Assessment of colour modifications in two different composite resins induced by the influence of chlorhexidine mouthwashes and gels, with and without anti-staining properties: An in vitro study.

OBJECTIVES: Chlorhexidine (CHX)-based products are the most effective chemical agents used in plaque control and oral disinfection. One of their side effects is tooth and restoration staining. For this reason, CHX products with anti-discolouration systems (ADS) have been developed. The aim of this in vitro study was to compare different CHX-based products (gel and mouthwash) with or without ADS in composite colour modification. METHODS: Two hundred specimens were created, 100 of which were made of packable composite and 100 of flowable composite. After 24 h, colour coordinates (L*, a*, b*, C*, h°) were recorded using a spectrophotometer (T0). Then, all samples were subjected to a CHX/tea staining model and immersed in human saliva for 2 min. Composite specimens were divided in 10 groups (N = 20). Control groups (PC, FC) were soaked in distilled water and test groups (PG, PGads, FG, FGads, PM, PMads, FM and FMads) were immersed in CHX-based solutions or brushed with CHX gel. Then the cycle was repeated 6 times, and colour differences (ΔEab and ΔE00 ) were finally calculated. RESULTS: Through flowable composites, FC and FG showed the highest colour differences, respectively ΔEab = 3.48 ± 1.0, ΔE00 = 2.24 ± 0.6 and ΔEab = 2.95 ± 1.3, ΔE00 = 1.53 ± 0.6. In the composite groups instead, PM and PMads showed the highest colour differences, respectively ΔEab = 2.78 ± 1.3, ΔE00 = 1.94 ± 0.8 and ΔEab = 2.71 ± 1.4, ΔE00 = 1.84 ± 0.9. CONCLUSIONS: CHX-containing products are able to cause stains on restorative composite materials. Discolouration is more likely to occur in flowable composites than packable composites, and ADS-containing products cause fewer pigmentations than CHX products without ADS. Packable composites showed more staining after mouthwash treatment, whereas flowable composites underwent higher discolouration after treatment with gels.

Pulp canal obliteration after extrusive and lateral luxation in young permanent teeth: A scoping review.

AIM: In the literature, no single therapeutic approach is preferred for treating dental pulp responses such as pulp canal obliteration (PCO). Some authors still recommend preventive endodontic treatment, whereas others choose not to intervene, to avoid causing possible iatrogenic complications. This review was conducted to explore, in the current scientific literature, the degree of knowledge concerning the onset and development of PCO and pulp necrosis (PN) following dental trauma (i.e. extrusive luxation and lateral luxation) in children and young adults (6-20 years). The authors also evaluated whether and to what extent the stage of dental root development at the time of traumatic dental injury (TDI) influences these pulp responses, and whether PN can arise in teeth already affected by PCO. MATERIALS AND METHODS The literature search was carried out during the period October 2019 to January 2020, using the following databases: PubMed/MEDLINE, SCOPUS and Web of Science. Articles in English reporting on young patients with PCO or PN in permanent teeth affected by trauma were included. Theresearch, whose questions were summarised according to the PICO method, considered the following aspects: patient age, type of TDI, stage of root development, initial treatment, presence of calcification or necrosis, time to onset of the two outcomes (PCO and PN), and duration of follow-up. The articles found were evaluated by two reviewers; in the event of disagreement regarding the inclusion of an article, a third reviewer was called upon to decide. RESULTS: The initial screening of the databases, using the selected search keywords, yielded a total of 343 articles. After exclusion of duplicates and articles not meeting the inclusion criteria, 11 articles remained. Of these, only four completely met the inclusion criteria. Closer analysis of these four publications revealed that they would not easily yield standardised sets of clinical data that might be homogenised in order to produce clear meta-analytical data. Hence the need to limit the data collected to the following seven items: number and type of injuries, type of initial intervention, duration of follow-up, main pulp responses, number and type of pulp responses. CONCLUSIONS: PCO is a physiological pulp response associated with a traumatic event, usually a luxation injury. It is diagnosed on the basis of combined radiographic and clinical-anamnesticdata. Signs of PCO start to appear at around one year after the traumatic event, and its development reaches completion by about five years post-trauma. PN, on the other hand, is clearly apparent within the first year. Endodontic treatment, be it carried out as a preventive measure or following detection of PCO, is inappropriate and can cause serious iatrogenic damage. Treatment is indicated only in cases of definite PN.

Combined Orthodontic and Restorative Minimally Invasive Approach to Diastema and Morphology Management in the Esthetic Area. Clinical Multidisciplinary Case Report with 3-Year Follow-Up.

INTRODUCTION: Ceramic laminates are restorations that are bonded using adhesive techniques, which provide for the treatment of the prepared dental elements according to well-defined steps. Adhesive cementation guarantees high predictability and esthetics. Orthodontic treatment is the first choice in patients with a dental misalignment. Patients who have dental element color and shape issues will undergo restorative treatment following orthodontics. Case Report. This clinical report describes a case treated with an interdisciplinary approach (orthodontic and prosthetic) of a patient who presented with diastemas, inversion of dental axes, small clinical crowns, and chromatic imperfections in the anterior maxillary teeth. The esthetic expectations of the patient for the anterior portion of the maxillary anterior teeth have been successfully achieved through orthodontic treatment and the realization of ceramic veneers. An accurate interdisciplinary evaluation of the treatment was necessary for a satisfactory result in the anterior maxillary teeth esthetically compromised in several aspects. Discussion. The modern materials used with the strict protocol of the adhesive procedures allow a minimally invasive, highly esthetic approach with an excellent long-term prognosis. The restorations must reproduce the physiological characteristics of the natural teeth aiming at an excellent biological, biomechanical, functional, and esthetic integration. Many adult patients come to visit with a combination of problems; the esthetic rehabilitation of these cases requires the evaluation of the quantity of gingival exposure, of the gingival architecture, of the size of the clinical crowns, and of the dental position. The ideal treatment of these cases involves an interdisciplinary approach. Prosthodontists, periodontists, orthodontists, and dental technicians must work together because the understanding of the various phases of treatment is fundamental to achieve the desired clinical result. CONCLUSION: The coordinated treatment of the orthodontist, periodontist, and prosthodontist, with careful consideration of the expectations and requests of patients, was fundamental for the success and satisfaction of the patient.

Delayed tooth replantation and inflammatory root resorption in childhood and adolescence.

Avulsion of one or more permanent teeth represents an emergency in dentistry. The main treatment is the replantation of the tooth/teeth as soon as possible to decrease possible complications. However, this is not always possible, and, in many cases, the patient undergoes a delayed replantation and subsequently prosthetic and implant treatments.

Tooth avulsion with extra oral time in less than 60 minutes: two different therapeutic protocols with 13-year follow-up.

The aim of this study is to assess what needs to be the priority in tooth avulsion: replantation as quickly as possible and deferred endodontic treatment, or replantation and elimination of every irritating stimulus for the periodontal ligament.

The use of only enamel matrix derivative allows outstanding regeneration results in periodontal intrabony defect treatment: a retrospective study.

Periodontal tissue regeneration depends on several biological, homeostatic and regulative variables that directly induce the clinical features. The aim of this study is to compare the clinical results obtained using the enamel matrix derivative peptide (EMP) compared to the less manageable association of EMP and bovine bone xenographic (BPBM) in the treatment of deep intraosseous defects. Ten healthy patients, suffering from moderate or severe chronic periodontitis, having at least two deep and narrow intrabony defects in the same dental arch and needing surgical treatment, were selected. The same patient was treated with the two different materials: EMP -TG1 in one defect and the association-TG2 in the other. Immediately before surgery (T0) and 12-month after (T2) the probing depth (PD) and gingival recession (GR) were registered at the experimental sites. No statistically significant differences were shown between TG1 and TG2 at T0 nor at T1 in term of PD and GR, while a statistically significant PD decrease was found both in TG1 and TG2 between T0 and T1 (p less than 0.05). GR increase resulted statistically significant in TG1 (p less than 0.05) but not in TG2 between T0 and T1 (p≥0.05). In this split-mouth retrospective study, both the treatments achieve favourable clinical results but the TG1 shows a significant increase in GR probably because EMP is not able to support the gingiva covering the intrabony defect. Therefore, the choice of the type of periodontal defect to be treated with EMP will be a therapeutic key-point.

Morphological classification of melanoma metastasis with reflectance confocal microscopy.

BACKGROUND: Cutaneous malignant melanoma metastases differential diagnosis is challenging, as clinical and dermoscopic features can simulate primary melanoma or other benign or malignant skin neoplasms, and in-vivo reflectance confocal microscopy could assist. Our aim was to identify specific reflectance confocal microscopy features for cutaneous malignant melanoma metastases, and epidermal and dermal involvement. METHODS: A retrospective, multicentre observational study of lesions with proven cutaneous malignant melanoma metastases diagnosis between January 2005 and December 2016. Lesions were retrospectively assessed according to morphological features observed at reflectance confocal microscopy. Potential homogeneous subgroups of epidermal or dermal involvement were investigated with cluster analysis. RESULTS: Cutaneous malignant melanoma metastases (51 lesions in 29 patients) exhibited different frequencies of features according to metastasis dermoscopy patterns. Lesions classified at dermoscopy with nevus-like globular and non-globular patterns were more likely to be epidermotropic, showing characteristics of epidermal and dermal involvement at reflectance confocal microscopy. Other dermoscopy pattern classifications were more likely to be dermotropic, showing characteristics od dermal involvement at reflectance confocal microscopy. Distinguishing features at reflectance confocal microscopy included irregular (78%) and altered (63%) epidermis, pagetoid infiltration (51%), disarranged junctional architecture (63%), non-edged papillae (76%), dense and sparse, and cerebriform nests in the upper dermis (74%), and vascularity (51%). Cluster analysis identified three groups, which were retrospectively correlated with histopathological diagnoses of dermotropic and epidermotropic diagnoses (P < 0.001). The third cluster represents lesions with deep dermis morphological changes, which were too deep for evaluation with reflectance confocal microscopy. CONCLUSIONS: Specific reflectance confocal microscopy features of cutaneous malignant melanoma metastases for correct diagnosis, and subtype diagnosis, seem achievable in most cases where morphological alterations are located above the deep dermis.

Effect of self-adjusting file and WaveOne reciprocating file on the filling ability of oval-shaped canals with thermoplasticized gutta-percha.

The aim of the study was to compare the effect of Self-Adjusting Files (SAF) and WaveOne Primary file with syringe and needle irrigation on the filling ability of oval-shaped root canals obturated with thermoplasticized gutta-percha. Twenty-four single root teeth with single oval-shaped root canals were distributed into two experimental homogeneous groups. One group was instrumented and cleansed using the SAF system while in the other group the WaveOne system with syringe and needle irrigation was used. After instrumentation, the roots were filled by Thermafil Obturators and TopSeal sealer. Specimens were transversally sectioned at 2-, 5- and 7-mm levels from the apex and observed under light microscope. The percentage of gutta-percha filled area (PGFA), the percentage of sealer filled area (PSFA) and the percentage of voids area (PVA) were measured for each section, moreover the percentage of completely filled sections was evaluated. At all levels, no significant differences in terms of PGFA, PSFA, PVA and percentage of completely filled canals between groups were obtained (P > 0.05). On the contrary, when the data were pooled, the mean PGFA in the SAF group was 95.8%, whereas it was 93.2% in the WaveOne group (P less than 0.05). The percentage of sections completely filled was 77.8% in the SAF group, and 52.8% in the WaveOne group (P less than 0.05). Overall, the use of the SAF system in oval canals allows to obtain a significantly greater complete filling than the use of the WaveOne system.

"Superficial infiltration to treat white hypomineralized defects of enamel: clinical trial with 12-month follow-up.

Hypomineralization represents one of the most common defects in tooth crowns. Thanks to a wide understanding of aesthetics, patients request a treatment to resolve these defects. Different techniques are available, such as crowns/veneers, traditional restorative treatments, microabrasion, whitening, remineralizing agents and infiltration technique. The objective of this trial is to assess the effectiveness of superficial infiltration with Icon (DMG, Hamburg, Germany) on the attenuation of crown hypomineralized lesions of various etiological origins with a 12-month follow-up. Seventeen patients with white defects of enamel in the aesthetic sector were selected. The infiltration procedure was carried out following the manufacturer's instructions. Intraoral photographs were taken before and directly after treatment in order to document the immediate change in colour. Check-ups were performed 1 and 12 months later. All the defects which were treated showed a degree of attenuation. The teeth affected by molar incisor hypomineralization (MIH) showed partial attenuation in 8 cases, and only in one case the defect disappeared. Regarding the post-trauma cases, 6 were partially attenuated and 2 disappeared. The post orthodontic defects disappeared in 6 cases and were attenuated in 5. All incipient caries defects were completely hidden. Four out of 6 cases of fluorosis disappeared. Diagnosis plays a key role in guiding the dental clinical selection of treatment. While it has always been possible to achieve a high level of attenuation in cases of fluorosis and lesions of caries origin, cases of MIH should probably be treated using more invasive techniques. Post-trauma lesions should be infiltrated with caution, and only after having informed the patient of the possible ineffective outcome.

Dental injuries in young athletes, a five-year follow-up study.

AIM: The aim of this study is to produce a clinical therapy protocol for a group of 20 athletes between the ages of 8 and 14, who all suffered traumas affecting hard dental and periodontal tissues. MATERIALS AND METHODS: This study involves a group of 20 athletes (10 male and 10 female) who had suffered dental traumas of varying severity. In order to collect the data, two classification systems were used: one for hard tissue traumas and another for periodontal lesions. The athletes were subdivided into lesion groups, treated depending on the type of lesions and then followed-up over a period of 5 years. A statistical analysis was carried out to study the association between type of lesions, types of sports and the number of teeth involved. RESULTS: We found that recovery time ranged from 3 to 5 days for uncomplicated fractures and up to 14 days for luxations. Only four complications were registered during the follow-up period and these were most likely due to the severity of the trauma. Out of the 20 athletes, 16 had begun and maintained the habit of using mouth protection devices when practicing their sport. The statistical analysis focused on the possible association between the risk levels of a sport and the typical lesions and complications that usually occur. Due to their high frequency, the two types of lesions taken into account in our study were complicated fractures (FP) and luxated/fractured teeth (LF). The average number of teeth involved varied according to the sport's risk level (medium or high) with averages of 1.6 teeth involved for medium-risk sports and 2.0 teeth for high-risk sports. CONCLUSIONS: What emerged in particular was the regular progress in the recovery time needed for the injuries sustained, with few complications or delays in rehabilitation; we also noted that the numerous athletes who habitually used mouthguards while competing during the recovery period did not suffer any recurrences of injuries or further complications. Regarding the results of our statistical analysis, no association was found between the sport's risk, the types of lesions and the occurrence of complications. In addition, analysis of the average number of teeth involved showed that there is no statistical evidence to reject the hypothesis that the ratios remain the same in the two groups.

SDR® vs traditional composite in class II restorations in primary molars.

This study aims to compare the clinical characteristics of a new flowable resin-based composite with those of a traditional composite when applied to deciduous molars for class II restorations. Twentyeight children between 6-12 years of age, with paired minimal Class II cavities present on their primary molars, were chosen. The paired cavities were restored with either a microhybrid composite or a new flowable resin-based composite. The composites were assigned to cavities in either the right or left side of the mouth, using random allocation tables. Each pair of restorations were clinically assessed at sixmonth intervals following the United States Public Health Service criteria. The prevalence of carious lesions was higher in maxillar molars (53.6%) compared to the mandibular molars (46.4%). At 24 months, Charlie or Delta scores in the paired groups were not seen in any patient, thus demonstrating a clinical success. The statistical analysis using Pearson’s chi-squared test did not reveal significant p-values for any parameter except the proximal contact showing significant p-values for this parameter. SDR appears to be the material of choice for the restoration of deciduous teeth due to its clinical features shown at 24 months as well as its ease and speed of application.

Deep infiltration for the treatment of hypomineralized enamel lesions in a patient with molar incisor hypomineralization: a clinical case.

This case report presents the technique of deep infiltration for the treatment of hypomineralized enamel lesions in a patient affected by molar incisor hypomineralization (MIH) with the purpose of obtaining an aesthetic improvement in the affected vestibular enamel. Deep infiltration treatment involves a sequence of steps starting with an initial mechanical abrasion of the outside surface of the enamel, followed by a phase of chemical erosion using 15% hydrochloric acid, penetration through the porosity of the enamel by a very fluid resin, and finally the repair of the thin layer of lost enamel using a composite. The aesthetic improvement of the elements affected by hypomineralized lesions is discernible immediately following treatment and becomes more accentuated with time. At the expense of minimal damage to surface enamel, deep infiltration enables treatment of all types of white spot enamel lesions, regardless of aetiology, offering the possibility of restoring an aesthetically pleasing smile for patients.

Oral Lichen planus.

Oral Lichen planus (OLP) is the most frequent mucosal localization of Lichen planus, affecting about 1-2% of the population. It is associated with skin lesions in 60-70% of cases, while occurring as the only manifestations in 15-25% of patients. Six clinical forms of OLP are identified: reticular (the most common), plaque, papular, atrophic, vesicles/bullous and erosive. The evolution is chronic, especially in the erosive form. A 1% incidence of squamous-cell carcinoma has been reported, thus considering OLP as a potential premalignant condition. The etiopathogenesis is still not completely understood: genetic (HLA-DR2), immunologic (T cell-mediated) and infectious (association with viral hepatitis C, differences in oral microbiota in OLP, and bacteria internalization into infiltrating T cells and oral epithelial cells) are considered the main predisposing or provoking factors. Management is based on the severity of the lesions; topical steroids are the first-line therapy and oral glucocorticoids are used for severe erosive lesions.

Single tooth anaesthesia: a new approach to the paediatric patient. A clinical experimental study.

AIM: The objective of this study is to assess the efficacy of the STA Wand System with respect to pain and fear reduction in paediatric patients and by using the Single Tooth Anaesthesia (STA) technique. MATERIALS AND METHODS: Patients included children and teenagers between 6 and 17 years of age, who required the administration of local anaesthesia prior to expected treatments. Local anaesthesia was performed by means of the electronic STA Wand System (Milestone scientific., Inc.) adopting the Single Tooth Anaesthesia (STA) technique. Pre- and post-anaesthesia, the patients were asked to complete the Wong-Baker faces image scale and the provider filled in the Frankl Scale. RESULTS: All treatments were completed successfully and no collaboration issues were recorded. Frankl's assessment showed that 91% of patients regarded dental experience positively. The efficacy of the computer-assisted anaesthesia was at 100% when treating primary teeth, and 70% for procedures on permanent teeth. Almost the totality of treated patients (94%) gave a positive evaluation after having tried the device with STA technique. Only 6% of the patients assessed the procedure negatively. CONCLUSIONS: The STA technique allows for absence of anticipatory anxiety, absence of physical pain, no anaesthetic effects in the perioral tissues and a controllable, lower dosage of the anaesthetic liquid.

Preventive treatment of post-traumatic dental infraocclusion: study on the knowledge of dental decoronation in a sample of Italian dental students and dentists.

AIM: The aim of the present work is to investigate whether dental decoronation is a procedure known by a sample of dental students and Italian dentists. Dental decoronation technique is performed in order to mitigate the outcomes which may occur after a delayed tooth replantation. MATERIALS AND METHODS: A cognitive survey about the knowledge of the dental decoronation technique was carried on two groups: a sample of 120 dental students (5th year of dental school), from University of Cagliari, Sassari and of Chieti-Pescara (60 males and 60 females), and a group which involved 200 Italian dentists (age comprised between 25 and 45, 130 females and 70 males) enrolled at pedodontics and orthodontics Masters and CE courses (University of Roma Sapienza, Chieti- Pescara, Cagliari). The latter group's main field of work was paediatric dentistry and orthodontics, two dental specialties often involved in treating Traumatic dental injuries. RESULTS: Only 20 dentists out of the 200 interviewed answered that they knew this technique and only 5 of them proved to know it and were able to describe it correctly. No students interviewed knew this technique. CONCLUSION: It is apparent from the results of this survey that there is very little information about the dental decoronation technique both during the Degree Course in Dentistry and Post Graduate specialty programmes (Continuing Education Courses and Masters).

Use of mouth guard in basketball: observational study of a group of teenagers with and without motivational reinforcement.

AIM: This study aims at ascertaining the capacity of 2 groups of young athletes to be faithful to the initial oral prevention project, with the difference that the study group received motivational reminders by either researchers and technical staff members of the team during the observation period, while the control group did not receive any motivational reminders. MATERIALS AND METHODS: This observational study was based on two groups selected from a wide group of 150 adolescent basketball players who accepted to use a custom-made mouth guard during their sport sessions. None of the selected athletes (60 adolescents aged between 12 and 15 years) had ever worn a mouth guard during their sports activity. A customised mouth guard was supplied, and subjetcs were requested to wear it for 12 months during training sessions and competitions. The study group was composed of 30 athletes, 15 males and 15 females, who received a constant motivational reinforcement to the use of the mouth guard by their coach and during checkups. Similarly, the control group was composed of 30 athletes (15 males and 15 females) who did not receive any motivational reinforcement. RESULTS: Twelve months after the beginning of the study, 24 subjects belonging to the control group were not using the mouth guard, while only 7 subjects of the study group were not using it. It was also noticed, six months after the beginning of the observation period, a rapid decline in the participants' interest in the use of the mouth guard. CONCLUSION: No traumatic event was registered among those adolescents who had used the mouth guard for the whole period of the study. Female athletes showed greater compliance to this prevention project. It is important that all technical staff members, and particularly the leading coach, encourage the regular use of oral protection devices for prevention among teenagers practicing sports.

Validation study on avermectine residues in foodstuffs.

Avermectines are antiparasitic agents widely used as veterinary drugs for food producing animals. The European Community, due to their side effects, limited the use of these molecules establishing maximum residue limits (MRLs) in some foods. A validated qualitative and quantitative high performance liquid chromatography method with fluorescence detection (HPLC-FL) is presented for the simultaneous determination of ivermectin (IVM), abemectin (ABA), moxidectin (MOX), eprinomectin (EPR), doramectin (DOR) and emamectin (EMA) in foodstuffs (muscle, eggs and milk). Samples were extracted with acetonitrile, purified with liquid-liquid extraction (LLE), and analysed by HLPC-FL previous derivatization with trifluoroacetic anhydride (TFAA) in presence of 1-methyl-imidazole (MI) and acetic acid. To date, the presented method is the first validated for the matrix eggs, and in accordance with the requirements set by Commission Decision 2002/657/EC. Recoveries of the methods, calculated spiking the samples in the range 5.0-100.0 µg kg(-1), were 64-83% for muscle, 65-89% for milk and 63-84% for eggs. The precision (CV) ranged between 9.2 and 17.1% for muscle, 9.9 and 16.6% for milk and from 9.4 to 17.4% for eggs. Linearity for the six analytes was calculated from 5.0 to 200.0 µg kg(-1). The main advantages of the presented method are its rapidity, the specificity, the good precision and recovery that make it very suitable to the detection and determination of avermectines.

Tetracycline residues in royal jelly and honey by liquid chromatography tandem mass spectrometry: validation study according to Commission Decision 2002/657/EC.

A specific, sensitive and robust liquid chromatography tandem mass spectrometry method for determining oxytetracycline, tetracycline, chlortetracycline and doxycycline in royal jelly and honey samples is presented. Extraction of drug residues was performed by ammonium acetate buffer as extractant followed by a clean-up with metal chelate affinity chromatography and solid-phase extraction. Tetracycline analysis was performed using liquid chromatography-electrospray ionisation-tandem mass spectrometry. The presented method is the first validated for royal jelly and in accordance with the requirements set by Commission Decision 2002/657/EC. Recoveries of the methods, calculated spiking the samples at 5.0, 10.0, 20.0 and 30.0 µg kg(-1), were 79% to 90% for honey and 77% to 90% for royal jelly. The intra-day precision (RSD) ranged between 8.1% and 15.0% for honey and from 9.1% to 16.3% for royal jelly, while inter-day precision values were from 10.2% to 17.6% and from 10.6% to 18.4% respectively for honey and royal jelly. Linearity for the four analytes was calculated from 5.0 to 50.0 µg kg(-1). The decision limits (CCα) ranged from 6.2 to 6.4 µg kg(-1) and from 6.1 to 6.5 µg kg(-1) for honey and royal jelly, respectively. Detection capabilities values (CCß) ranged between 7.2 and 7.7 µg kg(-1) and from 7.3 to 7.9 µg kg(-1) respectively for honey and royal jelly. The developed method is currently in use for confirmation of the official control analysis of honey and royal jelly samples.