Evaluation of the efficacy of inter-dental brush and dental floss for peri-implant mucositis: A crossover randomized clinical trial.

OBJECTIVES: To evaluate the most effective method for mechanical inter-dental plaque removal between inter-dental brushes (IDB) and dental floss (DF), in addition to toothbrushing in patients affected by peri-implant mucositis (PIM); to identify possible factors related to the patient or to the single implant-supported element that could influence plaque accumulation and inflammation of peri-implant tissues. METHODS: Forty patients with PIM were recruited. They were randomly assigned to two different groups depending on inter-dental device used (IDB or DF). At baseline (T0), interproximal area (IA), interproximal emergence angle of the implant crown (A°) and manual dexterity (evaluated with Purdue Pegboard) have been recorded. At 14 days (T1), the inter-dental cleaning devices have been inverted between groups. After 14 days (T2), the Plaque Index (PI) and Gingival Index (GI) have been recorded. A questionnaire has been submitted to a patient for the analysis of preferences at T0, T1 and T2. RESULTS: Both inter-dental cleaning devices were effective in reducing PI and GI in the inter-dental area after 14 days of use. GI reduction was influenced by manual dexterity of the dominant hand. No significant differences were found for PI and GI at the variation of IA and A°. CONCLUSION: IDB was the most effective method for inter-dental plaque removal in all subjects regardless of their manual dexterity. DF seems to be more effective than IDB only in subjects with good dexterity.

Shaping ability of Procodile and R6 Reziflow nickel-titanium reciprocating instruments in curved mesial root canals of mandibular molars: A MicroCT study.

To compare the shaping ability of Procodile and R6 Reziflow instruments used in reciprocating motion in severely curved root canals, assessed with micro-computed tomography (µCT). Fourteen extracted human mandibular first molars were randomly assigned to two instrumentation techniques (n = 14 mesial root canals): Procodile or R6 Reziflow. For both groups, root canals were prepared to the working length up to a size 25, .06 taper. Molars were virtually divided into apical, middle and coronal thirds and µCT was used to scan all samples pre- and post-root canal. Canal transportation, centring ability, volume, surface area and unprepared area were evaluated. Geometrical parameter changes were compared with preoperative values (one-way analyses of variance and Tukey multiple comparison post-hoc test) between groups and Student t-test within groups (α = 0.05) Significantly less transportation was observed associated with the Procodile technique in the molar's coronal third compared to the R6 Reziflow technique (p < .05). No significant differences in root canal centring ability, volume, surface area and unprepared area were observed. Procodile showed a lower percentage increase of surface area compared to R6 Reziflow (p < .05). The Procodile and R6 Reziflow techniques applied to first molar root canal performed similarly except for the less transportation observed in the coronal third using Procodile. RESEARCH HIGHLIGHTS: MicroCT analysis of canal geometry before and after instrumentation revealed that Procodile and R6 Reziflow showed a similar shaping ability to shape curved root canals without substantially modifications of the original tooth anatomy.

Outcome of Different Surgical Approaches in the Treatment of Class II Furcation Defects in Mandibular Molars: A Randomized Clinical Trial.

The aim of this study was to investigate which factors play a major role in the healing of Class II mandibular furcation defects treated with different surgical techniques. Twenty-five systemically healthy subjects with periodontitis stage III grade B and Class II buccal mandibular furcation involvement received one of the following open flap debridement approaches: Group 1 (n = 10), no further treatment; Group 2 (n = 10), piezoelectric contouring of the furcation roof; Group 3 (n = 9), piezoelectric contouring of the furcation roof and bone grafting; Group 4 (n = 10), piezoelectric contouring of the furcation roof and bone grafting with coronally positioned flap. Clinical and radiologic variables-bleeding on probing, probing depth (PPD), vertical and horizontal bone level (CAL and PH), gingival recession, root trunk length, radicular separation, and furcation perimeter (FP)-were evaluated at baseline and 180 days and 1 year after surgery. All clinical parameters were statistically analyzed. Surgical techniques caused clinical (CAL, PPD, PH) and radiographic (FP) improvements. Regenerative techniques and the coronally positioned flap yielded a major radiographic reduction of furcation areas. All therapies resulted in significant horizontal and vertical PPD reduction and CAL gain.

Primary Stability of Short Implants Inserted Using Piezoelectric or Drilling Systems: An In Vitro Comparison.

The primary objective of the present in vitro study was to evaluate the influence of implant site preparation technique (drills vs ultrasonic instrumentation) on the primary stability of short dental implants with two different designs inserted in simulated low-quality cancellous bone. Eighty implant sites were prepared in custom-made solid rigid polyurethane blocks with two different low cancellous bone densities (5 or 15 pounds per cubic foot [PCF]), equally distributed between piezoelectric (Surgysonic Moto, Esacrom, Italy) and conventional drilling techniques. Two short implant systems (Prama and Syra, Sweden & Martina) were tested by inserting 40 fixtures of each system (both 6.0 mm length and 5.0 mm diameter), divided in the four subgroups (drills/5 PCF density; drills/15 PCF density; piezo/5 PCF density; piezo/15 PCF density). Insertion torque (Ncm), implant stability quotient values, removal torque (Ncm), and surgical time were recorded. Data were analyzed by 3-way ANOVA and Scheffé's test (α = 0.05). With slight variations among the considered dependent variables, overall high primary implant stability was observed across all subgroups. Piezoelectric instrumentation allowed for comparable or slightly superior primary stability in comparison with the drilling procedures in both implant systems. The Prama implants group showed the highest mean reverse torque and Syra implants the highest implant stability quotient values. Piezoelectric implant site preparation took prolonged operative time compared to conventional preparation with drills; among the drilling procedures, Syra system required fewer surgical steps and shorter operative time.

Primary stability of short implants inserted using piezoelectric or drilling systems: an in vitro comparison.

The primary objective of the present in vitro study was to evaluate the influence of implant site preparation technique (drills vs. ultrasonic instrumentation) on the primary stability of short dental implants with two different designs inserted in simulated low quality cancellous bone. Eighty implant sites were prepared in custom-made solid rigid polyurethane blocks with two different low cancellous bone densities (5 or 15 pounds per cubic foot, PCF), equally distributed between piezoelectric (Surgysonic Moto, Esacrom, Italy) and conventional drilling techniques. Two short implant systems (Prama and Syra, Sweden & Martina) were tested by inserting 40 fixtures of each system (both 6.0 mm length and 5.0 mm diameter), divided in the four subgroups (drills/5 PCF density; drills/15 PCF density; piezo/5 PCF density; piezo/15 PCF density). Insertion torque (Ncm), implant stability quotient values, removal torque (Ncm) and surgical time were recorded. Data were analyzed by three-way ANOVA and Scheffé's test (α=0.05). With slight variations among the considered dependent variables, overall high primary implant stability was observed across all subgroups. Piezoelectric instrumentation allowed for comparable or slightly superior primary stability in comparison with the drilling procedures in both implant systems. Prama implants group showed the highest mean reverse torque, Syra implants the highest implant stability quotient values. Piezoelectric implant site preparation took prolonged operative time compared to conventional preparation with drills; among the drilling procedures, Syra system requires fewer surgical steps and shorter operative time.

The effectiveness of surgical management of oroantral communications: a systematic review of the literature.

BACKGROUND: An oroantral communication (OAC) is a common complication in alveolar surgery that usually occurs as a result of the extraction of maxillary posterior teeth. To avoid further complications, several closure techniques are used; most of them need a flap elevation. Recently, simpler conservative flapless techniques for OAC closure have been described. OBJECTIVES: To appraise the effectiveness of different techniques for closure of OACs also in comparison to nothing. SEARCH METHODS: The following electronic databases were searched for randomised controlled trials regarding techniques for closure of OACs: PubMed; SciVerse Scopus; Latin American and Caribbean Health Sciences; The Scientific Electronic Library Online and The Cochrane Library (from January 1949 to August 2014). Unspecific algorithms were chosen in order to maximise search sensibility. Additional manual searching was performed in PubMed related citations, in five journals and in the references of the selected articles. There were no restrictions with regard to publication language. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing techniques for closing oroantral communications to nothing, or different techniques for closing oroantral communications reporting the success rate with at least two months follow-up. DATA COLLECTION AND ANALYSIS: The screening of eligible studies, the assessment of methodological quality and data extraction were done by two independent reviewers working in duplicate. RESULTS: The research individuated 1256 publications. After screening, only five articles were assessed for eligibility. Only two RCTs evaluating the effectiveness of techniques for OAC closure fulfilled the inclusion criteria of the present review. One trial including 30 patients assessed whether flapless techniques (resorbable root analogues and haemostatic gauze) could be as effective as the Rehrmann's buccal flap; all the patients were reported as successfully healed in the three intervention groups. Another RCT with 20 patients compared the effectiveness of the buccal fat pad flap (100% success rate) with a sandwich graft with hydroxyapatite crystals within collagen sheaths (90% success rate). The authors found no significant difference. CONCLUSIONS: There are no RCTs evaluating whether an oroantral communication should be closed or not. There is weak evidence from two RCTs showing good results with five different techniques for closure of OACs (resorbable root analogues, haemostatic gauze, Rehrmann's buccal flap, buccal fat pad flap, sandwich graft with hydroxyapatite crystals). Until sufficiently high quality RCTs are conducted, elevating or not a flap for closure of OACs will be left to the personal choice of the surgeon.