Publications by authors named "Ilaria Zollino"

46 Publications

Efficacy and Safety of Treatment of Complex Idiopathic Fistula-in-Ano Using Autologous Centrifuged Adipose Tissue Containing Progenitor Cells: A Randomized Controlled Trial.

Dis Colon Rectum 2021 May 20. Epub 2021 May 20.

Department of Morphology, Surgery and Experimental Medicine, Section General Surgery, University of Ferrara, Italy Department of Morphology, Surgery and Experimental Medicine, Section of Translational of Medicine and Surgery, University of Ferrara Provincial Unique Laboratory Department, University Hospital Ferrara, Italy Research Innovation Quality and Accreditation Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy.

Background: Mesenchymal stem cells derived from adipose tissue have been successfully used to promote sphincter-saving anal fistula healing.

Objective: The aim of this study was to evaluate the efficacy and safety of the use of autologous centrifuged adipose tissue in the healing process of cryptoglandular complex anal fistulas.

Design: Randomized controlled trial.

Settings: Single-center study.

Patients: Patients with complex perianal fistulas not associated with Crohn's disease were included. Rectovaginal fistulas were not included.

Interventions: Patients were randomly allocated to receive treatment with centrifuged adipose tissue injection (experimental group) and without injection (control group) in combination with fistula surgery.

Main Outcome Measures: The primary outcome was defined as the proportion of patients with complete fistula closure at 4 weeks (short-term outcome), and 6 months after surgery (long-term outcome). Healing was defined when the external opening was closed with no perianal discharge on clinical assessment. The secondary outcome was safety that was evaluated by analysis of Adverse Events (AEs) out to 3 months following surgery. Pelvic MRI was performed at 3 months to assure safety and the accuracy of clinical determination of healing. Postoperative pain, return to work/daily activities, persistent closure at 6 months, faecal incontinence, and patient satisfaction were evaluated.

Results: Fifty-eight patients who received centrifuged adipose tissue injection, and 58 patients who didn't receive centrifuged adipose tissue injection were included in safety and efficacy analysis. After 4 weeks, the healing rate was 63.8% in experimental group compared to 15.5% in control group (p<0.001). No major adverse events were recorded. Postoperative anal pain was significantly lower in the injection group. Time taken to return to work/daily activities was significantly shorter in experimental group (3 days) respect to control group (17 days). At 6 months, persistent closure was similar in the two groups (86,2% vs 81%). Fecal Incontinence Score at 6 months after surgery was identical to preoperative score. Patient satisfaction was very high in both groups.

Limitations: Absence of blinding, lack of correlation between stem cell content and the clinical outcome.

Conclusions: Autologous centrifuged adipose tissue injection may represent a safe, efficacy, and inexpensive option for the treatment of complex fistula-in-ano. See Video Abstract at http://links.lww.com/DCR/B607.

Clinical Trials Registration: www.clinicaltrials. gov, identifier NCT04326907; Unsponsored.
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http://dx.doi.org/10.1097/DCR.0000000000001924DOI Listing
May 2021

Breast milk: To each his own. From metabolomic study, evidence of personalized nutrition in preterm infants.

Nutrition 2019 06 25;62:158-161. Epub 2019 Jan 25.

Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.

Objectives: The composition of milk from mothers delivering prematurely differs from that of full-term mature milk and changes over time. The aim of this study is to test the hypothesis that changes in milk metabolomic profile from mothers delivering prematurely persist over time when compared with mothers delivering at term.

Methods: Nuclear magnetic resonance spectroscopy was used to analyze the metabolome pattern of human milk samples collected from 18 mothers. Twelve mothers collected 12 term milk samples (one for each mother) once between 4 and 7 d after delivery. Six mothers delivering prematurely (29-31 wk of gestational age) and collected three samples each, once a week after delivery until the third week after birth.

Results: Principal component analysis identified two distinct metabolite groups, one represented by the 18 preterm milk samples and the other by term milk samples. Metabolite profiling identified that lactose and oligosaccharide levels were significantly more represented in preterm than in milk term samples.

Conclusions: The preterm milk metabolome pattern undergoes maturation during the first 3 wk after birth, but at the end of the third week it still does not resemble the term milk pattern. The specific changes in mothers' milk metabolomic profiles according to their offspring might reflect the different nutritional requirement of each preterm infant. This knowledge is crucial to move from standardized nutritional protocols to tailored, individualized nutrition in preterm infants.
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http://dx.doi.org/10.1016/j.nut.2018.12.015DOI Listing
June 2019

A phase II randomized clinical trial for the treatment of recalcitrant chronic leg ulcers using centrifuged adipose tissue containing progenitor cells.

Cytotherapy 2019 02 22;21(2):200-211. Epub 2018 Dec 22.

Department of Morphology, Surgery and Experimental Medicine, Section of Translational of Medicine and Surgery, University of Ferrara, Ferrara, Italy; Sant'Anna University Hospital, Unit of Translational Surgery and Vascular Diseases Center, Ferrara, Italy.

Background Aims: Preclinical and observational reports indicate that adipose tissue (AT) is a safe and promising tool to treat non-healing venous leg ulcers (VLUs).

Methods: From an initial cohort of 38 patients, 16 patients affected by non-healing VLUs were randomly allocated to the experimental arm (5 men and 3 women) and control arm (5 men and 3 women). In the experimental arm, wounds were treated by debridement, centrifuged adipose tissue (CAT), advanced dressings and compression. No experimental treatment (CAT) was administered to the control arm. We investigated the functional and the immunophenotypical features of the harvested CAT-derived stem cells. The primary outcome measures were healing time and safety of the cell treatment. Secondary outcomes were pain evaluated by numeric rating scale (NRS), complete wound healing at 24 weeks by Margolis Index and wound-healing process expressed in square centimeters per week. The various immunophenotypic and functional characteristics of CAT-derived stem cells were then correlated with the clinical outcomes.

Results: No major adverse events were recorded. The healing time was significantly faster by applying CAT, 17.5 ± 7.0 weeks versus 24.5 ± 4.9 weeks recorded in the control arm (P < 0.036). NRS dropped after the first week to 2.7 ± 2.0 in the experimental arm versus 6.6 ± 3.0 in the control group (P < 0.01). The rate of healing at the 24th week was not significantly different between arms. Interestingly, we found a strong reverse correlation between the percent of CD34/CD45 non-hematopoietic cells, respectively, with the healing time (r = -0.894, P < 0.041) and NRS (r = -0.934, P < 0.020).

Conclusions: CAT is safe and may accelerate healing time in VLUs as well as reduce wound pain. The percentage of CD34/CD45 cells in stromal vascular fraction (SVF) seems to be a predictive biomarker of successful CAT treatment in these patients.
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http://dx.doi.org/10.1016/j.jcyt.2018.10.012DOI Listing
February 2019

Autologous adipose-derived stem cells: Basic science, technique, and rationale for application in ulcer and wound healing.

Phlebology 2017 Apr 9;32(3):160-171. Epub 2016 Jul 9.

1 Department of Morphology, Surgery and Experimental Medicine, Section of Translational of Medicine and Surgery, University of Ferrara, Italy.

Objectives The present review represents a translational boundary between basic research and surgery, particularly focusing on the promising application of adipose-derived stem cells harvested intra-operatively during debridement of venous leg ulcers. Methods We reviewed 830 out of 5578 articles on MEDLINE starting from 1997 and sorted by the relevance option. Results The technique currently used for adipose-derived stem cells intra-operative harvesting is presented, including a safety evaluation on a cohort of 5089 revised patients who underwent plastic surgery and maxillo-facial surgical procedures. Complications were reported in 169 cases (3.3%). One hundred and forty-one (2.77%) patients were classified as having minor complications, specifically: nodularity/induration 93 (1.83%), dysesthesia 14 (0.26%), hematoma 12 (0.23%), superficial infection 11 (0.21%), pain 7 (0.13%), poor cosmesis 3 (0.06%), and abnormal breast secretion 1 (0.02%), while 28 patients (0.55%) were classified as having major complications, specifically: deep infection 22 (0.43%), sepsis 3 (0.06%), abdominal hematoma 2 (0.04%), and pneumothorax 1 (0.02%). Application of cell therapy in venous leg ulcer is currently used only for patients not responding to the standard treatment. The review shows the lack of randomized clinical trials for application of adipose-derived stem cells among treatments for venous leg ulcer. Finally, adipose-derived stem cells implantation at the wound site promotes a new tissue formation rich in vascular structures and remodeling collagen. Conclusion Adipose-derived stem cells strategy represents a great opportunity for the treatment of chronic wounds, due to the simplicity of the technique and the application of cell treatment in the operating room immediately following debridement. However, clinical studies and data from randomized trials are currently lacking.
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http://dx.doi.org/10.1177/0268355516641546DOI Listing
April 2017

Eyelid reconstruction following excision of cutaneous malignancy.

J Craniofac Surg 2014 Jan;25(1):e13-7

From the Departments of *Maxillofacial Surgery and †Plastic and Reconstructive Surgery, University of Ferrara, Ferrara, Italy.

Purpose: With advancing age, cutaneous malignancy around the eye becomes more prevalent. Different kinds of malignant tumors of the eyelid have features particular to their subtype, and a diagnosis should be obtained before definitive treatment if possible. The aim of treatment is total tumor eradication with the smallest recurrence risk, using the most cost-effective method that is acceptable to the patient. Reconstruction of periocular defects following excision of eyelid malignancy can present difficulties, and various reconstructive procedures can be applied.

Methods: The retrospective study carried out has analyzed 173 patients submitted to surgery for skin cancers located in the eyelid region with particular reference to the period January 2005 to January 2012. We analyzed certain data (age, sex, histological types, affected portion of eyelid, incidence recurrence by histological type, incidence recurrent tumors previously treated by surgery [secondary], type of removal, type of reconstruction, and mean time elapsed between the demolitive act and disease recurrence) both individually and in correlation with each other. Multivariate analysis (Cox algorithm) was used to identify those variables that had a clear statistical significance.

Results: Melanoma and lentigo maligna have the highest tendency to relapse (33%), but squamous cell carcinoma has more rapid replicative capacity.

Conclusions: Extensive demolition should always be followed by extensive reconstruction. Even through intervention with an extensive demolition in cases of large tumors in the eyelid and cantus, it has not been possible to avoid the recurrence of the disease. The average time of recurrence when compared with reconstruction varies between 28 (minimum) and 39 months (maximum).
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http://dx.doi.org/10.1097/SCS.0b013e3182a2ed04DOI Listing
January 2014

Sinus lift tissue engineering using autologous pulp micro-grafts: A case report of bone density evaluation.

J Indian Soc Periodontol 2013 Sep;17(5):644-7

Dental Clinic, Don Orione Hospital, Bergamo, Italy.

Background: Although autografts are the standard procedure for bone grafting, the use of bone regeneration by means of dental pulp stem cell is an alternative that opens a new era in this field. Rigenera Protocol is a new technique able to provide the surgeon autologous pulp micro-grafts.

Materials And Methods: At the Department of Oral Surgery, Don Orione Hospital, Bergamo, Italy, one patient underwent sinus lift elevation with pulp stem micro-grafts gentle poured onto collagen sponge. A CT scan control was performed after 4 months and DICOM data were processed with medical imaging software which gives the possibility to use a virtual probe to extract the bone density. Pearson's Chi-square test was used to investigate difference in bone density (BD) between native and newly formed bone.

Results: BD in newly formed bone is about the double of native bone.

Conclusion: This report demonstrated that micro-grafts derived from dental pulp poured onto collagen sponge are a useful method for bone regeneration in atrophic maxilla.
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http://dx.doi.org/10.4103/0972-124X.119284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808021PMC
September 2013

A case of mandible osteonecrosis after a severe periimplant infection.

Dent Res J (Isfahan) 2012 Dec;9(Suppl 2):S233-6

Department of Maxillofacial Surgery, Galeazzi Hospital, Milan, Italy.

The term osteonecrosis has been applied to describe the presence of a persistent inflammation of the mouth, osteomyelitis, delayed healing of extraction sockets, development of sequestra or presence of fistulae from the mouth to the lower skin. Here, we document a case of mandible osteonecrosis that developed in a patient after a severe periimplant infection. Osteonecrosis, severe inflammatory osteolysis, and heavy bacterial colonization were found. Surgical toilette and hyperbaric oxygen therapy permitted complete healing of the case. No complication was recorded in the post-operative period and no further surgery was performed. The clinical follow up and the imaging after one year showed a complete 'restitution ad integrum' of the mandible. Although the risk of developing osteonecrosis of the jaw for oral implants is low, the devastating complications still require caution.
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http://dx.doi.org/10.4103/1735-3327.109768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692181PMC
December 2012

A rare case of rynopharyngeal melanoma.

Dent Res J (Isfahan) 2012 Dec;9(Suppl 2):S229-32

Department of Maxillofacial Surgery, Galeazzi Hospital, Milan, Italy.

Primary mucosal melanomas (MM) of the head and neck region constitute 0.5-2% of all malignant melanomas. The rynopharynx is a region that is less often involved by malignant melanomas. Because most of mucosal melanotic lesions are painless in their early stages, the diagnosis is unfortunately often delayed until symptoms resulting from ulceration, growth, and/or bleeding are noted. Here, we document the rare case of a malignant rynopharynx melanoma of a 43 year old woman. Its treatment and the pertinent literature are discussed. No complication was recorded in the post-operative period and no further surgery was performed. The follow up showed no recurrence in the same position and with the same characteristics, even after six years. Mucosal melanomas are aggressive tumours and the prognosis in these patients is poor. Clinicians must use treatment strategies that provide functional benefit, so as to maintain quality of life without excessive toxicity.
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http://dx.doi.org/10.4103/1735-3327.109767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692180PMC
December 2012

A case of lipoma of lateral anterior neck treated with surgical enucleation.

Dent Res J (Isfahan) 2012 Dec;9(Suppl 2):S225-8

Department of Maxillofacial Surgery, Galeazzi Hospital, Milan, Italy.

Lipoma arise in almost 50% of all soft tumours. The neck lipomas are rare tumours that may present as painless masses with slow growth, in the lateral portions of the neck. Some lipomas, such as the one studied in our case, grow deep in the subcutaneous tissue, in close contact with muscles. Here, we report a case of lipoma extending from pre-tragal region up to the ascending branch of the mandible in a 62 year old man, treated with enucleation. The inferior margin of lipoma involved the pharyngeal and the superior margin was achieved by the top of the skull base. The mass of lipoma caused breathing difficulties in the patient, preventing regular sleep. No complication was recorded in the post-operative period and no further surgery was performed. The complete resolution after one year's follow-up, together with the rarity of the anatomical site, makes this case worthy of description. A correct diagnosis facilitated removal of this lesion with a surgical method.
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http://dx.doi.org/10.4103/1735-3327.109764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692179PMC
December 2012

A case report of haemorrhagic-aneurismal bone cyst of the mandible.

Dent Res J (Isfahan) 2012 Dec;9(Suppl 2):S222-4

Department of Maxillofacial Surgery, Galeazzi Hospital, Milan, Italy.

Haemorrhagic-aneurismal bone cysts (HABCs) are quite rare, benign, non-neoplastic, expansive, and vascular locally destructive lesions. They are generally considered sequelae of an earlier trauma causing an overflow of blood into the bone. HABCs are classified as pseudocysts and they should be differentiated from true cysts because their treatment is different. Since few of these cysts involve subjective symptoms, most are discovered accidentally during radiography, while a sure diagnosis is likely to be obtained only during surgery, on discovery of a non-epithelialised cavity. Here, we report a typical case of a haemorrhagic-mandibular cyst in a 13-year-old girl, which was treated by opening the cavity and scraping its walls following diagnostic arteriography and post-operative transcutaneous intralesional embolization. No further complications were recorded in the post-operative period, although the convalescence lasted for a time longer than expected, because of anemia. No further surgery was performed. She has been disease-free for two years. Evaluation of intralesional blood flow is important for HABCs because of the hemorrhagic risk in surgery. Embolization seems to be a useful procedure in the treatment of HABCs and could be tried as the treatment modality in the standard protocol for the treatment of HABCs.
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http://dx.doi.org/10.4103/1735-3327.109763DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692178PMC
December 2012

Fibroblast behavior after titanium surfaces exposure.

Dent Res J (Isfahan) 2012 Dec;9(Suppl 2):S211-5

Department of Oral Science, Nano and Biotechnologies, University of Chieti, Chieti, Italy.

Background: The main requirements for a good material are its ability to promote attraction and adhesion of bone precursor cells and their proliferation and differentiation. Different biocompatible materials are currently employed as scaffold. Among these, titanium is considered a gold standard because of its biocompatibility and good corrosion resistance.

Materials And Methods: The aim of this work was to compare two different AoN titanium layers (GR4 and GR5) to investigate which one had a greater osteoconductive power using human fibroblasts (HFb) culture at two different time-points. The expression levels of some adhesion and traction-resistance related genes (COL11A1, COL2A1, COL9A1, DSP, ELN, HAS1, and TFRC) were analyzed using real time reverse transcription-polymerase chain reaction.

Results: After 7 days of treatment with TiA 4GR, the only two up-regulated genes were COL2A1 and DSP. After 15 days of treatment, none of genes over expressed.

Conclusion: Our preliminary results suggest that neither AoN 4GR nor AoN 5GR are able to promote the production of protein involved in cell-cell and cell-matrix adhesion and in stress-resistance, required for a good outcome in dental implantology.
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http://dx.doi.org/10.4103/1735-3327.109760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692176PMC
December 2012

Titanium alloys (AoN) and their involvement in osseointegration.

Dent Res J (Isfahan) 2012 Dec;9(Suppl 2):S207-10

Department of Oral Science, Nano and Biotechnologies, University of Chieti, Chieti, Italy.

Background: Osseointegration is essential for a long-term successful and inflammation-free dental implant. Such a result depends on osteoblastic cells growth and differentiation at the tissue-implant interface. The aim of this study was to compare two different AoN titanium layers (GR4 and GR5) to investigate which one had a greater osteoconductive power using human osteoblasts (HOb) culture at two different time-points.

Materials And Methods: The expression levels of some bone-related (ALPL, COL1A1, COL3A1, SPP1, RUNX2, and SPARC) were analyzed using real time reverse transcription-polymerase chain reaction (real time RT-PCR).

Results: Real-time RT-PCR data showed that after 3 days of treatment with TiA4GR, the genes up-regulated were COL3A1, ALPL, SPP1, and RUNX2. Moreover, no difference in gene expression was noticed 4 days later. On the other hand, the genes that overexpressed after 3 days of treatment with AoN5GR were ALPL, SPP1, and RUNX2. In both cases, the expression of COL1A1 and SPARC was negatively regulated.

Conclusion: Our data showed that both titanium surfaces led to osteoblasts recruitment, maturation, and differentiation, thus promoting osseointegration at the tissue-implant interface.
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http://dx.doi.org/10.4103/1735-3327.109756DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692175PMC
December 2012

Anatase-based implants nanocoating on stem cells derived from adipose tissue.

Implant Dent 2012 Apr;21(2):118-23

Department of Maxillofacial Surgery, University of Ferrara, Ferrara, Italy.

Purpose: The aim of this study was to investigate the effect of a new anatase coating with antibacterial properties (Bactercline anatase coating [BAC]) on dental implants in the commitment of stem cells derived from adipose tissue to osteoblasts.

Materials And Methods: Using real-time reverse transcription polymerase chain reaction, the quantitative expression of specific genes, such as transcriptional factors (runx2 and sp7), bone-related genes (spp1, col1a1, col3a1, alpl, and fosl1), and mesenchymal stem cells marker (eng), was examined.

Results: BAC caused induction of bone-related genes such as sp7, fosl1, alpl, and spp1. In contrast, the expression of runx2, col3a1, and col1a1 was decreased in stem cells treated with BAC with respect to untreated cells.

Conclusion: The obtained results are relevant to better understand the molecular mechanism of bone regeneration and as a model for comparing other materials with similar clinical effects.
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http://dx.doi.org/10.1097/ID.0b013e31824bc948DOI Listing
April 2012

Evaluation of gene expression in MG63 human osteoblastlike cells exposed to tantalum powder by microarray technology.

Int J Periodontics Restorative Dent 2011 Jul-Aug;31(4):e17-28

Orthopedic Clinic, University of Ferrara, Ferrara, Italy.

Conventional orthopedic implants are composed from titanium. To improve some characteristics (ie, volumetric porosity, modulus of elasticity, frictional modulus), a new porous tantalum biomaterial has been developed and its biocompatibility reported. By using DNA microarrays containing 20,000 genes, several genes whose expression were significantly up- or down-regulated were identified in an osteoblastlike cell line (MG63) cultured with tantalum powder (TP). The differentially expressed genes cover a broad range of functional activities: signaling transduction; transcription; cell cycle regulation, proliferation, and apoptosis; and cytoskeleton formation. To the authors' knowledge, the data reported represent the first genetic portrait of TP.
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February 2012

Distance between implants has a potential impact of crestal bone resorption.

Saudi Dent J 2011 Jul 19;23(3):129-33. Epub 2011 Feb 19.

Dental School, University of Chieti, Chieti, Italy.

Objectives: Around dental implants exists a "biologic width" of few millimeters that have to be preserved in order to not have adverse effect on soft and hard tissues around implant. Because the minimum distance between adjacent implants has not been determined yet, we therefore, decided to perform a retrospective study on a series of spiral family implants (SFIs) to verify the minimum inter-implants' distance that has an impact on crestal bone resorption.

Materials And Methods: Fifty-nine implants were investigated with a mean follow-up of 14 months. Implant diameter was 3.75, 4.2, 5 and 6 mm in 11 (18.6%), 29 (49.2%), 17 (28.8%) and 2 (3.4%) SFIs. Implant length was shorter than 13 mm, equal to 13 mm and 16 mm in 23 (39%), 23 (39%) and 13 (22%) SFIs. Implants were inserted to replace 13 incisors (22%), 7 cuspids (11.9%), 30 premolars (50.8%) and 9 molars (15.3%). Twenty-seven fixtures were inserted in post-extractive sockets and the remaining 32 in healed bone; 36 (61%) were immediately loaded. In addition to the above mentioned implant-related factors, several host- and surgery-factors were investigated. Independent samples T-test, univariate and multivariate analysis were used to detect those variables associated with the clinical outcome.

Results: Data were evaluated with a two steps statistical analysis (i.e. univariate and multivariate) after having grouped implants in two series: those with an implant-implant distance less of 1.8 mm and those with an implant-implants distance greater than 1.8 mm. In univariate analysis, post-extractive implants and number of prosthetic units were statistically significant. In multivariate analysis, only post-extractive implants have a significant adverse effect on crestal bone resorption.

Conclusions: Adjacent implants inserted with a distance lower and higher than 1.8 mm have difference in crestal bone resorption but this difference is not statistically significant in a short period follow up. This could due to the specific implant used that has a reverse conical neck. No statistical difference was detected between implant subtypes. Post-extractive implant insertion is the major determinant in terms of peri-implant bone resorption in a short period follow-up.
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http://dx.doi.org/10.1016/j.sdentj.2011.02.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3723294PMC
July 2011

Biological effect of resorbable plates on normal osteoblasts and osteoblasts derived from Pfeiffer syndrome.

J Craniofac Surg 2011 May;22(3):860-3

Department of Maxillofacial Surgery, University of Ferrara, Ferrara, Italy.

Biodegradable fixation devices made of the polymers polylactide, polyglycolide and their copolymers are used routinely during maxillofacial, craniofacial, and orthopedic reconstructive surgical procedures, thanks to their property of biodegradation that avoid the need for implant removal. In particular, they are used in the treatment of craniosynostosis in pediatric patients affected by Pfeiffer syndrome, where the resorption time of 1 year or less does not interfere with the normal growth of the skull. To study the mechanism how polylactide-polyglycolide (PLPG) acid plates can induce osteoblast differentiation and proliferation in normal osteoblasts and in osteoblasts derived from a patient with Pfeiffer syndrome, the expression levels of bone-related genes were analyzed using real-time reverse transcription-polymerase chain reaction. Osteoblasts grown on the PLPG acid plates resulted in significant upregulation of mRNA expression of many genes related to osteodifferentiation during the treatment, indicating that polylactide, polyglycolide biopolymers enhance proliferation, differentiation, and deposition of matrix in osteoblasts. This study also revealed some differences in gene expression between normal osteoblasts and osteoblasts derived from patients with Pfeiffer syndrome, cultivated on PLPG acid plates.
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http://dx.doi.org/10.1097/SCS.0b013e31820f7d34DOI Listing
May 2011

Computer planning and bone density evaluation of jaws reconstructed with bone grafts from living donors.

J Craniofac Surg 2011 Mar;22(2):486-9

Department of Maxillofacial Surgery, Galeazzi Hospital, Milan, Italy.

Bone augmentation to reconstruct atrophic jaws provides the base for sufficient functional and aesthetic implant-supported oral rehabilitation. Although autografts are the standard procedure for bone grafting, the use of homolog bone provides a reasonable alternative because it is safe, cheap, and available in adequate amount. Five patients were grafted with femur bone derived from living donors, and in 2 of them, 16 implants were inserted after 6 months. Pearson χ test was used to investigate the difference in bone density (BD) between native and grafted bone and between peri-implant and bone far from fixtures. The BD of the grafted bone is about double that of the native bone. Peri-implant BD is higher than BD far from fixtures, demonstrating that implant loading increase BD. Computed tomography is a valuable and accurate preoperative and follow-up method to obtain information about bone quality and quantity (ie, volume of available bone). Femur graft has a high density that improves under loading, thus suggesting that early implant loading should be performed whenever possible. However, a larger implant series and a longer observation period are mandatory to have a stronger support to these preliminary data.
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http://dx.doi.org/10.1097/SCS.0b013e318208ba9cDOI Listing
March 2011

Implant treatment in grafted and native bone in patients affected by ectodermal dysplasia.

J Craniofac Surg 2010 Nov;21(6):1776-80

Maxillofacial Surgery, Galeazzi Hospital, Milan, Italy.

Ectodermal dysplasia (ED) is a congenital syndrome characterized chiefly by abnormalities of tissues of ectodermal origin, namely skin, nails, hair, and teeth. Dental treatment of patients with ED is necessary because it affords the opportunity to develop normal forms of speech, chewing, swallowing, and normal facial support. Because there are few reports focusing on implants inserted in bone grafted in patients with ED, we therefore performed a retrospective study on 44 implants inserted in 4 patients to detect those variables acting on survival and crestal bone remodeling around implant neck in such subjects. Forty-four fixtures were analyzed. Several patient-related (age and sex), anatomic (maxilla and mandible and tooth site), implant (type, length, and diameter), surgical (sites and types of grafts), and prosthetic (type of loading) variables were investigated. Implant failure and peri-implant bone resorption were considered as predictors of clinical outcome. Kaplan-Meier algorithm and Cox regression were then performed to detect those variables statistically associated with the clinical outcome. Implant length and diameter ranged from 11.5 to 15 mm and from 3.5 to 4.0 mm, respectively. Implants were inserted to replace 12 incisors, 12 cuspids, 11 premolars, and 9 molars. No implant was lost. On the contrary, implant's length, grafted sites, and type of loading affected univariate analysis, but these data were not confirmed by multivariate algorithm. Dental implants and bone grafts to orally rehabilitate patients with ED are valuable devices with no difference if compared with unaffected patients, at least in adults.
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http://dx.doi.org/10.1097/SCS.0b013e3181f40378DOI Listing
November 2010

Osteoplant acts on stem cells derived from peripheral blood.

J Indian Soc Periodontol 2010 Jan;14(1):12-7

Orthopedic Clinic, Corso Giovecca 203, 44100 Ferrara, Italy.

Objectives: The osteoplant is an equine, flexible, heterologous, deantigenic, cortical, and spongy bone tissue, totally reabsorbable, used for implantation of bone tissue, to restore skeletal, even weight-bearing structures. However, how the osteoplant alters osteoblast activity to promote bone formation is poorly understood.

Materials And Methods: To study how the osteoplant induces osteoblast differentiation in mesenchymal stem cells, the expression levels of bone-related genes, and mesenchymal stem cell markers are analyzed, using real time Reverse Transcription-Polymerase Chain Reaction (RT-PCR).

Results: The osteoplant causes induction of osteoblast transcriptional factors such as osterix (RUNX2), and of bone-related genes such as osteopontin (SPP1) and osteocalcin (BGLAP). In contrast the expression of ENG (CD105) is significantly decreased in stem cells treated with osteoplant, with respect to untreated cells, indicating the differentiation effect of this biomaterial on stem cells.

Conclusion: The obtained results can be relevant to better understand the molecular mechanism of bone regeneration and as a model for comparing other materials with similar clinical effects.
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http://dx.doi.org/10.4103/0972-124X.65429DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2933523PMC
January 2010

Implant rehabilitation in grafted and native bone in patients affected by ectodermal dysplasia: evaluation of 78 implants inserted in 8 patients.

Implant Dent 2010 Oct;19(5):400-8

Department of Maxillofacial Surgery, Galeazzi Hospital, Milan, Italy.

Objectives: Ectodermal dysplasia (ED) is a congenital syndrome characterized chiefly by abnormalities of tissues of ectodermal origin, namely skin, nails, hair, and teeth. Dental treatment of patients with ED is necessary, because it affords the opportunity to develop normal forms of speech, chewing, swallowing, and normal facial support. Because there are few reports focusing on implants inserted in bone grafted in patients affected by ED. This is a retrospective study of 78 implants inserted in 8 patients to detect those variables acting on survival and crestal bone remodeling around the implant neck in such subjects.

Materials: Seventy-eight fixtures were analyzed. Several patient-related (age and gender), anatomical (maxilla and mandible, tooth site), implant (type, length, and diameter), surgical (sites and types of grafts), and prosthetic (type of loading and implant/crow ratio) variables were investigated. Implant failure and peri-implant bone resorption were considered as predictors of clinical outcome. Kaplan-Meier algorithm and Cox regression were then performed to detect those variables statistically associated with the clinical outcome.

Results: Implant length and diameter ranged from 11.5 to 18 mm and from 3.5 to 6.0 mm, respectively. Implants were inserted to replace 19 incisors, 19 cuspids, 21 premolars, and 19 molars. One implant was lost. On the contrary, implant' length, grafted sites, and type of loading have an impact on univariate analysis, but this datum was not confirmed by multivariate algorithm.

Conclusion: The use of dental implants and bone grafts to orally rehabilitate patients affected by ED is a valuable service with no difference in the results compared with unaffected patients, at least in adults.
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http://dx.doi.org/10.1097/ID.0b013e3181e40609DOI Listing
October 2010

Relation between disk/condyle incoordination and joint morphological changes: a retrospective study on 268 TMJs.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010 Sep 24;110(3):e34-40. Epub 2010 Jul 24.

Objective: The relation between disk/condyle incoordination and temporomandibular joint (TMJ) morphological changes is incompletely known. To address the research purpose, the investigators designed a cohort study of 268 TMJs. MRIs were evaluated.

Study Design: A series of morphological parameters were investigated regarding disk, condyle, tuber, interarticular space, and muscles. Pearson chi square was the statistical method used.

Results: Disk incoordination is statistically associated with morphological changes of condyle and tuber. No association was detected regarding morphological changes of disk, interarticular space, muscles, and pain. Reported data have shown that disk and condyle incoordination are related to morphological changes of TMJ surfaces (i.e., both condyle and tuber). The functional changes (i.e., pain, interarticular space reduction or enlargement, presence of fat in muscles, and disk derangements) are not associated with disk and condyle incoordination.

Conclusion: The reported data do not allow determination of which is the first cause (i.e., the disk/condyle incoordination or morphological changes of TMJ surfaces). Additional studies are needed to address this last question.
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http://dx.doi.org/10.1016/j.tripleo.2010.04.014DOI Listing
September 2010

Effectiveness of fresh frozen and cryopreserved homologue iliac crest grafts used in sinus lifting: a comparative study.

Cell Tissue Bank 2011 Nov 6;12(4):263-71. Epub 2010 Jul 6.

Department of Maxillofacial Surgery, Civil Hospital, Castelfranco Veneto, Italy.

In the last decade, several investigators have reported that autologous and homologous fresh frozen bones (FFB) are effective materials to restore alveolar ridges previous to insert dental implants. Recently we have used cryopreserved homologue grafts (CFFB). Here we reported a retrospective comparative study between implants inserted in FFB and CFFB evaluate their clinical outcome. Patients were treated with a split mouth scheme for bone grafting with FFB and CFFB and spiral family implants (SPI) were inserted in the same surgical time. Several variables (patient, grafts, anatomic site, implant, prosthetic restoration) were investigated. Implant' failure and peri-implant bone resorption were considered as predictor of clinical outcome. A total of 84 SFIs were inserted in 12 patients. Implants were inserted to replace 8 incisors, 4 cuspids, 31 premolars and 41 molars. The mean follow-up was 14 months. Three out of 84 implants was lost (i.e. survival rate SVR = 96.4%) and no differences were detected among the studied variables. Similar result was obtained by analyzing the crestal bone resorption around implant' neck (i.e. success rate). FFB and CFFB have high and comparable survival and success rate. Implants inserted with one step surgical procedure in native (i.e. not grafted) bone, FFB and CFFB have similar clinical outcome.
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http://dx.doi.org/10.1007/s10561-010-9192-6DOI Listing
November 2011

Spiral implants bearing full-arch rehabilitation: analysis of clinical outcome.

J Oral Implantol 2011 Aug 16;37(4):447-55. Epub 2010 Jun 16.

Dental School, University of Chieti, Via dei Vestini 31, 66100, Chieti, Italy.

A spiral implant (SPI) is a conical internal helix implant with a variable thread design which confers the characteristic of self drilling, self tapping, and self bone condensing. The effectiveness of this type of implant has been reported in several clinical situations. However, because there are no reports that specifically focus on one of the biggest challenges in oral rehabilitation, that is, full arch rehabilitation, it was decided to perform a retrospective study. The study population was composed of 23 patients (12 women and 11 men, median age 57 years) for evaluation and implant treatment between January 2005 and June 2009. Two-hundred six spiral family implants (SFIs) were inserted with a mean postloading follow-up of 23 months. Several variables were investigated: demographic (age and gender), anatomic (maxilla and mandible, tooth site), implant (type, length, and diameter), surgical (surgeon, postextractive, flapless technique, grafts), and prosthetic (implant/crown ratio, dentition in the antagonist arch, type of loading, and computerized tomography [CT] planning) variables. Implant loss and peri-implant bone resorption were evaluated. Univariate and multivariate tests were performed. Survival and success rates were 97.1% and 82.5%, respectively. Only implant length and implant/crown ratio showed statistical significance in determining a better clinical outcome. In conclusion, SFIs are a reliable tool for the most difficult cases of oral rehabilitation. No differences were detected among implant type. Length and implant/crown ratio can influence the crestal bone resorption with better result for longer fixtures and a higher implant/crown ratio. In addition, banked bone derived from living donors can be used to restore alveolar ridge augmentation without adverse effects. Finally, flapless and CT-planned surgery did not significantly increase the clinical outcome in most complex rehabilitation.
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http://dx.doi.org/10.1563/AAID-JOI-D-09-00140.1DOI Listing
August 2011

Ectodermal dysplasia treated with one-step surgical rehabilitation: a case report.

Singapore Dent J 2010 Jun 25;31(1):9-14. Epub 2012 Jan 25.

Maxillofacial Surgery, Orthopedic Institute Galeazzi, Milan, Italy. Electronic address:

Ectodermal dysplasia (ED) comprises a large heterogeneous group of inherited disorders that are characterized by primary defects in the skin, hair, nails, eccrine glands and teeth. The most characteristic findings are the reduced number of teeth. All rehabilitative programmes involve proper evaluation of skeletal relationships. Prosthetic-implantological treatment at the end of bony growth can be used. In this article a case of ED treated with Le Fort I for maxillary advancement, femur homografts, implants' insertion and immediate loading is described. In December 2007, a 38-year-old female was referred to the Maxillofacial Department of Galeazzi Hospital (Milan, Italy) who had a diagnosis of ED. Twelve implants were inserted in one-step surgical procedure. No implant was lost and all are stable. The occlusion is stable after 15 months of follow-up. The results indicate that the one-step oral rehabilitation can be performed in adults who are affected by ED. Also, this significantly reduces the time of oral and facial rehabilitation.
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http://dx.doi.org/10.1016/S0377-5291(12)70003-2DOI Listing
June 2010

3D finite element analysis to detect stress distribution: spiral family implants.

J Maxillofac Oral Surg 2009 Dec 24;8(4):334-9. Epub 2010 Apr 24.

Dental School, University of Chieti, Chieti, Italy.

Aim: Spiral family implants are a root-form fixtures with increasing thickness of tread. This characteristic gives a self-tapping and self-condensing bone properties to implants. To study spiral family implant inserted in different bone quality and connected with abutments of different angulations a Finite Element Analysis (FEA) was performed. Once drawn the systems that were object of the study by CAD (Computer Aided Design), the FEA discretized solids composing the system in many infinitesimal little elementary solids defined finite elements. This lead to a mesh formation where the single finite elements were connected among them by nodes. For the 3 units bone-implant-abutments several thousand of tetrahedral elements having 10 parabolic nodes were employed.

Materials And Methods: The biomechanical behaviour of 4.2 mm × 13 mm dental implants, connecting screw, straight and 15° and 25° angulated abutment subjected to static loads, in contact with high and poor bone quality was evaluated by FEA. A double system was analyzed: a) FY strength acting along Y axis and having 200 N intensity; b) FY and FZ couple of strengths applied along Y and Z directions and having respectively 200N and 140N intensity. The materials were considered as homogeneous, linear and isotropic. Then the FEA simulation was performed hypothesizing a linearity between loads and deformations.

Results: The lowest stress value was found in the system composed by implants and straight abutments loaded with a vertical strength, while the highest stress value were found in implants and 15° angulated abutment loaded with a angulated strength. In addition, the lower is the bone quality (i.e. D4) the higher is the distribution of the stress within the bone.

Conclusion: Spiral family implants can be used successfully in low bone quality but a straight force is recommended.
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http://dx.doi.org/10.1007/s12663-009-0081-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3454091PMC
December 2009

One-step oral rehabilitation by means of implants' insertion, Le Fort I, grafts, and immediate loading.

J Craniofac Surg 2009 Nov;20(6):2205-10

Maxillofacial Surgery, Orthopaedic Institute Galeazzi, Milan, Italy.

Purpose: In the last decade, several investigators have reported that autologous and homologous fresh frozen bones are effective materials to restore alveolar ridges before insertion of dental implants. Recently, we have used femur homograft derived from living donors. Here, we reported a 1-step oral rehabilitation of the severely resorbed maxilla by means of implants' insertion, Le Fort I osteotomy for maxillary advancement, grafts, and immediate loading.

Methods: Patients were treated with 1-step oral rehabilitation. Age, sex, implant length and diameter, tooth site, loading, and grafts were the investigated variables. Implant failure and peri-implant bone resorption were considered as predictors of clinical outcome. Kaplan-Meier algorithm and Cox regression were then performed to detect those variables statistically associated with the clinical outcome.

Results: Eighty-four implants were inserted in 11 patients. Implants were inserted to replace 22 incisors, 21 cuspids, 20 premolars, and 21 molars. The mean follow-up was 17 months. Two of 84 implants were lost (ie, survival rate = 97.6%), and no differences were detected among the studied variables. By using the 82 fixtures processed with Kaplan-Meier and Cox regression, only implant site has an impact on clinical outcome, and molars have a worse outcome than incisors.

Conclusion: One-step oral rehabilitation can be used in selected patients. It significantly shortened the time of rehabilitation without adverse effects. Femur homograft derived from living donors is a valuable material for grafting jaw: it is safer, cheap, and available in programmed amounts and avoids a second operation field.
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http://dx.doi.org/10.1097/SCS.0b013e3181bf8487DOI Listing
November 2009

Clinical outcome of narrow diameter implants inserted into allografts.

J Appl Oral Sci 2009 Jul-Aug;17(4):301-6

Department of Maxillofacial Surgery, Civil Hospital, Castelfranco Veneto, Italy.

Objective: Narrow diameter implants (NDI) (i.e. diameter <3.75 mm) are a potential solution for specific clinical situations, such as reduced interradicular bone, thin alveolar crest and replacement of teeth with small cervical diameter. NDI have been available in clinical practice since the 1990s, but only few studies have analyzed their clinical outcome and no study have investigated NDI inserted in fresh-frozen bone (FFB) grafts. Thus, a retrospective study on a series of NDI placed in homologue FFB was designed to evaluate their clinical outcome.

Material And Methods: In the period between December 2003 and December 2006, 36 patients (22 females and 14 males, mean age 53 years) with FFB grafts were selected and 94 different NDI were inserted. The mean follow-up was 25 months. To evaluate the effect of several host-, surgery-, and implant-related factors, marginal bone loss (MBL) was considered an indicator of success rate (SCR). The Kaplan Meier algorithm and Cox regression were used.

Results: Only 5 out of 94 implants were lost (i.e. survival rate - SVR 95.7%) and no differences were detected among the studied variables. On the contrary, the Cox regression showed that the graft site (i.e. maxilla) reduced MBL.

Conclusions: NDI inserted in FFB have a high SVR and SCR similar to those reported in previous studies on regular and NDI inserted in non-grafted jaws. Homologue FFB is a valuable material in the insertion of NDI.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327646PMC
http://dx.doi.org/10.1590/s1678-77572009000400007DOI Listing
November 2009

A new device for impression transfer for non-parallel endosseus implants.

Saudi Dent J 2009 Jul 6;21(2):79-81. Epub 2009 Aug 6.

Dental School, University of Chieti, Chieti, Italy.

The three-dimensional orientation of dental implant is transferred to a model by means of transfer device and impression material. If more than one implant is inserted and fixtures are not perfectly parallel, the impression may become distorted when removed from the mouth. In this case, a transfer that can be disengaged from the internal implant-abutment connection and removed together with the tray could be useful. An impression transfer device composed of a proper transfer, an inner hexagon and a central screw is described. When the central screw and the hexagon are removed, the proper transfer is free to move horizontally and the tray can be removed from the mouth without distortion of the impression material.
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http://dx.doi.org/10.1016/j.sdentj.2009.07.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722992PMC
July 2009

Comparison between implants inserted with and without computer planning and custom model coordination.

J Craniofac Surg 2009 Jul;20(4):1086-92

Dental School, University of Pescara-Chieti, Italy.

Purpose: In the last decade, several systems for computer-planned implantology have been reported. Among them is a system that uses software and a three-dimensional parallelometer able to transfer the implant position from the virtual project to the master model. To verify the effectiveness of this system, a retrospective comparative study has been planned.

Materials And Methods: A series of 300 implants were analyzed. Sixty-six were inserted with computer planning. Several variables related to patient, anatomic site, implant, and surgery were investigated. Implants' failure and peri-implant bone resorption were considered as predictors of clinical outcome. Kaplan-Meier method and Cox regression analysis were then performed to detect those variables statistically associated with the clinical outcome.

Results: Implant length and diameter ranged from 10 to 16 mm and from 3.75 to 6.0 mm, respectively. Implants were inserted to replace 66 incisors, 39 canines, 116 premolars, and 79 molars. Mean follow-up was 14 months. Nine implants were lost (survival rate, 97%), but no differences were detected among the studied variables. On the contrary, lower crestal bone resorption was detected for implants inserted in healed bone and in anterior jaws.

Conclusions: Computer-planned and cast model-transferred implantology give good clinical results in survival and success rate. It is a useful technology that should be used in most difficult cases such as totally edentulous patients and reduced crestal bone volume.
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http://dx.doi.org/10.1097/SCS.0b013e3181abb322DOI Listing
July 2009

A comparison between genetic portraits of normal osteoblasts and osteosarcoma cell lines.

Indian J Dent Res 2009 Jan-Mar;20(1):52-9

Institute of Histology, University of Bologna, Bologna, Italy.

Background: Osteosarcoma (OS) is the most frequent malignant bone tumor occurring in young patients in the first two decades of life. Metastases are the cause of 90% of cancer deaths for patients with OS. OS of the jaw is rare and aggressive malignancy constitutes approximately 5-13% of all cases of skeletal OS. Chemotherapy plus surgery are the first choice for treatment.

Aims: Because OS cell lines (OCLs) should share a common pathway with primary OS and new drugs are screened in in vitro systems, new insight about the genetic profiling of OCLs is of paramount importance to a better understanding of the molecular mechanism of this rare tumor and detecting a potential target for specific therapy.

Materials And Methods: The SAOS2 and TE85 cell lines were analysed using DNA microarrays containing 19,000 genes. Several genes in which expression was significantly differentially expressed in OCLs vs. normal osteoblast (NO) were detected.

Results: The differentially expressed genes cover a broad range of functional activities: (a) cell cycle regulation, (b) cell differentiation, (c) apoptosis, and (d) immunity.

Conclusion: The reported data can be relevant to a better understanding of the biology of OS and as a model for comparing the effect of drugs used in OS treatment.
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http://dx.doi.org/10.4103/0970-9290.49069DOI Listing
July 2009
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