Endoscopy-assisted removal through combined lower and middle meatotomies of an ectopic upper third molar in the sinus associated with a dentigerous cyst

The aim of this case report is to present an original conservative technique for the transnasal endoscopy-assisted extraction of an ectopic upper third molar associated with a dentigerous cyst occupying the whole maxillary sinus by means of combined lower and middle meatotomies. The proposed technique is a viable, minimally-invasive alternative to the Caldwell–Luc operation (with or without the repositioning of a bone lid), and also to endoscopic middle meatal antrostomy in cases where this would be unable to ensure adequate access because of the position and size of the ectopic tooth and associated cyst

Maxillary nerve block: A comparison between the greater palatine canal and high tuberosity approaches.

Aim: Analgesia and anxiolysis during dental procedures are important for dental care and patient compliance. This study aims to compare two classical maxillary nerve block (MNB) techniques: the greater palatine canal (GPC) and the high tuberosity (HT) approaches, seldom used in routine dental practice. Methods: The study was conducted on 30 patients, scheduled for sinus lift surgery, who were randomly divided into 2 groups: the GPC approach to the MNB was used in 15 and the HT one in the other 15 patients. Anxiolysis was also used, depending on the results of the pre- preoperative assessment. Patients\u2019 sensations/pain during the procedure, details about anesthesia, and the dentist\u2019s considerations were all recorded. Data are expressed as mean \ub1SD. Statistical tests including ANOVA, \u3c72 following Yates correction and linear regression analysis were carried out. A < 0.05 p value was considered significant. Results: Study results showed that the anesthesia was effective and constant in the molar and premolar area. Additional infiltrations of local anesthetics were necessary for vestibular and palatal areas in the anterior oral cavity, respectively, in the GPC and HT groups. The two techniques were equally difficult to carry out in the dentist\u2019s opinion. There were no differences in pain or unpleasant sensations between the two groups, nor were any anesthesia-related complications reported. Conclusion: The GPC approach ensures effective anesthesia in the posterior maxillary region as far as both the dental pulp and the palatal/vestibular mucous membranes are concerned; the HT approach did not guarantee adequate anesthesia of the pterygopalatine branch of the maxillary nerve. These regional anesthesia techniques were characterized by a low incidence of intra and postoperative pain, no noteworthy complications, and high patient satisfaction

The impact of bioceramic scaffolds on bone regeneration in preclinical in vivo studies: A systematic review

Bioceramic scaffolds are appealing for alveolar bone regeneration, because they are emerging as promising alternatives to autogenous and heterogenous bone grafts. The aim of this systematic review is to answer to the focal question: in critical-sized bone defects in experimental animal models, does the use of a bioceramic scaffolds improve new bone formation, compared with leaving the empty defect without grafting materials or using autogenous bone or deproteinized bovine-derived bone substitutes? Electronic databases were searched using specific search terms. A hand search was also undertaken. Only randomized and controlled studies in the English language, published in peer-reviewed journals between 2013 and 2018, using critical-sized bone defect models in non-medically compromised animals, were considered. Risk of bias assessment was performed using the SYRCLE tool. A meta-analysis was planned to synthesize the evidence, if possible. Thirteen studies reporting on small animal models (six studies on rats and seven on rabbits) were included. The calvarial bone defect was the most common experimental site. The empty defect was used as the only control in all studies except one. In all studies the bioceramic materials demonstrated a trend for better outcomes compared to an empty control. Due to heterogeneity in protocols and outcomes among the included studies, no meta-analysis could be performed. Bioceramics can be considered promising grafting materials, though further evidence is needed

Genetic and acquired factors influencing the effectiveness and toxicity of drug therapy in osteoporosis

Introduction: Osteoporosis is a highly prevalent skeletal disorder characterized by compromised bone strength, usually related to decreased bone mass and microstructural alterations of bone tissue, predisposing a person to an increased risk of fracture. As other prevalent disorders, osteoporosis is the result of a complex interplay of genetic and acquired factors. Areas covered: We provide an update of recent studies aimed at identifying the clinical and genetic factors that influence the response to drugs used to treat osteoporosis, as well as those determining the risk of two intriguing adverse effects of antiresorptives: osteonecrosis of the jaw (ONJ) and atypical femoral fractures (AFF). Expert opinion: Several clinical factors have been suggested to increase the risk of a poor drug response, such as advanced age and frailty. Candidate gene studies suggest that some common polymorphisms of the Wnt pathway and farnesyl diphosphate synthase (FDPS), the target enzyme for bisphosphonates, also influence the response to antiresorptives. However, they await for replication in large independent cohorts of patients. Similarly, some genetic and acquired factors may influence the risk of ONJ and AFF. Preliminary data suggest that the risk of suffering these adverse effects may have a polygenic basis

In vitro concurrent endothelial and osteogenic commitment of adipose-derived stem cells and their genomical analyses through CGH array: novel strategies to increase the succesfull engraftement of a tissue engineered bone grafts

In the field of tissue engineering, adult stem cells are increasingly recognized as an important tool for in vitro reconstructed tissue-engineered grafts. In the world of cell therapies, mesenchymal stem cells from bone marrow or adipose tissue are undoubtedly the most promising progenitors for tissue engineering applications. In this setting, adipose-derived stem cells (ASC) are generally similar to those derived from bone marrow and are most conveniently extracted from tissue removed in elective cosmetic liposuction procedures; they also show a great potential for endothelization. The aim of the present work was to investigate how the co-commitment into a vascular and bone phenotype of ASC could be a usefull tools for improving the in vitro and in vivo reconstruction of a vascularized bone graft. Human ASC obtained from abdominoplasty procedures were loaded in a hydroxyapatite clinical-grade scaffold, co-differentiated and tested for proliferation, cell distribution, and osteogenic and vasculogenic gene expression. The chromosomal stability of the cultures was investigated using the CGH array for 3D cultures. ASC adhesion, distribution, proliferation and gene expression not only demonstrated a full osteogenic and vasculogenic commitment in vitro and in vivo, but also showed that endothelization strongly improves their osteogenic commitment. In the end, genetic analyses confirmed that no genomical alteration in long-term in vitro culture of ASC in 3D scaffolds occurs

Treatment of OPG-deficient mice with WP9QY, a RANKL-binding peptide, recovers alveolar bone loss by suppressing osteoclastogenesis and enhancing osteoblastogenesis.

Osteoblasts express two key molecules for osteoclast differentiation, receptor activator of NF-κB ligand (RANKL) and osteoprotegerin (OPG), a soluble decoy receptor for RANKL. RANKL induces osteoclastogenesis, while OPG inhibits it by blocking the binding of RANKL to RANK, a cellular receptor of RANKL. OPG-deficient (OPG–/–) mice exhibit severe alveolar bone loss with enhanced bone resorption. WP9QY (W9) peptide binds to RANKL and blocks RANKL-induced osteoclastogenesis. W9 is also reported to stimulate bone formation in vivo. Here, we show that treatment with W9 restores alveolar bone loss in OPG–/–mice by suppressing osteoclastogenesis and enhancing osteoblastogenesis. Administration of W9 or risedronate, a bisphosphonate, to OPG–/–mice significantly decreased the osteoclast number in the alveolar bone. Interestingly, treatment with W9, but not risedronate, enhanced Wnt/β-catenin signaling and induced alveolar bone formation in OPG–/–mice. Expression of sclerostin, an inhibitor of Wnt/β-catenin signaling, was significantly lower in tibiae of OPG–/–mice than in wild-type mice. Treatment with risedronate recovered sclerostin expression in OPG–/–mice, while W9 treatment further suppressed sclerostin expression. Histomorphometric analysis confirmed that bone formation-related parameters in OPG–/–mice, such as osteoblast number, osteoblast surface and osteoid surface, were increased by W9 administration but not by risedronate administration. These results suggest that treatment of OPG–/–mice with W9 suppressed osteoclastogenesis by inhibiting RANKL signaling and enhanced osteoblastogenesis by attenuating sclerostin expression in the alveolar bone. Taken together, W9 may be a useful drug to prevent alveolar bone loss in periodontitis

Biobanking in dentistry: A review

Biobanks are not-for-profit services for the collection, processing, storage and distribution of biological samples and data for research and diagnostic purposes. In dentistry, biological materials and data obtained from questionnaires investigating oral conditions can be stored and used for large-scale studies on oral and systemic diseases. To give some examples: gene expression microarrays obtained on biobanked specimens were used in the identification of genetic alterations in oral cancer; efforts to identify genetic mechanisms behind dental caries have been based on an integrative analysis of transcriptome-wide associations and messenger RNA expression. One of the largest studies on facial pain was conducted using Biobank data. Cryopreservation of dental pulp stem cells is a common practice in tooth biobanks. With the exception of teeth and pulp, also leftover oral soft and hard tissues may represent a source of healthy samples that has rarely been exploited as yet. While biobanks are increasingly attracting the attention of the scientific community and becoming economically sustainable, a systematic approach to this resource in dentistry seems to be lacking. This review illustrates the applications of biobanking in dentistry, describing biobanked pathological and healthy samples and data, and discussing future developments

BIOBANKING AND RESEARCH: DIGITAL TOOLS

Aim: biobanks are not-for-profit services for the collection, processing, storage and distribution of biological samples and data for research and diagnostic purposes. Aim of this update is to illustrate the available digital resources and how to use them in research in the dental field. Methods: a literature research was conducted in PubMed up to March 2021; a search was also performed on official websites of some biobanks and specific search engines. Most recent evidence and developments in the digital biobanks were summarized. Results: Dental biological materials and data are stored in biobanks and can be used for large-scale studies. Biobanks search engines such as BBMRI are useful tools which redirect to the official biobanks websites where catalogues can often be found, along with instructions to request a biosample from them. Although biobanks in the dental field are available and studies have already been conducted using their resources (i.e. MoBa), a systematic approach to this asset seems to be lacking. Conclusions: biobanking in dentistry represents an efficient tool for effectively advancing research and clinical translation on oral and systemic disorders. It should also help to generate therapeutic benefits and be a fundamental step towards personalized medicine