Background: tooth extraction is a common procedure in oral surgery. The socket healing process in... more Background: tooth extraction is a common procedure in oral surgery. The socket healing process involves hard and soft tissues and is characterized by intense remodeling, which may determine consistent dimension changes. Several autologous platelet concentrates (APCs) proved to be effective for enhancing alveolar socket healing after tooth extraction, accelerating socket closure and countering alveolar bone resorption. Concentrated growth factors (CGFs) are one of the most recently developed APCs, and their effect on the socket healing process still needs to be confirmed. Aim: The aim of the present split-mouth study was to evaluate the effectiveness of CGFs in enhancing the healing process in the postextraction alveolar socket and reducing postoperative pain. Methods: One hundred and fifty-four extractions were performed. One of the extraction sockets of each patient was treated with CGFs (test site), and the other socket was unfilled (control site). The main outcomes were: healing ...
Platelet concentrates (PCs) have been used for over 20 years in dentistry, as an adjunct to oral ... more Platelet concentrates (PCs) have been used for over 20 years in dentistry, as an adjunct to oral surgery procedures, to improve hard and soft tissue healing and control postoperative symptoms. Among various PCs, Leukocyte and Platelet-Rich Fibrin (L-PRF) has become very popular due to its excellent cost-effectiveness ratio, and to the simple preparation protocol, but comparative clinical studies with other PCs are lacking. The aim of this split-mouth cohort study was to evaluate the effect of Concentrated Growth Factors (CGF), a recently introduced PC, as compared to L-PRF for enhancing post-extraction socket healing. Methods: Patients in need of bilateral tooth extractions were included. Each side was treated with either CGF or L-PRF. Pain, socket closure and healing index were the main outcomes. Results: Forty-five patients (24 women), aged 60.52 ± 11.75 years (range 37–87 years) were treated. No significant difference in outcomes was found, except for Pain at day 1 (p < 0.001)...
Background: Platelet concentrates are biological, autologous products obtained from the patient’s... more Background: Platelet concentrates are biological, autologous products obtained from the patient’s whole blood, consisting of a supraphysiological concentration of platelets and growth factors, that have proved beneficial in different applications in the medical and dental fields. They are used in several medical and dental applications to enhance tissue healing. Previous evidence shows that platelet concentrates may be beneficial in patients with compromised systemic conditions, in which the healing process is impaired. Aim: To evaluate the 5-year clinical outcome of implant treatment using acid-etched implants with calcium ions-modified surface in association with plasma rich in growth factors, in patients with systemic diseases of a different nature. Methods: Charts of 99 medically compromised patients, who had received a total of 224 dental implants from January 2013 to June 2013, were retrospectively evaluated. Patients were divided into four groups, according to their condition...
Aim: Surgical treatment of patients with severe thrombocytopaenia (<50,000 platelets/mL) is a ... more Aim: Surgical treatment of patients with severe thrombocytopaenia (<50,000 platelets/mL) is a major problem for dentists due to an increased risk of bleeding. To reduce post-extraction haemorrhage, we tested a new approach using a platelet concentrate and compared its outcomes with those of routine platelet transfusion. Methodology: Sixty-six patients with a platelet count between 29,000 and 46,000/mL were included in the study. Each patient was to undergo at least two sessions for the extraction of teeth; in one session the patients received a platelet transfusion before the extraction and in the other the post-alveolar sockets were treated with Plasma Rich in Growth Factors (PRGF). Patients were evaluated after 0.4, 1, 3 and 7 days to assess bleeding and haematoma. Results: Patients treated with PRGF consistently exhibited a statistically significant reduction in post-extraction bleeding, hematoma and need for re-intervention. There is ample evidence that application of PRGF in...
The purpose of this study was to evaluate anti-inflammatory and analgesic efficacy of superpulsed... more The purpose of this study was to evaluate anti-inflammatory and analgesic efficacy of superpulsed low level laser therapy (SLLLT) after bilateral extraction of impacted mandibular third molars. Many studies in the literature show the anti-inflammatory and analgesic efficacy of laser therapy after oral surgery.The authors report the preliminary results of 25 patients who underwent bilateral extraction of mandibular eighths included in a single surgery. This is a split-mouth study, a site was randomized chosen to be treated with SLLLT at T0, 24 hours and 48 hours with a GaAs laser diode, whereas the other surgical site was evaluated as control. The suture was removed at 7 days and healing was controlled at 14 days. During the sessions were monitored and recorded the pain, using visual analog scale, and oedema with the visual analog scale and cephalometric measurements of cutaneous points (TR-GO, GO-CA, GO-SP, GO-PO). Each patient received only antibiotic prophylaxis and analgesic ther...
There is disagreement as to whether it is safe to place implants in patients under bisphosphonate... more There is disagreement as to whether it is safe to place implants in patients under bisphosphonates (BPs) therapy owing to the risk for developing BP-related osteonecrosis of the jaws (BRONJ). The American Association of Oral and Maxillofacial Surgeons recommends that dental implants should be avoided in oncologic patients treated with intravenous BPs. Conversely, for patients receiving oral BPs, dental implant placement is not explicitly contraindicated even if a cautious approach is suggested. The aim of the current study was to assess the risk level as related to adverse events such as implant failure and BRONJ in a large cohort of osteoporotic patients submitted to implant placement and concomitant application of plasma rich in growth factor (PGRF)-Endoret. The clinical charts of 235 middle-aged women under oral BPs therapy for osteoporosis, who underwent positioning of 1267 dental implants, were reviewed. The implants were always positioned in association with PRGF-Endoret. The outcomes were implant failure and BRONJ. A model based on personal risk factors distribution was used for risk assessment. Sixteen implants were lost in 16 patients up to 120 months of follow-up, leading to a survival of 98.7% and 93.2% on an implant basis and patient basis, respectively. No cases of BRONJ were reported. In line with the current literature, the present data show that the risk for developing BRONJ associated to dental implant surgery remains low for patients receiving oral BPs. The use of procedures that could enhance and support healing, such as platelet concentrates, should be recommended.
The objective of this study was to evaluate the effectiveness of the temporomandibular joint (TMJ... more The objective of this study was to evaluate the effectiveness of the temporomandibular joint (TMJ) osteoarthritis treatment through articular injections of plasma rich in growth factors (PGRF)-Endoret. Thirteen patients (median age, 47.64 y; SD, 7.51; range, 40-64 y; male-female ratio, 2:11) with osteoarthritis of TMJ associated to chronic pain have been selected. They were treated with articular injections of PRGF-Endoret, measuring the maximum mouth opening and pain level before the first injection (t0), 30 days after just before the second (t1), and after 6 months (t2). Data were analyzed using the paired Student&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s t-test data. The visual analogue scale score at t0 is 7.69 (range, 4-10; SD, 1.9), whereas that at t1 is 1.54 (range, 0-5; SD, 1.74) and that at t2 is 0.23 (range, 0-2; SD, 0.65). These differences in the results are statistically highly significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001 comparison t0-t1 and t0-t2 and P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01 comparison t1-t2). In terms of maximum mouth opening, it reduced from 30.15 mm at t0 (range, 26-40 mm; SD, 4.44) to 37.54 mm at t1 (range, 31-51 mm; SD, 5.10), with an increase of 7.38 mm (range, 4-11 mm; SD, 2.02) and a highly significant difference (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). At t2, it was 39.54 mm (range, 34-51; SD, 4.55) with an increase of 9.38 mm (range, 5-12 mm; SD, 2.21) compared with t0 and that of 2.00 mm compared with t1. Both differences in the results are statistically significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001 and P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01, respectively). The articular injections of PRGF-Endoret represent a very efficient method to control pain and to improve the TMJ mobility.
Denture-induced fibrous hyperplasia is a fibrous connective tissue lesion that commonly occurs in... more Denture-induced fibrous hyperplasia is a fibrous connective tissue lesion that commonly occurs in oral mucosa in patients showing important alveolar ridge atrophy. In this study, we propose Plasma Rich in Growth Factors (PRGF) to overcome constrains of traditional surgical treatment. Herein, we demonstrated that PRGF represents an autologous source of growth factors able to reduce the healing time of the alveolar mucosa and the discomfort of those patients. These properties are the result of PRGF's precise biological features that result in the following: reduction of duration and intensity of postsurgical pain, acceleration of re-epithelialization of the wound, and reduction of bleeding events and of edema. In conclusion, we showed that using PRGF on patients affected by denture-induced fibrous hyperplasia allows a short healing time, thereby reducing complications and overall improving their quality of life. The aims of this study were to evaluate the influence of PRGF-ENDORET on secondary re-epithelialization in vestibuloplasty after excision of denture irritation fibrous hyperplasia, with an explorative randomized case control trial with 10 patients, 5 patients treated with PRGF and 5 patients with traditional hemostasis, and to analyze differences with simple surgery, considering postoperative rapidity of re-epithelialization, comfort, and discomfort of patients, pain, swelling, and infections.
The effect superpulsed of low-level laser therapy (SLLLT) on bone regeneration has been the focus... more The effect superpulsed of low-level laser therapy (SLLLT) on bone regeneration has been the focus of recent research. This preliminary study investigated the effect of superpulsed laser irradiation on proliferation and bone formation in human osteoblast-like cells MG-63. Human osteoblast-like cells MG-63 were exposed every 24 h to superpulsed low-level laser produced by the device Lumix 2 HFPL Dental (Fisioline s.n.c., Verduno, Cuneo, Italy); the experimental protocol comprised 4 days of treatment. At each experimental time, cell proliferation and some markers of osteoblast activity were evaluated. Numbers of laser-treated cells increased starting from day 2 of treatment. The ability of SLLLT irradiation to stimulate bone production was evaluated by determining the expression of osteocalcin and alkaline phosphatase, proteins involved in calcium nodule formation. These proteins increased markedly after 3 days of laser treatment. These preliminary results show that repeated SLLLT irra...
Blood transfusion = Trasfusione del sangue, Jan 29, 2014
Dental extractions in haemophiliacs may cause secondary bleeding, requiring repeated surgical and... more Dental extractions in haemophiliacs may cause secondary bleeding, requiring repeated surgical and haematological interventions. As a local haemostatic, fibrin glue has recognised efficacy but, as a plasma-derived product, it carries the risk of viral infections. We, therefore, compared fibrin glue with an autologous haemostatic, plasma rich in growth factors (PRGF), in a controlled trial. One hundred and twenty patients with different blood disorders were randomised into two cohorts to undergo dental extraction procedures without hospitalisation. Prior to the extractions, patients underwent systemic haematological treatment. Complications were defined as secondary bleeding after the 7-day follow-up period or protracting after the repair procedure. There were 106 extractions (7 retained 3(rd) molars) in the group managed with fibrin glue: secondary bleeding affected 3/60 patients (5%) on the third day after extraction and necessitated additional surgery and systemic treatment (in one...
Objectives: Surgical management of patients following zoledronic acid therapy is particularly dif... more Objectives: Surgical management of patients following zoledronic acid therapy is particularly difficult, since the dental extraction is the main cause of BRONJ. Methods: A case-control study was conducted on 176 patients treated with intravenous (IV) bisphosphonates for oncologic pathologies who also underwent dental extractions. The study was divided randomly into two groups: 91 were treated with Plasma Rich in Growth Factor Plasma (PRGF) (study group) and the other 85 were not treated with the growth factor preparation (control group). Results: Panoramic X-ray and computed tomography were performed both before and 60 months after surgery. By clinical and radiological diagnosis, BRONJ was diagnosed in only 5 patients in the control group at an average of 91, 6 days after tooth extraction. Conclusions: We hypothesize that Plasma Rich in Growth Factor (PRGF) is important for the successful treatment of patients on bisphosphonates to restore the osteoblast/osteoclast homeostatic cycles via autologous cytokines. Moreover, this protocol reduces the risk of BRONJ when it is necessary to perform dental extractions in patients undergoing IV bisphosphonate treatment.
Objectives The intravenous injection of bisphosphonates, currently used for osteoporosis, myeloma... more Objectives The intravenous injection of bisphosphonates, currently used for osteoporosis, myeloma or bone metastases, can cause ONJ especially in consequence of trauma. In order to avoid trauma during bisphosphonate treatment, preventive oral surgery is recommended. The research aimed to evidence whether inflammatory and osteoclastogenic factors are not induced in oral mucosa after bisphosphonate treatment in patients receiving oral preventive surgery procedure, and whether proliferation factors are not inhibited. Patients and Methods Specimens of oral mucosa were removed from healthy subjects and from patients undergoing preventive oral surgery before bisphosphonate treatment. The expression of cytokines, factors involved in osteoclast activity, in cell proliferation and angiogenesis were examined. Results Cytokines and RANK-L levels decreased significantly in mucosa from patients undergoing preventive oral surgery procedure before bisphosphonate treatment in comparison with their levels at the beginning of procedure and also in comparison with the level in patients treated only with bisphosphonates and not developing ONJ; conversely, osteoprotegerin and hydroxymethylglutaryl coenzyme A reductase significantly increased or not changed. Conclusions The results suggest that preventive oral surgery could be able to prevent ONJ due to bisphosphonate treatment: the mucosa is not stimulated by bisphosphonates to cause ONJ, since bisphosphonates are probably not released from the bone.
Background and ObjectiveLaser therapy is a new approach applicable in different medical fields wh... more Background and ObjectiveLaser therapy is a new approach applicable in different medical fields when bone loss occurs, including orthopedics and dentistry. It has also been used to induce soft‐tissue healing, for pain relief, bone, and nerve regeneration. With regard to bone synthesis, laser exposure has been shown to increase osteoblast activity and decrease osteoclast number, by inducing alkaline phosphatase (ALP), osteopontin, and bone sialoprotein expression. Studies have investigated the effects of continuous or pulsed laser irradiation, but no data are yet available on the properties of superpulsed laser irradiation. This study thus aimed to investigate the effect of superpulsed laser irradiation on osteogenic activity of human osteoblast‐like cells, paying particular attention to investigating the molecular mechanisms underlying the effects of this type of laser radiation.Study Design/Materials and MethodsHuman osteoblast‐like MG‐63 cells were exposed to 3, 7, or 10 superpulse...
Alveolar healing following tooth extraction is a complex repair process involving different tissu... more Alveolar healing following tooth extraction is a complex repair process involving different tissues, including epithelium and bone. This research aimed to study the effect of laser therapy on alveolar healing process in patients waiting for liver transplantation, evaluating some inflammation, osteogenesis and clinical parameters. Twelve patients with hepatic failure waiting for liver transplantation, with indications to bilateral extraction, entered the split-mouth study. One post-extractive defect was treated with laser while the other was left without treatment. Specimens of soft tissues were removed from around the tooth before extraction and after 7 days. Superpulsed laser irradiation prevented IL-1β increase and induced IL-6, IL-10 and collagen III increase at 7 days in comparison with their level before extraction, whereas the other parameters were unmodified. Moreover, the epithelial regeneration evidenced a positive result of laser therapy, and the patients reported a lower pain in the site treated with laser. In conclusions, laser therapy appears to be a treatment of choice for patients, providing clinical efficacy, being safe, well tolerated and able to prevent inflammation.
The aim of this paper is to retrospectively assess the long-term clinical and radiological result... more The aim of this paper is to retrospectively assess the long-term clinical and radiological results in a group of patients treated with Brånemark TiUnite implants supporting mostly single-tooth and partial restorations. The clinical records of 90 consecutive patients (mean age 55.9 years; range 21–82 years), treated with 209 Brånemark System MkIII or MkIV TiUnite implants (72 maxillary/137 mandibular; 26 anterior intercanine/183 posterior sites), were analyzed. Indication types were single tooth (n = 21 implants), partial (n = 180) and full arches (n = 8). A delayed loading protocol was applied in 128 implants, while 81 were immediately loaded. Cumulative survival rate and marginal bone remodeling were evaluated. Marginal bone level was evaluated by an independent radiologist from periapical radiographs taken at implant insertion and at long-term follow up. Plaque, probing pocket depth and peri-implant mucosa conditions were also assessed. The results showed the mean follow-up durati...
To evaluate the efficacy of plasma-rich growth factor (PRGF) in improving socket healing after to... more To evaluate the efficacy of plasma-rich growth factor (PRGF) in improving socket healing after tooth extraction in diabetic patients. This was a split-mouth study in which each patient also served as the control: the study socket was treated with PRGF, whereas the control socket underwent natural healing. The outcome variables were the Healing Index, residual socket volume, visual analog scale score, postsurgical complications, and outcome of a patient questionnaire. The investigation considered the impact of hyperglycemia, glycated hemoglobin, End Organ Disease Score, and smoking habits. Follow-up included 4 postextraction checkups over a 21-day period. Pairs of correlated continuous variables were analyzed with the Wilcoxon test, independent continuous variables with the Mann-Whitney test, and categorical variables with the χ(2) test or Fisher test. From January 2012 to December 2012, 34 patients affected by insulin-dependent diabetes mellitus underwent contemporary bilateral extractions of homologous teeth. The treatment-versus-control postoperative comparison showed that PRGF resulted in significantly smaller residual socket volumes and better Healing Indices from days 3 to 14. The patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; questionnaire outcomes were unanimously in favor of PRGF treatment. The small sample of patients with glycemia values of at least 240 mg/dL showed worse Healing Index and minor socket decreases. PRGF application after extraction improved the healing process in diabetic patients by accelerating socket closure (epithelialization) and tissue maturation, proving the association between PRGF use and improved wound healing in diabetic patients.
The aim of this prospective hospital-based study was to refine a surgical protocol for tooth extr... more The aim of this prospective hospital-based study was to refine a surgical protocol for tooth extractions in patients with a history of intravenous use of a potent bisphosphonate by modifying a previously reported protocol to produce a significantly shortened operating time. Patients and Methods: Prospective patients with a follow-up of at least 4 months were included. Tooth extractions were performed without a vestibular split-thickness flap; healing was stimulated by filling the extraction site with autologous plasma rich in growth factors (PRGF System, BTI Biotechnology Institute, Vitoria, Spain). Local and systemic infection control was obtained with dental hygiene and antibiotic therapy. Results: Sixty-three patients participated in the study. Two hundred two tooth extractions were performed. Differences between the present and previous protocols (the previous protocol used a vestibular flap) were analyzed and the surgical time proved significantly shorter for the present approach (P = .00). Conclusions: The proposed surgical protocol appears to be a better choice for patients treated with intravenous bisphosphonates who need tooth extraction, because it seems to be faster and simpler than the previously reported successful protocol.
The objective of this study was to identify surgical protocols that can improve mucosal healing a... more The objective of this study was to identify surgical protocols that can improve mucosal healing and postextraction socket closure in patients who underwent radiation therapy for head and neck cancer. The study was designed as a prospective split-mouth trial on 20 patients who needed bilateral paired dental extractions. On the side directly impacted by radiation, chosen to be the study side, the sockets were filled with plasma rich in growth factors (PRGF), whereas, on the other side (control), they were allowed to undergo natural healing. Outcome variables were residual socket volume (RSV), healing index (HI), pain, and postsurgical complications as measured at the 2 sides at the 4 follow-up sessions (up to 30 days after the extraction). Continuous variables were analyzed with Wilcoxon (when matched) or Mann-Whitney (when independent) test; categorical variables, with Chi-squared or Fisher test. Statistical significance was set at P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05. Correlation was estimated with Pearson linear correlation coefficient. The PRGF side showed statistically significant better values for RSV and HI at all checkups and no postoperative complications. The control side had a slower healing and 2 cases of bone exposure, which were successfully cured with PRGF application. The RSV on the 21st day after the extraction was correlated with the dose received but not with the time since radiotherapy. Plasma rich in growth factors proved to be effective in the management of patients with a history of head and neck radiotherapy, accelerating and fostering mucosal healing and avoiding postextraction bone exposures.
Background: tooth extraction is a common procedure in oral surgery. The socket healing process in... more Background: tooth extraction is a common procedure in oral surgery. The socket healing process involves hard and soft tissues and is characterized by intense remodeling, which may determine consistent dimension changes. Several autologous platelet concentrates (APCs) proved to be effective for enhancing alveolar socket healing after tooth extraction, accelerating socket closure and countering alveolar bone resorption. Concentrated growth factors (CGFs) are one of the most recently developed APCs, and their effect on the socket healing process still needs to be confirmed. Aim: The aim of the present split-mouth study was to evaluate the effectiveness of CGFs in enhancing the healing process in the postextraction alveolar socket and reducing postoperative pain. Methods: One hundred and fifty-four extractions were performed. One of the extraction sockets of each patient was treated with CGFs (test site), and the other socket was unfilled (control site). The main outcomes were: healing ...
Platelet concentrates (PCs) have been used for over 20 years in dentistry, as an adjunct to oral ... more Platelet concentrates (PCs) have been used for over 20 years in dentistry, as an adjunct to oral surgery procedures, to improve hard and soft tissue healing and control postoperative symptoms. Among various PCs, Leukocyte and Platelet-Rich Fibrin (L-PRF) has become very popular due to its excellent cost-effectiveness ratio, and to the simple preparation protocol, but comparative clinical studies with other PCs are lacking. The aim of this split-mouth cohort study was to evaluate the effect of Concentrated Growth Factors (CGF), a recently introduced PC, as compared to L-PRF for enhancing post-extraction socket healing. Methods: Patients in need of bilateral tooth extractions were included. Each side was treated with either CGF or L-PRF. Pain, socket closure and healing index were the main outcomes. Results: Forty-five patients (24 women), aged 60.52 ± 11.75 years (range 37–87 years) were treated. No significant difference in outcomes was found, except for Pain at day 1 (p < 0.001)...
Background: Platelet concentrates are biological, autologous products obtained from the patient’s... more Background: Platelet concentrates are biological, autologous products obtained from the patient’s whole blood, consisting of a supraphysiological concentration of platelets and growth factors, that have proved beneficial in different applications in the medical and dental fields. They are used in several medical and dental applications to enhance tissue healing. Previous evidence shows that platelet concentrates may be beneficial in patients with compromised systemic conditions, in which the healing process is impaired. Aim: To evaluate the 5-year clinical outcome of implant treatment using acid-etched implants with calcium ions-modified surface in association with plasma rich in growth factors, in patients with systemic diseases of a different nature. Methods: Charts of 99 medically compromised patients, who had received a total of 224 dental implants from January 2013 to June 2013, were retrospectively evaluated. Patients were divided into four groups, according to their condition...
Aim: Surgical treatment of patients with severe thrombocytopaenia (<50,000 platelets/mL) is a ... more Aim: Surgical treatment of patients with severe thrombocytopaenia (<50,000 platelets/mL) is a major problem for dentists due to an increased risk of bleeding. To reduce post-extraction haemorrhage, we tested a new approach using a platelet concentrate and compared its outcomes with those of routine platelet transfusion. Methodology: Sixty-six patients with a platelet count between 29,000 and 46,000/mL were included in the study. Each patient was to undergo at least two sessions for the extraction of teeth; in one session the patients received a platelet transfusion before the extraction and in the other the post-alveolar sockets were treated with Plasma Rich in Growth Factors (PRGF). Patients were evaluated after 0.4, 1, 3 and 7 days to assess bleeding and haematoma. Results: Patients treated with PRGF consistently exhibited a statistically significant reduction in post-extraction bleeding, hematoma and need for re-intervention. There is ample evidence that application of PRGF in...
The purpose of this study was to evaluate anti-inflammatory and analgesic efficacy of superpulsed... more The purpose of this study was to evaluate anti-inflammatory and analgesic efficacy of superpulsed low level laser therapy (SLLLT) after bilateral extraction of impacted mandibular third molars. Many studies in the literature show the anti-inflammatory and analgesic efficacy of laser therapy after oral surgery.The authors report the preliminary results of 25 patients who underwent bilateral extraction of mandibular eighths included in a single surgery. This is a split-mouth study, a site was randomized chosen to be treated with SLLLT at T0, 24 hours and 48 hours with a GaAs laser diode, whereas the other surgical site was evaluated as control. The suture was removed at 7 days and healing was controlled at 14 days. During the sessions were monitored and recorded the pain, using visual analog scale, and oedema with the visual analog scale and cephalometric measurements of cutaneous points (TR-GO, GO-CA, GO-SP, GO-PO). Each patient received only antibiotic prophylaxis and analgesic ther...
There is disagreement as to whether it is safe to place implants in patients under bisphosphonate... more There is disagreement as to whether it is safe to place implants in patients under bisphosphonates (BPs) therapy owing to the risk for developing BP-related osteonecrosis of the jaws (BRONJ). The American Association of Oral and Maxillofacial Surgeons recommends that dental implants should be avoided in oncologic patients treated with intravenous BPs. Conversely, for patients receiving oral BPs, dental implant placement is not explicitly contraindicated even if a cautious approach is suggested. The aim of the current study was to assess the risk level as related to adverse events such as implant failure and BRONJ in a large cohort of osteoporotic patients submitted to implant placement and concomitant application of plasma rich in growth factor (PGRF)-Endoret. The clinical charts of 235 middle-aged women under oral BPs therapy for osteoporosis, who underwent positioning of 1267 dental implants, were reviewed. The implants were always positioned in association with PRGF-Endoret. The outcomes were implant failure and BRONJ. A model based on personal risk factors distribution was used for risk assessment. Sixteen implants were lost in 16 patients up to 120 months of follow-up, leading to a survival of 98.7% and 93.2% on an implant basis and patient basis, respectively. No cases of BRONJ were reported. In line with the current literature, the present data show that the risk for developing BRONJ associated to dental implant surgery remains low for patients receiving oral BPs. The use of procedures that could enhance and support healing, such as platelet concentrates, should be recommended.
The objective of this study was to evaluate the effectiveness of the temporomandibular joint (TMJ... more The objective of this study was to evaluate the effectiveness of the temporomandibular joint (TMJ) osteoarthritis treatment through articular injections of plasma rich in growth factors (PGRF)-Endoret. Thirteen patients (median age, 47.64 y; SD, 7.51; range, 40-64 y; male-female ratio, 2:11) with osteoarthritis of TMJ associated to chronic pain have been selected. They were treated with articular injections of PRGF-Endoret, measuring the maximum mouth opening and pain level before the first injection (t0), 30 days after just before the second (t1), and after 6 months (t2). Data were analyzed using the paired Student&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s t-test data. The visual analogue scale score at t0 is 7.69 (range, 4-10; SD, 1.9), whereas that at t1 is 1.54 (range, 0-5; SD, 1.74) and that at t2 is 0.23 (range, 0-2; SD, 0.65). These differences in the results are statistically highly significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001 comparison t0-t1 and t0-t2 and P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01 comparison t1-t2). In terms of maximum mouth opening, it reduced from 30.15 mm at t0 (range, 26-40 mm; SD, 4.44) to 37.54 mm at t1 (range, 31-51 mm; SD, 5.10), with an increase of 7.38 mm (range, 4-11 mm; SD, 2.02) and a highly significant difference (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). At t2, it was 39.54 mm (range, 34-51; SD, 4.55) with an increase of 9.38 mm (range, 5-12 mm; SD, 2.21) compared with t0 and that of 2.00 mm compared with t1. Both differences in the results are statistically significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001 and P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01, respectively). The articular injections of PRGF-Endoret represent a very efficient method to control pain and to improve the TMJ mobility.
Denture-induced fibrous hyperplasia is a fibrous connective tissue lesion that commonly occurs in... more Denture-induced fibrous hyperplasia is a fibrous connective tissue lesion that commonly occurs in oral mucosa in patients showing important alveolar ridge atrophy. In this study, we propose Plasma Rich in Growth Factors (PRGF) to overcome constrains of traditional surgical treatment. Herein, we demonstrated that PRGF represents an autologous source of growth factors able to reduce the healing time of the alveolar mucosa and the discomfort of those patients. These properties are the result of PRGF's precise biological features that result in the following: reduction of duration and intensity of postsurgical pain, acceleration of re-epithelialization of the wound, and reduction of bleeding events and of edema. In conclusion, we showed that using PRGF on patients affected by denture-induced fibrous hyperplasia allows a short healing time, thereby reducing complications and overall improving their quality of life. The aims of this study were to evaluate the influence of PRGF-ENDORET on secondary re-epithelialization in vestibuloplasty after excision of denture irritation fibrous hyperplasia, with an explorative randomized case control trial with 10 patients, 5 patients treated with PRGF and 5 patients with traditional hemostasis, and to analyze differences with simple surgery, considering postoperative rapidity of re-epithelialization, comfort, and discomfort of patients, pain, swelling, and infections.
The effect superpulsed of low-level laser therapy (SLLLT) on bone regeneration has been the focus... more The effect superpulsed of low-level laser therapy (SLLLT) on bone regeneration has been the focus of recent research. This preliminary study investigated the effect of superpulsed laser irradiation on proliferation and bone formation in human osteoblast-like cells MG-63. Human osteoblast-like cells MG-63 were exposed every 24 h to superpulsed low-level laser produced by the device Lumix 2 HFPL Dental (Fisioline s.n.c., Verduno, Cuneo, Italy); the experimental protocol comprised 4 days of treatment. At each experimental time, cell proliferation and some markers of osteoblast activity were evaluated. Numbers of laser-treated cells increased starting from day 2 of treatment. The ability of SLLLT irradiation to stimulate bone production was evaluated by determining the expression of osteocalcin and alkaline phosphatase, proteins involved in calcium nodule formation. These proteins increased markedly after 3 days of laser treatment. These preliminary results show that repeated SLLLT irra...
Blood transfusion = Trasfusione del sangue, Jan 29, 2014
Dental extractions in haemophiliacs may cause secondary bleeding, requiring repeated surgical and... more Dental extractions in haemophiliacs may cause secondary bleeding, requiring repeated surgical and haematological interventions. As a local haemostatic, fibrin glue has recognised efficacy but, as a plasma-derived product, it carries the risk of viral infections. We, therefore, compared fibrin glue with an autologous haemostatic, plasma rich in growth factors (PRGF), in a controlled trial. One hundred and twenty patients with different blood disorders were randomised into two cohorts to undergo dental extraction procedures without hospitalisation. Prior to the extractions, patients underwent systemic haematological treatment. Complications were defined as secondary bleeding after the 7-day follow-up period or protracting after the repair procedure. There were 106 extractions (7 retained 3(rd) molars) in the group managed with fibrin glue: secondary bleeding affected 3/60 patients (5%) on the third day after extraction and necessitated additional surgery and systemic treatment (in one...
Objectives: Surgical management of patients following zoledronic acid therapy is particularly dif... more Objectives: Surgical management of patients following zoledronic acid therapy is particularly difficult, since the dental extraction is the main cause of BRONJ. Methods: A case-control study was conducted on 176 patients treated with intravenous (IV) bisphosphonates for oncologic pathologies who also underwent dental extractions. The study was divided randomly into two groups: 91 were treated with Plasma Rich in Growth Factor Plasma (PRGF) (study group) and the other 85 were not treated with the growth factor preparation (control group). Results: Panoramic X-ray and computed tomography were performed both before and 60 months after surgery. By clinical and radiological diagnosis, BRONJ was diagnosed in only 5 patients in the control group at an average of 91, 6 days after tooth extraction. Conclusions: We hypothesize that Plasma Rich in Growth Factor (PRGF) is important for the successful treatment of patients on bisphosphonates to restore the osteoblast/osteoclast homeostatic cycles via autologous cytokines. Moreover, this protocol reduces the risk of BRONJ when it is necessary to perform dental extractions in patients undergoing IV bisphosphonate treatment.
Objectives The intravenous injection of bisphosphonates, currently used for osteoporosis, myeloma... more Objectives The intravenous injection of bisphosphonates, currently used for osteoporosis, myeloma or bone metastases, can cause ONJ especially in consequence of trauma. In order to avoid trauma during bisphosphonate treatment, preventive oral surgery is recommended. The research aimed to evidence whether inflammatory and osteoclastogenic factors are not induced in oral mucosa after bisphosphonate treatment in patients receiving oral preventive surgery procedure, and whether proliferation factors are not inhibited. Patients and Methods Specimens of oral mucosa were removed from healthy subjects and from patients undergoing preventive oral surgery before bisphosphonate treatment. The expression of cytokines, factors involved in osteoclast activity, in cell proliferation and angiogenesis were examined. Results Cytokines and RANK-L levels decreased significantly in mucosa from patients undergoing preventive oral surgery procedure before bisphosphonate treatment in comparison with their levels at the beginning of procedure and also in comparison with the level in patients treated only with bisphosphonates and not developing ONJ; conversely, osteoprotegerin and hydroxymethylglutaryl coenzyme A reductase significantly increased or not changed. Conclusions The results suggest that preventive oral surgery could be able to prevent ONJ due to bisphosphonate treatment: the mucosa is not stimulated by bisphosphonates to cause ONJ, since bisphosphonates are probably not released from the bone.
Background and ObjectiveLaser therapy is a new approach applicable in different medical fields wh... more Background and ObjectiveLaser therapy is a new approach applicable in different medical fields when bone loss occurs, including orthopedics and dentistry. It has also been used to induce soft‐tissue healing, for pain relief, bone, and nerve regeneration. With regard to bone synthesis, laser exposure has been shown to increase osteoblast activity and decrease osteoclast number, by inducing alkaline phosphatase (ALP), osteopontin, and bone sialoprotein expression. Studies have investigated the effects of continuous or pulsed laser irradiation, but no data are yet available on the properties of superpulsed laser irradiation. This study thus aimed to investigate the effect of superpulsed laser irradiation on osteogenic activity of human osteoblast‐like cells, paying particular attention to investigating the molecular mechanisms underlying the effects of this type of laser radiation.Study Design/Materials and MethodsHuman osteoblast‐like MG‐63 cells were exposed to 3, 7, or 10 superpulse...
Alveolar healing following tooth extraction is a complex repair process involving different tissu... more Alveolar healing following tooth extraction is a complex repair process involving different tissues, including epithelium and bone. This research aimed to study the effect of laser therapy on alveolar healing process in patients waiting for liver transplantation, evaluating some inflammation, osteogenesis and clinical parameters. Twelve patients with hepatic failure waiting for liver transplantation, with indications to bilateral extraction, entered the split-mouth study. One post-extractive defect was treated with laser while the other was left without treatment. Specimens of soft tissues were removed from around the tooth before extraction and after 7 days. Superpulsed laser irradiation prevented IL-1β increase and induced IL-6, IL-10 and collagen III increase at 7 days in comparison with their level before extraction, whereas the other parameters were unmodified. Moreover, the epithelial regeneration evidenced a positive result of laser therapy, and the patients reported a lower pain in the site treated with laser. In conclusions, laser therapy appears to be a treatment of choice for patients, providing clinical efficacy, being safe, well tolerated and able to prevent inflammation.
The aim of this paper is to retrospectively assess the long-term clinical and radiological result... more The aim of this paper is to retrospectively assess the long-term clinical and radiological results in a group of patients treated with Brånemark TiUnite implants supporting mostly single-tooth and partial restorations. The clinical records of 90 consecutive patients (mean age 55.9 years; range 21–82 years), treated with 209 Brånemark System MkIII or MkIV TiUnite implants (72 maxillary/137 mandibular; 26 anterior intercanine/183 posterior sites), were analyzed. Indication types were single tooth (n = 21 implants), partial (n = 180) and full arches (n = 8). A delayed loading protocol was applied in 128 implants, while 81 were immediately loaded. Cumulative survival rate and marginal bone remodeling were evaluated. Marginal bone level was evaluated by an independent radiologist from periapical radiographs taken at implant insertion and at long-term follow up. Plaque, probing pocket depth and peri-implant mucosa conditions were also assessed. The results showed the mean follow-up durati...
To evaluate the efficacy of plasma-rich growth factor (PRGF) in improving socket healing after to... more To evaluate the efficacy of plasma-rich growth factor (PRGF) in improving socket healing after tooth extraction in diabetic patients. This was a split-mouth study in which each patient also served as the control: the study socket was treated with PRGF, whereas the control socket underwent natural healing. The outcome variables were the Healing Index, residual socket volume, visual analog scale score, postsurgical complications, and outcome of a patient questionnaire. The investigation considered the impact of hyperglycemia, glycated hemoglobin, End Organ Disease Score, and smoking habits. Follow-up included 4 postextraction checkups over a 21-day period. Pairs of correlated continuous variables were analyzed with the Wilcoxon test, independent continuous variables with the Mann-Whitney test, and categorical variables with the χ(2) test or Fisher test. From January 2012 to December 2012, 34 patients affected by insulin-dependent diabetes mellitus underwent contemporary bilateral extractions of homologous teeth. The treatment-versus-control postoperative comparison showed that PRGF resulted in significantly smaller residual socket volumes and better Healing Indices from days 3 to 14. The patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; questionnaire outcomes were unanimously in favor of PRGF treatment. The small sample of patients with glycemia values of at least 240 mg/dL showed worse Healing Index and minor socket decreases. PRGF application after extraction improved the healing process in diabetic patients by accelerating socket closure (epithelialization) and tissue maturation, proving the association between PRGF use and improved wound healing in diabetic patients.
The aim of this prospective hospital-based study was to refine a surgical protocol for tooth extr... more The aim of this prospective hospital-based study was to refine a surgical protocol for tooth extractions in patients with a history of intravenous use of a potent bisphosphonate by modifying a previously reported protocol to produce a significantly shortened operating time. Patients and Methods: Prospective patients with a follow-up of at least 4 months were included. Tooth extractions were performed without a vestibular split-thickness flap; healing was stimulated by filling the extraction site with autologous plasma rich in growth factors (PRGF System, BTI Biotechnology Institute, Vitoria, Spain). Local and systemic infection control was obtained with dental hygiene and antibiotic therapy. Results: Sixty-three patients participated in the study. Two hundred two tooth extractions were performed. Differences between the present and previous protocols (the previous protocol used a vestibular flap) were analyzed and the surgical time proved significantly shorter for the present approach (P = .00). Conclusions: The proposed surgical protocol appears to be a better choice for patients treated with intravenous bisphosphonates who need tooth extraction, because it seems to be faster and simpler than the previously reported successful protocol.
The objective of this study was to identify surgical protocols that can improve mucosal healing a... more The objective of this study was to identify surgical protocols that can improve mucosal healing and postextraction socket closure in patients who underwent radiation therapy for head and neck cancer. The study was designed as a prospective split-mouth trial on 20 patients who needed bilateral paired dental extractions. On the side directly impacted by radiation, chosen to be the study side, the sockets were filled with plasma rich in growth factors (PRGF), whereas, on the other side (control), they were allowed to undergo natural healing. Outcome variables were residual socket volume (RSV), healing index (HI), pain, and postsurgical complications as measured at the 2 sides at the 4 follow-up sessions (up to 30 days after the extraction). Continuous variables were analyzed with Wilcoxon (when matched) or Mann-Whitney (when independent) test; categorical variables, with Chi-squared or Fisher test. Statistical significance was set at P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05. Correlation was estimated with Pearson linear correlation coefficient. The PRGF side showed statistically significant better values for RSV and HI at all checkups and no postoperative complications. The control side had a slower healing and 2 cases of bone exposure, which were successfully cured with PRGF application. The RSV on the 21st day after the extraction was correlated with the dose received but not with the time since radiotherapy. Plasma rich in growth factors proved to be effective in the management of patients with a history of head and neck radiotherapy, accelerating and fostering mucosal healing and avoiding postextraction bone exposures.
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