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.

Six-Month Soft Tissues Healing after Lower Third Molar Extraction: Comparison of Two Different Access Flaps.

BACKGROUND: As specific flap designs performed for lower third molar extractions usually influence periodontal healing of the adjacent first and second molars, this study aimed to evaluate the periodontal conditions of these sites after 6 months post-surgery. METHODS: Forty patients, aged 14-30 years, were included. Surgical extraction of the lower third molar was performed through a flap with papilla detachment (a modified envelope technique with detachment of gingival papilla between the first and second molars) or a trapezoidal flap (characterized by mesial- and distal-releasing incisions). Periodontal parameters at the first and second molar sites were assessed for visible plaque index, bleeding on probing, recession, probing pocket depth, and clinical attachment loss before surgery (T0), one month (T1), and six months after extraction (T2). RESULTS: No statistical differences were found for the plaque and bleeding indexes between the two flaps at each observation time and considering both time intervals. For recession, no statistical differences were found between the two flaps considering the final time interval. For probing pocket depth at the second molar site, both techniques registered a significant increase between T0 and T1, followed by a decrease up to T2. For clinical attachment loss, mean values assessed for the first and second molar sites demonstrated evidently increased values between T0 and T1, followed by moderate decreases up to T2. CONCLUSIONS: Considering short (T1) and mid-term (T2) follow-ups, a specific flap design does not seem to particularly influence periodontal healing six months after surgery.

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.

Enigmatic Formations Found in Routine Orthopantomography (OPG) Examinations: A Case Report.

We describe two clinical cases of occasional radiographic findings on orthopantomography (OPG) that were performed routinely, for which the definitive diagnosis may be uncertain. After an accurate remote and recent anamnesis, for reasons of exclusion, we hypothesize a rare case of the retention of a contrast medium in the parenchyma of the major salivary glands (parotid, submandibular, and sublingual) and their excretory ducts as a consequence of sialography examination. In the first case we analyzed, we found it difficult to classify the radiographic signs on the sublingual glands, left parotid, and submandibular, while in the second case, only the right parotid was involved. Using CBCT, the spherical findings were highlighted, with multiple having different dimensions, as well as radiopaque in their peripheral portion and more radiolucent inside them. We could immediately exclude salivary calculi, which usually have a more elongated/ovoid shape and appear homogeneously radiopaque without radiolucency areas. These two cases (of hypothetic medium contrast retention with unusual and atypical clinical-radiographic presentation) have very rarely been comprehensively and correctly documented in the literature. No papers have a follow-up longer than 5 years. We conducted a review of the literature on the PubMed database, finding only six articles reporting similar cases. Most of them were old articles, demonstrating the low frequency of this phenomenon. The research was performed using the following keywords: "sialography", "contrast medium", "retention" (six papers) and "sialography", and "retention" (13 papers). Some articles were present in both searches, and the really significant ones (defined after a careful reading of the entire article and not only of the abstract) resulted only in six occurrences in a time span from 1976 to 2022.

Evaluation of the Efficacy of Low-Particle-Size Toothpastes against Extrinsic Pigmentations: A Randomized Controlled Clinical Trial.

Stain-removing domiciliary protocols are focused on the elimination of dental extrinsic pigmentations by the application of abrasive toothpastes, extensively available in commerce. The goal of the present study is to evaluate the efficacy of two different stain removal molecule-formulated toothpastes by the reduction of clinical parameters: the micro-cleaning crystals and activated charcoal. A total of 40 participants with extrinsic dental pigmentations were enrolled and divided into two groups: a Control group, assigned to a toothpaste with micro-cleaning crystals (Colgate Sensation White); and a Trial group, with microparticle-activated charcoal toothpaste (Coswell Blanx Black). At T0 (baseline), T1 (10 days), T2 (1 month), and T3 (3 months), clinical parameters, including Lobene stain index calculated for intensity and extension, plaque control record, and bleeding on probing, were measured. Statistically significant differences were found in both groups (p < 0.05): a reduction of extrinsic pigmentation, both in intensity and extension, was obtained in the Control group, but their total elimination could be achieved only in the Trial group with the activated charcoal molecule, though without significant difference between the groups (p > 0.05). No intergroup differences were found for each timeframe for PCR, BoP, LSI-I, and LSI-E. Both tested toothpastes can be recommended for domiciliary oral hygiene of patients with extrinsic pigmentations.

Periodontal Healing after Lower Third Molars Extraction: A Clinical Evaluation of Different Flap Designs.

Periodontal healing after third molars extraction seems to be influenced by the choice of different flap techniques. The purpose of the present study was to assess the clinical condition of adjacent first and second molar sites, after the extraction of lower third molars, performed through different flap designs. Eighty patients, aged between 14 and 30 years, were analyzed for periodontal parameters of VPI, PPD, and CAL, pre-operatively (T0), after 15 days (T1), after 1 month (T2), and after 2 months (T3) from extraction. Techniques performed were trapezoidal flap (TRAP), marginal flap (MARG), flap with papilla detachment (DETP), and flap with papilla decapitation (DEC). No significant differences were found between the four flaps at each observation time and considering the interval between T0 and T3, for VPI, PPD at first molar site, PPD at second molar site, and CAL at second molar site. Significant variations for CAL were registered, for each flap, between T0 and T3, in all cases for buccal site, in three cases for buccal-distal site. After 2 months of follow-up, no strong evidence can be assumed for or against the use of a particular flap design for the extraction of lower third molars.

Short and ultra-short (<6-mm) locking-taper implants supporting single crowns in posterior areas (part II): A 5-year retrospective study on periodontally healthy patients and patients with a history of periodontitis.

BACKGROUND: Short and ultra-short implants implants supporting single crowns seem to demonstrate high percentages of survival and stable marginal bone levels at a mid-term follow-up. Nevertheless, insurgence of peri-implant complications still represents a critical issue, especially for patients with history of periodontitis. PURPOSE: The aim of this retrospective study was to evaluate implant survival, marginal bone loss and peri-implant complications in 333 short and ultra-short implants, placed in periodontally healthy patients and patients with a history of periodontitis. MATERIALS AND METHODS: Implants were placed in the maxillary and mandibular posterior regions of 142 patients with (PP) and without (NPP) a history of periodontitis. Clinical and radiographic examinations were performed at 5-year recall appointments. RESULTS: Implants respectively placed in PP and NPP were: 35.68% and 42.50% in 8.0 mm-length group, 33.33% and 36.67% in 6.0 mm-length group, and 30.99% and 20.83% in 5.0 mm-length group. Implant-based survival after 5 years of follow-up was 95.77% for PP and 96.67% for NPP (p = 0.77). Regarding crestal bone level variations, average crestal bone loss was statistically different (p = 0.04) among PP (0.74 mm) and NPP (0.61 mm). Implants presenting signs of mucositis were 6.86% in PP and 7.76% in NPP (p = 0.76). Setting the threshold for excessive bone loss at 1 mm after 60 months, peri-implantitis prevalence was 7.84% in PP and 2.59% in NPP (p = 0.08). Overall implant success was 92.16% and 97.41%, respectively, for PP and NPP. CONCLUSIONS: Under strict maintenance program, five-year outcomes suggest that short and ultra-short locking-taper implants can be successfully restored with single crowns in the posterior jaws both in PP and NPP.

Detection of Periodontal Pathogens in Oral Samples and Cardiac Specimens in Patients Undergoing Aortic Valve Replacement: A Pilot Study.

This observational study aimed to: (i) assess the presence of periodontal disease among patients requiring aortic valve replacement; (ii) investigate the presence of oral pathogens in aortic valve specimens and compare them with the microorganisms detected in the oral cavity. Twenty-six patients (15 men and 11 women) were scheduled to be visited the day before the cardiac surgery: periodontal conditions were accurately registered through clinical and radiographic examinations; dental plaque or salivary samples were collected. Valve specimens were collected during surgical aortic valve replacement and analyzed for pathogens detection through microbiological 16SrRna gene sequencing. Bacteria found in plaque samples and valve specimens were assessed according to oral and periodontal conditions. A qualitative comparison between oral and cardiac profiles of the microorganisms detected was performed. The overall number of patients examined for soft tissues conditions was 19, as 7 patients were edentulous. Twelve and three individuals, respectively, presented moderate and severe periodontitis. Nine valves were found to be positive for the presence of oral and periodontopathic bacterial DNA. The microbial species found in valve samples of patients with periodontitis suggest that the presence of these microorganisms in valvular tissue seems to be not coincidental.

Hyperbaric oxygen therapy for the treatment of moderate to severe periodontitis: a clinical pilot study.

Objectives: To clinically and microbiologically evaluate the effects of hyperbaric oxygen (HBO2) therapy in addition to full-mouth ultrasonic subgingival debridement (FM-UD), in the initial treatment of chronic periodontitis. Methods: Twenty patients presenting moderate to severe generalized forms of chronic periodontitis were included in a three-month randomized, parallel-group, single-blinded, prospective study. At baseline patients were randomly assigned to two treatment groups [Test Group (FM-UD+HBO2) and Control Group (FM-UD)]. Both groups were treated with an FM-UD session. Ten HBO2 sessions (one session per day for 10 days at a pressure of 2.5 ATA) were additionally administered to the Test Group. Soft tissues parameters [probing pocket depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL) and visible plaque index (VPI)] were assessed at baseline (immediately before FM-UD treatment), after two weeks, after six weeks and at three months. For each patient, a site presenting PPD ≥ 6mm and positive BOP was selected as a qualifying site (QS), to be monitored clinically (at T0, T1, T2 and T3) and microbiologically (at T0, T1 and T3). Results: There were no statistically significant differences between the two groups for any clinical parameter analyzed after three months, except for BOP, which was significantly (p < 0.05) reduced in the Test Group. Reductions in bacterial levels were detected in both groups after therapy. Faster bacterial recolonization occurred after three months in the Control Group. Conclusion: HBO2 therapy in combination with FM-UD may represent an efficacious approach to the treatment of moderate to severe forms of periodontitis.

A Topical Desiccant Agent in Association with Manual Debridement in the Initial Treatment of Peri-Implant Mucositis: A Clinical and Microbiological Pilot Study.

In patients presenting mucositis, effective sub-gingival debridement is crucial to prevent peri-implantitis. The aim of this randomized study was to assess the three-month (T1) effects of a locally delivered liquid desiccant agent with molecular hygroscopic properties, in association with manual debridement, at sites with peri-implant mucositis. Twenty-three patients presenting at least one implant with no radiographically detectable bone loss, a pocket probing depth (PPD) ≥ 4 mm, and bleeding on probing (BOP), were included. At baseline (T0), patients were randomly assigned to receive the aforementioned desiccant agent before debridement (Test-Group), or a Chlorhexidine 1% disinfectant gel after debridement (Control-Group). Treatments were repeated after seven and 14 days. Peri-implant soft tissue assessment [PPD, BOP, Modified Bleeding Index (mBI), Visible Plaque Index (VPI), and Modified Plaque Index (mPLI)] and microbial sampling were performed at T0 and T1. At T1 the Test-Group presented significantly greater reductions for BOP, mBI, VPI, and mPLI. Concerning the deepest sites of the treated implants, both groups showed statistically significant reductions for BOP and mBI between T0 and T1. Furthermore, the Test-Group exhibited a significant decrease in anaerobic bacteria. Despite these valid outcomes, a complete resolution of the inflammatory conditions was not achieved by any of the groups.

Cyclic fatigue comparison among endodontic instruments with similar cross section and different surface coating.

BACKGROUND: The aim of this study was to analyze the influence of rotary instruments' geometry and surface titanium-nitride (TiN) treatment on the fatigue fracture, through the comparison of cyclic fatigue resistance of two endodontic systems that have similar cross-sectional design and different surface coating. METHODS: In this study 130 Mtwo (10/.04; 15/.05; 20/.06; 25/.06; 30/.05; 35/.04; 40/.04) and Easy Shape (15/.04; 20/.05; 25/.06; 30/.05; 35/.04; 40/.04) were tested for cyclic fatigue resistance. Time to fracture (TtF) was determined by counting the seconds of continuous rotation until final fracture in an artificial canal with 60° angle and a 5 mm radius of curve. The fracture surface of each fragment was examined with a scanning electron microscope (SEM). Data were subjected to one-way analysis of variance (ANOVA) and Tukey post-hoc tests. RESULTS: Mtwo perform a significantly (P<0.001) higher number of cycles to fracture (NCF) compared with Easy Shape of the same size and taper. The comparison between Mtwo and Easy Shape instruments with the same taper showed higher TtF values of Mtwo files than the Easy Shape ones (P<0.001) while there were no differences among Mtwo and Easy Shape instruments with the same tip, (P>0.05). CONCLUSIONS: Mtwo exhibit a higher NCF thanks to the smaller metal volume contained in their core. Titanium-nitride coating does not influence the performance of Easy Shape instruments on static test of cyclic fatigue.

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.

Clinical, microbiologic and radiologic assessment of soft and hard tissues surrounding zygomatic implants: a retrospective study.

OBJECTIVES: To assess the clinical, microbiologic, and radiologic status of soft and hard tissues surrounding zygomatic implants. STUDY DESIGN: Patients who had at least two zygomatic implants were eligible for the study. Their soft tissues were analyzed, and microbial samples were collected. Cone beam computed tomography (CBCT) and orthopantomography were used to measure bone levels. The patients were also asked to complete a Visual Analogue Scale (VAS) questionnaire assessing their satisfaction. RESULTS: A total of 65 zygomatic implants placed in 20 patients were assessed. As one zygomatic implant was lost, the cumulative survival rate was 98.5%. All the prostheses were successful. Peri-implant soft tissues were generally in a healthy condition. The patients with a history of periodontitis had worse mean peri-implant clinical parameters and showed more bacterial colonization with respect to their nonperiodontal counterparts. The implant recipients had low levels of crestal and zygomatic bone loss and high VAS scores indicating their general satisfaction. CONCLUSIONS: Although zygomatic implants were confirmed to be a reliable treatment option, patients with a history of periodontitis were, nevertheless, found to have special needs, such as frequent dental hygiene sessions.

Extraordinary sneeze: Spontaneous transmaxillary-transnasal discharge of a migrated dental implant.

This case report describes an extraordinary case of the spontaneous transmaxillary-transnasal discharge of a dental implant, which occurred during a sneeze. The patient was complained of symptoms of acute sinusitis. She underwent a computed tomography scan that revealed a dental implant dislocated in the maxillary sinus. Medical treatment based on antibiotics and mucolytics was administered to the patient in order to prepare her for endoscopic endonasal surgery. The implant was spontaneously discharged two days after during a sneeze. Mucociliary clearance in combination with a local osteolytic inflammatory process and mucolytics therapy are the likely causes of this unusual discharge.

A topical desiccant agent in association with ultrasonic debridement in the initial treatment of chronic periodontitis: a clinical and microbiological study.

Effective sub-gingival debridement is crucial to prevent serious systemic infections in hospitalized patients. Lack of compliance and the impracticality of repeated treatment in a short span of time are identified barriers to the performance of full mouth scaling and root planing (SRP). The aim of this randomized study was to evaluate the clinical and microbiological effects of the adjunctive administration of a locally delivered desiccant liquid with molecular hygroscopic properties (HYBENX® Oral Tissue Decontaminant™; HBX) in association with sub-gingival ultrasonic debridement (UD) in a hospital setting. Sixteen patients presenting moderate to severe chronic periodontitis were followed in a randomized 3 month, split mouth, single-blind, prospective study. At baseline (T1) control and test sides were treated with supra and subgingival UD with or without the association of a locally delivered desiccant liquid (HBX). Treatment was repeated after 6 weeks (T2). Clinical and microbiological parameters were assessed at T1, T2 and at 3 months (T3). The test group sites presented a significantly greater reduction in visible plaque index (VPI), bleeding on probing scores (BOP) and gingival index (GI) at T2 and T3 compared to the control group sites. HBX as monotherapy reached the same bacterial load reduction as UD. Compared to UD, a combined HBX-UD treatment resulted in a statistically significant greater bacterial load reduction immediately after treatment. A significantly lower anaerobic bacterial load was still present at T2. Data obtained show that decreased inflammatory signs and reduction of the bacterial load can be obtained in the short term by topical association of the desiccant agent HBX with UD.