The impact of COVID-19 on Italian dentists: A cross-sectional survey on 2443 participants.

OBJECTIVE: To evaluate the impact of COVID-19 pandemic among a sample of Italian dentists in terms of infection, strategies for infection control, organization of the dental clinic, attitude, and behavior. MATERIAL AND METHODS: This was a cross-sectional survey. The sample consisted of 8000 Italian dentists selected among 63,375 using a computerized random sampling method. An electronic informed consent had to be signed. The questionnaire categories were on demographic, infection risk management, organization, and dentists' attitude and behavior. Geographic macro-areas were used for subgroup analysis. RESULTS: Among 8000 invited dentists, 2443 agreed to participate to the survey (30.6%). Mean age was 51.2 years, women were 34.5%. A total of 6.1% self-reported COVID-19 experience and higher rate of infection was reported in north Italy compared to the south (p < 0.05). FFP2/FFP3 respirators (97.1%) and visors (97.4%) were used by almost all dentists. While, natural ventilation and mouthwashes were the most frequent approaches used to reduce the infection risk. Most of the dentists reported positive attitude, nevertheless 83.6% felt an increased responsibility. CONCLUSION: The self-reported COVID-19 prevalence was 6.1% with some differences among geographic areas. COVID 19 had a deep impact on preventive strategies, dental office organization, and behavior within this sample.

Practical Guidelines for Patients with Hypertension and Periodontitis.

Arterial hypertension (AH) and periodontitis are among the most common non-communicable chronic diseases worldwide. Besides sharing common risk factors, an increasing body of evidence supports an independent association between the two conditions, with low-grade systemic inflammation acting as the plausible biological link with increased cardiovascular risk. In 2021, the Italian Society of Arterial Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP) have joined forces and published a joint report on the relationships between AH and periodontitis, reviewing the existing scientific evidence and underlining the need to increase awareness of the strong connection between the two conditions and promote treatment strategies for the control of gums inflammation in patients with AH. The current document extends the previous joint report, providing clinical practical guidelines aimed to support clinicians in the management of patients who suffer from or are at risk of being affected by both conditions. These recommendations are based on careful consideration of the available evidence as well as of the current guidelines on the management of periodontitis and AH and are supported by SIIA and SIdP.

Clinical decision-making and management of stage IV periodontitis: A survey.

OBJECTIVE: To investigate the clinical management of stage IV periodontitis patients among clinicians within the Italian Society of Periodontology and Implantology. METHODS: A cross-sectional study was designed on a web-based anonymous survey. Comparison between ordinary members (OMs) versus active and certified members (ACMs) and comparison between members with at least 10 years of experience in periodontology (Ov10) and members with less than 10 years of experience in periodontology (Un10) were performed. RESULTS: A total of 324 out of 1362 members (response rate of 24%) responded to the questionnaire. ACMs and Ov10 more often reported their teams hold adequate skills to manage cases. Step I and II periodontal therapy took more time in the ACMs and Ov10 groups. ACMs used different strategies to perform step I-II therapy, and antibiotics were used less frequently than OMs. Unresponsive sites were treated more often with surgery by ACMs compared to OMs. ACMs adopted different treatment sequences compared to OMs. Ov10 group used more often CBCT, lateral cephalogram, and wax-up while Un10 group tend to avoid orthodontic therapy. CONCLUSIONS: More experienced members spent more time in step I and II of periodontal therapy, used more diagnostic tools, and performed more often surgery and orthodontics in the treatment of stage IV periodontitis patients.

Surface disinfection and protective masks for SARS-CoV-2 and other respiratory viruses: A review by SIdP COVID-19 task force.

OBJECTIVES: Primary focused question for this systematic review (SR) was "Which is the evidence about surfaces decontamination and protection masks for SARS-Cov-2 in dental practice?" Secondary question was "Which is the evidence about surfaces decontamination and protection masks against airborne pathogens and directly transmitted viral pathogens causing respiratory infections?" MATERIALS AND METHODS: PRISMA guidelines were used. Studies on surface decontamination and protective masks for SARS-CoV-2 in dental practice were considered. Studies on other respiratory viruses were considered for the secondary question. RESULTS: No studies are available for SARS-CoV-2. Four studies on surface disinfection against respiratory viruses were included. Ethanol 70% and sodium hypochlorite 0,5% seem to be effective in reducing infectivity by > 3log TCID. Four RCTs compared different types of masks on HCW. The single studies reported no difference for laboratory-diagnosed influenza, laboratory-diagnosed respiratory infection, and influenza-like illness. A meta-analysis was not considered appropriate. CONCLUSIONS: There is lack of evidence on the efficacy of surface disinfection and protective masks to reduce the spread of SARS-CoV-2 or other respiratory viruses in dentistry. However, the consistent use of respirator and routine surface disinfection is strongly suggested. There is urgent need of data on the efficacy of specific protection protocols for dental HCW against viral infections.

Hypertension and Periodontitis: A Joint Report by the Italian Society of Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP).

An accumulating body of evidence supports an independent association between high blood pressure (BP) and periodontitis, possibly mediated by low-grade inflammation. This joint report by the Italian Society of Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP) working group on Hypertension and Periodontitis (Hy-Per Group) provides a review of the evidence on this topic encompassing epidemiology, biological plausibility, relevance, magnitude, and treatment management. Consensus recommendations are provided for health professionals on how to manage BP in individuals showing signs of poor oral health. In summary, (1) large epidemiological studies highlight that individuals with periodontal diseases have increased risk for high/uncontrolled BP independent of confounders; (2) mechanistically, low-grade inflammation might have a causal role in the association; (3) BP profile and control might benefit from periodontal treatment in pre-hypertensive and hypertensive individuals; (4) oral health status should be evaluated as a potential risk factor for high/uncontrolled BP, and effective oral care should be included as an adjunct lifestyle measure during hypertension management. Further research is needed to optimize BP management in individuals with poor oral health.

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.

Computer-guided implant surgery for immediate implanting and loading: The STIL technique.

A method is described for minimizing errors in positioning a surgical template during the insertion of implants immediately after extraction and the placement of interim prostheses with immediate loading. The technique, called sequential template immediate loading (STIL), uses modular templates to fix pins before extracting the teeth, thus giving a reliable position for the subsequent templates for inserting the implant and placing the interim prosthesis.

Marginal soft tissue recession after lateral guided bone regeneration at implant site: A long-term study with at least 5 years of loading.

BACKGROUND/AIM: This study evaluated marginal soft tissue recession at implants with simultaneous lateral guided bone regeneration (GBR), at least five years after prosthetic loading. MATERIAL AND METHODS: Patients treated with GBR at the time of implant placement and adherent to supportive periodontal therapy (SPT) program with at least 5 years of follow-up were re-examined in 5 clinical centers. At the last follow-up, clinical and radiographic data on peri-implant hard and soft tissue were collected. Multilevel analysis considering center, patient, and implant (brand, length, diameter, position) was performed. RESULTS: A total of 96 patients and 195 augmented implants were included. The mean duration of SPT was 8.3 ± 3.1 years, while mean recall frequency was 4.5 ± 1.3 months. Sixty-five (33%) implants received soft tissue graft before prosthetic delivery. Twenty-one (11%) implants developed biological complications during the follow-up. No implant failure was reported. Mean difference in bone levels (ΔBL) was -0.7 ± 0.9 mm, while mean difference in keratinized tissue (ΔKT) was -0.4 ± 0.9 mm. Eighty-five (44%) implants showed recession (REC) of soft tissue margin (mean 0.6 ± 0.8 mm). The presence of REC was associated with use of non-resorbable membrane (p < .0001) and wider implant diameter (p = .0305), while use of soft tissue graft significantly predicted higher stability of peri-implant mucosal margin (p = .0003). CONCLUSION: Peri-implant mucosal recession is a common feature 5 years after lateral GBR. The risk of recession may be reduced using GBR with resorbable membranes, small diameter implants, and soft tissue grafting before prosthetic treatment.

Immediate Postextraction Single-Tooth Implants and Provisional Crowns in the Esthetic Area: 2-year Results of a Cohort Prospective Multicenter Study- Patient-Centered Outcomes.

PURPOSE: A prospective cohort multicenter study was undertaken to identify risk factors for implant survival, complications, and patient-centered outcomes following single-tooth immediate implant placement and loading in esthetic areas. MATERIALS AND METHODS: Consecutive immediate implants placed in incisors, canines, and premolar sites were included. Variables recorded as possible risk factors included smoking habit, systemic conditions or therapies, previous assumption of bisphosphonates, inability to take amoxicillin, untreated periodontitis, thin periodontium, parafunctional habits, suppuration, bone dehiscences, and buccal bone fracture during implant insertion. Outcome variables included implant survival, recession, other complications, and patient satisfaction. RESULTS: Data of 215 implants in 215 patients were collected in 15 centers in 2 years. One implant was seated with a torque < 30 Ncm and was not immediately loaded. It was successfully loaded 10 weeks after placement and was healthy 2 years later. This implant was excluded from subsequent analysis. Potential risk factors were identified in 116 patients (54.21%). There were 11 dropouts after 1 year and 37 after 2 years. Failures were relatively frequent (14.6%) before the delivery of the definitive prosthesis. No significant association was observed between early failures and risk factors. One failure and six recessions were observed after the definitive prosthesis. High satisfaction scores (mean score of 9.47/10 and 9.55/10 for esthetics and function, respectively) were recorded at 2 years. No recession occurred in the no-risk group. Five mucositis cases and one peri-implantitis case were observed in the 2-year follow-up. CONCLUSION: Failures were frequent before the definitive restoration and could not be explained by specific risk factors. Tissues appeared stable after the definitive restoration. Patients were very satisfied during the follow-up.

Simplified osteotome sinus augmentation technique with simultaneous implant placement: a clinical study.

The aim of this study was to describe and evaluate a modified maxillary sinus floor augmentation technique: the simplified osteotome technique. The study consisted of 26 patients treated with 39 Brånemark implants (Nobel Biocare) placed using the simplified osteotome technique between September 1997 and November 2004 (87 months). Implant length ranged from 10 to 15 mm, while the loading time ranged from 5 to 74 months (mean: 35.2 months). The success rate was 97.4% according to Albrektsson's criteria. These preliminary data indicate that the simplified osteotome technique is effective and safe, though long-term, multicenter studies are still needed.

Accuracy of computerized tomography for the evaluation of mandibular sites prior to implant placement.

The objective of the present study was to observe the effect of positioning of the mandible on the accuracy of cross-sectional images obtained by reformatting computerized tomographic (CT) scans. An additional aim was to evaluate the ability of a software program (DentalVox, Era Scientific) to reconstruct these measurements on the reformatted images, regardless of the positioning of the mandible, accurately and without distortion. The test was carried out by examining a partially edentulous dry human mandible with an acrylic radiologic template. Through the use of an acrylic glass support, the mandible was positioned at angles of 0, 10, 15, 20, and 30 degrees relative to the scanning gantry, and a series of CT scans was performed that provided five sets of axial images. Each set of original axial images was reformatted by the DentalVox software, used first in its basic function, which is typical of all software for axial CT measurement (control group), and again in its function of site-specific multiplanar reconstruction (test group). The results showed that the position of the mandible in relation to the CT gantry can influence the precision of the linear measurements. The error ranged from 2% to 51%. The DentalVox software allowed the reconstruction of cross-sectional images with very little distortion regardless of the mandibular position.