Analysis of the Prognostic Factors That Influence the Outcome of Periapical Surgery, including Biomimetic Membranes for Tissue Regeneration: A Review.

The objective of this study was to analyze the prognostic factors that influence the outcome of periapical surgery. A systematic search of the literature was carried out using PubMed and Scopus databases between January 2000 and December 2023 with no language limitations. The PICO question of the present systematic review was: What prognostic factors may influence the outcome of periapical surgery? The most relevant randomized controlled clinical trials (RCTs), prospective clinical trials, retrospective studies, and meta-analyses (n = 44) were selected from 134 articles. The reviewed literature evidenced that bone-lesion healing could significantly be improved by the absence of deep periodontal pockets (>4 mm), localization in anterior teeth, the absence of pain and/or preoperative symptoms, a size of bone lesion < 5 mm, the use of ultrasound, the correct placement of retrograde filling material, and the use of different biomimetic membranes for guided tissue regeneration (GTR). Some preoperative and intraoperative factors could significantly improve the prognosis of periapical surgery. However, these results were not conclusive, and further high-quality research is required.

Doxycycline-Doped Polymeric Membranes Induced Growth, Differentiation and Expression of Antigenic Phenotype Markers of Osteoblasts.

Polymeric membranes are employed in guided bone regeneration (GBR) as physical barriers to facilitate bone in-growth. A bioactive and biomimetic membrane with the ability to participate in the healing and regeneration of the bone is necessary. The aim of the present study was to analyze how novel silicon dioxide composite membranes functionalized with zinc or doxycycline can modulate the osteoblasts' proliferation, differentiation, and expression of selected antigenic markers related to immunomodulation. Nanostructured acrylate-based membranes were developed, blended with silica, and functionalized with zinc or doxycycline. They were subjected to MG63 osteoblast-like cells culturing. Proliferation was assessed by MTT-assay, differentiation by evaluating the alkaline phosphatase activity by a spectrophotometric method and antigenic phenotype was assessed by flow cytometry for selected markers. Mean comparisons were conducted by one-way ANOVA and Tukey tests (p < 0.05). The blending of silica nanoparticles in the tested non-resorbable polymeric scaffold improved the proliferation and differentiation of osteoblasts, but doxycycline doped scaffolds attained the best results. Osteoblasts cultured on doxycycline functionalized membranes presented higher expression of CD54, CD80, CD86, and HLA-DR, indicating a beneficial immunomodulation activity. Doxycycline doped membranes may be a potential candidate for use in GBR procedures in several challenging pathologies, including periodontal disease.

Do perioperative antibiotics reduce complications of mandibular third molar removal? A double-blind randomized controlled clinical trial.

OBJECTIVE: The aim of this study was to compare the effects of different antibiotic prophylaxis regimens versus placebo in relation to possible postoperative complications derived from the surgical extraction of impacted lower third molars. STUDY DESIGN: The final study sample of this double-blind randomized controlled trial comprised 92 Caucasian volunteers. Patients were assigned to 3 groups by using a randomization table. Group 1 (n = 30) received 750 mg oral amoxicillin both before and after the surgery; group 2 (n = 32) received the same oral dose after surgery alone; and group 3 (n = 30) received placebo both before and after surgery. Infectious complications, postoperative pain, and inflammation intensity were measured. The requirement for and the timing of rescue medication were also measured. RESULTS: Postoperative pain and inflammation intensity were significantly higher (P < .05) in group 3 than in groups 1 or 2 at 48 hours, 72 hours, and 1 week. A significantly higher proportion of group 3 required rescue medication (analgesics and rescue antibiotics) (P = .013) compared with groups 1 or 2. CONCLUSIONS: Greater pain and inflammation were experienced by patients receiving placebo before lower third molar extraction than by those receiving antibiotics either before surgery or both before and after surgery. Other options, such as use of local antibiotics, should be considered to reduce the problems, including bacterial resistance, caused by overuse of systemic antibiotics.

Effects of Therapeutic Doses of Celecoxib on Several Physiological Parameters of Cultured Human Osteoblasts.

Non-steroidal anti-inflammatory drugs (NSAIDs), including cyclooxygenase-2 (COX-2)-selective NSAIDs, are associated with adverse effects on bone tissue. These drugs are frequently the treatment of choice but are the least studied with respect to their repercussion on bone. The objective of this study was to determine the effects of celecoxib on cultured human osteoblasts. Human osteoblasts obtained by primary culture from bone samples were treated with celecoxib at doses of 0.75, 2, or 5µM for 24 h. The MTT technique was used to determine the effect on proliferation; flow cytometry to establish the effect on cell cycle, cell viability, and antigenic profile; and real-time polymerase chain reaction to measure the effect on gene expressions of the differentiation markers RUNX2, alkaline phosphatase (ALP), osteocalcin (OSC), and osterix (OSX). Therapeutic doses of celecoxib had no effect on osteoblast cell growth or antigen expression but had a negative impact on the gene expression of RUNX2 and OSC, although there was no significant change in the expression of ALP and OSX. Celecoxib at therapeutic doses has no apparent adverse effects on cultured human osteoblasts and only inhibits the expression of some differentiation markers. These characteristics may place this drug in a preferential position among NSAIDs used for analgesic and anti-inflammatory therapy during bone tissue repair.

Repercussion of nonsteroidal anti-inflammatory drugs on the gene expression of human osteoblasts.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used in clinical practice, which can have adverse effects on the osteoblast. The objective of this study was to determine the effect of NSAIDs on the osteoblast by analyzing the gene expression of different markers related to osteoblast maturation and function when treated in vitro with different NSAIDs. METHODS: Three human osteoblast lines from bone samples of three healthy volunteers were treated with 10 µM acetaminophen, indomethacin, ketoprofen, diclofenac, ibuprofen, ketorolac, naproxen, and piroxicam. The gene expression of different markers (run related transcription factor 2 [RUNX-2], type 1 collagen [COL-I], osterix [OSX], osteocalcin [OSC], bone morphogenetic protein 2 [BMP-2] and 7 [BMP-7], transforming growth factor ß1 [TGF-ß1], and TGFß receptors [TGFßR1, TGFßR2; TGFBR3]) were analyzed by real-time PCR at 24 h of treatment. RESULTS: Expression of RUNX-2, COL-I, OSX, was reduced by treatment with all studied NSAIDs, OSC expression was reduced by all NSAIDs except for ketoprofen, naproxen, or piroxicam. Expression of BMP-7 was reduced by all NSAIDs; BMP-2 was reduced by all except for naproxen. In general, NSAID treatment increased the expression of TGF-ß1, but not of its receptors (TGFß-R1, TGFß-R2, andTFGß-R3), which was either unchanged or reduced by the treatment. CONCLUSION: These data confirm that NSAIDs can affect osteoblast physiology, suggesting their possible impact on bone.

Long-Term Survival of Dental Implants with Different Prosthetic Loading Times in Healthy Patients: A 5-Year Retrospective Clinical Study.

PURPOSE: To compare survival rates among dental implants restored with immediate, early, and conventional loading protocols, also comparing between maxillary and mandibular implants, and to evaluate the influence of implant length and diameter and the type of prosthesis on treatment outcomes. MATERIALS AND METHODS: This retrospective cohort study initially included all 52 patients receiving dental implants between July 2006 and February 2008 at a private oral surgery clinic in Granada (Southern Spain). Clinical and radiographic examinations were performed, including periapical or panoramic radiographs, and incidences during completion of the restoration were recorded at 1 week, 3 months, 6 months, and at 1, 2, 3, 4, and 5 years. After a 5-year follow-up, 1 patient had died, 3 were lost to follow-up, and 6 required grafting before implant placement; therefore, the final study sample comprised 42 patients with 164 implants. RESULTS: Variables associated with the survival/failure of the restoration were: number of implants (higher failure rate with fewer implants), bone type (higher failure rate in type III or IV bone), and type of prosthesis (higher failure rate with single crowns). No significant association was found in univariate or multivariate analyses between survival rate and the loading protocol, implant length or diameter, or maxillary/mandibular location. CONCLUSIONS: Immediate occlusal loading, immediate provisionalization without occlusal loading, and early loading are viable treatment options with similar survival rates to those obtained with conventional loading. Bone quality and number of implants per patient were the most influential factors.

Oral pregabalin for postoperative pain relief after third molar extraction: a randomized controlled clinical trial.

OBJECTIVES: The aim of this randomized controlled clinical trial was to evaluate the efficacy and safety of pregabalin administered pre- and postoperatively in patients with pain and swelling due to the surgical removal of impacted lower third molars. MATERIALS AND METHODS: The final study sample comprised 60 volunteers (23 males and 37 females). Group 1 (n = 30) received 75 mg oral pregabalin 1 h before surgery and 1 h after surgery. Group 2 (n = 30) served as a control group and received no pregabalin. Both groups were administered with 650 mg paracetamol every 8 h for 2 days. Postoperative pain intensity and swelling were measured using a visual analog scale (VAS); pain relief experienced was reported using a four-point verbal rating scale (VRS); the rescue medication requirement, adverse effects, and global impression of the medication were also recorded. RESULTS: No significant difference in pain intensity (VAS) was observed between the groups. However, fewer rescue medication tablets were needed by pregabalin-treated patients than by controls (p = 0.021). The frequency and intensity of adverse effects were significantly higher in pregabalin-treated patients (p < 0.001), although no serious adverse events occurred. No significant difference in the degree of swelling was observed in any measurement except that from mandibular angle to lip junction, which showed lesser inflammation in the pregabalin group at 24 h post-surgery (p = 0.011). The global opinion on the medication received was more positive in the pregabalin group (p = 0.042). CONCLUSIONS: The administration of pregabalin reduces the requirement for rescue medication after third molar surgery and results in a more constant pain level, with fewer peaks of pain intensity. CLINICAL RELEVANCE: These findings suggest that pregabalin may be useful to control acute postoperative pain. Adverse effects are known to be reduced at the low pregabalin dose used in our study.

Risk factors associated with early implant failure: A 5-year retrospective clinical study.

STATEMENT OF PROBLEM: The replacement of lost teeth with dental implants is a widespread treatment whose associated problems are also frequently encountered. Nevertheless, the factors associated with early implant failure have not been well documented. Further analyses of the factors influencing osseointegration establishment are required to maximize the predictability of the procedure and minimize implant failures. PURPOSE: The purpose of this retrospective clinical study was to explore the association between possible risk factors and early implant failure. MATERIAL AND METHODS: This retrospective clinical study evaluated 142 participants who received 276 external connection BTI implants between 2007 and 2011. Participant variables (age, sex, systemic disease, tobacco use, alcohol consumption, bruxism, and degree of periodontal disease), implant variables (type of edentulism, localization, area, diameter, length, and bone quality), intervention variables (expansion mechanisms, sinus augmentation techniques, bone regeneration, and implant insertion), and postoperative variables (presence of pain/inflammation at 1 week postsurgery) were studied. A multilevel logistic regression model (mixed effects-type model) was used to determine the influence of variables on early implant failure. RESULTS: Early implant failure was significantly associated with the male sex (P=.001), severe periodontal disease (P=.005), short implants (P=.001), expansion technique (P=.002), and postoperative pain/inflammation at 1 week postsurgery (P<.001). CONCLUSIONS: Early dental implant failure is more frequent in men and in individuals with severe periodontal disease, short implants, pain/inflammation at 1 week postsurgery, or bone expansion treatment.

The effect of low-level diode laser therapy on early differentiation of osteoblast via BMP-2/TGF-ß1 and its receptors.

OBJECTIVES: The objective of this study was to determine the effect of LLDL therapy on the gene expression of osteoblast markers of growth and differentiation. MATERIALS AND METHODS: The MG-63 cell line was exposed to diode laser (ezLase) of 940 nm at 1-1.5 W and 3-4 J, and gene expressions (Runx-2, alkaline phosphatase [ALP], type I collagen [Col-I], osterix [OSX], osteocalcin [OSC], osteoprotegerin [OPG], bone morphogenetic protein [BMP]-2 and -7, transforming growth factor-ß1 [TGF-ß1], and TGF-ß receptors [TGF-ß R1, TGF-ß R2; TGF-ß R3]) were evaluated by quantitative RT-PCR. RESULTS: LLDL treatment stimulated the expression of osteoblast differentiation markers ALP, Col-I, Runx-2, and OSX in relation to the doses applied (P < 0.05), but no changes were detected in OSC, OPG, or BMP-7 at any study dose. This effect may be mediated by TGF-ß1 and BMP-2, given that the treatment increased their expression and that of TGF-ß receptors R1, R2, and R3 (P < 0.001). CONCLUSION: These results suggest that the biostimulatory effect of laser therapy on osteoblasts may be attributable to the release of autocrine factors in response to the irradiation. A clinical trial is warranted to test its therapeutic usefulness in bone tissue regeneration and to define a treatment protocol.

Factors Affecting Dental Implant Stability Measured Using the Ostell Mentor Device: A Systematic Review.

OBJECTIVES: The aim of this study was to review the literature on factors that may affect dental implant stability as measured with the Ostell mentor device. MATERIALS AND METHODS: A systematic search of the literature was performed in Pubmed, Scopus, and Cochrane databases using dental implants, stability, and resonance frequency analysis as key words. RESULTS: The most relevant randomized controlled trials and clinical trials (n = 39) were selected from among 264 articles. CONCLUSIONS: Many factors can affect dental implant stability as measured with the Ostell mentor device. This may be a useful instrument for deciding the timing of implant loading, but additional research is required to establish the reliability and predictability of resonance frequency analysis for the future osseointegration of dental implants, which remains controversial.

Bacterial contamination levels of autogenous bone particles collected by 3 different techniques for harvesting intraoral bone grafts.

PURPOSE: The aim of this study was to compare levels of bacterial contamination of autogenous bone collected when using low-speed drilling, a back-action chisel, and a bone filter. MATERIALS AND METHODS: Bone tissue samples were taken from 31 patients who underwent surgical extraction of their third lower molars. Before surgical removal of the molar, bone particles were collected by a low-speed drill or a back-action chisel. Then, a stringent aspiration protocol was applied during the ostectomy to collect particulate bone by a bone filter. Processing of samples commenced immediately by incubation in an anaerobic or a CO2-rich atmosphere. The number of colony-forming units (CFUs) was determined at 48 hours of culture. RESULTS: No significant difference in the number of CFUs per milliliter was observed between the low-speed drilling group and the back-action chisel group in the anaerobic or CO2-rich condition (P = .34). However, significantly more micro-organisms were found in the bone filter group than in the low-speed drilling group or the back-action chisel group in the anaerobic and CO2-rich conditions (P < .001). CONCLUSIONS: Particulate bone harvested with low-speed drilling or a back-action chisel is safer for use as an autograft than are bone particles collected with a bone filter. These results suggest that bone obtained from low-speed drilling is safe and straightforward to harvest and could be the method of choice for collecting particulate bone. Further research is needed to lower the bacterial contamination levels of autogenous bone particles used as graft material.

Human fibroblast-like cultures in the presence of platelet-rich plasma as a single growth factor source: clinical implications.

OBJECTIVE: The purpose of this study was to compare the proliferation, morphology, and antigenic expression of human fibroblast-like cells between primary cultures treated with platelet-rich plasma (PRP) or fetal bovine serum (FBS) as the growth factor source. DESIGN: Cells from human gingival tissue samples obtained from healthy volunteers during oral surgery were studied. Isolated cells were cultured in media supplemented with 10% PRP or FBS. Platelet-rich plasma was prepared from the venous blood of each patient. The authors studied short- and long-term cell cultures in the presence of PRP or FBS as the sole growth factor source in order to determine (a) cell growth rate, by MTT (3-[4,5-Dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) assay; (b) cell morphology, by electronic microscopy; and (c) antigenic expression, by flow cytometry and confocal microscopy. RESULTS: In short-term cultures, the cell growth rate was higher with PRP versus FBS treatment. No differences in morphology or expression of vimentin, fibronectin, or α-actin antigens were observed between PRP and FBS cultures. In long-term cultures, PRP and FBS did not significantly differ in cell growth rate but differed in morphology and in the expression of vimentin, fibronectin, and α-actin. CONCLUSION: The PRP enhances cell proliferation over the short term and induces cell differentiation of fibroblast-like cells to myofibroblast-like cells over the long term, suggesting that fibroblast differentiation to myofibroblasts may underlie the action mechanism of PRP in soft tissue regeneration.