Spectroscopic insights into peri-implant mucositis and peri-implantitis: unveiling peri-implant crevicular fluid profiles using surface enhanced Raman scattering.

The precise identification and differentiation of peri-implant diseases, without the need for intrusive procedures, is crucial for the successful clinical treatment and overall durability of dental implants. This work introduces a novel approach that combines surface-enhanced Raman scattering (SERS) spectroscopy with advanced chemometrics to analyse peri-implant crevicular fluid (PICF) samples. The primary purpose is to offer an unbiased evaluation of implant health. A detailed investigation was performed on PICF samples obtained from a cohort of patients exhibiting different levels of peri-implant health, including those with healthy implants, implants impacted by peri-implantitis, and implants with peri-implant mucositis. The obtained SERS spectra were analysed using canonical-powered partial least squares (CPPLS) to identify unique chemical characteristics associated with each inflammatory state. Significantly, our research findings unveil the presence of a common inflammatory SERS spectral pattern in cases of peri-implantitis and peri-implant mucositis. Furthermore, the SERS-based scores obtained from CPPLS were combined with established clinical scores and subjected to a linear discriminant analysis (LDA) classifier. Repeated double cross-validation was used to validate the method's capacity to discriminate different implant conditions. The integrated approach showcased high sensitivity and specificity and an overall balanced accuracy of 92%, demonstrating its potential to serve as a non-invasive diagnostic tool for real-time implant monitoring and early detection of inflammatory conditions.

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.

IMPLANT SURVIVAL IN RENAL-TRANSPLANTED PATIENTS: A PROSPECTIVE LONG-TERM STUDY.

The present study aims to assess the feasibility of implant rehabilitation in kidney-transplanted patients. Patients with kidney transplantation included in periodontal supportive care and at least one year of dialysis with mono- or partial edentulism were eligible for this study. Histomorphometric evaluation of the harvested bone was matched with radiological bone assessment. Implant stability was also monitored with RFA and ITV. Fixed cemented prostheses have been delivered after conventional loading protocol. Supportive periodontal therapy has been administered. Eleven patients (9 males and 2 females) were included. The mean age was 58.1 ± 9.9 years. A total of 17 implants were inserted and analyzed. Mean ITV was 39.3 ± 23.8 Ncm. The mean primary stability (ISQ) at T0 was 71.7 ± 10.5, whereas the mean secondary stability at T1 was 73.0 ± 7.3. The minimum follow-up was 62 months, with a maximum of 84 months (7 years) reached by four patients. Fourteen out of 15 implants were in function at a 5-year follow-up (survival rate 93.3%). Two implants showed peri-implantitis. Seventeen bone samples were collected (13 in the mandible and 4 in the maxilla). The mean percentage of marrow spaces and lamellar bone was 41.6% and 58.4%, respectively. Class 3, according to Misch classification, was found as the mean value of radiological bone density. It can be concluded that implant-supported rehabilitation in kidney-transplanted patients is possible. Adequate periodontal maintenance allows implant rehabilitation in kidney transplanted patients with long-term sufficient survival rates.

Is L-PRF an effective hemostatic agent in single tooth extractions? A cohort study on VKA and DOAC patients.

OBJECTIVES: The aim of this clinical observational study was to assess the efficacy of L-PRF as a hemostatic agent in patients under treatment with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs). MATERIALS AND METHODS: Patients under oral anticoagulant therapy (VKA or DOACs) who needed a single simple tooth extraction were enrolled. L-PRF plug was positioned inside the alveolus and secured with non-absorbable sutures. Surgical time, pain-VAS, paracetamol intake, intra-operative, post-operative biological complications, and bleeding events have been registered. RESULTS: A total of 112 patients (59 patients for DOAC and 53 for VKA group) were enrolled. Post-operative bleeding was recorded in nine patients (17%) for VKA group and nine patients (15.3%) for DOACs group. None of the patients needed a medical support for managing of bleeding. Seven days after surgery, no cases of post-extractive complications occurred. CONCLUSIONS: The use of L-PRF resulted in limited mild late post-operative bleedings without the need of medical intervention. CLINICAL RELEVANCE: The use of L-PRF can be adopted for an uneventful post-operative curse in anticoagulated patients without chasing their therapy for single tooth extraction.

Does new bone formation vary in different sites within the same maxillary sinus after lateral augmentation? A prospective histomorphometric study.

OBJECTIVE: The aim of this study was to evaluate histomorphometric outcomes of lateral maxillary sinus augmentation in different areas of the same cavity and to correlate results to bucco-palatal sinus width (SW) and residual bone height (RBH). MATERIAL AND METHODS: Patients needing maxillary sinus floor elevation (RBH <5 mm) to insert two nonadjacent implants were treated with lateral augmentation using a composite graft. Six months later, two bone-core biopsies (mesial/distal) were retrieved in implant insertion sites. SW and RBH were measured on cone beam computed tomography, and correlations between histomorphometric and anatomical parameters were evaluated by multivariate linear regression analysis. RESULTS: Twenty patients underwent sinus augmentation, and eighteen were included in the final analysis (two dropouts for membrane perforation). Mean newly formed mineralized tissue percentage (%NFMT) after 6 months in mesial and distal sites was 17.5 ± 4.7 and 11.6 ± 4.7, respectively (p = .0004). Multivariate linear regression showed a strong negative correlation between SW and %NFMT (ß coefficient=-.774, p < .0001) and no correlation between RBH and %NFMT (ß coefficient =-.038, p = .825). CONCLUSIONS: The present study confirms that %NFMT after lateral sinus augmentation occurs at different rates in different anatomical areas of the same maxillary sinus, showing a strong negative correlation with SW, whereas no influence of RBH was observed. Clinicians should regard SW as a guide for graft selection and to decide duration of the healing period. Researchers should consider SW as a predictor variable, when comparing regenerative outcomes of different biomaterials by using maxillary sinus as an experimental model.

Label-free analysis of gingival crevicular fluid (GCF) by surface enhanced Raman scattering (SERS).

Gingival crevicular fluid (GCF) is an interesting biofluid reflecting the physiological and pathological states of a single dental element. Due to this unique feature, in recent years, metabolomic analysis of GCF has gained attention as a biometric tool for the diagnosis and therapy of periodontal disease. Traditional methods are, however, too slow, cumbersome and expensive for a health-care routine. Surface enhanced Raman scattering (SERS) can offer rapid and label-free detailed molecular fingerprints that can be used for biofluid analysis. Here we report the first SERS characterization of GCF using an easy and quick sample preparation. The dominant features in the SERS spectrum of GCF are ascribed to very few metabolites, in particular to uric acid, hypoxanthine, glutathione and ergothioneine. Additionally, we succeeded in differentiating between the SERS signal of GCF collected from healthy volunteers and the one collected from patients with periodontal disease.

Evaluating the stability of extended-pour alginate impression materials by using an optical scanning and digital method.

STATEMENT OF PROBLEM: The dimensional stability of alginate dental impressions is a key factor for the reliability of delayed gypsum pouring and digital scanning. However, studies of the dimensional stability of alginates with conventional methods that consider the dimensional variations of large impressions are lacking. PURPOSE: The purpose of this in vitro study was to investigate and compare 2 digital methods for the analysis of dimensional stability of large impressions made with 5 different extended-pour alginates and to assess dimensional stability up to 5 days. MATERIAL AND METHODS: Impressions of a simplified master maxillary model were made with Alginoplast, Blueprint, Hydrogum 5, Orthoprint, and Phase Plus and then analyzed at different time points. Digital scans of the alginate impression surfaces were obtained with a desktop scanner and analyzed by evaluating the linear measurements between reference points and by using a novel method that consists of the analysis of the entire scanned surface to evaluate the expansion and contraction of the impressions. RESULTS: The first method revealed that the dimensional changes did not exceed 0.5%, with the exception of Phase Plus at day 3 (-0.6 ±0.7%), and the average dimensional variation was always lower than or equal to 0.2 mm. Blueprint was the most stable material (-0.2 ±0.6%). The second method revealed dimensional variations always lower than 0.03 mm and confirmed Blueprint as the best performing material (0.001 ±0.006 mm) and Phase Plus the worst (-0.019 ±0.006 mm). CONCLUSIONS: Both the methods used to evaluate alginate stability showed that the analyzed materials remain stable over time; the dimensional variations showed a similar trend, with differences in the absolute values depending on the applied method. Linear measurements are affected by the operator and choice of reference points; however, by evaluating the average variations of the entire structure surfaces, local variations should be minimized. The evaluation of the average variations with the second method offers the advantage of a rapid visual representation of these variations.

Should we fear direct oral anticoagulants more than vitamin K antagonists in simple single tooth extraction? A prospective comparative study.

OBJECTIVES: The aim of this prospective comparative clinical study was to evaluate the effect of oral anticoagulants on peri- and post-operative bleeding during simple single tooth extractions, comparing patients in treatment with vitamin K antagonists (VKAs) and patients assuming direct oral anticoagulants (DOACs). MATERIALS AND METHODS: Patients under oral anticoagulant therapy needing dental extraction were eligible for entering the study; patients were enrolled following inclusion and exclusion criteria and divided into VKAs and DOAC group according to the anticoagulation therapy. Included patients underwent a simple single dental extraction with elevators and forceps with a maximum surgical time of 15 minutes, without anticoagulation therapy discontinuation. All participants were assessed pre-operatively, during surgery, 30 min minutes and 7 days after surgery. Biological complications were registered and post-extraction bleeding was clinically defined according to Iwabuchi classification. Parametric and non-parametric tests were used to evaluate the variables between the groups. RESULTS: Sixty-five patients per group were enrolled and 130 teeth were extracted. The two groups were comparable for pre-, peri-, and post-operative variables. Only 1 patient of DOAC group and 2 patients for VKA group needed medical evaluation for post-extractive bleeding. No statistically significant difference resulted in post-operative bleeding events between the groups (p = 0.425). CONCLUSIONS: DOAC and VKA patients showed the same incidence of bleeding complications after simple single tooth extraction. Bleeding events were not statistically significant and not clinically relevant. CLINICAL RELEVANCE: Patients assuming DOACs can be treated similarly to patients in VKAs therapy with INR index between 2 and 3. Non-ceasing of DOAC therapy seems to be appropriate for simple single dental extractions.

New bone formation after transcrestal sinus floor elevation was influenced by sinus cavity dimensions: A prospective histologic and histomorphometric study.

OBJECTIVE: The aim of this multicenter prospective study was to analyze clinically and histologically the influence of sinus cavity dimensions on new bone formation after transcrestal sinus floor elevation (tSFE). MATERIAL AND METHODS: Patients needing maxillary sinus augmentation (residual crest height <5 mm) were treated with tSFE using xenogeneic granules. Six months later, bone-core biopsies were retrieved for histological analysis in implant insertion sites. Bucco-palatal sinus width (SW) and contact between graft and bone walls (WGC) were evaluated on cone beam computed tomography, and correlations between histomorphometric and anatomical parameters were quantified by means of forward multiple linear regression analysis. RESULTS: Fifty consecutive patients were enrolled and underwent tSFE procedures, and forty-four were included in the final analysis. Mean percentage of newly formed bone (NFB) at 6 months was 21.2 ± 16.9%. Multivariate analysis showed a strong negative correlation between SW and NFB (R2  = .793) and a strong positive correlation between WGC and NFB (R2  = .781). Furthermore, when SW was stratified into three groups (<12 mm, 12 to 15 mm, and >15 mm), NFB percentages (36%, 13% and 3%, respectively) resulted significantly different. CONCLUSIONS: This study represented the first confirmation based on histomorphometric data that NFB after tSFE was strongly influenced by sinus width and occurred consistently only in narrow sinus cavities (SW <12 mm, measured between buccal and palatal walls at 10-mm level, comprising the residual alveolar crest).

Bone Scrapers Versus Piezoelectric Surgery in the Lateral Antrostomy for Sinus Floor Elevation.

The purpose of this investigation is to evaluate 2 different methods for reducing cortical wall thickness in sinus floor augmentation surgery. A manual bone scraper was compared in terms of efficacy, speed, and safety to an ultrasonic insert for osteoplasty, in a randomized controlled clinical trial with a split-mouth design. Twenty-five patients with severe posterior maxillary atrophy were treated with bilateral sinus floor elevation with lateral approach. Antrostomies were randomly performed by eroding the cortical wall with a manual bone scraper (test site) or with an ultrasonic insert (control site) until the membrane was visible under a thin layer of bone, before outlining the window with a piezoelectric device. Occurrence of membrane perforation, laceration of vascular branches, and surgical time were recorded. Mean surgical time of the antrostomy in the test sites was 9'18", while in the control sites was 9'47". No significant differences were found in terms of surgical time, incidence of membrane perforation during antrostomy (4.3% in both groups), or other intraoperative complications between the 2 techniques. Both surgical approaches represent effective options for performing lateral antrostomies during sinus floor elevation procedures in a safe and predictable way.

Influence of Maxillary Sinus Width on New Bone Formation After Transcrestal Sinus Floor Elevation: A Proof-of-Concept Prospective Cohort Study.

PURPOSE: Graft maturation in the maxillary sinus requires adequate angiogenesis and osteoprogenitor cells migration from the surrounding bony walls: the aim of this study was to analyze the correlation between sinus cavity dimensions and new bone formation after transcrestal sinus floor elevation (tSFE). METHODS: Patients needing maxillary sinus augmentation (residual crest height ≤ 4 mm) were treated with tSFE using xenogeneic granules. Six months later, bone-core biopsies were retrieved for histological analysis in the implant insertion sites. Buccopalatal sinus width (SW) was evaluated on cone beam computed tomography, and correlations between histomorphometric and anatomical parameters were quantified by means of linear regression analysis. RESULTS: Eight consecutive patients underwent tSFE procedures: at 6 months, average percentage of newly formed bone resulted 24.2% ± 7.9%. Statistical analysis showed a strong inverse correlation between SW and new bone formation (R = 0.88), and a strong direct correlation between the number of exposed bone walls and new bone formation (R = 0.82). CONCLUSION: Within the limitations of this proof-of-concept study, in which a restricted number of patients were analyzed, tSFE showed more predictable results in narrow than in large sinuses, in terms of new bone formation.

Implant Survival in Renal-Transplanted Patients: A Prospective Long-Term Study.

The present study aims to assess the feasibility of implant rehabilitation in kidney-transplanted patients. Patients with kidney transplantation included in periodontal supportive care and at least one year of dialysis with mono- or partial edentulism were eligible for this study. Histomorphometric evaluation of the harvested bone was matched with radiological bone assessment. Implant stability was also monitored with resonance frequency analysis and insertion torque value. Fixed cemented prostheses have been delivered after conventional loading protocol. Supportive periodontal therapy has been administered. Eleven patients (9 males and 2 females) were included. The mean age was 58.1 ± 9.9 years. A total of 17 implants were inserted and analyzed. Mean ITV was 39.3 ± 23.8 Ncm. The mean primary stability (implant stability quotient) at T0 was 71.7 ± 10.5, whereas the mean secondary stability at T1 was 73.0 ± 7.3. The minimum follow-up was 62 months, with a maximum of 84 months (7 years) reached by 4 patients. Fourteen out of 15 implants were in function at a 5-year follow-up (survival rate: 93.3%). Two implants showed peri-implantitis. Seventeen bone samples were collected (13 in the mandible and 4 in the maxilla). The mean percentage of marrow spaces and lamellar bone was 41.6% and 58.4%, respectively. Class 3, according to Misch classification, was found as the mean value of radiological bone density. It can be concluded that implant-supported rehabilitation in kidney-transplanted patients is possible. Adequate periodontal maintenance allows implant rehabilitation in kidney-transplanted patients with long-term sufficient survival rates.

Presence of microbrush remnants on the adhesion surface: A microscopical analysis.

OBJECTIVES: the aim of this ex vivo report was to evaluate, on a microscopical analysis, the presence of microbrush remnants on in the adhesive surface in extracted teeth. METHODS: Twenty extracted teeth were divided into four groups. Half of the teeth were prepared as Class I cavities, whereas the other half as Class II cavities, according to Black classification. The teeth were conditioned with primer and bonding, both applied with microbrushes. Each of these groups was divided into halves, and the two sub-groups received a polymerization process or not, respectively. The teeth were then analyzed by scanning electron microscopy working in environmental mode. RESULTS: All of the analyzed surfaces (100%) showed the presence of residual bristles on the adhesion surface. CONCLUSIONS: Microscopical analysis showed the presence of residual bristles in the 100% of the surfaces treated with Black Classes I and II cavities. Further studies are necessary to evaluate the influence of this factor on the adhesion strength and capacity. CLINICAL SIGNIFICANCE: Clinician should be aware of the realistic possibility of the presence of bristles belonging to disposable applicators in the adhesive interface of Black's class I and II cavities. The impact of these remnants has still to be ascertained.

In Vitro Qualitative Evaluation of Root-End Preparation Performed by Piezoelectric Instruments.

Although the application of ultrasounds in endodontic surgery allows for effective debridement of the root canal, incorrect device setting or inefficient tips seem to generate cracks during root-end retropreparation. The primary aim of this in vitro study was to establish the presence, or absence, of a correlation between ultrasonic root-end preparation and the formation of cracks. The present study was conducted on human teeth, extracted for periodontal reasons. After root canal treatment, roots were resected 3 mm from the anatomical apex by using a high-speed handpiece and carbide burs. The resected teeth were retroprepared by using an ultrasonic tip (R1D, Piezomed, W&H, Bürmoos, Austria), setting the piezoelectric device at maximum power available for the tip. Time required for the retropreparation was recorded. Before and after retropreparation, all roots were photographed under a stereomicroscope and analyzed by two different operators to evaluate: (a) the presence and extension of dentinal cracks and (b) the morphology of root-end preparation. Finally, piezoelectric tips were analyzed by scanning electron microscopy (SEM) to evaluate morphologic changes after use. A total of 43 single roots (33 with one root canal, 10 with two root canals) were treated. Average preparation time was 1 minute and 54 seconds. None of the roots without initial cracks developed new cracks after retropreparation. Quality of the preparation margins was fairly equal among the prepared specimens. None of the piezoelectric tips broke during instrumentation, and SEM analysis showed minimal surface wear of the tips after performing 11 retropreparations. Within the limits of the present study, the tested piezoelectric system does not seem to represent a major cause for root crack formation. Pre-existing cracks may expand after ultrasound root-end preparation.

Antibacterial Electrospun Polycaprolactone Membranes Coated with Polysaccharides and Silver Nanoparticles for Guided Bone and Tissue Regeneration.

Electrospun polycaprolactone (PCL) membranes have been widely explored in the literature as a solution for several applications in tissue engineering and regenerative medicine. PCL hydrophobicity and its lack of bioactivity drastically limit its use in the medical field. To overcome these drawbacks, many promising strategies have been developed and proposed in the literature. In order to increase the bioactivity of electrospun PCL membranes designed for guided bone and tissue regeneration purposes, in the present work, the membranes were functionalized with a coating of bioactive lactose-modified chitosan (CTL). Since CTL can be used for the synthesis and stabilization of silver nanoparticles, a coating of this compound was employed here to provide antibacterial properties to the membranes. Scanning electron microscopy imaging revealed that the electrospinning process adopted here allowed us to obtain membranes with homogeneous fibers and without defects. Also, PCL membranes retained their mechanical properties after several weeks of aging in simulated body fluid, representing a valid support for cell growth and tissue development. CTL adsorption on membranes was investigated by fluorescence microscopy using fluorescein-labeled CTL, resulting in a homogeneous and slow release over time. Inductively coupled plasma-mass spectrometry was used to analyze the release of silver, which was shown to be stably bonded to the CTL coating and to be slowly released over time. The CTL coating improved MG63 osteoblast adhesion and proliferation on membranes. On the other hand, the presence of silver nanoparticles discouraged biofilm formation by Pseudomonas aeruginosa and Staphylococcus aureus without being cytotoxic. Overall, the stability and the biological and antibacterial properties make these membranes a valid and versatile material for applications in guided tissue regeneration and in other biomedical fields like wound healing.

Factors influencing the prevalence of peri-implantitis in implants inserted in augmented maxillary sinuses: A multicenter cross-sectional study.

BACKGROUND: Peri-implantitis is widely recognized as a major cause of late implant failure, both in pristine and regenerated bone. The present study aims to evaluate the prevalence of peri-implantitis in implants inserted in augmented maxillary sinuses and to analyze possible risk factors. METHODS: A cross-sectional study was conducted in four centers including patients who underwent lateral or transcrestal sinus augmentation and received dental implants. Clinical and anamnestic data were collected using a standardized form. Univariate and multivariate logistic regression analyses have been performed for both implant-level and patient-level variables. Subsequently, a multilevel logistic mixed-effect model was built to analyze variables correlated with the occurrence of peri-implantitis. RESULTS: A total of 156 patients (61 males and 95 females; mean age: 60.9 ± 11.6 years) with 315 implants inserted into augmented maxillary sinuses with a follow-up ranging from 1 to 18 years were evaluated. Seven implants in seven patients were previously lost for peri-implantitis (2.2% and 4.5% at implant- and patient-level, respectively); 250 implants showed no signs of peri-implant diseases (79.4%), 34 implants presented mucositis (10.8%), and 24 implants exhibited peri-implantitis (7.6%). Corresponding data evaluated at patient-level were 125 (80.1%), 17 (10.9%), and 14 (9.0%), respectively. At the multilevel analysis, history of periodontitis, sinus elevation with lateral approach, and one-stage sinus floor elevation significantly correlated with the occurrence of peri-implantitis (P <0.001). CONCLUSIONS: History of periodontitis confirmed its well-known role as a risk factor for peri-implant pathologies. In addition, both lateral window technique and one-stage sinus floor elevation seemed to represent significant risk factors for peri-implantitis.

Long term survival of mature autotransplanted teeth: A retrospective single center analysis.

OBJECTIVE: The replacement of an irremediably compromised tooth requires an implant rehabilitation or a traditional fixed partial denture. In well-selected cases, a further therapeutic possibility is represented by tooth autotransplantation. Although dental transplants are poorly understood and practiced, the international literature agrees that it is considered the first choice when applicable. The advantages of this technique are numerous: use of an autologous element, maintenance of tissue trophism, aesthetic and functional restoration, costs reduction. Although autotransplantation is often performed with immature teeth, even mature teeth with fully formed apex can be used as donors. The aim of the present work was to analyze consecutive cases of completely formed donor teeth autotransplantations performed from 2005 to 2011 in 21 patients for evaluating the survival and success rate. MATERIALS AND METHODS: The medical records of patients who underwent transplantation in a specialized center in Rimini (Italy) from 2005 to 2011 were checked. Only transplants of mature donor molars were considered. Patients were called up to evaluate the survival rate and success rate. RESULTS: The mean age at the time of the surgery was 33,6 ±â€¯7,4; mean follow up was 11,9 years ±1,9. Success rate at the time of latest recall visit was 80 % and survival 95 % of the analyzed cases. CONCLUSIONS: The survival and success rate are in complete agreement with the most recent literature and confirm that the technique of autotransplantation is reliable when indications and protocols are rigidly followed, also using mature teeth as donors.