Oro-dental manifestations of eating disorders: a systematic review.

BACKGROUND: Eating disorders (EDs) pose a significant risk to health, especially when not diagnosed early. For several years EDs and oral health has been extensively studied, and now it is quite clear the existence of a correlation between specific oral manifestations and these disorders. While these oral signs could potentially aid early diagnosis of EDs, their identification and the eventual establishment of a correlation is currently heavily limited to the clinician's experience. The present systematic review critically examines existing literature, offering an updated overview of oro-dental manifestations associated with EDs. METHOD: MEDLINE (via PubMed), Web of Science, Scopus, and grey literature were searched, and relevant epidemiological comparative studies were screened using the Rayyan software. No limitations have been imposed on the research regarding oro-dental outcomes, encompassing all medically diagnosed EDs. The quality of the studies was valuated using AXIS appraisal tool for cross-sectional studies. RESULT: Out of 3990 studies, 32 fulfilled the eligibility criteria and were included in the synthesis. The identified eating disorders include Anorexia Nervosa, Bulimia Nervosa and/or Eating Disorders Not Otherwise Specified, predominantly among female subjects, primarily originating from Europe. The evaluated oro-dental outcomes include dental erosion, caries, saliva assessment, hygiene-periodontal parameters, and mucosal tissue appearance. The association with erosion is confirmed while gingival recession, dentinal hypersensitivity, salivary flow thresholds and aspects relating to oral pathology are receiving increasing support from emerging evidence. DISCUSSION: This trend emphasizes the critical role of the complete intraoral examination to detect significant oro-dental signs that may indicate the onset of an ED.

The article is a review of existing studies that explores the link between eating disorders and oral health issues. It found that people with eating disorders, including anorexia nervosa and bulimia nervosa, may experience dental problems such as tooth erosion, cavities, and altered saliva production. The review findings emphasize the importance of dental care providers recognizing these signs early and suggests better training for dental professionals. By doing so, they can help diagnose eating disorders sooner and recommend appropriate treatment. This approach aims to improve patients' overall wellbeing by addressing both the oral health issues and the underlying eating disorders, making it essential for patients and medical teams to be aware of the interconnectedness between oral health and eating disorders.

Minimally invasive non-surgical periodontal therapy of intrabony defects: A prospective multi-centre cohort study.

AIM: To assess the potential benefits of minimally invasive non-surgical therapy (MINST) in teeth with intrabony defects and to explore factors associated with the outcomes. MATERIALS AND METHODS: A multi-centre trial was conducted in 100 intrabony defects in periodontitis patients in private practice. Steps 1 and 2 periodontal therapy including MINST were provided. Clinical and radiographic data were analysed at baseline and 12 months after treatment, with the primary aim being change in radiographic defect depth at 12 months. RESULTS: Eighty-four patients completed the 12-month follow up. The mean total radiographic defect depth reduced by 1.42 mm and the defect angle increased by 3° (both p < .05). Statistically significant improvements in probing pocket depth (PPD) and clinical attachment level (CAL) were seen at 12 months compared to baseline (p < .001). Fifty-six defects (66.7%) achieved pocket closure (PPD ≤ 4 mm) and 49 defects (58.3%) achieved the composite outcome (PPD ≤ 4 mm and CAL gain ≥3 mm). Deeper and narrower angled defects were positively correlated with radiographic and clinical improvements, respectively. CONCLUSIONS: Improvements in clinical and radiographic outcomes were seen after MINST. This study highlights the generalizability and wide applicability of this approach, further supporting its effectiveness in the treatment of intrabony defects. CLINICAL TRIAL REGISTRATION: NCT03741374. https://clinicaltrials.gov/study/NCT03741374?cond=minimally%20invasive%20non%20surgical%20therapy&locStr=UK&country=United%20Kingdom&distance=50&rank=2.

In-vitro comparison of two different toothbrush bristles about peri-implant sulcus penetration.

OBJECTIVE: The aim of this preclinical study was to compare the ability of tapered and cylindrical bristles to penetrate the peri-implant sulcus. METHODS: A full mandibular dental arch was reproduced in plaster cast. In site #3.6 a hollow glass cylinder was positioned simulating a 4 mm diameter implant and the gingival component was recreated by using dedicated silicone. A Bass brushing technique was performed from the vestibular side in humid environment. During it, the penetration of the bristles between the gum and the implant was recorded by mean of an optic fibre fixed inside the cylinder. The protocol included 5 toothbrushes per group and 10 tests per toothbrush, for a total of 50 assessments for each of the two groups. A scale of 5 grades for bristle penetration was defined: grade 0 (× < 2 mm), grade 1 (2 ≤ × < 3 mm), grade 2 (3 ≤ × < 4 mm), grade 3 (4 ≤ × < 5 mm) and grade 4 (5 ≤ × < 8 mm). From the video recordings the highest value of penetration was identified for each test. RESULTS: The tapered bristles showed an 8 times greater penetration capacity (p = 0.001) in respect to the cylindrical bristles (multilevel analysis). The percentage of tests reaching depths ≥3 mm was 86% for tapered group and 28% for the cylindrical group. CONCLUSION: This preclinical study shows a clear and superior penetration capacity of the tapered bristles in respect to traditional cylindrical ones. For tapered bristles, a potentially greater hygienic efficacy around dental implants is suggested.

Role of dental training and distance of the observer on the perception of apically shifted gingival margin with increased vertical tooth size in the esthetic zone.

OBJECTIVES: To evaluate the influence of the gingival contour on the smile esthetics. The influence of size, symmetry, teeth involved in apically shifted gingival margins, and the distance and clinical training of the observer were investigated. MATERIALS AND METHODS: Two groups were identified: 33 first-year dental students (inexperienced) and 40 last-year students (trained). Each observer expressed four evaluations on four different images assigning a score from 0 to 10. Using a picture of an "ideal" female smile, 10 variants were virtually created by shifting (2 and 4 mm) the gingival contour apically at different sites of the upper incisors and canines. A total of 292 evaluations were collected. RESULTS: Considering a score >6 for a "pleasant smile," only one 4 mm single alteration at the canine gingival contour obtained an insufficient score. "Observational distance" and "clinical training" did not influence the final score, while size and symmetry of alterations displayed a significant role. CONCLUSIONS: The dental training of the observer and a close interpersonal distance seemed to be irrelevant in the esthetic perception of gingival margin alterations.

Bone Modeling after Orthodontic Extrusion: A Histomorphometric Pilot Study.

During osteogenesis and bone modeling, high vascularity and osteoblastic/osteoclastic cell activity have been detected. A decrease in this activity is a sign of complete bone formation and maturation. Alveolar bone maturation seems to occur within weeks and months; however, the precise timing of the alveolar bone modeling is still unknown. The aim of this clinical pilot study was to investigate the bone modeling of neo-apposed tissue during orthodontic extrusive movements, through a histomorphometric analysis of human biopsies. This study was conducted on third mandibular molars sockets, and all teeth were extracted after orthodontic extrusion between 2010 and 2014. After different stabilization timings, extractions were performed, and a specimen of neo-deposed bone was harvested from each socket for the histomorphometric analysis. Histological parameters were evaluated to identify bone quantity and quality. This study included 12 teeth extracted from 9 patients. All specimens were composed of bone tissue. Bone samples taken after 1 and 1.5 months of stabilization presented remarkable percentages of woven bone, while after 2 months, a relevant decrease was observed. Histomorphometric analysis suggested that after orthodontic extrusion, a period of stabilization of 2 months allows the neo-deposed bone to mature.

Bioburden Variation of Filtering Face Piece Respirators over Time: A Preliminary Study.

BACKGROUND: The microbial contamination of a respirator can be evaluated through a count of the number of bacteria living on a non-sterilized surface (bioburden). This preliminary study investigated the external contamination of two different FFP2s over time by studying the bioburden values in increasing exposure times. METHODS: FFP2 respirators of two different brands were used during routine clinical settings and examined through the bioburden test; for each brand, three devices were tested at 8, 16, and 30 h. RESULTS: No significant differences were observed between mask brands (p = 0.113). There were only significant CFU differences between each mask and its control (p = 0.027 and p = 0.004). CONCLUSIONS: Both brands of respirators were found to be contaminated and this contamination increased with the increase in exposure time. Further studies are needed to investigate the exact amount of contamination that could be considered acceptable before discarding each used mask.

Development and validation of the Italian version of the 'Parental Perceptions of Silver Diamine Fluoride Dental Color Changes' questionnaire.

BACKGROUND: The original English version of the questionnaire 'Parental Perceptions of SDF Dental Color Changes' was used among parents in the New York City metropolitan area. AIM: To develop an Italian version of the questionnaire and to assess its validity. DESIGN: The construct validity and the internal consistency were assessed in a convenience sample of Italian parents of 251 young healthy children seen at the University of Bologna and Pisa. Forward-backward technique was carried out for the translation of the questionnaire. Kaiser-Meyer-Olkin measure of sampling adequacy was equal to 0.91, and Bartlett's test of sphericity was statistically significant (P = .001), so the items were treated with the exploratory principal component analysis (PCA). RESULTS: Cronbach's alpha ranged from 0.69 to 0.95. PCA demonstrates that all the items load on the first component (87% of explained variance). All the Spearman correlation coefficients between each subscale (positive scenario: 0.563; negative scenario: 0.665) and the general acceptability showed significant correlation (P = .0001). Different age, educational level, and family income of the parents did not produce statistically significant different scores on any of the subscales (P > .05; Mann-Whitney test). CONCLUSION: The Italian version of the questionnaire showed high internal consistency and construct validity and was appropriate to be used in an Italian population.

Subgingival pathogens in chronic periodontitis patients affected by type 2 diabetes mellitus: a retrospective case-control study.

PURPOSE: The aim of this study was to compare the prevalence and bacterial load of 6 main periodontal pathogens between pairs of periodontal patients with and without type 2 diabetes mellitus. Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans genotypes were also investigated. METHODS: Twenty patients affected by chronic periodontitis and type 2 diabetes were retrospectively selected and matched to 20 patients without diabetes on the basis of the degree and severity of periodontal disease. Microbiological data of subgingival biofilms were analysed and compared for the examined pathogens: A. actinomycetemcomitans, P. gingivalis, Prevotella intermedia, Treponema denticola, Fusobacterium nucleatum, and Tannerella forsythia. RESULTS: The pairs were balanced in terms of demographic and clinical parameters, except for bleeding on probing and suppuration. In the microbiological test sites (4 for each patient), the mean probing pocket depth was 6.34±1.63 mm in patients with diabetes and 6.41±1.78 mm in patients without diabetes. No significant difference between pairs in the prevalence of P. gingivalis or the distribution of its genotypes was recorded. Patients with diabetes had a significantly greater amount of total bacterial load, P. gingivalis, T. denticola, T. forsythia, and F. nucleatum (P<0.05). Moreover, patients with diabetes had a higher number of sites with a greater cell count than patients without diabetes. When compared to the total bacterial load, only T. forsythia maintained its relative load in patients with diabetes (P=0.001). CONCLUSIONS: This retrospective matched study supports the hypothesis that microbiological differences exist among periodontal patients with and without diabetes mellitus. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03786133.

Recognition and treatment of peri-implant mucositis: Do we have the right perception? A structured review.

Peri-implant mucositis is a common inflammatory lesion of the soft tissues surrounding endosseous implants, with no loss of the supporting bone. Its prevention or early diagnosis are vital for dental implant success.The aim of this review was to investigate knowledge strengths and gaps in clinicians' perceptions of periimplant mucositis prevalence and evidence for successful treatment.A literature search for articles published until 2020, reporting on the prevalence of peri-implant mucositis and its treatment was performed in standard online databases. The inclusion criteria were as follows: studies in English; studies with an available abstract; studies on humans with at least 1 dental implant; and studies reporting on the prevalence and/or treatment of peri-implant mucositis. Sixty-five studies fulfilled the inclusion criteria. The included papers were analyzed to identify data on the prevalence and treatment of peri-implant mucositis. The prevalence statistics for peri-implant mucositis had wide ranges in both the patient-based (PB) analysis and the implant-based (IB) analysis; the possible reasons for these wide ranges are discussed. Treatment methods for peri-implant mucositis were analyzed individually and compared to the management of gingivitis.It was determined that the currently available information on the prevalence rates and the standardized therapeutic protocols for peri-implant mucositis are insufficient. Since the mean gingivitis and peri-implant mucositis prevalence rates in the PB analysis were similar, it is possible that peri-implant mucositis is underestimated due to variables related to implant rehabilitation itself.

Rapid maxillary expansion on oral breathing children: effects on tongue location, hyoid position and breathing. A pilot study.

BACKGROUND: Oral breathing and downward tongue position are generally associated with transverse hypo-development of the upper maxilla. Rapid maxillary expansion aims to expand the upper maxilla transversely. This pilot retrospective clinical study evaluates the effects of rapid maxillary expansion therapy on the resting position of the tongue, on the position of the hyoid bone and on clinical respiratory pattern in a group of mouth breathing patients with mono- or bilateral cross-bites due to transversal deficits of the maxilla. METHODS: A total of 39 prepubertal oral breathing subjects with posterior cross-bite (mean age 8.5 year) have been studied. Before (T0) and after treatment (T1), changes in the position of the hyoid bone and tongue were evaluated by comparing latero-lateral radiographs (TLL), while the modification of respiratory patterns by a clinical and anamnestic assessment. RESULTS: After the treatment, the dorsum of tongue moved closer to the palatine vault, the position of the hyoid bone did not undergo significant variations and the respiratory pattern clinically improved in 64% of subjects. CONCLUSIONS: In patients in early stages of oral respiratory development, rapid maxillary expansion promoted correct tongue position but did not produce significant changes in the position of the hyoid bone. It has been observed a general improvement of the breathing pattern.

Evaluation of Floss Remnants After Implant Flossing in Three Different Implant Conditions: A Preclinical Study.

PURPOSE: The aim of this preclinical study was to evaluate whether implant flossing could leave floss residues in three different implant-prosthetic conditions. MATERIALS AND METHODS: Using an anatomical model, three different conditions were studied: correct connection between the implant and abutment and complete insertion of the implant threads into the plaster (control group); misfit of approximately 220 to 230 µm between the implant platform and abutment in the absence of any thread exposure (misfit group); partial exposure of implant threads but absence of misfit (thread group). Twenty-one microstructured tapered threaded implants were divided among the three groups. Each sample was subjected to a flossing procedure using spongy floss, standardized in terms of movement, frequency, time, and pressure. Subsequently, a stereomicroscope examination with a standardized magnification of 10× was performed in order to highlight the possible presence of floss residues on the implant surface. RESULTS: No floss residue was ever detected for the control group. Both misfit and thread groups showed floss residues that were discernible in two different types: microfilaments and amorphous particles. Statistical analysis showed a significant difference for the presence of floss remnants between the control group and the other two experimental groups (P = .005). No difference was observed between the misfit and thread groups. CONCLUSION: This study shows that exposed threads and misfit can induce the release of floss residues during maintenance procedures.

Variation of Efficacy of Filtering Face Pieces Respirators over Time in a Dental Setting: A Pilot Study.

Since aerosol continuously persists in dental settings, where different procedures and patients come in succession, the use of oronasal masks is highly recommended. Among them, respirators known as Filtering Face Pieces (FFP) show a protective superiority compared to surgical masks. Even concerning respirators classified as non-reusable, it is not known how many hours of use are necessary to compromise their filtering capacity. The aim of this study is to investigate the variations of filtering capacity of an FFP2 respirator over time, in order to safely optimize the timing of its use. Five respirators were worn by the same operator during clinical activity for different usage times (8, 16, 24, 32, 40 h), and one respirator was kept unused. All respirators underwent a bacterial filtration efficacy (BFE) test. T-test for paired data with Bootstrap technique and Wilcoxon test for paired data compared BFE values of the five tested FFP2s respectively at each time, and the areas with the corresponding values of the control respirator (FFp2-F). A generalized linear mixed effect model (GLM) was applied considering type of respirator and time as fixed effects and intercept as random effect. No significant statistical differences were present in the BFE of each time. Data obtained by the present study highlight the important ability of FFP2s to maintain their BFE over time, suggesting a long lasting protective function.

The influence of root surface distance to alveolar bone and periodontal ligament on periodontal wound healing.

PURPOSE: The purpose of this animal study was to perform a 3-dimensional micro-computed tomography (micro-CT) analysis in order to investigate the influence of root surface distance to the alveolar bone and the periodontal ligament on periodontal wound healing after a guided tissue regeneration (GTR) procedure. METHODS: Three adult Sus scrofa domesticus specimens were used. The study sample included 6 teeth, corresponding to 2 third mandibular incisors from each animal. After coronectomy, a circumferential bone defect was created in each tooth by means of calibrated piezoelectric inserts. The experimental defects had depths of 3 mm, 5 mm, 7 mm, 9 mm, and 11 mm, with a constant width of 2 mm. One tooth with no defect was used as a control. The defects were covered with a bioresorbable membrane and protected with a flap. After 6 months, the animals were euthanised and tissue blocks were harvested and preserved for micro-CT analysis. RESULTS: New alveolar bone was consistently present in all experimental defects. Signs of root resorption were observed in all samples, with the extent of resorption directly correlated to the vertical extent of the defect; the medial third of the root was the most commonly affected area. Signs of ankylosis were recorded in the defects that were 3 mm and 7 mm in depth. Density and other indicators of bone quality decreased with increasing defect depth. CONCLUSIONS: After a GTR procedure, the periodontal ligament and the alveolar bone appeared to compete in periodontal wound healing. Moreover, the observed decrease in bone quality indicators suggests that intrabony defects beyond a critical size cannot be regenerated. This finding may be relevant for the clinical application of periodontal regeneration, since it implies that GTR has a dimensional limit.

Is Implant Flossing a Risk-Free Procedure? A Case Report with a 6-year Follow-up.

This study reports a case of peri-implantitis correlated with floss fibers trapped by the implant-prosthetic macrostructure. Discrepancy between the radiographic feature and probing depth was the starting point for a correct evaluation. The minimally invasive removal of the trapped material with the aid of a periodontal endoscope resulted in a complete resolution of the peri-implantitis with a stable long-term result (6 years). This case report argues for some reconsiderations in hygienic, diagnostic, and therapeutic approaches in oral implantology.

Microbiological Distribution of Six Periodontal Pathogens Between Untreated Italian and Dutch Periodontal Patients.

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 (α = 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.

Evaluation of clinical effectiveness and subjective satisfaction of a new toothbrush for postsurgical hygiene care: a randomized split-mouth double-blind clinical trial.

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.

Prevalence of six periodontal pathogens in subgingival samples of Italian patients with chronic periodontitis.

The aim of this study was to investigate the subgingival prevalence of six periodontal pathogens in 352 Italian patients with chronic periodontitis. Possible correlations with clinical parameters, age, gender and smoking status were also investigated. At first visit a pooled subgingival plaque sample was obtained for each subject by using the paper-point method. The samples were processed and analysed according to a commercially available quantitative real time polymerase chain reaction assay (Meridol® Perio Diagnostics, GABA International, Switzerland). Porphyromonas gingivalis (Pg), Treponema denticola (Td), Tannerella forsythia (Tf), Prevotella intermedia (Pi), Fusobacterium nucleatum (Fn) and Aggregatibacter actinomycetemcomitans (Aa) were investigated. Fn resulted the most frequently detected (95%) while Tf showed the highest load (12x105 cells/plaque sample). Aa was the less represented bacteria for load and presence. Bacterial load of Pg, Td, Tf and Fn showed a direct correlation to Bleeding On Probing (BOP) and presence of suppuration (p=0.0001). The bacterial load was always directly correlated to Probing Pocket Depth (PPD) (p=0.0001). Among the investigated variables, PPD resulted the most important risk indicator for periodontal pathogens. BOP appeared as a risk indicator for Td, Tf, Pg detection. Few studies have described the microbiological pattern of chronic periodontal disease in the Italian population. Considering the different forms of periodontitis, similar investigations in other countries are needed to disclose any microbiological differences among populations, which may lead to more specific approaches to prevention and therapy.

A proposed new index for clinical evaluation of interproximal soft tissues: the interdental pressure index.

The interdental pressure index (IPI) is introduced to specifically evaluate clinical interproximal-tissue conditions and assess the effect of interproximal hygiene stimulation. This index scores clinical responses of periodontal tissues to the apical pressure of a horizontally placed periodontal probe. It is negative when gingival tissues are firm, bleeding-free, and slightly ischemic by the stimulation; otherwise it is positive. The clinical validation showed high intraoperator agreement (0.92; 95% CI: 0.82-0.96; P = 0.0001) and excellent interoperator agreement (0.76; 95% CI: 0.14-1.38; P = 0.02). High internal consistency with bleeding on probing (κ = 0.88) and gingival index (Cronbach's α = 0.81) was obtained. Histological validation obtained high sensitivity (100%) and specificity (80%) for IPI+ toward inflammatory active form. The same results were recorded for IPI- toward chronic inactive form. IPI results as a simple and noninvasive method with low error probability and good reflection of histological condition that can be applied for oral hygiene motivation. Patient compliance to oral hygiene instructions is essential in periodontal therapy and IPI index can be a practical and intuitive tool to check and reinforce this important aspect.

Comparison of the antibacterial activity of an ozonated oil with chlorhexidine digluconate and povidone-iodine. A disk diffusion test.

Ozonated oils are antiseptics obtained from the chemical reaction between ozone and unsaturated fatty acids of vegetable oils. The aim of this study was to investigate the antimicrobial effectiveness of a commercially available ozonated oil (O3-Oil), in comparison with 0.2% chlorhexidine digluconate (CHX) and 10% povidone-iodine (PVP-I) through a disk diffusion test. For each antiseptic a series of two-fold dilutions was made, obtaining seven dilutions: 1:2, 1:4, 1:8, 1:16, 1:32, 1:64 and 1:128. The undiluted antiseptics and the seven dilutions were tested against two freeze-dried bacterial strains: Staphylococcus aureus (Sa) and Porphyromonas gingivalis (Pg). O3-Oil showed significantly greater diameters of growth inhibition (p<0.01) than CHX and PVP-I in all dilutions for both tested strains. CHX lost any antibacterial efficacy when diluted more than 1:32. At the highest dilution, the diameters of growth inhibition against Sa were 20.67±0.58 mm and 15.33±0.58 mm, for O3-Oil and PVP-I, respectively. At the same dilution, the diameters of growth inhibition against Pg were: 19.00 mm for O3-Oil and 13.67±0.58 mm for PVP-I. The promising results obtained for the O3-Oil, against the opportunistic Sa, and Pg, one of the main periodontal pathogens, suggest its potential applicability for periodontal treatment. Further preclinical and clinical investigations are warranted.

Management of a deeply impacted mandibular third molar and associated large dentigerous cyst to avoid nerve injury and improve periodontal healing: case report.

As dentigerous cysts increase in size, the risk of postsurgical complications increases as well. Emphasis is usually placed on the risk of neurologic damage caused by trauma during and after surgical removal and of mandibular fracture resulting from the large residual bone defect. However, influence on the periodontal status of neighbouring teeth should also be taken into account. In this article, we present an interdisciplinary, safe, minimally invasive approach to treating large dentigerous cysts associated with deeply impacted third molars. A dentigerous cyst is an epithelial-lined pathologic cavity that develops in association with the crown of an unerupted tooth and appears radiographically as a well-circumscribed pericoronal radiolucency. The cyst not only inhibits the eruption of the associated tooth (usually, a mandibular third molar), but can also carry it to unusual positions in the jaw. Dentigerous cysts may enlarge causing extensive bone resorption and even pathologic fracture. The greater the size of the cyst, the higher the risk of neurologic damage caused by trauma during and after surgical removal and of mandibular fracture resulting from the postoperative bone defect.7,8 Moreover, the removal of large cysts can lead to a severe infrabony defect at the root surface of adjacent teeth, jeopardizing their long-term periodontal health. "Orthodontic extraction" is a combined orthodontic-surgical approach that decreases the risk of neurologic complications and facilitates the surgical extraction of impacted mandibular third molars that are in close contact with the mandibular canal, even when associated with cystic lesions.13 This case report shows that the interdisciplinary approach is also effective in preventing periodontal breakdown on the distal surface of the adjacent second molar.