Marco Baldoni

Association between serum values of C-reactive protein and cytokine production in whole blood of patients with Type 2 diabetes

Diabetes mellitus accelerates atherosclerotic processes, and it is known that inflammation plays a key role in atherosclerosis. The aim of the present study was to evaluate in patients with Type 2 diabetes whether serum levels of CRP (C-reactive protein) are associated with cytokine production in whole blood. A total of 89 outpatients with Type 2 diabetes were enrolled, and blood pressure, body mass index, fasting blood glucose, glycated haemoglobin, cholesterol, triacylglycerols (triglycerides) and hs-CRP (high-sensitivity CRP) were measured. IL-6 (interleukin-6), IL-1beta (interleukin-1beta) and TNF-alpha (tumour necrosis factor-alpha) were measured before and after 24 h of incubation of whole blood with LPS (lipopolysaccharide) or saline. The basal values of IL-1beta, IL-6 and TNF-alpha were low and were not significantly related to hs-CRP levels. A univariate analysis showed that the level of IL-1beta and IL-6, obtained after 24 h of incubation of whole blood with LPS, increased significantly with increasing levels of hs-CRP and, after adjusting for potential confounders, IL-1beta still remained statistically significant. In our sample of patients with Type 2 diabetes, there was no association between serum hs-CRP levels and basal levels of IL-6, IL-1beta and TNF-alpha. Conversely, a significant association was observed between serum hs-CRP levels and IL-1beta and IL-6 production after 24 h of incubation of whole blood with LPS. In conclusion, our data suggest that patients with Type 2 diabetes and high hs-CRP levels may have an enhanced reactivity in response to specific stimuli that produce different interleukins, with possible implications in inflammatory atherosclerotic processes.

Hereditary Angioedema in Oral Surgery: Overview of the Clinical Picture and Report of a Case

p p t ngioedema is a pathologic condition first described y Quincke and Osler. It can be genetically deterined or acquired, and it is caused by a vascular eaction induced by deficiency or functional altertion of the C1 inhibitor (C1-INH), an enzyme inolved in the regulation of complement, contact, firinolytic, and coagulation systems. Two forms of angioedema have been described in he literature: hereditary angioedema (HAE) and acuired or idiopathic angioedema (AAE). HAE is characterized by dominant autosomal transission, early onset, and a positive family history. It s caused by a mutation of the gene for C1-INH, ocalized on chromosome 11. Type 1 HAE is the most requent form (85% of cases) and is associated with eficiency of functional C1-INH in plasma (10%-30% f normal values). Type 2 HAE is characterized by ormal or elevated plasma levels of dysfunctional C1NH. Type 3 HAE occurs mainly in women. Affected ersons display the typical clinical features of C1-INH

Clinical, Radiographic and Microbiological Evaluation of High Level Laser Therapy, a New Photodynamic Therapy Protocol, in Peri-Implantitis Treatment; a Pilot Experience.

Aim. Endosseous implants are widely used to replace missing teeth but mucositis and peri-implantitis are the most frequent long-term complications related with dental implants. Removing all bacterial deposits on contaminated implant surface is very difficult due to implant surface morphology. The aim of this study was to evaluate the bactericidal potential of photodynamic therapy by using a new high level laser irradiation protocol associated with hydrogen peroxide in peri-implantitis. Materials and Methods. 10 patients affected by peri-implantitis were selected for this study. Medical history, photographic documentation, periodontal examination, and periapical radiographs were collected at baseline and 6 months after surgery. Microbiological analysis was performed with PCR Real Time. Each patient underwent nonsurgical periodontal therapy and surgery combined with photodynamic therapy according to High Level Laser Therapy protocol. Results. All peri-implant pockets were treated successfully, without having any complication and not showing significant differences in results. All clinical parameters showed an improvement, with a decrease of Plaque Index (average decrease of 65%, range 23–86%), bleeding on probing (average decrease of 66%, range 26–80%), and probing depth (average decrease of 1,6 mm, range 0,46–2,6 mm). Periapical radiographs at 6 months after surgery showed a complete radiographic filling of peri-implant defect around implants treated. Results showed a decrease of total bacterial count and of all bacterial species, except for Eikenella corrodens, 6 months after surgery. Conclusion. Photodynamic therapy using HLLT appears to be a good adjunct to surgical treatment of peri-implantitis.

Immediate loading in mandible full-arch: pilot study in patients with osteoporosis in bisphosphonate therapy.

D ental implants have been used clinically in a routine manner to restore completely edentulous mandibles. A recent systematic review of the literature conducted by Bryant describes the 5-year cumulative survival rates of mandibular fixed and removable prostheses between 83% and 100%, with corresponding levels of crestal bone loss up to 1.1 mm the first year and 0.4 mm per year thereafter. The author included in his review studies using the classical two-stage surgical approach, whereby the implant is initially covered underneath the mucosa and kept unloaded for 4–6 months. However, over the past decade changes in dental implant design and surface configuration combined with an improved understanding of the biological and biomechanical aspects have improved the clinical outcome of implant treatments. These advancements have led to the onestage surgical procedures in conjunction with earlier loading, especially in the completely edentulous mandible. Today there is evidence, although based on a small number of studies and relatively low patient numbers, that immediate loading can lead to survival rates comparable to conventionally loaded implants. The ultimate goal of an immediate loading protocol is to reduce the number of surgical interventions and to decrease the timeframe between surgery and prosthetic delivery without sacrificing implant success rates. These new protocols will ultimately diminish patients’ reservations and result in increased acceptance of implant therapy. Before embracing the procedure as a routine treatment, the immediate loading technique needs to be validated with a significant number of clinical cases, extended follow-ups, and a clear definition of limitations. Because implant macrogeometry/microgeometry and the loading mode play a crucial role during the healing phase, it is important when documenting immediate loading cases to identify clearly the type of implant and rehabilitation used. In two preliminary investigations, two patients treated in one of the centers of this study received both submerged and immediately loaded (IL) implants, according to a 1 Department of Periodontology, University of MilanoBicocca, Milan, Italy. 2 Department of Oral Pathology, University of Parma, Parma, Italy. 3 Department of Oral Pathology, University of MilanoBicocca, Milan, Italy. *Corresponding author, e-mail: leo.doc73@libero.it DOI: 10.1563/AAID-JOI-D-09-00132.1 CASE LETTER

A Preliminary In Vitro Study on the Efficacy of High-Power Photodynamic Therapy (HLLT): Comparison between Pulsed Diode Lasers and Superpulsed Diode Lasers and Impact of Hydrogen Peroxide with Controlled Stabilization

Aim. In periodontology lasers have been suggested for the photodynamic therapy (PDT): such therapy can be defined as the inactivation of cells, microorganisms, or molecules induced by light and not by heat. The aim of this study was to evaluate results of PDT using a 980 nm diode laser (Wiser Doctor Smile, Lambda SPA, Italy) combined with hydrogen peroxide, comparing a pulsed diode laser (LI) activity to a high-frequency superpulsed diode laser (LII). Materials and Methods. Primary fibroblasts and keratinocytes cell lines, isolated from human dermis, were irradiated every 48 h for 10 days using LI and LII combined with SiOxyL+ ™ Solution (hydrogen peroxide (HP) stabilized with a glycerol phosphate complex). Two days after the last irradiation, the treated cultures were analyzed by flow cytofluorometry (FACS) and western blotting to quantify keratin 5 and keratin 8 with monoclonal antibodies reactive to cytokeratin 5 and cytokeratin 8. Antimicrobial activity was also evaluated. Results. Both experimental models show the superiority of LII against LI. In parallel, stabilized HP provided better results in the regeneration test in respect to common HP, while the biocidal activity remains comparable. Conclusion. The use of high-frequency lasers combined with stabilized hydrogen peroxide can provide optimal results for a substantial decrease of bacterial count combined with a maximal biostimulation induction of soft tissues and osteogenesis.

Posizionamento di impianti immediati o differiti in siti postestrattivi o in aree edentule in pazienti trattati con bifosfonati orali

Riassunto Obiettivi Valutare la guarigione postoperatoria, il successo dell’osteointegrazione e la sopravvivenza di impianti posizionati in siti postestrattivi immediati o ritardati e in aree edentule, in pazienti in trattamento con bifosfonati orali. Materiali e metodi La tecnica chirurgica ha previsto un’osteotomia iniziale del sito secondo il protocollo di fabbrica del sistema implantare. I 14 pazienti sono stati sottoposti a una terapia preventiva per il controllo delle infezioni locali e sistemiche e la chirurgia ha previsto trattamenti minimamente invasivi. Risultati e Conclusioni Sono stati posizionati 51 impianti con un follow-up medio di 36,2 mesi. Due impianti mascellari sono stati persi a 18 mesi dal carico occlusale. Non si sono verificate altre complicanze postchirurgiche e in nessun caso si e presentata osteonecrosi delle ossa mascellari correlata all’utilizzo dei bifosfonati (BRONJ).