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In recent years, the practice of dentistry and periodontology has become complicated by several risk factors, including the treatment of an increasing number of patients with substance use disorder. This review presents an update in the current literature of the impact of illegal drug use on periodontal conditions and their possible effect as risk factors or indicators. The main illegal drugs that may have an impact on periodontal health and conditions are described, including their effect, medical manifestations, risks, and the overall effect on oral health and on the periodontium. Where available, data from epidemiologic studies are analyzed and summarized. The clinical management of periodontal patients using illegal drugs is reported in a comprehensive approach inclusive of the detection of illicit drug users, screening, interviewing and counseling, the referral to treatment, and the dental and periodontal management. With regard to the impact of illegal substance use on periodontal conditions, there is moderate evidence that regular long-term use of cannabis is a risk factor for periodontal disease, manifesting as a loss of periodontal attachment, deep pockets, recessions, and gingival enlargements. Limited evidence also shows that the use of cocaine can cause a series of gingival conditions that mostly presents as chemical induced-traumatic lesions (application of cocaine on the gingiva) or necrotizing ulcerative lesions. There is a scarcity of data regarding the impact of other drug use on periodontal health. There is evidence to suggest that regular long-term use of cannabis is a risk factor for periodontal disease and that the use of cocaine can cause a series of periodontal conditions. The dental treatment of subjects that use illegal substances is becoming more common in the daily clinical practice of periodontists and other dental clinicians. When the clinicians encounter such patients, it is essential to manage their addiction properly taking into consideration the impact of it on comprehensive dental treatment. Further studies and clinical observations are required to obtain sound and definitive information.

Objective Treatment of implants with peri-implantitis is often unsuccessful due to residual microbial biofilm hindering re-osseointegration. The aim of this study was to treat biofilm-grown titanium (Ti) implants with different modalities involving air abrasion (AA) and cold atmospheric plasma (CAP) to compare the effectiveness in surface decontamination and the alteration/preservation of surface topography. Materials and methods Saliva collected from a peri-implantitis patient was used to in vitro develop human biofilm over 35 implants with moderately rough surface. The implants were then mounted onto standardized acrylic blocks simulating peri-implantitis defects and treated with AA (erythritol powder), CAP in a liquid medium, or a combination (COM) of both modalities. The remaining biofilm was measured by crystal violet (CV). Surface features and roughness before and after treatment were assessed by scanning electron microscope (SEM). The data were statistically analyzed using Kruskal-Wallis followed by Tukey’s multiple comparison test. Results In the present peri-implantitis model, the human complex biofilm growth was successful as indicated by the statistical significance between the negative and positive controls. All the treatment groups resulted in a remarkable implant surface decontamination, with values very close to the negative control for AA and COM. Indeed, statistically significant differences in the comparison between the positive control vs. all the treatment groups were found. SEM analysis showed no post-treatment alterations on the implant surface in all the groups. Conclusions Decontamination with AA delivering erythritol with or without CAP in liquid medium demonstrated compelling efficacy in the removal of biofilm from implants. All the tested treatments did not cause qualitative alterations to the Ti surface features. No specific effects of the CAP were observed, although further studies are necessary to assess its potential as monotherapy with different settings or in combination with other decontamination procedures. Clinical relevance CAP is a promising option in the treatment of peri-implantitis because it has potential to improve the elimination of bacterial plaque from implant surfaces, in inaccessible pockets or during open-flap debridement, and should stimulate the process of the re-osseointegration of affected dental implants by not altering surface features and roughness.

The aim of the present study was to assess the decontamination efficacy and titanium surface alterations of erythritol based air abrasion (AA) and cold atmospheric plasma (CAP) targeting a human complex biofilm.Saliva collected from a peri-implantitis patient was used to develop in vitro human biofilm over titanium discs with machined (group A) and moderately rough (group B) surface. The discs were treated with AA, experimental CAP or a combination of both treatments (COM). The amount of biofilm on the discs was measured by crystal violet (CV). Surface features and roughness before and after treatment were assessed by SEM and laser profilometry, respectively. The data were statistically analyzed using Kruskal Wallis followed by Dunn's multiple comparison test after being checked for normality by Shapiro-Wilk test.All the discs in group A performed better to treatments compared to group B. In both groups, CV data showed significantly lower amount of biofilm after AA treatment compared to CAP (p0.05). Cleaning efficacy revealed relevant decontamination of both the surfaces following AA and COM treatments and almost complete biofilm removal after AA application on group A (99.92%). SEM analysis demonstrated no post-treatment alterations on the discs and laser profilometry did not show statistically significant changes in SDecontamination with AA delivering erythritol with or without CAP is highly effective in biofilm removal from different titanium surfaces. All the tested treatments, including CAP showed no noticeable alterations of the titanium discs surface features. Further in vivo studies are necessary to understand the potential of CAP technology in implant surface decontamination.

This research is focused on the screw-structure interaction under dynamic impulses aimed to the contact analysis of gap propagation at dental implant-abutment interface under dynamic loading. The purpose is to investigate the fracture mechanism that occurs during the screw penetration in a support and during the support vibration. Numerical Finite Element (FEM) analyses are calibrated through experimental laboratory measurements on support materials and screws typologies. Uncertainty due to the laboratory error propagation is investigated using Polynomial Chaos Expansion (PCE) of experimental measurements. The research is planned through the following steps: FEM calibration trough laboratory experiments on materials; laboratory experiments and material mechanics identification; uncertainty error propagation analysis through PCE expansion; fragility curves for numerical model calibration; FEM models calibration trough laboratory measurements on cycling loads. Therefore, the main purpose of the research activity, of which this article constitutes a preliminary and an explorative step, is to study a methodology that minimizes the local damage of the dental material due to the generation of micro-cracks following the implantation actions. Accordingly, in this paper, preliminary results are reported.

Fractal analysis is a mathematical method used to describe the internal architecture of complex structures, such as the bone tissue. The aim of this study was to determine whether fractal dimension (FD) is able to distinguish between different bone densities (BD), assessed histomorphometrically, and whether there is a linear dependence between the FD and BD in order to support the use of FD as a supplementary non-invasive method for BD measurement. Microscopic photographs of bone specimens stained with acid fuchsin and toluidine blue obtained during block biopsies from nine segments of bovine ribs were used. A total of 42 regions of interest (ROI) were cut off from the original photo, converted into a bitmap and binarized. The evaluation of FD was carried out using the box counting method. Comparison of FD values in the four different densities bone sites (D1-D4) was made by means of Kruskal-Wallis test followed by Dunn's multiple comparison test. The linear dependence between the two variables (FD and BD) was investigated calculating the Pearson's r test correlation coefficient, which was considered significant when P < .05. The more the bone was compact, the higher were FD values. A strong positive correlation between BD evaluated by histomorphometry and FD (R : 0:9651), p-value < .00001 was found. The increase in the values of the FD strongly correlated with the increase of the percentage of the bone trabeculae observed in the histological slides. This pilot study demonstrates that FD might be able to distinguish different densities in bone sites and that there is a linear correlation between BD and FD on histological samples. Future studies will be addressed at evaluating whether this data can be confirmed on a larger samples size and on radiographic images. This will be useful for the early and non-invasive detection of structural changes in the trabecular bone pattern during healing, inflammatory processes and pathologies associated to bone breakdown.

The aim of this in vitro study was to evaluate the effect of air polishing on the implant abutment surface using different abrasive powders: sodium bicarbonate and amino acid glycine. Fifteen grade III machined surface titanium disks with 8-mm diameter and 2-mm thickness were divided in 3 groups of 5 samples each and subjected to air polishing for 20 seconds with an Ultrajet Flex air-abrasive device and a distinct prophylaxis protocol: air and water (G1); air, water, and sodium bicarbonate (G2); and air, water; and amino acid glycine (G3). After the air polishing, the average roughness (Ra) of the samples was measured using an optical profilometer, and the obtained data were statistically analyzed. We found that G1 and G3 had similar Ra, while Ra values for G2 were significantly higher. This study demonstrated that air-polishing powders containing glycine had less of an effect on the roughness of the surface of titanium disks compared with sodium bicarbonate powders. Future in vivo studies will be conducted to investigate the clinical relevance of the present results.

Background Air abrasion (AA) is one of the decontamination methods that have demonstrated promising results in treating peri-implant diseases. Purpose This systematic review aimed at evaluating the in vitro effect of AA on surface change, cleaning efficacy, and biocompatibility of titanium surfaces and at comparing it with other decontamination methods. Materials and methods A comprehensive search was conducted up to April 2018 using PubMed, Scopus, and Google Scholar databases to identify studies on the decontamination effect of AA. All types of titanium surfaces, abrasive powders, contaminated surfaces, and measuring methods were included. Results Overall, 1502 articles were identified. After screening the titles and abstracts, and carefully reading the full-texts, 48 articles published between 1989 and 2018 were selected. AA was considered almost safe, particularly for the nonmodified surfaces. Nevertheless, harder powders such as sodium bicarbonate tended to damage the surface more than glycine. AA resulted in surface change similar to plastic curettes and Er: YAG lasers. Regarding the cleaning efficacy, there was no significant difference between glycine and sodium bicarbonate, but different mixtures of calcium phosphate, hydroxyapatite, and erythritol were superior to glycine. AA was superior or equal to all other decontamination methods in cleaning. Regarding biocompatibility, AA was more successful in preserving biocompatibility for noncontaminated surfaces compared with contaminated surfaces and when used with erythritol and osteoinductive powders. Conclusions AA can efficiently remove contamination without serious damage to the surface. The main drawback of the AA method seems to be its limitation in restoring the biocompatibility of the surface.

Over the past decade, we witnessed a promising application of cold atmospheric plasma (CAP) in cancer therapy. The aim of this systematic review was to provide an exhaustive state of the art of CAP employed for the treatment of head and neck cancer (HNC), a tumor whose late diagnosis, local recurrence, distant metastases, and treatment failure are the main causes of patients’ death. Specifically, the characteristics and settings of the CAP devices and the in vitro and in vivo treatment protocols were summarized to meet the urgent need for standardization. Its molecular mechanisms of action, as well as the successes and pitfalls of current CAP applications in HNC, were discussed. Finally, the interesting emerging preclinical hypotheses that warrant further clinical investigation have risen. A total of 24 studies were included. Most studies used a plasma jet device (54.2%). Argon resulted as the mostly employed working gas (33.32%). Direct and indirect plasma application was reported in 87.5% and 20.8% of studies, respectively. In vitro investigations were 79.17%, most of them concerned with direct treatment (78.94%). Only eight (33.32%) in vivo studies were found; three were conducted in mice, and five on human beings. CAP showed pro-apoptotic effects more efficiently in tumor cells than in normal cells by altering redox balance in a way that oxidative distress leads to cell death. In preclinical studies, it exhibited efficacy and tolerability. Results from this systematic review pointed out the current limitations of translational application of CAP in the urge of standardization of the current protocols while highlighting promising effects as supporting treatment in HNC.

Simple Summary Head and neck cancer (HNC) is a complex and extremely heterogeneous disease that includes a wide variety of cancer subtypes. Despite notable advances in understanding the molecular mechanisms involved in the disease, which allowed the increase of the therapeutic armamentarium, HNC treatment remains very challenging. In fact, to date the average 5-year survival rate for this disease is around 65%; hence, HNC continues to be one of the most aggressive solid tumors. Surgical removal is the first treatment of choice for HCN; however, in addition to this treatment modality, a broad spectrum of new therapies has been developed so far, ranging from multimodal chemotherapy to targeted and immune-therapy, mainly through the use of antibodies. In this work, we systematically reviewed the progress obtained in antibody-drug conjugate (ADC) development for the treatment of HNC. Abstract Background: Antibody-drug conjugates (ADCs) are designed to deliver potent cytotoxic agents into tumor tissues. During the last two decades, a plethora of ADCs have been successfully developed and used for several indications, including hematologic and solid tumors. In this work, we systematically reviewed the progress in ADC development for the treatment of HNC. Methods: This review was registered in PROSPERO database. A comprehensive search was conducted following PRISMA guidelines and using PubMed, Scopus and Web of Science database. Results: In total, 19 studies were included. Due to the significant heterogeneity of the outcome measures, meta-analysis was not performed, and data were summarized in tables. HNC results are poorly represented in the cohorts of completed clinical trials; published data are mostly focused on safety evaluation rather than efficacy of ADCs. Conclusions: Although several novel agents against a wide range of different antigens were investigated, showing promising results at a preclinical level, most of the targets reported in this review are not specific for HNC; hence, the development of ADCs tailored for the HNC phenotype could open up new therapeutic perspectives. Moreover, the results from the present systematic review call attention to how limited is the application of current clinical trials in HNC.

To investigate the effect of laser microtextured collars or laser microtextured abutments on clinical measures that may relate to improved implant success and survival.This review was registered on the PROSPERO database and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. MEDLINE (via PubMed) and Embase were screened for studies with at least 10 participants and followed up for at least 1 year, reporting on the following clinical outcomes: radiographic marginal bone level, peri-implant probing depth, soft tissue index and failure rates of implants with laser microtextured collars or laser microtextured abutments. The quality of the studies was assessed using the Cochrane risk-of-bias tool or the Newcastle-Ottawa scale.After removal of duplicates, 86 articles were identified. A total of 25 articles were included after screening. Four were randomised controlled trials, two were non-randomised controlled trials, two were prospective studies, five were retrospective cohort studies and twelve had no control group. Most comparative studies reported that laser microtextured collar implants had less marginal bone loss and shallower peri-implant probing depth than machined collar implants. Only two studies had controls other than machined collar implants; in these, the use of laser microtextured collar implants was not observed to be significantly different. Three studies reported reduced marginal recession in laser microtextured collar implants when compared to machined collar controls. No difference in failure rate was observed between laser microtextured collar and machined collar implants. One study reported on peri-implant diseases and favoured laser microtextured collar implants. Three papers reported using laser microtextured abutments with no control, but no specific conclusions could be drawn.Laser microtextured collar implants appear to reduce marginal bone loss and peri-implant probing depth when compared to machined collar implants. There is weak evidence to suggest that laser microtextured collar implants may also improve aesthetic outcomes and reduce incidence of disease. Research is required regarding laser microtextured abutments, and studies comparing laser microtexturing with alternative solutions are also lacking.

Objectives The aim of the present study was to investigate whether peri-implant clinical parameters (modified plaque index (mPI), bleeding and/or suppuration on probing (B/SOP)) and local factors (type of prostheses, screw emergence, platform diameter, and abutment angulation) might contribute to the development of additional bone loss and peri-implantitis around dental implants. Materials and methods Two hundred seventy-seven external hex connection implants placed in the posterior maxilla of 124 patients were retrospectively evaluated. They were divided into two groups: physiologic bone loss < 2 mm (PBL) or additional bone loss ≥ 2 mm (ABL). GEE logistic regression was applied to evaluate the influence of type of prostheses (implant-supported single crown (ISSC), fixed partial denture (ISFPD), and full denture (ISFD)) and clinical parameters (mPI and S/BOP) on bone loss. Results Among the 277 implants, 159 (57.4%) presented PBL and 118 (42.6%) presented ABL. Within the ABL group, 20.6% implants were diagnosed with peri-implantitis. mPI significantly correlated with the type of prosthesis and the highest value of mPI (index = 3) was observed in ISFD (23.8%). Moreover, peri-implantitis was more frequently associated with ISFD (32.79%) than ISSC and ISFDP (13.79% and 13.48, respectively) Conclusions ISFD in the posterior maxilla presented high rates of ABL and showed a higher prevalence of peri-implantitis. None of the local factors seemed to contribute to the development of these conditions. Further investigations are needed to prospectively support the results of the present study. Clinical relevance Patients rehabilitated with ISFD should be carefully monitored and have more frequent maintenance visits to prevent or control peri-implant bone loss.

Fractal dimension (FD) calculated on oral radiographs has been proposed as a useful tool to screen for osteoporosis. This systematic review and meta-analysis firstly aimed at assessing the reliability of FD measures in distinguishing osteoporotic patients (OP) from healthy controls (HC), and secondly, to identify a standardized procedure of FD calculation in dental radiographs for the possible use as a surrogate measure of osteoporosis. A comprehensive search was conducted up to September 2020 using PubMed, Web of Science, and SCOPUS databases. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was followed. Meta-analysis was performed on FD values calculated for HC and OP. Overall, 293 articles were identified. After a three steps screening, 19 studies were included in the qualitative appraisal and 12 were considered for meta-analysis. The methodological quality of the retrieved studies was generally low. Most of the studies included used White and Rudolph and box counting to process the images and to calculate FD, respectively. Overall, 51% of the studies found a meaningful difference between HC and OP groups. Meta-analyses showed that to date, FD measures on dental radiographs are not able to distinguish the OP from HC group significantly. From the current evidence, the use of FD for the identification of OP is not reliable, and no clear conclusion can be drawn due to the heterogeneity of studies. The present review revealed the need for further studies and provided the fundamentals to design them in order to find a standardized procedure for FD calculation (regions for FD assessment; images processing technique; methods for FD measurement). More effort should be made to identify osteoporosis using dental images which are cheap and routinely taken during periodic dental examinations. Supplementary Information The online version contains supplementary material available at 10.1007/s00198-021-05852-3.

In recent years, cold atmospheric plasma (CAP) technologies have received increasing attention in the field of biomedical applications. The aim of this article is to review the currently available literature to provide an overview of the scientific principles of CAP application, its features, functions, and its applications in systemic and oral diseases, with a specific focus on its potential in implantology. In this narrative review, PubMed, Medline, and Scopus databases were searched using key words like “cold atmospheric plasma”, “argon plasma”, “helium plasma”, “air plasma”, “dental implants”, “implantology”, “peri-implantitis”, “decontamination”. In vitro studies demonstrated CAP’s potential to enhance surface colonization and osteoblast activity and to accelerate mineralization, as well as to determine a clean surface with cell growth comparable to the sterile control on both titanium and zirconia surfaces. The effect of CAP on biofilm removal was revealed in comparative studies to the currently available decontamination modalities (laser, air abrasion, and chlorhexidine). The combination of mechanical treatments and CAP resulted in synergistic antimicrobial effects and surface improvement, indicating that it may play a central role in surface “rejuvenation” and offer a novel approach for the treatment of peri-implantitis. It is noteworthy that the CAP conditioning of implant surfaces leads to an improvement in osseointegration in in vivo animal studies. To the best of our knowledge, this is the first review of the literature providing a summary of the current state of the art of this emerging field in implantology and it could represent a point of reference for basic researchers and clinicians interested in approaching and testing new technologies.

Agenesis of lateral incisors, besides the functional issues, represents a great esthetic drawback. The selection of an appropriate treatment is a complex decision, which should consider the stability of the clinical outcomes over time. The aim of the present study was a histological and clinical comparison of two-stage split crest technique (SCT), with bone chips alone or mixed with porcine bone in patients affected by unilateral and bilateral agenesis of the upper lateral incisors. Eleven patients were enrolled, and randomly assigned to receive a treatment with autologous bone chips (group 1) or autologous bone chips mixed 1:1 to porcine-derived xenogenic bone (group 2). After a 2-month healing period, implants were placed and biopsies harvested for histomorphometrical evaluation. Clinical assessment, according to ICOI PISA health scale, and radiographic marginal bone loss evaluation at 12- and 24-month follow-ups were conducted. The histomorphometry showed significantly greater new bone formation (p > 0.0229) in group 2. At 12- and 24-month follow-ups, all the evaluated implants, regardless of the group they were allocated, could be categorized as “success” in the ICOI Pisa Health Scale for Dental Implants, and did not show significant difference in crestal bone loss. To the best of our knowledge, these are the first histological and clinical outcomes indicating that the use of bone chips mixed 1:1 to porcine bone in SCT could be a promising technique for the rehabilitation of patients with agenesis of the upper lateral incisors, although studies with a larger number of patients and implants, and a longer follow up are needed.

Recently, it has been reported that heterologous biomaterials, where the collagen matrix is preserved, seem to facilitate blood clotting and the subsequent invasion of repairing and regenerative cells. This study aimed at evaluating the healing of human extraction sockets grafted with a collagenated cortico-cancellous porcine bone (mp3®, OsteoBiol®, Tecnoss®, Giaveno, Italy) by synchrotron radiation X-ray microtomography (microCT) and histology in order to have a 3D quantitative characterization over time. Ridge preservation with porcine bone and collagen membrane was performed on 21 patients using a flapless approach and a secondary soft tissue closure. At the time of implant placement, six bone samples were harvested, two in the 3-month group, two in the 6-month group, one in the 12-month group post-surgery, and one spontaneously healed control, and evaluated by microCT and histology. MicroCT revealed that in the grafted sites there were a greater number of trabeculae, although they appeared thinner than in the control sites; these trabeculae homogenously filled the defects, suggesting an improved strength of the socket. Histology showed that over time, the amount of biomaterial decreased and the newly formed bone increased, while less dense bone with wider marrow spaces was detected in the control sample, supporting synchrotron findings. The morphometric data converge to indicate the suitability of porcine bone for the preservation of post-extraction sockets. The use of mp3 is encouraged to preserve and heal sockets.

To review the literature on the effects of non-surgical periodontal treatment on surrogate markers of cardiovascular diseases (CVDs) and to clarify the impact of periodontal disease on systemic inflammation.PRISMA guidelines for systematic reviews and meta-analyses have been adopted. An electronic search in PubMed up to December 2018 was performed using the following search terms and keywords alone or in combination: non surgical periodontal therapy, atherosclerotic vascular disease (AVD), operative surgical procedures, CVD, IL-6, CRP, cholesterol, LDL, oxidized low density lipoprotein, HDL, endothelial dysfunction, dependent dilatation, carotid intima media thickness, periodontitis, tunica intima.The electronic search resulted in the inclusion of 28 articles that were grouped and discussed based on the investigated surrogate markers. Meta-analysis was not carried out due to the heterogeneity of the results. The included studies demonstrated that periodontal treatments contribute to the resolution of oral inflammation and in turn might positively modulate the levels of systemic inflammatory markers. The initial phase of periodontal therapy has a positive impact on the short-term reduction of a series of systemic markers that are considered as surrogate markers of AVD.The non-surgical therapy of periodontal disease would positively reduce the levels of systemic inflammation markers, decreasing the vascular risk and the possibility of developing CVD or the subclinical progression of the disease.

Objectives The primary aim of the present article was to review the effect and the clinical significance of abutment dis- and reconnection on the peri-implant marginal bone levels. Materials and methods English articles published from 2009 to April 2019 were identified on the MEDLINE, Cochrane Library, and PubMed databases, according to the PRISMA guidelines. Comparative in vivo studies on humans were included. Results A total of 4 studies with different levels of bias were included in this review. A significant heterogeneity of the reported data was observed, which limited the comparison of the findings. The only parameter that was homogenous throughout all 4 studies was the marginal bone level measurement. Conclusion Within the limitations of the present review, it can be suggested that minimizing the number of abutment dis- and reconnections would be beneficial to ensure minimal disruption to the peri-implant tissue and marginal bone level. However, the clinical significance of the marginal bone level changes is still inconclusive.

During insertion of dental implants, measurement of dynamic parameters such as the torque-depth curve integral or insertion energy might convey more information about primary stability than traditional static parameters such as the insertion or removal torque. However, the relationship between these dynamic parameters, bone density, and implant geometry is not well understood. The aim of this investigation was to compare static and dynamic implant stability measurements concerning three different implant designs when implants were inserted into bovine bone ribs and dynamic parameters were collected using an instantaneous torque measuring implant motor. Standard implant osteotomies were created in segments of bovine ribs. After measuring the bone density using the implant motor, 10 cylindrical, 10 hybrid tapered-cylindrical, and 10 modified cylindrical implants were placed, and their primary stability was assessed by measuring the torque&ndash, depth curve integral, along with insertion and removal torque. The relationship between these quantities, bone density, and implant geometry was investigated by means of regression and covariance analysis. The regression lines describing the relationship between the torque&ndash, depth integral and bone density differed significantly from those describing the relationship between insertion torque, removal torque, and bone density for all three designs. The torque&ndash, depth curve integral provides different information about immediate primary stability than insertion and removal torque and in certain clinical conditions might be more reliable than these static parameters for assessing implant primary stability. Further research should be carried out to investigate the findings of the present study.

The aim of the present study was to review the effectiveness, side effects, and patient acceptance of different concentrations and formulation of chlorhexidine-based mouthwashes used after periodontal and implant surgery.The PRISMA guideline was adopted in the search strategy using electronic databases PubMed and MEDLINE to identify randomized and case-control prospective studies on humans written in English language and published up to September 2017.A total of 10 articles were selected for a total of 344 patients. Because of the significant heterogeneity of the outcome measures, meta-analysis was not performed, and the data were summarized in a table. A positive relationship between the use of chlorhexidine and reduction of plaque was found, demonstrating the effectiveness of the substance in terms of antisepsis and decrease of inflammation after periodontal and implant surgery.Chlorhexidine is recognized as the primary agent for plaque control and the gold standard in preventing infection, although the presence of largely known side effects would affect patient compliance. Future research should be directed at finding chlorhexidine formulation with negligible adverse effects, without compromising or even increasing its effectiveness as the antiseptics and antiplaque agent.

Background The aim of this study was to compare different surgical therapies to treat peri-implantitis. Methods Twenty-three patients presenting one implant affected by peri-implantitis were divided into three groups: (i) open flap debridement (OFD) and citric acid decontamination (CAD); (ii) OFD, CAD and subepithelial connective tissue graft (SCTG); (iii) OFD, CAD and implantoplasty. Modified plaque index (MPI), gingival bleeding index (GBI), keratinized mucosa (KM) width, probing depth (PD), bleeding or suppuration on probing (B/SOP), and radiographic crestal bone level were registered 1(T1), 2(T2) and 3(T3) years after treatment. Results In Group 1 there was a significant improvement in MPI from baseline to T1, and a significant reduction in PD over time. In Group 2, none of the assessed clinical parameters showed any statistically significant variation over time. In Group 3, there was a significant decrease in PD and B/SOP over time. When comparing the 3 Groups, KM was significanlty greater in Group 2 vs. Group 1 and Group 3 at T1 and T2, and in Group 2 vs. Group 3 at T3. Conclusion All therapies were successful in the management of peri-implantitis; however, SCTG maintained the greatest KM width. Surgical therapies combined with mechanical and chemical decontamination contributed to peri-implant tissue health.

The only way to evaluate the short- and long-term response of human bone tissue to the insertion of dental implants and to corroborate the results of in vitro and of animal experimental studies is to study well-integrated human-retrieved dental implants, with surrounding human bone tissue, possibly after different time periods after the insertion in the bone. Several papers report that moderately rough implant surfaces are, probably, the best in terms of mineralized tissues response at the bone-implant interface. Results from our Laboratory, in a span of 30 years, have found that immediate loading did not create adverse effects regarding the formation of mineralized tissues at the interface with dental implants and has, probably, a beneficial effect on the peri-implant bone response, producing changes in the peri-implant bone microstructure. Osseointegration is a very dynamic ongoing process with the peri-implant bone tending to become more organized over the years; these higher degrees of organization are reflected by the large quantity of remodeling areas in the mature, lamellar bone, indication of multiple remodeling cycles over the years of loading. Bone remodeling is a prerequisite for dental implants to support functional loading in the long term, and remodeling, very well-organized, mineralized, lamellar bone is found at the interface of retrieved implants even after three decades of loading. Bone-implant contact (BIC) and bone mechanical properties were found to increase over time, and the bone tissue adapted to loading conditions to increase its biomechanics. In the specimens evaluated in our Laboratory, high percentages of bone-implant contact was found in all well-integrated retrieved implants, with the presence of mineralized, mature, lamellar bone in close contact with the metal surface, around all the implant perimeter, with no epithelium migration downward or presence of fibrous, connective tissue. In the specimens evaluated in our Laboratory over several decades, the bone-implant contact percentage was found to vary from 32 to 37% to more than 90–95%. These results point to the fact that dental implants could function with different percentages of mineralized tissues at the interface, and even implants with a low bone-implant contact percentage were stable, well-integrated, and able to bear loading conditions over the years. Mineralized bone was absent at the base of the threads in unloaded implants, and, at the tip of the threads in loaded implants, osteocytes (the mechanosensors in bone) were always found in the peri-implant bone, with a significantly higher number in loaded implants than in unloaded implants. Loaded implants presented a significantly higher number and thickness of bone trabeculae.

Minimising marginal bone loss around dental implants is of paramount importance. The success of methods such as platform switching (PS) and laser-micro-texturing (LM) are well documented. Whether or not a combination of these designs will further improve outcomes has not been studied previously. Hence, this prospective, randomized controlled single-centre pilot study compared the clinical and microbiological outcomes of implants with both PS and LM (test) to implants with only LM (control). A test and control implant were placed in thirteen patients totalling 26 implants. The primary investigated outcome was marginal bone level (MBL), secondary outcomes were peri-implant probing depths (PPD), bleeding on probing (BOP) and marginal tissue height (MTH). Additionally, the presence of five putative periodontal pathogens were assessed using real-time polymerized chain reaction. At 12 months the overall implant survival rate was 95.8%. MBL change was not found to be different between test and control at any time points, but a significant change was detected within the test implants at 6 months compared to baseline (p = 0.006). No differences were found in the secondary outcomes. Average PPD at 12 months was 2.68 ± 0.73 mm and 2.30 ± 0.46 mm and average change in MTH was 0.05 ± 0.72 mm and −0.24 ± 0.59 mm at tests and controls. No differences were reported in BOP frequency. Total periodontal pathogens count revealed no significant difference among control, test implants and adjacent tooth sites. Within the limitations of this study, it can be concluded that the addition of PS to LM implants does not significantly alter either short-term clinical outcomes or the vulnerability to pathogenic microflora colonization.

Objective: A wide range of surgical techniques are available for maxillary sinus augmentation. This review aimed to determine which techniques have achieved the highest success rates and so offer the greatest predictability. Materials and methods: A systematic literature review was performed using the PubMed, MEDLINE, and Scopus databases, identifying clinical trials that assessed different surgical techniques for maxillary sinus augmentation, and registered the success rates of subsequent implant placement. Results: A total of 40 articles described clinical studies involving different maxillary sinus augmentation procedures with follow-up periods of at least 6 months after dental implant placement. Implant success rates varied between 94% and 100% during the follow-up periods. Conclusion: A wide variety of clinical techniques are available for maxillary sinus augmentation; the choice of the technique will depend chiefly on the characteristics of the edentulous site, which will permit or prevent the placement of the implant at the moment of sinus augmentation surgery. Sin financiación 1.107 JCR Q3, 67/790 Dentistry, Oral Surgery & Medicine UEM

Graphene oxide (GO) demonstrated to improve the wound healing properties of materials intended for bone replacement. The main objective of this study was the setting up of a simple and effective procedure for the production of GO-coated porcine bone (PB) granules and the characterization of the obtained material in order to improve its properties by exploiting chemical, physical, biological and mechanical features that the GO coating could confer to pre-formed PB granules. The obtained coating was homogeneously distributed on PB granule surface and demonstrated to confer PB an increased resistance to fracture load. Biological analyses evidenced no toxic effects of GO-coated PB samples on primary human gingival fibroblasts, and no inflammatory response around the grafted particles when implanted in vivo on a sheep model although GO-coated PB samples did not appear to improve new bone formation efficacy compared with the control within the investigated time. A small loss of GO was however detected, indicating the opportunity to investigate less GO concentrated samples. In conclusion, this study presents a novel and low cost approach to the development of functionalized biomimetic hybrid materials which can be applied to other bone substitute materials in order to improve their performances.

This study aimed at a histologic and histomorphometric analysis of the periimplant tissues and bone-titanium interface reactions in successfully osseointegrated, clinically stable, and immobile human titanium dental implants retrieved after a long loading period.In the last 30 months (2013-2015), 21 implants, retrieved from individuals for different causes after a loading period ranging from 4 to 20 years, were sent to the Implant Retrieval Center, University of Chieti-Pescara, Italy. In 4 cases, almost all the bone had been lost during the retrieval, whereas in the remaining 17 cases, mineralized bone was still present.Around the majority of the implants, mature compact bone with few marrow spaces was found. The trabecular bone, constituted by a few thin bone trabeculae, was in a periimplant location around only a few implants. A high percentage of bone-implant contact (BIC) (comprised between 32 ± 4.1% and 83 ± 2.9%) was present. In almost all implants, the space within the threads was almost completely filled by compact lamellar bone or by a thin layer of bone. Close and tight contact between bone and implant surface was observed in all specimens with no gaps or connective tissue at the interface.All implants appeared to be well integrated in the surrounding mineralized bone, and all of them showed adequate bone-to-implant contact percentages.

OBJECTIVE To histologically evaluate hard and soft tissues adaptation at screw-shaped devices installed at recipient sites in the distal segments of the alveolar edentulous ridge prepared with a buccal bone width of 1 or 2 mm. MATERIAL AND METHODS Sixteen volunteers received 2 nonsubmerged titanium implants each; after 3 months, biopsies were obtained and processed for histology. The distances between implant shoulder (IS), top of the bony crest (C), coronal level of osseointegration (B), peri-implant mucosa (PM), and apical extension of the junctional epithelium (aJE) were measured. RESULTS There were no significant statistically differences between test and control sites regarding IS-C, IS-B, PM-IS, PM-B, PM-aJE, aJE-B measurements. The horizontal bone resorption 1 mm below IS was 0.3 ± 0.3 and 1.0 ± 0.7 mm at the test and control sites, respectively. This difference was statistically significant. CONCLUSIONS Similar hard and soft tissues dimensions were observed in both groups. However, a higher horizontal bone resorption was seen at the control sites. Nonsubmerged implant installation should be performed when a 1 mm buccal bony crest width is present so as to limit the horizontal bone resorption.

The aim of the present study was a histologic and histomorphometric analysis of the peri-implant tissue reactions and of the bone-titanium interface in successfully osseointegrated, clinically stable, and immobile retrieved titanium dental implants after a long loading period. Four successfully osseointegrated and stable implants with a sandblasted surface were retrieved from a patient due to fracture, two after 14 years of loading and two after 17 years. None of these implants has been previously reported. Mature, compact bone with a few marrow spaces was observed around all four implants. At low magnification, a high percentage of bone-implant contact (BIC) was present at the interface of almost all implants. BIC percentage for the four implants was 83%, 66%, 74%, and 65%. In almost all the implants, the space within the threads was almost completely filled by compact bone. Close, tight contact between bone and implant surface was observed in all specimens, and no gaps or fibrous connective tissue was found at the bone-implant interface. All implants appeared to be well integrated in the surrounding mineralized bone, and all showed adequate BIC percentages after a long loading history.

Background The aim of this study was to investigate for the first time the histological response of human periodontium to mineral trioxide aggregate (MTA) and Biodentine. Methods Six patients scheduled for implant full-arch rehabilitation were randomly assigned to one of the two test groups: MTA or Biodentine treatment. For each patient, two teeth scheduled for strategic extraction were randomly assigned either to the test or to the control treatment. A lateral perforation was drilled on the root and either repaired with MTA/Biodentine or filled with gutta-percha(control). Three months later, the teeth were extracted along with the coronal third of the alveolar bone and a portion of gingival tissue, while performing implant placement, and processed for histological analysis. Results Biodentine resulted in less extrusion into the periodontal environment. All the materials showed good biocompatibility. A new mineralized cementum-like tissue incorporating periodontal fibres was visible in all cases treated with MTA. A small amount of new mineralized tissue was found in two Biodentine cases but not in control cases. Biodentine resulted in less damage to the periodontal ligament. Conclusions Bioactivity and biocompatibility of MTA were confirmed in human models. Biodentine proved to be biocompatible, but it seems not to induce cementum regeneration.

OBJECTIVES The purpose of this study was to evaluate the peri-implant bone tissue level on postextractive resorbable calcium phosphate coated single implants placed in premaxillary sites grafted with autologous bone, anorganic bovine bone (ABB), platelet-rich plasma (PRP), and keratinized epithelial connective graft over 12 years. MATERIALS AND METHODS A total of 27 patients received a postextractive single implant in premaxillary sites grafted with ABB and PRP. Two months later, a keratinized epithelial connective graft was applied and the implants loaded. Clinical and radiographical evaluations were performed at baseline, 6 and 18 months, 4 and 6 years after the implant insertion, and then every 2 years up to the 12th year. RESULTS After 12 years, a total of 22 implants (81.48%), were available for the final data analysis; the implants achieved a 100% cumulative survival rate, and only a mild degree of periodontal tissue inflammation was recorded. The radiographic evaluation revealed a physiological marginal bone remodeling over the follow-up. CONCLUSION Although a good preservation of the residual bone tissue in postextraction implant sites treated with keratinized epithelial connective tissue grafts was observed, the low number of treated cases does not allow us to propose this experimental protocol to all cases of bone defects but it certainly represents a new option. Further studies on a greater number of patients and using implants with different surface characteristics should be conducted for a better understanding of the indications of the proposed treatment.

Purpose Different results have been reported on the internal colonization of Cone Morse connections under in vitro dynamic loading. The aim of the present in vitro study was to evaluate the bacterial leakage in Cone Morse implant-abutment connections, both under loaded and unloaded conditions. Methods A total of 20 implants with a Cone Morse taper internal connection were used in this study. Ten were loaded under a special testing equipment (Test Group), while 10 were left unloaded (Control Group). The inner part of all implants was inoculated with 0.1 μl of a viable Enterococcus faecalis suspension. A force of 120 N was applied to the loaded implants, for a total of 500,000 cycles at 1 Hz. All the samples were checked daily, for a total of 14 days, and presence or absence of turbidity recorded. Results In the unloaded assemblies, bacterial contamination was found in 2 out of 10 implant-abutment junctions, on the 12th and 13th days. In the loaded implant-abutment connections, bacterial contamination was found in 2 out of 10 implant-abutment assemblies, on the 13th and on the 14th days. Conclusions The resistance of the Cone Morse implant-abutment junction reported in the literature and confirmed in the present study, where no differences in the percentages of microbial leakage were found in assemblies unloaded and in those subjected to a dynamic loading procedure, could help to explain the histological results in man of a lack of peri-crestal bone resorption in Cone Morse implants, placed below the level of the alveolar crest.

Objective In the present study, a new healing cap that could generate a pulsed electromagnetic field (PEMF) around titanium implants to stimulate peri-implant osteogenesis was tested in the rabbit model. Materials and methods A total of 22 implants were inserted in the proximal tibial metaphysis of 22 rabbits. A healing cap containing the active device was inserted in half of the implants (11 test implants); an “empty” healing cap was inserted in the other ones (11 control implants). The animals were euthanized after 2 and 4 weeks, and the samples were processed for micro-computed tomography and histology. The peri-implant volume was divided into coronal (where the PEMF was the strongest) and apical regions. Results Most of the effects of the tested device were confined to the coronal region. Two weeks post-implantation, test implants showed a significant 56% higher trabecular bone fraction (BV/TV), associated with enhanced trabecular number (Tb.N, +37%) and connectivity density (Conn.D, +73%) as compared to the control group; at 4 weeks, the PEMF induced a 69% increase in BV/TV and 34% increase of Tb.N. There was no difference in the trabecular thickness (Tb.Th) at either time point. Furthermore, we observed a 48% higher bone-to-implant contact (BIC) in the test implants vs. controls after 2 weeks; this increase tended to remain stable until the fourth week. Mature trabecular and woven bone were observed in direct contact with the implant surface with no gaps or connective tissue at the bone-implant interface. Conclusions These results indicate that the PEMF device stimulated early bone formation around dental implants resulting in higher peri-implant BIC and bone mass already after 2 weeks which suggests an acceleration of the osseointegration process by more than three times.