Salute dentoparodontale in gravidanza e sue correlazioni con la salute sistemica: studio epidemiologico longitudinale in un campione di donne gravide milanesi

According to recent evidence, periodontal diseases may represent a risk factor for adverse pregnancy outcomes like preterm birth (<37 weeks) and/or low birth weight (<2500 g) as well as they are supposed to be related to systemic diseases like for example cardiovascular diseases, which are often characterized by a hyperinflammatory trait and are in turn associated to adverse pregnancy outcomes. The aim of this report was to analyze oral and systemic conditions in a sample of postpartum women and investigate a possible relationship between oral and systemic pathologies and adverse pregnancy outcomes. 363 post-partum women were interviewed and underwent a dental and periodontal examination within 5 days from delivery. Data was collected about sociodemographic status, smoking habit, oral hygiene habits, probing pocket depth, bleeding on probing, clinical attachment level and dental status. Basing on pregnancy outcomes, the sample was divided in 120 cases (28 women affected by preeclampsia, 33 by IUGR, 41 by PROM, 9 who delivered low birth babies, 26 who delivered preterm and 43 who delivered preterm low weight babies) and 243 controls. In the present study a strong correlation was observed between adverse pregnancy outcome and the presence of a maternal pathology. Considering single pathologies, allergies, hypertension, diabetes and cardiovascular diseases were significantly associated to cases. A correlation was observed between adverse pregnancy outcomes and a high maternal bleeding index. No statistically significant correlation was found with periodontal markers like probing pocket depth and clinical attachment level, or with DMFT index

Endocannabinoid system and periodontal diseases: a histological preliminary study

Periodontal disease is a chronic condition characterized by an opportunistic infection of the periodontal tissues by Gram- anaerobic bacteria (1). Tissue destruction can be limited by the production of anti-inflammatory substances and its final entity depends on the equilibrium between pro- and anti-inflammatory mechanisms. The endocannabinoid system (EC) is supposed to have an anti-inflammatory action. The two most extensively studied molecules of the EC are anandamide and 2-AG with their specific receptors, CB1 and CB2. Nakajima et al (2) showed the presence of CB1 and CB2 receptors in human gingival fibroblasts from healthy patients and subjects affected by periodontal inflammation and found that AEA significantly reduced the production of cytokines (IL-6, IL-8 and MCP-1) by gingival fibroblasts after bacteria stimulation, through CB1 and CB2 receptors. The aim of this project was to quantitatively and qualitatively evaluate the presence of CB1 and CB2 receptors in the gingival tissue from patients affected by periodontitis compared to healthy subjects. Ten patients were recruited, six healthy subjects (H) and four with chronic periodontitis (P). In each patient, a gingival biopsy was harvested during periodontal treatment and processed for immunohistochemistry to reveal CB1 and CB2 expression. Every sample was mapped at 200X total magnification and the presence of CB1 and CB2 was quantified using a standardized method with Adobe Photoshop PS5. The percentage of marked tissue in the connective tissue and in the epithelium was calculated. In P the mean CB1 percentage on the connective tissue (CB1-c) was 2.27% + 0.14% and CB2 (CN2-c) was 2.12% + 0.43%, while in H the values were 0.13% + 0.31% and 0.06% + 0.11% respectively. In P the mean CB1 value on the epithelium (CB1-e) was 5.08 + 2.27% and CB2 (CB2-e) was 4.07% + 1.64%, while in H the corresponding values were respectively 0.16% + 0.36% and 0.03% + 0.02%. CB1 and CB2 expression resulted significantly higher in P than in H samples in both epithelial and connective tissue (Wilcoxon sum rank test, p<0.01). Such data confirm that EC are involved in periodontal disease

Immunohistochemical evaluation of pro-inflammatory molecules in the soft tissue surrounding switching platform implants

Introduction. Switching platform implants have been proposed to reduce the peri-implant bone loss by shifting the implant abutment interface internally and away from the bone tissue. Aim of the present study was to characterize the inflammatory infiltrate in the soft tissue surrounding switching and matching platform implants and to evaluate the expression of pro-inflammatory molecules involved in the bone loss. Material and methods. A total of 32 implants with diameters of 3.8mm, 4.3mm, 4.8mm and 5.5mm were all restored with abutment of 3.8mm of diameter, thus resulting the following implant-abutment mismatches: 0mm (n=10) (control group), 0.25mm (n=7) (test group1), 0.5mm (n=8) (test group2), and 0.85mm (n=7) (test group3). Four years after loading, peri-implant soft tissue samples were harvested and processed for immunohistochemical analysis. Total amount of lymphocytes T (LyT) -B (LyB) infiltrated, and expression of IL-17 and RANKL were detected. Results. At the harvesting time all sites were clinically healthy. No significant differences were found between groups (p>0.05) in terms of infiltrated T and B cells amount, IL-17 and RANKL expression. In all samples lymphocytes T and B were mainly localized close to the junctional epithelium and sparsely detected in the surrounding connective tissue. The distribution of IL-17 and RANKL staining resulted strictly correlated to the inflammatory infiltrated. When pooled data were analyzed, amount of lymphocytes T and IL-17 were higher than respectively lymphocytes B and RANKL. Amount of LyT and LyB were highly correlated (Pearson’s r>0.7) and IL-17 was moderately correlated (Pearson’s r>0.4, <0.7) to LyT and LyB. Conclusions. In the prolonged exposure of the abutment at the oral cavity the configuration of the implant abutment interface may do not affect the inflammatory cellular and molecular pattern responsible for bone loss

Deproteinized bovine bone graft remodeling pattern in alveolar socket: an immunohistological evaluation

The biologic pattern of bone remodeling is well defined in several in vivo and in vitro studies, but the influence of bone substitutes on individual healing pattern in human is not completely defined and described. Several grafts are available on the market, homologous, heterologous and synthetic bone substitutes. Deproteinized bovine bone (Bio-Oss®, Geistlich Pharma AG, Switzerland) (DBB) is a heterologous substitute derived from bovine bone deprived of all the organic components and reduced in porous grains of different dimensions (0.25 - 2 mm). Preclinical and clinical studies widely described the biocompatibility of deproteinized bovine bone and the integration of this biomaterial in the regenerated bone, but several papers underlined the low rate resorption of the material, that still remains in situ until 11 years after regeneration procedures. This characteristic was also investigated in vitro in osteoblasts, unraveling the ability of DBB particles in down-regulating BMP-2, BMP- 7, TNF-alpha and IL6 genic expression in the early phase of healing but, to the best of our knowledge, no studies checked the same parameters in vivo. The aim of the present study is to describe the remodeling pattern of DBB in human socket alveolar preservation in the late phase of healing. Ten patients that needed tooth extraction and implant placement were recruited. At the time of the extraction a bone biopsy (T0) was collected and the alveolar socket was filled with DBB and covered with a membrane (Bio-Guide®, Geistlich Pharma AG, Switzerland). After 6 months, before implant placement, another bone biopsy was collected (T1). All specimens were processed for immunohistochemistry to mark BMP-2, BMP-7, ALP, IL6 and TNF-alpha. Every section was mapped at 200X total magnification and the presence of these factors was quantified using a standardized method with Adobe Photoshop PS5. For every marking the normalized delta between T1 and T0 was calculated and the results were respectively: BMP2 0.67 + 0.43, BMP7 0.36 + 0.23, ALP -0.28 + 0.18, IL6 0.81 + 0.60, TNF-alpha 1.09 + 0.85. The Wilcoxon paired test revealed highly significant differences between T0 and T1 for all markers (p<0.05 for IL6 and p<0.01 for the others). Differently from what expressed in “in vitro” studies, these data underline that DBB in late phases of healing does influence bone turnover by stimulating the production of morphogenetic proteins and inducing the expression of other catabolic and anabolic markers involved in bone remodeling, thus confirming its role as a valid bone substitute

Maxillary sinus lift with or without biomaterials in humans: radiographic and histomorphometric evaluation

Biomaterials are frequently used for sinus lift procedures at the time of implant installation in the posterior upper jaw. Nevertheless, some authors have reported the possibility of leaving an empty space, in order to exploit the regenerative potential of the residual periosteal and bony walls following the Schneiderian membrane elevation. The aim of this study was to compare the radiographic changes and histological characteristics of newly formed bone following sinus lift without any biomaterials or Bio-Oss®. Fifteen patients with edentulousness of the maxillary molar-premolar area and a residual crest thickness < 6 mm, were randomly allocated to a test group (sinus lift without biomaterial) or a control group (with Bio-Oss®). Two submerged Astra Tech implants were placed in the most mesial and distal portion of the augmented area. Six months later, a bone biopsy was harvested in the area between the 2 previously placed fixtures, where a third central implant was placed. Standard radiographies were taken before sinus lift and 6 months later in order to measure and compare the vertical bone changes. The biopsies were processed for ground sectioning. All implants but one case were successful. Radiographically, the basic level of bone tissue in the test group (n=5) was 5 ± 0.86 mm and 3.5 ± 0.57 mm in the control group (n=10); in the test group the bone tissue was increased vertically of 10 ± 2.53 (range 7-13), in the control group 13 ± 1.41 (range 12-14). At histological observation, all samples showed new bone formation without signs of inflammation. Bone remodeling was observed in the apical portion of both groups. Residual particles of biomaterial were embedded in mineralized new bone. Histometric results for the control group were: LB 38.8% ± 8.1, WB 9.2% ± 2.4, BM 30.2% ± 7.5, BO 21.7% ± 8.9; for the test group: LB 54.5% ± 2.1, WB 115.5% ± 6.1 and BM 33.5% ± 6.4. A clinically significant bone increase was achieved both with and without the use of biomaterials. The implants showed similar performances when inserted at sites augmented with or without biomaterials. The success of such procedure might depend on the anatomical conformation of the crest and on the level of surgical experience of the surgeon

Personal Protection Equipment and Infection Control Procedures among Health Workers during the COVID-19 Pandemic

Health workers have been particularly affected by the COVID-19 pandemic, but it is unclear which healthcare professions are more exposed. We search for information that can help identify health workers who are employed in exposure-prone professions and who, therefore, routinely wear and adopt strict infection control equipment and measures from other colleagues. Our purpose is to test the hypothesis that health professionals historically considered less exposure-prone are affected more severely by COVID-19. Taking dentists as an example of exposure-prone healthcare professionals, this study aims to analyze data on COVID-19-related deaths reported by the Italian board of doctors and dentists&rsquo; database to evaluate the number of COVID-19-related deaths of doctors and dentists in Italy from the beginning of the pandemic to 31 December 2022. As of 31 December 2021, out of 364 deaths, 38 were dentists, and of the remaining 326 doctors, 140 were general practitioners (GPs). The percentage of deaths among dentists, total doctors and GPs results in 0.06%, 0.09% and 0.33%, respectively, for the whole sample. Excluding subjects over 70 years of age, the corresponding values are 0.05%, 0.06% and 0.25%. Most of the deaths occurred in Lombardia, and the geographical distribution overlaps the trend of the corresponding general Italian population. Considering the outcome of &ldquo;death&rdquo;, dentists, despite being at high risk, are not particularly affected by COVID-19

Bone tissue reactions at sites grafted with Bio-Oss®

AIM: To analyze bone tissue reactions at sites grafted with a deproteinized bovine bone mineral (Bio-Oss®, Geistlich Pharma AG, Wolhusen, Switzerland). For this purpose experimental studies were conducted in dogs and one study was performed in humans.MATERIAL & METHODS: The mandibular premolars were extracted and open buccal bone defects were created in dogs. In study I, implants were placed in the compromized ridge, and compared with implants placed in a "normal" ridge. In study II, 5 months after tooth extraction, the buccal bone defect in the test animals was augmented with a graft made of Bio-Oss® and Tisseel® (Immuno AG, Vienna, Austria). After 3 months, titanium implants were inserted in the edentulous areas. Control sites consisted of implants placed in a non-augmented buccal defect. In studies I and II the animals were sacrificed 7 months after implant installation and biopsies were harvested. Ground sections were prepared for histological analysis.Cylindrical bone defects were prepared in the mandible of labrador dogs, 3 to 5 months after the extraction of the premolar teeth. The defects were either filled with Bio-Oss® alone or with Bio-Oss® mixed with Tisseel®, or covered with a collagen membrane (Bio-Gide®, Geistlich Pharma AG, Wolhusen, Switzerland). The animals were sacrificed 6 months after tooth extraction. Block biopsies were collected for histological analysis.In 21 subjects, tooth extraction was performed and bone augmentation was required at the extraction sites before fixture placement. The sockets were filled with Bio-Oss® granules or covered with a Bio-Gide® membrane. Bone biopsies were collected during implant installation and prepared for histological examination.In beagle dogs, the 4th mandibular premolars were extracted and the sockets filled with Bio-Oss®. Three months later an orthodontic device was inserted on the canine, the 3rd premolar and the 1st molar in each side of the mandible and bodily movement in a distal direction of the 3rd premolar was initiated. When the 3rd premolar had been moved into the extraction site of the 4th premolar, the animals were sacrificed and biopsies of the premolar-molar regions of the mandibles sampled. Paraffin sections were prepared and subjected to histological examination.RESULTS: Implants placed in a non-augmented compromized ridge were osseointegrated in their apical portion. At the buccal aspect of the fixture the bone defect was still present and at the lingual aspect a deep angular bone defect had formed. Sites where implants had been placed in the augmented buccal "defect" showed similar features at the buccal aspect as implants placed in the non-augmented ridge. The Bio-Oss® granules were located coronally to the bone crest and were surrounded by connective tissue.One and 3 months after grafting, cylindrical bone defects filled with a graft made of Bio-Oss® or Bio-Oss® mixed with Tisseel® showed the presence of newly formed bone in the periphery of the defect. In the central portion of the defect the graft was surrounded by connective tissue. The percentage of contact between Bio-Oss® particles and bone tissue was considerably smaller in sites grafted with Bio-Oss® mixed with Tisseel® than at sites grafted with Bio-Oss® alone.Human extraction sites covered with a Bio-Gide® membrane showed large amounts of lamellar bone and bone marrow and small proportions of woven bone. Sites grafted with Bio-Oss® were comprised of connective tissue including the graft particles and of scarce amounts of newly formed bone. Spontaneously healed sites were characterized by the presence of mineralized bone and bone marrow.It was possible to orthodontically move a tooth in bone tissue augmented with Bio-Oss®. At the pressure side of the 3rd premolar some Bio-Oss® granules were located in the periodontal ligament space. Osteoclast-like cells were occasionally observed to be in contact with the graft particles

Personal Protection Equipment and Infection Control Procedures among Health Workers during the COVID-19 Pandemic

Health workers have been particularly affected by the COVID-19 pandemic, but it is unclear which healthcare professions are more exposed. We search for information that can help identify health workers who are employed in exposure-prone professions and who, therefore, routinely wear and adopt strict infection control equipment and measures from other colleagues. Our purpose is to test the hypothesis that health professionals historically considered less exposure-prone are affected more severely by COVID-19. Taking dentists as an example of exposure-prone healthcare professionals, this study aims to analyze data on COVID-19-related deaths reported by the Italian board of doctors and dentists’ database to evaluate the number of COVID-19-related deaths of doctors and dentists in Italy from the beginning of the pandemic to 31 December 2022. As of 31 December 2021, out of 364 deaths, 38 were dentists, and of the remaining 326 doctors, 140 were general practitioners (GPs). The percentage of deaths among dentists, total doctors and GPs results in 0.06%, 0.09% and 0.33%, respectively, for the whole sample. Excluding subjects over 70 years of age, the corresponding values are 0.05%, 0.06% and 0.25%. Most of the deaths occurred in Lombardia, and the geographical distribution overlaps the trend of the corresponding general Italian population. Considering the outcome of “death”, dentists, despite being at high risk, are not particularly affected by COVID-19

Oral implants placed in bone defects treated with Bio-Oss, Ostim-Paste or PerioGlas: an experimental study in the rabbit tibiae

OBJECTIVES: To compare the histological features of bone filled with Bio-Oss, Ostim-Paste or PerioGlas placed in defects in the rabbit tibiae by evaluating bone tissue composition and the integration of titanium implants placed in the grafted bone. MATERIAL AND METHODS: Two cylindrical bone defects, about 4 mm in diameter and 6 mm in depth, were created in the tibiae of 10 rabbits. The defects were filled with either Bio-Oss, PerioGlas, Ostim-Paste or left untreated, and covered with a collagen membrane. Six weeks later, one titanium sandblasted and acid-etched (SLA) implant was inserted at the centre of each previously created defect. The animals were sacrificed after 6 weeks of healing. RESULTS: Implants placed in bone previously grafted with Bio-Oss, PerioGlas or Ostim-Paste obtained a larger extent of osseointegration, although not statistically significant, than implants placed in non-grafted bone. The three grafting materials seemed to perform in a similar way concerning their contribution towards implant osseointegration. All grafting materials appeared to be osteoconductive, thus leading to the formation of bridges of mineralized bone extending from the cortical plate towards the implants surface through the graft scaffold. CONCLUSIONS: Grafting with the above-mentioned biomaterials did not add any advantage to the osseointegration of titanium SLA implants in a self-contained defect