Radiographic and electronic working length comparison. An in vivo study of three Electronic Apex Locator devices.

The aim of this study is to compare the working length measured with Root ZX (EAL1), Propex II (EAL2) and Endo Analyzer Model 8005 (EAL3) with radiographic measurements during endodontic treatment. Fifty single canal teeth scheduled for endodontic treatment were selected for the study. After endodontic access preparation, pulp chamber was irrigated with 5mL of 5% sodium hypochlorite (NaOCl). The canal was scouted with a size 10 K-file introduced slightly over the apex to verify the canal patency. The working length (WL) was measured using all three EAL devices and radiographically. All measured working lengths were recorded and compared using ANOVA for repeated measures considering the multiple comparison of paired data Least Significant Difference (LSD). The WL mean values for EAL1 were 19.1 ± 1.7 mm; for EAL2 were 19.4 ± 1.7; for EAL3 were 19.4 ± 1.6 and for RG were 19.2 ± 1.7. The Pearson correlation coefficients indicated that the following correlation between electronic devices and radiographic WL: EAL1- 0.986, EAL2- 0.953 and EAL3- 0.931. Considering the mean values compared to radiographic measures, Root ZX gave better results than the other tested EAL devices. Endo Analyzer Model 8005 showed the worst performance.

Microbial leakage evaluation of warm gutta - percha techniques.

The aim of this study is to compare bacterial leakage of MicroHeat and continuous wave with and without endodontic sealer. Thirty-eight single-rooted extracted mandibular premolars were selected and randomly divided into four experimental groups (n=8) and two control groups (n=3). Teeth were prepared with Mtwo NiTi files and obturated with MicroHeat or System B with or without endodontic sealer. Three teeth were used as positive controls (Ct+) and three intact teeth served as negative controls (Ct-). All samples were tested for bacterial infiltration every day for 60 days. On day 32 overall contamination value was 62.5% for Mseal, 75% for Mnoseal, 75% for SBseal and 37.8% for SBnoseal; after 60 days, the final contamination result was 100% for Mseal, Mnoseal and SBseal and 87.5% for SBnoseal. At the end of the observation period, groups showed no statistically significant differences.

Reduction of radiations exposure in endodontics: comparative analysis of direct (GX S-700, Gendex) and semidirect (VistaScan Mini View, Dürr) digital systems.

The importance of intraoral periapical radiography is crucial as it represents a fundamental mean of evaluation and diagnosis for supporting bone and teeth hard tissues diseases and pathologies. Even though conventional film technology is still widespread, presently there are many digital radiography alternatives. Direct digital systems are devices with an intraoral sensor wired or paired wireless with a computer. These devices do generate an image immediately during exposure and acquisition. The semi direct digital systems instead are based on phosphor image plates. Digital radiography offers many chances to improve our patient's healthcare standards reducing exposition to X-rays and the related stochastic radiation risk. Aim of this study is to compare the quality of images for endodontic purposes comparing three systems: conventional films, direct digital radiography and semidirect digital radiography.

Antibacterial activity of first and latest generation bioceramic sealers on the elimination of enterococcus faecalis: An in vitro study.

The main concern of endodontics are bacteria: the microorganisms and the toxins they release determine tissue destruction and inflammatory changes that trigger the pulpal and periapical pathology. Enterococcus faecalis is a particularly hostile bacterium; it is strongly associated with refractory periapical pathology. In this study 3 materials were tested: Aureoseal (OGNA, Italy) (Aur) (first generation bioceramic sealer); Endo Seuqence BC sealer (Brasseler USA, Savannah, GA, USA) (EsBC) (latest generation bioceramic sealer); Endoidrox (OGNA, Italy) (Endx) (calcium hydroxide material). The antimicrobial activity of these materials against Enterococcus faecalis was evaluated using agar diffusion test (ADT). The results confirm the antibacterial activity of bioceramic sealers, which however do not show significant differences in the obtained values; it can therefore be concluded that there has been no increase in the antibacterial efficacy of the latest generation bioceramic sealers compared to those of the first generation.

Complications in sinus lift.

Prosthetic rehabilitation of atrophic maxillary implants often requires grafting owing to vertical and transversal bone deficiency. The use of this procedure in order to insert implants was introduced by Tatum and published as a clinical study by Boyne and James. It can be performed via a lateral or crestal approach. This surgery is now widespread, with good results in terms of bone augmentation and implant osseointegration. Nevertheless, there is a small proportion of patients who have infectious complications with an incidence ranging from 3.5% to 10.5%. We observe that maxillary sinus augmentation is a successful preprosthetic technique for augmentation of the edentulous posterior maxilla. Preoperative assessment of the anatomy of the sinus reduces the rate of complications considerably.

Aesthetic correction of double tooth: simplified technique.

The aim of this study is to report aesthetic conservative treatment of double tooth anomaly. Case report: A 7.5-year-old patient presents an anomaly of the maxillary right upper central incisor with a bifid crown and an increased mesio-distal width and a central incisal notch, probably amenable to a gemination. Single tooth anesthesia and conservative enameloplasty procedure was performed, with universal adhesive and a single shade universal composite restorative material. Adhesive aesthetic restorations allow to resolve dental anomalies quickly, cheaply and asily for pediatric dentistry.

Epidemiological study on radiographic dental health in Albania.

The aim of this epidemiological study is to assess the dental health status of the Albanian population and the most frequently performed dental treatments, also highlighting the differences between sex, geographic area and educational level. The study was performed by analyzing digital orthopanoramic radiographs of 739 Albanian patients, male and female, divided into 5 age groups. In addition, the patients were divided according to regions of origin in North, Centre and South and classified according to the level of education. The parameters examined are as follows: Missed Teeth (MT), Filled teeth (FT), Endodontically treated teeth (TT), Prosthetic restorations (PR). There are no statistically significant results regarding the distribution by area. Subjects with at least one missing tooth (MT) decreases with increasing education level. The percentage of individuals with Missed Teeth in the population increases with increasing age groups. Educational background affects health. This study highlights the need to introduce a national oral health system in Albania that would extend interventions to a wider segment of the population.

Effect of pressure and light curing of composite micro hardness.

The aim of this study is to evaluate the micro hardness Vickers of a composite micro hybrid polymerized under constant pressure. Twelve experimental samples were made equally divided into two groups: an experimental group and a control. Enamel plus HRi (Micerium) microbiotic composite resin, UD3 colour, was inserted into a syringe heater (ENA HEAT Composite Heating Conditioner) so that the material could be brought to a temperature of 39°C. A defined amount of composite resin is taken from the syringe with a Heidemann spatula and placed between two slides, previously cleaned with 90 ° alcohol. The samples are then inserted one at a time into a special device for constant pressure application. Vickers hardness measurements were made on the top of surfaces. The mean value of the samples belonging to the experimental group is 56.81 ± 0.71. The mean value of the control samples is 52.02 ± 2. The results obtained allow us to state that applying a constant pressure during the cementation phase of indirect adhesive restorations allows to obtain better mechanical characteristics of the composite used as a cementing agent.

Dentinal substrate variability and bonding effectiveness: SEM investigation.

Though the literature reports a well-documented scientific evidence of the performance of modern adhesive systems on normal dentin, few researches are available on the interaction between adhesives and compromised dentin. In this study, the authors analyzed the microscopic structural aspects of the adhesive interface on two common altered dentin substrates: dentin contaminated by metallic oxides and caries affected dentin. Thirty teeth were selected and divided in three groups of ten teeth according to the different dentin substrate they had: (A) normal dentin, (B) caries-affected dentin and (C) dentin contaminated by metallic oxides. The experimental cavity preparation was realised exposing in each sample, portion of pathologic dentin and portion of sound dentin as control. Each cavity was restored with micro-hybrid composite, with total etching and a two-step adhesive system. Each sample was sectioned in two halves analysed with two SEM micro-morphological methods: direct observation and decalcification. SEM investigations were able to show the difference in thickness and morphology of the adhesive interface with the two different dentin variables. Caries affected dentin determined the formation of less distinctive resin tags with few micro-tags. Discoloured dentin showed a poor infiltration with few resin tags probably due to alterations in the tubular structures. The micro-morphological variability of dentin substrate influences the clinical efficacy of bonding restorations determining significant differences in the qualitative and quantitative aspects of resin tags.

Comparison of coronal leakage of different root canal filling techniques: an ex vivo study.

The aim of this study was to compare the quality of the coronal seal, using an in vitro bacterial invasion test, of three different root canal filling systems. Twenty-seven freshly extracted mandibular premolars were selected and divided into three experimental groups (G1, G2 and G3 n=7) and two control groups (Ct+ and Ct- n=3). All teeth in the experimental groups were prepared using NiTi Mtwo rotating instruments and then the endodontic treatments were completed using the three-tested warm guttapercha root filling techniques: Microseal (G1), Thermafil (G2) and System B (G3). All root filling techniques were performed using the same endodontic sealer (Pulp Canal Sealer). Three teeth were instrumented and not filled, serving as positive controls (Ct+) and the last three teeth, with intact crowns and no endodontic treatment, served as negative controls (Ct-). All samples were mounted in a two-chamber apparatus and exposed to Enterococcus faecalis performing a bacterial infiltration test. All samples were observed for a maximum period of 60 days checking for turbidity of the BHI broth on a daily basis recording when contamination occurred. A quantitative evaluation of the bacterial CFU/ml was performed using the URO-QUICK™ system. On day 32 an overall value was recorded of contamination of 42.85% for group G1, 71.42% for G2 and 42.85% for G3; after 60 days, the final contamination result was 85.71% for group G1, and 100% for both G2 and G3 groups. Considering the number of contaminated samples at the end of the observation period, the three techniques showed no statistically significant differences. The study highlighted the bacterial permeability of gutta-percha/seal barrier, underlining the importance of an effective coronal restoration to ensure a durable seal after root canal treatment.

Indirect adhesive rehabilitation by cementation under pressure of a case of Dentinogenesis Imperfecta type II: follow-up after 13 years.

AIM: Dentinogenesis imperfecta (DI) is an autosomal dominant genetic disease that affects both deciduous and permanent teeth, with an incidence of 1 out of 6,000 to 1 out of 8,000. Teeth affected with DI type II present bulbous crowns, short and constricted roots, marked cervical constriction, translucent enamel and amber dentin. Also, they present a partial or total obliteration of pulp space, due to continuous dentin production. SEM analysis has shown an undulated dentin-enamel junction (DEJ) with irregularities and locally wide spaces between the two structures instead of a strict junction and a regular linear surface. Treatment options for patients affected by DI-II are intended to protect and restore function and aesthetics of both posterior and anterior teeth. In literature are presented many different therapies, but mainly centered on cemented prosthetic restorations instead of adhesive restorative procedures. We present in this paper a DI-II case successfully treated in 2005 with extensive adhesive rehabilitation. CONCLUSION: The 13 years follow-up proves the reliability of adhesion to dentine and enamel for indirect adhesive restorations even on this kind of anomalous substrates.

Pain and anxiety associated with Computer-Controlled Local Anaesthesia: systematic review and meta-analysis of cross-over studies.

AIM: This review focuses on Computer-Controlled Local Anaesthesia Delivery systems (CCLAD), in comparison with conventional carpule anaesthesia in means of pain and anxiety. METHODS: Medline, Embase, Web of Science and Cochrane Database for Systematic Reviews were searched up to August 2018. Only cross-over split-mouth design studies aimed to clinically compare CCLAD with a conventional carpule anaesthesia are included. Data about pain and anxiety associated with anaesthesia were sought. The authors performed meta-analysis where appropriate. RESULTS: A total of 20 studies are included in the systematic review (n = 973 subjects). Quantitative synthesis (conducted on VAS scores from 8 studies) shows that pain intensity is over 9 points lower in CCLAD than in conventional anaesthesia on a scale from 0 to 100 (95% confidence interval, ?12.90 to ?5,53; P<.001). The systematic review showed no differences between the two techniques according to the physiological parameters of pain (heart rate or blood pressure), and the data about anxiety are inconsistent. CONCLUSION: CCLAD results in significantly slightly less pain perception with respect to conventional injection and is a promising device to help patients. The literature needs to be expanded, mostly regarding anxiety.

Unconventional use of Invisalign® in the treatment of ectopic palatal maxillary canines.

BACKGROUND: The proper development of the dental arches, including the eruption and correct positioning of the canines in the arch, is essential for the oral health of growing patients. Impacted canines not only give rise to functional challenges but also pose esthetic issues for patients. The aim of this article is to show if it is possible to benefit from the exclusive use of transparent aligners to guide the eruption of ectopic upper canines into the arch in the correct position. CASE REPORT: The subject of the study is the clinical case of a 13-year-old female growing patient who presented displaced upper permanent canines located in the palatal ectopic site. Following the surgical extraction of the retained deciduous elements, treatment with aligners for repositioning the ectopic canines in the arch was performed in two phases. At the end of the treatment, a Class I canine was achieved with satisfactory repositioning of the upper canines in the arch. CONCLUSION: The use of transparent aligners makes it possible, with some procedural precautions and in carefully selected cases, to reposition the ectopic palatal canines in the dental arch using a treatment that is both esthetic and effective.

Prevention of malocclusion and the importance of early diagnosis in the Italian young population.

AIM: Malocclusion is an alteration of the normal relationships between skeletal, muscle and dental structures that can lead to impaired functionality as well as aesthetic alteration of the stomatognathic system. Functional alteration can affect various aspects, ranging from chewing ability to respiratory disorders. Paediatricians and dentists are called to prevent and diagnose these conditions as early as possible in order to preserve the patient's health. The purpose of this research is to study the incidence of malocclusion and its relationship with Obstructive Sleep Apnea Syndrome (OSAS) in a young population. Also, the role of paediatricians and dentists in prevention and early diagnosis of this condition was evaluated METHODS: An anonymous survey was given through Google form to 300 Italian children (139 males and 161 females) from different private dental practices in Italy. No personal information that identifies the individuals was collected, and the data was analysed in aggregate form only. All data was collected and statistically analysed. CONCLUSION: The data highlight the patients' good attitude towards dental check-ups, which help to intercept malocclusions. Unlike the past, the knowledge of the importance of oral health and dental occlusion is high among young patients, parents and paediatricians. This study underlines the role of paediatricians as key players in the prevention of dental health problems.

Recurrent aphthous stomatitis (RAS): guideline for differential diagnosis and management.

AIM: Recurrent aphthous stomatitis (RAS) is a painful and common ulcerative form that can pose a diagnostic challenge. In fact, similar oral ulcers can appear secondary to a variety of well-defined pathological conditions. Thus, the purpose of this work was to update the current knowledge about RAS METHODS: A narrative review is presented aiming to clarify the extensive differential diagnosis of RAS and its management. CONCLUSION: As a first aid in relieving the pain, topical applications of corticosteroids, antibiotics, and analgesics are highly recommended, while systemic therapy of RAS should be used in the case of multiple painful ulcerations compromising the quality of life of the patient. Also, natural anti-inflammatory substances from medicinal herbs, in the form of essential oils and extracts are promising agents in the management of RAS.

Paediatric endodontics Part 2: Pulp regeneration: current approaches.

Dental pulp regeneration: An overview of the current approaches. Regenerative Endodontic Procedures (REPs) are biologically based procedures aimed at restoring the damaged structures and physiological functions of the pulp-dentine complex. Clinically, two strategies have been proposed so far to induce REP: cell transplantation and cell homing. REPs success relies primarily on the clinical and biological conditions of the tooth; therefore, cell homing strategies will not be consistently successful in every condition. Root canal treatment remains the standard of care for mature teeth with necrotic pulps and closed apex.

State-of-the-art on MIH. Part. 1 Definition and aepidemiology.

Molar incisor hypomineralization (MIH) is one of the most pressing issues in paediatric dentistry. It is a qualitative enamel defect of systemic origin that affects at least one first permanent molar and can also be associated with permanent incisors. However, the same defects have also been observed on primary molars and other permanent teeth. Hypomineralised enamel has less distinct prisms edges and crystals and the interprismatic space is more marked. Children with MIH undergo dental treatment nearly 10 times more than unaffected children. Preventive treatment following the diagnosis of MIH should take into account patient's age and collaboration, patient's caries risk, type and extension of demarcated lesions and hypersensitivity. Risk assessment and early diagnosis are key factors to an effective and conservative treatment.

Paediatric endodontics. Part. 1: Portland Cements Apical Plug.

Treatment of necrotic immature permanent anterior teeth with Portland cements apical plug. The long-term success of endodontic treatment depends on the quality of the apical and coronal seal. In necrotic immature teeth the treatment can be challenging for the clinician as the endodontic anatomy and the presence of bacterial infection need to be addressed with special techniques and materials in order to obtain an effective and biocompatible apical seal. Unfortunately, despite the best treatments, immature permanent teeth have a reduced resistance to fracture due to the arrest of root walls development.

State-of-the-art on MIH. Part. 2 MIH clinical management using ozone.

MIH is still a challenge in paediatric dentistry, due to the high sensitivity caused to the first permanent molars, that can greatly reduce the cooperation either for home oral hygiene or for in-office treatment. In this contest the use of ozone emphasises the ART technique (Atraumatic Restorative Treatment) and introduces modern "no aerosol" concept.