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Intrabony defects can be the result of parodontitis. In this study we aimed to examine how clot stability is affected by different infrabony defect angles and superficial treatments in regenerative surgery. Methods: Thirty single-root extracted teeth were cut to obtain a section from each tooth. This section was placed in an artificial model containing an infrabony defect with three walls in order to achieve 10 models at angles of 25°, 37°, and 50°. Five root samples for every angle were not subjected any treatment (NT) and five were subjected to root conditioning with a neutral pH solution of ethylenediaminetetraacetic acid (EDTA) at 24%, applied for 2 min. Venous blood was put into the artificial models containing the root sections, and these were placed in an incubator at a constant temperature of 37 °C for 2 h. Samples were analyzed by laser confocal microscopy. Results: All samples exhibited signs of retraction. The EDTA group exhibited a plateau trend for infrabony defects, while in the NT group, there was a statistically significant difference between clot retraction and the increase in defect amplitude. Conclusion: The greater the angle of the infraosseous defect, the higher the rate of clot retraction. This showed that EDTA could reduce the influence of the angle of the infraosseous defect. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) was shown to be a viable method for graft healing evaluation. Platelet-rich fibrin (PRF) was found to speed up bone graft healing process. Sinus lift surgery outcomes after healing period are usually performed with computerized tomography that is not capable to describe graft vascularization and exposes patient to ionizing radiation. The objective of this study is to propose contrast-enhanced magnetic resonance imaging (CE-MRI) as a promising method for the in vivo assessment of sinus lift grafting procedures. A bilateral sinus augmentation surgery was performed. Left sinus was grafted only with bovine deproteinized bone mixed in a 1:1 ratio with autologous bone, in the right sinus, the same biomaterials with the addition of platelet-rich fibrin (PRF) were applied. CE-MRI was performed to evaluate angiogenesis before surgery and at 11, 25, 53, and 104 days after surgery. At 6 months (T0) and after 10 years (T1), before dental implants insertion, bone biopsies were performed and analysed quantitatively. Left sinus graft showed a centripetal pattern of angiogenesis, with the central region remaining unvascularized at 104 days post-surgery. Right side showed a wider and homogeneous vascularization from 25 days after surgery. At T0 new bone formation was only peripheral in the left sinus, whereas it developed both peripherally and through biomaterial in the right sinus. At T1 particles of biomaterial were still present in left sinus, while in right sinus they were not. CE-MRI offers quantitative parameters to evaluate vascularization of biomaterials. The addition of PRF promotes an early development of a widespread vascular system.

Objectives: To evaluate the most effective method for mechanical inter‐dental plaque removal between inter‐dental brushes (IDB) and dental floss (DF), in addition to toothbrushing in patients affected by peri‐implant mucositis (PIM); to identify possible factors related to the patient or to the single implant‐supported element that could influence plaque accumulation and inflammation of peri‐implant tissues. Methods: Forty patients with PIM were recruited. They were randomly assigned to two different groups depending on inter‐dental device used (IDB or DF). At baseline (T0), interproximal area (IA), interproximal emergence angle of the implant crown (A°) and manual dexterity (evaluated with Purdue Pegboard) have been recorded. At 14 days (T1), the inter‐dental cleaning devices have been inverted between groups. After 14 days (T2), the Plaque Index (PI) and Gingival Index (GI) have been recorded. A questionnaire has been submitted to a patient for the analysis of preferences at T0, T1 and T2. Results: Both inter‐dental cleaning devices were effective in reducing PI and GI in the inter‐dental area after 14 days of use. GI reduction was influenced by manual dexterity of the dominant hand. No significant differences were found for PI and GI at the variation of IA and A°. Conclusion: IDB was the most effective method for inter‐dental plaque removal in all subjects regardless of their manual dexterity. DF seems to be more effective than IDB only in subjects with good dexterity. [ABSTRACT FROM AUTHOR]

Objective: Metastatic tumours of bone must be considered in all patients with unexplained bone pain and particularly in patients who present with a known cancer, localised pain at multiple sites, and radiographic findings suggestive of metastasis. The purpose of this report was to present a case of a pathological fracture of the mandible as a consequence of metastatic pulmonary adenocarcinoma. Materials and Methods: In July 2018 a 68‐year‐old male patient was hospitalised because of pulmonary adenocarcinoma and attended our department for an oral maxillo‐facial evaluation. He complained of pain and swelling in the right temporomandibular region resulting in a reported functional limitation. An Orthopantomogram (OPG) demonstrated a right intracapsular condylar compound fracture associated with an osteolytic lesion at the condyle base with jagged margins. Subsequently, a CT scan with contrast of the maxillo‐facial complex and a fine‐needle aspiration of the lesion was performed. Results: CT images showed the presence of a right mandibular condyle fracture associated with a large osteolytic lesion which confirmed the pathological nature of the fracture. Fine‐needle aspiration of the lesion confirmed its metastatic nature. It was not possible to proceed with a mandibular resection due to the critical clinical condition of the patient who died in September 2018. Conclusion: Lung cancer frequently produces lytic‐type metastasis, sometimes even in the jaw. In patients with an established diagnosis of lung cancer, any radiolucent lesion of the jaw or an unexplained painful symptomatology to the oro‐maxillo facial complex should be placed in differential diagnosis with metastasis of the primary tumour. [ABSTRACT FROM AUTHOR]

Resin coating in implants rehabilitation cannot always be aesthetic, durable and comfortable for the patient mainly due to the limited dimensions of the final structure. Intraoral welding technique and computer-aided designed prosthetic shells may be a solution. This in vitro study evaluates the capacity of load and the weakest point of implant-supported provisional prosthesis using welded titanium framework. Twelve samples were produced to simulate an implant supported fixed prosthetic bridge. Two implants (Ankylos; Dentsply Sirona Implants; Germany) were inserted inside blocks of nanoceramic material produced with a stereolithographic 3D printer. A polymethylmethacrylate (PMMA) resin shell was performed with CAD/CAM and relined on welded framework. Six samples were produced with the same procedure reducing resin thickness. The samples were subjected to fatigue test (6,500,000 cycles) using ElectroForce 3310 fatigue machine (t 1); subsequently a mechanical compression test using a universal Shimadzu AGS-X 10 machine (t 2). The samples were analyzed with a photographic and radiographic documentation at t 0, t 1 and t 2. The samples survived mechanical fatigue test without evidence of failure. The radiographic and photographic evaluation revealed the fracture of resin coating after the mechanical compression test. The samples with minimal resin thickness fractured first. Adequate assessment of the resin thickness is mandatory to improve the longevity of these rehabilitations. CAD-CAM digital prosthetic design allows us to optimize the thicknesses and the prosthetic shapes, allowing us to obtain good degrees of resistance even in the presence of reduced prosthetic spaces. [ABSTRACT FROM AUTHOR]

Objectives: The aim was to investigate the efficacy of citric acid and ethylenediaminetetraacetic acid (EDTA)-based treatments on smear layer removal and blood clot formation and stabilization. Method and materials: After scaling and root planing, 126 root samples were divided into seven groups treated with: deionized water; saline; citric acid solution; Ultradent Citric Acid gel; EDTA solution; EDTA-based PrefGel; or untreated. Each group was divided into three subgroups: I for the evaluation of smear layer removal and surface wettability, II and III for the evaluation of blood clot formation and stabilization in static or dynamic rinsing conditions. Results: Conditioning agent treatments increased surface wettability with respect to untreated samples (Ultradent: 45 ± 1 degrees, P = 6.2 × 10-3; EDTA: 36 ± 5 degrees, P = 8.9 × 10-7; PrefGel: 47 ± 7 degrees, P = 3.2 × 10-2). Smear layer removal (30% to 60% with respect to untreated samples) was observed for all the conditioning agents. Clot was absent on untreated samples and samples treated with deionized water. Clot quality was significantly higher for samples treated with conditioning agents (P < .05) and similar between group II and III (P > .05). A statistically significant difference (P = .027) was observed for clot coverage of the saline group, comparing static and dynamic rinsing, confirming the positive effect of treatments on clot stabilization. Conclusions: The use of conditioning agents improves smear layer removal and clot formation and stabilization with respect to scaling and root planing procedure only, which is, however, considered an essential procedure to promote wound healing in periodontal surgery. [ABSTRACT FROM AUTHOR]

To assess the effects of grade IV titanium ultrasonic tip instrumentation on different grade IV titanium implant surfaces and compare the decontamination of different implant surfaces using chlorhexidine, blue laser, or ozone. Materials and Methods: Profilometry and energy-dispersive x-ray spectroscopy (EDS) analyses were performed on smooth, laser-micropatterned, and sandblasted grade IV titanium sample disks before (t0) and after (t1) ultrasonic instrumentation with an ultrasonic grade IV titanium tip. Samples were also incubated with a Streptococcus sanguinis culture. Each surface type was then treated with chlorhexidine, blue laser, or ozone (three test groups + control group). Scanning electron microscopy (SEM) images were taken after bacterial growth and after decontamination. Results: After ultrasonic instrumentation, surface roughness (Ra) decreased on sandblasted and micropatterned surfaces, whereas it remained substantially unvaried on the smooth surface. SEM images revealed that the laser-micropatterned structure remained substantially unvaried after instrumentation. EDS revealed a minimal quantity of carbon and iron, found in the laser-treated and sandblasted group at t0. A minimal quantity of aluminum and oxygen was found on the sandblasted surface at t0 and t1. Ozone therapy achieved the highest decontaminating effect, regardless of implant surface topography. Conclusion: Among the alternative therapies to ultrasonic instrumentation with titanium tips, ozone appears to be effective regardless of the type of implant surface; it can be used for the decontamination treatment of implants without altering the surface structure. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate which factors play a major role in the healing of Class II mandibular furcation defects treated with different surgical techniques. Twenty-five systemically healthy subjects with periodontitis stage III grade B and Class II buccal mandibular furcation involvement received one of the following open flap debridement approaches: Group 1 (n = 10), no further treatment; Group 2 (n = 10), piezoelectric contouring of the furcation roof; Group 3 (n = 9), piezoelectric contouring of the furcation roof and bone grafting; Group 4 (n = 10), piezoelectric contouring of the furcation roof and bone grafting with coronally positioned flap. Clinical and radiologic variables—bleeding on probing, probing depth (PPD), vertical and horizontal bone level (CAL and PH), gingival recession, root trunk length, radicular separation, and furcation perimeter (FP)—were evaluated at baseline and 180 days and 1 year after surgery. All clinical parameters were statistically analyzed. Surgical techniques caused clinical (CAL, PPD, PH) and radiographic (FP) improvements. Regenerative techniques and the coronally positioned flap yielded a major radiographic reduction of furcation areas. All therapies resulted in significant horizontal and vertical PPD reduction and CAL gain. [ABSTRACT FROM AUTHOR]

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Purpose: The aim of this work was to prove the synergic complementarity of attenuated total reflection Fourier transform infrared microspectroscopy (micro-ATR FTIR), scanning electron microscopy (SEM) coupled with energy-dispersive x-ray spectroscopy (EDS), and x-ray microcomputed tomography (micro-CT) by studying implant samples with bone affected by peri-implantitis. Materials and Methods: Six samples of implanted bone affected by peri-implantitis and one control healthy bone were analyzed. Thick bone sections included in epoxy-resin and removed implants were analyzed by micro-ATR FTIR, SEM-EDS, and micro-CT. Results: Micro-ATR FTIR revealed the complex nature of the bone composition. Vibrational bands characteristic of both mineral bone phase (acidic phosphates, CO3 2- groups) and organic bone phase (mostly collagen) could be recognized, and their proportion could be seen to change accordingly with the bone degradation. Similarly, SEM-EDS clearly revealed the cortical nature of the control mandible and its homogenous mineral composition. On the contrary, EDS analyses performed over relevant portions of pathologic samples revealed that defective areas were almost Ca and P free. Micro-CT data showed that the morphology of the interface was smooth and linear in the physiologic peri-implant bone, while in the pathologic samples, an altered morphology was evident. Conclusion: This study demonstrated that morphologic, elemental, and biochemical modifications of peri-implant bone can be studied using micro-ATR FTIR, SEM-EDS, and micro- CT. The complement of these techniques can be considered a new multipurpose approach to investigate bone affected by peri-implantitis. [ABSTRACT FROM AUTHOR]

Purpose: A retrospective clinical study was performed to compare the post-operative sequelae of the submucosal administration of two different low dosages of dexamethasone, after the surgical extraction of lower third molars. Methods: Data regarding edema, trismus, pain and analgesic consumption were collected from 150 subjects, selecting three equal groups (n= 50): a control group with no administered dexamethasone (Gl); submucosal injection of dexamethasone 2 mg/0.5 ml (G2) and submucosal injection of dexamethasone 4 mg/1 ml (G3). Collected data were evaluated at three different time points: To before surgery, T, on the third day after surgery and T2 on the 7th day after surgery. Patients' gender and age were also considered for statistical purposes. Results: The effects on facial swelling reduction were statistically significant in G2 at Ti in the male subgroup. With trismus, the differences between the time points considered were statistically significant in G2 in the subgroup of subjects younger than 25 years old. Differences in analgesics taken were statistically significant when Gl and G2 were compared at T1. [ABSTRACT FROM AUTHOR]

This case report presents the correction of severe alveolar ridge atrophy due to congenital and iatrogenic factors. Implants that compromised the natural adjacent teeth and overall esthetics for this young patient were removed and replaced after significant vertical bone and soft tissue regenerative procedures. A treatment combination of bone graft particles, a nonresorbable membrane, and enamel matrix derivatives was used. Significant and stable improvement in esthetics was achieved 12 months after final prosthetic restoration, demonstrating the ability of such a combined treatment to correct the esthetic deformity, improve the health of the adjacent natural teeth, and allow for successful implant treatment. [ABSTRACT FROM AUTHOR]

Background: An oroantral communication (OAC) is a common complication in alveolar surgery that usually occurs as a result of the extraction of maxillary posterior teeth. To avoid further complications, several closure techniques are used; most of them need a flap elevation. Recently, simpler conservative flapless techniques for OAC closure have been described. Objectives: To appraise the effectiveness of different techniques for closure of OACs also in comparison to nothing. Search methods: The following electronic databases were searched for randomised controlled trials regarding techniques for closure of OACs: PubMed; SciVerse Scopus; Latin American and Caribbean Health Sciences; The Scientific Electronic Library Online and The Cochrane Library (from January 1949 to August 2014). Unspecific algorithms were chosen in order to maximise search sensibility. Additional manual searching was performed in PubMed related citations, in five journals and in the references of the selected articles. There were no restrictions with regard to publication language. Selection criteria: Randomised controlled trials (RCTs) comparing techniques for closing oroantral communications to nothing, or different techniques for closing oroantral communications reporting the success rate with at least two months follow-up. Data collection and analysis: The screening of eligible studies, the assessment of methodological quality and data extraction were done by two independent reviewers working in duplicate. Results: The research individuated 1256 publications. After screening, only five articles were assessed for eligibility. Only two RCTs evaluating the effectiveness of techniques for OAC closure fulfilled the inclusion criteria of the present review. One trial including 30 patients assessed whether flapless techniques (resorbable root analogues and haemostatic gauze) could be as effective as the Rehrmann's buccal flap; all the patients were reported as successfully healed in the three intervention groups. Another RCT with 20 patients compared the effectiveness of the buccal fat pad flap (100% success rate) with a sandwich graft with hydroxyapatite crystals within collagen sheaths (90% success rate). The authors found no significant difference. Conclusions: There are no RCTs evaluating whether an oroantral communication should be closed or not. There is weak evidence from two RCTs showing good results with five different techniques for closure of OACs (resorbable root analogues, haemostatic gauze, Rehrmann's buccal flap, buccal fat pad flap, sandwich graft with hydroxyapatite crystals). Until sufficiently high quality RCTs are conducted, elevating or not a flap for closure of OACs will be left to the personal choice of the surgeon. Conflict of interest notification: The authors declare no competing financial interest. [ABSTRACT FROM AUTHOR]