Giorgio Gastaldi

Leukocyte adhesion deficiency in a child with severe oral involvement

Leukocyte adhesion deficiency is a rare inherited defect of phagocytic function resulting from a lack of leukocyte cell surface expression of beta2 integrin molecules (CD11 and CD18) that are essential for leukocyte adhesion to endothelial cells and chemotaxis. A small number of patients with leukocyte adhesion deficiency-1 have a milder defect, with residual expression of CD18. These patients tend to survive beyond infancy; they manifest progressive severe periodontitis, alveolar bone loss, periodontal pocket formation, and partial or total premature loss of the primary and permanent dentitions. We report on a 13-year-old boy with moderate leukocyte adhesion deficiency-1 and severe prepubertal periodontitis. This case illustrates the need for the dentist to work closely with the pediatrician in the prevention of premature tooth loss and control of oral infection in these patients.

Immediate occlusal loading of full-arch rehabilitations: screw-retained versus cement-retained prosthesis. An 8-year clinical evaluation.

PURPOSE The aim of this study was to evaluate the survival and success of screw-retained versus cement-retained implant restorations in immediately loaded implants at 8-year follow-up. MATERIALS AND METHODS Patients who were scheduled for full-arch ceramic prosthetic restorations were divided into two groups by randomization: in one group, prosthetic frameworks were screwed onto implants (screw-retained group, SRG), and in the second group, the frameworks were cemented on abutments (cement-retained group, CRG). Dental implants were placed both in postextraction and in healed sites. A temporary full-arch prosthesis was placed immediately after implant placement. Intraoral digital radiographic examinations (evaluating marginal bone levels) were made at baseline, 6 months, and each year after implant placement. RESULTS In 28 patients, 24 full arches and 192 implants were placed in the maxilla and 10 full arches and 80 implants in the mandible (17 rehabilitations in each group). After an 8-year follow-up period, a survival rate of 99.27% was reported for all implants. Within the first year after implant placement, bone loss was recorded as follows: the CRG showed mean bone levels of -1.23 ± 0.45 mm, while the SRG showed mean bone levels of -1.01 ± 0.33 mm. After a 3-year follow-up, a slight increase was found (0.30 ± 0.25 mm in CRG and 0.45 ± 0.29 mm in SRG). After that point, marginal bone levels remained stable over time, up to the 8-year follow-up. No statistically significant differences were found between groups (P > .05). CONCLUSION Definitive cement- and screw-retained ceramic restorations are highly predictable, biocompatible, and esthetically pleasing, and the two groups presented no statistically significant differences in bone loss.

Correlation between Initial BIC and the Insertion Torque/Depth Integral Recorded with an Instantaneous Torque-Measuring Implant Motor: An in vivo Study

BACKGROUND Quantitative intraoperative evaluation of bone quality at implant placement site and postinsertion implant primary stability assessment are two key parameters to perform implant-supported rehabilitation properly. A novel micromotor has been recently introduced allowing to measure bone density at implant placement site and to record implant insertion-related parameters, such as the instantaneous, average and peak insertion torque values, and the insertion torque/depth integral. PURPOSE The aim of this study was to investigate in vivo if any correlation existed between initial bone-to-implant contact (BIC) and bone density and integral values recorded with the instrument. MATERIALS AND METHODS Twenty-five patients seeking for implant-supported rehabilitation of edentulous areas were consecutively treated. Before implant placement, bone density at the insertion site was measured. For each patient, an undersized 3.3 × 8-mm implant was placed, recording the insertion torque/depth integral values. After 15 minutes, the undersized implant was retrieved with a 0.5 mm-thick layer of bone surrounding it. Standard implants were consequently placed. Retrieved implants were analyzed for initial BIC quantification after fixation, dehydration, acrylic resin embedment, sections cutting and grinding, and toluidine-blue and acid fuchsine staining. Correlation between initial BIC values, bone density at the insertion site, and the torque/depth integral values was investigated by linear regression analysis. RESULTS A significant linear correlation was found to exist between initial BIC and (a) bone density at the insertion site (R = 0.96, explained variance R(2)  = 0.92) and (b) torque/depth integral at placement (R = 0.81, explained variance R(2)  = 0.66). CONCLUSIONS The system provided quantitative, reliable data correlating significantly with immediate postinsertion initial BIC, and could therefore represent a valuable tool both for clinical research and for the oral implantologist in his/her daily clinical practice.

Virtual and physical prototyping by means of a 3D optical digitizer: Application to facial prosthetic reconstruction

In this article, optical 3D acquisition, reverse engineering and rapid prototyping are proposed for virtual sculpturing and fabrication of facial prostheses. A novel approach to the direct mould production by means of rapid prototyping fabrication is introduced. Full coverage of the surface is obtained by using multi-view acquisition and alignment of point clouds. Suitable topological description is provided by triangle tessellation. Depending on the clinical case, one or two prototypes can be used either to directly cast the final prosthesis or to fabricate the positive wax pattern. The method has been applied to the development of a nose prosthesis; its generality is investigated in the case of virtual ear modelling. The advantages with respect to known art manufacturing methods are addressed.

Temperature change in pulp cavity in vitro during the polymerization of provisional resins

OBJECTIVES To measure the temperature change in the pulp cavity of an extracted tooth during the polymerization of provisional resins within impression putty and polyethylene matrices. The effect of pre-cooling the putty matrix was also evaluated. METHODS A freshly extracted premolar tooth had putty impressions recorded prior to crown preparation. Putty matrices were stored at room temperature, 4 and -12 degrees C prior to use. A thermocouple placed in the pulp chamber recorded the temperature change every 15s for a 10-min duration during polymerization of three resins using putty and clear polyethylene matrices. Five recordings were made with each material at each storage temperature. RESULTS There is a temperature rise of 3.4-5.5 degrees C when the resins were autocured in a putty matrix. When the polyvinyl matrix was used the temperature rise increased to 4.0-8.2 degrees C (P<0.001). The temperature rise was reduced to zero when the putty had been pre-cooled in the fridge (P<0.001) and reduced further following pre-cooling in the freezer (P<0.001). SIGNIFICANCE The use of a polyvinyl matrix allows higher pulp temperature rises to occur due to the exotherm from provisional resins. Lower temperatures were recorded when putty was used. The temperature rise could be eliminated when the putty was cooled at 4 degrees C prior to reinsertion.

Implant Prosthetic Rehabilitation in Controlled HIV-Positive Patients: A Prospective Longitudinal Study with 1-Year Follow-Up

PURPOSE The clinical trial aimed to evaluate the survival of implant-prosthetic rehabilitation in controlled HIV-positive patients. MATERIALS AND METHODS This mono-centric study included HIV patients with a stable disease, requiring implant rehabilitation, with good oral hygiene. Each patient received at least one dental implant. After 90 days in the upper jaw and 60 days in the lower jaw, the appropriate prosthesis was delivered.Primary outcome measures were prosthetic failures, implant failures, peri-implant marginal bone level changes (MBLCs), and biological complications (peri-implantitis, pus, pain, paresthesia). Data were recorded before the intervention (T0), and 6 (T1) and 12 months (T2) after. RESULTS Implants were positioned in 68 patients (22 females and 46 males; 194 implants). Two dropouts occurred for exacerbation of the disease before the sixth month of follow-up, and 66 patients (with 190 implants) completed the study. Forty-eight patients (70.6%) received total removable dentures; 11 patients (16.2%) received partial prosthesis, and nine patients (13.2%) received single elements.Implant failure occurred in nine patients (15 fixtures out of 190). These were early implant failures due to primary infection (five fixtures out of 190: 2.6%) and to peri-implantitis (10 fixtures out of 190: 5.2%). Prosthetic failure was registered in two patients (3% of patients) due to the loss of all the fixtures. Pus and pain were observed in 4/7 and 3/7 patients with peri-implantitis, respectively. No fractures of fixtures or paresthesia were registered. At T2, the mean peri-implant MBLC was -1.19 ± 0.87 mm. CONCLUSIONS Within its limitations, the study showed that in a well-controlled population of HIV patients implant rehabilitation can be a suitable options with results slightly worse to those obtained in normal population. A higher incidence of peri implant infections in the first six months was present pointing to the need of a proper protocol for infection control.

A Prospective Longitudinal Study on Implant Prosthetic Rehabilitation in Controlled HIV‐Positive Patients with 1‐Year Follow‐Up: The Role of CD4+ Level, Smoking Habits, and Oral Hygiene

BACKGROUND A recent study showed that implant-prosthetic rehabilitation in well-controlled HIV patients gave slightly worse results than in an healthy population, and failures were all linked to infection. PURPOSE The aim of this study was to examine the associations between the success of implant-prosthetic treatment and systemic CD4+ level, smoking habits, and oral hygiene. MATERIALS AND METHODS This mono-centric study included HIV patients with a stable disease and good oral hygiene requiring implant rehabilitation. Each patient received at least one dental implant. Prosthesis were delivered after 90 days in the upper jaw and 60 days in the lower jaw. Primary outcome measures were prosthetic failures, implant failures, peri-implant marginal bone level changes, and biological complications (peri-implantitis, pus, pain, paresthesia). The possible association with CD4 count, smoking habits, and oral hygiene was analyzed. RESULTS Sixty-eight patients received 194 implants, and 66 patients (190 implants) were followed for 1 year. No significant associations were found between CD4+ count, oral hygiene-associated variables, and any of the outcome measures. If compared with nonsmoking/light smoking patients, patients who smoked >10 cigarettes/day suffered a statistically significant greater number of implant failures (p ≤ .005), presented a comparatively higher number of peri-implantitis (p < .001), as well as a higher frequency of pus (p ≤ .007), and reported pain (p ≤ .009). CONCLUSION Within the limitation of the present study, placement of dental implants in HIV-positive patients with stable disease seems a reasonable treatment option, regardless of CD4+ cell count, provided that they are in a normal range. Oral hygiene variables were not influent in this group of patient following recall appointments, while HIV-positive heavy smokers (>10 cigarettes/day) demonstrated an increased risk of early implant failure, peri-implantitis, episodes of pus, and self-reported pain.

Histomorphometric Comparison of Enzyme-Deantigenic Equine Bone and Anorganic Bovine Bone in Sinus Augmentation: A Randomized Clinical Trial with 3-Year Follow-Up

PURPOSE To conduct a histomorphometric investigation comparing the use of enzyme-deantigenic equine bone (EDEB) and anorganic bovine bone (ABB) for maxillary sinus augmentation. MATERIALS AND METHODS Forty patients with Cawood Class V atrophic ridges who required maxillary sinus augmentation randomly received EDEB (n = 20) or ABB (n = 20) granules. Six months later, biopsy specimens were obtained, and implants were placed. Bone specimens were subjected to histomorphometric analysis, and newly formed bone (NFB) and residual biomaterial (RB) percentages were calculated. Patients were followed up for 3 years after definitive prosthetic rehabilitation, and implant success and survival rates were determined according to the criteria of Albrektsson and Zarb. RESULTS All patients healed uneventfully. Histomorphometric results for the EDEB were as follows: NFB = 46.86% ± 12.81% and RB = 11.05% ± 9.27%. For ABB, they were: NFB = 25.12% ± 7.25% and RB = 28.65% ± 9.70%. The difference was significant at a .05 level of confidence both for NFB and RB. At the 3-year follow-up, the implant survival rate was identical in the two groups (100%). CONCLUSION Grafting with EDEB resulted in a greater quantity of NFB at implant insertion. No significant clinical differences were observed between the two patient groups at the 3-year follow-up. EDEB was as effective as ABB for sinus augmentation.

Evaluation of the accuracy of extraoral laboratory scanners with a single-tooth abutment model: A 3D analysis

PURPOSE The aim of this study was to compare the accuracy of different laboratory scanners using a calibrated coordinate measuring machine as reference. METHODS A sand blasted titanium reference model (RM) was scanned with an industrial 3D scanner in order to obtain a reference digital model (dRM) that was saved in the standard tessellation format (.stl). RM was scanned ten times with each one of the tested scanners (GC Europe Aadva, Zfx Evolution, 3Shape D640, 3Shape D700, NobilMetal Sinergia, EGS DScan3, Open Technologies Concept Scan Top) and all the scans were exported in .stl format for the comparison. All files were imported in a dedicated software (Geomagic Qualify 2013). Accuracy was evaluated calculating trueness and precision. RESULTS Trueness values (μm [95% confidence interval]) were: Aadva 7,7 [6,8-8,5]; Zfx Evolution 9,2 [8,6-9,8]; D640 18,1 [12,2-24,0]; D700 12,8 [12,4-13,3]; Sinergia 31,1 [26,3-35,9]; DScan3 15,6 [11,5-19,7]; Concept Scan Top 28,6 [25,6-31,6]. Differences between scanners were statistically significant (p<.0005). Precision values (μm [95% CI]) were: Aadva 4,0 [3,8-4,2]; Zfx Evolution 5,1 [4,4-5,9]; D640 12,7 [12,4-13,1]; D700 11,0 [10,7-11,3]; Sinergia 16,3 [15,0-17,5]; DScan3 9,5 [8,3-10,6]; Concept Scan Top 19,5 [19,1-19,8]. Differences between scanners were statistically significant (p<.0005). CONCLUSIONS The use a standardized scanning procedure fabricating a titanium reference model is useful to compare trueness and precision of different laboratory scanners; two laboratory scanners (Aadva, Zfx Evolution) were significantly better that other tested scanners.

Efficacy and effects of palifermin for the treatment of oral mucositis in patients affected by acute lymphoblastic leukemia

Abstract This randomized-controlled trial studied the efficacy of palifermin, administered as a dose during hematopoietic stem cell transplant (HSCT) therapy, as primary prophylaxis on pediatric patients with acute lymphoblastic leukemia in order to reduce oral mucositis (OM). Patients in the palifermin group were randomly assigned to receive palifermin, 60 μg/kg, intravenously as a single dose 3 days before and 0, +1, and +2 post autologous HSCT infusion. The patients in the control group received only a placebo treatment. OM-related assessments were the WHO oral-toxicity scale and the patient-reported outcomes. There was a statistically significant reduction in the incidence of OM grade 3 and 4 in the palifermin group compared to the control group. There was also a reduction in the degree of severity of OM in the palifermin group (1.65 grade respect to 2.33 in the control group). Palifermin could prevent the recurrence of severe OM and improve the quality of life in patients with acute lymphoblastic leukemia (ALL).