Topical Agents in Biofilm Disaggregation: A Systematic Review and Meta-Analysis.

Background: to evaluate the effectiveness of different topical agents in biofilm disaggregation during non-surgical periodontal therapy. Methods: the search strategy was conducted according to the PRISMA 2020 on Pubmed, Cochrane Library, Scopus, and Web of Science, and it was registered in PROSPERO, ID: CRD42023474232. It included studies comparing non-surgical periodontal therapy (NSPT) with and without the application of topical agents for biofilm disruption. A risk of bias analysis, a qualitative analysis, and a quantitative analysis were performed. Results: out of 1583 records, 11 articles were included: 10 randomized clinical trials and one retrospective analysis. The total number of participants considered in the 11 articles included in the study was 386. The primary outcomes were probing pocket depth (PPD), clinical attachment level (CAL), and bleeding indices. The secondary outcomes were plaque indices, gingival recessions, and microbiological parameters. The meta-analysis revealed the following: [Weighted mean difference (WMD): -0.37; 95% confidence interval (CI) (-0.62, -0.12), heterogeneity I2: 79%, statistical significance p = 0.004]. Conclusions: the meta-analysis of probing pocket depth reduction (PPD) between baseline and follow-up at 3-6 months showed a statistically significant result in favor of sulfonated phenolics gel. The scientific evidence is still limited and heterogeneous; further randomized clinical trials are required.

Clinical outcomes and periodontal conditions of dental implants placed in free fibula flaps (FFF): a retrospective study with a mean follow-up of 6 years.

OBJECTIVES: Up-to-date literature regarding long-term success of implant rehabilitations after microvascular reconstructions with free fibula flap (FFF) is still very scarce. This study aimed to evaluate clinical outcomes, especially related to oral hygiene conditions, of patients rehabilitated with this technique. MATERIALS AND METHODS: A total of 25 patients who underwent maxillofacial reconstructive surgery with FFF were retrospectively evaluated for soft tissues conditions, oral hygiene habits, and implant survival and success, assessed with a mean follow-up of 6 (range 2-15) years after loading. RESULTS: Fourteen patients received full-arch fixed prostheses and 11 removable bar-supported overdentures. At the follow-up evaluation, 52% of prostheses did not allow proper accessibility for oral hygiene. Overall prosthetic survival was 100%, and implant survival and success were respectively 93.6% and 72%. Prevalence of peri-implantitis was 29% at implant level and that at patient level 96%. CONCLUSIONS: Six-year clinical outcomes of this study reveal that poor oral hygiene practices and compliance by patients who underwent maxillofacial reconstruction with FFF are significantly associated with peri-implant disease. CLINICAL RELEVANCE: Findings of the present study underline the need by clinicians for a careful assessment, in reference to a specific implant therapy, of patient's prosthetic accessibility for oral hygiene procedures.

Influence of Surgical Technique on Post-Operative Complications in the Extraction of the Lower Third Molar: A Retrospective Study.

The surgical extraction of the impacted third molar is frequently associated with several complications. The purpose of this study is to assess how two different surgical protocols affect post-operative complications during the extraction of the lower impacted third molars. In order to compare and evaluate two different techniques (triangular flap vs. envelope flap), and the relative post-extraction complications, two groups of 150 patients each underwent to surgical impacted third molar extraction and 60 days of follow-up. The complication rate in the two groups was 14.00% in group A and 17.33% in group B. There was a strong association between smoking (OR: 2.8) and the use of oral contraceptives (OR: 1.75) with complications. The age- and sex-related incidence of complications in hard tissue healing has great variability in the literature; the analysis performed on our data did not show a statistically significant association between them. Even though related to a higher incidence of transient changes in sensitivity, it was found that the envelope flap saw a lower percentage of complications. There is still no clarity on which is the best protocol for the extraction of the lower impacted third molar, and the choice often depends on the surgeon's experience.

Fracture strength and ribbond fibers: In vitro analysis of mod restorations.

Background: Ribbond fibers are supposed to be a reinforcing material in restoration of compromised teeth. This study aims to compare MOD restorations with and without Ribbond Fiber in terms of fracture strength under axial loading; to identify the minimum depth of MOD cavities to use Ribbond Fiber (to improve the fracture strength under axial load. Material and Methods: 20 upper and lower molars extracted intact were used for the experiment. The teeth were prepared with 2 types of cavities and then divided into 4 groups: 1) 5 mm deep MOD cavities with residual interaxial dentin restored without Ribbond; 2) 5 mm deep MOD cavities with residual interaxial dentin restored with Ribbond; 3) 5 mm deep MOD cavities without residual interaxial dentin, restored without Ribbond; 4) 5 mm deep MOD cavities without residual interaxial dentin restored with Ribbond. The restored teeth were then subjected to thermal cycling and their fracture strength was evaluated using an Instron device. The Mann-Whitney statistical test was used to compare fracture strength among groups. Finally, a descriptive analysis of the verified fractures was performed. Results: There was a statistically significant difference between groups 1 and 2 (P = 0.0090) in the loading force required for a fracture. In contrast, there was no statistically significant difference between groups 3 and 4 (P = 0.7540). Groups 1 and 2 had the fewest non-restorable fractures, in contrast to groups 3 and 4. Conclusions: Ribbond fiber application in MOD cavities seems to be more effective in terms of strengthening where cavities have interaxial dentinal tissue. Key words:Ribbond fibers, fracture strenght, direct dental restorations.

Stamp Technique: An Explorative SEM Analysis.

BACKGROUND: Achieving correct tooth anatomy and saving time at the dental chair are some of the goals of modern restorative dentistry. Stamp technique has gained acceptance in clinical practice. The aim of this study was to evaluate the effectiveness of this technique in terms of microleakage, voids, overhangs and marginal adaptation of Class I restorations, and to analyse the operative times in comparison with traditional restorative procedures. METHODS: Twenty extracted teeth were divided into 2 groups. Ten teeth in the study group (SG) were Class I prepared and restored using stamp technique, and ten teeth in the control group (CG) were Class I restored traditionally. SEM analysis was performed to evaluate voids, microleakage, overhangs, and marginal adaptation, and operative times were recorded. A statistical analysis was performed. RESULTS: There were no significant differences in microleakage, marginal adaptation and filling defects between the two groups, however, the stamp technique seems to facilitate the formation of large overflowing margins that require a careful finishing phase. CONCLUSIONS: Stamp technique does not seem to have any critical aspects in terms of restoration durability and it can be performed in a short time.

Short and Ultra-Short Implants, in Association with Simultaneous Internal Sinus Lift in the Atrophic Posterior Maxilla: A Five-Year Retrospective Study.

Recent short-term studies suggested the use of short and ultra-short implants in association with a modified osteotome sinus floor elevation (internal sinus lift) technique for the treatment of edentulous resorbed posterior maxilla. The aim of this retrospective study was to investigate this hypothesis in locking-taper implants with a mid-term follow-up of 5 years. Overall, 155 implants (32, 100, and 23 of, respectively, 5.0 mm, 6.0 mm, and 8.0 mm length) were positioned in the atrophic upper maxilla of 79 patients, and 151 implants were loaded with single crowns. Overall implant survival after 5 years was 94.84%. Implant survival for each length group was 93.75%, 94%, and 100% for 5.0, 6.0, and 8.0 mm length, respectively. Preoperative residual crestal bone height of 4.45 (1.3) mm increased to 9.25 (2.13) mm after implant placement and settled at 6.35 (1.73) mm after loading and at 5.25 (1.68) mm at follow-up. Elevation of the Schneiderian membrane was 4.8 (2.46) mm after implant placement, 3.06 (1.3) mm after loading, and 1.46 (1.06) mm at follow-up. Mean variations of peri-implant crestal bone loss and first bone-to-implant contact point were, respectively, -0.36 (1.3) mm and -0.62 (1.15) mm. It can be confirmed that internal sinus lift procedure revealed stable bone gain and negligible resorption at mid-term follow-up for atrophic upper crests with reduced height.

Insights on dental care management and prevention in children with autism spectrum disorder (ASD). What is new?

Autistic subjects represent a severe concern to dentistry due to the considerable difficulty in managing their oral health, maintaining routine toothbrushing, and preventing dental and periodontal problems. The social and economic burden of managing dental care in autism spectrum disorder (ASD) children is particularly cumbersome for families and public and private health expenditure, especially when children reach the dentist following a late diagnosis with evident oral health problems. An early diagnosis of ASD helps dentists better address these children's oral health. Unfortunately, insufficient attention is paid to the training and education of general pediatricians, dentists, and dental hygienists, allowing them to get to approach the different clinical aspects of ASD. Usually, children diagnosed with ASD are scheduled for dental appointments like their neurotypical peers, whereas their needs are typically complex and personalized. Scant attention is also devoted to these patients by commercial manufacturers of dental products and devices for oral hygiene and prevention of caries and periodontal diseases, leaving parents without the support and often failing when they address the oral health of autistic children. The difficulties of oral care do not derive simply from the behavior of ASD patients, as is commonly assumed, and therefore cannot be overcome solely by the patience and attention of parents and dentists. Genetics, dietary habits, sensory impairments, and cognition disorders are other causes contributing in various degrees to the impact on the mood and psychological reactions of autistic children towards dentists. How can we prevent teeth caries, periodontal disorders, and other oral health impairments by properly managing ASD children? This manuscript gives an up-to-date overview of these problems and helps to provide good remarks.

Variations of the profile of the nose of the upper lip.

BACKGROUND: The aim of this study is to analyze the path needed to achieve a good aesthetic and functional result in patients treated with orthognathic surgery. METHODS: Seventy-three patients with only III class malocclusion were treated with sagittal split ramus osteotomy and with Le Fort I in only one piece. Through the analysis of anatomical cephalometric tracings, changes in the skeletal base, upper incisor and nose's shape were evaluated. The statistical analysis measurements were calculated for each length and for each angle at T0 (preoperative value) and at T1 (postoperative value). RESULTS: A significant statistical correlation was found mainly between forward movement of the upper maxilla and the outline of the nose, the nasal projection, and the naso-labial angle (NLA). The upper incisor in movements of verticality and inclination did not show any significant correlations with modifications of the NLA. CONCLUSIONS: A significant correlation can be seen between the forward movements of the upper maxilla with the outline of the nose, the nasal projection and the Naso-Labial Angle.

Cone-beam volumetric imaging in craniofacial medicine.

With the development of X-ray computed tomography (CT) in the 1960s and its first use for clinical studies in 1972 by Sir Godfrey Hounsfield, radiological tomography attained widespread use and today is one of the essential imaging techniques in medical radiology. It is a technically mature and clinically widely accepted method and complements classical X-ray panoramic radiography in many areas. The technology is frequently used in craniofacial radiology, because of its characteristic low radiation dose, high spatial resolution and lower cost compared with CT. The aim of this work was to describe the principles of cone beam computed tomography, to make a brief description of the existing devices, to present briefly the use of 3D diagnosis in craniofacial medicine.

Alveolar splitting with Piezosurgery®, bone bank grafts and NobelActive implants as an alternative to major bone grafting for maxillary reconstruction.

BACKGROUND: Piezosurgery® represents a novel alternative technique. The Piezosurgery® is well tolerated and permits a large number of applications in described literature. The principle of Piezosurgery® consists into inducing micro-vibrations to a metallic insert with a particular custom. The aim of this article is to study and to evaluate the use of NobelActive implants in combination with piezosurgical split-crest technique in severe atrophy of the upper maxilla. This approach allows avoiding the use of onlay grafts, due to rise the trasversal width of the crestal bone, which could have more complications and uncertain prognosis. This technique allows reducing timing of implant insertion because it is not necessary to wait for the graft to heal. METHODS: Ten patients (age 45-58) are selected, presenting from class 4 to 5 by Cawood and Howell of jaws. Those underwent piezosurgical split-crest technique and simultaneous implants surgery and bone grafts. Preoperative X-ray evaluation included standard X-panoramic and CT Dental-scan. Standard chemoprophylaxis was administered to each patient. The piezosurgical split-crest procedure was combined with tissue bank fresh frozen chips and double-layer collagen membrane to improve the thickness of alveolar bone and simultaneous implant surgery. Every patient received simultaneously from 3 to 6 implants which diameter was 4.3 mm and length 10-11.5 mm. Healing abutments have been applied at 5 months from the first procedure. RESULTS: Patients were clinically monitored, and marginal bone changes were calculated using periapical radiographs, which were taken with O-ring technique at placement and upon subsequent appointments and a 1-mm measurement grid for marginal bone remodeling, again at baseline and thereafter 3 months within loading. Cumulative implant survival was 97.8% (N.=45). Mean marginal bone resorption (SD) was 1.19 (1.01) mm for the early loading group after 1 year. The use of NobelActive implants seem to reduce peak stress in both cortical and trabecular bone. CONCLUSIONS: The use of NobelActive implants was revealed ideal in patients presenting jaw atrophy. The tapered designs show an ability to dissipate the interfacial stresses of bone, therefore improving the stability and the osteointegration if used in association to split crest made with piezosurgical device.

Odontogenic orbital abscess: a case report and review of literature.

Odontogenic orbital abscess is a rare but well-documented complication of sinusitis and infections spreading from dental apical lesion. We report a case of orbital abscess with periorbital cellulitis, in a 35-year-old man with positive recent dental history of a periapical dental infection arising from the second upper left premolar spread into maxillary sinus. The patient has shown facial edema, ocular pain, ophthalmoplegia, proptosis, and initial visual symptoms. A surgical intervention to drain the abscess and a revision of the dental lesion and maxillary sinus were required. A review of literature is also reported focusing on etiology and treatment options dealing with odontogenic orbital abscess and cellulitis.