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Pierantonio BELLINI

Professore Associato
Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa

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Pubblicazioni

2023 - Masticatory Functionality in Post-Acute-COVID-Syndrome (PACS) Patients with and without Sarcopenia [Articolo su rivista]
Pugliese, BRUNO DAVIDE; Garuti, Giovanna; Bergamini, Lucia; Khamaisi, RICCARDO KARIM; Guaraldi, Giovanni; Consolo, Ugo; Bellini, Pierantonio
abstract

Musculoskeletal symptoms are common in both acute COVID-19 disease and post-acute sequelae (Post-Acute COVID Syndrome). The purpose of this study is to investigate whether there are reduced levels of masticatory function in patients with PACS (Post Acute COVID Syndrome) who suffer from sarcopenia, under the hypothesis that the latter may also involve the masticatory muscles. This study includes 23 patients hospitalized for COVID-19 between February 2020 and April 2021 and currently suffering from PACS. Among these PACS patients, 13/23 (56%) suffer from sarcopenia, 5/23 (22%) complain of asthenia but do not suffer from sarcopenia and the remaining 5/23 (22%) do not present muscle symptoms (non-asthenic non-sarcopenic). Oral health indices of all patients were collected. The masticatory strength was assessed with a gnathodynamometer based on piezoresistive sensors, and the masticatory effectiveness was measured by administering the “chewing gum mixing ability test” by having patients perform 20 masticatory cycles on a two-color chewing gum and analyzing the outcome through the ViewGum© software. Moreover, we gathered data with a hand grip test and gait speed test. The data collected in this study show that PACS sarcopenic patients have decreased masticatory effectiveness and strength compared to PACS asthenic non-sarcopenic patients and PACS non-asthenic non-sarcopenic patients.

2023 - Metabolic Profile of Whole Unstimulated Saliva in Patients with Sjögren's Syndrome [Articolo su rivista]
Setti, Giacomo; Righi, Valeria; Mucci, Adele; Panari, Lucia; Bernardelli, Giuditta; Tarentini, Elisabetta; Gambini, Anna; Consolo, Ugo; Generali, Luigi; Magnoni, Cristina; Meleti, Marco; Sandri, Gilda; Bellini, Pierantonio
abstract

: Primary Sjögren's Syndrome (pSS) is a multi-system autoimmune disease that involves the exocrine glands. Lymphocytes infiltrate the gland tissue, leading to anatomical modification and hypofunction. Even if the prognosis of pSS is favorable, quality of life is typically reduced due to the diverse manifestations of the disease. The aim of this study is to compare the salivary metabolomes of pSS with healthy controls (HCs). Seven cases were selected from a cohort of pSS patients, and six age- and sex-matched HCs were recruited from a cohort of volunteers. Whole unstimulated saliva was collected for NMR analysis. Our metabolomic analysis focused on 360 ms total echo 1D 1H NMR CPMG spectra. Metabolites detected with CPMG NMR spectra were assigned through 2D NMR spectra (COSY, TOCSY, and HSQC). About 50 metabolites were detected and assigned. Unsupervised exploratory PCA returned partial clustering, and PLS-DA improved the separation between pSS and HCs, highlighting a pool of metabolites distinctly describing each group. Despite the limited number of samples, the presented preliminary data are promising. PLS-DA indicated well-defined group separation, suggesting that the application of 1H-NMR metabolomics is suitable for the study of pSS.

2022 - A rare case of solitary fibrous tumor of the temporal region: 7-year-follow-up clinical-radiographic evaluation and literature review [Articolo su rivista]
Consolo, U.; Diamante, F.; Salgarelli, A. C.; Bellini, P.
abstract

Solitary fibrous tumor is a rare spindle-cell neoplasm of mesenchymal origin. In head and neck region, the tumors present slow-growing masses, often with local compressive symptoms. Although it is generally benign, malignant variants have been identified. The radiological diagnosis of solitary fibrous tumor is usually based on computer tomography and/or magnetic resonance imaging. Microscopically, a solitary fibrous tumor is characteristically a circumscribed neoplasm composed of variably cellular and patternless distributions of bland spindle and ovoid cells within variably collagenous stroma that frequently shows areas of dense hyalinisation, as well as interspersed large branching or “staghorn”- shaped thin-walled vessels. Immunohistochemical staining is very effective to distinguish solitary fibrous tumors from other fibroblastic tumors. Recently, NAB2–STAT6 gene fusion derived from inv12 (q13q13) has been reported as the genetic hallmark of solitary fibrous tumor. Complete local surgical excision appears to be the treatment of choice for solitary fibrous tumor of the head and neck region. Recurrence was reported in 5% of cases. The median recurrence-free interval was 36.5 months. We report the case of a solitary fibrous tumor of the temporal region, surgically excised and with no clinical and/or radiological signs of recurrence after 7 years of follow-up.

2022 - Impact of the COVID-19 pandemic on dental hygiene students in the Italian region of Emilia-Romagna [Articolo su rivista]
Bellini, P.; Iani, C.; Zucchelli, G.; Franchi, M.; Mattioli, A. V.; Consolo, U.
abstract

BACKGROUND: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a new coronavirus detected in China at the end of 2019. Because SARS-CoV-2 is highly infectious due to contamination in the air, there is a high risk of infection in the dental environment which is represents a serious problem for professionals and students (dentistry and dental hygiene). In Italy, since February 23, 2020, the government has suspended all teaching activities of schools and universities. METHODS: An anonymous questionnaire was administered to the students of the degree courses in Dental Hygiene of the Emilia Romagna Region, one of the most affected regions in Italy. The survey was intended to highlight the practical and emotional consequences of the emergency of COVID-19 on educational activities and in the training of students. RESULTS: The survey was sent to the 150 students enrolled in the universities of Bologna, Ferrara and Modena and Reggio Emilia; 141 of them completed it (94%). Since the start of the COVID-19 pandemic, several surveys have been proposed to measure the impact of this emergency situation on dental professionals; at present, however, there are still no assessments for dental hygiene degree courses, in particular aimed at assessing the psychological impact on students. CONCLUSIONS: Students consider the dental hygienist as a risky profession, while the risk taken by patients is considered as low. Given the concern reported the students, it would be useful to address the issue of proper assessment of risk during the university training of dental hygienists.

2022 - Lifestyle changes during the first and second waves of the COVID-19 pandemic in medical college students: are there gender-related differences? [Articolo su rivista]
Coppi, Francesca; Nasi, Milena; Sabatini, Silvia; Bellini, Pierantonio; Generali, Luigi; Mecugni, Daniela; Farinetti, Alberto; Consolo, Ugo; Mattioli, Anna Vittoria
abstract

Background and aims: The COVID-19 pandemic has seriously affected young people. The present study aims to explore the effects of COVID-19 on lifestyle in 500 undergraduate students both during the acute phase of the pandemic (so-called “first wave”) and during the second spread of infections (so-called “second wave”). Gender differences were also explored. Methods and results: During the first wave we found weight gain in 48.6% of subjects, a switch to an unhealthy diet (43%), and an increase in the amount of food introduced (35%). Interestingly, women showed higher intake of food in order to cope, while men privileged higher wine consumption as a coping mechanism. We observed a sharp reduction in physical activity, increased sedentary behaviours and deterioration in sleep quality. Stress correlates with eating to cope (r=0.86; p<0.001); drinking to cope (r=0.83; p<0.001). Contrary to expectations, the second wave led to a situation similar to the first. We have detected a further deterioration in quality of sleep (67% vs 77%; p<0.01) and also a reduction in sleeping time (68.6% vs 77.7; p<0.01). Conclusions: The long pandemic has led to unhealthy lifestyle changes in the student population of our municipality in Northern Italy. There are gender differences in lifestyle modifications developed during the pandemic that suggest a different response to stress. Moreover, the persistence of pandemic-related stress due to the “second wave” has severely affected the lifestyle habits of undergraduate student. (www.actabiomedica.it)

2022 - Novel Options to Counteract Oral Biofilm Formation: In Vitro Evidence [Articolo su rivista]
Odorici, A.; Colombari, B.; Bellini, P.; Meto, A.; Venturelli, I.; Blasi, E.
abstract

Biofilm production on biotic and abiotic surfaces is crucial in the pathogenesis of most infections, particularly those occurring in the oral cavity. Its prevention and/or control may greatly facilitate the management of patients with oral diseases. Here, the antibiofilm activity of a biomimetic hydroxyapatite and a natural compound, MicroRepair (MicroR) and pomegranate (PomeGr), respectively, was assessed. By luminescence/fluorescence-based assays, Pseudomonas aeruginosa (P. aeruginosa), Staphylococcus aureus (S. aureus) and Candida albicans (C. albicans) were tested for biofilm production in the presence of MicroR and/or PomeGr. We found that both MicroR and PomeGr could affected biofilm production; however, the efficacy of the two, given alone or in combination, varied according to the microbial agent considered. These data open to clinical studies aimed at defining the most efficacious protocols to counteract oral biofilm-associated infections.

2022 - Oral health habits during COVID-19 pandemic in university medical students [Articolo su rivista]
Bellini, Pierantonio; Sabatini, Silvia; Nasi, Milena; Dall’Olio, Lucia; Generali, Luigi; Mecugni, Daniela; Consolo, Ugo; Mattioli, Anna Vittoria
abstract

2021 - Blood components for non-transfusion use in oral surgery [Articolo su rivista]
Bencivenni, D.; Bellini, P.; Garuti, C.; Consolo, U.
abstract

OBJECTIVES Platelet derivates are widely used for tissue regeneration, in dentistry and beyond, with shorter healing time and fewer side effects associated with the surgical trau-ma or with pathologic conditions. They are autologous products ob-tained from a little amount of ve-nous blood, through manipulation with closed circuit systems. Among these, L-PRF has a safe and promising use in the dental field. It can be used alone or to-gether with other materials and is, due to its peculiarities, the most used among the blood components in oral surgery. This paper has the aim to make an overview about the various ap-plications of the platelet deriva-tives in the dental field. Moreover, three clinical cases managed with L-PRF will be presented. MATERIALS AND METHODS Three clinical cases have been se-lected among those managed at the Oral-Maxillofacial Surgery Unit, at the Policlinico of Modena, Italy. Case 1: one patient with third mo-lar impaction, 3.8. This element, shows a significant sagittal incli-nation, greater than 50°, and a high impact on the II left molar; these conditions may lead to a periodontal damage to the 3.7. Due to this clinical situation, the surgical extraction of tooth 3.8 has been performed, with the ap-position of L-PRF within the residual alveolar socket. Case 2: patient with an osteolytic lesion at the pre-maxilla. After surgical removal of the inflamma-tory cystic lesion, the residual defect has been filled with L-PRF mixed with particulated bovine deproteinized bone to promote the regeneration of the defect and to make the graft material easier to handle for the operator. At the out-er aspect of the lesion L-PRF membranes have been used. Case 3: medical-related osteone-crosis of the lower jaw. After the re-moval of the necrotic bone and the surgical debridement, L-PRF has been used to obtain filling of the re-sidual bone defect. In this case, L-PRF was used to bring a higher quantity of growth factors to the site and due to its neangiogenetic proprieties, in order to create a good mucous seal and to promote the regeneration of the defect. RESULTS The three cases have been managed with L-PRF. The post-opera-tive sequelae have been very low in terms of incidente and severity. As a matter of fact, we note mild post-operative swelling and mild pain. At 6 months re-evaluation, the mucous seals were all main-tained and the soft tissue healing was perfectly achieved. Upon ra-diographic examination, bone regeneration could be appreciated. CONCLUSIONS Within the limits of this presenta-tion of only three clinical cases we just formulate some first im-pressions. We can confirm the versatility of L-PRF production and application in oral surgery. These preliminare data goes along with the data already exist-ing in the scientific literature. However, more observational and prospective studies are neces-sary, in order to provide the prac-titioner with specific guide-line for the application of L-PRF in the dental field. CLINICAL SIGNIFICANCE The blood components, and among them L-PRF, could be a valid alternative material for tissue regeneration. In a very close future it could lead us to reduce the use of etherologous biomatherials in favour of a completely autolo-gous one, cheaper and potentially very effective. At last, L-PRF in combination with an etherologous graft material could improve its potential and make it easer to handle for the operator itself.

2021 - COVID-19 dentistry-related aspects: a literature overview [Articolo su rivista]
Checchi, V.; Bellini, P.; Bencivenni, D.; Consolo, U.
abstract

A new coronavirus (Sars-CoV-2) was detected in China at the end of 2019 and has since caused a worldwide pandemic. This virus is responsible for an acute respiratory syndrome (COVID-19), distinguished by a potentially lethal interstitial bilateral pneumonia. Because Sars-CoV-2 is highly infective through airborne contamination, the high infection risk in the dental environment is a serious problem for both professional practitioners and patients. This literature overview provides a description of the clinical aspects of COVID-19 and its transmission, while supplying valuable information regarding protection and prevention measures.

2021 - How did italian adolescents with disability and parents deal with the covid-19 emergency? [Articolo su rivista]
Faccioli, S.; Lombardi, F.; Bellini, P.; Costi, S.; Sassi, S.; Pesci, M. C.
abstract

The COVID-19 emergency has imposed distanced education and has interrupted most rehabilitation services. Adolescents with disabilities have been isolated, and the burden on their families has been exacerbated. A cross-sectional survey was administered to adolescents with disability and to parents of disabled children to describe their experience during lockdown and their concerns or expectations about rehabilitation. A sample of 53 adolescents and 239 parents completed the survey. Adolescents were ages 13–18 years old (45.3% female). Most parents were between 35 and 55 years old (84.9% female). While 53.6% of the parents reported no positive effects of the lockdown, 92.5% of the adolescents expressed favorable consequences. The increased time spent with family members was judged positively by 27.2% of parents and by 64.2% of adolescents. Concern for their child’s disability was expressed by 47.3% of parents, while 73.6% of adolescents expressed concerns regarding the ban on meeting friends. In both groups, anxiety symptoms were correlated with the fear of contracting COVID-19 and with financial problems. Parents would have liked even more remote support from school and healthcare professionals, which was available for most participants. Thus, socioeconomic support, assistive technology and telerehabilitation strategies might help families with disabilities during a lockdown.

2021 - Psychological reactions to COVID-19 and epidemiological aspects of dental practitioners during lockdown in Italy [Articolo su rivista]
Bellini, Pierantonio; Checchi, Vittorio; Iani, Cristina; Bencivenni, Davide; Consolo, Ugo
abstract

BACKGROUND: Due to droplet production and exposure to saliva and blood, dental practitioners are at high risk of COVID-19 contagion during their routine procedures. The aim of this study was to investigate the behavior of Italian dentists and to analyze their reactions in relation to Sars-CoV-2 pandemic professional restrictive measures.METHODS: An online structured survey composed of 40 questions has been sent to dental practitioners all over Italy to investigate their behavior and to analyze their reactions in relation to Sars-CoV-2 pandemic restrictive measures introduced by the Italian national administrative order of 10 March 2020 (DM-10M20).RESULTS: 1109 dentists replied. To assess concerns and psychological responses the sample was divided into two groups based on the number of cases registered in their work area. In the first group were included all the responders working in the Italian regions that had more than 15.000 confirmed cases of COVID-19 as of April 29, 2020. The second group included responders working in the Italian regions that had less than 15,000 confirmed cases. The 45.2% of the respondents showed minimal anxiety, 34.5% showed mild anxiety, 13.9% showed moderate anxiety, while 6.4% showed a score indicative of a severe level of anxiety.CONCLUSIONS: The COVID-19-related emergency condition had a highly negative impact on dental practices in Italy. Those who completed the survey reported practice closure or reduction during the lockdown, and a high level of concern about the professional future for all dental practitioners. Concerns related to professional activity were accompanied by severe anxiety levels.

2021 - Super-short (4-mm) postextractive, immediately provisionalized implant in a minimally invasive rehabilitation approach avoiding extraction of the impacted maxillary canine: A 2-year follow-up case report [Articolo su rivista]
Barausse, C.; Gasparro, R.; Berti, C.; Bellini, P.; Colombelli, F.; Felice, P.
abstract

This case report describes an alternative minimally invasive fixed rehabilitation to approach an impacted maxillary canine (IMC) and the residual deciduous teeth. The patient refused any orthodontic treatment or surgical extraction of the IMC, asking for a fixed and fast option. Considering the available bone was about 5 mm in height, an immediately provisionalized postextractive 4-mm super-short implant was placed. Healing was uneventful. Two years after loading, the result was stable and the patient was fully satisfied. Within all the limitations of this case report, this approach could reduce rehabilitative times, possible complications, and costs.

2020 - A conservative transnasal endoscopic and intraoral approach in a case of a maxillary dentigerous cyst [Articolo su rivista]
Consolo, Ugo; Bellini, Pierantonio; Mattioli, Francesco; Lizio, Giuseppe
abstract

The transoral approach for enucleation of a voluminous odontogenic lesion involving the maxillary sinus is considerably invasive and can cause irreversible damage to the ciliated mucosa with definitive loss of the normal bone morphology. Functional endoscopic sinus surgery (FESS), which increases the patency of the osteomeatal complex (OMC), involves the use of a direct approach to the lesion, facilitating the drainage of secretions and improving the ventilation. Nevertheless, FESS cannot completely enucleate large odontogenic cystic lesions, particularly dentigerous cysts associated with dislocated teeth. Accordingly, a combined transnasal endoscopic and transoral approach is desirable. Here, we report the successful use of FESS combined with a conservative intraoral approach for the treatment of a voluminous dentigerous cyst that completely occupied the maxillary sinus. In a single surgery, FESS was used to enlarge OMC and open the cystic compartment into the nasal cavity, while an intraoral approach involving the removal of a bony lid from the anterolateral wall of the maxillary sinus facilitated minimal removal of the cystic wall associated with the dislocated tooth. The bony lid was repositioned and fixed with titanium plates. Computed tomography performed at 6 months showed that the original cystic compartment, which maintained communication with the nasal cavity through the enlarged OMC, was absent, and that the sinus had recovered its healthy morphology. Computed tomography at 27 months showed the maintenance of this status with no signs recurrence. We recommend this approach to eradicate such pathology while preserving the sinus structure and function.

2020 - An intraoperative study with ex vivo fluorescence confocal microscopy: diagnostic accuracy of the three visualization modalities [Articolo su rivista]
Reggiani, C.; Pellacani, G.; Reggiani Bonetti, L.; Zanelli, G.; Azzoni, P.; Chester, J.; Kaleci, S.; Ferrari, B.; Bellini, P.; Longo, C.; Bertoni, L.; Magnoni, C.
abstract

Ex-vivo fluorescence confocal microscopy (FCM) is an imaging technique that captures real time digital images of freshly excised tissue with quasi histopathological resolution. FCM reduces time to image acquisition compared to hematoxylin and eosin (H&E) frozen section analysis.

2020 - Analysis of Marsupialization of Mandibular Cysts in Improving the Healing of Related Bone Defects [Articolo su rivista]
Consolo, U.; Bellini, P.; Melini, G. M.; Ferri, A.; Lizio, G.
abstract

Purpose: Marsupialization, designed to reduce the mandibular cyst volume, has continued to debated regarding its influence on the healing of the related bone cavity. The aim of the present study was to evaluate the 3-dimensional radiographic variation over time in mandibular odontogenic cystic lesions after marsupialization and assess the correlations between these variations and variables that can affect the procedure. Materials and Methods: We planned a retrospective cohort study. The predictor variables were the treatment duration, preoperative volume, patient age, histologic type, and number of preoperative residual bony walls. The outcomes variables were the postoperative volume reduction and the daily reduction rate calculated using computed tomography (CT) from before to after marsupialization using software designed for volumetric reconstruction and measurement of cyst-related bone defects. The descriptive and bivariate statistics were computerized, and the significance level was set at P =.05. Results: The sample included 15 patients (12 men and 3 women; mean age, 51.6; range, 27 to 85 years) affected by keratocysts (n = 6), dentigerous cysts (n = 6), and radicular cysts (n = 3) who had undergone marsupialization. The median duration of marsupialization was 406 days (25th to 75th percentile, 276 to 519). The mean ± standard deviation (SD) pre- and postdecompression volumes were 6,908.27 ± 2,669.058 and 2,468.13 ± 1,343.517 mm3, respectively (P < 0.001), and the mean ± SD percentage of reduction was 63.90 ± 13.12%. The volume decrease in the bone defects correlated positively with the treatment duration (P =.009) and preoperative volume (P <.001). However, no correlation was found with the other variables (P >.05) nor between the daily reduction rate and other variables (P >.05). Conclusions: Marsupialization appears useful in improving the healing of cyst-related bone defects in mandibles, especially larger defects. Further studies with a wider sample size would add more knowledge to this topic.

2020 - COVID-19 and dentistry: a new challenge [Articolo su rivista]
Consolo, U; Bencivenni, D; Checchi, V; Bellini, P
abstract

OBJECTIVES. A new virus has been identified in China between the end of 2019 and the beginning of 2020. In few months, this coronavirus spread quickly all around the world, leading to an acute respiratory syndrome often asymptomatic but potentially lethal. This new coronavirus, named Sars-CoV-2, belongs to a pathogen family named Coronaviridae and presents a genomic sequence overlapped to SARS-CoV and MERS-CoV.Epidemiological and genetic studies performed on Chinese infected subjects led to the hypothesis that this pandemic originated from a transmission between animal and humans, followed by a contagion between humans. Sars-CoV-2 transmission potential is extremely high and infection pathways are different. This virus appears highly infective through droplets originated by cough, sneeze or exhalation of infected patients, but also through direct contact of hands or other body parts with contaminated surfaces.Incubation period seems to vary from three to fourteen days but some cases with a longer incubation period had been reported.Also patients in the incubation phase or asymptomatic subjects are considered potential virus carriers. Since the contagion window seems to be open already in the early phase of infection and seems to include also asymptomatic subjects, the difficulty in restricting the infection transmission is evident. Symptomatic patients mostly present fever, asthenia and dry cough, weather dyspnoea affects more severe subjects. In the worst cases, a severe involvement of respiratory functions leads to hospitalization. Form a clinical point of view, Sars-CoV-2 infection shows a bilateral interstitial pneumonia, radiographically evident as a bilateral opacity with no lobar involvement. In this environment, the high infection risk of dental professionals is undeniable. MATERIALS AND METHODS. This work is a literature review on this topic, since current published articles have been selected and valuable indications are given to the dentist. COVID-19 features, transmission and clinical aspects are given to the reader, as well as prevention and protections aspects in dentistry. CONCLUSIONS. Telephonic triage, an accurate anamnesis and a careful hand hygiene of both patients and operators are considered essential preliminary aspects to be considered. Moreover, big attention has to be placed on antimicrobial agents for personal hygiene effective on coronaviruses and on disinfectant agents for instruments and surfaces.Various methods for environment sanification are reported, through air changing and purification. For the most practical aspects instead, expedients suggested are the use of rubber dams, high-speed ejectors and anti-retraction handpieces. Very important is also the selection of the most adequate personal protection devices for airways and ocular protection. Differences between surgical masks and respirators are illustrated, highlighting indications towards Sars-CoV-2. Also indications and information are provided about eye protection devices. These aspects play an important role mostly in this historical period featured by the coronavirus diffusion. CLINICAL SIGNIFICANCE. This contribution highlights the risks of coronavirus contamination in dental environments and provides practical indications on preventive and protective systems that can be implemented in daily clinical practice.

2020 - CRESTAL OR 1.5 MM SUBCRESTAL POSITIONING OF TRANSMUCOSAL DENTAL IMPLANTS WITH CEMENTED OR SCREW-RETAINED CROWNS IN POSTERIOR JAWS: 4-MONTH DATA FROM A SINGLE-CENTRE RANDOMISED CONTROLLED TRIAL [Articolo su rivista]
Barausse, C.; Esposito, M.; Colombelli, F.; Bellini, P.; Buti, J.; Felice, P.
abstract

OBJECTIVES. To compare crestal versus 1.5 mm subcrestal positioning of single transmu-cosal dental implants and screw-retained versus cemented crowns. MATERIALS AND METHODS. One hundred and sixty partially edentulous patients requiring one single implant-supported crown in the premolar/molar area were randomly allocated to four arms: crestal positioning and screw-retained crown (Group 1, 40 patients); crestal positioning and cement-retained crown (Group 2, 40 patients); 1.5 mm subcrestal positioning and screw-retained crown (Group 3, 40 patients); or 1.5 mm subcrestal positioning and cement-retained crown (Group 4, 40 patients) by a single operator. After an unloaded healing period of 3 months, definitive metal-ceramic crowns were delivered, and patients were followed up to 4 months after loading. Outcome measures were: crown and implant failures, complications, aesthetics assessed using the pink aesthetic score (PES), peri-implant marginal bone level changes and patient satisfaction, all recorded, when possible, by blinded assessors. RESULTS. At four months post-loading, four patients dropped out (two from Group 1 and one each from Groups 2 and 3, respectively). Two implants each failed in Groups 2 and 4, but there were no statistically significant differences between groups (P = 1.000). Complications affected four patients from Group 1, one from Group 2, two from Group 3 and six from Group 4, but between-group differences were not statistically significant (P = 0.207). The mean pink aesthetic scores were 10.30 ± 2.13 (Group 1), 10.22 ± 2.76 (Group 2), 10.47 ± 2.96 (Group 3), and 10.51 ± 2.24 (Group 4), respectively, with no statistically significant differences between groups (P = 0.9541). Likewise, there were no statistically significant differences in peri-implant marginal bone loss at 4 months after loading between groups (P = 0.9011:-0.21 mm ± 0.28 for Group 1,-0.25 mm ± 0.27 for Group 2,-0.28 mm ± 0.57 for Group 3 and-0.24 mm ± 0.26 for Group 4). Furthermore, there were no differences in patient satisfaction in terms of either function (P = 0.400) or aesthetics (P = 1.000), and all patients would undergo the same intervention again. CONCLUSIONS. No appreciable statistical or clinical differences were found between cre-stal or 1.5 mm subcrestal placement of transmucosal implants in posterior jaws or between rehabilitation with screw-retained or cement-retained crowns. However, longer follow-ups are required in order to formulate reliable clinical recommendations. CONFLICT OF INTEREST STATEMENT. GlobalD (Brignais, France), the manufacturer of the implants used in this investigation, partially funded this trial and donated the implants and the prosthetic components. However, all data belongs to the authors and the sponsor by no means interfered with the conduct of the trial or the publication of its results.

2020 - Clinical Factors Influencing the Outcomes of an Acellular Dermal Matrix for Skin Cancer Treatment: A Retrospective Study [Articolo su rivista]
Ferrari, B.; Reggiani, C.; Francomano, M.; Bellini, P.; Ferrari, F.; Giacomelli, L.; Mannocci, A.; Magnoni, C.
abstract

OBJECTIVE: To evaluate the efficacy and safety of a biologically engineered dermal matrix used in reconstructive surgery after skin tumor resection, focusing on the frequency of successful grafting and identifying potential factors influencing treatment outcomes. DESIGN AND PARTICIPANTS: This retrospective analysis involved consecutive patients diagnosed with skin cancer in any area of the body and for which treatment with a dermal skin template was recommended as alternative to traditional surgery. MAIN OUTCOME MEASURES: Percentage of successful grafting and the patient and tumor characteristics influencing treatment outcome via univariate analysis. MAIN RESULTS: A total of 302 patients were included. Surgical reconstruction with the matrix was effective in 88.9% of the patients within 21 days of surgery. Notably, the matrix was successful regardless of tumor location, type, or size. Infection was the only variable significantly associated with graft failure (P < .001). CONCLUSIONS: The studied dermal matrix provides an efficient alternative to traditional reconstructive surgery in patients who present specific comorbidities or risk factors. The only variable significantly associated with graft failure was infection, which should be properly controlled through appropriate treatment.

2020 - Conservative treatment of unicystic mural ameloblastoma [Articolo su rivista]
Consolo, U.; Tognacci, S.; Bencivenni, D.; Felice, P.; Bellini, P.
abstract

Mural ameloblastoma is a subtype of Unicystic Ameloblastoma characterised by the expansion or infiltration of tumour nodules into the fibrous wall of the cyst. The behaviour of this subtype is highly aggressive, with a risk of recurrence comparable with that of Conventional Ameloblastoma. Consequently, the preferred treatment for Unicystic mural Ameloblastom is broad resection of the tumour. In this case report we describe the successful conservative treatment of a Unicystic mural Ameloblastom associated with an impacted tooth. The conservative treatment consinsted in a initial marsupialization followed by the enucleation of the lesion performed with a lateral corticotomy to create a “bone door” and the relocation of the “bone door” using microplates and titanium screws. Our conservative approach preserved the integrity of the inferior alveolar nerve as well as mandibular functionality and resulted in a good aesthetic outcome. Due to the behaviour of this lesion, a strict follow up is mandatory. In our experience, follow-up is conducted as long as possible regardless of the surgical treatment. This protocol includes Cone Beam CT performed 1 year after surgery and panoramic radiology (OPG) once a year until 5 years after surgery. OPG is then repeated every 3 years in patients with Unicystic Ameloblastoma and every 2 years in those with Conventional Ameloblastoma or ameloblastoma with mural invasion. Suspected recurrence should be evaluated by CBCT.

2020 - Dynamic Navigation in Dental Implantology: The Influence of Surgical Experience on Implant Placement Accuracy and Operating Time. An in Vitro Study [Articolo su rivista]
Pellegrino, Gerardo; Bellini, Pierantonio; Cavallini, Pier Francesco; Ferri, Agnese; Zacchino, Andrea; Taraschi, Valerio; Marchetti, Claudio; Consolo, Ugo
abstract

Aim: the aim of this in vitro study was to test whether the implant placement accuracy and the operating time can be influenced by the operator's experience. Materials and methods: sixteen models underwent a (Cone Beam Computer Tomography) CBCT and implant positioning was digitally planned on this. The models were randomly assigned to four operators with different levels of surgical experience. One hundred and twelve implant sites were drilled using a dynamic navigation system and operating times were measured. Based on postoperative CBCTs, dental implants were virtually inserted and superimposed over the planned ones. Two-dimensional and 3D deviations between planned and virtually inserted implants were measured at the entry point and at the apical point. Angular and vertical errors were also calculated. Results: considering coronal and apical 3D deviations, no statistically significant differences were found between the four operators (p = 0.27; p = 0.06). Some vectorial components of the deviation at the apical point and the angular errors of some operators differed from each other. Conclusions: within the limitations of this study, dynamic navigation can be considered a reliable technique both for experienced and novice clinicians.

2020 - Enucleation of a multilocular odontogenic keratocyst using sagittal osteotomy: A case report [Articolo su rivista]
Consolo, U.; Tognacci, S.; Barausse, C.; Carlo Salgarelli, A.; Bellini, P.
abstract

Odontogenic keratocysts are significant cysts of the jaw that are characterized by aggressive behavior and a high tendency to recur. The treatments of choice may be radical or conservative, and in the literature a debate is still open about the gold standard in the treatment of OKCs.This report describes a wide multilocular OKC extended in the right mandibular ramus and illustrates atypical behavior of a cystic lobe after marsupialization, not found to our knowledge in the previous literature. Moreover, an orthognathic procedure, consisting of sagittal osteotomy was chosen for the excision of the cyst to preserve as much bone as possible and the integrity of the inferior alveolar nerve.

2020 - Epidemiological Aspects and Psychological Reactions to COVID-19 of Dental Practitioners in the Northern Italy Districts of Modena and Reggio Emilia [Articolo su rivista]
Consolo, Ugo; Bellini, Pierantonio; Bencivenni, Davide; Iani, Cristina; Checchi, Vittorio
abstract

The outbreak and diffusion of the Severe Acute Respiratory Syndrome-Coronavirus-2 (Sars-CoV-2) and COronaVIrus Disease 19 (COVID-19) have caused an emergency status in the health system, including in the dentistry environment. Italy registered the third highest number of COVID-19 cases in the world and the second highest in Europe. An anonymous online survey composed of 40 questions has been sent to dentists practicing in the area of Modena and Reggio Emilia, one of the areas in Italy most affected by COVID-19. The survey was aimed at highlighting the practical and emotional consequences of COVID-19 emergence on daily clinical practice. Specifically, it assessed dentists' behavioral responses, emotions and concerns following the Sars-CoV-2 pandemic restrictive measures introduced by the Italian national administrative order of 10 March 2020 (DM-10M20), as well as the dentists' perception of infection likelihood for themselves and patients. Furthermore, the psychological impact of COVID-19 was assessed by means of the Generalized Anxiety Disorder-7 test (GAD-7), that measures the presence and severity of anxiety symptoms. Using local dental associations (ANDI-Associazione Nazionale Dentisti Italiani, CAO-Commissione Albo Odontoiatri) lists, the survey was sent by email to all dentists in the district of Modena and Reggio Emilia (874 practitioners) and was completed by 356 of them (40%). All dental practitioners closed or reduced their activity to urgent procedures, 38.2% prior to and 61.8% after the DM-10M20. All reported a routinely use of the most common protective personal equipment (PPE), but also admitted that the use of PPE had to be modified during COVID-19 pandemic. A high percentage of patients canceled their previous appointments after the DM-10M20. Almost 85% of the dentists reported being worried of contracting the infection during clinical activity. The results of the GAD-7 (General Anxiety Disorder-7) evaluation showed that 9% of respondents reported a severe anxiety. To conclude, the COVID-19 emergency is having a highly negative impact on the activity of dentists practicing in the area of Modena and Reggio Emilia. All respondents reported practice closure or strong activity reduction. The perception of this negative impact was accompanied by feelings of concern (70.2%), anxiety (46.4%) and fear (42.4%). The majority of them (89.6%) reported concerns about their professional future and the hope for economic measures to help dental practitioners.

2020 - Guided Bone Regeneration with Nonresorbable Membranes in the Rehabilitation of Partially Edentulous Atrophic Arches: A Retrospective Study on 122 Implants with a 3- to 7-Year Follow-up [Articolo su rivista]
Pistilli, R.; Simion, M.; Barausse, C.; Gasparro, R.; Pistilli, V.; Bellini, P.; Felice, P.
abstract

The aim of this retrospective study was to evaluate clinical and radiographic outcomes of guided bone regeneration (GBR) procedures in the rehabilitation of partially edentulous atrophic arches. A total of 58 patients were included with a follow-up of 3 to 7 years after loading. Data seem to indicate that GBR with nonresorbable membranes can be a good clinical choice and suggest that it could be used to vertically reconstruct no more than 6 mm of bone in the posterior mandible. However, this technique remains difficult and requires expert surgeons.

2020 - Histological changes in odontogenic parakeratinized keratocysts treated with marsupialization followed by enucleation [Articolo su rivista]
Consolo, U; Setti, G; Tognacci, S; Cavatorta, C; Cassi, D; Bellini, P
abstract

BACKGROUND: The purpose of this study was to evaluate whether marsupialization treatment induces changes in the histology of odontogenic keratocyst epithelium and to compare our experience with the literature.MATERIAL AND METHODS: A retrospective revision of histological samples was performed. 5 patients with odontogenic keratocyst treated with marsupialization follow by enucleation were selected. Histologic evaluation analyzed the changes in the keratocyst epithelium after marsupialization in terms of type of keratinization, thickness of the epithelium and connective tissue, the presence of acanthosis, the presence and grade of fibrosis, the type and grade of inflammation and the presence and number of mitotic figures and daughter cysts.RESULTS: In our case series, a variation of para-keratinized into ortho-keratinized keratocyst was found in one case, and no significant increases were observed in the epithelium and capsule thickness, or even in the level of inflammation. However, we observed an increase in fibrosis and qualitative changes in inflammation type.CONCLUSIONS: Minor and major histological changes were associated with reduction in cyst volume, which resulted in a simpler and less invasive cystic enucleation after marsupialization.

2020 - IMMEDIATE LOADING OF 3 MM-DIAMETER IMPLANTS AS AN ALTERNATIVE TO HORIZONTAL BONE AUGMENTATION FOR PLACING 4 MM-DIAMETER IMPLANTS: ONE-YEAR POST-LOADING RESULTS FROM A MULTICENTRE RANDOMISED CONTROLLED TRIAL [Articolo su rivista]
Esposito, M.; Barausse, C.; Pistilli, R.; Bellini, P.; Buti, J.; Felice, P.
abstract

PURPOSE. To evaluate the effectiveness of immediately loaded 3 mm-diameter implants as an alternative to horizontal bone augmentation procedures to allow placement of implants with a conventional diameter of 4 mm. MATERIALS AND METHODS. Forty-five partially edentulous patients with between 4 and 5 mm of bone width 3 mm below the crest in areas requiring one to three adjacent implants were randomised, according to a parallel-group design, to receive one to three 3.0 mm-diameter implants to be loaded immediately (23 patients) or horizontal crest augmentation with a granular bone substitute covered with a bone lamina for placing, after 6 months of healing, one to three 4 mm-diameter implants (22 patients) at two centres. Implants at augmented sites were left to heal unloaded for 4 months. Four mm-diameter implants were restored using provisional screw-retained reinforced acrylic prostheses, replaced after 4 months by definitive prostheses. Three mm-diameter implants were loaded immediately with definitive metal-composite prostheses if the insertion torque was ≥ 35 Ncm, or otherwise after 4 months. Patients were followed-up to 1 year post-loading. Outcome measures were: prosthesis and implant failures, any complication, peri-implant marginal bone level changes, and patient satisfaction. RESULTS. Two patients dropped out of the augmentation group. In three patients, five 3 mm-diameter implants could not be inserted with a torque of 35 Ncm, so they were submerged unloaded for 4 months. Two implants failed in two patients from the augmentation group (P = 0.2333; difference in proportion =-0.09; CI 95%-0.24 to 0.07) and neither patient was fitted with a prosthesis. Five patients with narrow-diameter implants were affected by six complications versus 11 augmented patients with 12 complications, the difference being statistically significant (P = 0.0477; difference in proportion =-0.28; CI 95%-0.52 to 0). One year after loading, patients with 3 mm-diameter implants lost on average 0.14 mm of peri-implant bone, while augmentation patients lost 0.52 mm. The difference in bone loss between the two groups was statistically significant (mean difference = 0.38 mm, 95% CI 0.10 to 0.66, P = 0.0112). Five 3-mm group patients versus two augmentation group patients (mean difference = 0.12 mm, 95% CI-0.12 to 0.32, P = 0.4205) and one 3-mm group patient versus two augmentation group patients (mean difference =-0.06 mm, 95% CI-0.23 to 0.12, P = 0.5900) were partially satisfied with function and ae-sthetics, respectively, all remaining patients being fully satisfied. All patients would un-dergo the same procedure again. CONCLUSIONS. One year after loading, patients treated with 3 mm-diameter implants exhibited better results than those receiving horizontal augmentation for placement of 4 mm-diameter implants. Three mm-diameter implants might therefore be the preferable choice with respect to horizontal bone augmentation, the treatment being less invasive, faster, cheaper, and associated with less morbidity and peri-implant marginal bone loss; however, 5-to 10-year post-loading data will be necessary before reliable recommenda-tions can be made.

2020 - Minimally invasive rehabilitation of a severely atrophic and fully edentulous maxilla using 4-mm-ultrashort implants: A case report with 1-year follow-up [Articolo su rivista]
Felice, P.; Karaban, M.; Pistilli, R.; Bellini, P.; Bonifazi, L.; Barausse, C.
abstract

This case report describes an alternative minimally invasive treatment option using 4-mm-long ultrashort implants placed to rehabilitate a severely atrophic edentulous maxilla. The patient, coming from a full removable denture, asked for an implant prosthesis avoiding reconstructive surgeries and expensive procedures. Considering that the mean available bone was about 4.8 mm in height on Cone Beam Computed Tomography (CBCT) scans, 6 implants were placed where bone volumes were sufficient to receive 4-mm-ultrashort implants. Six months after implant placement an implant-supported bar-retained overdenture prosthesis was delivered. The healing process was uneventful and 1 year after loading the result appears clinically and radiographically stable and the patient is fully satisfied. The described approach, despite some prosthetic compromises, within all the limitations of this case report, might be applied in selected cases, reducing rehabilitative times, possible complications and costs. However, longer follow-ups on large number of patients coming from Randomised Controlled clinical Trials (RCTs) are necessary before making more reliable recommendations.

2020 - Post-extractive implants: Clinical indications and literature analysis [Articolo su rivista]
Bentivogli, F.; Karaban, M.; Barausse, C.; Pistilli, R.; Iezzi, G.; Bellini, P.; Felice, P.
abstract

OBJECTIVES The aim of this study is to evalua-te the current state of the art in the management of the patient with the need for implant placement immediately after the extraction of the dental element. The advantages and disadvantages of the different therapeutic options in the fixed implant rehabilitation of the post-extractive socket have been analyzed. Authors’ clinical experience will be taken also into consideration to better support scientific evidence. MATERIALS AND METHODS Taken into consideration the recent literature and scientific evidence, the current studies with the highest scientific impact have been exami-ned. In particular, the different im-plant insertion timings, contextual to the extraction of the dental ele-ment (immediate), after 6-8 weeks (immediate-delayed) and the clas-sic approach after 4-6 months (de-layed) were evaluated. The management of the bone to implant gap and the need to sur-gically preserve the post-extrac-tion site have been also analyzed. RESULTS No statistically significant differences emerged between the various implant placement timings, in terms of failures, complications and patient satisfaction. However there seems to be a tendency for failure and complications in immediate and immedia-te-delayed implant placement, which are also technically more demanding. On the other hand, patients whom rehabilitation times are considera-bly reduced tend to be more sati-sfied. Moreover, immediate implant placement does not seem to prevent considerable loss of bone volume, while the use of bone grafts in the bone to implant gap seems to decrease the physiologi-cal buccal bone resorption, even if there are no statistically signifi-cant differences in the studies ta-ken into consideration. Additionally, the alveolar ridge preservation, compared to extraction alone, reduces the need for a surgical session in order to recon-struct the bone. No particular differences emerged by comparing various types of bio-materials or membranes, however, the application of biomaterial in as-sociation with resorbable membranes seems to achieve good results in terms of loss of bone volumes. CONCLUSIONS According to the current literature and the authors’ experience, post-extractive implants are nowadays considered as an alternative to tra-ditional procedures because they can have important benefits for both the patient and the clinician. However, there are a tendency for more failures and complications associated with this procedure. If the clinician decides to place post-extractive implants or delay-ed implants, in either cases, our suggestion is to fill the bone to im-plant gap with biomaterial in as-sociation with a resorbable mem-brane in order to prevent loss of bone volumes. However, larger studies, especial-ly Randomised Controlled Clinical Trials (RCTs) with longer follow-ups are needed to better evaluate these alternatives. CLINICAL SIGNIFICANCE Post-extractive implant placement can be an option for those patients requiring a reduction in re-habilitative times. However, the potential disadvantages, such as failures and complications should be always clarified and discussed with the patient along with possible therapeutic alternatives.

2020 - Salivary microRNA for diagnosis of cancer and systemic diseases: A systematic review [Articolo su rivista]
Setti, G.; Pezzi, M. E.; Viani, M. V.; Pertinhez, T. A.; Cassi, D.; Magnoni, C.; Bellini, P.; Musolino, A.; Vescovi, P.; Meleti, M.
abstract

Background: The aberrant expression of microRNAs (miRNAs) has been associated with several diseases, including cancer, inflammatory, and autoimmune conditions. Interest in salivary miRNAs as non-invasive tools for the diagnosis of malignancies and systemic diseases is rapidly increasing. The present systematic review was developed for answering the question: “Are salivary microRNAs reliable biomarkers for diagnosis of cancer and systemic diseases?” Methods: The application of inclusion and exclusion criteria led to the selection of 11 papers. Critical appraisals and quality assessments of the selected studies were performed through the National Institute of Health “Study Quality Assessment Tool” and the classification of the Oxford Center for Evidence-Based Medicine. Results: Seven studies reported statistically significant correlations between one or more salivary miRNAs and the investigated disease. The critical analysis allowed us to classify only two studies (18.2%) as having “good” quality, the rest being scored as “intermediate” (8; 73%) and “poor” (1; 9%). Evidence exists that salivary miR-940 and miR-3679-5p are reliable markers for pancreatic cancer and that miR140-5p and miR301a are promising molecules for the salivary diagnosis of gastric cancer. Conclusions: Further studies, possibly avoiding the risk of bias highlighted here, are necessary to consolidate these findings and to identify new reliable salivary biomarkers.

2020 - Surgical Management of Medication-Related Osteonecrosis of the Jaw Patients Related to Dental Implants [Articolo su rivista]
Nisi, Marco; Izzetti, Rossana; Gennai, Stefano; Bellini, Pierantonio; Graziani, Filippo; Gabriele, Mario
abstract

The aim of the present study is to report a case series of patients with peri-implant medication-related osteonecrosis of the jaw (MRONJ), in particular describing the onset of the condition and surgical treatment outcome.

2020 - The role of matrix metalloproteinases in periodontal disease [Articolo su rivista]
Checchi, V.; Maravic, T.; Bellini, P.; Generali, L.; Consolo, U.; Breschi, L.; Mazzoni, A.
abstract

This review provides a detailed description of matrix metalloproteinases (MMPs), focusing on those that are known to have critical roles in bone and periodontal disease. Periodontal disease is an inflammatory process initiated by anaerobic bacteria, which promote the host immune response in the form of a complex network of molecular pathways involving proinflammatory mediators such as cytokines, growth factors, and MMPs. MMPs are a family of 23 endopeptidases, collectively capable of degrading virtually all extracellular matrix (ECM) components. This study critically discusses the available research concerning the involvement of the MMPs in periodontal disease development and progression and presents possible therapeutic strategies. MMPs participate in morphogenesis, physiological tissue turnover, and pathological tissue destruction. Alterations in the regulation of MMP activity are implicated in the manifestation of oral diseases, and MMPs comprise the most important pathway in tissue destruction associated with periodontal disease. MMPs can be considered a risk factor for periodontal disease, and measurements of MMP levels may be useful markers for early detection of periodontitis and as a tool to assess prognostic follow-ups. Detection and inhibition of MMPs could, therefore, be useful in periodontal disease prevention or be an essential part of periodontal disease therapy, which, considering the huge incidence of the disease, may greatly improve oral health globally.

2019 - Evaluation of Biological Response of STRO-1/c-Kit Enriched Human Dental Pulp Stem Cells to Titanium Surfaces Treated with Two Different Cleaning Systems. [Articolo su rivista]
Conserva, E; Pisciotta, A; Bertoni, L; Bertani, Giulia; Meto, A; Colombari, B; Blasi, E; Bellini, P; de Pol, A; Consolo, U; Carnevale, G.
abstract

Peri-implantitis-an infection caused by bacterial deposition of biofilm-is a common complication in dentistry which may lead to implant loss. Several decontamination procedures have been investigated to identify the optimal approach being capable to remove the bacterial biofilm without modifying the implant surface properties. Our study evaluated whether two different systems-Ni-Ti Brushes (Brush) and Air-Polishing with 40 µm bicarbonate powder (Bic40)-might alter the physical/chemical features of two different titanium surfaces-machined (MCH) and Ca++ nanostructured (NCA)-and whether these decontamination systems may affect the biological properties of human STRO-1+/c-Kit+ dental pulp stem cells (hDPSCs) as well as the bacterial ability to produce biofilm. Cell morphology, proliferation and stemness markers were analysed in hDPSCs grown on both surfaces, before and after the decontamination treatments. Our findings highlighted that Bic40 treatment either maintained the surface characteristics of both implants and allowed hDPSCs to proliferate and preserve their stemness properties. Moreover, Bic40 treatment proved effective in removing bacterial biofilm from both titanium surfaces and consistently limited the biofilm re-growth. In conclusion, our data suggest that Bic40 treatment may operatively clean smooth and rough surfaces without altering their properties and, consequently, offer favourable conditions for reparative cells to hold their biological properties.

2019 - Integra in Scalp Reconstruction After Tumor Excision: Recommendations From a Multidisciplinary Advisory Board [Articolo su rivista]
Magnoni, Cristina; De Santis, Giorgio; Fraccalvieri, Marco; Bellini, Pietrantonio; Portincasa, Aurelio; Giacomelli, Luca; Papa, Giovanni
abstract

Integra is a dermal regeneration template used in the reconstruction of burns, traumatic injuries, or excision lesions in patients who present particular risk factors for traditional surgical procedures. A multidisciplinary advisory board of expert dermatologists and plastic surgeons have discussed the use of Integra in the reconstruction of scalp defects after tumor excision, focusing on the evidence derived from literature and on their experience in the treatment of approximately 400 patients. In this position paper, the authors summarize the main evidence discussed during the board, and the common practice guidelines proposed by the experts. The use of Integra is recommended in elderly patients with multiple comorbidities who have a higher risk for potential complications in traditional surgery; these patients may in fact benefit from a lower anesthetic risk, a less complicated postsurgical care and limited morbidity at the donor site obtained with the dermal template. Integra should also be used in the reconstruction of large and complex wounds and in case of bone exposure, as it helps to overcome the challenges related to wound healing in difficult areas. Notably, Integra has proven to be effective in patients who have undergone previous surgical procedures or adjuvant radiation therapy, in which previous incisions, scarring and radiation damages may hamper the effectiveness of traditional procedures. Finally, Integra is recommended in patients with recurrent and aggressive tumors who need closer tumor surveillance, as it gives easy access to the tumor site for oncologic follow-up examination.

2019 - Oral and cutaneous lichen planus correlate to primary sclerosing cholangitis: a case report [Abstract in Atti di Convegno]
Tognacci, S.; Setti, G.; Lizio, G.; Consolo, U.; Bellini, P.
abstract

Aim. Lichen planus (LP) is a chronic inflammatory and immune-mediated disease with a mucosal and cutaneous involvement. The pathogenesis is characterized by T CD8+ and CD4+ mediated response against epithelial basal cells, leading to basal layer degeneration and sub-epithelial band like T-lymphocytes infiltration. The etiology is still unknown, but it is believed that many environmental agents can trigger the disease in genetically predisposed subjects. These agents include drugs, microbial and viral infections and contact sensitizers. In literature, cases of LP are reported in association with other autoimmune pathologies such as graft versus-host disease, lupus erythematous, primary biliary cirrhosis and Sjögren’s syndrome. The elevated risk of developing LP in patients with chronic hepatopathy, in particular those infected with HCV, has been documented but it is still controversially discussed. The concurrent presentation of primary sclerosing colangitis (PSC) and LP has been previously described in five cases: one nail lichen and four oral lichen planus (OLP). Materials and Methods. A 67-year-old woman was referred to our clinic by her general dentist for evaluation of oral lesions associated with burning and pain symptoms. The patient reported the presence of a white-red painful fissured lesion, involving tongue and cheeks since 6 months. Fluctuating period of remission and worsening were described, strongly associated with spicy and acid food. Medical history was positive for primary sclerosing colangitis, diagnosed in 1997 and treated with angioplasty. In addition, the patient underwent excision of a pulmonary lobe for bronchial carcinoma and thyroidectomy for Hürthle cells adenoma. Drug history accounts for chronic intake of levothyroxine, potassium canreonate, ranitidine and torasemide. Widespread erythematous areas were highlighted during clinical examination, involving keratinized gingiva, lip vermilion, tongue dorsal mucosa and the buccal mucosa. Deep fissurations were present in the tongue dorsal mucosa, while the buccal mucosa showed the presence of reticular white lesion (Wickham's stripes). Moreover, a scaling erythematous dermatitis was appreciable in patient hands and legs skin with tendency to confluence and central atrophy. Scalp skin and hair follicles were also involved. The dermatitis appeared to be distributed predominantly in the photo-exposed areas. The patient referred the onset of these cutaneous manifestation since December 2008, firstly to hands and later to legs and back. Patient thus referred about a skin biopsy, which was not diagnostic for cutaneous lichen. An incisional biopsy of the buccal mucosa was performed. Results. Histologic examination showed sections of malpighian mucosa with hyperkeratosis, acanthosis and vacuolization of the basal cell layer associated with the presence of necrotic keratinocytes (civatte bodies) and chronic infiammatory infiltration. The diagnosis of oral lichen planus was determined by the clinical and histological result. To date, the patient has refused to perform a new skin biopsy for diagnosis completion. Discussion. The reported OLP case describes the common epidemiologic appearance. Average age of OLP onset is the 6th decade, lesion affects women and men with a ratio of 2:1. Clinically, characteristic features are present such as Wickham's striae, well- defined looping and intersecting white lines or striae on a background of minimal substantial erythema, and the typical course with period of remission and exacerbation. The buccal mucosa, the tongue, and the gingiva are the most often affected sites. Approximately two-thirds of patients experience discomfort even if the symptoms are very variable; in addition to a spontaneous manifestation, patients occasionally experience discomfort or pain only upon contact with spicy or acidic foods. Moreover, sense of mucosal roughness, reduced mucosal flexibility, a

2019 - Salivary 1H-NMR Metabolomics in Primary Sjögren Syndrome. Preliminary Results of a Pilot Case-Control Study [Abstract in Rivista]
Setti, G.; Sandri, G.; Tarentini, E.; Panari, L.; Mucci, A.; Righi, V.; Meleti, M.; Magnoni, C.; Consolo, U.; Bellini, P.
abstract

2019 - Self-healing CD30- T-clonal proliferation of the tongue: report of an extremely rare case [Articolo su rivista]
Setti, Giacomo; Martella, Eugenia; Mancini, Cristina; Vescovi, Paolo; Magnoni, Cristina; Bellini, Pierantonio; Giovannacci, Ilaria; Meleti, Marco
abstract

The etiology of traumatic ulcerative granulomas with stromal eosinophilia (TUGSE) is not clear, traumatic irritation having advocated as the most likely cause. TUGSEs are typically self-limiting slow-healing lesions of the oral mucosa with unclear pathogenesis, commonly manifesting as a rapidly developing, long-lasting ulcer.

2019 - The comparison of the proteomic profile of periodontal pocket and of corresponding gingival crevicular fluid to study periodontal disease biomarkers: feasibility study. biomarkers: feasibility study [Abstract in Rivista]
Bertoldi, Carlo; Franceschetti, Filippo; Bergamini, Stefania; Giannetti, Luca; Generali, Luigi; Bellini, Pierantonio; Consolo, Ugo
abstract

Aim: Periodontitis is a set of inflammatory disorders characterized by periodontal attachment loss by periodontal pocket development, leading to tooth loss if remain untreated. The etiology and progress of periodontal disease is complex and remains mostly unknown. So, periodontal disease therapy has considerable limitations. The easy, reliable and correct early detection and control of the disease, markedly reduces biological and social costs. However, the diagnosis of periodontitis is established exclusively by clinical criteria based on probing to assess periodontal pockets, which are the pathognomonic expression of periodontal disease. The -omic sciences acquired substantial significance of late years and, in particular, proteomic seemed to be the more promising in this initial stage. Most proteomic analysis regarding periodontal diseases have been performed on saliva, crevicular fluid samples, peripheral blood or periodontal plaque samples which are more easily to harvest than the tissue of the periodontal pocket. However, they failed to provide reliable results for clinical applications. On the contrary, very few studies were directly performed on the periodontal pocket. So, the aim of this study was to compare the proteomic profile of interproximal pocket tissues with that of GCF, and to analyze if they show a significant similarity in the proteomic profile. Methods: in this preliminary study, we enrolled 3 healthy subjects affected by severe periodontitis needing of periodontal surgery. Immediately before the surgery, GCF samples were taken by means of filter paper strips positioned in the gingival sulcus correspondent to periodontal pockets. Then, periodontal pocket tissue, harvested during surgery, was adequately stored for proteomic analyses. All samples were immediately frozen at –80°C and maintained until further analysis. Tissue samples were mechanically disrupted and incubated in lysis buffer, while GCF was obtained incubating the collecting paper in phosphate buffered. In both cases, after centrifugation, the supernatant was precipitated in cold acetone overnight and protein content were pelleted by centrifugation and then dissolved in a rehydration buffer. Mono-dimensional gel electrophoresis was used to separate protein content. After staining gel images were acquired and compared. Liquid chromatography coupled to mass spectrometry (LC-MS/MS) analysis was performed to allow protein spot identification. Results: 1-DE gels from periodontal pocket tissue and the correspondent GCF was analyzed by software Quantity One. Almost the same qualitative protein expression profile in pocket tissue and GCF was found from each patient. However, no statistical significant correlation between the quantitative proteomic profile of pocket tissue and GCF was found. Only one band (that of K immunoglobulin) resulted statistically significant between GCF and pocket tissue proteome in all patients. Conclusions To date, this is the first study comparing the proteome of periodontal pocket tissue and corresponding GCF. The periodontal pocket and the GCF are similar as proteomic networks, but the protein network of the periodontal pocket does not influence significantly the GCF protein network and the other way around. So, with the limitations of this study, the preliminary results seem to indicate that the GCF does not seem suitable to study on the pathogenesis of periodontal disease explaining the reason for the failure of studies based only on GCF to control the periodontal disease in real-time.

2019 - The “Bat Flap”: A flap for reconstruction of large skull skin defects [Articolo su rivista]
Reggiani, C.; Bellini, P.; Salgarelli, A. C.; Setti, G.; Ferrari, B.; De Santis, G.; Starnoni, M.; Magnoni, C.
abstract

2018 - Adhesion and proliferation of human dental pulp stem cells on a laser micro textured implant surface: An in vitro study [Articolo su rivista]
Conserva, Enrico; Consolo, Ugo; Bellini, Pierantonio
abstract

The roughness of the implant surface and its chemistery and toporaphy were demonstrated to impact cells biological properties. A moderate roughness seems to allow better and faster adhesion and proliferation and to accelerate the biological processes. The different physical and chemical procedures used to obtain a certain microtopography modify the surface chemical composition and, in consequence of it, can affect the biological cell behavior. The ideal surface shuold be obtained through processes that do not modify the chemical composition maintaining a right roughness and microtopography. The aim of this investigation was to study the morphology, proliferation and pattern of distribution of human Dental Pulp Stem Cells (hDPSCs) after 5 days of growth on a laser micro-grooved implant surface (Laser-Lock, Bio Horizons IPH, Inc. Birmingham, AL 35244, USA) characterized by a micro geometric design obtained by computer-aided laser ablation without any chemical treatment. Data from SEM surface observation and XPS chemical analysis have highlighted the absence of contaminating chemical elements. The results from cell cultures indicated that the hDPSCs maintained a good morphology and well proliferated following the microgrooves direction.

2018 - Identifying the factors that influence surgeon's compliance with excisional margins of non-melanoma skin cancer [Articolo su rivista]
Cautela, Jennifer Marchetti; Mannocci, Alice; Reggiani, Camilla; Persechino, Flavia; Ferrari, Federica; Rossi, Elena; Passini, Erika; Bellini, Pierantonio; Meleti, Marco; WERTZBERGER ROWAN, Sara; Magnoni, Cristina
abstract

The rising incidence of Non Melanoma Skin Cancers (NMSC) leads to a high number of surgical procedures worldwide. The strict compliance with international guidelines with regard to excisional margins may help decrease the number of re-excision procedures and reduce the risk of NMSC recurrence. The aim of this study was to investigate the prevalence of excisional margins as recommended by the European Academy of Dermatology and Venereology (EADV) and the European Dermatology Forum (EDF) guidelines, and the factors (demographic or clinical) that influence surgeons' compliance with these guidelines.This was a prevalence study looking at surgical excisions of NMSCs performed over a period of 2 years (2011-2012). A sample size of 1669 patients was considered. Definition of excisional margins recommended by the international guidelines (EADV and EDF) were used as point of reference for the analysis. Tumor and histologic specimen size were calculated ex vivo by 5 different pathologists. The size of skin specimens was measured with a major axis and a minor axis. The same was done for the tumor present on the skin specimens. The differences between the major and minor axes of surgical specimen and tumor were calculated. These differences were subsequently divided by two, hypothesizing that the lesion had the same distance from the margins of the surgical specimen. The differences obtained were named "Delta", the formulas applied being the following: Delta major = (major axis specimen-major axis tumor)/2; Delta minor = (minor axis specimen -minor axis tumor)/2.Results show a significant statistical difference, associated with factors such as: Age of the patient, anatomical localization of the tumor, histological diagnosis, and surgeons' experience.The identification of these factors sheds light on clinicians' practice and decision-making regarding excisional margins. Hopefully a higher level of adherence to the guidelines can be achieved in the future.

2018 - Trans-nasal endoscopic marsupialization of a voluminous radicular cyst involving maxillary sinus and nasal cavity: A case report and a literature review on this surgical approach [Articolo su rivista]
Consolo, U.; Bellini, P.; Lizio, G
abstract

The treatment of a huge cystic lesion in the upper jaw involving the respiratory cavities may result challenging. A traditional oral approach entails patient discomfort and may have negative aesthetic implications. This treatment, particularly in case of enucleation not preceded by marsupialization for volumetric reduction of the lesion, may cause irreversible damage to important anatomical structures and the collapse of the bone architecture. The purpose of this case report is to show the benefits of an endoscopic trans-nasal approach for the definitive treatment of such a clinical situation. The surgical technique aimed to remove part of the cystic wall and to open the inner compartment of the lesion to the nasal cavity after the resection of the anterior edge of the inferior turbinate and the lateral wall of the inferior nasal meatus. After a follow-up period of 18 months, without any problem or discomfort for the patient, the cyst appeared radiologically healed without the loss of any lesion-associated tooth. The bone nasal cavity, the maxillary sinus and the anterior alveolar process architecture, noticeably modified by the expansive enlargement of the cyst, resulted completely restored with a complete recover of the respiratory and oral functions.

2017 - Erratum to: Prevalence and characterization of non-sicca onset primary Sjögren syndrome with interstitial lung involvement (Clinical Rheumatology, (2017), 36, 6, (1261-1268), 10.1007/s10067-017-3601-1) [Articolo su rivista]
Manfredi, A.; Sebastiani, M.; Cerri, S.; Cassone, G.; Bellini, P.; Della Casa, G.; Luppi, F.; Ferri, C.
abstract

This article originally published with all author names incorrectly listed. All author names have now been transposed and appear correctly above. The original article was corrected.

2017 - Non-melanoma skin cancer of the head and neck: the aid of reflectance confocal microscopy for the accurate diagnosis and management [Articolo su rivista]
Ferrari, Barbara; Salgarelli, Attilio Carlo; Mandel, Victor Desmond; Bellini, Pierantonio; Reggiani, Camilla; Farnetani, Francesca; Pellacani, Giovanni; Magnoni, Cristina
abstract

Background: Non-melanoma skin cancer (NMSC) represents the most common cutaneous neoplasms of the head and neck. In recent years, novel non-invasive diagnostic tool have been developed, and among these we have the reflectance confocal microscopy (RCM), that offers the evaluation of the skin at real time with cellular resolution. Numerous studies have identified the main confocal features of skin tumours, demonstrating the good correlation of these features with certain dermatoscopic patterns and histologic findings. Evidence acquisition: The aim of this analysis was to provide new insight into the role of RCM in the diagnosis and management of NMSC of the head and neck. Data comes from the most recent literature, taking into account previous essential reported information in this field. The study eligibility criteria were: studies providing update information, focusing on RCM findings in NMSC, without restrictions for age, sex, ethnicity. A search concerning the role of dermoscopy and RCM in the diagnosis of NMSC was performed on Medline. Duplicated studies, single case report and papers with language other than English were excluded from this study. Evidence synthesis: RCM clues were analysed for NMSC in association with clinical, dermoscopic and histopathologic findings. Moreover, some new findings have been described and possible applications for NMSC of the head and neck have been discussed. Conclusions: RCM allows tissue imaging in vivo contributing to a more accurate diagnosis of NMSC of the head and neck, sparing time for the patient and costs for the public health system. RCM can also be used for selection of the biopsy site and it is helpful in defining the surgical safety margins to keep during the excision of skin cancers.

2017 - Prevalence and characterization of non-sicca onset primary Sjögren syndrome with interstitial lung involvement [Articolo su rivista]
Manfredi, Andreina Teresa; Sebastiani, Marco; Cerri, Stefania; Cassone, Giulia; Bellini, Pierantonio; DELLA CASA, Giovanni; Luppi, Fabrizio; Ferri, Clodoveo
abstract

Primary Sjögren syndrome (pSS)-related interstitial lung disease (ILD) involved about 10–20% of patients. In 20% of cases, ILD can be diagnosed before pSS; anyway, few studies have investigated the frequency of ILD as the first clinically relevant manifestation of pSS, generally referred to retrospective studies. Aim of our prospective study was to describe prevalence, clinical, serological, and instrumental features of non-sicca onset pSS patients with interstitial lung involvement. During a period of 48 months, all consecutive patients diagnosed as pSS were enrolled. For all patients, the reason for the first visit was recorded. When present, ILD was categorized as definite, possible, or inconsistent with usual interstitial pneumonia (UIP) pattern, according to the current criteria. ILD was the main presenting symptom in 13/77 new diagnoses of pSS patients; in particular, 6/13 patients were initially diagnosed as idiopathic ILD, and only later developed clinical manifestations suggestive for pSS; ILD-pSS patients were older than others and showed a higher EULAR primary Sjögren’s syndrome disease activity index. A radiologic definite or possible UIP pattern was detected in 12/13 pSS. For the first time, we prospectively observed a prevalence of 16.8% of non-sicca onset pSS patients with ILD. Interestingly, UIP pattern was the most frequently detected, while typical autoantibodies were often absent. These features stressed the importance of differential diagnosis in the first stage of the disease, considering the possible poorer prognosis in this subgroup of patients. Multidisciplinary approach is crucial for a correct and early diagnosis, at both onset and follow-up.

2016 - Crescentic flap for the reconstruction of the nose after skin cancer resection [Articolo su rivista]
Arginelli, Federica; Salgarelli, Attilio Carlo; Ferrari, Barbara; Losi, Amanda; Bellini, Pierantonio; Magnoni, Cristina
abstract

Purpose Non-melanoma skin cancers are the most frequent skin tumours; in 25.5% of cases, they are reported to affect the nasal area. For an excellent surgical outcome, first of all the radical excision of the lesion is important, with appropriate margins of healthy skin in order to avoid recurrences. Moreover is important to achieve a good aesthetical result, avoiding distortion of the aesthetic units and preserving their functions. Material and methods We have applied the modified crescentic flap, described by Smadja in 2007, to 24 nasal skin defects left by oncologic surgery. It consists of the crescent-shaped resection of Burow's triangle all around the alar groove that allows the advancement of the flap to the tip of the nose, hiding the scar in the alar groove. Results The outcome and the long-term follow-up were completely satisfactory both for patients and for surgeons. Conclusion For skin defects localized in the midline or paramedian line of the dorsum of the nose, the crescentic flap seems to be a good solution to obtain the better aesthetic result with respect to both anatomy and function of the nasal area, sparing the patient a second intervention or an overly invasive procedure.

2016 - Effects of titanium brushes on different implant surfaces: an in vivo investigation [Abstract in Rivista]
Conserva, Enrico; Bandieri, A.; Bellini, Pierantonio; Generali, Luigi; Sabbadini, L.; Agnini, A.; Consolo, Ugo
abstract

BACKGROUND: Recently, rotating brushes with titanium bristles have been introduced for the debridement of implant surfaces when peri implant problems occur. This study inves- tigated the effects induced by titanium brushes on different implant surfaces previously contaminated in vivo METHODS: n°9 disks, going sterilized directly from manu- facturer, (Megagen Implant Co, Ltd, Korea) (n=3 with HA grit sandblasted RBM surface; n=3 with a Ca2+ incorporated in titanium XPEED surface and n=3 with machined surface) Ø 8mm x 3mm were used for this investigation. N°1 disk for each surface treatment (tot. n°3 disks) were characterized at time 0 by SEM to study the surface morphology and by AFM to study the surface roughness. The other six disks were mounted on an acrylic bite embedded in a buccal lateral posi- tion (three for each side) worn for 48 hours by a student from Dental School, for biofilm accumulation. After 48 hours each disk was removed and randomly assigned to the control group (to study only plaque accumulation) and to the test group (toinvestigate the effects of the cleaning procedure using tita- nium brushes). All disks were treated by the same operator. The Nickel-Titanium brushes (I.C.T. De Ore, Verona, Italy) were used (one for each disk treated) mounted on a handpiece at 500 rpm speed and 100 N torque for 60 sec time with a calibrated pressure of 25 gr and a continue irrigation of NaCl 0.9%. All disks were then analyzed by SEM at 40x, 500x and 2000x, also in backscattering, and by AFM for the Ra (medium value of roughness) and Rp-v (max peak-max depth value) measurement. All Ni-Ti brushes used were analyzed by SEM and compared to a no used one. RESULTS: The MACHINED surface, after instrumentation, appeared well cleansed. However, the SEM images, revealed considerable surface alterations following treatment. The roughness values increased. The RBM surface showed a mini- mum percentage of residual material and after cleaning had some morphological changes. The typical RBM sandblasted structure appear flattened. The roughness values confirm this change by the reduction in value of R p-v. The cleaning effi- cacy of the brush on the XPEED surface was excellent but the surface morphology changed. The SEM images showed the presence of grooves and flattening caused by the use of brush that have eliminated most of the irregularities and of the peaks, confirmed by the roughness values measured. The EDX spectroscopy provided the evidence that part of the Ca ++ ions coating remains on the surface even after treatment. The statistical analysis shows that the Ra difference was statis- tically significant. (p<0.5) The brush used for Xpeed surface is the only one, among those used, that appeared more com- promised after its use. The bristles are very twisted. CONCLUSIONS: In conclusion we can say that the trial of toothbrushes NiTi has shown a good efficacy of cleansing on rough and smooth surfaces. The efficiency of the treatment was, however, accompanied by a visible change in the surface characteristics. While the machined surface at the end of treat- ment showed an increase of roughness values, the rough sur- faces undergo a flattening process with consequent decrease of the roughness measurements. Further studies will be needed to verify if and how these morphological changes will affect biological processes of healing.

2016 - Efficacy of three different irrigation systems on calcium hydroxide removal from round and oval canals: a scanning electron microscopy study [Abstract in Rivista]
Generali, Luigi; Franceschetti, F.; Cavani, Francesco; Pettenati, C. .; Bellini, Pierantonio; Conserva, Enrico; Consolo, Ugo
abstract

BACKGROUND: To evaluate by means of scanning electron microscopy the effectiveness of different irrigation systems in the removal of calcium hydroxide from round and oval canals. METHODS: 76 extracted single-rooted teeth were selected. Criteria for tooth selection included one single root canal; no visible root caries, fractures, or cracks; and a completely formed apex under light microscope examination (10x). Radiographs in bucco-lingual and mesio-distal direction were taken to cal- culate the ratio between canal diameters measured in the two projections. If ratio was less than or equal to 2.5, the canal was considered round, otherwise was considered oval. According to ratio and root length teeth were divided into 8 groups, with 2 control samples. After access cavity preparation, working length was determined 1 mm short of the length where the file extruded the apical foramen. To simulate clinical conditions the apex was sealed with glue. Glide path and canal instrumentation were performed with Path File size 13, 16, 19 and ProTaper Universal rotary system in a crown-down sequence to size 40 at the WL. A size 25 lentulo spiral was used to fill teeth with calci- um hydroxide. Radiographs were taken to confirm the complete filling of the canals. Samples were kept in an incubator at 37° C for a week. Canals were cleaned with Irrisafe, Endovac, Xp Endo Finisher and conventional endodontic needle irrigation. Teeth were split along their long axis in a bucco-lingual direc- tion into 2 halves. For scanning electron microscopic analysis, tooth halves were fixed on aluminum stubs, gold sputter coated and observed with a scanning electron microscope. Apical, middle, and coronal thirds were established by dividing the roots according to their length. The center of each third was examined at 500x magnification. Images were taken using backscattered mode and analyzed with a digital processing software (ImageJ v. 1.49, National Institutes of Health, NIH, USA) for a quantitative analysis. The efficacy of the irriga- tion system was evaluated calculating the amount of calcium hydroxide left inside the canal, expressed as percentage of the total area of the image. To compare the 8 groups, the results were statistically analyzed using the analysis of variance test (ANOVA) with Bonferroni test or T-test (P<0.05). RESULTS: No statistically significant differences were observed among different thirds for each group. Comparing canal shape for each instrument, significant differences were found only for Endovac, where coronal and middle thirds of oval canals were cleaner than round ones. Analyzing the whole canal, significant difference can be found between irrigation systems and conventional irrigation in the oval ones. In round canals Irrisafe and Xp Endo Finisher are more effective compared to conventional irrigation, but only Irrisafe is more effective compared to Endovac. No statistical- ly significant differences can be observed between Endovac and conventional irrigation. CONCLUSIONS: None of the investigated techniques removed the calcium hydroxide completely. However, the results demonstrate greater removal of calcium hydroxide if the irrigant solutions are activated, compared with conven- tional endodontic irrigation. Therefore, it is recommended to activate the irrigant solutions to enhance chemical debride- ment of the root canal system.

2016 - Epithelioid hemangioendothelioma of the mandibular gingiva: A rare case of metastasis 4 years after radical excision and literature review [Articolo su rivista]
Salgarelli, Attilio Carlo; Bellini, Pierantonio; Maccio, Livia; Setti, Giacomo
abstract

Malignant epithelioid hemangioendothelioma (MEH), or high-risk epithelioid hemangioendothelioma, is a low- to intermediate-grade vascular malignancy. A few cases of MEH have been documented in the head and neck region, including the neck, thyroid gland, larynx and scalp. MEHs are extremely rare in the oral cavity. Only 31 cases of MEH in the oral cavity were described in English literature between 1975 and 2014. Further, only eleven cases were referred to MEH of the maxillary or mandibular gingiva. No gingival MEH metastases have been described in literature. We report a literature review and a case of MEH with a metastatic occurrence 4 years after surgical excision.

2016 - Epithelioid hemangioendothelioma of the mandibular gingiva: report of a case and literature review [Abstract in Rivista]
Bellini, Pierantonio; Setti, G; Borghi, F; Conserva, Enrico; Bertoldi, Carlo; Generali, Luigi; Consolo, Ugo
abstract

BACKGROUND: Malignant epithelioid hemangioendothelioma, or high-risk epithelioid hemangioendothelioma, is a low- to intermediate-grade vascular malignancy originally described by Weiss and Enzinger in 1982 as a vascular neo- plasm of endothelial origin. Epithelioid hemangioendothelio- mas have been reported in numerous locations, particularly the lungs, liver, soft tissues, viscera, skin, and bone. The World Health Organisation describes MEH as an intermedi- ate malignant neoplasm. MEHs are extremely rare in the oral cavity. Only eleven cases referred to MEH of the maxillary or mandibular gingiva. CASE REPORT: A 33-year-old male was referred to our Oral and Maxillofacial Service in 2009 for the evaluation of a forma- tion on the alveolar mucosa. A panoramic radiograph review showed a radiolucency between lateral incisor and second pre- molar roots. CT scans showed diffuse cortical bone loss. No signs of radiographic root resorption were detected. The patient denied any history of pain or swelling. A tissue punch biopsy was performed by removing two punches of tissue. A microscopic evaluation revealed fragments composed of a proliferation of spindled, ovoid, and epithelioid cells arranged in nests, cords, and short strands. The neoplastic cells were large and polygonal with an abundant and granular cytoplasm, nuclear pleomorphism, and nuclear hyperchromatism. The lesion exhibited small vascular channels with a moderate cel- lular inflammatory infiltrate, composed mainly of lympho- cytes, plasma cells, and eosinophils surrounding the vessels. Focal mitotic activity was identified, and the Ki-67 percentage score was 20%. After immunohistochemistry a diagnosis of MEH was made. No signs of metastasis were detected (cN0) by an investigation of the patient’s neck nodes, computed tomography, and ultrasonography. Anterior mandibular bone excision, including eight teeth and all related soft tissues, was performed under general anesthesia. A histologic examination of the lesion confirmed the diagnosis of MEH. The limits of resection were investigated to ensure clean and safe excision margins. No neck dissection was performed at this time. The patient was followed up at 15 days, 1 month, 3 months, 6 months, and then every 6 months for 4 years with a clinical investigation of soft tissues, clinical and ultrasonographic evaluations of lymph nodes, and radiographic assessment of bone healing. The entire follow-up period was 46 months. DISCUSSION: No consistent clinical or histologic criteria for predicting the biologic behavior of MEHs have been identified. A higher mortality rate is observed when epithelioid hemangioendotheliomas occur in bone, liver, or the lungs; therefore, the importance of immunohistochemical analyses to establish a definitive diagnosis should be emphasised. In this context, the majority of intraoral epithelioid hemangioendothelioma lesions were immunoreactive for CD34, CD31, fac- tor VIII-Rag, and vimentin, which characterise the epithelioid endothelial origin of this entity. It was not possible to identify common risk factors for MEH. The literature review indicated a mean age at diagnosis for MEH of 17±13.01 years, suggesting a predisposition to dis- ease in young people. Systemic metastases have been described in the literature at a rate of 21%, and a mortality rate of 17% has been described for cutaneous MEH, in accordance with the histological aspects of the malignancy. In gingival MEH no metastases has been described in literature before our report. Due to the potential malignancy of epithelioid hemangioen- dotheliomas, wide local excision is the treatment of choice for oral cavity cases according to the literature. The mean recurrence time was 21.33±23.44 months. Given the possibility of recurrence and metastasis several years after clean and safe excision, clinicians should apply at least 5 years of follow-up.

2016 - Guidance flap choice for lip cancer: Principles, timing and esthetic-functional results [Articolo su rivista]
Salgarelli, Attilio Carlo; Setti, Giacomo; Bellini, Pierantonio; Magnoni, Cristina; Robiony, Massimo; Consolo, Ugo
abstract

The purpose of this study is to help in the choice of an appropriate reconstructive technique by reference to the dimensions of the defect, the required functional and esthetic outcomes, and retention of adequate surgical safety margins to prevent primary tumor recurrence. Material and methods: A total of 158 patients were treated. We indicate how the most appropriate reconstructive method may be chosen, with reference to the size and position of the cancer and depth of tissue infiltration. Result: Of all patients, 89 (56.3%) had T1 (lesions up to 2 cm long, less than 1/3). The remaining patients had T2 lesions &gt;2 cm, from 1/3 to 2/3 of lip involvement (50 patients), T3 lesions &gt;4 cm, more than 2/3 of lip involvement (18), and a T4 lesion &gt; 5.5 cm with commissure involvement (1). Conclusion: We share the widespread view that a surgeon who performs a reconstruction using the minimal tissue components required to close the lesion will achieve the best results. Reconstruction does not influence prognosis and overall should be oriented to the defect. Careful, clean, and safe resection of lip carcinoma, with creation of healthy margins, can be followed by functional and esthetic lip reconstruction.

2016 - Influence of different irrigation techniques on sealer penetration into dentinal tubules: a confocal laser scanning microscope analysis [Abstract in Rivista]
Generali, Luigi; Serena, V; Cavani, Francesco; Righi, Elena; Pettenati, C; Bellini, Pierantonio; Consolo, Ugo
abstract

BACKGROUND: The instrumentation of roots canals pro- duces smear layer, which consists of organic and inorganic material and may also contain bacteria and they by-products. This layer covers the root canal walls, could obliterate den- tinal tubules and consequently can inhibit the penetration of irrigants and endodontic sealers. To obtain a good seal is necessary to use an endodontic sealer in association with a core filling material in order to fill any voids, morphological irregularities, apical deltas and dentinal tubules and to create an obturation as much as possible impervious. The aim of the study was to compare the effect of conventional endodontic needle irrigation and different irrigation systems on sealer penetration into dentinal tubules. METHODS: 40 single round root canals were selected and divided into four groups (n=10) before root canal preparation according to the final irrigation protocol: group 1 (conventional endodontic needle irrigation), group 2 (EndoActivator) group 3 (Irrisafe) group 4 (EndoVac). The root canal were shaped using Path File and ProTaper Universal rotary system in a crown-down sequence to size #40 at the WL. Obturation of the teeth was done with Thermafil Obturators size 40 with TopSeal sealer labeled with 0,1% wt Rhodamin B dye. Transverse sec- tion at 2-, 5- and 7-mm from the apex were analyzed by means of confocal laser scanning microscopy. Percentage of pen- etration around the root canal and the mean penetration into dentinal tubules at eight standardized points were calculated. RESULTS: No significant differences in percentage of pen- etration around the root canal and mean penetration depth into dentinal tubules were observed among groups when same levels were compared. Within each group both variables are significantly higher at the coronal and middle level with respect to the apical one. CONCLUSIONS: The use of the techniques employed in the present study did not significantly improve the sealer pen- etration into dentinal tubules compared with conventional endodontic needle irrigation.

2016 - Oral atrophic lichen planus and oral lichenoid lesion malignant transformation: report and management of two cases [Abstract in Rivista]
Bellini, Pierantonio; Setti, G; Mataca, E; Conserva, Enrico; Bertoldi, Carlo; Generali, Luigi; Consolo, Ugo
abstract

BACKGROUND: There is an ongoing debate in the literature whether patients with oral lichen planus (OLP) carry an increased risk of developing a squamous cell carcinomas. Nevertheless, there is a tendency to accept that there is. The annual malignant transformation rate amounting less than 0.5%. This chronic disorder mainly affects middle-aged people. The etiopathogenesis is still poorly understood. There is no effective treatment and there are no preventive measures either. An important obstacle in the discussion on the possible potentially malignant character of oral lichen planus is caused by the lack of clear clinical and histopathologic diag- nostic criteria of oral lichen planus, resulting in a poor clin- icopathologic correlation in the diagnosis. One of the major problems of interpretation of malignant potential studies of OLP is the inexistence of strict diagnostic criteria to differentiate lichenoid processes. Some studies have included cases of OLP with OLL and vice versa. The differentiation between OLP and OLL has become important, since the latter might have a greater malignant potential. For this reason, it is important to establish precise clinical and histopathological criteria of differentiation of the lesions. CASE REPORT: 1st) A 73 years old woman with a 12 months histological diagnosis of oral lichen planus localized on tongue dorsum, previously biopsied and studied in a differ- ent structure, came to our attention to investigate an ulcerative lesion on tongue midline. No smoking habit, alcohol abuse, anemia or previous malignancies diagnosis were referred; topical corticosteroid therapy was referred. An incisional biopsy was performed showing lichenoid lesion, atypia and high grade of dysplasia at histological examination. Subsequently, lesion was radically removed with wide excision margins. Microscopic examination returned diagnosis of mild differentiated squamous cell carcinoma arose on lichenoid lesion. Resection margins were clean without perineural or vascular invasion. After 18 months follow-up, symptoms of dull pain and burn sensation were referred. Tongue dorsum was macroscopically altered, with an ulcer-like lesion surrounded by edematous mucosa. Consequently, an incisional biopsy was performed showing the presence of a low differentiated squamous cell carcinoma. Lesion was radically excised, margins were widened and examined with frozen sections. Patient underwent to bilateral SND (level I-III) and RTP. Histological examination returns a diagnosis of recurrent pT1 pN1 micro-invasive squamous cell carcinoma. Microscopic signs of lichenoid lesion were still evident. 2nd) A 74 years old woman, with a 20 months history of

2016 - The protein expression network in periodontal pocket tissue: a preliminary study [Abstract in Rivista]
Bertoldi, C; Monari, E; Generali, L; Franceschetti, F; Bellini, P; Salgarelli, Ac; Consolo, U
abstract

Background and Objective The periodontal disease (PD) is caused by a set of inflammatory disorders characterized by periodontal pocket formation that lead to tooth loss if untreated. Periodontitis diagnosis is only based on clinical assessment only, in the absence of a reliable pathogenic check based on appropriate interpretation of inflammation. A modern pathogenic model based on a multilevel framework including disease-initiating and -resolving mechanisms is requested. Studies on PD utilizing proteomic analysis have been performed on saliva or crevicular fluid samples, peripheral blood or periodontal plaque samples, but not on the pathologic tissue of the periodontal pocket, which is the key lesion of the PD. The aim of this work was to compare the proteomic profile of the pathologic interproximal gingival pocket tissue with the corresponding of interproximal gingival healthy tissue, obtained from sites where no periodontal-pathogenic bacteria were detectable. Materials and methods Twenty healthy subjects (T, test group), affected by chronic PD and twenty periodontally healthy subjects (C, control group), were enrolled in the study. T subjects underwent to the periodontal resective treatment, while C subjects underwent to the crown lengthening surgical treatment. To characterize the proteomic profile of periodontally-affected patients, their interproximal periodontal pocket tissue was compared with that of periodontally-healthy patients. Pocket-associated and healthy tissue samples, harvested during surgical therapy, were treated to extract the protein content. Tissues were always collected at sites where no periodontal-pathogenic bacteria were detectable. 2DE (Two-dimensional gel electrophoresis) and LC-MS/MS (Liquid Chromatography-tandem mass spectrometry) analysis were performed for T and C gingival tissue samples to separate and identify the proteins. Web-based bioinformatics tools (iPROClass and CateGOrize) were employed to investigate all potential localizations, molecular functions and biological processes of the identified proteins. After identification, proteins were selected for subsequent Western Blot quantitation both in pathological and healthy tissues. Results The identified proteins are mainly involved in metabolism (32 %), transport (13 %) and cell organization and biogenesis (13 %). A significant unbalance in protein expression between healthy and pathological sites was recorded. Thirty-two protein spots were overall identified, and four proteins, the protein S100-A9 (S100A9), heat shock protein beta-1 (HSPB1), Galectin-7 (LEG7) and 14-3-3 protein zeta/delta (14-3-3) were selected for Western blot analysis of both periodontally-affected and healthy patients. The four selected proteins resulted extremely over-expressed in periodontal pocket tissue when compared with the corresponding tissue of periodontally-healthy patients. Discussion: S100A9 is involved in the regulation of inflammatory processes, immune response, oxidant-scavenging and apoptosis-inducing activities. HSPB1 synthesis increases in response to a variety of stresses (e.g. elevated temperatures, heavy metals, toxins, oxidants, bacterial and viral infections) in order to minimize the attendant deleterious consequences. LEG7 expression contributes to the tissue remodeling processes following tissue damage and protects cell from death. The 14-3-3 proteins are involved in the control of several cell cycle checkpoint, connective tissue remodeling, apoptosis signaling, during inflammation response. The Western blot and proteomic analyses are congruent with the reaction of injured periodontal tissues in PD. The proteomic analysis was performed for the first time directly on periodontal pocket tissue. The proteomic network highlighted enhances the understanding of PD pathogenesis revealing a defensive protein strategy which, however, evidently fails in patients affected by PD. Further study are requested also for specific therapeutic strateg

2015 - Foreign body mimicking an oral pathology [Articolo su rivista]
Bellini, Pierantonio; Salgarelli, Attilio Carlo; Barberini, S.; Negrello, S.
abstract

Foreign bodies’ adherence to the hard palate is unusual and can mimic an oral pathology. The diagnosis of this foreign body is challenging: it is based on an amnestic history, unspecific or absent symptoms and oral examination. The oral examination could be difficult when dealing with paediatric patients. Imaging techniques may mislead and so an exam under anaesthesia is often necessary to make the proper diagnosis. We report a case of 2 years-old male child referred to our attention for a strange lesion on the hard palate. After poorly significant MRI, we were unable to perform an oral examination and a general anaesthesia procedure was performed. A small translucent mass that turned out to be a piece of plastic adherent to the hard palate, was removed.

2015 - Sentinel lymph node biopsy in lower lip cancer [Abstract in Rivista]
Setti, G.; Salgarelli, Attilio Carlo; Magnoni, Cristina; Bellini, Pierantonio; Consolo, Ugo
abstract

Objective Lower lip SCC neck nodes metastases increase mortality to 50% of cases when involved. Recent NCCN guidelines don't refer to occult metastases investigation strategy. We report application and results of sentinel node biopsy as diagnostic method in cN0 lesions. Study Design Through the use of lymphoscintigraphy, performed with colloidal 99Tc injected in the main lesion, 22 patients with neck cN0 and negative ultrasonography were treated. Tumor staging varies from T1 (77,3%) to T4. Results Only two cases, both T2, result positive to micro metastases investigation, realized with monoclonal anti-body MNF 116 marking and 200μm microtome sections; either undergo to ND which allowed to identify respectively 1 pN+ each, same neck level of sentinel node. Conclusions To avoid needless elective neck dissection or a delay of treatment in occult N+ cases, biopsy method can identify metastases presence in cN0 cases, though we suggest expanding the method also to all T1 less than 1 cm.

2014 - Foreign body mimicking an oral pathology [Abstract in Rivista]
Bellini, Pierantonio; Salgarelli, Attilio Carlo; Bertoldi, Carlo; Generali, Luigi; Giannetti, Luca; Consolo, Ugo
abstract

vedasi l'allegato

2014 - Fresh-Frozen Bone Blocks for Horizontal Ridge Augmentation in the Upper Maxilla: 6-Month Outcomes of a Randomized Controlled Trial. [Articolo su rivista]
S., Lumetti; Consolo, Ugo; C., Galli; A., Multinu; L., Piersanti; Bellini, Pierantonio; E., Manfredi; G., Corinaldesi G; Zaffe, Davide; Gm, Macaluso; C., Marchetti
abstract

Purpose: This randomized controlled trial compared fresh-frozen versus autologous bone blocks for maxillary horizontal ridge augmentation in patients with Cawood and Howell class IV atrophies. Materials and Methods: Twenty-four patients were allocated to the autologous and fresh-frozen groups in a 1:1 ratio. Patients underwent computed tomography scans 1 week and 6 months after surgery for graft volume and density analysis. Doxycycline was administered at day 120 and day 150 to label new bone formation. Biopsy for histologic and histomorphometric analyses was performed at reentry for implant insertion, 6 months after grafting. Results: Fresh-frozen grafts had lower density than autologous bone. Autologous and fresh-frozen grafts lost, respectively, 25% and 52% of their initial volume (p=.0041). Histology revealed the presence of newly formed bone within both graft types, but clear signs of inflammation were present in fresh-frozen blocks. Conclusions: According to these 6-month results, autologous bone blocks are preferable to fresh-frozen bone grafts. © 2012 Wiley Periodicals, Inc.

2014 - Sentinel lymph node biopsy in lower lip cancer [Abstract in Rivista]
Setti, C.; Salgarelli, Attilio Carlo; Magnoni, Cristina; Bellini, Pierantonio; Consolo, Ugo
abstract

Vedasi l'allegato

2014 - Wave technique in lower lip cancer [Abstract in Rivista]
Bellini, Pierantonio; Salgarelli, Attilio Carlo; Setti, G.; Magnoni, Cristina; Consolo, Ugo
abstract

Vedasi l'allegato

2013 - How to improve retromandibular transmasseteric anteroparotid approach for mandibular condylar fractures: our clinical experience [Articolo su rivista]
Salgarelli, Attilio Carlo; Anesi, Alexandre; Bellini, Pierantonio; G., Pollastri; D., Tanza; S., Barberini; Chiarini, Luigi
abstract

Fractures of the mandibular condyle are common and account for 25–35% of all mandibular fractures reported in the literature. Even with the development of a consensus on the preference for open reduction and internal fixation of these fractures, the clinician is still faced with a dilemma concerning the optimal approach to the ramus–condyle unit. Limited access and injury to the facial nerve are the most common problems. The most commonly used extraoral approaches are the submandibular, retromandibular and preauricular methods. In this study, we propose a modified cosmetic preauricular incision with a short end in the neck, to improve the transmasseteric anteroparotid (TMAP) approach previously described by Wilson et al. in 2005. We retrospectively analysed 13 patients treated in our department for mandibular condylar fractures. Post-operative complications, occlusal status, interincisal opening and joint tenderness were evaluated at 3 months after surgery. The wider skin incision described here provides a convenient approach for open reduction and rigid internal fixation, and good results were obtained. The follow-up ranged from 6 to 40 months.

2012 - CLINICAL-RADIOGRAPHIC FOLLOW-UP OF IMPLANTS PLACED IN RECONSTRUCTED MAXILLA USING ONLAY AND/ OR INLAY THECNIQUE [Abstract in Atti di Convegno]
Dotti, A.; Bandieri, A.; Giannetti, Luca; Bertoldi, Carlo; Bellini, Pierantonio; Travaglini, Domenico; Consolo, Ugo
abstract

Vedi allegato

2012 - Intraoral Approach for Aesthetic Restoration of Posttraumatic Zygomatic Arch Deformities. [Articolo su rivista]
Robiony, M; Tenani, G; Bellini, Pierantonio; Salgarelli, Attilio Carlo
abstract

Minimally invasive oral and maxillofacial surgery is now being developed for virtually all minor and major oral and maxillofacial surgeries, and developments are now focused on facial trauma surgery. This article assesses the feasibility of reducing isolated zygomatic arch fractures using the intraoral lateral coronoid approach. The procedure is cost-effective and timesaving, as it can be performed under local anesthesia in an emergency department or similar clinical setting and does not need postoperative hospitalization if no other comorbidities are present.

2012 - Technical tips for a cosmetic approach to parotid surgery [Articolo su rivista]
Salgarelli, Attilio Carlo; Bellini, Pierantonio; Consolo, Ugo; M., Collini
abstract

Purpose: Recently, skin incisions have tended to be smaller if surgical exposure is not greatly compromised, especially for benign lesions of the head and neck. An incision in a visible area of the neck needs to be moved to hidden or less prominent sites or away from the head and neck. For aesthetic considerations, the preauricular broken/postauricular trichophytic skin incision was developed for parotid surgery. Patients and Methods: This retrospective clinical study enrolled 36 patients (20 women and 16 men) with benign preneural parotid tumors. Six months after surgery, patients were specifically asked to rate their satisfaction with their postoperative appearance on a scale of 1 to 10, with higher scores meaning better patient satisfaction, and whether they would consent to the operation again. Results: All patients were satisfied with the cosmetic outcome: 24, 9, and 3 patients rated the procedure 8, 9, and 10, respectively. Conclusions: The preauricular broken/postauricular trichophytic skin incision provides generous access to the parotid gland, which is at least as good as the access provided by a Blair incision. It is an aesthetically superior incision that allows good surgical access and improved contour reconstruction.

2012 - Wave technique for treatment of lower lip cancer [Articolo su rivista]
Salgarelli, Attilio Carlo; Magnoni, Cristina; Bellini, Pierantonio
abstract

Vedasi l'allegato

2012 - “Surgical management of the spinal nerve in modified radical neck dissection” submitted chapter for the book titled “Neck dissection – clinical application and recent advances” . [Capitolo/Saggio]
Salgarelli, Attilio Carlo; Bellini, Pierantonio
abstract

Shoulder and neck pain associated with neck dissection are well recognized and closely related to the quality of life of patients undergoing surgical treatment for head and neck cancer. Shoulder pain and disfunction have been reduced using modified radical neck dissection that preserves cranial nerve XI.

2011 - Cicatricial iatrogenic lower eyelid malposition in skin cancer surgery: results of a combined approach [Articolo su rivista]
Salgarelli, Attilio Carlo; Francomano, Mariangela; Magnoni, Cristina; Bellini, Pierantonio
abstract

Purpose: Malposition of the lower lid, including rounding of the lateral canthal angle, lower eyelidretraction with inferior scleral show, and ectropion, is a relatively frequent complication in the surgicaltreatment of skin cancer of the cheek and zygomatic areas. The tarsal strip technique, in association witha vertical vector cheek lift, is a reliable method for correcting lower lid malposition.Materials and patients: From January 2008 to January 2010, we treated 19 patients with lower eyelidmalposition after skin cancer surgery of the cheek and zygomatic areas. To correct lower eyelidmalposition, we used the tarsal strip technique and a vertical vector cheek lift in all patients.Results: Eleven patients had scleral show and eight patients had ectropion. Sixteen patients obtainedsatisfactory correction of the eyelid malposition in a single surgical procedure, while three patientsrequired a second surgical step to correct the remaining scleral show. Good esthetic and functionalresults were achieved in all cases.Conclusions: The surgical treatment of skin cancer of the cheek and zygomatic areas has the potential forpostoperative sequelae. The tarsal strip technique, in association with a vertical vector cheek lift, isa relatively simple technique for correcting scleral show and ectropion.

2011 - Clinical Study – Reconstruction of Nasal Skin Cancer Defects with Local Flaps [Articolo su rivista]
Salgarelli, Attilio Carlo; Bellini, Pierantonio; Multinu, A.; Magnoni, Cristina; Francomano, M.; Fantini, F.; Consolo, Ugo; Seidenari, S.
abstract

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2011 - Piezosurgery to Perform Hyoid Bone Osteotomies in Thyroglossal Duct Cyst Surgery [Articolo su rivista]
Salgarelli, Attilio Carlo; Massimo, Robiony; Consolo, Ugo; Marco, Collini; Bellini, Pierantonio
abstract

Ultrasonic bone-cutting surgery has been introduced asa feasible alternative to the conventional sharp instruments used incraniomaxillofacial surgery because of its precision and safety. Thedevice used is unique in that the cutting action occurs when the toolis used on mineralized tissues and stops on soft tissues. This workdescribes the use of piezosurgery for hyoid bone resection in thyroglossalduct cyst surgery, briefly reviews the literature on the surgicaltechnique, and reports our experience with 12 cases.

2011 - Reconstruction of nasal skin cancer defects with local flaps. [Articolo su rivista]
Salgarelli, Attilio Carlo; Bellini, Pierantonio; A., Multinu; Magnoni, Cristina; M., Francomano; F., Fantini; Consolo, Ugo; Seidenari, Stefania
abstract

Reconstruction of nasal defects must preserve the integrity of complex facial functions and expressions, as well as facial symmetry and a pleasing aesthetic outcome. The reconstructive modality of choice will depend largely on the location, size, and depth of the surgical defect. Individualized therapy is the best course, and numerous flaps have been designed to provide coverage of a variety of nasal-specific defects. We describe our experience in the aesthetic reconstruction of nasal skin defects following oncological surgery. The use of different local flaps for nasal skin cancer defects is reported in 286 patients. Complications in this series were one partial flap dehiscence that healed by secondary intention, two forehead flaps, and one bilobed flap with minimal rim necrosis that resulted in an irregular scar requiring revision. Aesthetic results were deemed satisfactory by all patients and the operating surgeons. The color and texture matches were aesthetically good, and the nasal contour was distinct in all patients. All scars were inconspicuous and symmetrical. No patient had tenting or a flat nose.

2011 - Synergistic Use of Local Flaps for Total Lower Lip Reconstruction [Articolo su rivista]
Salgarelli, Attilio Carlo; Bellini, Pierantonio; Magnoni, Cristina; Anesi, Alexandre; Collini, M.
abstract

The loss of tissue in the lower lip has beentreated using different techniques dependingon the size and location (median or lateral) of thedefect.1,2 Plastic surgery for small defects of up totwo-thirds of the lower lip relies on surgicaltechniques such as direct suturing of the resectionmargins with or without Z-plasty. The methodsthat Gillies and Millard,3 Estlander,4 Abbe´,5 andKarapandzic6 proposed, as well as the staircasetechnique,7 have been used for reconstructionsinvolving up to two-thirds of the lip, whereas theproximity of the flaps is suitable for treatingcomplete lower lip losses, according to Von Bruns,8Bernard,9 and Bernard-Freeman-Fries.10–12The multiplicity of techniques reported in the literatureindicates that there is no ideal method fortotal lower lip reconstruction. It is generally agreedthat reconstruction after resection of more thantwo-thirds of the lower lip produces visible scarsand alters the kinetics of smiling.1,2,7The Sabattini-Abbe´ flap is a full-thickness one-lipflap that is pedicled on the superior or inferiorlabial vessels and rotated 180° to fit into the defectof the opposite lip. The Sabattini-Abbe´ flap can beused for reconstructing up to two-thirds of the lip.The staircase technique, used to close full-thicknessdefects of up to two-thirds of the lower lip, is basedon the advancement flap. Johanson and colleaguesfirst described it in 1974,13 and by Dado andAngelats,14 Stiernberg,15 Kuttenberger and Hardt16and Salgarelli and colleagues7 subsequentlymodified it. Reconstruction of the lower lip isperformed using a lateral advancement flap fromthe lateral parts of the lip and chin, in a stepwisefashion.7Here, we propose the synergistic use of thestaircase technique and a Sabattini-Abbe´ flap forreconstructions involving more than two-thirds ofthe lower lip (Figures 1A and B).

2011 - Tracheostomy in maxillofacial surgery: a simple and safe technique for residents in training. [Articolo su rivista]
Salgarelli, Attilio Carlo; M., Collini; Bellini, Pierantonio; P., Capparè
abstract

: Tracheostomy is a frequently performed surgical procedure and may be required under emergency, semiurgent, or elective conditions. In maxillofacial surgery, it is indicated in congenital, inflammatory, oncologic, or traumatic respiratory obstruction and prolonged intubation. This article presents a simplified tracheostomy procedure based on anatomic markers that gives the best compromise between minimum invasiveness and safety.: A retrospective study analyzed the clinical aspects, treatment methods, and clinical course of 198 patients who underwent tracheostomies performed by residents in training under the supervision of surgeons between October 2002 and December 2007 at the Maxillofacial Surgery Department of Carlo Poma Hospital, Mantova, and the Maxillofacial Unit, Head and Neck Department, University of Modena and Reggio Emilia, Italy. Tracheostomies were performed in 127 patients (64.14\%) with neoplastic diseases (tumors of the tongue base, tonsils, and oral and pharyngeal regions) and in 71 patients with trauma (35.86\%). The patients were followed up for 3 to 65 months.: Acceptable clinical healing and outcomes were obtained in all patients. Intraoperative complications occurred in 35 patients (17.7\%): bleeding in 32 patients (16.2\%) and pretracheal or paratracheal tube placement in 3 patients (1.51\%). Postoperative complications after tracheostomy closure included tracheostomy dehiscence in 5 patients (2.52\%) and subcutaneous emphysema in 26 patients (13.12\%). Tracheostomy dehiscence occurred in 3 patients with neoplasia (1.51\%) and in 2 patients with trauma (1.01\%). No symptomatic tracheal stenosis developed.: The standardized surgical technique presented here reduces the associated surgical risk when the correct anatomic markers are used and important structures are recognized and handled correctly.

2010 - A comparative study of different approaches in the treatment of orbital trauma: an experience based on 274 cases. [Articolo su rivista]
Salgarelli, Attilio Carlo; Bellini, Pierantonio; B., Landini; A., Multinu; Consolo, Ugo
abstract

PURPOSE: The aim of the study was to compare the aesthetic results, complications and surgical indications in patients treated for orbital trauma by one of three different approaches: subciliary, transconjunctival or transconjunctival with lateral canthotomy. MATERIALS AND METHODS: In this retrospective study, 274 patients (169 men and 105 women aged 16-78 years) who had been treated for orbital trauma without soft tissue lacerations of orbital region and then returned for long-term follow-up (6-48 months) between 2000 and 2007 were evaluated in terms of aesthetics and function for the presence of a visible scar and lower-eyelid malposition (scleral show or ectropion). RESULTS: Of the 274 patients, 50 (18.2\%) experienced complications. In the group of 219 patients treated with the subciliary approach, 41 experienced complications, whereas amongst the 32 patients treated with the transconjunctival approach, there was one complication (0.3\%) and amongst the 23 patients treated with the transconjunctival approach and canthotomy, there were eight complications (34.8\%). CONCLUSIONS: Patients treated for orbital trauma with the transconjunctival approach with canthotomy had a higher rate of lower eyelid malposition. Transconjunctival incision without canthotomy was the most successful surgical approach for the treatment of isolated fracture of the orbital floor; however, when major surgical exposure is necessary, subciliary incision is recommended.

2010 - Aesthetic reconstruction of nasal skin cancer defects [Abstract in Rivista]
Salgarelli, Attilio Carlo; Bellini, Pierantonio; Landini, Barbara; Multinu, A.; Consolo, Ugo
abstract

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2010 - FNA in parotid diagnosis [Abstract in Rivista]
Salgarelli, Attilio Carlo; Capparè, P.; Bellini, Pierantonio; Collini, M.; Consolo, Ugo
abstract

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2010 - Re: A.C. Salgarelli, et al., Tarsal strip technique for correction of malposition of the lower eyelid after treatment of orbital trauma, Br J Oral Maxillofacial Surg 47 (2009) 298-301 [Articolo su rivista]
Salgarelli, A. C.; Bellini, P.
abstract

2010 - The bilobed flap in skin cancer of the face: our experience on 285 cases. [Articolo su rivista]
Salgarelli, Attilio Carlo; A., Cangiano; F., Sartorelli; Bellini, Pierantonio; M., Collini
abstract

BACKGROUND: This article describes how many of the defects caused by oncological surgery can be closed with an easily estended flap. PATIENT AND METHOD: The Zitelli bilobed flap was used to treat 285 consecutive patients with basal cell carcinomas (BCCs) or squamous cell carcinomas (SCCs); 167 men (58.60\%) and 118 women (41.40\%) between 45 and 98 years of age. Histologically, 247 BCCs (86.6\%) and 38 SCCs (13.4\%) were documented. Regarding the site, 148 (51.9\%) involved the nose, 51 (17.9\%) the cheeks, 36 (12.6\%) the preauricular region, 27 (9.5\%) the perilabial region and chin and 23 (8.1\%) the periorbital region. To measure long-term satisfaction patients responded to a telephone survey consisting of a single global question. RESULTS: The size of the defect following tumour removal was between 1 and 4cm. Carcinomas up to 1cm were treated using a one step procedure with a cryostat test of the surgical margins; all others cases were treated using two step procedure after excision and histological in sano resection. Completely acceptable aesthetic and functional deficits were obtained in 275 (96.4\%) patients over a 6-72-month follow-up. Ten (3.6\%) patients suffered postoperative complications. Two cases of local infection; one case of completely flap necrosis and seven cases of partial revision due to flap necrosis occurred. The level of satisfaction with the surgical long-term result reported by the patients was high. CONCLUSION: In our experience the bilobed Zitelli flap for covering defects in the area of the face showed very few complications and good aesthetic results.

2010 - The use of piezoelectric devices in oral surgery: advantages and disadvantages [Abstract in Rivista]
Dotti, D.; Travaglini, Domenico; Bellini, Pierantonio; Generali, Luigi; Consolo, Ugo
abstract

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2010 - Use of the reabsorbable filler in lip esthetics [Articolo su rivista]
Salgarelli, A. C.; Landini, B.; Bellini, P.; Consolo, U.
abstract

2009 - A simple method of identifying the spinal accessory nerve in modified radical neck dissection: Anatomic study and clinical implications for resident training [Articolo su rivista]
Salgarelli, Attilio Carlo; Landini, Barbara; Bellini, Pierantonio; A., Multinu; Consolo, Ugo; M., Collini
abstract

PURPOSE: The major complication of neck dissection and surgery at the posterior triangle of the neck is the shoulder syndrome, which results from spinal accessory nerve injury. Erb's point (the great auricular nerve) and the point where the spinal accessory nerve enters the trapezius muscle are used to identify the spinal accessory nerve in the posterior nerve triangle. MATERIALS AND METHODS: Measurements were made during unilateral neck dissections in 30 patients to identify the relationship between the spinal accessory nerve and great auricular nerve and the distance between the entrance of the accessory nerve in the trapezious and clavicle. RESULTS: The distance between the spinal accessory nerve and Erb's point was ranging from 0 to 3.8 cm (mean 1.53 cm). The distance between the spinal accessory nerve entering the trapezious muscle and the clavicle was between 2.5 and 7.3 cm (mean 4.8 cm). CONCLUSIONS: Since the great auricular nerve (Erb's point) represents a constantly identifiable landmark, it allows simple and reliable identification of the course of the spinal accessory nerve. Also useful, but of secondary importance in our opinion, is identifying the nerve at the point where it enters the trapezius muscle.

2009 - Combined technique for the correction of prominent ears: Results in 140 patients [Articolo su rivista]
Salgarelli, Attilio Carlo; Bellini, Pierantonio; Multinu, A.; Landini, B.; Broccaioli, E.; Consolo, Ugo
abstract

We present our assessment of a combined technique for the correction of prominent ears in 140 patients between 1991 and 2007. We had no major complications, and minor complications including extrusion of a stitch, granuloma around a suture, hypertrophic scarring, and superficial ulceration on the anterior side of the helix developed in nine patients. Two also developed residual asymmetry. A good aesthetic result was achieved in all cases.

2009 - Tarsal strip technique for correction of malposition of the lower eyelid after treatment of orbital trauma [Articolo su rivista]
Salgarelli, Attilio Carlo; Bellini, Pierantonio; A., Multinu; B., Landini; Consolo, Ugo
abstract

Purpose: The transconjunctival, subciliary, subtarsal, and subpalpebral approaches for accessing the infraorbital rim and orbital floor have both advantages and disadvantages. The most common complications include rounding of the lateral canthal angle, lower eyelid retraction with inferior scleral show, and frank ectropion. Materials and patients: From 2000 to 2007, we treated 29 patients with lower eyelid malposition after surgery to manage the floor and infraorbital trauma (22 subciliary approaches, five transconjunctival approaches and lateral canthotomies, and two transconjunctival approaches). To correct lower eyelid malposition, we applied the tarsal strip technique in all patients. Results: Twenty-five patients had scleral show and four patients had ectropion: three were previous treated using transconjunctival access and one using subciliary access. Twenty-six patients obtained satisfactory correction of eyelid malposition in a single-step surgical procedure, while three patients required a second surgical step to correct the remaining scleral show. Good aesthetic and functional results were achieved in all cases. Conclusions: All approaches to the infraorbital rim or orbital floor have the potential for postoperative sequelae. The tarsal strip technique is a relatively simple technique that oral and maxillofacial surgeons can use to manage lower lid malposition, such as scleral show and ectropion. (C) 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

2009 - The use of temporary injectable filler in lip augmentation [Uso dei filler riassorbibili nell'estetica delle labbra] [Articolo su rivista]
Salgarelli, Attilio Carlo; Landini, Barbara; Bellini, Pierantonio; Consolo, Ugo
abstract

The present "must" in facial aesthetics has favoured the use of temporary injectable filler for lip augmentation. Even if simple, this technique bides some risks. A careful evaluation must be done on right indications in relation to the patient's wishes and to the proper consensus about the need of more sessions and carrying out the single application. The technique reported step by step (photographs before and after treatment, anaesthesia, injection technique), must be supported by a scientific, anatomical and clinical knowledge and by the knowledge of the uncommon, but possible risks.

2009 - Usefulness of fine-needle aspiration in parotid diagnostics. [Articolo su rivista]
Salgarelli, Attilio Carlo; P., Capparè; Bellini, Pierantonio; M., Collini
abstract

PURPOSE: Fine needle aspiration (FNA) is a safe diagnostic technique that is widely employed for lesions of the head and neck. Among head and neck sites, the parotid gland is unique in the number, diversity, and peculiarity of its pathological processes. This complexity has prompted a great deal of discussion regarding the application of FNA to parotid masses, primarily focusing on the reliability of FNA as a diagnostic tool in guiding patient management. METHODS: This review presents an analysis of the usefulness of FNA in differential diagnosis of parotid pathologies. RESULTS: Recent studies have confirmed a wide range of accuracy rates for FNA evaluation of parotid masses, varying from 79\% to 97\%. These data cannot be uniformly anticipated across all diagnostic scenarios. FNA is notoriously unreliable in recognising the malignant nature of parotid carcinoma providing its precise classification and establishing its grade. A few malignant neoplasms are particularly prone to diagnostic error: acinic cell carcinoma is frequently interpreted as benign, and low-grade lymphomas are often discounted as inflammatory processes. CONCLUSIONS: FNA cytology is useful in avoiding surgery (inflammatory lesions) or limiting surgical procedures (benign tumours). For planning the extent of surgery of malignant parotid tumours, the histological subtype and/or grade should be determined; therefore, a histological diagnosis by frozen section analysis is required. Moreover, reliance on FNA findings at the expense of clinical, radiographic, and intraoperative findings is unwarranted. Regardless of whether FNA is used routinely or selectively in patients with parotid masses, the findings should contribute to, and not replace, the overall diagnostic impression.

2008 - Alveolar distraction osteogenesis: histo-densitometric evaluation. [Abstract in Rivista]
Bertoldi, Carlo; Bellini, Pierantonio; Landini, B.; Zaffe, Davide
abstract

Vedi allegato

2008 - Correction of prominent ears: our experiences [Articolo su rivista]
Salgarelli, Attilio Carlo; Bellini, Pierantonio; Multinu, A.; Consolo, Ugo
abstract

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2008 - FES indications in the sinus lift for implant rehabilitation [Articolo su rivista]
Bellini, Pierantonio; Consolo, Ugo; Salgarelli, Attilio Carlo; Presutti, Livio
abstract

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2008 - Impacted third molar extraction: methylprednisolone or nimesulide [Articolo su rivista]
C., Montosi; A., Murri; Bellini, Pierantonio; D., Travaglini; Giannetti, Luca
abstract

Objectives: The aim of this study was to evaluate the effect oftwo different drugs (methylprednisolone and nimesulide) to decreasethe swelling, pain and trismus after the surgical extractionof mandibular impacted third molars.Methods: This randomized clinical trial comprised thirty (30)adult patients of both genders (15 male and 15 female) withno local or systemic problems, with bilateral impacted lowerthird molars in similar position (Pell and Gregory’s class IIB),where surgical extraction had been indicated. These patientswere separated in two groups at random: the methylprednisolonegroup and the nimesulide group. A record card was filled inwith preoperative and postoperative epidemiological and clinicdata about inflammation, pain and trismus. The choice of whichside to operate first was made randomly and double-blindly. Theswelling was evaluated by ecography. The pain was evaluated byVAS modificated in GRS. The trismus was evaluated by interincisaldistance.Mean values were compared between the 2 groups with a 2-wayanalysis of variance and a Student’s t-test or the c2 test forqualitative comparisons. The threshold of significance was setat 5%.Results: Patients in the nimesulide group showed a moresevere swelling (p = 4.2175E-06) and a more severe trismus(p = 0.00034); pain was very similar in both groups.Conclusions: The results confirm the efficacy of methylprednisolonein providing a more comfortable postoperative courseafter surgical extraction of impacted lower third molars. It wasmore effective than nimesulide to reduce the degree of swellingand trismus. However, it had no clear effect on pain control.

2008 - Piezoelectric devices and rotative instruments: cutting efficacy [Articolo su rivista]
Generali, Luigi; Travaglini, Domenico; Bellini, Pierantonio; Consolo, Ugo
abstract

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2008 - Preemptive analgesia after impacted third molar extraction [Abstract in Rivista]
Bellini, Pierantonio; F., Vecci; A., Dotti; Giannetti, Luca
abstract

OBJECTIVESThe aim of this study was to evaluate the effect of sodic naproxen as pre-emptive medication to decrease the post-operative pain after the surgical extraction of mandibular impacted third molars.METHODSThis randomized clinical trial comprised thirty (40) adult patients of both genders(20 male and 20 female) with no local or systemic problems, with bilateral impacted lower third molars in similar position (Pell and Gregory’s class IIB), where surgical extraction had been indicated. These patients were separated in two groups at random: the study group (naproxen 220 mg one hour before the extraction) and the control group (naproxen 220 mg at the end of the extraction). Both group received naproxen 220 mg 6 and 16 hours after the extraction.The pain was evaluated by VAS modified in GRS at 0, 6 and 16 h.Mean values were compared between the 2 groups with a 2-way analysis of variance and a Student’s t-test or the χ2 test for qualitative comparisons. The threshold of significance was set at 5%. RESULTSThe mean VAS values were 2.42±1.64, 3.17±1.75 e 2.52±1.51.Analysis of variance at 6 and 16 h after operation showed that there was less pain on the pre-emptive side (p< 0.001 and p< 0.023)while analysis of variance at 0 was not significant.CONCLUSIONSThe results confirm the efficacy of sodic naproxen in providing a more comfortable postoperative course after surgical extraction of impacted lower third molars.If used as pre-emptive medication sodic naproxen has an effective pain control.

2008 - The importance of 3D solid modeling in maxillary reconstruction [Articolo su rivista]
Multinu, A.; Consolo, Ugo; Bellini, Pierantonio; Salgarelli, Attilio Carlo
abstract

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2007 - Enucleazione conservativa di un fibro-odontoma amelobblastico: caso clinico [Articolo su rivista]
Generali, Luigi; Giannetti, Luca; Bellini, Pierantonio; Consolo, Ugo
abstract

■ Scopo del lavoro è quello di presentare la tecnica chirurgica utilizzata dagli Autori per l’asportazione, mediante utilizzo di microscopio operatorio, di una neoformazione gigante localizzata a livello del tuber mascellare ed estrinse- cantesi a livello del processo alveolare e nella cavità sinusale. La lesione è stata inquadrata istologicamente come fibro-odontoma ameloblastico.

2007 - Lembi d’accesso in chirurgia implantare [Articolo su rivista]
Bellini, Pierantonio; Travaglini, Domenico; Salgarelli, Attilio Carlo; Consolo, Ugo
abstract

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2007 - Plasma arricchito di piastrine nel rialzo del seno mascellare. Studio preliminare [Articolo su rivista]
Consolo, Ugo; Zaffe, Davide; Bertoldi, Carlo; Ceccherelli, G; Bellini, Pierantonio
abstract

Questo studio preliminare ha inteso valutare il potenziale rigenerativo del platelet-rich plasma (PRP) in un sito peculiare: il seno mascellare.Quattro pazienti consenzienti (3 di sesso femminile e 1 di sesso maschile), con atrofia simmetrica del pavimento sinusale, sono stati sottoposti a sinus lift utilizzando osso autologo (cresta iliaca) da solo in un lato e addizionato a PRP nell’altro. Ortopantomografia, TC e analisi densitometrica e valutazioni cliniche vennero utilizzate per seguire l’.evoluzione dell’innesto. Impianti furono inseriti a 4 mesi dall’intervento di sinus lift, eseguendo anche una biopsia per ciascun sito. I valori densitometrici medi risultavano più elevati nei siti trattati con PRP anche se la valutazione clinica complessiva non forniva risultati statisticamente differenziabili. Le biopsie evidenziavano la presenza di una maggiore quantità ossea e una maggior espressione dell’attività fosfatasica alcalina nei siti trattati con PRP. In conclusione i risultati sembrerebbero indicare che il PRP abbia un’ azione amplificante sull’attività osteogenica dell’osso autologo. Ulteriori studi dovranno essere attuati per verificare gli effetti del PRP nel tempo ed il suo effettivo impatto clinico.

2006 - Bio-oss ed idrossiapatite nella riparazione di difetti ossei: studio preliminare. [Abstract in Rivista]
Bertoldi, Carlo; Zaffe, Davide; Bellini, Pierantonio; Giannetti, Luca; Consolo, Ugo
abstract

Vedi allegato

2006 - Difetti cistici e trattamento con Fisiograft: studio pilota. [Abstract in Rivista]
Bertoldi, Carlo; Ciacci, L.; Bellini, Pierantonio; Zaffe, Davide; Consolo, Ugo
abstract

Vedi allegato

2006 - Fibro-odontoma ameloblastico localizzato nel seno mascellare: caso clinico [Abstract in Rivista]
Generali, Luigi; Bellini, Pierantonio; Giannetti, Luca; Generali, P.; Consolo, Ugo
abstract

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2006 - Nuovo disegno di pin/vite riassorbibile per fissaggio di membrane [Abstract in Rivista]
Bellini, Pierantonio; Giannetti, Luca; Travaglini, Domenico; Ciacci, L.; Consolo, Ugo
abstract

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2006 - Positività HSV ed insuccessi nella terapia delle recessioni: cases report. [Abstract in Rivista]
Bertoldi, Carlo; Barbolini, Giuseppe; Bencivenni, D.; Bellini, Pierantonio; Giannetti, Luca
abstract

Vedi allegato

2006 - Torque di inserimento e necrosi ossea: studio istologico su animale [Abstract in Rivista]
Travaglini, Domenico; Todisco, M.; Ciacci, L.; Bellini, Pierantonio; Consolo, Ugo
abstract

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2006 - Torque di inserimento e necrosi ossea: studio su mandibole ovine. [Abstract in Rivista]
Travaglini, Domenico; Todisco, M.; Ciacci, L.; Bellini, Pierantonio; Consolo, Ugo
abstract

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2006 - Valutazione del successo implantare in rialzi di seno e innesti additivi [Abstract in Rivista]
Orlandi, A.; Bencivenni, D.; Giannetti, Luca; Bellini, Pierantonio; Consolo, Ugo
abstract

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2006 - Valutazione del successo implantare nei rialzi di seno mascellare. [Abstract in Rivista]
Nemesini, N.; Bencivenni, D.; Travaglini, Domenico; Bellini, Pierantonio; Consolo, Ugo
abstract

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2005 - Analisi comparativa della riparazione di difetti ossei con Fisiograft®. [Abstract in Rivista]
Ciacci, L.; Bellini, Pierantonio; Bertoldi, Carlo; Zaffe, Davide; Consolo, Ugo
abstract

Vedi allegato

2005 - Analisi psicologica del paziente chirurgico preprotesico [Abstract in Rivista]
Landini, Barbara; Ravasini, T.; La Marca, S.; Bellini, Pierantonio; Consolo, Ugo
abstract

Vedasi allegato

2005 - Distrazione alveolare e stimolazione meccanica. [Abstract in Rivista]
Consolo, Ugo; Bertoldi, Carlo; Bellini, Pierantonio; Ciacci, L.; Zaffe, Davide
abstract

Vedi allegato

2005 - Il sovrannumerario dentario, valutazione e presentazione di un caso. [Abstract in Rivista]
Giansoldati, L.; Bertoldi, Carlo; Micucci, N.; Giannetti, Luca; Bellini, Pierantonio
abstract

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2005 - Innesti ad apposizione mediante tecnica piezoelettrica; considerazioni cliniche e metodologiche. [Abstract in Rivista]
Bailo, A.; Bertoldi, Carlo; Bellini, Pierantonio; Ciacci, L.; Bencivenni, D.
abstract

Vedi allegato

2005 - Innesti di corticale autologa da prelievi intraorali in terapia rigenerativa [Abstract in Rivista]
Consolo, Ugo; Ferri, V.; D’Avenia, F.; Zaffe, Davide; Bellini, Pierantonio
abstract

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2005 - La prevalenza della patologia periapicale nei denti trattati endodonticamente [Articolo su rivista]
Ciacci, L.; Bertani, P.; Giannetti, Luca; Bellini, Pierantonio; Tozzi, S.; Generali, P.
abstract

Il presente lavoro mostra come vi sia una prevalenza di patologia periapicale nel cavo orale di pazienti trattati endodonticamente.

2005 - Ricostruzione post-endodontica con perni in fibra [Articolo su rivista]
Tozzi, S.; Generali, P.; Bertani, P.; Giannetti, Luca; Bellini, Pierantonio; Ciacci, L.
abstract

Il presente lavoro valuta la ricostruzione post-endodontica utlizzando perni in fibra.

2005 - Tecnica chirurgica di prelievo osseo dalla metafisi tibiale per finalità ricostruttive maxillofacciali [Articolo su rivista]
Consolo, Ugo; Bencivenni, D.; Bellini, Pierantonio; DE SANTIS, Giorgio
abstract

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2005 - Un nuovo disegno di vite per innesti autologhi in blocchi. [Abstract in Rivista]
Consolo, Ugo; Giannetti, Luca; Bertoldi, Carlo; Ciacci, L.; Bellini, Pierantonio
abstract

Vedi allegato

2004 - Possibilità di riabilitazione protesica nei traumi mascellari [Abstract in Rivista]
Giannetti, Luca; Generali, Luigi; Bortolini, Sergio; Bellini, Pierantonio; Consolo, Ugo
abstract

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2004 - Tecnica di prelievo di osso autologo dalla tibia [Abstract in Rivista]
Bellini, Pierantonio; Consolo, Ugo; Cannizzaro, G.; M., Pinelli; DE SANTIS, Giorgio
abstract

Tecnica di prelievo di osso autologo dalla tibia

2004 - Utilizzo dei prelievi da tibia a scopo rigenerativo [Abstract in Rivista]
Bellini, Pierantonio; Bencivenni, D.; Consolo, Ugo
abstract

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2004 - Utilizzo di calvaria per riabilitazione impianto-protesica della mandibola edentula: descrizione di un caso clinico [Abstract in Rivista]
Bellini, Pierantonio; Generali, Luigi; Giannetti, Luca; Bortolini, Sergio; Consolo, Ugo
abstract

Vedsai l'allegato

2003 - Sinus lift, biomateriali e rilascio ionico. [Abstract in Rivista]
Bertoldi, Carlo; Bellini, Pierantonio; Consolo, Ugo; Zaffe, Davide
abstract

Al fine di limitare la subsidenza del rialzo nelle procedure di sinus lift, osservabile con l’innesto formato da solo osso autologo, idrossiapatite non riassorbibile (Osprovit®) è stata mescolata all’osso autologo in percentuale volumetrica del 50% in 6 pazienti. I deludenti risultati radiografici e clinico/terapeutici trovavano un riscontro nelle biopsie a 6 mesi che evidenziavano una riduzione del numero e della massa dei granuli di Osprovit® ed una forte riduzione ossea. A 3 mesi i granuli di idrossiapatite risultavano in via di disgregazione, circondati da cellule TRAP (fosfatasi acida tartrato-resistente) positive che li aggredivano e da un tessuto connettivo privo di attività TALP (fosfatasi alcalina). Attività osteogenetica elevata, valutata in termini di TALP, e neodeposizione ossea si riscontravano, invece, sull’osso innestato lontano dai granuli. Le analisi radiologiche densitometriche attuate sui siti di innesto davano risultati uniformi, compatibili con valori di osso mascellare, sui seni mascellari sottoposti a sinus lift con solo osso autologo ed utilizzati come controllo. I valori, invece, sui seni trattati con innesto autologo ed Osprovit® era diversificato. Si evidenziavano, infatti, due picchi gaussiani, uno attestato in un intorno di 1700 HU, congruente per l’idrossiapatite e l’altro mediamente inferiore a quello riscontrato nei seni con solo innesto osseo. Queste evidenze, nel complesso, rendono ragione di uno stato di sofferenza dell’innesto nei siti trattati anche con l’idrossiapate ma non ne chiariscono, tuttavia, l’etiopatogenesi. Indagini successive al SEM (microscopio elettronico a scansione) e con microsonda a raggi X evidenziano nel connettivo dei seni trattati anche con idrossiapatite la presenza di calcio, fosforo ma anche alluminio. Questo ultimo elemento è, in particolare, accumulato nel tessuto circostante i granuli. L’alluminio è, ancora, presente nell’osso neoformato, posto anche a distanza dai granuli,, con localizzazioni peculiari in rapporto alle lamelle dense acellulari. Tale elemento risulta nella composizione dell’Osprovit®, ma anche dell’attuale prodotto commerciale Biolox Osprovit® che lo ha sostituito. I risultati, nell’avvalorare un possibile rapporto tra la natura biochimica del biomateriale e i risultati clinici negativi ottenuti, ingenerano, inoltre, perplessità in considerazione della pericolosità dell’alluminio, in particolare sul sistema nervoso

2001 - Alveolar distraction osteogenesis: is the process improvable? [Relazione in Atti di Convegno]
Consolo, Ugo; Bertoldi, Carlo; Bellini, Pierantonio; Zaffe, Davide
abstract

Bone processes of Alveolar Distraction Osteogenesis (ADO) were studied to optimize the implanto-prosthetic rehabilitation. ADO was applied on 11 patients with ridge deformities. Clinical and radiological evaluations, and morphological (histology, histochemistry, microradiography) studies were performed during the following 12 weeks. Ossification starts at 40 days after the end of distraction. Sixty days after the end of distraction, soft callus was widely converted into a network of trabecular woven bone and high osteogenic activity (TBV about 50%). Osteoclast resorption reduces the bone amount (TBV about 37%) though there was a more ordered bone structure 88 days. Densitometric assay shows increasing values since the end of the distraction. The results suggest the possibility of avoiding bone loss due to mechanical unloading through an early implant insertion ISI WOS:000172402500019 IDS Number: BT24C

2001 - Dispersione nei tessuti limitrofi di elementi metallici provenienti da sistemi di fissazione rigida. [Relazione in Atti di Convegno]
Consolo, Ugo; Bellini, Pierantonio; Bertoldi, Carlo; Zaffe, Davide
abstract

La diffusione di costituenti metallici corpuscolari o ionici da mezzi protesici o meno innestati in ambito biologico è accertato che possa condurre ad importanti effetti collaterali che si sviluppano in fenomeni flogistici, allergici o in altre patologie sistemiche anche croniche (es.: intossicazioni, patologie da accumulo, forme parkinsoniane, demenze pre-senili). Scopo della presente ricerca è di rilevare la diffusione di costituenti metallici da viti e placche impiegate per fissazione interna rigida rapportandola ad un indice di flogosi locale. La ricerca è stata condotta su 18 pazienti mediante monitorizzazioni cliniche, radiologiche, istologiche e di scansione elettronica con sonda per microanalisi. In questo studio è sempre stato documentato un certo grado di “aggressione” dei dispositivi metallici da parte dell’organismo. Nei soggetti con gradi più elevati di flogosi, si evidenziava una maggior dispersione tissutale di costituenti. In gran parte questi ultimi casi erano in rapporto a placche in vitallium piuttosto che di titanio. Anche quest’ultimo elemento, tuttavia, si dimostra in grado di diffondere nei tessuti. Non ostante al riguardo del titanio non siano, per ora, documentabili effetti flogistici o tossici sovrapponibili ad altri costituenti metallici (es.: nickel o alluminio), occorre dire che molti studi circostanziali non sono stati ancora condotti sull’argomento. Saranno, perciò, opportune altre ricerche inerenti sia gli schemi di dispersione tissutale dei microcostituenti che la loro eventuale pericolosità.

2001 - Elementi metallici nei tessuti circondanti dispositivi per fissazione interna rigida FIR [Articolo su rivista]
Bertoldi, Carlo; Consolo, Ugo; Bellini, Pierantonio; Zaffe, Davide
abstract

Obiettivo. Placche e altri dispositivi in lega metallica sono stati introdotti per ottenere la stabilizzazione di frammenti ossei fratturati. Gli elementi che costituiscono le leghe sono stati riscontrati soprattutto in diversi organi, ma anche localmente nei tessuti circondanti i dispositivi. Scopo del presente studio è l’analisi dei tessuti circondanti dispositivi per FIR al fine di evidenziare la diffusione di elementi, analizzando la morfologia delle particelle liberate e studiando il comportamento dei tessuti.Metodi.Il materiale bioptico fu ottenuto da 18 pazienti (20÷76 anni di età), portatori di placche, viti e griglie per FIR da 4 mesi a 9 anni. I pazienti furono suddivisi in 5 gruppi in rapporto al grado flogistico locale. Microscopio ottico, elettronico a scansione e microanalisi a raggi X (EDS system) furono utilizzati nello studio morfologico e nell’identificazione delle particelle metalliche e degli elementi.Risultati. Particelle metalliche o elementi mobilizzati da placche, viti o griglie possono generare diffusione tissutale e uptake cellulare. Non solo Cromo, Ferro o Alluminio ma anche Titanio può facilmente essere rilasciato dai dispositivi e accumularsi nei tessuti. La diffusione del Titanio è particolarmente evidenziabile nel tessuto fibroso circondante i dispositivi per FIR. L’Alluminio non solo mostra una maggiore persistenza nel tessuto fibroso, ma esibisce un particolare comportamento di accumulo nell’osso lamellare. Conclusioni. Il grado flogistico locale sembra essere strettamente correlato alla metallosi. Non solo Cromo, Ferro, Alluminio ma anche Titanio, anche se con un diverso grado, possono originare effetti flogistici. La metallosi e la flogosi danno origine probabilmente a un processo a cascata nel quale possono essere sia causa che effetto allo stesso tempo. Il deciso rilascio di Titanio, che normalmente non produce effetti clinici flogistici come per esempio quelli prodotti dall’Alluminio, necessiterebbe ulteriori approfondimenti sui suoi effetti sulle cellule. PMID: 11420563

2001 - Platelet-rich plasma nei difetti cistici e nel sinus lifting. [Abstract in Rivista]
Consolo, Ugo; Bertoldi, Carlo; Bellini, Pierantonio
abstract

L’intento del presente lavoro è quello di valutare l’attività del Platelet-rich Plasma (PRP) sulla rigenerazione tissutale. Otto pazienti necessitanti di exeresi di cisti odontogena flogistica apicale (resistente alla terapia endodontica e di diametro * 2cm) e 6 pazienti necessitanti di sinus lift sono stati monitorizzati clinicamente e radiologicamente nel pre-intervento e sino a 6 mesi dall’intervento. L’atrofia mascellare con ptosi del pavimento dei seni mascellari, che motivava l’inserimento nei protocolli di studio, doveva essere bilateralmente sovrapponibile e, comunque, variabile dal grado IV al grado VI secondo Cawood e Howell. I risultati ottenuti evidenziano un’ottima capacità del PRP di controllare gli effetti flogistici post-operatori (per quanto una esatta valutazione obbiettiva degli stessi richieda sia estremamente difficoltosa) e di accelerare i processi di guarigione connettivali e, quindi, anche ossei. Il gel di PRP utilizzato da solo (senza innesto), invece, non sembrerebbe sortire effetti osteogenetici diretti.

2001 - Sinus lifting and cystic bone defects treated with platelet-rich plasma. [Abstract in Rivista]
Consolo, Ugo; Bertoldi, Carlo; Zaffe, Davide; Cossarizza, Andrea; Ceccherelli, G.; Bellini, Pierantonio
abstract

Vedi allegato (in Inglese) Riassunto italiano: Da una popolazione di pazienti che si sottopone a procedure di innesto osseo, previo consenso informato, vengono prelevati alcuni cc aggiuntivi di osso. Tali campioni vengono ad essere coltivati in vitro in presenza o, rispettivamente, in assenza di Platelet-rich Plasma. La cellularità ossea, tuttavia, non veniva separata dalle rispettive trabecole con cui, invece, veniva incubata. Le diverse colture, una volta giunte a confluenza, vengono ad essere analizzate e, quindi, distaccate dalle fiasche di coltura. La cellularità ottenuta è, quindi, marcata con appositi anticorpi ed è analizzata al citofluorimetro per ottenerne dati micromorfologici ed immunoistochimici. Dal punto di vista clinico, il PRP viene testato in rapporto a difetti cistici odontogeni apicali (resistenti alla terapia endodontica e di diametro * di 2cm) e di siti atrofici mascellari bilaterali (grado IV-VI secondo Cawood e Howell) sovrapponibili. Il PRP è testato da solo come gel di riempimento, in alcuni difetti cistici, addizionato ad osso autologo, in altri difetti cistici ed in uno dei due seni mascellari. Tali interventi vengono confrontati tra loro ed in rapporto al solo osso autologo, rispettivamente, impiegato come riempitivo in altri difetti cistici e nei sinus lift nel seno mascellare controlaterale a quello in cui l’osso era utilizzato con PRP. Scopo del lavoro era precisare gli effetti del PRP in rapporto alla rigenerazione ossea. I risultati ottenuti dimostrano la capacità, in vitro, del PRP di generare colture complete di tessuto calcifico ove, diversamente, si ottengono quasi esclusivamente fibroblasti. Micromorfologicamente, la cellularità coltivata con PRP presenta una volumetria ed una densità cellulare comparabile a quella osteoblastica ed anche il mosaico antigenico rilevato, ed in particolare la glicoproteina CD38, fanno pensare ad un’attivazione cellulare probabilmente in tal senso. I rilievi clinico/radiologici (anche densitometrici) ed istologici fanno pensare che il PRP possa supportare, prevalentemente processi di accelerazione della neorigenerazione tissutale. Codici: ISSN: 0177-3348 (Print) - 0177-3348 (Linking) – Altre ID: (DNLM)SR0058226(s) - (OCoLC)28226223 NLM ID: 9426456 [Serial]

2001 - Studio preliminare dell’efficacia del PRP in chirurgia rigenerativa [Relazione in Atti di Convegno]
Consolo, Ugo; Bellini, Pierantonio; Bertoldi, Carlo; Zaffe, Davide
abstract

La stadiazione della capacità rigenerativa ossea mediata dal Platelet-rich Plasma (PRP) è l’obbiettivo di questo studio condotto su 18 pazienti affetti da cisti odontogena flogistica apicale (resistente alla terapia endodontica e di diametro * 2cm) e 8 pazienti necessitanti di sinus lift. Questi soggetti selezionati per essere rigorosamente omogenei tra loro e nell’ambito della stessa patologia, venivano divisi in sottogruppi a seconda del tipo di trattamento cui sarebbero stati sottoposti. I soggetti affetti da cisti, quindi, erano suddivisi in 3 sottogruppi: un primo sarebbe stato sottoposto ad exeresi cistica e ad innesto osseo autologo, un secondo ad exeresi cistica ed a innesto di osso autologo addizionato a PRP ed un 3° sottogruppo, ad innesto di solo GEL di PRP dopo l’exeresi cistica. Degli 8 soggetti sottoposti a procedura di sinus lift, 3 erano di 4° grado, 4 di 5° grado ed 1 di 6° grado di atrofia maxillo-sinusale secondo Cawood e Howell. Ognuno di tali soggetti doveva presentare bilateralmente le stesse caratteristiche atrofiche al fine di poter confrontare un tipo di intervento con l’altro e disporre così di un’accurato sistema per cogliere differenze. Così, in modo assolutamente randomizzato, in un seno mascellare il sinus lift è stato compiuto con solo innesto di osso autologo (secondo una procedura chirurgica ormai consolidata) e nel controlaterale il rialzo è stato compiuto trattando l’innesto (uguale volumetricamente) con PRP. Nei sottogruppi cistici, monitorizzazioni cliniche e radiologiche sono state compiute nel pre-intervento e a 2, 3, 4, 5 e 6 mesi dall’intervento. Nel caso delle procedure di sinus lift, tali monitorizzazioni avevano una tempistica simile alla precedentemente descritta se non perché, nel post-intervento, cominciavano ad essere eseguite a 3 mesi (e non 2) dall’intervento poiché si era fatto in modo che potessero coincidere con l’innesto implantare. Nelle diverse fasi del post-intervento sono state ricavate anche delle biopsie tramite fresa trephine. IL PRP si dimostra sicuramente un mezzo in grado di agevolare alcune procedure chirurgiche di compattamento degli innesti, un buon sistema per il controllo emorragico (come già facevano altri gel come quelli a base di fibrina) ed in grado di sortire buoni effetti nel controllo delle reazioni flogistiche post-chirurgiche. La sua capacità osteorigenerativa, invece, appare limitata dalle influenze ambientali biologiche e pare degradare nel tempo non rendendo stabili i guadagni ossei ottenuti quando questi si trovino in situazioni biologicamente sfavorevoli (es.: innesti per sinus lift).

2000 - Le sinusiti mascellari ad eziologia aspergillare: incidenza e valutazioni clinico-diagnostiche. [Articolo su rivista]
Consolo, Ugo; Bertoldi, Carlo; Faccioni, F.; Bellini, Pierantonio
abstract

Data una incidenza delle forme aspergillari in ambito oro-maxillo-facciale probabilmente sottostimata a seguito di protocolli diagnostici suscettibili di miglioramento, gli autori compiono uno studio retrospettivo su una casistica di 74 pazienti al fine individuare migliori percorsi diagnostici e di trarre possibili indicazioni etiopatogenetiche. L’analisi della casitica indica un’incidenza del 6,75% dell’aspergillosi del seno mascellare rispetto a tutte le patologie sinusali riscontrate. Esiste, tuttavia, un 19% di casi di diagnosi di sinusite micotica in cui è carente un approfondimento sulla qualificazione dell’agente fungino. In rapporto costante con le aspergillosi sono sempre stati riscontrati corpi radiodensi endosinusali in posizione periostale. Tali formazioni indicano una possibile derivazione endodontica della patologia anche se, la particolare loro posizione, suggerisce un ruolo ben preciso giocato dall’areazione fisiologica dei seni e dal loro eventuale ostacolo. Non è, invece, rilevante l’età dei soggetti esaminati in rapporto alla diagnosi aspergillare. Il valore diagnostico degli esami clinici e radiologici non è sufficiente per la definizione nosologica mentre tali esami conservano intatta la loro valenza nella monitorizzazione post-terapeutica del paziente. L’iter diagnostico delle forme sinusali a sospetta etiologia infettiva va sempre completato con l’esame istopatologico. L’individuazione di un’aspergillosi nell’ambito di una forma sinusitica è importante dal punto di vista odontostomatologico in quanto suggerisce le eventuali revisioni canalari necessarie a scongiurare possibili, ma non provati, rischi di recidive a trattamento sinusale avvenuto.

2000 - Studio preliminare dell’utilizzo del gel di piastrine autologo in chirurgia maxillo-facciale. [Abstract in Rivista]
Ceccherelli, G. B.; Bertoldi, Carlo; Bellini, Pierantonio; Zaffe, Davide; Cossarizza, Andrea; De Palma, M.; Consolo, Ugo
abstract

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1998 - Ricostruzione post-traumatica del pavimento orbitario. [Relazione in Atti di Convegno]
Giannetti, Luca; Bellini, Pierantonio; Consolo, Ugo
abstract

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