Evaluation of bradykinin, VEGF, and EGF biomarkers in gingival crevicular fluid and comparison of PhotoBioModulation with conventional techniques in periodontitis: a split-mouth randomized clinical trial.

Periodontal disease is a chronic progressive inflammatory process leading to damage of tooth-supporting tissues. This comparative study assessed the effect of PhotoBioModulation (PBM) versus conventional therapy, and investigated biomarkers involved in the healing process. The test group comprised twenty systemically-healthy non-smoking subjects with chronic periodontitis with the presence of two matched contro-lateral premolar sites (probing depth > 5 mm); twenty subjects without chronic periodontitis (CP) served as control group. Patients were treated at baseline, either with scaling and root planing (SRP group) or with a procedure entailing SRP supported by PBM (PBM group). The laser used was a diode laser operating at 645 nm wavelength, 10 J/cm2, and 0.5 W/cm2 with a 600 µm fiber optic. Crevicular fluid levels of bradykinin (BK), vascular endothelial growth factor (VEGF), and epidermal growth factor z (EGF) were determined at both sites. Crevicular fluid specimens from both groups were analyzed with the ELISA TEST. Clinical differences in analyzed outcomes were observed in favor of PBM treatment. Taking average values as 100%, the reduction in BK concentration was 47.68% with SRP and 68.43% with PBM on day 3; the VEGF concentration decreased by 35.73% with SRP and 48.59% with PBM on day 7; the EGF concentration increased by 55.58% with SRP and by 58.11% with PBM on day 21.Clinical parameters improved significantly in both groups (pooled mean values of probing depth decreased from 5.6 to 4.5 mm; gingival index from 1.92 to 1.1; and bleeding on probing from 49.67 to 23.23) but did not vary significantly between the PBM and the SRP group. The results confirmed that PBM have beneficial effects in the early phases of the healing process playing a role in modulation of BK, EGF, and VEGF in gingival crevicular fluid levels; both groups had significant clinical improvement over control but there was no significant difference between them, only a trend for PBM group. The overall results of the study suggest a potential benefit of PBM in conjunction with SRP in treating chronic periodontitis.

A multicenter, prospective, randomized trial of pain and discomfort during maxillary expansion: Leaf expander versus hyrax expander.

BACKGROUND: Pain suffered by the young patient is the most frequent symptom during orthodontic treatment and is the one that most frightens children and causes worry in their families. AIM: To investigate pain perception and function impairment during the first week of activation of two palatal expansion screws. DESIGN: A total of 101 subjects were randomly divided into two groups: RME group included patients treated with the standard hyrax expansion screw and LEAF group included patients treated with Leaf Expander appliance. Pain intensity was assessed via the Wong-Baker scale. A questionnaire on oral function impairments was also compiled by the patients. RESULTS: The Pain Scale analysis showed that patients in the RME group suffered from a significantly higher level of pain than those in the LEAF group (88.6% vs 25%, P < .01). RME group showed highest pain indexes from day 1 to day 4 (51.4% RME vs 9.7% LEAF suffered at least once from strong pain in the first 4 days, P < .01). Furthermore, oral functions were similarly affected in both groups. CONCLUSIONS: Pain reported during maxillary arch expansion is influenced by clinical activation protocol and by the screw type. Patients treated with Leaf Expander reported significantly lower pain level in the first 7 days of treatment.

Efficacy of ketoprofen lysine salt and paracetamol/acetaminophen to reduce pain during rapid maxillary expansion: A randomized controlled clinical trial.

BACKGROUND: Rapid maxillary expansion (RME) is an orthopaedic procedure indicated for a wide variety of clinical conditions. AIM: The aim of the study was to compare the effects of ketoprofen lysine salt (KLS) vs paracetamol/acetaminophen (P) on pain perception during RME. DESIGN: One hundred and fifty-one subjects (mean age 8.6 year) were enrolled in this prospective controlled clinical trial according to inclusion criteria: prepuberal stage of development, negative posterior transverse interarch discrepancy, non-concurrent use of other drugs. First phase: n.40 allocated to Group 1 used 40 mg of KLS, n.40 to Group 2 used 250 mg of P, n.36 to Group 3 as control group. Second phase: n.35 allocated to Group 4 used 40 mg ketoprofen lysine salt once a day for the first 3 days of activation. Pain experience was reported on a numeric rating scale (0-4) and a 100-mm visual analogue scale. Pain perception was tested with the Mann-Whitney test (P < 0.05). RESULTS: Pain perception was higher during the first 3 days of activation and it was described as mild to moderate. Group 1 experienced significantly less pain during the fourth, fifth, and sixth day (P < 0.05) compared with Group 2. Patients of the Group 4 reported significantly lower pain during the whole period of RME activation (P < 0.05). CONCLUSIONS: The perceived higher pain was reported during the second and third day of expansion. The analgesic effect of KLS is more effective than P during the fourth, fifth, and sixth day. The use of KLS during the first 3 days of activation seems to be able reducing pain during the whole active phase.

Three-dimensional evaluation of upper airway in patients with obstructive sleep apnea syndrome during oral appliance therapy.

Obstructive sleep apnea syndrome (OSAS) represents a frequent and common respiratory disease characterized by repeated episodes of complete and/or partial obstruction of upper airways during sleep, normally associated with reduction of oxygen saturation in blood. The oral appliances (OAs) are considered to be an effective treatment modality thanks to the upper airway enlargement. Lateral cephalometry has been used for the 2-dimensional evaluation of upper airway form with several limits. We obtained an accurate 3-dimensional (3D) volume analyses with cone beam computed tomography (CBCT) scans to confirm the effects of OA on the upper airway in patients with OSAS. Ten Italian patients with moderate or severe OSA (3 males and 7 females, 53.4 ± 11.3 years of age, and BMI 24.5 ± 2.7), who cannot tolerate continuous positive air pressure therapy and rejected a surgical approach, were treated with non-adjustable customized OAs and evaluated with CBCT and polysomnography. Upper airway form was examined in the presence and absence of OA and the volume was measured and compared in 2 different areas. Specific planes have been considered to match the data and calculate the benefit obtained with therapy. Nine out of ten patients showed an improvement of total upper airway volume and an improvement in apnea-hypopnea index. Volume increased both in the posterior soft palate region and in the posterior tongue region. In the inferior area, we observed greater differences. 3D image reconstruction accurately confirmed morphological changes in the upper airway during OA therapy. The use of this 3D evaluation is expected to improve the results of OA therapy in the future.

Orthodontic Treatment of Binder Syndrome: A Case Report With 5 Years of Follow-up.

We report here the case of orthodontic nonsurgical treatment in a patient with Binder syndrome. This rare syndrome (<1/10,000) is a deforming alteration of the middle third of the face, also known as maxillonasal dysplasia/dysostosis. The therapeutic approach often undertaken is an orthodontic-surgical protocol, which includes several invasive interventions such as LeFort I or II. In this patient and early diagnosis made it possible to intervene on an orthodontic level only, thus avoiding highly invasive surgical procedures (as of a 5-year follow-up).

Accidental aspiration of foreign bodies in dental practice: clinical management and prevention.

OBJECTIVE: Foreign body aspiration is a possible complication of dental treatment that may result in a life-threatening situation. The foreign body is often spontaneously ejected from the airway, but in other cases, surgical intervention is needed. Prevention, diagnostic procedures, treatment and complications are discussed. MATERIALS AND METHODS: Three cases of aspiration of dental instruments are described: the piece was localised in the right main bronchus in two cases and in the left main bronchus in one case. RESULTS: All three cases underwent surgery (resection and bronchoscopy); in one case, the surgical attempt failed, and the foreign body was not located by radiography; it was assumed to have been expelled spontaneously. CONCLUSION: The management of dental materials and instruments requires particular care, especially if the patient is supine or semi-recumbent. The dentist must be able to manage emergency situations in which patients accidentally inspire or swallow dental instruments or materials during treatment. Preventive techniques must be put in place because these incidents are preventable if the correct precautions are taken.

Correlation between facial growth patterns and cortical bone thickness assessed with cone-beam computed tomography in young adult untreated patients.

BACKGROUND: The vertical facial growth pattern is one of the most important issue in the orthodontic diagnosis and treatment. Previous studies investigated the association between interdental bone thickness and facial divergence using mainly bidimensional analysis. When two-dimensional dental radiographic views are not sufficient for diagnosis and measurements, cone-beam computed tomography (CBCT) images should be used to assess the alveolar bone structure three-dimensionally and with high accuracy and reliability.The aim of the present study was to evaluate the correlation between alveolar bone thickness and facial divergence in young adults untreated patients using a three-dimensional method analysis with CBCT images. METHODS: Records of 30 untreated patients (mean age 16 ± 2 years) with Angle Class I and mild to moderate crowding were analyzed. Subjects were classified as hypodivergent (<39˚), normodivergent (41 ± 2˚), and hyperdivergent (>43°). according to the inter-maxillary angle between the sagittal maxillary plane (ANS-PNS) and the mandibular plane (GN-ME). The alveolar bone thickness measurements were taken for the buccal and palatal/lingual surfaces of maxillary and mandibular anterior teeth. Axial-guided navigation (AGN) was used to locate all landmarks using a specific software (Horos 3.0). RESULTS: The statistical analysis showed a significant difference between the hypodivergent and hyperdivergent group regarding buccal bone height (P = 0.005), buccal apical bone thickness (P = 0.003) and palatal mid-root bone thickness (P = 0.006). Moreover, buccal bone height (P = 0.006) was found to be statistically significant different in normodivergent compared with hypodivergent individuals. CONCLUSIONS: Facial types were found to be correlated with alveolar bone thickness. The hyperdivergent subjects presented thinner alveolus bone in the anterior maxilla and at almost all sites in the mandible. Clinicians should be aware of the possibility of thin cortical bone plates in hyperdivergent patients, reducing antero-posterior movements to avoid fenestration and dehiscence.

Assessment of the Stability of the Palatal Rugae in a 3D-3D Superimposition Technique Following Slow Maxillary Expansion (SME).

The Palatal Rugae are considered a useful human identification marker for both orthodontists and forensic personnel. The principal aim of the present study was to evaluate the stability of palatal rugae with a 3D-3D superimposition procedure following Slow Maxillary Expansion (SME), in order to assess whether they kept their uniqueness and validity for human identification, even after a specific dental treatment. For this purpose, a sample of 27 digital dental models - belonging to growing patients (13 males and 14 females), aged between 8.5 and 15 years, who underwent SME therapy - was retrospectively studied and compared with a control group of 27 untreated subjects - (13 males and 14 females). Digital dental models were obtained pre-treatment and at device removal; both were processed by means of an intraoral scanner. A superimposition procedure was thus performed to reach the minimum point-to-point distance between two models of palatal rugae. Intra- and inter-observer differences were statistically analyzed by paired Wilcoxon test and Intra-class Correlation coefficient (ICC), showing values larger than 0.93. There was no difference in Root-Mean-Square (RMS) values between untreated control subjects and subjects treated with Leaf Expander (p = 0.062). A RMS value of 0.43 was the threshold to distinguish the pooled group ("Untreated" and "Leaf") from any mismatch. According to the obtained results, this study failed to reject the null hypothesis and presented no differences between the RMS values of the Test group and the RMS values of the untreated control group. This work highlighted the usefulness of 3D superimposition procedure for purposes of human identification, in subjects undergoing dental treatment. However, keeping in sight the forensic use of this technique as a helpful probation element in court, further studies should be performed to confirm these findings.

Volumetric Changes in the Upper Airways after Rapid and Slow Maxillary Expansion in Growing Patients: A Case-Control Study.

The aim is to evaluate changes in the volume of the upper airways before and after slow maxillary expansion (SME) obtained with the flexible properties of a nickel titanium leaf spring and rapid maxillary expansion (RME) with a conventional Hyrax appliance in growing patients. The records of 1200 orthodontic patients undergoing maxillary expansion from 2018 to 2019 were analyzed; among these pre and post treatment CBCT scans of 22 patients (mean age 8.2 ± 0.6 years old) treated by SME were compared with those obtained from 22 patients (mean age 8.1 ± 0.7 years old) treated by RME banded on the second primary molars. The following inclusion criteria were used: Maxillary transverse constriction, good general health, and no previous orthodontic treatment. Volumes of nasal cavity (NCavV), nasopharynx (NsPxV), and right and left maxillary sinuses (MSV) were calculated with ITK-SNAP. Shapiro-Wilk test revealed a normal distribution of data in each group. Paired t-test was used for within-group comparisons and independent t-test for between-group comparisons. Statistically significant increases occurred in NCavV, NsPxV, and MSVs after treatment with both appliances. No statistically significant difference between the appliances occurred in NCavV, NsPxV, and MSVs. Method error was considered negligible (mean intra-operator and inter-operator intraclass correlation coefficient were 0.928 and 0.911, respectively). It appears that both appliances produce similar effects on the different segments of the upper airway tract.

The efficacy of orthodontic treatments for anterior crowding with Invisalign compared with fixed appliances using the Peer Assessment Rating Index.

OBJECTIVE: The purpose of this retrospective study was to determine the efficacy of Invisalign in a large sample of patients compared to fixed appliances. METHOD AND MATERIALS: The test group consisted of 100 patients treated with Invisalign compared with a control group treated with conventional fixed appliances matched for sex, age, and initial severity of malocclusion based on the amount of anterior dental crowding (Little Index) and the Peer Assessment Rating (PAR Index) scores. The retainer used was a 0.0175-inch multistranded stainless-steel wire bonded from canine-to-canine in the mandibular arch and from lateral inisor-to-lateral incisor in the maxillary arch. A paired t test was used to compare both initial and final PAR scores. RESULTS: There was an overall 80.9% improvement, and 63 subjects did not need any refinement. The mean number of aligners used was 14 (+ 15 for the refinements) in the maxillary arch and 29 (+ 14 for the refinements) in the mandibular arch. The mean duration of treatment was 14 months (+ 7 months for the refinements). Significant statistical differences were found in the posttreatment scores, within both the Invisalign group and the control group. No differences were found in the follow-up scores. Additionally, the duration of treatment was 4 months longer in the control group. CONCLUSION: More than 90% of the subjects treated with Invisalign achieved a significant improvement, as shown by the PAR scores. A need for additional aligners was reported for 37% of the patients. Fixed bonded retainers seem to be a good option in preventing tooth relapse after Invisalign and fixed conventional treatments.

Advanced 3D Models Cultured to Investigate Mesenchymal Stromal Cells of the Human Dental Follicle.

The human dental follicle (hDF) contains the developing tooth and is involved in regulating tooth maturation and eruption. To investigate the mesenchymal stromal cells of the dental follicle, 2 three-dimensional (3D) culture models were used, based on a dynamic bioreactor: the Rotary Cell Culture System (RCCS™) and the 3D culture of precursor cells isolated from follicular tissue (human dental follicle cells [hDFCs]). The hDFCs were obtained from impacted third molars of 20 patients. Two 3D culture models were tested. In the first model, intact hDF explants were cultured in 3D conditions, preserving the original tissue architecture; they were studied using histomorphological and molecular analyses. The second model involved the 3D culture of hDFCs, which were characterized to evaluate their multipotency in terms of differentiation capability. Of the biomarkers known to characterize hDFCs, hDF precursors were selected for our study. The immunophenotype and in situ immunocytochemistry were evaluated for markers CD44, CD90, CD146, CD105, CD31, CD34, and CD45 Ag. The results show that the conditions provided by the RCCS preserve the original organizational architecture of the cells. The 3D conditions of the model enhanced differentiation in response to adipogenic, osteogenic, and chondrogenic inductive growth media. The immunophenotype and the immunocytochemistry showed generally high expression of CD90, CD44, and CD105, while CD146 expression was more restricted to ∼30% of cells. No expression was observed for CD31, CD34, and CD45 Ags. Two 3D tissue- and cell-based ex vivo models of the hDF supported the long-term maintenance of hDF-specific cell phenotypes and their ability to recapitulate typical cellular differentiation states. As such, these ex vivo models could be used to study the physiopathology of human odontogenesis. In addition, in a therapeutic context, they could be used to examine the role of specific chemical signals (e.g., new therapeutic agents) in the processes of dental tissue repair and regeneration.

Timing considerations on the shear bond strength of orthodontic brackets after topical fluoride varnish applications.

OBJECTIVES: To assess the best temporal association between the application of a fluoride varnish on enamel and bonding procedures. MATERIALS AND METHODS: Eighty mandibular bovine incisors were used. Teeth were divided into 4 groups (20 per group); Groups 1-3 were treated with fluoride varnish (Fluor Protector, Ivoclar Vivadent, Schaan, Liechtenstein), and Group 4 served as control with no pretreatment. Tooth were stored in deionized water (37°C) and subjected to thermal cycling for 400 (Group 1), 800 (Group 2), and 2500 (Group 3) cycles corresponding, respectively, to 15, 30, and 90 days in order to simulate the three different timing of bracket bonding. Shear bond strength (SBS) was measured using an Instron Universal Testing machine. Tooth surfaces were examined under a stereomicroscope at 10× magnification to assess the amount of adhesive remnant index (ARI). One-way analysis of variance (ANOVA) and Tukey's honestly significant difference post-hoc test were used for the comparison of SBS values between groups (P < 0.05). The Chi-square test was used to examine differences among ARI scores. (P < 0.05). RESULTS: One-way ANOVA and Tukey post-hoc test showed that the SBS of different groups were significantly different and was impacted by different timing of bonding (P < 0.05). The main differences were between the control group (17.02 ± 6.38 MPa) and Group 1 (6.93 ± 4.3 MPa). The ARI scores showed that there were no significant differences between the four tested groups. CONCLUSIONS: The SBS of the brackets bonded 15 days after the application of the fluoride was set back to an optimal value.

Idiopathic hypoplasia of the masseter muscle: A case report.

OBJECTIVE AND IMPORTANCE: Hypoplasia of the masseter muscle is a rare condition, described as partial or total, associated with congenital malformations or pathologies. Rare cases are those with no genetic alterations in their familiar picture. The authors present a case of an idiopathic masseter muscle hypoplasia in the absence of other pathologies. CLINICAL PRESENTATION: The case report involved a patient who presented to the consultant clinic complaining of facial asymmetry. The patient underwent several exams to confirm the diagnosis of masseter muscle hypoplasia, which included an X-ray, magnetic resonance of the temporomandibular articulation, and electromyography. INTERVENTION: The patient was treated with a customized functional appliance and fixed orthodontic treatment with satisfactory functional and esthetic results. CONCLUSION: The case presented highlights the possibility of finding a hypoplasia of the masseter muscle even in the absence of other pathologies and without specific clinical symptoms, and how to plan an appropriate treatment with functional appliance and fixed orthodontic therapy.

Titanium and Zirconium Levels Are Associated with Changes in MicroRNAs Expression: Results from a Human Cross-Sectional Study on Obese Population.

OBJECTIVES: In this study on 90 individuals we aimed at evaluating the microRNAs (miRNAs) expression profile associated with personal levels of Titanium (Ti) and Zirconium (Zr) traced in hair samples. Ti and Zr materials are broadly used for dental implants but the biological reactions triggered by a long term presence of these materials in the oral cavity still need to be assessed. MiRNAs are mechanisms that need to be investigated as they play a fundamental role in the control of gene expression following external stimuli and contribute to a wide range of pathophysiological processes. METHODS: Using the TaqMan® Low-Density Array, we assessed the expression levels of 377 human miRNAs in peripheral blood of 90 subjects. Hair samples were analyzed for Ti and Zr content using Inductively Coupled Plasma-Mass Spectrometry. We performed multivariable regression analysis to investigate the effects of Ti and Zr exposure on miRNA expression levels. We used the Ingenuity Pathway Analysis (IPA) software to explore the functional role of the investigated miRNAs and the related target genes. RESULTS: Seven miRNAs (miR-99b, miR-142-5p, miR-152, miR-193a-5p, miR-323-3p, miR-335, miR-494) resulted specifically associated with Zr levels. The functional target analysis showed that miRNAs are involved in mechanisms such as inflammation, skeletal and connective tissue disorders. CONCLUSIONS: Our data suggest that Zr is more bioactive than Ti and show that miRNAs are relevant molecular mechanisms sensitive to Zr exposure.

Cell-mediated drug delivery by gingival interdental papilla mesenchymal stromal cells (GinPa-MSCs) loaded with paclitaxel.

OBJECTIVE: Gingival tissue is composed of cell types that contribute to the body's defense against many agents in oral environment, wound healing and tissue regeneration. Thanks to their easy and scarcely invasive withdrawal procedure, interdental papilla provide a good source of mesenchymal stromal cells (GinPa-MSCs). We isolated GinPa-MSCs and verified their ability to uptake/release the anticancer agent Paclitaxel (PTX). METHODS: In vitro expanded GinPa-MSCs were characterized for CD markers by FACS, tested for differentiation ability and analyzed by TEM. Their ability to uptake/release PTX was assessed according to a standardized procedure. RESULTS: The CD expression and chondro-adipo-osteo differentiation ability confirmed the mesenchymal feature of GinPa-MSCs. Surprisingly, 28% of GinPa-MSCs expressed CD14 marker and had an impressive pinocytotic activity. GinPa-MSCs were able to take up and release a sufficient amount of PTX to demonstrate effective in vitro activity against pancreatic carcinoma cells, suggesting that the drug was not inactivated. CONCLUSIONS: The procedure to obtain MSCs from interdental papilla is less invasive than that used for both bone marrow and adipose tissue, GinPa-MSCs are easy to expand and can be efficiently loaded with PTX. Taken together these qualities suggest that GinPa-MSCs may prove to be a good tool for cell-mediated drug delivery in cancer, particularly if related to stomatognathic system.

Laser-assisted treatment of dentinal hypersensitivity: a literature review.

The purpose of this literature review was to evaluate the effectiveness of the laser-assisted treatment of dentinal hypersensitivity. A review with inclusion and exclusion criteria was performed from January 2009 to December 2014 with electronic data-bases: MedLine via PubMed, Science Direct and Cochrane Library. Research of paper magazines by hand was not considered. Forty-three articles were selected between literature reviews, in vitro studies, clinical trials, pilot and preliminary studies. The items were divided into laser-used groups for an accurate description, and then the reading of results into various typologies. Laser-assisted treatment reduces dentinal hypersensitivity-related pain, but also a psychosomatic component must be considered, so further studies and more suitable follow-ups are necessary.

Effects of six different preventive treatments on the shear bond strength of orthodontic brackets: in vitro study.

Objective: The aim of this study is to evaluate the effect of six different prophylactic agents on shear bond strength (SBS) of orthodontic brackets. Materials and methods: One hundred twenty-six freshly extracted mandibular bovine incisors were used. Teeth were randomly divided into 7 equal groups (18 per group) as follows: group-1 served as control with no pre-treatment; group-2 enamel treated with fluoride varnish (Fluor Protector, Ivoclar Vivadent); group-3 containing casein-phosphopeptide-amorphous calcium-phosphate (CPP-ACP) paste (GC Tooth Mousse, RECALDENT™); group-4 with ozone (HealOzone, Kavo); group-5 with glycine powder (Perio Flow, EMS); group-6 with hydroxyapatite powder 99.5% (Coswell S.p.A.); group-7 with a toothpaste made of hydroxyapatite nanocrystals (BioRepair® Plus, Coswell S.p.A). Brackets were all bonded using the same technique with transbond XT (3 M Unitek, Monrovia, CA). All the bonded specimens were stored for 24 h in deionized water (37 °C) and subjected to thermal cycling for 1000 cycles. The SBS was measured with an Instron Universal Testing machine and the adhesive remnant was assessed with the adhesive remnant index (ARI) using a stereomicroscope at 10× magnification. Results: Statistical differences (ANOVA) were found among the seven investigated groups (F = 12.226, p < 0.001). SBS of groups 2, 5 and 6 were significantly lower than the control group (p < 0.05). ARI scores (chi-square test) were correlated with the differences of SBS values. Conclusion: CPP-ACP paste, ozone or BioRepair® did not compromise on bracket bond strength. Fluoride, glycine or hydroxyapatite significantly decreased the SBS; only the fluoride group showed significant clinically low (<6 MPa) SBS values.

Complete pre-eruptive idiopathic crown resorption.

The purpose of this paper was to present the unique case of complete pre-eruptive idiopathic crown resorption, few of which have ever been reported, because most have concerned partial idiopathic crowns. Crown resorption affects only a part of the crown and begins when crown mineralization is complete, leading to hypomineralization of the teeth. Treatment usually consists of restorative/endodontic care or extraction. A 12-year-old-boy presented with complete idiopathic resorption of the permanent mandibular left third molar and secondary failure of eruption of the permanent mandibular left first molar. The finding was incidental during routine radiographs for orthodontic treatment and was documented using cone beam computed tomography and computed tomography (one-mm slices). Follow-up, using a panoramic radiograph, occurred after one year, confirming the absence of the third molar. No preventive or therapeutic regimen is known.