High-Density Dermal Matrix for Soft Tissue Augmentation Using a Matrix Tissue Graph Technique-A Comprehensive Multicenter Analysis of 20 Implants: A 1-Year Follow-Up Retrospective Study.

Background: In this multicenter case series analysis, the authors present successful instances of 20 single-screw-retained and implant-supported prosthetic rehabilitation samples. Methods: A high-density heterologous dermal matrix (Derma® Osteobiol by Tecnoss, Torino, Italy) was employed with a specific technique named the matrix tissue graft (MTG) in all these cases characterized by an inadequate initial supra-crestal tissue height (thin if 1 mm or medium if 2 mm) to enhance the peri-implant soft tissues both vertically and horizontally. Results: The implants were deemed successful in all cases, yielding a success proportion of 100% (one-sided 97.5% confidence interval = 83.2-100%). The buccal and lingual gains were, respectively, 2.2 ± 0.38 mm (range 1.7-3.22 mm) and 0.83 ± 0.33 mm (range 0.1-1.5 mm). These measurements were calculated as the maximum distance between two superimposed .stl file models (derived from two different IOS devices) scanned before implant placement and 1 year after dermal matrix healing. Conclusions: An outstanding vertical and horizontal gain was obtained using this heterologous derma matrix placed above the bone crest and surrounding the dental implants.

Inter and intra-operator reliability of Lekholm and Zarb classification and proposal of a novel radiomic data-driven clustering for qualitative assessment of edentulous alveolar ridges.

OBJECTIVES: The present study was conducted to evaluate the reproducibility of Lekholm and Zarb classification system (L&Z) for bone quality assessment of edentulous alveolar ridges and to investigate the potential of a data-driven approach for bone quality classification. MATERIALS AND METHODS: Twenty-six expert clinicians were asked to classify 110 CBCT cross-sections according to L&Z classification (T0). The same evaluation was repeated after one month with the images put in a different order (T1). Intra- and inter-examiner agreement analyses were performed using Cohen's kappa coefficient (CK) and Fleiss' kappa coefficient (FK), respectively. Additionally, radiomic features extraction was performed from 3D edentulous ridge blocks derived from the same 110 CBCTs, and unsupervised clustering using 3 different clustering methods was used to identify patterns in the obtained data. RESULTS: Intra-examiner agreement between T0 and T1 was weak (CK 0.515). Inter-examiner agreement at both time points was minimal (FK at T0: 0.273; FK at T1: 0.243). The three different unsupervised clustering methods based on radiomic features aggregated the 110 CBCTs in three groups in the same way. CONCLUSIONS: The results showed low agreement among clinicians when using L&Z classification, indicating that the system may not be as reliable as previously thought. The present study suggests the possible application of a reproducible data-driven approach based on radiomics for the classification of edentulous alveolar ridges, with potential implications for improving clinical outcomes. Further research is needed to determine the clinical significance of these findings and to develop more standardized and accurate methods for assessing bone quality of edentulous alveolar ridges.

Exploring the potential of calcium-based biomaterials for bone regeneration in dentistry: a systematic review.

INTRODUCTION: Regenerative medicine emerged as a promising strategy for addressing bone defects, with several bone grafts currently being used, including autografts, allografts, xenografts and alloplasts. Calcium-based biomaterials (CaXs), a well-known class of synthetic materials, have demonstrated good biological properties and are being investigated for their potential to facilitate bone regeneration. This systematic review evaluates the current clinical applications of CaXs in dentistry for bone regeneration. EVIDENCE ACQUISITION: A comprehensive search was conducted to collect information about CaXs and their applications in the dental field over the last ten years. The search was limited to relevant articles published in peer-reviewed journals. EVIDENCE SYNTHESIS: A total of 72 articles were included in this scoping review, with eight studies related to periodontology, 63 in implantology and three in maxillofacial surgery respectively. The findings suggest that CaXs hold promise as an alternative intervention for minor bone regeneration in dentistry. CONCLUSIONS: Calcium-based biomaterials have shown potential as a viable option for bone regeneration in dentistry. Further research is warranted to fully understand their efficacy and safety in larger bone defects. CaXs represent an exciting avenue for researchers and clinicians to explore in their ongoing efforts to advance regenerative medicine.

Treatment of Mandibular Impacted Canine in a Patient with Class II Division 1 Malocclusion with "Reverse Pin": A Case Report.

This case report presents an orthodontic treatment conducted on a 13-year-old girl with bilateral Class II malocclusion and a mandibular impacted canine. The presence of an impacted tooth necessitates careful consideration of the timing of orthodontic treatment, the appropriate surgical procedure to expose the tooth, the specific orthodontic mechanics involved, and the potential problems that may arise, all of which depend on the type and location of the canine impaction in the jaw. The treatment plan included a surgical procedure to expose the impacted tooth and orthodontic traction to guide it into position. Correction of the Class II Division 1 malocclusion utilized a specialized technique called the "reverse pin", reducing vertical side effects. The revised version maintains clarity and key information about the case report and treatment.

Labial Frenectomy using Laser: A Scoping Review.

Labial frenectomy is a surgical technique, that aims to remove the frenulum with its attachment to the underlying bone. Frenectomy, is indicated if the frenulum attachment causes midline diastema, gingival recession, hindrance in maintaining oral hygiene, or if it interferes with lip movements and for prosthetic needs. A labial frenectomy can be performed either by the routine scalpel technique, electrocautery, and most recently medical lasers. The aim of this study was to evaluate, whether the laser technique is more effective than the conventional surgical technique, and whether there are differences between the different types of lasers. The scoping review was conducted and prepared on the basis of the indications of the PRISMA guidelines (PRISMA Extension for Scoping Reviews, PRISMA-ScR) of PRISMA checklist, and nine papers were considered admissible to the qualitative analysis for the following outcomes: bleeding during intervention, use of sutures, duration of the intervention, and use of analgesic drugs in the days following the intervention. This review suggests that laser-performed labial frenectomy is faster and offers better intra- and postoperative management; however, due to the limited number of available papers, the final results of the present review are not absolute.

Does miR-197 Represent a Valid Prognostic Biomarker in Head and Neck Squamous Cell Carcinoma (HNSCC)? A Systematic Review and Trial Sequential Analysis.

(1) Background: Between tumors of the head and neck region, the squamous cell variant (HNSCC) is the most common and represents one of the main neoplasms affecting humans. At the base of carcinogenesis processes, there are genetic alterations whose regulation can be influenced by changes in the expression of microRNA (miR). Consequently, despite recent studies indicating miR-197 as a potential prognostic biomarker of survival for many varieties of cancer, there are currently no systematic reviews and trial sequential/bioinformatics/meta-analysis regarding the role of miR-197 in HNSCC. Our hypothesis was that with the existing literature, it is possible to clarify whether the different expressions of miR-197 in neoplastic tissues can represent a prognostic biomarker of survival in head and neck tumors. (2) Methods: The systematic review was reported following the indications of PRISMA and by consulting six electronic databases (including one register). Moreover, this review was carried out using the Kaplan-Meier plotter database portal, and hazard ratio (HR) data were extracted. Finally, a trial sequential analysis (TSA) was conducted to test the robustness of the proposed meta-analysis. (3) Results: This search identified 1119 articles and outcomes of the meta-analysis, reporting an aggregate HR for overall survival (OS) between the highest and lowest miR-197 expression of 1.01, 95% CI: [1.00, 1.02]. (4) Conclusions: We can state that, from the literature data included in the present meta-analysis, and from the TSA and bioinformatics analysis data, miR-197 does not currently represent a valid prognostic biomarker for HNSCC, although the data provided by the Kaplan-Meier plotter suggest that miR-197 can serve as a putative biomarker in short-term (5 years) survival.

Morphometric evaluation of the early stages of healing at cortical and marrow compartments at titanium implants: an experimental study in the dog.

OBJECTIVE: To study the early sequential stages of tissue composition in the cortical and marrow compartments of the alveolar bone crest at implants with a moderately rough surface. MATERIALS AND METHODS: Three month after tooth extraction in 12 Labrador dogs, full-thickness flaps were elevated in the edentulous region of the right side of the mandible and one implant was installed. The flaps were sutured to allow a fully submerged healing. The timing of the installations in the left side of the mandible and of sacrifices were scheduled in such a way to obtained biopsies representing the healing after 5, 10, 20, and 30 days. Ground sections (n = 6 per each healing period) were prepared, and the percentages of osteoid/new bone, old bone, new soft tissues (provisional matrix and primitive marrow), mature bone marrow, vessels, and other tissues (bone debris/particles and clot) were evaluated laterally to the implant surface up to a distance of about 0.4 mm from it. RESULTS: Osteoid/new bone was found after 5 days at percentages of 10.8 ± 4.3% at the marrow and 0.6 ± 0.6% at the cortical compartments. After 30 days, these percentages increased up to 56.4 ± 4.0% and 23.3 ± 6.1%, respectively. Old parent bone was resorbed between 5 and 30 days from 28.7 ± 10.9% to 14.9 ± 3.4% at the marrow (~48% of resorption) and from 81.2 ± 9.4% to 67.6 ± 5.6% at the cortical (~17% of resorption) compartments. All differences were statistically significant. CONCLUSION: Bone apposition to an implant surface followed a significantly different pattern in the compact and the marrow compartments around the implants. While in the compact compartments, bone apposition had to develop through the BMUs following resorption, it developed in very dense layers through an early apposition in the marrow compartments.

Healing at implants placed in bone of different morphology: an experimental study in dogs.

OBJECTIVE: To study osseointegration at implants installed using a standard bed preparation in sites of different bone morphology. MATERIAL AND METHODS: In six Labrador dogs, all mandibular premolars and first molars were extracted. After 4 months of healing, flaps were elevated, and two recipient sites were prepared in each side of the mandible, one in the second premolar and the other in the molar regions. Bone morphology and final insertion torque were evaluated. Healing abutments were applied, and the flaps were sutured to allow a non-submerged healing. After 4 months, the animals were sacrificed and ground sections were obtained for histomorphometric analyses. RESULTS: At the premolar sites, bone morphology Class 2 and at the molar regions Class 3 or 4 were identified. The final insertion torque was 50-55 Ncm at the premolar and 30-35 Ncm at the molar sites. Mean osseointegration in percentage reached 61.5 ± 11.5% and 63.3 ± 10.1% at the premolar and molar sites, respectively. Mineralized bone density evaluated from the implant surface up to a distance of about 0.6 mm lateral to the implant surface was 63.0 ± 7.4% and 65.4 ± 17.7% at the premolar and molar sites, respectively. CONCLUSIONS: Similar implant bed preparations performed at premolar and molar sites with different bone morphology, yielding insertion torque values of about 30-35 and 50-55 Ncm, respectively, did not affect osseointegration after 4 months at non-submerged implants.

Sequential healing events of osseointegration at UnicCa(®) and SLActive(®) implant surfaces: an experimental study in the dog.

AIM: To study the sequential events in osseointegration at implants with highly hydrophilic surfaces. MATERIAL AND METHODS: All premolars and the first molars were bilaterally extracted in 12 Beagle dogs. After 3 months, full-thickness flaps were elevated and two different implants systems with various surfaces were randomly installed in the edentulous premolar region in one side of the mandible. One surface was acid etched and further modified with calcium ions (UnicCa(®)), while the other was sandblasted with large grits and acid etched (SLActive(®)). The flaps were sutured to allow a fully submerged healing. The surgery on the other side of the mandible and the sacrifices were planned in such a way to obtain biopsies representing the healing after 1, 2, 4, and 8 weeks (n = 6 per period). RESULTS: After one week of healing, new bone apposition was found at both surfaces with percentages of 6.9 ± 3.3% and 6.1 ± 4.6% at UnicCa(®) and SLActive(®), respectively. After 2 weeks, the percentages had increased to 29.1 ± 11.9% and 21.6 ± 14.3%, respectively. After 4 and 8 weeks of healing, mean values of 46.3 ± 7.3% and 58.7 ± 15.1% at UnicCa(®) and 51.2 ± 16.1% and 68.9 ± 15.4% at SLActive(®) surfaces were found, respectively. None of the differences in percentages were statistically significant. Concomitantly, the old bone was resorbed at both surfaces from about 21-22% after 1 week to about 4-6% after 8 weeks of healing. CONCLUSIONS: The osseointegration process onto moderately rough titanium implant surfaces of high hydrophilicity was very similar for two implant systems that were both nanotechnologically modified.

Sequential Healing at Calcium- versus Calcium Phosphate-Modified Titanium Implant Surfaces: An Experimental Study in Dogs.

PURPOSE: The aim of this paper was to study the sequential healing of bone tissues at implants with different configuration and different modified surfaces. MATERIALS AND METHODS: Twelve Beagle dogs were used. Extractions of all teeth from the second premolar to the first molar were performed in both sides of the mandible. After 3 months, full-thickness flaps were elevated and two implants of different systems and with different surfaces were randomly installed in the premolar region in one side of the mandible. One surface was acid etched and further modified with calcium ions (BTI unicCa®), the other was sandblasted and acid etched plus a nanometer calcium phosphate deposition (3i T3®). The flaps were sutured to allow a fully submerged healing. The surgery on the other side of the mandible and the sacrifices were planned in such a way to obtain biopsies representing the healing after 1, 2, 4, and 8 weeks (n = 6 per period). RESULTS: After 1 and 2 weeks of healing, the mean values of new bone apposition on the implant surfaces were 5.9 ± 3.3% and 29.8 ± 16.0% at BTI unicCa and 4.6 ± 3.3% and 12.4 ± 5.6% at 3i T3, respectively. After 4 and 8 weeks, the percentage increased, being 49.4 ± 8.1% and 63.6 ± 7.3% at BTI unicCa and 40.3 ± 10.0% and 47.3 ± 20.2 at 3i T3, respectively. Differences statistically significant between the two surfaces were found only at the 2- and 4-week observation periods. Concomitantly, the old bone was resorbed at both surfaces from about 15-17% after 1 week to about 4-6% after 8 weeks of healing. CONCLUSION: Moderately rough surfaces modified with calcium ions or discrete calcium phosphate nanocrystalline deposition showed similar patterns of sequential healing. Higher new bone percentages were found at BTI unicCa compared with the 3i T3 implants, the difference being statistically significant at 2 and 4 weeks observation.

Dimensional changes in soft tissues around dental implants following free gingival grafting: an experimental study in dogs.

OBJECTIVE: To study the buccal dimensional tissue changes at oral implants following free gingival grafting, with or without including the keratin layer, performed at the time of implant installation into alveolar mucosa. MATERIAL AND METHODS: The mandibular premolars and first molars were extracted bilaterally in six Beagle dogs. In the right side of the mandible (Test), flaps were first elevated, and the buccal as well as part of the lingual masticatory mucosa was removed. An incision of the periosteum at the buccal aspect was performed to allow the flap to be coronally repositioned. Primary wound closure was obtained. In the left side, the masticatory (keratinized) mucosa was left in situ, and no sutures were applied (Control). After 3 months of healing, absence of keratinized mucosa was confirmed at the test sites. Two recipient sites were prepared at each side of the mandible in the region of the third and fourth premolars. All implants were installed with the shoulder placed flush with the buccal alveolar bony crest, and abutments were connected to allow a non-submerged healing. Two free gingival mucosal grafts were harvested from the buccal region of the maxillary canines. One graft was left intact (gingival mucosal graft), while for the second, the epithelial layer was removed (gingival connective tissue graft). Subsequently, the grafts were fixed around the test implants in position of the third and fourth premolars, respectively. After 3 months, the animals were euthanized and ground sections obtained. RESULTS: Similar bony crest resorption and coronal extension of osseointegration were found at test and control sites. Moreover, similar dimensions of the peri-implant soft tissues were obtained at test and control sites. CONCLUSIONS: The increase in the alveolar mucosal thickness by means of a gingival graft affected the peri-implant marginal bone resorption and soft tissue recession around implants. This resulted in outcomes that were similar to those at implants surrounded by masticatory mucosa, indicating that gingival grafting in the absence of keratinized mucosa around implants may reduce the resorption of the marginal crest and soft tissue recession.

[Oral complications in patients with head and neck cancer after radio-chemotherapy. Mucositis and xerostomia]. / Complicanze orali in pazienti affetti da carcinoma del cavo orale e sottoposti a radio e chemioterapia. Mucositi e xerostomia.

Surgery, chemotherapy and radiotherapy are different therapeutical options for the management of the head and neck cancers. Their indication is strictly relate to some parameters (macro and microscopic characteristics of the tumor, the patient's general health and the remaining expectations of the life of the patients). Surgical treatment of the cancer, even if it represents the most radical approach and with the most therapeutical index, it always can't be practicable, since, often, it is associated to imposing aesthetical and functional alterations of the interested district. Chemotherapic agents are among the drugs with the lower therapeutical index, that are able to cause side effects, mainly due to the immunosuppression. About radiations, side effects could be indicates as immediates or acutes, and backward or chronic. Among the acute manifestations are enumerated: xerostomia, mucositis, bacterial infections, dysgeusia, dysphagia; among chronic forms: hyposalivation-xerostomia, caries, telangiectasis, infections, osteoradionecrosis, trismus, muscular fibrosis, necrosis of the soft tissues. Mucositis and xerostomia are the most common side effects, and they are a potential source of life-threatening infections. Few interventions are of proven efficacy to reducing severity and duration of mucositis, and there are no universally accepted treatment protocols, but research activity is increasing because of the upward recognition of the importance of mucositis, that need a complex and multidisciplinary clinical management.