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TheraCal LC (TLC, Bisco Inc., Schaumburg, IL, USA) is a light-cured, resin-modified, calcium silicate-filled base/liner material designed for direct and indirect pulp-capping. In this study the result of the evaluation in vitro of the biocompatibility and chemical-physical properties of TLC are reported. TLC specimens were prepared under aseptic conditions in strict compliance with the manufacturer’s instructions and sterilized. Osteoblast-like cells (MG63) were used. For different time points, solubility, water uptake, alkalinizing activity and cytotoxicity were evaluated. In ddH20 and in DMEM+FBS, TLC showed a loss of material increasing simultaneously with the absorption capacity. The increase of water uptake of the material promoting the solubilization of mineral ions in medium is a requisite for a bioactive material. The alkalinizing activity is correlated to antimicrobial/bacteriostatic activity and to the ability to favor the formation of apatite deposits. The pH values for water absorption after immersion of the disks ranged between 8 and 9 at each times of evaluation. Cytotoxicity was not observed in MG63 cells treated with TLC and after 5 days, the cells were organized to form a confluent monolayer as demonstrated by fluorescence microscopy observation. TLC showed biocompatibility on MG63 cells allowing a physiologic cell growth and differentiation. The chemical-physical properties and biocompatibility of TLC observed in vitro in the present study, allows considering this cement as an innovative pulp-capping material for the vital pulp therapy.
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This preliminary study aims to establish the Virtual Chromoendoscopic Magnification (VCM) feasibility to visualize and distinguish the Intraepithelial Papillary Capillary Loops (IPCL) patterns of benign oral pathologies from malignant ones. Thirty-one consecutive subjects affected by oral lesions/pathologies underwent white light examination and VCM imaging by the Narrow Band Imaging System (Olympus Medical Systems Corp., Tokyo, Japan). A class system of four IPCL types corresponding to progressive vessel disarray was adopted. IPCL type IV were considered criterion of "malignancy". A histopathological exam completed the diagnosis: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. IPCL patterns of benign oral entities ranged from types I to III. IPCL type IV was associated with malignancy in 4 out of 6 cases. Sensitivity, specificity, PPV, and NPV were 100%, 93%, 67% and 100%, respectively. This study preliminarily describes IPCL patterns of different oral mucosal diseases and confirms the association between IPCL IV and oral cancer.
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Oral mucosa is constantly under the influence of various internal and external stimuli, therefore it is interested by a range of developmental disorders, irritation, inflammation, and neoplastic conditions. Traumatic fibroma is one of these lesions. The aim of this work is to obtain an ultrasound characterization of a lip fibroma with a high frequency probe (8-18 MHz) as feasibility and experimental model of this non-invasive technique in the oral mucosa compared with its histo-pathological section. Ultrasound characterization of a fibroma in a 50-year-old patient in the right retro commissural area of mucosa was performed. The ultrasound images were compared with its histological image. Fibroma is a traumatic lesion clinically recognizable and with a complex and well-defined histopathology structure. Although further investigations are necessary to determine the potential of ultrasonographic images as an aid in the diagnosis of oral lesions, this case report might be a model for ultrasound imaging compared with its histological section.
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The present study was based on the screening of procedures and materials used by dentists in constructing complete removable dental prostheses, considering their professional background and years of experience. Questions arose regarding differences and similarities within the local dental society, of which approximately 75% were trained in Europeans countries with differences in academic background, and compared to international dentistry. A questionnaire web site was used in order to anonymously collect answers to the survey by general practicing and specialist dentists. The survey contained 28 multiple choice questions that were based on 5 parameters: years of experience, location of dental studies, specialization, location and field of specialization. One hundred one survey sheets were collected. The results show statistical significance (p<0.05) for the following comparisons: practicing time had an impact on practitioner-technician interaction, while the level of qualification had an effect on articulator and face-bow usage. Location of dental studies, specialization and residency had impact on final impression materials, teeth set-up as well as tooth shape and color selection. The differences found between dentists’ working techniques set the ground for future research that should focus on rating the success of the different methods towards a goal of creating recommendations for an ideal set of working techniques.
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The final outcome of dental treatment needs to be not only clinically sufficient, but also esthetically pleasing. Bilateral symmetry in the maxillary incisor teeth is of significant importance in esthetic dentistry. In restorative dentistry, symmetry refers to the appearance of balance around the dental midline. The purpose of this study was to measure and compare the maxillary incisor teeth dimensions from both sides of the dental midline, in order to asses if this symmetry occurs naturally. From the student community population at Tel Aviv University, 66 students between the ages of 20-35 (35 males, 31 females) were enrolled and gave consent. The inclusion criteria for this study were: upper maxillary incisors that have never undergone restorative or rehabilitative treatment, and no history of orthodontic treatment. Standardized digital photographs were taken, and the length and width of the maxillary central and lateral incisors were measured and proportions were calculated. SPSS was used to compare the measured differences between teeth on the left versus right of the midline. Tooth proportions were not significantly different between the left and right sides. Asymmetry was found only between the lengths of the maxillary lateral incisors (p=0.009); the width for these teeth was symmetrical. A significant statistical difference was not found on most parameters when evaluating symmetry of the upper incisors. Therefore, when treating the esthetically important anterior of the mouth, care must be taken to ensure bilateral symmetry to mirror the natural symmetry found in most patients.
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Denture adhesives are widely used in dentistry. The growth of Candida albicans on the denture base is common on both jaws, particularly in elderly patients. A strong correlation has been found between the growth of Candida albicans and dentures, potentially leading to denture stomatitis. Recent studies show that the addition of chlorhexidine diacetate (CHDA) to denture adhesives can have a protective effect against denture stomatitis. The aim of this research is to examine the antifungal properties of three denture adhesives when CHDA is added. We hypothesize that the addition of CHDA to denture adhesives will result in antifungal activity against Candida albicans. Three denture adhesive materials (Corega, Protefix and Kukident) were prepared with and without the addition of CHDA in order to measure whether CHDA increased the resistance of the adhesives to the growth of Candida albicans. Dynamic and static intercellular changes were assessed through direct contact test (DCT) and confocal microscopy. The tested materials were evaluated immediately after setting and at 14 days post-setting. When combined with CHDA, all three denture adhesive materials decreased Candida albicans growth compared to the control (p less than 0.0001). This inhibition of growth was more prominent in the first 24 h. The confocal microscopy results supported the DCT findings. The addition of CHDA to denture adhesive pastes inhibits growth of Candida albicans, and may potentially reduce the incidence of denture stomatitis. Further studies are warranted.
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The purpose of this work is to evaluate changes in temperature of one-piece titanium implant surface during the setting of acrylic resin temporary crowns and to correlate thermal changes to implant diameter. Thirty-three one-piece implants (ARRP, Alpha-Biotec) were divided into 3 groups according to diameter size (G1=3 mm, G2=3.3 mm, G3=3.6 mm). Implants were mounted on an acrylic glass apparatus. Thermocouples were positioned at the most coronal thread. Lower incisor temporary polycarbonate crowns were filled with 80 μL of self-curing acrylic resin and positioned immediately on the implant abutment. Thermal changes of the implant surface were recorded continuously for 10 min. Data were statistically analyzed using one-way analysis of variance. The mean initial temperature (C0) of groups G1, G2 and G3 was similar (24.79±0.78ºC, 25.26±0.63ºC, 24.97±1.06ºC, respectively). The setting of the acrylic resin temporary crown resulted in a significant increase in the implant surface temperature of all groups. The mean thermal amplitude (ΔC) for groups G1, G2 and G3 were 6.79±1.02ºC, 6.61±0.94ºC, 6.65±1.26ºC, respectively. The mean time to maximum temperature (Tmax) for groups G1, G2 and G3 were 337.38±42.91 sec, 324.69±41.46 sec and 317.98±37.91 sec respectively (P>0.05). Direct application of auto-polymerizing resin to the titanium abutment of one-piece implants significantly increased the cervical implant surface temperature. Implant diameter did not influence the temperature changes.
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The Acro-Dermato-Ungual-Lacrimal-Tooth syndrome (ADULT syndrome) is one of the rarest ectodermal dysplasias and it is associated with several malformations involving especially the limbs. The most clinical features are the presence of ectrodactyly, syndactyly, hypermelanosis or multiple lentigines, onhycodysplasia, abnormalities in the lacrimal duct, recurrent conjuntivitis, photophobia, mammarian hypoplasia, hypotrichosis and frontal alopecia, hypohydrosis, cutaneous photosensitivity, nasal bridge prominence, exfoliative dermatitis and xerosis. The ectodermal dysfunction expresses itself with conoid teeth, enamel hypoplasia, dentinal dysplasia and especially hypodontia, with following functional and aesthetic defects. We report the case of an 11-year-old Caucasian girl affected by ADULT syndrome.
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The chronic stimulation of the immune system due to the presence of bacterial antigens within periodontal tissues has been associated with several autoimmune diseases, like diabetes mellitus, infective endocarditis or cardiovascular atherosclerosis. The current study aims at evaluating the correlation between Rheumatoid Arthritis (RA) and Periodontal Disease (PD) with special attention to genetic polymorphisms in cytokine expression. A total number of 34 patients affected by RA were recruited. Each of them underwent haematochemical analysis and data were collected for Rheumatoid Factor (RF), Anti-Citrullinated Protein's Antibody (CCP) and HLA-BDR1. DAS-28 questionnaire for disease activity was fulfilled by the rheumatologist, while a periodontal examination was carried out by the dental clinician and crevicular fluid samples were collected to evaluate the IL-6, IL-10 and VDR polymorphysms. A connection between CCP and IL-10 polymorphisms was found, with IL-10 expressing protecting tendency against periodontal disease when CCP are found in the bloodstream (p=0.0017). Finally, males mainly expressed IL-10 predisposing genes (p=0.046), while females showed a greater tendency to express RF (p=0.014) and CCP (p=0.050). This paper corroborates the idea of a correlation between sex, IL-10 polymorphisms and RA, which should be studied in depth, since recent papers have shown that IL-10 injected into joints seems to decrease inflammation.
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In this work, it was decided to study the role of HBD-2, an inducible and not constitutionally expressed defensin, in the pathogenesis of Oral Lichen Planus (OLP) and of Burning Mouth Syndrome (BMS). Seventeen OLP patients, with a positive histopathologic diagnosis of the disease, were recruited into this study in order to measure the relative quantity of HBD-2 in their saliva and crevicular fluid. The values were compared with those collected from a group of 9 patients affected by the Burning Mouth Syndrome (BMS) and with a control group (CTRL) of 9 patients. There was no statistically significant difference between the groups (p=0.523; p=0.897). However, patients affected by OLP showed a dycotomic distribution of values: while 10 of them showed similar values to those found out in the other two groups, 7 patients expressed high levels of HBD-2, and 3500 pg/ml was the threshold to distinguish the subgroups. During the dental visit the clinician classified OLP patients into two groups according to the clinical presentation of the disease: reticular and hyperplastic (white OLP), atrophic and erosive forms (red OLP). There was a statistical significant correlation between the clinical and numeric classification of the patients (p=0.004; p=0.001), and the expression of HBD-2 was higher in the red OLP group than in the white OLP group (p=0.000; p=0.000). In conclusion, this study shows that HBD-2 represents an index to assess active inflammation and it is probably linked to the presence of the typical band-like CD8+ infiltrate in Oral Lichen Planus.
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Burning mouth syndrome is defined as an intraoral burning sensation for which no medical or dental cause can be found. Recently, researchers have demonstrated an altered trophism of the small nerve fibres and alterations in the numbers of TRPV-1 vanilloid receptors. Capsaicin is a molecule that is contained in hot peppers and is specifically detected by TRPV-1 vanilloid receptors that are distributed in the oral mucosae. We aimed at verifying if topical capsaicin could prove to be an effective treatment of Burning Mouth Syndrome. A group of 99 BMS patients were recruited. We subdivided the BMS patients into two groups: the collaborative patients, who expressed a predominantly neuropathic pattern of symptoms, and the non-collaborative patients, who were characterised by stronger psychogenic patterns of the syndrome. Both groups underwent topical therapy with capsaicin in the form of a mouth rinse 3 times a day for a long period. After 1 year of treatment, the final overall success rate was approximately 78%, but with a significant difference in the success rates of the two groups of patients (87% and 20% among the collaborative and non-collaborative patients, respectively; p=0.000). The use of topical capsaicin can improve the oral discomfort of BMS patients, especially during the first month of therapy, but it is more effective for those patients in which the neuropathic component of the syndrome is predominant. Our hypothesis is that chronic stimulation with capsaicin leads to decreases in burning symptoms. This phenomenon is called desensitisation and is accompanied by substantial improvements in oral symptoms.
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Rheumatoid Arthritis is a disease, which can be described as an autoimmune response after molecular mimicry caused by infective agents. The current study aims at evaluating the correlation between Rhematoid Arthritis (RA) and Periodontal Disease (PD), with special attention to the microbioma detected in the gums. Thirty-four patients with RD were recruited into the current study. Among rheumatic parameters, Rheumatoid Factor (RF), anti-citrullinated protein antibody (CCP), HLA-BDR1 and DAS28 were collected. A dental clinician evaluated the periodontal screening record (PSR). Afterwards, 1 paper cone was inserted for 30 seconds into the gingival sulcus then sent to the laboratory for evaluation. Quantitative PCR of 16S rRNA genes was performed with the hydrolysis probes method to identify and evaluate the amount Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, Fusobacterium nucleatum and Campylobacter rectus. There were no statistical differences in the composition of oral microbioma between PSR groups. There were no statistical significant differences between bacterial loads and serum values. On the contrary, a positive correlation was found between the presence of Porphyromonas gingivalis in periodontal pockets on one side and RF and CCP on the other. Therefore, the presence of Porhyromonas gingivalis in periodontal pockets is associated to RA inflammatory indices.
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Williams Syndrome is a rare congenital disorder characterized by supravalvular aortic stenosis, peripheral pulmonary artery stenosis, mental retard and dysmorfic facial features. As regards the dental aspects of the syndrome, the deletion of the elastin gene induced clinicians to suspect periodontal alterations with a greater frequency of gingivo-periodontitis, but on the contrary no association between the syndrome and periodontal diseases have been found. Furthermore, patients show a higher frequency of teeth hypoplasia, an abnormal tooth morphology during primary dentition (12.5%) and during permanent dentition. We present a case report of a 12-year-old Caucasian boy affected by Williams-Beuren Syndrome who visited our hospital for a dental and orthodontic evaluation.
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Immunoglobulin A deficiency is the most common primary immunodeficiency defined as decreased serum level of IgA (less than 7 mg/dl) in the presence of normal levels of other immunoglobulin isotypes. Most individuals with IgA deficiency are asymptomatic and identified coincidentally. However, some patients may present with recurrent infections, allergic disorders and autoimmune manifestations, such as diabetes mellitus, Graves disease and celiac disease. The international literature has not produced any kind of review yet about intra-oral manifestations of selective IgA-deficiency. L.S., a 7-year-old Caucasian girl, was examined at our hospital. After she had undergone a professional dental cleaning, a symmetric, bilateral ulcerative gingivitis developed nearby the upper second primary molars. The gingival ulcers were persistent and did not disappear in the following 3 weeks. In the meantime, the young patient reported the presence of gastrointestinal symptoms. IgA serum level was 4.5 mg/dl, while the other isotypes levels were in the common range. The diagnosis of selective IgA-deficiency was formulated and the girl underwent further examination for the specific IgG autoantibodies in celiac disease, which were not present. Consequently, a full prevention program was planned. This case report emphasizes the role of the paediatric dentist in the early detection of systemic disorder, such as the immunological diseases. The oral cavity often reveals to be the first site of manifestation of important systemic diseases. Immunoglobulin A (IgA) deficiency is the most common primary immunodeficiency and is defined as a decrease in serum IgA levels in the presence of normal levels of other immunoglobulin isotypes (1). Serum IgA deficiency was first described in children with ataxia-telangiectasia (2) and has since been identified in other patients, including normal patients. The prevalence of IgA deficiency ranges from 1:223 to 1:1000 in community studies and from 1:400 to 1:3000 in healthy blood donors (3).
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Odontomas are one of the most common Odontogenic Tumors of the jaw. The exact etiology of odontomas is unknown. Histologically they are composed of various formations of dental tissue (enamel, dentin, cementum and sometimes pulp). In the WHO classification, they are divided into complex odontoma and compound odontoma. Clinically, odontomas are generally asymptomatic and only in rare cases cause swelling, pain, suppuration or bony expansion. Radiologically, the tumor is initially lucent, but with time, it develops small calcifications, which eventually coalesce to form a radiodense lesion with a lucent rim. Surgical resection is the treatment of choice and there is no recurrence. The aim of this paper is to define the principal characteristics and the treatment of these lesions, based on literature and personal experience.
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Eyelid reconstruction, though challenging, can produce a functional, esthetically pleasing lid. This should preferably be accomplished with a one-stage procedure, using robust, well-vascularized tissues similar to those being replaced, with minimal associated donor morbidity. According to the experience with Bichat pedicled flap in oral reconstruction, the authors propose the use of pedicle infraorbital fat pad for repair of conjunctival defect. Seven patients underwent eyelid reconstruction of full-thickness oncological or post-traumatic defects. In all cases, the reconstruction involved an orbital fat pad flap for the posterior lamella in addition to local flaps for the anterior lamella. All of the flaps survived. The transferred fat flap had a complete epithelization, histologically documented. No tumor relapse occurred in oncological cases. The results have been satisfactory both for clinical evaluation and for the patients. Reconstruction of the palpebral inner lamella with the orbital fat pad is a simple and low-morbidity procedure that has good morphological and functional results.
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Among all different types of cutaneous scleroderma, Parry Romberg syndrome and linear scleroderma “en coup de sabre” typically involve the visage. Gradual degeneration of the tissues, from the skin up to the bone, is the stigmata of the diseases and the range of clinical manifestations is wide. They typically start during childhood and slowly progress before stabilizing. Considering the gravity of the associated deformity and its impact on facial function and appearance, we strongly advocate a prompt intervention that however must be tailored on paediatric patients. There is not a general consensus on hemifacial atrophy treatment, but autologous fat grafting has been proved to be a suitable technique, due to its low morbidity, repeatability and efficacy in correcting volume defects and in improving skin texture. Following the same concept of safeness and non-invasiveness we propose 3D stereophotogrammetric acquisitions as a possible tool for the pre- and post-surgical follow up, indispensable to evaluate the surgical results. We present our case series composed of 8 paediatric patients, aged between 11 and 17 years, who underwent several lipofilling procedures, from 2012 to 2016. Starting from 2015, 3D stereophotgrammetric data has been obtained.
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Bilateral coronoid process hyperplasia is a rare condition defined as an abnormal elongation of the mandibular coronoid process, formed of histologically normal bone. Coronoid process hyperplasia usually develops progressively, and the clinical symptoms are often similar to those of temporomandibular joint disorders (TMD). Therefore, it is often misdiagnosed as TMD initially. From 2013 to 2016, six patients were referred to our maxillofacial surgery unit by their dentist, to evaluate mouth opening with suspected TMJ disorder. Average age was 30 years No hypertrophy of the masseter muscles was found and the patient had no history of pain and/or dysfunction of the temporomandibular joint. Average maximal incisal opening was 16.3 mm. (Rance 13-20 mm). At the end of surgery the average mouth opening achieved was of 40.3 mm. After 6 months from surgery an average mouth opening of 41 mm was obtained, with no recidivism in the coronoid process growth or decrease in the mouth opening. The only successful treatment to restore the mouth opening caused by coronoid process hyperplasia is surgical correction of coronoid-malar interference by coronoidectomy or coronoidotomy. Commencement of physiotherapy is recommended to begin between three days and one week after surgery. We also recommend the use of the TeraBite®, a simple manual physiotherapy device.
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Osteocartilagineous differentiation within malignant melanoma is a rare occurrence with several implications for diagnosis. Most of the reported cases have occurred in acral lentiginous malignant melanomas. In this paper, the authors describe the clinical, morphological, immunohistochemical features and surgical treatment of a case of primary oral mucosal melanoma with osteocartilaginous differentiation and they review the existing literature. The clinical history of a 67-year-old man affected of oral malignant melanoma was described from the first presentation to the second recurrence. FISH analysis on primary lesion and on relapses showed positive results both in epithelioid and in osteocondroblastic areas. Because of the scarcity of literature in osteogenic melanoma, histological identification may be problematic and prognostic factors and therapeutic protocols are nor well established. Immunohistochemical and molecular techniques can help to diagnosis this rare lesion.
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The purpose of the present microbiological study was to evaluate bacterial leakage at implant-abutment connection level of a new type of implant (Storm implant (FMD, Falappa Medical Devices®, Rome, Italy) using Real-Time Polymerase Chain Reaction (RT-PCR). This implant presents a polygonal external implantabutment connection with a geometry that provides a hex on which engage complementary abutments. To identify the capability of the implant to protect the internal space from the external environment, the passage of genetically modified Escherichia coli across implant-abutment interface was evaluated. Four Storm implants (FMD, Falappa Medical Devices®, Rome, Italy) were immerged in a bacterial culture for 24 h and bacteria amount was measured inside implant-abutment interface with Real-time PCR. Bacteria were detected inside all studied implants, with a median percentage of 15% for P. gingivalis and 14% for T. forsythia. Our results are similar to those reported in the English literature. Additional studies are needed to explore the relationship in terms of microbiota between the internal implant and implant-prosthetic connection. In addition, the dynamics of internal colonization needs to be thoroughly documented in longitudinal in vivo studies. As a result, microbial leakage along the implant abutment interface was acceptable and considered the most probable explanation for peri-implantitis.
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Bacterial leakage at the implant-abutment connection of a two-piece implant system is considered the main cause of peri-implantitis. Prevention of bacterial leakage at the implant-abutment connection is mandatory for reducing inflammation process around implant neck and achieving bone stability. Micro-cavities at implant-abutment connection level can favour bacterial leakage, even in modern two-piece implant systems. The conical connection with an internal octagon (CCIO) is considered to be more stable mechanically, and allows a more tight link between implant and abutment. As P. gingivalis and T. forsythia penetration might have clinical relevance, it was the purpose of this investigation to evaluate molecular leakage of these two bacteria in a new two-implant system with an internal conical implant-abutment connection with internal octagon (Shiner XT, FMD Falappa Medical Devices S.p.A. Rome, Italy). To verify the ability of the implant in protecting the internal space from the external environment, the passage of genetically modified Escherichia coli across implant-abutment interface was evaluated. Four Shiner XT implants (FMD, Falappa Medical Devices®, Rome, Italy) were immerged in a bacterial culture for 24 h and bacteria amount was measured inside implant-abutment interface with Real-time PCR. Bacteria were detected inside all studied implants, with a median percentage of 6% for P. gingivalis and 5% for T. forsythia. Other comparable studies about the tightness of the tested implant system reported similar results. The gap size at the implant-abutment connection of CCIOs was measured by other authors discovering a gap size of 1–2μm of the AstraTech system and of 4μm for the Ankylos system. Bacterial leakage along implant-abutment connection of cylindrical and tapered implants, Shiner XT, (FMD Falappa Medical Devices S.p.A. Rome, Italy) showed better results compared to other implants. Additional studies are needed to explore the relationship in terms of microbiota of the CCIO. In addition, the dynamics of internal colonization needs to be thoroughly documented in longitudinal in vivo studies.
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The nose is a critically important aesthetic and functional portion of the face. We can explore nasal defects following trauma or tumor resections. Reconstructive techniques based on primary closure, skin graft, local flap, regional flap and microvascular free tissue transfer provides an algorithmic framework applicable to any reconstructive problem. From 2010 to 2016, 33 patients were treated with nasal reconstruction. Malignant tumor resection was the main cause of nasal defect. The most common tumor resected was BCC (basal cell carcinoma) followed by SCC (squamous cell carcinoma). Recurrence of malignant tumor were also treated. As described in the literature, we used the most common reconstructive techniques to handle post-resection defects. Most of the defects involved the dorsum and the ala of the nose, only rarely had the skeleton been affected by the resection. When the cartilage had been sacrificed, a graft from the septum or from the ear flap was harvested. All patients resulted in optimal reconstruction. In any case, a second surgery was needed. All the surgical procedures were performed in one single stage except for the paramedian forehead flap that required a second stage for division and inset of the flap. All donor sites did not show functional and aesthetic damage. All patients resulted in a morpho-functional restoration of the area affected by the resection with a high success rate. Following the algorithm whenn restoring the anatomical subunit is the base purpose has determined satisfactory results.
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The aim of this study is to present a new approach to the surgical treatment of fractures of the middle third of the face, based on the use of resorbable materials and stereolithographic models. From 2009 to 2014, we treated 10 cases of orbitozygomatic trauma mostly as secondary surgery. For each case, an anatomical replica had been produced simulating the expected result and was then used to contour the resorbable plates on its surface, even before the beginning of the surgical procedure itself. The plates and meshes already bended act as a guide to bony reduction procedure. No complications occurred: all patients healed well, without inflammatory reactions. The results obtained corresponded to the expected results. This technique has been employed for primary or secondary treatment of fractures of the middle third facial, where it is not always easy to understand the displacement of bony segments and where the use of resorbables plates could be particularly beneficial, as they do not interfere with the maxillofacial skeleton physiology and avoid the necessity to remove plates and screws. Combined use of stereolithographic model and resorbable materials allow a new surgical approach based on the realisation of the surgical procedure on the model, then transferred from the patient to the model, thanks to plates and meshes. This technique helps to overcome many of the limits of the conventional technique: the need of minimal surgical access, in order to minimize facial scarring and the vasculo-nervous structures that cross the head and neck district and the obligation to restore not only the morphology but also the biological functions.
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A study was made of the correlation between the serum and salivary glucose levels in healthy subjects and in patients with type 2 diabetes, in order to establish the validity of salivary glucose determination in monitoring glycemia. Ninety-seven subjects were included in the study: 47 diabetic patients and 46 controls, aged between 40- and 80-years-of-age. Venous blood and saliva samples were collected in both groups under fasting conditions and after administering a test meal (15% proteins, 55% carbohydrates and 30% lipids). The glucose levels were measured using the glucose oxidase technique. The salivary glucose levels were seen to be greater in the diabetic group vs the controls both under fasting conditions (baseline) and after the meal (postprandial) (p=0.023 and p=0.008, respectively). A significant positive correlation was found between the serum and salivary glucose levels at baseline and under resting conditions, particularly in the diabetic group (r=0.389, p=0.002). The coefficient of determination of the simple linear regression model was R2=0.042, showing salivary glucose to be related to the blood glucose levels. In conclusion, salivary glucose concentration is correlated to serum glucose, particularly in type 2 diabetics.
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Alzheimer’s disease (AD) is a very common cause of dementia in developed countries and increases its prevalence progressively with age. AD etiopathogenesis is not yet understood. However, it is recognized that neuroinflammation plays a key role in its pathogenesis with the activation of microglia and the secretion of proinflammatory cytokines triggering irreversible neurodegenerative deterioration. This paper is a short review of the relationship between AD and periodontal disease (PD). Both processes may have common causes: both are inflammatory diseases and the prevalence and progression increases with ageing. However, we must consider that AD begins to develop many years before its clinical diagnosis. It is thought that in this prodromal period a connection could be established between both processes, both sustained by low intensity inflammation. There are several studies that relate both processes such as the possible systemic exposure to certain periodontopathogenic bacteria or the proinflammatory cytokines and other elements. It is argued that there are no modifiable factors such as age, or genetic factors, but that there are other factors that could be avoided, modified or controlled such as periodontal peripheral inflammation.
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Diabetic patients are more prone to develop infections such as periodontal diseases. Bacteriotherapy with the concept of using good bacterial strains to replace the pathogenic ones emerged as a fascinating field due to the increasing incidence of antibiotic resistance. The aim of this study was to evaluate if a particular combination of probiotics (Lactobacillus Reuteri DSM 17938 and Lactobaciullus Reuteri ATCC PTA 5289) is useful in treating gingivitis in diabetic patients. Eighty adult patients with diagnosis of controlled diabetes type II and gingivitis were enrolled for this study and randomized in two groups. Only oral hygiene instructions were given. Bacteriotherapy (Lactobacillus Reuteri) was administered to test group. Outcome measures were presence of Plaque (P.I.) and Bleeding on Probing (B.O.P.). Data were collected at baseline and after 30 days. At 30 days, both groups showed a statistically significant clinical indexes reduction from baseline. More reduction was present in the test group for P.I. (14%±6) and for B.O.P. (18%±4) and was statistically significant (p<0.05). Within the limitations of this study, bacteriotherapy can be considered effective in reducing plaque and BOP in patients with controlled diabetes type II and gingivitis.
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Osseointegrated implants are very popular dental treatments today in the world. In osseointegrated implants, the occlusal forces are transmitted from prosthesis through an abutment to a dental implant. The abutment is connected to the implant by mean of a screw. A screw is the most used mean for connecting an implant to an abutment. Frequently the screws break and are lost. There is an alternative to screw retained abutment systems: the cone-morse connection (CMC). The CMC, thanks to the absence of the abutment screw, guarantees no micro-gaps, no micro-movements, and a reduction of bacterial leakage between implant and abutment. As P. gingivalis and T. forsythia penetration might have clinical relevance, it was the purpose of this investigation to evaluate molecular leakage of these two bacteria in a new CMC implants systems (Leone Spa®, Florence, Italy). To identify the capability of the implant to protect the internal space from the external environment, the passage of genetically modified Escherichia coli across implant-abutment interface was evaluated. Four cone-morse Leone implants (Leone® Spa, Florence, Italy) were immerged in a bacterial culture for 24 h and bacteria amount was then measured inside implant-abutment interface with Real-time PCR. Bacteria were detected inside all studied implants, with a median percentage of 3% for P. gingivalis and 4% for T. forsythia. Cone-morse connection implant system has very low bacterial leakage percentage and is similar to one-piece implants.
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BIOPAD® is an ivory-white soft sponge, made exclusively of lyophilized type I native heterologous collagen extracted from horse flexor tendon, gelatine free, that keeps its native structure specific to the body’s skin tissue. BIOPAD® is an active dressing, playing an active role in all stages of wound healing process, stimulating granulation tissue growth and enhancing regeneration tissues. It ensures balance between absorption and humidity at wound surface, gaseous exchange of soft tissues during healing process, barrier to prevent bacterial infections and it is completely non-adherent. The use of BIOPAD® is painless for the patient and does not require removal or change of dressing. In this work, we evaluated the effect of BIOPAD® on fibroblasts behavior in term of cell viability, survival and growth and collagen production. The expression levels of some adhesion and traction-resistance related genes (ELN, DSP, FN1, FBN1, ITGB1, ITGA1, ITGA5, ITGA2, COL1A1, COL3A1) were analyzed using real time Reverse Transcription-Polymerase Chain Reaction (real time RT-PCR). All genes, except for ELN, DSP, ITGB1 and ITGA1 are up-regulated after 48 h of treatment. Altogether, our results point out the good potential of BIOPAD® as a biocompatible and regenerative tool in medicine.
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Vicryl® (polyglactin 910) is an absorbable, synthetic, usually braided suture, indicated for soft tissue approximation and ligation. Vicryl® has a special coating for minimizing friction, easing passage through tissue and easy knot tie down. It is synthetic for minimal tissue reaction. Fibroblasts are the main cells of connective tissue that synthesize extracellular matrix. In this work, we tried to judge the action of Vicryl® on fibroblasts behaviour. We evaluated the expression levels of some adhesion and traction-resistance related genes (ELN, DSP, FN1, FBN1, ITGB1, ITGA1, ITGA5, ITGA2, COL1A1, COL3A1) by using real time Reverse Transcription-Polymerase Chain Reaction (real time RT-PCR). All but 2 genes resulted up-regulated after 48 h of treatment. Our preliminary results point out the potential of Vicryl® as a biocompatible and regenerative tool in medicine.
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Bone is a complexly structured tissue and hierarchically organized from macro to nano levels of dimensions. Biomaterial devices developed to replace and interact with bone tissues have been designed from the macro to nano perspective to provide suitable performance in acquiring primary and biological stability. Macro level designed features provide mechanical interlock and primary stability to implants inside the bone. Surface micro and nano structures influence cells behavior to promote the secondary or biological stability, reaching successful osseointegration.
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The intraoral welder was invented by Dr. Pierluigi Mondani during the early 70’s to weld titanium needle implants to a titanium bar in patient’s mouth and to load them immediately by means of resin prosthesis. The clinical use documented dates back to 1972. Over the years, many practical applications have been added to the initial one, which have expanded the use of this device. In this scientific work, main applications are described. The aim of the work was to trace the historical process of intra-oral welding according to Mondani and describe the main practical applications. Intra-oral welding is a process introduced by dr. Pier Luigi Mondani of Genova (Italy) which allows to firmly conjoin titanium implants of any shape by means of a titanium bar or also directly between them in the mouth during surgery. The immediate stabilization achieved by intraoral welding increases implants success rate, allows immediate loading even in situations of bone atrophy, saves implants that are running into failure, re-evaluates fractured implants, allows to stabilize submerged implants postponing prosthesis management, allows to achieve efficient rehabilitation protocols to deal with difficult cases. The 40-years’ experience with intra-oral welding described in this article, confirms the ease of use and efficiency in providing immediate stabilization of titanium implants of all types.
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To correct skin imperfections, aesthetic medicine today makes use of injectable dermal fillers that allow filling skin by increasing the volume of soft tissue. Currently, there are many fillers usable for their excellent biocompatibility and low allergic reactions that ensure good results and good compliance. Among these, the most widely used filler is Human Plasma, obtained by centrifugation from patient blood and processed through cycles of centrifugation and heating, until it becomes a gel. In this work, we evaluated the effect of the Plasma on fibroblasts behavior in terms of cell viability, survival, growth and collagen production. To this aim, the expression levels of some adhesion and traction-resistance related genes (COL11A1, ELN, GDF6, IGF1, DSP, ELANE, HAS1, HYAL1, COL1A1 and COL3A1) were analyzed using real time Reverse Transcription-Polymerase Chain Reaction (real time RT-PCR). All genes, except for COL1A1, COL3A1 and COL11A1, were up-regulated after 24 h of treatment. Altogether, our results point out the good potential of Plasma. In particular, we appreciated an up-regulation in some of the most important genes involved in bio-revitalization, such as elastin and hyaluronic acid.
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The use of minimally invasive surgical techniques undoubtedly represents a huge advantage for both the clinician and the patient. This case report shows the possibility of making an implant-prosthetic rehabilitation in an upper jaw in a patient who presented dental elements 1.3 and 2.3 in bone inclusion. The use of computer-guided surgery offers us the possibility to carry out this type of implant rehabilitation without performing the extraction of the above-mentioned dental elements combined with the bone regeneration of the extraction sockets. Consequently, surgery invasiveness and post-surgery complications are reduced to a minimum. Additionally, the predictability of the methodology is evaluated with specific software that enables a comparison between what is virtually planned and what occurs in clinical practice.
