Advances in Clinical and Translational Research of Oral Surgery, Biomaterials, and Oral Disease Management

Conflicting results have been published regarding the associations between dental status and hypertension. This study aims to explore whether or not hypertension is associated with dental status among young to middle-aged adults. To that end, data from the Dental, Oral, Medical Epidemiological (DOME) study were analyzed. The DOME is a cross-sectional records-based study that combines comprehensive socio-demographic, medical, and dental databases of a nationally representative sample of military personnel. Included were 132,529 subjects aged 18–50 years who attended the military dental clinics for one year. The prevalence of hypertension in the study population was 2.5% (3363/132,529). Following multivariate analysis, the associations between hypertension and dental parameters were lost and hypertension retained a positive association with obesity (Odds ratio (OR) = 4.2 (3.7–4.9)), diabetes mellitus (OR = 4.0 (2.9–5.7)), birth country of Western Europe vs. Israeli birth country (OR = 1.9 (1.6–2.2)), male sex (OR = 1.9 (1.6–2.2)), cardiovascular disease (OR = 1.9 (1.6–2.3)), presence of fatty liver (OR = 1.8 (1.5–2.3)), the birth country Asia vs. Israeli birth country (OR = 1.6 (1.1–2.3)), smoking (OR = 1.2 (1.05–1.4)), and older age (OR = 1.05 (1.04–1.06)). Further analysis among an age-, smoking- and sex matched sub-population (N = 13,452) also revealed that the dental parameters lost their statistically significant association with hypertension following multivariate analysis, and hypertension retained a positive association with diabetes (OR = 4.08 (2.6–6.1)), obesity (OR = 2.7 (2.4–3.2)), birth country of Western Europe vs. Israel (OR = 1.9 (1.6–2.3)), cardiovascular disease (OR = 1.8 (1.5–2.2)), fatty liver (OR = 1.7 (1.3–2.3)), high school education vs. academic (OR = 1.5 (1.3–1.8)), and low socio-economic status (SES) vs. high (OR = 1.4 (1.03–1.8)). We analyzed the associations between C-reactive protein (CRP) and dental parameters and combined the statistically significant variables to create a dental inflammation score (DIS). This crated a final model with the appropriate weights written as follows: DIS = (periodontal disease × 14) + (the number of teeth that required crowns × 11) + (missing teeth × 75). The mean DIS was 10.106 ± 25.184, and it exhibited a weak positive association with hypertension in the univariate analysis (OR = 1.011 (1.010–1.012)). Receiver operating characteristic (ROC) analysis of the DIS against hypertension produced a failed area under the curve (AUC) result (0.57 (0.56–0.58)). Moreover, the DIS also lost its statistical significance association with hypertension following multivariate analysis. We conclude that hypertension had no statistically significant nor clinically significant association with dental status. The study established a profile of the “patient vulnerable to hypertension”, which retained well-known risk factors for hypertension such as older age, male sex, smoking, diabetes, obesity, and fatty liver but not dental parameters. Full article

Schneiderian membrane perforation (SMP) is the most common complication during sinus floor elevation (SFE). Conventional methods to repair SMP, such as using a collagen barrier, may be clinically demanding. The aim of the present study was to compare the effects of collagenated bone substitute materials with and without a collagen barrier to repair SMP during SFE in terms of new bone formation and dimensional stability. In 12 rabbits, intentional SMP was made during bilateral SFE. The rabbits were randomly assigned under two groups: the control group, in which the sinus was repaired with a collagen barrier, and the test group, in which the sinus was repaired without a collagen barrier. Collagenated bone substitute material was grafted in both groups. Healing periods of 2 weeks and 4 weeks were provided in both groups. There were no adverse clinical events. Histology revealed that the Schneiderian membrane had atrophied with loss of cilia and serous glands in both groups at 4 weeks. Histomorphometry revealed that the newly formed bone (test: 0.42 ± 0.17 mm², control: 0.36 ± 0.18 mm² at 2 weeks; test: 1.21 ± 0.36 mm², control: 1.23 ± 0.55 mm² at 4 weeks) or total augmented area did not significantly differ between the two groups at either time points (p > 0.05). In conclusion, collagenated bone substitute material without a collagen barrier demonstrated similar new bone formation and dimensional stability as that with a collagen barrier in repairing SMP. Full article

Titanium dental implants are used routinely, with surgical procedure, to replace missing teeth. Even though they lead to satisfactory results, novel developments with implant materials can still improve implant treatment outcomes. The aim of this study was to investigate the efficiency of porous tantalum (Ta) dental implants for osseointegration, in comparison to classical titanium (Ti). Mesenchymal stem cells from the dental pulp (DPSC) were incubated on Ta, smooth titanium (STi), and rough titanium (RTi) to assess their adhesion, proliferation, osteodifferentiation, and mineralized matrix production. Cell proliferation was measured at 4 h, 24 h, 48 h with MTT test. Early osteogenic differentiation was followed after 4, 8, 12 days by alkaline phosphatase (ALP) quantification. Cells organization and matrix microstructure were studied with scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX). Collagen production and matrix mineralization were evaluated by immunostaining and histological staining. MTT test showed significantly higher proliferation of DPSC on Ta at 24 h and 48 h. However, APL quantification after 8 and 12 days was significantly lower for Ta, revealing a delayed differentiation, where cells were proliferating the more. After 3 weeks, collagen immunostaining showed an efficient production of collagen on all samples. However, Red Alizarin staining clearly revealed a higher calcification on Ta. The overall results tend to demonstrate that DPSC differentiation is delayed on Ta surface, due to a longer proliferation period until cells cover the 3D porous Ta structure. However, after 3 weeks, a more abundant mineralized matrix is produced on and inside Ta implants. Cell populations on porous Ta proliferate greater and faster, leading to the production of more calcium phosphate deposits than cells on roughened and smooth titanium surfaces, revealing a potential enhanced capacity for osseointegration. Full article

Background. The aim of this study was to compare retrospectively the effect of three different treatment protocols on the healing outcome in patients with established medication-related osteonecrosis of the jaw (MRONJ). Methods. A total of 34 MRONJ patients were recruited from the Department database and were divided according to the treatment protocols in a study group (G1) and two control groups (G2 and G3). G1 was treated with antibiotic therapy, surgery, leukocyte- and platelet-rich fibrin (L-PRF), and photobiomodulation; G2 was treated with antibiotic therapy and surgery; G3 was treated with antibiotic therapy and photobiomodulation. Various clinical variables and treatment protocols were analyzed to determine their correlation with the healing outcome at three and six months of follow-up. Results. There was a significant association between the different treatment protocols and the outcomes at both three and six months follow-up (p = 0.001 and p = 0.002, respectively). No significant association was observed between the outcomes and MRONJ localization, MRONJ stage, duration of drug treatment, gender, diabetes, corticosteroid therapy, smoking habits, underlying disease, and history of chemotherapy at both three and six months follow-up. Conclusions. Our results show that the combination of antibiotic therapy, surgery, L-PRF, and photobiomodulation may effectively contribute to MRONJ management. Full article

Dental anomalies coincide with genetic disorders, and prenatal identification may contribute to a more accurate diagnosis. The aim of this study was to assess whether fetal Magnet Resonance Imaging (MRI) is suitable to visualize and investigate intrauterine dental development in the upper jaw, and to compare the quality of visibility of tooth buds between 1.5 Tesla (T) and 3T images. MR images of fetuses Gestational Week (GW) 26.71 ± 4.97 from 286 pregnant women with diagnoses unrelated to dental anomalies were assessed by three raters. We compared the visibility between groups and field strengths in five gestational age groups, using chi square and Fisher’s exact tests. All ten primary tooth buds were identifiable in 5.4% at GW 18–21, in 75.5% at GW 26–29, and in 90.6% at GW 34+. Before GW 30, more tooth buds were identifiable on 3T images than on 1.5T images. Statistical significance was only reached for identification of incisors (p = 0.047). Therefore, 1.5T and 3T images are viable to visualize tooth buds, particularly after GW 25, and their analysis may serve as diagnostic criterion. MRI tooth bud data might have an impact on various fields of research, such as the maldevelopment of teeth and their causes. Analyzing tooth buds as an additional diagnostic criterion is not time consuming, and could lead to an improvement of syndrome diagnosis. Full article

The present study aims to investigate clinical and patient-centered outcomes after the implant-supported rehabilitation of narrow ridges using a novel wedge-shaped implant. Forty-four patients were treated with the insertion of 59 tissue-level wedge implants (1.8 mm bucco-lingual width) in horizontally atrophic ridges (mean bone width 3.8 ± 0.4 mm). The main outcome measures were: implant stability quotient (ISQ), marginal bone loss (MBL) and patient morbidity. Fifty-eight implants were functioning satisfactorily after one year of loading (98.3% survival rate). ISQ values measured in the mesio-distal direction resulted significantly higher than those in the bucco-lingual direction at all time points (p < 0.001). Both mesio-distal and bucco-lingual ISQ values at 6-month follow-up resulted significantly higher than at 4-month follow-up (p < 0.001 for both). Mean MBL was 0.38 ± 0.48 mm at prosthesis delivery (6 months after implant insertion) and 0.60 ± 0.52 mm after one year of functional loading. The majority of patients reported slight discomfort related to the surgical procedure. Postoperative pain score was classified as mild pain on the day of surgery and the first postoperative day and no pain over the following five days. Within the limitations of the present study, the device investigated showed low morbidity and positive short-term clinical results in narrow ridges treatment. Full article

“SOS teeth” are defined as the first priority teeth for treatment, that have distinct cavitation reaching the pulp chamber or only root fragments are present. These are teeth with severe morbidity, that may require pulp capping, root canal treatment, or extraction, and therefore should be treated first. The study aims to explore whether or not a metabolic syndrome (MetS) is associated with SOS teeth. To that end, we performed across-sectional records-based study of a nationally representative sample of 132,529 military personnel aged 18–50 years, who attended the military dental clinics for one year. The mean number of SOS had no statistically significant association with: smoking (p = 0.858), alcohol consumption (p = 0.878), hypertension (p = 0.429), diabetes mellitus (p = 0.866), impaired glucose tolerance (p = 0.909), hyperlipidemia (p = 0.246), ischemic heart disease (p = 0.694), S/P myocardial infarction (p = 0.957), obstructive sleep apnea (p = 0.395), fatty liver (p = 0.074), S/P stroke (p = 0.589), and S/P transient ischemic attack (p = 0.095) and with parental history of: diabetes (p = 0.396)], cardiovascular disease (p = 0.360), stroke (p = 0.368), and sudden death (p = 0.063) as well as with any of the medical auxiliary examinations (p > 0.05). Cariogenic diet was positively associated with SOS teeth (p < 0.001). We conclude that SOS teeth had no statistically significant association with MetS components or with conditions that are consequences or associated with MetS. The only statistically significant parameter was a cariogenic diet, a well-known risk factor for caries and MetS. Full article

The purpose of this study is to describe the Minimally Invasive Intraoral Approach (MIIA) performed on selected cases of abscesses and neck phlegmons of odontogenic origin when the infection has not spread beyond the inferior mandibular margin. This technique allows us to avoid cervicotomy by a direct approach to the abscess, draining it through the oral cavity. If the limits have already been crossed, then cervicotomy is necessary. The aim of the study is to show the surgical outcomes that we have achieved during a time span of two years, and to show the effectiveness of the MIIA and its results. We selected 66 patients with abscesses and neck phlegmons, from January 2018 to June 2020. Among these cases, five patients were excluded as it was not possible to recover medical records from database. The MIIA technique has been performed on 16 patients (26.2%) when a successful dental extraction and drainage of the submandibular lodge were accomplished. The patients who underwent the MIIA surgery have all perfectly healed and did not suffer from relapses during the follow-up. The results show the achievement of excellent healing, underlining the lower impact required by MIIA when compared to a more traditional approach through cervicotomy. Full article

The aim of this study was to evaluate the effectiveness of open treatment of mandibular condyle fractures using 3D miniplates. A group of 113 patients has been chosen for evaluation, including 100 men and 13 women. After hospitalization, each patient underwent a 6-month postoperative follow-up. The material chosen for the analysis consisted of data collected during the patient’s stay in the hospital as well as the postoperative outpatient care. A single 4-hole Delta Condyle Compression Plate (4-DCCP) was used in 90 out of 113 (79.6%) cases. In 16 out of 113 (14.2%) patients, the Trapezoid Condyle Plate (4-TCP or 9-TCP) was used. The remaining cases required more than one miniplate. No 3D miniplate fractures were found in the study subjects during the analyzed observation period. Loosening of one or more osteosynthesis screws was observed in 4 out of 113 (3.5%) patients. Screw loosening was a complication that did not affect bone healing in any of the patient cases. The conducted research confirms that titanium 3D mini-plates are easy to adjust and take up little space, therefore they can easily be used in cases of mandibular condyle base and lower condyle neck fractures. The stability of the three-dimensional miniplates for osteosynthesis gives very good reliability for the rigid fixation of the fractured mandibular condyle. Full article

Background: The long-term stability after soft tissue graft for covering gingival recession remains a pivotal goal for both patient and periodontist. Therefore, the aim of this study was to compare the four-year outcomes of the coronally advanced flap (CAF) versus the pouch/tunnel (POT) technique, both combined with connective tissue graft (CTG), for gingival recession treatment. Methods: Forty patients were initially randomly assigned to the control group (CAF + CTG; N = 20) and the test group (POT + CTG; N = 20). Clinical outcomes included mean root coverage (MRC) and complete root coverage (CRC), gingival thickness (GT), and keratinized tissue (KT) gain. Esthetic outcomes were also analyzed using the pink esthetic score (PES) and patient-reported outcome measures (PROMs). All outcomes initially assessed at six months were extended to four years post-surgery. Results: No significant differences were observed between the two patient groups in terms of MRC and CRC. At four years, significantly greater GT and KT gain were noted in the POT + CTG group, and tissue texture enhancement was also more prominent in the test group. Conclusions: The POT + CTG technique allows for long-term clinical coverage of gingival recessions comparable to that of the CAF + CTG technique, but it potentially improves gingival thickness, keratinized tissue and esthetic results. Full article

Background: To assess the soft tissue dimension following tooth extraction and alveolar ridge preservation in the posterior maxilla compared to spontaneous healing. Methods: Thirty-five patients randomly assigned to alveolar ridge preservation (ARP) and spontaneous healing (SH) after maxillary molar extraction. The crestal, buccal, and palatal gingival thickness at 6 months was measured around virtually placed implant fixtures using superimposed cone-beam computed tomography and intraoral scan taken at 6 months. Buccal mucogingival junction (MGJ) level change over 6 months was estimated using intraoral scans obtained at suture-removal and 6 months. Results: The crestal gingiva was significantly thinner in group ARP (−1.16 mm) compared to group SH (p < 0.05). The buccal and palatal gingiva was significantly thinner at the implant shoulder (IS) level in group ARP (buccal: −0.75 mm; palatal: −0.85 mm) compared to group SH (p < 0.05). The thickness at 2 mm below the IS of both sides and the buccal MGJ level change were similar in both groups (p > 0.05). Conclusions: ARP in the posterior maxilla resulted in a thinner soft tissue on top of and at the prospective level of the implant shoulder at 6 months. The buccal MGJ level changed minimal for 6 months in both groups. Full article

This study aimed to assess the asymmetry of the lower face and motor dysfunction of the masticatory system resulting from unilateral or asymmetrical bilateral temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) patients. The study consisted of clinical examination and cone beam computed tomography (CBCT) of TMJs. Statistical analysis showed correlations between several factors: facial asymmetry and mandibular lateral deviation; the direction of mandibular deviation and the degree of radiological deformities in TMJs; the child’s age at the time of the onset and the range of lateral movement towards the healthy or less destructed joint. In addition, there was a significant difference in ranges of lateral movements; a significantly smaller range was observed for the joint with fewer condylar abnormalities compared to the range in the opposite direction. In JIA children, among the clinical markers of unilateral or asymmetrical TMJ involvement, the asymmetry of the lower face, deviation of the mandible on opening, and an uneven range of mandibular lateral movements deserve attention. The obtained results do not show a relationship between the degree of condylar changes and the asymmetry of the lower face and the presence and degree of mandibular motor dysfunction. Full article

Background: Oral hygiene instructions (OHI) and periodontal nonsurgical treatment (PNST) play pivotal roles in the management of periodontitis. The study aims to discern their respective effects on periodontal clinical parameters and patient-reported outcome measures (PROMs). Methods: Ninety-one patients were included, 34 non-smokers (NS), 25 former smokers (FS) and 32 current smoker (CS). Clinical parameters such as probing depth (PD) and bleeding on probing (BOP) were collected, and the periodontal inflamed tissue area (PISA) was calculated. Clinical parameters and PROMs were recorded before and after receiving OHI, with electronic tooth brush and interdental brushes, as well as 3 months after debridement. Results: Smokers presented a significantly higher proportion of severe periodontitis (64.7%) with generalized extension (76.5%) and with a rapid rate of progression (97.1%) compared to NS and FS. OHI led to a significant decrease of PD, BOP, and PISA (p < 0.0001) only in NS and FS. Debridement reduced PD and the percentage of PD >6 mm in all groups (p < 0.0001). OHI induced significant improvement of oral hygiene, frequency of interdental cleaning, and PROMs (p < 0.0001). Further debridement induced significant additional improvement PROMs in FS and NS (p < 0.0001). Conclusion: OHI and debridement improved periodontal clinical parameters and PROMs in both NS and FS. Former smokers had comparable outcomes to non-smokers, suggesting that smoking cessation should be encouraged. Full article

In this study, we explore the diagnostic accuracy of a Radiographic-based Periodontal Bone Loss (R-PBL) method as a screening tool for periodontitis, in the form of radiographic bone loss, under the 2018 case definition in comparison to the 2012 case definition. The analysis was based on 456 patients (253 females and 203 males), screened for periodontal status in the Study of Periodontal Health in Almada-Seixal (SoPHiAS) project and subjected to a panoramic dental X-ray. Patients were diagnosed for the presence of periodontitis following the 2018 and 2012 case definition. R-PBL classification was defined by alveolar bone loss and diagnosed as no periodontitis (≥80% remaining alveolar bone), mild to moderate periodontitis (66% to 79%), or severe periodontitis (<66%). We appraise the X-ray quality to look for the influence on the performance of R-PBL. Sensitivity, specificity, accuracy, and precision, through several indicators, were determined. Performance measurement was assessed through binary and multiclass Receiver operating characteristic/are under the curve (ROC/AUC) analyses. Our results show that the tested R-PBL method under the 2018 case definition is a reliable tool in periodontitis cases screening. This method does not replace clinical periodontal evaluation, but rather, it screens patients towards a definitive periodontitis diagnosis. These results will contribute to support the development of automated prediction systems towards periodontitis surveillance. Full article

The study described in this paper was conducted to assess the short-term outcomes of intra-articular administration of hyaluronic acid in patients with symptoms of temporomandibular joint disorders. A group of 40 patients suffering from temporomandibular joint disorders underwent a series of hyaluronic acid intra-articular injections. Questionnaires and clinical examinations were conducted to assess stress exposure of the subjects and to evaluate short-term treatment outcomes, i.e., reducing joint and muscle pain and increasing the mobility of the mandible. A weak positive correlation between stress exposure and pain was observed. As a result of treatment, 61% of subjects revealed a total reduction of muscle pain, while joint pain completely resolved in 88% of patients. Mandibular mobility increased by 11%, 31%, 9%, and 11% regarding opening, protrusive, and lateral right and left movements, respectively. The study confirms the short-term effectiveness of intra-articular administration of hyaluronic acid on reducing joint and muscle pain in patients with articular disc displacement. The treatment positively affected the mobility of the mandible in all directions. The verification of late treatment effects of hyaluronic acid viscosupplementation requires the continuation of the research. Full article

Diagnoses based on oral fluid biomarkers have been introduced to overcome limitations of periodontal probe-based diagnoses. Diagnostic ability of certain biomarkers for periodontitis have been identified and widely studied, however, such studies targeting gingivitis is scarce. The aims of this study were to determine and compare the efficacies and accuracies of eight biomarkers in diagnosing gingivitis with the aid of receiver operating characteristic (ROC) curves. The probing depth (PD), clinical attachment loss (CAL), bleeding on probing (BOP), gingival index (GI), and plaque index (PI) were examined in 100 participants. Gingival crevicular fluid was collected using paper points, and whole-saliva samples were collected using cotton roll. Samples were analyzed using enzyme-linked immunosorbent assay kits for the different biomarkers. The levels of matrix metalloproteinase (MMP)-8, MMP-9, lactoferrin, cystatin C, myeloperoxidase (MPO), platelet-activating factor, cathepsin B, and pyridinoline cross-linked carboxyterminal telopeptide of type I collagen were analyzed. MPO and MMP-8 levels in saliva were strongly correlated with gingivitis, with Pearson’s correlation coefficients of 0.399 and 0.217, respectively. The area under the curve (AUC) was largest for MMP-8, at 0.814, followed by values of 0.793 and 0.777 for MPO and MMP-9, respectively. The clinical parameters of GI and PI showed strong correlations and large AUC values, whereas PD and CAL did not. MMP-8 and MPO were found to be effective for diagnosing gingivitis. Further investigations based on the results of this study may identify clinically useful biomarkers for the accurate and early detection of gingivitis. Full article

Silica-based ceramics have been proposed for coating purposes to enhance dental and orthopedic titanium (Ti) implant bioactivity. The aim of this study was to investigate the influence of sphene-based bioceramic (CaO.TiO₂.SiO₂) coatings on implant osseointegration in vivo. Sphene coatings were obtained from preceramic polymers and nano-sized active precursors and deposited by an automatic airbrush. Twenty customized Ti implants, ten sphene-coated and ten uncoated rough implants were implanted into the proximal femurs of ten Sprague-Dawley rats. Overall, cortical and cancellous bone-to-implant contact (BIC) were determined using micro-computed tomography (micro-CT) at 14 and 28 days. Moreover, peri-implant bone healing was histologically and histomorphometrically evaluated. The white blood cell count in the synovial fluid of the knee joints, if present, was also assessed. No difference in the BIC values was observed between the sphene-coated and uncoated implants, overall and in the two bone compartments (p > 0.05). Delamination of the coating occurred in three cases. Consistently with micro-CT data, the histological evaluation revealed no differences between the two groups. In addition, no synovial fluid could be collected on the test side, thus confirming sphene biocompatibility. In conclusion, sphene coating was found to be a suitable material for biomedical applications. Further studies are needed to improve coating adhesion to the implants. Full article

Background: Juvenile idiopathic arthritis (JIA) affecting temporomandibular joints (TMJ) in growing patients results in maxillofacial deformities, especially if only one condyle has been affected by the rheumatic disease. Mandibular hypoplasia is the most common issue and it may be associated with maxillary hypoplasia. The aim of this retrospective case-control study is to evaluate the effects of rapid maxillary expansion (RME) in these patients. Methods: 25 growing patients affected by maxillary hypoplasia, currently in a quiescent phase of JIA for at least one year and monolateral involvement of the TMJs, were treated with RME. Data gathered from posteroanterior and lateral cephalograms before and after 1 year from RME were compared to those of 25 non-JIA controls. Results: Nasal cavity width, maxillary width and upper and lower intermolar width statistically increased. Maxillary and mandibular symmetry indexes presented a statistically significant increase, so did the skeletal class. No signs or symptoms of TMJ activity of JIA occurred according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) criteria. No difference was found when comparing JIA and non-JIA patients apart from the better improvement of several mandibular symmetry indexes in the affected TMJ side of JIA patients. This event is allegedly due to a worse baseline asymmetry in JIA patients that underwent a bigger relative improvement after treatment. Conclusions: Results suggest that solving maxillary hypoplasia and, therefore, premature contacts are likely to have allowed mandibular repositioning and condylar growth. RME is a safe and effective solution that can substantially improve maxillary and mandibular symmetry in growing patients affected by JIA with TMJ involvement. Full article

Liquid fibrinogen is an injectable platelet concentrate rich in platelets, leukocytes, and fibrinogen obtained by blood centrifugation. The aim of this study was to analyze the release of different growth factors in the liquid fibrinogen at different times and to assess possible correlations between growth factors and cell counts. The concentration of transforming growth factor beta 1 (TGF-β1), platelet-derived growth factor-AB (PDGF-AB), platelet-derived growth factor-BB (PDGF-BB), bone morphogenetic protein 2 (BMP-2), fibroblast growth factor 2 (FGF-2) and vascular endothelial growth factor (VEGF) released by liquid fibrinogen were examined with ELISA at three time points (T0, time of collection; T7, 7 days; T14, 14 days). The cellular content of the liquid fibrinogen and whole blood was also calculated for each volunteer. A mean accumulation of platelets of almost 1.5-fold in liquid fibrinogen compared to whole blood samples was found. An increase of TGF-β1, PDGF-AB, FGF-2, and VEGF levels was detected at T7. At T14, the level of TGF-β1 returned to T0 level; PDGF-AB amount remained high; the levels of FGF-2 and VEGF decreased with respect to T7, but remained higher than the T0 levels; PDGF-BB was high at all time points; BMP-2 level was low and remained constant at all time points. TGF-β1, PDGF-AB, and PDGF-BB showed a correlation with platelet amount, whereas BMP-2, FGF-2, and VEGF showed a mild correlation with platelet amount. Due to the high concentration of platelets, liquid fibrinogen does contain important growth factors for the regeneration of both soft and hard tissue. The centrifugation protocol tested in this study provides a valid solution to stimulate wound healing in oral and periodontal surgery. Full article

Although, the high success rate of implant rehabilitation treatment, the biological complications such as bone loss and peri-implantitis are still present. The creation of a coronal biological seal between the implant and the oral tissues seems to be a crucial point on preserving dental implants. The objective of this study was to immunohistochemically analyze the behavior of peri-implant soft tissues around a new implant healing-abutment surface on humans. A total of 30 soft tissue biopsies were collected after a healing period of 30 (±7) days, to analyze the expression of inflammatory (cluster of differentiation 63 (CD63), human neutrophil peptides 1–3 (HPN1–3)) and junctional (E-cadherin, occludin, and β-catenin) markers, on soft tissues around laser treated and machined alternated healing abutments. The evaluation demonstrated the whole area of the soft tissues adherent to the laser treated surface with a regular morphology. While several stress hallmarks in correspondence of machined surfaces were shown such as: (a) An irregular, disrupted, and discontinued basal membrane with an increased inflammation evident both the epithelial and connective tissues; (b) the absence or defective proper keratinization process of the external layer, and (c) damages in the cell to cell interaction. In conclusion, the laser treated surface is preferable to maintain the integrity and functionality of the gingiva epithelium. Full article

The aim of this cohort study was to quantify the morphological changes in the palatal cleft and true cleft areas with passive plate therapy using a new analysis method based on three-dimensional standardized reproducible landmarks. Forty-five casts of 15 consecutive patients with complete unilateral cleft lip and palate were laser scanned and investigated retrospectively. The landmarks and the coordinate system were defined, and the interrater and intrarater measurement errors were within 1.0 mm. The morphological changes of the cleft palate area after a period of 8 months of passive plate therapy without prior lip surgery are presented graphically. The median decrease in cleft width was 38.0% for the palatal cleft, whereas it was 44.5% for the true cleft. The width of the true and palatal cleft decreased significantly over a period of 8 months. The true cleft area decreased by 34.7% from a median of 185.4 mm² (interquartile range, IQR = 151.5–220.1) to 121.1 mm² (IQR = 100.2–144.6). The palatal cleft area decreased by 31.5% from a median of 334 mm² (IQR = 294.9–349.8) to 228.8 mm². The most important clinical considerations are the reproducibility and reliability of the anatomical points, as well as the associated morphological changes. We propose using the vomer edge to establish a validated measuring method for the width, area, and height of the true cleft. Full article

Secondary alveolar bone grafting (SABG) is associated with donor site morbidities. We aimed to compare the outcomes of SABG and extensive gingivoperiosteoplasty (EGPP) at the mixed dentition stage. This single-blinded, randomized, prospective trial enrolled 50 consecutive patients with unilateral complete cleft lip and palate who had residual alveolar bone cleft, of which 44 (19 SABG, 25 EGPP) completed the study. Bone volumes before surgery, 6 months postoperatively, and 1-year postoperatively were compared using computed tomography. The Bergland scale score was recorded at 6 months postoperatively. Both groups had the same preoperative alveolar cleft volume. On the Bergland scale, 21, 3, and 1 patient in the EGPP group and 16, 2, and 1 patient in the SABG group were classified as types I, II, and IV, respectively, which did not show significant difference. With perioperative orthodontic treatment, the 1-year residual bone defect volume in both groups did not show significant difference (SABG 0.12 cm³ vs. EGPP at 0.14 cm³, p > 0.05). The study was not able to reveal much difference between SABG and EGPP combined with perioperative orthodontic treatment. Full article

Chlorhexidine (CHX) has been incorporated into the composition of polymethyl methacrylate (PMMA) dental restorations to enhance their antimicrobial performance. However, the controlled delivery of CHX remains a challenge. Although previous findings with pure silica or polymer coatings demonstrated the resistance to bacterial adhesion, they did not provide antibacterial activity beyond the coated surface. Polydimethylsiloxane (PDMS) and mesoporous silica nanoparticles (MSNs) are widely used in biomedical science as a transfer medium in drug delivery systems. Here, the MSNs are used to encapsulate CHX, and the combination is added to PDMS. A thin coating film is formed on the PMMA, using oxygen plasma and thermal treatment. The liquid chromatography analysis shows that the coating film has high encapsulation efficiency and loading capacity, with a slow and stable release rate of CHX. The cytotoxicity tests also show that the coating does not affect the proinflammatory cytokines, cellular mitotic activity, or apoptotic cell death. The ability of the coating to release CHX indicates that the coating may even be effective against bacteria that are not directly in contact with the surface. This antibacterial protective film is expected to be a novel method to inhibit bacterial activity distal to the coated surfaces of PMMA restorations. Full article

NANOG, a key regulator of pluripotency and self-renewal in embryonic and adult stem cells, is frequently overexpressed in multiple cancers, including oral squamous cell carcinoma (OSCC). It has been frequently associated with poor outcomes in epithelial cancers, and recently implicated in laryngeal tumorigenesis. On this basis, we investigated the role of NANOG protein expression as an early cancer risk biomarker in oral potentially malignant disorders (OPMD), and the impact on prognosis and disease outcomes in OSCC patients. NANOG expression was evaluated by immunohistochemistry in 55 patients with oral epithelial dysplasia, and 125 OSCC patients. Correlations with clinical and follow-up data were assessed. Nuclear NANOG expression was detected in 2 (3.6%) and cytoplasmic NANOG expression in 9 (16.4%) oral dysplasias. NANOG expression increased with the grade of dysplasia. Cytoplasmic NANOG expression and the histopathological grading were significantly correlated with oral cancer risk, although dysplasia grading was the only significant independent predictor of oral cancer development in multivariate analyses. Cytoplasmic NANOG expression was also detected in 39 (31%) OSCC samples. Positive NANOG expression was significantly associated with tobacco and alcohol consumption, and was more frequent in pN0 tumors, early I-II stages. These data unveil the clinical relevance of NANOG in early stages of OSCC tumorigenesis rather than in advanced neoplastic disease. NANOG expression emerges as an early predictor of oral cancer risk in patients with OPMD. Full article

This systematic review was conducted to evaluate the retro-auricular trans-meatal approach (RA) to mandibular head fractures. Fractures of the mandibular head (8%) are a specific type of mandibular condyle fractures (34%). Despite numerous complications of conservative treatment, e.g., limited mobility and even ankylosis of the temporomandibular joint, as well as shortening of the mandibular ramus resulting in malocclusion, surgical intervention in this type of fracture is still problematic. The main problems with the dominant pre-auricular approach are the high risk of paralysis of the facial nerve and persistence of a visible scar. An attractive alternative is RA, which, despite its long history, has been described in English very few times, i.e., in only two clinical trials described in three articles in the last 21 years. According to these studies, RA gives a minimum of 90% of ideal positions of bone fragments and an always fully preserved function of the facial nerve in the course of long-term observation. RA allows the application of long screws for fixation, which provide good stabilization. In addition, new types of headless screws leave a smooth, non-irritating bone surface, and the immediate future may be dominated by their resorbable varieties. RA can, therefore, be treated as a very favorable access to fractures of the mandibular head, especially due to the protection of the facial nerve and the possibility of providing a stable and predictable fixation. Full article

There are many randomized clinical trials suggesting a positive effect of kinesiotaping on postoperative swelling. In dentistry, however, the use of kinesiotaping still seems to be innovative, since not many articles on kinesiotaping within the craniofacial area have been published. This study aimed to systematically review and synthesize available controlled trials examining the use of kinesiotaping to reduce morbidity after third molar extraction. Literature searches for free text and MeSH terms were performed using five search engines, and used to find studies which focused on kinesiotaping as a form of rehabilitation after third molar extraction. The keywords used in the search were: “((“molar, third”[MeSH Terms] OR (“molar”[All Fields] AND “third”[All Fields]) OR “third molar”[All Fields] OR (“third”[All Fields] AND “molar”[All Fields])) AND extraction [All Fields]) AND “kinesiology”[All Fields]”. For the assessment of the risk of bias, the Jadad and Maastricht scales were applied. The search strategy identified 317 potential articles. After analysis, 10 papers were included in the final evaluation. Despite the fact that most of the included articles adhered to methodological standards, the fact that there are only a few of them points to a further need for scientific development of physiotherapy in this regard. Kinesiology taping is useful against post-operative morbidity of the third molar extraction site. The present studies show a low level of the risk of bias, but they are limited in number; therefore, it seems that more research is needed. Full article

Background: Dysphagia causes severe complications among people with a stroke. Physiotherapy allows the cure of this pathology, and among the tools it offers is neuromuscular electrical stimulation. However, this is a technique that has not been protocolized. Therefore, it was considered necessary to carry out a systematic review on the efficacy of the various parameters of application of the neuromuscular electrical stimulation in dysphagia generated after a stroke. Methods: A systematic search for publications was conducted in March 2020 in the Pubmed, Cinahl, Medline, Web of Science and Scopus databases, using as search terms: Electric stimulation therapy, Deglutition disorders and Stroke. Results: 21 articles were obtained in which the application of neuromuscular electrical stimulation was applied in isolation (n = 7) or in combination with other techniques such as strengthening exercises and manual therapy techniques (n = 14), with this second modality of treatment having greater benefits for patients. Conclusion: The greatest efficacy of this technique is reached when applied at 60-80 Hz, 700 μs of pulse duration, at the motor intensity threshold and in sessions of 20–30 min. Full article

In periodontitis patients, furcation defects are crucial sites to regenerate due to their complex anatomy. Various modern surgical techniques and use of biomaterials have been suggested in the literature. Among all, platelet-rich fibrin (PRF) has potential in tissue regeneration thanks to its role in the release of growth factors. Therefore, the purpose of this study was to evaluate the beneficial effect of the addition of PRF to open flap debridement (OFD) or as an adjuvant to other biomaterials such as bone grafts in the treatment of grade 2 mandibular furcation defects. Systematic research was carried out on the databases Medline, Scopus, Embase, and Cochrane Library and registered on PROSPERO (CRD42020167662). According to the PICO guidelines by Cochrane, randomized trials and prospective non-randomized trials were evaluated, with a minimum follow-up period of 6 months. The inclusion criteria were the absence of systemic diseases, non-smoking patients, and a population aged from 18 to 65 years. Vertical pocket probing depth (PPD), vertical clinical attachment level (VCAL), and gingival recession (REC) were the primary outcomes. Vertical furcation depth (VFD), and the percentage of bone defect fill (%v-BDF) were considered as secondary outcomes. A meta-analysis of the primary and secondary outcomes was performed. Publication bias was assessed through a funnel plot. Eighty-four articles were initially extracted. Eight randomized clinical trials were analyzed according to the exclusion and inclusion criteria. The Quality assessment instrument (QAI) revealed four articles at low risk of bias, one at moderate, and three at high risk of bias. The metanalysis showed significant data regarding PPD, VCAL, VFD and %v-BDF in the comparison between PRF + OFD vs. OFD alone. The adjunct of PRF to a bone graft showed a significant difference for VCAL and a not statistically significant result for the other involved parameters. In conclusion, the adjunctive use of PRF to OFD seems to enhance the periodontal regeneration in the treatment of grade 2 furcation defects. The combination of PRF and bone graft did not show better clinical results, except for VCAL, although the amount of literature with low risk of bias is scarce. Further well-designed studies to evaluate the combination of these two materials are therefore needed. Full article