Clinical Classification of Bone Augmentation Procedure Failures in the Atrophic Anterior Maxillae: Esthetic Consequences and Treatment Options

Although the number of complications and failures in bone augmentation procedures is still relatively high, these problems remain poorly documented. Moreover, the literature concerning reconstructive techniques and the treatment of their complications in the anterior areas rarely considers the final esthetic result. The aim of this paper is to propose a new classification of bone augmentation complications in the esthetic area, providing treatment guidelines useful for the management of these cases. Failures of bony regeneration procedures can be mainly divided into partial failures and complete failures. A partial failure can be solved with a corrective surgical intervention: this second surgery can have success or may not be able to provide the desired esthetic result. When the bone reconstructive procedure fails totally, a complete failure occurs and the whole procedure has to be repeated. This new intervention can have success but also this new reconstructive surgery can fail in the same way as the first, causing important damage and a compromise solution that will hardly be acceptable from an esthetic point of view. Bone augmentation techniques are not completely predictable and are not always able to guarantee the expected result, especially in the atrophic anterior maxilla. Complications and failures can often occur and this possibility must always be clearly explained to those patients with high esthetic demands and expectations

Plant-RNA in Extracellular Vesicles: The Secret of Cross-Kingdom Communication

The release of extracellular vesicles (EVs) is a common language, used by living organisms from different kingdoms as a means of communication between them. Extracellular vesicles are lipoproteic particles that contain many biomolecules, such as proteins, nucleic acids, and lipids. The primary role of EVs is to convey information to the recipient cells, affecting their function. Plantderived extracellular vesicles (PDEVs) can be isolated from several plant species, and the study of their biological properties is becoming an essential starting point to study cross-kingdom communication, especially between plants and mammalians. Furthermore, the presence of microRNAs (miRNAs) in PDEVs represents an interesting aspect for understanding how PDEVs can target the mammalian genes involved in pathological conditions such as cancer, inflammation, and oxidative stress. In particular, this review focuses on the history of PDEVs, from their discovery, to purification from various matrices, and on the functional role of PDEV-RNAs in cross-kingdom interactions. It is worth noting that miRNAs packaged in PDEVs can be key modulators of human gene expression, representing potential therapeutic agents

Multidisciplinary Approach to Fused Maxillary central Incisors: a Case Report

Introduction: The fusion of permanent teeth is a development anomaly of dental hard tissue. It may require a hard multidisciplinary approach with orthodontics, endodontics, surgery and prosthetics to solve aesthetic and functional problems. Case presentation: A 20-year-old Caucasian man presented to our Department to solve a dental anomaly of his upper central incisors. An oral investigation revealed the fusion of his maxillary central incisors and dyschromia of right central incisor. Vitality pulp tests were negative for lateral upper incisors and left central incisor. Radiographic examinations showed a fused tooth with two separate pulp chambers, two distinct roots and two separate root canals. There were also periapical lesions of central incisors and right lateral incisor, so he underwent endodontic treatment. Six months later, OPT examination revealed persistence of the periapical radiolucency, so endodontic surgery was performed, which included exeresis of the lesion, an apicoectomy and retrograde obturation with a reinforced zinc oxide-eugenol cement (SuperEBA) Complete healing of the lesion was obtained six months postoperatively. Fused teeth crowns were separated and orthodontic appliances were put in place. When correct teeth position was achieved (after nine months), the anterior teeth were prosthetically rehabilitated. Conclusion: Many treatment options have been proposed in the literature to solve cases of dental fusion. The best treatment plan depends on the nature of the anomaly, its location, the morphology of the pulp chamber and root canal system, the subgingival extent of the separation line, and the patient compliance. Following an analysis of radiographical and clinical data, it was possible to solve our patient’s dental anomaly with a multidisciplinary approach

The platform switching approach to optimize split crest technique.

The split crest technique is a reliable procedure used simultaneously in the implant positioning. In the literature some authors describe a secondary bone resorption as postoperative complication. The authors show how platform switching can be able to avoid secondary resorption as complication of split crest technique

Short implants versus longer implants in vertically augmented atrophic mandibles: A systematic review of randomised controlled trials with a 5-year post-loading follow-up

Purpose: To compare the clinical outcome of fixed prostheses supported by 4 to 8 mmlong implants with prostheses supported by longer implants placed in vertically augmented atrophic mandibles after a follow-up of 5 years in function. Materials and methods: The Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE were searched up to 1 st September 2018 for randomised controlled trials (RCTs) with a follow up of at least 5 years in function comparing fixed prostheses supported by 4 to 8 mm-long implants with prostheses supported by longer implants placed in vertically augmented atrophic mandibles. Outcome measures were prosthesis failure, implant failures, augmentation procedure failures, complications, and peri-implant marginal bone level changes. Screening of eligible studies, assessment of the risk of bias and data extraction were conducted in duplicate and independently by two review authors. The statistical unit of the analysis was the prosthesis. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CIs). Results: Four eligible RCTs which included originally 135 patients were included. Two RCTs had a parallel group design and two a split-mouth design. Short implants were 5 to 6.6 mm long and were compared with longer implants placed in posterior mandibles augmented with interpositional blocks of bone substitutes. All trials were judged at unclear risk of bias. Twelve (14%) bone augmentation procedures failed to achieve the planned bone height to allow placement of implants with the planned length. Five years after loading 28 patients (21%) dropped from the four RCTs. There were no differences for patients having prosthesis (RR = 1.46; 95% CI 0.52 to 4.09; P = 0.47; Chi² = 1.35, df = 3 (P = 0.72); I² = 0%) or implant (RR = 1; 95% CI 0.31 to 3.21; P = 1.00; Chi² = 0, df = 3 (P = 1.00); I² = 0%) failures between the two interventions, but there were more patients experiencing complications (RR = 4.72; 95% CI 2.43 to 9.17; P < 0.00001; Chi² = 3.02, df = 3 (P = 0.39); I² = 0%) and peri-implant marginal bone loss (mean difference = 0.60 mm; 95% CI 0.36 to 0.83; P < 0.00001; Chi² = 5.47, df = 3 (P = 0.14); I² = 45%) at longer implants in augmented bone. Conclusions: Five years after loading, prosthetic and implants failures were similar between the two interventions, but complications and peri-implant marginal bone loss were higher and more severe at longer implants placed in vertically augmented mandibles. Larger trials and longer follow-ups up to 10 years after loading are needed to confirm or reject the present preliminary findings. However in the meantime short implants could be the preferable option

Effectiveness of surgical procedures in the acceleration of orthodontic tooth movement: Findings from systematic reviews and meta-analyses

The current overview aimed to summarise the findings provided by systematic reviews (SRs) on the effect of surgical procedures in the acceleration of tooth movement and to assess the methodological quality of the included SRs. Three electronic databases have been explored. SRs addressing the effects of surgical procedures on the acceleration of tooth movement were included. The methodological quality of the included SRs was assessed using the updated version of “A Measurement Tool to Assess Systematic Review” (AMSTAR-2). Twenty-eight (28) SRs were included. The methodological quality of the included reviews ranged between critically low (6 studies) and high (12 studies). The most common critical weakness in the included reviews was the absence of clearly a-prior established review methods and any significant deviations from the protocol. The most studied surgical procedure was corticotomy, followed by micro-osteoperforation, piezocision and periodontally accelerated osteogenic orthodontics. The majority of the included SRs supported short-term favourable effects of corticotomy on treatment time and tooth movement rate, in the short-term. However, the authors of the included SRs reported that results were based on weak quality evidence. Conflicting results arise from the existent SRs with regards to the effectiveness of piezocision and micro-osteoperforation. Few SRs summarised complications and side effects of surgical techniques, supporting absence of loss of tooth vitality, periodontal problems, or severe root resorption. The current overview of SRs highlighted the need of high quality SRs comparing different surgical approaches for tooth movement acceleration though network meta-analysis, in order to determine the most efficient instrument for orthodontic movement acceleration

Influence of the Antithrombotic Therapy in the Healing of Simple Post-Extraction Sockets: A Randomized Clinical Trial

Background: An adequate blood supply plays a leading role in the healing process of the post-extractive socket; its coagulation leads to fibrin clot formation, which acts as a physical barrier able to prevent postoperative bleeding and microbial infection. The purpose of this study was to evaluate the effectiveness of antiaggregant drugs in healing post-extraction sockets compared to natural wound healing. Methods: This was a single-center prospective clinical trial. Extraction sockets allocated in healthy patients and in patients assuming antiplatelet drugs were considered. Thirty consecutive patients under (treated with/in treatment with) oral antiplatelet treatment were enrolled in the test group. In order to provide a control group, 30 consecutive patients meeting all the exclusion and inclusion criteria were enrolled. The extraction of the mono-radicular tooth was atraumatically performed without gingivoplasty or osteotomy procedures that could influence the healing process. Photographs were obtained before and immediately after surgery and at 3-, 7-, 14-and 28-days follow-up. Results: All patients assumed the prescribed therapy and their postoperative recovery was uneventful without any kind of post-extractive complications. The results of inter-group comparison show that on the third and seventh days of follow-up, the antiplatelet group expressed a statistically significant higher level of healing compared to the control group (p &lt; 0.05), while no statistically significant differences were recorded at 14-and 28-days follow-up. Conclusions: Patients treated with antiplatelet agents seemed to show that this therapy can positively affect the healing process after tooth extractions

Evidence of non-seed transmission of viruses in grapevine breeding material

The vertical transmission of viruses is an important phenomenon affecting a wide range of viruses and host plants. Nevertheless, the presence of virus in a seed does not always lead to seedling infection. In grapevine, seed transmission has been reported for many nepoviruses, but little is known about Leafroll, Rugose wood complex and Fleck diseases. Thus, the aim of this study is to monitor the virological condition of seedlings obtained by crosses between infected parents, analyzing the sanitary status of seedlings after the transfer in experimental fields. It was observed that, although the viral state of parents was quite compromised, viruses were not detected in any of the 150 progeny plants, demonstrating that the main grapevine viruses are at low risk for seed transmission