Bone change after tooth extraction has been well documented by different studies. Tooth extraction is followed by loss in height and width of the alveolar process. After tooth loss, the natural healing process is governed by the formation of the blood clot, which is stabilized by a fibrin bridge, the starting structure for new bone apposition. The hematoma is then replaced by the granulation tissue which is rich in fibroblasts that synthesize the extra-cellular matrix. The adjoining of wound edges requires further contraction of the healing tissue which is exerted by myofibroblasts. Excessive myofibroblasts contraction at the early stage of healing might explain, in part, the pathophysiology of alveolar bone resorption. The authors advocate the use of collagen right after tooth extraction to sustain the soft tissue and releasing the tension at the most coronal portion of the wound, thus preventing excessive detrimental myofibroblasts contraction.

A new developed collagen matrix CM-10826 (CM) of porcine origin designed to be used as oral soft tissue substitute was investigated before and after implantation by light microscopy (LM), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). In a case series biopsy specimens were harvested from thirteen patients at 10, 20, 30, 43 days after abutment surgery for uncovering dental implants. The in vivo histological evaluations of each patient were performed via micro-coring of newly formed oral mucosa in the area covered by CM (test side) or left uncovered (control). Results showed that CM can be integrated in connective and epithelial tissues within 10 days, can be completely resorbed within 20 days and it is able to reduce inflammatory infiltrates and to stimulate both fibroblast/epithelial cell proliferation and neo-angiogenesis. Generally it seems to be superior in promoting soft tissue healing compared to that induced by secondary intention healing. Furthermore, it is able to act as a scaffold for soft-tissue regeneration, allowing the proliferation of keratinocytes from the wound edges and favoring neovascularization and growth of connective tissue in the mesh of porous layer. It appears that a CM might function in oral surgery as a substitute for autologous grafts and to avoid secondary intention healing in soft tissue defects.

The atrophic posterior ridges are usually characterized by poor bone quality and quantity: this situation requires the use of bone regenerative techniques. Other alternative surgical approaches are investigated. Nowadays the use of tilted implants offers some advantages due to its feasibility. Today, bone grafting may be practical, but depends on many factors, such as the type of bone graft used (autogenous, alloplastic, or xenograft), host response, age of the patient, various complications associated with grafting procedures, infection, and, most importantly, the time spent while the grafted material matures and is taken up by the bone. So this case report describes the feasibility of an alternative surgical technique.

Several techniques have been proposed for bone regeneration in patients with atrophic ridges. Nowadays, GBR represents the gold standard, and it allows obtaining sufficient bone volumes for a correct implant-prosthetic rehabilitation. Our goal is to perform a systematic review of the literature on the use of titanium meshes in GBR in order to evaluate the reliability of the procedure, the regeneration obtained, and the failures. Furthermore, we will evaluate the success and survival rate of the inserted implants. The selected articles concern vertical and/or horizontal regeneration of the alveolar ridge using titanium grids, in association or not with biomaterials, before and simultaneously with implant placement. Six articles were selected for the present review, including a total of 139 patients, 156 sites, and 303 implants. Titanium grids in combination with autogenous bone were used in 2 cases, 5 in combination with a mixture of autogenous bone and bone substitutes. The overall survival and success rates of implants were 98.3% and 85.25%, respectively. In conclusion, our review shows how the use of titanium mesh represented a predictable method for the rehabilitation of complex atrophic sites.

Aim The aim of the present study was to compare the clinical efficacy of chlorhexidine and ozonised water in the oral hygiene maintenance of orthodontic patients. Materials and methods Study design: This is a prospective clinical study. Thirty patients with orthodontic brackets were selected at the Versilia General Hospital (Lido di Camaiore, Italy). Patients were randomly allocated to one of two groups: standard oral hygiene session followed by prescription of either chlorhexidine mouth-rinse or ozonated water. At each moment of the follow-up, the following parameters were recorded: pocket probing depth (PPD), full-mouth plaque index (FMPI), and full mouth bleeding score (FMBS). Statistics: Sample size was computed according to previously published data. Significance level was set at 0.05 for all analyses, and non-parametric Wilcoxon signed rank test was used for comparisons. Results At baseline, mean PPD was 129 +/- 0.13 mm for the control group and 1.95 +/- 0.10 mm for the test group. Mean FMPI was 63.9 +/- 16.5% and 68.7 +/- 10.33% respectively. Mean FMBS was 3.13 +/- 15.6% and 32.8 +/- 8.85 respectively. One month after treatment (T2), both groups showed a significant improvement of FMPI and FMBS. Mean FMPI was 42.8 +/- 14.3% and 24.3 +/- 6.41% respectively. Mean FMBS was 19.5 +/- 12.6% and 4.70 +/- 336% respectively. The test group treated with ozone exhibited a greater improvement of FMPI and FMBS. Conclusions Ozone yielded better outcomes than chlorhexidine in the management of gingivitis in orthodontic patients. Ozone should be further investigated in longitudinal studies with larger samples.

Suture threads used after oral surgery may be colonized by pathogenic microorganisms which could infect the surrounding tissue and impair the wound-healing process. Therefore, the postoperative use of antimicrobial mouthwashes is highly recommended. In this study, a mouthwash containing zinc-substituted nanohydroxyapatite (Zn-nHAp) and zinc L-pyrrolidone carboxylate (Zn-PCA) was compared with a product containing chlorhexidine for its efficacy in reducing microbial adherence to suture threads.

In the aesthetic field, successful replacement of a tooth with a dental implant requires blend and harmony within the existing dentition. The influence of the dimension of buccal bone at implant sites on aesthetic outcomes and the relation between buccal bone horizontal and vertical dimensions are unclear. The aim of the present study is to investigate the correlation between buccal bone thickness, buccal bone level and aesthetic outcome in conventionally placed implants – placed five or more years previously – supporting single maxillary incisors. Eight subjects with 8 implants and with periapical and parallel profile X-rays were clinically examined to assess the “Pink Aesthetic Score” (PES). Buccal bone level and thickness, together with the interproximal bone level, were measured. Implant survival was 100%. The mean time of implants function was 89.3 months (standard deviation 43, range 61-145). The mean PES value was 9.4. The mean interproximal bone level was located 1.3 mm apically to the implant abutment junction, while the corresponding buccal value was 1.6 mm. Buccal bone was mostly absent at the implant abutment junction; 2 and 4 mm apically respect to the junction the thickness was on average 0.44 and 0.89 mm, respectively. The dimension of buccal bone level was correlated to the buccal bone thickness at 2mm-level, to the interproximal bone level and to the soft tissue contour score. Conventional implant placement in pristine bone might lead to satisfactory long-term aesthetic results. The level of the facial mucosa and appearance of the alveolar process might emerge as critical aspects.

Aim Implant rehabilitation has become a very reliable and safe procedure. However, in some cases, a small amount of bone could make implant surgery extremely difficult or even impossible. Hence, a surgical technique to augment sinus floor has been developed and improved. Nevertheless, there is still controversy over the use of a membrane over the osteotomy window. Therefore, the aim of this study was to investigate whether the use of a membrane could be beneficial in sinus floor augmentation. Materials and methods A group of 12 patients requiring sinus floor lift were recruited. The patients were randomly allocated to either control group (membrane) or test group (no membrane) and only one sinus for patient was augmented. After 6 months, a bone biopsy was harvested from the lateral window to be processed for histological analysis. Results The mean amount of newly formed bone in test group was 28.0 +/- 19.5%, the connective tissue accounted for a mean value of 59.2 +/- 15.6%, while 12.8 +/- 12.6% was the amount of residual graft particles. In the membrane group the newly formed bone counted for a mean value of 30.4 +/- 15.8%, the mean quantity of connective tissue was 50.3 +/- 18.9% and about residual graft particles a mean value of 18.2 +/- 20.4% was registered. Conclusion According to our data, the use of a membrane over the lateral bone wall in sinus lift surgery does not significantly influence healing. However, the membrane could influence the residual particles resorption rate as well as soft tissue ingrowth.

Background: The aim of present study was to clinically assess and compare a sonic toothbrush versus a rotating oscillating power toothbrush on plaque removal and gingival health in reducing plaque and bleeding on probing. Methods: Patients were selected according to specific inclusion and exclusion criteria and they were enrolled in test group or control group using Random Allocation Software. Visual score plaque index (PI) was recorded by the same blind operator using a plaque revelator and bleeding on probing (BoP) index was recorded using a periodontal probe at baseline, 15th day and 30th day. Results: The group of patients who used sonic toothbrush showed a greater reduction of PI and BoP comparing with patients who used rotating-oscillating power toothbrush. Conclusions: Although this pilot study has several limitations, it seems to indicate that sonic toothbrushes are capable of removing plaque and reducing bleeding on probing better than electric toothbrushes.

The present case report describes the case of a 15-year-old female who was referred with a radiolucent lesion between her mandibular right molars. The original radiographic image suggested the presence of an odontogenic cyst. The surgical enucleation and the following osteotomy of the residual cavity was performed by using the piezoelectric technology. The histological analysis confirmed that the lesion was an odontogenic keratocyst with no evidence of epithelial invasion in the connective tissue wall. The patient refused any further surgical treatment. In consideration of the pathological result - no presence of invasive epithelial cells in the connective tissue wall of the cyst- the patient was suggested a "follow-up and wait-and-see policy", with more extensive surgical treatment to be given only in case of a recurrence. The patient was followed up clinically and radiographically at 6 months intervals for 5 years.

Background: The success of implant therapy depends on the availability of an adequate bone volume in the edentulous site. In the case of posterior bone atrophy, the increase of the alveolar ridge is a prerequisite for the optimal placement of endosseous implants. Purpose: The purpose of this research is to analyze in Literature the success of bone grafts in posterior atrophic edentulous mandible. Materials and methods: The Literature analysis includes only relevant articles specifically on the topic. The following parameters were evaluated: the type of materials used, the average gain expressed in millimeters, the success of the grafts over time and their complications, the outcome of the grafts according of the materials used and the survival rate of endosseous implants over time. Results: Autologous, homologous and heterologous materials were used for the grafts, either separately or in combination. However autologous bone, obtained from the mandible, was preferentially used for grafts in atrophic posterior mandible. Membranes could be also associated to the grafts. The gain in the alveolar ridge was achieved both horizontally and vertically, and usually reflected the surgeon's effort to meet patient's needs. Conclusions: A review of literature reveals that the intraoral autologous bone graft is the most used and allows to achieve the best result in restoring posterior atrophic mandible.

Objective: Trying to limit the use of antimicrobial drugs in periodontitis is a general trend. Thus, the aim of the present study was to assess the efficacy of daily water irrigation in comparison with subgingival minocycline in periodontal maintenance, in subjects with moderate to severe periodontitis. This was done by evaluating probing pocket depth (the primary outcome), other clinical parameters such as clinical attachment level, plaque index and bleeding on probing, and bacterial flora changes inside periodontal pockets. Materials and Methods: In this single-center, parallel, single blind, randomized clinical study, thirty subjects (12 men, mean age 56 ± 2.2 years) with moderate to severe periodontitis were randomized 1:1 into a minocycline-treated group (M-group, n=15) and a water-treated group (W-group, n=15). Clinical and microbiological parameters were measured at baseline. Scaling and root planing were carried out on all subjects, then to M-group patients minocycline was administered inside the pockets. W-group subjects had instead to daily apply oral irrigation with water. Clinical and microbiological measurements were repeated after 30 days. Results: Both water irrigation and minocycline treatment led to a significant reduction of all the clinical parameters tested at t=30 days with respect to baseline. Moreover, both procedures appeared to be able to maintain a low bacterial load inside periodontal pockets, for most of the microorganisms tested. No statistically significant differences were observed between M-group and W-group at t=30 days, concerning both clinical and microbiological parameters. However, further studies are needed to assess the long-term effect. Conclusion: Daily oral irrigation with water showed comparable efficacy to a single administration of minocycline in periodontal maintenance subjects.

Introduction: Over the years, several different implant systems have been introduced, and the indications for implant rehabilitation have gradually been extended 2. Although an high success rates have consistently been reported for many implant systems, complications leading to loss of osseointegration still occurs 3. Thus, oral hygiene and maintenance are imperative, because implants, as well as teeth, are susceptible to accumulation of bacterial plaque and calculus formation. The aim of the present study was to evaluate and compare the in vivo cleaning efficacy of the three systems (air powder, curette, laser) comparing at the same time the alterations of the titanium abutment surface in terms of roughness. Methods: Forthy-two patients (25 males and 17 females) were included in the study. The 42 healing abutments were treated by the same clinician (UC). Results and conclusions: The rate of debris removal by the air powder was higher than that for the laser and than that for the curettes. The SEM analysis showed that the air powder system did not induce significant differences of the abutment if compared to the curettes as well as to the laser.

The aim of study was to determine and compare serum concentrations of interleukin 1 beta (IL-1β), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) in patients with oral ameloblastoma and healthy controls. Sixteen patients with ameloblastoma and 16 healthy controls were enrolled in this study. Cytokine concentrations were measured by chemiluminescent enzyme linked immunoassay. Serum concentrations of IL-1β were below level of detection in all but four participants. No significant differences between the groups were observed in serum concentrations of IL-6. Serum TNF-α was significantly higher in control subjects than in ameloblastoma patients. Patients diagnosed with ameloblastoma have relatively normal levels of inflammatory cytokines in their blood and thus cannot be used as indicators of disease severity or for monitoring the treatment outcomes.

Abnormal frenula may require treatment by frenulectomy. Several techniques are available, but using a laser for this purpose represents an innovative technology that may provide more efficient, more comfortable and more predictable treatment outcomes for both patient and surgeon. On this respect, Nd-YAP laser treatment is very useful allowing for excellent clinical outcomes with low morbidity. This case series reports on the use of Nd-YAP laser for a labial frenulectomy. Twenty-three patients were treated and afterward controlled. Laser treatment, above all Nd-YAP, appears to be the gold standard technique.

Periodontitis is a complex disease and bacterial infection is one of the most common factors involved in this disease. Current strategies for the local delivery of antibiotics do not allow a complete clearance of bacteria filling dentinal tubules and this limits their therapeutic efficacy. Therefore, there is a strong need for the development of new delivery strategies aimed at improving the efficacy of antibiotic therapy for periodontitis with special reference to their ability to penetrate into the tubules. The aim of the present study is to develop liposome-based delivery systems of sub-micron dimension, able to diffuse into the dentinal tubules. A further aim of the research is to develop a protocol for enhanced diffusion based on the use of magnetic liposomes and magnetic fields. Liposomes were produced by hydration of a pre-liposomal formulation. The vesicles were stabilised with PEG and their re-sizing was achieved by extrusion. Magnetite nanoparticles were synthesized inside the vesicles, i.e., the chemical reaction involving FeCl2, FeCl3 and NH3 occurred within the core of the newly formed liposomes. Dynamic Light Scattering analysis was performed for size characterization. A mathematical model was implemented to predict the diffusion of the liposomes in dentinal tubules. Ex-vivo validation was performed on extracted human teeth. We produced PEG-ylated liposomes (average size 204.3 nm) and PEG-ylated magnetic liposomes (average size 286 nm) and an iron content of 4.2μg/ml. Through mathematical modelling, we deduced that sub-micrometer vesicles are able to penetrate into dentinal tubules. This penetration is considerably more effective when the vesicles are magnetized and subjected to an external magnetic field which accelerates their movement within the tubules. The liposome-based delivery systems developed by the present study are able to penetrate deeply into the tubules, sometimes reaching their terminal ends.

Purpose: The purpose of this study was to investigate and compare, in a randomized and controlled clinical trial, the use of ultrasound bone surgery devices and the use of rotary instruments in lower third molar extractions.Materials and Methods: We selected 26 patients (12 women and 14 men) for this study; the mean age was 31.2 years (range, 24-45 years). A randomized clinical trial was planned. Patients in the control group received treatment with the conventional rotary instruments; patients in the test group received treatment with the ultrasound bone surgery tools. Twenty-six third molars were allocated to the test and control groups according to a computer-generated randomization list. All the surgical procedures were performed by the same surgeon. Pain, trismus, cheek swelling, and number of analgesics taken were evaluated at baseline (before surgery) and at the first-, third-, fifth-, and seventh-day visits.Results: Pain levels (evaluated on a visual analog scale) were higher in the control group when compared with the ultrasonic group; however, no statistically significant differences were found. On the contrary, the number of analgesics taken in the test group was significantly lower when compared with the control group. The occurrence of trismus was significantly higher in the control group when compared with the test group. The clinical values of cheek swelling were higher in the rotary group when compared with the ultrasound group at the fifth-day visit.Conclusion: This study showed that the use of ultrasound bone surgery for third molar extraction significantly reduced the occurrence of postsurgical trismus, the occurrence of swelling, and the number of analgesics taken after surgery. (C) 2010 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 68:330-336, 2010