Characterization and morphological methods for oral biofilm visualization: where are we nowadays?

The oral microbiome represents an essential component of the oral ecosystem whose symbiotic relationship contributes to health maintenance. The biofilm represents a state of living of microorganisms surrounding themselves with a complex and tridimensional organized polymeric support and defense matrix. The substrates where the oral biofilm adhere can suffer from damages due to the microbial community metabolisms. Therefore, microbial biofilm represents the main etiological factor of the two pathologies of dental interest with the highest incidence, such as carious pathology and periodontal pathology. The study, analysis, and understanding of the characteristics of the biofilm, starting from the macroscopic structure up to the microscopic architecture, appear essential. This review examined the morphological methods used through the years to identify species, adhesion mechanisms that contribute to biofilm formation and stability, and how the action of microbicidal molecules is effective against pathological biofilm. Microscopy is the primary technique for the morphological characterization of biofilm. Light microscopy, which includes the stereomicroscope and confocal laser microscopy (CLSM), allows the visualization of microbial communities in their natural state, providing valuable information on the spatial arrangement of different microorganisms within the biofilm and revealing microbial diversity in the biofilm matrix. The stereomicroscope provides a three-dimensional view of the sample, allowing detailed observation of the structure, thickness, morphology, and distribution of the various species in the biofilm while CLSM provides information on its three-dimensional architecture, microbial composition, and dynamic development. Electron microscopy, scanning (SEM) or transmission (TEM), allows the high-resolution investigation of the architecture of the biofilm, analyzing the bacterial population, the extracellular polymeric matrix (EPS), and the mechanisms of the physical and chemical forces that contribute to the adhesion of the biofilm to the substrates, on a nanometric scale. More advanced microscopic methodologies, such as scanning transmission electron microscopy (STEM), high-resolution transmission electron microscopy (HR-TEM), and correlative microscopy, have enabled the evaluation of antibacterial treatments, due to the potential to reveal the efficacy of different molecules in breaking down the biofilm. In conclusion, evidence based on scientific literature shows that established microscopic methods represent the most common tools used to characterize biofilm and its morphology in oral microbiology. Further protocols and studies on the application of advanced microscopic techniques are needed to obtain precise details on the microbiological and pathological aspects of oral biofilm.

RA.DI.CA. Splint Therapy in the Management of Temporomandibular Joint Displacement without Reduction.

BACKGROUND: The purpose of this study is to report clinical and instrumental changes after RA.DI.CA splint therapy for temporomandibular joint disc displacement without reduction. METHODS: Subjects affected by disc dislocation without reduction were recruited between July 2020 and May 2022 based on inclusion and exclusion criteria and treated with RA.DI.CA. splints over a period of 6 months. Clinical data were collected at each phase of the study (T0, T1, T2). Magnetic resonance imaging and electrognathography data were recorded at the beginning (T0) and at the end (T2) of the study. ANOVA with post-hoc contrasts was performed to assess differences in outcome measures over time. The Wilcoxon test was used to evaluate changes in disc-condyle angle between before- and after-treatment MRI. A two-tailed value of p < 0.05 was regarded as significant. METHODS: Ten patients completed the study. There were statistically significant differences over time for arthralgia, headache, neck pain, and mouth opening. Disc recapture and an improved quality of mandibular movement were recorded in 70% of subjects. The clinical and instrumental improvements are probably due to the orthopedic action of RA.DI.CA splint treatment, which allows for a greater degree of joint mobilization. CONCLUSIONS: The purpose of this therapy is to recover the disc position if possible and achieve an adequate joint functional adaptation that avoids the progression of the structural damage and the recurrence of symptoms.

Conservative Therapies for TMJ Closed Lock: A Randomized Controlled Trial.

Background. Acute anterior disc displacement without reduction (ADDWoR) is characterized by permanent TMJ disc displacement, pain and functional limitations. Occlusal appliances (OA) are among the therapies of choice. Methods. A single-blind randomized study was carried out to compare the therapeutic success of two different types of splints in patients with ADDWoR. A total of 30 subjects were eligible for the study out of the 330 screened. Group I (n = 15) received RA.DI.CA splint therapy and Group II (n = 15) received stabilization splint therapy. Temporomandibular pain, headache, neck pain and functional excursions were evaluated at baseline (T0), after 4 weeks (T1) and after 6 months (T2). Descriptive and inferential statistics were performed. Results. There was a significant increase in maximum jaw opening and a reduction in pain in both groups (p < 0.05), except for neck pain in Group II. Significant differences in between- and within-subject factors emerged in all of the parameters evaluated, especially between T1 and T2 scores, with a greater trend of improvement in Group I than Group II. Conclusion. RA.DI.CA splints were found to be more effective for the considered sample, especially in the treatment of comorbidities and functional movements, probably due to the greater orthopedic action and joint mobilization.

A Female Psoriatic Arthritis Patient Involving the TMJ.

Psoriatic arthritis (PsA) is an inflammatory chronic arthritis associated with psoriasis. Currently, data about gender differences in clinical manifestation and therapeutic outcomes of PsA are limited. Frequently, women manifest a peripheral disease while men have an axial localization. Moreover, women display higher disease activity and physical activity limitations, if compared to men. Although the involvement of the temporomandibular joint (TMJ) is quite rare, it can seriously impact the quality of life. The morpho-functional peculiarities of TMJ require a multidisciplinary approach to perform a correct diagnosis and a successful treatment. Here, we report a case of a woman affected by PsA involving TMJ treated by combining pharmacological therapy and an occlusal splint. The coordination between different specialties led to a complete remission of clinical symptoms and a regression of lesions.

Ultrashort Implants, Alternative Prosthetic Rehabilitation in Mandibular Atrophies in Fragile Subjects: A Retrospective Study.

This study aimed to evaluate the effectiveness of using ultrashort implants in the rehabilitation of jaws of fragile patients. The aim of the study was to retrospectively evaluate the survival rate of full-arch prosthetic rehabilitation on ultrashort implants, length 4 mm, 4 mm in diameter in the premolar and canine area and 4.5 mm in diameter in the molar area, with the insertion torque of 60 Nw and immediate loading. Nineteen patients were evaluated for 3 years clinically and radiographically. The significant majority of the patients at the 3 year follow-up (T4) presented a stable and functional implant-supported prothesis, and the survival rate of the implants was 85%, with a loss of 16 implants on 114 implants. The combination of the innovative implant surfaces and the correct project of the prostheses, with the related implant connection, determined a different timing in the therapy, allowing to obtain an immediate loading, which is currently demanded by patients. This and recent reports on short and ultrashort implant usage in atrophic jaws offer a good solution in critical cases. In conclusion, within the limits of the study, the full-arch rehabilitation with immediate loading on ultrashort implants showed good results with few postoperative complications and related low biological cost.

"RA.DI.CA." Splint for the Management of the Mandibular Functional Limitation: A Retrospective Study on Patients with Anterior Disc Displacement without Reduction.

The study aimed at assessing the effectiveness of the RA.DI.CA. splint in the management of temporomandibular joint disc displacement without reduction (ADDwoR) and jaw functional limitation. The authors developed a retrospective clinical study. A total of 2739 medical records were screened. One hundred and forty-one patients with chronic unilateral disc displacement without reduction and jaw limitation, treated with a multifunctional RA.DI.CA. splint, were enrolled. Temporomandibular pain, headache, familiar pain, neck pain, and emotional strain, maximum spontaneous mouth opening, and lateral excursions were evaluated at baseline (T0), after therapy (T1), and during the follow-up (T2). Descriptive statistical analysis was performed. Wilcoxon test assessed changes in symptomatology and functional aspects before and after treatment and between T1 and T2, with p < 0.05. Ninety-nine patients (70%) declared themselves "healed" from jaw functional limitation with no residual painful symptoms, 31 (22%) improved their symptoms and jaw function, 11 (8%) reported no changes compared to T0 and no one worsened. As for all parameters analyzed, the comparison between the ones before and after treatment was statistically significant (p < 0.05). The RA.DI.CA. splint proved to be highly performing and promoting functional and symptomatologic recovery, also in the medium and long term, through the restoration of the functional disc-condyle relationship and the healing of joint tissues.

Short Versus Longer Implants in Mandibular Alveolar Ridge Augmented Using Osteogenic Distraction: One-Year Follow-up of a Randomized Split-Mouth Trial.

The aim of this study was to evaluate the reliability of 6-mm-long implants compared with normal-length implants placed in a vertical augmented atrophic posterior mandible, supporting cemented single crowns. Thirty-six patients with bilateral posterior edentulous mandible and presenting a bone availability height less than 9 mm from the mandibular canal were enrolled in this study. Patient hemiarches were randomized to receive both 6-mm-long and normal-length implants (10 mm). The technique used for the vertical bone augmentation was the "sandwich" technique, using a bone substitute block as graft. The data outcomes at 1 year postloading follow-up were the loss of implants and complications. Eighty-six 6-mm-long implants and 84 normal implants were inserted. Five short implants and 13 normal implants were lost. In 28 patients, complications occurred, and in 21 cases, the complication was present on the side of the ridge vertical augmentation. From the statistical analysis, the association between the side of the ridge augmentation and the side of occurrence of the complication was statistically significant ( P < .05). The results from this trial suggest short implants can be preferred over vertical bone augmentation for the placement of longer implants in the rehabilitation of edentulous posterior mandibles. These initial results must be confirmed by larger and longer follow-ups of 5 years or more.

Digital evaluation of occlusal forces: comparison between healthy subjects and TMD patients.

AIM: Continuous technological innovation has provided the clinicians to access to a computerized device that can analyse the different characteristics of occlusal contacts. The purpose of this research was to use this device to study the occlusal forces comparing healthy subjects and TMD patients. MATERIALS AND METHODS: The study was conducted by following specific criteria to select participants; the sample was divided into two homogeneous groups: control group (CG) comprising healthy subjects, and dysfunctional group (DG) comprising TMD patients. The occlusal force analysis was performed using the computerized system T-Scan III V 5.20 T. The data were analysed with statistical methods. RESULTS: The most significant differences emerged between the groups in the average occlusal load distribution and in the location of the centre of occlusal forces (COF). In particular, compared with the CG and the functional standard, reductions in the molar field forces on the second and first molars of 27% and 6.9%, respectively, were observed in the DG. The COF was located in the most forward position in TMD patients compared with healthy subjects. CONCLUSIONS: Although the differences in the distribution of the occlusal forces and the location of the occlusal centre of gravity were significant, the relationship between occlusal contacts and TMD remains to be fully clarified. Further research is needed to investigate whether studying occlusal force distributions in both healthy subjects and TMD patients.

The effects of surgical preparation techniques and implant macro-geometry on primary stability: An in vitro study

BACKGROUND: The attainment of a good primary stability is a necessary condition to ensure the success of osseointegration in implantology. In type IV cancellous bone, however, it is possible that a reduced primary stability can lead to an increased rate of failure. The aim of this study was therefore to determine, with the help of the resonance frequency (Osstell mentor), which technique of implant site preparation (piezo surgery, conventional, under-preparation, bone compaction, osteodistraction) and macro-geometry is able to improve implant stability in type IV cancellous bone. MATERIAL AND METHODS: 10 pig ribs were prepared with a surgical pre-drilled guide, calibrated for a correct implant positioning. On each rib, 5 implant sites (one for each technique) were prepared. Successively, 50 conical implants (Tekka Global D) were inserted and measured with the resonance frequency to evaluate the primary stability. Data collected were analyzed by analysis of variance (ANOVA) to test whether the Implant Stability Quotient (ISQ) values of the five techniques were significantly different. RESULTS: The results showed that no significant differences among the ISQ values of the five techniques used were found. Also, no significant differences in the macro-geometry of the two types of compared implants were observed. However, the macro-geometry of Tekka implants, characterized by a double condensing thread, seems to provide greater ISQ values than those of single thread implants when using the same technique. CONCLUSIONS: In light of these preliminary data, it is conceivable that in cases of reduced stability, such as those occurring with a type IV bone, all means ameliorating the primary stability and accelerating the osseointegration can be utilized

Innovative approach for the in vitro research on biomedical scaffolds designed and customized with CAD-CAM technology.

INTRODUCTION: Studies on biomaterials involve assays aimed to assess the interactions between the biomaterial and the cells seeded on its surface. However, the morphology of biomaterials is heterogeneous and it could be tricky to standardize the results among different biomaterials and the classic plastic plates. In this light, we decided to create, by means of computer-aided design (CAD) technology, a standardized sample model, with equal shape and sizes, able to fit into a classic shape of a 96-wells tissue culture plate (TCP). METHODS: The design of this sample consists of a hole in the top in order to allow the injected cells to settle without them being able to slip from the sides of the sample to the bottom of the TCP wells. This CAD project is made using the software Pro-Engineer. The sample will totally fill the wells of the 96-well TCP. Dental pulp stem cells have been used to assess the ability of the different sample to support and promote the cell proliferation. RESULTS: Twelve titanium, 12 gold-palladium, and 12 zirconium oxide customized samples were designed by means of the software cam powermill, by importing the .stl file created in Pro-Engineer software. The proliferation rate of the tested scaffolds showed to be similar to the control in the group with the customized shape. CONCLUSION: We think that our method can be useful to test different types of scaffolds when a greater accuracy of the measurements is desirable in order to verify the cell behavior of these scaffolds. Our innovative method can improve the standardization process in the evaluation of cell behavior on different biomaterials to open the way to more reliable tests on biomatrices functionalized with drugs or growth factors applied to the future regenerative medicine.

Headache and temporo mandibular disorders: epidemiological assessment.

BACKGROUND: Temporo mandibular disorders (TMDs) and headache are closely related pathologies. The aim of this study was to determine the prevalence, incidence, and the intensity of headache in 3304 dysfunctional patients (G1) at the Service of Clinical Gnathology of the Head-Neck Assistance Department of Umberto I Polyclinic at Sapienza University of Rome. METHODS: G1 is composed by two subgroups of patient S1 (N.=2375) and S2 (N.=929) analyzed in different periods, respectively 1996-2006 and 2011-2013. The findings were compared with those of a control group of subjects from the general Italian population recently reported elsewhere. The prevalence of headache in the dysfunctional population was analyzed by calculating the proportion of that population who tested positive to cephalic pain for the entire study period. The incidence of headache has been calculated by determining the proportion cases of headache in TMD population, during the period analyzed among those considered at risk at the beginning of the examination period. The intensity of cephalic pain was evaluated using the Verbal Numeric Scale. Confidence Intervals (CI) at the 95% confidence level were calculated to get a precise estimate of research data. RESULTS: Comparison of G1 and control sample did not reveal many important differences, respectively with a headache prevalence of 49.5% (95%CI 47.8%-51.2%) and 42.8%(95%CI 46.8-38.8%). However, comparison of S1, which constituted a sample similar in numbers to the control sample and was observed during a similar time period, revealed a clearly greater prevalence of headache in the dysfunctional population 67.3% (95%CI 64.3-70.3%) than in the general representative population of Italian people 42.8% (95%CI 46.8-38.8%). The incidence of headache in the dysfunctional population was 39.49% (95%CI 37.79-41.19%). Headache incidence in the first subgroup (S1) was 32.7%(95%CI 34.6-30.8%), while in S2 was 59.24%(95%CI 56.24-62.24%), demonstrating an increase of incidence in the second subgroup analyzed. In G1 the average intensity of headache was severe (VNS>50). Headache is more intense in dysfunctional patients of the second subgroups (S2) than the first subgroup (S1) VNS 24.91 (95%CI 23.11-26.71) vs. 70.00 (95%CI 67.0-73.0). CONCLUSIONS: These findings confirm the existence of a relationship between headache and TMDs, showing that a dysfunctional patient has a greater predisposition to headache than a non-dysfunctional subject.

Mechanical influence of tissue culture plates and extracellular matrix on mesenchymal stem cell behavior: A topical review.

Tissue engineering applications need a continuous development of new biomaterials able to generate an ideal cell-extracellular matrix interaction. The stem cell fate is regulated by several factors, such as growth factors or transcription factors. The most recent literature has reported several publications able to demonstrate that environmental factors also contribute to the regulation of stem cell behavior, leading to the opinion that the environment plays the major role in the cell differentiation.The interaction between mesenchymal stem cells (MSCs) and extracellular environment has been widely described, and it has a crucial role in regulating the cell phenotype. In our laboratory (Tecnologica Research Institute, Crotone, Italy), we have recently studied how several physical factors influence the distribution and the morphology of MSCs isolated from dental pulp, and how they are able to regulate stem cell differentiation. Mechanical and geometrical factors are only a small part of the environmental factors able to influence stem cell behavior, however, this influence should be properly known: in fact, this assumption must be clearly considered during those studies involving MSCs; furthermore, these interactions should be considered as an important bias that involves an high number of studies on the MSCs, since in worldwide laboratories the scientists mostly use tissue culture plates for their experiments.

Inferior alveolar nerve laceration after implant site preparation: A case report.

PURPOSE: The aim of this article is to present a referred clinical case of an inferior alveolar nerve laceration during the insertion of a dental implant in the mandible, that came to our attention after the injury. MATERIALS AND METHODS: A 71-year-old female was treated by a colleague in order to be rehabilitated with a fixed implant-supported prosthesis for her missing teeth in positions 44, 45 and 46. After implant site osteotomy in region 46, the speed of the surgical motor was not changed; as a consequence, the implant was inserted at 1200 rpm and intruded into the mandibular canal, causing the laceration of the neurovascular bundle. RESULTS: During the first 2 weeks after surgery the patient complained of paresthesia in the mental and lower lip area, with labial ptosis and drooling. After 14 days, the paresthesia reduced and mucosal and gingival normosensitivity was detected; however, the patient complained about hyperesthesia of the lower inside lip. After 21 days, the lower lip tone and function were almost completely restored and the paresthesia was further reduced, however the hyperesthesia persisted. CONCLUSIONS: It is extremely important to pay attention to preventing neurological complications through proper preoperative planning, careful execution of the surgical techniques and correct management of instruments and motor speed settings. The latter procedure should be double-checked by both the operator and the assistant.

Psychotropic drugs and bruxism.

INTRODUCTION: Sleep and awake bruxism is defined as 'a parafunctional activity including clenching, bracing, gnashing, and grinding of the teeth'. Some evidence suggests that bruxism may be caused by, or associated with, alterations in the CNS neurotransmission. Several classes of psychotropic drugs interfering with CNS activity may potentially contribute to bruxism. Thus, the purpose of this study was to examine relevant peer-reviewed papers to identify and describe the various classes of psychotropic substances that may cause, exacerbate or reduce bruxism as the result of their pharmacological action in CNS neurons. AREAS COVERED: A literature search from 1980 to the present was performed using PubMed database. The term 'bruxism' was used in association with 'psychotropic', 'dopamine (DA)', 'serotonin', 'histamine', 'antipsychotics', 'antidepressants', 'antihistaminergics' and 'stimulants'. EXPERT OPINION: Studies on the effects of DA agonists (Levo-DOPA, psychostimulants) and antagonists (antipsychotics) identified a central role of DA in the pathogenesis of pharmacologically induced bruxism. Important information from studies on drugs acting on serotonin neurotransmission (antidepressants) was recognized. Other mechanisms involving different neurotransmitters are emerging. This is the case of antihistaminergic drugs which may induce bruxism as a consequence of their disinhibitory effect on the serotonergic system.

Heavy metals and pain in the dysfunctional patient.

AIMS: The aim of this research is to verify the quality and quantity of heavy metals (HM) of dental origin in TMD patients. METHODS: A population of 100 subject was studied and divided in two homogeneous groups: Study Group (SG) and Control Group (CG). Organism heavy metals were tested by a spot sampling method in which the first urine of the day, through Inductively Coupled Plasma-Mass Spectrometry (ICP-MS), were analyzed. The results obtained were compared with reference values (RV) of Italian people. Descriptive statistical analysis and student's t-test has been applied (statistical significance for p > 0.05). RESULTS: The SG presented the absolute highest levels of HM compared to the CG (p=0.787). As regards the relation between pain and HM, the subjects that refer "severe/very severe" values of pain present the highest levels of HM in urines. CONCLUSIONS: The obtained results seem to highlight a possible direct proportionality between the level of pain the increase of the concentration of heavy metals in all the examined groups and subgroups.

Temporomandibular dysfunction: internal derangement associated with facial and/or mandibular asymmetry.

The aim of this study was to observe the association between facial and/or mandibular asymmetry and internal derangement of the temporomandibular joint (TMJ) in patients with temporomandibular dysfunction (TMD). The sample consisted of 17 patients with facial and/or condylar-mandibular asymmetry who had signs and symptoms of TMD. They were evaluated by means of clinical examination, panoramic radiography, nuclear magnetic resonance (NMR), and in some cases, computed tomography (CT) and scintigraphy. All patients with facial and/or condylar-mandibular asymmetry had TMJ disc displacement (DD). The results of this study suggest a possible association between facial and/or condylar-mandibular asymmetry and DD. Based on these findings, it is important to consider the need for treating this disorder, particularly in growing patients, in order to prevent the generation of asymmetry, which is very difficult to treat once it sets in.

Use of 3D cartilage scaffolds for the stabilization of implants and bone regeneration with the fit-lock technique

Los procedimientos quirúrgicos para la aplicación de los implantes en los sectores latero superiores, están condicionadas por la neumatización del seno y la disponibilidad del huesoresidual. En estos casos el injerto de hueso autólogo permanece como lamejor opción, pero a causa de la morbilidad asociada al sitio donante y a las complicaciones post quirúrgicas, se pusieron a disposición diversas alternativas de sustitutos óseos, que implican sin embargo un aumento de los costos económicos y con limitadas propiedades osteoinductivas. Tales defectos pueden ser compensados con nuevas estrategias de regeneración biológica y mecánica de los tejidos a loscuales fue dirigida la ingeniería biológica y mecánica en los últimos años.Se presenta una nueva posibilidad terapéutica en la aplicación de los implantes en el maxilar superior con disponibilidad ósea inferior a los 4 mm, mediante la utilización de andamios 3D confeccionados en cartilago de cerdo libre de antígenos obtenido según la tecnica Fit-Lock. Se realizo un estudio longitudinal en 18 casos consecutivosevidenciando al cabo de un año de la carga implantológica, un éxito del 95,2 por ciento. Las ventajas en esta nueva técnica son: 1)La recuperación funcionaly anatómica del antro del maxilar 2).La aplicación inmediata de los implantes; 3)Reducción de los tiempos quirúrgicos; 4) Ausencia de morbilidad para el paciente; 5) Uso de anestesia local; 6)Uso de implantes con diámetros superiores a los 4 mm

Implant stability evaluation by resonance frequency analysis in the fit lock technique. A clinical study.

Surgical procedures for the application of implants in the lateral-superior sectors are affected by the availability of the residual bone. When this condition is lower than 5 mm it is recommended that techniques involving two therapeutic phases, a reconstructive and an applicative one, as reported in the international literature, are adopted. The authors propose here a new method with the potential to apply implants simultaneously with the reconstructive phase. The aim of this longitudinal retrospective study was to evaluate the stability of implants applied with the fit lock technique in the upper maxillarys in us with bone availability lower than 4 mm by measuring resonance frequency at different follow-up periods The seme as urements, carried out on 30 implants, were analysed with specific statistical procedures. The results indicate that the stability of the implants inserted with the fit lock method increases progressively over time in a statistically significant manner. The stability recorded after one year from the insertion (ISQ T2) is significantly higher than that recorded after six months (ISQ T1), and this is significantly higher than that recorded at the time of implant placement (ISQ T0). The implants inserted in the maxillary zones with scarce bone availability and applied with this technique showed a similar stability as reported with other techniques. In light of the results, the authors confirm that the primary stability represents the basic requirement to guarantee a correct healing of the implant and demonstrate that the fit lock technique also all ows reaching this condition when bone availability is minimal.

Epidemiological analysis on 2375 patients with TMJ disorders: basic statistical aspects.

The aim of this work was to present data from a large sample of patients with Temporo-Mandibular Disorders (TMD) in order to clarify some aspects of the development of pathological conditions that affect large parts of the population. This preliminary work put in relation, through an epidemiological evaluation, anamnestic and clinical data collected from a sample of 2375 patients affected by TMD. Personal data were provided by questionnaire (age, sex, status, etc.), while clinical data were collected following a specific medical chart compiled in accordance with international criteria for TMD. An analysis of these data clearly showed that there were large quantities of variables involved in these disorders and which occur with a wide variety possible of clinical signs. This complexity, in accordance with the current knowledge that it is not able to clarify the etiology of these disorders, makes intricate both diagnostic then therapeutic aspects. You would find in front of a multi-factorial systemic disease that, interfering with the individual bioavailability, exposes him to the possibility of perceiving noxious stimuli which otherwise would not able to reach the pain threshold. To support this hypothesis is the data founded in this report that showed how many patients suffered, at the same time, by muscle and spinal pain associated to headache, pain that occur with high frequency from the same side. The presence of these painful conditions tends to underestimate the dysfunctional problems even if they occur with greater clinical prevalence. Further research should be carried out to clarify these controversial issues.

Use of 3D cartilage scaffolds for the stabilization of implants and bone regeneration with the fit-lock technique.

The surgical procedures for implant applications on the lateral-upper areas depend on sinus pneumatization and availability of the residual bone. In these cases, autologous bone grafting remains the gold standard. Nevertheless, because of the morbidity associated to the donor site and the post-surgical complications, several alternative bone substitutes have been introduced, which, however, imply additional costs and show limited osteoinductive properties. Such limitations can be compensated with new regeneration strategies for biological and mechanical tissue restoration, a subject which has been addressed by tissue engineering in recent years. The authors present a new therapeutic option for implant application in the upper maxilla with bone availability less than 4 mm by using 3D scaffolds obtained from antigen-free porcine cartilage in the fit-lock technique. A longitudinal study on 18 consecutive cases was performed, with a 95.2% success rate one year after the implant. The advantages of this new technique are: 1) Functional and anatomical recovery of the maxillary antrum, 2) Immediate application of the implants; 3) Reduction of surgical times; 4) Absence of patient morbidity; 5) Local anesthesia; 6) Use of implants with a diameter > 4 mm.