Saturnino Marco Lupi

Mandibular traumatic peripheral osteoma: a case report.

An osteoma is a slow-growing, benign lesion comprising mature bone tissue. Osteomas rarely occur in maxillary bones, with the exception of the maxillary sinuses. Various possible etiologies have been proposed, including congenital anomalies, chronic inflammation, muscular activity, embryogenetic changes, and trauma. Here we present a case of an osteoma of the buccal plate of the mandible at the site where a sports-related traumatic injury occurred 15 years earlier. Both conventional and 3-dimensional x-ray examinations were used for diagnosis and preoperative evaluation of the possible involvement of the adjacent anatomic structures. The lesion was treated surgically without complications and the patient made a complete recovery. Histologic tests confirmed the preoperative diagnosis. A review of the international literature is also presented.

Emerging Perspectives in Scaffold for Tissue Engineering in Oral Surgery

Bone regeneration is currently one of the most important and challenging tissue engineering approaches in regenerative medicine. Bone regeneration is a promising approach in dentistry and is considered an ideal clinical strategy in treating diseases, injuries, and defects of the maxillofacial region. Advances in tissue engineering have resulted in the development of innovative scaffold designs, complemented by the progress made in cell-based therapies. In vitro bone regeneration can be achieved by the combination of stem cells, scaffolds, and bioactive factors. The biomimetic approach to create an ideal bone substitute provides strategies for developing combined scaffolds composed of adult stem cells with mesenchymal phenotype and different organic biomaterials (such as collagen and hyaluronic acid derivatives) or inorganic biomaterials such as manufactured polymers (polyglycolic acid (PGA), polylactic acid (PLA), and polycaprolactone). This review focuses on different biomaterials currently used in dentistry as scaffolds for bone regeneration in treating bone defects or in surgical techniques, such as sinus lift, horizontal and vertical bone grafts, or socket preservation. Our review would be of particular interest to medical and surgical researchers at the interface of cell biology, materials science, and tissue engineering, as well as industry-related manufacturers and researchers in healthcare, prosthetics, and 3D printing, too.

Radiographic Evaluation of Regenerated Bone Following Poly(Lactic-Co-Glycolic) Acid/Hydroxyapatite and Deproteinized Bovine Bone Graft in Sinus Lifting

AbstractAlthough numerous biomaterials are used for maxillary sinus-lift surgery, the ideal material for such procedures has not yet been identified. Both heterologous and alloplastic bone substitutes have a solely osteoconductive effect and lack the osteoinductive properties of the bone morphogenetic proteins typical of autologous bone. Our group assessed a new alloplastic graft material, poly(lactic-co-glycolic) acid/hydroxyapatite (PLGA/HA), implanted in a human model of maxillary sinus-lift surgery. For this prospective, random, double-blind trial, we used deproteinized bovine bone (DBB) as the comparison material. Radiographic bone vertical height and density were assessed at approximately 28 weeks after grafting using cone-beam computed tomography. The vertical dimension of the regenerated bone was equivalent between the 2 groups. The density of the bone regenerated using PLGA/HA was significantly lower than that obtained with DBB. Despite clinical assessments demonstrating that PLGA/HA has sufficient characteristics for use in sinus-lift surgery, DBB provided greater bone density and an equivalent vertical dimension of grafted bone. Further studies are needed to supplement the radiologic findings with histologic and micromorphometric examinations.

Cytopathological and chemico-physical analyses of smears of mucosa surrounding oral piercing

OBJECTIVE The aim of this comparative study was to analyze cytopathologically and chemico-physically the mucosa surrounding oral piercing to correlate results with adverse tissue signs. MATERIALS AND METHODS The tongue superficial mucosa of 15 young subjects (control group) and the superficial mucosa surrounding oral piercing of 15 young subjects (test group, TG) were smeared on slides, Papanicolaou stained and analyzed under the optical microscope. Some smears were prepared for (back-scattered) scanning electron microscope (SEM) and X-ray microanalysis to study piercing fragments. RESULTS Smears of TG displayed a variable extent of bacterial cytolysis of epithelial cells, fungi, hyperkeratosis, parakeratosis, granulocyte infiltration, calcium formations and bacterial flora; the four last statistically significant (P < 0.05). Foreign bodies surrounded by keratinocytes were detected under both light and SEM. X-ray microanalyses highlighted piercing alloy aggression, ion release and an inverse gradient of ion concentration inside keratinocytes. CONCLUSIONS The pathological findings in smears correlated with adverse effects of oral piercing. Ion release may be related to direct toxic effects and belated reactions because of metal sensitization. A strict regulation of piercing is warranted.

Histomorphometric evaluation of two different bone substitutes in sinus augmentation procedures: A randomized controlled trial in humans

PURPOSE The histomorphometric results of sinus floor augmentation with deproteinized bovine bone (DBB) and a new fully synthetic bone substitute, poly(lactic-co-glycolic acid/hydroxyapatite) (PLGA/HA), were compared in humans. MATERIALS AND METHODS Twelve maxillary sinuses of eight patients requiring major maxillary sinus floor augmentation and free of concomitant conditions (ASA scores 1 and 2) were studied. Lateral sinus augmentation was performed using DBB or PLGA/HA grafts; sites were randomly assigned to control or test groups. Patients were reexamined approximately 6 months after grafting using cone beam computed tomography scans, and biopsy samples were harvested from implant sites. Total bone volume, residual graft material volume, and new bone volume were assessed. RESULTS Healing times were similar between groups. Measurable biopsy specimens were available from four of the test sites and six of the control sites. PLGA/HA grafts showed no trace of graft material, whereas DBB grafts had a mean graft area of 16.5% (P < .05). Mean percent newly formed bone tended to be greater for PLGA/HA (44.45%) than for DBB (27.51%). Mean total volume percent did not differ significantly: PLGA/HA = 44.45%, DBB = 44.10%. CONCLUSION DBB and PLGA/HA produced similar total bone volumes. PLGA/HA appeared to be completely resorbed, whereas DBB presented residual graft material. With the limitations due to the small sample size, both materials were suitable for sinus floor augmentation.

Periosteum-derived micro-grafts for tissue regeneration of human maxillary bone

The bone regeneration is one of the most important challenges for regenerative medicine. In maxillo-facial area, bone resorption of the alveolar crest occurs after tooth extraction and leads to several risks for rehabilitation treatments, including dental implants procedures. Goal of our study was to demonstrate the efficacy of an innovative clinical protocol of bone tissue engineering called Rigenera protocol, aimed to create and optimize bio-complexes constituted by collagen biomaterial and human autologous periosteum-derived micro-grafts. We assessed the capacity of these bio-complexes to prevent the bone resorption in the alveolar crest with respect to simple collagen performing histological evaluations of neo-formed osseous tissue. We demonstrated that autologous bio-complexes significantly reduced the bone resorption of both horizontal and vertical dimension of alveolar crest when compared to collagen alone. We also showed that these bio-complexes accelerate the ossification process triggering the formation of new osseous tissue after 45 days from treatment and increasing the calcified matrix after 60 days and until to 120 days with respect to collagen alone. Taken together, these data showed the efficacy of bio-complexes composed by periosteum-derived micro-grafts and collagen in the alveolar ridge preservation through a reduction of bone resorption and an enhancement of new osseous tissue formation.

Evaluation of Poly(Lactic-co-glycolic) Acid Alone or in Combination with Hydroxyapatite on Human-Periosteal Cells Bone Differentiation and in Sinus Lift Treatment

Most recent advances in tissue engineering in the fields of oral surgery and dentistry have aimed to restore hard and soft tissues. Further improvement of these therapies may involve more biological approaches and the use of dental tissue stem cells in combination with inorganic/organic scaffolds. In this study, we analyzed the osteoconductivity of two different inorganic scaffolds based on poly (lactic-co-glycolic) acid alone (PLGA-Fisiograft) or in combination with hydroxyapatite (PLGA/HA-Alos) in comparison with an organic material based on equine collagen (PARASORB Sombrero) both in vitro and in vivo. We developed a simple in vitro model in which periosteum-derived stem cells were grown in contact with chips of these scaffolds to mimic bone mineralization. The viability of cells and material osteoconductivity were evaluated by osteogenic gene expression and histological analyses at different time points. In addition, the capacity of scaffolds to improve bone healing in sinus lift was examined. Our results demonstrated that the osteoconductivity of PLGA/HA-Alos and the efficacy of scaffolds in promoting bone healing in the sinus lift were increased. Thus, new clinical approaches in sinus lift follow-up should be considered to elucidate the clinical potential of these two PLGA-based materials in dentistry.

Air-abrasive debridement with glycine powder versus manual debridement and chlorhexidine administration for the maintenance of peri-implant health status: a six-month randomized clinical trial

STUDY DESIGN This single-masked, randomized and six-month clinical intervention trial including two study groups was planned to evaluate the efficacy of maintenance treatment with glycine powder on the periodontal health of peri-implant tissues. METHODS A total of 46 patients with partial or total edentulism, carrying a total of 88 implants, were assigned either to an air abrasive with the glycine powder treatment group (AAD) or to a manual debridement and clorexidine administration treatment group (MDA). Clinical data were collected before treatment and at 3 and 6 months after the treatment. Plaque index (PI), bleeding index (BOP), probing depth (PD), clinical attachment level (CAL) and bleeding score (BS) were analysed. RESULTS After 3 months, AAD treatment statistically significantly improved BS (P < 0.05); at 6 months, AAD treatment statistically significantly improved indexes PD, PI, BOP and BS (P < 0.05). In addition, the AAD treatment proved to be more effective than MDA in maintaining the peri-implant health of PD at three and 6 months, and of PI at 6 months (P < 0.05). There were no significant changes of CAL in both groups, and all the indexes remained within the physiological levels. CONCLUSIONS Within the limits of the study, treatment with glycine seems appropriate in the maintenance of peri-implant health and more effective than the traditional treatment with plastic curette and chlorhexidine.

Autologous Periosteum-Derived Micrografts and PLGA/HA Enhance the Bone Formation in Sinus Lift Augmentation

Sinus lift augmentation is a procedure required for the placement of a dental implant, whose success can be limited by the quantity or quality of available bone. To this purpose, the first aim of the current study was to evaluate the ability of autologous periosteum-derived micrografts and Poly(lactic-co-glycolic acid) (PLGA) supplemented with hydroxyl apatite (HA) to induce bone augmentation in the sinus lift procedure. Secondly, we compared the micrografts behavior with respect to biomaterial alone, including Bio-Oss® and PLGA/HA, commercially named Alos. Sinus lift procedure was performed on 24 patients who required dental implants and who, according to the study design and procedure performed, were divided into three groups: group A (Alos + periosteum-derived micrografts); group B (Alos alone); and group C (Bio-Oss® alone). Briefly, in group A, a small piece of periosteum was collected from each patient and mechanically disaggregated by Rigenera® protocol using the Rigeneracons medical device. This protocol allowed for the obtainment of autologous micrografts, which in turn were used to soak the Alos scaffold. At 6 months after the sinus lift procedure and before the installation of dental implants, histological and radiographic evaluations in all three groups were performed. In group A, where sinus lift augmentation was performed using periosteum-derived micrografts and Alos, the bone regeneration was much faster than in the control groups where it was performed with Alos or Bio-Oss® alone (groups B and C, respectively). In addition, the radiographic evaluation in the patients of group A showed a radio-opacity after 4 months, while after 6 months, the prosthetic rehabilitation was improved and was maintained after 2 years post-surgery. In summary, we report on the efficacy of periosteum-derived micrografts and Alos to augment sinus lift in patients requiring dental implants. This efficacy is supported by an increased percentage of vital mineralized tisssue in the group treated with both periosteum-derived micrografts and Alos, with respect to the control group of Alos or Bio-Oss® alone, as confirmed by histological analysis and radiographic evaluations at 6 months from treatment.

In Vitro Cytokine Expression and In Vivo Healing and Inflammatory Response to a Collagen-Coated Synthetic Bone Filler

The goal of the present work was to investigate the relationship between in vivo healing and inflammatory response and in vitro cytokine expression by macrophages of a synthetic bone filler (25% hydroxylapatite-75% β-tricalcium phosphate) bearing a surface nanolayer of collagen. A clinically accepted, state-of-the-art xenograft material was used as a “negative control,” that is, as a material that provides the correct clinical response for the intended use. In vitro data show that both materials exert a very low stimulation of proinflammatory cytokines by macrophages, and this was confirmed by the very mild inflammatory response detected in in vivo tests of local response in a rabbit model. Also, in vitro findings suggest a different mechanism of healing for the test and the control material, with a higher regenerative activity for the synthetic, resorbable filler, as confirmed by in vivo observation and literature reports. Thus, the simple in vitro model adopted provides a reasonable forecast of in vivo results, suggesting that new product development can be guided by in vitro tuning of cell-materials interactions.