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A special issue of Materials (ISSN 1996-1944). This special issue belongs to the section "Biomaterials".

Deadline for manuscript submissions: closed (30 November 2020) | Viewed by 48774

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Prof. Dr. Gaetano Isola

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Department of General Surgery and Surgical-Medical Specialties, University of Catania, 95124 Catania, Italy
Interests: periodontitis; oral surgery; oral pathology; oral health-systemic health; bone biology
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Dr. Vincenzo Grassia

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Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
Interests: tooth movement; Tads; interdisciplinary approach; clear aligner
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Special Issue Information

Dear Colleagues,

Material sciences is a major field of research in the current era of tissue engineering and regenerative medicine. New developments in this field define the new frontier in many medical disciplines. Biomaterials play a significant role in the expansion of regenerative treatments of the maxilla, allowing a more sophisticated oral rehabilitation of edentulous patients. Periodontology, oral surgery, esthetic and implant dentistry are significant beneficiaries of the recent promising developments. These interconnected clinical domains are themselves major sources of research in implantable materials, particularly for bone materials and surgical adjuvants.

During the last decades, a plethora of different types of bone graft, adjuvants, bone substitutes, growth and differentiation factors, enamel matrix proteins, and various combinations thereof have been employed to achieve bone and periodontal regeneration. Despite positive observations in animal models and successful outcomes reported for many of the available regenerative techniques and materials in patients, robust information on the degree to which the reported clinical improvements reflect true bone and periodontal regeneration does not exist.

Thus, the aim of this Special Issue is to update and summarize the available evidence of the beneficial effects of biomaterials on periodontal wound healing and regeneration in bone reconstruction and in the treatment of defects and atrophies.

We especially welcome interventional studies aiming at improving the knowledge of the effectiveness of biomaterials and adjuvants in dentistry. Review studies including those that use conceptual frameworks for any of the aforementioned topics will also be welcomed.

It is my pleasure to invite you to contribute to this Special Issue.

Prof. Gaetano Isola
Dr. Vincenzo Grassia
Guest Editors

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Keywords

Biomaterials
Periodontal regeneration
Bone regeneration
Adjuvants
Periodontal disease
Peri-implant disease
Growth factors
Oral surgery
Periodontal surgery

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Published Papers (10 papers)

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Editorial

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3 pages, 188 KiB

Open AccessEditorial

New Materials in Oral Surgery

by Vincenzo Grassia and Ludovica Nucci

Materials 2020, 13(5), 1034; https://doi.org/10.3390/ma13051034 - 25 Feb 2020

Cited by 2 | Viewed by 1998

Abstract

Currently, in the field of dentistry literature, one of most active research topics is clearly related to implants, bone materials, and regenerative strategies for the reconstruction of different oral tissues. Biomaterials and related technologies used with these purposes could only be derived from the integration of the knowledge of different disciplines, which together are skilled in generating innovation and research development, with extensive support of basic sciences and intense international cooperation. The combination of these resources, associated with the greater need for increasingly comprehensive and predictable therapeutic protocols, brings a substantial change in the treatment of oral rehabilitations. Full article

(This article belongs to the Special Issue Advanced Materials for Oral and Dentofacial Surgery)

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12 pages, 13303 KiB

Open AccessArticle

Description of a Digital Work-Flow for CBCT-Guided Construction of Micro-Implant Supported Maxillary Skeletal Expander

by Antonino Lo Giudice, Vincenzo Quinzi, Vincenzo Ronsivalle, Stefano Martina, Orazio Bennici and Gaetano Isola

Materials 2020, 13(8), 1815; https://doi.org/10.3390/ma13081815 - 12 Apr 2020

Cited by 41 | Viewed by 8282

Abstract

The introduction of miniscrew-assisted rapid palatal expansion (MARPE) has widened the boundaries of orthodontic skeletal correction of maxillary transversal deficiency to late adolescence and adult patients. In this respect, Maxillary Skeletal Expander (MSE) is a particular device characterized by the engagement of four miniscrews in the palatal and nasal cortical bone layers. Thus, the availability of sufficient supporting bone and the perforation of both cortical laminas (bi-corticalism) are two mandatory parameters for mini-screw stability, especially when orthopedic forces are used. Virtual planning and construction of MSE based on cone-beam computed tomography (CBCT)-derived stereolithography (.stl) files have been recently described in the literature. In this manuscript we described: (a) a user-friendly digital workflow which can provide a predictable placement of maxillary skeletal expander (MSE) appliance according to the patient’s anatomical characteristics, (b) the construction of a positional template of the MSE that allows lab technician to construct the MSE appliance in a reliable and accurate position, according to the virtual project planned by the orthodontist on the patient CBCT scans. We also described a case report of an adult female patient affected by skeletal transversal maxillary deficiency treated with MSE appliance that was projected according to the described workflow. Full article

(This article belongs to the Special Issue Advanced Materials for Oral and Dentofacial Surgery)

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10 pages, 5027 KiB

Open AccessArticle

Alveolar Socket Preservation with Different Autologous Graft Materials: Preliminary Results of a Multicenter Pilot Study in Human

by Elio Minetti, Edoardo Giacometti, Ugo Gambardella, Marcello Contessi, Andrea Ballini, Gaetano Marenzi, Martin Celko and Filiberto Mastrangelo

Materials 2020, 13(5), 1153; https://doi.org/10.3390/ma13051153 - 5 Mar 2020

Cited by 44 | Viewed by 3351

Abstract

Background: The histological and histomorphometrical results were evaluated between vital whole and non-vital endodontically treated teeth used as autologous grafts in post-extractive socket preservation procedures. Methods: Twenty-eight patients (average age 51.79 ± 5.97 years) with post-extractive defects were enrolled in five dentistry centers. All patients were divided into two groups: with whole teeth (Group 1) and teeth with endodontical root canal therapy (Group 2). The extracted teeth were processed with the Tooth Transformer device to obtain a demineralized and granulated graft material used with a resorbable collagen membrane for socket preservation. After four months, 32 bone biopsies were obtained for histological, histomorphometric, and statistical analysis. Results: During the bone healing period, no infection signs were observed. Nineteen biopsies in group 1 and 13 biopsies in group 2 were detected. The histological analysis showed neither inflammatory nor infective reaction in both groups. Autologous grafts surrounded by new bone were observed in all samples and, at high magnification, partially resorbed dentin and enamel structures were detected. No gutta-percha or cement was identified. Small non-statistically significant differences between the groups, in total bone volume (BV), autologous graft residual, and vital bone percentage were detected. Conclusions: The study showed that the TT Transformer grafts were capable of producing new vital bone in socket preservation procedures. The histomorphometric results showed no statistical differences comparing whole and endodontically treated teeth in bone regeneration. Further studies will be carried out in order to understand the advantages of the autologous graft materials obtained from the tooth compared with the current biomaterials in bone regeneration treatments. Full article

(This article belongs to the Special Issue Advanced Materials for Oral and Dentofacial Surgery)

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11 pages, 1798 KiB

Open AccessArticle

The Stability of Hydroxyapatite/Poly-L-Lactide Fixation for Unilateral Angle Fracture of the Mandible Assessed Using a Finite Element Analysis Model

by Byungho Park, Bryan Taekyung Jung, Won Hyeon Kim, Jong-Ho Lee, Bongju Kim and Jee-Ho Lee

Materials 2020, 13(1), 228; https://doi.org/10.3390/ma13010228 - 4 Jan 2020

Cited by 16 | Viewed by 6827

Abstract

Recently, a hydroxyapatite particle/poly-L-lactide (HA-PLLA) composite device was introduced as an alternative to previous fixation systems. In this study, we used finite element analysis to simulate peak von Mises stress (PVMS) and deformation of bone plates and screws with the following four materials—Ti, Mg alloy, PLLA, and HA-PLLA—at a unilateral mandibular fracture. A three-dimensional virtual mandibular model was constructed, and the fracture surface was designed to run from the left mandibular angle. Masticatory loading was applied on the right first molars. Stress was concentrated at the upper part and the neck of the screw. The largest PVMS was observed for Ti; that was followed by Mg alloy, HA-PLLA, and PLLA. The largest deformation was observed for PLLA; next was HA-PLLA, then Mg alloy, and finally Ti. We could rank relative superiority in terms of mechanical properties. The HA-PLLA screw and mini-plate deformed less than 0.15 mm until 300 N. Thus, we can expect good bone healing with usual masticatory loading six weeks postoperatively. HA-PLLA is more frequently indicated clinically than PLLA owing to less deformation. If the quality of HA-PLLA fixation is improved, it could be widely utilized in facial bone trauma or craniofacial surgery. Full article

(This article belongs to the Special Issue Advanced Materials for Oral and Dentofacial Surgery)

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12 pages, 1059 KiB

Open AccessArticle

Effectiveness of Low-Level Laser Therapy during Tooth Movement: A Randomized Clinical Trial

by Gaetano Isola, Marco Matarese, Francesco Briguglio, Vincenzo Grassia, Giacomo Picciolo, Luca Fiorillo and Giovanni Matarese

Materials 2019, 12(13), 2187; https://doi.org/10.3390/ma12132187 - 8 Jul 2019

Cited by 37 | Viewed by 5075

Abstract

The present study evaluated the effects of low-level laser therapy (LLLT) by means of a diode laser in accelerating orthodontic tooth movement (OTM). After extraction of the first upper premolars for orthodontic purpose, 82 maxillary canines which needed distalization were analyzed in 41 enrolled patients (21 males, 20 females, mean age 13.4 ± 2.1 years). On all experimental sites, an orthodontic force of 50/N was applied by a nickel-titanium (NiTi) closed coil spring (G&H, Franklin, IN, USA) in order to obtain the space closure. Using a split mouth randomized design, the test side was treated using a diode laser (Wiser Laser Doctor Smile, Brendola, Italy) operating at 810 nm wavelength in continuous wave mode at both the buccal and palatal side on three points/side (distal, medial and mesial) (1 W output power, continuous wave of 66.7 J/cm², energy density of 8 J) at baseline and at 3, 7, and 14 days and every 15 days until the space closed. On the control side, the opposite selected canine was treated only using orthodontic traction. The primary outcome chosen was the overall time needed to complete the levelling and closing space, measured on a study cast. The secondary outcome chosen was the evaluation of pain levels related to tooth traction, using a Visual Analogue Scale (VAS), recorded at 3, 7, and 14 days after treatments. The mean space closures of the maxillary canines were comparable between groups [Test, 4.56 mm (95% CI 3.9–4.8); Control, 4.49 mm (95% CI 3.8–4.7), p = 0.456]. The laser group yielded less mean time [84.35 ± 12.34 days (95% CI 79.3–86)] to accomplish space closure compared to the control group [97.49 ± 11.44 days (91.7–102.3)] (p < 0.001). The test side showed a significant reduction in the average range of dental pain at 3 [Test, 5.41 (95% CI 5.1–5.6); Control, 7.23 (95% CI 6.9–7.6), p < 0.001], 7 [Test, 4.12 (95% CI 3.8–4.7); Control, 5.79 (95% CI 5.4–5.8), p < 0.001], and at 14 days [Test, 2.31 (95% CI 1.8–2.3); Control, 3.84 (95% CI 3.3–4.2), p < 0.001] after treatment (p < 0.001). This study demonstrates that the use of LLLT therapy was effective in accelerating tooth movement and reducing pain levels related to OTM. Full article

(This article belongs to the Special Issue Advanced Materials for Oral and Dentofacial Surgery)

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9 pages, 1381 KiB

Open AccessArticle

Evaluation of Predation Capability of Periodontopathogens Bacteria by Bdellovibrio Bacteriovorus HD100. An in Vitro Study

by Romeo Patini, Paola Cattani, Simona Marchetti, Gaetano Isola, Gianluca Quaranta and Patrizia Gallenzi

Materials 2019, 12(12), 2008; https://doi.org/10.3390/ma12122008 - 23 Jun 2019

Cited by 32 | Viewed by 4625

Abstract

Treatment options against periodontitis attempt to completely remove oral microbiota even if several species in dental plaque demonstrate protective features. Predatory bacteria that selectively predate solely on Gram-negative bacteria might be a viable therapeutic alternative. Therefore, the aim of this study is to in vitro evaluate the susceptibility of some oral pathogens to predation by B. bacteriovorus HD100 in liquid suspension. Cultures of prey cell were prepared in brain heart infusion broth (BHI) broth incubating overnight at the appropriate conditions for each organism to reach log phase of growth. Predatory activity was assessed by measuring optical density at 600 nm after 12, 24, 48 and 72 hours. Statistical analysis was performed using the Mann–Whitney U test and p values less than 0.05 were considered statistically significant. The study demonstrated that B. bacteriovorus is able to predate on aerobic species and on microaerophilic ones (p < 0.05) but also that its predatory capacity is strongly compromised by the conditions of anaerobiosis. B. bacteriovorus, in fact, was unable to predate the anaerobic species involved in the present study (F. nucleatum and P. gingivalis). The findings of the study suggest that B. bacteriovorus is able to tolerate microaerophilic conditions and that in anaerobiosis it cannot exert its predatory capacity. Such evidence could lead to its use as an agent to prevent recolonization of the periodontal pocket following therapy. Further studies are needed to investigate the activity of B. bacteriovorus against recently recognized periodontopathogens, alone or organized in biofilms of multi-species communities. Full article

(This article belongs to the Special Issue Advanced Materials for Oral and Dentofacial Surgery)

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15 pages, 7729 KiB

Open AccessArticle

Comparative Analysis of the Chemical Composition and Microstructure Conformation Between Different Dental Implant Bone Drills

by Gaetano Marenzi, Josè Camilla Sammartino, Fabio Scherillo, Carlo Rengo, Alfredo De Rosa, Vincenzo Graziano and Gianrico Spagnuolo

Materials 2019, 12(11), 1866; https://doi.org/10.3390/ma12111866 - 9 Jun 2019

Cited by 5 | Viewed by 3625

Abstract

Background: Hardness is considered an important parameter for evaluating the clinical performance of dental implant bone drills. It is connected to the chemical composition, microstructure conformation and manufacture of the surgical drills. Methods: Microstructure of five dental implant drills using scanning electronic microscopy (SEM) integrated with energy dispersive X-ray spectrometry. Vickers microhardness was measured using a CV 2000 microhardness tester with an indentation force of 500 g. Results: Composition of the implant drills was typical of martensitic stainless steel (MSS). The drills contained 13%–17% of Cr; Mo, Si and Mn were present as minor ligands. The examined bone drills showed different external surface conformation and hardness in relation to the different industrial production processes. A rougher external surface and a higher hardness value are characteristics of the surgical bone drills produced by hot forming; the implant drills produced by machining showed mailing lines on their external surface and a lower hardness. Conclusions: Different compositions and treatments were used by the manufacturers to improve the hardness of the external layer of the dental implant drills making them prone to a diverse heat generation during the implant site preparation. Full article

(This article belongs to the Special Issue Advanced Materials for Oral and Dentofacial Surgery)

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11 pages, 2219 KiB

Open AccessArticle

Micro-Scale Surface Patterning of Titanium Dental Implants by Anodization in the Presence of Modifying Salts

by Gaetano Marenzi, Gianrico Spagnuolo, Josè Camilla Sammartino, Roberta Gasparro, Alberto Rebaudi and Marco Salerno

Materials 2019, 12(11), 1753; https://doi.org/10.3390/ma12111753 - 30 May 2019

Cited by 21 | Viewed by 4004

Abstract

The bone-implant interface influences peri-implant bone healing and osseointegration. Among various nano-engineering techniques used for titanium surface modification, anodization is a simple, high-throughput and low-cost process, resulting in a nanoporous oxide coating which can promote osseointegration and impart antimicrobial and immunomodulatory properties. We anodized rounded tip dental implants of commercial grade titanium in aqueous phosphoric acid modified with calcium and potassium acetate, and characterized the resulting surface morphology and composition with scanning electron microscopy and energy dispersive spectrometry. The appearance of nanopores on these implants confirmed successful nanoscale morphology modification. Additionally, the metal cations of the used salts were incorporated into the porous coating together with phosphate, which can be convenient for osseointegration. The proposed method for surface nanostructuring of titanium alloy could allow for fabrication of dental implants with improved biocompatibility in the next stage of research. Full article

(This article belongs to the Special Issue Advanced Materials for Oral and Dentofacial Surgery)

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20 pages, 1844 KiB

Open AccessArticle

Advances in Antiplatelet Therapy for Dentofacial Surgery Patients: Focus on Past and Present Strategies

by Gabriele Cervino, Luca Fiorillo, Ines Paola Monte, Rosa De Stefano, Luigi Laino, Salvatore Crimi, Alberto Bianchi, Alan Scott Herford, Antonio Biondi and Marco Cicciù

Materials 2019, 12(9), 1524; https://doi.org/10.3390/ma12091524 - 9 May 2019

Cited by 30 | Viewed by 4650

Abstract

Background: Nowadays, patients involved in antiplatelet therapy required special attention during oral surgery procedures, due to the antiplatelet drugs assumption. The motivations of the assumption may be different and related to the patient’s different systemic condition. For this reason, accordingly to the current international guidelines, different protocols can be followed. The aim of this work is to analyze how the dentist’s approach to these patients has changed from the past to the present, evaluating the risk exposure for the patients. Methods: This review paper considered different published papers in literature through quoted scientific channels, going in search of “ancient” works in such a way as to highlight the differences in the protocols undertaken. The analyzed manuscripts are in the English language, taking into consideration reviews, case reports, and case series in such a way as to extrapolate a sufficient amount of data and for evaluating the past therapeutic approaches compared to those of today. Results: Colleagues in the past preferred to subject patients to substitution therapy with low molecular weight anticoagulants, by suspending antiplatelet agents to treatment patients, often for an arbitrary number of days. The new guidelines clarify everything, without highlighting an increased risk of bleeding during simple oral surgery in patients undergoing antiplatelet therapy. Conclusion: Either patients take these medications for different reasons, because of cardiovascular pathologies, recent cardiovascular events, or even for simple prevention, although the latest research shows that there is no decrease of cardiovascular accidents in patients who carry out preventive therapy. Surely, it will be at the expense of the doctor to assess the patient’s situation and risk according to the guidelines. For simple oral surgery, it is not necessary to stop therapy with antiplatelet agents because the risk of bleeding has not increased, and is localized to a post-extraction alveolus or to an implant preparation, compared to patients who do not carry out this therapy. From an analysis of the results it emerges that the substitutive therapy should no longer be performed and that it is possible to perform oral surgery safely in patients who take antiplatelet drugs, after a thorough medical history. Furthermore, by suspending therapy, we expose our patients to more serious risks, concerning their main pathology, where present. Full article

(This article belongs to the Special Issue Advanced Materials for Oral and Dentofacial Surgery)

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Review

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12 pages, 687 KiB

Open AccessReview

A Literature Review of Metagenomics and Culturomics of the Peri-implant Microbiome: Current Evidence and Future Perspectives

by Leonardo Martellacci, Gianluca Quaranta, Romeo Patini, Gaetano Isola, Patrizia Gallenzi and Luca Masucci

Materials 2019, 12(18), 3010; https://doi.org/10.3390/ma12183010 - 17 Sep 2019

Cited by 64 | Viewed by 5342

Abstract

Background and objectives: In recent years, many different culture-independent molecular techniques have been developed with the aim of investigating the not yet cultivated part of the resident flora of the oral cavity and of analyzing the peri-implant and periodontal flora both in healthy and diseased sites. The most used technologies are Roche 454 pyrosequencing, Illumina HiSeq/MiSeq, ABI SOLiD and Ion Torrent. Due to these methods, two different approaches are available: Metagenomics and the 16S gene analysis. A complementary strategy was also recently developed: Culturomics. Culturomics consists of different culture conditions that allow a very rapid bacterial identification. The focused question of this review was developed in PICO format in order to investigate the role of metagenomics, 16S gene analysis and culturomics (interventions) in the differential study (comparison) of the peri-implant and periodontal microbiome (outcome) in humans (participants). The secondary aim was the characterization of currents limits and future applications of the three techniques. Methods: The authors performed a literature search on three databases (Web of Science, Scopus and PubMed) from 01/01/2003 to 31/06/2019. Date of last search was: 25/08/19. Any type of article dealing with the analysis of periodontal and peri-implant flora with metagenomic, culturomic or 16S gene analysis was included. No language restrictions were applied. Risk of bias for RCT was assessed using the Cochrane collaboration’s tool whereas case-control and cohort studies were evaluated through the Newcastle–Ottawa scale. Results: The initial search resulted in 330 titles in total. After careful evaluation of all results no studies were found to satisfy the primary outcome of the present review. Hence a narrative review dealing with the secondary aim was performed. Conclusions: Metagenomic and 16S gene analysis approaches contributed in clarifying some crucial aspects of the oral microbiome. Based on the reported evidence some bacteria could be found around teeth and implants even in the absence of signs of inflammation and other species are more frequently found in supragingival peri-implant biofilm. Teeth and implants (even if adjacent) seem not to share the same microbiome and healthy teeth have a more diversified one. The same analyses also highlighted that the oral biofilm of smokers is composed by more periodontopathogen bacteria compared to non-smokers and that geographical location and ethnicity seem to play a role in bacterial composition. Culturomics, which has not yet been applied to the study of oral microbiota, consists of the use of different culture conditions and of the identification by matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI–TOF MS) with the aim of increasing the bacterial repertoire and avoiding the limits of molecular methods. In order to better evaluate perspectives and limits of the all presented approaches further studies comparing the different molecular techniques are encouraged. This review received no funding. Full article

(This article belongs to the Special Issue Advanced Materials for Oral and Dentofacial Surgery)

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