Reducing the spread of COVID-19 within the dental practice: the era of single use.

The year 2020 will be remembered around the world for the Coronavirus pandemic. The better-known Coronavirus disease (COVID-19) is transmitted between individuals through the droplets produced by infected people and is an infectious disease caused by a type of Coronavirus when they exhale, cough or sneeze, or touch a contaminated surface and then touch their eyes, nose or mouth. The pandemic has activated all those measures that provide for a state of emergency with consequent remodeling of health facilities in cases of urgency that cannot be deferred. In this work, a path within a public or private medical facility was highlighted, using individual protective devices for the patient, establishing behaviors that can reduce the spread of the virus. The COVID-19 path has allowed the health personnel and the staff of the study to be able to work in peace as there is the perception of the total containment of the spread of the virus. Coronavirus disease (COVID-19) is an infectious disease caused by a Coronavirus type transmitted through droplets produced by infected people when they cough, sneeze or exhale. Our proposal in dictating the sequence and types of protective devices to be worn by patients minimizes the contagion between patients in a professional healthcare office and is applicable for any type of infectious emergency.

Dental Prosthetic Rehabilitation Interventions in Elderly Patients Hospitalized in the Nursing Homes of the Lombardy Region: A Retrospective Study.

Background: The difficulty of frail, non-self-sufficient or non-ambulatory collaborating elderly residents in nursing homes to eat due to a lack of teeth or the absence of a dental prosthesis leads to an increasingly evident increase in the patients' systemic pathological state, particularly in older patients who take a lot of medications. Total or partial edentulousness that is not filled with dental prostheses or that is filled with inadequate prostheses, associated with socioeconomic factors, depression, impaired motor functions, heart disease and a large number of chronic diseases including excessive use of drugs, often affects elderlies' feeding. Aim: In this study, prosthetic rehabilitation was performed on some frail elderly residents in 10 nursing homes in the Lombardy district, and, subsequently, meal behavior and social activity were examined in two information questionnaires through compilation. Methods: The research was conducted on only 67 patients, 26 men and 41 women, aged between 75 and 99, who were guests in 10 health facilities (nursing homes) in the Lombard district; only 8 residents did not undergo prosthetic rehabilitation, as they did not cooperate. All the patients who were visited underwent oral prosthetic rehabilitation, and, subsequently, some aspects such as nutrition and socialization were assessed with other residents through the aid of two information dossiers. Results: the results showed that all the residents, despite difficulties in chewing with the new prosthesis, were fed and did not refuse more consistent foods; in addition, there was an improvement in social activity among the residents. Only 19.3% of men and 22% of women continued to eat little; there was an improvement in the participation in social activities among the residents, with a percentage of 73% of men and 88% of women; in particular, during meals 35 residents conversed with the other residents. Discussion: The dental problems of elderly people residing in social welfare homes are increasingly evident when other systemic pathologies are present. It would be desirable to introduce telemedicine in residences for the elderly for the monitoring of dental problems. Conclusions: From the information obtained and from the evaluation of the change in the elderly, it can be concluded that it would be desirable to include specific dental protocols to create a network, including a telematic one, to monitor and perform more dental checks in nursing homes.

Efficacy of Home Oral-Hygiene Protocols during Orthodontic Treatment with Multibrackets and Clear Aligners: Microbiological Analysis with Phase-Contrast Microscope.

The purpose of this study is to analyze the microbiota of patients undergoing orthodontic treatment with multibrackets and transparent aligners. The second goal is to evaluate the effectiveness of the oral irrigator on the oral hygiene and periodontal health of orthodontic patients. Fifty patients (27 F, 23 M; mean age 21.5 years) were recruited for the study, then divided into two groups. Group A underwent fixed orthodontic therapy with multibracket, and a home protocol that included manual orthodontic toothbrush, interdental brushes, and one-tuft brushes. Group B used transparent aligners for 22 h a day and a home protocol that included a manual brush with soft bristles and dental floss. After 3 months, all patients of the two groups, A and B, underwent plaque evaluation with a phase-contrast microscope. If the test result showed non-pathogenic bacterial flora, the subject continued with the traditional home oral-hygiene protocol. If the test detected pathogenic flora, the subject changed the home protocol, with a sonic toothbrush and oral irrigator, while the microbiological analysis continued to be performed after 3 months. After 3 months, 10 out of 25 patients treated with multibrackets (group A) and only 3 out of 25 patients with aligners (group B) passed from non-pathogenic flora to pathogenic flora. After 6 months, using the oral irrigator and a sonic toothbrush for 3 months, all subjects returned to non-pathogenic flora. This study confirms that in patients treated with multibrackets, the risk of developing unfavorable microbiota increases compared to those treated with clear aligners. The use of an oral irrigator combined with the sonic toothbrush seems to be able to restore good oral hygiene in subjects with pathogenic flora and therefore to be effective at reducing the risk of caries and gingivitis in orthodontic patients.

Distribution of Malocclusion Traits in the Pediatric Population of Milan: An Observational Study.

Background: Epidemiological investigations define the prevalence and distribution of the various types of malocclusions, and can help to identify etiological factors and set the most correct orthodontic therapy. Aim: The goal of this study was to verify the prevalence and distribution of various types of malocclusions in the pediatric population. Methods: The study was performed on a sample of 350 patients (ages 5-9) being treated at the ASST Grande Ospedale Metropolitano Niguarda in Milan. A comparison was presented with one similar epidemiological investigation conducted 22 years earlier by the same researchers. The values of the malocclusion indices were reported from the cephalometric analyzes of the patients and were differentiated on the basis of gender and ethnicity. Results: The predominant traits of malocclusion in the general population of the analyzed sample were: skeletal class II (47.43%), hyper-divergence (40.86%), maxillary retrusion (46%), mandibular retrusion (66%), maxillary hypoplasia (50%), mandibular hypoplasia (49.14%), Wits index > 2 mm (22.57%); overjet > 4 mm (31.1%) and overbite > 4 mm (24.86%). Substantial differences were found between Italian patients and patients belonging to different ethnic groups in almost all parameters, and between the male and female genders in some of them. Patients in the 2000 study had a higher prevalence of Class II and hyper-divergence. Conclusions: This epidemiological investigation can suggest different approaches in setting the orthodontic treatment plan based on the ethnic group of the patient taken in charge and encourage more specific and large-scale analytical studies on the subject.

COVID-19 and Prosthetic Emergencies, Home Care in Fragile Patients: A Case Report.

A case of home care is proposed on a frail non-ambulatory patient who presents an old lower total prosthesis in resin broken in several parts. The various pieces of the prosthesis were joined by the patient, as if it were a puzzle, using a glue for plastics and wood. The union of the parts attached with glue was the consequence of the lockdown in the COVID-19 period and of the economic hardship experienced by the elderly disabled patient during the pandemic period. The procedure for preserving the glued parts was carried out carefully, trying not to modify the edges of the glued pieces, to join them correctly, thereby restoring the correct occlusion to subsequently perform the relining. The old lower total prosthesis obtained after the repair and relining operations allowed for the restoration of the patient's chewing and smile. The procedure presented is easily repeatable, risk-free and achievable even in a short time, satisfying elderly non-self-sufficient patients who need interventions for prosthetic emergencies during a period of confinement.

Concentrated Growth Factors (CGF) Combined with Melatonin in Guided Bone Regeneration (GBR): A Case Report.

During implant restorative dentistry, common and crippling postoperative complications are pain and swelling of perioral soft tissues which engraving on patient quality of life. Concentrated growth factors (CGF), a novel generation of autologous platelet concentrate, and melatonin, endogenous indoleamine with also bone regenerative properties, may be useful for reconstruction of bony defects as well as in prosthetic and esthetic rehabilitation. We report a clinical case in which guided bone regeneration was performed combining CGF, melatonin and heterologous biomaterial. Great postoperative recovery without any complications was reported. In conclusion, in restorative dentistry the combined use of CGF and melatonin may have important roles in restoring bone defect, in improving implant osteointegration and, not less important, in preventing postoperative complications.

Laser Decontamination and LED Photobiomodulation Promote Bone Regeneration and Wound Healing by Secondary Intention, in Alveolar Ridge Preservation-Clinical and Radiographic Evaluation: A Pilot Experience.

Background: Tooth loss reduces crestal bone with important resorption of alveolar dimensions, reducing the possibility of placing implants after wounds healing. Objective: The goal of this pilot experience was to consider, in alveolar ridge preservation, the regenerative and decontaminating potential of oxygen high-level laser therapy (OHLLT), a high-frequency and high-power diode laser combined with hydrogen peroxide 10 volumes 3%, and to evaluate wound closure during the 14-21 days after surgery. Methods: For this study we selected 15 patients (age range from 30 to 70 years old) who underwent alveolar ridge preservation (three patients were treated in the anterior maxilla, 12 in the mandibular jaw, with molars and premolars involved). A clinical and radiographic examination was performed at baseline. In this pilot experience, after the extractions, the sockets were treated with photodynamic therapy without dye (OHLLT/SiOxyL+ protocol) to decontaminate the area that was treated, combined with allografts, Osteobiol, granulometry 25, Platelet-Rich Fibrin and collagen membranes, Biogide/Geistlich. Photobiomodulation (PBM) sessions with ATP38 were made for the first 4 months every 2 weeks. Clinical evaluations were performed at 14, 21, 90, and 240 days. Radiographic evaluations with cone beam computed tomography (CBCT) were performed at 240 days, before the second surgery. Two hundred seventy days after the first surgery, a new surgical treatment was made with the same concepts adopted in the first surgery, to place implants. Results: All alveolar ridge preservation surgeries were successful, with minimal bone resorption after 9 months. Closure of gingival tissue healed by secondary intention was achieved after 14 days for all patients, except one, who showed wound closure after 21 days. Conclusions: This pilot experience showed that this technique allowed to obtain new bone and wound healing by secondary intention in treated sites and to place implants in all patients, without other bone augmentation techniques, thanks to extracellular matrix induced by photodynamic laser therapy on grafts materials and to PBM made each 2 weeks for the first 4 months postsurgery. The study was conducted according to the guidelines of the Ethics Committee of the School of Medicine and Surgery at the Milano Bicocca University (protocol n. 11/17), and derived from the approval of Italian National Institute of Health (ISS), protocol 30 July 2007-0040488.

Pain Reduction during Rapid Palatal Expansion Due to LED Photobiomodulation Irradiation: A Randomized Clinical Trial.

Objective: The purpose of this research is to assess the analgesic efficiency of Photobiomodulation (PBM) in pain reduction in young patients during rapid maxillary expansion therapy. Materials and Methods: Thirty patients were included and allocated to an experimental group [Rapid Palatal Expansion (RPE) and PBM] and a control group (RPE only) at random. Inclusion criteria were skeletal age from CVS1 to CVS3, examined on the cephalometric lateral teleradiography, with cervical vertebra staging and completed eruption of upper first molar. Exclusion criteria were previous orthodontic treatment, bone disease, disability, or skeletal age from CVS4. Patients referred the pain they felt using a Numerical scale rate (NRS), ranging from 0 to 10, with specific intervals of time: 6 h, 12 h, 24 h, and from days 2 to 7. The Wilcoxon-Mann-Whitney test was used to evaluate differences in NRS reported values between the two groups. Results: The final sample included 30 patients, 14 males and 16 females, with a mean age of 7.8 ± 1.2 years. The pain that was felt at each time interval and the maximum score of pain were significantly lower in the experimental group (p < 0.05) and decreased faster in the experimental group, with a score test near to 0 after 2/3 days. Conclusions: PBM is efficient in reducing the intensity and the time of pain felt by young patients that undergo rapid maxillary expansion.

A Comparative Assessment of Pain Caused by the Placement of Banded Orthodontic Appliances with and without Low-Level Laser Therapy: A Randomized Controlled Prospective Study.

Patients still refuse or discontinue orthodontic treatment due to related pain and discomfort. In this study, we investigate if low-level laser therapy (LLLT) can reduce pain caused by orthodontic bands. Sixty subjects who needed bands placed on the upper permanent first molars were assigned randomly to the LLLT group, placebo, and control groups. Inclusion criteria were: age range 10-14 years, fully erupted upper first molars in healthy condition, presence of tight mesial proximal contact. Exclusion criteria were: systemic or metabolic diseases, chronic pain or neurological or psychiatric disorders, use of pharmacological agents interfering with pain perception, previous orthodontic treatment or the simultaneous presence of other devices in the patient's mouth. The assessment of pain was performed by using a numeric rating scale (NRS) considering different time intervals, i.e., immediately after bands placement, 6 h, 24 h, and from day 2 to day 5. Differences in the maximum pain and in pain experienced at each time-point, among the three groups, was assessed by using the Kruskal-Wallis H. The final sample included 56 patients, 29 males, and 27 females, with a mean age of 12.03 ± 1.3 years. Patients were randomly allocated into three groups (tested, control, and placebo group) with each group consisting respectively of 19, 20, and 17 individuals. Subjects in the LLLT experienced less pain at each time interval as well as the maximum pain score being lower in the LLLT compared to control and placebo groups. These findings were all statistically significant (p < 0.05). LLLT can alleviate the intensity of pain after the placement of orthodontic bands.

A Comparative Assessment of the Efficiency of Orthodontic Treatment With and Without Photobiomodulation During Mandibular Decrowding in Young Subjects: A Single-Center, Single-Blind Randomized Controlled Trial.

Objective: To assess if photobiomodulation (PBM) improves the efficiency of orthodontic treatment with fixed appliance during the alignment stage. Methods: Eighty-nine subjects were included in this trial and randomly assigned for treatment with fixed appliance and PBM group or with fixed appliance only (control group). Inclusion criteria were as follows: (1) age between 13 and 30 years, (2) permanent dentition, (3) class I malocclusion, (4) lower 6-6 mild crowding measured on dental cast, (5) no spaces or diastema in the lower arch, (6) no ectopic teeth, (7) nonextractive treatment plan, and (8) no previous orthodontic treatment. PBM was administered in the PBM group every 14 days using the ATP38® (Biotech Dental, Allée de Craponne, Salon de Provence, France) (72 J/cm2 of fluency for each session). Dental alignment was assessed by visual inspection, and treatment time was defined in days as T2 (date of assessment of complete dental alignment)-T1 (date of brackets bonding). The number of monthly scheduled appointments was also recorded. All the data underwent statistical analysis for comparison between groups. Results: Treatment time was significantly shorter (p < 0.001) in the PBM group (203 days) compared with the control (260 days). Consequently, control visits (p < 0.001) were lower in the PBM group (7) compared with the control group (9). Conclusions: The present findings would confirm that PBM can be used to enhance the efficiency of orthodontic treatment during dental decrowding.

Maxillary Orthodontic Expansion Assisted by Unilateral Alveolar Corticotomy and Low-Level Laser Therapy: A Novel Approach for Correction of a Posterior Unilateral Cross-Bite in Adults.

Introduction: The treatment of a true unilateral posterior crossbite often requires asymmetric maxillary expansion; however, this is challenging to achieve with conventional expansion methods because of several biomechanical limitations. In this paper, we introduce a new protocol for the treatment of a unilateral posterior crossbite in adults based on maxillary orthodontic expansion assisted by corticotomy and low-level laser therapy (LLLT) performed on the crossbite side. Methods: The study sample included 15 adults (8 females, 7 males) affected by a true unilateral posterior crossbite, with a mean age of 21.6 ± 3.1 years at the at the beginning of treatment. After the application of orthodontic appliances (palatal expander and self-ligating brackets), corticomy was performed at the buccal aspect of the crossbite side while LLLT was monthly administered up to the correction of the crossbite. The efficacy of the technique was evaluated through measurements performed on maxillary digital models. Results: All subjects reported successful correction of the posterior unilateral crossbite, and functional occlusion was achieved as well. The average expansion was greater at the crossbite side compared to the unaffected side and such difference was significant at the levels of first premolars (P < 0.05), second premolars (P < 0.05) and first molars (P < 0.05). Conclusion: Orthodontic maxillary expansion assisted by unilateral corticotomy and LLLT was effective in the treatment of the true unilateral crossbite.

Is Low-Level Laser Therapy an Effective Method to Alleviate Pain Induced by Active Orthodontic Alignment Archwire? A Randomized Clinical Trial.

OBJECTIVE: The aim of this study is to assess if low-level laser therapy (LLLT) alleviates pain after the placement of orthodontic alignment archwire and if there could be a specific indication for the usage of LLLT according to the amount of dental crowding. MATERIALS AND METHODS: Ninety subjects were included and randomly assigned to the tested group (orthodontic treatment and LLLT), placebo group (orthodontic treatment and simulated LLLT), and control group (orthodontic treatment only). Inclusion criteria are age between 13 and 30 years, completely erupted mandibular teeth, and lower crowding of ≥3 mm. Exclusion criteria are spaces or diastema in the lower arch, ectopic teeth, treatment plan including extractions or the use of auxiliary devices, and previous orthodontic treatment. Patients reported the pain experienced by using a numeric rating scale, ranging from 0 to 10, at specific time intervals, that is, 2 hours, 6 hours, 24 hours, and from day 2 to 7. Kruskal-Wallis H Test was used to assess differences in the maximum pain and pain experienced at each time interval among the three groups and in the maximum pain reported among subjects with different degree of crowding. RESULTS: The final sample consisted of 84 patients, 41 male and 43 female patients, with a mean age of 16.5 ± 2.8 years. The pain experienced at each time interval and the maximum pain score were significantly lower in the tested group, whereas no differences were found between control and placebo groups. Moreover, no differences were found in the pain experienced among subjects with mild, moderate, and severe incisor crowding in all groups. CONCLUSIONS: LLLT is effective in alleviating the intensity and duration of pain experienced by patients after the engagement of alignment archwire. However, there is no specific indication for the usage of LLLT according to the amount of crowding.

Frequency and type of ponticulus posticus in a longitudinal sample of nonorthodontically treated patients: relationship with gender, age, skeletal maturity, and skeletal malocclusion.

OBJECTIVES: The aim of this study was to assess the frequency and type of ponticulus posticus and to evaluate its relationship to gender, chronologic age, skeletal maturity, and skeletal malocclusion. STUDY DESIGN: The sample included the longitudinal lateral cephalograms of 734 patients (378 males and 356 females) retrieved from the American Association of Orthodontists Craniofacial Growth Legacy Collection. The presence of ponticulus posticus (complete and partial forms) was assessed by visual inspection, and the cervical vertebral maturation method was used to determine the skeletal maturation stage. The presence and type (complete or partial) of ponticulus posticus were assessed by gender, age at first appearance of ponticulus posticus, skeletal maturation stage as determined by the cervical vertebral maturation method, and skeletal malocclusion. RESULTS: The overall prevalence of ponticulus posticus was 12.6% (93 of 734) with complete and partial forms observed respectively in 8.7% (64 of 734) and 3.9% (29 of 734) of the sample. Both forms of ponticulus posticus occurred mainly in the age range of 7 to 13 years (P = .04). No differences were found in groups based on gender, skeletal maturity stages, or skeletal malocclusion (P > .05). However, approximately 90% of ponticulus posticus occurred before and after the circumpubertal stage. CONCLUSIONS: Ponticulus posticus should be expected mainly during childhood and the pubertal age. This may support the theory of a genetic cause of this vertebral anomaly.

Use of a Partial-thickness Flap for Guided Bone Regeneration in the Upper Jaw.

INTRODUCTION: Guided bone regeneration (GBR) aims to restore adequate bone volume for the placement of implants in an ideal location. In this article, we analyze different surgical techniques for tissue management during GBR and a modified partial-thickness surgical approach. MATERIALS AND METHODS: In a year's time span, five patients were enrolled in the study: Four women and one man (aged 44-59 years). In four patients, a GBR with simultaneous implant placement was adopted, whereas in another patient, a delayed implant placement was done. The flap was of full thickness and overturned on the side palatal with the aim of a retractor, thus exposing the bone crest. The graft material was covered and protected with a resorbable collagen membrane (Geistlich Bio-Gide®, Switzerland). The periosteal layer of the flap was then positioned above the resorbable membrane without traction. The sutures as vertical mattress were then positioned. Each patient received an intramuscular betamethasone dose (4 mg/50 kg) and antibiotic therapy for 7 days (amoxicillin + clavulanic acid 1 gm every 12 hours) and was instructed to maintain oral hygiene and appropriate wound cleaning. The patients were recalled at different times to monitor the healing. RESULTS: No cases of tissue dehiscence were observed during the period of wound healing. One patient, however, showed a delayed exposure 4 months after surgery. This occurrence was managed without complications for the patient. CONCLUSION: The design of proposed flap seems to be effective in controlling the risk of dehiscence during the healing time in the GBR. The vascular supply was rarely compromised. The results we obtained are encouraging even if further studies on this technique are needed. CLINICAL SIGNIFICANCE: Lateral partial-thickness flaps seem to be effective in controlling tissue tension and consequently the risk of dehiscence. The incision vestibularly performed should favor the soft tissue healing.

Does Low-Level Laser Therapy Enhance the Efficiency of Orthodontic Dental Alignment? Results from a Randomized Pilot Study.

OBJECTIVE: To assess if low-level laser therapy (LLLT) enhances the efficiency of orthodontic dental alignment. BACKGROUND: There is no evidence of the effect of LLLT on the orthodontic treatment time from randomized clinical trials. METHODS: Thirty-six subjects were included in this interventional pilot study and randomly assigned for treatment with fixed appliance and LLLT (test group) or with fixed appliance only (control group). A single monthly administration of LLLT was performed intraorally using a Diode laser (980 nm, 1 W, continuous wave, total energy density = 150 J/cm2; Doctor Smile-Lambda Spa). The date of brackets bonding (T1) and the date of complete resolution of dental crowding (T2) were recorded. The alignment treatment time was defined in days as T2 - T1. The number of monthly scheduled control visits was also recorded. Treatment time duration was assessed in both groups with the log-rank (Mantel-Cox) Test for survival analysis. Mann-Whitney U tests was used to compare the number of control visits from T1 to T2 between the two groups. RESULTS: Patients' age, sex, and amount of crowding were equally distributed between the two groups. The alignment treatment time was significantly shorter (p < 0.001) in the tested group (211.8 days) compared to the control (284.1 days). Consequently, control visits (p < 0.001) were lower in the test group (7 visits, median value) compared to the control group (9.5 visits, median value). CONCLUSIONS: The results of this pilot study suggest that the administration of LLLT might significantly increase the efficiency of orthodontic treatment during dental alignment.

A Preliminary In Vitro Study on the Efficacy of High-Power Photodynamic Therapy (HLLT): Comparison between Pulsed Diode Lasers and Superpulsed Diode Lasers and Impact of Hydrogen Peroxide with Controlled Stabilization.

Aim. In periodontology lasers have been suggested for the photodynamic therapy (PDT): such therapy can be defined as the inactivation of cells, microorganisms, or molecules induced by light and not by heat. The aim of this study was to evaluate results of PDT using a 980 nm diode laser (Wiser Doctor Smile, Lambda SPA, Italy) combined with hydrogen peroxide, comparing a pulsed diode laser (LI) activity to a high-frequency superpulsed diode laser (LII). Materials and Methods. Primary fibroblasts and keratinocytes cell lines, isolated from human dermis, were irradiated every 48 h for 10 days using LI and LII combined with SiOxyL(+) ™ Solution (hydrogen peroxide (HP) stabilized with a glycerol phosphate complex). Two days after the last irradiation, the treated cultures were analyzed by flow cytofluorometry (FACS) and western blotting to quantify keratin 5 and keratin 8 with monoclonal antibodies reactive to cytokeratin 5 and cytokeratin 8. Antimicrobial activity was also evaluated. Results. Both experimental models show the superiority of LII against LI. In parallel, stabilized HP provided better results in the regeneration test in respect to common HP, while the biocidal activity remains comparable. Conclusion. The use of high-frequency lasers combined with stabilized hydrogen peroxide can provide optimal results for a substantial decrease of bacterial count combined with a maximal biostimulation induction of soft tissues and osteogenesis.

Clinical, Radiographic and Microbiological Evaluation of High Level Laser Therapy, a New Photodynamic Therapy Protocol, in Peri-Implantitis Treatment; a Pilot Experience.

Aim. Endosseous implants are widely used to replace missing teeth but mucositis and peri-implantitis are the most frequent long-term complications related with dental implants. Removing all bacterial deposits on contaminated implant surface is very difficult due to implant surface morphology. The aim of this study was to evaluate the bactericidal potential of photodynamic therapy by using a new high level laser irradiation protocol associated with hydrogen peroxide in peri-implantitis. Materials and Methods. 10 patients affected by peri-implantitis were selected for this study. Medical history, photographic documentation, periodontal examination, and periapical radiographs were collected at baseline and 6 months after surgery. Microbiological analysis was performed with PCR Real Time. Each patient underwent nonsurgical periodontal therapy and surgery combined with photodynamic therapy according to High Level Laser Therapy protocol. Results. All peri-implant pockets were treated successfully, without having any complication and not showing significant differences in results. All clinical parameters showed an improvement, with a decrease of Plaque Index (average decrease of 65%, range 23-86%), bleeding on probing (average decrease of 66%, range 26-80%), and probing depth (average decrease of 1,6 mm, range 0,46-2,6 mm). Periapical radiographs at 6 months after surgery showed a complete radiographic filling of peri-implant defect around implants treated. Results showed a decrease of total bacterial count and of all bacterial species, except for Eikenella corrodens, 6 months after surgery. Conclusion. Photodynamic therapy using HLLT appears to be a good adjunct to surgical treatment of peri-implantitis.

Periodontal effects with self ligating appliances and laser biostimulation.

BACKGROUND: Recently, various biostimulation's effects of low energy laser irradiation have been reported. The present study was designed to examine the effects of low-energy laser irradiation on alveolar bone remodelling during orthodontic tooth movement and finally on formation of new keratinized gingiva. MATERIALS AND METHODS: 22 patients and 27 teeth in vestibular mucosal without keratinized gingiva were selected. Every patient was treated with self ligating appliances. In every orthodontic session the patient was treated with Diode laser biostimulation. At the moment of debonding, 27 teeth involved in the research were evaluated in terms of quality and quantity of attached gingiva. BOP and CAL loss were investigated. RESULTS: EVERY TOOTH CONSIDERED AT THE END OF ORTHODONTIC TREATMENT SHOWED AN ATTACHED GINGIVA AROUND THE CROWN: The average of keratinized gingiva at the end of the study was 3.10 mm and the mean increasing at each month was 0,49 mm. CONCLUSIONS: The combination between self ligating appliances and laser's biostimulation could improve the differentiation of periodontal ligaments stem cells in fibroblasts, able to promote attached gingiva around the crown of the teeth erupted in oral vestibular mucosa.

Association between serum values of C-reactive protein and cytokine production in whole blood of patients with type 2 diabetes.

Diabetes mellitus accelerates atherosclerotic processes, and it is known that inflammation plays a key role in atherosclerosis. The aim of the present study was to evaluate in patients with Type 2 diabetes whether serum levels of CRP (C-reactive protein) are associated with cytokine production in whole blood. A total of 89 outpatients with Type 2 diabetes were enrolled, and blood pressure, body mass index, fasting blood glucose, glycated haemoglobin, cholesterol, triacylglycerols (triglycerides) and hs-CRP (high-sensitivity CRP) were measured. IL-6 (interleukin-6), IL-1beta (interleukin-1beta) and TNF-alpha (tumour necrosis factor-alpha) were measured before and after 24 h of incubation of whole blood with LPS (lipopolysaccharide) or saline. The basal values of IL-1beta, IL-6 and TNF-alpha were low and were not significantly related to hs-CRP levels. A univariate analysis showed that the level of IL-1beta and IL-6, obtained after 24 h of incubation of whole blood with LPS, increased significantly with increasing levels of hs-CRP and, after adjusting for potential confounders, IL-1beta still remained statistically significant. In our sample of patients with Type 2 diabetes, there was no association between serum hs-CRP levels and basal levels of IL-6, IL-1beta and TNF-alpha. Conversely, a significant association was observed between serum hs-CRP levels and IL-1beta and IL-6 production after 24 h of incubation of whole blood with LPS. In conclusion, our data suggest that patients with Type 2 diabetes and high hs-CRP levels may have an enhanced reactivity in response to specific stimuli that produce different interleukins, with possible implications in inflammatory atherosclerotic processes.