on light transmission through different all-ceramic crowns: spectrophotometric and clinical evaluation.

PURPOSE: The influence of different types of posts and cores on light transmission through all-ceramic crowns was assessed by spectrophotometric analysis and clinical evaluation. MATERIALS AND METHODS: Three extracted natural teeth were replicated in acrylic resin, with roots prepared to receive standardized posts and cores. Using a silicone impression material as a template, various prosthodontic reconstructions were obtained by combining four types of posts and cores (polished and matte-finished gold alloy, all-ceramic, and ceramized metal alloy) and three types of all-ceramic crowns (IPS-Empress 2 surface-colored, IPS-Empress 2 stratified, and In-Ceram). The spectrophotometric analysis was performed in the dark at 25 degrees C. The teeth were backlit with an incandescent lamp at the color temperature of A illuminant and shielded to avoid spurious light entering the spectrophotometer. The transmitted light was analyzed in terms of luminance at four points of the sample surface (cervical, middle, incisal, and proximal). Twelve measurements were performed for the natural teeth, and 144 were performed for the artificial teeth. RESULTS: Natural teeth had the highest luminance. Among all-ceramic crowns, surface-colored IPS-Empress 2 had the highest luminance, and stratified IPS-Empress 2 had the lowest. Regarding posts and cores, the luminance was highest with the all ceramic, lower with the ceramized and the polished gold alloy (which had very similar luminance), and lowest with the matte-finished gold alloy. No significant difference among prosthodontic combinations was detected under clinical observation. CONCLUSION: The surface-colored glass ceramic (IPS-Empress 2) was the most translucent crown. At the standard crown thickness used, there were small, significant spectrophotometric, but not clinical, differences among the combinations tested. These findings show no esthetic contraindications for the use of polished gold alloy posts and cores with all-ceramic crowns.

[Correlation between edentulism, sleep disorders and arterial hypertension. Preliminary research]. / Correlazione fra edentulismo, disturbi del sonno e ipertensione arteriosa. Indagine preliminare.

BACKGROUND: Respiratory disturbances during sleep are considered risk factors for arterial hypertension and cardiovascular diseases. Edentulism, by decreasing retro-pharyngeal space, may favor upper airway occlusion during sleep. Aim of the study is to evaluate whether edentulism is associated with greater prevalence of sleep disturbances, arterial hypertension and other cardiovascular diseases. METHODS: Eighty edentulous subjects with dentures (removed during sleep) and 57 subjects with natural teeth, matched for age, underwent assessment of oral conditions and recording of questionnaires on diseases and respiratory sleep disturbances. RESULTS: Edentulous subjects had a significantly higher prevalence of arterial hypertension and cardiovascular diseases, than subjects with natural teeth. CONCLUSIONS: In edentulous subjects, removing dentures during sleep may favor respiratory disorders, and increase the risk for hypertension and cardiovascular disease.

[The influence of edentulism on spirometric values]. / Influenza dell'edentulismo sui valori spirometrici.

BACKGROUND: Aim of the paper is to study whether edentulism, by causing a decrease in size and tone of pharyngeal musculature, may affect spirometric measurements. METHODS: Spirometry was recorded with and without dentures in 58 edentulous subjects, 36 asymptomatic normal subjects (N) and 22 patients with chronic obstructive pulmonary disease (COPD). In 10 subjects retropharyngeal space with and without dentures was assessed by cephalometry. RESULTS: In the N group, removing dentures produced a significant decrease in lung volumes and airflow rates, while in COPD patients it was ineffective. In both groups, retropharyngeal space was significantly decreased by removing dentures. CONCLUSIONS: Edentulism, by decreasing extrathoracic airway caliber, influences significantly spirometric measurements in normal subjects but not in those with COPD.

[Squamous cell carcinoma in oral lichen ruber planus. A clinico-pathological and immunohistochemical study of 11 cases]. / Carcinoma squamoso su lichen ruber planus orale. Studio clinico-patologico ed immunoistochimico di 11 casi.

The malignant transformation of lichen ruber planus (LRP) is a quite frequent event for which, at present, no clear pathogenetic explanation has been given. Recently, attention has been paid to growth factors and growth factor receptors as possible pathogenetic factors of malignancy, even if not enough studies have been performed to exploit their role in oral diseases. Aim of the present study was to investigate the expression of epidermal growth factor receptor (EGFr) in squamous carcinomas arising in patients with LRP. The study has been performed on formalin-fixed, paraffin-embedded tissue biopsies obtained from 11 patients with previous diagnosis of LRP in which squamous carcinoma had developed. A monoclonal anti-EGFr antibody has been used, with the ABC technique, on histological sections. EGFr has been immunolocalized in basal and suprabasal epithelial layers in LRP with the highest intensity of staining in the areas with strong inflammation. EGFr immunostaining could be detected in dysplastic areas as well, even if the intensity of staining seemed to decrease with severity of dysplasia. In well-differentiated squamous carcinoma EGFr was intensely expressed, especially in mature keratinized cells. Weaker or absent EGFr immunoreaction was detected in moderately and poorly differentiated carcinomas. The results of the present study seem to show that EGFr is expressed in squamous carcinomas arising from LRP. The variability of EGFr expression in inflamed oral mucosa, in dysplastic areas and in tumors with different degrees of differentiation seem to point out that EGFr might somehow regulate the maturation and replication of epithelial cells in LRP and in its malignant counterpart. The speculations achieved from the present study need further evaluation on wider series of cases and, possibly, with different antibodies which would allow the identification of mutant forms of the receptor.