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Ricercatore t.d. art. 24 c. 3 lett. B presso: Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa

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

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

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.

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 - 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.

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.

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

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

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

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 - 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.

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

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

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

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 - 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

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 is 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.

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

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.

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: 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.

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 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.

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 - 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

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

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

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.

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.

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

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.

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.

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.

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 - 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.

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.

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.

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.

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

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.

Checchi, L; Gatto, Mr; Checchi, V; Carinci, F

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 - 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.

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.

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.

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.

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.

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

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.

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.

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.

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

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.