Incidental findings detected with panoramic radiography: prevalence calculated on a sample of 2017 cases treated at a major Italian trauma and cancer centre

Objectives: This study aimed to assess the prevalence of incidental findings, not strictly related to dentistry, viewed with panoramic radiography. Methods: Panoramic radiographs performed between December 2013 and June 2016 were retrospectively collected. These images were analyzed, searching for incidental findings. All the information collected was statistically analysed Results: A total of 2307 Panoramic Radiograph were analyzed and 2017 of them were included in the study. 529 incidental findings were seen: 255 (48.2%) were ESP (Elongation of Styloid Process), 167 were CAC (Carotid Artery Calcification) (31.57%), 36 were maxillary sinus pathologies (6.8%) and 71 were other incidental findings (13.42%). The total prevalence of IF was 26, 23%., CAC was 8.28% in the total population, and it was higher in women (9.82%) than men (6.54%). 48.5% of CAC were bilateral. When unilateral, the right side showed a higher right side prevalence. The prevalence of ESP was 12.64% in total population (men: 13.82%; women: 11.60%). 84.71% of ESP were bilateral and, when present unilaterally, no side difference was seen. 13.33% of the ESP appeared segmented. The prevalence of maxillary sinus pathologies was 1.78% (men: 2.32%; women: 1.31%). Only 8.33% of these pathologies were bilateral, and, when unilateral, they were mostly present on the right side. Between the 71 other IF (prevalence: 3.52%), sialoliths and tonsilloliths were assessed most frequently. Conclusion: Due to the high prevalence of incidental findings detected with panoramic radiography, dental practitioners should be aware of the various pathologic conditions seen on the panoramic radiographs

Endodontic Retreatment of Teeth With Uncertain Endodontic Prognosis Versus Dental Implants: 5-year Results From a Randomised Controlled Trial

PURPOSE. To ascertain whether it is better to endodontically retreat a previously endo-dontically treated tooth with periapical pathology and/or symptoms and an uncertain prognosis, or to replace the tooth with a single implant-supported crown. MATERIALS AND METHODS. Twenty patients requiring treatment of a previously endodon-tically treated tooth with periapical pathology and/or symptoms of endodontic origin and an uncertain prognosis, as judged by the recruiting investigator, were randomly allocated to endodontic retreatment (endo group; 10 patients) or tooth extraction and replacement with an implant-supported crown (implant group; 10 patients) according to a paral-lel-group design at a single centre. Patients were followed up to 5 years after treatment completion. Outcome measures were: procedure failure; complications; marginal bone level changes at both teeth and implants; radiographic endodontic success (teeth only); number of patient visits and days to complete treatment; chairside time; costs; and ae-sthetics, as assessed using the pink aesthetic score (PES) for the soft tissues and the white aesthetic score (WES) for the tooth/crown by independent assessors. RESULTS. One patient from the endo group dropped out. One endodontically retreated tooth fractured. There were no statistically significant differences in treatment failure between groups (difference in proportions = 0.1; 95% CI-0.18 to 0.35; P = 1.00). Three endo group patients had one complication each versus one complication in the implant group, the difference not being statistically significant (difference in proportions = 0.2; 95% CI-0.17 to 0.51; P = 0.582). The mean marginal bone levels at endo retreatment/implant insertion were 2.10 ± 0.66 mm for the endo and 0.05 ± 0.15 mm for the implant group. Five years after treatment completion, teeth lost on average 0.60 ± 0.96 mm and implants 0.56 ± 0.77 mm, the difference not being statistically significant (mean difference =-0.05 mm; 95% CI:-0.95 to 0.86; P = 0.914). Of the four teeth that originally showed periapical radiolucency, one was lost, two displayed complete healing, and one showed radiographic improvement. There were no statistically significant differences in the number of patient visits (endo = 6.7 ± 0.7; implant = 6.1 ± 0.7; mean difference = 0.6; 95% CI:-0.1 to 1.3 P = 0.106). However, it took significantly more days (endo = 61 ± 13.0; implant = 191.4 ± 75.0; mean difference =-130.4; 95% CI:-184.5 to-76.4; P < 0.001) but less chairside time (endo = 628 ± 41.4 min; implant = 328.5 ± 196.4 min; mean difference =-299.5; 95% CI:-441.3 to 1.0; P = < 0.001) to complete the rehabilitation. Implant treatment was significantly more expensive (endo = 1440 ± 549.7; implant = 2099 ± 170.3; mean difference = 659; 95% CI: 257.2 to 1060.8; P = 0.004). Five years after treatment completion, mean PES were 12.3 ± (1.3) and 8.9 ± 2.2 and mean WES were 8.1 ± 1.4 and 7.1 ± 1.7 in the endo group and implant group, respectively. Soft tissues aesthetics (PES) was significantly better at endodontically retreated teeth (mean difference-3.4; 95% CI-5.1 to-1.6; P (t-test) = 0.001), whereas no significant differences were observed between treatments in tooth aesthetics (WES) (mean difference =-1.0; 95% CI-2.6 to 0.5; P (t-test) = 0.178)

Graphene-based nanomaterials for tissue engineering in the dental field

The world of dentistry is approaching graphene-based nanomaterials as substitutes for tissue engineering. Apart from its exceptional mechanical strength, electrical conductivity and thermal stability, graphene and its derivatives can be functionalized with several bioactive molecules. They can also be incorporated into different scaffolds used in regenerative dentistry, generating nanocomposites with improved characteristics. This review presents the state of the art of graphene-based nanomaterial applications in the dental field. We first discuss the interactions between cells and graphene, summarizing the available in vitro and in vivo studies concerning graphene biocompatibility and cytotoxicity. We then highlight the role of graphene-based nanomaterials in stem cell control, in terms of adhesion, proliferation and differentiation. Particular attention will be given to stem cells of dental origin, such as those isolated from dental pulp, periodontal ligament or dental follicle. The review then discusses the interactions between graphene-based nanomaterials with cells of the immune system; we also focus on the antibacterial activity of graphene nanomaterials. In the last section, we offer our perspectives on the various opportunities facing the use of graphene and its derivatives in associations with titanium dental implants, membranes for bone regeneration, resins, cements and adhesives as well as for tooth-whitening procedure

Immediate, Early (6 Weeks) and Delayed Loading (3 Months) of Single, Partial and Full Fixed Implant- Supported Prostheses: Three-year Post- Loading Data From a Multicentre Randomised Controlled Trial

PURPOSE. To compare the clinical outcomes of single, partial and complete fixed im-plant-supported prostheses immediately loaded (within 48 hours), early loaded at 6 we-eks, and conventionally loaded at 3 months (delayed loading). MATERIALS AND METHODS. Fifty-four patients (18 requiring single implants, 18 partial fixed prostheses, and 18 total fixed cross-arch prostheses) were randomised in equal numbers in two private practices to immediate loading (18 patients), early loading (18 patients), and conventional loading (18 patients) according to a parallel group design with three arms. To be immediately or early loaded, implants had to be inserted with a torque superior to 40 Ncm. Implants were initially loaded with provisional prostheses, replaced after 4 months by definitive ones. Outcome measures were prosthesis and implant failu-res, complications and peri-implant marginal bone levels. RESULTS. Two conventionally loaded patients rehabilitated with cross-arch fixed total prostheses dropped-out before 3-year post-loading follow-up. No implant failed. One early-loaded partial prosthesis had to be remade (P = 1.0). Three complications occurred in the immediately loaded group, two in the early-loaded and one in the conventionally loaded group with no statistically significant differences across groups (P = 0.861). Pe-ri-implant marginal bone loss was-0.04 ± 0.85 mm at immediately loaded implants,-0.01 ± 0.55 mm at early-loaded implants and 0.33 ± 0.36 mm at conventional loaded implants with no statistically significant differences between the three loading strategies (P=0.191). CONCLUSIONS. All loading strategies were highly successful, and no differences were observed in terms of implant survival and complications when implants were loaded immediately, early or conventionally

Multicentre Withinperson Randomised Controlled Trial of 0.5 Mm Versus 1.5 Mm Subcrestal Placement of Dental Implants With Internal Conical Connection: Five-year Post-loading Results

PURPOSE. To assess whether there are any clinical benefits to placing single dental implants either 0.5 or 1.5 mm subcrestally in healed bone crests. MATERIALS AND METHODS. Sixty partially edentulous patients at six centres requiring two single implant-supported crowns had both sites randomly allocated according to a split-mouth design to either 0.5 mm or 1.5 mm subcrestal implant placement; implants in aesthetic areas were submerged for 3 months while those in non-aesthetic areas were not. Provisional acrylic crowns were fitted and replaced with definitive metal-ceramic crowns after 2 months. Patients were followed up to 5 years after loading. Outcome measures were: crown and implant failures, complications, aesthetics assessed using the pink esthetic score (PES), peri-implant marginal bone level changes, and patient prefe-rence, recorded by blinded assessors. RESULTS. Two patients dropped out. There were no statistically significant differences in failure rate (out of 58 patients, four implants failed in the 0.5 mm group versus one in the 1.5 mm group; difference =-5.17%; 95% CI-10.87% to 0.53%; P = 0.250) or complications (out of 58 patients eight complications occurred in eight patients from the 0.5 mm group versus five complications in five patients from the 1.5 mm group (difference =-5.17%; 95% CI-14.01% to 3.67%; P = 0.453) between groups. At 5 years after loading, the mean pink aesthetic scores were 10.89 ± 2.30 and 10.79 ± 2.41 in the 0.5 and 1.5 mm groups, respecti-vely, a difference that was not statistically significant (P = 0.943). Patients from the 0.5 mm group lost on average 0.53 ± 1.43 mm peri-implant marginal bone, and those in the 1.5 mm group lost 0.31 ± 0.98 mm, a statistically significant difference (0.26 mm; 95% CI 0.05 to 0.47; P = 0.016). Patients did not prefer any depth of implant placement over the other. There were no differences in outcomes between centres. CONCLUSIONS. No clinically appreciable differences were noted when placing implants surrounded by at least 1 mm of bone 0.5 mm or 1.5 mm subcrestally. Clinicians are therefore free to choose which strategy they prefer

The Impact of Repeated Abutment Changes on Peri-implant Tissue Stability: Five-year Post-loading Results From a Multicentre Randomised Controlled Trial

PURPOSE. To evaluate the impact of at least three abutment disconnections on hard and soft tissues around conventionally loaded implants versus definitive immediately non-oc-clusally loaded abutments in implants. A secondary aim was to evaluate whether the presence of less than 2 mm of keratinised mucosa is associated with increased soft tissue recession and/or peri-implant marginal bone loss. MATERIALS AND METHODS. Eighty patients requiring one single crown or one fixed partial prosthesis supported by a maximum of three implants were randomised, after implant placement at greater than 35 Ncm, according to a parallel-group design to receive either definitive immediately loaded abutments (definitive abutment or immediate loading group) or transmucosal abutments which were loaded after a delay of 3 months and removed at least three times. Patients were treated in four centres, and each patient contributed to the study with only one prosthesis, which was followed up for 5 years after initial loading. Outcome measures were: prosthesis failures, implant failures, complica-tions, pink aesthetic score (PES), buccal recessions, patient satisfaction, peri-implant marginal bone-level changes and height of the keratinised mucosa. RESULTS. Forty patients were randomly allocated to each group according to a paral-lel-group design. Seven patients from the definitive abutment group versus six from the repeated disconnection group dropped out or died. No patient from the definitive group had implant failures versus three patients who lost five implants in the repeated disconnection group (difference = 9.1%; CI95%:-0.7% to 18.9% to; P = 0.227). Nine patients from the repeated disconnection group lost or had to have their prosthesis remade (four provisional and five definitive prostheses) versus one provisional prosthesis failure in the definitive abutment group; this difference was statistically significant (difference = 23.5%; CI95%: 7.6% to 39.4%; P = 0.017), but was due to the erroneous use of non-indexed abutments in indexed implants in patients from the repeated disconnection group alone. Seven patients from the definitive abutment group versus nine patients from the repeated disconnection group were affected by complications (difference =-5.9%; CI95%:-26.0% to 14.2%; P = 0.775), the difference being not statistically significant. PES scores assessed at 5 years post-loading were 12.1±1.8 for the definitive abutment group and 11.9±1.7 for the repeated abutment changes group (difference = 0.2; CI95%:-0.7 to 1.1; P = 0.615); however, there was a statistically significant difference of 0.20 out of a maximum score of 2 in favour of the definitive abutment group for soft tissue contour alone (P = 0.045). Buccal recessions at 5 years post-loading amounted to-0.19±0.77 mm for the definitive abutment group and-0.07±1.24 mm for the repeated abutment changes group (difference = 0.12 mm CI95%:-0.42 to 0.66; P = 0.662). All patients declared being very satisfied or sati-sfied with the function and aesthetics of their prosthesis and would undergo the same procedure again. Mean peri-implant marginal bone loss 5 years after loading was 0.11±0.30 mm for the definitive abutment group and 0.48±0.73 mm for the repeated abutment change group (difference =-0.37 [SE=0.14] mm; CI95%:-0.66 to-0.09; P = 0.012), the difference being statistically significant. The height of keratinised mucosa at 5 years post-loading was 2.81±1.46 mm in the definitive abutment group and 2.83±1.84 mm in the repeated abutment change group (difference =-0.02 mm; CI95%:-0.85 to 0.80; P = 0.956), and there were no significant differences in marginal bone loss (difference = 0.00 mm; CI95%:-0.32 to 0.32, P = 0.990) or buccal recession (difference = 0.05 mm, CI95%:-0.43 to 0.54, P = 0.826) at implants having less than 2 mm of keratinised mucosa at loading compared to those having more than 2 mm of keratinised mucosa. CONCLUSIONS. Five-year post-loading data show that at least three repeated abutment disconnections significantly increased bone loss by 0.37 mm when compared to no di-sconnection, but this difference may not be clinically significant. While it might be advi-sable to avoid unnecessary abutment disconnection whenever possible, if disconnections are required, no clinically significant side effects may be expected. Immediately non-oc-clusally loaded dental implants are a viable alternative to conventional loading, and no increased bone loss or buccal recessions were noted even at implants with less than 2 mm of keratinised mucosa

On the role of keratinised mucosa at dental implants: A 5-year prospective single-cohort study

Purpose: The purpose of this study was to evaluate the role of keratinised mucosa on the longterm success of dental implants. Materials and methods: Thirty-two edentulous patients had one of their dental arches rehabilitated with a provisional screw-retained resin reinforced cross-arch fixed prosthesis supported by four immediately loaded implants. The two central straight implants were randomly allocated in two equal groups, according to a parallel-group design, to receive or not intermediate abutments (Multi -Unit Abutment, MUA). However, for the purpose of the present publication, the study was considered as a prospective single cohort study. To be immediately loaded, implants had to be inserted with a minimum torque of 30 Ncm, which was achieved by all implants. Provisional prostheses were delivered within 24 hours and were replaced, after 4 months, by definitive screwretained metal-ceramic prostheses. Patients were followed up to 5 years after loading. Prostheses were removed every 8 months to facilitate professionally delivered maintenance. Outcome measures were prosthesis and implant failures, complications, peri-implant marginal bone level (MBL) changes, bleeding on probing (BoP) and keratinised mucosa height (KMH). The absence of vestibular or lingual keratinised mucosa was put in relation with peri-implant bone loss and BoP. Results: Five-years after loading two patients dropped out and no implant or prosthetic failure occurred. Four patients were affected by prosthetic complications. At delivery of definitive prostheses, 32 (25%) implants had at least one vestibular or lingual site with no KMH and 96 (75%) implants had both sites with some KMH. Multi-level models did not show any statistically significant association between KMH at the time of delivery of the definitive prosthesis and changes in MBL and BoP at 5 years (estimate = 0.02; 95% CI: -0.02 to 0.05; P = 0.3393; and 1.02; 95% CI: 0.79 to 1.33; P = 0.8695, respectively). When KMH was analysed as dichotomous variable, implants with presence of KMH at delivery of definitive prosthesis at both vestibular and lingual aspects showed a trend of less BoP (estimate = -0.8; 95% CI: -1.69 to 0.08; P = 0.0741) but a statistically significant greater MBL loss compared to implants where KMH was only present at one site (estimate = 0.18; 95% CI: -0.1 to 0.3; P = 0.0041). Conclusions: The 5-year after loading outcome of immediately loaded screw-retained cross-arch prostheses supported by four implants is excellent in both the maxilla and mandible. Although the height of the keratinised mucosa did not seem to alter the clinical outcomes, its presence both at vestibular and lingual sites was associated with an increased marginal bone loss when compared to implants having at least one side without keratinised mucosa

On the role of keratinised mucosa at dental implants: a 5-year prospective single-cohort study

PURPOSE: The purpose of this study was to evaluate the role of keratinised mucosa on the long-term success of dental implants. MATERIALS AND METHODS: Thirty-two edentulous patients had one of their dental arches rehabilitated with a provisional screw-retained resin reinforced cross-arch fixed prosthesis supported by four immediately loaded implants. The two central straight implants were randomly allocated in two equal groups, according to a parallel-group design, to receive or not intermediate abutments (Multi-Unit Abutment, MUA). However, for the purpose of the present publication, the study was considered as a prospective single cohort study. To be immediately loaded, implants had to be inserted with a minimum torque of 30 Ncm, which was achieved by all implants. Provisional prostheses were delivered within 24 hours and were replaced, after 4 months, by definitive screw-retained metal-ceramic prostheses. Patients were followed up to 5 years after loading. Prostheses were removed every 8 months to facilitate professionally delivered maintenance. Outcome measures were prosthesis and implant failures, complications, peri-implant marginal bone level (MBL) changes, bleeding on probing (BoP) and keratinised mucosa height (KMH). The absence of vestibular or lingual keratinised mucosa was put in relation with peri-implant bone loss and BoP. RESULTS: Five-years after loading two patients dropped out and no implant or prosthetic failure occurred. Four patients were affected by prosthetic complications. At delivery of definitive prostheses, 32 (25%) implants had at least one vestibular or lingual site with no KMH and 96 (75%) implants had both sites with some KMH. Multi-level models did not show any statistically significant association between KMH at the time of delivery of the definitive prosthesis and changes in MBL and BoP at 5 years (estimate = 0.02; 95% CI: -0.02 to 0.05; P = 0.3393; and 1.02; 95% CI: 0.79 to 1.33; P = 0.8695, respectively). When KMH was analysed as dichotomous variable, implants with presence of KMH at delivery of definitive prosthesis at both vestibular and lingual aspects showed a trend of less BoP (estimate = -0.8; 95% CI: -1.69 to 0.08; P = 0.0741) but a statistically significant greater MBL loss compared to implants where KMH was only present at one site (estimate = 0.18; 95% CI: -0.1 to 0.3; P = 0.0041). CONCLUSIONS: The 5-year after loading outcome of immediately loaded screw-retained cross-arch prostheses supported by four implants is excellent in both the maxilla and mandible. Although the height of the keratinised mucosa did not seem to alter the clinical outcomes, its presence both at vestibular and lingual sites was associated with an increased marginal bone loss when compared to implants having at least one side without keratinised mucosa

Decellularization and delipidation protocols of bovine bone and pericardium for bone grafting and guided bone regeneration procedures

The combination of bone grafting materials with guided bone regeneration (GBR) membranes seems to provide promising results to restore bone defects in dental clinical practice. In the first part of this work, a novel protocol for decellularization and delipidation of bovine bone, based on multiple steps of thermal shock, washes with detergent and dehydration with alcohol, is described. This protocol is more effective in removal of cellular materials, and shows superior biocompatibility compared to other three methods tested in this study. Furthermore, histological and morphological analyses confirm the maintenance of an intact bone extracellular matrix (ECM). In vitro and in vivo experiments evidence osteoinductive and osteoconductive properties of the produced scaffold, respectively. In the second part of this study, two methods of bovine pericardium decellularization are compared. The osmotic shock-based protocol gives better results in terms of removal of cell components, biocompatibility, maintenance of native ECM structure, and host tissue reaction, in respect to the freeze/thaw method. Overall, the results of this study demonstrate the characterization of a novel protocol for the decellularization of bovine bone to be used as bone graft, and the acquisition of a method to produce a pericardium membrane suitable for GBR applications