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The concept of "fibro-osseous lesions" of bone has evolved over the last several years and now includes two mayor entities: the fibrous dysplasia (FD) and the cement-ossifying fibroma (COF). Fibrous dysplasia is considered to be a developmental, tumor-like (hamartomatous), fibro-osseous disease of unknown etiology. There is a maxillary predominance when craniofacial FD occurs in the jaws and the maxillary sinus is commonly involved. Differentiation of OF from FD is important because of differences in treatment and behaviour. This article report a case of 60-year-old female with a history of painless unilateral palatal swelling.

In the last ten years was observed a significant increase of publications about piezoelectric bone surgery. The purpose of this review was to define the state of art and to realize a comparison between piezoelectric devices and manual or rotating traditional techniques, analyzing advantages and disadvantages from a clinical and histological point of view for various dental procedures. The literature review has been carried out using medical databases on line: MEDLINE and COCHRANE LIBRARY. The authors selected 37 publications about dental field and consistent with inclusion criteria established. From the clinical point of view, the analysis of selected publications concerning procedures such as maxillary sinus lift, alveolar ridge expansion, samples of autologous bone, etc, showed surgical trauma reduction, especially towards to soft and nervous tissues, surgical mini-invasiveness, cut precision and selectivity and speed of learning guaranteed by piezoelectric devices compared to traditional ones. Histologically, however, the study of biology and postintervention bone tissue healing showed a lower loss of bone with piezoelectric instruments than with conventional devices, as well as a better healing quality by reducing patient's postsurgery morbidity. The use of piezoelectric devices seems thus to simplify different sinus lift surgical procedures and to allow greater predictability, although some studies reveal that there are not substantial differences in comparison of long-term results between conventional and piezoelectric instruments and also criticize their increase in operation time.

The purpose of this preliminary study was to compare the rate of orthodontic tooth movement into bone regenerate created after mandibular DO with the rate of orthodontic tooth movement in patients in which extraction was performed and followed by traditional orthodontic treatment. The rate of orthodontic tooth movement into bone regenerate created after mandibular DO in 14 Class II subjects (5 males and 9 females, mean age 25.0 +/- 1.1 years) treated with Distraction Osteogenesis appliance was compared with the rate of orthodontic tooth movement in 20 subjects (mean age 19.9 +/- 3.8 years), in which extraction was performed and followed by traditional orthodontic treatment for space closure. Teeth movements (amount and rate) were evaluated by measuring the distance between the distal wing of the canine and the mesial wing of the first premolar bracket with Vernier callipers (Dentaurum). Readings were noted every 2 weeks until space closure was completed. In the present study the mean duration of the Post-distraction orthodontic treatment (orthodontic tooth movements, finishing) was 10 +/- .5 months. The mandibular posterior teeth were moved into the edentulous segment created by distraction using active tieback in 8 +/- 1 months; the average time to complete space closure was 3.34 +/- .94 months in the traditional orthodontic treatment. The average space closure was 4.24 +/- 1.32 mm in the traditional orthodontic treatment and 5.46 +/- 0.35 mm in the patients treated with DO. The mean rate of tooth movement was 1.27 +/- 0.23 mm/month in the in the traditional orthodontic treatment and 0.68 +/- 0.20 mm/month in the in the patients treated with DO (Table I). Unpaired t test showed a significant difference between tooth movement in the study sample and in the control group (p>.05). As suggested by most scientific literature, in our sample, dental movement was started at the end of the latency and consolidation time. However, the amount and rate of space closure in the distraction area were higher than with traditional orthodontic treatment. In conclusion, the purpose of this study was to highlight the need for careful assessment of working time on patients undergoing distraction osteogenesis. Undoubtedly, this approach can be used for treatment of very severe skeletal malocclusions and maxillofacial deformities, but it cannot be considered an alternative to traditional orthodontic surgery to speed up treatment since the process of tooth movement requires its time.

OsteoBiol (R) (OsteoBiol, Tecnoss Dental, Turin, Italy) a cortical collagenated porcine bone is largely employed in oral implant techniques for bone regeneration thanks to its biocompatibility and osteoconductivity To study the mechanism by which cortical porcine bone promotes osteoblast differentiation and bone regeneration, changes in expression level of bone related genes were investigated by real time RT-PCR, in bone marrow derived stem cells and human osteoblasts cultivated with OsteoBiol (R).

Osteoplant, an equine flexible cortical and spongy bone tissue, is a promising material for bone grafting in orthopedic, maxillofacial and dental surgery. Osteoplant is completely resorbable, inducing oteoclast activation and promoting the substitution of the scaffold with new bone. To study how Osteoplant can induce osteoblast differentiation in mesenchymal stem cells, the expression levels of bone related genes and mesenchymal stem cells marker were analyzed, using real time Reverse Transcription-Polymerase Chain Reaction. Osteoplant is an inducer of osteogenesis on human stem cells, as showed by the activation of bone related genes ALPE, SPP1 and RUNX2, and by the down-regulation of the mesenchymal stem cells marker ENG.

Medpor (R) is an alloplastic material largely employed hi craniofacial reconstruction due to its characteristics of biological compatibility, easy morphological adaptability and mantaining it's initial volume after beeing positioned. To better understand how Medpor (R) promotes bone formation we analyzed the expression levels of bone related genes in stem cells isolated from dental pulp after 15 and 30 days of exposure to the biomaterial. To this aim we focused on the expression levels of bone related genes (RUNX2, SP7, ALPL, SPP1, COL1A1, COL3A1 and FOSL1) and mesenchymal stem cells marker (ENG). Our results suggest that Medpor (R) induces osteoblast phenotype expression in human DPSCs as demonstrated by the activation of osteoblast related genes FOSL1, RUNX2 and COL3A1 and the disappearance of the mesenchymal stem cells marker, ENG.

Bacillus subtilis spores displaying the tetanus toxin fragment C (TTFC) on their surface have been previously shown to induce the production of specific IgG and secretory IgA in mice immunized through the oral or nasal route. Aim of this study was to analyze whether these spores were also able to induce cellular immunity, and whether such immune response was dependent on spore germination in the animal gastro-intestinal tract (GIT). We first developed a germination defective strain of B. subtilis unable to produce viable cells inside the mouse GIT. Germination-defective and congenic wild-type spores both expressing TTFC on their surface were then used to orally immunize Balb/C mice. Both types of spores induced spleen and mesenteric lymph nodes cell proliferation as well as production of IFNgamma but not of IL-4 and IL-10 in both districts. Our results indicate that recombinant spores preferentially induce a strong cell-mediated immune response with a Th1 phenotype, independently from their ability to germinate in the GIT.

The aim of this prospective observational study is to assess the efficacy and safety profile of intraarticular Sinovial® Forte 1.6% administered under ultrasound-guidance in a large cohort of patients affected by symptomatic hip osteoarthritis (OA). Patients with symptomatic hip OA referred to our clinic in 2008–2010 received one 4 ml (2 vials) intra-articular injection of Sinovial® Forte 1.6% under ultrasound guidance. Patients were followed-up every 3 months for a total of 6 months and were offered an optional, additional injection at the 3-month follow-up visit if clinically justified. At each visit, pain scores [0–10 Visual Analogue Scale (pain VAS)], Lequesne index scores and NSAID intake were recorded. Adverse events (AEs) were recorded throughout the study. An effect size of 30% and 50% reduction in Lequesne index and Pain VAS scores was evaluated for each patient to ascertain the number of patients achieving partial remission of symptoms and functional impairment by the use of intra-articular hyaluronic acid in hip osteoarthritis. One hundred and fourteen patients completed the 6-month follow-up and received a total of 142 injections. A statistically significant reduction in Lequesne index scores, VAS pain scores and NSAID consumption was observed at all time-points ( p < 0.05). No systemic, severe or even moderate side effects were observed. Only 7 patients reported mild local reaction at the injection site, consisting of mild pain and localized warmth, which resolved spontaneously without any additional medication. This study provides evidence of the efficacy and tolerability of Sinovial® Forte 1.6% in the treatment of patients affected by symptomatic hip OA. Sinovial® Forte may also offer economical benefits, owing to the reduction in NSAID consumption associated with this treatment. The percentage of patients achieving the effect size of 30% and 50% reduction in Lequesne index and pain VAS scores encourages the use of intra-articular hyaluronic acid in patients with hip osteoarthritis.

Bacillus subtilis spores displaying the tetanus toxin fragment C (TTFC) on their surface have been previously shown to induce the production of specific IgG and secretory IgA in mice immunized through the oral or nasal route. Aim of this study was to analyze whether these spores were also able to induce cellular immunity, and whether such immune response was dependent on spore germination in the animal gastro-intestinal tract (GIT). We first developed a germination defective strain of B. subtilis unable to produce viable cells inside the mouse GIT. Germination-defective and congenic wild-type spores both expressing TTFC on their surface were then used to orally immunize Balb/C mice. Both types of spores induced spleen and mesenteric lymph nodes cell proliferation as well as production of IFNgamma but not of IL-4 and IL-10 in both districts. Our results indicate that recombinant spores preferentially induce a strong cell-mediated immune response with a Th1 phenotype, independently from their ability to germinate in the GIT.

Immediate loading in implantology brings various benefits to the patient both esthetical and functional. The aim of this study was to evaluate the efficiency of the Nobel Replace® implant while applying a functionalization implant protocol with fixed prostheses immediately loaded after their placement and to compare the results of this technique with the traditional loading. The study sample consisted of 202 subjects who had 198 delayed-loaded dental implants and 187 immediate-loaded implants. A total of n.385 implants were placed in the study sample. The primary stability was evaluated through the measurement of the insertion torque values. The torque value at 35 N was considered the key factor while choosing whether or not to perform an immediate load procedure. A resonance frequency analysis (RFA) was used for measuring implant stability quotient (ISQ).Throughout the first year 10 implants failed, thus the cumulative success rate of all the implants was 97.04%. Six of the failed implants (3%) were of the immediate load type (placed 1 in the antero-superior, 3 in the postero-superior, and 2 in the postero-inferior area) while the remaining 4 (2.1%) were of the non-immediate load type. The 2-year prosthetic survival rate was equal to 100%. Three of the six immediate load implants that had failed had a torque value slightly above the crucial value (35 N) at the moment of the implantation. Amongst the implants that survived the first year there was no significant statistic difference between the immediate-loaded implants (ISQ 60.95±0.26) and the traditional delayed-loaded implants (ISQ 61.01±0.29). As well as no significant statistical difference was registered in the rate of the marginal bone reabsorption between the immediate-loaded implants (0.46±0.20 mm/1 year) and the traditional delayed-loaded implants (0.50±0.23mm/1year). No implants placed using bone grafting technique failed. These results suggest that the immediate loading protocol implant is to be considered a predictable and safe treatment choice, as long as the implant presents an appropriate primary stability and are strongly stabilized together

BACKGROUND: The aim of this study was to evaluate the accuracy of implant placement using static guided surgery. Two methods of measuring accuracy were compared, the superimposition of CBCTand the non-radiological Superimposition Touch Absolute Precision (S.T.A.P.) method. METHODS: In this prospective clinical study 23 implants were placed with static surgical template using a flapless technique and postextractive procedure. Six months after surgery, a postoperative CBCTwas performed to assess the position of the implants and at the same time dental impressions were taken for the final prosthesis. The plaster models made at this stage have made it possible to obtain the position of the implants inserted using the probe technology. Preoperative and postoperative data were superimposed, deviations in the three dimensions of the space were calculated. The differences between the two measurement methods were assessed. RESULTS: The study showed no statistically significant differences between the two methods of measuring accuracy at the implant platform level, apex, or angles. The average real deviation detected at the implant platform level is 1.16±0.58 mm with CBCT, 1.22±0.55 mm with the S.T.A.P. method; at the apex level is 1.48±0.98 mm with CBCT, 1.47±0.72 mm with the S.T.A.P. method. The average difference between CBCTand S.T.A.P. method for real deviation is 0.06±0.75 mm at the platform level and 0.007±1.24 mm at the apex level. CONCLUSIONS: The present study showed that measuring accuracy by S.T.A.P. method was comparable to that obtained by CBCTsuperimposition.

Solitary central osteomas of the jaw seem to be especially rare lesions; since 1955, only 12 cases have been reported and 4 of these were located in the maxilla. Osteomas are benign osteogenic lesions considered as real tumours but without infiltrative or metastatic potential. Their growth potential is usually limited, but certain rare and large cases of peripheral osteoma are described in literature. Although surgery is recommended, there are no reports of malignant transformation. In this study, we describe successful implant rehabilitation in a patient with a central osteoma of the maxilla with immediate loading in a fresh extraction socket.The report concerns a 33-year-old woman with a compromised deciduous first molar in the left premolar region of the maxilla; an asymptomatic bony expansion of the palatal and vestibular sides of the left canine/premolar/molar area of the maxilla and by radiograph revealed a well-defined radiopaque mass. An immediate non-occlusal loading was performed, and complete loading of the implant was completed five months later.The pathogenesis of these osteomas is unclear. Several authors reported a clear history of traumatic events, but others had no history of previous trauma or contributory medical factors. Since in our case no cancer growth happened over a period of more than four years, we decided to perform an immediate loading procedure during the implant rehabilitation. The outcome was successful.

Implant rehabilitation delivered in accordance with the traditional protocol has proven to be highly predictable and acceptable (1). Nevertheless, the application of immediate loading on post-extraction implants, especially for aesthetic zones, has now considerably increased (2). The aim of this work is to illustrate the immediate loading of implants placed in the aesthetic zone through tapered design fixtures with microgeometry of a high degree of porosity inserted at the same time or 4-8 weeks from dental avulsion (TSA® Advance, Phibo®).A total of 15 implant fixtures of which 8 at an interval of 4-8 weeks from extraction (type 2) and the remaining according to the immediate post-extraction technique (type 1) were positioned. All implants were prosthesized within 24 hours from the placement. Definitive crowns replaced provisional restorations after 20-24 weeks. After 4 and 12 months from implant insertion, the following parameters were assessed: X-ray image, pain, mobility or suppuration, soft tissue condition and aesthetic appearance.Percentage of osseointegration was 93.75%, and 53.5% of the osseointegrated fixtures was type 2. No statistically significant difference between the mean ISQ values for implants of type 1 and 2 both in the post-operative period and after 12 months was evident, indicating that the timing of insertion did not affect the achievement of stability for the implant fixtures tested in our study. Immediate post-extraction implants showed a greater propensity for gingival recession and a peri-implant radiolucency greater than those placed at an interval of 4-8 weeks. The values obtained for the PES/WES and the subjective evaluation of the analyzed sample showed the considerable aesthetic value and the high level of satisfaction guaranteed by the implant technique illustrated.Although well-designed, high quality, randomized clinical trials are still needed as well as the requirement to establish a common, complete, and reproducible index for the evaluation of aesthetic outcome, immediate/early placement and loading of a single TSA® Advance, Phibo® may be considered a valuable and predictable option in terms of implant success as well as hard and soft tissue stability.