Erythritol powder airflow for the treatment of peri-implant mucositis: A randomized controlled clinical trial

OBJECTIVES

Peri-implant mucositis is a biofilm-related, reversible inflammatory disease that can evolve into peri-implantitis if not adequately treated. The aim of the present randomized controlled clinical trial was to evaluate the efficacy of air-abrasive powder as compared to chlorhexidine (CHX) for the treatment of peri-implant mucositis, in terms of clinical and patient-reported outcomes (PROMs) and occurrence of peri-implantitis 12 months after treatment.

METHODS

In the control group, full-mouth calculus and plaque removal was performed with ultrasound and manual devices, and a 1.0% CHX gel was applied; in the test group, supra- and subgingival biofilm removal was performed using erythritol powder with a dedicated nozzle and calculus removal was performed with ultrasonic instruments if needed. Bleeding and plaque indexes, peri-implant probing depth and tissue level were measured at 1 week, and 1, 3, 6 and 12 months after treatment, while PROMs were evaluated up to 7 days after treatment.

RESULTS

Among 80 included implants, 70 were analysed at 12 months follow-up (30 in the test group, 40 in the control group, and 20 subjects). Success rates (implant-level) in terms of bleeding index were significantly different between the test (96.7%) and control group (92.5%); as for PROMs, only taste sensation was significantly better in the test group. The test group was significantly correlated to the smallest changes in peri-implant probing depth between baseline and 3 months.

CONCLUSIONS

The study showed that both treatment strategies are effective. This suggests that the use of air-abrasive powders could be used as an alternative biofilm removal method instead of adjunctive treatments with antiseptics.

A Proposal for a Multidisciplinary Integrated Oral Health Network for Patients Undergoing Major Orthopaedic Surgery (IOHN-OS)

The passing of the years of life physiologically leads to the accumulation of changes in tissues in the oral cavity, influencing dentition, chewing and swallowing mechanisms, and the oral microbiota. Some diseases and medications can aggravate oral symptoms and negatively influence eating behaviours, increasing the likelihood of becoming malnourished. This could make older individuals more vulnerable to complications when undergoing major orthopaedic surgery. Hidden infection foci in the oral cavity are a recognised cause of post-operative periprosthetic joint infections. Dysfunctional oral problems might also compromise feeding after surgery when good nutrition represents a fundamental aspect of a proper recovery. To manage these shortcomings, in this article, the authors hypothesise a multidisciplinary path of care named the Integrated Oral Health Network applied to major Orthopaedic Surgery (IOHN-OS). This peri-operative initiative would include pre-operative oral health screening and risk management by a dental team, patient education programmes before and after surgery, and bedside gerodontology actions like oral care and meal and eating support for fragile individuals. The IOHN-OS has the potential to reshape the concept of suitability for major orthopaedic surgery and generate momentum for designing community-based surveillance programmes that can keep the mouths of older subjects healthy for a long time.

Mucosal cyst aspiration in conjunction with maxillary sinus elevation: A clinical cohort study

INTRODUCTION

Patients with mucosal cysts in the maxillary sinus require special consideration in patients who require implant therapy for the restoration when undergoing implant therapy for the restoration of the posterior maxillary dentition. Treatment strategies for these clinical situations remain controversial in the literature. Thus, this study seeks to describe a safe and effective therapeutic strategy for sinus augmentation in patients with pre-existing maxillary antral cysts.

METHODS

A total of 15 patients and 18 sinuses were consecutively enrolled in this cohort study and underwent maxillary antral cyst treatment by needle aspiration and simultaneous maxillary sinus augmentation (MSA). During surgical procedures, threeimplants (Zimmer Biomet, Indiana, USA) were positioned in 11 sinuses and two implants (Zimmer Biomet, Indiana, USA) were positioned in 5 sinuses.

RESULTS

Overall implant success and survival rates were 100% and 97.8%, respectively at 1 year and 5-year follow-ups. Crestal bone resorption averaged 0.3 ± 0.2 mm 5-year post-loading, showing bone stability. Implant survival rate at 5-year follow-up expressed predictability of the technique comparable to historical data when MSA was performed alone. Crestal bone resorption averaged 0.3 ± 0.2 mm 5 years post-loading and shows bone stability utilizing mucosal cyst aspiration with concomitant MSA procedures. Quality of life evaluation at 1-week post-op showed similar results to published historical data. In 81% (13 sinuses), the CBCT examination at 5-year follow-up showed no cyst reformation, in 19% (3 sinuses) cyst reformation was visible, but smaller in size when compared to the pre-op CBCT evaluation, and all the patients were asymptomatic.

CONCLUSIONS

Maxillary sinus mucosal cyst aspiration with concomitant MSA, may be a viable option to treat maxillary sinus cyst.

The Correlation between Intraorifice Distance and the Anatomical Characteristics of the Second Mesiobuccal Canal of Maxillary Molars: A CBCT Study

Introduction

Missing anatomy is one of the main causes of endodontic failures, and accurate knowledge of teeth anatomy is a prerequisite for adequate root canal treatment. The aim of the present cone beam computed tomography (CBCT) study was to describe the anatomical characteristics of the mesiobuccal (MB) root canals of maxillary molars and to understand if a correlation exists between the position of the canal orifices and the anatomical features of the root.

Methods

For the purposes of the study, a total of 100 CBCT scans of maxillary molars with two MB canals were selected and studied. The features of root canal anatomy of the MB root of the same teeth were analyzed and recorded (root length, confluence, and Vertucci classification). The distance between MB1 and MB2 orifices and the palatal orifice were recorded, as well as the distance between the orifices and the line joining the palatal orifice and the others. A statistical analysis was performed by providing descriptive measures, the measure of the correlation between different parameters, and the influence of some of these measures on the presence of a confluence between MB1 and MB2.

Results

It resulted that the most frequent configuration is type II Vertucci. The length measured on the sagittal plane was significantly correlated to the presence of a confluence in the MB root. When the root length was higher than 14.56 mm, the confluence is three times more frequent than when the length is lower (OR = 3.635). The area under the curve (AUC) of the receiver operator characteristic (ROC) curve for length on the sagittal plane was 0.632 (P=0.036).

Conclusions

The presence of a confluence between the MB canals of maxillary molars is correlated to the length of the root that could be measured on the sagittal plane and to the distance between the canal orifices. The relative position of the root canal orifices in relation to anatomic landmarks needs to be further explored.

The influence of implant position and of prosthetic characteristics on the occurrence of peri-implantitis: a retrospective study on periapical radiographs

OBJECTIVE

The present retrospective study aimed to investigate the influence of malposition on the occurrence of peri-implantitis.

MATERIALS AND METHODS

The study included clinical records of systemically healthy patients with single and partial implant-supported rehabilitations and at least 1-year post-loading follow-up. The parameters collected included implant-related factors, patient-related factors, site-related factors, and prosthesis-related factors. The radiographic measurements were taken by using a dedicated software and the diagnosis of peri-implantitis was made based on all the available clinical and radiographic data. Descriptive statistics were provided for all variables. Following an exploratory approach, an implant-level analysis of factors influencing the occurrence of peri-implantitis was done through a multilevel multivariate logistic regression (mixed).

RESULTS

A total of 180 implants belonging to 90 subjects were randomly selected. Malposition showed no statistically significant association with the occurrence of peri-implantitis. According to the multi-level analysis, the parameters that were significantly associated with peri-implantitis included presence / history of periodontitis (OR = 5.945, 95% CI: 1.093 - 32.334, P = 0.039) and presence of an emergence profile angle ≥ 45° (OR = 9.094, 95% CI: 2.017 - 40.995, P = 0.005).

CONCLUSIONS

Implant malposition, as defined following Buser's criteria (2004), did not influence the occurrence of peri-implantitis in the selected cohort. Conversely, history of periodontitis and presence of a prosthetic emergence profile with an angle ≥ 45° were correlated to an increased risk of peri-implantitis.

The Relevant Oral Burden of Patients with Hidradenitis Suppurativa

INTRODUCTION

Interleukin-17 plays a pivotal role in both hidradenitis suppurativa (HS) and in maintaining oral homeostasis, but their potential link remains unknown. Thus, we aimed to evaluate and quantify the oral burden of patients with HS.

METHODS

In this real-life, multicenter, cross-sectional study, patients with HS were clinically evaluated by two board-certified dermatologists and two board-certified dentists. Oral comorbidities were carefully collected with medical history and therapeutic information.

RESULTS

A total of 102 patients (44.0 ± 0.9 years, body mass index 27.0 ± 2.2 kg/m2) were enrolled. Remarkably, 48% and 43% did not undergo at least an oral hygiene or a dental visit each year, respectively. Oral disorders were found in 55.9% of patients with HS, in particular 39.2% had caries and 46.7% reported at least one missing tooth. The main oral manifestations in patients with HS were recurrent aphthous stomatitis (N = 19, 19.2%), amalgam tattoo (N = 14, 14.1%), leukoplakia (N = 11, 11.1%), nicotinic stomatitis (N = 9, 9.1%), papilloma (N = 8, 8.1%), and geographic tongue (N = 8, 8.1%). Whilst the main predictor of oral pathological conditions was Hurley staging (P = 0.0276), multivariate regression analysis indicated that gender and International Hidradenitis Suppurativa Severity Score System (IHS4) were the main predictors for the presence of caries and number of missing teeth.

CONCLUSION

As a result of the relevant oral burden in patients with HS, dentists should be part of the multidisciplinary team and oral education should be promoted among patients with HS.

Endodontic Surgery of the Palatal Root of a Maxillary Molar Associated with Simultaneous Management of a Maxillary Sinus Lesion

This case report describes a particular application of endodontic microsurgery with a palatal approach in the presence of a radiopaque lesion inside the maxillary sinus. The patient presented complaining of pain related to the first maxillary molar and events of nasal obstruction and facial pain in the cheek and nasal area. The endodontic orthograde treatment and retreatment were done, respectively, 7 and 4 years earlier. The cone-beam computed tomography (CBCT) scan taken before the treatment showed two separate lesions: one associated with the palatine root of the molar and another one inside the maxillary sinus. The patient agreed to solve both problems in one surgical step: endodontic surgery of the palatine root with palatal access with the simultaneous asportation of a lesion from the maxillary sinus floor. Complete bone healing of the periapical area and the maxillary sinus was visualized on intra-oral radiographs, and CBCT was taken one year after the treatment. As far as the authors know, no one in literature has ever described this approach and solved in such a conservative way both the problems at the tooth and in the maxillary sinus.

How to avoid intraoperative and postoperative complications in maxillary sinus elevation

Maxillary sinus floor elevation, via the lateral approach, is one of the most predictable bone augmentation procedures performed in implant dentistry. but both intra- and postoperative complications can occur, and some of them are severe. Our aim is as follows: To review the pertinent literature on the topic, especially assessing the risk factors related to complications. To give clinical recommendations to minimize intra- and postoperative complications with the ultimate scope of improving the standard of clinical care and patient safety.

Avoiding implant-related complications in medically compromised patients with or without unhealthy lifestyle/Elevated oxidative stress

Increased human life expectancy broadens the alternatives for missing teeth and played a role in the widespread use of dental implants and related augmentation procedures for the aging population. Though, many of these patients may have one or more diseases. These systemic conditions may directly lead to surgical complications, compromise implant/bone healing, or influence long-term peri-implant health and its response to biologic nuisances. Offering patients credible expectations regarding intra- and postoperative complications and therapeutic prognosis is an ethical and legal obligation. Clear identification of potential types of adverse effects, complications, or errors is important for decision-making processes as they may be related to different local, systemic, and technical aspects. Therefore, the present review structures the underlying biological mechanisms, clinical evidence, and clinical recommendations for the most common systemic risk factors for implant-related complications.

Influence of implant diameter on implant survival rate and clinical outcomes in the posterior area: a systematic review and meta-analysis

OBJECTIVE

The aim of the present systematic review was to test the hypothesis that the diameter of implants inserted in the posterior area affects implant survival rate, prosthetic survival rate and peri-implant parameters (bleeding on probing (BoP), marginal bone loss (MBL), pocket probing depth (PPD)).

MATERIALS AND METHODS

An electronic search of studies published until December 2021 was done on three databases (Pubmed, Scopus, Cochrane) independently by two authors. Clinical trials comparing implant survival rate, BoP, MBL and PPD among narrow diameter implants (NDI: ≥ 3.0 mm to < 3.75 mm) and regular diameter implants (RDI ≥ 3.75 mm to < 5 mm) were included. Data were independently extracted by two reviewers. Risk of bias was evaluated according to the Cochrane risk-of-bias tool for randomized studies and to the Joanna Briggs Institute Critical Appraisal tools for non-randomized ones. A pair-wise meta-analysis was conducted on the included studies.

RESULTS

Seven articles were included out of the 4291 identified from the digital research. Overall, a total of 939 implants were inserted (319 NDI, 620 RDI). Only one study was judged at serious risk of bias. No statistically significant difference was found in implant survival rate (risk ratio 1.01 (95% CI [0.98 to 1.04], P = 0.67)) while the difference was significant for BoP (mean difference 2.89 (95% CI [0.30 to 5.48] mm, P = 0.03)) with higher values for NDI. Higher MBL was identified among regular diameter implants (mean difference -0.15 mm (95% CI [-0.32 to 0.01 mm], P = 0.07). No statistically significant differences were identified for prosthetic survival and PPD.

CONCLUSIONS

No differences were found in implant survival rate between narrow and regular implants. A higher BoP was identified among narrow implants, but there was no higher bone loss. It is not possible to draw definitive conclusions about the use of narrow-diameter implants in the posterior region.

Mechanical resistance of a 2.9 mm diameter dental implant with a Morse-taper implant-abutment connection

Among the complications that can occur at dental implants, the fracture of any implant component is a relatively infrequent but clinically relevant problem. Due to their mechanical characteristics, small diameter implants are at higher risk of such complication. The aim of this laboratory and FEM study was to compare the mechanical behavior of a 2.9 mm and a 3.3 mm diameter implant with a conical connection under standard static and dynamic conditions, following the ISO 14801:2017. Finite element analysis was performed to compare the stress distribution on the tested implant systems under a 300 N, 30° inclined force. Static tests were performed with a load cell of 2 kN; the force was applied on the experimental samples at 30° with respect to the implant-abutment axis, with an arm of 5.5 mm. Fatigue tests were performed with decreasing loads, at 2 Hz frequency, until three specimens survived without any damage after 2 million cycles. The emergence profile of the abutment resulted the most stressed area in finite element analysis, with a maximum stress of 5829 MPa and 5480 MPa for 2.9 mm and 3.3 mm diameter implant complex respectively. The mean maximum load resulted 360 N for 2.9 mm diameter and 370 N for 3.3 mm diameter implants. The fatigue limit was recorded to be 220 N and 240 N respectively. Despite the more favorable results of 3.3 mm diameter implants, the difference between the tested implants could be considered clinically negligible. This is probably due to the conical design of the implant-abutment connection, which has been reported to present low stress values in the implant neck region, thus increasing the fracture resistance.

Immediate implant positioning using tooth-derived bone substitute material for alveolar ridge preservation: Preliminary results at 6 months

OBJECTIVES

In the present study we evaluated the effectiveness of the use of a novel autologous bone substitute derived directly from processing the extracted tooth in the upper premolar area to preserve a suitable esthetic score and functionality.

MATERIAL AND METHODS

Fourteen bone-level implants with platform switching were inserted in 12 patients immediately after atraumatic extraction of premolars for restorative or endodontic reasons. The implant buccal bone gap was filled using autologous tooth extracted-derived material. Clinical and radiographic parameters, including Pink Esthetic Score (PES) were evaluated at 6 months.

RESULTS

A total of 10 patients accounting for 11 implants were included. PES showed a suitable esthetic result, and all the implant-prosthetic rehabilitation reported full satisfaction for masticatory function, phonetics, and aesthetics. Bone levels were stable and not affected by implant location, lesion type, or bone quality.

CONCLUSION

Radiographically the autologous bone substitute used appears stable in the surgical site and there is good continuity between the autologous bone and the graft. No adverse effects such as periodontal inflammation, infection, or graft rejection was reported.

Radiographic protrusion of dental implants in the maxillary sinus and nasal fossae: A multidisciplinary consensus utilising the modified Delphi method

The aim of the present study was to generate an international and multidisciplinary consensus on the clinical management of implant protrusion into the maxillary sinuses and nasal fossae. A total of 31 experts participated, 23 of whom were experts in implantology (periodontologists, maxillofacial surgeons and implantologists), 6 were otolaryngologists and 2 were radiologists. All the participants were informed of the current scientific knowledge on the topic based on a systematic search of the literature. A list of statements was created and divided into three surveys: one for all participants, one for implant providers and radiologists and one for otolaryngologists and radiologists. A consensus was reached on 15 out of 17 statements. According to the participants, osseointegrated implants protruding radiographically into the maxillary sinus or nasal fossae require as much monitoring and maintenance as implants fully covered by bone. In the event of symptoms of sinusitis, collaboration between implant providers and otolaryngologists is required. Implant removal should be considered only after pharmacological and surgical management of sinusitis have failed.

The Buccally Displaced Palatal (BDP) Flap to Increase Quantity and Thickness of Peri-implant Soft Tissue

Common challenges encountered for atrophic maxilla rehabilitation are the inadequate width and height of attached keratinized mucosa (AKM) and shallow vestibular depth. This study presents a buccally displaced palatal (BDP) flap technique to increase the tissue thickness and AKM width at the second-stage surgery and reestablish the correct fornix depth. The peri-implant pocket depths, modified Plaque Index score, modified sulcus Bleeding Index score, and soft tissue recession were evaluated 6 and 12 months after prostheses loading. A total of 52 implants were placed and analyzed, and no implant failures were found. No significant changes in peri-implant parameters were observed between 6 and 12 months, and mean recession was less than 0.2 mm after 12 months. Though this change was statistically significant, it was clinically irrelevant. The results demonstrate that adequately healthy peri-implant soft tissues and substantial dimensional stability of vestibular soft tissues at the 1-year follow-up were achieved with the BDP flap technique. The BDP flap could represent a viable option for increasing the width and the height of AKM and establishing the correct maxillary fornix depth.

The effect of the use of proton pump inhibitors, serotonin uptake inhibitors, anti-hypertensive, and anti-inflammatory drugs on clinical outcomes of functional dental implants: a retrospective study

OBJECTIVE

The present retrospective study investigated the effect of chronic intake of proton pump inhibitors, selective serotonin uptake inhibitors, anti-inflammatory, and anti-hypertensive drugs on the survival of dental implants and on the occurrence of peri-implantitis.

MATERIALS AND METHODS

Survival analyses for implant failure and peri-implantitis were performed patient level for each drug subcategory and for risk factors. The HR for each drug was calculated with adjusted models as compared to a control group made of subjects not assuming the specific drug. Multilevel logistic regression was used to explore the influence of implant-level and patient-level variables on the outcomes.

RESULTS

A total of 270 subjects receiving 1118 dental implants were included, with a mean follow-up time of 5.19 ± 4.22 years. After 10 years, the survival rate was 86.9% (patient level) and, according to survival analysis, 61.3% of subjects were free from peri-implantitis. The use of anti-inflammatory medicines produced a significant effect (P = 0.04) on peri-implantitis as compared to subjects not using the drug, with a 2.7 year drop of the mean survival time. The HR was slightly above the level of significance in a semi-adjusted model (P = 0.058). The multilevel analysis found a significant effect on the entire sample and not when considering only subjects with implants with more than 1 year follow-up.

CONCLUSIONS

We found a possible relationship between anti-inflammatory drugs use and the occurrence of peri-implantitis in the examined cohort of patients, and no correlation for the other drugs.

Split-Thickness Flap for the Management of a Maxillary Sinus Wall Bony Fenestration During Lateral Window Sinus Augmentation: Case Reports and Technical Surgical Notes

Maxillary sinus wall fenestration at the lateral wall or floor of the sinus can result from many potential factors, such as the repair of oro-antral communication, Caldwell-Luc antrostomy, tooth extraction after an endodontic or periodontal infection that eroded the sinus wall, and the combination of sinus pneumatization and alveolar ridge resorption after teeth removal. When sinus wall fenestration is observed on radiographs, it usually indicates adhesion between the sinus membrane and buccal flap, which makes the reentry surgery for subsequent sinus augmentation challenging. To minimize surgical complications in these challenging scenarios, this paper presents a split-flap surgical technique for the management of soft tissue adhesion between the sinus membrane and alveolar mucosa when attempting a lateral window sinus augmentation.

Frequency and anatomic variability of the mandibular lingual foramina: a cone-beam CT study

Background

To evaluate the distribution of lingual foramina (LF) and their correlation with demographic characteristics and mandible width, shape, and bone thickness in Caucasian Italian patients subjected to cone-beam CT (CBCT).

Methods

CBCTs were reviewed to assess the number of all LF, midline and lateral LF. We also assessed the relationship of the number of lateral LF with gender and mandibular width, shape, and bone thickness using the Chi Square test. A p value < 0.05 was considered statistically significant.

Results

Three-hundred patients (180 males; age range: 21–87 years) were included. The highest frequency per patient was of 2 LF (97/300, 32.3%), followed by 3 (81/300, 27%) and 4 (53/300, 17.7%). No LF were observed in 2/300 patients (0.7%), while the highest number was of 8 LF in one patient. The highest frequency of midline LF per person was of 2 LF (57.3%, 172/300), while the highest number per person was 5 LF in one patient (0.3%). The highest frequency of midline LF located above and below the genial tubercle was of 1 in 197/300 patients (65.7%) and in 169/300 patients (56.3%), respectively. Concerning lateral LF, the highest frequencies were of 0 (113/300, 37.7%) and of 1 (112/300, 37.3%). We did not observe any significant difference of the number of midline and lateral LF based on gender (P = .438 and P = .195, respectively) or mandible width (P = .069 and P = .114, respectively). The mandible shape was normal in 188 cases, with facial constriction in 42, lingual constriction in 54, and hour glass constriction in 16. The mean bone thickness was 10.76 mm in the symphysis, 10.92 mm in the right hemiarches, and 10.68 in the left hemiarches. No significant differences in the distribution of LF were observed also based on mandibular shape and bone thickness (both with P > .05).

Conclusions

We have shown the high variability of number and anatomic distribution of LF in an Italian group of patients subjected to CBCT without reporting any association with gender and mandible width, shape, and bone thickness.

Comparative Study of Deproteinized Bovine Bone Mineral and Bovine Bone Mineral Enriched with a Polymer and Gelatin in Maxillary Sinus Floor Elevation Procedures

The aim of this histomorphometric study was to compare the outcome of sinus floor augmentation procedures using bovine bone mineral and a xenograft enriched with gelatin and a polymer. In 20 patients a single sinus floor elevation procedure with a lateral window approach was performed. In half of the patients, sinuses were grafted with a deproteinized bovine bone mineral-DBBM (control group)-while in the remaining 10, a xenograft enriched by polymer and gelatin-NBS (test group)-was applied. In the DBBM group, histomorphometric analysis revealed 23.14 ± 10.62% of lamellar bone, 19.43% ± 9.18% of woven bone, 23.35% ± 6.04% of osteoid, 17.16% ± 6.13% of biomaterial particles, and 16.93% ± 9.78% of medullary spaces. In the NBS group, histomorphometric analysis found 39.64% ± 12.02% of lamellar bone, 16.28% ± 7.75% of woven bone, 17.51% ± 4.87% of osteoid, 12.72% ± 5.36% of biomaterial particles, and 13.84% ± 6.53% of medullary spaces. Differences between groups for proportion of lamellar bone (P = .004) and osteoid (P = .0287) were statistically significant. Inflammatory infiltration was appreciated only in the NBS group. The enriched xenograft showed a statistically significant higher proportion of lamellar bone and osteoid; however, this was accompanied by an accentuated inflammatory infiltrate.

Fungal species in endodontic infections: A systematic review and meta-analysis

Fungal infections are common on oral mucosae, but their role in other oral sites is ill defined. Over the last few decades, numerous studies have reported the presence of fungi, particularly Candida species in endodontic infections, albeit in relatively small numbers in comparison to its predominant anaerobic bacteriome. Here, we review the fungal biome of primary and secondary endodontic infections, with particular reference to the prevalence and behavior of Candida species. Meta-analysis of the available data from a total of 39 studies fitting the inclusion criteria, indicate the overall weighted mean prevalence (WMP) of fungal species in endodontic infections to be 9.11% (from a cumulative total of 2003 samples), with 9.0% in primary (n = 1341), and 9.3% in secondary infections (n = 662). Nevertheless, WMP for fungi in primary and secondary infections which were 6.3% and 7.5% for culture-based studies, increased to 12.5% and 16.0% in molecular studies, respectively. The most prevalent fungal species was Candida spp. The high heterogeneity in the reported fungal prevalence suggests the need for standardized sampling, and speciation methods. The advent of the new molecular biological analytical platforms, such as the next generation sequencing (NGS), and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF), that enables identification and quantitation of a broad spectrum of hitherto unknown organisms in endodontic infections should radically alter our understanding of the endodontic mycobiome in the future. Candida spp. appear to be co-pathogens with bacteria in approximately one in ten patients with endodontic infections. Hence, clinicians should comprehend the importance and the role of fungi in endodontic infections and be cognizant of the need to eradicate both bacteria and fungi for successful therapy.

Evaluation of mental foramen and inferior alveolar nerve canal and its relationship to adjacent anatomical landmarks using cone-beam computer tomography

The objective of the research was to evaluate the location, size, variability, and morphologic features of mental foramen (MF) and the inferior alveolar nerve canal (IAN) on cone-beam CT. We evaluated the morphologic findings of mental foramen (MF) and inferior alveolar nerve (IAN) canal of 88 mandibular hemiarches of 65 Caucasian subjects (35 males, 30 females; age range 25-75 years) using cone beam CT. The most common horizontal position of MF was type 3 (53.4%), followed by type 4 (39.8%), type 1 (2.3%), type 2 (2.3%), and type 5 (2.3%). Regarding the vertical position, in 71.6% of cases (63/88) we found type 3 position, followed by type 2 (22.7%) and type 1 (5.7%). MF presented as oval in 51.1% and round in 42%, with double oval and triple foramens having been observed in 5.7% and 1.1% respectively. In 36.9% of cases, we found an anterior loop of the IAN. The mean depth of MF was 6.12±1.65mm; width and height were 3.7±0.83mm and 3.14±0.78mm. Width and height of the IAN distal to MF were 2.27±0.53mm and 2.74±0.51mm, while those of the incisive nerve canal mesial to MF were 1.37±0.44mm and 1.54±0.58mm, respectively. An increase in the width of MF was correlated to oval shape (r=0.45; P < 0.01), and there was a low but significant correlation (r=0.23; P < 0.05) between the round shape of MF and the size of the IAN. MF shape appears to be correlated to MF width and size of the IAN. The individual anatomical variability of this structure is a factor that must be considered when dealing with mandibular surgery.

A 3D evaluation of the upper airways and sagittal craniofacial pattern: are these two parameters associated?

Numerous studies have been published aiming to investigate the relationship between sagittal craniofacial pattern and the dimensions of upper airway, but with controversial results. The aim of the study is to verify if an association exists between a specific sagittal cranio-facial pattern and smaller dimensions of upper airway, leading so to a possible risk indicator for OSAS development. Ninety-nine cone-beam computed tomographies (CBCT) were selected from adult patients (48 males, 51 females, age range 18- 65 years). Patients were divided into 3 groups, with 33 patients each, according to their skeletal class (I: 1<ANB<3; II: ANB>3; III: ANB<1). The CBCT data were imported into Simplant O&O software as Dicom files. Borders for the oropharynx and for the hypopharynx of which the volumes were calculated, and the total length (L) were defined. Finally, the average cross-sectional area (a-CSA) was defined as the ratio between total volume and total length for each patient. All data were statistically analyzed using GraphPad Software. A significant difference was found between groups for oropharynx, hypopharynx, and total volume, with Class II having smaller airway dimensions. In a gender-based comparison, there was a statistically significant difference between female and male patients of the same group, and between the same gender in different groups. Regarding the total length and the a-CSA, there was a statistically significant difference between the groups. These results indicate that class II and female patients have smaller dimensions of upper airway leading to a possible risk indicator for OSAS development.

Cutaneous and oral comorbidities in patients with geographic tongue: a multicenter multidisciplinary cross-sectional observational study

Geographic tongue (GT) represents a localized type of psoriasis inversa and its burden of dermatological and oral comorbidities frequently conditions its severity and diagnosis. Currently, no epidemiological studies have evaluated GT muco-cutaneous comorbidities. We aimed to study oral and dermatological comorbidities in a large sample of GT patients. In this multicenter, cross-sectional study, involving 4 primary referral centers in Italy, we evaluated adult GT patients, who were assessed by board certified dermatologists and dentists for 5 months and collected demographics and medical history. GT was evaluated using Hume's classification together with Geographic tongue severity index (GTASI) to score its severity. The prevalence of oral and dermatological comorbidities was recorded. In the sample we enrolled 137 GT patients (M/F= 5:1) with a mean age of 48,2 ± 14,7 yoa and 33.6% had GT family history. The clinical evaluation found 96 (70.1%) GT type I, 7 (5.1%) type II, 13 (9.5%) type IIIa, 19 (13.9%) type IIIb, 2 (1.5%) type IV, following Hume's classification. The mean GTASI score was 23,7 ± 14,2 and the vast majority displayed a severe form of GT. Eighty-nine patients had oral comorbidities (burning mouth syndrome, caries, parulid and lichen planus) and 80 had dermatological concurrent conditions (plaque psoriasis, inverse psoriasis and atopic dermatitis). In GT patients, both dermatological and dental evaluation should be mandatory to identify previously undiagnosed mucocutaneous comorbidities.

Delayed post-extraction implants placed using a modified Summers technique: Preliminary results of a single cohort study

The aim of this retrospective case series was to evaluate the clinical and radiographic outcomes of the patients that underwent implant surgery with a modification of the sinus lift summers protocol. Forty healthy patients in need for oral rehabilitation with dental implants were included in this study. Inclusion criterion was the need for extraction of one compromised tooth due to persistent abscess/ periodontitis/cyst in the atrophic posterior maxilla region. The treatment consisted of two stage surgery for all patients. In the first stage, after tooth extraction, the sockets were preserved with allogenic bone graft and equine collagen membrane. After 4-5 months, 40 implants with a sandblasted surface, were inserted with osseodensification technique and a modification of the Summers sinus lift protocol for fracturing the sinus floor. The implant survival rate was the primary outcome. Intra- and postoperative complications were additional criteria for success. The mean follow-up from implant surgery was 28.0±7.3 (standard deviation) months (range 17.8-43.4 months). One implant was lost before the delivery of the prosthesis. The overall implant survival rate was 97.5%. The overall mean peri-implant marginal bone level change after 6 and 12 months of function was, respectively, 0.26±0.24 mm (95% CI: 0.19, 0.34 mm) and 0.71±0.36 mm (95% CI: 0.60, 0.82 mm). Marginal bone loss was statistically significant at both time frames respect to implant placement, and also the difference between 6 and 12 months was significant (p<0.001 in both cases). No biological nor mechanical complications were recorded throughout the observation period. As a conclusion, the technique presented in this cohort study can be an effective and safe alternative to standard maxillary sinus floor augmentation procedures and immediate implant insertion protocol, especially in cases of periodontitis and infected sites, which can represent a high risk for implant failure in patients with atrophic posterior maxilla.

Geographic tongue clinical response in moderate-to-severe psoriatic patients undergoing secukinumab: a real-life, multicenter retrospective observational study

Geographic tongue (GT), a form of inverse psoriasis, is frequently linked to plaque psoriasis. The objective of the study is to evaluate IL-17 blocker (secukinumab) effect on GT severity. This reallife, multicenter, retrospective observational pilot study evaluated patients with plaque psoriasis and concomitant GT that started in label treatment with secukinumab. Patients were evaluated twice (T0=baseline and T1=after 16 weeks) by a dentist and a dermatologist collecting data on cutaneous Psoriasis Area Severity Index (PASI) and oral statuses using Hume's classification of the Geographic Tongue Severity Index (GTASI). Twenty-nine psoriatic patients with GT treated with secukinumab were enrolled for the study. Seventeen patients display type I GT, 6 type II and 6 type III with an overall GTASI of 25.52±9.57 at the baseline (T0). No correlation was found between delta GTASI and delta PASI (r=-0.27, p=0.1551). GTASI decrement from T0 to T1 was statistically significant ([95%CI -26.64 to -19.56], t=-13.36, p<0.0001). Secukinumab may enter in GT therapeutic armamentarium as the first biologic IL-17 blocker in patients with concomitant moderate-to-severe plaque psoriasis.

Effect of concentrated growth factors on quality of life of patients undergoing implant therapy: a cohort study

Pain, bad taste, and impaired daily activity after implant therapy are common sequelae. Concentrated growth factors (CGF) are a platelet concentrate with a favourable effect on wound healing, but there is still no evidence regarding its potential benefits for reducing postoperative pain and symptoms. Therefore, aim of this prospective comparative study was to determine the effect of CGF on quality of life (QoL) of patients after implant therapy. Fifty-two consecutive patients with one missing mandibular molar were included in the study and alternatively assigned to two groups. Control group received standard implant treatment, and test group received CGF associated with implants. Standard periapical radiographs were taken before and after procedure. Post-operative care consisted of 0.2% chlorhexidine digluconate solution twice daily for 10 days. A QoL questionnaire (OHIP-14) for bad taste, pain and limitation in daily activities was filled and returned one week post-operatively. Daily pain was also assessed through Visual Analogue Scale (VAS) on a 1-100 scale. Parametric test (chi-square) was performed to compare the results of the questionnaire between the two groups using STATA statistical software. All patients correctly filled and returned the questionnaire. Significantly higher proportions of patients of test group reported no bad taste, pain, and limited activity, (24/26, 13/26, and 25/26, respectively) respect to control. Postoperative pain with VAS score was significantly lower in the test group on day 1, 2, and 3 as compared to control. CGF positively influenced QoL when associated with implant rehabilitation of mandibular molars, minimizing post-operative discomfort.

Microsurgical endodontic treatment of the upper molar teeth and their relationship with the maxillary sinus: a retrospective multicentric clinical study

PURPOSE

To assess the clinical and radiographic success rate of microsurgical endodontic treatment of upper molar teeth in relationship with the maxillary sinus, with 12 months follow-up.

METHODS

Patients treated with microsurgical endodontic treatment of upper molar teeth in the period between 2017 and 2019 were recruited from two dental clinics according to specific selection criteria. The outcomes were determined based on clinical and radiographic results taken three, six and 12 months post-operatively, compared with those taken immediately before and after surgery. Clinical and radiographic outcomes were recorded. The distance between the most apical part of the root and of the lesion to the maxillary sinus was measured on CBCT images before the surgery. Patient-related outcomes were recorded.

RESULTS

Out of 35 patients evaluated, 21 were selected according with the selection criteria for a total of 27 roots and 29 canals treated. After 12 months, 18 patients showed a complete healing whereas three demonstrated incomplete healing. Consequently, the success rate in this study was 85.7% after one year. In 28.5% (6 patients) there was a perforation of the Schneiderian membrane that didn't seem to affect the outcome. All patients kept the molar one year later. The pain level decreased significantly over the time during the first week after surgery.

CONCLUSION

Microsurgical Endodontic treatment of the upper molar teeth should be considered a valid and predictable treatment option even in case of Schneiderian membrane perforation. Future clinical studies with a larger sample size are needed to compare the results obtained.

Medium- and Long-Term Survival Rates of Implant-Supported Single and Partial Restorations at a Maximum Follow-up of 12 Years: A Retrospective Study

PURPOSE

To present medium- and long-term biologic outcomes of implant-supported single-tooth restorations and fixed partial dentures and to analyze their correlations with prosthesis and patient characteristics.

MATERIALS AND METHODS

The records of patients treated with implant-supported fixed restorations between 2004 and 2019 reporting the presence or absence of peri-implantitis and/or implant failure were analyzed. The cumulative survival rate (%) over time was calculated, as well as the cumulative prevalence of units free of peri-implantitis.

RESULTS

A total of 344 implants in 112 patients were included, with a mean follow-up period of 5.3 ± 4.0 years after loading. The cumulative survival rates for implants supporting single crowns and fixed partial dentures were 98.11% and 100% after 5 years, respectively, and 97.43% and 98.96% after 10 years, with an overall survival rate of 91.69% after 12 years. At the patient level, the implant survival rates were 95.42%, 92.73%, and 85.31% at 5, 10, and 12 years, respectively. The cumulative rate of implants free from peri-implantitis was 87.46% at the implant level and 72.39% at the patient level. Implant and prosthesis characteristics did not affect the long-term occurrence of implant failure or peri-implantitis. The development of peri-implantitis was statistically correlated with patient smoking habits, but not with history of periodontitis or with diabetes mellitus.

CONCLUSION

Implants supporting single crowns and fixed partial dentures showed relatively high medium- and long-term survival rates that were not influenced by the implant or prosthesis characteristics, including the retention method. As for patient characteristics, only smoking was correlated with the occurrence of peri-implantitis.

The Influence of Residual Alveolar Bone Height on Graft Composition after Maxillary Sinus Augmentation Using Two Different Xenografts: A Histomorphometric Comparative Study

AIM

To evaluate the hypothesis of a correlation between the preoperative residual alveolar bone height (RBH) and graft maturation after maxillary sinus floor augmentation procedures using two different bone substitutes.

METHODS

A total of 20 patients who underwent unilateral maxillary sinus floor augmentation with either mineralized deproteinized bovine bone (DBBM) or a xenograft enriched with polymer and gelatin (NBS) were included in this prospective study. Six months after sinus surgery, bone biopsies were harvested with a 3.2 mm diameter trephine bur, prior to dental implant placement. Histomorphometric analysis was performed, and the results were correlated with the individual RBH. Implants were loaded after 5 months of insertion, and 1-year implant success and marginal bone level change were assessed.

RESULTS

RBH was 2.17 ± 1.11 mm (range 0.5-3.5 mm) and 2.14 ± 0.72 mm (range 0.5-3.0 mm) in the NBS and DBBM group, respectively. The biopsy analyses for the DBBM group showed woven bone increases by 5.08% per 1-mm increment of RBH; medullary spaces decreased by 9.02%, osteoid decreased by 4.4%, residual biomaterial decreased by 0.34%, and lamellar bone increased by 5.68% per 1-mm increase of RBH. In the NBS group, samples showed woven bone increases by 8.08% per 1-mm increase of RBH; medullary spaces decreased by 0.38%; osteoid increased by 1.34%, residual biomaterial decreased by 0.58%, and lamellar bone decreased by 5.50% per 1-mm increase of RBH. There was no statistically significant difference in the correlation between RBH and lamellar bone, woven bone, and osteoid, independently of the material used. Implant success was 100% in both groups, and marginal bone loss was 1.02 ± 0.42 mm in DBBM and 0.95 ± 0.31 mm in the NBS group after the 1-year follow-up.

CONCLUSION

In spite of the absence of significance, the observed trend for woven bone to increase and medullary spaces to decrease when RBH increases deserves attention. Residual bone dimension might be a determinant in the bone graft maturation after maxillary sinus augmentation.

Influence of teeth anatomical characteristics on the efficacy of manual toothbrushing manoeuvres

Purpose

The aim of the study was to investigate the efficacy of two toothbrushing techniques on the amount of plaque accumulation and to evaluate how the changes were correlated to the anatomical characteristics of the anterior maxillary arch.

Methods

Thirty subjects of both genders were included, they were asked not to brush for 12 h. Afterwards, they were asked to manually brush the left side of their maxillary arch with the modified Bass technique and the right side adopting the roll technique. The comparison of photographs taken before and after the manoeuvres, using a plaque disclosing agent, allowed the researchers to measure the changes in plaque accumulation measured using the Quigley and Hein plaque scoring classification. Linear regression analysis was used to evaluate the correlation between such changes and the teeth and arch anatomical characteristics.

Results

A mean reduction of 9.6 ± 5.2% considering both arches after brushing was observed. The changes in plaque accumulation were not different between the two techniques. The length of the line obtained joining the contact point between the central incisors and the contact point between the second premolar and the first molar on the left side and the distance between that line and the lateral incisor on the same side positively correlated to the decrease in the plaque scores (P = 0.046 and P = 0.044, respectively).

Conclusion

Both tested techniques were effective in plaque removal in the anterior maxillary arches. However, the research for the anatomical factors influencing the amount of efficacy of the toothbrushing manoeuvres was inconclusive. We can hypothesise that the adoption of one adequate technique could be more important than the teeth characteristics.

Influence of Diabetes on Implant Failure and Peri-Implant Diseases: A Retrospective Study

Diabetes is an important modifying factor of periodontitis, but its association with peri-implant diseases has not been fully explored and the existing literature reports controversial results. The aim of this retrospective study was to evaluate the influence of diabetes on peri-implantitis and implant failure. Smoking status, history of periodontal disease, presence of diabetes, diabetes type, therapy and glycaemia levels were collected in a total of 204 subjects treated with 929 implants, with a mean follow-up time of 5.7 ± 3.82 years after loading. Odds ratio (OR) for diabetes as a direct cause of peri-implantitis and implant failure were calculated, adjusted for smoking status and history of periodontitis. Nineteen patients were diabetic and most of them presented a good control of the disease at the time of surgery. The overall patient-level prevalence of peri-implantitis was 11.3%. Among diabetic patients, one developed peri-implantitis, whereas one experienced multiple implant failures. The calculated ORs, adjusted for smoking status and periodontitis, were not statistically significant. The results revealed no association between diabetes and peri-implantitis or implant failure coherently with the existing scientific literature. The actual influence of hyperglycemia on implant failure is still uncertain and new studies with larger cohorts of patients are needed.

Biofilm Formation on Dental Implant Surface Treated by Implantoplasty: An In Situ Study

Peri-implantitis is a biofilm-related disease whose characteristics are peri-implant tissues inflammation and bone resorption. Some clinical trials report beneficial effects after implantoplasty, namely the surgical smoothening of the implant surface, but there is a lack of data about the development of the bacterial biofilm on those smoothened surfaces. The aim of this study is to evaluate how implantoplasty influences biofilm formation. Three implants with moderately rough surfaces (control) and three implants treated with implantoplasty (test) were set on a tray reproducing the supra- and sub-gingival environment. One volunteer wore this tray for five days. Every 24 h, plaque coverage was measured and, at the end of the period of observartion, the implant surfaces were analyzed using scanning electron microscopy and confocal laser scanning microscopy. The proportion of implant surface covered with plaque was 65% (SD = 7.07) of the control implants and 16% (SD = 0) of the test implants. Untreated surfaces showed mature, complex biofilm structures with wide morphological diversity, and treated surfaces did not show the formation of mature biofilm structures. This study supports the efficacy of implantoplasty in reducing plaque adhesion and influencing biofilm formation. These results can be considered a preliminary proof of concept, but they may encourage further studies about the effects of implantoplasty on biofilm formation.

Hard and soft tissue changes in the rehabilitation of the anterior maxilla with triangular shape neck implants: a retrospective clinical study with a one-year follow up

Aim of this retrospective study was to evaluate the one-year clinical and radiographic outcomes of implants with a triangular shaped neck inserted immediately after tooth extraction in esthetic zones. Patients in which immediate postextraction implants were placed and restored in the anterior maxilla, who underwent a Cone Beam Computed Tomograpy (CBCT) at baseline and after 12-16 months were included. The socket was preserved using deproteinized bovine bone to fill the buccal gap, and a resorbable collagen membrane. One-year implant survival and prosthesis success were evaluated. Hard and soft tissue stability was assessed by measuring various parameters on CBCT images. Clinical evaluation was also performed and Pink Esthetic Score (PES) assessed. Data from baseline and one-year follow-up were statistically compared using paired tests and a significance threshold of p=0.05. Twenty patients (13 males, 7 females, mean age 50.42±11.35 years) were included. Each contributed with one implant. No implant was lost. A significant improvement in PES was detected. Excellent hard and soft tissue preservation was observed after one year of function. Immediate placement of implants with a triangular shaped neck after tooth extraction, can be a suitable solution even for areas with a high aesthetic demand, such as the anterior maxilla.

Anatomical factors associated with gender recognizability: A study on intraoral standardized photographs

AIM

The aim of this research was to evaluate the possibility of identifying the sex of 1 subject through visual assessment of a frontal photograph of dentition, and to investigate if some morphological characteristics are related to sex determination.

METHODS

5 expert dentists, 5 non-expert dentists and 5 laypeople were made to watch 100 intraoral photographs for 5 seconds each and to establish their sex. The responses of the participants and the baseline characteristics of photographed dentitions were analyzed.

RESULTS

The proportion of right answers was 56.0% ± 8.2% in the group of expert dentists, 65.0% ± 6.0% in the group of non-expert dentists and 58.6% ± 4.5% in the group of non-expert people. The round shape of maxillary central incisors was related to the female gender (P = .006). The male condition was correlated with poor oral hygiene for 4 observers. Female sex perception was correlated with round morphology of upper central incisors for 3 observers.

CONCLUSION

No difference in the ability to determine the sex was registered among groups, suggesting that sex perception is not strongly influenced by the characteristics of dentition.

Autologous Platelet Concentrates in Treatment of Furcation Defects-A Systematic Review and Meta-Analysis

Background: The aim of this review was to evaluate the adjunctive effect of autologous platelet concentrates (APCs) for the treatment of furcation defects, in terms of scientific quality of the clinical trials and regeneration parameters assessment. Methods: A systematic search was carried out in the electronic databases MEDLINE, SCOPUS, CENTRAL (Cochrane Central Register of Controlled Trials), and EMBASE, together with hand searching of relevant journals. Two independent reviewers screened the articles yielded in the initial search and retrieved the full-text version of potentially eligible studies. Relevant data and outcomes were extracted from the included studies. Risk of bias assessment was also carried out. The outcome variables, relative to baseline and post-operative defect characteristics (probing pocket depth (PPD), horizontal and vertical clinical attachment loss (HCAL, VCAL), horizontal and vertical furcation depth (HFD, VFD) were considered for meta-analysis. Results: Ten randomized trials were included in this review. Only one study was judged at high risk of bias, while seven had a low risk, testifying to the good level of the evidence of this review. The meta-analysis showed a favorable effect regarding all outcome variables, for APCs used in adjunct to open flap debridement (p < 0.001). Regarding APCs in adjunct to bone grafting, a significant advantage was found only for HCAL (p < 0.001, mean difference 0.74, 95% CI 0.54, 0.94). The sub-group analysis showed that both platelet-rich fibrin and platelet-rich plasma in adjunct with open flap debridement, yielded significantly favorable results. No meta-analysis was performed for APCs in combination with guided tissue regeneration (GTR) as only one study was found. Conclusion: For the treatment of furcation defects APCs may be beneficial as an adjunct to open flap debridement alone and bone grafting, while limited evidence of an effect of APCs when used in combination with GTR was found.

Enamel matrix derivative for the treatment of partially contained intrabony defects: 12-month results

BACKGROUND

The aim of the study was to evaluate the use of enamel matrix derivative (EMD) alone or in association with deproteinized bovine bone mineral (DBBM) for the treatment of partially contained intrabony defects.

METHODS

A total of 20 two-walled intrabony defects belonging to nine patients were included. Ten defects were treated with EMD alone (test group 1) and the other 10 were treated with EMD and DBBM (test group 2), applying either modified papilla preservation technique or simplified papilla preservation technique.

RESULTS

Twelve months after surgery, in the test group 1, PD was 2.8 ± 0.8 mm, REC was 2.3 ± 2.4 mm and CAL was 5.0 ± 2.8 mm, significantly reduced from baseline values (P < 0.05). Likewise, in test group 2, PD, REC and CAL reduced to 3.0 ± 0.7 mm, 3.9 ± 1.5 mm and 6.9 ± 1.1 mm respectively, from baseline values at 12 months (P < 0.05). No significant differences between groups were found.

CONCLUSIONS

The results showed that the use of EMD alone and the use of a combination of EMD and DBBM for the treatment of partially contained defects showed comparable clinical and radiographic outcomes after 12 months.