Gingival displacement using diode laser or retraction cords: A comparative clinical study.

PURPOSE: To compare two systems used for conditioning the gingival sulcus and exposing the finish line before the final impression for a fixed denture: retraction cords and diode laser. METHODS: All subjects participating in the study had healthy gingival and periodontal status before intervention for fixed prosthesis. 74 abutments for complete crown restoration were randomly divided into two groups for displacing the gingival sulcus before the final impression: gingival retraction cords (RC) and diode laser (DL). The height of the clinical crowns was measured by a blinded examiner in three points of the buccal surface (mesial, midline and distal) at four different times: after tooth preparation (T0), 15 days after tooth preparation, before exposing the finish line with RC or with DL (T1), 10 minutes after exposing the finish line (T2), and 15 days after the final impression was taken (T3). The amount of gingival retraction produced (ΔT2-T1) and restoration to baseline (ΔT3-T1) were calculated. Ease of technique and patient comfort were evaluated through the Visual Analog Scale. The time required to carry out the technique and bleeding during and after the conditioning procedure were also evaluated. RESULTS: There was no difference between the two techniques with regard to the height differences: ΔT2-T1 was 0.65±0.33 for RC and 0.66#177;0.43 for the DL (P= 0.966), while ΔT3-T1 was 0.03#177;0.27 for RC and 0.02#177;0.46 for DL (P= 0.286). DL required less time, was easier for the operator and more comfortable than RC for the patient (all P<0.001). CLINICAL SIGNIFICANCE: The amount of gingival retraction and restoration to baseline resulting from use of gingival retraction cords or diode laser technique is similar, but diode laser required less time, was simpler for the operator and was more comfortable to the patient than retraction cords.

Evaluation of marginal leakage after mechanical fatigue cycling of composite inlays luted with different cements.

This in vitro study evaluated the marginal microleakage of composite inlays luted with 3 different cement systems. The null hypothesis was that the luting materials would not influence dye penetration, showing the same degree of microleakage. Thirty-six sound molars were selected, mesio-occlusodistal cavities were prepared, and the teeth were randomly divided into 3 groups (n = 12). Composite resin inlay restorations were made and cemented using a dual-curing resin cement (Calibra), a light-curing flowable composite (Charisma Flow), or a self-adhesive resin cement (RelyX Unicem). The restored teeth were subjected to fatigue cycles and immersed in 0.5% basic fuchsin dye for 24 hours. Two orthogonal cuts were made to enable evaluation of dye penetration at the cervical and occlusal margins. The sections were evaluated with a 4-point scale ranging from 0 (no penetration) to 3 (penetration up to the cavity floor [occlusal margins] or axial wall [cervical margins]). The Calibra and Charisma Flow groups showed greater microleakage, notably at the cervical margins, whereas RelyX Unicem specimens showed the least dye penetration. Significant differences were found between the Calibra and Charisma Flow groups and between the Charisma Flow and RelyX Unicem groups (P < 0.05). No statistically significant differences were detected between the Calibra and RelyX Unicem groups. The microleakage associated with the flowable composite was significantly greater than that associated with both resin cements, results that discourage its use for luting of Class II composite inlays.

Epidemiology, clinical manifestations, risk reduction and treatment strategies of jaw osteonecrosis in cancer patients exposed to antiresorptive agents.

 Osteonecrosis of the jaws (ONJ) is an adverse side event of bisphosphonates and denosumab, antiresorptive agents that effectively reduce the incidence of skeletal-related events in patients with metastatic bone cancer and multiple myeloma. Available data suggest that 0-27.5% of individuals exposed to antiresorptive agents can develop ONJ. There is increasing evidence that avoidance of surgical trauma and infection to the jawbones can minimize the risk of ONJ, but there are still a significant number of individuals who develop ONJ in the absence of these risk factors. Bone necrosis is almost irreversible and there is no definitive cure for ONJ with the exclusion, in certain cases, of surgical resection. However, most ONJ individuals are affected by advanced incurable cancer and are often managed with minimally invasive nonsurgical interventions in order to control jawbone infections and painful symptoms. This article summarizes current knowledge of ONJ epidemiology, manifestations, risk-reduction and therapeutic strategies. Further research is needed in order to determine individual predisposition to ONJ and clarify the effectiveness of available treatments.

Periodontal clinical and microbiological data in desquamative gingivitis patients.

OBJECTIVES: A series of patients affected by desquamative gingivitis (DG) was investigated in order to evaluate relation patterns among clinical parameters relevant to plaque-induced periodontitis, periodontal microbiological data and the presence of DG lesions. PATIENTS AND METHODS: Eight oral lichen planus (OLP) and four mucous membrane pemphigoid (MMP) patients were examined. Periodontal measurements (performed at six sites per tooth on all teeth) included probing depth (PD), gingival recession (REC), clinical attachment loss (CAL) and full-mouth plaque (FMPS) and bleeding (FMBS) scores; the presence and the exact location (site by site) of DG lesions were carefully recorded. Sub-gingival plaque samples were collected and examined by means of real-time PCR for the quantitative determination of the six most important marker organisms of periodontitis. Statistically significant differences and correlation of studied variables between DG-positive and DG-negative sites were investigated in MMP and OLP cases using Mann-Whitney test (p < 0.05) and the Spearman rank correlation coefficient, respectively. RESULTS: OLP gingival lesions do not significantly affect CAL, although the presence of such lesions may reduce REC and increase PD and FMPS. MMP gingival lesions significantly worsened CAL and increased REC and FMPS. In both OLP and MMP cases, no significant difference was found between DG-positive and DG-negative sites as regards the relative percentage of the investigated species on the total bacterial load. Correlations between the presence of DG lesions and clinical parameters (CAL, PD, REC) were not significant (p < 0.05). Significant correlations were found for the presence of gingival OLP lesions and Aggregatibacter actinomycetemcomitans (AA) and for the absence of gingival MMP lesions and AA. CONCLUSIONS: These findings are not definitive, but highlight the need for further investigations of periodontal clinical and microbiological aspects of disorders causing DG in order to clarify their potential interference with plaque-related periodontitis.

Effects of two essential oil mouthrinses on 4-day supragingival plaque regrowth: a randomized cross-over study.

PURPOSE: To investigate the plaque inhibiting effects of two commercially available mouthrinses containing essential oils (EO). Both products contained the same concentration of EO, but one of them did not contain ethanol. METHODS: The study was an observer-masked, randomized, 4 x 4 Latin square cross-over design, balanced for carryover effects, involving 12 participants in a 4-day plaque regrowth model. A 0.12% chlorhexidine (CHX) rinse and a saline solution served as positive and negative controls, respectively. On Day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced rinsing with their allocated rinses. On Day 5, subjects were scored for disclosed plaque. RESULTS: Differences among treatments were highly significant (P < 0.0001), with greater plaque inhibition by CHX compared to EO rinse containing ethanol (P = 0.012), which, in turn, was significantly more effective than the rinse without ethanol and the saline (P < 0.001). The reduction in plaque regrowth seen with the EO rinse without ethanol was quite similar to that elicited by saline (P > 0.05).

Caries Severity, Decayed First Permanent Molars and Associated Factors in 6-7 Years Old Schoolchildren Living in Palermo (Southern Italy).

To date, there are very few epidemiologic studies on caries disease in 6-7 year old children living in Sicily (Southern Italy). The first permanent molar (FPM) is the most commonly affected tooth in this target population, and a one-unit increase in the number of decayed FPMs is predictive of caries in other teeth and in adulthood. The primary aim of this research is to estimate the prevalence of caries in 6-7 year old schoolchildren living in Palermo and, as a secondary aim, to estimate the prevalence of affected FPMs. It was designed as a cluster cross-sectional survey on 995 children from 16 schools, selected based on their geographical location, in one of the eight city districts. Caries data were recorded using the International Caries Detection and Assessment System for each tooth surface. The relation between socio-economic status, behavioural determinants, and clinical information and the number of teeth with initial caries (IC), moderate caries (MC), or extensive caries (SC) was analysed through the ordinal logistic regression. Among the 995 schoolchildren, 662 (66.5%) had at least one lesion and 742 (74.6%) had FPMs. Of the latter, 238 (32.0%) were affected by IC, 86 (11.6%) were affected by MC, and only 3 (0.4%) were affected by SC. During multivariable analysis, there was evidence of an increased risk of MC and SC related to the deprivation of the district in which the children lived and went to school, as well as to the protective role of parental education and employment. The same significant determinants were found for IC and MC FPMs. The study showed the important role of socio-economic determinants, unhealthy behaviours, and social deprivation related to the increased risk of moderate and extensive caries in 6-7 year old schoolchildren. Investigating this target population is very important, as early development of caries in FPMs may have serious consequences in the prognostics of oral health in an adult.

The Effects of Low-frequency Vibration on Aligner Treatment Duration: A Clinical Trial.

Objectives: The aim of this study was to investigate the effectiveness of an orthodontic tooth movement acceleration device (AcceleDent, OrthoAccel Technologies, Houston, Texas) when used during an aligner treatment. Materials and Methods: Adult patients who began an aligner treatment (Lineo, Micerium Lab, Avegno, Italy) were allocated to two treatment groups. The first one (Group A), with a 7-day aligner change regimen, used the AcceleDent device for 20 min per day, whereas the second one (Group B) changed the aligners every 14 days and did not use any device. The registered outcomes were the possibility of completing the treatment, the number of aligners needed and treatment duration in the two groups. Moreover, we assessed patients' perception of pain during the first week of treatment. Results: Twenty-four patients were allocated to Group A or B depending on the acceptance of AcceleDent use. Patients which used AcceleDent (Group A) completed the treatment using each aligner for fewer days than those belonging to Group B (9.0 ± 1.0 and 15.4 ± 1.2 days, respectively) (P < 0.001). As a secondary outcome, a significant difference was found in pain perception during the first week of treatment between the two groups (P < 0.05). Conclusions: This controlled clinical trial shows that is possible to apply a 7-day change regimen together with AcceleDent use and successfully complete an aligner treatment with a significant saving of time when compared to a standard 14-days change regimen. Finally, the use of this device allowed reduction in pain perception during the orthodontic treatment.

Effect of hormone replacement therapy (HRT) on periodontal status of postmenopausal women.

BACKGROUND: The risks/benefits balance of hormone replacement therapy (HRT) is controversial. The aim of this study was to assess the periodontal status of a postmenopausal women group receiving HRT and to determine the effects of HRT on clinical measures of periodontal disease. MATERIAL/METHODS: Ninety-one postmenopausal women, 52 taking HRT (HRT+) and 39 not taking HRT (HRT-), completed the study. Clinical parameters measured included visible supragingival plaque, probing pocket depth (PD) and clinical attachment level (CAL). Gingival status was recorded as gingival bleeding on probing (BOP). Previous oral contraceptive use and current and past smoking status were also assessed. RESULTS: Data indicated that PD and CAL were not significantly different between HRT+ patients and HRT- patients (P=0.8067 and P=0.1627, respectively). The HRT+ group exhibited significantly lower visible plaque levels compared to the control group (P<0.0001). The percentage of gingival sites with positive BOP was significantly lower in the HRT+ group compared to the HRT- group (34.85% vs. 65.15%; P=0.0007). Plaque accumulation was also tested in ANCOVA as a possible explanatory variable for the differences observed in gingival bleeding. The ANCOVA showed no significant differences in gingival bleeding between HRT+ and HRT- women (P=0.4677). No significant differences in past smoking status and oral contraceptive use were detected between HRT+ and HRT- women (P=0.9999 and P=0.0845, respectively). CONCLUSIONS: These findings indicated that long-term HRT was not associated with relevant effects on periodontal status and clinical measures of periodontal disease, thus suggesting that HRT may not confer protection against periodontitis in postmenopausal women.

Knowledge and attitudes towards smoking cessation counselling: an Italian cross-sectional survey on tertiary care nursing staff.

BACKGROUND: One of the most effective smoking cessation strategies involves care and advice from nurses due to their role in the front line of treatment. Lack of education on smoking cessation counselling may be detrimental, and adequate smoking cessation training during healthcare studies is needed. OBJECTIVES: The study aimed to examine nurses' attitudes, belief, and knowledge of smoking cessation counselling; knowledge of the health risks associated with smoking was also assessed. DESIGN: A cross-sectional survey on 77 nurses from the nursing staff of Cardiology, Cardiac Intensive Care and Surgical Oncology Units of two tertiary hospitals. METHODS: Cronbach's alpha was calculated to assess the questionnaire's internal consistency, and three composite indicators were computed to assess the three dimensions of the questionnaire (knowledge, attitude, belief). Furthermore, a stepwise linear regression model was used to predict the attitude to be engaged in smoking cessation counselling, related to demographic and behavioural variables, as well as knowledge and belief indicators. The analysis was stratified by Unit. RESULTS: Nurses from three Units had a significantly different attitude score (2.55 ± 0.93 for Cardiology, 2.49 ± 0.72 for Cardiac Intensive Care and 2.09 ± 0.59 for Surgical Oncology Unit) (P-value = 0.0493). Analogously, knowledge of smoking cessation counselling was reported to be higher for Cardiac Intensive Care Unit nurses (3.19 ± 0.70) compared to Surgical Oncology nurses (2.73 ± 0.74) (P-value = 0.021). At the multivariable analysis, attitude towards smoking cessation counselling was significantly related to the nurse's belief about counselling, for Cardiology staff (coeff = 0.74, 95% CI [0.32-1.16], P-value = 0.002) and for Surgical Oncology staff (coeff = 0.37, 95% CI [0.01-0.72], P-value = 0.042). CONCLUSIONS: Incorporation of smoking cessation interventions in nurses' and nursing managers' education could improve the nursing staff's attitude, belief, and knowledge regarding smoking cessation counselling, which would lead to the inclusion of tobacco prevention and cessation as an integral part of patient care.

The Treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Systematic Review with a Pooled Analysis of Only Surgery versus Combined Protocols.

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents, and it is also a potentially painful and debilitating condition. To date, no specific studies have prospectively evaluated the efficacy of its treatment and no robust standard of care has been established. Therefore, a systematic review (2007-2020) with a pooled analysis was performed in order to compare MRONJ surgical techniques (conservative or aggressive) versus combined surgical procedures (surgery plus a non-invasive procedure), where 1137 patients were included in the pooled analysis. A statistically significant difference in the 6-month improvement rate, comparing combined conservative surgery versus only aggressive (91% versus 72%, p = 0.05), was observed. No significant difference regarding any group with respect to the 6-month total resolution rate (82% versus 72%) was demonstrated. Of note, conservative surgery combined with various, adjuvant, non-invasive procedures (ozone, LLLT or blood component + Nd:YAG) was found to achieve partial or full healing in all stages, with improved results and the amelioration of many variables. In conclusion, specific adjuvant treatments associated with minimally conservative surgery can be considered effective and safe in the treatment of MRONJ, although well-controlled studies are a requisite in arriving at definitive statements.

Prevalence and socio-behavioral determinants of dental caries in Sicilian schoolchildren.

BACKGROUND: Epidemiological data revealed a marked decline in dental caries prevalence in schoolchildren of Western industrialized countries. In Italy this decline is not well documented, particularly for schoolchildren living in southern Italy. This study investigated the prevalence of caries in schoolchildren in the city of Palermo, Sicily, and assessed the relationship between socio-behavioral determinants and caries. MATERIAL/METHODS: A sample of 511 schoolchildren, 153 aged 5 (29.94%) and 358 aged 12 (70.06%), was selected using the cluster sampling technique from a stratified population. The World Health Organization caries diagnostic criteria for Decayed, Missing and Filled Teeth and Surfaces for both permanent (DMFT/DMFS) and primary (dmft/dmfs) dentition was used. A questionnaire to assess oral health behaviors and socio-economic factors was completed by the parents. A logistic regression model was estimated, with DMFT/dmft index properly dichotomized as the dependent variable, and oral hygiene, dietary habits, dentist visit attendance, mother's employment status and level of education as explanatory variables. Two separate analyses were made for 5- and 12-year-old subjects. RESULTS: The overall prevalence of dental caries was 38.56% in 5-year-olds and 44.97% in 12-year-olds. In the case of the 5-year-olds, maternal educational level was a protective factor for caries, while in the case of the subjects aged 12, frequent snack consumption was significantly associated with caries. CONCLUSIONS: The prevalence of caries in Sicilian schoolchildren was quite high and appears to be related to socio-behavioral determinants (socio-economic background of mothers and frequency of cariogenic snack consumption).

Plaque removal efficacy of power and manual toothbrushes: a comparative study.

The aim of this study was to compare the plaque removal efficacy of a new oscillating/rotating/pulsating toothbrush [Oral-B Professional Care 8500 (PC 8500)] with two manual toothbrushes [Oral-B CrossAction Vitalizer (CAV) and Oral-B Indicator (IND), respectively]. The safety of the PC 8500 was also assessed. The study was a single-use, observer-masked, randomised 3 x 3 Latin square crossover design balanced for carryover effects. The enrolled subjects (n = 66) refrained from brushing for 23-25 h before each clinical examination. Plaque scores were recorded before and after brushing with the allocated toothbrush using the Turesky et al. modification of the Quigley and Hein plaque index. The safety was assessed evaluating the soft tissue conditions present after 30 days of the use of the PC 8500. The PC 8500 toothbrush was better in plaque removal efficacy compared with the CAV and IND brushes for full mouth and approximal surfaces (P < 0.01). When marginal surfaces were considered, the PC 8500 was significantly more effective than the IND (P < 0.01). No significant differences were found between PC 8500 and CAV (P > 0.05). The latter was shown to be significantly more effective than the IND at all tooth surfaces (P < 0.01). Safety examinations revealed the onset of only two small gingival abrasions after the 30-day use of the PC 8500. The PC 8500 toothbrush demonstrated to be more effective in plaque control than the CAV and IND in the full mouth and approximal surfaces and similar to the CAV in the marginal surfaces. The PC 8500 was safe to oral tissues in long-term use.

Growth and Osteogenic Differentiation of Discarded Gingiva-Derived Mesenchymal Stem Cells on a Commercial Scaffold.

BACKGROUND: In periodontal patients with jawbone resorption, the autologous bone graft is considered a "gold standard" procedure for the placing of dental prosthesis; however, this procedure is a costly intervention and poses the risk of clinical complications. Thanks to the use of adult mesenchymal stem cells, smart biomaterials, and active biomolecules, regenerative medicine and bone tissue engineering represent a valid alternative to the traditional procedures. AIMS: In the past, mesenchymal stem cells isolated from periodontally compromised gingiva were considered a biological waste and discarded during surgical procedures. This study aims to test the osteoconductive activity of FISIOGRAFT Bone Granular® and Matriderm® collagen scaffolds on mesenchymal stem cells isolated from periodontally compromised gingiva as a low-cost and painless strategy of autologous bone tissue regeneration. MATERIALS AND METHODS: We isolated human mesenchymal stem cells from 22 healthy and 26 periodontally compromised gingival biopsy tissues and confirmed the stem cell phenotype by doubling time assay, colony-forming unit assay, and expression of surface and nuclear mesenchymal stem cell markers, respectively by cytofluorimetry and real-time quantitative PCR. Healthy and periodontally compromised gingival mesenchymal stem cells were seeded on FISIOGRAFT Bone Granular® and Matriderm® scaffolds, and in vitro cell viability and bone differentiation were then evaluated. RESULTS: Even though preliminary, the results demonstrate that FISIOGRAFT Bone Granular® is not suitable for in vitro growth and osteogenic differentiation of healthy and periodontally compromised mesenchymal stem cells, which, instead, are able to grow, homogeneously distribute, and bone differentiate in the Matriderm® collagen scaffold. CONCLUSION: Matriderm® represents a biocompatible scaffold able to support the in vitro cell growth and osteodifferentiation ability of gingival mesenchymal stem cells isolated from waste gingiva, and could be employed to develop low-cost and painless strategy of autologous bone tissue regeneration.

Lifestyle Medicine and Psychological Well-Being toward Health Promotion: A Cross-Sectional Study on Palermo (Southern Italy) Undergraduates.

(1) Aim: To assess the attitude toward Lifestyle Medicine and healthy behaviours among students in the healthcare area and to demonstrate its association to psychological well-being; (2) Methods: A cross-sectional study is conducted among 508 undergraduates of the University of Palermo (140 (27.6%) in the healthcare area and 368 (72.4%) in the non-healthcare area), during the academic year 2018-2019. Psychological well-being is measured through two dimensions of eudaimonia and hedonia, using the 10-item Hedonic and Eudaimonic Motives for Activities-Revised (HEMA-R) scale, with answers coded on a 7-point scale. The association between demographic and modifiable behavioural risk factors for chronic diseases is assessed through crude and adjusted Odds ratios with 95% confidence intervals; (3) Results: Orientation to both hedonia and eudaimonia is significantly associated to the Mediterranean diet (ORAdj = 2.28; 95% CI = (1.42-3.70)) and drinking spirits less than once a week (ORAdj = 1.89; 95% CI = (1.10-3.27)) and once a week or more (ORAdj = 6.02; 95% CI = (1.05-34.52)), while these conditions occur together less frequently for current smokers (ORAdj = 0.38; 95% CI = (0.18-0.81)). Students inclined to well-being consider healthcare professionals as models for their patients and all people in general (OR = 1.96, 95% CI = (1.28-3.00)); (4) Conclusions: The positive relation found between a virtuous lifestyle and psychological well-being suggests the construction, development and cultivation of individual skills are a means to succeed in counteracting at risk behaviours for health.

Bifocal manifestation of eosinophilic granuloma in a pediatric patient.

BACKGROUND: Eosinophilic granuloma (EG) is a clinical variant of the Langerhans cell histiocytosis (LCH) characterized by unifocal or multifocal bone lesions which predominantly affects children, adolescents, and young adults. CASE REPORT: A case is reported of a 13-year-old Caucasian boy who presented unifocal EG in the mandible as the first clinic manifestation. Radiographic examination and skeletal scintigraphy revealed a further localization with an osteolytic lesion in the right femur. The therapeutic protocol used for the mandibular lesion included causal periodontal therapy, extraction of the compromised teeth, alveolar curettage, and intralesional injections of corticosteroids, in correspondence with femoral and mandibular bone lesions. CONCLUSIONS: Early diagnosis of LCH is considered an important factor which can improve the patient's prognosis and quality of life and also the cost-effectiveness of therapy. Dentists could play a fundamental role in the diagnosis and management of EG. The aim of the treatment is to eradicate EG lesions and provide adequate oral rehabilitation after the tooth loss. A careful multidisciplinary follow-up program is mandatory to identify any signs of local recurrence or dissemination.

Genetic disorders and periodontal health: a literature review.

Periodontal diseases include a group of inflammatory diseases characterized by progressive destruction of the periodontium. Dental plaque is the initiator of periodontal disease, but disease severity and response to treatment are determined predominantly by host-based risk factors. Genetic disorders can modify the host defense mechanisms or influence the homeostasis of the periodontium during childhood, thus increasing patients' susceptibility to periodontal disease. The periodontal manifestations of these disorders may persist into adulthood. When dealing with periodontal problems, particularly in children and adolescents, it is advisable to establish a differential diagnosis of periodontal disease due to systemic conditions. This paper reviews the current literature concerning the effect on periodontal health of genetic disorders such as connective tissue metabolism disorders, metabolic disorders, skin disorders, leukocyte defects, and chromosome abnormalities. Treatment strategies of patients with genetic disorders affected by periodontal diseases are also suggested according to the evidence available. In patients affected by genetic disorders, the response to treatment is not always as expected, and sometimes the progression of periodontal disease is inevitable despite adequate maintenance treatment.

Resistance to disinfection of a polymicrobial association contaminating the surface of elastomeric dental impressions.

The aim of this study was to evaluate the ability to resist disinfection of a polymicrobial association contaminating the surface of dental impressions obtained with two different elastomers: a polyether (Impregum) and an addition-polymerized silicone (Elite). Impressions were contaminated with a mixture of three biofilm-forming microorganisms (Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans) and disinfected immediately after contamination, or after microbial layers were allowed to develop during a six-hour storage. Two commercial disinfectants were tested: MD 520 containing 0.5% glutaraldehyde and Sterigum Powder without glutaraldehyde. Residual contamination was recovered by mechanical rinsing immediately after disinfection and after a six-hour storage of disinfected impressions, and assessed by colony counting. Both disinfectants tested were shown to be effective in reducing the microbial presence on the impression materials, achieving at least a 102 reduction of microbial counts compared to water rinsing. However, Sterigum was generally less effective on the Elite elastomer and could not grant disinfection on six-hour aged P. aeruginosa and C. albicans microbial layers. The results of this study suggest that the materials used for the impressions influence the efficacy of disinfection. Disinfectants should be tested according to conditions encountered in everyday clinical practice and the need for immediate disinfection of impressions should be clearly indicated by manufacturers.

In vitro evaluation of the antibacterial activity of cured dentin/enamel adhesive incorporating the antimicrobial agent MDPB.

The aim of this study was to investigate in vitro the antibacterial effect of a dentin/enamel adhesive containing MDPB (Clearfil Protect Bond) after curing and to compare it with an adhesive not containing MDPB (Clearfil SE Bond). The antibacterial effect of the cured adhesives was tested on Enterococcus faecalis by the evaluation of growth inhibition in a 48-h microplate direct contact test (DCT). The presence of antibacterial activity due to soluble components was also investigated by an agar diffusion test (ADT) performed with the adhesives cured on the surface of dentin disks. In the DCT, both the tested materials showed complete inhibition of bacterial growth until the 7-h reading, regardless of whether direct contact with the bacterial inoculum was continued or limited to 1 h. Stationary growth phase turbidity levels were observed at 24 or 48-h incubation. The ADT produced no inhibition areas around the dentin disks. Both adhesives tested in vitro under conditions simulating those encountered in the restorative treatment of dental caries were equally able to delay bacterial growth demonstrating a similar bacteriostatic effect. As suggested by both the DCT and the ADT, the antibacterial effect of the two adhesives depends on direct contact and does not seem to be related to the diffusion of soluble components.

The effects of an essential oil and an amine fluoride/stannous fluoride mouthrinse on supragingival plaque regrowth.

BACKGROUND: The side effects of chlorhexidine (CHX) have stimulated the search for alternative antiplaque agents such as amine fluoride/stannous fluoride (ASF) and essential oils (EO). The aim of the study was to investigate the plaque-inhibiting effects of two commercially available mouthrinses containing ASF and EO, respectively. METHODS: The study was an observer-masked, randomized, 5 x 5 Latin square cross-over design, balanced for carryover effects, involving 15 volunteers in a 4-day plaque regrowth model. A 0.12% CHX rinse and a saline solution served as positive and negative controls, respectively. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced rinsing with their allocated rinses. On day 5, subjects were scored for disclosed plaque. The ASF rinse was tested at two dosages: 10 and 20 ml (ASF-10 and ASF-20, respectively). RESULTS: The ASF and EO rinses showed a significant inhibition of plaque regrowth compared to saline (P <0.0001), but the lowest plaque indices were obtained with the CHX product (P <0.01). There were no significant differences among products containing ASF-10, ASF-20, and EO (P >0.05). There was no correlation between the occurrence of side effects and the use of a particular rinse product (P >0.2). CONCLUSIONS: ASF and EO mouthrinses exerted effective and similar plaque inhibition. The two dosages tested for ASF did not differ in plaque reduction. These findings, together with those from long-term trials, suggest that ASF and EO rinses may represent effective alternatives to CHX rinse as adjuncts to oral hygiene.

Clinical and microbiologic effects of subgingival controlled-release delivery of chlorhexidine chip in the treatment of periodontitis: a multicenter study.

BACKGROUND: The main therapeutic approach for periodontal diseases is mechanical treatment of root surfaces via scaling and root planing (SRP). Multicenter clinical trials have demonstrated that the adjunctive use of a chlorhexidine (CHX) chip is effective in improving clinical results compared to SRP alone. However, some recent studies failed to confirm these clinical results, and conflicting results were reported regarding the effects of the CHX chip on subgingival microflora. The aim of this study was to provide further data on the clinical and microbiologic effects of CHX chips when used as an adjunct to SRP. METHODS: A total of 116 systemically healthy individuals with moderate to advanced periodontitis, aged 33 to 65 years, were recruited from the Departments of Periodontology of four Italian universities. For each subject, two experimental sites were chosen that had probing depths (PD) > or =5 mm and bleeding on probing (BOP) and were located in two symmetric quadrants. These two sites were randomized at the split-mouth level, with one receiving SRP treatment alone and the other receiving treatment with SRP plus one CHX chip (SRP + CHX). PD, relative attachment level (RAL), and BOP were evaluated at baseline, prior to any treatment, and after 3 and 6 months. Supragingival plaque and the modified gingival index were evaluated at baseline and after 15 days and 1, 3, and 6 months. Subgingival microbiologic samples were harvested at baseline and after 15 days and 1, 3, and 6 months, cultured for total bacterial counts (TBCs), and investigated by polymerase chain reaction analysis for the identification of eight putative periodontopathogens. RESULTS: When all of the pockets were considered, the PD and RAL were significantly less at 3 and 6 months compared to the baseline scores (P <0.01) for both treatments. Moreover, the PD was reduced in the SRP + CHX treatment group compared to the SRP treatment group at 3 and 6 months, whereas the RAL was similar for both treatments at 3 months and was reduced in the SRP + CHX treatment group at 6 months. The differences in PD reductions between the treatments were 0.30 and 0.55 mm at 3 and 6 months, respectively (P <0.01); for the RAL gain, the differences were 0.28 and 0.64 mm, respectively (P <0.001). The TBCs decreased significantly with both treatments. A similar, although less evident, pattern was noted when only the pockets with an initial PD > or =7 mm were considered. The percentage of sites positive for BOP was similar between the treatments at each time point. At 15 days and 1 month, the TBC for the SRP + CHX treatment group was significantly lower than for the SRP treatment group (P <0.01 and P <0.05, respectively). Over time, both treatments generally reduced the percentages of sites positive for the eight putative periodontopathic bacteria, although greater reductions were seen often for the SRP + CHX treatment group. CONCLUSIONS: The adjunctive use of the CHX chip resulted in a significant PD reduction and a clinical attachment gain compared to SRP alone. These results were concomitant with a significant benefit of SRP + CHX treatment on the subgingival microbiota.