Regenerative endodontics procedure of an immature permanent mandibular molar with a necrotic pulp using biodentine: a 16 months radiographic follow-up.

An ideal scenario for a tooth in necrosis with immature root would be to continue root development after the regeneration of pulp tissue. We report a case, where the regenerative endodontic procedure (REP) was done using biodentine as a scaffold in an immature mandibular molar tooth.

Modified bonded acrylic expander in patient with anterior crossbite and pseudo-class III.

The open-bite treatment can be considered one of the most difficult malocclusions to treat in children as well as in adult patients. Several papers show that the traditional maxillary expander device contribute to increase the vertical face dimension and bite opening due to posterior rotation of the mandible, buccal tipping of lateral segments and cuspal interferences. Other more specific studies compared the effects of traditional maxillary expander to those of bonded acrylic expander and evidenced that the acrylic expander can better control the vertical effects of the maxillary expansion by the resin bite plane on which the heavy occlusal forces are exerted. We decided to use an acrylic expander in order to prevent worsening of anterior openbite after a careful assessment of nasal airflow by the otorhinolaryngologist.

Human Papilloma Virus associated with oral cancer and preventive strategies: the role of vaccines.

The aim of this paper is to describe the efficacy of Human Papilloma Virus (HPV) vaccines for preventing oral cancer. A systematic review of the literature was conducted to describe the state of the art about HPV vaccines for preventing oral cancer. The aspects of prevention and control of infection by administering vaccines and the diffusion of sexual education campaigns are discussed also. In recent years there has been a growing interest in HPV in dentistry, suggesting a role of such a family of viruses in the development of oral cancers as well as of the uterine cervix. Even if the mass media have increasingly faced the problem, causing frequent alarming among patients, the dentist therefore needs a complete and up-to-date knowledge of this infectious condition that is one of the most common causes of sexually transmitted mucous membrane infections (eg genital, anal and oral). Recent studies about HPV infection are a basic requirement in order to promote the HPV vaccinations and patient’s health.

HPV acting on E-cadherin, p53 and p16: literature review.

In addition to tobacco and alcohol consumption, the two main risk factors for oral squamous cell carcinoma (OSCC), recent studies have revealed infections with human papilloma virus (HPV) as an additional risk factor for OSCC development. In the field of head and neck malignancies, the prevalence of HPV infections in oropharyngeal cancer (OC) ranges in different studies up to 84%. While HPV infection is discussed as an independent risk factor in this region, its distinguished role in carcinogenesis of tumours localized to the oral cavity remains uncertain. A systematic literature search was performed using PubMed, Cochrane library, Science Direct, and the Internet search, with language restricted to English. The search included published studies which dealt with detection methods of HPV-related oral and oropharyngeal cancers and biomolecular studies, particularly regarding the compromising of p53 p16 and e-cadherin’s. P53 Tumour suppressor protein p53 has several functions that are related to maintaining genomic stability and inhibiting cell proliferation in response to DNA damage. For preventing neoplasia to occur, the most important of these functions are cessation of cell growth and induction of either apoptosis or senescence. P16 is a cellular protein involved in cell cycle regulation. It is a cyclin-dependent kinase 4 (CDK4) inhibitor, and is integral to Rb mediated regulation of G1-S phase of the cell cycle. P16 is expressed at a very low level in normal cell as Rb inhibits transcription of p16. Various detection methods ranging from immunohistochemistry (IHC) to molecular techniques have been used to determine the HPV status of HNSCC. E-cadherin, a 120 kDa Type I classical cadherin, is expressed primarily on epithelial cells. It is found on the surface of keratinocytesand Langerhans cells (LC) and E-cadherin mediated adhesion between these cell types is required for LC retention in the epidermis. It is also an important tumour suppressor protein: its loss or inactivation is associated with epithelial-to-mesenchymal transition (EMT), a process involving dedifferentiation, infiltration and metastasis of tumours. Oral carcinogenesis is a multi-factorial process involving socioeconomic, environmental and microbial factors leading to multistep changes. Smoking and tobacco exposure seems to modify the survival and recurrence of HPV positive tumours and should be considered in future trials for risk stratification of HPV positive patients. HPV associated oropharynx cancer represents a distinct clinical and biologic entity with many unresolved issues that will be investigated in future translational, clinical research. We need to further explore and understand why the disease occurs predominantly in males, and whether the natural history of oral HPV infection differences in men and women.

Human papilloma virus in the tonsillar microbiota of an Afghan population group.

Cancer of the oral cavity is known to have a diverse aetiology that includes infectious agents. Human papilloma virus has been found to be associated with several types of human cancer, inclusive of cervical, vulvar, vaginal, penile, anal, and cancer of tonsil. The aim of this manuscript is to investigate the presence of human papilloma virus in tonsillar microbiota of an Afghan population group. A sample of the tonsillar microbiota was collected by oral swab paper stick from 80 healthy donors. The sample was investigated for the presence of high-risk human papillomavirus types 16, 18, 31 and 45 by real time PCR. Eight samples produced some positive endpoint signals for human papillomaviruses. The human papillomavirus 31 was the unique papillomavirus detected; its calculated prevalence rate was 0.10 (C.I. 0.05-0.19). However, the viral load was always very low, in the order of 10-3 viral genomes per cell. The high prevalence of high-risk human papillomavirus in healthy population suggest a need for further investigation on virus spreading and supports the development of vaccination strategies.

Association between salivary cortisol level and caries in early childhood.

AIM: The present study aimed to evaluate the association between caries and oral health status, age, salivary cortisol levels, and parental education in children with and without prior dental caries experience. MATERIALS AND METHODS: An observational case-control study was performed including 122 children aged between 3 and 6 years who were clinically examined for caries experience using the sum of decayed, missing, and filled teeth in the primary (dmft index) and permanent (DMFT index) dentition. Oral health status was also evaluated using the Simplified Oral Hygiene index (OHI-S). Parents filled a questionnaire to provide information on other variables. Salivary cortisol levels were estimated 1 h after routine dental brushing. RESULTS: We found that dental caries experience was associated with cortisol level, plaque, age, and high calculus levels. High cortisol levels and age are important risk factors for caries development with odds ratios of 3.05 (95% CI: 1.84-5.06) and 1.59 (95% CI: 1.09-2.58), respectively. Multivariate logistic analysis showed that cortisol level and age were independently associated with caries presence. Caries experience was not associated with education of parents, feeding-hygiene habits of child or birth events. CONCLUSION: The present findings support the hypothesis that caries is mainly correlated with high salivary cortisol levels. Dental caries experience in children was also positively associated with tartar, plaque, and age.

Sagittal dentoskeletal modifications associated with different activation protocols of rapid maxillary expansion.

AIM: The aim of this study is to compare the sagittal dentoskeletal changes associated with different activation protocols of maxillary expander. MATERIALS AND METHODS: A total of 101 subjects with constricted maxillary arches (49 males and 52 females; mean age 10.08 ± 1.57 years) were enrolled in the study. The study comprised also a control group of 20 subjects (11 females and 9 males, mean age 10.27 ± 1.24 years) who were not treated during the observation period. All the subjects underwent rapid maxillary expansion with a stainless steel banded expander cemented to the maxillary first molars. The expansion screw was randomly activated with two different rapid maxillary expansion protocols (one-quarter per day or two-quarters per day). A statistical comparison between the sagittal cephalometric variations obtained in the two expansion groups was made, and compared with the untreated control group. Data were then stratified for skeletal maturation of each subject. RESULTS: The Wilcoxon rank-sum test shows statistically significant differences between the two RME activation protocols only for overjet. Statistically significant differences were reported in comparison with the control group. CONCLUSIONS: This study suggests that the increase in overjet after RME could be associated with faster activation protocols especially in subjects with lower skeletal maturation.

Meditation training for people with amyotrophic lateral sclerosis: a randomized clinical trial.

BACKGROUND AND PURPOSE: Studies investigating psychological interventions for the promotion of well-being in people with amyotrophic lateral sclerosis (ALS) are lacking. The purpose of the current study was to examine the use of an ALS-specific mindfulness-based intervention for improving quality of life in this population. METHODS: A randomized, open-label and controlled clinical trial was conducted on the efficacy of an ALS-specific meditation programme in promoting quality of life. Adults who received a diagnosis of ALS within 18 months were randomly assigned either to usual care or to an 8-week meditation training based on the original mindfulness-based stress reduction programme and tailored for people with ALS. Quality of life, assessed with the ALS-Specific Quality of Life Revised scale, represented the primary outcome, whilst secondary outcomes included anxiety and depression, assessed with the Hospital Anxiety and Depression Scale, and specific quality of life domains. Participants were assessed at recruitment and after 2, 6 and 12 months. The efficacy of the treatment was assessed on an intention-to-treat basis of a linear mixed model. RESULTS: A hundred participants were recruited between November 2012 and December 2014. Over time, there was a significant difference between the two groups in terms of quality of life (ß = 0.24, P = 0.015, d = 0.89). Significant differences between groups over time were also found for anxiety, depression, negative emotions, and interaction with people and the environment. CONCLUSIONS: An ALS-specific meditation programme is beneficial for the quality of life and psychological well-being of people with ALS.

Dental fear/anxiety among children and adolescents. A systematic review.

AIM: The aim of this paper was to review the published scientific literature to quantify the prevalence and mean score of dental fear/anxiety (DFA) in children/adolescents and its variation according to several variables. MATERIALS AND METHODS: Cross- sectional and cohort studies published from 2000 to 2014, that measured DFA in children /adolescents (aged 0-19 years), in the general population, or visiting private or public dental services (general or pediatric) or attending school and kindergarten, were searched, with specific terms, in 3 electronic databases (Medline, Embase, Web Of Science). Primary data, collected with specific questionnaires of demonstrated reliability and/or validity, were extracted. RESULTS: After screening 743 abstracts and evaluating 164 full-text publications, 36 articles were selected. Dental fear/anxiety prevalence rates were 12.2%, 10.0%, 12.2%,11.0% and 20.0% for the CFSS-DS, DAS, MDAS, DFS, and DFSS-SF scores, respectively. In the studies that used MCDAS Dental fear/prevalence rates varied from 13.3% to 29.3%. In the studies that used CFSS-DS ratings, the prevalence and the mean score of dental fear/anxiety was lower in Northern Europe than the remaining countries, the prevalence decreased with increasing age and the frequency was higher in females than males. CONCLUSIONS: Dental fear/anxiety is a common problem in children/adolescents worldwide, therefore, new strategies to overcome this relevant children/adolescent condition should be encouraged.

Reliability and validity of the Italian versions of the Children's Fear Survey Schedule - Dental Subscale and the Modified Child Dental Anxiety Scale.

AIM: Children's dental fear and anxiety (DFA) causes significant problems in clinical practice. The 15-item Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) and the 8-item Modified Child Dental Anxiety Scale (MCDAS) are the most widely used measures of dental fear in children. The aim of this study is to examine the reliability and validity of the Italian versions of the CFSS-DS and MCDAS, also in comparison with a simple visual analogue scale (VAS). MATERIALS AND METHODS: The CFSS-DS and MCDAS were translated into Italian by a consensus panel of experts and administered to 210 dental patients aged 4-11 years from three Italian Institutions. Internal reliability was assessed using the Cronbach's alpha correlation. A sub-sample of 60 children was selected for test-retest analysis. CFSS-DS and MCDAS, plus a VAS scale, rated both by children and parents, were validated using as gold standard the 4-item Frankl scale for behaviours assessed by dentists. RESULTS: Mean CFSS-DS score was 30.8 (SD: 11.1) and mean MCDAS score was 17.9 (SD: 7.2), significantly higher among children aged 4-7 years and among children at their first dental visit. The alpha value for internal reliability was 0.90 (95%, CI= 0.88-0.92) for CFSS-DS and 0.87 (95% CI=0.85-0.90) for MCDAS. Both CFSS-DS and MCDAS showed good test-retest reliability (rsp= 0.80; p<0.001 for both scales). CFSS-DS and MCDAS predicted a Frankl score ≤2 (i.e., indicating children with an uncooperative behaviour) with a fair accuracy (AUC=0.69 and AUC=0.68, respectively). The VAS scale was more effective in predicting a negative behaviour (AUC=0.78). The scales self-reported by children were only slightly more accurate than those reported by parents. CONCLUSION: The Italian versions of the CFSS-DS and MCDAS are valid and reliable tools for the assessment of dental fear in Italian children aged 4-11 years. A simple, one-item VAS, and dental fear and anxiety evaluation by parents may be valid and quick alternatives to multi-item indices to predict an uncooperative children behaviour.

Tumor MGMT promoter hypermethylation changes over time limit temozolomide efficacy in a phase II trial for metastatic colorectal cancer.

BACKGROUND: Objective response to dacarbazine, the intravenous form of temozolomide (TMZ), in metastatic colorectal cancer (mCRC) is confined to tumors harboring O(6)-methylguanine-DNA-methyltransferase (MGMT) promoter hypermethylation. We conducted a phase II study of TMZ enriched by MGMT hypermethylation in archival tumor (AT), exploring dynamic of this biomarker in baseline tumor (BT) biopsy and plasma (liquid biopsy). PATIENTS AND METHODS: We screened 150 mCRC patients for MGMT hypermethylation with methylation-specific PCR on AT from FFPE specimens. Eligible patients (n = 29) underwent BT biopsy and then received TMZ 200 mg/m(2) days 1-5 q28 until progression. A Fleming single-stage design was used to determine whether progression-free survival (PFS) rate at 12 weeks would be ≥35% [H0 ≤ 15%, type I error = 0.059 (one-sided), power = 0.849]. Exploratory analyses included comparison between MGMT hypermethylation in AT and BT, and MGMT methylation testing by MethylBEAMing in solid (AT, BT) and LB with regard to tumor response. RESULTS: The PFS rate at 12 weeks was 10.3% [90% confidence interval (CI) 2.9-24.6]. Objective response rate was 3.4% (90% CI 0.2-15.3), disease control rate 48.3% (90% CI 32.0-64.8), median OS 6.2 months (95% CI 3.8-7.6), and median PFS 2.6 months (95% CI 1.4-2.7). We observed the absence of MGMT hypermethylation in BT in 62.7% of tumors. CONCLUSION: Treatment of mCRC with TMZ driven by MGMT promoter hypermethylation in AT samples did not provide meaningful PFS rate at 12 weeks. This biomarker changed from AT to BT, indicating that testing BT biopsy or plasma is needed for refined target selection.

Craniofacial morphology in pediatric patients with Prader-Willi syndrome: a retrospective study.

OBJECTIVE: To investigate craniofacial characteristics in pediatric patients with Prader-Willi syndrome (PWS). SETTING AND SAMPLE POPULATION: A retrospective sample of 20 consecutive patients with PWS who had lateral and antero-posterior (AP) cephalograms (14 males and six females; average age 10.2 ± 3 years) was compared to 20 controls matched for age and sex (14 males and six females; average age 10.5 ± 3.7 years). MATERIALS AND METHODS: Cephalometric skeletal measurements were performed twice at a 1-week interval by one calibrated operator, and random error was calculated using Dahlberg's formula. Mean values and standard deviations were computed for all variables. Student's t-test for independent samples was used to determine significant differences between PWS and controls. The level of significance was set at p < 0.05. RESULTS: Cephalometric values for the length of the maxilla (p < 0.01), mandibular length (p < 0.05) at both the ramus (p < 0.05) and the mandibular body (p < 0.01), and posterior and anterior facial height (p < 0.01) were significantly lower in patients with PWS compared to controls. The AP cephalometric analysis revealed a significant reduction (p < 0.01) in maxillary skeletal width, mandibular skeletal width, and interzygomatic distance. CONCLUSIONS: Pediatric patients with PWS seem to have a general reduction in certain craniofacial skeletal parameters (i.e., maxillary and mandibular length) compared to controls, but this study did not assess the overall craniofacial characteristics.

Electromyographic evaluation of a patient treated with extraoral traction: a case report.

BACKGROUND: This work seeks to provide information on the utility of surface electromyography (SEMG) as an aid for diagnosing orthodontic conditions. Classic orthodontic monitoring by radiography, plaster models, cephalometry, and photography can be improved by using SEMG before and during treatment, to prevent clinical worsening and relapses. CASE REPORT: This paper presents the SEMG results for a 10-year-old female patient, orthodontically treated by extraoral traction (EOT). Significant muscular variations in the patient's EMG were observed as she changed different postures and as headgear device was used. CONCLUSION: SEMG should be performed prior to the orthodontic treatment to assess the neuromuscular patient's pattern, in order to prevent strain induced by extraoral forces. EMG can be a valid aid for evaluating the patient's neuromuscular condition before, during, and after orthodontic treatment.

The process of mineralisation in the development of human tooth.

AIM: Tooth development and mineralisation are processes that derive from different tissues interactions, in particular ectodermal and mesenchymal layers. These interactions are responsible for the formation of unique structures with a particular chemical composition. Despite differences, mineralised tissues are similar and they derive by highly concerted extracellular processes that involve matrix proteins, proteases, and mineral ion fluxes that collectively regulate the nucleation, growth and organisation of forming mineral crystals. This review aims at explaining mineralisation, its stages and when damage occurs and alters the hard tissues structure.

Aesthetic rehabilitation in a young patient using a minimally invasive approach. A multidisciplinary case report.

BACKGROUND: Optimal integration and long-term stability of oral rehabilitations require correct diagnostic approach, appropriate pre-prosthetic treatments and accurate therapeutic protocols. Technology provides devices to optimise therapeutic results, according to biologic constraints and aesthetic parameters. CASE REPORT: The present report describes a multidisciplinary management in a young patient affected by lateral incisor agenesis, including pre-prosthetic orthodontic treatment and restorative and implant-supported prosthetic rehabilitation. Minimally invasive clinical procedures with veneer restorations and flapless implant placement, followed by immediate prosthesis delivery, are carried out. Tridimensional diagnostic data and dedicated software were used for treatment planning, allowing to achieve optimal results.

Periodontitis, implant loss and peri-implantitis. A meta-analysis.

OBJECTIVE: The aim of the present systematic review and meta-analysis was to assess the role of periodontal disease as a risk factor for implant loss, peri-implantitis and implant-bone loss. MATERIALS AND METHODS: Six electronic database and a manual search resulted in 7391 unique publications; after selection only 16 studies were included in systematic review. Dichotomous data were expressed as risk ratio (RR) and 95% confidence interval (CI), while continuous data were expressed as standardized mean difference (SMD). Due to the expected inter-study heterogeneity, a random effect model was used for both type of data. The pooled effect was considered significant for a P < 0.05. RESULTS: Meta-analysis revealed that an higher and significant risk for implant loss was present in patients affected by PD (RR: 1.69, 95% CI: 1.31-2.17, P < 0.0001). A higher and significant IBL was present in patients with periodontal disease, when compared with patients periodontally healthy (SMD: 0.38, 95% CI: 0.18-0.58, P = 0.0002). Patients periodontally compromised showed an increased risk of PI, when compared with patients without periodontitis (RR: 2.17, 95% CI: 1.51-3.12, P < 0.0001) No evidence of significant heterogeneity was detected for the three outcomes. CONCLUSION: Strong evidence suggests that periodontitis is a risk factor for implant loss; moderate evidence revealed that periodontitis is a risk factor for peri-implantitis and that patients with periodontitis have higher implant-bone loss.

Investigation of periodontal status in type 1 diabetic adolescents.

AIM: The purpose of this study was to evaluate the effects of type 1 diabetes and the possible role of metabolic control on the periodontal status of diabetic adolescents. MATERIALS AND METHODS: Three groups of 40 patients each were examined: diabetic subjects with a good metabolic control (well controlled WC) (glycated haemoglobin HbA1c ≤ 7%) (20 males and 20 females; mean age: 14.1 ± 1.5 years); diabetic subjects with poor metabolic control (poorly controlled PC) (glycated haemoglobin HbA1c> 7%) (20 males and 20 females; mean age: 14.5 ± 1.3 years); and patients in good general health, which constituted the control group (20 males and 20 females; mean age: 14.1 ± 1.2 years). For each subject, a periodontal evaluation was performed and the following parameters were assessed: Plaque Index (PI), Gingival Index (GI), Bleeding on probing (BOP), Probing Depth (PD), Clinical Attachment Level (CAL). Chi-square was used to compare categorical variables. Kruskal-Wallis one-way ANOVA by ranks was used to compare the quantitative variables (GBI, PD) among the 3 groups. Post-hoc comparison between pairs of groups was assessed by Wilcoxon's rank sum test, with a downward adjustment of the alpha level to compensate for multiple comparisons. RESULTS: The levels of PI in WC subjects (1.9 ± 0.8) and in PC subjects (2.1 ± 0.6) were significantly higher compared to healthy subjects in the control group (0.8 ± 0.7) (p <0.0001). Similarly, the GI in both PC (1.9 ± 0.8) and WC subjetcs (1.7 ± 0.9) was significantly higher (p <0.05) compared to controls (0.9 ± 0.8). GBI in the PC (60.2 ± 23.6%) and the WC (57.4 ± 22.5%) groups was significantly higher compared to healthy subjects (35.9 ± 18.7%) (p <0.05). The PD parameter was found significantly higher (p <0.05) in the PC group (26.7 ± 12.6) and WC group (23.5 ± 11.3%) compared with controls (8.3 ± 6.2%). Regarding the CAL, no significant differences were found between the groups (p> 0.05). In addition, the comparisons between groups PC and WC were not statistically significant (p> 0.05). CONCLUSIONS: Adolescents affected with type 1 diabetes show a higher level of bacterial plaque, gingival inflammation with bleeding on probing and probing depth, compared to healthy subjects. There were no significant changes with regard to the accumulation of plaque and periodontal status among diabetic patients both with good control and with poor metabolic control.

Effectiveness of metronidazole as an adjunct to scaling and root planing in the treatment of chronic periodontitis: a systematic review and meta-analysis.

BACKGROUND: Metronidazole (MET) has been suggested as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. However, its clinical effectiveness and effects on periodontal pathogens remain to be defined. The present meta-analysis assessed the scientific evidence concerning the effect of MET adjunctive to SRP as compared to SRP alone. METHODS: A literature search of electronic databases was performed for articles published through December 16, 2012, followed by a manual search of several dental journals. A meta-analysis was conducted according to recommendations of the Cochrane Collaboration and PRISMA. Weighted mean differences (MDs) and 95% confidence intervals (CIs) were calculated for probing depth reduction, clinical attachment level gain, bleeding on probing index and suppuration. All outcomes were evaluated as changes from baseline to the end of follow-up. Heterogeneity was assessed with the chi-squared-based Cochran Q test and I(2) statistic. The level of significance was set at p < 0.05. RESULTS: After the study selection process, six randomized clinical trials were included in the meta-analysis. The results of the meta-analysis indicated that SRP + MET provided additional benefits when compared to SRP alone in terms of probing depth reduction (MD, 0.18; 95% CI, 0.09-0.28; p < 0.05) and clinical attachment level gain (MD, 0.10; 95% CI, 0.08-0.12; p < 0.05). No evidence of heterogeneity was detected. CONCLUSION: The meta-analysis results seem to support the effectiveness of adjunctive MET with SRP compared to SRP alone. However, given the low number of included studies and limitations of meta-analysis, future studies are needed to confirm these results.

Dental pulp regeneration in paediatric dentistry: the role of stem cells.

AIM: In the last decade, tissue engineering has undergone enormous expansion in the fields of regenerative medicine and dentistry. In response to mechanical and chemical injuries, the dentine-pulp complex possesses a regenerative ability due to a speci?c population of mesenchymal stem cells, which have been widely described in literature. The postnatal dental pulp also contains progenitor stem cells that participate in dental regeneration. Knowledge of the regenerative potential of these cells is important in terms of understanding and applying their biological and chemical characteristics. CONCLUSION: Through the isolation and exploration of the regenerative abilities of these stem cells, new therapeutic possibilities may be possible, opening the way for improving paediatric endodontic therapy.