Papers

Intragroup comparisons between preoperative and postoperative clinical parameters

01/03/2024

Reconstructive Approach in Residual Periodontal Pockets with Biofunctionalized Heterografts a Retrospective Comparison of 12-Months Data from Three Centers

Abstract: Regenerative capacity of well-preserved blood clot may be enhanced by biologics like enamel matrix derivative (EMD). This retrospective analysis compares outcomes reported by three centers using different heterografts. Center 1 (C1) treated intrabony defects combining cross-linked heavy weight hyaluronic acid (xHyA) with a xenograft, Center 2 (C2) used EMD with an allograft combination to […]

Activity of Two Hayluronic Perparations on Primary Human Oral Fibroblasts

03/11/2021

Activity of Two Hyaluronan Preparations on Primary Human Fibroblasts

Background and Objective: The potential benefit of using hyaluronan (HA) in
reconstructive periodontal surgery is still a matter of debate. The aim of the present
study was to evaluate the effects of two HA formulations on human oral fibroblasts
involved in soft tissue wound healing/regeneration.
Material and Methods: Metabolic, proliferative and migratory abilities of primary
human palatal and gingival fibroblasts were examined upon HA treatment. To uncover
the mechanisms whereby HA influences cellular behavior, wound healing-related
gene expression and activation of signaling kinases were analyzed by qRT-PCR
and immunoblotting, respectively.
Results: The investigated HA formulations maintained the viability of oral fibroblasts
and increased their proliferative and migratory abilities. They enhanced expression
of genes encoding type III collagen and transforming growth factor-β3,
characteristic
of scarless wound healing. The HAs upregulated the expression of genes encoding
pro-proliferative,
pro-migratory,
and pro-inflammatory
factors, with only a moderate
effect on the latter in gingival fibroblasts. In palatal but not gingival fibroblasts, an
indirect effect of HA on the expression of matrix metalloproteinases 2 and 3 was
detected, potentially exerted through induction of pro-inflammatory
cytokines.
Finally, our data pointed on Akt, Erk1/2 and p38 as the signaling molecules whereby
the HAs exert their effects on oral fibroblasts.
Conclusion: Both investigated HA formulations are biocompatible and enhance the
proliferative, migratory and wound healing properties of cell types involved in soft
tissue wound healing following regenerative periodontal surgery. Our data further
suggest that in gingival tissues, the HAs are not likely to impair the healing process by
prolonging inflammation or causing excessive MMP expression at the repair site.

03/11/2021

Periodontal Healing After Application of Enamel Matrix Derivative in Surgical Supra Infrabony Periodontal Defects in Rates with Streptozotocin-Induced Diabetes

Background and Objective: Epidemiologic and clinical studies have indicated that
diabetes is a risk factor for periodontal disease progression and healing. The
aim of the present study was to evaluate short-term healing after enamel matrix
derivative (EMD) application in combined supra/infrabony periodontal defects
in diabetic rats.
Material and Methods: Thirty male Wistar rats were initially divided into two
groups, one with streptozotocin-induced diabetes and another one with healthy
(non-diabetic) animals. Bony defects were surgically created on the mesial root
of the first maxillary molars. After root surface planing and EDTA conditioning,
EMD was applied to the roots at one side of the maxillae, while those on
the contralateral sides were left untreated. Animals were killed 3 wk after surgery,
and block sections were prepared for histologic and histomorphometric
analysis.
Results: There was statistically significant more gingival recession in diabetic
animals than in non-diabetic animals. The length of the junctional epithelium
was significantly shorter in the EMD-treated sites in both diabetic and normoglycemic
rats. Sulcus depth and length of supracrestal soft connective tissue
showed no statistically significant differences between groups. In all animals,
new bone formation was observed. Although new bone occurred more frequently
in healthy animals, the extent of new bone was not significantly different
between groups. In none of the teeth, a layer of new cementum was detectable.
EMD had no influence on bone or cementum regeneration. Adverse reactions
such as excessive inflammation due to bacterial root colonization, ankylosis and
bone fractures were exclusively observed in diabetic animals, irrespective of
EMD treatment.

03/11/2021

Hyaluronic Acid as Adjunctive to Non-Surgical and Meta-Analysis

Objectives To evaluate the potential added benefit of the topical application of hyaluronic acid (HA) on the clinical outcomes
following non-surgical or surgical periodontal therapy.
Materials and methods A systematic search was performed in Medline, Embase, Cochrane, Web of Science, Scopus and Grey
literature databases. The literature search was preformed according to PRISMA guidelines. The Cochrane risk of bias tool was
used in order to assess the methodology of the included trials.Weighted mean differences (WMDs) and 95%confidence intervals
(CIs) between the treatment and controls were estimated using the random-effect model for amount of bleeding on probing
(BOP), probing depth (PD) reduction and clinical attachment level (CAL) gain. In order to minimize the bias and to perform
meta-analysis, only randomized clinical studies (RCTs) were selected.
Results Thirteen RCTs were included: 11 on non-surgical periodontal treatment and two on surgical periodontal treatment.
Overall analysis of PD reduction, CAL gain and BOP reduction in non-surgical therapy with adjunctive HA presented WMD
of − 0.36 mm (95% CI − 0.54 to − 0.19 mm; p < 0.0001), 0.73 mm (95%CI 0.28 to 1.17 mm; p < 0.0001) and − 15% (95% CI − 22 to − 8%; p < 0.001) respectively, favouring the application of HA. The overall analysis on PD and CAL gain in surgical therapy with adjunctive HA presented WMD of − 0.89 mm (95% CI − 1.42 to − 0.36 mm; p < 0.0001) for PD reduction and 0.85 mm (95% CI 0.08 to 1.62 mm; p < 0.0001) for CAL gain after 6–24 months favouring the treatment with HA. However, comparison presented considerable heterogeneity between the non-surgical studies and a high risk of bias in general. Conclusions Within their limits, the present data indicate that the topical application ofHA may lead to additional clinical benefits when used as an adjunctive to non-surgical and surgical periodontal therapy. However, due to the high risk of bias and heterogeneity, there is a need for further well-designed RCTs to evaluate this material in various clinical scenarios. Clinical relevance The adjunctive use of HA may improve the clinical outcomes when used in conjunction with non-surgical and surgical periodontal therapy.

03/11/2021

Accelerated Degradation of Collagen Membranes in Diabetic Rats is Associated with Increased Infiltration of Macrophages and Blood Vessels

Objectives Increased collagenolytic activity in diabetes may
compromise collagen membrane (CM) survival. Tetracycline
(TTC) possesses anti-collagenolytic properties and delaysCM
degradation. This study evaluated macrophage and capillary
infiltration within CMs in diabetic rats.
Materials and methods Diabetes was induced in 20 Wistar
rats by streptozotocin and 20 served as controls. Biotinlabeled
CM discs were immersed in either TTC (50 mg/ml)
or PBS. In each animal, 2 discs (TTC and control) were implanted
under the parietal periosteum and rats were sacrificed
at 2 or 4 weeks post-implantation. The area and thickness of
the residual disc collagen were measured following staining
with streptavidin, and the number of macrophages and blood
vessels within the membranes was determined using specific
antibodies (to CD68 and transglutaminase II, respectively).
Results Diabetes significantly reduced the area and thickness
of the CMs, while TTC increased CMthickness significantly
in both groups of rats at 2 and 4 weeks. Diabetes
increased the number of macrophages (∼eightfold at
2 weeks and ∼fourfold at 4 weeks), but TTC had no significant
effect. Finally, diabetes increased the number of blood
vessels within the discs (∼threefold at 2 weeks and ∼twofold
at 4 weeks), while TTC had no effect.
Conclusions Diabetes increases degradation of native CMs
and the number of blood vessels and macrophages within
them. TTC immersion delays CM degradation without an apparent
effect on macrophage and blood vessel penetration.
Clinical relevance Enhanced CMdegradation in diabetic conditions
which impair guided regenerative procedure outcome
is apparently related to increased blood vessel formation and
macrophage infiltration.

03/11/2021

Hyaluronic Acid Slows Down Collagen Membrane Degradation In Uncontrolled Diabetic Rats

Abstract
Aim: To examine the in vitro biokinetics of hyaluronic acid (HA) from a collagen membrane
(CM) and to evaluate the in vivo effect of immersion of the CM in HA solution
on its degradation in streptozotocin (STZ)‐induced diabetes conditions in a rat calvaria
subcutaneous model.
Background: CM degradation is accelerated in uncontrolled diabetic rats. Immersion
of CM in HA has been suggested to decrease their resorption rate without interfering
with their tissue integration and structural degradation. However, it is unknown
to what extent CM degradation may be influenced by its immersion in HA solution
under a condition mimicking a medically compromised situation with an increased
inflammatory level such as diabetes.
Materials and Methods: CMs were soaked in cross‐linked HA. Protein adsorption and
the HA release were quantified by ELISA. Diabetes was induced in sixteen rats, while
16 healthy rats served as control. CM was prepared and labeled prior to implantation
with Biotin. Seventeen CM were immersed in HA and 17 CM in PBS. In each animal,
one test or one control disk was implanted. In order to compare the collagen content,
two similar non‐implanted CM were used as baseline. Fourteen days after surgery,
thirty‐two animals were sacrificed. The entire calvaria including the skin above, was
chemically fixed, decalcified, and embedded in paraffin. Five‐μm‐thick sections were
analyzed histologically and histomorphometrically using H&E and avidin‐peroxidase
staining.
Results: The in vitro results demonstrated that the CM adsorbed roughly 80% of
the total HA content. After 10 days, 36.3% of the initial HA remained on the CM.
The in vivo results demonstrated that diabetes significantly reduced the thickness of
the CM, while HA had a significant effect on keeping the membrane thickness. HA
increased the residual collagen content in the diabetic group (P < 0.0001) but no such effect was observed in the healthy group. Conclusion: Immersion of CM in HA prior to the implantation delays membrane degradation in uncontrolled diabetic compared with normoglycemic rats.

03/11/2021

Oral Lichen Planus and Dental Implants – A Retrospective Study

ABSTRACT
Objectives: To examine whether oral lichen planus (OLP) affects the success rate of dental implants and if the manifestations
of OLP are altered by implant-borne prostheses.
Materials andMethods: OLP patients, treated in the oral medicine department,with (the study group) and without (control
group) dental implants were included. Pocket depth, mobility, bleeding on probing, erythema, pain and radiolucency
around the implants, as well as clinical findings and OLP symptoms were recorded. Follow-up ranged from 12–24 months.
Ordinal variables and visual analog scale score were compared using the Mann–Whitney test. The significance of the trend
within each of the groups was assed using the Friedman test. Categorical variables were compared using Pearson
chi-squared test and Fisher’s exact test.
Results: Fourteen patients in the study group with 1–15 implants per patient and 15 in the control group were included.
No implant failures were recorded. Comparison between the clinical manifestations of OLP in both groups did not reveal
any significant differences.
Conclusions: Success of implant rehabilitation among treated OLP patients does not seem to be different from the success
rate in the general population. Nor does implant placement influence the disease manifestations.

03/11/2021

Opposing Effects of Diabetes and Tetracycline on the Degradation of Collagen Membranes in Rats

Background: Increased collagenolytic activity, characteristic
of uncontrolled diabetes, may compromise collagen
membrane (CM) survival. Tetracycline (TCN) possesses
anticollagenolytic properties and delays CM degradation in
healthy animals. This study evaluates the degradation of
TCN–immersed and -non-immersed CMs in rats with diabetes
compared to those with normoglycemia.

03/11/2021

New-Design Dental Implants

A 1 year prospective clinical study of 344 consecutively placed implants comparing immediate loading versus delayed loading and flapless versus full-thickness flap

use of platal-rich fibrin in gingival recessions

03/11/2021

Use Of Platelet-Rich Fibrin For The Treatment Of Gingival Recessions

Conclusions The use of CAF/PRF improved rRC and CAL compared with the use of CAF alone.While similar outcomes were
observed between CAF/PRF and CAF/CTG for CAL and PD change, the latter group led to statistically significantly better
outcomes in terms of rRC and KTW. In summary, the use of PRF in conjunction with CAF may represent a valid treatment
modality for gingival recessions exhibiting adequate baseline KMW.