Publications by authors named "Flavia Iaculli"

27 Publications

  • Page 1 of 1

External Root Resorption Management of an Avulsed and Reimplanted Central Incisor: A Case Report.

Dent J (Basel) 2021 Jun 16;9(6). Epub 2021 Jun 16.

Department of Oral and Maxillofacial Science, "Sapienza" University of Rome, Via Caserta, 6, 00161 Rome, Italy.

: Avulsion and reimplantation of permanent teeth represent a major challenge in terms of treatment and long-term prognosis. The present study reported clinical management of external root resorption of an avulsed and reimplanted maxillary central incisor. : A 9-year-old boy reported an uncomplicated crown fracture and avulsion of tooth 11 and complicated crown fracture of tooth 21 due to trauma. Reimplantation of element 11 was obtained within 30 min post-trauma and 3 days after both elements were diagnosed with necrotic pulp. In addition, tooth 11 showed early external root resorption. Both elements underwent endodontic treatment and root closure with apical plug using calcium-silicate-based cement. At 6-month follow-up root resorption appeared to be arrested. Twenty-four months after trauma the clinical results were stable, although signs and symptoms of ankylosis were observed. : An immediate endodontic approach and use of calcium-silicate-based cement seemed to contrast the progression of root resorption of an avulsed and reimplanted central incisor after 24 months of follow-up.
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http://dx.doi.org/10.3390/dj9060072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233981PMC
June 2021

Fracture resistance of endodontically-treated maxillary premolars restored with different type of posts and direct composite reconstructions: A systematic review and meta-analysis of in vitro studies.

Dent Mater 2021 Jun 17. Epub 2021 Jun 17.

Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy.

Objective: To conduct a systematic review and meta-analysis to assess if the presence of an endodontic post may increase the fracture resistance of endodontically-treated maxillary premolars directly restored with composite.

Methods: A comprehensive systematic literature search according to the PRISMA statement was conducted to assess in vitro studies including endodontically-treated maxillary premolars, restored with different type of posts supporting direct composite reconstructions. Two groups of meta-analyses were performed using fixed effects model and additional Trial Sequential Analysis (TSA) was carried out. Moreover, risk of bias was conducted and quality of evidence for any performed meta-analysis was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results: Twenty-four articles met the inclusion criteria and 13 studies also underwent quantitative evaluation. Fracture resistance of endodontically-treated premolars restored with fiber posts was significantly less than sound teeth (p value: < 0.00001), however endodontically-treated premolars with a fiber post provided an increase in fracture resistance when compared to equivalent teeth restored without post (p value: 0.003). TSA revealed high power of both meta-analyses. Moderate risk of bias was reported in 23/24 studies; only 1 study showed high risk of bias. GRADE system showed moderate strength of evidence due to the presence of a study with high risk of bias and to wide confidence intervals.

Significance: Within the limitation of the present systematic review and meta-analysis, it can be concluded that endodontically-treated maxillary premolars restored with a fiber post and direct composite restoration demonstrated increased fracture resistance when compared to equivalent teeth without post.
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http://dx.doi.org/10.1016/j.dental.2021.06.007DOI Listing
June 2021

Biocompatibility and Antibiofilm Properties of Calcium Silicate-Based Cements: An In Vitro Evaluation and Report of Two Clinical Cases.

Biology (Basel) 2021 May 26;10(6). Epub 2021 May 26.

Department of Oral and Maxillofacial Science, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy.

Calcium silicate-based cements have reached excellent levels of performance in endodontics, providing predictable and successful results. To better assess the properties of these bioactive materials, the present study aimed to compare the biocompatibility and antibiofilm properties of ProRoot MTA and Biodentine. Human osteogenic sarcoma (Saos-2) cells were cultured on ProRoot MTA and Biodentine samples or in the presence of both cement extracts. Cell viability assay, measurement of reactive oxygen species (ROS), immunofluorescence analysis, as well as morphological evaluations were conducted. Moreover, was used to assess the biofilm forming ability on ProRoot MTA and Biodentine disks. Finally, both cements were applied in vivo to treat immature permanent teeth affected by reversible pulpitis. Results: Cell viability assay demonstrated that Saos-2 cells had a dose- and time-dependent cytotoxicity to both analyzed cements, although cells exposed to ProRoot MTA showed a better cell vitality than those exposed to Biodentine ( < 0.001). Both cements demonstrated ROS production while this was greater in the case of Biodentine than ProRoot MTA ( < 0.001). Immunofluorescence images of the cytoskeleton and focal adhesions showed no differences in Saos-2 cells grown in the presence of ProRoot MTA eluate; whereas in the Biodentine groups, cells showed a morphology and focal adhesions more similar to that of the control sample, as the eluate concentration decreased. Morphological analysis revealed that Saos-2 cells were more flattened and exhibited better spreading when attached to ProRoot MTA disks than to Biodentine ones. The antibiofilm properties showed a time-dependent powerful inhibition of superficial colonization and an antibiofilm effect of both cements. Clinically, complete root formation of the treated elements was achieved using the two studied cements, showing stable results over time. ProRoot MTA and Biodentine was demonstrated to be biocompatible and to possess antibiofilm properties. Their clinical application in vital pulp therapy provided successful outcomes after 2 years of follow-up.
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http://dx.doi.org/10.3390/biology10060470DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8226987PMC
May 2021

Dietary Fluoride Intake by Children: When to Use a Fluoride Toothpaste?

Int J Environ Res Public Health 2021 05 28;18(11). Epub 2021 May 28.

Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy.

Fluoride is recommended for its cariostatic effect, but excessive fluoride intake may have health risks. Increased prevalence of dental fluorosis in areas with low fluoride content in drinking water has been attributed to the inappropriate excessive intake of fluoride supplements (tablets and drops) and toothpaste ingestion. The aim of the present study was to estimate the fluoride intake and the risk of fluorosis in children (6 months-6 years) in the Castelli Romani area (province of Rome, Italy), which is volcanic, therefore with a higher concentration of fluorine. Measurements of the fluoride content in drinking water, mineral waters, vegetables and commercial toothpaste for children were performed. The fluoride concentrations of all samples were determined using a Fluoride Ion Selective Electrode (GLP 22, Crison, Esp). Data were analyzed by descriptive statistics. Differences between samples were determined by Student's -test. The fluoride content in tap water samples collected from public sources averaged from 0.35 to 1.11 ppm. The Pavona area showed the highest content of fluoride with respect to the others ( ≤ 0.05). The fluoride content in mineral water samples averaged from 0.07 to 1.50 ppm. The fluoride content of some vegetables showed increased mean values when compared to control vegetables ( ≤ 0.05). Within the limitations of the present study, considerations should be made when prescribing fluoride toothpaste for infants (6 months-4 years) in the areas with high fluoride content, because involuntary ingestion is consistent.
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http://dx.doi.org/10.3390/ijerph18115791DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8198230PMC
May 2021

Multivariate analysis of the influence of peri-implant clinical parameters and local factors on radiographic bone loss in the posterior maxilla: a retrospective study on 277 dental implants.

Clin Oral Investig 2021 Jun 5;25(6):3441-3451. Epub 2020 Nov 5.

Perio/Implantology, Department of Dentistry, Center for Research on Dental Implants, Federal University of Santa Catarina, Florianópolis, Brazil.

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.
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http://dx.doi.org/10.1007/s00784-020-03666-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137597PMC
June 2021

The Emerging Role of Cold Atmospheric Plasma in Implantology: A Review of the Literature.

Nanomaterials (Basel) 2020 Jul 31;10(8). Epub 2020 Jul 31.

Sydney Dental Hospital, Sydney 2010, Australia.

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.
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http://dx.doi.org/10.3390/nano10081505DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7466481PMC
July 2020

Morpho-Chemical Observations of Human Deciduous Teeth Enamel in Response to Biomimetic Toothpastes Treatment.

Materials (Basel) 2020 Apr 11;13(8). Epub 2020 Apr 11.

Department of Oral and Maxillofacial Science, Sapienza University of Rome, Via A. Borelli 50, 00161 Rome, Italy.

Today, biomaterial research on biomimetic mineralization strategies represents a new challenge in the prevention and cure of enamel mineral loss on delicate deciduous teeth. Distinctive assumptions about the origin, the growth, and the functionalization on the biomimetic materials have been recently proposed by scientific research studies in evaluating the different clinical aspects of treating the deciduous tooth. Therefore, appropriate morpho-chemical observations on delivering specific biomaterials to enamel teeth is the most important factor for controlling biomineralization processes. Detailed morpho-chemical investigations of the treated enamel layer using three commercial toothpastes (Biorepair, F1400, and F500) were performed through variable pressure scanning electron microscopy (VP-SEM) and energy dispersive X-ray spectroscopy (EDS) on deciduous teeth in their native state. A new microscopy methodology allowed us to determine the behaviors of silicate, phosphate, and calcium contents from the early stage, as commercially available toothpastes, to the final stage of delivered diffusion, occurring within the enamel layer together with their penetration depth properties. The reported results represent a valuable background towards full comprehension of the role of organic-inorganic biomaterials for developing a controlled biomimetic toothpaste in biofluid media.
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http://dx.doi.org/10.3390/ma13081803DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215857PMC
April 2020

Different Pulp Dressing Materials for the Pulpotomy of Primary Teeth: A Systematic Review of the Literature.

J Clin Med 2020 Mar 19;9(3). Epub 2020 Mar 19.

Department of Oral and Maxillofacial Science, "Sapienza" University of Rome, 00185 Rome, Italy.

: Pulpotomy of primary teeth provides favorable clinical results over time; however, to date, there is still not a consensus on an ideal pulp dressing material. Therefore, the aim of the present systematic review was to compare pulpotomy agents to establish a preferred material to use. : After raising a PICO question, the PRISMA guideline was adopted to carry out an electronic search through the MEDLINE database to identify comparative studies on several pulp dressing agents, published up to October 2019. : The search resulted in 4274 records; after exclusion, a total of 41 papers were included in the present review. Mineral trioxide aggregate (MTA), Biodentine and ferric sulphate yielded good clinical results over time and might be safely used in the pulpotomies of primary molars. Among agents, MTA seemed to be the material of choice. On the contrary, calcium hydroxide showed the worst clinical performance. Although clinically successful, formocreosol should be replaced by other materials, due to its potential cytotoxicity and carcinogenicity. : MTA seemed to be the gold standard material in the pulpotomy of primary teeth. Promising results were also provided by calcium silicate-based cements. Further randomized clinical trials (RCTs) with adequate sample sizes and long follow-ups are encouraged to support these outcomes.
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http://dx.doi.org/10.3390/jcm9030838DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141304PMC
March 2020

The impact of non-surgical therapy of periodontal disease on surrogate markers for cardiovascular disease: A literature review.

Am J Dent 2019 Aug;32(4):191-200

School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia.

Purpose: 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.

Methods: 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.

Results: 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.

Clinical Significance: 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.
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August 2019

Effects of air abrasive decontamination on titanium surfaces: A systematic review of in vitro studies.

Clin Implant Dent Relat Res 2019 Apr 5;21(2):398-421. Epub 2019 Mar 5.

School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia.

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.
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http://dx.doi.org/10.1111/cid.12747DOI Listing
April 2019

Effectiveness of Different Commercial Chlorhexidine-Based Mouthwashes After Periodontal and Implant Surgery: A Systematic Review.

Implant Dent 2019 Feb;28(1):74-85

Professor, Discipline Lead and Program Director, Periodontics and Implantology School of Dentistry and Oral Health, Griffith University, Australia.

Objectives: 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.

Materials And Methods: 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.

Results: 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.

Conclusion: 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.
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http://dx.doi.org/10.1097/ID.0000000000000854DOI Listing
February 2019

Bacterial leakage in external hexagon implants with and without the interposition of a sealing-connector.

Am J Dent 2018 Oct;31(5):234-238

Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy.

Purpose: To investigate whether the interposition of a sealing-connector was able to reduce the bacterial leakage in external hexagon implants.

Methods: 20 implants with external hexagon connection were used. Ten Test implant-abutment assemblies were connected with the interposition of a sealing-connector molded in the exact shape of the two opposed surfaces. Ten Control implant-abutment assemblies were connected with no sealing-connector interposed. Two types of bacteria were introduced into the internal portion of the implant, before placing the connector. The study lasted 28 days.

Results: All control specimens, seeded with P. aeruginosa (PA) and A. actynomycetemcomitans (AA), showed contamination of the culture medium, indicative of microbial leakage. In the Test specimens, three instances of contaminated specimens were found in the samples seeded with PA and two contaminated specimens in the ones seeded with AA, for a total of five contaminated samples out of 10. The use of the sealing-connector was able to prevent bacterial leakage in half of the samples (50%). The leakage in both groups occurred mainly in the last week of the experiment. Probably, a longer period, under the conditions of this experiment, is necessary for the migration of the bacteria, and, furthermore, an observation period of 7 or 14 days may not be enough to show microbial contamination.

Clinical Significance: Using an interface under in vitro non-loading experimental conditions, could sometimes (50%) prevent bacterial microleakage and thus possibly the risk of peri-implant site infection. Moreover, less bone resorption and the maintenance of soft tissues and esthetics might be achieved in those cases where bacterial leakage does not occur.
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October 2018

Rehabilitation of Postextractive Socket in the Premaxilla: A 12-Year Study on 27 Titanium Plasma Spray Resorbable Calcium Phosphate Coated Single Implants.

Implant Dent 2018 Aug;27(4):452-460

Discipline Lead and Program Director, Periodontics and Implantology School of Dentistry and Oral Health. Griffith University, Gold Coast, Australia.

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.
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http://dx.doi.org/10.1097/ID.0000000000000790DOI Listing
August 2018

Histological and Histomorphometrical Analysis on a Loaded Implant With Platform-Switching and Conical Connection: A Case Report.

J Oral Implantol 2017 Jun 16;43(3):180-186. Epub 2017 Mar 16.

2   Department of Social Dentistry, National Institute for Health, Migration and Poverty, Rome, Italy.

The association of Morse taper implant-abutment design with the use of a smaller abutment diameter (platform switching) may improve dental implant success rate and prevent peri-implant bone loss. The aim of the present study was to histologically and histomorphometrically evaluate the behavior of peri-implant tissues around an implant with a conical connection associated with platform switching. A platform-switched Morse-cone connection implant was inserted in the left posterior mandible of a 61-year-old patient. The implant was inserted at the level of the alveolar crest. After 11 months from placement and 6 months of loading, the implant was retrieved for psychological reasons and processed for histological evaluation. The retrieved implant was wholly surrounded by bone tissue, except for a small area in the apical portion. At higher magnification, in the coronal portion of the implant, it was possible to observe bone directly at the implant platform level. No resorption of the coronal bone was present, except for 0.2 mm on the vestibular aspect. Crestally, bone remodeling with areas of newly formed bone was detected; the bone-implant contact was 73.9%. Apposition of bone was detected even upon the platform. Peri-implant crestal bone preservation can be achieved with the combination of Morse taper conical internal implant-abutment connection with the use of a smaller abutment diameter (platform-switching).
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http://dx.doi.org/10.1563/aaid-joi-D-16-00182DOI Listing
June 2017

Medication-Related Osteonecrosis of the Jaw and Dental Implants Failures: A Systematic Review.

J Oral Implantol 2017 Feb;43(1):51-57

2   Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.

No well-established evidence supporting safe use of bisphosphonates (BPs) or other antiresorptive agents prior, during, or after dentoalveolar surgery, are currently available; moreover, the real risk of osteonecrosis of the jaw (ONJ) development is still unknown. The aim of the present systematic review was to assess the scientific literature concerning the implants placement in antiresorptive agent users and the related risk of implants failure and ONJ development. English papers published from January 2003 until December 2014 were identified on the MEDLINE database. Titles and abstracts retrieved form electronic search were screened separately by 2 examiners; thus, original studies dealing with dental implants placement during or before bone antiresorptive agent therapy and the relative risk of implant failure or development of osteonecrosis were evaluated. Due to the heterogeneity of the included studies and the high risk of bias, there is no evidence of the safe use of oral antiresorptive agents prior or after dental implant surgery. Indeed, implant failure and ONJ development can occur and represent a devastating side effect that should be considered during treatment. Within the limitation of the present systematic review, high quality studies are needed to provide an adequate level of evidence regarding the safety of dentoalveolar surgery during or before bone resorption inhibition therapy and the increase predisposition to osteonecrosis of the jaw (ONJ) development. Therefore, antiresorptive agent therapy should be considered a risk factor until further evidence is prospectively obtained.
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http://dx.doi.org/10.1563/aaid-joi-16-00057DOI Listing
February 2017

Molecular, Cellular and Pharmaceutical Aspects of Bone Grafting Materials and Membranes During Maxillary Sinus-lift Procedures. Part 1: A General Overview.

Curr Pharm Biotechnol 2017 ;18(1):19-32

Department of Medical, Oral and Biotechnological Sciences, Dental School, University G. D'Annunzio of Chieti-Pescara, Via dei vestini 31, 66100 Chieti, Italy.

Sinus augmentation procedure has been demonstrated to be a highly predictable treatment in posterior maxilla atrophy. All the surgical interventions in the maxillary region require deep knowledge of anatomy and possible anatomical variations. In this article, pre-operative and post- operative assessments of sinus cavity as well as novel approaches to deepen our knowledge of the behavior of bone substitute materials are described. The awareness of the patient's morphologic conditions enables exact planning of invasive surgery and aids to avoid complications. Pre- operative radiologic evaluation of the region before sinus lift is advisable both for a planning of the sinus augmentation and for selection and alignment of the optimum placement of implants. On the orthopantomography it is possible to measure the vertical dimension of graft, but not the volume and 3D changes. Cone-beam computed tomography (CBCT) has become the "gold standard" to plan a comprehensive implant treatment and to achieve a post-operative assessment. A computer-aided design/computer-aided manufacturing (CAD/CAM) technique is proposed to produce custom-made block grafts for sinus lift procedure, and a customized cutting guide to accurately place the lateral wall and ease membrane elevation. This procedure allows to reduce intervention time, to precisely adapt the scaffold, to reduce risk of complications and to improve operation quality. Recently, a novel approach has been used to deepen our knowledge of the behavior of BSBs: by means of synchrotron micro-tomography (SCT). It is a 3-D analyzing method, suitable to examine the dynamic and spatial arrangement of regenerative phenomena in complex anatomical structures such as bone, where tissues with several morphologies (alveolar process, unmineralized extracellular matrix, regenerated vessels, etc.) compete to achieve the final goal of bone regeneration.
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http://dx.doi.org/10.2174/1389201017666161221155237DOI Listing
December 2017

Dental pulp stem cells grown on dental implant titanium surfaces: An in vitro evaluation of differentiation and microRNAs expression.

J Biomed Mater Res B Appl Biomater 2017 07 9;105(5):953-965. Epub 2016 Feb 9.

Cell Physiology Laboratory, Department of Neuroscience Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy.

The surface roughness of dental implants influences the proliferation and differentiation rate of adult mesenchymal stem cells (MSCs). The aim of the present study was to evaluate whether specifically treated titanium implant surfaces influenced human dental pulp stem cells (DPSCs) differentiation in an osteogenic pattern through modulation of microRNAs expression. The degree of differentiation was evaluated after 7, 14, and 21 days, through the expression of microRNAs characterizing the osteogenesis (miR-133 and miR-135), of Runx2 and Smad5 (key factor transcriptions associated with osteoblast differentiation) and Osteocalcin, marker for the bone formation process. DPSCs were cultured on sandblasted and acid-etched titanium disks, with (Test) or without the presence of ions (Control). Early differentiation of DPSCs cultured on titanium could be detected at all the evaluated time points, respect to cells grown alone. Moreover, the Test surfaces seemed to induce a more marked cells differentiation. The obtained results demonstrated that microRNAs played a pivotal role in the differentiation of MSCs and could be used as marker of osteogenic differentiation. Furthermore, the evaluated ionized sandblasted and acid-etched surface seemed to markedly enhance the development of osteoblast cells. A faster osseointegration could be achieved in the presence of specifically treated implant surfaces, promising encouraging clinical outcomes. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 953-965, 2017.
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http://dx.doi.org/10.1002/jbm.b.33628DOI Listing
July 2017

Analysis of Effectiveness of Different Rotational Instruments in Implantoplasty: An In Vitro Study.

Implant Dent 2016 Jun;25(3):341-7

*PhD Student, Department of Dental Implantology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. †Professor, Department of Dental Implantology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. ‡Professor, School of Dentistry, Federal University of Pará, Belém, Pará, Brazil. §PhD Student, Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy. ¶Professor, Researcher, Department of Medical, Oral and Biotechnological Sciences, Dental School, University of Chieti-Pescara, Chieti, Italy. ‖Head Professor, Department of Dental Implantology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.

Objective: To analyze the temperature increase in the implant, adjacent bone, procedure time, and roughness provided by different rotatory instruments in the implantoplasty procedure.

Material And Methods: Three types of rotational instruments were used to evaluate the implant surface wear, divided according to their surface features: Group 1 (G1) diamond, Group 2 (G2) tungsten carbide, and Group 3 (G3) multilaminar. For the roughness test, a control group was included for comparison with the test groups.

Results: The temperature variation was statistically significant in the implant (P < 0.05) where G2 showed the lowest variation. There was no statistically significant difference between the 3 groups regarding the temperature increase measured in the bone (P > 0.05). The difference of wear time was statistically significant (P < 0.05) with faster results for G3. In the surface roughness analyses, there was a statistically significant difference (P < 0.05) between the control group and the test groups. Among the 3 test groups, the difference between measurements was not statistically significant (P > 0.05).

Conclusion: All tested rotatory instruments performed the same level of surface roughness in the implantoplasty. The tungsten carbide bur caused a minor change in the implant temperature. The multilaminar bur performed a faster wear time. More in vivo studies are necessary to conclude which is the best rotatory instrument for implantoplasty.
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http://dx.doi.org/10.1097/ID.0000000000000381DOI Listing
June 2016

Degree of bacterial microleakage at the implant-abutment junction in Cone Morse tapered implants under loaded and unloaded conditions.

J Appl Biomater Funct Mater 2015 Dec 18;13(4):e367-71. Epub 2015 Dec 18.

Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti - Italy.

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.
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http://dx.doi.org/10.5301/jabfm.5000247DOI Listing
December 2015

Sealing capability of implant-abutment junction under cyclic loading: a toluidine blue in vitro study.

J Appl Biomater Funct Mater 2015 Oct 16;13(3):e293-5. Epub 2015 Oct 16.

Department of Medical, Oral and Biotechnological Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti - Italy.

Purpose: The aim of the present in vitro study was to evaluate the leakage observed in external hexagon (EH) and cone Morse (CM) tapered implant-abutment connections, using toluidine blue.

Methods: A total of 60 implants, 30 with a screw-retained EH abutment and 30 with a CM taper internal connection, were used. Toluidine blue was placed into the deepest portion of the internal compartment of the 2 different implant systems, and cyclic loading was applied for each group as follows: 10 samples underwent 1 × 10(6) loading cycles, 10 samples underwent 3 × 10(6) cyclic loading and the least 10 samples underwent 6 × 10(6) cyclic loading.

Results: No significant differences between the EH and CM groups were detected when the lowest loading cycles were applied (p = 0.2624), while differences were found when the samples were loaded with 3 x 10(6) and 6 x 10(6) cycles (p = 0.00124), with significantly lower toluidine leakage in CM group.

Conclusions: In conclusion, the results of the present in vitro study demonstrated that flow of the toluidine blue to the external portion of the implant-abutment assembly occurred in both types of implant-abutment connections, with very different percentages. Indeed, the CM taper internal connection seems to be more resistant to the leakage of dyes when compared with EH connections.
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http://dx.doi.org/10.5301/jabfm.5000224DOI Listing
October 2015

Microleakage of bacteria in different implant-abutment assemblies: an in vitro study.

J Appl Biomater Funct Mater 2015 Jul 4;13(2):e174-80. Epub 2015 Jul 4.

MESVA, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila - Italy.

Purpose: The aim of the present in vitro study was to evaluate the leakage observed for 2 different microbial species at the level of the implant-abutment (I-A) interface, and the marginal fit and size of microgap at the I-A interface in 2 different implant connections.

Methods: Ten specimens of each group were tested. The inner parts of 5 implants per group were inoculated with 0.1 μL of a viable Enterococcus faecalis suspension and 5 implants per group with Aggregatibacter actinomycetemcomitans. All of the vials containing the control specimens were incubated at 37°C under aerobic condition for E. faecalis and 37°C in presence of 5% CO2 for A. actinomycetemcomitans. They were maintained for 14 days, and the possible penetration of bacterial suspension into the surrounding solution was determined by the observation of turbidity of the broth. The I-A interface was evaluated for size of microgap and measured under SEM. Five implants of each group were evaluated. The marginal fit between implant and abutment was measured at 8 random locations in each assembly, under different magnifications at the interface.

Results: No leakages through the I-A interface were demonstrated for either type of connection evaluated. The microgap values of all I-A interfaces ranged from 0.008 to 2.009 μm; the differences between the 2 systems were statistically significant.

Conclusions: The present study demonstrated that a good marginal fit of implant components seemed to be able to prevent bacterial leakage.
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http://dx.doi.org/10.5301/jabfm.5000214DOI Listing
July 2015

Fixed restorations supported by Morse-taper connection implants: a retrospective clinical study with 10-20 years of follow-up.

Clin Oral Implants Res 2015 Oct 21;26(10):1229-36. Epub 2014 Jun 21.

Department of Surgical and Morphological Science, Dental School, University of Varese, Varese, Italy.

Objectives: Rehabilitation with implant-supported fixed prostheses is a predictable modality to restore lost function and esthetics; however, fixed restorations are subject to biological and prosthetic complications, which may represent a problem in the long-term. The aim of this study was to evaluate the long-term survival and complication rates of fixed restorations supported by Morse-taper connection implants.

Materials And Methods: Between January 1992 and December 2002, 49 patients (age range 22-70 years), were included in this study. The restorations involved 58 fixed reconstructions (15 single crowns [SCS], 29 partial prostheses, 14 full-arches), supported by 178 Morse-taper connection implants with a follow-up ranging from 10 to 20 years. Outcomes such as implant survival, marginal bone loss, frequency of biological and prosthetic complications as well as "complication-free" survival of restorations were investigated.

Results: The 20-year overall cumulative implant survival was 97.2%. A few biological (3.4%) and prosthetic (10.3%) complications were reported. The "complication-free" survival rate of restorations was 85.5%. No statistically significant differences were observed among patients' gender, age, smoking or parafunctional habits, prosthesis site and type.

Conclusions: Satisfactory "complication-free" survival rates can be achieved after 20 years for fixed restorations supported by Morse-taper connection implants, with minimal marginal bone loss and complications.
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http://dx.doi.org/10.1111/clr.12439DOI Listing
October 2015

Relationship between the surface energy and the histologic results of different titanium surfaces.

J Craniofac Surg 2014 May;25(3):863-7

From the *Catholic University of Uruguay, Montevideo, Uruguay; Departments of †Pharmacy and ‡Medical, Oral and Biotechnological Science, University "G. d'Annunzio," Chieti, Italy; §Department of Medical Science, Faculty of Medicine, University of Eastern Piedmont, Novara, Italy; and ∥Oral Surgery Unit, Regina Margherita Pediatric Hospital, Turin, Italy.

The aim of this study was to evaluate, through in vitro and in vivo studies, the existence of a relationship between surface energy, for wettability, and the clinical behavior of dental implants with different surfaces, one with a surface treated by sandblasting with titanium oxide microparticles followed by acid-etching treatment (experimental group) and another with a machined surface (control group). For the in vitro tests, a total of 30 titanium disks (15 disks for each group) were evaluated by scanning electron microscopy and dispersive energy spectroscopy and for surface roughness and wettability. For the in vivo tests, a total of 24 implants (12 implants for each group) were inserted in the tibiae of 6 rabbits and were removed after 30 and 60 days for histologic analysis. The results showed that the implants with the experimental surface presented a low wettability, and it also resulted in highly stimulated new bone formation in vivo, when compared with the control group dental implant. As for the bone formation, differences between the different surfaces seemed evident, both in quantity and in quality, as implants from the experimental group showed a higher new bone deposition than that from the control group. Thus, in vitro and in vivo tests demonstrated an excellent biologic response of the surfaces treated by sandblasting with microparticles of titanium oxide followed by acid etching.
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http://dx.doi.org/10.1097/SCS.0000000000000873DOI Listing
May 2014

Hemostasis control in dental extractions in patients receiving oral anticoagulant therapy: an approach with calcium sulfate.

J Craniofac Surg 2014 May;25(3):843-6

From the *Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy; †Department of Oral Rehabilitation, School of Dental Medicine, Tel-Aviv University, Israel; and ‡Department of Medical Science, Faculty of Medicine, University of Eastern Piedmont, Novara, Italy.

The aim of this study was to evaluate the use of calcium sulfate (CaS) as a hemostatic agent after tooth extraction in patients with anticoagulant drug therapy. A total of 30 patients undergoing anticoagulant therapy (22 women and 8 men) with a mean age of 54.6 years (SD = 9.2 years), needing dental extractions, were selected for this study. They were divided into 2 groups, control (group 1) and test (group 2), in a randomized way. In group 1 patients, the postextraction socket was managed with obliterative suture only. Group 2 patients were treated with CaS placed into the postextraction sockets. All the patients did not interrupt the anticoagulant therapy during the dental treatment. The healing pattern was found to be approximately similar in all treatment groups, showing significant improvement at each consecutive visit. However, a statistically significant difference in the adequate hemostasis was evident between groups 1 and 2 (P = 0.0056). The use of CaS helped to control the bleeding from inside the socket, producing instantly a very good hemostasis. Further studies are necessary to confirm the simplicity, possibilities, and limits of the proposed procedure.
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http://dx.doi.org/10.1097/SCS.0000000000000824DOI Listing
May 2014

Clinical and histologic evaluation of calcium carbonate in sinus augmentation: a case series.

Int J Periodontics Restorative Dent 2014 Mar-Apr;34(2):e43-9

The aim of this case series was a clinical, histologic, and histomorphometric evaluation of calcium carbonate in sinus elevation procedures. Sinus augmentation was performed in the atrophic maxillae of 24 subjects using calcium carbonate. Six months after the regeneration procedures, 68 implants were placed and clinically followed for 1 to 5 years, depending on the placement timing. At the last implant placement procedure, 8 bone cores were harvested and processed for histology. After a 6-month healing period, sinuses grafted with calcium carbonate showed a mean vertical bone gain of 6.93 ± 0.23 mm. The histomorphometric analysis revealed 15% ± 3% residual grafted biomaterial, 28% ± 2% newly formed bone, and 57% ± 2% marrow spaces. The implant survival rate was 98.5%. It can be concluded that calcium carbonate was shown to be clinically suitable for sinus elevation procedures after 1 to 5 years of follow-up and histologically biocompatible and osteoconductive.
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http://dx.doi.org/10.11607/prd.1832DOI Listing
February 2016

Osteocyte density in the peri-implant bone of implants retrieved after different time periods (4 weeks to 27 years).

J Biomed Mater Res B Appl Biomater 2014 Feb 16;102(2):239-43. Epub 2013 Sep 16.

Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Italy.

Bone tissue is characterized by a constant turnover in response to mechanical stimuli, and osteocytes play an essential role in bone mechanical adaptation. However, little to no information has been published regarding osteocyte density as a function of implantation time in vivo. The aim of this retrospective histological study was to evaluate the osteocyte density of the peri-implant bone in implants retrieved because of different reasons in a time period from 4 weeks to 27 years. A total of 18 samples were included in the present study. Specimens were divided into 3 groups depending on the loading history of the implants: loading between 4 weeks and 7 months (group 1); loading between 1 and 5 years (group 2); loading between 14 and 27 years (group 3). All the samples were histologically evaluated and osteocyte density was obtained using the ratio of the number of osteocytes to the bone-area (mm(2) ). The osteocyte density values significantly increased in the Group 2 (1-5 years) compared with Group 1 (4 weeks-7 months), and significantly decreased in the Group 3 (14-27 years) compared to Group 2. No significant differences were detected between Group 1 and Group 3. The decrease in osteocyte density observed in samples that were in vivo for long periods of time under loading is possibly because of the fact that once the bone structure is well aligned and biomechanically competent, a lower number of osteocytes are necessary to keep the tissue homeostasis under loading.
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http://dx.doi.org/10.1002/jbm.b.33000DOI Listing
February 2014

Short (8-mm) locking-taper implants supporting single crowns in posterior region: a prospective clinical study with 1-to 10-years of follow-up.

Clin Oral Implants Res 2014 Aug 28;25(8):933-40. Epub 2013 Apr 28.

Private Practice, Gravedona (Como), Italy.

Objective: The aim of this study was to evaluate the long-term outcome of short (8-mm) locking-taper implants supporting single crowns in the posterior regions and to analyze the influence of different factors on implant survival and implant-crown success rates.

Materials And Methods: Between June 2002 and September 2011, all patients referred to two private practices for treatment with short (8-mm) implants supporting single tooth restorations in posterior areas of both jaws were considered for inclusion in this study. At each annual follow-up session, clinical and radiographic parameters were assessed. Implant-crown success criteria included absence of pain, suppuration, mobility, and peri-implant radiolucency, distance between the implant shoulder and the first visible bone-to-implant contact (DIB) <1.5 mm after 12 months and not exceeding 0.2 mm for each following year, absence of prosthetic complications. The cumulative survival and implant-crown success were assessed using the Kaplan-Meier survival estimator; Chi-square test was applied to evaluate correlations between the study variables. The statistical analysis was performed at the patient and at the implant level.

Results: Two hundred and fifteen implants (124 maxilla; 91 mandible) were placed in 194 patients (104 men; 90 women). Three implants failed (2 maxilla; 1 mandible). The 10-year cumulative survival rate was 98.4% (patient-based) and 98.5% (implant-based). Among the surviving implants, the mean DIB was 0.31 (±0.24), 0.43 (±0.29), and 0.62 (±0.31) mm at the 1-, 5-, and 10-year follow-up session; two biologic and three prosthetic complications were reported, for a 10-year cumulative implant-crown success rate of 95.8% (patient-based) and 95.9% (implant-based). The implant survival and implant-crown success rates did not differ significantly with respect to patients' gender, age, smoking habit, parafunctional habit, implant location, implant diameter, and bone type.

Conclusions: The use of short (8-mm) locking-taper implants is a predictable treatment modality for the restoration of single tooth gaps of posterior segments of dentition.
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http://dx.doi.org/10.1111/clr.12181DOI Listing
August 2014
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