Accident due to Incorrect Selection of Diode Laser Technique in the Treatment of Oral Venous Malformation.

Venous malformation (VM) originates from a congenital venous network disorder, configuring about 40% of the vascular anomalies that occur in the head and neck region. The usage of diode lasers in the treatment of VM is associated with various advantages, such as short operating time and few postoperative complications. Nevertheless, for larger and deeper VM treatment, it may require more than one session for the complete resolution of the lesion. Laser surgery for oral VM may induce heat accumulation due to excessive irradiation causing adverse events postoperatively, including pain and ulcer formation with scarring. In this clinical case, it was recommended to use the leopard technique (LT) to reduce the lesion size, evaluate the remaining unhealed lesion, and apply different laser techniques to obtain the complete resolution of the lesion.

Erythema Multiforme as Early Manifestation of COVID-19: A Case Report.

Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a viral infection involving multi-organ manifestations. The main oral symptoms of COVID-19 associated are taste loss and xerostomia, but literature has reported other oral manifestation, such as oral blisters, ulcers, vesicles and other immunological lesions. This case report showed an Erythema Multiforme (EM) manifesting as oral mucosa lesions in a patient with a late diagnosis of COVID-19 infection. Case Presentation: A 30 years-old Caucasian woman was sent to an oral medicine office, in order to manage painful and oral mucosa lesions associated with target symmetrical skin lesions. Oral examination revealed extensive ulcers in the mouth and crusts on the lips. Based on clinical examinations, a diagnosis of Erythema Multiforme major was made and a drug therapy with steroids was administered. Five days after the specialist visit, the patient discovered that she was positive for COVID-19. The complete recovery occurred in 3 weeks. Conclusion: Confirming the literature studies, EM is an early disease associated with COVID-19 infection.

Comparison of Two Root Canal Filling Techniques: Obturation with Guttacore Carrier Based System and Obturation with Guttaflow2 Fluid Gutta-Percha.

INTRODUCTION: The aim of the present study was to compare the quality of the root canal obturation obtained with two different techniques, i.e., thermoplastic gutta-percha introduced through a carrier (GuttaCore) and fluid gutta-percha (GuttaFlow2). MATERIALS AND METHODS: The study included 40 permanent single-rooted human teeth, divided into two groups and obturated with Guttaflow (group G) and with GuttaCore (group T). The teeth were fixed and transversely sectioned, they were examined by scanning electron microscopy. The dentin-cement-gutta-percha interface and the percentage of voids produced by the two techniques were statistically analyzed. RESULTS: GuttaCore showed a better filling in the apical third of the canal with a percentage of voids equal to 5%. GuttaFlow showed a lower percentage of voids in the middle and coronal thirds of the canal, 1.6% of coronal voids. Statistical analysis showed a statistically significant difference in the percentage of voids in the two groups (GuttaCore and Guttaflow2) in each portion. CONCLUSIONS: GuttaFlow2 seems to flow optimally in the middle and coronal third of the canal, with greater difficulty in filling the apical third. Due to the rigidity of the carrier, GuttaCore is able to reach better the most apical portions of the canals, with greater difficulty in creating the three-dimensional seal at the level of the middle third and coronal third.

Classification review of dental adhesive systems: from the IV generation to the universal type.

Adhesive dentistry has undergone great progress in the last decades. In light of minimal-invasive dentistry, this new approach promotes a more conservative cavity design, which relies on the effectiveness of current enamel-dentine adhesives. Adhesive dentistry began in 1955 by Buonocore on the benefits of acid etching. With changing technologies, dental adhesives have evolved from no-etch to total-etch (4th and 5th generation) to self-etch (6th, 7th and 8th generation) systems. Currently, bonding to dental substrates is based on three different strategies: 1) etch-and-rinse, 2) self-etch and 3) resin-modified glass-ionomer approach as possessing the unique properties of self-adherence to the tooth tissue. More recently, a new family of dentin adhesives has been introduced (universal or multi-mode adhesives), which may be used either as etch-and-rinse or as self-etch adhesives. The purpose of this article is to review the literature on the current knowledge for each adhesive system according to their classification that have been advocated by many authorities in most operative/restorative procedures. As noted by several valuable studies that have contributed to understanding of bonding to various substrates helps clinicians to choose the appropriate dentin bonding agents for optimal clinical outcomes.

Comparison between three glass fiber post cementation techniques.

OBJECTIVE: The aim of this experimental study was to compare the traditional cement systems with those of the latest generation, to assess if indeed these could represent of viable substitutes in the cementation of indirect restorations, and in the specific case of endodontic posts. METHODS: The assessment of the validity of the cementing methods was performed according to the test of the push-out, conducted on sections obtained from the roots of treated teeth. The samples were divided into three groups. Group A (10 samples): etching for 30 seconds with 37% orthophosphoric acid (Superlux-Thixo-etch-DMG) combined with a dual-curing adhesive system (LuxaBond-Total Etch-DMG), dual-cured resin-composite cement (LuxaCore-DMG) and glass fiber posts (LuxaPost-DMG). Group B (10 samples): self-adhesive resin cement (Breeze-Pentron Clinical) and glass fiber posts (LuxaPost-DMG). Group C (10 samples): 3 steps light-curing, self-etching, self-conditioning bonding agent (Contax-Total-etch-DMG), dual-cured resin-composite cement (LuxaCore-DMG) and glass fiber posts (LuxaPost-DMG). The survey was conducted by examining the breaking resistance of the post-cement-tooth complex, subjected to a mechanical force. Statistical analysis was performed using SPSS Inc. ver. 13.0, Chicago, IL, USA. RESULTS: Group A values of bond strenth ranged from a minimum of 10.14 Mpa to a maximum value of 14.73 Mpa with a mean value of 12.58 Mpa. In Group B the highest value of bond strength was 6.54 Mpa and the minimum 5.55 Mpa. The mean value of the bond strength for the entire group was 6.58 Mpa. In Group C the highest bond strength was 6.59 Mpa whereas the lowest bond strength was 4.84 Mpa. Mean value of the bond strength of Group C was calculated at 5.7 Mpa. CONCLUSIONS: Etching with orthophosphoric acid combined with a dual-curing adhesive system and a dual-cured resin-composite cement was the technique that guaranteed the highest bond strength. Lowest bond strength values were obtained when dual self-adhesive cement was used.

Comparison of two different debonding techniques in orthodontic treatment.

AIM: The purpose of this research is to investigate whether and how the adhesive bond failure site varied in relation to the material used for the orthodontic bonding and debonding technique applied. MATERIALS AND METHODS: Two different methods of orthodontic debonding were included in our survey; cutters for orthodontics and debonding plier. Three different materials for the adhesion of the bracket: composite light curing, self-curing composite and glass ionomer cement. The remaining amount of adhesive on the tooth surface is an important parameter that gives information on how the location of the posting site varied during the debonding. 60 dental elements, maxillary and mandibular, previously extracted for orthodontic reasons, as well as periodontal, were included in our research. We investigated a possible significant correlation between different variables (debonding technique and materials for membership) and the ARI index. CONCLUSIONS: The use of orthodontic cutters or debonding pliers does not affect the adhesive bond failure site and both techniques have a tendency to leave a significant amount of adhesive on the surface enamel. In the resin-reinforced glass ionomer cements, detachment occurs at the interface enamel-adhesive and this pattern of detachment increases the risk of the enamel damage during debonding. In both types of composite resins (photopolymerizable or self-curing), the detachment occurs at the interface bracketing adhesive. In this case the amount of remaining adhesive material on the tooth must be removed with further methods, which in addition, increase the risk of iatrogenic injury as well as the working hours.

Benchmarking matching color in composite restorations.

The purpose of this study was to investigate the color samples (A2, A3 and B1) of three different brands of resin composites using dentine masses. 135 discs were prepared (5 plates for each thickness, color and brand of composite material). A colorimetric evaluation, using white and black background, was performed just after preparation. The color was measured corresponding to "Vita" scale and ΔL, Δa, Δb and ΔE values were calculated using a spectrophotometer. The results showed that Value, Chroma and Hue often differ even if the same commercial color and same thickness is used. In conclusion, this study showed that the perfect aesthetics restoration is possible combining individual abilities, experience and correct techniques.

Evaluation of over-etching technique in the endodontically treated tooth restoration.

The main purpose of a post-endodontic restoration with posts is to guarantee the retention of the restorative material. The aim of the study was to examine, through the push-out test, how bond strength between the post and the dentin varied with etching time with 37% orthophosphoric acid, before cementation of a glass fiber post. Moreover, it has been examined if over-etching (application time of the acid: 2 minutes) was an effective technique to improve the adhesion to the endodontic substrate, after highlighting the problems of adhesion concerning its anatomical characteristics and the changes after the endodontic treatment. Highest bond strength values were found by etching the substrate for 30 sec., while over-etching didn't improve bond strength to the endodontic substrate.

Endo-restorative treatment of a severly discolored upper incisor: resolution of the "aesthetic" problem through Componeer veneering System.

AIM: Re-establishing a patient's lost dental aesthetic appearance is one of the most important topics for contemporary dentistry. New treatment materials and methods have been coming on the scene, day by day, in order to achieve such an aim. Most dentists prefer more conservative and aesthetic approaches, such as direct or indirect veneer restorations, instead of full-ceramic crowns for anteriors where aesthetics is really important. The aim of the study is to evaluate clinically the effectiveness of a direct composite veneering system in resolving aesthetic problem of an upper incisor with a multidisciplinary treatment approach. METHODS: Patient with a severe discolored upper incisor came to our attention; at the X-ray exam there was an evidence of a past not good root canal treatment and also old and incongruent composite obturation. After removing all the material inside the root canal was performed a new correct endodontic filling, then Authors tried to bleach the tooth trough "walking-bleach" technique with a hydrogen peroxide (30 volumes) and sodium perborate solution without excellent results. So it was decided to insert a glass-fiber post and than to perform a direct composite veneer with Componeer System (Coltene). Componeer System is a system of prefabricated composite veneers that are abled to be applied directly in the first appointment: after a conservative preparation of the tooth, it must be used an adhesive agent (for example a "three steps") and then with composite stratification it's possible to apply the componeer veneer (choosing the right measure, modified as necessary) as the last covering aesthetic layer. RESULT: The evaluation of result of this multidisciplinary treatment was essentially clinical and radiological; in fact it's possible to observe, from a clinical point of view, the good aesthetic aspect of the direct composite restoration with componeer veneer that offers also some advantages: conservative preparation with minimal lost of tooth tissue, easy standardized technique, low cost and immediate restoration of the tooth (without provisional passage). From a radiological point of view it's possible to check the good quality of endodontic retreatment on the post-operative periapical X-ray. To verify the long-term result Authors consider follow up at six months and one year. CONCLUSION: A multidisciplinary approach is always necessary to program a treatment plan in dentistry; in the case reported Authors decide to perform an endo-conservative treatment with different steps: - root canal therapy to resolve endodontical problem- glass fiber post to reinforce the conservative restoration- direct composite veneer restoration (after bleaching) to obtain the resolution of anterior aesthetic problems.

Root canal obturation: experimental study on the thermafil system related to different irrigation protocols.

AIM: The aim of this study was to stress the ability of a specific obturation technique (thermafil technique) to seal root canal system in presence or absence of smear layer. METHODOLOGY: Sixteen monoradicular teeth, extracted for periodontal reasons, were collected for this study. All specimens were prepared with nickel-titanium rotary files, and then divided into two groups: for each group was applied a different kind of irrigation method, verifying the effectiveness in removing the smear layer, thus rendering the dentinal tubules more permeable for penetration of softened gutta-percha. Thermafil system was used to fill the root canals, and then all the specimens were observed under scanning electron microscope (SEM). RESULTS: The results showed that the Group which followed irrigation only with sodium hypochlorite exhibited significantly less gutta-percha tags when compared to the second Group, which was irrigated with sodium hypochlorite and EDTA. CONCLUSION: The thermafil systems have a very good quality of compression and fluency that permit to gain a good seal of endodontic space; furthermore it allows the penetration of gutta-percha with the formation of numerous of gutta-percha tags inside the dentinal tubules above all when smear layer is reduced or eliminated.

Nano-hydroxyapatite and its applications in preventive, restorative and regenerative dentistry: a review of literature.

This study aims to critically summarize the literature about nano-hydroxyapatite. The purpose of this work is to analyze the benefits of using nano-hydroxyapatite in dentistry, especially for its preventive, restorative and regenerative applications. We also provide an overview of new dental materials, still experimental, which contain the nano-hydroxyapatite in its nano-crystalline form. Hydroxyapatite is one of the most studied biomaterials in the medical field for its proven biocompatibility and for being the main constituent of the mineral part of bone and teeth. In terms of restorative and preventive dentistry, nano-hydroxyapatite has significant remineralizing effects on initial enamel lesions, certainly superior to conventional fluoride, and good results on the sensitivity of the teeth. The nano-HA has also been used as an additive material, in order to improve already existing and widely used dental materials, in the restorative field (experimental addition to conventional glass ionomer cements, that has led to significant improvements in their mechanical properties). Because of its unique properties, such as the ability to chemically bond to bone, to not induce toxicity or inflammation and to stimulate bone growth through a direct action on osteoblasts, nano-HA has been widely used in periodontology and in oral and maxillofacial surgery. Its use in oral implantology, however, is a widely used practice established for years, as this substance has excellent osteoinductive capacity and improves bone-to-implant integration.

Biopsy of different oral soft tissues lesions by KTP and diode laser: histological evaluation.

INTRODUCTION: Oral biopsy aims to obtain clear and safe diagnosis; it can be performed by scalpel or laser. The controversy in this latter application is the thermal alteration due to tissue heating. The aim of this study is the histological evaluation of margins of "in vivo" biopsies collected by diode and KTP lasers. MATERIAL AND METHODS: 17 oral benign lesions biopsies were made by diode 808 nm (SOL, DenMatItalia, Italy) and KTP 532 nm (SmartLite, DEKA, Italy). Samples were observed at OM LEICA DM 2000; margin alterations were evaluated through Leica Application Suite 3.4. RESULTS: Epithelial and connective damages were assessed for each pathology with an average of 0.245 mm and a standard deviation of ± 0.162 mm in mucoceles, 0.382 mm ± 0.149 mm in fibromas, 0.336 mm ± 0.106 mm in hyperkeratosis, 0.473 mm ± 0.105 mm in squamous hyperplasia, 0.182 mm in giant cell granuloma, and 0.149 mm in melanotic macula. DISCUSSION: The histologic aspect of lesions influenced the response to laser, whereas the greater inflammation and cellularity were linked with the higher thermal signs. Many artifacts were also associated to histologic procedures. CONCLUSION: Both tested lasers permitted sure histologic diagnosis. However, it is suggested to enlarge biopsies of about 0.5 mm, to avoid thermal alterations, especially in inflammatory lesions like oral lichen planus.

Tooth wear among patients suffering from mental disorders.

AIM: Assess oral health, treatment needs and the correlation between tooth wear and medications in patients with psychiatric disease. METHODOLOGY: 92 patients (40 male and 52 female) admitted in the Department of Neurology and Psychiatry of the Umberto I Hospital of Rome underwent an oral and dental clinical examination in accordance according to World Health Organization Basic Methods Criteria. One dentist performed all clinical examinations, training and calibration was carried out by an experienced clinical examiner. To measure the degree of inter-examiner agreement Kappa statistics was calculated. Level of tooth wear was assessed using the tooth wear classification of Johansson et al. Exact psychiatric pathology and medications of each patient were registrated. The Statistical Package for the Social Sciences (SPSS Inc., Chicago, Ill.) was used to analyze the data. A value of P < 0.05 was considered statistically significant. RESULTS: 34.78% of the sample regarding tooth wear demonstrated score 2. Men demonstrated 30% score 2, and 20% score 3 and 4 whereas female patients 38.46% score 2, 7.69% score 3 and none score 4. CONCLUSIONS: Chronic exposure to neuroleptic drugs can cause phenomena of bruxism. There is a direct correlation between tooth wear, psychiatric disorders and administration of certain drugs. Poor oral hygiene and extensive unmet needs for dental treatment were widespread among psychiatric patients.

Resolution of endodontic issues linked to complex anatomy.

Anatomical abnormalities of the root canal system are frequently seen in specialist endodontic practice, and represent a challenge to be faced with skill and thoroughness, beginning with an accurate diagnostic phase and devising the most appropriate treatment plan. Fortunately, much progress has been made in endodontic research thanks to technological advances and the evolution of higher performance instruments, which now consent even very complex cases to be resolved with relative ease. Below are described the salient features of recent progress in endodontics, along with a description of several clinical cases in which the operator has encountered numerous difficulties due to peculiar tooth morphology, overcome successfully thanks to the application of modern tools and consolidated clinical experience in the field.

Mozart: the toothache of a genius.

The medical history of Wolfgang Amadeus Mozart (1756-1791) has been pieced together from his letters and from anecdotes, but his dental health is one aspect which has been somewhat overlooked. It is known that, from an early age, he suffered from toothache and tooth abscesses, problems that may even have had other medical repercussions. In this paper, the authors explore and consider whether these negative experiences might have influenced Mozart's work and his attitude to teeth and dental pathologies. Two pieces of evidence from the life and work of this great composer provide clues: the aria entitled "A tooth decayed and sensitive to cold" (KV 209 a) (1772), containing the lament of a "sick man" suffering from toothache; and the first of the "Zoroastrian Riddles," which Mozart proposed during a masked ball in 1786, and whose solution is "teeth." Close examination of these two creative feats demonstrate that Mozart's attitude toward dental pathologies was calm and rational, so much so that he even managed to use the topic as a source of inspiration for a small jewel of a composition.