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This report describes the restoration of the healed single implant in the posterior region by using a lithium disilicate crown supported by an Acuris abutment. The restored implants were placed in the premolar and molar region of both the mandible and the maxilla by using a 1-stage approach. The definitive Acuris abutment was placed after an implant healing period of at least 3 months. Definitive impressions were made at least 3 months after surgery. The precrystallized lithium disilicate crown was adapted to a laboratory abutment and evaluated. The crown was then crystallized, finished, colored, and cemented to the definitive abutment by using an adhesive resin cement. The definitive restoration engaged the abutment without the use of screws or cement. A single healed implant can be successfully restored by using a lithium disilicate restoration supported by an Acuris abutment.

Overweight and obesity have been shown to significantly affect brain structures and size. Obesity has been associated with cerebral atrophy, alteration of brain functions, including cognitive impairement, and psychiatric diseases such as depression. Given the importance of lipids in the structure of the brain, here, by using 47 mice fed a high fat diet (HFD) with 60% calories from fat (40% saturated fatty acids) and 20% calories from carbohydrates and age-matched control animals on a normal chow diet, we examined the effects of HFD and diet-induced obesity on the brain lipidome. Using a targeted liquid chromatography mass spectrometry analysis and a non-targeted mass spectrometry MALDI imaging approach, we show that the relative concentration of most lipids, in particular brain phospholipids, is modified by diet-induced obesity (+ 40%of body weight). Use of a non-targeted MALDI-MS imaging approach further allowed define cerebral regions of interest (ROI) involved in eating behavior and changes in their lipid profile. Principal component analysis (PCA) of the obese/chow lipidome revealed persistence of some of the changes in the brain lipidome of obese animals even after their switch to chow feeding and associated weight loss. Altogether, these data reveal that HFD feeding rapidly modifies the murine brain lipidome. Some of these HFD-induced changes persist even after weight loss, implying that some brain sequelae caused by diet-induced obesity are irreversible.

Purpose To evaluate the performance of definitive, implant-supported, lithium disilicate fixed dental prostheses (LS2 FDPs) manufactured with a computer-assisted design/computer-assisted manufacturing (CAD/CAM) system. All patients received two-unit restorations placed in posterior regions, supported by osseointegrated implants with cone-in-cone connection abutments. Materials and methods Two implants (Ankylos) were placed into healed sites or fresh extraction sockets in the maxillary/mandibular posterior regions of partially edentulous patients. Definitive digital impressions were made 3 months after surgery. Twenty-four patients received fixed monolithic LS2 restorations manufactured with the CEREC system. All restorations were connected to the implants using cone-in-cone connection abutments. Peri-implant pocket depths were recorded for 2 years at each follow-up visit. Esthetic, functional, and biologic United States Public Health Services (USPHS) parameters modified by the FDI World Dental Federation study design were assessed yearly until the last follow-up appointment. The opposing dentitions were identified by type of restoration and supporting structures at the time of placement of the definitive restorations and at the 2-year follow-up visits. Results One patient (4.16%) moved to an unknown location during the study. A total of 23 FDPs (95.8%) supported by 46 implants reached the 2-year follow-up. None of the prostheses failed, or became loose or detached. No significant difference involving probing levels between the experimental times were found. Conclusions The results of this research indicated that the abutment-prostheses connection using a cone-in-cone approach was successful within the 2-year period of this study. None of the studied monolithic LS2 glass-ceramic prostheses milled using the CEREC CAD/CAM system fractured or became detached.

Systemic sclerosis (SSc) is an autoimmune disease characterized by vasculopathy, excessive extracellular matrix deposition, and fibrosis of the skin and internal organs. Several infectious agents, including human herpesvirus-6 (HHV-6), have been suggested as possible triggering factors, but a direct association is still missing. We characterized 26 SSc patients for the presence of HHV-6 in tissues and blood, the anti-HHV-6 response, HLA-G plasma levels, and KIR typing. Given the prominent role of endothelial cells (EC) in SSc pathogenesis, along with HHV-6 tropism for EC, we also investigated the expression of pro-fibrosis factors in HHV-6 infected EC. Results showed the presence of HHV-6A in skin biopsies, and an increased virus load was associated with disease severity and poor natural killer (NK) response against the virus, particularly in subjects exhibiting a KIR2 phenotype. HLA-G plasma levels were significantly higher in HHV-6A/B-KIR2 positive SSc patients and in vitro HHV-6A infection-induced pro-fibrosis factors expression in EC, supporting its role in the development of the fibrosing process. Our data suggest an association between virus infection/reactivation and disease, opening the way to future studies to understand the mechanisms by which HHV-6A might contribute to the multifactorial pathogenesis of SSc.

Background: Systemic Sclerosis (SSc) is a connective tissue disease, characterized by endothelial dysfunction and fibrosis, potentially affecting internal organs and reducing life expectancy. Digital ulcers (DUs), as well as hand and face skin thickening, are the hallmarks of the disease. These alterations lead to pain, functional impairment, aesthetic damages, and psychological distress. Autologous fat grafting (AFG) is a surgical technique used also to promote tissue regeneration. In the last decade, AFG has been successfully developed to treat clinical conditions characterized by skin atrophy or fibrosis. AFG composition of multipotent cells, carrying angiogenic, and immunogenic properties, may be able to restore the damaged tissues. Objectives: Evaluate our experience with AFG to treat and prevent damage and disability due to DUs and SSc skin complications. Methods: We analyzed 25 SSc patients, extrapolated from a larger series of 45 subjects, complaining about mouth and/or hand impairment, due to skin involvement, and, in some cases, long-lasting DUs (M/F 6/19, mean age 55.69±9.25-SD-years, mean disease duration 184.68±121.09-SD-months, L/D cutaneous subsets 21/4). Surgical procedures consisted in the injection of centrifuged and purified autologous fat, harvested from hips or abdomen. 2ml of fat were grafted in each of the 8 sites around the mouth, while 0.5 or 1 ml around the neurovascular bundle at the base of each finger. The study included: preoperative data collection; 2 or 3 surgical sessions at a distance of 6 months one from the other; data collection at 3 months after each surgical session; data collection at 3 and 6 months of follow up-FU after the last surgical procedure. Data collection consisted of clinic-serological SSc features and clinimetric measures about hand and mouth, if present DUs were assessed as well. Furthermore, patients were asked to fill in questionnaires in order to express their level of satisfaction with hand and mouth functionality. Results: Overall 63 surgical procedures were performed. After 1 to 3 procedures, patients reported an improvement of perioral skin tension (p=0.0238) and a reduced dry mouth feeling (p=0.0269). Similarly, patients stated an improvement of hands tension (p=0.0037). Furthermore, we observed a complete healing of DUs in 8/9 patients (p=0.0297). These positive clinical changes were mirrored by a subjective amelioration. In particular, pain decreased, evaluated by short-form McGill Pain Questionnaire (SF-MPQ), scrutinizing sensory (p=0.3340) and affective (p=0.2234) descriptors. The perception of disability improved too, showing an amelioration trend in Health Assessment Questionnaire-HAQ (p=0.4301) and Mouth Handicap in Systemic Sclerosis scale-MHISS- (p=0.9775). Conclusion: Our results confirm the potential efficacy of AFG to treat SSc skin complications and DUs. We reported an almost complete healing of DUs and a promising improvement of skin thickness and hardness both at hands and mouth, with good safety profiles. These clinical results were reflected by the subjective improvement of patients’ well-being. Population enlargement and extended FU is ongoing to identify more responsive SSc subsets. Long term results with soft tissue biopsies will give us further data to finally evaluate the efficacy of this approach that aims to improve the care and quality of life of our SSc patients. Disclosure of Interests: None declared

Objective This study evaluated Neem oil and Hypericum perforatum (Holoil®) for treatment of scleroderma skin ulcers related to calcinosis (SU-calc). Procedure: We retrospectively analyzed 21 consecutive systemic sclerosis (SSc) patients with a total of 33 SU-calcs treated daily with Holoil® cream compared with a control group of 20 patients with 26 SU-calcs. Holoil® was directly applied to skin lesions, while the control group received only standard medication. Results Application of Holoil® either resulted in crushing and complete resolution of calcium deposits or facilitated sharp excision of calcinosis during wound care sessions in 27/33 cases (81.8%). Complete healing of SU-calc occurred in 15/33 (45%) of cases within a time period of 40.1 ± 16.3 (mean ± SD) days, while 18/33 (55%) of lesions improved in terms of size, erythema, fibrin and calcium deposits. Patients reported a reduction of pain (mean numeric rating scale 7.3 ± 1.9 at baseline versus 2.9 ± 1.4 at follow-up) The control group had longer healing times and a higher percentage of infections. Conclusions The efficacy of local treatment with neem oil and Hypericum perforatum suggest that Holoil® could be a promising tool in the management of SSc SU-calc.

Parvovirus B19 (B19V) has been proposed as a triggering agent for some autoimmune diseases including systemic sclerosis (SSc). In this study, we investigated whether B19V infection in vitro differently activates inflammatory pathways, including those dependent on caspase-1 activation, in monocytes from patients with SSc and healthy controls. We showed that B19V can infect both THP-1 cells and primary monocytes but is not able to replicate in these cells. B19V infection increases the production of tumor necrosis factor-α and induces NLRP3-mediated caspase-1 activation in both THP-1 cells differentiated with phorbol 12-myristate 13-acetate and in monocytes from patients with SSc but not from healthy controls. B19V infection was sufficient for THP-1 to produce mature IL-1β. Monocytes from patients with SSc required an additional stimulus, here represented by lipopolysaccharides, to activate cytokine genes. Following B19V infection, however, lipopolysaccharide-activated monocytes from patients with SSc strongly increased the production of IL-1β and tumor necrosis factor-α. Altogether, these data suggest that viral components might potentiate the response to endogenous and/or exogenous toll-like receptor 4 ligands in monocytes from patients with SSc. The B19V-mediated activation of inflammatory pathways in monocytes might contribute to the disease progression and/or development of specific clinical phenotypes.

Purpose This study evaluated the retention strength of welding caps for Ankylos standard abutments using a pull-out test. Materials and methods Each sample consisted of an implant abutment and its welding cap. The tests were performed with a Zwick Roell testing machine with a 1-kN load cell. Results The retention strength of the welding caps increased with higher abutment diameters and higher head heights and was comparable or superior to the values reported in the literature for the temporary cements used in implant dentistry. Conclusion Welding caps provide a reliable connection between an abutment and a fixed prosthesis without the use of cement.

Human cytomegalovirus (HCMV) is a highly prevalent opportunistic agent in the world population, which persists as a latent virus after a primary infection. Besides the well-established role of this agent causing severe diseases in immunocompromised individuals, more recently, HCMV has been evoked as a possible factor contributing to the pathogenesis of autoimmune diseases such as systemic sclerosis (SSc). The interplay between HCMV and immune surveillance is supposed to become unbalanced in SSc patients with expanded anti-HCMV immune responses, which are likely involved in the exacerbation of inflammatory processes. In this study, blood samples from a cohort of SSc patients vs. healthy subjects were tested for anti-HCMV immune responses (IgM, IgG antibodies, and T cells to peptide pools spanning the most immunogenic HCMV proteins). Statistically significant increase of HCMV-specific CD8+ T cell responses in SSc patients vs. healthy subjects was observed. Moreover, significantly greater HCMV-specific CD8+ T cell responses were found in SSc patients with a longer disease duration and those with higher modified Rodnan skin scores. Given the known importance of T cells in the development of SSc and that this virus may contribute to chronic inflammatory diseases, these data support a relevant role of HCMV-specific CD8+ T cell responses in SSc pathogenesis.

Background: Systemic sclerosis (SSc) is an autoimmune systemic disease characterized by diffuse fibrosis of skin and visceral organs due to different genetic, infectious, and/or environmental/occupational causative factors, including the inhalation of silica dust. Objectives: To investigate serum trace elements including silicon (s-Si) levels in SSc patients living in a restricted geographical area with high density of worksites with silica exposure hazard. Methods: This case-control study included 80 SSc patients (M:F 10:70; aged 58.4 ± 11.9SD years, mean disease duration 10.1 ± 7.8SD) and 50 age-/sex-matched healthy control subjects consecutively investigated at our University-based Rheumatology Unit. Patients and controls were evaluated for environmental/occupational exposure categories (structured questionnaire), morphological characterization of serum micro-/nanoparticles (Environmental Scanning Electron Microscopy and Energy Dispersive X-ray Spectroscopy microanalysis), and quantitative assessment of trace elements (inductively coupled plasma atomic emission spectroscopy). Results: Among various categories, only occupational exposure to silica dust was recorded in a significant proportion of SSc patients compared to controls (55% vs. 11%; p

Fatigue behavior of the titanium bars is of utmost importance for the safe and reliable operation of dental implants and prosthetic constructions based on these implants. To date, however, only few data are available on the fatigue strength of dental prostheses made with electric resistance welding and laser welding techniques. This in-vitro study highlighted that although the joints made with the laser welding approach are credited of a superior tensile strength, joints made with electric resistance welding exhibited double the minimum fatigue strength with respect to the joints made with laser welding (120 vs 60 N).

BACKGROUND Mixed cryoglobulinemia (MC) is a rare multisystem disease whose aetiopathogenesis is not completely understood. Hepatitis C virus (HCV) infection may have a causative role, and genetic and/or environmental factors may also contribute. AIMS To investigate the presence and possible role of environmental agents in MC. METHODS We recruited 30 HCV-infected MC patients with different clinical manifestations and a control group of 30 healthy, sex-/age-matched volunteers. We collected serum samples from each patient and incubated at 4°C for 7 days to obtain cryoprecipitate samples. We used environmental scanning electron microscopy (ESEM) and energy dispersive X-ray spectroscopy microanalysis to verify the presence of microparticles (MPs) and nanoparticles (NPs) in serum and cryoprecipitate samples. We evaluated environmental exposure using a medical and occupational history questionnaire for each subject. RESULTS MC patients had a significantly higher risk of occupational exposure (OR 5.6; 95% CI 1.84-17.50) than controls. ESEM evaluation revealed a significantly higher concentration, expressed as number of positive spots (NS), of serum inorganic particles in MC patients compared with controls (mean NS 18, SD = 16 versus NS 5.4, SD = 5.1; P < 0.05). Cryoprecipitate samples of MC patients showed high concentrations of inorganic particles (mean NS 49, SD = 19). We found a strong correlation between NS and cryocrit (i.e. percentage of cryoprecipitate/total serum after centrifugation at 4°C) levels (P < 0.001). CONCLUSIONS In addition to HCV infection, MPs and NPs might play an important role in the aetiopathogenesis of MC.