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Fulltext Bone Regeneration: Overview and Future Trends

De Angelis N, Bagnasco F, Amaroli A

J Clin Med, 2023 Jul 06;12(13).
PMID: 37445566 DOI: 10.3390/jcm12134529

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Effects of photobiomodulation on bone defects grafted with bone substitutes: A systematic review of in vivo animal studies

Hanna R, Dalvi S, Amaroli A, De Angelis N, Benedicenti S

J Biophotonics, 2021 01;14(1):e202000267.
PMID: 32857463 DOI: 10.1002/jbio.202000267

A present, photobiomodulation therapy (PBMT) effectiveness in enhancing bone regeneration in bone defects grafted with or without biomaterials is unclear. This systematic review (PROSPERO, ref. CRD 42019148959) aimed to critically appraise animal in vivo published data and present the efficacy of PBMT and its potential synergistic effects on grafted bone defects. MEDLINE, CCCT, Scopus, Science Direct, Google Scholar, EMBASE, EBSCO were searched, utilizing the following keywords: bone repair; low-level laser therapy; LLLT; light emitting diode; LEDs; photobiomodulation therapy; in vivo animal studies, bone substitutes, to identify studies between 1994 and 2019. After applying the eligibility criteria, 38 papers included where the results reported according to "PRISMA." The results revealed insufficient and incomplete PBM parameters, however, the outcomes with or without biomaterials have positive effects on bone healing. In conclusion, in vivo animal studies with a standardized protocol to elucidate the effects of PBMT on biomaterials are required initially prior to clinical studies.
Fulltext Comparison of the Clinical Outcomes of Titanium and Zirconia Implant Abutments: A Systematic Review of Systematic Reviews

Halim FC, Pesce P, De Angelis N, Benedicenti S, Menini M

J Clin Med, 2022 Aug 28;11(17).
PMID: 36078982 DOI: 10.3390/jcm11175052

Background: Dental implants are widely used and in order to answer to esthetic demands, zirconia has been introduced as an abutment material as an alternative to titanium. Several studies have been published on this topic, but the results have been often inconsistent. The objective of the present study is to systematically analyze the existing literature comparing clinical outcomes of titanium and zirconia implant abutments. The study was designed as a systematic review of systematic reviews. Methods: This systematic review is in accordance with the Transparent Reporting of Systematic Reviews and Meta-analyses. A MEDLINE/PubMed, Cochrane Database of Systematic Reviews and SCOPUS literature search was performed up to and including June 2021. Data were extracted independently by two reviewers and tAMSTAR2 was used to assess the quality of the systematic reviews. Results: The electronic search identified 1146 papers, and 175 duplicates were removed. After manual screening, 954 studies were excluded and the final analysis was conducted on 11 papers. Both mechanical and esthetic outcomes and biological complications were analyzed. Conclusions: It can be concluded that titanium abutments have a better mechanical resistance than zirconia ones. Plaque accumulation is reported to be slightly higher on titanium but without any significant inflammatory process. The esthetic outcomes seem to be more related to the thickness (>3 mm) of the soft tissues than to the abutment material.
Fulltext Evaluation of Prosthetic Marginal Fit and Implant Survival Rates for Conventional and Digital Workflows in Full-Arch Immediate Loading Rehabilitations: A Retrospective Clinical Study

De Angelis N, Pesce P, De Lorenzi M, Menini M

J Clin Med, 2023 May 13;12(10).
PMID: 37240558 DOI: 10.3390/jcm12103452

Digital impression provides several advantages in implant prosthodontics; however, its use in full-arch rehabilitations, especially immediately after surgery, has yet to be validated. The aim of this study was to retrospectively analyse the fit of immediate full-arch prostheses, fabricated using conventional or digital impressions. Patients requiring a full-arch immediate loading rehabilitation were divided into three groups: T1 (digital impression taken immediately after surgery), T2 (Preoperative digital impression, guided surgery-prefabricated temporary bridge) and C (conventional impression taken immediately after surgery). Immediate temporary prostheses were delivered within 24 h after surgery. X-rays were obtained at the time of prosthesis delivery and at the 2-year follow-up. Primary outcomes were cumulative survival rate (CSR) and prosthesis fit. Secondary outcomes were marginal bone level (MBL) and patient satisfaction. One hundred and fifty patients were treated from 2018 to 2020, with 50 in each group. Seven implants failed during the observation period. The CSR was 99% for T1, 98% for T2 and 99.5% for C. A statistically significant difference in prosthesis fit was found among T1 and T2 vs. C. A statistically significant difference was found in the MBL between T1 and C. The outcomes of the present study suggest that digital impression is a viable alternative to conventional protocols for the realisation of full-arch immediate loading prostheses.
Primary stability of self-tapping dual etched implants

Kassim ZH, Nor Hisham ND, Dardiri NA, Goot Heah K, Hazwani Baharuddin I, De Angelis N

Minerva Stomatol, 2019 Dec;68(6):291-296.
PMID: 32052617 DOI: 10.23736/S0026-4970.19.04242-0

BACKGROUND: The aims of this study were to enumerate the primary implant stability quotient (ISQ) value of self-tapping dual etched implants and to explore the influence of parameters such as implant length, implant diameter, age, gender, implant location and osteotomy preparation on the ISQ value.
METHODS: Retrospective data from clinical worksheets given to participants during two implant courses held between the periods of 2013 to 2014 were evaluated. A total of 61 implants were considered based on the inclusion criteria. The effects of parameters such as implant diameter, implant length, age, gender, implant location and osteotomy protocol on ISQ values were analyzed.
RESULTS: Mean ISQ value for all implants was 67.21±9.13. Age of patients (P=0.016) and location of implants (P=0.041) had a significant linear relationship with the ISQ values. Within the age limit of the patients in this study, it was found that an increase in one year of patient's age results in 0.20 decrease in ISQ value (95% CI: -0.36, -0.04). However, placing an implant in the posterior maxilla may negatively affect the ISQ with a likely decrease in primary stability by 6.76 ISQ value (95% CI: -13.22, -0.30).
CONCLUSIONS: The results suggest that the mean ISQ achieved by the participants were comparable with the range reported for this particular type of implants. The patient's age and location of implants were elucidated as the determinant factors of primary implant stability.
Fulltext Immediate Implants in the Aesthetic Zone: Is Socket Shield Technique a Predictable Treatment Option? A Narrative Review

De Angelis N, Signore A, Alsayed A, Hai Hock W, Solimei L, Barberis F, et al.

J Clin Med, 2021 Oct 26;10(21).
PMID: 34768483 DOI: 10.3390/jcm10214963

(1) Background. Dental implant placement in the anterior region requires extreme precision due to relatively high aesthetic demand. This narrative review aimed to analyse some of the available clinical studies of the socket-shield technique and determine its viability for dental implant survival/success and complication rates. (2) Methods. An electronic search for publications was performed using the Cochrane, PubMed-MEDLINE, Web of Science, and Google Scholar databases. All electronic searches included human clinical and animal studies and were performed by three independent examiners. (3) Results. A total of 1383 records were identified with the initial search strategies, but only 25 full texts + five abstracts clinical studies were kept after the recruitment criteria screening. The technical details, advantages, and limitations of the techniques were illustrated. (4) Conclusion. Within the limitations of the present review, it would be merely justified that immediate dental implant placement in conjunction with the socket-shield technique can be a promising strategy for dental implant therapy.
The 808 nm and 980 nm infrared laser irradiation affects spore germination and stored calcium homeostasis: A comparative study using delivery hand-pieces with standard (Gaussian) or flat-top profile

Ferrando S, Agas D, Mirata S, Signore A, De Angelis N, Ravera S, et al.

J. Photochem. Photobiol. B, Biol., 2019 Oct;199:111627.
PMID: 31536925 DOI: 10.1016/j.jphotobiol.2019.111627

Photobiomodulation relies on the transfer of energy from incident photons to a cell photoacceptor. For many years the concept of photobiomodulation and its outcome has been based upon a belief that the sole receptor within the cell was the mitochondrion. Recently, it has become apparent that there are other photoacceptors operating in different regions of the electromagnetic spectrum. Alternative photoacceptors would appear to be water and mechanisms regulating calcium homeostasis, despite a direct effect of laser photonic energy on intracellular calcium concentration outwith mitochondrial activity or influence, have not been clearly demonstrated. Therefore, to increase the knowledge of intracellular‑calcium and laser photon interaction, as well as to demonstrate differences in irradiation profiles with modern hand-pieces, we tested and compared the photobiomodulatory effect of 808 nm and 980 nm diode laser light by low- and higher-energy (60s, 100 mW/cm2, 100 mW/cm2, 500 mW/cm2, 1000 mW/cm2, 1500 mW/cm2, 2000 mW/cm2) irradiated with a "standard" (Gaussian fluence distribution) hand-piece or with a "flat-top" (uniform fluence) hand-piece. For this purpose, we used the eukaryote unicellular-model Dictyostelium discoideum. The 808 nm and 980 nm infrared laser light, at the energy tested directly affect the stored Ca2+ homeostasis, independent of the mitochondrial respiratory chain activities. From an organism perspective, the effect on Ca2+-dependent signal transduction as the regulator of spore germination in Dictyostelium, demonstrates how a cell can respond quickly to the correct laser photonic stimulus through a different cellular pathway than the known light-chromophore(mitochondria) interaction. Additionally, both hand-piece designs tested were able to photobiomodulate the D. discoideum cell; however, the hand-piece with a flat-top profile, through uniform fluence levels allows more effective and reproducible effects.
1064 nm Nd:YAG laser light affects transmembrane mitochondria respiratory chain complexes

Ravera S, Ferrando S, Agas D, De Angelis N, Raffetto M, Sabbieti MG, et al.

J Biophotonics, 2019 09;12(9):e201900101.
PMID: 31033186 DOI: 10.1002/jbio.201900101

Photobiomodulation (PBM) is a non-plant-cell manipulation through a transfer of energy by means of light sources at the non-ablative or thermal intensity. Authors showed that cytochrome-c-oxidase (complex IV) is the specific chromophore's target of PBM at the red (600-700 nm) and NIR (760-900 nm) wavelength regions. Recently, it was suggested that the infrared region of the spectrum could influence other chromospheres, despite the interaction by wavelengths higher than 900 nm with mitochondrial chromophores was not clearly demonstrated. We characterized the interaction between mitochondria respiratory chain, malate dehydrogenase, a key enzyme of Krebs cycle, and 3-hydroxyacyl-CoA dehydrogenase, an enzyme involved in the β-oxidation (two mitochondrial matrix enzymes) with the 1064 nm Nd:YAG (100mps and 10 Hz frequency mode) irradiated at the average power density of 0.50, 0.75, 1.00, 1.25 and 1.50 W/cm2 to generate the respective fluences of 30, 45, 60, 75 and 90 J/cm2 . Our results show the effect of laser light on the transmembrane mitochondrial complexes I, III, IV and V (adenosine triphosphate synthase) (window effects), but not on the extrinsic mitochondrial membrane complex II and mitochondria matrix enzymes. The effect is not due to macroscopical thermal change. An interaction of this wavelength with the Fe-S proteins and Cu-centers of respiratory complexes and with the water molecules could be supposed.
Newly formulated 5% 5-aminolevulinic acid photodynamic therapy on Candida albicans

Greco G, Di Piazza S, Chan J, Zotti M, Hanna R, Gheno E, et al.

Photodiagnosis Photodyn Ther, 2020 Mar;29:101575.
PMID: 31614222 DOI: 10.1016/j.pdpdt.2019.10.010

BACKGROUND: A large number of systemic diseases can be linked to oral candida pathogenicity. The global trend of invasive candidiasis has increased progressively and is often accentuated by increasing Candida albicans resistance to the most common antifungal medications. Photodynamic therapy (PDT) is a promising therapeutic approach for oral microbial infections. A new formulation of 5-aminolevulinic acid (5%ALA) in a thermosetting gel (t) (5%ALA-PTt) was patented and recently has become available on the market. However, its antimicrobial properties, whether mediated or not by PDT, are not yet known. In this work we characterised them.
METHODS: We isolated a strain of C. albicans from plaques on the oral mucus membrane of an infected patient. Colonies of this strain were exposed for 1 24 h, to 5%ALA-PTt, 5%ALA-PTt buffered to pH 6.5 (the pH of the oral mucosa) (5%ALA-PTtb) or not exposed (control). The 1 h-exposed samples were also irradiated at a wavelength of 630 nm with 0.14 watts (W) and 0.37 W/cm2 for 7 min at a distance of <1 mm.
RESULTS AND CONCLUSION: The 5% ALA-PTt preparation was shown to be effective in reducing the growth of biofilm and inoculum of C. albicans. This effect seems to be linked to the intrinsic characteristics of 5%ALA-TPt, such acidic pH and the induction of free radical production. This outcome was significantly enhanced by the effect of PDT at relatively short incubation and irradiation times, which resulted in growth inhibition of both treated biofilm and inoculum by ∼80% and ∼95%, respectively.
Fulltext WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections

Sartelli M, Coccolini F, Kluger Y, Agastra E, Abu-Zidan FM, Abbas AES, et al.

World J Emerg Surg, 2021 09 25;16(1):49.
PMID: 34563232 DOI: 10.1186/s13017-021-00387-8

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in hospitals worldwide. The cornerstones of effective treatment of IAIs include early recognition, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using a critical care environment, combined with an optimal surgical approach. Together, the World Society of Emergency Surgery (WSES), the Global Alliance for Infections in Surgery (GAIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), and the American Association for the Surgery of Trauma (AAST) have jointly completed an international multi-society document in order to facilitate clinical management of patients with IAIs worldwide building evidence-based clinical pathways for the most common IAIs. An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting information was shared by an international task force from 46 countries with different clinical backgrounds. The aim of the document is to promote global standards of care in IAIs providing guidance to clinicians by describing reasonable approaches to the management of IAIs.