Oroantral communication (OAC) can be defined as a pathologic space created between the maxillary sinus and the oral cavity.This communication and subsequent formation of a chronic oroantral fistula is a common complication often encountered by oral and maxillofacial surgeons.Although various techniques have been proposed in published studies, long-term successful closure of oroantral fistulas is still one of the most difficult problems confronting the surgeon working in the oral and maxillofacial region.The decision of which treatment modality to use is influenced by many factors, such as the amount and condition of tissue available for repair, the size and location of the defect, the presence of infection, the time to the diagnosis of the fistula. To evaluate an alternative technique for the treatment of oro-antral fistula, using a combined therapeutic ear nose and throat/intraoral approach. Twelve consecutive patients affected by complicated OAC were included in this study.The protocol consisted of: clinical, endoscopic, and radiological preoperative evaluation (panoramic tomogram and computed tomography); systemic antibiotic and steroid therapy for 2 weeks before surgery; one-stage surgical procedure consisting of Functional Endoscopic Sinus Surgery technique associated with the closure of the OAC by a titanium mesh and a mucoperiosteal flap; postoperative antibiotic and cortisone-based therapy.A titanium mesh was used to obtain an optimal support and stabilization of soft tissues.Follow-up consisted of weekly clinical evaluation during the first month, a clinical evaluation at 1, 3, 6, 12, 24 months and a nasal endoscopy at 3, 8, 24 weeks after surgery. A second surgical step took place to remove the mesh, after a period of healing, which went from 6 to 18 months. Samples were harvested from the surgical site after mesh removal for histological analysis. At 1 month follow-up, in 10 patients of 12, the Valsalva manoeuvre was negative, same result at the 3rd month follow-up, although in 11 of 12 patients. In 5 of 12 patients, the mesh was exposed. The histological analysis confirmed the formation of a pseudo-periosteum layer.One patient failed because the mesh lost its stability. The patient was operated again 8 months later and new mesh was fixed into place. The current study showed that one-stage, combined endoscopic and intraoral approach represents a feasible and minimally invasive procedure for the long-term effective treatment of chronic complicated OACs.The main advantage of the use of a titanium mesh to guide the regeneration is that it assures a predictable healing, mechanic scaffold, tissues stability and allows a possible following oral rehabilitation.

Background: to assess the radiological marginal bone loss between bone-level or tissue-level dental implants through a systematic review of literature until September 2019. Methods: MEDLINE, Embase and other database were searched by two independent authors including only English articles. Results: The search provided 1028 records and, after removing the duplicates through titles and abstracts screening, 45 full-text articles were assessed for eligibility. For qualitative analysis 20 articles were included, 17 articles of them for quantitative analysis counting a total of 1161 patients (mean age 54.4 years) and 2933 implants, 1427 inserted at Tissue-level (TL) and 1506 inserted at Bone-level (BL). The survival rate and the success rate were more than 90%, except for 2 studies with a success rate of 88% and 86.2%. No studies reported any differences between groups in term of success and survival rates. Three studies showed that BL-implants had statistically less marginal bone loss (p < 0.05). Only one study reported statistically less marginal bone loss in TL-implants (p < 0.05). Conclusion: In the most part of the studies, differences between implant types in marginal bone loss were not statistically significant after a variable period of follow-up ranged between 1 and 5 years.

Introduction: Periodontitis is a multifactorial chronic inflammatory disease induced by a dysbiosis between the host and oral microbiota, which can compromise the host’s immune defenses and lead to the destruction of periodontal tissues. Despite the efficacy of non-surgical periodontal therapy (NSPT) as the gold standard of periodontal treatment, its application can produce lower results due to anatomical and microbiological limitations. This systematic literature review was performed to assess the long-term efficacy of the effects of probiotics as an adjunct to NSPT compared to the control groups with follow-up of clinical, microbiological and immunological outcomes. Materials and methods: A literature review was conducted, considering manuscripts published from November 2016 to February 2022. The research question was formulated following the population, intervention, comparison and outcome strategies. Randomized controlled trials (RCT), systematic review and meta-analysis investigating the periodontal efficacy of domiciliary probiotic therapy in an adjunct to the mechanical therapy were included. Results: Regarding clinical outcomes, there is a reduction in periodontal probing depth (PPD), clinical attachments level (CAL), bleeding on probing (BoP) and plaque index (PI) for the test groups compared to the control groups in a short-term period. No differences were generally observed in the following indices over a period of more than 3 months for most studies considered. Conclusions: Weak evidence suggests that the use of probiotics as an adjunct to non-surgical periodontal therapy treatment may be able to show improvements in periodontal clinical parameters for up to 3 months. However, a significant and large heterogeneity of studies, along with the absence of long-term microbiological and immunological data, preclude any definitive conclusions.