Apical transportation using Mtwo or Reciproc retreatment systems in severely curved canals: a micro-computed tomographic study.

OBJECTIVE: To assess apical root canal transportation using Mtwo or Reciproc during retreatment of severely curved canals, using a multi-analytical approach. METHODS: Forty mesial canals from mandibular molars (Vertucci type IV) were evaluated before and after endodontic retreatment to compare apical transportation with Mtwo retreatment or Reciproc. The systems were used on the same root but alternating the mesial canals. The analyses were performed by micro-computed tomography. Four evaluations were performed: (a) longitudinal transportation, (b) horizontal transportation, (c) variation in the angle of curvature of the canal, and (d) canal-root width ratio. Horizontal transportation and canal-root width ratio were evaluated in 1-, 3-, and 5-mm levels. RESULTS: Longitudinal transportation occurred in all samples, with a mean of 0.13 mm for Mtwo and 0.17 mm for Reciproc. Horizontal transportation increased as distant from the apex was the evaluated level, in mean. However, the transport was not observed in all samples. The mean angle of curvature was 4.16 for Mtwo and 3.03 for Reciproc. Canal-root width decreased as distant from the apex was the evaluated level. No significant differences were observed considering all tested variables, independently of the retreatment system or evaluated level (p > 0.05). CONCLUSION: Mtwo retreatment and Reciproc presented similar apical transportation (horizontal or vertical). CLINICAL RELEVANCE: Both Mtwo retreatment and Reciproc systems could be considered safe regarding apical transportation.

Stage II and stage III periodontitis clinical burdens of HIV-1 undergoing antiretroviral therapy.

OBJECTIVES: The aim of this retrospective cross-sectional study was to estimate the association of HIV-1 infection under highly active antiretroviral treatment (HAART) on the clinical parameters of periodontitis. MATERIALS AND METHODS: A total of 205 patients were divided in two groups: 74 HIV + and 131 HIV - . Periodontal probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and visible supragingival biofilm (VSB) were recorded. The association of HIV-1 infection with the presence of at least 3 sites with PPD ≥ 5 mm and/or CAL ≥ 4 mm in non-adjacent teeth was estimated using binary logistic regression models. RESULTS: The variables HIV-1 infection (OR = 5.53, p < 0.0001, 95% CI: 2.45-13.64), age [range 35-50 years old (OR = 5.73, p < 0.0001, 95% CI: 2.49-13.20); > 50 years old (OR = 6.29, p = 0.002, 95% CI: 1.94-20.42)], and VSB (OR = 23.68, p < 0.0001, 95% CI: 8.07-69.53) showed a significant direct association with BOP outcome. CONCLUSIONS: HIV-1 infection under HAART did not have association with the presence of at least 3 sites with PPD ≥ 5 mm and/or CAL ≥ 4 mm. However, HIV patients on HAART had direct association of HIV-1 infection with BOP and an inverse association with PPD. CLINICAL RELEVANCE: These results support that monitoring gingival bleeding associated with oral prophylaxis would be beneficial in the prevention and management of periodontitis in HIV-1 patients on HAART.

Role of professional expertise in the decision-making process for periodontally compromised teeth.

The objective of this study was to evaluate factors that may influence decision-making with regard to extraction or maintenance of periodontally compromised teeth. A questionnaire with 2 distinct clinical scenarios, each including a radiographic image, was provided to students in their final year of dental school and practicing dentists. The participants were asked to record the action that they would take in each case (tooth maintenance vs extraction) and provide a justification for their decision. The questionnaires were answered by 158 dental students and 57 dentists (N = 215). Among the sample as a whole, 31.16% of participants recommended extraction in scenario 1, while only 5.58% recommended that action in scenario 2. In scenario 1, there was a statistically significant difference in the recommendations of the dental students and the dentists, with the former group significantly more disposed to conservative action, that is, maintenance of the tooth (P < 0.001; chi-square test). When the actions recommended by participants specializing in implants or periodontics (or both) were compared with those recommended by other specialists, there was a statistically significant difference between the groups regarding maintenance and extraction (P = 0.012; Fisher exact test), with the former group recommending fewer extractions. When the responses were evaluated in terms of the participants' years of specialty practice, it was observed that professionals with fewer than 20 years of practice were more conservative in their decisions, choosing tooth maintenance significantly more often than specialists with longer experience (P = 0.031; Fisher exact test). Among the majority of both dental students and practicing dentists, the decision in both scenarios was to maintain the compromised teeth; however, the results suggested that that both the years of experience of the individual and the specialty of the practitioner can influence decision-making.

Clinical oral profile of pediatric patients with atopic dermatitis: A cross-sectional study.

OBJECTIVES: This work aims to describe oral health conditions, eating habits, and oral hygiene in pediatric and adolescent patients with atopic dermatitis and correlate them with the severity of the Scoring Atopic Dermatitis (SCORAD). Also, we aim to estimate the effect of several variables on the diagnosis of dental caries in these patients. MATERIAL AND METHODS: A total of 92 children and adolescents with atopic dermatitis had their oral cavities examined. The effect of independent variables on the diagnosis of dental caries (outcome) was assessed using multiple binary logistic regression model. RESULTS: Mild patients presented higher score of decayed, missing, and filled teeth in permanent dentition than moderate patients (p = 0.040). In the multivariable regression final model, the covariates using inhaled corticoid (OR = 6.4; p = 0.003), type of teething [deciduous dentition (OR = 7.9; p = 0.027) and mixed dentition (OR = 10.5; p = 0.007)], and brushing quality [poor mechanical control (OR = 10.6; p < 0.0001)] demonstrated significant direct effect on the diagnosis of dental caries. CONCLUSIONS: Our findings suggest that the presence of dental biofilm, use of inhaled corticoid, and type of teething are related to the presence of caries in atopic dermatitis patients.

Odontogenic sinusitis: a comprehensive review.

Odontogenic sinusitis (OS) is a highly prevalent, underappreciated and underdiagnosed disease that has been known for over 100 years. Apical periodontitis, periodontal disease and iatrogenic extrusion of foreign bodies into the sinus are the main causes of OS. Although the prevalence of sinus pathosis of dental origin is still controversial, otolaryngologists recognize that in the presence of recalcitrant sinusitis, a dental origin should be considered and properly treated. Currently, cone-beam computed tomography is the gold-standard imaging technique to assess the relationship between dental conditions, especially apical periodontitis and sinus diseases, and whenever this association is detected, patients should be seen by both a dentist and an otolaryngologist in order to achieve complete recovery. This article reviews the current concepts regarding the definitions, diagnosis and management of OS from a clinical point of view.

Study of the causes of facial fractures in a reference center in Rio de Janeiro, Brazil from 2003-2012.

OBJECTIVE: This study describes the facial fractures of patients at a reference center in oral and maxillofacial surgery of a Public University Hospital in the city of Rio de Janeiro, from January 2003 to December 2012. METHODS: The data were collected from medical records and included the fractured bones, etiology, gender, and age of the patients. A total of 202 cases were identified, and 159 were included in the study (129 men and 30 women). RESULTS: The mandible was the most commonly injured bone (90 cases, 73 men and 17 women) with a mean age of 33.7 years old (±15.2), and traffic accidents (75 cases) were shown to be the major cause. CONCLUSION: In the city of Rio de Janeiro, young men in their fourth decade of life are prone to trauma to their facial bones, especially the mandible, and they are most commonly caused by traffic accidents.

Biocorrosion of Endodontic Files through the Action of Two Species of Sulfate-reducing Bacteria: Desulfovibrio desulfuricans and Desulfovibrio fairfieldensis.

AIM: This study assessed the biocorrosive capacity of two bacteria: Desulfovibrio desulfuricans and Desulfovibrio fairfieldensis on endodontic files, as a preliminary step in the development of a biopharmaceutical, to facilitate the removal of endodontic file fragments from root canals. MATERIALS AND METHODS: In the first stage, the corrosive potential of the artificial saliva medium (ASM), modified Postgate E medium (MPEM), 2.5 % sodium hypochlorite (NaOCl) solution and white medium (WM), without the inoculation of bacteria was assessed by immersion assays. In the second stage, test samples were inoculated with the two species of sulphur-reducing bacteria (SRB) on ASM and modified artificial saliva medium (MASM). In the third stage, test samples were inoculated with the same species on MPEM, ASM and MASM. All test samples were viewed under an infinite focus Alicona microscope. RESULTS: No test sample became corroded when immersed only in media, without bacteria. With the exception of one test sample between those inoculated with bacteria in ASM and MASM, there was no evidence of corrosion. Fifty percent of the test samples demonstrated a greater intensity of biocorrosion when compared with the initial assays. CONCLUSION: Desulfovibrio desulfuricans and D. fairfieldensis are capable of promoting biocorrosion of the steel constituent of endodontic files. CLINICAL SIGNIFICANCE: This study describes the initial development of a biopharmaceutical to facilitate the removal of endodontic file fragments from root canals, which can be successfully implicated in endodontic therapy in order to avoiding parendodontic surgery or even tooth loss in such events.

Levels of HIV-1 in subgingival biofilm of HIV-infected patients.

AIM: The aims of the current study were to compare the levels of HIV-1 in the subgingival biofilm (SHVL) between detectable and undetectable plasmatic HIV-1 viral load (PHVL) in HIV-infected patients as well as to determine the association of SHVL with PHVL and clinical periodontal parameters. MATERIAL AND METHODS: Forty-one HIV-infected individuals were divided into two groups: detectable (21) and undetectable (20) PHVL. Subgingival biofilm samples were obtained for detection and quantification of HIV-1 by real-time RT-PCR. To estimate the effect of co-variables on the outcome undetectable SHVL, the Generalized Estimation Equation (GEE) was employed. RESULTS: Detectable SHVL was observed only in the detectable PHVL group and the detection of the HIV-1 was observed in 40% of these individuals. In the bivariate analysis between co-variables from the individual level and the outcome SHVL, significant difference was observed only for the CD4+ T lymphocytes levels (p = 0.017). The multiple logistic model demonstrated that only CD4+ T lymphocytes levels had a significant effect on the outcome undetectable SHVL [OR 8.85 (CI 3.6-9.2), p = 0.002]. CONCLUSION: HIV-1 can be detected and quantified in the subgingival biofilm of HIV-infected individuals, but these findings are not associated with PHVL and periodontal clinical parameters.

Gender differences in oral manifestations among HIV-infected Brazilian adults.

AIM: The purpose of this study was to compare gender differences in the prevalence of oral lesions in HIV-infected Brazilian adults. METHODOLOGY: A retrospective study was conducted of medical records from HIV/AIDS patients from 1993 to 2004. Oral lesions were only included in this study if definitively diagnosed through microscopic analysis, therapeutic test or according to EC-Clearing house criteria. RESULTS: A total of 750 men and 237 women were included in the study. Statistically significant differences were observed only for oral hairy leukoplakia, Kaposi sarcoma and lymphadenopathy (P < 0.01). However, a model of logistic regression showed that only oral hairy leukoplakia presented a significant association with gender and males had a significantly likelihood (four times higher than females) of presenting with this oral manifestation [OR 4.3 (95% CI: 1.39-13.36)]. CONCLUSION: These data shows that oral manifestations are less prevalent in females than in males, particularly oral hairy leukoplakia.

Detection of sulphate-reducing bacteria in human saliva.

OBJECTIVE: The aim of the current study was to investigate the presence of sulphate-reducing bacteria (SRB) in human saliva and correlate with oral and systemic conditions. METHODS: Saliva samples were collected from 118 patients and inoculated in 2 ml of modified Postgate's E medium culture. After 28 days of incubation at 30°C the presence of SRB was identified by the production of sulphide. RESULTS: Of 118 saliva samples collected, 35 were positive for the presence of SRB. Three positive samples were randomly chosen to identify the species of SRB by PCR and sequenced. The three selected samples were identified as Desulfovibrio fairfieldensis, Desulfovibrio desulfuricans and Raoultella ornithinolytica. Gastritis (14.4%) was the most prevalent systemic disease, followed by diabetes (3.4%), while periodontitis (11%) and traumatic fibroma (4.2%) were the oral manifestations most frequently found. A bivariate analysis was performed to examine for the presence of SRB and the most prevalent systemic and oral manifestations. Only periodontitis showed a statistically significant association (p = 0.0003). CONCLUSIONS: The results showed SRB can be found in oral microbiota of healthy patients. Regarding the several conditions studied, there was a higher prevalence of SRB in patients with gastritis and patients with periodontal disease, with a possible correlation between the presence of SRB in the oral microbiota and periodontal disease.

Prevalence, Severity of Extension, and Risk Factors of Gingivitis in a 3-Month Pregnant Population: A Multicenter Cross-Sectional Study.

The scope of this study was to assess the prevalence, severity of extension, and risk factors of gingivitis among pregnant women. In this cross-sectional study, 220 nulliparous women at 3 months of pregnancy were recruited in 2022 at the first obstetrical visit in Dakar, Senegal. Demographic characteristics, lifestyle habits, prenatal clinical status, and oral clinical parameters were recorded. Multivariable logistic regression modeling was used to assess relationships between gingivitis and risk factors. Eighty-eight percent of women had gingivitis, 15% were classified as moderate and 73% as severe. A total of 66.7% (95% CI [28.8-92.1]) of the sites had bleeding on interdental brushing. The odds for gingivitis decreased significantly for women consuming more than five portions of fruits and vegetables per day (OR = 0.15; 95% CI [0.03-0.66]) and increased in women who had a professional activity (OR = 6.75; 95% CI [1.27-35.87]) and high education. Concomitantly, the percentage of dental plaque (OR = 131.6; 95% CI [10.80-1619.71] and the severity of clinical attachment loss (OR = 7.70; 95% CI [3.16-18.92]) were important risk factors. Inverse associations were observed with increasing body mass index (OR = 0.76; 95% CI [0.63-0.93]). Our results underline that gingivitis cases and bleeding were particularly high among 3-month pregnant women. Literacy and adequate oral hygiene actions to modify behaviors and to achieve meticulous biofilm disorganization could make a favorable change in the gingival health outcome. Additionally, further research is necessary to precisely determine the role of biofilm-induced gingivitis and systemic-induced gingivitis in improving gingival conditions.

Short Implant and Heavy Smokers as Predictors for Failure of Immediate Implants: a Retrospective Study.

Background: The possibility of installing implants in fresh sockets was first proposed as a viable treatment option in the 1970s. Objective: to assess the relationships of subject-level and implant-level characteristics on the failure of immediate implants installed in sites that contained teeth associated or not with chronic apical periodontitis. Material and Methods: A retrospective study was undertaken with data from patients who received immediate implants with a minimum follow-up of 12 months after loading. The Generalized Estimating Equation, applying a multiple logistic regression model, was employed to investigate the association between predictor variables/co-variables and failure of the immediate implants. Results: Four hundred and twenty-three implants were installed (208 uninfected/215 infected sites) in 186 patients (92 men/96 women) with a mean age of 57.1 years old. The survival rate of implants was 91%. Approximately half (215/50.8%) of the alveoli that received immediate implants had chronic apical periodontitis associated with the extracted teeth, and 191 (88.8%) of these survived until the last follow-up visit. When the infection-free sites were analyzed, this frequency was higher (93,3%), but the presence of chronic apical periodontitis did not show statistical significance in the implant failure (p=0.167). Smokers with a consumption of more than 20 cigarettes/day and short implants had more failures (OR:7.66, p=0.012; OR:14.06, p=0.002; respectively). Conclusions: Short implants and consumption of more than 20 cigarettes/day were important predictors for failure of immediate implants, regardless of presence of chronic apical periodontitis. Key words:Osseointegration, dental implant, smokers, study, immediate dental implant loading.

Dental implants in individuals living with HIV-1: Results from a prospective study in patients undergoing highly active antiretroviral therapy.

OBJECTIVE: To assess survival and success rates of dental implants and the occurrence of peri-implant diseases (mucositis/peri-implantitis) in HIV-1-infected individuals. MATERIAL AND METHODS: In this prospective study, 13 HIV-1-infected individuals undergoing highly active antiretroviral therapy (with undetectable plasma HIV RNA levels, and CD4+ T cells > 350/mm3 ) were followed after implant placement, as well as 13 non-HIV-1-infected matched controls. Patients enrolled in this study were followed up to 120 months (mean = 40.6 months; standard deviation = 22.2; range 18 -120 months). Twenty-five implants were placed in pristine healed sites for each group and bone augmentation procedures, when needed, were done only for contour augmentation. Patients were enrolled in a strict periodontal/peri-implant supportive therapy protocol with three recalls per year. The two groups were compared regarding subject-level characteristics (age, gender, smoking, diabetes) and implant-level characteristics (marginal bone level, peri-implant health status). RESULTS: All the implants healed uneventfully and reached 100% survival rates (after at least 18 months) in both groups. There were no significant differences between groups for peri-implant diseases (mucositis/peri-implantitis) and for all subject-level co-variables (p > .05). Only the variables dental implant prosthesis type (DIPT) (p = .021, d = .86) and follow up (p = .011, d = .77) showed statistically significant differences between groups. CONCLUSION: The findings suggest that well-controlled HIV-1-infected individuals are eligible to undergo implant therapy, achieving survival and success rates comparable to non-HIV-1-infected controls.

Paecilomyces variotti in deep dental caries.

Paecilomyces variotti (P. variotti) is a fungal species found in soil, wood and some foods, and has been associated with some severe systemic infections. P. variotti has not been previously identified in carious tissue, and the aim of the present study is to report the presence of P. variotti in a deep carious lesion discussing its possible local and systemic associations. A 28 year-old male was submitted to extraction of the upper left second premolar (tooth #25) presenting a deep carious lesion. After extraction the tooth was cleaved in its long axis, and the infected dentinal tissue was curetted and submitted to microbiological analysis using CHROMagar® Candida medium and Malt Extract Agar. Macroscopic and microscopic analysis confirmed the presence of P. variotti in the carious tissue. Post-operatory period was uneventful, healing of the dental socket was complete, and the patient remained well during the follow-up period. P. variotti, a fungus not considered saprophyte in the oral cavity, was encountered in a deep caries lesion, and its potential association with local and systemic infections should be considered. Key words:Paecilomyces variotti, dental caries.

Leukocyte-platelet rich fibrin on the treatment of a large paradental cyst: a novel regenerative approach.

Leukocyte-platelet rich fibrin (PRF) is an autologous biomaterial formed by platelets, cytokines, growth factors and cells imprisoned on a fibrin mesh, produced according to Choukroun's protocol. The aim of the present article was to report the use of PRF, associated with a bone substitute, on the regenerative treatment of a large bone defect resulting from the enucleation of a paradental cyst involving the posterior mandible. The treatment resulted in the maintenance of the bone volume, and radiographic evaluation showed new bone formation after 40 days, suggesting an osteogenic and osteoinductive effect. Also, the current literature was reviewed.

Canal transportation using Mani GPR or HyFlex NT during the retreatment of curved root canals: A micro-computed tomographic study.

This study assessed the apical transportation using Mani GPR or HyFlex NT during the retreatment of curved root canals. Thirty-eight roots were analysed using micro-CT for the comparison of apical transportation produced by two retreatment systems. Longitudinal transportation, horizontal transportation, variation in the canal angle of curvature and variation in the canal/root width ratio were analysed. Longitudinal transportation was frequently observed, regardless of the system used. The canals retreated with Mani GPR showed a significantly higher horizontal transportation at 1 mm from the root apex (P < 0.01) and greater variation of the canal curvature angle (P < 0.01). The canal/root width ratio was similar between groups (P > 0.05). In conclusion, longitudinal transportation occurred more frequently in the mesial canal walls. Mani GPR showed greater horizontal transportation at 1 mm short of the apex, and higher variation of the canal curvature angle compared with HyFlex NT.

Quality of Root Canal Filling Using a Bioceramic Sealer in Oval Canals: A Three-Dimensional Analysis.

OBJECTIVES: The oval canals may be associated with inadequate debridement, which can affect the quality of the root canal filling, thus the treatment outcome. The aim of the present work was to compare the quality of oval canals fillings using EndoSequence BC sealer with the single-cone technique or cold lateral compaction. MATERIALS AND METHODS: Thirty-eight human single-rooted premolars with oval canals were instrumented to 1 mm from the apical foramen with hand nickel-titanium files, followed by circumferential filing with Hedstrom files. Teeth were paired into two groups based on their micro-computed tomography (CT) morphological parameters. Both groups were filled using EndoSequence BC sealer. The first used a single cone and the other with the cold lateral compaction technique. The voids volume was evaluated by micro-CT and the percentage was calculated for the total length and for the apical 5 mm of each canal. The Mann-Whitney U test was used to assess whether the surface area and obturation length differed significantly between the groups and to compare the percentage of voids for each technique. RESULTS: Both techniques resulted in less than 16% voids, with no statistically significant difference between them for the total canal length and for the apical 5 mm (p > 0.05). CONCLUSIONS: The quality of the obturation performed with the single-cone technique was similar to that achieved with lateral compaction using EndoSequence BC sealer in oval canals.

COVID-19: A Recommendation to Examine the Effect of Mouthrinses with ß-Cyclodextrin Combined with Citrox in Preventing Infection and Progression.

Considered to be a major portal of entry for infectious agents, the oral cavity is directly associated with the evolutionary process of SARS-CoV-2 in its inhalation of ambient particles in the air and in expectorations. Some new generations of mouth rinses currently on the market have ingredients that could contribute to lower the SARS-CoV-2 viral load, and thus facilitate the fight against oral transmission. If chlorhexidine, a usual component of mouth rinse, is not efficient to kill SARS-CoV-2, the use of a mouth rinses and/or with local nasal applications that contain ß-cyclodextrins combined with flavonoids agents, such as Citrox, could provide valuable adjunctive treatment to reduce the viral load of saliva and nasopharyngeal microbiota, including potential SARS-CoV-2 carriage. We urge national agencies and authorities to start clinical trials to evaluate the preventive effects of ßCD-Citrox therapeutic oral biofilm rinses in reducing the viral load of the infection and possibly disease progression.

Biocorrosive behavior of sulphate-reducing bacteria in kerr endodontic files: Determination of the corrosion.

AIMS: This study determined the corrosion rate by mass loss caused by oral strains of sulphate-reducing bacteria (SRB) in Kerr endodontic files (KF), aiming the development of a biopharmaceutical that facilitates the removal of endodontic limb fragments from root canals. MATERIALS AND METHODS: Nine new KF were analyzed after immersion in the modified Postgate E culture medium inoculated with Desulfovibrio desulfuricans oral (84 days), Desulfovibrio fairfieldensis in the consortium (84 days) and environmental D. desulfuricans (119 days). RESULTS: Optical microscopy revealed corrosion suggestive areas in all files submitted to immersion in SRB cultures, presenting a statistical difference (P < 0.05) between the samples environmental D. desulfuricans and KF control and between oral D. desulfuricans and KF control. Epifluorescence microscopy revealed an active SRB biofilm over the entire metal surface of the KF, as evidenced by the SYTO® 9 fluorophore. CONCLUSION: SRB were capable of promoting biocorrosion in Kerr type endodontic files, but with low rate.

Oral Aspects Identified in Atopic Dermatitis Patients: A Literature Review.

INTRODUCTION: Atopic dermatitis is a chronic inflammatory skin condition that is more prevalent in children (10-20% of the world's population) than in adults. As its etiology is multifactorial, it is important to know the most frequent oral manifestations in atopic dermatitis patients. METHODOLOGY: In the last decades, the correlation between atopic dermatitis and conditions and/or changes in the oral cavity has been demonstrated by several studies. The objective of this paper was to describe, through a review of the literature, the oral health conditions and/or oral aspects identified in patients with atopic dermatitis. SEARCH STRATEGY: A descriptive literature review was carried out through a bibliographical survey based on the last 10 years, in order to answer the study questions. RESULTS: As a result, we found six studies with different sample sizes, ranging from 43 to 468 patients, and the majority of them were of cross-sectional study design. DISCUSSION: Two studies performed their analysis through dental exams and reported that patients with atopic dermatitis tend to have a greater frequency of carious lesions, and two studies correlated Candida with atopic dermatitis through mycological analyzes. CONCLUSION: There are a few studies in the literature that identify the oral aspects of atopic dermatitis. More investigations are needed in order to contribute to the knowledge of such oral aspects and the approach to treat these patients regarding oral health.