Libri correalti

Objectives: To assess blood flow alterations after horizontal Guided Bone Regeneration (GBR) and to evaluate correlations between blood flow and hard tissue changes. Method and Materials: Twelve mandibular surgical sites were involved in the current case series. GBR was carried out using a split-thickness flap design. Blood circulation was assessed with Laser Speckle Contrast Imaging at baseline as well as 1, 4, 6, 11, 13, 20, 27, and 34 days after the surgery, subsequently on a monthly basis until 6 months. Hard tissue alterations were measured horizontally and vertically using linear measurements. The first measurement point was 2 mm distal to the distal surface of the last tooth; additional measurement points were placed every 3 mm up to the 15th mm. Volumetric hard tissue loss and gain were also assessed. Results: Baseline blood circulation was statistically significantly higher on the buccal side. On the first postoperative day, all regions presented a statistically significant decrease in blood flow circulation. The buccal-inner region presented significant ischemia on day 6. Mean volumetric hard tissue gain and loss were 712.62 ± 317.08 mm3 and 222.431 ± 103.19 mm3, respectively. Mean baseline alveolar ridge width was 4.82 ± 1.02 mm, 6 months ridge width averaged 7.21 ± 0.99 mm. Vertical resorption measured 1.24 ± 0.5 mm. Correlations between blood flow changes and hard tissue alterations were only found on Day 34 and Day 60. Conclusion: Laser Speckle Contrast Imaging is an efficient method to measure flap microcirculation. No correlation was found between flap microcirculation changes hard tissue and alterations. Parole chiave: Bone graft, Case-report/series, Guided Bone Regeneration, Membranes, Ridge augmentation

Background: The wire syndrome (WS) or X-effect/twist-effect describes undesired long-term tooth movements following fixed retainer placement. Since it includes root torque changes that might cause gingival recession, those situations often require periodontal, orthodontic and conservative treatment. Aim of this study was to assess the effectiveness of fixed orthodontic treatment with completely customized lingual appliances (CCLA) and continuous archwires for a clinically significant reduction in the dimensions of labial gingival recessions in the anterior mandible, caused by the wire syndrome (WS), in a group of consecutive patients treated with the same approach. Moreover, the reduction in root prominence (ROP) of the affected teeth relative to the two neighboring teeth was evaluated. Subjects and methods: This retrospective cohort study from three centers included 20 consecutively recruited patients with labial gingival recession at lower incisors and canines due to WS. A total of 25 teeth were assessed. CCLA treatment with a standardized archwire sequence (0.012”/0.014” NiTi, 0.016”x0.022” NiTi, 0.018”x0.018” Beta-TMA with optional extra-torque) was identical in all three centers. Primary endpoints of recession depth (RD), recession width (RW), and recession surface (RS) were assessed on digital models at debonding (T1) and compared to baseline (T0) both as absolute differences (T0-T1), and as ratios ((T0-T1)/T0) by one-sample t-tests with p<0.05. As a secondary endpoint, the reduction of ROP relative to the gingival surface of the alveolar yoke of the two neighboring teeth was measured in millimeters. Results: Treatment resulted in a significant reduction in all dimensions of gingival recession. The mean reduction in RD was 1.86 mm (44.9%) and in RW 0.70 mm (35.6%). The mean RS was reduced from 10.77 mm2 to 3.93 mm2, indicating a mean RS reduction of 61.4%. All changes were statistically significant (p<0.001). The range of RS reduction was from 25.4% to 100%, while 18 out of the 25 recessions showed a reduction of more than 50%. The maximum reduction in ROP amounted to more than three millimeters. Conclusion: The use of completely customized lingual appliances to torque roots of the lower anterior teeth, exposed by the wire syndrome, towards the middle of the alveolar process reduces the area of subsequent labial gingival recession and reduces the root prominence of the affected teeth substantially. This is considered as a critical step in optimizing the predictability of the surgical recession coverage. Parole chiave: wire syndrome, retainer X-effect, retainer twist-effect, gingival recessions, recession depth, recession width, completely customized lingual appliances, torque, root coverage, root prominence, alveolar yoke

Background: The treatment of advanced peri-implantitis–related bone defects is often associated with ineffective efforts to halt disease progression. The objective of this case series was to evaluate the performance of reconstructive therapy for the management of advanced peri-implantitis using recombinant human platelet-derived growth factor-BB as an adjunctive biological agent. Materials and methods: A prospective case series study on advanced intrabony peri-implantitis bone defects (≥ 50% bone loss) was performed. Clinical and radiographic variables were collected at baseline (after non-surgical therapy) and 12 months after surgical treatment. Implant surface decontamination of the intrabony component was carried out using titanium brushes and the electrolytic method. Before grafting, recombinant human platelet-derived growth factor-BB was applied on the implant surface. A mixture of mineralised allograft and xenograft hydrated with recombinant human platelet-derived growth factor-BB and covered by a collagen barrier membrane was used for reconstructive therapy. Disease resolution was defined as an absence of bleeding on probing, pocket depth 6 mm and no radiographic evidence of progressive bone loss. Descriptive statistics were performed to assess the effect of treatment on the clinical and radiographic variables. Results: A total of 10 patients exhibiting 13 advanced peri-implantitis-related bone defects were included. Implant survival at the 1-year follow-up was 100%. No major complications occurred during the early healing phase. All the clinical parameters, with the exception of keratinised mucosa, and radiographic parameters yielded statistical significance. In particular, mean pocket depth decreased by 4.5 mm and the mean Sulcus Bleeding Index was reduced by 1.8. Radiographic intrabony defects displayed a significantly narrower, shallower and less angled configuration at the 1-year follow-up. The disease resolution rate at implant level was 61.5%. Conclusion: The surgical reconstructive strategy involving the use of recombinant human platelet-derived growth factor-BB proved to be safe and effective for treating advanced peri-implantitis–related bone defects. Parole chiave: growth factors, guided bone regeneration, peri-implantitis AM receives fees for lecturing and participating in other education-related events from Straumann (Basel, Switzerland) and SigmaGraft (Fullerton, CA, USA). MHAS was a scientific consultant for Lynch Biologics (Franklin, TN, USA) at the time of inception of this study. The other authors declare no conflicts of interest relating to this study.

Dental implants are commonly used to replace missing single teeth. However, esthetic rehabilitation of an adjacent tooth may also be required due to diastemas, crowding, or existing large direct restorations to improve the final esthetic outcome. With the advancements in ceramics and bonding techniques, minimally invasive esthetic approaches have become viable for compromised spacing issues. This case report describes a dental technique for the esthetic rehabilitation of compromised anterior spacing with a customized zirconia implant abutment at a maxillary central incisor site and a partial ceramic veneer bonded to the adjacent central incisor. Parole chiave: Anterior spacing; case report; implants; partial laminate veneer; prosthetic dentistry

Die vorliegende Arbeit untersucht die Implantatversorgung bei Patienten mit Parodontitis im Stadium IV auf der Grundlage der neuesten Klassifikationen und Langzeitergebnisse. Parodontitis, eine chronische bakteriell induzierte Entzündung, führt zu signifikantem Gewebeverlust und beeinträchtigt die Stabilität von Implantaten, wobei die Entzündung zunächst als Mukositis ohne Knochenverlust beginnt und im weiteren Verlauf zu einer Periimplantitis führen kann. Die Inzidenz von Periimplantitis ist bei parodontal vorgeschädigten Patienten erhöht und trotz ähnlicher Überlebensraten von Implantaten nach 5 und 10 Jahren weisen diese Patienten signifikant größere Sondierungstiefen und Knochenverluste auf. Diese Arbeit unterstreicht die Notwendigkeit eines adäquaten präventiven und therapeutischen Ansatzes, einschließlich der Planung der Implantatposition und des Weichgewebemanagements sowie der Einbindung in eine regelmäßige Erhaltungstherapie, um langfristig erfolgreiche Ergebnisse zu sichern. Diese Konzepte werden abschließend anhand eines Patientenbeispiels erläutert. Parole chiave: Parodontitis im Stadium IV, Zahnimplantate, unterstützende Parodontalbehandlung

Purpose: To investigate the microbiological outcomes obtained with either subgingival debridement (SD) in conjunction with a gel containing sodium hypochlorite and amino acids followed by subsequent application of a cross-linked hyaluronic acid gel (xHyA) gel, or with SD alone. Materials and Methods: Forty-eight patients diagnosed with stages II-III (grades A/B) generalised periodontitis were randomly treated with either SD (control) or SD plus adjunctive sodium hypochlorite/amino acids and xHyA gel (test). Subgingival plaque samples were collected from the deepest site per quadrant in each patient at baseline and after 3 and 6 months. Pooled sample analysis was performed using a multiplex polymerase chain reaction (PCR)-based method for the identification of detection frequencies and changes in numbers of the following bacteria: Aggregatibacter actinomycetemcomitans (A.a), Porphyromonas gingivalis (P.g), Tannerella forsythia (T.f), Treponema denticola (T.d), and Prevotella intermedia (P.i). Results: In terms of detection frequency, in the test group, statistically significant reductions were found for P.g, T.f, T.d and P.i (p < 0.05) after 6 months. In the control group, the detection frequencies of all investigated bacterial species at 6 months were comparable to the baseline values (p > 0.05). The comparison of the test and control groups revealed statistically significant differences in detection frequency for P.g (p = 0.034), T.d (p < 0.01) and P.i (p = 0.02) after 6 months, favouring the test group. Regarding reduction in detection frequency scores, at 6 months, statistically significant differences in favour of the test group were observed for all investigated bacterial species: A.a (p = 0.028), P.g (p = 0.028), T.f (p = 0.004), T.d (p <0.001), and P.i (p = 0.003). Conclusions: The present microbiological results, which are related to short-term outcomes up to 6 months post-treatment, support the adjunctive subgingival application of sodium hypochlorite/amino acids and xHyA to subgingival debridement in the treatment of periodontitis. Parole chiave: cross-linked hyaluronic acid, microbiology, non-surgical periodontal therapy, periodontitis, periopathogenic bacteria, sodium hypochlorite/amino acids

Purpose: The COVID-19 pandemic raised the question about the extent of microbial exposure encountered by dentists during dental therapy. The purpose of this study was to quantify microbial counts on surgical masks related to duration and type of dental therapy, as well as patient oral health variables. Materials and Methods: Sterile filter papers were fixed on surgical masks used during routine daily dental therapy. Thereafter, the filter papers were pressed onto blood agar plates for 1 min, before the agar plates were incubated with 10% CO2. After 48 h, the colony forming units (CFU) were counted and microorganisms were identified. The dependence of the CFU counts on treatment and patient-related variables was analysed using linear regression. Results: Filter papers obtained from 322 dental treatments (429 masks) were included in the final analysis. On average, 5.41 ± 9.94 CFUs were counted. While mostly oral bacteria were detected, Staphylococcus aureus was also identified on 16 masks. Linear regression, incorporating patient-related and treatment characteristics through step-wise inclusion, revealed statistical significance (p 0.001) only with the variable “assistance during therapy”. The type of dental treatment exhibited a trend, with fewer CFUs observed in caries treatment compared to periodontal or prosthodontic therapy. Furthermore, after analysing filter papers from masks used by dental assistants in 107 dental treatments, fewer CFUs were found on the masks compared to those used by dentists (p 0.001). Conclusion: The mean number of CFUs observed consistently remained low, highlighting the efficacy of the implemented hygiene measures. Consequently, it is clinically recommended to support dental treatment with precise suction of the generated aerosols. Parole chiave: aerosols, dental care, dental care team, masks

Purpose: Dental students learn knowledge and practical skills to provide oral health care to the population. Practical skills must be maintained or continuously developed throughout a professional career. This cross-sectional survey aimed to evaluate the perception of practical skills of dental students and dental-school graduates by national dental associations (NDAs) in international comparison in the European Regional Organization of the FDI World Dental Federation (ERO-FDI) zone. Materials and Methods: A questionnaire of 14 items collected information on pre-/postgraduate areas. Results: A total of 25 countries participated (response rate: 69.4%), with 80.0% having minimum requirements for practical skills acquisition and 64.0% starting practical training in the 3rd year of study. In countries where clinical practical work on patients begins in the 2nd year of study, practical skills of graduates are perceived as average, starting in the 3rd year of study as mainly good, starting in the 4th as varying widely from poor to very good. In total, 76.0% of respondents feel that improvements are needed before entering dental practice. Improvements could be reached by treating more patients in dental school (32.0%), increasing the quantity of clinical training (20.0%), or having more clinical instructors (12.0%). In 56.0% of the countries, it is possible to open one’s own dental practice immediately after graduation, and in 16.0%, prior vocational training is mandatory. Conclusions: All participating countries in the ERO-FDI zone reported practical training in dental school, most starting in the 3rd year of study. The perception of practical skills of dental students and dental-school graduates among NDAs is very heterogeneous. Reasons for the perceived deficiencies should be further explored. Parole chiave: dental association, graduate, international, practical skills, student

Purpose: To compare the regenerative clinical and radiographic effects of cross-linked hyaluronic acid (xHyA) with enamel matrix proteins (EMD) at six months after regenerative treatment of periodontal intrabony defects. Materials and Methods: Sixty patients presenting one intrabony defect each were randomly assigned into control (EMD) and test (xHyA) groups. Clinical attachment level (CAL) gain was the primary outcome, while pocket probing depth (PPD), gingival recession (REC), bleeding on probing (BOP), full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), and radiographic parameters such as defect depth (BC-BD), and defect width (DW) were considered secondary outcome variables. Parameters were recorded at baseline and after 6 months. Results: At the 6-month follow-up, 54 patients were available for statistical analysis. In the control and test groups, the mean CAL gain was statistically significant in the intragroup comparison (p < 0.001). 48.1% of test sites showed a CAL gain ≤ 2 mm compared with 33.3% of control sites. The mean PPD reduction was statistically significant in the intragroup comparison in both groups (p < 0.001). The mean REC increase was similar in the two groups: 1.04 ± 1.29 mm vs 1.11 ± 1.22 mm (test vs control). The mean BC-BD, DW, FMPS, FMBS, and BOP changed statistically significantly only in the intragroup comparison, not in the intergroup comparison. Conclusion: Both treatments, EMD and xHyA, produced similar statistically significant clinical and radiographical improvements after six months when compared with baseline. Parole chiave: cross-linked hyaluronic acid, enamel matrix derivative, intrabony defects, periodontal pocket, periodontal regeneration

Objective: To clinically and histologically evaluate the potential effect of a cross-linked, high molecular weight hyaluronic acid (xHyA) on the outcomes of guided bone regeneration performed with a demineralized bovine bone mineral (DBBM) covered with a natural collagen membrane. Method and materials: Eleven patients (eight females and three males, mean age 53 years) with a total of 27 surgical sites were treated. Treatments were performed with either DBBM and natural collagen membrane fixed with tacks (group A) or DBBM mixed with xHyA and subsequently covered with natural collagen membrane (group B). Clinical evaluations were made at baseline (T1), immediately after guided bone regeneration (T2), and at the time of implant placement (T3). Additionally, at the time of implant placement, core biopsies were retrieved and submitted for histologic analysis. Results: Healing was uneventful in all cases. At 6 months, group B revealed a statistically significantly higher crestal ridge dimension compared to group A (P = .007). The histologic analysis revealed a tendency for greater mineralized tissue formation in group B compared to group A (67.5% versus 41.6%) and contained a higher amount of new bone (37.2%) and less DBBM residues (20.9%) than group A (12.8% new bone and 28.8% DBBM residues, respectively). Conclusions: Within their limits, the present data indicate that, during guided bone regeneration with natural collagen membrane, the combination of DBBM and xHyA may improve the quality and quantity of bone formed with DBBM alone. Parole chiave: bone defect, bone grafting, bovine bone–derived mineral, cross-linked hyaluronic acid, graft fixation, graft stability, guided bone regeneration, histomorphometry, resorbable membrane