Platelet rich plasma grafting technique combined with trans-sinusal post-extractive implants placement in the posterior maxilla: a technical report and brief literature review.

The atrophic posterior ridges are usually characterized by poor bone quality and quantity: this situation requires the use of bone regenerative techniques. Other alternative surgical approaches are investigated. Nowadays the use of trans-sinus implants offers some advantages due to its feasibility. Today, bone grafting may be practical, but depends on many factors, such as the type of bone graft used (autogenous, alloplastic, or xenograft), host response, age of the patient, various complications associated with grafting procedures, infection, and, most importantly, the time spent while the grafted material matures and is taken up by the bone. So, this case report describes the feasibility of an alternative surgical technique associated to PRP (Platelet Rich Plasma).

New trends in adjunctive treatment and diagnosis in medication-related osteonecrosis of the jaw: A 10-year review.

Medication-related osteonecrosis of the jaw (MRONJ) is a major disease under study for over the last twenty years. Different classifications have been proposed and many therapies for the different stages have been applied. The evolution of treatments lead to an increasingly conservative approach. Numerous adjuvant treatments have been proposed in the last decade. All these complementary treatments have been proposed mainly to resolve or reduce the painful stress, predominantly caused by bacterial infection, simplifying the wound healing process and improving patients' compliance. Nowadays "secondary" treatments, such as autologous platelet concentrates (APCs, more specifically PRP, PRGF or PRF), hyperbaric oxygen (HBO), Auto/tetracycline fluorescence-guided bone surgery (AF-GBS/TF-GBS), medical drugs like teriparatide or the combination between pentoxifylline and tocopherol, fluorodeoxyglucose positron emission tomography (FDG-PET), laser and/or low-laser therapy and ozone therapy are more or less well documented and known considering their clinical effectiveness. The aim of the present review is the evaluation of the quantity and quality of scientific studies concerning this specific topic.

The use of computer-guided flapless dental implant surgery (Nobel guide®) and immediate function to support a fixed full-arch prosthesis in fresh frozen homologous bone grafted patients: a retrospective cohort study with 5 to 8-year follow-up.

The introduction of computer-assisted and guided surgery has radically improved the possibility of using all available bone for implant support, reducing the need for extensive grafting procedures and allowing for better implant placement and restoration. Moreover, fresh frozen homologous bone (FFB) grafts have shown good osteoconductive properties and biocompatibility with results comparable to autologous bone patients. The purpose of this retrospective cohort study was to evaluate the survival and the success rate of implants and related fixed full arch prosthesis at the 5 to 8 years follow-up when performed with immediate function using a flapless surgical procedure and computer-aided technology (NobelGuide®, Nobel Biocare® AB, Goteborg, Sweden) in patients previously treated with FFB grafts; treated at the University of Verona with the NobelGuide® system from January 2007 to December 2012 with at least 5 years follow-up were reviewed. Survival implants and survival prosthesis' percentage reached 95% in a 5 to 8-year period. This study indicates that patients previously augmented with FFB graft for maxillary or mandibular bone atrophy can be safely treated with implant supported prosthesis based on the NobelGuide® protocol, with the aid of computer-generated guide.

The rule of hydrogen peroxide long term rinse during a particular alveolar bone healing after ONJ injuries in a patient with periodontal disease: a 4-year radiological follow up report of a mental nerve emergence migration.

Bisphosphonate Related Osteonecrosis of the Jaw (BRONJ) is a pathology initially described in the early 2000s that has become increasingly common in clinical dentistry and maxillofacial practice due to the frequent use of bisphosphonates medical drugs (BPs) to treat various diseases such as osteoporosis, Paget's syndrome, osteomyelitis and in bone metastases secondary to tumors. Supragingival irrigation applied as monotherapy and in combination with root planning or BFs related bone necrosectomy revealed that supragingival irrigation with a variety of agents reduced the gingival microbial load and gingival inflammation. In this 4-year follow-up study we analyze the use of hydrogen peroxide (H2O2) as an antimicrobial agent for maintenance periodontal health, improving the longevity of teeth and oral cavity healing process.

Zygomatic implants supported rehabilitations in atrophic maxilla: sinus complications, radiological, periodontal and prosthodontic evaluations: a one year follow up retrospective longitudinal study.

The rehabilitation of maxillary bone atrophy represents one of the main challenges of modern oral implantology. The use of zygomatic implants in the prosthetic rehabilitation of the patient affected by severe maxillary bone atrophy is another therapeutic alternative, not exempt from complications. The present study included 19 patients with edentulous maxillae who were treated between 2013 to 2015 with at least two zygomatic implants at the Department of Maxillofacial Surgery, Verona, Italy. The purpose of this retrospective longitudinal study was to evaluate sinus complications and radiological, periodontal and prosthetic evaluations of zygomatic implants technique in severe atrophic. Implant-prosthetic rehabilitation of the upper jaw edentulous severely atrophic using zygomatic implants represents one safe and repeatable technique. In terms of implant survival from our study showed an implant CRS (common reporting standard) of 98.5% and a prosthetic CRS 100% with a mean follow-up period of 19.2 months (range). Both recorded data are superimposed on major reported studies in literature.

Efficacy of the Andresen activator before peak growth in class II patients.

Andresen activator (AA) is a functional appliance used to correct Class II malocclusion in growing patients. It corrects the malocclusion stimulating mandibular growth and determining a palatoversion of the upper incisors and a vestibularization of the lower incisors. The aim of this study was to analyze the treatment efficacy of class II malocclusion due to mandibular hypodevelopment before peak growth. Fourteen subjects with class II relationship of the skeletal bases and cervical vertebrae maturation stage 1 or 2 were enrolled in the study. Cephalometric analyses were carried out using landmarks derived from the analyses of Pancherz, Ricketts, Tweed and Steiner. A significant decrease (P less than 0.05) in ANB angle was found (-2.29±3.05°) after treatment, which was expression of an improvement in maxillo-mandibular sagittal skeletal relationships. There was also a significant reduction of OJ after treatment (-4.44±2.36 mm; P less than 0.001), indicating a vestibularization of the mandibular incisors and a palatoversion of the maxillary incisors, and a correction of the molar relationship. The favorable effects of the Andresen activator for the correction of the mandibular defect can be found even prior to peak growth; the achieved class I relationship maintains a correct mandible position in time, ensuring a proper skeletal growth. .

Evaluation of pain, swelling and trismus after extraction of impacted third molars relative to the use of betamethasone in submucusal infiltration.

The aim of this study was to evaluate the anti-inflammatory effect of a single 4 mg injection of submucosal betamethasone after extraction of impacted third molars. Single-centre, single-blinded, parallel group study; Forty-three patients were submitted to impacted third molar extraction. In this study, 4 mg single-dose submucosal betamethasone was injected in the interventional group, while in the control group nothing was injected. Postoperative measurement included pain via the VAS scale, swelling and trismus with facial measurements and maximum mouth openings, and finally nerve sensitivity. There was a significant difference between the two groups regarding trismic pain and edema. The use of a single 4 mg submucosal betamethasone injection leads to a reduction of oedema, trismus and pain in patients undergoing impacted third molar extraction. .

Tooth agenesis: part 2. Orthodontic treatment and prosthetic possibilities.

Dental agenesis has a great clinical significance due to its frequency during daily practice and the therapeutic problems that can arise from it. This paper will explore all the aspects to consider in order creating a proper multidisciplinary treatment plan: in particular, orthodontic, prosthetic and implantologic therapeutic alternatives are described for the rehabilitation of the different areas of the dental arches. In fact, dental agenesis is a problem that often requires the intervention of specialists from the different fields of dentistry and its treatment must meet aesthetics needs, stomatognathic function and patient satisfaction.

Bi-layered collagen nano-structured membrane prototype collagen matrix CM-10826 for oral soft tissue regeneration: an in vivo ultrastructural study on 13 patients.

A new developed collagen matrix CM-10826 (CM) of porcine origin designed to be used as oral soft tissue substitute was investigated before and after implantation by light microscopy (LM), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). In a case series biopsy specimens were harvested from thirteen patients at 10, 20, 30, 43 days after abutment surgery for uncovering dental implants. The in vivo histological evaluations of each patient were performed via micro-coring of newly formed oral mucosa in the area covered by CM (test side) or left uncovered (control). Results showed that CM can be integrated in connective and epithelial tissues within 10 days, can be completely resorbed within 20 days and it is able to reduce inflammatory infiltrates and to stimulate both fibroblast/epithelial cell proliferation and neo-angiogenesis. Generally it seems to be superior in promoting soft tissue healing compared to that induced by secondary intention healing. Furthermore, it is able to act as a scaffold for soft-tissue regeneration, allowing the proliferation of keratinocytes from the wound edges and favoring neovascularization and growth of connective tissue in the mesh of porous layer. It appears that a CM might function in oral surgery as a substitute for autologous grafts and to avoid secondary intention healing in soft tissue defects.

Guidelines for achieving the best implants survival rates in the rehabilitation of the atrophic posterior maxilla.

The first option in the rehabilitation of the posterior atrophic maxilla is the sinus lift. The aim of this study is to highlight the characteristics that a sinus lift should have to maximize the subsequent implant survival rate. 33 systematic reviews regarding sinus lift procedures, implants success and survival rates were identified through scientific archives and analysed. The obtained results indicated that a heterogeneity of sinus lift procedures are described in the literature. The sinus lift should be performed through the apposition of particulate xenograft materials, in at least 4mm residual bone. Implants should have a rough surface and the patient should be non-smoker.

An overview of socket preservation.

Socket preservation is a surgical procedure whose aim is to limit the physiological resorption of the alveolar ridge that occurs after a dental extraction, in order to have sufficient bone to perform an implant placement. 16 articles regarding socket preservation procedures were identified through scientific archives and analysed. The biological rationale, the graft materials and the predictive factors are identified to help the clinicians in their practice. Socket preservation is an effective treatment to prevent bone resorption if performed after an atraumatic extraction with the use of biomaterials and membranes. It is also important not to forget local and systemic predictive factors.

Immediate rehabilitation of the posterior maxilla with an axial and a tilted post-extractive implant: a technical report and brief literature review.

The atrophic posterior ridges are usually characterized by poor bone quality and quantity: this situation requires the use of bone regenerative techniques. Other alternative surgical approaches are investigated. Nowadays the use of tilted implants offers some advantages due to its feasibility. Today, bone grafting may be practical, but depends on many factors, such as the type of bone graft used (autogenous, alloplastic, or xenograft), host response, age of the patient, various complications associated with grafting procedures, infection, and, most importantly, the time spent while the grafted material matures and is taken up by the bone. So this case report describes the feasibility of an alternative surgical technique.

An overview of guided bone regeneration.

TGuided bone regeneration (GBR) is a surgical procedure whose purpose is to obtain, new bone, new cementum and a new periodontal attachment around a periodontally compromised tooth. In this work, an overview of the literature was performed to analyze the state of the art concerning GBR in order to draw useful conclusions for clinical practice. Twenty-nine articles regarding GBR procedures were identified through scientific archives and analyzed. The biological rationale, the graft materials and the predictive factors were identified to help the clinicians in their practice. GBR is an effective treatment to prevent tooth loss if performed in adequate bone defects and it is also important to keep in mind predictive factors.

Agenesis: pilot case report by 2.9 mm implant.

The agenesis of the upper lateral incisor is one of the most frequent aesthetic-functional problems in dentistry. The reported case concerns a 49 years old male patient with bilateral agenesis of teeth 1.2-2.2 and a root stump of tooth 5.2 temporarily rehabilitated through a Maryland bridge. Without orthodontic treatment, the only solution for implant-prosthetic rehabilitation of tooth 1.2 results therefore in the use of a 2.9 mm diameter implant. The clinical and radiographic control of the implant and the gingival stability at a distance of 1 year gives a positive result both clinically and radiographically. The use of the implant with a 2.9 mm diameter is therefore indicated in extreme cases of limited bone availability.

Tooth agenesis: part 1. Incidence and diagnosis in orthodontics.

Dental agenesis has a great clinical significance due to its frequency during daily practice and the therapeutic problems that can arise from it. This paper will explore the incidence of dental agenesis, its diagnosis and how this anomaly affects the teeth differently. The second subsequent paper will look at its treatment and management.

Histological evaluation of periodontal ligament in human after orthodontic treatment with piezosurgery and monolateral tooth dislocation and ligament distraction technique: a first morphologic and histologic evaluation.

Traditional orthodontic tooth movement is based on the concept that application of a protracted force causes alveolar bone remodelling and adaptive changes in periodontal and dental tissues. Thus, if orthodontic tooth movement is described as a biological bone reaction to orthodontic forces mediated by the periodontal ligament (PDL), this event involves a series of sophisticated signal transduction processes that allows the PDL compression with specific histologic and biomolecular modifications. However, the preservation of the integrity of the PDL is generally difficult to achieve when it is associated with a long duration of orthodontic treatment. A total of 20 Caucasian patients with different dental-skeletal were treated using the Monocortical Tooth Dislocation and Ligament Distraction (MTDLD) technique with Piezosurgery associated with morphologic and histological evaluation of the PDL. The histological results obtained, confirm a good clinical outcome with an improvement of the speed on orthodontic treatment without any signs of tissue injury of PDL fiber without areas of hyalinization. The data suggests that MTDLD with Piezosurgery seems to be a valid alternative to the traditional orthodontic movement in adult patients preserving the anatomy and the integrity of PDL.

Piezoelectric surgery inserts vs conventional burst: a clinical investigation.

Piezosurgery is a new technique that can be used to cut mineralized structures without damaging adjacent soft tissues. This device has a lot of advantages: reduced surgical time, blood loss, and inferior alveolar nerve injury in bimaxillary osteotomy. Fifty patients underwent different surgical operations (orthognathic surgery, traumatic surgery, reconstructive surgery, aesthetic procedures) with 7 different kind of piezosurgery inserts in a period of 8 months. The same two surgeons performed all the procedures. All the procedures were carried out in order to improve the precision of the osteotomy and the comfort of the surgeon. Piezoelectric devices provide an innovative ultrasonic technique for safe and effective osteotomy compared with methods that use rotating instruments. Different inserts have been developed in order to achieve the utmost advantages.

Evaluation of bacterial flora composition on teeth and periodontal tissues in patients in treatment with rapid palatal expander.

Patients in treatment with rapid palatal expander (RPE) require professional assistance and more meticulous instructions on oral hygiene, since this appliance predisposes to gingivitis and caries. The aim of this work is to analyse the variability of the oral microbial flora found in patients in treatment with RPE with occlusal acrylic splint. It was also investigated whether the association of an antimicrobial mouthwash was useful during orthodontic treatment or whether regular and specific home oral hygiene manoeuvres were sufficient to maintain a good plaque control. The last goal was to highlight which of the different mouthwashes was the most effective in reducing the bacterial load. The patients were divided into 3 test groups and each one of them had a different mouthwash (chlorhexidine and sodium fluoride, fluorine, essential oils) randomly assigned. There was also a control group. Plaque samples were analysed through cultural analysis and PCR from T0 to T4 (8 months). Chlorhexidine mouthwash reduces the bacterial count by 96.08%, the fluorine by 94.50% and the essential oils by 95.74%. The results of the three mouthwashes are superimposable and although chlorhexidine gives the highest rate of bacteria reduction, its side effects lead the authors to prefer the essential oils.

Short-term in vivo evaluation of cellular DNA damage induced by fixed orthodontic appliances.

Metal ions accumulate inside the epithelial cells of the oral mucosa and damage the DNA. The aim of this study was to analyze whether DNA damage and/or apoptosis also occurs after a short-term exposure to the metals of fixed orthodontic appliances. 23 subjects were enrolled in the test group and 8 patients in the control group. Analyses performed on samples of oral mucosa were cell count, cellular viability, quantification of intracellular metal concentration, comet and micronuclei tests and quantification of intracellular Glutathione (GSH). The obtained results indicated that orthodontic appliances release metal ions, especially chromium, that cause inflammatory processes leading to DNA damages. These phenomenon are visible only after 30 days from application of fixed orthodontic appliances.