Biomechanically and Periodontally-Based Orthodontic Treatment of a Patient with Upper Canine Affected by External Cervical Resorption (ECR): A Case Report.

(1) Background: Orthodontic treatment may be a potential predisposing factor for ECR. The affected tooth goes to ankylosis, which could lead to a malocclusion. Although teeth severely affected by ECR (class IV Heithersay) are usually extracted, this case report aims to present the use of an ECR class IV upper canine, both as ankylosed to solve the malocclusion and the occlusal plane canting, as well as not ankylosed to correct its ridge defect with orthodontic extrusion. (2) Methods: A 14-year-old male, complaining of an ugly smile and a failed orthodontic attempt to recover an impacted canine, was referred to the orthodontic clinic. He was diagnosed with class II right subdivision, midline deviation, both upper and lower occlusal plane canting, and an upper left canine, previously impacted, showing ECR class IV. The treatment first included canting resolution with a cantilever and a spring, exploiting the anchorage offered by the ankylosed ECR canine. Then, a coronectomy, endodontic treatment, and orthodontic extrusion of that canine were performed to obtain the implant site development. (3) Results: Clinical and radiographic outcomes showed normocclusion and better bony conditions for safer implant placement in the aesthetic zone. (4) Conclusions: The high aesthetics and the periodontal and bony conditions obtained are probably not achievable by other therapeutic alternatives.

Patient-reported outcome measures of leucocyte- and platelet-rich fibrin (L-PRF) or hemostatic agent application at palatal donor sites after free gingival graft harvesting: a randomized controlled clinical trial.

OBJECTIVE: The aim of this study was to evaluate the patient's morbidity and postsurgical complications after treatment of palatal donor sites after free gingival graft harvesting using leucocyte- and platelet-rich fibrin (L-PRF) membranes or a hemostatic agent with oxidized and regenerated cellulose. METHOD AND MATERIALS: Forty-two palatal donor sites after free gingival graft harvesting in 42 patients were randomly assigned to experimental (L-PRF membrane) or control procedure (hemostatic agent). The primary outcome was postoperative pain related to the wound located at the palatal area, and the secondary outcomes were postoperative discomfort, inability to chew, postoperative stress, surgical chair time, thickness of the palatal fibromucosa, and thickness of the free gingival graft. The patient-reported outcome measures were recorded after 1 week. RESULTS: After 1 week, a statistically significant difference was found between groups in terms of postoperative stress (P = .008). No statistically significant differences in terms of postoperative pain (P = .326), patient discomfort (P = .509), inability to chew (P = .936), or surgical chair time (P = .932) were recorded between the test and the control group. No statistically significant differences were recorded in terms of thickness of the palatal fibromucosa (P = .647) and thickness of the free gingival graft (P = .756) between groups. Postsurgical wound healing complications (ie, necrosis or infections) were not observed in both groups. CONCLUSION: Within their limitations, the present outcomes indicated that the application of L-PRF membrane at palatal donor sites after FGG harvesting did not produce significant advantages for the patients.

Incidence and risk factors associated to Medication-Related Osteo Necrosis of the Jaw (MRONJ) in patients with osteoporosis after tooth extractions. A 12-months observational cohort study.

OBJECTIVE: To evaluate the 12-months incidence of MRONJ after tooth extractions and possible related risk factors in patients with osteoporosis treated by means of oral bisphosphonates. MATERIAL AND METHODS: Forty-five records of osteoporotic patients on therapy with oral bisphosphonates and treated with at least one dental extraction at the Department of Oral Surgery of University of Naples Federico II were selected. All patients were treated using a standardized surgical extraction protocol. At baseline and after 12-months follow-up, the following variables were recorded: "mucosal healing", "gender", "type of drug"; "duration of therapy"; "drug holiday". The collected data were analyzed and a linear regression analysis was performed to assess a possible correlation with onset MRONJ. RESULTS: A total of 159 tooth extraction in 43 females (95.6%) and in 2 males (4.4%) with a mean age of 67.5 ± 3 years were available for the analysis. The majority part of patients was on therapy with alendronate (23; 51.2%), 11 patients (24.4%) were treated with risedronate and 11 (24.4%) with ibandronate. Before oral surgery, 84% of the patients showed a low-medium risk of MRONJ, while in 16% of the patients a medium-high risk was recorded. After 12-months follow-up, osteonecrosis was observed in 1 patient, with an overall incidence of MRONJ of 0.6%. The linear regression showed a significant correlation with MRONJ onset only for "gender" variable, with a R2 of 0.489. CONCLUSIONS: Within their limitations, the outcomes of the study indicate that the risk of MRONJ after tooth extraction in osteoporotic patients taking bisphosphonates for OS is very low. A prolonged and specific antibiotic and antiseptic therapy, in addition to a surgical procedure as little traumatic as possible, will allow to perform oral surgery safely.

Infective Endocarditis: A Focus on Oral Microbiota.

Infective endocarditis (IE) is an inflammatory disease usually caused by bacteria entering the bloodstream and settling in the heart lining valves or blood vessels. Despite modern antimicrobial and surgical treatments, IE continues to cause substantial morbidity and mortality. Thus, primary prevention and enhanced diagnosis remain the most important strategies to fight this disease. In this regard, it is worth noting that for over 50 years, oral microbiota has been considered one of the significant risk factors for IE. Indeed, among the disparate recommendations from the American heart association and the European Society of Cardiology, there are good oral hygiene and prophylaxis for high-risk patients undergoing dental procedures. Thus, significant interest has grown in the role of oral microbiota and it continues to be a subject of research interest, especially if we consider that antimicrobial treatments can generate drug-resistant mutant bacteria, becoming a severe social problem. This review will describe the current knowledge about the relationship between oral microbiota, dental procedures, and IE. Further, it will discuss current methods used to prevent IE cases that originate from oral pathogens and how these should be focused on improving oral hygiene, which remains the significant persuasible way to prevent bacteremia and systemic disorders.

Treatment of gingival recessions using coronally advanced flap and connective tissue graft: a long-term retrospective analysis.

OBJECTIVES: The aim of this retrospective study was to evaluate the long-term effectiveness of coronally advanced flap (CAF) in combination with connective tissue graft (CTG) in the treatment of gingival recessions. METHOD AND MATERIALS: Periodontal charts of 13 patients with single and multiple gingival recessions treated by means of CAF and CTG with a follow-up of 7 years were selected for the study. Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), gingival recession depth (GRD), gingival recession width (GRW), height of keratin-ized gingiva (KG), probing depth (PD), and clinical attachment level (CAL) were assessed at baseline, and after 1 and 7 years of follow-up. Complete root coverage (CRC) was evaluated at 1 year and after 7 years of follow-up. A comparison of gingival recessions with or without non-carious cervical lesions (NCCL) was also performed. RESULTS: All clinical variables showed a significant improvement (P < .05) between baseline and after 7 years of follow-up. CRC was achieved in 69.2% and 53.8% of sites after 1 and 7 years of follow-up, respectively. The comparison between gingival recessions with and without NCCL did not show statistically significant differences (P > .05) in terms of all parameters. CONCLUSIONS: Within limits of the present study, the combination of CAF and CTG for the treatment of single and multiple recessions yielded positive outcomes in terms of GRD reduction and CRC after 7 years. These findings were independent of the presence of NCCLs.

Alveolar Ridge Preservation with Deproteinized Bovine Bone Mineral and Xenogeneic Collagen Matrix: A 12-Month Clinical and Histomorphometric Case Series.

The aim of the present study was to evaluate the efficacy of alveolar ridge preservation (ARP) protocol using deproteinized bovine bone mineral (DBBM) covered with a collagen matrix (CM), as well as to clinically and histologically analyze the alveolar bone healing at 12 months, prior to implant placement. Six patients had bone biopsy samples harvested and underwent implant placement at 12 months following ARP. At 12 months, DBBM granules represented a mean 29.52% ± 6.09% of the specimens and were embedded in the newly formed bone, which represented a mean 27.72% ± 5.64% of the sample. Data suggest that 12 months of ARP using DBBM granules covered with a CM may be considered a predictable technique providing favorable conditions for implant placement in the anterior maxilla.