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VITTORIO CHECCHI

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

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Pubblicazioni

2024 - Changes in Oral Health and Dental Esthetic in Smokers Switching to Combustion-Free Nicotine Alternatives: Protocol for a Multicenter and Prospective Randomized Controlled Trial [Articolo su rivista]
Conte, Gianluca; Pacino, Sebastiano Antonio; Urso, Salvatore; Greiling, Doris; Caponnetto, Pasquale; Pedullà, Eugenio; Generali, Luigi; Consolo, Ugo; Checchi, Vittorio; Gospodaru, Stefan; Bordeniuc, Gheorghe; Fala, Valeriu; Kowalski, Jan; Nowak, Maciej; Górska, Renata; Amaliya, Amaliya; Chapple, Iain; Milward, Michael; Maclure, Robert; Nardi, Gianna Maria; Polosa, Riccardo
abstract

Background: Although the detrimental effects of conventional combustible cigarettes on oral health and dental esthetics are well known, there is limited information about the long-term impact of combustion-free nicotine alternatives (C-F NA) such as e-cigarettes or heated tobacco products. Objective: This multicenter, prospective, 3-parallel-arm randomized controlled trial will investigate whether switching from combustible cigarettes to C-F NA will lead to measurable improvements in oral health parameters and dental esthetics over 18 months in adult smokers with limited gum disease. Methods: Regular smokers not intending to quit and without clinical signs of periodontitis will be randomly assigned (1:4 ratio) to either standard of care with brief cessation advice (control group; arm A) or C-F NA use (intervention group; arm B). The study will also include a reference group of never smokers (reference group; arm C). The primary end point is the change in the Modified Gingival Index (MGI) score from baseline between the control arm (arm A) and the intervention arm (arm B) at the 18-month follow-up. In addition, the study will analyze the within- and between-group (arms A, B, and C) changes in MGI assessment, plaque imaging, dental shade quantitation, tooth stain scores, and oral health-related quality of life questionnaires measured at each study time point. All participants will attend a total of 7 clinic visits: screening, enrollment, and randomization (visit 0); baseline visit-day 14 (visit 1); day 90 (visit 2); day 180 (visit 3); day 360 (visit 4); and day 540 (visit 5). This multicenter study will be conducted in 4 dental clinics in 4 countries. The statistical analysis will involve descriptive statistics for continuous and categorical data. Primary end points will undergo tests for normality and, based on distribution, either a 2-sided t test or Mann-Whitney U test. Linear mixed model with random factors center and study arms by center will also be applied. Secondary end points, including MGI assessment and quality of life, will be subjected to similar tests and comparisons. Only if one value of the parameter MGI is missing after day 1, the last available observation will be carried forward. The analysis will be performed on the substituted data. Secondary parameters will not have missing value replacement. Results: Participant recruitment began in October 2021, and enrollment was completed in June 2023. Results will be reported in 2025. Conclusions: This will be the first study to provide key insights into oral health benefits or risks associated with using C-F NA in smokers who are seeking alternatives to cigarette smoking. Trial registration: ClinicalTrials.gov NCT04649645; https://clinicaltrials.gov/ct2/show/NCT04649645. International registered report identifier (irrid): DERR1-10.2196/53222.

2024 - Comparisons of ammonia- and water-based silver-containing solutions on dentin bonding and enzymatic activity: 1-yr evaluation [Articolo su rivista]
D' Alessandro, C.; Mancuso, E.; Mazzitelli, C.; Maravic, T.; Josic, U.; D' Urso, D.; Forte, A.; Florenzano, F.; Generali, L.; Checchi, V.; Mazzoni, A.; Breschi, L.
abstract

Objective: To evaluate the effects of an ammonia-based and a water-based silver-containing solutions on bonding performance and matrix-metalloproteinases (MMPs) activity of a universal adhesive to dentin after 1 year of artificial aging. Methods: Mid-coronal dentin surfaces of 60 sound human molars were exposed and the following groups were formed according to the surface pre-treatment and etching mode of the universal adhesive (Zipbond Universal, SDI) (n = 10): G1) Zipbond in the self-etch mode (ZSE); G2) Riva Star (SDI) applied before ZSE; G3) Riva Star Aqua (SDI) applied before ZSE; G4) Zipbond in the etch-and-rinse mode (ZER); G5) Riva Star applied before ZER; G6) Riva Star Aqua applied before ZER. The specimens were sectioned and subjected to microtensile bond strength (µTBS) test at baseline (T0) and after 12 months (T12) of artificial storage. Scanning electron microscope (SEM) and energy dispersive spectroscopy analysis (EDS) were also conducted. Three additional molars per group were processed for the in situ zymography analysis at T0 and T12. Data were statistically analyzed (p < 0.05). Results: Dentin pre-treatments and aging decreased bonding values, regardless of the etching mode (p < 0.05). No differences in µTBS were observed between the two silver-containing solutions, both at T0 and T12. Riva Star Aqua and etching significantly increased the MMPs activity, independent of the storage period (p < 0.05). Significance: Dentin surface pre-treatment with silver-containing solutions negatively affects the bonding performances of resin composite restorations placed with a universal adhesive. However, the ammonia-based product Riva Star might show better stability in the long term, due to lower activation of MMPs.

2024 - Push-out bond strength and SEM fractographical analysis of hollow fibre posts used with self-adhesive resin cement: a pilot study [Articolo su rivista]
Generali, Luigi; Veneri, Federica; Forabosco, Eleonora; Cavani, Francesco; Piergianni, Veronica; Sassatelli, Paolo; Checchi, Vittorio; Pedullà, Eugenio
abstract

Detachment is the major cause of failure of endodontic fibre posts. Hollow posts have been recently introduced to overcome such issue. The primary aim of this pilot study was to compare the push-out bond strength of hollow posts and traditional solid posts. Eight round-shaped single-canal premolars extracted for periodontal reason were selected as sample and equally randomized into two groups: (i) traditional solid fibre posts-TECH21xop and ii) hollow fibre posts-TECHOLE. A dual-curing self-adhesive cement (new TECHCEM) was used for posts placement. Six horizontal sections-two from each portion of the root (coronal, middle and apical)-were obtained from each sample root, yielding a total of 24 sections for each group. Push-out test was performed on the sections and bond strength values were compared between groups and within each group. Scanning electron microscope (SEM) fractographical analysis was conducted on each section. Additional SEM and EDX analyses were performed on new samples of both posts, to assess fibres density and distribution, and the chemical composition of the fibres and the matrix. Hollow posts showed a significantly higher push-out bond strength (6.36 +/- 1.22 MPa) than solid posts (3.64 +/- 1.62 MPa). Among the three root portions of the same group, there was no significant difference in bond strength. In both groups, the most frequent type of fracture was a mixed adhesive failure with the cement covering 0 to 50% of the post perimeter. Hollow post fibres appear more similar in size and have a more homogeneous distribution, compared to solid posts. The two post types also have different chemical compositions.

2023 - BONDING PERFORMANCE OF A HEMA-FREE UNIVERSAL ADHESIVE TO DENTIN [Abstract in Rivista]
Claretti, P; Maravic, T; Josic, U; D’Alessandro, C; D’Urso, D; Forte, A; Mazzitelli, C; Generali, L; Checchi, V; Del Bianco, F; Mancuso, E; Breschi, L; Mazzoni, A
abstract

2023 - EFFECTS OF CYCLING LOADING ON SURFACE ROUGHNESS OF HIGHLY-FILLED FLOWABLE COMPOSITE [Abstract in Rivista]
Checchi, V; Corciolani, L; Maravic, T; Generali, L; Breschi, L; Mazzitelli, C
abstract

2023 - Effect of adhesive strategy on resin cement bonding to dentin [Articolo su rivista]
Mazzitelli, C; Maravic, T; Josic, U; Mancuso, E; Generali, L; Checchi, V; Breschi, L; Mazzoni, A
abstract

Objective: The cement bonding strategy and the polymerization mode can influence the prognosis of indirect restorations. The microtensile bond strength (μTBS) and dentin endogenous enzymatic activity of a dual-cure resin cement (PV5) used in com- bination with two dentin surface conditioners (accelerator-enhancer primer, TP or universal adhesive, UA) were evaluated. Materials and Methods: PV5 was used to lute composite overlays after dentin treat- ment with TP or UA. The resin cement was self-cured, SC (1h at 37 C) or dual-cured, DC (20 s light-cure followed by 15 min self-cure at 37 C). The μTBS test, fractographic analysis, and the in situ zymography evaluations were performed after 24 h (T0) or 1 yr (T12) of artificial storage. Data were statistically analyzed (α = 0.05). Results: TP/DC obtained the highest adhesive strengths (45 ± 9 and 36.6 ± 8), while UA/SC (17 ± 8 and 11 ± 4) the lowest, both at T0 and T12, respectively. DC resulted in superior bonding values than the SC, independent of the dentin surface treatment (p < 0.05). The type of adhesive, curing mode and aging influenced the gelatinolytic activity (p < 0.05). Conclusions: The dual-cure resin cement used in combination with its accelerator- enhancer primer showed superior bonding performances with respect to universal adhesive. Dual-curing the resin cement was determinant to enhance bonding capabil- ity over time, independent of the adhesive strategy. Clinical Relevance: Clinicians must be aware to faithfully follow manufacturer's rec- ommendation regarding the adhesive strategy suggested with the resin cement used.

2023 - Effect of bleaching on the color match of single-shade resin composites [Articolo su rivista]
Forabosco, E.; Consolo, U.; Mazzitelli, C.; Kaleci, S.; Generali, L.; Checchi, V.
abstract

2023 - Glutaraldehyde-based desensitizers’ influence on bonding performances and dentin enzymatic activity of universal adhesives [Articolo su rivista]
Mancuso, E.; Durso, D.; Mazzitelli, C.; Maravic, T.; Josic, U.; D'Alessandro, C.; Generali, L.; Checchi, V.; Breschi, L.; Mazzoni, A.
abstract

Objectives: To evaluate the influence of two glutaraldehyde-based desensitizers (L: GLUMA Desensitizer, Heraeus Kulzer and G: GLUMA Desensitizer PowerGel) prior to the adhesive procedures on microtensile bond strength (µTBS) to dentin and endogenous enzymatic activity. Methods: Noncarious human third molars (N = 48) were cut to expose middle coronal dentin. Six experimental groups were formed according to the dentin pre-treatment (L or G) and the universal adhesives (IBU - iBond universal, Kulzer or AU - Adhese Universal, Ivoclar Vivadent) used in the self-etch mode (n = 8): 1) L/IBU; 2) G/IBU; 3) IBU; 4) L/AU; 5) G/AU; 6) AU. Specimens were cut into sticks and stressed until failure after 24 h (T0) or 1 yr of aging (T12). Additional 4 teeth were used for in situ zymography evaluation and data were statistically analyzed (α = 0.05). Results: Dentin pre-treatment, adhesive and aging statistically influenced bond strength and enzymatic activity (P<0.001). AU demonstrated higher bond strength values than IBU (P<0.001). The L resulted in higher bond strength compared to the G and control groups (P<0.001). aging statistically influenced bonding performance, especially when no dentin pre-treatment was performed (P<0.001). In situ zymography revealed that at baseline the control groups exhibited lower interfacial fluorescence compared to the experimental groups, irrespective of the adhesive used (P<0,001). However, after 1 yr of artificial storage, no differences were found among the groups (P>0.05). Conclusions: : Glutharldeadeyde-based products increased bond strength and determined a stabilization of the adhesive interface over time apparently not related to the MMPs inhibition. Clinical Significance: The results of this in vitro study suggest that the application of glutaraldehyde-based desensitizers prior to the adhesive procedures when associated with universal adhesives could result in increased bond strength and stabilization of the adhesive interface over time.

2023 - INFLUENCE OF A CHLORHEXIDINE-BASED GEL ON CHROMATIC VARIATIONS OF TWO COMPOSITE RESINS [Abstract in Rivista]
Checchi, V; Forabosco, E; Dall’Olio, F; Veneri, F; Generali, L
abstract

2023 - Shaping ability of Procodile and R6 Reziflow nickel-titanium reciprocating instruments in curved mesial root canals of mandibular molars: A MicroCT study [Articolo su rivista]
Generali, Luigi; Checchi, Vittorio; Borghi, Alessia; La Rosa, Giusy Rita Maria; Conte, Gianluca; Zavattini, Angelo; Mannocci, Francesco; Angerame, Daniele; Consolo, Ugo; Pedullà, Eugenio
abstract

To compare the shaping ability of Procodileand R6 Reziflow instruments used in reciprocating motion in severely curved root canals, assessed with micro-computed tomography (mu CT). Fourteen extracted human mandibular first molars were randomly assigned to two instrumentation techniques (n = 14 mesial root canals): Procodile or R6 Reziflow. For both groups, root canals were prepared to the working length up to a size 25,.06 taper. Molars were virtually divided into apical, middle and coronal thirds and mu CT was used to scan all samples pre- and post-root canal. Canal transportation, centring ability, volume, surface area and unprepared area were evaluated. Geometrical parameter changes were compared with preoperative values (one-way analyses of variance and Tukey multiple comparison post-hoc test) between groups and Student t-test within groups (alpha = 0.05) Significantly less transportation was observed associated with the Procodile technique in the molar's coronal third compared to the R6 Reziflow technique (p <.05). No significant differences in root canal centring ability, volume, surface area and unprepared area were observed. Procodile showed a lower percentage increase of surface area compared to R6 Reziflow (p <.05). The Procodile and R6 Reziflow techniques applied to first molar root canal performed similarly except for the less transportation observed in the coronal third using Procodile.Research Highlights MicroCT analysis of canal geometry before and after instrumentation revealed that Procodile and R6 Reziflow showed a similar shaping ability to shape curved root canals without substantially modifications of the original tooth anatomy.

2023 - Special Issue on Dental Materials: Latest Advances and Prospects—Volume II [Articolo su rivista]
Checchi, V.
abstract

2023 - Visual and Instrumental Color Match Evaluation of Single Shade Composites before and after Bleaching Procedures: A Pilot Study [Articolo su rivista]
Forabosco, Eleonora; Checchi, Vittorio
abstract

Background: One of the major challenges in restorative dentistry is to obtain an adequate color match between composite restorations and the surrounding tooth. This match depends on several chromatic variables related to the composite itself but also to the teeth. Bleaching procedures are not to be able to modify the shade of composite restorations to a lighter color as it does on natural teeth. Objective: The objective of this study is to evaluate the visual and instrumental color match of two single-shade resin-based composites in human-extracted teeth before and after bleaching treatment. Methods: Six extracted human posterior sound teeth were used. Round-shaped V-class cavities (2x2x4mm) were prepared buccally 2mm away from the CEJ. Two single-shade resin composites (OM-Omnichroma and VE-Venus Diamond One) were used for the restorations. Tooth color was measured using an intraoral spectrophotometer. Visual analysis was carried out by 16 calibrated observers, and the differences were graded from 0 (excellent match) to 4 (huge mismatch). Teeth were then bleached using 40% H2O2 (Opalescence Boost PF, Ultradent), and visual and instrumental evaluations were performed after 24 hours. Results: Before bleaching, visual analysis showed a mean value of 0.16 for OM and 0.24 for VE. After bleaching, the color match showed a mean value of 0.14 for OM and 0.22 for VE. Regarding the instrumental analysis, each restoration matched the tooth VITA scale grade before bleaching and followed the natural tooth VITA scale grade after bleaching procedures. Conclusion: Within the limits of this pilot study, both composites seem to have excellent color-match properties with the surrounding tooth structure.

2022 - Anti-aging dentistry - Odontoiatria anti-aging [Articolo su rivista]
Checchi, Luigi; Checchi, Vittorio
abstract

2022 - Bioburden Variation of Filtering Face Piece Respirators over Time: A Preliminary Study [Articolo su rivista]
Checchi, Vittorio; Montevecchi, Marco; Valeriani, Leoluca; Checchi, Luigi
abstract

Background: The microbial contamination of a respirator can be evaluated through a count of the number of bacteria living on a non-sterilized surface (bioburden). This preliminary study investigated the external contamination of two different FFP2s over time by studying the bioburden values in increasing exposure times. Methods: FFP2 respirators of two different brands were used during routine clinical settings and examined through the bioburden test; for each brand, three devices were tested at 8, 16, and 30 h. Results: No significant differences were observed between mask brands (p = 0.113). There were only significant CFU differences between each mask and its control (p = 0.027 and p = 0.004). Conclusions: Both brands of respirators were found to be contaminated and this contamination increased with the increase in exposure time. Further studies are needed to investigate the exact amount of contamination that could be considered acceptable before discarding each used mask.

2022 - Bone Modeling after Orthodontic Extrusion: A Histomorphometric Pilot Study [Articolo su rivista]
Montevecchi, Marco; Marucci, Gianluca; Pignataro, Barbara; Piana, Gabriela; Alessandri-Bonetti, Giulio; Checchi, Vittorio
abstract

During osteogenesis and bone modeling, high vascularity and osteoblastic/osteoclastic cell activity have been detected. A decrease in this activity is a sign of complete bone formation and maturation. Alveolar bone maturation seems to occur within weeks and months; however, the precise timing of the alveolar bone modeling is still unknown. The aim of this clinical pilot study was to investigate the bone modeling of neo-apposed tissue during orthodontic extrusive movements, through a histomorphometric analysis of human biopsies. This study was conducted on third mandibular molars sockets, and all teeth were extracted after orthodontic extrusion between 2010 and 2014. After different stabilization timings, extractions were performed, and a specimen of neo-deposed bone was harvested from each socket for the histomorphometric analysis. Histological parameters were evaluated to identify bone quantity and quality. This study included 12 teeth extracted from 9 patients. All specimens were composed of bone tissue. Bone samples taken after 1 and 1.5 months of stabilization presented remarkable percentages of woven bone, while after 2 months, a relevant decrease was observed. Histomorphometric analysis suggested that after orthodontic extrusion, a period of stabilization of 2 months allows the neo-deposed bone to mature.

2022 - COLOR MATCH EVALUATION OF TWO SINGLE SHADE COMPOSITES BEFORE AND AFTER BLEACHING PROCEDURE [Abstract in Rivista]
Forabosco, E.; Generali, L.; Consolo, U.; Checchi, V.
abstract

Aim: the aim of this case report was to evaluate instrumental and visual color match of two single shade resin-based com- posites in human extracted teeth before and after bleaching treatments. Methods: two extracted human posterior sound teeth were used. Round shaped V class cavities (2x2x4mm) were prepa- red buccally 2mm away from the CEJ. Two single shade resin composites (ES-Essentia Universal, GC and CL-Clearfill Maje- sty ES2 Universal, Kuraray) were used for the restorations. To- oth color was measured 1mm beside the cavity and in the cen- ter of the restoration using a spectrophotometer (VITA Easysha- de V, VITA Zahnfabrik). Visual analysis were carried out by 16 calibrated observers and differences were graded as 0:excel- lent match; 1:very good match; 2:not so good match; 3:obvious mismatch; 4:huge mismatch. Teeth were then bleached using 40% H2O2 (Opalescence Boost PF, Ultradent) and instrumental and visual evaluations were replied after 24 hours. Results: at baseline, both ES restoration and tooth showed an A3 VITA scale grade, and respectively A2 and C2 after blea- ching. Color match visual analysis showed a mean value of 0.25 both prior and after bleaching. At baseline, both CL resto- ration and tooth showed an A4VITA scale grade, and respecti- vely A3 and C3 after bleaching. Color match visual analysis showed a mean value of 0.87 before and 0.31 after bleaching. Conclusions: within the limits of a single case report, both composites seem to have excellent color match properties with the surrounding tooth structure, from both instrumental and visual points of view.

2022 - Calcium hydroxide removal using four different irrigation systems: A quantitative evaluation by scanning electron microscopy [Articolo su rivista]
Generali, L.; Cavani, F.; Franceschetti, F.; Sassatelli, P.; Giardino, L.; Pirani, C.; Iacono, F.; Bertoldi, C.; Angerame, D.; Checchi, V.; Pedulla, E.
abstract

This study compares conventional endodontic needle irrigation, passive ultrasonic irriga-tion, apical negative pressure irrigation, and mechanical activation to remove calcium hydroxide from single straight root canals. Eighty-four mandibular premolars were prepared in a crown-down manner up to size #40. Two teeth represented a negative control, and another two served as a positive control. Calcium hydroxide paste was placed inside root canals. The remaining eighty samples were analyzed based on the activation techniques, and the cleanliness of the canals was quantified using Fiji’s software on 500× magnified SEM backscattered electron micrographs. Considering the whole canal, all instruments showed better performance than conventional endodontic needle irrigation in removing calcium hydroxide (p < 0.05). Irrisafe and XP-endo Finisher could remove a significantly higher amount of calcium hydroxide than Endovac (p < 0.05). Irrisafe and XP-endo Finisher have been able to remove more calcium hydroxide than EndoVac.

2022 - Can a single molar root act as a whole tooth? [Articolo su rivista]
Checchi, Vittorio
abstract

: This clinical case describes the longitudinal outcome of a radisected upper molar root. The palatal root acted as an abutment and was finalized with a double-premolar-shaped metal-resin crown with two rests on the adjacent teeth. Fifteen years later, the root and its crown were still in place, with no pathologic pocket probing depth and lack of inflammation; the tooth was still in function with no signs of periodontal breakdown. This therapeutic option seemed to have been biologically respectful and maintains the possibility to provide future implant therapy.

2022 - Effect of Orthophosphoric Acid and Er:YAG Laser Etching on Micro-shear Bond Strength to Enamel: An In Vitro Pilot Study [Articolo su rivista]
Zanigni, Ludovica; Checchi, Vittorio; Davide Pugliese, Bruno; Josic, Uros; Mazzitelli, Claudia; Giannetti, Luca; Breschi, Lorenzo; Nucci, Cesare
abstract

Background: Dental conditioning is one of the most important phases during enamel bonding procedures to obtain clean surfaces, smear layer removal with collagen active sites and hydroxyapatite exposure. Objective: The aim of this study was to compare the micro-shear bond strength (μSBS) of different adhesive systems after two different etching techniques: 37% orthophosphoric acid (H3PO4) and Er:YAG laser. Methods: Ninety permanent extracted molars were embedded into epoxy resin blocks and sectioned longitudinally. Specimens were randomly assigned to one of the following groups (n=30), depending on the etching protocol: 37% H3PO4 for 30 s (Group 1), Er:YAG laser 100mJ-10Hz (Group 2), and Er:YAG laser 100mJ-10Hz followed by 37% H3PO4 for 30 s (Group 3). Each group was further divided into two subgroups depending on the bonding agent used on enamel (n=15): A) EE-Bond (Tokuyama) and B) Peak universal (Ultradent). A two-way analysis of variance (two-way ANOVA) was conducted and the level of significance was set to p=0.05. Results: The etching procedure was a significant factor influencing the results (p=0.006), while no differences were observed for the two adhesive systems tested (p>0.05). Group 3 recorded the highest bond strength values, according to the following sequel: Group 3 < Group 2 < Group 1 < 0.05. Conclusion: The combination of phosphoric acid etching with Er:YAG laser provided the most favourable bond strength to enamel. Further morphological studies are currently ongoing.

2022 - Special Issue on Dental Materials: Latest Advances and Prospects [Articolo su rivista]
Checchi, V.
abstract

2021 - A brief review on micro-implants and their use in orthodontics and dentofacial orthopaedics [Articolo su rivista]
Bucur, S. -M.; Vaida, L. L.; Olteanu, C. D.; Checchi, V.
abstract

The aim of this study was to review the literature and evaluate the failure rates and factors that affect the stability and success of temporary anchorage devices (TADs) used as orthodontic anchorage. Data was collected from electronic databases: MEDLINE database and Google Scholar. Four combinations of term were used as keywords: “micro-implant”, “mini-implant”, “mini-screw”, and “orthodontics”. The following selection criteria were used to select appropriate articles: articles on implants and screws used as orthodontic anchorage, published in English, with both prospective and retrospective clinical and experimental investigations. The search provided 209 abstracts about TADs used as anchorage. After reading and applying the selection criteria, 66 articles were included in the study. The data obtained were divided into two topics: which factors affected TAD success rate and to what degree and in how many articles they were quoted. Clinical factors were divided into three main groups: patient-related, implant related, and management-related factors. Although all articles included in this meta-analysis reported success rates of greater than 80 percent, the factors determining success rates were inconsistent between the studies analyzed and this made conclusions difficult.

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 - Comparative evaluation of the penetration depth into dentinal tubules of three endodontic irrigants [Articolo su rivista]
Giardino, L.; Pedullà, E.; Cavani, F.; Bisciotti, F.; Giannetti, L.; Checchi, V.; Angerame, D.; Consolo, U.; Generali, L.
abstract

This study aimed to examine the penetration depth into dentinal tubules of some chelating agents. The 17% EDTA and two preparations containing surfactants (Smear Clear, Bioakt Endo) were tested. Surface tension and liquid viscosity were measured using a Dynamic Contact Angle Analyzer and a Haake rotational rheometer. To measure the penetration depth inside dentinal tubules, thirty maxillary central incisors were selected from a pool of extracted human permanent teeth and allocated to three experimental groups (10 samples each), as well as were mechanically shaped and cleansed with 5.25% NaOCl, followed by each of the chelators being labeled with 0.1 wt % Rhodamine B according to final irrigation protocol established. The samples were embedded in an epoxy resin, after which 200 μm thick transverse sections were obtained at 2, 5, and 8 mm from the apex with a saw microtome. The specimens were then observed using a confocal laser microscope (CLSM) and the penetration of the labeled solution was measured in every third of each sample. Statistical analysis was performed using ANOVA or Kruskal–Wallis tests according to the distribution of data, evaluated with the Shapiro–Wilk normality test. Viscosity and surface tension tests have shown that BioAKT Endo has the lowest values compared to EDTA and Smear Clear. The medium penetration depth did not significantly differ among the three irrigants, while it increased considerably from the apical to the coronal level in all groups. Additionally, the maximum penetration depth increased significantly from the apical to coronal level, while among groups, BioAKT Endo showed the highest values at the apical and middle level compared to the other irrigants. No significant differences were observed among the three groups in medium and maximum penetration depths when the entire root was considered. New irrigants containing surfactants show reduced surface tension and, in one case (BioAKT Endo), viscosity. The lowering of the surface tension allows for better penetration of liquids into dentinal tubules than EDTA alone, thus improving the cleaning of the root canal system.

2021 - Dentin Cross-linking Effect of Carbodiimide After 5 Years [Articolo su rivista]
Maravic, T; Mancuso, E; Comba, A; Checchi, V; Generali, L; Mazzitelli, C; Josic, U; Hass, V; Reis, A; Loguercio, A D; Tay, F R; Breschi, L; Mazzoni, A
abstract

Carbodiimide (EDC)-based dentin primers preserve hybrid layer (HL) integrity. However, aging >1 y has not been investigated. The present study examined whether the cross-linking effect of EDC was reflected in dentin bond strength, endogenous enzymatic activity, and the chemical profile of the HL after 5-y aging in artificial saliva. Noncarious human third molars (N = 42) were cut to expose middle/deep coronal dentin and treated as follows: group 1, dentin etched with 35% H3PO4, pretreated with a 0.3M aqueous EDC primer for 1 min and restored with XP Bond (Dentsply Sirona); group 2, as in group 1 but without EDC pretreatment; group 3, Clearfil SE Bond (Kuraray-Noritake) primer applied to dentin surface, followed by EDC pretreatment as in group 1 and application of bond; group 4, as in group 3 without EDC pretreatment. After composite buildup, the specimens were cut into sticks or slabs, depending on the experiment. All tests were performed at baseline (T0) and after 5 y of aging (T5) in artificial saliva at 37 °C. Microtensile bond strength (µTBS) was tested at a crosshead speed of 1 mm/min until failure. Endogenous enzymatic activity was investigated with in situ zymography. The chemical profile of HL was determined via Raman spectroscopy. Three-way analysis of variance and post hoc Tukey test were used to analyze µTBS and in situ zymography data (α = 0.05). EDC pretreatment and aging significantly influenced µTBS and in situ zymography results (P < 0.05). Higher bond strength and lower gelatinolytic activity were identified in the EDC-treated groups at T5 (P < 0.05), especially in the etch-and-rinse groups. Raman spectra revealed less defined amide III peaks in control specimens at T5. The EDC cross-linking effect persisted in the HL for 5 y in terms of bond strength, collagen structure preservation, and dentinal enzyme silencing.

2021 - Endogenous Enzymatic Activity of Primary and Permanent Dentine [Articolo su rivista]
Maravic, Tatjana; Breschi, Lorenzo; Paganelli, Federica; Bonetti, Giulio Alessandri; Martina, Stefano; Di Giorgio, Gianni; Bossù, Maurizio; Polimeni, Antonella; Checchi, Vittorio; Generali, Luigi; Tay, Franklin R; Cadenaro, Milena; Mazzoni, Annalisa
abstract

Matrix metalloproteinases (MMPs) play an important role in tooth development and influence caries development and hybrid layer degradation. Literature is scant on the differences in the activity of MMPs between primary and permanent dentine. Accordingly, the aim of the present study was to investigate endogenous gelatinolytic activity in primary and permanent dentine. Separate batches of dentine powder were obtained from intact human primary and permanent molars (n = 6). Each batch was divided in two subgroups: (1) mineralised; and (2) demineralised with 10% H3PO4. After protein extraction, gelatine zymography was performed. Furthermore, in situ zymography was performed on dentine sections of the same groups (n = 3). The slices were polished, covered with fluorescein-conjugated gelatine and evaluated using a confocal microscope. In situ zymography data were analysed using two-way analysis of variance and post hoc Holm-Šidák statistics (α = 0.05). Primary dentine showed poorly defined bands in the zymograms that vaguely corresponded to the pro-form and active form of MMP-2 and the pro-form of MMP-9. In permanent dentine, demineralised powder demonstrated stronger gelatinolytic activity than mineralised powder. In situ zymography identified stronger enzymatic activity in primary etched dentine (p < 0.05). Stronger enzymatic activity recorded in primary dentine may be related to the differences in morphology and composition between primary and permanent dentine.

2021 - Endogenous enzymatic activity in dentin treated with a chitosan primer [Articolo su rivista]
Maravic, T.; Baena, E.; Mazzitelli, C.; Josic, U.; Mancuso, E.; Checchi, V.; Generali, L.; Ceballos, L.; Breschi, L.; Mazzoni, A.
abstract

The aim of this study was to evaluate the effect of different concentrations of chitosan polymer on dentinal enzymatic activity by means of gelatin and in situ zymography. Human dentin was frozen and ground in a miller. Dentin powder aliquots were demineralized with phosphoric acid and treated with three different concentrations of lyophilized chitosan polymer (1, 0.5 and 0.1 wt%) dissolved in distilled water. Dentin proteins were extracted from each experimental group and electrophoresed under non-reducing conditions in 10% SDS-PAGE containing fluoresceinlabeled gelatin. After 48 h in the incubation buffer at 37 °C, proteolytic activity was registered under long-wave UV light scanner and quantified by using Image J software. Furthermore, additional teeth (n = 4) were prepared for the in situ zymographic analysis in unrestored as well as restored dentin pretreated with the same chitosan primers. The registered enzymatic activity was directly proportional to the chitosan concentration and higher in the restored dentin groups (p < 0.05), except for the 0.1% chitosan primer. Chitosan 0.1% only showed faint expression of enzymatic activity compared to 1% and 0.5% concentrations. Chitosan 0.1% dissolved in water can produce significant reduction in MMPs activity and could possibly contribute to bond strength preservation over time.

2021 - Histologic Observations of Two Dental Implants Retrieved After Osseointegration [Articolo su rivista]
Checchi, Vittorio; Mazzoni, Annalisa; Breschi, Lorenzo; Felice, Pietro
abstract

This study aimed to histologically analyze the bony tissue formed around dental implants after osseointegration. A 58-year-old patient presented with pain and discomfort caused by two dental implants in her maxilla placed 8 months earlier. At clinical and radiographic analysis, the implants appeared well osseointegrated but tilted buccally, emerging in nonkeratinized mucosa. For this reason, the discomfort began right after the prosthetic load, 4 months after implant placement, and the patient felt pain when wearing the implant-supported removable prosthesis. Both implants were made of titanium, airborne-particle abraded with zirconium oxide, and etched with mineral acids. The implants were removed, preserving the bone around the implant threads, and replaced with two new implants, inserted in a prosthetically guided, correct position. The removed implants were histologically observed. Histologic analysis showed good bone-to-implant contact, mature bone with few marrow spaces, presence of direct connecting bridges between the peri-implant bone trabeculae and the implant surface, and no inflammatory cells nor connective fibrous tissue ingrowth. This study showed that dental implants coated with a rough surface were properly osseointegrated, with no inflammatory signs nor connective fibrous tissue ingrowth, 8 months after placement.

2021 - Hypersensitivity in molar incisor hypomineralization: Superficial infiltration treatment [Articolo su rivista]
Diago, A. M. D.; Cadenaro, M.; Ricchiuto, R.; Banchelli, F.; Spinas, E.; Checchi, V.; Giannetti, L.
abstract

To date, there are no standardized protocols available in the literature for hypersensitivity treatment in molar incisor hypomineralization (MIH) patients. The aim of this study was to evaluate the efficacy of erosion–infiltration treatments with resin in children with a strong hypersensitivity and also to develop a minimally invasive diagnostic–therapeutic pathway for young MIH patients. Patients with clinical signs of MIH were enrolled according to international guidelines. A total of 42 patients (8–14 years old) with sensitivity of at least one molar and patients with post eruptive enamel fractures, but without dentin involvement or cavitated carious lesions were selected. A single superficial infiltration treatment with ICON (DMG, Germany) was performed with a modified etching technique. Sensitivity was tested with the Schiff Scale and Wong Baker Face Scale and was repeated at 12 months follow‐up. All patients reported lower sensitivity values at the end of the treatment. Significant differences of sensitivity according to the Schiff scale were reported between T0 and all subsequent follow‐ups, p < 0.05. The treatment of erosion infiltration with ICON resin is a minimally invasive preventive treatment that significantly improves the problem of hypersensitivity in permanent molars with MIH.

2021 - Isolation through rubber dam to prevent COVID-19 exposure during flapless trans-crestal sinus lift procedures [Articolo su rivista]
Checchi, Vittorio; Generali, Luigi; Generali, Paolo
abstract

In 2020, a highly infective new pathogen (Sars-CoV-2) spread from China to the whole globe, and became responsible of an acute respiratory syndrome, often asymptomatic but potentially lethal, named COVID-19. Airborne and direct contact contamination are the major infection pathways of Sars-CoV-2 and it has been shown that virus spread can also happen in absence of clinical symptoms. SARS-CoV-2 transmission during dental procedures can happen through inhalation of droplets from infected patients or direct contact with mucous membranes, oral fluids, and contaminated instruments. Both sinus lift and implant surgeries often involve bleeding and exposure to oral fluids, and a rubber dam could be used to reduce direct contact and the amount of potentially infected aerosol. The aim of this short case presentation is to illustrate how the use of a rubber dam could be extremely useful in preventing COVID-19 exposure during flapless trans-crestal sinus lift procedures.

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 - Recognition and treatment of peri-implant mucositis: Do we have the right perception? A structured review [Articolo su rivista]
Bianco, Laura Lo; Montevecchi, Marco; Ostanello, Michele; Checchi, Vittorio
abstract

Peri-implant mucositis is a common inflammatory lesion of the soft tissues surrounding endosseous implants, with no loss of the supporting bone. Its prevention or early diagnosis are vital for dental implant success.The aim of this review was to investigate knowledge strengths and gaps in clinicians'perceptions of periimplant mucositis prevalence and evidence for successful treatment.A literature search for articles published until 2020, reporting on the prevalence of peri-implant mucositis and its treatment was performed in standard online databases. The inclusion criteria were as follows: studies in English; studies with an available abstract; studies on humans with at least 1 dental implant; and studies reporting on the prevalence and/or treatment of peri-implant mucositis. Sixty-five studies fulfilled the inclusion criteria. The included papers were analyzed to identify data on the prevalence and treatment of peri-implant mucositis. The prevalence statistics for peri-implant mucositis had wide ranges in both the patient-based (PB) analysis and the implant-based (IB) analysis; the possible reasons for these wide ranges are discussed. Treatment methods for peri-implant mucositis were analyzed individually and compared to the management of gingivitis.It was determined that the currently available information on the prevalence rates and the standardized therapeutic protocols for peri-implant mucositis are insufficient. Since the mean gingivitis and peri-implant mucositis prevalence rates in the PB analysis were similar, it is possible that peri-implant mucositis is under estimated due to variables related to implant rehabilitation itself.

2021 - Surgical field isolation through rubber dam to prevent covid-19 exposure during tooth extraction: Case report [Articolo su rivista]
Checchi, V.; Ragazzini, S.; Ragazzini, N.
abstract

Background: At the beginning of 2020, a new pathogen named SARS-CoV-2 spread from China to the globe, becoming responsible for a potentially lethal acute respiratory syndrome: COVID-19. Direct contact and airborne contamination are the most frequent infection ways of SARS-CoV-2. During routine dental practice, SARS-CoV-2 transmission can occur through direct contact with mucous membranes, oral fluids, and contaminated instruments or inhalation of aerosol from infected patients. Introduction: Tooth extraction often involves exposure to blood and oral fluids, and the use of a rubber dam could be indicated to minimize direct contact and to decrease the amount of potentially infected droplets around the operatory field. The aim of this clinical case is to show how the use of a rubber dam could help in preventing or minimizing COVID-19 exposure during dental extraction. Materials and Methods: A 32-year-old patient reported severe pain and discomfort to an upper first molar due to a deep carious lesion and vertical tooth fracture. Under local anaesthesia, a rubber dam was placed, isolating the whole upper right sextant, and an atraumatic extraction was performed. Results: All three roots were intact, the bone septum was stable, and no oro-antral communication was present. A gauze swab was placed onto the socket and compressed slightly. After 5 minutes, the socket stopped bleeding, and both clamp and rubber dam, were removed. Conclusion: Within the limits of this single case report, the use rubber dam prior to tooth extraction could be a useful device to decrease aerosol spread and exposure to blood.

2021 - Traumatic Dental Injuries: Clinical Case Presentation and a 10-Year Epidemiological Investigation in an Italian Dental Emergency Service [Articolo su rivista]
Murri Dello Diago, A.; Generali, L.; Apponi, R.; Colombini, V.; Checchi, V.
abstract

Traumatic dental injuries (TDIs) are very common in the world population, and international literature reports several studies which helped in the definition of international guidelines. The aim of this study is to present two clinical cases of TDI and to investigate epidemiological and etiological aspects of TDIs in patients treated in Modena, Italy, between January 2010 and December 2020. The presented case reports are two explicative clinical cases of successful TDI management with a long-Term follow-up. The epidemiological analysis was performed on patients who visited the Dental Emergency Service of the Dentistry and Oral-Maxillo-Facial Surgery Unit of Modena (Italy) over a period of 10 years. Data relating to age, gender, type of trauma, and place of accident were collected. Five-hundred-sixty-five TDIs that occurred to patients from 1 to 68 years old were reported, with a total of 860 injured teeth. The peak age at which TDIs are most represented varies between 2 and 3 years old, and they occurred frequently from 1 up to 7 years old. 57.5% were male, while 42.5% were female. The most common trauma resulted to be the uncomplicated crown fracture (20%), immediately followed by lateral luxation (19%), intrusive luxation (18%), avulsion (17%), and complicated crown fracture (15%). TDIs occurred at home in 44% of cases. The need for more prevention training must be highlighted, due to the fact that many TDIs occur at home and in a preschool age.

2021 - Variation of Efficacy of Filtering Face Pieces Respirators over Time in a Dental Setting: A Pilot Study [Articolo su rivista]
Checchi, Vittorio; Montevecchi, Marco; Checchi, Luigi
abstract

Since aerosol continuously persists in dental settings, where different procedures and patients come in succession, the use of oronasal masks is highly recommended. Among them, respirators known as Filtering Face Pieces (FFP) show a protective superiority compared to surgical masks. Even concerning respirators classified as non-reusable, it is not known how many hours of use are necessary to compromise their filtering capacity. The aim of this study is to investigate the variations of filtering capacity of an FFP2 respirator over time, in order to safely optimize the timing of its use. Five respirators were worn by the same operator during clinical activity for different usage times (8, 16, 24, 32, 40 h), and one respirator was kept unused. All respirators underwent a bacterial filtration efficacy (BFE) test. T-test for paired data with Bootstrap technique and Wilcoxon test for paired data compared BFE values of the five tested FFP2s respectively at each time, and the areas with the corresponding values of the control respirator (FFp2-F). A generalized linear mixed effect model (GLM) was applied considering type of respirator and time as fixed effects and intercept as random effect. No significant statistical differences were present in the BFE of each time. Data obtained by the present study highlight the important ability of FFP2s to maintain their BFE over time, suggesting a long lasting protective function.

2020 - Behavior of Two Resin Composites after Aging in Drink Solutions [Abstract in Rivista]
Generali, L; Vignudini, G; Maravic, T; Puddu, P; Bolelli, G; Lusvarghi, L; Breschi, L; Consolo, U; Checchi, V
abstract

Objectives: The aim of this study was to investigate the effects of artificial saliva and drink solutions on colorimetric variations and wear resistance of 2 composites: Herculite XRV Ultra (HXRVU) and Harmonize (HZ) (Kavo-Kerr), after one month aging Methods: Forty composite specimens were prepared in an oxygen-free environment and polymerized. Four specimens were immedialtely investigated (T0), while thirty-six specimens were soaked into different drink solutions (artificial saliva, cola, ethanol), sealed into PET bottles and incubated at 37°C. Control specimens were kept in air. Specimens evaluation was made at T0, after 1 week (T1) and 1 month (T2). Twenty-four samples (12 HXRVU, 12 HZ) were analyzed using a spectrophotometer to assay three color-identifying values: L, a and b. To evaluate wear resistance, the remaining sixteen samples (8 HXRVU, 8 HZ) were fitted into a rotary tribometer, placed into a food-like bolus-simulating slurry and wear rate was evaluated with a profilometer. Results: L values for all specimens of both groups did not show differences between T0 and T2. All a values showed an increase compared to control group. b values for HXRVU specimens did not show differences between T0 and T2, whereas b values for HZ specimens decreased, compared to control group. HXRVU specimens were more wear resistant than HZ group at T0 and seemed to be less susceptible to modifications in different drink solutions. Ethanol solution produced a marked increase of wear rate in HZ specimens at T2. Conclusions: Aging effects on chromatic variations of composites placed into different drink solutions were demonstrated only for a value, resulting in a slightly change into red color. Wear rate was composite related. Additional in vivo testing is needed to clarify the clinical behaviour of the tested composite materials in terms of color changes and wear rate.

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 - Computer-guided implant placement in contact with root remnants in the esthetic area [Articolo su rivista]
Checchi, Vittorio; Bertani, Pio; Generali, Paolo; Generali, Luigi
abstract

The extraction of a tooth with root resorption can be a complicated procedure and can result in the removal of a significant amount of alveolar bone. In the anterior maxilla, esthetic rehabilitation of damaged sites with implant-supported crown could require multiple surgeries. Patients often ask for an alternative, and minimally invasive treatments are generally preferred. In this paper, a clinical case of implant-supported crown in a site affected by root resorption is described. Immediate implant was placed leaving some root fragments in the osteotomy site, thus avoiding invasive extractive surgeries. A minimally invasive flapless technique with a computer-guided implant placement procedure was used. After 8 years, clinical and radiologic data were stable, gingival tissues around the implant appeared healthy, no dark translucency appeared through marginal gingiva around the implant, and there was no pathologic probing pocket depth or bleeding on probing. In the presence of root resorption and ankylosis, computer-guided surgery could be helpful to prepare a precise implant site through various tissues, such as partially resorbed root remnants.

2020 - Effect of an ethanol cross-linker on universal adhesive [Articolo su rivista]
Comba, A.; Maravic, T.; Villalta, V.; Tozzola, S.; Mazzitelli, C.; Checchi, V.; Mancuso, E.; Scotti, N.; Tay, F. R.; Breschi, L.; Mazzoni, A.
abstract

Objective: To evaluate the effects of N,N'-dicyclohexylcarbodiimide (DCC), an ethanol-based dentin cross-linker, on the immediate and long-term microtensile bond strength (μTBS) and nanoleakage expression of a universal adhesive employed in self-etch mode (SE) or etch-and-rinse mode (ER). The effect of DCC on the dentinal MMP activity was also investigated by means of in-situ zymography. Methods: Eighty freshly extracted human molars were sectioned to expose mid-coronal dentin surfaces. The teeth were assigned to one of the following groups, according to the dentin surface priming/adhesive approach: (G1): DCC pre-treatment and Scotchbond Universal (SBU) in ER mode; (G2): SBU in ER mode; (G3): DCC pretreatment and SBU in SE mode; (G4): SBU in SE mode. μTBS test was performed immediately (T0) or after 1-year aging (T12) in artificial saliva. Ten additional teeth per group were prepared for nanoleakage evaluation (N = 5) and for in-situ zymography (N = 5). Results: Three-factor analysis of variance revealed significant difference for the variables DCC pretreatment, application mode and aging (p < 0.05) for both microtensile bond strength testing and in-situ zymography. Nanoleakage analysis revealed reduced marginal infiltration of DCC experimental groups both at T0 and T12. Significance: The use of an ethanol-based primer containing DCC appears to be promising in preserving the stability of the adhesive interface of a universal adhesive, especially in the SE mode.

2020 - Effect of shelf-life of a universal adhesive to dentin [Articolo su rivista]
Mazzitelli, Claudia; Maravic, Tatjana; Sebold, Maicon; Checchi, Vittorio; Josic, Uros; Breschi, Lorenzo; Mazzoni, Annalisa
abstract

The microtensile bond strength (μTBS), nanoleakage expression (NL), and endogenous enzymatic activity of a simplified universal adhesive system used in combination with a dual-cure resin cement for luting indirect restorations were evaluated considering its shelf-life (as-received vs expired). The universal adhesive was used asreceived (AS-R) by manufacturer or after three months after being expired (EXP). Resin composite overlays (n ¼ 10) were luted to flat deep coronal dentin surfaces with a universal bonding system (iBond universal, used in the self-etch mode) in combination with a dual-cure resin cement (RelyX Ultimate; 20s of light-cure followed by 15 min of self-cure at 37 �C). After 24 h, the specimens were cut into microtensile sticks (1 mm2) and stressed to failure under tension, in accordance with ISO/TS 11.405. The fracture pattern was evaluated with optical microscopy. The significance level of p ¼ 0.05 was used for the statistical analysis. Additional specimens (n ¼ 4) were processed for quantitative interfacial nanoleakage expression using ammoniacal silver nitrate. To investigate the endogenous enzymatic activity within the hybrid layer in situ zymography was performed. The EXP group obtained significantly lower μTBS values than those recorded in the AS-R group (p < 0.05). NL resulted in higher deposition of AgNO3 granules when the adhesive was used in the EXP group compared to the AS-R bonding system. In situ zymography assay revealed increased level of fluorescence when the universal bonding system was used at the end of shelf-life compared to the AS-R group. The use of the universal adhesive system beyond the expiry limit resulted in decreased bonding performances. Furthermore, the higher endogenous enzymatic activity recorded after the end of the shelf life of the universal adhesive would portend for a shortened durability of the restorations.

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 - Influence of Light-curing on Endogenous Dentinal Enzymatic Activity. [Abstract in Rivista]
Mazzitelli, Claudia; Maravic, Tatjana; Comba, Allegra; Mancuso, Edoardo; Josic, Uros; Checchi, Vittorio; Generali, Luigi; Mazzoni, Annalisa; Breschi, Lorenzo
abstract

Objectives: Dentin collagen fibrils exposed after bonding procedures are possibly subject to degradation through a mechanism mediated by dentinal endogenous enzymes, thus impairing the longevity of the hybrid layer (HL). The aim of this in vitro study was to investigate the ability of a universal adhesive used in combination with dual-cure resin cements with/out light-activation to inhibit enzymatic activity, using in situ zymography. Methods: Composite overlays were prepared to be luted to middle/deep dentin surfaces of non-carious human molars. After bonding application (iBond universal adhesive used in the self-etch modality), the following resin cements were used for luting procedures: 1) RelyX Ultimate (RXU); 2) Panavia V5 (PAN); 3) Variolink EstheticDC (VAR). Resin cements were either used in the self-cure mode (SC; 1h at 37°C) or in the dual-cure mode (DC; 20s light-cure followed by 15 min self-cure at 37°C). After 24h, specimens were cut to expose the HL, glued to glass slides, polished and prepared for in situ zymography. Self-quenched fluorescein-conjugated gelatine mixture was placed on top of each specimen, protected with a cover slip and incubated in a dark humidified chamber at 37°C for 12h. Detection of endogenous gelatinolytic enzyme activity within the HL was evaluated with a multi-photon confocal laser scanning microscope. Results: The enzymatic activity, as showed by in situ zymography, was dependent to the polymerization mode of the resin cement. A lower level of fluorescence was present for RXU when DC, and this was statistically significant among all the groups (p<0.05). PAN demonstrated inferior enzymatic activity when only SC (P<0.05). VAR specimens in the SC group completely fractured during preparation procedures. Conclusions: Light-cure influences the dentinal enzymatic activity when a simplified bonding system is used in combination with dual-cure resin cements with a material-dependent trend. Further studies are necessary to investigate whether the enzymatic activity would change over time.

2020 - Surgical masks vs respirators: properties and indications for use [Articolo su rivista]
Checchi, V; Checchi, L
abstract

OBJECTIVES. Many dental procedures are responsible for the creation of an aerosol capable of transporting bacteria, virus and infected particles into the surrounding environment. The use of handpieces and/or ultrasonic devices creates an aerosol of particles with different diameters that present a severe risk for nasal and tracheobronchial cavities. This deposition of particles occurs on different levels, depending on their dimensions: particles with larger diameter stops in the nasal cavities, while the smaller ones end up in lung alveoli. These aerosol particles have their own movement, partly caused by the displacement of air masses and by the Brownian motions produced by the impact of the gaseous particles against the aerosol ones. Since these droplets are able to persist continuously for long time in environments where patients and procedures follow and overlap over the course of a day, it is essential for dental clinicians to adopt personal protective equipment, among which the choice of an appropriate mask. The aim of this literature overview is to clarify the terminology, the criteria for the construction of a mask, to illustrate the differences between masks and oral respirators. and to provide practical support for personal and patient protection, choosing the device suitable for each clinical situation. MATERIALS AND METHODS. This work is a literature review of the national and international literature on this topic: the scientific data published since mask introduction to date have been collected, and the characteristics, differences and clinical indications for the use of masks and oral respirators in dentistry have been analyzed. CONCLUSIONS. The surgical mask and the respirator are individual devices that meet specific standards and whose use must always be combined with other PPE such as screens and protective glasses, headgear, gloves, disposable gowns and of course a careful personal hygiene. The importance of examining the technical data sheet referring to the devices used, in order to check the necessary strict adherence to the reference protocols, must always be underlined. To date there are still conflicting opinions on what the correct indication may be on the type of respirator to be used to prevent contagion from Sars-CoV-2. Respirators without a filter-valve seem to be the devices capable of providing the highest protection to the operator and patient but, precisely because of their high filtering capacity, they make breathing difficult if worn for a long time continuously. To improve respiratory capacity and therefore to seek greater comfort, the use of a high filter respirator with exhalation valve, in association with a surgical mask to be applied on it, is conceivable. However, surgical masks remain valid devices for all those services that do not involve the creation of highly infected aerosols and the consequent dispersion of potentially contaminated particles in the air. Finally, to limit the spread of Covid-19 as much as possible, anyone should wear a surgical mask, so that an infected person cannot contaminate the surrounding environment and people nearby. CLINICAL SIGNIFICANCE. This work highlights the characteristics of surgical masks and oral respirators, providing practical indications on the most suitable devices for protection from Covid-19 infection.

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 - Assessment of C-Reactive Protein Levels in Periodontal Patients Using a Standard Laboratory Procedure [Articolo su rivista]
Checchi, Vittorio; Daprile, Giuseppe; Genovesi, Karin; Checchi, Luigi
abstract

Abstract: Background: the aims of the randomized clinical trial were (i) to verify the association between periodontal disease and C-reactive protein (CRP) and (ii) to evaluate a possible reduction of serum CRP levels after non-surgical periodontal treatment. Methods: Thirty-two subjects, 18 affected by chronic periodontitis, and 14 periodontally healthy patients, aged between 21 and 65 (41± 13) were included. Clinical and radiographic examinations were used for each patient to obtain three dental indices that were used to evaluate severity of periodontal disease and changes after treatment. Periodontal patients were randomly assigned to one of two groups for different treatments: special oral hygiene instructions alone or in combination with scaling and root planing. Blood samples were taken for measurement of CRP levels and eritrosedimentation rate before and after treatment. Results: a reduction of clinical index CPSS was observed for both groups of periodontal patients after treatment but there were no statistically significant differences for CRP and ESR at baseline and between baseline and reexamination. Non statistically significant differences of CRP values between periodontal patients and healthy controls were found. Conclusions: CRP values don’t seem to change after non-surgical treatment of periodontitis, even in presence of a reduction of clinical indices.

2019 - Clinical Classification of Bone Augmentation Procedure Failures in the Atrophic Anterior Maxillae: Esthetic Consequences and Treatment Options [Articolo su rivista]
Checchi, V.; Gasparro, R.; Pistilli, R.; Canullo, L.; Felice, P.
abstract

Although the number of complications and failures in bone augmentation procedures is still relatively high, these problems remain poorly documented. Moreover, the literature concerning reconstructive techniques and the treatment of their complications in the anterior areas rarely considers the final esthetic result. The aim of this paper is to propose a new classification of bone augmentation complications in the esthetic area, providing treatment guidelines useful for the management of these cases. Failures of bony regeneration procedures can be mainly divided into partial failures and complete failures. A partial failure can be solved with a corrective surgical intervention: this second surgery can have success or may not be able to provide the desired esthetic result. When the bone reconstructive procedure fails totally, a complete failure occurs and the whole procedure has to be repeated. This new intervention can have success but also this new reconstructive surgery can fail in the same way as the first, causing important damage and a compromise solution that will hardly be acceptable from an esthetic point of view. Bone augmentation techniques are not completely predictable and are not always able to guarantee the expected result, especially in the atrophic anterior maxilla. Complications and failures can often occur and this possibility must always be clearly explained to those patients with high esthetic demands and expectations.

2019 - Effect of Cross-linkers on Bond-strength and MMPs on Radicular Dentin. [Abstract in Rivista]
A33., Comba A; Maravic, T; Mazzoni, A; Mayer-Santos, E; Checchi, V; Mancuso, E; Scotti, N; Alovisi, M; Breschi, L
abstract

2019 - Effect of benzalkonium chloride on dentin bond strength and endogenous enzymatic activity [Articolo su rivista]
Comba, A.; Maravic, T.; Valente, L.; Girlando, M.; Cunha, S. R.; Checchi, V.; Salgarello, S.; Tay, F. R.; Scotti, N.; Breschi, L.; Mazzoni, A.
abstract

Objective: This in vitro study evaluated at baseline (T0) and over time (T12 months), the effect of a multi-mode universal adhesive compared with two experimental formulations blended with different concentrations of benzalkonium chloride (BAC), on bond strength and endogenous enzymatic activity. Methods and materials: Specimens were assigned to the following groups according to the adhesive protocol: G1) All-Bond Universal (ABU) self-etch (SE); G2) ABU + 0.5% BAC SE; G3) ABU + 1% methacrylate BAC SE; G4) ABU etch-and-rinse (E&R); G5) ABU + 0.5% BAC E&R; G6) ABU + 1% methacrylate BAC E&R. Gelatin zymography was performed on dentin powder obtained from eight human third molars. Endogenous enzymatic activity within the hybrid layer was examined using in situ zymography after 24 h (T0) or 1-year storage in artificial saliva (T12). Forty intact molars were prepared for microtensile bond strength test at T0 and T12. Results were statistically analyzed with three-way ANOVA (α = 0.05). Results: Gelatin zymography assay and in situ zymography quantification analyses indicated that all the BAC-containing formulations decreased matrix metalloproteinase expression. However, in situ zymography showed a general trend of enzymatic activity increase after aging. Microtensile bond-strength testing showed decrease in bond strength over time in all the tested groups; performances of the 1% methacrylate BAC experimental groups were worse than the control. Conclusions: BAC-containing adhesives reduce endogenous enzymatic activity both immediately and over time. However, independently from the adhesive employed, increase in the gelatinolytic activity over time and decrease in bond strength was found (especially in the BAC + 1% methacrylate groups), probably due to impaired polymerization properties. Clinical significance: Adhesives containing protease inhibitors are practical and efficient tools in clinical practice for enhancement of the longevity of dental restorations. However, extensive investigation of the mechanical and adhesive properties of the material is necessary prior to their clinical use.

2019 - Role of Dental Implant Homecare in Mucositis and Peri-implantitis Prevention: A Literature Overview [Articolo su rivista]
Checchi, Vittorio; Racca, Fabrizio; Bencivenni, Davide; Lo Bianco, Laura
abstract

Background: Correlation between high plaque index and inflammatory lesions around dental implants has been shown and this highlights the importance of patient plaque control. Until now, knowledge of peri-implant home care practices has been based on periodontal devices. Objective: The aim of this overview is to identify the presence of scientific evidence that peri-implant homecare plays a role in mucositis and peri-implantitis prevention. Methods: Different databases were used in order to detect publications reflecting the inclusion criteria. The search looked into peri-implant homecare studies published from 1991 to 2019 and the terms used for the identification of keywords were: Dental implants, Brush, Interproximal brushing, Interdental brushing, Power toothbrush, Cleaning, Interdental cleaning, Interspace cleaning, Flossing, Super floss, Mouth rinses, Chlorhexidine. The type of studies included in the selection for this structured review were Randomized Clinical Trials, Controlled Clinical Trials, Systematic Reviews, Reviews, Cohort Studies and Clinical cases. Results: Seven studies fulfilled all the inclusion criteria: 3 RCTs, one Consensus report, one cohort study, one systematic review and one review. Other 14 studies that partially met the inclusion criteria were analyzed and classified into 3 different levels of evidence: good evidence for RCTs, fair evidence for case control and cohort studies and poor evidence for expert opinion and case report. Conclusion: Not much research has been done regarding homecare implant maintenance. Scientific literature seems to show little evidence regarding these practices therefore most of the current knowledge comes from the periodontal literature. Manual and powered toothbrushes, dental floss and interdental brushes seem to be useful in maintaining peri-implant health. The use of antiseptic rinses or gels does not seem to have any beneficial effects. It can be concluded that to better understand which are the most effective home care practices to prevent mucositis and peri-implantitis in implant- rehabilitated patients, new specific high evidence studies are needed.

2019 - SISTEMA DI DECONTAMINAZIONE DI CIRCUITI IDRICI [Brevetto]
Checchi, L; Checchi, V
abstract

La presente invenzione si riferisce ad un sistema per la decontaminazione di un circuito idrico costituito da un condotto di alimentazione di acqua, in particolare proveniente dalla rete di fornitura o da serbatoio interno al riunito o allo studio, ed almeno un condotto di scarico dell'acqua circolante nel circuito; il sistema comprende mezzi di apertura e chiusura del condotto di alimentazione di acqua, mezzi di apertura e chiusura del condotto di scarico dell'acqua circolante nel circuito e mezzi di immissione di aria in pressione nel circuito idrico.

2019 - The Influence of a CHX-containing Etchant on Bond Strength. [Abstract in Rivista]
Checchi, V; Maravic, T; Comba, A; Teuolde, L; Mazzoni, A; Breschi, L.
abstract

2019 - The connective tissue graft in the surgical treatment of epulis: a clinical case [Articolo su rivista]
Checchi, Vittorio; Masi, Irene; Checchi, Luigi
abstract

OBJECTIVES Epulis is an asymptomatic lesion and its election treatment consists in the surgical excision that often produces important esthetic and functional alterations of the gingival complex. The purpose of this case report is to describe an alternative surgical approach to remove an epulis while preserving and improving the aesthetics of the much-gingival complex. MATERIALS AND METHODS A 29-years-old patient was referred for the evaluation of a hyper plastic gingival lesion localized on the buccal aspect of the upper central incisors. The histologic diagnosis was of pyogenic granuloma. After initial periodontal therapy and labial frenectomy, the patient underwent surgical treatment. A sub-epithelial connective tissue graft was interposed between a full-thickness muco-periosteal flap and the recipient bed, preserving the lesion. RESULTS AND CONCLUSIONS No post surgical complications were detected. More than a one year after surgery the patient exhibited no epulis with a stable gingival situation and no recurrence was detected. This technique seems to be able to remove the lesion and allow a thickness increase of the connective tissue underlying the mass, preventing post surgical gingival recessions and retraction scars and avoiding a second surgical reconstructive procedure.

2018 - Displacement of a dental implant in the mandible body: an unusual case report [Articolo su rivista]
Pistilli, Valeria; Checchi, Vittorio; De Paolis, Filippo; Pistilli, Roberto; Barausse, Carlo
abstract

Purpose: to present a case of a woman referred for the management of displacement of one implant in her right posterior mandible occurred three days earlier. Materials and methods: After implant placement, the dentist was not able to detect the implant anymore and inserted a second implant in the same site without taking a control x-ray. At the end of the surgery, when finally an x-ray was taken, the first implant appeared displaced into the mandible body. The patient suffered total paraesthesia on the right lower lip and chin area. A flap was raised and bone osteotomies were performed on the lateral side of the mandible to create a rectangular cortical bone window that was removed. The implant was stuck by the second implant placed coronally, and only after unscrewing this second implant it was possible to remove the first one. Results: Eighteen months later, the patient recovered full sensitivity. Conclusions: In case of implant displacement, it is always recommended to perform appropriate radiographs to visualize where the implants could have been displaced in order to avoid more serious consequences.

2018 - Microbiological response to periodontal therapy: A retrospective study [Articolo su rivista]
Checchi, VITTORIO LUIGI GAETANO; Pascolo, G.
abstract

Background: Periodontitis is a multifactorial infection caused by a complex of pathogenic bacterial species that induce the destruction of periodontal structures. Objective: The aim of this study is to evaluate the presence and bacterial load of six periodontal pathogens bacteria, measured at initial visit and after osseous surgery in patients affected by chronic periodontitis and treated between 2005 and 2007. Methods: This cohort study was carried out on a sample of 38 consecutive patients affected by severe chronic periodontitis, diagnosed at baseline on the basis of probing depths equal to 6.68 ± 1.47 mm. On each subject, a microbiological test was performed before periodontal initial therapy and after osseous surgery (one year later). Five compromised teeth were chosen for each patient (the same teeth, before and after surgery), for a total of 190 teeth. Real-time PCR based analysis computed total bacterial load of the samples and quantified six periodontal pathogens: Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum and Prevotella intermedia. Data collection was made consulting medical charts. Results: Pocket probing depth reduction after surgery was 4.50 ± 1.54 mm (p=0.0001). The mean number of sites with bleeding at baseline was 2.08 ± 1.17 and 0.58 ± 1.00 after surgery (p=0.001). The mean number of sites with suppuration at baseline was 0.26 ± 0.86 and 0 after surgery (p=0.02). Cell count of each pathogen and total cell count were significantly higher at baseline than after surgery. Almost all bacteria presented a mean percentage reduction equal to that of the total count, except for Aa and Pi, which seemed to show a greater resistance. The difference of bacterial load, both before and after surgery, between smokers and non-smokers was not statistically significant (p<0.05). A statistically significant correlation was detected between pocket probing depth variation and bleeding on probing variation before and after the surgery, controlling for age (r=0.6, p=0.001). No significant correlations were observed between pocket probing depth and bacterial loads, except for Pg (r=0.5, p=0.001), Tf (r=0.6, p=0.001) and Td (r=0.4, p=0.02). Conclusions: Reduction of presence and bacterial load of the examined periodontal pathogens bacteria after osseous surgery, along with periodontal pocket reduction, appeared to be essential to achieve and maintain periodontal stability over years.

2018 - Relationships between curcuma and periodontitis: Literature overview [Articolo su rivista]
Checchi, V.; Grande, F.; Simone, S. D.; Tissino, B.; Ongaro, F.; Checchi, L.
abstract

OBJECTIVES Controlled life styles and correct dietary habits operate on oxidative stress and on the mechanisms of inflammatory regulations, causing a reduction of its destructive effects. This literature review has the aim of underline curcumin anti-inflammatory effects on oral and periodontal tissues. MATERIALS AND METHODS A review of the literature was performed by inserting the following key words both in english and italian: periodontal disease, periodontitis, curcuma, curcumin, anti-aging medicine and oxidative stress. Only scientific articles and textbooks published between 1989 and 2016 were included. RESULTS Curcumin seems to be a valid anti-bacterial agent with good plaque reduction properties and it seems to have anti-inflammatory effects since is able to reduce gingival inflammation. In addition to non surgical periodontal therapy, curcumin showed an important reduction of gingival inflammation signs and bacteria reduction. CONCLUSIONS More and more researches confirm that inflammatory diseases can be managed better interfering with patients alimentation. Some types of food, as curcumin, can act to alle terapie tradizionali. Anche la parodontite potrebbe essere quindi meglio affrontata con interventi combinati di terapia tradizionale, igiene orale domiciliare e supporto nutrizionale e nutraceutico. as a support for traditional therapies. Therefore, also periodontitis could be better handled with combined interventions of traditional therapy, oral hygiene and nutritional and nutraceutical support.

2017 - A new transalveolar sinus lift procedure for single implant placement: The ebanist technique. A technical description and case series [Articolo su rivista]
Rizzo, R.; Checchi, V.; Marsili, F.; Zani, A.; Incerti-Parenti, S.; Checchi, L.
abstract

Background: Nowadays, there are many techniques to compensate bone atrophies of the posterior maxilla in order to obtain an implant-supported rehabilitation. Objective: This case series describes the Ebanist technique: a sinus lift procedure to be used in case of extremely resorbed bone crests (≤3 mm) allowing simultaneous implant placement. Methods: With a dedicated cylindrical trephine bur, it is possible to harvest a cylinder of bone from a fresh mineralized frozen homologous bone block graft and to simultaneously create a trapdoor on the recipient site. The trapdoor cortical bone is detached from the sinus membrane and removed. Dental implant is placed into the graft before the grafting procedure since the cylindrical block, once inserted in the recipient area, is not able to oppose sufficient resistance to the torque needed for implant placement. Results: Second-stage surgery and following prosthetic rehabilitation were performed after 5 months. In all cases, implant stability was manually checked and no pathological symptoms or signs were recovered at any follow-up visit. Conclusion: This technique can be considered a valid procedure for implant therapy on atrophic posterior upper maxillae, when the residual bone crest is extremely resorbed.

2017 - APPARATO DI AVANZAMENTO E MISURA E METODO DI RILEVAZIONE PER RILEVARE UNA POSIZIONE MODIFICATA IN AVANZAMENTO DELLA MANDIBOLA [Brevetto]
ALESSANDRI BONETTI, Giulio; Felice, Pietro; Checchi, Vittorio
abstract

2017 - How Stable is Dentin As a Substrate for Bonding? [Articolo su rivista]
Maravic, T.; Mazzoni, A.; Comba, A.; Scotti, N.; Checchi, V.; Breschi, L.
abstract

Purpose of Review: This paper reviews the complexity of the composition of dentin, and the repercussions of this composition on the stability of dentin over time, particularly in relation to adhesive dental procedures. Recent Findings: Dentin is a complex and dynamic structure that comprises the major part of the tooth. Most adhesive procedures in dentistry involve bonding to dentin. The hybrid layer (HL) created on the very variable and dynamic organic dentin phase may fail over time, leading to the failure of dental restorations. Literature showed that the collagen fibers in the HL are prone to hydrolysis and mechanical strain, as well as endogenous proteolytic activity (collagenolytic activity of matrix metalloproteinases and cysteine cathepsins). Hydrolysis of the resin phase of the HL also occurs over time. Summary: Advancements in the area of dental adhesion have been huge. Silencing of collagenolytic enzymes (protease inhibitors and cross-linking agents) is one of the main strategies to decrease the degradation of the HL. In the following years, new techniques will also probably be available, and efficacy of some of the available techniques will perhaps be further clarified.

2017 - Prognostic value of a simplified method for periodontal risk assessment during supportive periodontal therapy [Articolo su rivista]
Trombelli, L.; Minenna, L.; Toselli, L.; Zaetta, A.; Checchi, L.; Checchi, V.; Nieri, M.; Farina, R.
abstract

Aim: To evaluate the association between risk scores generated with a simplified method for periodontal risk assessment (Perio Risk), and tooth loss as well as bone loss during supportive periodontal therapy (SPT). Materials & Methods: Data related to 109 patients (42 males; mean age: 42.2 ± 10.2 years, range 22–62) enrolled in a SPT programme for a mean period of 5.6 years were retrospectively obtained at two specialist periodontal clinics. Patients were stratified according to Perio Risk score (on a scale from 1 – low risk to 5 – high risk) as calculated at the end of active periodontal therapy. Risk groups were compared for tooth loss as well as the changes in radiographic bone levels occurred during SPT. Results: The mean number of teeth lost per patient during SPT varied from 0 to 1.8 ± 2.5 for patients with a risk score of 1 and 5 respectively (p = 0.041). Mean radiographic bone loss during SPT was ≤0.5 mm in all risk groups, without significant inter-group differences. Conclusions: Periodontal risk assessment according to Perio Risk may help to identify patients at risk for tooth loss during SPT.

2017 - Reconstruction of atrophied posterior mandible with an inlay technique and allograft block: Technical description and histologic case reports [Articolo su rivista]
Checchi, V.; Mazzoni, A.; Zucchelli, G.; Breschi, L.; Felice, P.
abstract

This paper presents a technical description of the inlay technique performed with an allograft block in the reconstruction of a severely atrophic posterior mandible. It includes a histologic case series of five patients treated with the same grafting procedure and rehabilitated with dental implants 2 months after placement of the graft. The histologic analysis showed large amounts of newly formed bone in tight connection with the allograft and large marrow spaces with intense cellular activity and the presence of osteocytes. Allografts might serve as an alternative to autogenous and heterologous grafting in posterior mandible augmentation using the inlay technique.

2017 - Relationship between omega-3 and periodontitis: Literature review [Articolo su rivista]
Ongaro, F.; Checchi, V.; Papale, C.; Rossi, R.; Tissino, B.; Checchi, L.
abstract

OBJECTIVES. Omega-3 fatty acids have proven a potent anti-inflammatory action in the human body. This article considers the actions that reduce the inflammatory response created by periodontal disease, actions which would induce a modulation of periodontal inflammatory cascade. MATERIALS AND METHODS. A review of the literature was performed by inserting the following key words both in English and Italian: periodontal disease, periodontitis, omega-3, anti-aging medicine and polyunsaturated fatty acids. Only scientific articles and textbooks published between 1965 and 2015 were included. RESULTS. Omega-3 exert a significant action on inflammatory mediators, thereby regulating inflammation related to oxidative stress and promoting repair of periodontal tissues. CONCLUSIONS. Periodontal therapy may be supported by the use of omega-3 in modulating the host's immuno inflammatory-response, reducing the destructive aspects of the response itself.

2017 - Safe new approach to the lingual flap management in mandibular augmentation procedures: The digitoclastic technique [Articolo su rivista]
Pistilli, R.; Checchi, V.; Sammartino, G.; Simion, M.; Felice, P.
abstract

Purpose: This article describes the digitoclastic technique, an innovative procedure for coronal displacement of the lingual flap. The new technique has the potential to obtain primary flap closure without surgical risks to the anatomical structures on the lingual side of the mandible. Materials and Methods: Reconstruction of an atrophic mandible with guided tissue regeneration (guided bone regeneration) and implant placement is described, using the digitoclastic technique to displace the lingual flap coronally. Results: Coronal flap displacement was sufficient to obtain complete passive coverage of the grafted area. No bleeding or neurosensory complications were recorded, and no membrane exposure occurred. Conclusions: The digitoclastic technique reduces the risk of damage to the lingual nerve and minimizes the amount of bleeding during surgery, allowing progressive and controlled retraction of the flap until the desired detachment is achieved.

2017 - Wide diameter immediate post-extractive implants vs delayed placement of normal-diameter implants in preserved sockets in the molar region: 1-year post-loading outcome of a randomised controlled trial [Articolo su rivista]
Checchi, V; Felice, P; Zucchelli, G; Barausse, C; Piattelli, M; Pistilli, R; Grandi, G; Esposito, M
abstract

Purpose: To compare the effectiveness of 6.0 to 8.0 mm-wide diameter implants, placed immediately after tooth extraction, with conventional 4.0 or 5.0 mm diameter implants placed in a preserved socket after a 4-month period of healing in the molar region.Materials and Methods: Just after extraction of one or two molar teeth, and with no vertical loss of the buccal bone in relation to the palatal wall, 100 patients requiring immediate post-extractive implants were randomly allocated to immediate placement of one or two 6.0 to 8.0 mm-wide diameter implants (immediate group; 50 patients) or for socket preservation using a porcine bone substitute covered by a resorbable collagen barrier (delayed group; 50 patients), according to a parallel group design in one centre. Bone-to-implant gaps were filled with autogenous bone retrieved with a trephine drill used to prepare the implant sites for the immediate wide diameter post-extractive implants. Four months after socket preservation, one to two 4.0 or 5.0 mm-wide delayed implants were placed. Implants were loaded 4 months after placement with fixed provisional restorations in acrylic, and replaced after 4 months by fixed, definitive, metal-ceramic restorations. Patients were followed to 1 year after loading. Outcome measures were: implant failures, complications, aesthetics assessed using the pink esthetic score (PES), peri-implant marginal bone level changes, patient satisfaction, number of appointments and surgical interventions recorded, when possible, by blinded assessors.Results: Three patients dropped out 1 year after loading from the immediate group vs six from the delayed group. Five implants out of 47 failed in the immediate group (10.6%) vs two out 44 (4.6%) in the delayed group, the difference being not statistically significant (difference in proportion = 6.0%, 95% CI: -8.8% to 20.8%, P = 0.436). In the immediate group 10 patients were affected by 10 complications, while in the delayed group four patients were affected by four complications. The difference was not statistically significant (difference in proportion = 12%, 95% CI: -2% to 26%, P = 0.084). At delivery of the definitive prostheses, 4 months after loading, the mean total PES score was 9.65 +/- 1.62 and 10.44 +/- 1.47 in the immediate and delayed groups, respectively. At 1 year after loading, the mean total PES score was 9.71 +/- 2.71 and 10.86 +/- 1.37 in the immediate and delayed groups, respectively. The Total PES score was statistically significantly better at delayed implants both at 4 months (mean difference = 0.79; 95% CI: 0.05 to 1.53; P = 0.03) and at 1 year (mean difference = 1.15; 95% CI: 0.13 to 2.17; P = 0.02). Marginal bone levels at implant insertion (after bone grafting) were 0.04 mm for immediate and 0.11 mm for delayed implants, which was statistically significantly different (mean difference = 0.07; 95% CI: 0.02 to 0.12; P < 0.0001).One year after loading, patients in the immediate group lost on average 1.06 mm and those from the delayed group 0.63 mm, the difference being statistically significant (mean difference = 0.43 mm; 95% CI: 0.15 to 0.61; P < 0.0001). All patients were fully or partially satisfied both for function and aesthetics, and would undergo the same procedure again both at 4 months and 1 year after loading. Patients from the immediate group required on average 7.48 +/- 1.45 visits to the clinician and 2.14 +/- 0.49 surgical interventions and to have their definitive prostheses delivered vs 10.30 +/- 0.99 visits and 3.08 +/- 0.40 surgical interventions for the delayed group, the difference being statistically significant (P < 0.001 for visits, and P < 0.001 for surgical interventions).Conclusions: Preliminary 1 year follow-up data suggest that immediate placement of 6.0 to 8.0 mm wide diameter implants in molar extraction sockets yielded inferior aesthetic outcomes than ridge preservation and delayed placement of conventional 4.0 to 5.0 mm diameter implants.

2016 - BACTERIA PREVALENCE IN A LARGE ITALIAN POPULATION SAMPLE: A CLINICAL AND MICROBIOLOGICAL STUDY [Articolo su rivista]
Checchi, L; Gatto, Mr; Checchi, V; Carinci, F
abstract

The present study detects those bacterial species which are more strongly related to bleeding on probing, suppuration and smoking in periodontal-affected patients. Nine hundred and fifty-one patients with periodontal diseases were admitted to the Department of Periodontology & Implantology, Dental School of Bologna University where they underwent microbiological tests for six periodontal pathogens (Actinomyces actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Treponema denticola, Fusobacterium nucleatum and Tannerella forsythia). Cluster analysis explored the variables that mostly influence both the presence and absolute elative bacterial load. Logistic regression and multivariate linear regression quantifies these relations. The probability of recovering bacteria belonging to the Red Complex is greater by 25-48% in presence of bleeding on probing. When probing depth is <3 mm the probability of presence of each bacterial species is inferior in comparison with depth >6 mm both for Red Complex (of 20-37%), the Orange complex (of 41-61%) and Actinomyces actinomycetemcomitans (46%). Total bacterial cell count increases with pocket depth above all for the Red Complex. As Treponema Denticola and Tannerella Forsytia presence is associated with bleeding on probing and Prevotella intermedia presence with suppuration and smoking. The examination of these three as indicators of periodontitis evolution is suggested.

2016 - Dispositivo per la decontaminazione di circuiti idrici di ambulatori medici, odontoiatrici ed ospedalieri [Brevetto]
Checchi, Vittorio; Checchi, Luigi
abstract

2016 - Microbiological distribution of six periodontal pathogens between untreated Italian and dutch periodontal patients [Articolo su rivista]
Montevecchi, M.; Angelini, F.; Checchi, V.; Gatto, M. R.; Checchi, L.
abstract

Purpose: To compare prevalence and microbial load of six periodontal pathogens between Italian and Dutch patients affected by chronic periodontitis, using oligonucleotide probe technology. Materials and Methods: Subgingival plaque samples data from 352 Italians and 115 Dutch periodontal patients were analysed and compared. Bleeding on probing, suppuration, probing pocket depth, clinical attachment level, age, gender, ethnicities and smoking habits were recorded. Presence and level of bacterial species were determined by realtime polymerase chain reaction under the identical microbiological protocol. Statistical analysis was performed using the chi-square test, Mann-Whitney U-test and binary unconditional logistic regression (a = 0.05). Results: Between populations, only Treponema denticola and Porphyromonas gingivalis differed significantly, being more prevalent in the Italian group (p = 0.0001). Except for Tannerella forsythia, all bacterial loads differed significantly: Treponema denticola (p = 0.0001) and Prevotella intermedia (p = 0.001) were higher in Italians, while Porphyromonas gingivalis (p = 0.001), Fusobacterium nucleatum (p = 0.03) and Aggregatibacter actinomycetemcomitans (p = 0.001) were higher in Dutch patients. Conclusions: Significant differences in prevalence and bacterial load of periodontal pathogens exist between Italian and Dutch patients affected by chronic periodontitis. The microbiological profile, and particularly the bacterial load of pathogens, varied significantly between populations.

2016 - Periodontal status after surgical-orthodontic treatment of labially impacted canines with different surgical techniques: A systematic review [Articolo su rivista]
Incerti-Parenti, S.; Checchi, V.; Ippolito, D. R.; Gracco, A.; Alessandri-Bonetti, G.
abstract

Introduction Good periodontal status is essential for a successful treatment outcome of impacted maxillary canines. Whereas the surgical technique used for tooth uncovering has been shown not to affect the final periodontal status of palatally impacted canines, its effect on labially impacted canines is still unclear. Methods Searches of electronic databases through January 2015 and reference lists of relevant publications were used to identify studies evaluating the periodontal status of labially impacted canines after combined surgical-orthodontic treatment. Two reviewers independently screened the articles, extracted data, and ascertained the quality of the studies. Results Ninety-one studies were identified; 3 were included in the review. No included study examined the periodontal outcome of the closed eruption technique. Excisional uncovering was reported to have a detrimental effect on the periodontium (bleeding of the gingival margin, 29% vs 7% in the control group; gingival recession, -0.5 mm [SD, 1.0] vs -1.5 mm [SD, 0.8] in the control group; and width of keratinized gingiva, 2.6 mm [SD, 1.4] vs 4.1 mm [SD, 1.5] in the control group). Impacted canines uncovered with an apically positioned flap had periodontal outcomes comparable with those of untreated teeth. Conclusions The current literature is insufficient to determine which surgical procedure is better for periodontal health for uncovering labially impacted canines.

2016 - Soft Tissue Response to Titanium Abutments with Different Surface Treatment: Preliminary Histologic Report of a Randomized Controlled Trial [Articolo su rivista]
Canullo, L.; Dehner, J. F.; Penarrocha, D.; Checchi, V.; Mazzoni, A.; Breschi, L.
abstract

The aim of this preliminary prospective RCT was to histologically evaluate peri-implant soft tissues around titanium abutments treated using different cleaning methods. Sixteen patients were randomized into three groups: laboratory customized abutments underwent Plasma of Argon treatment (Plasma Group), laboratory customized abutments underwent cleaning by steam (Steam Group), and abutments were used as they came from industry (Control Group). Seven days after the second surgery, soft tissues around abutments were harvested. Samples were histologically analyzed. Soft tissues surrounding Plasma Group abutments predominantly showed diffuse chronic infiltrate, almost no acute infiltrate, with presence of few polymorphonuclear neutrophil granulocytes, and a diffuse presence of collagenization bands. Similarly, in Steam Group, the histological analysis showed a high variability of inflammatory expression factors. Tissues harvested from Control Group showed presence of few neutrophil granulocytes, moderate presence of lymphocytes, and diffuse collagenization bands in some sections, while they showed absence of acute infiltrate in 40% of sections. However, no statistical difference was found among the tested groups for each parameter (p > 0.05). Within the limit of the present study, results showed no statistically significant difference concerning inflammation and healing tendency between test and control groups.

2016 - The use of a plaque disclosing agent in the dental hygiene practice: a literature review [Articolo su rivista]
Checchi, V.; Montagno Cappuccinello, C.; Montevecchi, M.; Checchi, L.
abstract

Objectives The daily use of dental plaque disclosing agents is able to enhance the efficacy of both professional and domestic oral hygiene procedures. The aim of this article is to describe the different formulations of these products and to test their clinical results. Materials and methods Since 1914 many colorants, with different codifications and chemical concentrations, have been used, although their application procedures have remained unvaried. In this literature analysis some key words were chosen, then translated into English and finally searched, in both languages, on specific search engines. Only scientific articles and textbooks published between 1970 and 2014, both in Italian and English languages were included in this review. Results User friendliness and product safety make plaque disclosing agents suitable for all collaborative patients. The very few articles found in the literature show how plaque disclosing agents are subject to debate regarding their usefulness and effectiveness. Conclusions Although no clear efficacy evidence exists to encourage the use of a plaque disclosing agent, the literature review seems to support the colorimetric technique for its ability to increase plaque control and patient compliance.

2015 - Evaluation of clinical effectiveness and subjective satisfaction of a new toothbrush for postsurgical hygiene care: A randomized split-mouth double-blind clinical trial [Articolo su rivista]
Montevecchi, M.; Moreschi, A.; Gatto, M. R.; Checchi, L.; Checchi, V.
abstract

The aim of this RCT was to evaluate plaque control and gingival health promotion effectiveness of a new toothbrush with extra-soft filaments in postsurgical sets. Ten consecutive patients with at least two scheduled symmetrical periodontal surgeries were selected. Following the first periodontal surgery, a test (TB1) or control (TB2) toothbrush was randomly assigned. After the second surgery, the remaining toothbrush was given. Patients were asked to gently wipe the surgical area from days 3 to 7 postoperatively and to gently brush using a roll technique from day 7 till the end of the study. Baseline evaluation took place on the day of surgery and follow-ups were performed at days 7, 14, and 30 postoperatively. A more evident PI reduction was recorded for test toothbrush where a regular decrease was observed till day 14; then, this parameter tended to stabilize, remaining however lower than that recorded for the control toothbrush. There were no statistical differences in the GI between test and control toothbrushes. All patients introduced the test toothbrush at surgical site at third day; the control toothbrush was introduced within a mean of 9 days. The introduction of the test toothbrush 3 days after periodontal surgery may be recommended.

2015 - Periodontal Side Effect During Orthopedic Face Mask Therapy [Articolo su rivista]
Incerti-Parenti, Serena; Checchi, Vittorio; Molinari, Camilla; Alessandri-Bonetti, Giulio
abstract

A 7-year-old patient exhibited gingival recession of tooth #41 and severe plaque accumulation after 3 months of face mask therapy. The recession improved only slightly after appropriate oral hygiene instructions and motivation. Decisive improvement began when the vertical chin pad extension was reduced to avoid pressure on the affected area.

2015 - Posterior jaws rehabilitated with partial prostheses supported by 4.0 x 4.0 mm or by longer implants: Four-month post-loading data from a randomised controlled trial [Articolo su rivista]
Esposito, M.; Barausse, C.; Pistilli, R.; Checchi, V.; Diazzi, M.; Gatto, M. R.; Felice, P.
abstract

Purpose: To evaluate whether 4.0 x 4.0 mm dental implants could be an alternative to implants at least 8.5 mm long, which were placed in posterior jaws in the presence of adequate bone volumes. Materials and methods: One hundred and fifty patients with posterior (premolar and molar areas) mandibles having at least 12.5 mm bone height above the mandibular canal or 11.5 mm bone height below the maxillary sinus, were randomised according to a parallel group design, in order to receive one to three 4.0 mm-long implants or one to three implants which were at least 8.5 mm long, at three centres. All implants had a diameter of 4.0 mm. Implants were loaded after 4 months with definitive screw-retained prostheses. Patients were followed up to 4-month post-loading and outcome measures were prosthesis and implant failures, any complications and peri-implant marginal bone level changes. Results: No patients dropped-out before the 4-month evaluation. Three patients experienced the early failures of one 4.0 mm-long implant each, in comparison to two patients who lost one long implant each (difference in proportion = 0.01; 95% CI -0.06 to 0.09; P = 0.50). Consequently, two prostheses in each group could not be delivered as planned (difference in proportion = 0; 95% CI -0.07 to 0.07; P = 0.69), and one patient from each group is still waiting to have their prostheses delivered. Three short implant patients experienced three complications versus two long implant patients (difference in proportion = 0.01; 95% CI -0.06 to 0.09; P = 0.50). There were no statistically significant differences in prosthesis failures, implant failures and complications. Patients with short implants lost on average 0.38 mm of peri-implant bone at 4 months and patients with long mandibular implants lost 0.42 mm. There were no statistically significant differences in bone level changes up to 4 months between short and long implants (mean difference = 0.04 mm; 95% CI: -0.041 to 0.117; P = 0.274). Conclusions: Four months after loading, 4.0 x 4.0 mm implants achieved similar results as 8.5 x 4.0 mm-long or longer implants in posterior jaws, however 5 to 10 years post-loading data are necessary before reliable recommendations can be made. Conflict-of-interest statement: Global D (Lyon, France) donated implants and prosthetic components and Tecnoss (Coazze, Italy) donated the biomaterials used in this study. Data property belonged to the authors and by no means did the manufacturers interfere with the conduct of the trial or the publication of its results.

2015 - Reconstruction of an atrophied posterior mandible with the inlay technique and allograft block versus allograft particulate: A case report [Articolo su rivista]
Checchi, V.; Mazzoni, A.; Breschi, L.; Felice, P.
abstract

This case report describes the bilateral reconstruction of a severely atrophic posterior mandible in a 30-year-old woman using allograft block versus particulate grafting in the inlay technique. Three months later, four dental implants were placed and bone core biopsy specimens were taken for histologic evaluation. During implant placement, the grafted sites were stable with good clinical osseointegration. The histologic analysis showed the presence of compact bone revealing areas of demarcation between grafted bone, newly formed bone, and bone-regenerated areas. Allografts might serve as an alternative to autogenous and heterologous grafting in posterior mandible augmentation using the inlay technique.

2015 - Role of dentin MMPs in caries progression and bond stability [Articolo su rivista]
Mazzoni, A.; Tjaderhane, L.; Checchi, V.; Di Lenarda, R.; Salo, T.; Tay, F. R.; Pashley, D. H.; Breschi, L.
abstract

Dentin can be described as a biological composite with collagen matrix embedded with nanosized hydroxyapatite mineral crystallites. Matrix metalloproteinases (MMPs) and cysteine cathepsins are families of endopeptidases. Enzymes of both families are present in dentin and collectively capable of degrading virtually all extracellular matrix components. This review describes these enzymes and their presence in dentin, mainly focusing on their role in dentin caries pathogenesis and loss of collagen in the adhesive hybrid layer under composite restorations. MMPs and cysteine cathepsins present in saliva, mineralized dentin, and/or dentinal fluid may affect the dentin caries process at the early phases of demineralization. Changes in collagen and noncollagenous protein structure may participate in observed decreases in mechanical properties of caries-affected dentin and reduce the ability of caries-affected dentin to remineralize. These endogenous enzymes also remain entrapped within the hybrid layer during the resin infiltration process, and the acidic bonding agents themselves (irrespective of whether they are etch-and-rinse or self-etch) can activate these endogenous protease proforms. Since resin impregnation is frequently incomplete, denuded collagen matrices associated with free water (which serves as a collagen cleavage reagent for these endogenous hydrolase enzymes) can be enzymatically disrupted, finally contributing to the degradation of the hybrid layer. There are multiple in vitro and in vivo reports showing that the longevity of the adhesive interface is increased when nonspecific enzyme-inhibiting strategies are used. Different chemicals (i.e., chlorhexidine, galardin, and benzalkonium chloride) or collagen cross-linker agents have been successfully employed as therapeutic primers in the bonding procedure. In addition, the incorporation of enzyme inhibitors (i.e., quaternary ammonium methacrylates) into the resin blends has been recently promoted. This review will describe MMP functions in caries and hybrid layer degradation and explore the potential therapeutic role of MMP inhibitors for the development of improved intervention strategies for MMP-related oral diseases.

2015 - The Inlay Technique With an Allograft Block Used for the Rehabilitation of an Atrophic Posterior Mandible: A Case Report [Articolo su rivista]
Checchi, Vittorio; Felice, Pietro
abstract

To the best of the authors' knowledge, this case report is the first in the literature to describe the reconstruction of a severely atrophic poster mandible using an allograft block in the inlay technique.

2014 - A proposed new index for clinical evaluation of interproximal soft tissues: The interdental pressure index [Articolo su rivista]
Checchi, L.; Montevecchi, M.; Marucci, G.; Checchi, V.
abstract

The interdental pressure index (IPI) is introduced to specifically evaluate clinical interproximal-tissue conditions and assess the effect of interproximal hygiene stimulation. This index scores clinical responses of periodontal tissues to the apical pressure of a horizontally placed periodontal probe. It is negative when gingival tissues are firm, bleeding-free, and slightly ischemic by the stimulation; otherwise it is positive. The clinical validation showed high intraoperator agreement (0.92; 95% CI: 0.82-0.96; P = 0.0001) and excellent interoperator agreement (0.76; 95% CI: 0.14-1.38; P = 0.02). High internal consistency with bleeding on probing ( = 0.88) and gingival index (Cronbach's α = 0.81) was obtained. Histological validation obtained high sensitivity (100%) and specificity (80%) for IPI+ toward inflammatory active form. The same results were recorded for IPI- toward chronic inactive form. IPI results as a simple and noninvasive method with low error probability and good reflection of histological condition that can be applied for oral hygiene motivation. Patient compliance to oral hygiene instructions is essential in periodontal therapy and IPI index can be a practical and intuitive tool to check and reinforce this important aspect. © 2014 Checchi Luigi et al.

2014 - Carbodiimide inactivation of MMPs and effect on dentin bonding [Articolo su rivista]
Mazzoni, A.; Apolonio, F. M.; Saboia, V. P. A.; Santi, S.; Angeloni, V.; Checchi, V.; Curci, R.; Di Lenarda, R.; Tay, F. R.; Pashley, D. H.; Breschi, L.
abstract

The use of protein cross-linking agents during bonding procedures has been recently proposed to improve bond durability. This study aimed to use zymography and in situ zymography techniques to evaluate the ability of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) cross-linker to inhibit matrix metalloproteinase (MMP) activity. The hypotheses tested were that: (1) bonding procedures increase dentin gelatinolytic activity and (2) EDC pre-treatment prevents this enzymatic activity. The zymographic assay was performed on protein extracts obtained from dentin powder treated with Optibond FL or Scotchbond 1XT with or without 0.3M EDC pre-treatment. For in situ zymography, adhesive/dentin interfaces were created with the same adhesives applied to acid-etched dentin slabs pre-treated or not with EDC conditioner. Zymograms revealed increased expression of dentin endogenous MMP-2 and -9 after adhesive application, while the use of EDC as a primer inactivated dentin gelatinases. Results of in situ zymograpy showed that hybrid layers of tested adhesives exhibited intense collagenolytic activity, while almost no fluorescence signal was detected when specimens were pre-treated with EDC. The correlative analysis used in this study demonstrated that EDC could contribute to inactivate endogenous dentin MMPs within the hybrid layer created by etch-and-rinse adhesives. © International & American Associations for Dental Research.

2014 - Erratum: A proposed new index for clinical evaluation of interproximal soft tissues: The interdental pressure index (International Journal of Dentistry) [Articolo su rivista]
Checchi, L.; Montevecchi, M.; Marucci, G.; Checchi, V.
abstract

2014 - Periodontal healing after 'orthodontic extraction' of mandibular third molars: A retrospective cohort study [Articolo su rivista]
Montevecchi, M.; Incerti Parenti, S.; Checchi, V.; Palumbo, B.; Checchi, L.; Alessandri Bonetti, G.
abstract

In this study we investigated periodontal healing of mandibular second molars following 'orthodontic extraction' of adjacent impacted third molars, under the null hypothesis that there would be no difference in probing pocket depths (PPD) and clinical attachment levels (CAL) at the distal aspect of second molars before and after treatment. A retrospective survey was conducted of 64 patients who consecutively underwent 'orthodontic extraction' of mandibular third molars in close anatomical relationship with the mandibular canal from January 1997 to January 2011. Age, smoking habit, and PPD and CAL at the distal aspect of second molars before and after treatment were recorded. A statistically significant difference was found in PPD and CAL before and after treatment for the overall sample and for the sample classified by age (>25 or ≤25 years), smoking habit (smoker or non-smoker), and type of third molar impaction (horizontal, mesioangular, or vertical). Median PPD and CAL reductions amounted to 6 mm and 5 mm, respectively. The null hypothesis was rejected and orthodontic extraction proved to be indicated for those impacted mandibular third molars at high risk of a postoperative periodontal defect at the distal aspect of the adjacent second molar. © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

2014 - Surgical reconstruction of a maxilla after tumour resection with a heterologous equine bone block created with CAD/CAM procedure: A case report [Articolo su rivista]
Pistilli, R.; Checchi, V.; Nisii, A.; Marcelli, V.; Felice, P.
abstract

This case report describes a successful post-tumour surgical reconstruction of a complete maxilla resection in a 62-year-old man, using an equine bone block [pre-shaped using computer aided design/computer aided manufacturing (CAD/CAM) procedure] as grafting material. Computerised tomographic scans taken 5 months after the reconstructive surgery showed good reconstruction and dimensional augmentation of the lost bone. One year after surgery, the patient showed a great improvement in the emergence profile of the middle part of the face. The use of an equine bone block, pre-shaped using CAD/CAM system, for alveolar ridge reconstruction, seems to be a valuable alternative to autograft. This technique could significantly shorten the actual surgical procedure for the patient and may result in a better fit of the graft than chair-side preparation may allow.

2013 - Radiographic analysis of a transalveolar sinus-lift technique: A multipractice retrospective study with a mean follow-up of 5 years [Articolo su rivista]
Soardi, E.; Cosci, F.; Checchi, V.; Pellegrino, G.; Bozzoli, P.; Felice, P.
abstract

Background: Various sinus-lift techniques have been described in the literature. The aim of this retrospective study is to evaluate the efficacy of a transalveolar sinus-lift technique in terms of implant survival, marginal bone loss, and complications. Methods: A total of 538 patient records were examined, and after applying exclusion and inclusion criteria, a sample of patients was included with a mean follow-up of 5 years. Implants with a smooth or tapered surface were considered. Therefore, only sinus lifts with inorganic bovine bone matrix or demineralized bone matrix were included, and 1,536 periapical radiographs were analyzed. Outcome measures were implant success, implant failure (peri-implantitis and loss of osseointegration), marginal bone resorption, and biologic complications (membrane perforations, sinusitis, and intraoperative and/or postoperative hemorrhage). Periapical radiographs were evaluated before surgery, postsurgery, and after 6 months and 1, 3, and 5 years. We analyzed the residual crestal bone height under the sinus, the amount (mm) of height increase after surgery, and values of implant marginal bone resorption for considered follow-ups. Results: Two hundred eighty-two (282) patients were excluded. Therefore, 256 patients treated with the transalveolar sinus-lift technique were included. A total of 376 dental implants and 323 sinus lifts were analyzed. The overall rates of implant success and failure were 94.9% and 5.1%, respectively. The mean bone loss around implants was 1.98 mm (mean follow-up of 5 years). Patients treated with inorganic bovine bone matrix showed a better implant success rate (P = 0.03) than did patients treated with demineralized human matrix. Three Schneiderian membrane perforations occurred in the 323 sinus lifts. In these cases, the surgeon performed another surgical operation after 3 months. Postoperative complications were peri-implantitis (six cases) and osseointegration losses (13 cases). Conclusions: The transalveolar sinus-lift technique was a safe, minimally invasive technique with an implant success rate comparable to traditional implantology. The implant success rate was positively affected by the low-resorption graft material, and a low bone-resorption rate around implants was found.

2013 - The distal wedge: Comparison of the surgical techniques [Articolo su rivista]
Checchi, L.; Montevecchi, M.; Felice, P.; Checchi, V.
abstract

Objectives The surgical approach to the retromolar area can be obtained through different techniques. The aim of this paper is to analyze what has already been proposed by literature for treatment of this area in order to discuss rational and clinical indications. Materials and methods Osseous surgery is an extremely refined technique in which the clinician has to make scrupulous analysis that have to be associated to the specific characteristics of the anatomical areas. A clear example of this is the treatment of periodontal pockets of the distal surfaces of the last molar. A surgical approach with a flap technique is preferred because, thanks to the primary closure of the flaps, the healing is less traumatic and because the surgeon can access the bone in order to correct bone morphology. Results and conclusions The anatomical characteristics of the retromolar area are the reason for the creation of various surgical techniques that can changed because of the anatomical space available, pocket depth, type of bony defect, presence of the third molar and type of soft tissues. The combination of these parameters will lead to a clinical decision in order to eliminate the periodontal pocket. © 2013 LSWR Srl. Tutti i diritti riservati.

2012 - Management of a deeply impacted mandibular third molar and associated large dentigerous cyst to avoid nerve injury and improve periodontal healing: Case report [Articolo su rivista]
Montevecchi, M.; Checchi, V.; Bonetti, G. A.
abstract

As dentigerous cysts increase in size, the risk of postsurgical complications increases as well. Emphasis is usually placed on the risk of neurologic damage caused by trauma during and after surgical removal and of mandibular fracture resulting from the large residual bone defect. However, influence on the periodontal status of neighbouring teeth should also be taken into account. In this article, we present an interdisciplinary, safe, minimally invasive approach to treating large dentigerous cysts associated with deeply impacted third molars. A dentigerous cyst is an epithelial-lined pathologic cavity that develops in association with the crown of an unerupted tooth and appears radiographically as a well-circumscribed pericoronal radiolucency. 1 The cyst not only inhibits the eruption of the associated tooth (usually, a mandibular third molar),2 but can also carry it to unusual positions in the jaw.3-5 Dentigerous cysts may enlarge causing extensive bone resorption and even pathologic fracture.6 The greater the size of the cyst, the higher the risk of neurologic damage caused by trauma during and after surgical removal and of mandibular fracture resulting from the postoperative bone defect.7,8 Moreover, the removal of large cysts can lead to a severe infrabony defect at the root surface of adjacent teeth, jeopardizing their long-term periodontal health. "Orthodontic extraction" is a combined orthodontic-surgical approach that decreases the risk of neurologic complications and facilitates the surgical extraction of impacted mandibular third molars that are in close contact with the mandibular canal,9-12 even when associated with cystic lesions.13 This case report shows that the interdisciplinary approach is also effective in preventing periodontal breakdown on the distal surface of the adjacent second molar.

2012 - Management rules for a dental practice: Biological risk and safety at work [Articolo su rivista]
Checchi, L.; Montevecchi, M.; Violante, F.; Raimondo, D.; Legnani, P.; Checchi, V.
abstract

Objectives: Comprehensive continuing medical education programs in dentistry are difficult to achieve because of the extreme complexity of a dental practice and the multiple roles played by the dentist. As a result, dentists may not always be informed on one of the crucial points of their daily activity: professional risk management. The aim of this paper is to present up-to-date scientific data that can guide the dentist in this fundamental sector of dental practice. Materials and methods: Professional risk is a key aspect of every job. Continuing education is essential to keep dentists abreast of the developments in this field, such as the introduction of specific laws. This article analyzes the various types of professional risk and their implications for office management to provide dentists with the fundamental concepts needed for safe, rational management of their dental practice. Conclusions: In-depth understanding of the different types of professional risk and the appropriate distribution of duties between the members of the office staff constitute the basis for a safe, unflustered dental practice. © 2011 Elsevier Srl. Tutti i dirtti riservati.

2012 - Management rules of the dental practice: Individual protection devices [Articolo su rivista]
Montevecchi, M.; Checchi, V.; Felice, P.; Checchi, L.
abstract

Objectives. In dental field every form of potential risk needs precautionary laws in order to establish a safe and complete control. If following laws are not enough to limit the risk, it becomes mandatory to adopt specific personal protective equipments. The aim of this paper is to give solid basis of knowledge regarding a rational choice, use and management of these professional aids. Materials and methods. It describes the set of laws that rules the production, the choice and the use of different personal protective equipments. The reader is guided through the rational use of the individual aids based on the protecting capacity and the correct application and maintenance. Conclusions. All personal protective equipments represent an important resource for professional risk control in its various aspects. Their use, scheduled by law or just suggested, is an excellent help for a safe and peaceful job. © 2012 Elsevier Srl. Tutti i dirtti riservati.

2012 - Rules for managing a dental practice: Waste disposal, disinfection, and sterilization [Articolo su rivista]
Checchi, V.; Montevecchi, M.; Legnani, P.; Cristino, S.; Violante, F.; Checchi, L.
abstract

Objectives: For persons working in the field of dentistry, one of the most important sectors of professional risk is that of biologic risks. The aim of this article is to summarize current knowledge regarding waste disposal, disinfection, and sterilization procedures and the laws that regulate these activities. Materials and methods: The authors review the current laws regarding biological risk, the criteria for identification and classification of risk levels, and the correct management of waste products, materials used in dental practices, and the work place. Conclusions: Rational management of biological risks requires that all members of the staff have a sound knowledge base in this field. Specific duties must be assigned and operative protocols followed to the letter. This approach is the only way to ensure safe and professional management of this important aspect of dentistry. © 2011 Elsevier Srl. Tutti i dirtti riservati.

2012 - The use of a disclosing agent during resective periodontal surgery for improved removal of biofilm [Articolo su rivista]
Montevecchi, M.; Checchi, V.; Gatto, M. R.; Klein, S.; Checchi, L.
abstract

A total removal of the bacterial deposits is one of the main challenges of periodontal therapy. A surgical approach is sometimes required in order to allow a correct access to the areas not thoroughly reached during the initial therapy. The present study focuses on the surgical scaling effectiveness in root deposits removal; the potential support of a disclosing agent during this procedure is also evaluated. Forty surgical periodontal patients were randomly divided between surgeries where the operator was informed about a final examination of the residual root deposits and surgeries where the operator was not informed. Straight after scaling procedures a supervisor recorded the O'Leary Plaque Index of the exposed roots by mean of a disclosing agent and the percentage of teeth with residual biofilm. After the stained deposits removal, a second chromatic examination was performed and new data were collected. Mann-Whitney U-test and Wilcoxon test for paired samples were used for comparisons respectively between the two surgery groups and the first and the second chromatic examination; one-sided p-value was set at 0.05. At first examination no significant differences between the two groups were observed regarding Plaque Index (p=0.24) and percentages of teeth with residual biofilm (p=0.07). The 100% removal of roots deposits was never achieved during the study but a significant reduction of 80% of root deposits was observed between first and second examination (p=0.0001). Since root deposits removal during periodontal surgery resulted always suboptimal, the use of a disclosing agent during this procedure could be a useful and practical aid. © Montevecchi et al.

2011 - Clinical-radiographic and histological evaluation of two hydroxyapatites in human extraction sockets: A pilot study [Articolo su rivista]
Checchi, V.; Savarino, L.; Montevecchi, M.; Felice, P.; Checchi, L.
abstract

After tooth extraction the healing process involves bone resorption and soft tissue contraction, events that can compromise the ideal implant placement with functional and aesthetic limitations. Following tooth extraction, a socket preservation technique can limit bone resorption. This study evaluated two different types of hydroxyapatite (HA) grafting materials placed into fresh extraction sockets, 6 months after tooth extraction, histologically, clinically and radiographically. Ten extraction sockets from 10 patients were divided in two groups: 5 sockets received a biomimetic HA and 5 received nanocrystalline HA. After 6 months, before implant placement, samples from the grafted area were harvested and evaluated clinically, radiographically and histologically. The percentages of bone, osteoid areas and residual material in the two groups were not statistically different. All samples showed great variability with extensive bone formation and total material resorption or amounts of osteoid tissue that filled the spaces between the residual material particles. The authors did not find any differences between biomimetic and nanocrystalline HA and assume that, within the limits of this study, both these materials could be applied into fresh extraction sockets to limit bone resorption. A control material and a much larger sample size are needed to confirm these findings. © 2011 International Association of Oral and Maxillofacial Surgeons.

2011 - Flapless versus open flap implant surgery in partially edentulous patients subjected to immediate loading: 1-year results from a split-mouth randomised controlled trial [Articolo su rivista]
Cannizzaro, G.; Felice, P.; Leone, M.; Checchi, V.; Esposito, M.
abstract

Purpose: To evaluate the efficacy of flapless versus open flap implant placement in partially edentulous patients. Materials and methods: Forty patients with two separate edentulous areas characterised by residual bone at least 5 mm thick and 10 mm in height had these sites randomised following a split-mouth design to receive at least one implant to each side after flap elevation or not. Implants were first placed in one site, and after 2 weeks in the other site freehand. Implants inserted with a torque > 48 Ncm were immediately loaded with full occluding acrylic temporary restorations. Definitive single cemented crowns or screw-retained metal ceramic fixed dental prostheses were delivered after 2 months. Outcome measures were prosthesis and implant failures, complications, postoperative swelling and pain, consumption of analgesics, patient preference, surgical time, marginal bone level changes, and implant stability quotient (ISQ) values. Results: Seventy-six implants were placed flapless and 67 after flap elevation. In the flapless group, four flaps had to be raised to control the direction of the bur, whereas one haemorrhage and one fracture of the buccal bone occurred in two patients of the flap elevation group. Four implants did not reach the planned stability (three belonging to the flapless group) and they were all immediately replaced by larger diameter ones. After 1 year, no drop-outs occurred. Two definitive bridges could not be placed when planned (one in each group) and two crowns had to be remade (one in each group). Two implants failed in each group, all in different patients. There were no statistically significant differences for prosthetic and implant failures, complications, ISQ values and marginal bone levels between groups. However, flapless implant placement required significantly less operation time (17 minutes less, saving almost two-thirds of the time for implant placement), induced less postoperative pain, swelling, analgesic consumption and was preferred by patients. Mean ISQ values of both groups significantly decreased over time. Conclusions: Implants can be successfully placed flapless and loaded immediately, reducing treatment time and patient discomfort.

2011 - Reconstruction of atrophied anterior mandible with an inlay technique and resorbable miniplates: A case report [Articolo su rivista]
Felice, P.; Pistilli, R.; Marchetti, C.; Piana, L.; Checchi, V.; Nisii, A.; Iezzi, G.
abstract

This case report describes an inlay augmentation procedure with resorbable bone plates and fixation screws in a case of vertical atrophy of the anterior mandible. After 3 months from the surgery, vertical bone height augmentation was evaluated, and at the time of implant insertion, core biopsies from the grafted area were taken. Moreover, 8 months after the start of prosthetic loading, radiographic assessments showed no pathological signs. This case report shows that the effectiveness of resorbable plates during the graft healing process is similar to that of titanium plates. © 2011 by Lippincott Williams & Wilkins.

2011 - Self-assessed bruxism and phobic symptomatology [Articolo su rivista]
Bellini, M.; Marini, I.; Checchi, V.; Pelliccioni, G. A.; Gatto, M. R.
abstract

The aim of this observational study was to compare two samples of patients (identified, from a previous survey carried out in 2007, as self-assessed bruxers and not) on the basis of the presence of anxious/phobic symptoms, general and linked to an oral surgery. Forty-three bruxers and 207 non-bruxers were identified; among these last ones a sub-sample of 89 subjects was randomly selected as control and analyzed. The instruments for data collecting were two self-administered psychological questionnaires: STAI-Y1, Phobia Scale by Marks-Sheehan, and supplementary items on specific dental fear/phobia. No significant differences were observed for age, gender and occupation data but interestingly bruxers are significantly more represented among widows/divorced and graduated in comparisons with non-bruxers. Alcohol consumers were more frequent in bruxers than in non-bruxers (55.8% and 12.4%, respectively; P=0.0001). Global anxiety (P=0.02), agoraphobia, claustrophobia, pathophobia, social phobia (P<0.05), are more frequent in bruxers as also a suffocation feeling (P=0.02). The severity of behaviours that aim to avoid the same situations that causes phobias is low and similar in the two groups. The involuntary habit of clenching is, in our opinion, reported by the patients who control their anxiety/phobias without avoiding behaviours, increasing the muscular activity at a level relevant to bruxism.

2011 - Variables affecting the gingival embrasure space in aesthetically important regions: Differences between central and lateral papillae [Articolo su rivista]
Montevecchi, M.; Checchi, V.; Piana, L.; Checchi, L.
abstract

This study evaluated different variables to determine their role in the appearance of the central and lateral upper jaw papillae. 292 interdental embrasures were examined. Personal variables were: age, smoke, and use of interproximal hygiene devices. The clinical characteristics were: tooth shape, periodontal biotype and papilla appearance. Radiographic measurements were: root to root distance at the cemento-enamel junction (horizontal distance), and bone crest to interdental contact point distance (vertical distance). The papilla recession increased with patient age. The horizontal distance of the central papilla was always greater (up to 1 mm) than that of the other papillae. The vertical distance of the central papilla was greater (up to 2 mm) than that of the other papillae for each class except for the normal one (Nordland & Tarnow classification). For vertical distances ≤5 mm, papillae were almost always present; for distances up to 6 mm, the lateral papillae belonging to the normal class disappeared, while the central papilla remained in 11% of cases; central papillae of class 1 were present in larger proportions until a vertical distance of 8 mm. The present observational study shows that differences on clinical and radiographic determinants do exist between central and lateral papillae. This variance should be strictly taken in account for a harmonious and stable treatment outcome on this highly aesthetic area. © Montevecchi et al.; Licensee Bentham Open.

2010 - "Orthodontic extraction" for the treatment of dentigerous cysts [Articolo su rivista]
Bonetti, G. A.; Checchi, V.; Bendandi, M.; Marchetti, C.
abstract

OBJECTIVES. Dentigerous cysts are a frequent finding in both jaws. They are usually treated by complete surgical enucleation with high risk of post-surgical complications, especially in case of large lesions. An innovative, more conservative and less traumatic approach is proposed in this paper. MATERIALS AND METHODS. 7 patients with mandibular cysts larger than 3 cm associated with impacted third molars were treated by a combined orthodontic-surgical approach. During cyst marsupialization under local anesthesia, tooth crown was exposed and an orthodontic bracket was bonded. RESULTS. The teeth were extruded and extracted with no post-surgical complications after that they were moved away from mandibular canal and new bone developed distally to second molar. A significant reduction of cystic cavity and improvement of periodontal health of adjacent second molars were obtained. CONCLUSIONS. This combined approach makes surgery easier and greatly reduces the risk of post-surgical complications. The procedure proved to be effective in treating large mandibular cysts associated with impacted third molars.

2009 - A modified papilla preservation technique, 22 years later [Articolo su rivista]
Checchi, L.; Montevecchi, M.; Checchi, V.; Bonetti, G. A.
abstract

The contour of the interdental tissues, as well as the color and texture of the keratinized tissues, are essential elements of anterior esthetics. Tissue loss in the interproximal regions, with related esthetic concerns, phonetic difficulties, and food impaction, can occur for a variety of reasons, including treatment of periodontal diseases. In periodontal surgical procedures, the soft tissues require elevation and resection to gain access to the root surfaces and osseous supporting structures. Compromised esthetics in the anterior region of the mouth could be a serious consequence of periodontal surgical procedures. Several articles have been devoted to flap designs and surgical techniques to maintain full papillary form and preserve the soft tissues during surgical access. Unfortunately, very little evidence of long-term results is available. The aims of the present article are to report a 22-year follow-up case of surgical interdental papilla preservation, discuss the anatomic variables that conditioned the outcome, and review and compare existing surgical techniques for maintaining the interproximal soft tissues. © 2009 by Quintessence Publishing Co Inc.

2009 - Bone augmentation versus 5-mm dental implants in posterior atrophic jaws. Four-month post-loading results from a randomised controlled clinical trial [Articolo su rivista]
Felice, P.; Checchi, V.; Pistilli, R.; Scarano, A.; Pellegrino, G.; Esposito, M.
abstract

Purpose: To evaluate whether short (5 mm) dental implants could be a suitable alternative to augmentation and placement of longer implants (10 mm) in posterior atrophic jaws. Materials and methods: Thirty partially edentulous patients with bilateral posterior edentulism were included: 15 patients having 5 to 7 mm of residual crestal height above the mandibular canal, and 15 patients having 4 to 6 mm of residual crestal height below the maxillary sinus and bone thickness of at least 8 mm measured on a CT scan. The patients were randomised either to receive one to three submerged 5-mm-long Rescue implants (Megagen) or 10-mm-long implants placed in augmented bone according to a split-mouth design. Mandibles were augmented with interpositional anorganic bovine bone blocks (Bio-Oss) and maxillae with granular Bio-Oss placed through a lateral window under the lifted sinus membrane. Resorbable barriers were used to cover the grafted sites. Grafts were left to heal for 4 months before placing the implants using a submerged technique. Four months after implant placement, provisional reinforced acrylic prostheses were delivered and replaced 4 months later by definitive screw-retained metal-ceramic prostheses. Outcome measures were: prosthesis and implant failures, any complications, time needed to fully recover mental nerve function (only for mandibular implants) and patient preference assessed 1 month after loading. All patients were followed up to delivery of the final restorations (4 months after loading). Results: A systematic deviation from the research protocol occurred: the operator used another implant system (EZ Plus, Megagen) for implants 10 mm or longer with a diameter of 4 mm at the augmented sites. No patients dropped out. In 5 patients of the augmented group (all mandibles), there was not enough height to place 10-mm-long implants as planned and shorter implants (7 and 8.5 mm) were used instead. In each group, one prosthesis could not be placed when planned because an implant was found to be mobile at abutment connection: one 5 mm maxillary implant and one 8.5 mm mandibular implant in the augmented group. Five complications occurred: two in the augmented group (one maxillary sinus perforation and one mandibular wound dehiscence after implant placement possibly associated with the failure of one implant) versus three maxillary sinus perforations in the 5-mm-long implant group. The difference was not statistically significant. No patient suffered from permanent disruption of alveolar inferior nerve function, however, significantly more patients had paraesthesia for up to 3 days in the augmented group. There was no statistically significant difference in patient preference with the majority of patients expressing no preference for which treatment they received, finding both of them acceptable.Conclusions: With residual bone height of 5 to 7 mm over the mandibular canal, short 5 mm implants might be preferable to vertical augmentation since the treatment is faster, cheaper and associated with less morbidity. In the presence of 4 to 6 mm of bone height below the maxillary sinus it is still unclear which procedure could be preferable. These preliminary results must be validated by a follow-up of at least 5 years.

2009 - Human dental pulp stem cells: From biology to clinical applications [Articolo su rivista]
D'aquino, R.; de Rosa, A.; Laino, G.; Caruso, F.; Guida, L.; Rullo, R.; Checchi, V.; Laino, L.; Tirino, V.; Papaccio, G.
abstract

Dental pulp stem cells (DPSCs) can be found within the "cell rich zone" of dental pulp. Their embryonic origin, from neural crests, explains their multipotency. Up to now, two groups have studied these cells extensively, albeit with different results. One group claims that these cells produce a "dentin-like tissue", whereas the other research group has demonstrated that these cells are capable of producing bone, both in vitro and in vivo. In addition, it has been reported that these cells can be easily cryopreserved and stored for long periods of time and still retain their multipotency and bone-producing capacity. Moreover, recent attention has been focused on tissue engineering and on the properties of these cells: several scaffolds have been used to promote 3-D tissue formation and studies have demonstrated that DPSCs show good adherence and bone tissue formation on microconcavity surface textures. In addition, adult bone tissue with good vascularization has been obtained in grafts. These results enforce the notion that DPSCs can be used successfully for tissue engineering. © 2008 Wiley-Liss, Inc.

2009 - Preservation and reconstructive techniques of interdental papilla [Articolo su rivista]
Checchi, L.; Montevecchi, M.; Piana, L.; Checchi, V.
abstract

2009 - Vertical bone augmentation versus 7-mm-long implants in posterior atrophic mandibles. Results of a randomised controlled clinical trial of up to 4 months after loading [Articolo su rivista]
Felice, P.; Cannizzaro, G.; Checchi, V.; Marchetti, C.; Pellegrino, G.; Censi, P.; Esposito, M.
abstract

Purpose: To evaluate whether 7-mm-long implants could be a suitable alternative to longer implants placed in vertically augmented bone for the treatment of atrophic posterior mandibles. Materials and methods: Sixty partially edentulous patients having 7 to 8 mm of residual crestal height and at least 5.5 mm thickness measured on a computed tomography scan above the mandibular canal were randomised to receive either two to three submerged 7-mm-long NanoTite External Hex implants (Biomet 3i) or 10-mm or longer implants (30 patients per group) placed in vertically augmented bone. Bone was augmented with anorganic bovine bone blocks (Bio-Oss) using a sandwich technique and resorbable barriers. The grafts were left healing for 5 months before placing the implants, which were submerged. Four months after implant placement, provisional acrylic prostheses were delivered. Definitive screw-retained metal-ceramic prostheses were delivered 4 months later. Outcome measures were: Prosthesis and implant failures, any complications, and time needed to fully recover mental nerve sensitivity. All patients were followed up to the delivery of the final restorations (4 months after loading). Results: No patient dropped out. In two patients of the augmented group, there was not enough space to place 10-mm or longer implants as planned and 7-mm-long implants were used instead. The most likely reason for this is that the Bio-Oss blocks fractured in many pieces at placement. One prosthesis could not be placed when planned in the 7-mm group versus three prostheses in the augmented group, because of failure of one implant in each patient. The difference was not statistically significant. All implants were successfully replaced and final prostheses delivered. Four complications (wound dehiscence) occurred during graft healing in the augmented group (one possibly associated with the failure of one implant) versus none in the 7-mm-long implant group. The difference was not statistically significant. No patient suffered from permanent paraesthesia of the alveolar inferior nerve; however, sensitivity was recovered significantly faster in the short implant group. Conclusions: The early results of this study suggest that, when the residual bone height over the mandibular canal is between 7 and 8 mm, 7-mm short implants might be a preferable choice since the treatment is faster, cheaper and associated with less morbidity than vertical bone augmentation. These preliminary results must be confirmed by follow-ups of 5 years or more in order to monitor the performance of short implants over time.

2008 - A coronally positioned single flap approach in periodontal reconstructive surgery [Articolo su rivista]
Checchi, L.; Montevecchi, M.; Checchi, V.; Laino, G.
abstract

Aim of work. The goal of this article is to describe an innovative surgical technique for the treatment of periodontal bony defects that combines the characteristics of both reconstructive and mucogingival techniques. Method. The special features of this technique, named Coronally Positioned Single Flap Approach (CP-SFA), consist in a surgical flap elevated just on one side (buccal or lingual/palatal), and in its coronal reposition that is stabilized thanks to interdental papillae whose epithelium has been removed. Clinical implications. This surgical technique has many advantages, for instance the improvement of periodontal aesthetics due to reduced post surgical contraction and discomfort for the patient because of a smaller surgical field. The site selected for this technique must meet several demands: intrabony defects localized only on buccal or lingual/patatal side, healthy and intact interproximal areas close to bony defect and the possibility of adequately cleansing of bone defects and root surfaces. Conclusions. Short term results confirm the utility of the CP-SFA; further and meticulous investigations are however needed.

2008 - Dental phobia in dentistry patients [Articolo su rivista]
Bellini, M.; Maltoni, O.; Gatto, M. R.; Pelliccioni, G.; Checchi, V.; Checchi, L.
abstract

AIM: This study evaluated the presence of current and general phobia and anxiety symptoms in periodontology patients just before treatment in relation to specific dental fears and to general health status and quality of life. METHODS: The study population was all consecutive outpatients attending the Periodontics and Implantology Services, School of Dentistry, University of Bologna, over a 12-month period in 2007. Data collection instruments were psychological questionnaires (State-Trait Anxiety Inventory [STAI]-Y1, Marks-Sheehan Phobia Scale [MSPS], World Health Organization Quality of Life [WHOQOL] short form) plus supplementary items investigating specific dental fears, patient's dental history, and the dentist's clinical assessment of the patient. RESULTS: In all, 250 consecutive patients were recruited. Most (86%) presented with very mild anxiety and phobia symptoms; 13.2% and 13% presented with psychological symptoms of anxiety and phobia, respectively, independently of those subjects with specific dental fears who were significantly younger. The most common dental fears were fear of pain (48.8%) and of receiving an injection (29.9%). The patients' quality of life did not appear to be affected by these fears. CONCLUSIONS: In the dental outpatients seeking treatment for moderate-to-severe dental pathology at a university periodontics and implantology clinic and referring good general health and psychosocial functioning, levels of anxiety and phobia were usually low or absent; but when present, they were independent of ascertained specific dental fears.

2008 - Osseous resective surgery: Long-term case report [Articolo su rivista]
Checchi, L.; Mele, M.; Checchi, V.; Zucchelli, G.
abstract

This case report evaluated the long-term effects of osseous resective therapy in the treatment of a patient with moderately advanced periodontal disease. In 1984, the patient underwent initial therapy followed by a periodontal surgical phase consisting of osseous recontouring with an apically positioned flap. After 20 years, in 2003, the patient presented with a traumatic complication. An exploratory surgery revealed a fracture on the roof of the pulp chamber on the maxillary left first molar. The buccal roots were resected, preserving the palatal root, and a reevaluation of the long-term outcome of osseous resective surgery was performed. It is suggested that the positive treatment result is the consequence of the reestablishment of tissue morphology favorable for oral hygiene and plaque control by the patient.

2008 - Vertical ridge augmentation of the atrophic posterior mandible with interpositional block grafts: Bone from the iliac crest versus bovine anorganic bone. Results up to delivery of the final prostheses from a split-mouth, randomised controlled clinical trial [Articolo su rivista]
Felice, P.; Marchetti, C.; Piattelli, A.; Pellegrino, G.; Checchi, V.; Worthington, H.; Esposito, M.
abstract

Purpose: To compare the efficacy, complications and patient preference of two different techniques for vertical bone augmentation of the posterior mandible: bone blocks harvested from the iliac crest versus anorganic bovine bone blocks (Bio-Oss®) were used as inlays. Materials and methods: Ten partially edentulous patients, requiring bilateral and vertical bone augmentation of the posterior mandible (having 5 to 7mm of residual crestal height and at least 5mm thickness above the mandibular canal to allow for implant placement) had their posterior mandibles randomly allocated to both interventions. Resorbable barriers were used to cover the grafts. After 4 months, implants were inserted, and after a further 4 months, provisional prostheses were inserted. Definitive prostheses were delivered 4 months later. Prosthesis and implant failures, the amount of vertically regenerated bone measured on computerised tomography (CT) scans, any complications, the time needed to fully recover mental nerve sensitivity and patient preference were all recorded. All patients were followed up for up to 1 month after the delivery of the final restorations. Results: Up to 5 months post-loading no patients dropped out or were excluded. Both procedures obtained significant bone gain and achieved the desired results. Four months after grafting, autogenous bone loss was on average 1.1mm (P=0.088) and Bio-Oss 0.6mm (P=0.001). There were no statistically significant differences in bone gain and maintenance among the two procedures. The sides treated with Bio-Oss recovered their full mental nerve sensitivity significantly faster than those treated with autogenous bone (4 versus 6.3 days). Three complications occurred during graft healing; two in the autogenous bone group and one determining the complete failure of the augmentation procedure. No implants or prosthesis could be placed in the planed area. There was no statistically significant differences in the occurrence of complications between the procedures. After implant placement one complication occurred in the autogenous bone group (probably as a consequence of a previous complication). Patients significantly preferred the treatment with Bio-Oss: 3 weeks after augmentation seven patients preferred Bio-Oss and three patients found the treatments to be 'equally good' (odds ratio 0.045 [5% confidence interval (CI) 0.00 to 0.87], P=0.04). One month after delivery of the final prostheses, eight patients preferred Bio-Oss and two patients found the treatments to be 'equally good' (odds ratio 0.03 [95% CI 0.00 to 0.64], P=0.02). Conclusions: This pilot study suggests that it might be sensible to use Bio-Oss blocks rather than bone harvested from the iliac crest as the interpositional graft in the treatment of resorbed posterior mandible, as patient discomfort is reduced.

2007 - Bilaminar connective tissue graft as an alternative treatment of leukoplakia: Case report [Articolo su rivista]
Checchi, L.; Pucar, A.; Checchi, V.
abstract

Oral leukoplakia is a predominantly white lesion of the oral mucosa that cannot be clinicopathologically characterized as any other definable lesion. Any oral site may be affected by leukoplakia, the most common sites being buccal and alveolar mucosa, floor of the mouth, tongue, lips, and palate. To date there is no evidence of effective treatment of oral leukoplakia that may prevent recurrence. This case report describes a new surgical technique using a bilaminar connective tissue graft in the treatment of oral leukoplakia. During the regular periodontal recall visit, the clinical diagnosis of gingival leukoplakia at the maxillary left sextant was established in a 45-year-old patient. Histopathologic analysis suggested reactive hyperkeratosis. The patient agreed to a new surgical treatment of the lesion. Under local anesthesia a 20-mm-long bilaminar connective tissue graft was interposed between the affected tissue and the bone. Healing was followed by the disappearance of the white lesion within the borders of the underlying graft. Five years after therapy, the treated area remained intact, with no clinical sign of recurrence.

2007 - Clinical efficacy of two toothbrushes with different bristles [Articolo su rivista]
Checchi, L.; Montevecchi, M.; Gatto, R. M.; Moreschi, A.; Checchi, V.
abstract

OBJECTIVE: The purpose of this single-blind clinical study was to evaluate the efficacy of an innovative manual toothbrush versus a traditional one. METHODS: The toothbrushes were randomly assigned to 30 volunteers in a student population of the Dental School of the University of Bologna, Italy, divided into 15 test and 15 control subjects. A clinical examination assessing Plaque Index (PI), Gingival Index (GI) and buccal Gingival Recessions was performed at baseline, 3 and 6 months. During the baseline examination, each subject received dental debridement, oral hygiene instructions and a standard kit containing: three standard tubes of toothpaste, 1 hourglass (2 min) and one plaque disclosing solution; each subject of the test group received three innovative toothbrushes, while each subject of the control group received three traditional toothbrushes. RESULTS: During the 6 months of observation both groups presented a PI and GI decrease. A more evident improvement of both indices was observed in the test group (PI P = 0.0001, GI P = 0.0001). The greatest part of recessions remained stable (0-3 months: 70% test group, 60% control group and 3-6 months: 86% test group, 94% control group). Some amplitude modifications (0.5 mm) were mainly detected in the first 3 months (control group chi(2) = 17.55, P = 0.0001 and test group chi(2) = 3.31, P = 0.07). They always increased in the control group and decreased in the study group. CONCLUSIONS: The innovative manual toothbrush is more likely to be effective in reducing PI and GI compared to the traditional one and widely safe on periodontal tissues during the period of observation.

2007 - Orthodontic Extraction: Riskless Extraction of Impacted Lower Third Molars Close to the Mandibular Canal [Articolo su rivista]
Alessandri Bonetti, G.; Bendandi, M.; Laino, L.; Checchi, V.; Checchi, L.
abstract