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Monolateral and bilateral crossbites are amongst the most frequent forms of malocclusion in the world population. The lack of early correction of this type of malocclusion leads to the partial or total ossification of the sutures which then require surgical treatment in adult patients. In recent years, devices on minipalatal screws have noticeably increased the time window in which it is possible to correct these types of alterations. In this case report, we show how it is possible to correct a third-class skeletal malocclusion associated with a posterior bilateral crossbite in a young woman using a rapid expander on miniscrews and fixed orthodontic device to finalise the process. The procedure for the insertion of the palatal screws was aided by the use of a digitally printed surgical guide, and the appliance was applied in the same sitting thanks to the use of a digital flow software and a systematic easy driver. The CBCT scans show how the orthopaedic expansion of the upper maxilla was obtained without any important alterations that damaged the permanent teeth. This case report wishes to demonstrate how easy and predictable it can be to resolve cases of this type with optimal aesthetic and functional results even when body growth has ended.

Introduction: Today’s society is always more interested to the concept of aesthetics. The patients frequently ask to dentist to resolve unaesthetic problems of teeth, in particular that of the upper frontal group. The WSLs are enamel white alterations due to alteration during the demineralization and remineralization of enamel. This effect is caused by alteration of the pH in the oral cavity and buffer action of saliva. An alteration of this relationship leads to a progressive demineralization of enamel until the formation of a dental cavitation. Materials and Methods: For this study are selected 11 patients, of which 3 men and 8 women, with total of 17 WSLs. The inclusion criteria included WLSs with ICDAS = 2 and WLSs caused by hypomineralization of traumatic origin. These patients were subjected to treatment with infiltrating resin according to operative procedure. Discussion: The therapy with infiltrating resin gave great results in 12 lesions out of 17. In the lesions where there weren’t a complete remission we obtained a great aesthetic improvement and a good reduction of lesions. The follow up could improve the result after a better rehydration of hard tissue. Conclusions: With a correct selection of cases and good operative procedure, the use of the micro-infiltrative technique by low viscosity resin is a good procedure to resolve WSLs problems of non-orthodontic origins. Other studies with a larger sample are required to validate this clinical approach.

Periodontitis is a chronic degenerative disease which is inflammatory and whose bacteriological aetiology interests the hard and soft tissues supporting the dental elements. A typical characteristic of periodontitis is its correlation with other branches of medicine since periodontal disease is often associated with several other illnesses or systemic conditions which exacerbate or predispose the course of the disease. Amongst the most frequent gastroduodenal diseases are those associated with Helicobacter pylori (Hp) infections such as acute gastritis, chronic atrophic gastritis, gastric atrophy, gastritis ulcers, dysplasia, duodenal ulcer, gastric cancer, gastric MALT-lymphoma. Transmission of the microorganism occurs through iatrogenic pathways (faecal-oral, oral-oral) and through food and water ingestion. From this the possible role of the oral cavity becomes evident as a means of transmitting the microorganism and as an extra-gastric reservoir of Hp which develops inside the oral plaque, the main aetiological agent of periodontal disease. Considering that in a patient affected with periodontal disease the oral cavity presents elevated indices of bacterial plaque in association with infrabony pockets one is brought to ask if it might represent a favourable habitat for Hp colonisation. Furthermore, another query that one might pose is whether the presence of Hp in the oral cavity might be the cause of relapse in gastric infections caused by Hp. Consequently, might non-surgical periodontal treatment, in association with an eradicating gastric therapy, foster decontamination of the microorganism in the oral cavity leading to a better prevention of relapse and re-infection of the gastric cavity? Could non-surgical periodontal treatment thus mean prevention of gastric diseases brought on by Helicobacter pylori? The objective of this study is therefore to evaluate the incidence of periodontal disease and oral Hp infection in patients affected by gastric Hpinfection and to determine the possible benefits of the association of non-surgical periodontal therapy with eradicating gastric therapy compared with treatment that involves just the eradicating gastric therapy in patients who are affected by periodontal disease and Hp infection.

Objective. The aim of this study is to identify a possible link between macrovascular hemodynamic status and microvascular hemodynamic indices in patients with periodontal disease. Methods and Materials. Seventeen adult patients are recruited on a voluntary basis at the Dentistry Department of the “Mater Domini” University of Catanzaro, with sampling that determines the lipid profile, blood glucose, inflammatory mediators, blood plasma viscosity: anamnesis, blood pressure measurement, and detection of anthropometric parameters: eco-Doppler of the carotid arteries and brachial arteries with noninvasive measurements of hemodynamics and evaluation of inflammation and periodontal circulation with a noninvasive spectroscopic technique. The subjects underwent a dental inspection with periodontal proves. The different indices of periodontal disease were evaluated. Results. The sites with high probing depth differ from the healthy ones, showing low oxygen saturation and a notable increase in tissue edema, but no correlation between macro- and microvascular values was found. Conclusion. Periodontal probing and spectroscopic examination showed the correlation between low oxygen saturation levels and tissue edema values with probing depth; however, no correlation between macrovascular hemodynamic status and microvascular hemodynamics indices was found probably given the heterogeneity of the population under consideration, the low number of data gathered, and the small sample size.

Purpose The main limitation of surgical treatment of medication-related osteonecrosis of the jaw (MRONJ) is difficulty in defining resection margins. The aim of this study was to compare the efficacy of the surgeon's experience and autofluorescence-guided bone surgery to delimit resection margins for necrotic bone. Materials and Methods MRONJ requiring surgical treatment was classified according to American Association of Oral and Maxillofacial Surgeons staging. To detect vital bone and resection margins, patients of each stage were randomly assigned to 1 of 2 surgical groups: an autofluorescence-guided surgery (AF) group and a conventional surgery (non-AF) group based on the surgeon's experience. Bone samples from the 2 groups were analyzed histopathologically. The main outcomes were defined as the absence of bone exposure or infection at the time of evaluation. Infection was defined as the presence of swelling, pain, or numbness in the area. Measurements were collected preoperatively and 1 week, 1 month, 6 months, and 1 year after surgery. Statistical analysis included descriptive statistics and the Fisher exact test to evaluate eventual differences between the 2 surgical protocols. Results The 36 patients (21 women and 15 men) included in this study were equally divided into 2 groups according to the surgical protocol: 18 patients in the non-AF group and 18 in the AF group. Thirty-nine lesions were included in this analysis: 20 lesions in the non-AF group and 19 in the AF group. Histopathologic examination confirmed the necrotic nature of all bone samples. Statistical analysis showed no differences in necrotic bone exposure or signs of infections between the 2 surgical protocols at different times (P > .05). Conclusions Although the VELscope appears to be useful in guiding bone resection margins in patients with MRONJ, autofluorescence does not appear to be superior to conventional surgical techniques in mucosal healing and quality of life.

Background: The aim of this in vitro study was to analyse the primary stability of 20 implants placed with Twist drills (TD) versus 20 implants placed with Summers osteotomes (SO) and 20 implants placed with B&amp, B bone compactors (BC) in medullary bone (quality type III and type IV). Methods: The implants were placed in 10 fresh pig ribs fixed on a bench vice in order to avoid micro-movements during surgical procedures and measure recording. Peak insertion torque (PIT) and Peak removal torque (PRT) were recorded with MGT-12 digital torque gauge and ISQ was recorded through OSSTELL ISQ&trade, device by an independent operator. Results: Comparing our data (Tukey test p = 0.05), it was evidenced a statistically significant difference in the PIT between TD and BC groups (p = 0.01). Analysing ISQ data, there was a statistically significant difference between the TD and BC groups (p = 0.0001) and between the SO and BC groups (p = 0.014). The analysis of PRT evidenced a statistically significant difference between the TD and BC groups (p = 0.038). Conclusions: This study evidenced that bone compactor preparation can positively influence primary implant stability (PS), however further in vivo studies and a larger sample are necessary to assess the usefulness in several clinical settings.

COVID-19, which appeared to originate in China in December 2019, has spread worldwide in a pandemic way. The aim of this work is to present a protocol to standardize the outpatient oral surgery activities through remote triage, diagnostic tests, protections, and precautions that allow to provide care while minimizing risk for both patients and surgeons. This article summarizes the clinical and surgical experience of the Oral Surgery Unit of the “Mater Domini” Hospital (Magna Graecia University of Catanzaro, Italy) during the COVID-19 pandemic. The application of a scrupulous triage protocol, the use of remote consultations to limit patients’ access to the clinic, and the correct use of PPE prevented transmission of the virus between patients and staff members.

Several molecular technologies aimed at regulating gene expression that have been recently developed as a strategy to combat inflammatory and neoplastic diseases. Among these, antisense technology is a specific, rapid, and potentially high-throughput approach for inhibiting gene expression through recognition of cellular RNAs. Advances in the understanding of the molecular mechanisms that drive tissue damage in different inflammatory diseases, including Crohn's disease (CD) and ulcerative colitis (UC), the two major inflammatory bowel diseases (IBDs) in humans, have facilitated the identification of novel druggable targets and offered interesting therapeutic perspectives for the treatment of patients. This short review provides a comprehensive understanding of the basic concepts underlying the mechanism of action of the oligonucleotide therapeutics, and summarizes the available pre-clinical and clinical data for oligonucleotide-based therapy in IBD.

Background and aims In ulcerative colitis [UC], mucosal damage occurs in areas that are infiltrated with neutrophils. The antimicrobial function of neutrophils relies in part on the formation of extracellular web-like structures, named neutrophil extracellular traps [NETs]. The formation and/or clearance of aberrant NETs have been associated with several immune diseases. Here we investigated the role of NETs in UC-related inflammation. Methods The expression of NET-associated proteins was evaluated in colonic biopsies of patients with Crohn's disease [CD], UC and in normal controls [NC] by Western blotting, immunofluorescence and immunohistochemistry. Colonic biopsies of UC patients were analysed before and after anti-tumour necrosis factor α [anti-TNF-α] treatment. The capacity of neutrophils to produce NETs upon activation was tested in vitro. UC lamina propria mononuclear cells [LPMCs] were cultured with NETs in the presence or absence of an extracellular signal-regulated kinase-1/2 [ERK1/2] inhibitor and inflammatory cytokine induction was assessed by real-time polymerase chain reaction and enzyme-linked immunosorbent assay. We also characterized the contribution of NETs in dextran sodium sulfate [DSS]-induced colitis. Results NET-associated proteins were over-expressed in inflamed colon of UC patients as compared to CD patients and NC. Circulating neutrophils of UC patients produced NETs in response to TNF-α stimulation, and reduced expression of NET-related proteins and diminished NET formation were seen in patients receiving successful treatment with anti-TNF-α. Treatment of UC LPMCs with NETs activated ERK1/2, thus enhancing TNF-α and interleukin-1β [IL-1β] production. NETs were induced in mice with DSS-colitis and in vivo inhibition of NET release attenuated colitis. Conclusions Our data show that NET release occurs in UC and suggest a role for NETs in sustaining mucosal inflammation in this disorder.

The case that is reported here describes the replanting of a 1.1 from an ectopic position during orthodontic therapy. The 9-year-old patient suffered from class 2 type malocclusion with the upper maxilla contracted, right-left posterior cross-bite. The clinical case presented the following details: in the upper incisor group, the 1.1 was overlapping the 1.2 and was distalised and completely vestibularised, whilst in the place of the 1.1, a 1.1 supernumerary persisted in occlusion. Following several medical investigations, such as OPT and, most importantly, TC cone beam investigation, the dangerous position of the dental element became clear. This did not present vestibular cortical bone but only gingival mucosa. Following these investigations, the difficulty in bringing the dental element into its natural position through orthodontic treatment became obvious since the natural position was without sufficient bone support. From this, it became obvious that surgery and replanting of the 1.1 immediately after the extraction of the supernumerary 1.1 was the only choice available.

The reported clinical case describes the surgical procedure of ridge augmentation by using a “split crest” technique with a partial thickness flap and a subsequent implant-prosthetic rehabilitation aimed at treating a bilateral agenesis of the upper lateral incisors. In such cases with vestibule-palatal and mesial-distal scarce bone thicknesses associated with the need of a proper functional and aesthetic rehabilitation, the split crest technique is particularly suitable. In the case we reported, because of the poor bone thicknesses, we performed a minimally invasive split crest which allowed a correct insertion of the fixtures. This technique allowed us to achieve an optimal functional and aesthetic rehabilitation; moreover, we obtained a good emergency profile, ensuring the vitality of the close teeth and ensuring a good primary stability and the following osseointegration of dental implants.

Aim. This study aims to explain the main steps that characterize the implant-prosthetic rehabilitation in complex combined dental and maxillofacial trauma.Material and Methods. A 20-year-old patient reported an extensive facial trauma which also involved the alveolar process of the maxillary bone. The patient reported a maxillofacial fracture and the loss of teeth 1.3, 1.2, 1.1, and 2.1. A “Le Fort” type 2 fracture was also reported, with the malar bone involvement. After reduction and containment of bone fractures, through appropriate mounting plates, appropriate functional and aesthetic rehabilitation of the patient were replaced thanks to a temporary removable prosthesis. After 6 months, the patient performed numerous clinical investigations, aimed at a proper planning of implant-prosthetic rehabilitation of the upper dental arch.Conclusion. With the planning of the case, as well as respecting the surrounding biological structures, the surgery of implants can be carried out with the most appropriate procedure. Lastly, new dental implants with highly bioactive surfaces have been developed, providing an excellent and rapid bone integration.

Ulcerative colitis (UC) is a chronic inflammatory condition of the colon that affects several million people worldwide. UC is histologically characterized by mucosal infiltration with macrophages, ...

Objectives: In contrast to the excellent long-term outcomes described for implant-supported mandibular overdentures, less favorable long-term survival and success rates have been reported for maxillary implants supporting overdentures. The aim of this study was to evaluate the treatment outcome of “planned” bar-retained maxillary and mandibular overdentures supported by Morse taper connection implants, investigating implant survival, peri-implant tissue health, marginal bone resorption and prosthetic complications. Material and methods: Over a 2-year period, 60 patients were enrolled in this study, in four different clinical centers. The overdentures (maxilla 38, mandible 34) were planned with support from four implants anchored on a bar. A total of 288 Morse taper connection implants (Leone Implant System®) were inserted (152 maxilla, 136 mandible). Implants were evaluated 5 years after insertion. Success criteria included the absence of pain, suppuration or clinical mobility, the distance between implant shoulder and first crestal bone–implant contact (DIB)

Background: Today, modern cone beam computed tomography (CBCT) acquisition and three-dimensional (3D) image processing, combined with the direct metal laser sintering (DMLS) process, allows the production of custom-made, rootanalogue implants (RAIs). Purpose: The aim of the present report was to demonstrate how DMLS technology allows the production of a customized titanium RAI, which can be immediately inserted and restored in a fresh extraction socket of the anterior maxilla. Materials and methods: A customized DMLS titanium RAI, perfect copy of the radicular unit needed for replacement was fabricated and inserted into a fresh extraction socket of the esthetic area of the anterior maxilla. Results: After 1 year of follow-up, the DMLS RAI implant showed a satisfactory functional and esthetic integration, with no bone resorption or soft tissue recessions. Conclusions: The production of customized DMLS RAIs opens new interesting perspectives for immediate implantation.

IL-21, a cytokine produced by activated CD4(+) cells, activated natural killer T cells and T helper cells in the germinal centers, is involved in the control of the function of both immune and parenchymal cells.IL-21 is overproduced in many chronic inflammatory disorders, including inflammatory bowel diseases, psoriasis, rheumatoid arthritis, type I diabetes and systemic lupus erythematosus, and studies in experimental models indicate that IL-21 plays an important role in sustaining tissue-damaging immune responses in such pathologies. However, genetic deficiency of IL-21 associates with inflammatory bowel diseases and blockade of IL-21 in the early phases exacerbates the disease progression in some models of rheumatoid arthritis and systemic lupus erythematosus, thus suggesting a dual role of IL-21 in the control of immune-mediated diseases. IL-21 can exert additional protective functions for the host as it promotes cytotoxic responses against tumors and viruses.We here review the available data on the role of IL-21 in chronic inflammatory diseases and discuss the therapeutic benefit of IL-21 inhibitors in such diseases as well as the potential risks of such treatments.

The use of substitute materials is one of the solutions used in periodontology for the reconstruction of intrabony defects. Advances in scientific research gave rise to a new generation of biomaterials of synthetic origin stoichiometrically unstable and therefore really absorbable. Our research is directed precisely towards a bio-material synthesis, Engipore® (Finceramica, Faenza, Italy) which is a bone substitute of the latest hydroxyapatite-based generation, that possesses chemical and morphological properties similar to those of natural bone in the treatment of infrabony periodontal defects. Aim of this study was to evaluate the efficacy of Engipore® in the treatment of intrabony periodontal defects. The study was conducted on 100 parodontopatics patients, which had gingival pockets of at least infrabonies 8/10 mm. The histological evaluation was performed with samples after one year from the graft. The histological samples collected after one year showed an abundant new bone formation, with mature lamellar bone tissue surrounding the residual particles of Engipore® that appear completely osteointegrated. The surrounding connective tissue shows no signs of inflammation. The results obtained in our research demonstrated that, after a proper selection of patients and lesions, and applying an adequate surgical technique, this type of biomaterial in the treatment of periodontal defects acts in an optimal manner as a filler inducing the formation of new bone as evidenced by histological examinations.

In Crohn’s disease (CD) and ulcerative colitis (UC), the two major forms of inflammatory bowel disease (IBD) in human beings, the pathological process is driven by an excessive immune response that is directed against components of the luminal flora and inappropriately controlled by immunesuppressive mechanisms. One such a mechanism involves TGF-β1, a pleiotropic cytokine that targets both immune and non-immune cells in the gut. TGF- β1 is highly expressed in inflamed mucosa of IBD patients but paradoxically it is unable to activate Smad-associated intracellular signalling and suppress inflammatory cytokine responses. This is because IBD-related inflammation is marked by elevated levels of Smad7, an inhibitor of TGF-β1 signalling. Consistently, knockdown of Smad7 with a specific antisense oligonucleotide restores TGF-β1 function, inhibits inflammatory cytokine production, and ameliorates colitis in mice. In this article we review the available data supporting the pathogenic role of Smad7 in gut as well as the results of a recent phase 1 trial assessing the safety and tolerability of a Smad7 antisense oligonucleotide in CD patients.

The present study describes a new protocol for the manufacturing of custom-made hydroxyapatite scaffolds using computer-aided design/computer-aided manufacturing (CAD/CAM), to augment posterior mandibular bone and minimize surgery when severe atrophy is present. Computed tomographic images of an atrophic posterior mandible were acquired and modified into a 3-dimensional (3D) reconstruction model. This model was transferred as a stereolithographic file to a CAD program, where virtual 3D reconstructions of the alveolar ridge were performed, drawing 2 anatomically shaped, custom-made scaffolds. Computer-aided-manufacturing software generated a set of tool-paths for manufacture on a computer-numerical-control milling machine into the exact shape of the 3D projects. Clinically sized, anatomically shaped scaffolds were generated from commercially available porous hydroxyapatite blocks. The custom-made scaffolds well matched the shape of the bone defects and could be easily implanted during surgery. This matching of the shape helped to reduce the time for the operation and contributed to the good healing of the defects. At the 6-month recall, a newly formed and well-integrated bone was observed, completely filling the mandibular posterior defects, and implants were placed, with good primary stability. At the 1-year follow-up examination, the implant-supported restorations showed a good functional and esthetic integration. Although this is an interim report, this study demonstrates that anatomically shaped custom-made scaffolds can be fabricated by combining computed tomographic scans and CAD/CAM techniques. Further studies are needed to confirm these results.

Despite advances in its diagnosis and management, cardiovascular disease remains the leading cause of death in western countries. Many risk factors are involved in the development of cardiovascular disease; recently, periodontal disease was recognized as a new risk factor in many epidemiological studies. The association between dental and cardiovascular disease is intriguing for the potential clinical implications, and it is independent of other risk factors. This association has been demonstrated for several localization of atherosclerotic plaques, involving coronary, cerebral and/or peripheral arteries. The finding that patients with periodontitis show also more evident carotid atherosclerotic plaques is clinically important because this disease localization is the most important cause of cerebral ischemia, in turn the main cause of disabilities in western world (A.H.A, 2002). On this basis, the following chapters highlight the links between periodontal disease and carotid atherosclerosis, focusing on the mechanisms of this association: inflammation, dental pathogens and toxins, endothelial dysfunction, with the addition of hemorheology as a new evidence. In details, the first chapters exploit the main features of these processes (chronic periodontitis, atherosclerosis, wall shear stress in hemorheology); then, we report and analyze a series of cross sectional, prospective and intervention studies in this field. In the last section will elucidate the interplays between periodontal disease, hemodynamic forces and atherosclerosis.

Direct laser metal forming (DLMF) is a new technique which allows solids with complex geometry to be produced by annealing metal powder microparticles in a focused laser beam, according to a computer-generated three-dimensional (3D) model. For dental implants, the fabrication process involves the laser-induced fusion of titanium microparticles, in order to build, layer by layer, the desired object. Modern computed tomography (CT) acquisition and 3D image conversion, combined with the DLMF process, allows the fabrication of custom-made, root-analogue implants (RAI), perfect copies of the radicular units that need replacing. This report demonstrates the successful clinical use of a custom-made, root-analogue DLMF implant. CT images of the residual non-restorable root of a right maxillary premolar were acquired and modified with specific software into a 3D model. From this model, a custom-made, root-analogue, DLMF implant was fabricated. Immediately after tooth extraction, the root-analogue implant was placed in the extraction socket and restored with a single crown. At the 1-year follow-up examination, the custom-made implant showed almost perfect functional and aesthetic integration. The possibility of fabricating custom-made, root-analogue DLMF implants opens new interesting perspectives for immediate placement of dental implants.

The aim of this study is to evaluate the implant survival, the implant-crown success, and the prosthetic complications of 2,549 Morse taper interference-fit connection implants.A total of 2,549 Morse taper connection implants were inserted in 893 patients from January 2003 until December 2008. At each annual recall, clinical, radiographic, and prosthetic parameters were assessed. The implant-crown success criteria included the absence of pain, suppuration, and clinical mobility; an average distance between the implant shoulder and the first visible bone contact2 mm from initial surgery; and the absence of prosthetic complications at the implant-abutment interface. Prosthetic restorations were fixed partial prostheses (462 units); fixed full-arch prostheses (60 units); single crowns (531 units); and overdentures (93 units).The cumulative implant survival rate was 98.23% (97.25% maxilla, 99.05% mandible). The implant-crown success was 92.49%. A few prosthetic complications at implant-abutment interface were reported (0.37%). After 6 years, distance between the implant shoulder and the first visible bone contact was 1.10 mm (± 0.30 mm).The use of Morse taper connection implants represents a successful procedure for the rehabilitation of partially and completely edentulous arches.

This prospective clinical study evaluated the survival rate and the implant-crown success of 201 direct laser metal forming (DLMF) implants in different clinical applications, after short-term follow-up of functional loading. At the 1-year scheduled follow-up examination, several clinical, radiographic, and prosthetic parameters were assessed. Success criteria included absence of pain, sensitivity, suppuration, exudation; absence of implant mobility; absence of continuous peri-implant radiolucency, DIB

Periodontal disease is associated with endothelial dysfunction of the brachial artery and hemodynamic alterations of the common carotid artery. Periodontal therapy improves endothelial function. It is not known if it is able also to improve the hemodynamics of the carotid artery. The aim of the current study was to evaluate the efficacy of 2 different periodontal treatments on carotid hemodynamics: scaling and root planing (SRP) alone or together with low-level laser therapy (LLLT). Forty patients were recruited and randomly treated with SRP (n = 20) or SRP + LLLT (n = 20). Periodontal indices (plaque, gingival, and probing depth indices) were measured before and 5 months after treatment. Blood viscosity, common carotid wall shear stress, circumferential wall tension, and Peterson elastic modulus were evaluated before, soon after and 5 months after treatment. It was found that the periodontal indices improved in both groups, but significantly more so for SRP + LLLT than for SRP (decrease in gingival index 69.3% versus 45.4%, respectively, P = 0.04). In the SRP + LLLT group, after a transient reduction by 5% immediately after therapy, shear stress increased by 11% after 5 months. In SRP only group, however, shear stress variations were less marked. No significant changes were found for the other hemodynamic parameters in either of the groups. Periodontal disease treatment by SRP + LLLT can therefore be said to improve common carotid wall shear stress. This suggests a possible mechanism by which the treatment of periodontal disease has beneficial effects on the cardiovascular system.