Primary Stability of Implants Inserted into Polyurethane Blocks: Micro-CT and Analysis In Vitro.

The approach employed for the site preparation of the dental implant is a variable factor that affects the implant's primary stability and its ability to integrate with the surrounding bone. The main objective of this in vitro study is to evaluate the influence of different techniques used to prepare the implant site on the primary stability of the implant in two different densities of artificial bone. MATERIALS AND METHODS: A total of 150 implant sites were prepared in rigid polyurethane blocks to simulate two distinct bone densities of 15 pounds per cubic foot (PCF) and 30 PCF, with a 1-mm-thick simulated cortex. The implant sites were equally distributed among piezoelectric surgery (PES), traditional drills (TD), and black ruby magnetic mallet inserts (MM). Two methods have been employed to evaluate the implant's primary stability, Osstell and micro-tomography. RESULTS: In the present study, we observed significant variations in the implant stability quotient (ISQ) values. More precisely, our findings indicate that the ISQ values were generally higher for 30 PCF compared to 15 PCF. In terms of the preparation technique, PES exhibited the greatest ISQ values, followed by MM, and finally TD. These findings corresponded for both bone densities of 30 PCF (PES 75.6 ± 1.73, MM 69.8 ± 1.91, and TD 65.8 ± 1.91) and 15 PCF (PES 72.3 ± 1.63, MM 62.4 ± 1.77, and TD 60.6 ± 1.81). By utilizing Micro-CT scans, we were able to determine the ratio of the implant occupation to the preparation site. Furthermore, we could calculate the maximum distance between the implant and the wall of the preparation site. The findings demonstrated that PES had a higher ratio of implant to preparation site occupation, followed by TD, and then the MM, at a bone density of 30 PCF (PES 96 ± 1.95, TD 94 ± 1.88, and MM 90.3 ± 2.11). Nevertheless, there were no statistically significant differences in the occupation ratio among these three approaches in the bone density of 15 PCF (PES 89.6 ± 1.22, TD 90 ± 1.31, and MM 88.4 ± 1.17). Regarding the maximum gap between the implant and the site preparation, the smallest gaps were seen when TD were used, followed by MM, and finally by PES, either in a bone density 15 PCF (PES 318 ± 21, TD 238 ± 17, and MM 301 ± 20 µm) or in a bone density 30 PCF (PES 299 ± 20, TD 221 ± 16, and MM 281 ± 19 µm). A statistical analysis using ANOVA revealed these differences to be significant, with p-values of < 0.05. CONCLUSION: The outcomes of this study indicate that employing the PES technique and osteo-densification with MM during implant insertion may enhance the primary stability and increase the possibility of early implant loading.

Evaluation of the efficacy of inter-dental brush and dental floss for peri-implant mucositis: A crossover randomized clinical trial.

OBJECTIVES: To evaluate the most effective method for mechanical inter-dental plaque removal between inter-dental brushes (IDB) and dental floss (DF), in addition to toothbrushing in patients affected by peri-implant mucositis (PIM); to identify possible factors related to the patient or to the single implant-supported element that could influence plaque accumulation and inflammation of peri-implant tissues. METHODS: Forty patients with PIM were recruited. They were randomly assigned to two different groups depending on inter-dental device used (IDB or DF). At baseline (T0), interproximal area (IA), interproximal emergence angle of the implant crown (A°) and manual dexterity (evaluated with Purdue Pegboard) have been recorded. At 14 days (T1), the inter-dental cleaning devices have been inverted between groups. After 14 days (T2), the Plaque Index (PI) and Gingival Index (GI) have been recorded. A questionnaire has been submitted to a patient for the analysis of preferences at T0, T1 and T2. RESULTS: Both inter-dental cleaning devices were effective in reducing PI and GI in the inter-dental area after 14 days of use. GI reduction was influenced by manual dexterity of the dominant hand. No significant differences were found for PI and GI at the variation of IA and A°. CONCLUSION: IDB was the most effective method for inter-dental plaque removal in all subjects regardless of their manual dexterity. DF seems to be more effective than IDB only in subjects with good dexterity.

Mechanical and fatigue resistance of restorations supported by welded-framework and realized using computer-aided designed prosthetic shells: In vitro pilot study.

Resin coating in implants rehabilitation cannot always be aesthetic, durable and comfortable for the patient mainly due to the limited dimensions of the final structure. Intraoral welding technique and computer-aided designed prosthetic shells may be a solution. This in vitro study evaluates the capacity of load and the weakest point of implant-supported provisional prosthesis using welded titanium framework. Twelve samples were produced to simulate an implant supported fixed prosthetic bridge. Two implants (Ankylos; Dentsply Sirona Implants; Germany) were inserted inside blocks of nanoceramic material produced with a stereolithographic 3D printer. A polymethylmethacrylate (PMMA) resin shell was performed with CAD/CAM and relined on welded framework. Six samples were produced with the same procedure reducing resin thickness. The samples were subjected to fatigue test (6,500,000 cycles) using ElectroForce 3310 fatigue machine (t1); subsequently a mechanical compression test using a universal Shimadzu AGS-X 10 machine (t2). The samples were analyzed with a photographic and radiographic documentation at t0, t1 and t2. The samples survived mechanical fatigue test without evidence of failure. The radiographic and photographic evaluation revealed the fracture of resin coating after the mechanical compression test. The samples with minimal resin thickness fractured first. Adequate assessment of the resin thickness is mandatory to improve the longevity of these rehabilitations. CAD-CAM digital prosthetic design allows us to optimize the thicknesses and the prosthetic shapes, allowing us to obtain good degrees of resistance even in the presence of reduced prosthetic spaces.

Considering the Value of 3D Cultures for Enhancing the Understanding of Adhesion, Proliferation, and Osteogenesis on Titanium Dental Implants.

BACKGROUND: Individuals with pathologic conditions and restorative deficiencies might benefit from a combinatorial approach encompassing stem cells and dental implants; however, due to the various surface textures and coatings, the influence of titanium dental implants on cells exhibits extensive, wide variations. Three-dimensional (3D) cultures of stem cells on whole dental implants are superior in testing implant properties and were used to examine their capabilities thoroughly. MATERIALS AND METHODS: The surface micro-topography of five titanium dental implants manufactured by sandblasting with titanium, aluminum, corundum, or laser sintered and laser machined was compared in this study. After characterization, including particle size distribution and roughness, the adhesion, proliferation, and viability of adipose-derived stem cells (ADSCs) cultured on the whole-body implants were tested at three time points (one to seven days). Finally, the capacity of the implant to induce ADSCs' spontaneous osteoblastic differentiation was examined at the same time points, assessing the gene expression of collagen type 1 (coll-I), osteonectin (osn), alkaline phosphatase (alp), and osteocalcin (osc). RESULTS: Laser-treated (Laser Mach and Laser Sint) implants exhibited the highest adhesion degree; however, limited proliferation was observed, except for Laser Sint implants, while viability differences were seen throughout the three time points, except for Ti Blast implants. Sandblasted surfaces (Al Blast, Cor Blast, and Ti Blast) outpaced the laser-treated ones, inducing higher amounts of coll-I, osn, and alp, but not osc. Among the sandblasted surfaces, Ti Blast showed moderate roughness and the highest superficial texture density, favoring the most significant spontaneous differentiation relative to all the other implant surfaces. CONCLUSIONS: The results indicate that 3D cultures of stem cells on whole-body titanium dental implants is a practical and physiologically appropriate way to test the biological characteristics of the implants, revealing peculiar differences in ADSCs' adhesion, proliferation, and activity toward osteogenic commitment in the absence of specific osteoinductive cues. In addition, the 3D method would allow researchers to test various implant surfaces more thoroughly. Integrating with preconditioned stem cells would inspire a more substantial combinatorial approach to promote a quicker recovery for patients with restorative impairments.

Impression heater: effectiveness of the thermal accelerator of dental impressions.

BACKGROUND: The success in acquiring a precision impression in the dental field is a compromise between the processing time and the setting time of the impression material. A device called "Impression Heater" (EU application n° EP20186042.6) has recently been patented, which consists of a self-heating disposable adhesive patch with an exothermic chemical reaction to be placed on the dental impression tray. The aim of the study was to evaluate the effectiveness of a thermal impression accelerator in reducing the setting time of different elastomers. METHODS: Three samples of 5 different elastomeric materials (width 6 mm x length 50 mm x depth 3-5-7 mm) the hardening of the material was evaluated at intervals of 15 seconds using an ASTM 2240 Shore-A durometer at 20 °C. The same procedure was replicated 3 times after positioning on a Impression Heater at temperatures of 35 °C, 50 °C and 65 °C, for each material. RESULTS: An increase in the impression material temperature from 35 °C to 50 °C reduces the setting time of an amount between 38.1% and 45.8%. Increasing the temperature from 35 °C to 65 °C results in a reduction of the setting time between 52.4% and 66.9%. At higher temperatures, the greater thickness of the impression material requires longer hardening times. CONCLUSIONS: The tests carried out confirm the validity of the patented idea which reduces the time of impression taking while keeping the working time sufficiently long for the operator to manoeuvre.

Assessing the Efficacy of Whole-Body Titanium Dental Implant Surface Modifications in Inducing Adhesion, Proliferation, and Osteogenesis in Human Adipose Tissue Stem Cells.

BACKGROUND: Although the influence of titanium implants' micro-surface properties on titanium discs has been extensively investigated, the research has not taken into consideration their whole-body effect, which may be considered possible using a combinatorial approach. METHODS: Five titanium dental implants with a similar moderate roughness and different surface textures were thoroughly characterized. The cell adhesion and proliferation were assessed after adipose-tissue-derived stem cells (ADSCs) were seeded on whole-body implants. The implants' inductive properties were assessed by evaluating the osteoblastic gene expression. RESULTS: The surface micro-topography was analyzed, showing that hydroxyapatite (HA)-blasted and bland acid etching implants had the highest roughness and a lower number of surface particles. Cell adhesion was observed after 24 h on all the implants, with the highest score registered for the HA-blasted and bland acid etching implants. Cell proliferation was observed only on the laser-treated and double-acid-etched surfaces. The ADSCs expressed collagen type I, osteonectin, and alkaline phosphatase on all the implant surfaces, with high levels on the HA-treated surfaces, which also triggered osteocalcin expression on day seven. CONCLUSIONS: The findings of this study show that the morphology and treatment of whole titanium dental implants, primarily HA-treated and bland acid etching implants, impact the adherence and activity of ADSCs in osteogenic differentiation in the absence of specific osteo-inductive signals.

Efficacy of two dosages of dexamethasone administered by submucosal injection on postoperative sequelae after third molar surgery: A retrospective study.

PURPOSE: A retrospective clinical study was performed to compare the post-operative sequelae of the submucosal administration of two different low dosages of dexamethasone, after the surgical extraction of lower third molars. METHODS: Data regarding edema, trismus, pain and analgesic consumption were collected from 150 subjects, selecting three equal groups (n= 50): a control group with no administered dexamethasone (G1); submucosal injection of dexamethasone 2 mg/0.5 ml (G2) and submucosal injection of dexamethasone 4 mg/1 ml (G3). Collected data were evaluated at three different time points: T0 before surgery, T1 on the third day after surgery and T2 on the 7th day after surgery. Patients' gender and age were also considered for statistical purposes. RESULTS: The effects on facial swelling reduction were statistically significant in G2 at T1 in the male subgroup. With trismus, the differences between the time points considered were statistically significant in G2 in the subgroup of subjects younger than 25 years old. Differences in analgesics taken were statistically significant when G1 and G2 were compared at T1. CLINICAL SIGNIFICANCE: The submucosal injection of 2 mg/0.5 ml of dexamethasone to subjects younger than 25 years old is enough to reduce trismus. For females and subjects older than 25 years old, it is preferable to administer at least 4 mg of dexamethasone to reduce edema.

Influence of the anesthetic modality on the development of neurological injury after lower third molar extraction: A systematic review of the literature.

The aim of this study was to determine if the risk of neurological injury to the inferior alveolar nerve (IAN) and the lingual nerve (LN) following the extraction of lower third molars is affected by the anesthetic modality (local anesthesia (LA) vs. general anesthesia (GA)). A systematic search was performed through the PubMed, Scopus, Cochrane Library, and Web of Science databases; furthermore, a manual search was performed by analyzing the references of full-text articles. From a total of 309 studies (collected after the removal of duplicates), 6 studies were selected. Of these, 4 reported a correlation between GA and nerve damage, while the other 2 did not show an obvious association. The level of bias in the studies was also calculated. Only 2 studies showed a medium risk of bias, while 4 studies showed a high risk of bias; no study showed a low risk of bias. Four of the 6 studies highlighted a higher incidence of IAN and LN injury following the extractions performed under GA. Although no scientific evidence is yet available, due to the scarcity and the limited quality of the studies in the literature, considering the risk­benefit ratio, LA should be the first choice in lower third molar surgery.

Root-end resection with or without retrograde obturation after orthograde filling with two techniques: A micro-CT study.

To evaluate the filling ability of two orthograde obturation techniques followed by the apical resection with or without retrograde obturation through micro-computed tomography (CT). Thirty-two single-rooted permanent teeth were prepared and randomised into four groups (n = 8) according to the orthograde obturation technique (single cone technique [SCT] and mineral trioxide aggregate placement) combined or not with retrograde obturation. The volume of voids (VoV) within the entire endodontic space, the apical 3 mm, and 1 mm after root resection was calculated by micro-CT. Statistical analysis showed no significant difference among the groups regarding the total VoV in all root canals, as well as within the apical 1 mm after root resection. The SCT and apical resection without retrograde filling showed significantly better results in terms of VoV at the apical 3 mm after root resection. Within the study limitations, SCT associated with apical resection without retrograde preparation exhibited a similar or less amount of voids than the other groups.

Retreatability of calcium silicate-based root canal sealer using reciprocating instrumentation with different irrigation activation techniques in single-rooted canals.

This study analysed the bioceramic sealer cleaning ability of two chemo-mechanical systems in intact and restored teeth. Thirty-two single-rooted teeth were used, and half of them restored with a pre-endodontic composite restoration (PCR). All samples were instrumented with a size 40 Reciproc Blue file and filled with BioRoot RCS. Canals were retreated using the R40 and then R50 Reciproc Blue. The samples were divided into four experimental groups (n = 8): intact teeth/passive ultrasonic irrigation (PUI) (G1), intact teeth/shock wave-enhanced emission photoacoustic streaming (SWEEPS) (G2), PCR/PUI (G3) and PCR/SWEEPS (G4). The samples were scanned by micro-CT before and after retreatment, and the volume of remaining filling material was evaluated. The minor percentage of residues were observed in G2, with a volume of 0.447 ± 0.356% of the endodontic space (P < 0.001). The Reciproc/SWEEPS technique showed the better performance in intact teeth compared with PUI technique. Pre-endodontic restoration did not significantly affect the effectiveness of sealer removal.

Nanotechnology-Based Drug Delivery Strategies to Repair the Mitochondrial Function in Neuroinflammatory and Neurodegenerative Diseases.

Mitochondria are vital organelles in eukaryotic cells that control diverse physiological processes related to energy production, calcium homeostasis, the generation of reactive oxygen species, and cell death. Several studies have demonstrated that structural and functional mitochondrial disturbances are involved in the development of different neuroinflammatory (NI) and neurodegenerative (ND) diseases (NI&NDDs) such as multiple sclerosis, Alzheimer's disease, Parkinson's disease, Huntington's disease, and amyotrophic lateral sclerosis. Remarkably, counteracting mitochondrial impairment by genetic or pharmacologic treatment ameliorates neurodegeneration and clinical disability in animal models of these diseases. Therefore, the development of nanosystems enabling the sustained and selective delivery of mitochondria-targeted drugs is a novel and effective strategy to tackle NI&NDDs. In this review, we outline the impact of mitochondrial dysfunction associated with unbalanced mitochondrial dynamics, altered mitophagy, oxidative stress, energy deficit, and proteinopathies in NI&NDDs. In addition, we review different strategies for selective mitochondria-specific ligand targeting and discuss novel nanomaterials, nanozymes, and drug-loaded nanosystems developed to repair mitochondrial function and their therapeutic benefits protecting against oxidative stress, restoring cell energy production, preventing cell death, inhibiting protein aggregates, and improving motor and cognitive disability in cellular and animal models of different NI&NDDs.

Therapeutic Approach in the Treatment of Medication-Related Osteonecrosis of the Jaw: Case Series of 3 Patients and State of the Art on Surgical Strategies.

BACKGROUND: Bisphosphonates and receptor activator of nuclear factor kappa-B ligand inhibitors are currently the most widely used antiresorptive therapies in bone metabolism diseases treatment. Unfortunately they can evoke medication-related osteonecrosis of the jaws. The present case series study proposes to evaluate clinical features, evolution and the surgical therapeutic approaches in three patients affected by medication-related osteonecrosis of the jaw and to review the state of art regarding the management of this complication in light of the most recent literature. METHODS: Three cases of medication-related osteonecrosis of the jaws are discussed, two related to bisphosphonates therapy (ibandronic acid) and one due to denosumab. RESULTS: All three patients were aged female and had probably a dental trigger agent. The lesions located in posterior mandible were treated in one case with the surgical approach alone and, in the other case, with surgical approach associated with Erb-YAG laser. The lesion related to denosumab was treated with surgical approach and platelet rich fibrin application. A complete healing was always achieved. CONCLUSIONS: Dentists should be aware of the potential risk of developing medication-related osteonecrosis of the jaws for patients who take or had taken antiresorptive drugs. The side effects of denosumab and bisphosphonates are partly overlapping and currently there is still no consensus about the therapeutic surgical options. Prevention and early detection of the lesions should be the primary strategy.

Ultrasonic Instrument Effects on Different Implant Surfaces: Profilometry, Energy-Dispersive X-ray Spectroscopy, and Microbiology In Vitro Study.

PURPOSE: To assess the effects of grade IV titanium ultrasonic tip instrumentation on different grade IV titanium implant surfaces and compare the decontamination of different implant surfaces using chlorhexidine, blue laser, or ozone. MATERIALS AND METHODS: Profilometry and energy-dispersive x-ray spectroscopy (EDS) analyses were performed on smooth, laser-micropatterned, and sandblasted grade IV titanium sample disks before (t0) and after (t1) ultrasonic instrumentation with an ultrasonic grade IV titanium tip. Samples were also incubated with a Streptococcus sanguinis culture. Each surface type was then treated with chlorhexidine, blue laser, or ozone (three test groups + control group). Scanning electron microscopy (SEM) images were taken after bacterial growth and after decontamination. RESULTS: After ultrasonic instrumentation, surface roughness (Ra) decreased on sandblasted and micropatterned surfaces, whereas it remained substantially unvaried on the smooth surface. SEM images revealed that the laser-micropatterned structure remained substantially unvaried after instrumentation. EDS revealed a minimal quantity of carbon and iron, found in the laser-treated and sandblasted group at t0. A minimal quantity of aluminum and oxygen was found on the sandblasted surface at t0 and t1. Ozone therapy achieved the highest decontaminating effect, regardless of implant surface topography. CONCLUSION: Among the alternative therapies to ultrasonic instrumentation with titanium tips, ozone appears to be effective regardless of the type of implant surface; it can be used for the decontamination treatment of implants without altering the surface structure.

Influence of Thickness and Shade on the Color of Layered Novel Nanohybrid Composite Systems.

The influence of the layer thickness and composite shade on the final color of Ceram.X composites (Dentsply Sirona) was tested, selecting five intermediate-translucency Ceram.X Universal shades, three high-translucency Ceram.X Duo "enamel" shades, and four low-translucency Ceram.X Duo "dentin" shades. Using cylindrical molds, 850 specimens were obtained, representing the whole array of possible Universal single specimens (in seven thicknesses, ranging from 1.0 to 4.0 mm in 0.5-mm increments) and Duo combinations. The CIELAB coordinates of each specimen were determined with a spectrophotometer. Different thicknesses and composites were compared with Clark's ΔE. The difference in color among specimens of different thicknesses was material-dependent. The thickness and shade of the composite markedly affected the color yield of the Ceram.X system. For each shade of the Universal systems, only one Duo enamel-dentin combination corresponded.

The knowledge about periodontal health of northeastern Italian pharmacists: a cross-sectional survey.

BACKGROUND: The aim of this study was to determine the knowledge of periodontal health and prevention of periodontal diseases of a pool of pharmacists working in Friuli Venezia Giulia. METHODS: A 22-questions questionnaire about oral health was sent by mail to all the pharmacies working in Friuli Venezia Giulia and to the most known associations of pharmacists. The data were collected and analyzed by Google Forms software. RESULTS: One-hundred sixty-four questionnaires were analyzed. Ninety-one percent of the pharmacists assert to give advice about prevention and treatment of oral affection during professional practice, but 97% never attended university courses about it. Only 21% took part in postgraduate courses about oral health. Most of them have not enough notions about periodontal disease. CONCLUSIONS: The findings from this study highlight that pharmacists have not enough knowledge about periodontal disease and its treatment but every day they provide advice about oral health. It would be appropriate a better organization of postgraduate courses about oral health and prevention of periodontal diseases.

CBCT Radiological Features as Predictors of Nerve Injuries in Third Molar Extractions: Multicenter Prospective Study on a Northeastern Italian Population.

BACKGROUND: Neurological alterations are one of the main complications occurring after the third molar extractions. The aim of this prospective multicenter cohort study was to find out Cone Beam Computed Tomography (CBCT) features and distribution of neurological complications in patients undergoing lower third molar surgery and to determine the radiological and patient-related factors that could be correlated to the occurrence of inferior alveolar and lingual nerves injury. MATERIAL AND METHODS: 378 patients who underwent lower third molar extraction from March 2018 to March 2019 were included. Clinical and radiological data were collected. CBCT features were recorded following Maglione et al. classification. Symptoms and characteristics of patients who experienced neurological alterations were evaluated. RESULTS: 193 patients needed a second-level radiological exam (CBCT). In these patients, the most common feature was Maglione class 3: a higher frequency of apical or buccal mandibular canals in direct contact with the tooth was observed. 3.17% of the patients developed a neurological complication. Maglione class 4, increased age, and operative time were all positively correlated with neurological alterations. CONCLUSIONS: while the buccal or apical position of the mandibular canal was the more common findings, the lingual position was found to have a higher correlation with a negative outcome. Age and operative time were also found to be risk factors for developing nerve injury in the considered population.

In vitro study on conditioned dental root surfaces: evaluation of wettability, smear layer, and blood clot adhesion.

OBJECTIVES: The aim was to investigate the efficacy of citric acid and ethylenediaminetetraacetic acid (EDTA)-based treatments on smear layer removal and blood clot formation and stabilization. METHOD AND MATERIALS: After scaling and root planing, 126 root samples were divided into seven groups treated with: deionized water; saline; citric acid solution; Ultradent Citric Acid gel; EDTA solution; EDTA-based PrefGel; or untreated. Each group was divided into three subgroups: I for the evaluation of smear layer removal and surface wettability, II and III for the evaluation of blood clot formation and stabilization in static or dynamic rinsing conditions. RESULTS: Conditioning agent treatments increased surface wettability with respect to untreated samples (Ultradent: 45 ± 1 degrees, P = 6.2 × 10-3; EDTA: 36 ± 5 degrees, P = 8.9 × 10-7; PrefGel: 47 ± 7 degrees, P = 3.2 × 10-2). Smear layer removal (30% to 60% with respect to untreated samples) was observed for all the conditioning agents. Clot was absent on untreated samples and samples treated with deionized water. Clot quality was significantly higher for samples treated with conditioning agents (P < .05) and similar between group II and III (P > .05). A statistically significant difference (P = .027) was observed for clot coverage of the saline group, comparing static and dynamic rinsing, confirming the positive effect of treatments on clot stabilization. CONCLUSIONS: The use of conditioning agents improves smear layer removal and clot formation and stabilization with respect to scaling and root planing procedure only, which is, however, considered an essential procedure to promote wound healing in periodontal surgery.

Runs of homozygosity are associated with staging of periodontitis in isolated populations.

Periodontitis is a common inflammatory disease characterized by a complex etiology, which is the result of a combination of genetic and environmental factors. Genetic variants linked to the periodontitis disease were already investigated, however, little was known regarding the severity of this disease. Recently, long runs of homozygosity (ROH) were associated with several multifactorial diseases. Therefore, in our work, we tried to assess the role of ROH and periodontitis status. We found an association between the excess of homozygosity owing to ROH and staging of periodontitis. More in detail, the total amount of homozygosity owing to ROH is positively associated with an increased severity of periodontitis (P = 0.0001). Regression tree analysis showed the impact of ROH burden in discriminating individuals with mild periodontitis stages I and II and periodontitis stages III and IV (P < 0.001). Furthermore, ROH mapping highlights several regions associated with a severe status of periodontitis (odds ratio > 1). Among them, we found a total of 33 genes. Interestingly, some of these genes were previously associated with granulocyte or platelet measures, both linked to the onset and the progression of periodontal disease. Our results suggest the not only single variants association test could help to risk assessment but even individual genomic features; furthermore, our ROH mapping highlighted the possible role of multiple genes in periodontal development.

Outcome of Different Surgical Approaches in the Treatment of Class II Furcation Defects in Mandibular Molars: A Randomized Clinical Trial.

The aim of this study was to investigate which factors play a major role in the healing of Class II mandibular furcation defects treated with different surgical techniques. Twenty-five systemically healthy subjects with periodontitis stage III grade B and Class II buccal mandibular furcation involvement received one of the following open flap debridement approaches: Group 1 (n = 10), no further treatment; Group 2 (n = 10), piezoelectric contouring of the furcation roof; Group 3 (n = 9), piezoelectric contouring of the furcation roof and bone grafting; Group 4 (n = 10), piezoelectric contouring of the furcation roof and bone grafting with coronally positioned flap. Clinical and radiologic variables-bleeding on probing, probing depth (PPD), vertical and horizontal bone level (CAL and PH), gingival recession, root trunk length, radicular separation, and furcation perimeter (FP)-were evaluated at baseline and 180 days and 1 year after surgery. All clinical parameters were statistically analyzed. Surgical techniques caused clinical (CAL, PPD, PH) and radiographic (FP) improvements. Regenerative techniques and the coronally positioned flap yielded a major radiographic reduction of furcation areas. All therapies resulted in significant horizontal and vertical PPD reduction and CAL gain.

Observational Study on the Preparation of the Implant Site with Piezosurgery vs. Drill: Comparison between the Two Methods in terms of Postoperative Pain, Surgical Times, and Operational Advantages.

PURPOSE: Recent advances show that ultrasonic implant site osteotomy is related to a decreased trauma and a better postoperative healing of the surgical site when compared to traditional drilling techniques. The micrometric bone cutting control and the operative advantages related to the piezoelectric approach are also characterized by a learning curve for the clinician in surgical practice and an increased operative duration of the procedure. The aim of this investigation is to compare the operative time, the postoperative pain, and the amount of painkillers taken by the patient during the healing period. METHODS: A total of 65 patients were treated at the Unit of Oral Surgery (Department of Medical Sciences, Surgery and Health, University of Trieste, Italy) using a split mouth model: 75 drill-inserted implants (G1) and 75 piezoelectric device-inserted implants (G2) were placed. The Visual Analogue Scale (VAS) was performed to evaluate the postoperative pain at 15 days from surgery. The operative time and frequency of intake of painkillers were measured. RESULTS: The G1 and G2 groups showed a significant difference with a higher use of painkillers observed for G1. The G2 patients showed a lower level of pain (VAS) at all experimental times between 8 hours to 7 days (p < 0.01) postsurgery. At 15 days, the pain levels were similar for both groups. No differences were found in site preparation duration between the study groups. CONCLUSIONS: The evidence supports the application of the piezoelectric approach compared to the drill's osteotomy as a useful technique for implant site preparation. This trial is registered with NCT03978923.