Frameworks made of carbon fibre-reinforced composites (CFRC) seem to be a viable alternative to traditional metal frameworks in implant prosthodontics. CFRC provide stiffness, rigidity and optimal biocompatibility. The aim of the present prospective study was to compare carbon fibre frameworks versus metal frameworks used to rigidly splint implants in full-arch immediate loading rehabilitations. Forty-two patients (test group) were rehabilitated with full-arch immediate loading rehabilitations of the upper jaw (total: 170 implants) following the Columbus Bridge Protocol with four to six implants with distal tilted implants. All patients were treated with resin screw-retained full-arch prostheses endowed with carbon fibre frameworks. The mean follow-up was 22 months (range: 18-24). Differences in the absolute change of bone resorption over time between the two implant sides (mesial and distal) were assessed performing a Mann-Whitney U-test. The outcomes were statistically compared with those of patients rehabilitated following the same protocol but using metal frameworks (control group: 34 patients with 163 implants - data reported in Tealdo, Menini, Bevilacqua, Pera, Pesce, Signori, Pera, Int J Prosthodont, 27, 2014, 207). Ten implants failed in the control group (6·1%); none failed in the test group (P = 0·002). A statistically significant difference in the absolute change of bone resorption around the implants was found between the two groups (P = 0·004), with greater mean peri-implant bone resorption in the control group (1 mm) compared to the test group (0·8 mm). Carbon fibre frameworks may be considered as a viable alternative to the metal ones and showed less marginal bone loss around implants and a greater implant survival rate during the observation period.

The aim of this split-mouth, double-blind, randomized study was to determine whether pulsed electromagnetic field therapy (PEMF) can improve swelling and the management of pain after full-arch immediate loading implant surgery. Eleven patients were selected for the study. Each patient received four distal tilted implants in the upper or lower jaw and underwent full-arch immediate loading rehabilitation. After surgery, two PEMF devices were applied to each patient, one on each cheek. In a random manner, one of these PEMF devices was switched on (test side); the other served as a placebo (control side). Forty-eight hours after surgery clinicians estimated postoperative swelling through photographic documentation, comparing the condition before and after surgery, while pain was assessed using a verbal rating scale. The patient's degree of comfort in relation to the PEMF devices was analyzed by questionnaire using a numerical rating scale. No statistically significant difference was observed between the test and control sides for swelling or pain (P > 0.05). Most of the patients did not present swelling or pain at 48 h after surgery, regardless of whether the PEMF device was activated or not. Various outcomes were found in the comfort evaluation. Within the limitations of this study, PEMF does not reduce postoperative swelling or pain after implant surgery.

OBJECTIVESThis split-mouth study evaluated miRNA expression of tissues around implants with different surface treatments.MATERIAL AND METHODSEach patient of the sample (five men and five women) received two implants (one control and one test) into an edentulous quadrant to support fixed partial dentures. The control implants (Osseotite) had a dual acid-etched (DAE) surface in the apical portion and a machined coronal part, test implants (Full Osseotite, FOSS) were completely DAE. Machined healing abutments were placed on control implants and DAE abutments on test ones. All implants were assigned codes for blinding. Standardized periapical radiographs were taken at baseline, 2 and 6 months, and 1 year after surgery. Plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were recorded at 3 and 6 weeks, and 2, 3, 6, and 12 months post-implant placement. After 3 months, a mini-invasive sample of soft tissue was collected from seven patients (four women and three men) for miRNA microarray analysis.RESULTSControl implants showed greater bone resorption (BR) and lower PI: this was not statistically significant. No statistically significant differences in BOP and PD appeared. miRNA modulated by implant surfaces as well as by other clinical conditions has been identified. miRNA microarray analysis revealed that: (i) implant sites with low PI and absence of BOP had a miRNA expression profile similar to those with plaque and absence of BOP; sites with high PI and high BOP had a different profile. (ii) Implant sites with BOP presented similar profiles independently from implant surface. (iii) Implant sites with high PI and normal BR differed from others for miRNA expression profile. (iv) Implant sites with normal BR despite high BOP differed from others. This profile resembled that of FOSS implants. (v) Implant surface affected BR; groups having similar BR clusterized differently according to the implant type.CONCLUSIONSDAE surfaces induced lower BR and more plaque accumulation: This did not affect the health of soft tissues. miRNA analysis indicated that soft tissue inflammation is more related to gene expression profile than to plaque or to implant surface. Specific miRNA profile can protect implant sites from bleeding and BR irrespective of plaque accumulation.

Full-arch immediate loading implant rehabilitations provide patients with compromised dentition an effective treatment to improve their aesthetic and function. Aim of this prospective cohort study was to investigate the correlation between masticatory ability and gastric emptying rates among these patients. Ten subjects (five men and five women) with compromised dentition were tested in two occasions: before treatment and 30 days after the immediate loading rehabilitation. Masticatory ability was evaluated using the sieves test, and the gastric half emptying time (T(1/2)) was assessed by means of the 13C-octanoic acid breath test. A statistically significant increment (P < 0.005) in masticatory ability was found only in reference to the particles smaller than or equal to 4.75 mm, whereas the gastric emptying rate showed a statistically significant reduction between pre- and post-treatment (P = 0.003). A moderate negative correlation (rho = 0.64, P = 0.048) between the percentage change in masticatory ability and the percentage change in gastric emptying rate was evidenced. Patients with compromised dentition rehabilitated with full-arch immediate implant prostheses present a significant improvement of the gastric process.

Purpose: Bone augmentation in oral surgery relies on osteogenic andosteoconductive properties of bone graftmaterial (BGM). Several types of BGMs with different chemical compositions andmicrostructures are today available, including natural derived or artificially modified heterologous bone, and synthetically synthetized bioceramics. A further improvement is represented by the tissue engineering approach, where autologous mesenchymal stem cells (MSCs), expanded in vitro, are seeded on BGM prior implantation in the bone defect. In this study the effect of different bone substitutes on MSC differentiation when they were adopted as cell culture substrates has been evaluated. Methods andmaterials:HumanMSCwere cultured in vitro in the presence of BGMs of different origins (natural bone derived, synthetic and mixed). Cellular adhesion on BGMs were analyzed with SEM. Alkaline phosphatase (ALP – early marker of the osteogenic differentiation) gene expression was evaluated by real time PCR andALP enzyme activitywas determined at different culture time points (7, 14 and 28 days). In vivo osteogenic differentiation of implanted tissue constructs (BGM+MSC) was investigated taking advantage of an ectopic bone formation in an immunodeficient mouse model and analyzed by histology. Results: A good cell adhesion to all BGMs was observed already after 6h from plating and cells were successfully cultured for 28 days. ALP gene expression and enzymatic activity was detectable after 14 day culture. The ALP gene expression analysis indicated that the MSC cultured with BGM derived from natural bone (BioGen, Bio-Oss) presented a steady increase of the ALP expression reaching a significantly higher level at 28th day of osteoinduction compared to the other BGMs. Instead, cells cultured in the presence of BGMs of synthetic origin (Bonit, Skelite), presented themaximum level of ALP gene expression at day 14 with a subsequent stabilization in the expression at day 28. Interestingly the cells cultured in the presence of mixed origin (Pepgen P-15) BGM presented a peak in the gene expression at day 7. The in vivo osteogenic test showed a good bone formation at the periphery of all BGMsparticles seededwith BMSCs. Neo-formed bone progressively filled the gap between the particles bridging them after 8 weeks, maintaining a peripheral vasculature. Conclusion: All tested BGMs implemented bone formation in guided bone regeneration. BGMs of animal origin showed greater ALP expression at 28 days.

Biphosphonate (BPN) are widely used in clinics to treat metastatic cancer and osteoporosis thus representing a problem not only for patients but also for workers involved in their preparation and administration. A similar exposure occurred years ago in match-making workers undergoing bone alterations similar to those consequent to BPN exposure. Osteonecrosis of the jaw (ONJ) is a main adverse effect related to BPN administration, which is performed in millions of patients worldwide for osteoporosis and cancer therapy, thus representing an emerging problem in public health. In susceptible patients, BPN induce severe, progressive, and irreversible degeneration of facial bones, resulting in avascular ONJ often triggered by dental surgery. BPN induced ONJ occurs in subjects depending on lifestyle factors of both environmental and endogenous origins. Exogenous risk factors include cigarette smoke, alcohol consumption, bacterial infections, and cyclosporine therapy. Endogenous risk factors include systemic diseases such as diabetes or hypertension and adverse polymorphisms of genes involved in metabolism (CYPs, MTHFR), thrombosis (Factor V, Prothrombin), and detoxification (MDR). Available molecular findings provide evidence that ONJ is related to risk-factors associated with environmental mutagenesis and gene-environment interactions. This issues may be useful to identify susceptible subjects by molecular analyses in order to prevent ONJ occurrence.

The aim of this study is to investigate the in vivo efficacy of Puros® cancellous particulate allograft bone in the regeneration of post-extractive sites. Twelve molar or premolar sites were selected. Seven days after minimally invasive tooth extraction, Puros® cancellous particulate allografts were inserted into the elected sites. TC Cone-Beam investigation and at 4 months from surgery; bone height and width were evaluated. Five months after surgery, biopsy samples of the regenerated sites were taken and histologically analyzed to qualitatively evaluate bone regeneration. TC analysis showed, a mean bone gain of 4.1 mm in height and 2.02 mm in width. The histological analysis of the samples showed intense bone metabolic activity with active osteoblasts on the implant surface, at the level of the native bone-graft interface and in the grafted area. The radiographic and histological analyses demonstrate an optimal bonen regeneration, both in terms of quality and quantity using Puros®.

OBJECTIVES:As the oral cavity is regarded as a relevant site for Staphylococcus aureus colonization and interhuman transmission, this study aimed to investigate whether different oral conditions influence the rates of S. aureus oral carriage and genetic characters of S. aureus isolates.SUBJECTS AND METHODS:Staphylococcus aureus was searched in samples collected from cheek, gingival margin, and anterior nares of 45 healthy subjects, 27 periodontitis affected subjects, and 29 subjects with fixed prosthetic restorations. Isolates were screened for 17 genetic determinants, and Partial Least Square Discriminant Analysis was performed to evaluate whether specific characters correlated with oral condition or site of isolation.RESULTS:The three subject groups showed comparable nasal carriage rates but, both the periodontitis and prosthetic restoration groups showed significantly higher oral carriage rates, as compared to healthy subjects (P = 0.01 and 0.02, respectively). Moreover, periodontitis affected subjects hosted strains possessing a distinct genotypic and phenotypic background, characterized by the presence of a larger number of exotoxins encoding genes.CONCLUSIONS:These data confirm that the oral cavity is an important site of S. aureus colonization and demonstrate that conditions modifying the oral environment, as the presence of periodontitis and of fixed prosthetic restorations, promote S. aureus carriage and may favor the spread of more pathogenic strains.

Tilted implants have been proposed as an alternative to traditional protocols in the rehabilitation of edentulous maxillae. The aim of this meta-analysis was to evaluate the outcomes of upright and tilted implants supporting full-arch fixed dentures for the immediate rehabilitation of edentulous maxillae, after at least 1 year of function. An electronic search of databases and a hand search of relevant journals in oral implantology were performed according to PRISMA guidelines through August, 2011. The literature search yielded 1,069 articles. Eleven articles were available for analysis. A total of 1,623 implants (778 tilted, 845 upright) were inserted into the maxillae of 324 patients. Seventeen tilted (2.19%) and 16 upright implants (1.89%) failed during the first year. No significant difference in failure rate was found between tilted and upright implants (p value = 0.52). Marginal bone level results were obtained from 6 studies. A non-significant mean difference between tilted and upright implants was found with regard to bone loss. Tilted implants demonstrated a favorable short-term prognosis in full-arch immediate loading rehabilitations of the maxillae. Randomized long-term trials are needed to better elucidate long-term success of tilted vs. upright-positioned implants.

The aim of the present research was to measure in vitro the chewing load forces transmitted through crowns made of different prosthetic restorative materials onto the dental implant. A masticatory robot that is able to reproduce the mandibular movements and the forces exerted during mastication was used. The forces transmitted to the simulated periimplant bone during the robot mastication were analyzed, using different occlusal materials. Two-way analysis of variance (ANOVA) was used. The zirconia and the ceramic crowns transmitted significantly greater forces (p-value < 0.000 1) than the other crowns tested. Dental materials with lower elastic modulus were better able to absorb shock from occlusal forces than more rigid materials.

The aim of this paper is to describe a technique for sinus floor augmentation with a 1-step crestal approach where the residual bone is ≤7.5mm. 36 implants were installed in 25 patients in the atrophic posterior maxilla immediately after sinus floor elevation. Sinus floor elevation was performed with a crestal approach using either osteotomes and burs or piezosurgery. Standardized intraoral radiographs were taken prior to surgery and 1 year after surgery. The mean residual bone height was 5.61mm (range 3–7.5mm). The mean gain of sinus elevation was 6.78mm (range 3.5–10mm) at 1 year after surgery. Two patients dropped out of the study. Of the 23 patients completing the study, one implant failed, whilst the remaining 33 implants were stable 12 months after surgery (cumulative survival rate 97%). A statistically significantly higher bone height was achieved with tapered implants compared with cylindrical implants (P<0.05). No statistically significant differences were found in bone level using osteotomes or piezosurgery. Piezosurgery was considered to provide less discomfort for the patient and greater convenience for the surgeon.

Endosseous implants are really important in dentistry to correct maxillary edentulism, but in the international literature few information is provided regards the diet and the hygiene to be followed during the post-surgery in order to protect the osseointegration. The aim of this experimental work is to give a dietetic and hygienic protocol and to evaluate that with the patient's opinions and the operator's clinical evaluation.