Full-Digital Workflow for Fabricating a Custom-Made Direct Metal Laser Sintering (DMLS) Mandibular Implant: A Case Report.

Direct Laser Metal Sintering (DLMS) is an additive manufacturing (AM) technique that is capable of manufacturing metal parts according to a three-dimensional (3D) design made using computer-assisted-design (CAD) software, thanks to a powerful laser beam that melts selectively micro-powder layers, one on top of the other, until the desired object is generated. With DMLS, it is now possible to fabricate custom-made titanium implants for oral and maxillofacial applications. We present the case of a 67-year-old woman diagnosed with a squamous cell carcinoma of the mandible. The patient underwent subtotal mandibular resection; conventional reconstruction procedures failed to rehabilitate the function of the mandible. A prosthesis replacing the resected mandible was designed and fabricated using a digital workflow. The extensive bone defect was rehabilitated with a prosthesis replacing the mandibular bone and supporting a morse-taper dental prosthesis. The masticatory function was reestablished.

Gummy Smile Correction Using Botulinum Toxin With Respective Gingival Surgery.

The pursuit of esthetic excellence has become a major goal in the dental treatment and orthodontic treatment. The beauty of the smile is not only constituted by the shape, position, and size of the teeth, but also based on the characteristics of the gingival tissue and conformation of the lips, which should be as harmonious as teeth. Gummy smile is one of the complaints of the patients, since such a situation can influence self-esteem and social relationships. The development of new more conservative techniques may provide a better therapeutic option than surgical procedures, such as the application of botulinum toxin, in the treatment of gummy smile. The purpose of this article is to present the case of a patient who presented dentogingival discrepancy and gummy smile, treated by resective gingival surgery and by application of botulinum toxin, optimizing smile harmony, and achieving improved self-esteem and quality of life. The application of botulinum toxin is an alternative less invasive, faster, safer, and more effective. Moreover, it produces harmonics and pleasing results when applied in target muscles, respecting the appropriate dose and type of smile. Therefore, the technique is a useful adjunct in the esthetic improvement of the smile and provides better results when combined with resective gingival surgery.

Conventional Vs Digital Impressions: Acceptability, Treatment Comfort and Stress Among Young Orthodontic Patients.

OBJECTIVE: The objective of the present study was to compare patients' acceptability, comfort and stress with conventional and digital impressions. MATERIALS AND METHODS: Thirty young orthodontic patients (15 males and 15 females) who had no previous experience of impressions were enrolled in this study. Conventional impressions for orthodontic study models of the dental arches were taken using an alginate impression material (Hydrogum®, Zhermack Spa, Badia Polesine, Rovigo, Italy). Fifteen days later, digital impressions of both arches were acquired using an intraoral scanner (CS3600®, Carestream Dental, Rochester, NY, USA). Immediately after impression taking, patients' acceptability, comfort and stress were measured using two questionnaires and the State anxiety scale. RESULTS: Data showed no difference in terms of anxiety and stress; however, patients preferred the use of digital impressions systems instead of conventional impression techniques. Alginate impressions resulted as fast as digital impressions. CONCLUSIONS: Digital impressions resulted the most accepted and comfortable impression technique in young orthodontic patients, when compared to conventional techniques.

ATP Bioluminometers Analysis on the Surfaces of Removable Orthodontic Aligners after the Use of Different Cleaning Methods.

Purpose. The aim was to quantify the bacteria concentration on the surface of orthodontic clear aligners using three different cleaning methods. Furthermore the objective was to validate the efficacy of the bioluminometer in assessing the bacteria concentration. Materials and Methods. Twenty subjects (six males and fourteen females) undergoing orthodontic therapy with clear aligners (Invisalign® Align Technology, Santa Clara, California) were enrolled in this study. The observation time was of six weeks. The patients were instructed to use different cleaning methods (water, brushing with toothpaste, and brushing with toothpaste and use of sodium carbonate and sulphate tablet). At the end of each phase a microbiological analysis was performed using the bioluminometer. Results. The highest bacteria concentration was found on aligners cleaned using only water (583 relative light units); a value of 189 relative light units was found on aligners cleaned with brushing and toothpaste. The lowest bacteria concentration was recorded on aligners cleaned with brushing and toothpaste and the use of sodium carbonate and sulfate tablet. Conclusions. The mechanical removal of the bacterial biofilm proved to be effective with brushing and toothpaste. The best results in terms of bacteria concentration were achieved adding the use of sodium carbonate and sulfate tablet.

Experimentally Induced Pulpal Lesion and Substance P Expression: Effect of Ketoprofen-A Preliminary Study.

Objectives. To evaluate substance P (SP) and the effect of ketoprofen administration, a nonsteroidal anti-inflammatory drug (NSAID), on SP in the pulp of upper third molars with experimentally induced pulpal lesion. Materials and Methods. A sample of 20 young systemically healthy adults of both sexes, nonsmokers, with a healthy upper third molar to extract for orthodontic purposes, was selected. Prior to the procedure, an inflammatory process was generated by mechanical exposure of the pulp. After 15 minutes, the pulp was collected using a sterile barbed broach. SP levels were determined by using a commercially available enzyme immunoassay (ELISA) kit. The subjects were randomly divided into two groups: group 1 received a dose of ketoprofen 30 minutes prior to the experimental procedure. The subjects of group 2 did not receive any kind of drug administration. The patients were asked to complete a diary on the postoperative pain. Results. No statistically significant difference could be detected in SP expression between the two groups. In group 1, pain manifestation was significantly delayed in comparison with group 2. Conclusions. Preventive administration of ketoprofen did not significantly affect the pulpal levels of SP but resulted in a significantly postponed manifestation of pain after extraction.

Periodontal health status in patients treated with the Invisalign(®) system and fixed orthodontic appliances: A 3 months clinical and microbiological evaluation.

OBJECTIVE: The aim of this prospective study was to compare the periodontal health and the microbiological changes via real-time polymerase chain reaction (PCR) in patients treated with fixed orthodontic appliances and Invisalign(®) system (Align Technology, Santa Clara, California). MATERIALS AND METHODS: Seventy-seven patients were enrolled in this study and divided into three groups (Invisalign(®) group, fixed orthodontic appliances group and control group). Plaque index, probing depth, bleeding on probing were assessed. Total biofilm mass and periodontal pathogens were analyzed and detected via real-time PCR. All these data were analyzed at the T0 (beginning of the treatment) T1 (1-month) and T2 (3 months); and statistically compared using the Mann-Whitney test for independent groups. RESULTS: After 1-month and after 3 months of treatment there was only one sample with periodontopathic anaerobes found in patient treated using fixed orthodontic appliances. The Invisalign(®) group showed better results in terms of periodontal health and total biofilm mass compared to the fixed orthodontic appliance group. A statistical significant difference (P < 0.05) at the T2 in the total biofilm mass was found between the two groups. CONCLUSION: Patients undergoing orthodontic treatment with the Invisalign(®) System show a superior periodontal health in the short-term when compared to patients in treatment with fixed orthodontic appliances. Invisalign(®) should be considered as a first treatment option in patients with risk of developing periodontal disease.

Craniofacial growth and respiration: a study on an animal model.

AIMS: The aim of this study was to analyse the effects of nasal obliteration with regards to the linear dimensions of dissected hemimandibles of a homogeneous sample of young rats. METHODS: 68 pure breed male Sprague-Dawley rats, aged four weeks, were divided into four groups of 17: two control groups and two test groups. The first control group was sacrificed at the beginning of the observation period and the other one at the end. The test groups, one of which had the right nostril occluded by silicon material while the other had the left occluded, were sacrificed after eight weeks, at twelve weeks. After isolating the hemi-mandibles, four vertical and four sagittal measurements were taken; comparison was then made between the control groups and the experimental groups. The sagittal measurements are articular surface of the condyle-neck incisor (SARCIN), articular surface of the condyle-mental foramen (SARFORO), articular surface of the condyle-margo incisalis (SARMI), articular surface of the condyle-surface mesial of the first molar (SARSMM). The vertical measurements are superior condyle surface-base (SCOSUB), mesial surface of the first molar-base (SUMESM), maximum inferior arched concavity-base, (XCOARIB), maximum sigmoid notch concavity-base (XCOINSB). RESULTS: The sagittal and vertical measurements showed an increase in the values of the experimental group when compared to the controls. CONCLUSION: An altered nasal respiration is able to influence the patterns of facial growth and in particular to induce an increase in the growth of the mandible.

The role of heat shock proteins in cancer.

Heat shock proteins (HSPs) are an evolutionary family of proteins that act as molecular chaperones. According to their size they have been classified into the following families; HSP90, HSP70, HSP60, HSP40 and HSP27. They prevent the formation of nonspecific protein aggregates and they assist proteins in the acquisition of their normal architecture. Moreover, HSPs are likely to have anti-apoptotic properties and are actively involved in various processes as tumor cell proliferation, invasion, metastases and death. Notably, these proteins have been reported to be significantly elevated in a plethora of human cancers. Their over-expression has been robustly associated with therapeutic resistance and poor survival. In this way, HSPs may have important therapeutic implications and they can be targeted by specific drugs. In this review, we discuss the influence of HSP27, HSP40, HSP60, HSP70 and HSP90 on human cancers. In addition, we report the existing scientific data on this issue with an effort to highlight the possible future implication of HSPs as tumor biomarkers or drug targets for improving prognosis and treatment of cancer patients around the world.

Esthetic evaluation of implants placed after orthodontic treatment in patients with congenitally missing lateral incisors.

OBJECTIVE: The aim of this retrospective study was to evaluate the esthetic outcome of single tooth Morse taper connection implants used to replace congenitally missing lateral incisors after orthodontic treatment by means of the pink esthetic score (PES) and white esthetic score (WES) index. MATERIALS AND METHODS: Twenty consecutive patients who were treated with a single tooth Morse taper connection implants (Leone Implant System®, Florence, Italy) were enrolled in this study. An independent calibrated examiner applied the PES/WES index to 20 implant-supported restorations 3 months and 3 years after implant placement. RESULTS: No implants were lost. All 20 implants fulfilled the established success criteria for dental implants with regard to osseointegration and prosthetic complications, with an overall implant-crown success of 100.0%. At the 3 year examination, the mean distance between the implant shoulder and the first visible bone-implant contact was of 0.49 ± 0.18 mm (95% confidence interval 0.41-0.57); the mean PES was 8.15 ± 1.69, and the mean WES was 8.70 ± 0.92. CONCLUSIONS: The placement of single-tooth Morse taper connection implants for rehabilitation of congenitally missing lateral incisors after orthodontic treatment represents a successful procedure in the medium term. Further studies are necessary in order to assess the long-term esthetic score. CLINICAL SIGNIFICANCE: This paper evaluates the esthetic outcome of Morse taper connection implants placed to restore congenitally missing lateral incisors after orthodontic treatment.