In Vitro Study of the Proliferation of MG63 Cells Cultured on Five Different Titanium Surfaces.

The use of dental implants for prosthetic rehabilitation in dentistry is based on the concept of osteointegration. This concept enables the clinical stability of the implants and a total absence of inflammatory tissue between the implant surface and the bone tissue. For this reason, it is essential to understand the role of the titanium surface in promoting and maintaining or not maintaining contact between the bone matrix and the surface of the titanium implant. MATERIALS AND METHODS: Five types of titanium discs placed in contact with osteoblast cultures of osteosarcomas were studied. The materials had different roughness. Scanning electron microscopy (SEM) photos were taken before the in vitro culture to analyze the surfaces, and at the end of the culturing time, the different gene expressions of a broad pattern of proteins were evaluated to analyze the osteoblast response, as indicated in the scientific literature. RESULTS: It was demonstrated that the responses of the osteoblasts were different in the five cultures in contact with the five titanium discs with different surfaces; in particular, the response in the production of some proteins was statistically significant. DISCUSSION: The key role of titanium surfaces underlines how it is still possible to carry out increasingly accurate and targeted studies in the search for new surfaces capable of stimulating a better osteoblastic response and the long-term maintenance of osteointegration.

Psoriatic Arthritis Involving TMJ: A Review on Pathogenesis and Consideration on Eventual Gender Differences.

Psoriatic arthritis is defined as chronic inflammatory arthritis associated with psoriasis. The current data regarding gender differences in clinical manifestation and therapeutic outcomes of psoriatic arthritis are limited. Generally, men show a peripheral disease manifestation, while women have an axial distribution of the lesions. If we look at temporomandibular joint (TMJ) involvement, epidemiological data on the involvement of the TMJ are hard to find. Few studies on therapeutic management and the related impact on the quality of life are reported in the literature. Given the morpho-functional peculiarities of the TMJ and the different pain burdens between male and female genders, when manifestation of psoriatic arthritis occurs, clinicians should face it using a multidisciplinary approach for a correct diagnosis and successful treatment. This review aims to examine the diagnostic signs of psoriatic arthritis in the TMJ, the eventual variations of this disease in male and female patients, and the therapeutical strategies. The coordination of different specialties is fundamental to the remission of clinical symptoms and lesion regression.

The Use of Nano-Hydroxyapatite (NH) for Socket Preservation: Communication of an Upcoming Multicenter Study with the Presentation of a Pilot Case Report.

Background and Objectives: The use of biomaterials in dentistry is extremely common. From a commercial perspective, different types of osteoconductive and osteoinductive biomaterials are available to clinicians. In the field of osteoconductive materials, clinicians have biomaterials made of heterologous bones at their disposal, including biomaterials of bovine, porcine, and equine origins, and biomaterials of natural origin, such as corals and hydroxyapatites. In recent years, it has become possible to synthesize nano-Ha and produce scaffolds using digital information. Although a large variety of biomaterials has been produced, there is no scientific evidence that proves their absolute indispensability in terms of the preservation of postextraction sites or in the execution of guided bone regeneration. While there is no scientific evidence showing that one material is better than another, there is evidence suggesting that several products have better in situ permanence. This article describes a preliminary study to evaluate the histological results, ISQ values, and prevalence of nano-HA. Materials and Methods: In this study, we planned to use a new biomaterial based on nanohydroxyapatite for implantation at one postextraction site; the nano-HA in this study was NuvaBONE (Overmed, Buccinasco, Milano, Italy). This is a synthetic bone graft substitute that is based on nanostructured biomimetic hydroxyapatite for application in oral-maxillofacial surgery, orthopedics, traumatology, spine surgery, and neurosurgery. In our pilot case, a patient with a hopeless tooth underwent extraction, and the large defect remaining after the removal of the tooth was filled with nano-HA to restore the volume. Twelve months later, the patient was booked for implant surgery to replace the missing tooth. At the time of the surgery, a biopsy of the regenerated tissue was taken using a trephine of 4 mm in the inner side and 8 mm deep. Results: The histological results of the biopsy showed abundant bone formation, high values of ISQ increasing from the insertion to the prosthetic phase, and a good reorganization of hydroxyapatite granules during resorption. The implant is in good function, and the replaced tooth shows good esthetics. Conclusions: The good results of this pilot case indicate starting the next Multicentric study to have more and clearer information about this nanohydroxyapatite (NH) compared with control sites.

FT-IR analysis of the Interface between Universal Scotchbond and Oral Mucosa: a preliminary in-vitro study.

BACKGROUND: The long-term success of implant therapy depends not only on proper osseointegration, but also on the healing of the epithelium and the quality of the biological seal on the abutment and on the implant neck. This study aims to evaluate the possible use of dentinal adhesives on the surface of the transmucosal path of dental implants in order to create a hermetic seal between keratinized epithelium and abutment. METHODS: Four sections of 12 µm thickness were obtained from a sample of the oral mucosa. Scotchbond TM Universal Adhesive (3M ESPE, Seefeld, Germany) was carefully applied both to the samples and to the transmucosal path of titanium abutment (Win-Six, BioSAFin, Italy). The adhesives were polymerized. FT-IR analysis was performed on: 1) polymerized Scotchbond Universal Adhesive (3M ESPE, Seefeld, Germany); 2) the interface between the titanium abutment and the adhesive; 3) the interface between the adhesive and the mucosa; 4) the mucosa samples. RESULTS: Comparing the spectra, it emerged that the adhesive has established chemical bonds both on titanium and on the keratinized mucosa, involving different types of chemical interactions. CONCLUSIONS: The results of this in-vitro study are encouraging. In the future biocompatibility and comparative study with other adhesives will be required.

Custom-made additively manufactured subperiosteal implant.

Subperiosteal implants were introduced in the last century. Poor clinical results led those implants to be progressively abandoned. Recently, several Authors suggested a revival of subperiosteal implants as an alternative to regenerative procedures. The purpose of this study was to describe the clinical application of custom-made additively manufactured subperiosteal implant for fixed prosthetic rehabilitation of edentulous maxilla. Plaster models of the upper and the lower arch were scanned, as well as the mock-up. Digital Imaging and Communications in Medicine data obtained from cone beam computed tomography were processed through the thresholding procedure. The design of the subperiosteal implant was drawn on the stereolithographic model and scanned. Once the digital project of the subperiosteal implant was completed, it was sent to additive manufacturing. After the surgery, the patient was strictly monitored for up to 2 years. The outcomes were assessed based on the incurrence of biological and mechanical complications, postoperative complications, and implant survival. The patient did not suffer from postoperative complications. Neither biological nor mechanical complications occurred during the follow-up period. At the end of the study, the implant was still in function. Custom-made subperiosteal implants could be considered as an alternative to regenerative procedures for the rehabilitation of severe bone atrophy. Further studies are needed in the future to confirm the positive outcome.

Epithelial Biological Response to Machined Titanium vs. PVD Zirconium-Coated Titanium: An In Vitro Study.

The aim of this study was to compare the epithelial biological response to machined titanium Ti-6Al-4V grade 5 and titanium Ti-6Al-4V grade 5 coated with zirconia (ZrN) by physical vapor deposition (PVD). Human keratinocytes were cultured in six-well plates. Machined titanium TiAl4V4 grade 5 (T1) and ZrN-coated titanium TiAl4V4 grade 5 (T2) discs were placed in two different wells. The remaining two wells served as control (C). Scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS) were performed to compare the T1 and T2 surfaces. Subsequent analyses were performed to explore the effect of T1 and T2 contact with human keratinocyte HUKE cell lines. Cell viability was evaluated using a trypan blue exclusion test and MTT assay. Cell lysates from C, T1, and T2 were Western blotted to evaluate E-cadherin and Integrin-α6ß4 expression. SEM revealed that T2 was smoother and more homogeneous than T1. EDS showed homogeneous and uniform distribution of ZrN coating on T2. Cell viability analyses did not show significant differences between T1 and T2. Furthermore, E-cadherin and Integrin-α6ß4 expressions of the epithelial cells cultured in T1 and T2 were similar. Therefore, titanium Ti-6Al-4V grade 5 surfaces coated with ZrN by PVD seem to be similar substrates to the uncoated surfaces for keratinocyte adhesion and proliferation.

Biological Oriented Immediate Loading: A New Mathematical Implant Vertical Insertion Protocol, Five-Year Follow-Up Study.

One of the current major challenges in implant therapy is to minimize marginal bone loss around implants, since it can trigger bacterial colonization of the implant's neck, leading to its failure. The present study aimed (1) to scientifically validate a new mathematical rule based on soft tissues thickness, for choosing the correct implant position with respect to the bone level, in order to provide a better tissue adaptation to the abutment/implant surface to avoid bacterial invasion, and (2) to apply this mathematical rule to the Biological Oriented Immediate Loading (B.O.I.L.) surgical protocol, avoiding peri-implant bone resorption. N. 127 implants were inserted following B.O.I.L. protocol: implants were placed according to the mathematical rule Y = X - 3, which correlates the position of the implant from the bone crest level (Y) with the thickness of the soft tissues (X). All the implants were inserted in fresh extraction sockets, and immediately loaded with temporary abutments and prostheses. Bone levels were evaluated through radiographic examination just after surgical procedure (T0), and after 10 days (10D), 6 months (6M), 1 year (1Y), and 5 years (5Y). After 5 years, the implant survival rate was 100%, with a medium marginal bone loss around implants of 0.0704 mm (SD = 0.169 mm). One-way ANOVA, followed by Tukey's multiple comparison test was performed for statistical evaluations (p < 0.05). This protocol provided a safe and successful procedure, with a good soft tissue seal against bacterial challenge. The application of the mathematical rule allows the implant placement in a correct vertical position from the bone crest, avoiding bone resorption and bacterial infiltrations. Moreover, the use of Multi Unit Abutment (MUA) determined a stable biological seal, favouring the implant healing and preserving the adhesion of hemidesmosomes to the titanium of MUA.

Assessment of antiplaque effectiveness of chlorhexidine-soaked gauze compared to chlorhexidine mouth rinse: Randomized clinical trial.

AIM: The aim of the present study was to compare the efficacy of a disposable gauze soaked with chlorhexidine and rolled up on the finger vs chlorhexidine mouth rinse (CM) to maintain oral hygiene. METHODS: In this single-blind, randomized trial, both groups were instructed to brush their teeth and use the 0.12% chlorhexidine intervention twice per day (experimental group: toothbrushing + chlorhexidine-soaked gauze; control group: toothbrushing + mouth rinse). The main outcome was the change in full mouth plaque index scores from baseline to 2 weeks. Secondary outcomes were the patient's appreciation (visual analog scale) and the bleeding index. RESULTS: The final sample consisted of 60 young patients: 31 in the experimental group and 29 in the control group. After 2 weeks, both interventions were effective in reducing plaque index. The percentage of score reduction was 33% in the experimental group and 30% for the controls, with no significant difference between groups. Both interventions reduced the bleeding index, but this reduction was significant only in the experimental group (P < .001). CONCLUSIONS: There is no difference between chlorhexidine-soaked gauze and CM regarding plaque control. In addition, gauze soaked with chlorhexidine was significantly more effective in reducing the bleeding index score and was appreciated by the patients.

Cystic lesions of the jaws: a retrospective clinicopathologic study of 2030 cases.

OBJECTIVE: The aim of this study was to perform an epidemiologic analysis of cases of jaw cysts treated from 1973 to 2012 at the Dentistry and Maxillofacial Surgery Unit of the Verona Hospital, Italy, and to compare the data obtained with those published in the literature. STUDY DESIGN: A retrospective survey of 2030 patients treated for jaw cysts from 1973 to 2012 was performed. The lesions were classified according to the 2005 World Health Organization histologic classification, and the following variables were analyzed: age, gender, histopathologic diagnosis, and site of onset. RESULTS: Of 2030 total lesions, there were 1970 odontogenic cysts (97.04%), 50 nonodontogenic cysts (2.46%), and 10 pseudocysts (0.49%). Of the patients, 314 were children (15.47%), and 1716 were adults (84.53%). Mean age was 37.24 years, with a male/female ratio of 1.71:1. CONCLUSIONS: There is a wide variety of cysts, some of which are subject to variations according to gender, localization, and age.

Nuclear Survivin as a Prognostic Factor in Squamous-Cell Carcinoma of the Oral Cavity.

Oral squamous-cell carcinoma (OSCC) and most human tumors are characterized by an imbalance of regulatory mechanisms controlling cell processes such as apoptosis. Survivin, a member of the inhibitor of apoptosis family, is overexpressed in most solid and hematological malignancies and correlates with a reduced overall survival rate. Thus, the aim of this study was to find a correlation between nuclear Survivin expression and clinicopathologic data and the prognosis in OSCC patients. A total of 152 OSCC samples were investigated by immunohistochemistry for nuclear Survivin expression. Then, Survivin was scored semiquantitatively using an immunoreactivity score (IRS), calculated by multiplying the percentage of positive cells with the staining intensity. Using a digital image analysis software, OSCC patients were stratified into 4 groups. Results showed that patients with a lower IRS score displayed better survival rates than patients with a higher IRS score, reaching statistical significance. As the expression of Survivin at the nuclear level seems to suggest a poor prognosis in OSCC patients, the evaluation of nuclear Survivin IRS may be a useful tool to identify patients with more aggressive and disseminated disease, influencing follow-up and therapeutic protocols.

Potential Bone to Implant Contact Area of Short Versus Standard Implants: An In Vitro Micro-Computed Tomography Analysis.

AIM: To compare the available potential bone-implant contact (PBIC) area of standard and short dental implants by micro-computed tomography (µCT) assessment. METHODS: Three short implants with different diameters (4.5 × 6 mm, 4.1 × 7 mm, and 4.1 × 6 mm) and 2 standard implants (3.5 × 10 mm and 3.3 × 9 mm) with diverse design and surface features were scanned with µCT. Cross-sectional images were obtained. Image data were manually processed to find the plane that corresponds to the most coronal contact point between the crestal bone and implant. The available PBIC was calculated for each sample. Later on, the cross-sectional slices were processed by a 3-dimensional (3D) software, and 3D images of each sample were used for descriptive analysis and display the microtopography and macrotopography. RESULTS: The wide-diameter short implant (4.5 × 6 mm) showed the higher PBIC (210.89 mm) value followed by the standard (178.07 mm and 185.37 mm) and short implants (130.70 mm and 110.70 mm). CONCLUSIONS: Wide-diameter short implants show a surface area comparable with standard implants. Micro-CT analysis is a promising technique to evaluate surface area in dental implants with different macrodesign, microdesign, and surface features.

Active inflammatory biomarkers in oral lichen planus.

Oral lichen planus (OLP) is a chronic disease, with a central role to cell-mediated autoimmunity. Osteopontin promotes migration and recruitment of immune cells, CD44 is its receptor, and Survivin seems to be important in skin/mucosa homeostasis. The aim of this study was to investigate their expression in biopsy specimens of patients with different OLP clinical types and healthy controls.Biopsy specimens from 30 patients with OLP (15 atrophic and 15 hyperplastic) and 15 healthy controls were subjected to immune-histochemical analysis, to detect the expression of osteopontin, CD44, and Survivin in oral epithelia. The distributions of positively stained cells were evaluated with a quantitative method, while the inflammation degree was evaluated with a semi-quantitative one.Expression of osteopontin and CD44 was higher in OLP than controls, while Survivin expression was lower in OLP patients. There was a greater reduction of Survivin expression in atrophic OLP than hyperplastic OLP. A correlation between osteopontin expression and a high degree of inflammation was found. Furthermore, Survivin expression was higher in cases with low intensity of inflammation.Osteopontin, CD44, and Survivin seem to be involved in OLP pathogenesis, and further investigations are needed for clarifying their role in this oral disease.

Expression and prognostic significance of apoptotic genes in oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is the most common malignancy of oral cavity. Human cancers are characterized by an imbalance of regulatory mechanisms controlling different cellular pathways, including apoptosis. Apoptosis occurs in a wide variety of physiological processes, such as embryonic development, tissue homeostasis or immune defense, and its role is to remove harmful, damaged, or unwanted cells. Defective apoptosis represents an important causative factor in the development/progression of cancer, and the ability of tumor cells to evade apoptosis can play a significant role in their resistance to conventional anticancer treatment. We investigated the expression profile of genes involved in the apoptotic mechanism in 21 paired tissue samples (OSCC and adjacent normal oral mucosa) by cDNA macroarray, in order to identify differentially expressed genes in oral cancer compared to normal tissue. To validate the results obtained by cDNA macroarray, quantitative real-time PCR, Western blot, and immunohistochemical analyses were performed. Results obtained by cDNA macroarray analysis showed different expression levels of CRADD, FADD, ATM, APAF1, and TP63 genes in OSCC compared to normal mucosa. Differential gene expression measurements (tumor vs. normal tissue) performed by real-time PCR showed an overexpression of FADD and a downregulation of ATM. Moreover, Western blot analysis confirmed that both CRADD and APAF-1 were decreased in OSCC compared to normal oral mucosa. As showed by immunohistochemistry, OSCC exhibited increased expression of p63 compared to normal tissue. Interestingly, a statistically significant positive correlation was found between p63 expression and the histological grade.

Is expression of p120ctn in oral squamous cell carcinomas a prognostic factor?

OBJECTIVES: p120ctn is a component of the catenin family. To date, there have only been two studies examining expression levels of p120ctn in oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: Paraffined specimens of 113 OSCCs and 12 of normal mucosa were examined by immunohistochemistry. Frozen samples of 20 OSCCs and 5 of normal mucosa were examined by Western blot (WB). Results were correlated with clinicopathological parameters. Five cell lines were examined by immunofluorescence, immunocytochemistry, and WB to show immunoreactivity and cellular localization of p120ctn. RESULTS: Altered p120ctn expression was observed in 109/113 cases of OSCC. Heterogenous cytoplasmic/nuclear expression was associated with loss of membranous distribution (88/113 cases). Complete loss of expression was noted in 21/113 cases. Increased cytoplasmic expression was evident in all positive cases, without significant correlation among p120ctn staining/pattern and grading/stage. Reduction/absence of p120ctn expression was related to poor prognosis (P < .05). CONCLUSION: p120ctn delocalization/loss of expression could be an independent prognostic marker in OSCC.

A 3-day randomized clinical trial to investigate the desensitizing properties of three dentifrices.

BACKGROUND: The aim of the present study is to evaluate the relative abilities of three desensitizing dentifrices to provide rapid relief of dentin hypersensitivity (DH). METHODS: Using a double-mask, randomized design, three dentifrices: 1) containing 8% arginine and 1,450 ppm sodium monofluorophosphate; 2) containing 8% strontium acetate and 1,040 ppm sodium fluoride; and 3) containing 30% microaggregation of zinc-carbonate hydroxyapatite nanocrystals were compared after 3-day treatment. Participant's DH was evaluated at baseline and after 3 days using air-blast, tactile, cold water, and subjective tests. RESULTS: The final sample consisted of 85 individuals: 29 received the arginine-based dentifrice (group 1), 27 the strontium acetate-based dentifrice (group 2), and 29 the dentifrice based on zinc-carbonate hydroxyapatite (group 3). All dentifrices were mostly effective to reduce DH: the percentage of score reduction from baseline to 3 days was >30% for all tests (except for subjective test of group 2). The comparison among the three dentifrices showed that, after 3 days, there was an improvement in air-blast (mean percentage of reduction, 39.2% in group 1, 42.0% in group 2, and 39.2% in group 3), cold water (41.5%, 51.8%, and 50%), tactile (50.3%, 40.1%, and 33.8%), and subjective (33.1%, 17.4%, and 31.4%) test scores, with differences being significant for cold water and subjective tests. For air-blast and tactile tests, there were no significant differences across groups at 3 days. Moreover, no significant differences at any test were observed in a subset of patients that were followed up to 8 weeks: all dentifrices were all highly efficacious. CONCLUSIONS: This study documents that the three tested dentifrices significantly reduced DH after 3-day treatment, supporting their use in clinical practice. To the best of the authors' knowledge, this is the first report documenting the rapid relief from DH of a zinc-carbonate hydroxyapatite dentifrice.

Expression of cell cycle markers and human papillomavirus infection in oral squamous cell carcinoma: use of fuzzy neural networks.

Our aim was to evaluate in oral squamous cell carcinoma (OSCC) the relationship between some cell cycle markers and HPV infection, conditionally to age, gender and certain habits of patients, and to assess the ability of fuzzy neural networks (FNNs) in building up an adequate predictive model based on logic inference rules. Eighteen cases of OSCC were examined by immunohistochemistry for MIB-1, PCNA and survivin expression; presence of HPV DNA was investigated in exfoliated oral mucosa cells by nested PCR (nPCR, MY09-MY11/GP5-GP6), and HPV genotype was determined by direct DNA sequencing. Data were analyzed by traditional statistics (TS) and FNNs. HPV DNA was found in 9/18 OSCCs (50.0 %) without any significant higher risk of HPV infection with respect to the sociodemographic variables considered (p > 0.2), apart from tobacco smoking, reported in 44.4% of OSCC HPV-positive vs. 100% HPV-negative subjects (p = 0.029). Regarding cell cycle markers, TS and FNN revealed that survivin was expressed significantly more in HPV-negative than in HPV-positive OSCC [root mean-square error (RMSE) = 5.89 x 10(-6), % predicted 100.0]; furthermore, smoking played a protective role for survivin expression in HPV-positive cases (OR = 0.019, 95%CI 0.001-0.723, RMSE = 0.20, % of prevision 94.4). FNN, although on a small sample size, allowed us to confirm data by TS and to hypothesize a different cell cycle pattern for HPV-positive vs. HPV-negative OSCC. In the latter cases, the relevance of apoptotic vs. proliferative markers suggested that they may be related to the different supposed outcome of HPV-negative OSCC and that HPV may have a protective role in the expression level of survivin, especially in tobacco smokers.

Bone scintigraphy and SPECT in the evaluation of the osseointegrative response to immediate prosthetic loading of endosseous implants: a pilot study.

PURPOSE: Several recent medical reports have focused attention on the possible application of skeletal scintigraphy imaging in odontostomatology. The aim of the present report was to assess the influence of immediate prosthetic loading on peri-implant osteoblastic activity through bone scintigraphy. MATERIALS AND METHODS: Implants were placed in 2 healthy women. A nuclear medicine investigation with single-photon emission-computed tomography (SPECT) was performed for both patients at 30 and 90 days after implant placement. The study was completed with acquisitions of planar images of the skull in an anterior view and the use of regions of interest (ROIs) of the same size in the area corresponding to immediate loading and in the opposite hemimandible (at the control sites). Count density ratios (counts/pixel) obtained from each ROI were used for a quantitative/relative assessment. Tomographic images were evaluated with a qualitative method. The spatial resolution of the reconstructed tomograms and of the planar images was approximately 7 mm. RESULTS: Routine planar methodology provided a direct measure of cellular activity of the examined areas. The difference in count density ratio registered from the same ROI between the first and the second scintigraphy revealed the course of peri-implant osteoblastic activity, which was very high in the first month and then declined during subsequent months. DISCUSSION AND CONCLUSION: In spite of the small number of involved patients, the results obtained from this pilot study suggest that nuclear medicine may hold possible advantages in implant dentistry for those who seek to clarify the still unknown aspects of osteoblastic activity.