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Numerous pieces of evidence demonstrate that oxidative stress impairs biological functions, speeds up aging, and has a role in a variety of human diseases, including systemic and oral inflammatory disorders, and even cancer. Therefore, technologies providing accurate measures of oxidative stress indicators or biomarkers appear essential in the identification/prevention of such diseases, and in their management. Particularly advantageous is the employement of point-of-care tests based on affordable and small biochips since they can quickly process biological samples and deliver results near the point of care for a prompt therapeutic intervention. Malondialdehyde (MDA) is a key byproduct of oxidative reaction and has been identified as an effective marker of oxidative stress. Herein, we describe the detection of MDA in buffer and in a complex matrix such as saliva, using a plasmonic optical fiber device combined with a highly selective anti-MDA antibody. The experimental results highlight the excellent performance of the proposed biosensor, as well as its ability to provide a low-cost point-of-care test (PoC-T) to be used in real life situations. We demonstrated that a single saliva dilution step and a short incubation time are required for the accurate detection of low concentrations of total MDA (free and conjugated). As a proof-of-concept of future biomedical applications, the method has been tested to determine MDA concentration in saliva of a periodontitis patient compared to that of a healthy control. The obtained findings represent the basis for developing PoC-Ts to be employed in monitoring oral diseases like periodontitis, oral cancers or systemic oxidative-stress associated pathologies. Conclusively, our study puts the ground for an oxidative stress biosensor widely-applicable to different scenarios.

Objectives: The evaluation of salivary biomarkers has been proposed as a simple and non-invasive aid to the conventional periodontal diagnosis based on clinical-radiographic parameters. Matrix metalloproteinase-8 (MMP-8), especially in its active form, is considered one of the most reliable biomarkers of periodontitis, and point-of-care tests (POCTs) have been proposed for its clinical monitoring. In this proof-of-concept study, a novel highly sensitive POCT based on a plastic optical fiber (POF) biosensor exploiting surface plasmon resonance (SPR) to detect salivary MMP-8 is described. Methods: A SPR-POF biosensor was functionalized with a specific antibody to develop a surface-assembled monolayer (SAM) for the detection of total MMP-8. A white light source and a spectrometer connected to the biosensor were used to quantify MMP-8 level in both buffer and real matrix (saliva) by analysing the shift of the resonance wavelength determined by the specific antigen-antibody binding upon the SAM. Results: Dose-response curves by serial dilutions of human recombinant MMP-8 were realized, obtaining a limit of detection (LOD) of 40 pM (1.76 ng/ml) in buffer and 225 pM (9.9 ng/ml) in saliva and high selectivity compared to interferent analytes (MMP-2 and IL-6). Conclusions: The proposed optical fiber-based POCT was able to detect and measure total MMP-8 with high selectivity and very low LOD in both buffer and saliva. Clinical significance: The SPR-POF technology may be employed to create highly sensitive biosensors to monitor salivary MMP-8 levels. The possibility of specifically detecting its active, rather than total, form need to be further investigated. If confirmed and clinically validated, such a device may represent a promising tool to make an immediate, highly sensitive and reliable diagnosis of periodontitis, and to carry out a timely and targeted therapy, possibly helping to prevent the onset of local and systemic periodontitis-related complications.

The aim of this multicenter parallel-group randomized controlled trial is to compare, in the same clinical scenario, 6 mm short with 11 mm long implants for the rehabilitation of completely edentulous non-atrophic mandibles.Thirty patients in three study centers received a fixed full-arch mandibular rehabilitation supported by five inter-foraminal implants, with no need for bone augmentation procedures. Patients were randomly allocated (1:1 ratio), at the time of surgery, to test (6 mm implants) or control group (11 mm implants). After 3 months, a screw-retained full-arch prosthesis was positioned (baseline). Peri-implant marginal bone level change (MBLc, primary outcome) together with implant and prosthesis survival rate, and biological/technical complications (secondary outcomes) were evaluated up to 5 years.Twenty seven patients were controlled at 5 years (3 drop-outs). No implant or prosthesis loss occurred. No significant intergroup difference for biological/technical complications (p .05, Fisher's exact test) and no significant intragroup and intergroup difference in the MBLc values were registered (test -0.03 ± 0.17 mm and control -0.13 ± 0.32 mm at 5-years; p .025, one-sided Mann-Whitney U-test).When used in comparable anatomic, surgical, and prosthetic conditions, no difference in the clinical and radiographic outcomes between 6-mm and 11-mm implants was observed at 5 years of follow-up. Short implants showed to be a reliable option for the rehabilitation of completely edentulous non-atrophic mandibles. There is growing clinical evidence supporting the use of short implants, even in the case of non-atrophic sites.

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.

Prevention of alveolar bone resorption after tooth extraction may be useful for implant rehabilitation of the edentulous site minimizing the future need for bone augmentation procedures. A number of studies have investigated the efficacy of autologous platelet concentrates for the preservation of the alveolar bone volume after tooth extraction. Although encouraging results have been published, the available data are still controversial. The aim of the present systematic review was to assess the effect of platelet concentrates on alveolar socket preservation after tooth extraction. A literature search was carried out up to September 2017 for prospective controlled trials in which a test group using exclusively a platelet concentrate was compared with a control group in which extraction sockets were left to heal spontaneously. Seven controlled clinical trials published between 2010 and 2016 were included. A total of 320 extractions (170 tests and 150 controls) in 190 patients was considered. A great heterogeneity was found in terms of study design, methodological aspects, and outcome evaluation. For this reason, a quantitative analysis followed by meta-analysis was not possible, and only a descriptive analysis on the role of platelet concentrates in alveolar socket preservation was carried out. There is growing evidence that platelet concentrates may be advantageously used in postextraction sites, mainly to improve soft tissue healing and to reduce postoperative symptoms. Data about their potential in preserving the alveolar bone volume are still scarce and controversial, although recently encouraging results have been presented using more reliable and accurate evaluation technologies, such as the computed tomography. Further, well-designed and methodologically standardized investigations are strongly demanded to reach a higher level of evidence on this topic.

Several factors affect dental implant osseointegration, including surgical issues, bone quality and quantity, and host-related factors, such as patients’ nutritional status. Many micronutrients might play a key role in dental implant osseointegration by influencing some alveolar bone parameters, such as healing of the alveolus after tooth extraction. This scoping review aims to summarize the role of dietary supplements in optimizing osseointegration after implant insertion surgery. A technical expert panel (TEP) of 11 medical specialists with expertise in oral surgery, bone metabolism, nutrition, and orthopedic surgery performed the review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) model. The TEP identified micronutrients from the “European Union (EU) Register of nutrition and health claims made on foods” that have a relationship with bone and tooth health, and planned a PubMed search, selecting micronutrients previously identified as MeSH (Medical Subject Headings) terms and adding to each of them the words “dental implants” and “osseointegration”. The TEP identified 19 studies concerning vitamin D, magnesium, resveratrol, vitamin C, a mixture of calcium, magnesium, zinc, and vitamin D, and synthetic bone mineral. However, several micronutrients are non-authorized by the “EU Register on nutrition and health claims” for improving bone and/or tooth health. Our scoping review suggests a limited role of nutraceuticals in promoting osseointegration of dental implants, although, in some cases, such as for vitamin D deficiency, there is a clear link among their deficit, reduced osseointegration, and early implant failure, thus requiring an adequate supplementation.

Statement of problem How the properties of the implant-abutment unit may affect the peri-implant soft-tissue seal, whose stability is considered key to safeguarding the implant from bacterial contamination and preserve peri-implant health conditions, is unclear. Purpose The purpose of this systematic review and meta-analysis of animal studies was to investigate whether material and surface properties of transmucosal implant components can influence the peri-implant soft-tissue adhesion at a histological level. Material and methods An electronic and hand search was conducted until August 2019. Histological animal studies comparing soft-tissue response to abutment or transmucosal collar with different materials and/or surface characteristics were selected by 2 independent reviewers. Risk of bias in individual studies was evaluated. Histomorphometric data on the dimension of the peri-implant attachment were recorded, and a quantitative synthesis by a meta-analysis was performed. Risk of bias in individual studies was evaluated in accordance with the Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias tool. Results Eighteen relevant studies out of 1187 were identified, none with a low risk of bias for all domains. Data from only 4 studies could be meta-analyzed. Comparable results in terms of peri-implant attachment dimensions between test and control groups were found, except for a significantly higher apical junctional epithelium to coronal bone to implant (ajE-CBI) distance for chemically modified acid-etched compared with titanium machined surfaces. Non–meta-analyzable and/or qualitative results highlighted some improved properties also for microgrooved and oxidized surfaces. Conclusions Limited data from animal studies suggest that some characteristics of the transmucosal implant components may affect peri-implant soft-tissue adhesion and stabilization but do not allow definitive conclusions. Future research should improve study design to increase the availability of comparable and suitable data on this topic.

The combination of enamel matrix derivative (EMD) with an autogenous bone graft in periodontal regeneration has been proposed to improve clinical outcomes, especially in case of deep non-contained periodontal defects, with variable results. The aim of the present systematic review and meta-analysis was to assess the efficacy of EMD in combination with autogenous bone graft compared with the use of EMD alone for the regeneration of periodontal intrabony defects. A literature search in PubMed and in the Cochrane Central Register of Controlled Trials was carried out on February 2019 using an ad-hoc search string created by two independent and calibrated reviewers. All randomized controlled trials (RCTs) comparing a combination of EMD and autogenous bone graft with EMD alone for the treatment of periodontal intrabony defects were included. Studies involving other graft materials were excluded. The requested follow-up was at least 6 months. There was no restriction on age or number of patients. Standard difference in means between test and control groups as well as relative forest plots were calculated for clinical attachment level gain (CALgain), probing depth reduction (PDred), and gingival recession increase (RECinc). Three RCTs reporting on 79 patients and 98 intrabony defects were selected for the analysis. Statistical heterogeneity was detected as significantly high in the analysis of PDred and RECinc (I2 = 85.28%, p = 0.001; I2 = 73.95%, p = 0.022, respectively), but not in the analysis of CALgain (I2 = 59.30%, p = 0.086). Standard difference in means (SDM) for CALgain between test and control groups amounted to -0.34 mm (95% CI -0.77 to 0.09; p = 0.12). SDM for PDred amounted to -0.43 mm (95% CI -0.86 to 0.01; p = 0.06). SDM for RECinc amounted to 0.12 mm (95% CI -0.30 to 0.55. p = 0.57). Within their limits, the obtained results indicate that the combination of enamel matrix derivative and autogenous bone graft may result in non-significant additional clinical improvements in terms of CALgain, PDred, and RECinc compared with those obtained with EMD alone. Several factors, including the surgical protocol used (e.g. supracrestal soft tissue preservation techniques) could have masked the potential additional benefit of the combined approach. Further well-designed randomized controlled trials, with well-defined selection criteria and operative protocols, are needed to draw more definite conclusions. The combination of enamel matrix derivative (EMD) with an autogenous bone graft in periodontal regeneration has been proposed to improve clinical outcomes, especially in case of deep non-contained periodontal defects, with variable results. The aim of the present systematic review and meta-analysis was to assess the efficacy of EMD in combination with autogenous bone graft compared with the use of EMD alone for the regeneration of periodontal intrabony defects. A literature search in PubMed and in the Cochrane Central Register of Controlled Trials was carried out on February 2019 using an ad-hoc search string created by two independent and calibrated reviewers. All randomized controlled trials (RCTs) comparing a combination of EMD and autogenous bone graft with EMD alone for the treatment of periodontal intrabony defects were included. Studies involving other graft materials were excluded. The requested follow-up was at least 6 months. There was no restriction on age or number of patients. Standard difference in means between test and control groups as well as relative forest plots were calculated for clinical attachment level gain (CALgain), probing depth reduction (PDred), and gingival recession increase (RECinc). Three RCTs reporting on 79 patients and 98 intrabony defects were selected for the analysis. Statistical heterogeneity was detected as significantly high in the analysis of PDred and RECinc (I-2 = 85.28%, p = 0.001; I-2 = 73.95%, p = 0.022, respectively), but not in the analysis of CALgain (I-2 = 59.30%, p = 0.086). Standard difference in means (SDM) for CALgain between test and control groups amounted to -0.34 mm (95% CI -0.77 to 0.09; p = 0.12). SDM for PDred amounted to -0.43 mm (95% CI -0.86 to 0.01; p = 0.06). SDM for RECinc amounted to 0.12 mm (95% CI -0.30 to 0.55. p = 0.57). Within their limits, the obtained results indicate that the combination of enamel matrix derivative and autogenous bone graft may result in non-significant additional clinical improvements in terms of CALgain, PDred, and RECinc compared with those obtained with EMD alone. Several factors, including the surgical protocol used (e.g. supracrestal soft tissue preservation techniques) could have masked the potential additional benefit of the combined approach. Further well-designed randomized controlled trials, with well-defined selection criteria and operative protocols, are needed to draw more definite conclusions.

L’Organizzazione Mondiale della Sanità considera la salute orale come parte integrante, non solo dello stato di salute generale, ma anche della qualità della vita di ciascun individuo. In tale ottica, in accordo e con il sostegno del mondo professionale e della comunità scientifica di questo settore, le raccomandazioni cliniche in odontostomatologia contenute nel presente volume forniscono indicazioni e definiscono standard di intervento per la prevenzione e la cura delle più comuni patologie del cavo orale nonché per l’identificazione di percorsi terapeutici appropriati a supporto degli operatori pubblici e privati. Esse costituiscono, inoltre, uno strumento utile per mantenere alto il livello di qualità delle cure in questo periodo storico, nel quale, se da un lato crescono le opportunità tecniche di cura e la potenziale domanda delle stesse, dall’altro la riduzione delle risorse economiche a disposizione dei cittadini tende a limitare l’accesso all’offerta professionale privata e, al contempo, i processi di razionalizzazione dell’allocazione dei fondi nel SSN rendono più difficile l’accesso alle strutture pubbliche. L’individuazione di raccomandazioni cliniche chiaramente definite e rese pubbliche può facilitare la condivisione degli obiettivi e dei percorsi terapeutici tra odontoiatra e paziente, migliorare la comunicazione e, in ultima analisi, accrescere la fiducia sia nei riguardi del proprio specifico professionista che del “sistema delle cure” più in generale. La revisione delle “Raccomandazioni cliniche in odontostomatologia” si è resa necessaria in considerazione del cambiamento dell’evidenza scientifica, dell’immissione in commercio di nuovi materiali e dell’utilizzo di nuove tecnologie, specie in ambito protesico. Come per la precedente, alla realizzazione di questa edizione ha contribuito un ampio gruppo di docenti ed esperti delle singole branche odontoiatriche insieme alle più importanti e rappresentative Associazioni professionali e ai componenti della Commissione Albo Odontoiatri (CAO) nazionale.

BACKGROUND: It has been demonstrated that vitamin D exerts several functions other than those implied in the bone homeostasis. It has been published the vitamin D can act on many cells and tissues behaving also as a modulatory factor in the immune responses. The aim of our study was to evaluate the effect of active vitamin D3 (VD) on the expression of pro-inflammatory and anti-inflammatory cytokines (IL-6, IL-8, IL-10 and IL-12) in human gingival fibroblasts (hGF) and human periodontal ligament cells (hPDLc) triggered by Porphyromonas gingivalis and Streptococcus pyogenes. METHODS: Primary hGF and hPDLc pretreated or not by VD (10-8 mol/L) were exposed to P. gingivalis and S. pyogenes for 24 h. Production of IL-6, IL-8, IL-10 and IL-12 was evaluated by immunoenzymatic assay. mRNA of the same cytokines were evaluated by PCR. RESULTS: IL-6 secretion increased by 25.2% (±2.1) up to 51% (±3.3) in VD treated hGF and hPDLc exposed to P. gingivalis and S. pyogenes, compared to VD not treated cells. IL-8 secretion decreased approximately by 30% in VD-treated hGF and hPDLc compared to VD not-treated cells. IL-12 secretion decreased by 60%. On the contrary, anti-inflammatory cytokine IL-10 increased by approximately 200%. mRNA PCR confirmed these results. CONCLUSIONS: Within the limits of the study, the obtained results support the hypothesis of a modulatory role of VD on periodontal cells exposed to bacterial infection, reducing their inflammatory response and increasing the secretion of anti-inflammatory and modulatory cytokines. Consequently, it could be speculated that vitamin D assessment, and its possible implementation in deficiency cases, could play a role in periodontal treatment. BACKGROUND: It has been demonstrated that vitamin D exerts several functions other than those implied in the bone homeostasis. It has been published the vitamin D can act on many cells and tissues behaving also as a modulatory factor in the immune responses. The aim of our study was to evaluate the effect of active vitamin D3 (VD) on the expression of pro-inflammatory and anti-inflammatory cytokines (IL-6, IL-8, IL-10 and IL-12) in human gingival fibroblasts (hGF) and human periodontal ligament cells (hPDLc) triggered by Porphyromonas gingivalis and Streptococcus pyogenes. METHODS: Primary hGF and hPDLc pretreated or not by VD (10-8 mol/L) were exposed to P. gingivalis and S. pyogenes for 24 h. Production of IL-6, IL-8, IL-10 and IL-12 was evaluated by immunoenzymatic assay. mRNA of the same cytokines were evaluated by PCR. RESULTS: IL-6 secretion increased by 25.2% (±2.1) up to 51% (±3.3) in VD treated hGF and hPDLc exposed to P. gingivalis and S. pyogenes, compared to VD not treated cells. IL-8 secretion decreased approximately by 30% in VD-treated hGF and hPDLc compared to VD not-treated cells. IL-12 secretion decreased by 60%. On the contrary, anti-inflammatory cytokine IL-10 increased by approximately 200%. mRNA PCR confirmed these results. CONCLUSIONS: Within the limits of the study, the obtained results support the hypothesis of a modulatory role of VD on periodontal cells exposed to bacterial infection, reducing their inflammatory response and increasing the secretion of anti-inflammatory and modulatory cytokines. Consequently, it could be speculated that vitamin D assessment, and its possible implementation in deficiency cases, could play a role in periodontal treatment.

Direct laser metal forming (DLMF) and mildly acid-etching (MA) are currently used to produce roughened titanium implant surfaces with the aim to promote osseointegration. However, their effect on bacterial colonization and peri-implant disease occurrence has been poorly investigated. Aim of the work is to study the influence of DLMF and MA surfaces characteristics on bacterial adhesion in vitro and biofilm formation in situ compared to turned (T) control surfaces. T, MA and DLMF grade 5 titanium, in form of 6 × 1 mm disks, were characterized by scanning electronic microscopy and 3D-profilometry. Average roughness (Sa), density of tops (Sds) and developed surface (Sdr) were measured. Cultures of Streptococcus sanguinis were seeded on disks for 2 and 6 h, adherent bacteria were quantified by counting of colony forming units (CFU). Samples were exposed to the oral environment for 12 h; then, the biofilm was disrupted and bacteria were quantified. Intergroup differences were analyzed by Kruskal–Wallis rank analysis of variance α = 0.05. Significantly (p < 0.005 at least) different roughness values were found for DLMF vs MA, DLMF vs T and, to a less extent, MA vs T surfaces. Significantly (p < 0.01 at least) higher CFU counts were found for DLMF vs MA, DLMF vs T, and, to a less extent, for MA vs T surfaces, both in vitro and, even more, in situ. Bacterial adhesion to implant surfaces is significantly correlated to the measured roughness parameters. MA and DLMF are more prone to bacterial colonization than T surfaces. Direct laser metal forming (DLMF) and mildly acid-etching (MA) are currently used to produce roughened titanium implant surfaces with the aim to promote osseointegration. However, their effect on bacterial colonization and peri-implant disease occurrence has been poorly investigated. Aim of the work is to study the influence of DLMF and MA surfaces characteristics on bacterial adhesion in vitro and biofilm formation in situ compared to turned (T) control surfaces. T, MA and DLMF grade 5 titanium, in form of 6 × 1 mm disks, were characterized by scanning electronic microscopy and 3D-profilometry. Average roughness (Sa), density of tops (Sds) and developed surface (Sdr) were measured. Cultures of Streptococcus sanguinis were seeded on disks for 2 and 6 h, adherent bacteria were quantified by counting of colony forming units (CFU). Samples were exposed to the oral environment for 12 h; then, the biofilm was disrupted and bacteria were quantified. Intergroup differences were analyzed by Kruskal–Wallis rank analysis of variance α = 0.05. Significantly (p < 0.005 at least) different roughness values were found for DLMF vs MA, DLMF vs T and, to a less extent, MA vs T surfaces. Significantly (p < 0.01 at least) higher CFU counts were found for DLMF vs MA, DLMF vs T, and, to a less extent, for MA vs T surfaces, both in vitro and, even more, in situ. Bacterial adhesion to implant surfaces is significantly correlated to the measured roughness parameters. MA and DLMF are more prone to bacterial colonization than T surfaces.