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Objective: Assess whether horizontal ridge augmentation with guided bone regeneration (GBR) using deproteinized bovine bone mineral (DBBM), autologous bone, and a resorbable collagen membrane supports successful implant placement., Materials and Methods: This open, prospective, single-cohort, multicenter clinical study included patients with ridge defects that required GBR prior to implant insertion. The primary endpoint was radiologically assessed bone gain after 8 months post-GBR, measured at the center of planned implant sites. Secondary endpoints included implant survival and success, marginal bone levels (MBLs), MBL changes, and soft tissue health., Results: Of 45 patients evaluated 8 months post-GBR, nine experienced dehiscence in the first 3 weeks of the healing period. GBR led to radiologically determined mean bone width gain of 4.0 ± 1.5 mm and 4.8 ± 1.7 mm, measured 1 and 3 mm from the top of the crest, respectively, allowing successful implant placement in 44 patients (97.8%). The cumulative implant survival and success rates were 98.9% and 95.5%, respectively. MBLs were stable: -1.18 ± 0.64 mm at definitive prosthesis placement (DPP) and - 1.07 ± 0.74 mm at 1 year. Soft tissue health and esthetics (plaque and bleeding indices, papilla, keratinized mucosa, and pink esthetic score) improved from DPP to 1 year. Patients were highly satisfied with implant function and esthetics, and their oral health-related quality of life improved., Conclusions: GBR using DBBM and a collagen membrane offered a safe and effective treatment option for horizontal ridge augmentation sufficient to support implant-based tooth rehabilitation., Trial Registration: Registered at ClinicalTrials.gov NCT03028922 (registrations sites, as above listed affiliations, first posted January 23, 2017)., (© 2024 The Author(s). Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Objective: To evaluate the potential mid-term benefit of the use of a bone substitute material in the reconstructive surgical treatment of peri-implantitis., Methods: A total of 120 subjects (127 implants) affected by peri-implantitis were followed over 3 years in a multicenter randomized clinical trial. Participants had been randomized to either control (access flap surgery) or test group (access flap surgery and bone substitute material). Clinical, radiographic, and patient-reported outcomes were assessed. The primary outcome was a composite measure including probing pocket depth ≤ 5 mm, absence of bleeding and suppuration on probing, soft tissue recession ≤ 1 mm, and implant neither reoperated nor lost. In an additional outcome (disease resolution), we allowed for one bleeding site and did not consider recession., Results: While 14 implants (11%) were lost and a second surgical intervention had been performed at 3 implants (2.4%), pronounced improvements of clinical parameters were noted at remaining implants in both treatment groups at the 3-year follow-up. This was illustrated by a 3.2-3.5 mm reduction in probing pocket depth and a marginal bone level gain of 1.1-1.3 mm. The primary composite outcome, however, was only achieved at 14% of implants. The second composite outcome defining disease resolution was accomplished at 39% of implants. Patient-reported outcomes were generally favorable., Conclusion: At 3 years, the use of a bone substitute material in the surgical therapy of peri-implantitis did not result in a clear benefit over access flap surgery alone., Trial Registration: ClinicalTrials.gov identifier: NCT0307706., (© 2024 The Author(s). Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Population aging, reduced economic capacity, and neglecting the treatments for oral pathologies, are the main causal factors for about 3 billion individuals who are suffering from partial/total edentulism or alveolar bone resorption: thus, the demand for dental implants is increasingly growing. To achieve a good prognosis for implant-supported restorations, adequate peri-implant bone volume is mandatory. The Guided Bone Regeneration (GBR) technique is one of the most applied methods for alveolar bone reconstruction and treatment of peri-implant bone deficiencies. This technique involves the use of different types of membranes in association with some bone substitutes (autologous, homologous, or heterologous). However, time for bone regeneration is often too long and the bone quality is not simply predictable. This study aims at engineering and evaluating the efficacy of modified barrier membranes, enhancing their bioactivity for improved alveolar bone tissue regeneration. We investigated membranes functionalized with chitosan (CS) and chitosan combined with the peptide GBMP1α (CS + GBMP1α), to improve bone growth. OsseoGuard® membranes, derived from bovine Achilles tendon type I collagen crosslinked with formaldehyde, were modified using CS and CS + GBMP1α. The functionalization, carried out with 1-ethyl-3-(3 dimethylaminopropyl)carbodiimide and sulfo-N-Hydroxysuccinimide (EDC/sulfo-NHS), was assessed through FT-IR and XPS analyses. Biological assays were performed by directly seeding human osteoblasts onto the materials to assess cell proliferation, mineralization, gene expression of Secreted Phosphoprotein 1 (SPP1) and Runt-Related Transcription Factor 2 (Runx2), and antibacterial properties. Both CS and CS + GBMP1α functionalizations significantly enhanced human osteoblast proliferation, mineralization, gene expression, and antibacterial activity compared to commercial membranes. The CS + GBMP1α functionalization exhibited superior outcomes in all biological assays. Mechanical tests showed no significant alterations of membrane biomechanical properties post-functionalization. The engineered membranes, especially those functionalized with CS + GBMP1α, are suitable for GBR applications thanks to their ability to enhance osteoblast activity and promote bone tissue regeneration. These findings suggest a potential advancement in the treatment of oral cavity problems requiring bone regeneration., (© 2024 Wiley Periodicals LLC.)

Background and Objectives : The influence of the quantity and quality of peri-implant soft tissue on implant health and long-term maintenance is controversial. This consensus aimed to assess the importance of peri-implant soft tissue by analyzing four aspects: the role of keratinized mucosa (KM), the efficacy of specific collagen matrix, the influence of abutment material, and soft-tissue thickness. Materials and Methods : Active members of the Italian Academy of Osseointegration (IAO) participated in the consensus. Four systematic reviews were conducted, and their results were discussed to provide guidelines on the importance of soft tissue around implants. The first review evaluated the effect of KM on soft-tissue health, peri-implant bone loss, and patient-related variables. The second one analyzed if there was a specific type of matrix that provided better results in terms of peri-implant buccal soft-tissue thickness and keratinized mucosa width compared to autogenous soft-tissue graft. The third review evaluated the influence of different abutment materials on the soft tissues, and the fourth assessed the effect of soft-tissue thickness on peri-implant marginal bone loss (MBL). Results and Conclusions : The agreements reached by the assembly were as follows: the presence of supra-periosteal keratinized tissue is considered to favorably influence peri-implant health and aesthetics but had no relation to preventing bone crest resorption unrelated to infection. It facilitates patient cleaning around implants and reduces patient-reported pain. The free gingival graft (FGG) is considered the best in terms of supra-periosteal KM increase. Connective tissue grafts (CTG) perform better than volume-stable collagen matrices to increase soft-tissue thickness. Collagen matrices reduce surgical time and patient morbidity and can give better camouflaging. The influence of abutment material (titanium or zirconia) on MBL remains controversial, and no conclusion could be reached on this issue. Peri-implant soft-tissue health and recession seem not to be influenced by abutment material, but data are limited to zirconia and titanium. Although this systematic review highlighted the absence of a correlation between soft-tissue thickness and MBL, the assembly failed to find a consensus on this issue.

Purpose: To establish consensus-driven guidelines that could support the clinical decision-making process for implant-supported rehabilitation of the posterior atrophic maxilla and ultimately improve long-term treatment outcomes and patient satisfaction., Materials and Methods: A total of 33 participants were enrolled (18 active members of the Italian Academy of Osseointegration and 15 international experts). Based on the available evidence, the development group discussed and proposed an initial list of 20 statements, which were later evalu-ated by all participants. After the forms were completed, the responses were sent for blinded ana-lysis. In most cases, when a consensus was not reached, the statements were rephrased and sent to the participants for another round of evaluation. Three rounds were planned., Results: After the first round of voting, participants came close to reaching a consensus on six statements, but no consensus was achieved for the other fourteen. Following this, nineteen statements were rephrased and sent to participants again for the second round of voting, after which a consensus was reached for six statements and almost reached for three statements, but no consensus was achieved for the other ten. All 13 statements upon which no consensus was reached were rephrased and included in the third round. After this round, a consensus was achieved for an additional nine statements and almost achieved for three statements, but no consensus was reached for the remaining statement., Conclusion: This Delphi consensus highlights the importance of accurate preoperative planning, taking into consideration the maxillomandibular relationship to meet the functional and aesthetic requirements of the final restoration. Emphasis is placed on the role played by the sinus bony walls and floor in providing essential elements for bone formation, and on evaluation of bucco-palatal sinus width for choosing between lateral and transcrestal sinus floor elevation. Tilted and trans-sinus implants are considered viable options, whereas caution is advised when placing pterygoid implants. Zygomatic implants are seen as a potential option in specific cases, such as for completely edentulous elderly or oncological patients, for whom conventional alternatives are unsuitable.

The problem of antibiotic resistance is becoming increasingly serious worldwide due to uncontrolled prescription. Dentists are among the groups that prescribe the most antibiotics, often to delay urgent treatment. The purpose of the present study is to investigate the prescribing protocols adopted by dentists for prophylaxis and antibiotic therapy in major clinical surgical indications., Methods: A ten-question survey was administered to a group of Italian dentists. The participants were asked about their preferences for antibiotic administration for the prevention of infective endocarditis, the administration of antibiotics to patients allergic to penicillin, the insertion of implants, and the extraction of third molars. The retrieved data were screened and analyzed., Results: A total of 298 surveys were filled out. The most-prescribed antibiotic was amoxicillin or amoxicillin with clavulanic acid or macrolides for allergic patients. The administration of two grams of amoxicillin one hour before surgery was the most widely used prescriptive protocol for prophylaxis. International guidelines on antibiotic prophylaxis for infective endocarditis were only partially followed. The most heterogeneous results emerged for prophylaxis associated with dental implants or provided prior to surgical third-molar extraction., Conclusions: The present study shows widespread antibiotic prescriptive heterogeneity among the sample of dentists analyzed, especially in conditions where international guidelines are lacking. An evidence-based consensus on prescriptive modalities in dentistry would be desirable in the near future.

Human papilloma virus (HPV) is known as the main cause of cervical cancer. Data also indicate its role in head-neck cancer, especially oropharyngeal cancer. The correlation between high-risk HPV and oral cancer is still controversial. HPV-related lesions of the oral cavity are frequent and, in most cases, benign. The primary aim of this study was to establish if there is a different follow-up necessity between HPV-positive compared to HPV-negative oral lesions. The secondary aim was to evaluate the recurrence of HPV-related lesions. All patients who underwent a surgical procedure of oral biopsy between 2018 and 2022, with ulterior histopathological examination and HPV typing, were examined. A total of 230 patients were included: 75 received traumatic fibroma as diagnosis, 131 HPV-related lesions, 9 proliferative verrucous leukoplakia, and 15 leukoplakia. The frequency and period of follow-up varied in relation to HPV positivity and diagnosis. This study confirms what has already been reported by other authors regarding the absence of recommendations of follow-up necessity in patients with oral mucosal lesions. However, the data demonstrate that there was a statistically significant difference in the sample analyzed regarding the follow-up of HPV-positive vs. HPV-negative patients. It also confirms the low recurrence frequency of HPV-related oral lesions., Competing Interests: The authors declare no conflicts of interest.

Aim: To identify predictors of treatment outcomes following surgical therapy of peri-implantitis., Materials and Methods: We performed a secondary analysis of data from a randomized controlled trial (RCT) comparing access flap with or without bone replacement graft. Outcomes at 12 months were probing pocket depth (PPD), bleeding on probing (BOP), soft-tissue recession (REC) and marginal bone level (MBL) change. Multilevel regression analyses were used to identify predictors. We also built an explanatory model for residual signs of inflammation., Results: Baseline PPD was the most relevant predictor, showing positive associations with final PPD, REC and MBL gain, and negative association with probability of pocket closure. Smokers presented higher residual PPD. Absence of keratinized mucosa at baseline increased the probability of BOP but was otherwise not indicative of outcomes. Plaque at 6 weeks was detrimental in terms of residual PPD and BOP. Treatment allocation had an effect on REC. Final BOP was explained by residual PPD ≥6 mm and plaque at more than two sites., Conclusions: Baseline PPD was the most relevant predictor of the outcomes of surgical therapy of peri-implantitis. Pocket closure should be a primary goal of treatment. Bone replacement grafts may be indicated in aesthetically demanding cases to reduce soft-tissue recession. The importance of smoking cessation and patient-performed plaque control is also underlined., (© 2023 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.)

Purpose: The aim of this study was to review the literature on current surface modification strategies used to improve the binding efficiency of an emerging biological material, polyetheretherketone (PEEK), with bone and soft tissues., Study Selection: This review was based on articles retrieved from PubMed, Google Scholar, Web of Science, and ScienceDirect databases. The main keywords used during the search were "polyetheretherketone (PEEK)," "implant," "surface modification," "biomaterials," "bone," "osseointegration," and "soft tissue.", Results: The suitability of PEEK surface modification strategies has been critically analyzed and summarized here. Many cell and in vivo experiments in small animals have shown that the use of advanced modification technologies with appropriate surface modification strategies can effectively improve the surface inertness of PEEK, thereby improving its binding efficiency with bone and soft tissues., Conclusions: Surface modifications of PEEK have revealed new possibilities for implant treatment; however, most results are based on in vitro or short-term in vivo evaluations in small animals. To achieve a broad application of PEEK in the field of oral implantology, more in vivo experiments and long-term clinical evaluations are needed to investigate the effects of various surface modifications on the tissue integration ability of PEEK to develop an ideal implant material.

Objectives: The aim of the present review and meta-analysis was to evaluate the influence of soft tissue thickness on initial bone remodeling after implant installation., Materials and Methods: A literature search was conducted by two independent reviewers on electronic databases up to May 2022. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) performed on human subjects were included. The risk of bias was evaluated using Cochrane Collaboration's tool. Meta-analysis and Trial Sequential Analysis (TSA) were performed on the selected articles. The primary outcome was marginal bone loss., Results: After screening, 6 studies were included in the final analysis, with a total of 354 implants, and a follow-up from 10 to 14 months. 194 implants were placed in a ≥ 2 mm soft tissue thickness, while 160 had <2 mm soft tissue thickness before implant placement. The included studies had a high level of heterogeneity (I 2  > 50%). The meta-analysis indicated a statistically significant difference between the two groups (0.54; p = .027) and the TSA analysis confirmed the results, despite the limited number of dental implants. Additional analysis showed that age and follow-up parameters were not statistically significant factors influencing the bone loss (p = .22 and p = .16, respectively)., Conclusions: Based on the available RCTS and CCTs, initial soft tissue thickness seems to influence marginal bone loss after a short follow-up period. Based on TSA analysis, further studies are needed to assess the influence of the soft tissue thickness on marginal bone loss. PROSPERO registration number: CRD42021235324., (© 2023 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

The Foundational Data Initiative for Parkinson Disease (FOUNDIN-PD) is an international collaboration producing fundamental resources for Parkinson disease (PD). FOUNDIN-PD generated a multi-layered molecular dataset in a cohort of induced pluripotent stem cell (iPSC) lines differentiated to dopaminergic (DA) neurons, a major affected cell type in PD. The lines were derived from the Parkinson's Progression Markers Initiative study, which included participants with PD carrying monogenic PD variants, variants with intermediate effects, and variants identified by genome-wide association studies and unaffected individuals. We generated genetic, epigenetic, regulatory, transcriptomic, and longitudinal cellular imaging data from iPSC-derived DA neurons to understand molecular relationships between disease-associated genetic variation and proximate molecular events. These data reveal that iPSC-derived DA neurons provide a valuable cellular context and foundational atlas for modeling PD genetic risk. We have integrated these data into a FOUNDIN-PD data browser as a resource for understanding the molecular pathogenesis of PD.

Monensin and virginiamycin are included in beef cattle finishing diets as prophylaxis to minimize the incidence of ruminal acidosis and liver abscesses. Due to different and probably complementary modes of action, this study aimed to determine the effects of a combination of monensin and virginiamycin, both included in the diet at recommended doses, on ruminal health, the occurrence of liver abscesses, and growth performance of feedlot-finished cattle. One hundred and forty-four steers (6 animals/pen) were fed 1 of 3 corn-based finishing diets containing 30 mg of monensin ( MN ), 25 mg of virginiamycin ( VM ), or 30 and 25 mg of monensin and virginiamycin ( MN + VM ), respectively, per kilogram of dry matter. Ruminal pH probes were inserted into two animals per pen and set to record pH every 10 min. On d 100, animals were slaughtered, and rumens and livers were recovered, on which occurrence and degree of ruminal damage, prevalence and number of liver abscesses, and liver scores (A-: livers with no more than two small abscesses; A+: livers with at least one large abscess or more than four medium abscesses; A: any other abscessed liver) were determined. Simultaneous inclusion of monensin and virginiamycin resulted in a 4.3% decrease ( P < 0.04) in dry matter intake ( DMI ; 8.8, 9.2, and 9.2 ± 0.19 kg/d for MN + VM, MN, and VM-fed animals, respectively) and similar ( P > 0.13) average daily body weight gain ( ADG ; 1.49 ± 0.021 kg/d) and hot carcass weight ( HCW ; 269 ± 1.7 kg), compared with feeding diets containing one additive or the other. Therefore, in terms of ADG, a 9.4% improvement ( P < 0.01) in feed efficiency was observed in MN + VM-fed animals. Backfat thickness (5.6 ± 0.08 mm) and ribeye area (69.9 ± 0.53 cm 2 ) remained unaffected ( P ≥ 0.74), as well as the minimum (4.98 ± 0.047), mean (6.11 ± 0.037), and maximum ruminal pH (7.23 ± 0.033) values and the time (125 ± 22.3 min/d), area (57.67 ± 12.383 pH × h), and episodes (22 ± 3.8 bouts) of pH below 5.6 ( P ≥ 0.12). Overall, prevalence (24 ± 3.4%) and the number of liver abscesses (1.6 ± 0.14 abscesses/abscessed liver), liver scores (20 ± 3.1% of A- and 4 ± 1.8% of A livers), and prevalence (67 ± 3.5%) and degree of damage to the ruminal epithelium (2.5 ± 0.22% affected surface) were similar ( P ≥ 0.18) across treatments; however, the occurrence of ruminal lesions tended ( P ≤ 0.07) to be associated with that of liver abscesses and reduced ADG when feeding monensin alone., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society of Animal Science.)

Objective: To evaluate the potential benefit of the use of a bone substitute material in the reconstructive surgical therapy of peri-implantitis., Methods: In this multicenter randomized clinical trial, 138 patients (147 implants) with peri-implantitis were treated surgically, randomized by coin toss to either a control (access flap surgery) or a test group (reconstructive surgery using bone substitute material). Clinical assessments, including probing pocket depth (PPD), bleeding and suppuration on probing (BOP & SOP) as well as soft tissue recession (REC), were recorded at baseline, 6 and 12 months. Marginal bone levels (MBL), measured on intra-oral radiographs, and patient-reported outcomes (PROs) were recorded at baseline and 12 months. No blinding to group allocation was performed. The primary outcome at 12 months was a composite measure including (i) implant not lost, (ii) absence of BOP/SOP at all aspects, (iii) PPD ≤5 mm at all aspects and (iv) ≤1 mm recession of mucosal margin on the buccal aspect of the implant. Secondary outcomes included (i) changes of MBL, (ii) changes of PPD, BOP%, and buccal KM, (iii) buccal REC and (iv) patient-reported outcomes., Results: During follow-up, four implants (one in the test group, three in the control group) in four patients were removed due to disease progression. At 12 months, a total of 69 implants in the test and 68 implants in the control group were examined. Thus, 16.4% and 13.5% of implants in the test and control group, respectively, met all predefined criteria of the composite outcome. PPD reduction and MBL gain were 3.7 mm and about 1.0 mm in both groups. Reduction in mean BOP% varied between 45% (test) and 50% (control), without significant differences between groups. Buccal REC was less pronounced in the test group (M = 0.7, SD = 0.9 mm) when compared to controls (M = 1.1, SD = 1.5 mm). PROs were favorable in both groups without significant differences. One case of allergic reaction to the antibiotic therapy was recorded. No other adverse events were noted., Conclusions: Surgical therapy of peri-implantitis effectively improved the clinical and radiographic status at 12 months. While the use of a bone substitute material did not improve reductions of PPD and BOP, buccal REC was less pronounced in the test group. Patient satisfaction was high in both groups., (© 2022 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)

Background: The management of eruption anomalies affecting second molars, although quite uncommon, may represent a real challenge for the clinician. The aim of this study is to present a novel technique that combines the surgical and orthodontic approach in order to obtain the retrieval of impacted second molars through a complex distalizing movement and skeletal anchorage., Methods: Nineteen consecutive patients with impacted second molars were treated according to this technique, which involved extraction of the third molar followed by the placement of a distally positioned screw, and the subsequent use of a coil spring to connect the screw to an eyelet directly bonded on the second molar. In selected cases, it proved to be necessary to reposition the second molar through traditional orthodontics. All of the parameters were recorded: the time required for completing the treatment, the initial angle between the second molar and the adjacent tooth, and treatment related-complications., Results: Twenty impacted second molars were correctly repositioned. The mean initial angle of the second molar was 55.7° (SD 22.6°, min 13.3°, max 104.8°). The mean treatment time was 10 months. There were no major complications., Conclusions: Given that periodontal tissues were minimally affected, the temporary anchorage device was fully controlled, and there was no unwanted movement of adjacent teeth, the presented technique not only proved effective but also minimally invasive.

Objectives: The present systematic review and meta-analysis aims to analyse the clinical performance of short compared to longer implants inserted in sites without the need for bone augmentation., Methods: The protocol of the present PRISMA-driven meta-analysis was registered on PROSPERO (CRD42021264781). Electronic and manual searches were performed up to January 2022. All Randomized Controlled Trials (RCTs) comparing short (≤6 mm) to longer (≥8.5 mm) implants placed in non-atrophic and non-augmented sites were included. The quality of the included studies was assessed using the Cochrane risk of bias tool for randomized clinical trials (RoB 2) and the quality of evidence was determined with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. A meta-analysis was performed on implant survival rate, marginal bone level change (MBLc), and technical and biological complications at the available follow-up time points. The power of the meta-analytic findings was determined by trial sequential analysis (TSA)., Results: From 1485 initial records, 13 articles were finally included. No significant difference was found in the survival rate between short and long implant at any follow-up (moderate quality of evidence). Significantly more bone loss for long implants at 1 and 5 years from implant placement and more technical complications with short implants at 10 years were found. No other significant inter-group differences in terms of MBLc and biological complications were detected., Conclusions: Moderate evidence exists suggesting that short implants perform as well as longer ones in the rehabilitation of edentulous sites without the need for bone augmentation. Further long-term, well-designed RCTs, however, are still needed to provide specific evidence-based clinical recommendations for an extended use of short implants in non-atrophic sites.

Craniofacial tissue reconstruction still represents a challenge in regenerative medicine. Mesenchymal stem cell (MSC)-based tissue engineering strategies have been introduced to enhance bone tissue repair. However, the risk of related complications is limiting their usage. To overcome these drawbacks, exosomes (EXOs) derived from MSCs have been recently proposed as a cell-free alternative to MSCs to direct tissue regeneration. It was hypothesized that there is a correlation between the biological properties of exosomes derived from the dental pulp and the age of the donor. The aim of the study was to investigate the effect of EXOs derived from dental pulp stem cells of permanent teeth (old donor group) or exfoliated deciduous teeth (young donor group) on MSCs cultured in vitro. Proliferation potential was evaluated by doubling time, and commitment ability by gene expression and biochemical quantification for tissue-specific factors. Results showed a well-defined proliferative influence for the younger donor aged group. Similarly, a higher commitment ability was detected in the young group. In conclusion, EXOs could be employed to promote bone regeneration, likely playing an important role in neo-angiogenesis in early healing phases.

(1) Background: Intraoral scanners (IOS) are widely used in prosthodontics. However, a good trueness is mandatory to achieve optimal clinical results. The aim of the present in vitro study was to compare two IOS considering the operator's experience and different implant clinical scenarios. (2) Methods: Two IOS (IT-Itero, Align Technology; and OP-Opera MC, Opera System, Monaco) were compared simulating three different clinical scenarios: single implant, two implants, and full-arch rehabilitation. Ten scans were taken for each configuration by two different operators (one expert, one inexperienced); influence of operator experience and the type of scanner used was investigated. (3) Results: Trueness of the scans differed between the experienced and non-experienced operator and this difference was statistically significant in all the three scenarios ( p = 0.000-0.001, 0.037). A significant difference was present between the scanners ( p = 0.000), in the two-implant and full-arch scenarios ( p = 0.00). (4) Conclusions: Experience of the operator significantly affect trueness of IT and OP scanners. A statistically significant difference was present among IOS in the two-implant and full-arch scenarios.

This study investigated the incidence, genetic diversity, antifungal sensitivity, and virulence of Candida albicans and C. dubliniensis isolated from subjects using dental prostheses and subjects clinically indicated for the first prosthetic rehabilitation. Subjects were divided into four groups and samples were collected twice: at first rehabilitation by removable partial (A) and total (C) dental prostheses, and replacement of the removable partial (B) and total (D) prostheses. Yeasts were genotyped using DNA microsatellite markers. Microbiological methods were used to screen for azole antifungal resistance and exoenzyme production. In the initial sampling, oral colonization by Candida was observed in 31 (53.4%) subjects in groups A (33.3%), B (68.2%), and D (65%); 20 (47.6%) subjects displayed colonization of prostheses: groups B (50%) and D (45%). The second sampling (±30 days) revealed Candida in 2 (3.4%: oral cavity) and 4 (6.9%: prosthetic) subjects from group B. C. albicans and C. dubliniensis displayed both polyclonal and monoclonal patterns of infection. Azole-resistant C. albicans and SAPs + strains were prevalent. Related strains were found in one or several oral sites (mucosa and prosthesis), as well as intra- and inter-subject, -gender, -group, and -time of sampling. However, the patterns of clonality can be altered under dental care., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: To evaluate patients' perceptions regarding implant treatment and maintenance., Material and Methods: A semi-structured questionnaire was developed focusing on 4 main domains: (a) information regarding possible complications received before implant therapy; (b) information received after treatment regarding maintenance; (c) self-performed daily home care; and (d) implant maintenance received at the dental office. Adult patients, restored with implant-supported prosthesis by at least 6 months, were recruited between June 2016 and December 2017., Results: The study population consisted of 522 patients with a mean age of 61 years. The majority of the participants referred to have received information about the need of periodical check-ups (91.6%). However, only 58.9% declared to have been informed about complications and failures before treatment commencement. Even though 91.2% of the participants declared to have received instruction about cleaning measures around implants, less than half of the sample reported to have been asked to try the cleaning tools at the office (40.4%). Even though patients' awareness about implant treatment and maintenance resulted to be low in a consistent part of the sample, patients' satisfaction level about information received regarding implant care was high (Visual Analogue Scale 8.18)., Conclusions: Most patients appeared to be informed about the importance of specific oral hygiene measurements and recall programs. However, an unsatisfactory level of knowledge about implant-related complications was evidenced. Improvements in time and energy employed by dentists and hygienist in communication with patients are needed, in order to enhance health outcomes and compliance both to the treatment and to the maintenance., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The purpose of this prospective, single-center randomized pilot study was to histologically evaluate and compare vital bone development in premolar and molar-extraction sites grafted with two different bovine-derived xenografts. The secondary outcome of interest was implant survival in the grafted sites., Materials and Methods: Adult patients in need of at least two tooth extractions were enrolled. A paired design was used; each patient received at least one of each type of graft at different sites. Each extraction site was randomized to one of two xenograft treatment groups. A resorbable membrane was always placed, and primary intention soft tissue closure was achieved. Four months later, implants were placed and a trephine drill was used to remove bone cores for histologic and histomorphometric analysis., Results: Sixteen patients with 40 extraction sites were enrolled; 20 sites were grafted with one type of xenograft and 20 with another. Mean patient age was 53.5 years, and 65% of patients were male. Evaluation of bone core samples taken from grafted sites showed no significant difference in the mean value of percentage of new bone formation between the different grafted sites (33.4% and 32.4%, p = .76). Cumulative implant survival was 97.5% at the 24-month follow-up visit., Conclusion: Within the limitations of this pilot study, no statistically significant differences in new bone growth between sites grafted with two different types of xenograft were found. Both graft materials promoted the formation of new bone and provided osseous support for implant placement after socket grafting., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Manual culture and differentiation protocols for human induced pluripotent stem cells (hiPSC) are difficult to standardize, show high variability and are prone to spontaneous differentiation into unwanted cell types. The methods are labor-intensive and are not easily amenable to large-scale experiments. To overcome these limitations, we developed an automated cell culture system coupled to a high-throughput imaging system and implemented protocols for maintaining multiple hiPSC lines in parallel and neuronal differentiation. We describe the automation of a short-term differentiation protocol using Neurogenin-2 (NGN2) over-expression to produce hiPSC-derived cortical neurons within 6‒8 days, and the implementation of a long-term differentiation protocol to generate hiPSC-derived midbrain dopaminergic (mDA) neurons within 65 days. Also, we applied the NGN2 approach to a small molecule-derived neural precursor cells (smNPC) transduced with GFP lentivirus and established a live-cell automated neurite outgrowth assay. We present an automated system with protocols suitable for routine hiPSC culture and differentiation into cortical and dopaminergic neurons. Our platform is suitable for long term hands-free culture and high-content/high-throughput hiPSC-based compound, RNAi and CRISPR/Cas9 screenings to identify novel disease mechanisms and drug targets.

Subgingival margins are often associated with adverse periodontal reactions, such as recession and gingival inflammation. The purpose of this cross-sectional dual-center study was to evaluate the periodontal health and stability of intrasulcular margins, comparing two prosthetic margin preparations: subgingival chamfer (SC) and subgingival feather-edge (SF) with gingival curettage. Ninety-six patients with 205 crowns (buccal margin 0.5 mm into the gingival sulcus) were included in the study. SF, gingival curettage, and intrasulcular restorative margin were prepared on 109 crowns; SC was prepared on 96. Restorations were in place for a mean of 55.9 months (range: 12 months to 10 years). No significant differences were found regarding probing depth between the two groups (mean buccal: 1.6 mm; mean interproximal: 2.3 mm). Significant increased recession was present around SCs, showing a higher margin-exposure frequency (buccal: 19.8% vs 3.7%; interproximal: 5.2% vs 1.4%). SC showed 8.5 times the risk of margin exposure compared to SF, men 5.5 times compared to women, and smokers 3.7 times compared to nonsmokers. Follow-up time was not a significant factor. SC sites showed a tendency for reduced buccal bleeding on probing compared to SF sites (3.0% vs 12.1%), but no significant difference was seen in a regression model. Plaque presence increased the risk of bleeding (4.1×), and women presented a higher risk of bleeding than men (3×). Subgingival margins can provide adequate periodontal health and stability if restorative procedures are well controlled and if patients are enrolled in an adequate maintenance program. SF with intrasulcular margin favors facial soft tissue stability, as reduced gingival recession was observed. The technique should be carefully applied to promote an adequate periodontal response.

This retrospective study evaluated hard and soft tissue response and reported mechanical and technical complications around computer-aided design/computer-assisted manufactured (CAD/CAM) abutments. A total of 123 patients restored with titanium, gold-hue titanium, and zirconia CAD/CAM abutments were included (N = 291). Each patient was followed up for at least 2 years. Clinical and radiographic parameters were assessed annually and complications were recorded. No implant or reconstruction failures were reported. One fracture of a zirconia abutment occurred. The prosthetic survival rate after 4 years of function for restorations and abutments was 100% and 99.66%, respectively. No significant differences in biologic and radiographic indices were found. The bleeding on probing index was positive at 42% of implant sites, and it had no significant correlation with the overall change in marginal bone level (0.02 mm) of bone gain. The short-term survival of CAD/CAM abutments was reliable, no matter of the material used for manufacturing.

Several treatment modalities have been proposed to regenerate bone, including guided bone regeneration (GBR) where barrier membranes play an important role by isolating soft tissue and allowing bone to grow. Not all membranes biologically behave the same way, as they differ from their origin and structure, with reflections on their mechanical properties and on their clinical performance. Collagen membranes have been widely used in medicine and dentistry, because of their high biocompatibility and capability of promoting wound healing. Recently, collagen membranes have been applied in guided bone regeneration with comparable outcomes to non-resorbable membranes. Aim of this work is to provide a review on the main features, application, outcomes, and clinical employment of the different types of collagen membranes. Comparisons with non-resorbable membranes are clarified, characteristics of cross-linked collagen versus native collagen, use of different grafting materials and need for membrane fixation are explored in order to gain awareness of the indications and limits and to be able to choose the right membrane required by the clinical condition.

The aim of this study is to evaluate the anatomical characteristics of the posterior region of the mandible and their surgical relevance related to bone harvesting procedures. Fifty retromolar cone beam computed tomography scans were analyzed considering the donor site anatomies. For each site, linear measurements were taken of cross-sectional scans to record perpendicular distances between the mandibular canal (MC) and the vestibular and crestal bone walls. Data showed that the distance from the MC to the vestibular bone wall is lower in the ramus area than in the external oblique ridge area (< 2.00 mm in 26% of cases). However, the distance between the MC and the crestal bone wall is higher in the ramus area than in the external oblique ridge area. There is less bone thickness in the ramus area, and this could expose the inferior alveolar nerve to damage if osteotomies are performed with fewer depth limitations, as reported in the literature.

With the development of X-ray computed tomography (CT) in the 1960s and its first use for clinical studies in 1972 by Sir Godfrey Hounsfield, radiological tomography attained widespread use and today is one of the essential imaging techniques in medical radiology. It is a technically mature and clinically widely accepted method and complements classical X-ray panoramic radiography in many areas. The technology is frequently used in craniofacial radiology, because of its characteristic low radiation dose, high spatial resolution and lower cost compared with CT. The aim of this work was to describe the principles of cone beam computed tomography, to make a brief description of the existing devices, to present briefly the use of 3D diagnosis in craniofacial medicine.

Peri-implantitis is an inflammatory disease affecting tissues surrounding dental implants. Although it represents a common complication of dental implant treatments, the underlying mechanisms have not yet been fully described. The aim of this study is to identify the role of titanium nanoparticles released form the implants on the chronic inflammation and bone lysis in the surrounding tissue. We analyzed the in vitro effect of titanium (Ti) particle exposure on mesenchymal stem cells (MSCs) and fibroblasts (FU), evaluating cell proliferation by MTT test and the generation of reactive oxygen species (ROS). Subsequently, in vivo analysis of peri-implant Ti particle distribution, histological, and molecular analyses were performed. Ti particles led to a time-dependent decrease in cell viability and increase in ROS production in both MSCs and FU. Tissue analyses revealed presence of oxidative stress, high extracellular and intracellular Ti levels and imbalanced bone turnover. High expression of ZFP467 and the presence of adipose-like tissue suggested dysregulation of the MSC population; alterations in vessel morphology were identified. The results suggest that Ti particles may induce the production of high ROS levels, recruiting abnormal quantity of neutrophils able to produce high level of metalloproteinase. This induces the degradation of collagen fibers. These events may influence MSC commitment, with an imbalance of bone regeneration.

The chronic pain syndrome inherited erythromelalgia (IEM) is attributed to mutations in the voltage-gated sodium channel (NaV) 1.7. Still, recent studies targeting NaV1.7 in clinical trials have provided conflicting results. Here, we differentiated induced pluripotent stem cells from IEM patients with the NaV1.7/I848T mutation into sensory nociceptors. Action potentials in these IEM nociceptors displayed a decreased firing threshold, an enhanced upstroke, and afterhyperpolarization, all of which may explain the increased pain experienced by patients. Subsequently, we investigated the voltage dependence of the tetrodotoxin-sensitive NaV activation in these human sensory neurons using a specific prepulse voltage protocol. The IEM mutation induced a hyperpolarizing shift of NaV activation, which leads to activation of NaV1.7 at more negative potentials. Our results indicate that NaV1.7 is not active during subthreshold depolarizations, but that its activity defines the action potential threshold and contributes significantly to the action potential upstroke. Thus, our model system with induced pluripotent stem cell-derived sensory neurons provides a new rationale for NaV1.7 function and promises to be valuable as a translational tool to profile and develop more efficacious clinical analgesics.

The aims of the study were to initially investigate whether the perceived distance of a field hockey push pass task was influenced by manipulating task difficulty (Experiment 1), and further, expanding on the research, whether perceptual biases would translate into the execution of a corresponding push pass action (Experiment 2). Based on predictions from the two-visual systems model, we hypothesized that the action-specific perceptual biases in distance perception would not translate into the control of movement. In Experiment 1, elite field hockey players estimated the distance from targets that differed in size before making push pass actions toward the target (i.e., the smaller targets being more difficult). Results showed that participants did estimate the perceived distance of the push pass task to be larger as a function of task difficulty. We found a similar result in Experiment 2, and in addition, manipulated the required outcome of the push-pass while measuring the speed of the push-pass and found that a perceptual bias did not translate into the execution of the actual push pass task (Experiment 2). In line with the action-specific account of perception, a perceptual bias arose that may assist in making adaptive action choices. However, consistent with the two-visual systems model, this perceptual bias did not affect subsequent control of movement, preventing it from becoming maladaptive. Implications for talent identification and development are briefly discussed., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: The aim of this trial was to investigate the effects of different inclusion levels of a partially defatted black soldier fly (BSF, Hermetia illucens L.) larva meal on the growth performance, nutrient digestibility, blood profile, gut morphology and histological features of piglets. A total of 48 newly weaned piglets were individually weighed (initial body weight (IBW): 6.1 ± 0.16 kg) and randomly allocated to 3 dietary treatments (4 boxes as replicates/treatment and 4 animals/box). BSF larva meal was included at increasing levels (0% [BSF0], 5% [BSF5] and 10% [BSF10]) in isonitrogenous and isoenergetic diets formulated for two feeding phases: I (from d 1 to d 23) and II (from d 24 to d 61). The weight gain (WG), average daily gain (ADG), average daily feed intake (ADFI) and feed conversion ratio (FCR) were calculated for each feeding phase and for the whole trial. The haematochemical parameters and nutrient digestibility of the piglets were also evaluated. A total of 3 piglets per box were slaughtered on d 61 and the slaughtered piglets were submitted to morphometric investigations and histopathological examinations., Results: No overall significant differences were observed for growth performance ( P  > 0.05), except for the ADFI of phase II, which showed a linear response to increasing BSF meal levels ( P  < 0.05, maximum for the BSF10 group). Dietary BSF meal inclusion did not significantly influence the blood profile, except as far as monocytes and neutrophils are concerned, and these showed a linear and quadratic response, respectively, to increasing BSF meal levels ( P  < 0.05, maximum for the BSF10 and BSF5 groups, respectively). On the other hand, the nutrient digestibility, gut morphology and histological features were not affected by dietary BSF meal inclusion ( P  > 0.05)., Conclusions: The obtained results show that a partially defatted BSF larva meal can be used as a feed ingredient in diets for weaned piglets without negatively affecting their growth performance, nutrient digestibility, blood profile, gut morphology or histological features., Competing Interests: The experimental protocol was designed according to the guidelines of the current European Directive (2010/63/EU) on the care and protection of animals used for scientific purposes and approved by the Animal Welfare and Ethical Committee of the Department of Veterinary Sciences of the University of Turin (Italy) (Ref. 2, 28/06/2016).Not applicable.The authors declare that they have no competing interests.

Purpose: To evaluate the reliability of a conometric system for fixed retention of complete prostheses (CPs) on four implants after 5 years of function., Materials and Methods: Twenty-five patients with a completely edentulous mandible received four implants supporting a CP. A total of 100 implants were immediately loaded with CPs on conometric abutments. A follow-up of 5 years was observed for each patient. Outcome measures were prosthesis and implant success, complications, probing pocket depth changes, marginal bleeding and plaque changes, and patient satisfaction., Results: One patient dropped-out. In total, 96 implants supporting the 24 CPs completed the follow-up examination at 5 years. No implant failed. Two framework fractures occurred after 4 and 5 years of function. No loss of retention was recorded for the CPs. Mucositis was recorded for two implants after 1 year of prostheses function for two patients, for one implant after 3 years and for two implants after 4 years in different patients and successfully treated with interceptive supportive therapy. No significant differences were found between Plaque Index (PI) at baseline and after 2 years (P = 1.0); similar findings were calculated between PI at baseline and after 5 years (P = 0.6) of function. At baseline, after 2 and after 5 years, respectively, 69%, 64% and 56% of implants showed a PI of 0; 31%, 36% and 44% of implants showed a PI between 1 and 3. Modify Bleeding Index (MBI) was not significantly different both between baseline and after 2 years of function (P = 1.0) and between baseline and 5 years of function (P = 0.5). At baseline, after 2 and after 5 years, respectively, 69%, 65% and 61% of implants showed a MBI of 0; 27%, 28% and 29% of implants showed a MBI of 1; and 4%, 7% and 10% of implants showed a MBI of 2. The mean probing pocket depth was 1.2 ± 0.4 mm at baseline, 1.2 ± 0.4 mm after 2 years and 1.4 ± 0.5 mm after 5 years of function. The differences were not statistically significant between baseline and 2 years (P = 1.0) and between baseline and 5 years (P = 0.1). From the patient satisfaction questionnaire, 85% percent of patients were satisfied from both aesthetic and functional points of view after 5 years of conometric prostheses function., Conclusions: The present implant-supported conometric retention system can be used to give fixed retention to a CP supported by four implants. An adequate metal framework should be provided to the definitive restoration in order to avoid fractures in the long term., Competing Interests: Conflict of interest statement: No conflict of interest was declared by authors in the present study design and clinical application. No donation of free materials, prostheses or any other support was provided.

Background: Alveolar bone cyst enucleation can give rise to critical-size defects whose healing may be incomplete due to the loss of periosteum or bone walls and there is a paucity of studies investigating the use of immediate bone grafts. The aim of this study was to compare spontaneous healing versus a deproteinized bovine bone graft., Methods: In this prospective randomized clinical pilot study, twenty patients requiring the removal of a cyst ≥20 mm in maximum diameter were randomly assigned to one of two groups: deproteinized bovine bone grafting (test) or spontaneous healing (control). Computed tomographies were obtained preoperatively and 12 months after surgery and the radiolucent volumes were compared. Residual radiological morphology and clinical outcomes at 7 days and 1, 6 and 12 months after surgery were also assessed., Results: The median percentage reduction in the volume of the defect was 98% in the test group and 73% in the control group (P=0.001) with an evidence of soft tissue invagination in the latter. There were no differences in the clinical parameters between the two groups., Conclusions: Within the limitations of this pilot study, the healing of critical-size alveolar bone defects is incomplete at 1 year observation and the use of deproteinized bovine bone graft did not influence the clinical outcomes.

Improving soft tissue attachment and reducing bacterial colonization on titanium abutments are key factors for the long-term maintenance of healthy soft and hard peri-implant tissues. This in vitro study was conducted to compare the biocompatibility and antibacterial activity of four different surfaces: uncoated Ti6Al4V, anodized, and coated with titanium nitride or zirconium nitride. Surface topography was investigated with a high-resolution system for measuring surface finishes. Human gingival fibroblast (HGF) adhesion and proliferation were examined using MTT assay, Scanning Electron Microscopy (SEM) imaging, immunofluorescence analysis and real-time PCR for selected target genes. The hemolysis and AMES tests were performed to assess the chemical compounds' blood compatibility and mutagenic potential, respectively. Antibacterial activity was tested against five bacterial strains isolated from the oral cavity (Streptococcus salivarius, S. sanguinis, S. mutans, S. sobrinus, S. oralis), and the percentage of dead bacteria was calculated. Roughness measurements confirmed a substantial similarity between the surfaces and their compatibility with clinical applications. MTT assay, SEM analysis and immunofluorescence staining showed adhesion and proliferation of HGFs cultured on all the examined surfaces. PCR confirmed that HGFs produced extracellular matrix components efficiently on all the surfaces. No hemolytic activity was detected, and the AMES test confirmed the surfaces' clinical safety. For all tested bacterial strains, biofilms grown on the zirconium nitride surface showed a higher percentage of dead bacteria than on the other disks. The titanium nitride surface inactivated bacterial biofilms, too, but to a lesser extent., Competing Interests: This work was partially supported by MegaGen Implant Co. Ltd. (South Korea), which provided the disks. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

The world of dentistry is approaching graphene-based nanomaterials as substitutes for tissue engineering. Apart from its exceptional mechanical strength, electrical conductivity and thermal stability, graphene and its derivatives can be functionalized with several bioactive molecules. They can also be incorporated into different scaffolds used in regenerative dentistry, generating nanocomposites with improved characteristics. This review presents the state of the art of graphene-based nanomaterial applications in the dental field. We first discuss the interactions between cells and graphene, summarizing the available in vitro and in vivo studies concerning graphene biocompatibility and cytotoxicity. We then highlight the role of graphene-based nanomaterials in stem cell control, in terms of adhesion, proliferation and differentiation. Particular attention will be given to stem cells of dental origin, such as those isolated from dental pulp, periodontal ligament or dental follicle. The review then discusses the interactions between graphene-based nanomaterials with cells of the immune system; we also focus on the antibacterial activity of graphene nanomaterials. In the last section, we offer our perspectives on the various opportunities facing the use of graphene and its derivatives in associations with titanium dental implants, membranes for bone regeneration, resins, cements and adhesives as well as for tooth-whitening procedures.

Full-arch fixed implant-supported prostheses have shown high biologic success rates after long-term follow-up, along with technical and prosthetic complications. Adequate planning is necessary for immediate implant occlusal loading in a completely edentulous maxilla or mandible. For totally edentulous patients, the main prosthetic problem is the transfer of diagnostic information to the master cast when an immediate loading approach is used. The aim of this clinical case report is to illustrate a new prosthetic protocol for immediate implant loading in edentulous or potentially edentulous patients. This innovative procedure can successfully guide the clinician step by step in a predictable way from diagnosis to delivery of an immediately loaded implant-supported full-arch rehabilitation.

The conometric retention system was proposed and described as a predictable alternative to retain fixed implant-supported complete dentures and, more recently, to retain fixed partial restorations. Currently available studies describe a technique based on the Ankylos (Dentsply) implant system and stock conic coupling abutments. The purpose of this case series study is therefore to demonstrate the possibility of using Atlantis computer-aided design/computer-assisted manufacture technology to produce Conus abutments (Dentsply) and using the fixed conometric retention with other implant brands for which appropriate stock conic coupling abutments are not available.

Purpose: The aim of this in vitro study was to verify whether or not stock and computer-aided design/computer-aided manufacturing (CAD/CAM) abutments show similar precision in the connection with the respective implants., Materials and Methods: Ten CAD/CAM titanium abutments were compared with 10 stock titanium abutments. Each abutment fit a regular-platform implant (Institute Straumann). Implants and abutments were measured independently and then connected. During the connection procedure, the torque was measured using a six-axes load cell. Then, outer geometric features of the implant-abutment connection were measured again. Finally, the assembly was sectioned to provide the analysis of inner surfaces in contact. The geometric measurements were performed using a multisensored opto-mechanical coordinate measuring machine. The following parameters were measured and compared for the CAD/CAM and stock titanium abutment groups, respectively: width of interference and interference length between the conical surfaces of the implant and abutment; and volume of material involved in the implant-abutment connection., Results: Interference width mean ± SD values of 18 ± 0.5 and 14 μ 0.5 μm were calculated for the stock and CAD/CAM titanium abutment groups, respectively. The difference was statistically significant (P = .02). Furthermore, the interference length mean ± SD values of 763 ± 10 and 816 ± 43 μm were calculated for stock and CAD/CAM titanium abutment groups, respectively. The difference was also statistically significant (P = .04). Finally, the volume of material involved in the implant-abutment connection was compared between stock and CAD/CAM titanium abutment groups; the mean ± SD values of 0.134 ± 0.014 and 0.108 ± 0.023 mm 3 were significantly different (P = .009)., Conclusion: Both standard and CAD/CAM abutment groups showed a three-dimensional (3D) seal activation after the screw tightening. Nevertheless, stock titanium abutments showed a significantly higher volume of material involved in the implant-abutment connection compared with that of CAD/CAM titanium abutments.

Osteogenesis process displays a fundamental role during dental implant osteointegration. In the present work, we studied the influence of Osteon Growth Induction (OGI) surface properties on the angiogenic and osteogenic behaviors of Mesenchymal Stem cells (MSC). MSC derived from dental pulp and HUVEC (Human Umbilical Vein Endothelial Cells) were grown in on OGI titanium surfaces, and cell proliferation and DNA synthesis were evaluated by MTT [3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide] test and DNA quantification. Gene expression has been performed in order to evaluate the presence of mRNA related to endothelial and osteogenesis markers. Moreover, morphological and biochemical analyses of osteogenesis commitments has been performed. On OGI surfaces, MSC and HUVEC are able to proliferate. Gene expression profiler confirms that MSC on OGI surfaces are able to express endothelial and osteogenic markers, and that these expression are higher compared the expression on control surfaces. In conclusion On OGI surfaces proliferation, expression and morphological analyses of angiogenesis-associated markers in MSC are promoted. This process induces an increasing on their osteogenesis commitment., Competing Interests: The authors declare no conflict of interest.

Purpose: The aim of the present clinical trial was to analyze, through spectrophotometric digital technology, the influence of the abutment material on the color of the peri-implant soft tissue in patients with thin gingival biotype., Material and Methods: Thirty-seven patients received an endosseous dental implant in the anterior maxilla. At time of each definitive prosthesis delivery, an all-ceramic crown has been tried on gold, titanium and zirconia abutment. Peri-implant soft-tissue color has been measured through a spectrophotometer after the insertion of each single abutment. Also facial peri-implant soft-tissue thickness was measured at the level of the implant neck through a caliper. A specific software has been utilized to identify a standardized tissue area and to collect the data before the statistical analysis in Lab* color space. ΔE parameters of the selected abutments were tested for correlation with mucosal thickness. Pearson correlation test was used., Results: Only 15 patients met the study inclusion criteria on peri-implant soft-tissue thickness. Peri-implant soft-tissue color was different from that around natural teeth, no matter which type of restorative material was selected. Measurements regarding all the abutments were above the critical threshold of ΔE 8.74 for intraoral color distinction by the naked eye. The ΔE mean values of gold and zirconium abutments were similar (11.43 and 11.37, respectively) and significantly lower (P = 0.03 and P = 0.04, respectively) than the titanium abutment (13.55). In patients with a facial soft-tissue thickness ≤2 mm, the ΔE mean value of gold and zirconia abutments was significantly lower than that of titanium abutments (P = 0.03 and P = 0.04, respectively) and much more close to the reference threshold of 8.74., Conclusions: For peri-implant soft tissue of ≤2 mm, gold or zirconia abutments could be selected in anterior areas treatment. Moreover, the thickness of the peri-implant soft tissue seemed to be a crucial factor in the abutment impact on the color of soft tissues with a thickness of ≤2 mm., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To evaluate in vitro the sealing capability at the prosthetic connection interface of 2 conometric systems., Materials and Methods: Two conometric systems with the same design and different material were used, for a total of 24 samples. Each sample was assembled by a tapered abutment and respective coping. In group A, the copings were made of gold, whereas in group B they were made of PEEK. Three μL of mix bacterial suspension (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Fusobacterium nucleatum species) was inoculated into the abutment screw hole, and the coping was inserted on the abutment. Samples were immersed into culture tubes and incubated for 24, 48, and 72 hours into anaerobic conditions. Visual evaluation of turbidity was performed at each time point. Qualitative-quantitative assessment using real-time polymerase chain reaction was performed at 72 hours. Any difference between the groups was checked by means of Fisher exact test., Results: Microbial leakage occurred in both groups, and there was no statistically significant difference between groups. Microbial concentration resulted in a presence inferior to 1 × 10 copies/μL in all positive assemblies., Conclusions: Because of the low bacterial count, it can be concluded that a minimal bacterial infiltration may be allowed by conometric interfaces for prosthetic connection.

An ideal tissue-engineered bone graft should have both excellent pro-osteogenesis and pro-angiogenesis properties to rapidly realize the bone regeneration in vivo. To meet this goal, in this work a porcine bone scaffold was successfully used as a Trojan horse to store growth factors produced by mesenchymal stem cells (MSCs). This new scaffold showed a time-dependent release of bioactive growth factors, such as vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), in vitro. The biological effect of the growth factors-adsorbed scaffold on the in vitro commitment of MSCs into osteogenic and endothelial cell phenotypes has been evaluated. In addition, we have investigated the activity of growth factor-impregnated granules in the repair of critical-size defects in rat calvaria by means of histological, immunohistochemical, and molecular biology analyses. Based on the results of our work bone tissue formation and markers for bone and vascularization were significantly increased by the growth factor-enriched bone granules after implantation. This suggests that the controlled release of active growth factors from porcine bone granules can enhance and promote bone regeneration., Competing Interests: The authors declare no conflict of interest.

The aim of this study was to compare the interproximal papilla stability of restorations supported by computer-aided design/computer-assisted manufacture (CAD/CAM) abutments to those supported by prefabricated stock abutments in anterior areas over a 2-year follow-up. Abutments were selected depending on implant inclination and thickness of buccal peri-implant soft tissues from the following: zirconia stock, titanium stock, zirconia CAD/CAM and titanium CAD/CAM. Differences between the height of the papilla tip were measured (REC)., Results: REC values of titanium and zirconia CAD/CAM abutments were significantly lower than those of titanium and zirconia stock. The use of titanium and zirconia CAD/CAM abutments is related to better interproximal papillae stability.

Surface characteristics play a special role for the biological performance of implants and several strategies are available to this end. The OGI (Osteo Growth Induction) titanium surface is a surface, obtained by applying a strong acid onto the blasted surface. The aim of this in-vitro study is to evaluate in vitro the osteoproperties of OGI surfaces on Mesenchymal Stem cells derived from dental pulp. Our results confirm that this treatment exert a positive effect on mitochondrial homeostasis, as shown by a decrease in ROS production related to environmental stress on the mitochondria. Morphological and molecular biology analyses confirmed more over that the DPSC cultured on the OGI surfaces appeared more spread in comparison to those grown on control titanium surface and real time PCR and biochemical data clearly demonstrated the increase of osteoconductive properties of the OGI treatment. In conclusion, our results suggest that mesenchymal stem cells sensitively respond to surface properties related to OGI treatment enhancing their osteogenic activities., (Copyright © 2016 Elsevier B.V. All rights reserved.)

In the aesthetic field, successful replacement of a tooth with a dental implant requires blend and harmony within the existing dentition. The influence of the dimension of buccal bone at implant sites on aesthetic outcomes and the relation between buccal bone horizontal and vertical dimensions are unclear. The aim of the present study is to investigate the correlation between buccal bone thickness, buccal bone level and aesthetic outcome in conventionally placed implants – placed five or more years previously – supporting single maxillary incisors. Eight subjects with 8 implants and with periapical and parallel profile X-rays were clinically examined to assess the “Pink Aesthetic Score” (PES). Buccal bone level and thickness, together with the interproximal bone level, were measured. Implant survival was 100%. The mean time of implants function was 89.3 months (standard deviation 43, range 61-145). The mean PES value was 9.4. The mean interproximal bone level was located 1.3 mm apically to the implant abutment junction, while the corresponding buccal value was 1.6 mm. Buccal bone was mostly absent at the implant abutment junction; 2 and 4 mm apically respect to the junction the thickness was on average 0.44 and 0.89 mm, respectively. The dimension of buccal bone level was correlated to the buccal bone thickness at 2mm-level, to the interproximal bone level and to the soft tissue contour score. Conventional implant placement in pristine bone might lead to satisfactory long-term aesthetic results. The level of the facial mucosa and appearance of the alveolar process might emerge as critical aspects.

Aims: To evaluate the ridge dimensions of posterior sextant in totally edentulous mandibles., Material and Methods: Cone beam computed tomography scans of 136 patients were retrospectively included for analysis. At sites corresponding to the second premolar (site a) and the mesial and distal root of first molar (sites b and c, respectively), bone height (BH) and bone width (BW) were measured., Results: BH significantly decreased from site a (11.20 ± 4.03 mm) to site c (10.28 ± 3.33 mm). Males showed a significantly higher BH compared with females at all sites (P < 0.001), No significant impact of age on BH was found. BW increased from coronal to apical at all sites. At all height levels, BW increased from mesial to distal (BWc > BWb > BWa)., Conclusions: BH decreased from mesial to distal, whereas BW showed an increase. Sex showed a significant impact on BH, with males having on average a 2.8 mm greater height than females, but not on BW. Age did not significantly influence the dimensions of the residual bone crest.

No well-established evidence supporting safe use of bisphosphonates (BPs) or other antiresorptive agents prior, during, or after dentoalveolar surgery, are currently available; moreover, the real risk of osteonecrosis of the jaw (ONJ) development is still unknown. The aim of the present systematic review was to assess the scientific literature concerning the implants placement in antiresorptive agent users and the related risk of implants failure and ONJ development. English papers published from January 2003 until December 2014 were identified on the MEDLINE database. Titles and abstracts retrieved form electronic search were screened separately by 2 examiners; thus, original studies dealing with dental implants placement during or before bone antiresorptive agent therapy and the relative risk of implant failure or development of osteonecrosis were evaluated. Due to the heterogeneity of the included studies and the high risk of bias, there is no evidence of the safe use of oral antiresorptive agents prior or after dental implant surgery. Indeed, implant failure and ONJ development can occur and represent a devastating side effect that should be considered during treatment. Within the limitation of the present systematic review, high quality studies are needed to provide an adequate level of evidence regarding the safety of dentoalveolar surgery during or before bone resorption inhibition therapy and the increase predisposition to osteonecrosis of the jaw (ONJ) development. Therefore, antiresorptive agent therapy should be considered a risk factor until further evidence is prospectively obtained.

Subgingival margins are often required for biologic, mechanical, or esthetic reasons. Several investigations have demonstrated that their use is associated with adverse periodontal reactions, such as inflammation or recession. The purpose of this prospective randomized clinical study was to determine if two different subgingival margin designs influence the periodontal parameters and patient perception. Deep chamfer and feather-edge preparations were compared on 58 patients with 6 months follow-up. Statistically significant differences were present for bleeding on probing, gingival recession, and patient satisfaction. Feather-edge preparation was associated with increased bleeding on probing and deep chamfer with increased recession; improved patient comfort was registered with chamfer margin design. Subgingival margins are technique sensitive, especially when feather-edge design is selected. This margin design may facilitate soft tissue stability but can expose the patient to an increased risk of gingival inflammation.

Purpose: To evaluate the influence of at least three abutment disconnections in conventional loaded implants against placement of a definitive abutment in immediately non-occlusal loaded implants on hard and soft tissue changes. A secondary aim was to evaluate whether the presence of less than 2 mm of keratinised mucosa is associated with increased peri-implant marginal bone loss and soft tissue recessions., Materials and Methods: Eighty patients requiring one single crown or one fixed partial prosthesis supported by a maximum of three implants were randomised, after implants were placed with more than 35 Ncm, according to a parallel group design to receive definitive abutments that were loaded immediately (definitive abutment or immediate loading group) or transmucosal abutments, which were delayed loaded after 3 months and removed at least three times: 1. At impression taking (3 months after implant placement); 2. When checking the zirconium core on titanium abutments at single crowns or the fitting the metal structure at prostheses supported by multiple implants; 3. At delivery of the definitive prostheses (repeated disconnection or conventional loading group). Patients were treated at four centres and each patient contributed to the study, with only one prosthesis followed for 3 years after initial loading. Outcome measures were: prosthesis failures, implant failures, complications, pink aesthetic score (PES), buccal recessions, patient satisfaction, peri-implant marginal bone level changes and height of the keratinised mucosa., Results: Forty patients were randomly allocated to each group according to a parallel group design. Six patients from the definitive abutment group dropped out or died, and one left from the repeated disconnection group. One implant, from the repeated disconnection group, fractured (difference = 3%; CI 95%: -2%, 8%; P = 1). Four provisional crowns and one definitive single crown had to be remade because of poor fitting, and one definitive crown and one definitive prosthesis because of ceramic and implant fracture, respectively, in the repeated disconnection group vs one provisional prosthesis from the definitive abutment group due to frequent debondings (difference = 15%; CI 95%: 2%, 28%; P = 0.060). Five patients from the definitive abutment group and four patients from the repeated disconnection group were affected by complications (difference = 4%; CI 95%: -11%, 20%; P = 0.725). PES scores assessed at 3 years post-loading were 11.7 (standard deviation = 1.8) mm for the definitive abutment group and 11.3 (1.5) mm for the repeated abutment changes group (difference = 0.4; CI 95%: -0.4, 1.2; P = 0.315). However, there was a difference of 0.26 out of a maximum score of 2 in favour of the definitive abutment group for soft tissue contour only. Buccal recessions at 3 years post-loading amounted to -0.1 (0.8) mm for the definitive abutment group and -0.1 (1.2) mm for the repeated abutment changes group (it was actually a soft tissue gain; difference = 0.01 mm CI 95%: -0.48, 0.50; P = 0.965). All patients declared being very satisfied or satisfied with the function and aesthetics of the prostheses and said they would undergo the same procedure again, with the exception of one patient from the repeated disconnection group who was uncertain regarding function. Mean peri-implant marginal bone loss 3 years after loading was 0.07 (0.18) mm for the definitive abutment group and 0.50 (0.93) mm for the repeated abutment changes group (difference = 0.43 mm; CI 95%: 0.13, 0.74; P = 0.007). The height of keratinised mucosa at 3 years post-loading was 2.8 (1.3) mm for the definitive abutment group and 2.8 (1.6) mm for the repeated abutment changes group (difference = 0.03; CI 95%: -0.67, 0.73; P = .926). Up to 3 years after initial loading there were no statistically significant differences between the two procedures, with the exception of 0.4 mm more marginal bone loss at implants subjected to three abutment disconnections. There were no significantly increased marginal bone loss (difference = 0.1 mm, CI 95%: -0.3, 0.5, P = 0.590) or buccal recessions (difference = 0.1 mm, CI 95%: -0.4, 0.7, P = 0.674) at implants with less than 2 mm of keratinised mucosa at loading., Conclusions: Three-year post-loading data showed that repeated abutment disconnections significantly increased bone loss of 0.43 mm, but this difference may not be considered clinically relevant; therefore clinicians can use the procedure they find more convenient for each specific patient. Immediately non-occlusally loaded dental implants are a viable alternative to conventional loading and no increased bone loss or buccal recessions were noticed at implants with less than 2 mm of keratinised mucosa. Conflict of interest statement: This trial was partially funded by Dentsply Sirona Implants, the manufacturer of the implants and other products evaluated in this investigation. However, data belonged to the authors and by no means did the manufacturer interfere with the conduct of the trial or the publication of the results, with the exception of rejecting a proposal to change the protocol, after the trial was started, allowing the use of indexed abutments.

Autogenous bone harvesting is a well-documented surgical procedure. Autogenous mandibular bone harvesting carries a risk of anatomical structural damage because the surgeon has no three-dimensional (3D) control of the osteotomy planes. The aim of this case series was to describe the results of mandibular bone block harvesting applying computer-guided surgery. A sample of 13 partially dentate patients presenting bone deficiencies in the horizontal and/or vertical plane were selected for autogenous mandibular bone block graft. The bone block dimension was planned through a computer-aided design (CAD) process, defining ideal bone osteotomy planes to avoid damage to anatomical structures (nerves, teeth roots, etc) and to generate a surgical guide that imposed the 3D working direction to the bone-cutting instrument. The bone block dimension was always related to the defect dimension to be compensated. A total of 13 mandibular bone blocks were harvested to treat 16 alveolar defects (9 vertical and 7 horizontal). The mean planned mesiodistal dimension of the bone block was 24.8 ± 7.3 mm, the mean height was 8 ± 1 mm, and the mean thickness was 4 ± 2 mm. None of the treated patients experienced neurologic alteration of their alveolar nerve function. The preliminary data from this case series suggested that computer-guided bone harvesting could be a concrete opportunity for clinicians to obtain an appropriate volume of autogenous bone in a safe manner.