Impact of SARS-CoV-2 on dentistry: a review of literature.

OBJECTIVE: SARS-CoV-2 is a new Coronavirus identified as the cause of Coronavirus disease in 2019 (COVID-19). The epidemic spread in China and beyond its borders, involving 114 countries with more than 5 million dead. On March 11, the WHO declared the spread of SARS-CoV-2 to be a pandemic and encouraged nations to adopt harsh restrictive measures. Therefore, patients more and more often turn to dental offices only for emergencies. Healthcare professionals, including dentists, are at high infectious risk. In fact, the closeness to the oral cavity and nasopharynx and the use of drills or ultrasonic devices that cause aerosol release, make dental professions at high risk of bacterial and viral infections. The way patients are treated has changed. In fact, it should be mandatory to carry out a pre-treatment telephone triage and the use of mouthwashes to reduce bacterial load. In the current pandemic, it is necessary to adopt specific safety protocols that can protect dental operators as well as limit the spread of the virus. The purpose of this review is to present an overview on ways to reduce the risk of SARS-CoV-2 contagion in dentistry by focusing on the immediate situation as well as by looking towards the future. MATERIALS AND METHODS: To reach the review purpose, we selected a series of studies using keywords "COVID-19" OR "SARS-CoV-2" in association with "dentistry" AND "safety protocols" AND "healthcare procedures" AND "individual protection dispositive" AND "air transmission" AND "droplet". We selected papers exclusively in English language, up to 1st January 2022. RESULTS: During future phases of the pandemic, everywhere in the World, it is necessary to impose all dentistry team both a serological screening and the vaccination, as already established for all health staff in Italy. CONCLUSIONS: For own safety, it is an important for the whole dentistry category constantly update the devices and the protocols adopted, as well as monitoring the real infectious threats, which may occur.

Obesity, bariatric surgery and periodontal disease: a literature update.

Obesity is linked to other systemic diseases, such as diabetes mellitus, dyslipidemia, and arterial hypertension. These comorbidities increase the risk of developing cardiovascular disease risk. Adipose tissue is a true endocrine organ and releases various pro-inflammatory cytokines. Periodontal disease (PD) is a chronic inflammatory disorder of the gingiva and bone support (periodontal tissues) that surrounds the teeth. The relationship between obesity and an increased risk of developing PD is already known in the literature. Many studies correlated the cardiometabolic risk with periodontal disease. Bariatric surgery is a way to reduce the adipose tissue in obese patients, that meet specific criteria. It has been observed that this type of surgery usually reduces both the systemic inflammation and the cardiometabolic risk. Some authors have hypothesized that, as a result, the progression of periodontal disease is also reduced. Five articles are analyzed in this systematic review. In these papers, the periodontal health before and after the bariatric surgery was compared. However, the conclusion of the previous studies demonstrated a scarce literature and did not confirm the reduction of periodontal disease after bariatric surgery, but a reduction of cardiometabolic risk. Therefore, periodontal disease in no way influences the reduction of cardiovascular risk after bariatric surgery.

Autologous tooth graft: a histological comparison between dentin mixed with xenograft and dentin alone grafts in socket preservation.

The aim of this study is to compare the histological results after socket preservation between dentin mixed with xenograft and dentin alone in tooth graft procedure. Six patients were included in this prospective case series study and treated in three clinical centers using standardized clinical procedures. This clinical trial enrolled patients with three walls post-extractive defects requiring the restoration of bone dimension and shape in mandibular zone. The patients were divided in two groups: extracted teeth alone (first group) and extracted teeth mixed with equal quantity of xenograft (second group). The extracted tooth was cleaned and processed by a recently introduced automated device, that allows fragmentation and partial demineralization of the tooth matrix and used as graft material. The graft obtained in this way, was inserted at the time of the extraction. A covering membrane was used to protect the graft. Implants were placed after 4 months of healing. Bone biopsies of the all grafted sites were taken at the time of implant surgery, for histological analysis. Descriptive statistics was used to synthesize the results, using mean values and standard deviations. Six patients (5 women, mean age at surgery 50.3±12.1 years) were treated and after 4 months of healing both groups, grafts height appeared stable. No signs of infection were present. Bone biopsy were taken in all grafted sites (3 with group one and 3 with group two). The histologic analysis revealed no inflammatory or infective reaction against both groups. The histomorphometry results between the two groups are different. The first group show an amount of new bone greater than the second group (+85.29%) and minor quantity of residual graft (-83.59%). The dentin alone shows a larger amount of new bone.

Oral Management of Steinert's Disease and Role of Anxiolysis.

BACKGROUND: Myotonic dystrophy type I (DM1) is a genetic autosomal dominant disorder; malignant hyperthermia is a possible complication. It may occur following administration of some halogenated general anesthetics, muscle relaxants, or surgical stress. AIM: The purpose of this case report is to evaluate the dental management of patients with Steinert's disease. CASE REPORT: The patient needed dental extraction. A locore-gional paraperiosteal anesthesia was performed using bupiva-caine without vasoconstrictor and sedation with nitrous oxide. The syndesmotomy of the elements 3.1, 4.1, and 4.2 was executed. The elements were dislocated through a straight lever and avulsed with an appropriate clamp. The socket was courted, washing with saline solution, inserting a fibrin sponge, and applying sutures (silk 3-0). CONCLUSION: Dental treatment of the patient with Steinert's dystrophy must be carried out under a hospital environment and the use of local anesthetic without vasoconstrictor and with use of nitrous oxide; anxiolysis is recommended. CLINICAL SIGNIFICANCE: This case report describes the precautions to perform oral surgery in patients with Steinert's disease and emphasizes the role of anxiolysis to avoid episodes of malignant hyperthermia.

Titanium alloy vs. stainless steel miniscrews: an in vivo split-mouth study.

OBJECTIVE: To compare in vivo Titanium Alloy (TiA) with Stainless Steel (SS) miniscrews Temporary Anchorage Devices (TADs) using removal torque and Scanning Electron Microscopic (SEM) analysis. PATIENTS AND METHODS: 15 subjects (6 males and 9 females) who required maximum anchorage were recruited. For each patient, a TiA TAD and a SS TAD with same length and width were implanted following a randomized split-mouth study design. Retraction was carried out with nickel-titanium spring ligated directly from the anterior hooks of the archwire to the TADs to produce 90 to 100 g of force. When no further anchorage supplementation was needed, the TADs were removed. The removal torque values were registered with a digital screwdriver. After removal, the TADs were collected in a fixed solution and examined using SEM and X-ray microanalysis. RESULTS: All TADs remained intact, with a 100% success rate. There was no difference in removal torque between TiA and SS miniscrews (4.4 ± 1.3 N-cm and 5.1 ± 0.7 N-cm, respectively). All specimens' loss of gloss with signs of biological contaminations resulted in a dull implant surface. SEM photomicrographs of TiA miniscrews showed predominantly blood cells while SS miniscrews showed the precipitation of an amorphous layer with low cellular component. There was no difference in spectroscopic analysis between TiA and SS miniscrews. CONCLUSIONS: TiA and SS miniscrews had comparable removal torque values. SEM photomicrographs showed no evidence of osseointegration with both TADs having similar biological responses.

Oral management of adult patients undergoing hematopoietic stem cell transplantation.

Chemotherapy and hematopoietic stem cell transplantation (HSCT) are the current treatments for patients with hematological diseases; they result in myelosuppression, and increase the susceptibility of patients to severe infections. The oral cavity is a potential site of complications in HSCT patients, because it is the entrance for agents that can cause systemic infections; it is one of the most frequent locations for side effects deriving from conditioning therapy. The importance of dental pre-chemotherapy and transplant prescription is often stressed, since both therapies depress the immune system and platelets, making each intervention at this stage a high risk. The aim of this article is to review the potential complications of HSCT, and to extrapolate from the scientific literature the treatments and timeframes in which dental therapies can be performed, avoiding important risks for patients.

Correlations between dental malocclusions, ocular motility, and convergence disorders: a cross-sectional study in growing subjects.

OBJECTIVE: The purpose of the study was to analyze the association between dento-skeletal malocclusions, ocular motility, and convergence disorders in growing subjects. MATERIALS AND METHODS: 84 subjects (49 males, 35 females) with a mean age of 7.3±1.7 years were enrolled in a screening procedure for celiac disease at the Department of Gastroenterology of the University of Rome "Tor Vergata". Each child underwent an orthodontic, orthoptic, and ophtalmological examination. Pearson's Chi-Square test with Yates' correction and Fisher's exact test were conducted to assess the association between orthoptic defects and malocclusions (p<0.05). RESULTS: Ocular motility disorders were present in 44.9% of males and in 57.1% of females, while convergence defects were present in 10.2% of males and in 2.9% of females. Ocular motility disorders were more frequent in subjects with Angle Class III malocclusion (66.7%) than in subjects with Angle Class II (59.1%) and Class I (45.8%) malocclusion. Convergence defects were equally frequent in Angle Class I and Class II malocclusion (5.1%), while none subject presenting with Angle Class III malocclusion exhibited convergence defects. A statistically significant correlations was found between ocular motility disorders and unilateral cross-bite with midline deviation. CONCLUSION: Ocular motility defects had a significant greater prevalence in subjects presenting with unilateral cross-bite and midline deviation. The importance of role of orthodontic diagnosis among interdisciplinary treatment in growing children should be recognized.

Effects of new probiotic mouthwash in patients with diabetes mellitus and cardiovascular diseases.

OBJECTIVE: To evaluate the impact of a new formulation of probiotic mouthwash (PM), using Biocult strong® dissolved in neutral mouthwash. PATIENTS AND METHODS: Forty-two patients with cardiovascular disease (CVD) or type 1 and type 2 diabetes were enrolled. Plaque Control Record (PCR) and Bleeding on Probing (BOP) were assessed at baseline and after two weeks of PM or positive control treatment in intervention group (IG) and control group (CG). Food intake was estimated by 3-day diet record. RESULTS: BOP was significantly reduced in all treatments and samples, except for IG in CVD sample (p=0.15). PCR decreased significantly in all treatments and samples (p<0.01). No significance was obtained for BOP and IP in the time x group interaction. Food intake was not significantly different between IG and CG in all samples. Nutrients such as fats and simple carbohydrates were correlated with BOP in patients who received positive control, rather than PM, indicating a lack of food influence on BOP and PCR in IG. CONCLUSIONS: PM treatment was effective in relation to the reduction of PCR and BOP. Probiotics represent a good, but additional, tool for prophylaxis, because they cannot completely substitute the classic oral hygiene methods. Moreover, one week of treatment was not sufficient to draw firm conclusions about the efficacy of the treatment itself.

Marfan Syndrome: oral implication and management.

Marfan's Syndrome is a multisistemic pathology of connective tissues, a dominant autosomal transmission, first discovered by a French pediatrician, Antoine Bernard-Jean Marfan, who first found in some of his patients a disproportionate alteration of inferior infertility. This alteration was caused by the mutation of the FBN1 gene, located on the long arm of the chromosome 15, which encodes for an extracellular matrix protein, fibrin-1. Later it was discovered that the disease could occasionally be due also to the mutation of the TGFBR2 gene, which encodes for a TGF-beta receptor 1. The estimated incidence of the disease is 2-3 subjects affected every 10,000, in the absence of predilection ratial, ethnic, geographic and gender. It is believed that some 15,000 people in Italy suffer from Marfan Syndrome. The disease is characterized by a wide range of clinical manifestations that affect different organs. The study evaluates through a literature review the manifestations in the oral cavity of the marfan syndrome and the correct management of the patient during dental maneuvers.

Oral health and implant therapy in Parkinson's patients: review.

Parkinson's Disease (PD) is one of the most frequent neurodegenerative diseases, second only to Alzheimer's disease. It is a progressive disease that inevitably leads the patient to death, in most cases for pneumonia ab ingestis. It affects 120 people out of 100,000 and more frequently affects men than women. The main symptoms are divided into motor, non-motor and behavioral ones. The main motors symptoms are tremor, bradykinesia and postural instability. Non-motor symptoms include autonomic nervous dysfunction (orthostatic hypotension, cardiac arrhythmia, sexual dysfunction, excessive sweating due to hypothalamic dysfunction, constipation), insomnia, OSAS, and olfactory dysfunction. Behavioral symptoms are depression, dementia and psychosis. The purpose of this study is to evaluate, through a systematic review of literature, the oral health status of the Parkinson's patient compared with the general population with particular reference to the incidence of caries and periodontal disease, the patient's management during dental interventions and the possibility of rehabilitating the patient with implanted therapy.

Long-term periodontal status of palatally and buccally impacted canines after closed surgical-orthodontic approach.

INTRODUCTION: The aim of this study is to evaluate the periodontal status of palatally and buccally impacted canines exposed with closed technique, and to compare them with the controlateral canines that served as control teeth as well as to compare them each other. METHODS: 28 patients, 14 with unilateral palatally impacted canines and 14 with unilateral buccally impacted canines comprised the subjects of the study. Mean recall observational period was 2 years 4 months ± 1 year 1 month. Closed eruption technique without the tunnel was performed to expose both the palatally and the buccally impacted canines. Six periodontal variables were considered: probing pocket depth (PPD); width of keratinized tissue (KT); gingival thickness (GT); plaque index (PI); gingival bleeding index (GBI); gingival recession (REC). RESULTS: Palatally impacted canines exhibited significant greater PPD on the mesiolingual site compared to their controlaterals (P<0.05). Buccally impacted canines had significant increased KT compared to their contralaterals (P<0.05). Palatally impacted canines had significant greater PPD on the midbuccal site and on all the palatal sites when compared to the buccally impacted canines (P<0.05). CONCLUSION: The changes observed in the periodontal status of impacted canines, although statistically significant, did not reach clinical significance.

Therapeutic efficiency of platelet gel for the treatment of oral ulcers related to chronic graft versus host disease after allogeneic haematopoietic stem cell transplantation.

BACKGROUND: Platelet (PLT) gel has been successfully used in tissue regeneration of diabetic and surgical wounds through the releasing of growth factors such as basic fibroblast and PLT-derived growth factors. Based on this background, our previous clinical trial have assessed the feasibility and efficacy of PLT gel for the treatment of muco-cutaneous lesions related to graft versus host disease (GvHD) after allogeneic haematopoietic stem cell transplantion (HSCT). The promising results reported in a small series of 6 patients, of whom 1 with oral ulcers, represent the rationale of the present study. MATERIALS AND METHODS: The aim of this study was to verify the efficacy and safety of PLT gel for treating oral ulcers due to chronic GvHD. Allogeneic hemocomponents were used to obtain PLT gel with an automated system for the on-site preparation and application of patient (autologous) or healthy blood donor (allogeneic)-derived fibrin sealant or PLT-rich fibrin (Vivostat system, Vivostat A/S). Ten patients with multiple oral lesions related to chronic GvHD underwent allogeneic PLT gel as local therapy alone or in combination with systemic therapy in half of the cases. RESULTS: After the second PLT gel application, all patients resumed the feeding and a significant improvement of the oral pain was observed. After a median of five PLT gel applications (range, 2-15), 7 out of 10 patients showed a complete response. No side effects were documented. CONCLUSION: These data confirm that the PLT gel may be used as a safe and effective tool, alone or in combination with systemic therapy, for the treatment of mucosal lesions of mouth related to cGvHD.

Identification of oral risk factors for chronic graft versus host disease in haematological patients who underwent allogeneic haematopoietic stem cell transplantation.

OBJECTIVE: The aim of this prospective observational study was to identify local risk factors for the development of clinical manifestations of oral chronic Graft versus Host Disease (cGvHD) in a cohort of patients affected by haematological malignant diseases who underwent allogeneic haematopoietic stem cell transplantation (HSCT). MATERIALS AND METHODS: In the context of an active collaboration between the Rome Transplant Network of the Hematology and the Oral Pathology Division at "Policlinico Tor Vergata", in Rome, 47 haematological patients were included in this trial based on a systematic dental screening and follow-up protocol. The dental checks were planned 1 month before the transplant procedure while the subsequent follow ups were scheduled on day +100, +180, +365 and + 730 after the transplant. The tool used for the dental checks was a detailed report including all the potential oral features responsible of mechanical, chemical or infective injuries, except for the drugs. RESULTS: Overall, 64% of patients (N=30) did not perform dental hygiene during the screening pre-transplant and 53% (25/47) developed cGvHD with oral involvement. The most part of patients (84%) who experienced oral manifestations of cGvHD during the follow-up period after HSCT did not perform dental hygiene before the transplant procedure. Moreover, the comparison between the "presence" or "absence" of dental hygiene before the allogeneic HSCT showed a statistical significant increasing during the follow-up period in the occurrence of oral lesions due to the cGvHD for patients who lack pre-transplant dental care (p=0.029).On the contrary, the frequency of the other factors such as malocclusions, fractured teeth, incongruous prosthesis, food, smoke, alcol and bad habits, resulted similar between the group with or without typical oral lesions of cGvHD. CONCLUSIONS: The prevention of oral infectious complications provided by primary and secondary dental cares can result in a great benefit for haematological patients who underwent allogeneic HSCT. The combined hematological and dental management represents a clinical need before and after allogeneic HSCT for the removal of inconvenient issues with impact on the short and long-term outcome. Poor dental hygiene seems to be a local risk factor for the development of oral lesions due to cGvHD. However, a larger cohort of patients is necessary to confirm these preliminary data and to evaluate the best preventive and therapeutic oral hygiene protocol in this specific setting.

Low-level laser therapy in the treatment of muscle-skelet pain in patients affected by temporo-mandibular disorders.

BACKGROUND: The purpose of the study is to evaluate the effectiveness of Low-Level Laser Therapy in reducing joint and muscle pain in patients with acute and chronic temporomandibular dysfunction. MATERIALS AND METHODS: The study was conducted on a sample of 180 patients. The sample was divided into two groups according to the time of onset of the disease: acute TMD (<6 months) and chronic TMD (> 6 months). The treatment for all patients provided for the irradiation with Diode Laser Wiser Doctor Smile with tip plane wave at wavelength of 830 nm, continuous beam to 40nW diameter and radius of 6 mm. The irradiated areas were the joint area, temporal, masseter and pterygoid. The irradiation time for each zone was 60s.The protocol adopted consisted of two weekly treatment for six weeks. Pain assessment was performed using the Visual Analog Scale (VAS), in which different scores (s) depending accused of pain by the patient: s0 no pain, s1-3 mild pain, s4-6 moderate pain, s7-9 severe pain and s10 excessive pain. The pain monitoring was performed before treatment, after 15 days and after one month. RESULTS: The sample included 80 patients with acute TMD and 100 with chronic TMD. The sample belonging to acute TMD group before treatment, was distributed as follows: 0% in s0; 12,5% in s1-3; 31.3% in s4-6; 53.6% in s7-9 and 2.5% in s10. After 15 days the distribution was was as follows: 6.25% in s0; 47.5% in s1-3; 20% in s4-6; 26.3% in s7-9 and 0% in s10. After 30 days the sample was well distributed: 35% in s0; 45% in 1-3; 10% in s4-6; 10% in s7-9 and 0% in s10. The sample belonging to the chronic TMD group, at time zero, was as follows: 0% at s0; 48% in S1-3; 35% in s4-6; 15% in s7-9 and 2% in s10. After 15 days the distribution was: 29% in s0; 28% in S1-3; 33% in s4-6; 10% in s7-9 and 0% in s10. After 30 days the sample was well distributed: 45% in s0; 36% in S1-3; 15% in s4-6; 4% in s7-9 and 0% in s10. CONCLUSIONS: The Low-Level-Laser-Therapy is a valuable tool that can significantly decrease the perception of pain in patients with temporomandibular joint dysfunction, acute and chronic.

Polysonographical evaluation in a case of moderate osas treated with mandibular advancement device.

BACKGROUND: The Obstructive Sleep Apnea Syndrome (OSAS) is a clinical picture characterized by partial or complete obstruction of the upper airway during sleep, associated with a reduction of oxygen saturation in the blood.The most common symptoms are: apnea sleep, snoring, headache, sleepiness, reduced concentration and memory, irritability, increased blood pressure and dry mouth. MATERIALS AND METHODS: It was examinated a not-smoker man of 54 years that suffers of roncophaty. He did physical examination, rhinoscopyexam, faringoscopy, rhinofibrolaringoscopy, gnathological evaluation and polysomnographic examination performed with multichannel polygraphy (VitalNight). From the performed examinations, it has been diagnosed a moderate form of obstructive apnea sleep syndrome. He was treated with a mandibular advancement device and it was repeated the polysomnographic exam. RESULTS: Comparing the results of the polysonographic examination performed before and after the treatment, the patient's clinical picture clearly improved. It has shown a clear reduction of obstructive apneas, hypopneas and snoring. CONCLUSIONS: The use of a mandibular advancement device is certainly a valuable aid in the treatment of moderate type OSAS. The quality of diurnal life is also improved as shown with Sleepness Epworth Scale.

Orthopaedic treatment effects of functional therapy on the sagittal pharyngeal dimensions in subjects with sleep-disordered breathing and Class II malocclusion.

The purpose of this cephalometric study was to evaluate the craniofacial changes induced by functional treatment of mandibular advancement with special regard to pharyngeal sagittal airway dimensions, tongue and hyoid bone position in subjects with sleep-disordered breathing (SDB) and dentoskeletal Class II malocclusions compared with an untreated Class II control group. 51 subjects (24 female, 27 male; mean age 9.9 ± 1.3 years) with Class II malocclusion and SDB consecutively treated with a functional appliance (Modify Monobloc, MM) were compared with a control group of 31 subjects (15 males, 16 females; mean age 10.1 ± 1.1) with untreated Class II malocclusion. For the study group, mode of breathing was defined by an otorhinolaryngologist according to complete physical examination. The parents of all participants completed a modified version of the paediatric sleep questionnaire, PSQ-SRBD Scale, by Ronald Chervin (the Italian version in 22 items form) before and after the trial. Lateral cephalograms were available at the start and end of treatment with the MM. Descriptive statistics were used for all cephalometric measurements in the two groups for active treatment changes. Significant, favourable skeletal changes in the mandible were observed in the treated group after T2. Significant short-term changes in sagittal airway dimensions, hyoid position and tongue position were induced by functional therapy of mandibular advancement in subjects with Class II malocclusion and SDB compared with untreated controls. After orthodontic treatment, a significant reduction in diurnal symptoms was observed in 45 of the 51 participants who had received an oral appliance. Orthodontic treatment is considered to be a potential therapeutic approach for SDB in children. Orthodontists are playing an increasingly important role in managing snoring and respiratory problems by oral mandibular advancement devices and rapid maxillary expansion.

Experimental protocol of dental procedures In patients with hereditary angioedema: the role of anxiety and the use of nitrogen oxide.

Hereditary angioedema (HAE) is a rare disease, little known to the medical and dental community, but with a growing rate of hospitalization over the years. HAE is due to a deficit/dysfunction of C1 esterase inhibitor which leads to an increase in vascular permeability and the appearance of edemas widespread in all body areas. The airways are the most affected and laryngeal swelling, which can occur, it is dangerous for the patient's life, is also a sensitive spot in our daily practice, therefore, it is also important to be aware of all the signs of this disease. Episodes of HAE have no obvious cause, but it can be triggered by anxiety, invasive procedures and trauma. So this disease is a major problem in oral and maxillofacial surgery, ENT, endoscopy, emergency medicine and anesthesia because even simple procedures can cause laryngeal edema. The recommendations on the management of HAE include long- and short-term prophylaxis and treatment for acute attacks, however, the importance of anxiety control during the operating phases is undervalued. The present work suggests an experimental protocol for the surgery management of HAE patients with the help of nitrous oxide, with a brief review of the literature on this topic.

Differences between warfarin and new oral anticoagulants in dental clinical practice.

The oral anticoagulant therapy is used for the cure and the prevention of thromboembolic diseases. In the last fifty years the warfarin has been considered the oral anticoagulant of choice. However, its use is limited by a narrow therapeutic index and by a complex pharmacodynamics, which requires regular adjustments and monitoring of the dose. Recently, three new oral anticoagulant - dabigatran etexilato (direct thrombin inhibitor), rivaroxaban and apixaban (Xa factor direct inhibitor) - have been approved for use in europe. Increasing the number of patients taking these drugs, it is important that the dentist knows these new oral anticoagulants, their indications and methods of action, in particular for the management of patients, who require invasive treatments. With regard to the management of the patient threated with the new oral anticoagulants (NAO), there have been new significant changes in the procedure compared to the one followed by patients treated with warfarin. This led to the development of new guidelines that the dentist has to follow in order to ensure a safe and appropriate dental treatment and reduce any postoperative complications. The aim of this work is to evaluate the effectiveness of the new oral anticoagulants compared to warfarin, especially in terms of risks of bleeding events and intra and postoperative complications, in patients requiring multiple dental extractions.

Statistical analysis of the frequency distribution of signs and symptoms of patients with temporomandibular disorders.

The purpose of this text is to evaluate the distribution by sex and age of TMD patients and the frequency of pain on palpation of the lateral pterygoid muscle, pterygoid internal, sternocleidomastoid, masseter, temporal. The purpose is also to assess the existence of direct correlations between the articulating click and lateral deviation, the headache and tenderness of the temporal, the back pain and tenderness of the sternocleidomastoid, the postural disorders and difficulty finding the exact mating closing, the disorders related to previous dental procedures (large conservative reconstructions, rehabilitations fixed dentures and dental extractions) and tenderness to the temporal and masseter. 623 medical records, including 451 males and 175 females were randomly selected. It was statistically calculated the F/M ratio, age distribution and frequency of muscle tenderness to palpation through the relationship of positive feedback on the total sample multiplied by one hundred. The correlation between various disorders was calculated by estimating the Mantel-Haenszel common odds ratio. For each result it has been finally calculated the asymptotic level of significance.

Digital work-flow.

OBJECTIVE: The project presents a clinical case in which the digital work-flow procedure was applied for a prosthetic rehabilitation in natural teeth and implants. MATERIALS: Digital work-flow uses patient's photo for the aesthetic's planning, digital smile technology for the simulation of the final restoration and real time scanning to register the two arches. Than the scanning are sent to the laboratory that proceed with CAD-CAM production. RESULTS: Digital work-flow offers the opportunities to easily speak with laboratory and patients, gives better clinical results and demonstrated to be a less invasiveness method for the patient. CONCLUSION: Intra-oral scanner, digital smile design, preview using digital wax-up, CAD-CAM production, are new predictable opportunities for prosthetic team. This work-flow, compared with traditional methods, is faster, more precise and predictable.