White spot lesions in orthodontics: prevention and treatment. A descriptive review.

White spot lesions (WSL) are demineralizations of the enamel found on the tooth surfaces. WSL are considered incipient non-cavitated caries caused by bacterial plaque activity. Subjects with malocclusion such as dental crowding and fixed orthodontic appliances have a greater number of retention sites and consequently difficulty in cleaning and greater predisposition to caries. In fact, WSL are a frequent side effect of orthodontic fixed treatments. The prevention and resolution of this problem is the goal of any orthodontist because untreated WSL can lead to the formation of deeper dental caries and restorative treatment with consequent compromise of patient satisfaction with the aesthetic result obtained at the end of the orthodontic treatment. This review is intended not only for orthodontists but also for general and pediatric dentists who want to learn how to correctly prevent, and treat this unsightly problem. On the market there are many products sold to achieve this goal, some of them can be managed independently by the patient at home, others require the intervention of the dentist. The purpose of this literature review is to understand how these substances work, to identify with which of the currently most widespread the best results have been obtained and then to provide useful information to guide the clinician in choosing the most suitable one for the patient.

The bad relationship, osteo-decay and diabetes type 2 searching for a link: a literature review.

The diabetes and osteoporotic metabolic diseases are characterized by a wide prevalence of the population worldwide and correlated to alteration of the bone tissues. Several cofactors could influence the clinical course and the biochemistry of the pathologies such as human microbiome, nutrition characteristics, gut microbiota activity and interactions with vitamin K and D across IGF/GH and TP53 signaling pathways and the glucose/energy as mechanism for bone tissue health. Moreover, also the calories and sugar consumption seem to be correlated to an increased inflammatory state with several consequences for hematopoiesis and host tissues response. The aim of the present literature review was to highlight the role of osteoporotic diseases and diabetes type 2 link for the bone metabolism. The literature cases showed that a correlation between bone-gut-kidney-heart-CNS-Immunity crosstalk seems to be linked with bone metabolism and health regulation. Moreover, also the aging process could represent a valuable co-factor for the sustaining of the metabolic disorders upon a multi-systemic level.

Management of anterior open-bite in the deciduous, mixed and permanent dentition stage: a descriptive review.

Anterior open bite is one of the most complex malocclusions to manage. The interaction of skeletal, dental, and soft tissue effects can contribute to develop an anterior open bite. The skeletal open bite requires a more complex approach of treatment to reach function, aesthetics, and stability. The approaches vary depending on the causative factors and the age of patients. Treatment approaches for open bite patients differ when dealing with adults and growing patients. The aim of this descriptive review was to summarize the main existing treatment strategies for anterior open bite, from the noninvasive behavioural shaping to the orthodontic intrusion with skeletal anchorage.

The effectiveness of autologous demineralized tooth graft for the bone ridge preservation: a systematic review of the literature.

Resorption of alveolar ridge after tooth extraction often compromises dental implant placement and esthetic. Alveolar ridge preservation is a common procedure performed in order to preserve the pontic site for a prosthetically ideal position. This procedure has already become an indisputable need. Tooth matrix as bone substituted material poses osteoconduction and osteoinduction properties and as autologous graft, this material is free of antigenic reaction. This biomaterial allows the threedimensional reconstruction of the bone, is easy to prepare and has a low cost. The aim of this review is to summarize and put in evidence the properties of tooth as bone substitute and its use in alveolar ridge preservation. Keyword: autologous tooth, autologous graft, bone regeneration, bone substitute, alveolar ridge preservation, alveolar ridge augmentation, socket preservation.

Compliance of children with removable functional appliance with microchip integrated during covid-19 pandemic: a systematic review.

Treatments with removable appliances are widely used in Europe to correct dento-skeletal dysgnatia in the growth phase that is a period of poor cooperation of the patients. Adherence to the wear-time prescription is often not achieved and it represent the main argument against the use of removable devices. Suspected non-compliant behavior with the wear time prescription is often the subject of medico-legal disputes, which can deteriorate doctor-patient relationship. The use of microchips allows to document objectively and clarify the patient's behavior. To conduct a systematic review of the orthodontic literature to identify the factors associated with compliance in orthodontic treatment. We conduct a systematic review that aimed to identity the factors associate with compliance in orthodontic treatment. The main purpose was to assess the objective levels of time of use of the removable appliances and the self-reported levels. A literature search was conducted by the electronic databases PubMed and Cochrane Library. The following search terms were used: compliance functional removable orthodontic appliance. Randomized and nonrandomized controlled trials, prospective cohort studies, case series, qualitative and mixed-methods studies objectively assessing compliance levels were included in the study. A total of 94 articles were identified by PubMed and 14 articles by Cochrane. The papers selected were included for the qualitative analysis and categorized according to the subjects age, the clinical appliance, compliance factors, wear time and monitoring. Removable appliances are an important part of orthodontic treatment, used in growth phase of the patient. Collaboration with removable functional devices determines success / failure in treatment.

Obstructive site localization in patients with Obstructive Sleep Apnea Syndrome: a comparison between otolaryngologic data and cephalometric values.

PURPOSE: Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory disorder characterized by repeated obstructive episodes affecting upper airways.This study aims at examining the anatomical craniofacial and pharyngeal characteristics of the patient as to identify the obstructive site which triggers the pathologic process.Correlations between otolaryngologic data observed in the patient and the cephalometric ones for the identification of the obstructive site were also highlighted. MATERIALS AND METHODS: We worked on a sample of 16 patients, 12 males and 4 females, attended to at the Otolaryngology Operative Unit of Bari University Hospital.The patients underwent an otolaryngologic (ORL) diagnostic procedure which provided for ApneaGraph (AG) recording, and a dental diagnostic procedure with cephalometric assessment. RESULTS: The statistical analysis highlighted a strict correlation between the otolaryngologic value of AHI and the cephalometric values of the ANB angle, with the distance between the hyoid bone and the mandibular plane and with the distance between the hyoid bone and the plane passing between C3 and Me. CONCLUSIONS: We observed a concurrence between the ORL diagnosis of the obstruction level assessed with AG and the cephalometric values regarding respiratory tracts (IPAS and SAS). More precisely, we observed the correlation between the otolaryngologic value of AHI with cephalometric values of the ANB angle, with the distance between hyoid bone and mandibular plan, and with the distance between the hyoid bone and the plane passing between C3 and Me. Furthermore, the identification of the caudal position of the hyoid bone can be considered an alarm bell in the diagnosis of severe OSAS.

Correlation between parodontal indexes and orthodontic retainers: prospective study in a group of 16 patients.

PURPOSE: Fixed retainers are used to stabilize dental elements after orthodontic treatment. Being it a permanent treatment, it is necessary to instruct patients about a constant and continuous monitoring of their periodontal conditions and a correct oral hygiene. The aim of this study was to highlight the possible adverse effects of bonded retainers on parameters correlated to the health conditions of periodontal tissues. MATERIALS AND METHODS: We selected 16 patients, under treatment in the Orthodontics Department of University of Bari Dental School, who had undergone a lingual retainer insertion at the end of the orthodontic treatment. The patients were then divided into two groups (Control Group and Study Group) and monitored for 3 and 36 months, respectively. The following indexes were taken into consideration: gingival index (GI), plaque index (PI) and the presence of calculus (Calculus Index, CI), the probing depth and the presence of gingival recession on the six inferior frontal dental elements. RESULTS: After the observation was carried out, any of the patients showed periodontal sockets and gingival recession. In the Study Group, only 1 patient had a PI score=3, the 7 left had scores between 0.66 and 2.83. In the Control Group, one patient had score=0, the other ones showed values between 0.5 and 1.66. The mean GI in the Study Group peaked at a score of 2.83, the minimum was 0.66; whereas in the Control Group the maximum value was 2 and the minimum 0.66. The CI in the Group Study was between 1 and 2. In the Control Group it was absent in only 1 patient, whereas in the remaining 7, it had a value between 0.3 and 1. The clinical data were studied by means of the Wilcoxon test. We found a statistically significant difference for what concerns the Plaque Indexes (PI) (P>0.05) and Calculus Indexes (CI) (P>0.1) in both groups, with higher scores in the Study Group, having retainers for 36 months. Any statistically significant difference was calculated for the GI. CONCLUSIONS: We can therefore conclude that patients with lingual retainers need periodontal hygiene and treatment as to prevent, in the course of time, periodontal damages non-detectable in short-term.

Early mandibular canine-lateral incisor transposition: case report.

PURPOSE: The main aim of the present study is to present a case of mandibular transposition between lateral incisor and canine in a paediatric patient. MATERIALS AND METHODS: A fixed multibracket orthodontic treatment was performed by means of a modified welded arch as to correct the transposition and obtaining a class I functional and symmetrical occlusion, also thanks to the early diagnosis of the eruption anomaly. RESULTS: Our case report shows that a satisfactory treatment of mandibular transpositions is obtained when detected at an early stage of the tooth development. CONCLUSIONS: The main treatment options to be taken into consideration in case of a mandibular transposition are two: correcting the transposition or aligning it leaving the dental elements in their transposed order; in both cases, the follow-ups show a stable condition, maintained without relapses. Several factors, such as age of the patient, occlusion, aesthetics, patient's collaboration, periodontal support and duration of treatment have to be considered as to prevent potential damage to dental elements and support appliances. The choice between the two treatment approaches for mandibular lateral incisor/canine transpositions mainly depends on the time the anomaly is detected.

Non-surgical periodontal management in scleroderma disease patients.

The aim of the present study is to investigate the periodontal status of people with scleroderma and their response to non-surgical treatment protocol aimed at controlling the evolution of the disease. The response to non-surgical periodontal treatment was tested on patients belonging to a scleroderma group and a control group: the data show an improvement of the periodontal conditions of all these patients in response to treatment. When compared on the same diagram, a slight remission of the periodontal disease was obtained in both scleroderma and healthy patients. This highlights the benefit to soft tissues produced by non-surgical periodontal treatment also in patients affected by systemic diseases.

Correlation between dento-skeletal characteristics and craniomandibular disorders in growing children and adolescent orthodontic patients: retrospective case-control study.

PURPOSE: The aim of this retrospective case-control study was to identify, in a group of growing children and adolescents affected by malocclusion, specific dento-skeletal characteristics which could be correlated to the onset, in the above-mentioned subjects, of craniomandibular disorders (CMD). MATERIALS AND METHODS: Among the patients treated at the Paedodontics and Orthodontics department of Bari Dental School, we recruited a group of patients with malocclusion and symptoms of temporomandibular disorders, as an experimental group. We considered as controls those patients who, match-paired to their skeletal class depending on the ANB angle, did not show any CMD sign or symptom. RESULTS: Of the 128 examined patients, 15 showed signs and/or symptoms of CMD (11.7%). When compared to 15 patients non-affected by CMD, we could not detect statistically significant differences in both skeletal and occlusal characteristics. It is still interesting to notice how in CMD patients, characteristics of skeletal hyperdivergence are often to be found. CONCLUSIONS: The present study seems to confirm that in growing children and adolescents, the presence of signs and/or symptoms of CMD is not associable to a specific vertical skeletal growth pattern or to other specific occlusal characteristics.

Nicotine effects on polymorphonuclear cell apoptosis and lipopolysaccharide-induced monocyte functions. A possible role in periodontal disease?

Apoptosis provides a mechanism for clearance of unwanted cells in a variety of situations in which programmed or physiological cell death occurs; but the premature death of defensive cells could promote infection, inflammation and concomitant disease. We detected high values of apoptosis in polymorphonuclear cells (PMN) elicited from crevicular sulci of smokers affected by adult periodontitis. To learn more about the effects of nicotine on the periodontal environment, we studied its ability to modulate the apoptosis of two phagocytic lines, PMN and mononuclear cells, which are continuously recruited from gingival vessels to prevent or control plaque extension. Brief exposure of PMN to nicotine concentrations ranging from 0.01 to 0.3% shortened, in a dose-dependent relationship, the lag culture time required to observe at fluorescent microscopy the morphological traces of apoptosis. These observations were confirmed by specific tools of apoptosis: DNA fragmentation on gel electrophoresis and expression of the apoptosis-signaling receptor Fas/Apo-1. The apoptotic effect excited by nicotine on these first line defensive cells may be an important feature of the pathogenesis of periodontal disease. As for mononuclear leukocytes, nicotine was unable to induce apoptotic modifications on cells observed up to 72 h culture time, but the drug inhibited IL-1beta release and procoagulant activity (PCA) expression. The conflicting role played by these lipopolysaccharide (LPS)-induced monocyte functions in the inflammatory process is a further intrigue in the mechanism by which nicotine compromises the oral health.

[Oromaxillofacial changes in thalassemia major]. / Alterazioni oro-maxillo-facciali nella thalassemia major.

Sixty patients (31 male and 29 female) with thalassemia major, aged between 6 and 26 years, 18 of which were splenectomized, were observed in this study evaluating the oro-maxillo-facial alterations and correlating them to transfusion indexes, serum ferritin levels, splenectomy and age. For each patient a haematologic and odontostomatologic card was filed with a view to report the medical and clinical history regarding: the haematologic picture, the prevention of caries and parodontal disease, the facies characteristics, the odonto-stomatologic examination, the orthodontic diagnosis, the skull X-rays and the orthopantomography. Poor oral hygiene as well as misknowledge of prevention were generally observed. All the patients showed carious lesions but most of them had never seen a dentist for therapy. The disharmonious growth of splanchnocranium, with the enlargement of the jaw and of its alveolar process, induced by the bone marrow hyperplasia, produced various and serious malocclusion stages (Angle's II class, deep bite, open bite), gnathologic alterations, hypodiaphanous paranasal sinuses and orbital hypertelorism, with a typical oriental-like facies. Malocclusion and the poor oral hygienic conditions determined the occurrence of marginal gingivitis, mainly localized at the level of the lower frontal teeth. In only 3 patients the oral mucous membrane was pale and atrophic. During this investigation agenesia and dental retention were reported in 30% and in 26% of the examined cases respectively, while no patients had supernumerary teeth. Tooth volume, position and shape abnormalities rarely occurred. Only in two patients was enamel hypoplasia described. The caries frequency greatly varied in number and in degree. Only five patients did not show any carious lesions. The caries index (DMF) for the permanent teeth calculated in all the 60 subjects was 5, 12 +/- 4.76. By utilizing Spearman's rank test the number of teeth with caries in the permanent dentition (DFM) and in the mixed dentition (DFM + dmf) was correlated to the average value of ferritin, with the ferritin peak, with transfusion requirements and with the age of the patient at the date of the clinical examination. A significant inverse correlation was therefore demonstrated between transfusion requirements and caries in the mixed dentition. The chi 2 test was used to assess the different frequency of the caries index (above 5) between splenectomized and non-splenectomized patients. Splenectomy proved to be associated only apparently to the total number of patients with more than 5 caries. Conversely, in the non-splenectomized group the frequency of patients with more than 5 caries was definitely lower. Indeed the overall number of caries in both groups of splenectomized and non-splenectomized subjects, of the same average age, was almost identical. Consequently, splenectomy and the higher number of caries are statistically more probable in individuals affected by thalassemia, of increasing age, without however being mutually correlated.

Salivary up-regulation of human polymorphonuclear leucocyte chemotaxis and adhesion-molecule expression.

Chemotaxis and adhesion molecules were investigated in peripheral blood neutrophils incubated with saliva collected from healthy donors. A salivary concentration of 20% increased chemotactic responses and CD11a/CD18 and CD11b/CD18 expression, but had no effect on formyl-methionyl-leucyl-phenylalanine receptors.

[Wegener's syndrome (or granulomatosis). A clinical case]. / Sindrome di Wegener (o granulomatosi). Caso clinico.

Wegener granulomatosis is characterized by focal necrotizing granulomatosis of the upper respiratory and pulmonary tracts, by a necrotizing vasculitis and focal necrotizing glomerulonephritis. Clinical symptoms typically include intractable sinusitis or persistent nasal obstruction, serous otitis media, hemoptysis and pleurisy. These symptoms can also be accompanied by intermittent fever, weight loss, myalgia and sensory neuropathy. The oral lesions, including palatal ulceration, lingual ulceration, aphthae, nonhealing extraction sockets, gingivitis, have been infrequently described. Wegener's granulomatosis occasionally presents in the early stages as a characteristic hyperplastic gingivitis, named by the authors "strawberry gums", which fails to respond to conventional periodontal therapy. A case is reported, in which this clinically distinctive gingivitis was the presenting lesion with the serous otitis, illustrating that less frequently occurring entities, such as Wegener's granulomatosis, should be considered in the differential diagnosis of localized gingival lesions which fail to respond to conventional therapy.

Salivary effects on polymorphonuclear leukocyte functions.

Respiratory burst, enzymatic degranulation and bacterial killing were investigated on peripheral blood polymorphonuclear leukocytes (polymorphonuclear leukocytes) incubated with a pool of salivary fluids elicited from healthy donors. Low saliva concentrations primed polymorphonuclear leukocytes for enhancement of O2 consumption, O2- and beta-glucuronidase release and Staphylococcus aureus killing. Whole saliva, on the contrary, depressed all tested phagocytic activities.

Effects of calcium-phosphate-based materials on proliferation and alkaline phosphatase activity of newborn rat periosteal cells in vitro.

The effects of dental materials, intended for bone substitution, on cell growth and alkaline phosphatase activity of newborn rat periosteal cells have been studied in vitro. Confluent periosteal cells were exposed to three apatite-based materials (400 micrograms/mL) with different physico-chemical properties. The materials were a beta-tricalcium phosphate with a microporous granular structure obtained by sinterization (Synthograft, Johnson & Johnson, East Windsor, NY), a 40-60-mesh microporous durapatite ceramic (Periograf, Sterling Drug, Inc., Rensselaer, NY), and a 1-2-mm-diameter hydroxyapatite ceramic (Osprovit, Feldmuhle Aktiengeselschaft, Plochingen, Germany) with macropores larger than 100 microns. Cell proliferation and alkaline phosphatase activity were assessed by incorporation of 3H-thymidine into trichloroacetic-acid-precipitable material and by a fluorimetric method, respectively. Cell viability and compatibility with the materials were determined by morphology in phase-contrast microscopy. Periosteal cells showed increased proliferation following exposure to Synthograft, but were unaffected by Osprovit, whereas Periograf caused significantly reduced cell growth. Alkaline phosphatase activity was unaffected by Osprovit, but was decreased by both Synthograft and Periograf. The results indicated a differential response of periosteal cells to bone-substituting materials with heterogeneous physico-chemical characteristics.

[A bacteriological study of supragingival bacterial plaque in subjects undergoing orthodontic therapy]. / Studio batteriologico della placca batterica sopragengivale in soggetti sottoposti a terapia ortodontica.

Direct contact between tooth enamel and bacteria is currently considered a sine qua non of tooth decay. Any condition which encourages the deposit and accumulation of bacterial plaque represents a risk factor for tooth decay. Dental therapy often entails the use of bands or brackets which house metal apparatus used to apply force or support mobile devices (plates, etc.). It is therefore possible to hypothesise that, by preventing its mechanical removal, dental treatment can lead to quantitative and qualitative changes in bacterial plaque.

[The polymerization exothermicity of self-curing resins. Thermal measurements in the pulp chamber]. / L'esotermia di polimerizzazione delle resine autoindurenti. Misurazioni termiche in camera pulpare.

The study first assessed the influence of the quantity of resin and the type of matrix on exothermic polymerisation of self-curing resins. The temperature in vitro inside the pulp chamber was then measured during the preparation of a provisional single and multiple sample using different matrices; samples were prepared using a direct technique.

[Bonding between resins for bridges and crowns and composites: an experimental quantitative assessment]. / Il legame tra resine per ponti e corone e compositi: valutazione quantitativa sperimentale.

Bonding between resin for bridges and crowns and composite substances: an experimental and quantitative assessment. Using a rigorous scientific protocol, a photopolymerizing composite was "stuck" in vitro to samples of four resins C + B using an enamel-dentine bonding and silanic primer. Subsequently, bonding was performed in two experimental conditions (dry and humid environments) in addition to analysing the site of fracture.

[Orofacial tuberculosis. A general and anatomico-clinical analysis of 35 cases]. / La tubercolosi oro-facciale. Analisi generale ed anatomo-clinica di 35 casi.

Anatomo-clinical data of 35 cases of maxillofacial tuberculosis are reported; the different clinical presentations of primary and secondary forms (ulcers are the most common clinical feature) and of rare form (lupus) are described and the problems concerning differential diagnosis and therapy are discussed. In the author's experience the microinvasive cytohistologic techniques (FNAB) with elective histochemical stains have been founded very usefully. The role of the stomatologist in the early diagnosis of this still-diffuse and misleading pathology is also underlined.