The health of soft tissues around four dental implants loaded immediately supporting a 4-year-old fixed screw-retained prosthesis.

The aim of this study was to assess the soft tissues health around the implant/abutment interfaces of fixed screw-retained prosthesis supported by four dental implants after at least 1-year in function. All the implants were placed between December 1, 2015 and April 30, 2019. Digital implant surgical planning was performed for all the complete-arch rehabilitations and then full-guided surgery was performed. The fixed-interim prostheses were delivered the day of the surgery and replaced by definitive prostheses after the healing period. Patients were followed-up to determinate peri-implant scores, such as Plaque Score (PS) and Bleeding on Probing (BoP). A total of 160 implants were placed in 37 patients, whereas 3 patients received both arches rehabilitated. A total of 40 complete-arch rehabilitations were performed, 26 in the maxilla and 14 in the mandible. Only 5 implants failed resulting in an overall implant survival rate of 96.9%. BoP was detected around 6 implants (3.7%) and 16 implants showed a superficial amount of plaque resulting a Plaque Score of 10%. Within the limitation of this study, it seems that the use of a fixed screw-retained prostheses supported by four dental implants to rehabilitate edentulous jaws could be a valid treatment option in the short and medium term without critical peri-implant issues. However, several perspective studies with longer follow-up are needed to achieve more predictable results.

The effectiveness of subgingival irrigant ozone-based as adjuvant for non-surgical periodontal therapy in the treatment of chronic periodontitis: a review.

The aim of this review was to establish the efficacy of Ozone therapy (OT) in Periodontal disease's (PD) tratment. An electronic search of publications was established from two electronic databases: PubMed and Web of Science. The search strategy used a combination of controlled vocabulary and freetext words. Inclusion and exclusion criteria were defined by the authors before the start of the study. The inclusion criteria were: all studies published in English language; studies in vivo on humans; studies analyzing the correlation between PD and OT. The search resulted in 102 titles. Only 9 articles were included in the quantitative analysis. By the analyzed studies a strictly connection is still not evincible. More clinical trials are recommended to investigate the role of ozone, in its various types of topical administration, as a valid subgingival irrigant to achieve the goal of periodontal tissue health.

Convergent implant transmucosal collar and healing abutment: aesthetics influence on soft tissues. A clinical study.

Two conditions are necessary for a correct and functional prosthetic implant rehabilitation: maintaining pre-implant soft tissue health and stability of bone tissue, in terms of implant osseous-integration and maintenance of optimal crestal attachment levels. In addition to these parameters - necessary for the longevity of the restoration - one of the main aspects of therapy is the achievement of a final aesthetic that reproduces as faithfully as possible the natural anatomy of the lost tooth and the associated soft tissues. To achieve this last objective, an implant system was designed and used by our group. This implant is characterized by a convergent trans-mucosal emergence fixture associated with a progressive closing system of trans-mucosa healing pillars (healing abutment). This guarantee, together with the micro and macrostructure of the implant, an immediate and highly aesthetic condition of the peri-implant soft tissues, and in the same time an optimal seal on the convergent neck of the implant itself.

Transgingival implants with a convergent collar (PRAMA); surgical and screwed prosthetic approach. A case report.

This article presents a case report of transmucosal implant with a convergent collar (PRAMA) inserted in the anterior maxillary esthetic area. The purpose of this study is to evaluate soft and hard tissue after 12 months. One implant was placed in the esthetic area. The implant was immediately loaded with a screwed provisional prosthesis. After 3 months the definitive screwed prosthesis was inserted. The patient was reassessed 12 months post-implant placement, and during the examination, the soft-tissue texture, color, and amount of keratinized tissue was checked. No statistically significant horizontal dimensional changes of the alveolar ridge were observed between each time-point. Mean soft tissue levels significantly improved between base-line and 12 months. The reduced buccal width of the transmucosal component gives more space to the gingival thickness and promotes stability and give a better seal. The use of transmucosal implant creates a shift of the inflammatory cell infiltrate away from the crestal bone level.

Foreign body granuloma in the maxillofacial region: a case report.

Foreign bodies can penetrate in soft tissues of the maxillofacial region through injuries and cutaneous lacerations from trauma. Most commonly found bodies are glass, metal and wood. We report the case of a 50-year-old male patient who came to our maxillofacial department complaining about the presence of an intraoral nodule located in the right upper gingival mucosa. The patient reported the story of a road accident, three months earlier, falling from a scooter without the aid of a protective helmet.

Articular disc of temporomandibular joint: an anatomical and histological study. Functional considerations.

The articular disc is an important component of the temporomandibular joint, whose morphology has been studied on autopsy and biopsy materials. The normal posterior attachment of the disc is usually described as having two layers, one upper and one lower. The upper layer consists of elastic fibres, collagen fibres, fat deposits and blood vessels. It is connected posteriorly to the anterior face of the post-glenoid tubercle, the tympanic wall of the temporal bone, the cartilaginous meatus and the parotid gland lining. The lower layer, on the other hand, consists of a compact lamina of non-elastic collagen fibres, attached to the posterior surface of the condyle. Elastic fibres are one of the main constituents of the extracellular matrix of many connective tissues, and they are believed to play a very important role in the normal functions of many tissues such as blood vessels, lungs and dermis. The existence and functional importance of a fibroelastic tissue in the upper layer of the posterior portion of the articular disc has been described in human TMJ and in joints of many animal species. In human TMJ, it is believed that elastic fibres in the posterior and anterior attachment regions may play an important role in the repositioning of the disc during jaw closure. This study presents a review of the current literature on the morphology of elastic fibres in the posterior portion of the joint disc and the role attributed to them during all functions.

Clinical applications of Natural Bone Morphoproteins in dentistry: a narrative review.

The need to restore bone loss in maxilla and mandible has led to find natural bone substitutes, such as fresh autogenous bone grafts. Fresh autogenous bone grafts (FABGs) have a remarkable capacity to induce new bone formation, a phenomenon called ‘osteoinduction.’ FABGs are useful in craniomaxillofacial and oral applications to restore bone deficiencies. The isolation of those proteins believed to be responsible for the osteoinductive activity of FABGs, namely Natural Bone Morphogenetic Proteins (NBMPs), led to a new era in bone regeneration. NBMPs have been approved for use in specific oral and maxillofacial applications. Clinical trials and studies of oral and craniofacial surgery have indicated that NBMPs can promote bone repair. Information about the biology, chemistry, and actions of NBMPs has called into question whether NBMPs would result in clinically useful bone induction and morphogenesis. Preclinical and specific clinical trials have indicated the efficacy of NBMPs either combined with autograft or compared with an autograft alone. In light of questions about potency and safety of NBMPs, however, additional high-level evidence is needed for specific clinical indications and appropriate patient populations that would benefit from their use.

Prevalence of HIV-related oral manifestations and their association with HAART and CD4+ T cell count: a review.

HIV infection is one of the major health problem of the last decades. This disease causes a chronic infection that can lead to acquired immunodeficiency syndrome (AIDS). According to the Global AIDS update, released in 2016 by HIV department of World Health Organization (WHO) and by the Joint United Nations Program on HIV/AIDS (UNAIDS), at the end of 2015, 36.7 million people were infected by HIV: 34.9 million of these were adults and 1.8 million were children under 15 years of age. The same report shows that during 2015, 2.1 million of new infection cases have occurred all over the world and about 1.1 million people have died for HIV. The aim of this short review is to up-date of the main HIV-related oral manifestations and their correlation with HAART (Highly Active Antiretroviral Therapy) and CD4+ T-cell count. Despite that more than 20 years have elapsed, this classification still remains valid: even today, group 1 lesions are found in the majority of HIV-positive patients with oral manifestations. Group 1 includes the following conditions: oral candidiasis (pseudomembranous candidiasis, erythematous candidiasis, angle cheilitis), oral hairy leukoplakia, periodontal diseases (necrotizing gingivitis, necrotizing periodontitis, linear gingival erythema), Kaposi’s sarcoma, and non-Hodgkin’s lymphoma. Melanotic hyperpigmentation, HSV infection and HPV infection, which are included in group 2, are also common. Oral candidiasis, oral hairy leukoplakia, Kaposi’s sarcoma and HSV infection are the lesions that have seen the major drop in their incidence after the HAART introduction. The increase in CD4+ T-cell count is not significantly correlated to the decrease of every type of oral lesions, but it is statistically significant only in relation to oral candidiasis (p-value less than 0.001). Oral lesions are an important sign of immunodepression and with the introduction of HAART their incidence has strongly decreased, particularly in urban areas. Nevertheless, developing countries still have a high prevalence of these manifestations because of the persistence of many risk factors, like the difficulty to access treatment, poor oral hygiene, low socioeconomic status and late diagnosis.

Human Papilloma Virus associated with oral cancer and preventive strategies: the role of vaccines.

The aim of this paper is to describe the efficacy of Human Papilloma Virus (HPV) vaccines for preventing oral cancer. A systematic review of the literature was conducted to describe the state of the art about HPV vaccines for preventing oral cancer. The aspects of prevention and control of infection by administering vaccines and the diffusion of sexual education campaigns are discussed also. In recent years there has been a growing interest in HPV in dentistry, suggesting a role of such a family of viruses in the development of oral cancers as well as of the uterine cervix. Even if the mass media have increasingly faced the problem, causing frequent alarming among patients, the dentist therefore needs a complete and up-to-date knowledge of this infectious condition that is one of the most common causes of sexually transmitted mucous membrane infections (eg genital, anal and oral). Recent studies about HPV infection are a basic requirement in order to promote the HPV vaccinations and patient’s health.

Peri-implant test is a proposal of a new procedure to prevent peri-implantitis and forensic claims.

Implant dentistry has become one of the most successful techniques for oral rehabilitation over the last 20 years. The success rate of implant oral rehabilitation is above 80% while peri-implant disease (PID) is the most important complication of implant dentistry. The main cause of PID is considered bacterial leakage at the implant-abutment connection of a two-piece implant system. Prevention and control of bacterial leakage at the implant-abutment connection is mandatory for reducing inflammation process around implants neck and achieving bone stability. Since bacteria leakage at implant-abutment connection level is the main cause of PID, a microbiological test should be important to identify bacteria that cause PID. According with the conclusion of workshop of the European Federation on Periodontology, a test that detects the most frequent bacterial species involved in the onset of PID (Actinobacillus actinomycetecomitans, Porphyromonas gengivalis, Tannnerella forsythia, Treponema denticola) should be used in clinical practice. In fact, PID progression depends on the typology, quantity and composition of bacterial flora in peri-implant pockets, so controlling PID onset and progression, is a keystone for preventing implant failures and consequently forensic conflicts. The effort to prevent PID and consequently assurance or forensic conflicts have become one of the main focal points of all dental professionals. Behind these efforts lie, above all, ethical but also economic reasons, as well as a desire to prevent PID, improving implant care quality and increasing the legal security of health care professionals themselves. Since the legal decisions in our society influence how we practice dentistry, especially in the fast-evolving field of implant dentistry, using diagnostic tools that will allow dentists to demonstrate that they have acted correctly in accordance with the knowledge of modern medicine, it is of great importance to defend themselves in the case of legal-legal disputes.

HPV acting on E-cadherin, p53 and p16: literature review.

In addition to tobacco and alcohol consumption, the two main risk factors for oral squamous cell carcinoma (OSCC), recent studies have revealed infections with human papilloma virus (HPV) as an additional risk factor for OSCC development. In the field of head and neck malignancies, the prevalence of HPV infections in oropharyngeal cancer (OC) ranges in different studies up to 84%. While HPV infection is discussed as an independent risk factor in this region, its distinguished role in carcinogenesis of tumours localized to the oral cavity remains uncertain. A systematic literature search was performed using PubMed, Cochrane library, Science Direct, and the Internet search, with language restricted to English. The search included published studies which dealt with detection methods of HPV-related oral and oropharyngeal cancers and biomolecular studies, particularly regarding the compromising of p53 p16 and e-cadherin’s. P53 Tumour suppressor protein p53 has several functions that are related to maintaining genomic stability and inhibiting cell proliferation in response to DNA damage. For preventing neoplasia to occur, the most important of these functions are cessation of cell growth and induction of either apoptosis or senescence. P16 is a cellular protein involved in cell cycle regulation. It is a cyclin-dependent kinase 4 (CDK4) inhibitor, and is integral to Rb mediated regulation of G1-S phase of the cell cycle. P16 is expressed at a very low level in normal cell as Rb inhibits transcription of p16. Various detection methods ranging from immunohistochemistry (IHC) to molecular techniques have been used to determine the HPV status of HNSCC. E-cadherin, a 120 kDa Type I classical cadherin, is expressed primarily on epithelial cells. It is found on the surface of keratinocytesand Langerhans cells (LC) and E-cadherin mediated adhesion between these cell types is required for LC retention in the epidermis. It is also an important tumour suppressor protein: its loss or inactivation is associated with epithelial-to-mesenchymal transition (EMT), a process involving dedifferentiation, infiltration and metastasis of tumours. Oral carcinogenesis is a multi-factorial process involving socioeconomic, environmental and microbial factors leading to multistep changes. Smoking and tobacco exposure seems to modify the survival and recurrence of HPV positive tumours and should be considered in future trials for risk stratification of HPV positive patients. HPV associated oropharynx cancer represents a distinct clinical and biologic entity with many unresolved issues that will be investigated in future translational, clinical research. We need to further explore and understand why the disease occurs predominantly in males, and whether the natural history of oral HPV infection differences in men and women.

Mechanical, chemical and biological aspects of titanium and titanium alloys in implant dentistry.

Implant dentistry has become a popular restorative option in clinical practice. Titanium and titanium alloys are the gold standard for endo-osseus dental implants production, thanks to their biocompatibility, resistance to corrosion and mechanical properties. The characteristics of the titanium implant surface seem to be particularly relevant in the early phase of osseointegration. Furthermore, the microstructure of implant surface can largely influence the bone remodelling at the level of the bone-implant surface. Recently, research has stated on the long-term of both survival and success rates of osseointegrated implants and mainly on biomechanical aspects, such as load distribution and biochemical and histological processes at the bone-implant interface. This short review reports recent knowledge on chemical and mechanical properties, biological aspects, innovations in preventing peri-implantitis, describing clinical applications and recent improvements of titanium dental implants. In addition, it highlights current knowledge about a new implant coating that has been demonstrated to reduce the number of initially adhering bacteria and peri-implantitis.

Radiosurgery-assisted gingival displacement: a proof of concept technique to enhance the efficiency of intraoral digital impression.

Nowadays, an increasing number of dentists are using intraoral scanners (IOS) in their daily practice as an alternative to conventional impression taking. One of the main concerns is related to the capability of scanning the subgingival anatomy of the die, usually very challenging due to the limited operative field and the presence of oral fluids. The radiosurgery assisted gingival displacement technique (RAGD) may enhance the intraoral optical scanning of the finish line and neighbor tooth anatomy. The contour of the interim prosthesis is used to drive the tip of radiosurgery electrode along the tooth surface and open selectively the gingival crevice with a prosthetically-driven and minimally invasive approach. The clinical implication of this technique is related to increasing the efficiency and accuracy of the digital impression technique in the critical zone of the prosthetic shoulder.

FDPS finish line design and tooth preparation technique.

The purpose of this research is to perform and verify the “modified 50° preparation” suggested by the authors. This procedure was performed with a scrupulous standardization of the tooth’s preparation and then of the laboratory techniques to produce a metal-ceramic crown, and the same for the crown cementation technique of on the preparation of the original sample. After the esthetic evaluations, the obtained sample was included in EPON resin and sectioned in the lingual-vestibular sense. The sections were then observed with an optical microscope in different magnifications for the final evaluations. The geometric design proposed presents the advantages of two great preparation techniques: 50° preparation and circumferential shoulder. The 50° bevel designed in first phase of preparation and the second phase of the circumferential 27° shoulder, together allowed to satisfy the following requirements: aesthetic, marginal accuracy, periodontal compliance, conservation and stability. However, this type of prosthetic preparation is not the only one, but it is one of the marginal designs in prosthetic dentistry.

Hyperbaric oxygen therapy (HBOT) and peridontal health.

This study has tested the effects of hyperbaric oxygen in periodontal structures in agreement with the theories supported by literature research. Eight patients, from 30 to 50 years-of-age, were tested with pure oxygen inhalation, at the 2.5 ATA absolute pressure. Main approved tests of periodontal health were evaluated before and after HBOT’s cycles. The results in all patients treated with HBOT, have founded clear improvement of clinical and instrumental parameters.

Anatomic relationship between temporomandibular joint and middle ear.

The present study was designed to identify a relationship between temporomandibular joint and tympanic cavity and potentially justify the possible clinical correlations between these two anatomical entities. For this reason the authors conducted an anatomic-pathological study about the temporomandibular joint (TMJ) and the neighboring anatomical areas of the middle ear by autopsy finds of human adults.

Temporomandibular joint and related structures: anatomical and Histological aspects.

In literature, there is no unanimous agreement about the anatomical and functional characteristics of the temporomandibular joint (TMJ) and its components. The aim of this work is to increase the knowledge about components of the temporomandibular joint, starting from the revision of classical anatomy, through macroscopic and microscopic study, 20 samples of human dissected temporomandibular joints.

TMJ’s capsule histological and macroscopical study: relationship between ligamentous laxity and TMI dysfunctions.

In this study, the authors examined the capsular structures of 20 human temporomandibular joints (TMJ) macroscopically and microscopically, in order to improve knowledge of these structures, as part of their possible participation in the genesis of TMJ dysfunctions.

The flap recovery on the impacted lower third molar surgery comparing 3 different flap designs: a clinical study.

AIM: The purpose of the study was to analyze the healing of the deep and superficial lower first and second molars periodontium, after the surgical extraction of the contiguous impacted third molar, comparing 3 mucoperiosteal flap designs. MATERIALS AND METHODS: 150 patients which had to undergo a impacted lower third molar surgery were enrolled in this study. They were checked from day 0 to day 90, in order to focus on the recovery quality of the soft tissues around the lower second molar, comparing 3 different flap designs. RESULTS: No intraoperatory incident happened. The complete recovery of the periodontium around the second molar has been shown in each patient after 90 days from surgery and each adverse reaction happened within the sixth week after surgery. Only 2 slight gengival recessions 0,5 mm have been find out. CONCLUSIONS: The impacted third molar surgery is an operation that, if rightly programmed and performed, is relatively safe. Besides, the correct handling and management of periodontium around the second molar and the choice of the flap type to be used support a correct recovery on the second molar periodontium, avoiding any long-term damage. CLINICAL SIGNIFICANCE: This study wanted to analyze the healing of the deep and superficial lower second molar periodontium, after the impacted lower third molar surgery. In order to improve the surgical technique used for lower third molar germectomies, we wanted to compare 3 different kind of flap designs.

Clinical protocol with digital cad/cam chairside workflow for the rehabilitation of severely worn dentition patients.

OBJECTIVES: The purpose of this paper is to investigate the effectiveness and to describe a clinical protocol with digital CAD CAM chairside workflow for the rehabilitation of severely compromised and worn dentitions. METHODS: This article reports 4 consecutive cases, where a clinical digital chairside workflow is used for the rehabilitation of severely compromised and worn dentitions. Advantages and limitations of this method compared with the traditional prosthetic protocol are also described and discussed. RESULTS: With all four patients treated with this protocol, we obtained a good aesthetic and functional result, improvement in chewing function, loss of cold sensitivity, better preservation of most of the left hard tissue and a good level of satisfaction. In a two-year follow-up, all patients also maintained the condition obtained with prosthetic chairside rehabilitation, resulting in almost 100% cumulative survival rate. CONCLUSION: Within the limitations of this study, we can assert that the aforementioned restorative treatment with digital CAD/CAM chairside workflow represents a valid alternative to rehabilitate this kind of patients, because it is a safe, predictable and personalized procedure but also it seems easier, faster and cheaper than traditional protocols.