Gian Luca Sfasciotti

Histological and Histomorphometric Human Results of HA-Beta-TCP 30/70 Compared to Three Different Biomaterials in Maxillary Sinus Augmentation at 6 Months: A Preliminary Report

Objective. The aim of this investigation was to examine the bone regenerative potential of newly biphasic calcium phosphate ceramics (HA-β-TCP 30/70), by assessing histological and histomorphometric results of human specimens retrieved from sinuses augmented with HA-β-TCP 30/70, and comparing them to anorganic bovine bone (ABB), mineralized solvent-dehydrated bone allograft (MSDBA), and equine bone (EB), after a healing period of 6 months. Materials and Methods. Four consecutive patients with edentulous atrophic posterior maxilla were included in this report. A two-stage procedure was carried out for sinus augmentation with HA-β-TCP 30/70, ABB, MSDBA, and EB. After 6 months, specimens were retrieved at the time of implant placement and processed for histological and histomorphometric analyses. Results. At histological examination, all biomaterials were in close contact with the newly formed bone and showed the same pattern of bone formation; the grafted granules were surrounded by a bridge-like network of newly formed bone. A limited number of ABB particles were partially covered by connective tissue. The histomorphometric analysis revealed 30.2% newly formed bone for Ha-β-TCP 30/70, 20.1% for ABB, 16.4% for MSDBA, and 21.9% for EB. Conclusions. Within the limitations of the present investigation, these results support the successful use of HA-β-TCP 30/70 for sinus augmentation.

Graftless sinus augmentation technique with contextual placement of implants: a case report

IntroductionThe positioning of implants in the jaw bones with contextual graftless lateral approach sinus lifting is finding an increasingly broad consensus in the literature.Since the 1970s, various clinical research projects have been conducted on applications of biological and synthetic biomaterials in bone regenerative surgery, both in sinus lift procedures and in cystic cavity filling after cystectomy or in bone defects in regenerative periodontal surgery. Currently, we are finding that there is an increasing trend of clinicians aiming to adopt graftless techniques, with satisfactory results in terms of implant survival in the long term.In our study, through a case report, we describe a variant of graftless sinus augmentation technique with contextual implant placement, emphasizing the role of the blood clot, combined with collagen sponges, as a natural scaffold and the osteogenic potential of the subantral membrane in guided bone regeneration, with reduced morbidity of the patient.Case presentationTo describe the surgical technique, the clinical case of a 38-year-old Caucasian woman with a lateral posterior edentulism was selected. The rehabilitation was solved by a graftless sinus augmentation technique with a contextual implant placement.For each implant, a resonance frequency analysis evaluation was reported as implant stability quotient values. The performance of the implant stability quotient values followed a gradual increase from time zero to the sixth month, as the clot was differentiated into osteoid tissue and then into bone tissue, due to the scaffold effect conferred by the equine collagen sponge. The stabilization phase took place between the fourth and the sixth month, according to the implant stability quotient values.ConclusionsOur graftless sinus augmentation technique seems to be very predictable thanks to the osteoconductive principles on which it is based, and in association with the proper management of peri-implant soft tissue, so as to increase the amount of keratinized tissue, which could represent the new gold standard for this type of rehabilitation in the future.

Childhood overweight-obesity and periodontal diseases: is there a real correlation?

OBJECTIVEnThe association between obesity and periodontitis has been extensively investigated in adults but not in young people. The aim of this study was to examine the association between overweight-obesity and periodontal disease in pediatric subjects.nnnMETHODSnControlled cross-sectional study involving 100 school children of both gender (50 M and 50 F) between 7 and 12 years of age (mean age 9,19±1,57). Two groups were formed based on Body Mass Index value: test group with BMI ≥ 25 Kg/m2 and control group with BMI ≤ 24 Kg/m2. Diet intake and oral hygiene habits were recorded by a specific questionnaire and the periodontal clinical parameters were evaluated.nnnRESULTSnThe periodontal examination in the control group revealed a full-mouth plaque score (FMPS) value equal to 21.86% against 50.08% in the group of patients overweight/obese; the full-mouth bleeding score (FMBS) in the control group amounted to 12.7% against 26.24% of test group. No patient in either group included in the study presented a probing pocket depth (PPD) ≥3, so a significant difference regarding this value was not found. Regarding the frequency and quantity of food consumption, the number of obese patients who did not follow a balanced diet largely exceeded the number of normal-weight patients (70 versus 20%).nnnCONCLUSIONSnThese results focus the attention on the negative impact of obesity on gingival health in young subjects, probably due to a combination of metabolic and inflammatory profiles and the result of a careless attitude towards prevention diseases of the oral cavity.

Clinical Management of a Peri-Implant Giant Cell Granuloma.

Purpose. Implant therapy plays an important role in contemporary dentistry with high rates of long-term success. However, in recent years, the incidence of peri-implantitis and implant failures has significantly increased. The peripheral giant cell granuloma (PGCG) rarely occurs in peri-implant tissues and it is clinically comparable to the lesions associated with natural teeth. Therefore, the study of possible diseases associated with dental implants plays an important role in order to be able to diagnose and treat these conditions. Materials and Methods. This report described a 60-year-old Caucasian male who presented a reddish-purple pedunculated mass, of about 2u2009cm in diameter, associated with a dental implant and the adjacent natural tooth. Results. An excisional biopsy was performed and the dental implant was not removed. Histological examination provided the diagnosis of PGCG. After 19-month follow-up, there were no signs of recurrence of peri-implantitis around the implant. Conclusion. The correct diagnosis and appropriate surgical treatment of peri-implant giant cell granuloma are very important for a proper management of the lesion in order to preserve the implant prosthetic rehabilitation and prevent recurrences.

Unusual symptomatic inclusion cysts in a newborn: a case report

IntroductionDental lamina cysts are cysts that occur as white or pink small nodules, often multiple, approximately 1 to 3mm in diameter. They are typically located on the midpalatine raphe and less frequently on the maxillary and mandibular alveolar mucosa; in the latter case these can be appear to be neonatal teeth.On microscopic examination, these lesions show a stratified squamous epithelium (two to three cell layers); it is possible to find protein, keratin and/or exfoliated epithelial cells in the lumen of the lesions.Neonatal cysts usually show no particular symptoms. They are associated with an excellent prognosis because they regress spontaneously within a few weeks and are not associated to any complications. However, if pain, bleeding or other symptoms occur, a surgical excision is required.Case presentationIn this paper, we present an anomalous case of symptomatic dental lamina cyst which affected a 60-day-old male Caucasian newborn. The surgical treatment was elective in this case and 6-month follow-ups were mandatory.ConclusionsWe can underline the successful predictability of the surgical approach; however, we consider that the treatment choice should take place in the light of medical history and clinical considerations, and always be evaluated on a case-by-case basis. Further studies and reviews in this field should be performed in order to suggest guidelines for clinicians, although these cases are rare.

Comparative Histological and Histomorphometric Results of Six Biomaterials Used in Two-Stage Maxillary Sinus Augmentation Model after 6-Month Healing

Objectives To evaluate the performances of six different bone substitute materials used as graft in maxillary sinus augmentation by means of histological and histomorphometric analysis of bone biopsies retrieved from human subjects after a 6-month healing period. Materials and Methods Six consecutive patients (3 males, 3 females, aged 50-72 years), healthy, nonsmokers, and with good oral hygiene, presenting edentulous posterior maxilla with a residual bone crest measuring ≤ 4 mm in vertical height and 3 to 5 mm in horizontal thickness at radiographic examination, were selected to receive sinus augmentation and delayed implant placement. Under randomized conditions, sinus augmentation procedures were carried out using mineralized solvent-dehydrated bone allograft (MCBA), freeze-dried mineralized bone allograft (FDBA), anorganic bovine bone (ABB), equine-derived bone (EB), synthetic micro-macroporous biphasic calcium-phosphate block consisting of 70% beta-tricalcium phosphate and 30% hydroxyapatite (HA-β-TCP 30/70), or bioapatite-collagen (BC). After 6 months, bone core biopsies were retrieved and 13 implants were placed. Bone samples were processed for histological and histomorphometric analysis. CT scans were taken before and after surgery. After 4 months of healing, patients were restored with a provisional fixed acrylic resin prosthesis, as well as after further 2-4 months with a definitive cemented zirconia or porcelain-fused-to-metal crowns. Results There were no postoperative complications or implant failures. The histological examination showed that all biomaterials were in close contact with newly formed bone, surrounding the graft granules with a bridge-like network. No signs of acute inflammation were observed. The histomorphometry revealed 20.1% newly formed bone for MCBA, 32.1% for FDBA, 16.1% for ABB, 22.8% for EB, 20.3% for HA-β-TCP 30/70, and 21.4% for BC. Conclusions Within the limitations of the present investigation, all the six tested biomaterials showed good biocompatibility and osteoconductive properties when used in sinus augmentation procedures, although the FDBA seemed to have a better histomorphometric result in terms of newly formed bone and residual graft material. This trial is registered with ClinicalTrials.gov Identifier (Registration Number): NCT03496688.