Spermidine Associated to Non-Surgical Treatment of Periodontal Disease: Split Mouth Randomized Controlled Clinical Trial

Objectives. Spermidine is an endogenous polyamine whose increase induces the autocrine remodeling into targeted cells. The aim of the present study was to evaluate the adjunctive beneficial effects of the local delivery of spermidine to periodontal non-surgical therapy on reduction of periodontal pocket. Methods. In this split mouth, blind, randomized controlled clinical trial, 20 patients with severe chronic generalized periodontal disease scheduled for cause related non-surgical periodontal treatment were enrolled. In three quadrants for each patients, three experimental teeth with probing pocket depth (PPD) 65 6mm were selected and randomly assigned to one of the following treatments: scaling and root planning (SRP)+ spermidine gel (spermidine + alginate) (group a), SRP+ placebo gel (only alginate) (positive control, group b) or SRP (negative control, group c). PPD at baseline, 3 and 6 months after treatment was assessed. Descriptive and inferential statistics was done. Results. After periodontal treatment, a reduction of PPD was observed in all sites. No differences emerged between groups at each time point. In all groups, a significant PPD reduction was observed at T1 and T2 compared to baseline (p<0.05 and p<0.001). PPD reduction from T1 to T2 was significant only in group a (p<0.001). Conclusions. After non-surgical treatment, local delivery of spermidine may induce prolonged improvement of clinical outcome

Palatal size and shape in 6-year olds affected by hypohidrotic ectodermal dysplasia

Objective: To analyze the size and shape of the hard tissue palate of Italian subjects with hypohidrotic ectodermal dysplasia (HED). Materials and Methods: The morphology and the dimensions of the hard tissue palate were analyzed in eight 6-year-old boys affected by HED. Four of the boys were completely edentulous and four partially dentate. Palatal landmarks were identified on stone casts and digitized with three-dimensional computerized electromagnetic instrumentation. Palatal length, slope, width, and maximum palatal height in both the sagittal and frontal planes were measured. From the coordinates of palatal landmarks, a mathematical equation of palatal shape was constructed, independent of size. HED palatal data were compared with reference data obtained from 12 healthy boys with a complete deciduous dentition. Results: Palatal length and height in both the sagittal and frontal planes were significantly reduced in HED as compared with control individuals. A less steep (not significant) palatal slope was found in HED than in reference subjects, whereas similar palatal width values were observed. All palatal measurements were larger in partially dentate than in edentulous patients. Both HED and edentulousness influenced palatal shape. The HED boys had a relatively lower palate than the reference boys. In the edentulous HED boys, the hard tissue palate was relatively lower than in partially dentate HED subjects. Conclusions: Palatal size and shape were significantly modified by the presence of hypohidrotic ectodermal dysplasia, and the major alterations were found in edentulous HED subjects

Histomorphometrical evaluation of the effects of Aminogam® gel in oral healing process of post-surgical soft tissue

Wound healing is a dynamic process that involves a complex interaction of inflammatory cells, cytokines and mediators of extracellular matrix [1]. One of the processes that occur during tissue regeneration is angiogenesis and it is considered to have a pivotal role in wound repair. Previous studies have shown that a topical application of proteins and sodium hyaluronate to wounds can expedite the repair of damaged tissue [2]. The aim of this preliminary study is to evaluate the efficacy of Aminogam\uae gel (A\uae) (ErreKappa Euroterapici SpA, Milano), a topical medication which contains 4 amino acids (glycine, leucine, proline, lysine) and sodium hyaluronate, used to improve and accelerate gingival flap healing following molar extraction by analyzing collagen fibers amount, orientation and microvascular distribution (MVD). Ten patients (mean age 49ys) were included in the study. Two teeth (38 and 48) were extracted at an interval of 30 days. The \u201ctest\u201d site (AM) was treated with A\uae while the \u201ccontrol\u201d site (no AM) was not. Dental extraction was performed and the flaps were sutured with a consequent excess of tissue for histological processing (T0). A\uae had been applied only at the AM site for 10 days post-extraction. At suture removal, a gingivoplasty was performed and the exceeding tissue was histologically analysed (T1). Paraffin blocks were cut and slides were stained with haematoxylin-eosin and Sirius Red. No signs of inflammatory infiltrate or necrosis were observed. Sirius Red staining highlighted a lower degree of organized collagen fibers at T1 vs T0. At T0 the fibers were organized in closely packed and well-oriented bundles. At T1-no AM fibers were thin and formed a disorganized grid. At T1-AM fibers appeared thicker and the tissue appeared more mature compared to T1-no AM. Immunohistochemistry against CD31 was performed to mark endothelial cells and to calculate MVD by stereological method [3]. MVD resulted highest at T1-AM. The T1 data normalized on T0 presented a statistically significant difference (p=0.012) between AM and no AM group. In conclusion, A\uae gel seems to increase new blood vessels formation and to promote collagen deposition and organization. References [1] Gurtner et al. Nature. 2008;453(7193):314-21. [2] Zhu et al. BMC Oral Health. 2015;15:60. [3] Canullo et al. J Clin Periodontol. 2016;38:86-94

Three-dimensional ridge augmentation with xenograft and recombinant human platelet-derived growth factor-BB in humans: report of two cases

The present paper reports on two patients who underwent three-dimensional ridge augmentation using a xenograft in combination with recombinant human platelet-derived growth factor-BB (rhPDGF-BB). Patient 1 received a deproteinized bovine block infused with PDGF and secured to the alveolar crest by two fixation screws to augment the crest horizontally. After 5 months, implants were successfully placed. Patient 2 underwent a vertical ridge augmentation procedure that combined deproteinized bovine bone particles embedded in a collagen matrix soaked in PDGF Three titanium dental implants were placed in each patient 5 months later. Clinical and histologic results showed excellent soft and hard tissue healing. Bone had regenerated throughout the whole area and the xenograft particles were embedded in bone, which presented resorption lacunae close to areas with ongoing bone formation. This indicated that, in augmented areas, intense physiologic remodeling was ongoing. No data exist concerning three-dimensional bone augmentation using PDGF and a xenograft in humans. This report suggests that the use of rhPDGF-BB in combination with a deproteinized bovine graft may have the potential to regenerate large three-dimensional alveolar defects in humans

Biocompatibility and histologic evaluation of the osseointegration of dental implants coating with titanium niobium nitride

Background: The rehabilitation of edentulous patients by titanium dental implants provides successful results in a large number of cases. Dental implant surfaces may influence in different ways the osseous healing process, the contact osteogenesis and finally the osteointegration at short or long time. Some studies in the orthopedic field reported that the prosthesis corrosion and wear seem to affect directly the surrounding tissue by the releasing of detrimental metallic ions. Ceramic coatings of the dental titanium implants have been proposed since they are chemically inert, with high hardness and bioactive features. Titanium niobium nitride (TiNbN) deposited by a Physical Vapor Deposition technique is a innovative ceramic coating characterized by a good aesthetic feature that aims to increase the surface resistance to abrasion and corrosion, thus acting on several biological processes with a possible improvement in the biocompatibility and osteointegration of the implants at long term. Aim/Hypothesis: The aim of this preliminary study was to investigate in vitro the cytotoxic effects of a TiNbN coating and to assess histologically the bone response to dental mini-implants coated with TiNbN placed in the mandible of some patients. Material and Methods: For the in vitro evaluation, a cytotoxicity assay was conducted according to the EN ISO 10993 standards. The test item was immersed in culture medium and the eluate was brought into contact with a sub-confluent BALB/c 3T3 cell culture. After a 24 hours period of incubation the cells were observed by microscope to evaluate the biological reaction and cell viability. For the in vivo analysis, four patients were treated with a TiNbN custom manufactured mini-implants (BIOLOGY , PERMEDICA Spa, Italy) inserted simultaneously with a dental extraction in the mandibular arch. In two patients, 3 implants were removed at 3 and 4 months respectively using a trephine bur that allowed to harvest part of the surrounding bone and processed for histology. All the samples were fixed in formalin 10%, dehydrated in increasing alcohol scale, infiltrated in alcohol resin and finally embedded in pure resin (Technovit7200 VLC, Exact Kulzer). The samples were sectioned longitudinally using a diamond blade (Micromet, Remet, Italy), ground and polished to a final thickness of 80 lm with a microgrinding unit (LS2 , Remet, Italy). Two sections for each specimen were stained in Toluidine Blue/Pyronine G (Sigma-Aldrich, USA), and observed using a light microscope (Eclipse E600 , Nikon) equipped with digital camera. Each section was photographed at 10x, 20x and 40x magnifications in order to study the per-implant tissue morphology, the bone implant contact and the eventual presence of inflammatory infiltrate. Results: The TiNbN coating was found not cytotoxic. Cells treated with the test item showed a cell viability of 94.17%. Excellent clinical and radiological results were obtained in patients treated with TiNbN coating mini-implants. In all specimens a satisfactory bone healing was observed with new bone formation along the bone-implant interface. Many bone remodeling areas were present along the implant surface and in the bony trabeculae of the surrounding tissue. At high magnification, osteoblastlike cells seemed to form a new bone matrix layer in correspondence of the remodeling edges and in some areas they were found in direct contact with the implant threads. No gaps were observed at the interface between the regenerated bone and the implant surface. Furthermore, the medullary spaces were rich in cells and new blood vessels without inflammatory infiltrate. Conclusions and Clinical Implications: After the favorable results of the cytotoxicity test, the quality of the bone around miniimplants coated with TiNbN was assessed at the time of loading since this data represents a critical factor for the prognosis of implant-supported reconstructions. The histological aspect of the regenerated peri-implant bone showed an active remodeling with an intimate contact to the implant surface, thus providing promising outcomes of this new coating in terms of biocompatibility and osteointegration

Oral features in five adult patients with Wolf-Hirschhorn syndrome

The Wolf-Hirschhorn syndrome (WHS) is a rare genetic condition presenting with severe mental disability, growth retardation, muscular hypotonia, seizures, craniofacial abnormalities and defects in the cardiovascular, genitourinary and digestive apparata. To date, few data about oral status of afflicted patients were reported, and this syndrome is still unfamiliar among dental and maxillofacial professionals. Aim of the present case series was to provide oral data from five patients with WHS (3 women and 2 men) aged 19-41 years. All patients entered in a long-stay Institution with an inner dental service in 1998 and underwent regular dental examination and hygiene treatment. Neither tooth agenesis or dental size and shape anomalies were found in the analyzed subjects except for one man showing multiple cone-shaped teeth. At the beginning, bad dental and periodontal conditions with gingival signs and recurrent mucosal inflammation were found in all patients. After motivation of their tutors, dental and periodontal parameters were recorded during periodic assessments and a large decrease in the gingival index was found over time. These data could aware dentists about the therapeutic modalities to improve oral health of WHS patients

Occlusal morphology one year after orthodontic and surgical-orthodontic therapy : a quantitative analysis of clinically successful patients

OBJECTIVE: To evaluate morphologic characteristics of occlusion (contact points, contact areas, and frequency of contact) in clinically successful patients 1 year after orthodontic and surgical-orthodontic therapy followed by passive retention. MATERIALS AND METHODS: Twenty-two orthodontic and 18 surgical-orthodontic patients were analyzed. All patients were treated with standard edgewise technique by the same orthodontist. Contact points and areas were evaluated using a new method of digital image analysis of occlusal impressions. Polivinylsyloxan impressions were taken, scanned, and turned into gray-scale images. The physic relationship of light absorbance through the polivinylsyloxan for known thickness was calculated to determine contact areas (less than 50 microm of thickness) and near contact areas (less than 350 microm of thickness). RESULTS: The contact area was significantly larger in the orthodontic than in the surgical-orthodontic patients (Student's t-test, P < .05). The surgical-orthodontic group had significantly fewer contact points than the orthodontic group only at 150 microm of thickness. In both groups of patients, the first molar had the largest contact surface. Occlusal support was distributed mainly in the posterior regions with an important role involving the first molars. CONCLUSION: Surgical-orthodontic patients appear to have smaller contact surfaces and fewer contact points than orthodontic patients do. However, there were no differences in the number of teeth in contact with opposing teeth

Morphological and functional features of the human temporomandibular joint

The temporomandibular joint is a complex bilateral synovial articulation composed by the two temporal bones and the mandible. The skeletal surfaces are covered by a layer of fibrous connective tissue, are highly incongruent, and are separated by a fibrous disc, that reduces joint incongruence, increases joint stability, and allows movements of the lower jaw with six degrees of freedom. The joint develops from a phylogenetically older articulation typical of non-mammalian vertebrates, and its development is strictly related to that of the middle ear. The characteristics of this joint are unique, and its features are among those used to define the class Mammalia and separate mammals from other vertebrates. In particular, the human joint possesses several differences from that of the other mammals, and animal models cannot be easily used to investigate its dynamic and kinematic characteristics

Ridge Preservation Using a Novel Freeze-dried Enzymedeantigenic Bone Paste: A Histomorphometric-retrospective Pilot Case Series

Aim and objective: The aim of this study is to provide preliminary retrospective evidence concerning the histologic and histomorphometric outcome of a novel freeze-dried equine-derived bone paste (EDEBEX) for ridge preservation of sockets following tooth extraction. Materials and methods: This pilot retrospective case series describes the histologic and histomorphometric outcome of three patients who received the equine-derived bone paste in post-extractive sockets to allow the preservation of the alveolar ridge. Patients were later rehabilitated with monolithic-zirconia, implant-supported prostheses. Results: All patients healed uneventfully. The collected biopsies showed a prevalence of bone formation at 4 months, compact lamellar bone, with well-defined lamellae surrounding Haversian and Volkmann\u2019s canals at 6 months, and an intermediate degree of maturation in active anabolic phase at 7 months after grafting. The amount of mineralized matrix was 63.3\u201370.7%, whereas medullar spaces were 26.0\u201330.7%. Conclusion: Histologic examination showed that the bone paste was fully biocompatible. Bone regeneration occurred within the first 4 months from grafting, with 63.3\u201370.7% mineralized bone matrix. The residual biomaterial, when present, did not exceed, on average, 2%. Clinical significance: Ridge preservation using bone substitutes as an alternative to autogenous bone is known to be effective. However, available clinical evidence still does not indicate the biomaterial, if any, that should be preferred to carry it out. The equine bone paste used in the present study appears to be a good candidate for further investigation because it is easy to handle in the clinical setting and it displays a good bone formation rate

Correlazione tra immagini radiografiche e anatomia dei canali radicolari dei primi molari inferiori

Introduction- Nowadays, the anatomy of endodontic system, particularly of the apical third, has reached a primary interest in planning the cleaning, shaping and filling of root canals. Aim of the study- The present study aimed to correlate the actual anatomy with the radiologic anatomy of the canals of the first human mandibular molars. Method- Six mandibular first molars were extracted in periodontal patients and embedded in acrilic resin. Canal diameters were measured by means of intraoral radiographies and photographic images of serial sections. Data were compared with one-way analysis of variance (ANOVA, p<0.05). Results- Statistically significant differences between radiographic and photographic measures were found in all root canals (ANOVA, p<0.05). A continuous funnel taper was not evident in mesio-vestibular and mesio-lingual canals in none of the four analyzed radiographic projections. In contrast, distal canal revealed a cilindric shape in 90\ub0 radiographic projection and a continuous funnel taper in 0\ub0 projection. Conclusions- The differences between the observed data of the canal diameters in the first mandibular molars showed a lower appraisal (about 25-30%) of the actual canal anatomy in radiographic images