New plates with polyaxial locking system and PSI technique in medial open wedge high tibial osteotomy: preliminary results.

Medial open-wedge (MOW) high tibial osteotomy (HTO) is proven treatment option, indicated in medial unicompartimental knee osteoarthritis (OA) and in varus OA. New devices and techniques were developed in last years, such as Activemotion plates with polyaxial locking system (Dualtec System®, NewClip-Technics) and PSI technique. We describe outcomes and rate of complications in patients treated with Activemotion plates and PSI technique. From January 2019 to August 2019 a sample of 77 cases (72 NCT plates, 5 PSI technique) was observed, evaluating the rate of complications and the return to activity. The rate of complications is 2.6% and the mean time to return to activity is 10 weeks. MOW HTO with Activemotion plate has showed good results with a low rate of complications. About PSI technique, the preliminary results are excellent, but we need to increase the sample.

Antimicrobial efficacy of photodynamic therapy (PDT) in periodontitis and peri-implantitis: A systematic review.

To systematically review the literature regarding the antimicrobial effects of photodynamic therapy (PDT) on multi-bacterial species in periodontitis and peri-implantitis disease. The addressed focused question was: "Does PDT show antimicrobial efficacy against multi-bacterial species colonization in periodontal pockets and on the surface of dental implants?" Electronic databases including MEDLINE and EMBASE up to and including December 2018 were searched. Of the ninety studied analyzed, seven were included, four for the study of PDT in peri-implantitis disease and three for periodontal disease. All studies reported the multibacterial species outcomes after the application of antimicrobial PDT. All studies showed a significant reduction in the bacterial load, both in studies based on periodontal and peri-implantary disease, with an average reduction of the total amount of bacterial load of 99.3%. Moreover, the change in clinical parameters is equally important, with an average reduction of PPD of 1.01 mm (from 4.92 to 3.49 ± SD with a percentage reduction of 29%); of BoP of 50%; of RCAL of 1.19 mm (from 9.93 to 8.74, with an average percentage reduction of 12%); of PI of 0.3 (from 1 to 0.7 with a percentage reduction of 30%) and of GI of 1.2 (from 1.8 to 0.6 with a percentage reduction of 66.6%). This review demonstrated significant reduction in the bacterial load in periodontal pocket and dental implant surface with the use of PDT. The results of this review should be considered preliminary and further studies with standardized laser parameters are needed to obtain strong conclusions.

Photodynamic therapy (PDT) in non-surgical treatment of periodontitis.

Periodontitis represents a major problem for patients, since it is not possible to eliminate the bacteria that are responsible for this pathology with a pharmacological treatment. The present study included forty-four patients with periodontitis, who had undergone disinfection via photodynamic therapy (PDT) using a laser source having a 635 nm wavelength associated with a photoactivable substance (methylene blue). Clinical assessment of plaque index (PI), bleeding on probing (BOP), probing depth (PD), calculus index (CI), gingival recession (REC) and clinical attachment level (CAL) were recorded at base line, 1 month (4 weeks) after treatment and again 3 months (12 weeks) after treatment, while site radiography (RX) and microbiological test (MT) were recorded at base line and 3 months (12 weeks) after treatment. The outcomes show a good efficacy of the PDT in the elimination of the periodontal pathogenic microflora and in the improvement of the clinical parameters considered: from the base line to the final check after 12 weeks it has been observed a reduction in REC of about 16.9%, a reduction of CAL of about 17.85%, a reduction of the BoP of about 93.3%, a reduction of the PD of about 17%, a reduction of the CI of about 66.3%, a reduction of PI of about 44%, and microbiologically a reduction of the total amount of bacteria with proven parodontopathic properties (red complex bacteria) of about 58.74%. Within the limits of the present study, PDT can be reasonably considered as a good carrier that leads to significant improvements in the parameters (clinical and microbiological) considered.

Evaluation of the periodontal healing of the second mandibular molar distal site following insertion of PRF in the third molar post extraction alveolus.

The aim of this study was to evaluate the periodontal healing of the distal sites of the mandibular second molars, comparing the extraction therapy of the third molar with and without PRF adjunct into the postextraction alveolus. The study sample was composed by 40 consecutive patients who underwent extraction of mandibular third molars. Patients were divided in two groups: the last 20 participants who have only been subjected to extraction (spontaneous healing group, SHG) and the first 20 patients who had PRF adjunct (PRF group, PG). Healing was evaluated by analyzing the variations in terms of PPD (Probing Pocket Depth), REC (Recession), CAL (Level of Clinical Attachment), BoP (Bleeding on Probing) and GI (Gingival Index) from Baseline to further follow-ups at 1 month and 3 months. The disto-vestibular (DV) and disto-lingual (DL) PPD values of the second mandibular molar were measured at Baseline and after three months in the two groups. Patients of the PG group showed lower PPD values at 1 month and 3 months postoperatively: DV: 3.6±1.09 - DL: 3.5±1.15 and DV: 2.5±0.83 - DL: 2.6±1.09, respectively. Patients belonging to the SHG also showed lower PPD values, reporting respectively the following DV values after 3 months: 2.7±0.86 - DL: 2.75±0. 85. However, there was no statistically significant difference comparing the results obtained in PG and SHG groups at 1 and 3 months (p>0.05). The insertion of PRF inside the post-extraction alveolus of the mandibular third molar leads to limited improvement in terms of periodontal healing, compared to extraction therapy only.

Heat shock induces the expression of pro-inflammatory cytokines in human Achilles tendon tenocytes.

The aim of our study is to investigate the behaviour of healthy and tendinopathic human tenocytes after a heat shock. After we harvested tendinopathic and healthy human tendon samples, we split tenocytes into 4 groups: 3 groups were submitted to heat shock, followed by different periods of post-heating (2, 4 and 20 h). The other group represents our negative control. The target genes were analysed using Real Time PCR. IL-1ß and IL-6 expression were significantly increased in tendinopathic samples after heat shock. COL1 and COL3 expression were increased in non-stimulated tendinopathic tenocytes, but their levels significantly decreased after heat shock (p less than 0.01). COL3 levels increase in healthy samples after 20 h post-heating (p less than 0.01). COL1 and COL3 decreased after heat shock as a sign of the failure of repair mechanisms in tendinopathic tendons. Heat shock in in vitro models was insufficient to trigger pro-inflammatory cytokines in healthy human tenocytes.

Implant platform switching concept: a literature review.

BACKGROUND: The platform switching concept involves the reduction of the restoration abutment diameter with respect to the diameter of dental implant. Long-term follow up around these wide-platforms showed higher levels of bone preservation. AIM: The aim of this article is to carry out a literature review of studies which deal with the influence of platform-switched implants in hard and soft oral tissues. MATERIALS AND METHODS: All papers involving "platform switching" that are indexed in MedLine and published between 2005 and 2011 were used. Clinical cases, experimental and non-experimental studies were included, as well as literature reviews. RESULTS: In our search, we analized 18 clinical cases and 3 reviews. The results indicate that peri-implant bone resorption is reduced with platform switching system. CONCLUSIONS: All papers written by different researchers show an improvement in peri-implant bone preservation and satisfactory aesthetic results. Further long-term studies are necessary to confirm these results.

Xenogeneic collagen matrix versus connective tissue graft for soft tissue augmentation at immediately placed implants: a prospective clinical trial.

The advantages of immediate implant placement for patients include a reduced number of surgical procedures and a shorter overall treatment time. Disadvantages include a higher risk of aesthetic complications. The aim of this study was to compare xenogeneic collagen matrix (XCM) versus a subepithelial connective tissue graft (SCTG) used for soft tissue augmentation in combination with immediate implant placement without provisionalization. Forty-eight patients requiring a single implant-supported rehabilitation were selected and assigned to one of two surgical procedures: immediate implant with SCTG (SCTG group) or immediate implant with XCM (XCM group). Marginal changes in the peri-implant soft tissue and the facial soft tissue thickness (FSTT) were assessed after 12 months. Secondary outcomes included peri-implant health status, aesthetics, patient satisfaction, and perceived pain. All of the implants placed were successfully osseointegrated, resulting in 1-year survival and success rates of 100%. The patients in the SCTG group had a significantly lower mid-buccal marginal level (MBML) recession (P = 0.021) and a greater increase in FSTT (P < 0.001) than the patients in the XCM group. Using xenogeneic collagen matrix during immediate implant placement significantly increased FSTT from the baseline, leading to good aesthetic and patient satisfaction results. However, the connective tissue graft yielded better MBML and FSTT results.

Subjective pain response to two anesthetic systems in dental surgery: traditional syringe vs. a computer controlled delivery system.

The present study was conducted to evaluate human pain perception at different phases of dental surgery using a computer controlled device, the Single Tooth Anesthesia System (STA System), versus the traditional syringe technique. One hundred healthy patients participated in this single-blind split-mouth design study. Individuals provided pain ratings at needle insertion, delivery of anesthetic solution and tooth extraction via a numeric visual rating scale or NVRS. The anterior middle superior alveolar, or AMSA, injection was compared with traditional syringe injections in maxillary quadrants. NVRS scores for AMSA were significantly lower for the STA System when compared to traditional syringe technique at needle insertion, delivery of anesthetic solution (p less than 0.0001) and also during tooth extractions (p=0.0002). A higher percentage of patients (23 percent) required a second injection after the traditional syringe technique. Subjects reported having less clinical pain with AMSA injection at every step of the dental surgery. The STA System combines an anesthetic pathway and controlled flow rate resulting in virtually imperceptible needle insertion and injection, and a rapid onset of profound anesthesia. NVRS scoring system facilitated patient comprehension in assessing pain value and intensity experienced. The two anesthetic delivery techniques were therapeutically equivalent for maxillary injections but AMSA/computer controlled protocol significantly minimizes subjective pain perception at needle insertion, anesthetic delivery and during tooth extraction.

Platelet-rich plasma improves wound healing in multiple myeloma bisphosphonate-associated osteonecrosis of the jaw patients.

Bisphosphonates are drugs used to treat various metabolic and malignant bone diseases. In the past 10 years intravenous bisphosphonates have been associated with increased risk of osteonecrosis of the jaw (ONJ). The aim of the present study is to evaluate platelet-rich plasma (PRP) wound healing benefits in multiple myeloma (MM) patients who developed ONJ after surgical tooth extraction. The study included 7 patients, 2 males and 5 females. All individuals had been taking zoledronate or pamidronate followed by zoledronate for an average of 5 years. Four subjects had only standard surgical debridement and sequestrectomy to treat the ONJ and three had additional autologous PRP. The patients were followed-up for 3 months. The use of PRP to enhance wound healing and reduce bone exposure seems to be a good treatment protocol in ONJ MM subjects.

Interobserver variability of dynamic MR imaging of the temporomandibular joint.

PURPOSE: This study investigated the interobserver variability of dynamic magnetic resonance (MR) imaging of the temporomandibular joint (TMJ). MATERIALS AND METHODS: Sixty-two patients with internal derangement of the TMJ (124 TMJs) were investigated with a 1.5-T MR imaging system during physiological opening and closing of the mouth. Two readers evaluated independently the quality of the dynamic examination (Q: nondiagnostic, diagnostic, optimal), condylar motion (CM: limited, suboptimal, optimal), condylar orientation (CO: in-plane, through-plane shift), disc visibility and movement (DV: visible, nonvisible; DM: normal, reducing, nonreducing dislocation) and joint effusion (JE: present, absent). For each TMJ, the condylar path was measured by tracing the position of the condyle in the frames of the dynamic acquisition. Agreement between the two readers was assessed with Cohen's Kappa and the Bland-Altman method. RESULTS: Interobserver agreement was almost perfect for Q (nondiagnostic, diagnostic, optimal: 0.8%, 4.9%, 94.3%; κ=1), CM (limited, suboptimal, optimal: 14%, 26.4%, 59.5%; κ=0.84) and DV (visible, nonvisible: 100%, 0%). Substantial agreement was found for DM (normal, reducing, nonreducing: 66.1%, 14.8%, 19.1%; κ=0.64) and JE (present, absent: 41.3%, 58.7%; κ=0.67). Moderate agreement was found for CO (in-plane, through-plane shift: 94.2%, 5.8%; κ=0.41). As for the condylar path, the means of the percentage differences and limits of agreement (LA) were -3% (LA: -34.5%, 28.3%) on the right and -1.2% (LA: -35%, 32.6%) on the left. CONCLUSIONS: In dynamic imaging of the TMJ, qualitative assessment of condyle-disc movement and joint effusion is minimally dependent on the reader's evaluation. Measurement of the condylar pathway shows an interobserver variability of ±30%.

Clinical comparison of a xenogeneic collagen matrix versus subepithelial autogenous connective tissue graft for augmentation of soft tissue around implants.

Dental implant placement is a predictable therapy for replacing teeth. Nevertheless, mechanical, biological, and aesthetic complications frequently occur. The aim of this study was to compare the clinical outcomes of a xenogeneic collagen matrix (XCM) used at the time of implant placement as an alternative to a subepithelial connective tissue graft (SCTG), for soft tissue augmentation. This was a prospective clinical trial with 12 months of follow-up. In the control group, soft tissue augmentation at the time of implant placement was performed with a SCTG, while in the test group, a XCM was employed. At 12 months postoperative, all xenografts showed no postoperative complications. In both groups, a significantly greater thickness was observed on the buccal and occlusal sides from preoperative to 3 months postoperative (P<0.05). No statistically significant difference in pink aesthetic score (P=0.379, 6 months postoperative) or marginal bone loss (P=0.449 at 3 months postoperative, P=0.778 at 6 months postoperative) was observed between the groups. Statistically significant differences in pain perceived by the patients (P<0.0001) and the time to complete the surgical procedure (P=0.0008) were detected. At 12 months after surgery, XCM provided similar clinical results in terms of soft tissue augmentation on the buccal and occlusal sides as compared with the SCTG.

Examination of periodontal pathogens in stenotic valve specimens and in whole blood samples in patients affected by aortic valve stenosis and chronic periodontitis.

Periodontitis may be a risk factor for atherosclerosis and coronary heart disease. The influence of periodontal pathogens in cardiovascular diseases needs further investigation. Therefore, the aims of this clinical study are: to test the presence of periodontal bacteria DNA in aortic valves and to assess the concomitant presence of the same periodontal bacteria DNA in whole blood samples in patients affected by aortic valve stenosis and chronic periodontitis. Nineteen consecutive patients (12 males and 7 females, age: 49-85 years) were enrolled in this study after having been subjected to a complete periodontal evaluation to confirm the diagnosis of chronic periodontitis. All patients were scheduled for aortic valve replacement surgery. After clinical and microbial periodontal examination, the aortic valve tissue specimens were obtained by excision during valve replacement surgery and the patients were subjected to the whole blood sampling before the surgery. The polymerase chain reaction technology was used to detect the putative periodontal pathogens Tannerella forshytia, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Fusobacterium nucleatum, Campylobacter rectus, Eikenella corrodens and Treponema denticola. Neither the 19 aortic valve specimens nor the blood samples were positive for the genoma of the selected periodontal pathogens. The selected periodontal pathogens did not colonize the aortic valve of patients affected by stenosis and bacterial genoma was not present in whole blood samples. A high blood pressure at the aortic valve may prevent the adhesion and proliferation of bacterial colonies.

Hormonal influence on the physiology and pathology of the dental gingival unit: the preliminary results of a pilot study.

AIM: The effects of steroid hormones on the periodontium are most prominent at certain stages of a woman's life especially during the menstrual cycle when there is an increase in the secretion of sex hormones or a significant fluctuation in their concentration. The deterioration of existing periodontal conditions can be attributed to a fluctuation in the steroid hormones in circulation. By contributing to our understanding of periodontal changes caused by variation in hormone concentrations, this study aims to encourage the implementation in dental practice of the most suitable forms of treatment for hormone-related pathologies. METHODS: Tartar was removed from the teeth of five young women and four biopsies and blood tests were carried out on them at regular intervals. The information gathered was used to monitor periodontal changes arising from variation in hormone concentrations. RESULTS: The histological analysis of the test samples under an optical microscope did not reveal signs of inflammation, hyperaemia or oedema at any stage of the menstrual cycle in the patients examined. The extent of gingival Keratinization was found to be comparable to that present in the follicular phase. CONCLUSION: The occurrence of ovulation could not be shown in the pilot study. The histological analysis and the analysis of hormone concentrations show primarily the absence of surges in estradiol and LH which normally accompany ovulation; the levels recorded are similar to those found in the follicular phase.

Study of cellular toxicity in vitro of two resins for orthodontic use.

OBJECTIVE: The objective of this work is to compare cellular toxicity in vitro of two resins for orthodontic use: an auto-polymerizable composite and a photo-polymerizable composite. MATERIALS AND METHODS: Samples were obtained by joining a couple of steel orthodontic brackets by using auto-polymerizing or photo-polymerizing resin. We used a halogen lamp, a mini LED lamp and a fast LED lamp used for orthodontics cure for 40 seconds. The 3T3 Swiss cellular line of fibroblasts was used. The samples obtained were used to determine the cellular toxicity in vitro using the Neutral Red Up-take (NRU) and the 3-(4,5-dimethylthiazol-2-Yl)-2,5-diphenyltetrazolium bromide (MTT) assay. RESULTS: Toxicity of the extract appraised at a low level at MTT and NRU assays. There were statistically relevant differences between the toxicity induced by the auto-polymerizing material and the toxicity induced by the photo-polymerizing composite material, polymerized with the blue-light lamp (p < 0.001) and with the mini LED lamp (p < 0.05). CONCLUSIONS: From the data collected in this study, we can conclude that both resins show a low level of cytotoxicity that, in the case of photochemical polymerizing resin, depends on the characteristics of the lamp.

Quality of Life of Patients with Mandibular Third Molars and Mild Pericoronitis. A Comparison between Two Different Treatments: Extraction or Periodontal Approach.

Background: The extraction of the mandibular third molar is one of the most frequent intervention in oral surgery. A common indication for wisdom tooth extraction is represented by pericoronitis, which can determine discomfort and pain in patients. The present study aimed to evaluate the impact of patients' quality of life by comparing a surgical approach with a periodontal approach. METHODS: We evaluated 82 patients diagnosed with pericoronitis that occurred at the third molar site. In total, 41 of them received a periodontal treatment and 41 were treated by extraction. The quality of life (QoL) of the patients was assessed by using the Oral Health Impact Profile-14 (OHIP-14) index. RESULTS: A total of 82 patients were included in the study and were followed up for 6 months. Of the patients, 41 received a periodontal treatment and 41 underwent surgical extraction. At the baseline, the OHIP-14 scores of the surgical group were higher (19.71, SD 9.90) than the periodontal group (14.41, SD 8.71). At 1 week, there was a reduction in terms of OHIP-14 in both groups, but the periodontal group showed lower values (12.3, SD 8.11). Long-term follow-up showed a reduction of the OHIP-14 values, with a difference in favor of the surgical group (0.10, SD 0.45). However, there was a reduction in OHIP-14 scores in both groups. CONCLUSION: Although the periodontal treatment offered a rapid improvement in terms of quality of life during the first week after the treatment, after 1 month and 6 months, the extraction of the mandibular third molar extraction remained the best treatment, removing the occurrence of re-inflammation of the site.

Proteomic evaluation of GCF in the development of pregnancy related periodontal disease: a pilot clinical study.

OBJECTIVE: This pilot study analyzed the possible changes of periodontal disease status in female patients during the period following pregnancy. Both clinical and laboratory data were collected and analyzed. PATIENTS AND METHODS: A non-randomized controlled clinical trial was conducted by the Periodontal Department of the Dental Clinic in collaboration with the Pediatrics Department, at Fondazione Policlinico Universitario A. Gemelli, Rome, Italy. Ten female patients, who completed the pregnancy without complications, were enrolled in this research protocol forming the experimental group. During the first post-partum days, gingival crevicular fluid (GCF) samples were collected and analyzed with high-performance liquid chromatography associated with high-resolution mass spectrometry (HPLC ESI MS); periodontal parameters as pocket depth (PD), full mouth plaque score (FMPS) and full mouth bleeding score (FMBS) were recorded, and a professional oral hygiene session was performed. The same protocol was applied after three months with the same patients forming the recall group. A control group was created in order to compare the results with GCF samples from 10 not pregnant fertile women. RESULTS: Student's t-test has been used to evaluate the statistical significance of the collected data. Mean levels of PD decreased from 3.75 mm ± 1.2 mm after pregnancy to 2.88 mm ± 0.85 mm at three months post-partum (p<0.01). Mean value of FMPS and FMBS decreased from 21.8% ± 1.35% and 34.27% ± 1.5% after pregnancy to 13% ± 2.81% and 17.55% ± 2.84% at three months post-partum, respectively (p<0.05). The concentration of each analyzed peptide has changed in relation to the general improvement of the periodontal status at three months post-partum. CONCLUSIONS: Pregnancy may be associated with an increased risk of periodontal disease. Both clinical and laboratory data have demonstrated that a professional oral hygiene session can affect the course of pregnancy inducing periodontal diseases allowing a faster healing and restitutio ab integrum.

Oral management of adult patients undergoing hematopoietic stem cell transplantation.

Chemotherapy and hematopoietic stem cell transplantation (HSCT) are the current treatments for patients with hematological diseases; they result in myelosuppression, and increase the susceptibility of patients to severe infections. The oral cavity is a potential site of complications in HSCT patients, because it is the entrance for agents that can cause systemic infections; it is one of the most frequent locations for side effects deriving from conditioning therapy. The importance of dental pre-chemotherapy and transplant prescription is often stressed, since both therapies depress the immune system and platelets, making each intervention at this stage a high risk. The aim of this article is to review the potential complications of HSCT, and to extrapolate from the scientific literature the treatments and timeframes in which dental therapies can be performed, avoiding important risks for patients.