Maxillary sinus lift augmentation: A randomized clinical trial with histological data comparing deproteinized bovine bone grafting vs graftless procedure with a 5-12-year follow-up.

INTRODUCTION: Different protocols and procedures for sinus lift and implant placement are available, generally involving the use of grafts to increase the tissue volume and/or prevent the Schneiderian membrane from collapsing. Among xenografts, deproteinised bovine bone graft (DBBP) is frequently used in sinus lift procedures. Leaving an ungrafted space following membrane elevation has proven to have a bony regenerative potential as well. This study aimed to compare the clinical and histological features of sinus lift surgery performed with or without biomaterials. METHODS: Patients with severe maxillary posterior atrophy (residual bone height 2-6 mm and residual crest thickness ≥4 mm), and in need of sinus lift surgery to allow the placement of three implants were enrolled and randomly divided into two groups. They underwent sinus lifts with DBBP (control) or with a graftless technique (test) and immediate placement of two implants (a mesial and distal one). After 6 months, a bone sample was retrieved from the area between the previously inserted fixtures, and a third, central implant was placed. The collected bone samples were analyzed morphologically and histomorphometrically. The patients were provided with prosthetic restorations after 6 months and followed up for 5-12 years. RESULTS: Ten patients were enrolled in the test and nine in the control group. The 6-month follow-up showed in the control group an average augmentation of 10.31 mm (±2.12), while in the test group it was 8.5 mm (±1.41) and a success rate of 96.3% in the control and 86.7% in the test group (p > 0.05). The histological analysis evidenced the presence of new bone tissue surrounded by immature osteoid matrix in the test group, and a variable number of DBBP particles surrounded by an immature woven bone matrix in the control group. CONCLUSION: The results of the present trial indicate that, with residual bone height of 2-6 mm and residual crest thickness ≥4 mm, sinus lift surgery with or without biomaterials followed by implant restoration, produces similar clinical and histological outcomes.

Molecular Analysis of Peri-implant Soft Tissue Response to Different Abutment Materials in Humans. A Pilot Study.

PURPOSE: To evaluate the response of human peri-implant soft tissue (PIST) on different healing abutment materials 24 hours after positioning, by assessing the expression of genes related to the early connective tissue wound healing response. MATERIALS AND METHODS: Experimental abutments of 4 different materials (A): grade 4 titanium, (B) grade 5 titanium, (C) zirconia and (D) PEEK, were mounted on installed implants in 5 patients, four different abutments each. Before implant placement, a gingival biopsy (control-CT) was obtained using a 2 mm diameter punch (T0). After 24 hours (T24), PIST biopsies were collected using a specifically designed custom-made cutting device. Real-time PCR was performed to analyze the expression of the following genes: COL-I, COL-III, MMP-1, TIMP-1,TGF-b1, FN, ITGA4, ITGA5, ITGB1, RAC-1, COL-IV, aSMA, IL-6 and CXCL-1. RESULTS: Gene expression analysis showed some differences between CT and abutment of different materials, although no significant differences were detected comparing the experimental groups. COL-I was significantly down-regulated in groups A and C compared to CT. MMP-1 and TIMP-1 increased in all the experimental groups, although at a lower extent in group A. FN, RAC-1, COL-IV and aSMA were down-regulated, especially in group A, in which CXCL-1 and IL-6 showed the lowest expression. CONCLUSIONS: The results of grade 4 titanium and zirconia abutments seem to be promising, since a lower expression of genes related with inflammation, myofibroblasts activation and ECM remodeling was observed when compared with grade 5 titanium and PEEK, without triggering a pro-fibrotic response in the early phases of PIST repair.

COVID-19 monitoring of school personnel through molecular salivary test and dried blood spot analysis.

Background: When the coronavirus disease 2019 (COVID-19) pandemic broke out, most countries enforced school closures as a precautionary measure. Although COVID-19 is still present three years later, schools have been reopened. We aimed to test the association of molecular salivary testing (MST) and dried blood spot (DBS) analysis for community surveillance by investigating the immunological profile of a group of school staff during and following COVID-19 vaccination. Methods: We conducted the study in a school in Milan from April 2021, when school staff were administered the first dose of vaccine against SARS-CoV-2, until the school year ended in June 2022. Each participant provided samples for MST and DBS one month (T1, W1) after receiving their first dose of vaccine. Subsequently, they collected weekly MST samples for five weeks (W2-W6), plus a DBS sample in the last week (T2). Both samples were collected one (T3), four (T4), and seven months (T5) after the administration of the second vaccine dose in May 2021. A final DBS sample was collected one year (T6) after T3. Results: Sixty participants provided 327 MSTs and 251 DBSs. None of the MST samples tested positive for SARS-CoV-2 RNA during the study period. A total of 201 DBS samples tested positive for the IgG semiquantitative analysis. Negative samples were found only at T1 (20.45%) and T2 (7.32%). We observed borderline results at T1 (4.55%), T2 (7.32%), and T4 (2.70%). The anti-SARS-CoV-2 average antibody ratio increased after the second dose between T2 and T3, and the trend peaked after the third dose between T4 and T6. We performed an immunoenzymatic assay of antibodies against nucleocapsid protein on samples collected at T1 from five participants who reported having been infected before the study and from four subjects with an abnormal increase in the antibody values at T4. Two samples tested positive in the first group and two in the second one. Conclusions: Our findings show that MST and DBS could be effective tools in the active surveillance of school personnel and that schools could be considered safe settings in view of SARS-CoV-2 infection. Vaccines might have contributed to case and/or symptom reduction.

Quantitative Evaluation of Inflammatory Markers in Peri-Implantitis and Periodontitis Tissues: Digital vs. Manual Analysis-A Proof of Concept Study.

Background and Objectives: In dentistry, the assessment of the histomorphometric features of periodontal (PD) and peri-implant (PI) lesions is important to evaluate their underlying pathogenic mechanism. The present study aimed to compare manual and digital methods of analysis in the evaluation of the inflammatory biomarkers in PI and PD lesions. Materials and Methods: PD and PI inflamed soft tissues were excised and processed for histological and immunohistochemical analyses for CD3+, CD4+, CD8+, CD15+, CD20+, CD68+, and CD138+. The obtained slides were acquired using a digital scanner. For each marker, 4 pictures per sample were extracted and the area fraction of the stained tissue was computed both manually using a 594-point counting grid (MC) and digitally using a dedicated image analysis software (DC). To assess the concordance between MC and DC, two blinded observers analysed a total of 200 pictures either with good quality of staining or with non-specific background noise. The inter and intraobserver concordance was evaluated using the intraclass coefficient and the agreement between MC and DC was assessed using the Bland-Altman plot. The time spent analysing each picture using the two methodologies by both observers was recorded. Further, the amount of each marker was compared between PI and PD with both methodologies. Results: The inter- and intraobserver concordance was excellent, except for images with background noise analysed using DC. MC and DC showed a satisfying concordance. DC was performed in half the time compared to MC. The morphological analysis showed a larger inflammatory infiltrate in PI than PD lesions. The comparison between PI and PD showed differences for CD68+ and CD138+ expression. Conclusions: DC could be used as a reliable and time-saving procedure for the immunohistochemical analysis of PD and PI soft tissues. When non-specific background noise is present, the experience of the pathologist may be still required.

Personal Protection Equipment and Infection Control Procedures among Health Workers during the COVID-19 Pandemic.

Health workers have been particularly affected by the COVID-19 pandemic, but it is unclear which healthcare professions are more exposed. We search for information that can help identify health workers who are employed in exposure-prone professions and who, therefore, routinely wear and adopt strict infection control equipment and measures from other colleagues. Our purpose is to test the hypothesis that health professionals historically considered less exposure-prone are affected more severely by COVID-19. Taking dentists as an example of exposure-prone healthcare professionals, this study aims to analyze data on COVID-19-related deaths reported by the Italian board of doctors and dentists' database to evaluate the number of COVID-19-related deaths of doctors and dentists in Italy from the beginning of the pandemic to 31 December 2022. As of 31 December 2021, out of 364 deaths, 38 were dentists, and of the remaining 326 doctors, 140 were general practitioners (GPs). The percentage of deaths among dentists, total doctors and GPs results in 0.06%, 0.09% and 0.33%, respectively, for the whole sample. Excluding subjects over 70 years of age, the corresponding values are 0.05%, 0.06% and 0.25%. Most of the deaths occurred in Lombardia, and the geographical distribution overlaps the trend of the corresponding general Italian population. Considering the outcome of "death", dentists, despite being at high risk, are not particularly affected by COVID-19.

Morphological and Immunopathological Aspects of Lingual Tissues in COVID-19.

COVID-19, a recently emerged disease caused by SARS-CoV-2 infection, can present with different degrees of severity and a large variety of signs and symptoms. The oral manifestations of COVID-19 often involve the tongue, with loss of taste being one of the most common symptoms of the disease. This study aimed to detect SARS-CoV-2 RNA and assess possible morphological and immunopathological alterations in the lingual tissue of patients who died with a history of SARS-CoV-2 infection. Sixteen cadavers from 8 SARS-CoV-2 positive (COVID-19+) and 8 negative (COVID-19-) subjects provided 16 tongues, that were biopsied. Samples underwent molecular analysis through Real-Time RT-PCR for the detection of SARS-CoV-2 RNA. Lingual papillae were harvested and processed for histological analysis and for immunohistochemical evaluation for ACE2, IFN-γ and factor VIII. Real-Time RT-PCR revealed the presence of SARS-CoV-2 RNA in filiform, foliate, and circumvallate papillae in 6 out of 8 COVID-19+ subjects while all COVID-19- samples resulted negative. Histology showed a severe inflammation of COVID-19+ papillae with destruction of the taste buds. ACE2 and IFN-γ resulted downregulated in COVID-19+ and no differences were evidenced for factor VIII between the two groups. The virus was detectable in most COVID-19+ tongues. An inflammatory damage to the lingual papillae, putatively mediated by ACE2 and IFN-γ in tongues from COVID-19+ cadavers, was observed. Further investigations are needed to confirm these findings and deepen the association between taste disorders and inflammation in SARS-CoV-2 infection.

Dental Emergencies in an Italian Pediatric Hospital during the COVID-19 Pandemic.

Emergency rooms (ER) are largely used by patients with oral complaints, who choose the ER over private or public dental offices for oral prevention and treatment. During the COVID-19 pandemic, the activity of most dental facilities was limited, and most hospitals and ERs were dedicated to the treatment of COVID-19 patients. The present study analyzed the number of and reason for visits at the emergency room (ER) of Ospedale dei Bambini "Vittore Buzzi", the main pediatric hospital in Milano, Italy, between 2019 and 2020, with a particular focus on oral emergencies. In 2019, 25,435 children turned to the ER, compared to 16,750 in 2020. About 10% of the children were eventually admitted to the hospital in both years. The number of admissions for infectious diseases, other than COVID-19, signed an important decrease in 2020, while trauma/injuries decreased slightly in number but increased in proportion. The number and proportion of ER visits for oral complaints decreased in 2020 compared to 2019. Stomatitis was the most frequent condition, followed by traumatic injuries, which decreased in number and percentage between 2019 and 2020. Oral infections and painful caries accounted for about 15% of the cases in both 2019 and 2020. These data highlight the need to promote territorial services for the prevention and treatment of oral health complaints, including dental emergencies.

Saliva Molecular Testing for SARS-CoV-2 Surveillance in Two Italian Primary Schools.

BACKGROUND: No evidence has so far proven a significant role of schools in SARS-CoV-2 transmission, while the negative effects of their closure on children and adolescents are well documented. Surveillance, by means of frequent students and staff testing, has been advocated in order to implement school safety. Our aim was to report the results of a school surveillance program for the early detection of SARS-CoV-2 infection in pre- and asymptomatic subjects, by means of molecular salivary testing (MST). METHODS: School surveillance in two schools in Milan, Italy, was carried out for six weeks. Each participant received a saliva collection kit, to be self-performed. RESULTS: 401 students and 12 teachers were enrolled, and 5 positive children in 5 different classes were observed. All the cases were asymptomatic. Their nasopharyngeal swab was positive on the same day in four cases, while in one case it resulted negative on the same day and positive 3 days later. In one positive case, the whole family was set under surveillance. The positive child did not develop symptoms and no family member was infected. CONCLUSIONS: MST might represent an efficient way to actively survey communities in order to detect asymptomatic cases, thus limiting SARS-CoV-2 transmission.

Effects of Vitamin and Amino Acid-Enriched Hyaluronic Acid Gel on the Healing of Oral Mucosa: In Vivo and In Vitro Study.

Background and Objectives: Wound healing is a dynamic process that can be compromised in patients with chronic and metabolic conditions or unhealthy lifestyles. Numerous medical substances designed for topical use, charged with compounds that promote the healing process, have been developed to improve wound healing, especially in compromised subjects. The present study aimed to extend our understanding of the in vivo effects of a hyaluronic acid gel charged with amino acids (HAplus gel, Aminogam gel® Errekappa Euroterapici spa, Milan, Italy) and study the in vitro effects of the same gel charged with additional substances in an attempt to optimize its formulation. Materials and Methods: In a randomized controlled split-mouth clinical and histological trial, HAplus gel was tested on the gingival tissue of the lower third molar post-extraction socket. The gingiva was collected at the time of extraction (T0) and ten days after the extraction (T1) to be histologically analyzed. During the second stage of the study, culture media with HAplus gel and vitamin C and E at different concentrations (TEST) were tested on human gingival fibroblasts and compared to the HAplus-enriched medium (HA-Control). Results: Histological and immunohistochemical analysis of collected gingiva showed higher microvascular density and collagen fibers organized in closely packed and well-oriented bundles in sites treated with HAplus gel. In the in vitro study, all TEST groups showed an increased viability from 24 h to 48 h. After 24 h, the viability percentage in all experimental groups was below 100% of the HA-Control, demonstrating a mild toxicity. After 48 h from seeding, the TEST groups' viability grew significantly compared to HA-Control. Conclusions: These encouraging preliminary results suggest that the use of HAplus gel enriched with vitamins C and E may be beneficial in patients with conditions that impair soft tissue healing.

Impact of Lifestyle Variables on Oral Diseases and Oral Health-Related Quality of Life in Children of Milan (Italy).

A large part of the Italian population doesn't receive adequate information and support on how to maintain oral health. In this observational, cross-sectional, pilot study, we investigated how some lifestyle-related variables affect oral diseases and oral health-related quality of life (OHRQoL) of children attending public-school summer services in Milan. A survey that included questions on children's oral disease, OHRQoL and lifestyle-related factors (feeding habits, oral hygiene protective behaviors, dental coaching and socio-economic and educational status), was administered to the children's caregivers. Data from 296 surveys were analyzed to assess the protective/negative effect of each variable on oral disease and OHRQoL. With respect to disease, the "never" consumption of fruit juice, the use of fluoride toothpaste, higher educational qualification and ISEE (equivalent family income) of those who filled out the form, resulted protective factors. Regarding OHRQoL, the "never" assumption/use of tea bottle, sugared pacifier and fruit juice as well as the use of fluoride toothpaste, a higher educational qualification and ISEE of those who filled out the form, resulted to have protective effects. In conclusion, protective behaviors and socio-economic status affect oral disease and OHRQoL in children of Milan.