Oral Rehabilitation as Part of a Multidisciplinary Treatment in a Case Study of Pigmentary Incontinence.

We present the clinical course of a 9-year-old female patient with Bloch-Sulzberger syndrome and severe neurological deficit that met the major (classic cutaneous signs) and minor (dental anomalies and retinal pathology) diagnostic criteria of Landy and Donnai. Longitudinal multidisciplinary follow-up was carried out from birth to adulthood. Neurological involvement was assessed with electroencephalographic (EEG) and neuroimaging tests at different times during the patient's life. Cranio-maxillofacial involvement was evaluated using lateral skeletal facial and cephalometric analyses. The right and left facial widths were measured through frontal face analysis and using the vertical zygomatic-midline distance. Oral rehabilitation was performed through orthodontic treatment and major dental reconstruction using composite resins. This treatment aimed to improve the occlusion and masticatory function, relieve the transversal compression of the maxilla, and reconstruct the fractured teeth. We believe that, due to significant neurological and cognitive impairment, orthognathic surgery was not the best option for restoring function and improving oral health-related quality of life.

How Does Orthodontic Mini-Implant Thread Minidesign Influence the Stability?-Systematic Review with Meta-Analysis.

BACKGROUND: Clinical guidelines are lacking for the use of orthodontic mini-implants (OMIs) in terms of scientific evidence referring to the choice of proper mini-design. Thus, the present study aimed to investigate to what extent orthodontic mini-implant thread design influences its stability. METHODS: Search was conducted in five search engines on 10 May. Quality assessment was performed using study type specific scales. Whenever possible, meta-analysis was performed. RESULTS: The search strategy identified 118 potential articles. Twenty papers were subjected to qualitative analysis and data from 8 papers-to meta-analysis. Studies included were characterized by high or medium quality. Four studies were considered as low quality. No clinical studies considering the number of threads, threads depth, or TSF have been found in the literature. CONCLUSIONS: Minidesign of OMIs seems to influence their stability in the bone. Thread pitch seems to be of special importance for OMIs retention-the more dense thread-the better stability. Thread depth seems to be of low importance for OMIs stability. There is no clear scientific evidence for optimal thread shape factor. Studies present in the literature vary greatly in study design and results reporting. Research received no external funding. Study protocol number in PROSPERO database: CRD42022340970.

The Impact of Maxillary Expansion on Adults' Nasal Breathing: A Systematic Review and Meta-Analysis.

OBJECTIVE: Nasal surgery fails to restore nasal breathing in some cases. Maxillary constriction is suggested as a major cause of failure. It is thought that maxillary constriction leads to the closure of the internal and external nasal valves. Moreover, it is well established in the literature that maxillary expansion, both in adults and children, increases upper airway volume. However, it is yet unclear whether maxillary expansion may improve nasal function.Review Methods: Pubmed (Medline), the Cochrane Library, EMBASE and Trip Database were checked by two authors from the Rhinology Study Group of the Young Otolaryngologists section of the International Federation of Otorhinolaryngological Societies. Two authors extracted the data. The main outcome was expressed as the value (in variable units) prior to treatment (T0), after expansion procedures (T1), after the retention period (T2), and after a follow-up period (T3). RESULTS: A total of 10 studies (257 patients) met the inclusion criteria. The data pooled in the meta-analysis reveals a statistically significant reduction of 0.27 Pa/cm3/s (CI 95% 0.15, 0.39) in nasal resistance after palatal expansion As far as subjective changes are concerned, the pooled data for the change in the NOSE score shows a statistically significant mean reduction after maxillary expansion of 40.08 points (CI 95% 36.28, 43.89). CONCLUSION: The initial available evidence is too limited to suggest maxillary expansion as a primary treatment option to target nasal breathing. However the data is encouraging with regards to the effect of maxillary expansion on nasal function. Further higher quality studies are needed in order to define clearer patient selection criteria, distinguish optimal techniques, and demonstrate long-term efficacy in long term follow up studies.

In Situ Antibacterial Activity of Essential Oils with and without Alcohol on Oral Biofilm: A Randomized Clinical Trial.

Currently, there is little evidence on the in situ antibacterial activity of essential oils (EO) without alcohol. This study aimed to evaluate in situ the substantivity and antiplaque effect on the plaque-like biofilm (PL-biofilm) of two solutions, a traditional formulation that contains EO with alcohol (T-EO) and an alcohol-free formulation of EO (Af-EO). Eighteen healthy adults performed a single mouthwash of: T-EO, Af-EO, and sterile water (WATER) after wearing an individualized disk-holding splint for 2 days. The bacterial viability (BV) and thickness of the PL-biofilm were quantified at baseline, 30 s, and 1, 3, 5, and 7 h post-rinsing (Test 1). Subsequently, each volunteer wore the splint for 4 days, applying two daily mouthwashes of: T-EO, Af-EO, and WATER. The BV, thickness, and covering grade (CG) of the PL-biofilm were quantified (Test 2). Samples were analyzed by confocal laser scanning microscopy after staining with the LIVE/DEAD® BacLight™ solution. To conduct the computations of the BV automatically, a Matlab toolbox called Dentius Biofilm was developed. In test 1, both EO antiseptics had a similar antibacterial effect, reducing BV after a single rinse compared to the WATER, and keeping it below baseline levels up to 7 h post-rinse (P < 0.001). The mean thickness of the PL-biofilm after rinsing was not affected by any of the EO formulations and ranged from 18.58 to 20.19 µm. After 4 days, the T-EO and Af-EO solutions were significantly more effective than the WATER, reducing the BV, thickness, and CG of the PL-biofilm (P < 0.001). Although, both EO antiseptics presented a similar bactericidal activity, the Af-EO rinses led to more significant reductions in the thickness and CG of the PL-biofilm than the T-EO rinses (thickness = 7.90 vs. 9.92 µm, P = 0.012; CG = 33.36 vs. 46.61%, P = 0.001). In conclusion, both essential oils antiseptics had very high immediate antibacterial activity and substantivity in situ on the 2-day PL-biofilm after a single mouthwash. In the 4-day PL-biofilm, both essential oils formulations demonstrated a very good antiplaque effect in situ, although the alcohol-free formula performed better at reducing the biofilm thickness and covering grade.

Devices for In situ Development of Non-disturbed Oral Biofilm. A Systematic Review.

OBJECTIVE: The aim of this review was to assess the types of devices used for in situ development of oral biofilm analyzed microbiologically. MATERIALS AND METHODS: A systematic search of the literature was conducted to identify all in situ studies of oral biofilm which used an oral device; the Ovid MEDLINE and EMBASE databases complemented with manual search were used. Specific devices used to microbiologically analyze oral biofilm in adults were included. After reading of the selected full texts, devices were identified and classified according to the oral cavity zone and manufacturing material. The "ideal" characteristics were analyzed in every group. RESULTS: The search provided 787 abstracts, of which 111 papers were included. The devices used in these studies were classified as palatal, lingual or buccal. The last group was sub-classified in six groups based on the material of the device. Considering the analyzed characteristics, the thermoplastic devices and the Intraoral Device of Overlaid Disk-holding Splints (IDODS) presented more advantages than limitations. CONCLUSIONS: Buccal devices were the most commonly used for the study of in situ biofilm. The majority of buccal devices seemed to slightly affect the volunteer's comfort, the IDODS being the closest to the "ideal" model. CLINICAL RELEVANCE: New devices for in situ oral biofilm microbiological studies should take into account the possible effect of their design on the volunteer's comfort and biofilm formation.

Ex vivo vs. in vivo antibacterial activity of two antiseptics on oral biofilm.

AIM: To compare the immediate antibacterial effect of two application methods (passive immersion and active mouthwash) of two antiseptic solutions on the in situ oral biofilm. MATERIAL AND METHODS: A randomized observer-masked crossover study was conducted. Fifteen healthy volunteers wore a specific intraoral device for 48 h to form a biofilm in three glass disks. One of these disks was used as a baseline; another one was immersed in a solution of 0.2% Chlorhexidine (0.2% CHX), remaining the third in the device, placed in the oral cavity, during the 0.2% CHX mouthwash application. After a 2-weeks washout period, the protocol was repeated using a solution of Essential Oils (EO). Samples were analyzed for bacterial viability with the confocal laser scanning microscope after previous staining with LIVE/DEAD® BacLight™. RESULTS: The EO showed a better antibacterial effect compared to the 0.2% CHX after the mouthwash application (% of bacterial viability = 1.16 ± 1.00% vs. 5.08 ± 5.79%, respectively), and was more effective in all layers (p < 0.05). In the immersion, both antiseptics were significantly less effective (% of bacterial viability = 26.93 ± 13.11%, EO vs. 15.17 ± 6.14%, 0.2% CHX); in the case of EO immersion, there were no significant changes in the bacterial viability of the deepest layer in comparison with the baseline. CONCLUSIONS: The method of application conditioned the antibacterial activity of the 0.2% CHX and EO solutions on the in situ oral biofilm. The in vivo active mouthwash was more effective than the ex vivo passive immersion in both antiseptic solutions. There was more penetration of the antiseptic inside the biofilm with an active mouthwash, especially with the EO. Trial registered in clinicaltrials.gov with the number NCT02267239. URL: https://clinicaltrials.gov/ct2/show/NCT02267239.

Characteristics of in situ oral biofilm after 2 and 4 days of evolution.

OBJECTIVE: To analyze the evolution of the thickness, bacterial vitality, covering grade, and the structure after 2 and 4 days of aging in "non-disturbed" plaque-like biofilm (PL-biofilm). METHOD AND MATERIALS: Twenty healthy volunteers wore a specific appliance. After 2 days half of the samples were removed from the appliance. Posteriorly, after bacterial vital staining, samples were analyzed using a confocal laser scanning microscope. In the first volunteer, one of the disks was analyzed using a scanning electronic microscope. The same process was realized on the remaining disks after 4 days. RESULTS: The thicknesses of the PL-biofilm after 2 and 4 days were not significantly different. The bacterial vitality changed significantly from 72.50 ± 15.50% to 57.54 ± 15.66% over time, which was in contrast to the covering grade (53.08 ± 18.03% and 70.74 ± 19.11%). The structure changed from an irregular surface and compact deepest layer with a high predominance of the coccus shape to a complex structure with voids in the deepest layer and a great proportion of bacillus-shaped bacteria. CONCLUSION: The PL-biofilm thickness remained practically constant, decreasing the bacterial vitality and increasing the covering grade over time. Regarding the structure, differences were principally bacterial disposition in the surface and bacterial shape. Clinically, the findings show that new control strategies for combating the oral biofilm should be focused on inhibiting bacterial adhesion to tooth surfaces, which would reduce biofilm formation.

Antiplaque effect of essential oils and 0.2% chlorhexidine on an in situ model of oral biofilm growth: a randomised clinical trial.

OBJECTIVE: To evaluate the in situ antiplaque effect after 4 days of using of 2 commercial antimicrobial agents in short term on undisturbed plaque-like biofilm. TRIAL DESIGN AND PARTICIPANTS: An observer-masked, crossover randomised clinical trial on 15 oral and systemically healthy volunteers between 20-30 years who were randomly and sequentially allocated in the same group which performed 3 interventions in different randomised sequences. INTERVENTION: The participants wore an appliance in 3 different rinsing periods doing mouthwashes twice a day (1/0/1) with essential oils, 0.2% chlorhexidine or sterile water (negative control). At the end of each 4-day mouthwash period, samples were removed from the appliance. Posteriorly, after bacterial vital staining, samples were analysed using a Confocal Laser Scanning Microscope. MAIN OUTCOME MEASURES: Bacterial vitality, thickness and covering grade by the biofilm after 4 days of applying each of the mouthwashes. RESULTS: The essential oils and the 0.2% chlorhexidine were significantly more effective than the sterile water at reducing bacterial vitality, thickness and covering grade by the biofilm. No significant differences were found between the 0.2% chlorhexidine and the essential oils at reducing the bacterial vitality (13.2% vs. 14.7%). However, the 0.2% chlorhexidine showed more reduction than the essential oils in thickness (6.5 µm vs. 10.0 µm; p<0.05) and covering grade by the biofilm (20.0% vs. 54.3%; p<0.001). CONCLUSION: The essential oils and 0.2% chlorhexidine showed a high antiplaque effect. Although the 0.2% chlorhexidine showed better results with regard to reducing the thickness and covering grade by the biofilm, both antiseptics showed a high and similar antibacterial activity. CLINICAL RELEVANCE: Daily essential oils or 0.2% chlorhexidine mouthwashes are effective when reducing dental plaque formation in the short term. Although 0.2% chlorhexidine continues to be the "gold standard" in terms of antiplaque effect, essential oils could be considered a reliable alternative. TRIAL REGISTRATION: ClinicalTrials.gov NCT02124655.

Enhanced cell affinity of chitosan membranes mediated by superficial cross-linking: a straightforward method attainable by standard laboratory procedures.

It is well accepted that the surface modification of biomaterials can improve their biocompatibility. In this context, techniques like ion etching, plasma-mediated chemical functionalization, electrospinning, and contact microprinting have successfully been employed to promote the cell adhesion and proliferation of chitosan (CH) substrates. However, they prove to be time-consuming, highly dependent on environmental conditions, and/or limited to the use of expensive materials and sophisticated instruments not accessible to standard laboratories, hindering to a high extent their straightforward application. Filling this gap, this paper proposes the superficial cross-linking of CH as a much simpler and accessible means to modify its superficial properties in order to enhance its cellular affinity. CH membranes were prepared by solvent casting followed by a cross-linking step mediated by the chemical vapor deposition (CVD) of glutaraldehyde (GA). The membranes were characterized against non- and solution cross-linked membranes in terms of their mechanical/surface properties and biological performance. Among others, the CVD membranes proved (i) to be more mechanically stable against cell culture and sterilization than membranes cross-linked in solution and (ii) to prompt the adherence and sustained proliferation of healthy cells to levels even superior to commercial tissue culture plates (TCPs). Accordingly, the CVD cross-linking approach was demonstrated to be a simple and cost-effective alternative to the aforementioned conventional methods. Interestingly, this concept can also be applied to other biomaterials as long as GA (or other volatile components alike) can be employed as a cross-linker, making possible the cross-linking reaction at mild experimental conditions, neither requiring sophisticated lab implements nor using any potentially harmful procedure.

Valoración de la resistencia mecánica a la fuerza de tracción de los microimplantes utilizados como anclaje en el tratamiento ortodóncico / Assessment of mechanical resistance to traction force of microimplants used as anchorage in orthodontic treatment

El manejo del anclaje es fundamental en el tratamiento ortodóncico. La falta de cooperación obliga al profesional a elegir otras alternativas terapéuticas comprometiendo, en algunos casos, los objetivos establecidos. Esta evidencia ha inducido a los profesionales a buscar nuevos métodos de anclaje que requieran poca o ninguna colaboración por parte del paciente. Los objetivos de este estudio fueron: a) valorar y cuantificar la resistencia mecánica a fuerzas de tracción de los miniimplantes con la comparación de los parámetros de diámetro y longitud; b) valorar si la resistencia a la tracción permanecía constante al someter los miniimplantes a un segundo análisis, y c) observar microscópicamente el comportamiento superficial del filo del miniimplante. Se analizaron la resistencia a fuerzas de tracción de 12 miniimplantes Jeil Medical Corporation mediante la máquina electromecánica ibertest modelo elib -5/W. Los datos obtenidos fueron codificados y analizados estadísticamente mediante el programa SPSS 12.00 para el sistema Windows, y se observó que presentaban mayor resistencia los miniimplantes de mayor diámetro y mayor longitud. En un segundo análisis se observó que la resistencia a la tracción disminuye considerablemente para todos los tipos de miniimplantes, y ésta fue estadísticamente significativa, a excepción de aquéllos de mayor diámetro y mayor longitud que lo hacen en una proporción menor, y puede estar relacionada con la deformación superficial del filo del miniimplante (AU)

The management of anchorage is very important in orthodontic treatment. The lack of cooperation makes the professional choose other treatments compromising, sometimes, the established aims. This evidence has induced the orthodontist to look for new anchorage methods without patient collaboration. The aims of this study were: evaluate and quantificate the mini-implants mechanic resistance to traction forces and compare this resistance with diameter and length, and evaluate if the resistance to traction was constant when the mini-implants were analyzed for the second time and valutare the superficial behaviour about the blade of mini-implants with microscope . We analyzed the traction forces resistance of twelve mini-implants Jeil Medical corporation with the electromechanic machine ibertest model elib -5/W. The analysis was carried out by statistical analysis software (Spss 12.00) for the windows system observing that the mini-implantss with major diameter and length have better resistance. In the second analysis we observed that the traction resistance decreases considerablely in all groups with significance. The exception was the mini-implants with a major diameter and length because the decrease is in minor proportion. This founds would be related with the blade superficial deformation (AU)

Angular photogrammetric analysis of the soft tissue facial profile.

All medical specialties interested in improving facial appearance need to measure the face to quantify the desired facial changes. The purpose of this investigation was to obtain objective average measurements of the soft tissue facial profile to use them as a guide for aesthetic treatment goals. The analysis of the soft tissue facial profile from photographic records provides information on the morphology of the profile and its relationship with the underlying dentoskeletal tissues. In this investigation the soft tissue facial profile of a young adult European Caucasian population (212 individual, 50 males and 162 females, 18-20 years of age) was studied by means of standardized photographic records taken in the natural head position (NHP). Angular measurements were analysed digitally. Sexual dimorphism was found for several angles: nasofrontal (G-N-Prn: P < 0.01), vertical nasal (Cm-Sn/N-Prn: P < 0.01), nasal (N-Prn/TV: P < 0.01), nasal dorsum (N-Mn-Prn: P < 0.05), and mandibular contour (C-Me/G-Pg: P < 0.01). Wide individual variations in nasolabial and mentolabial angles were also observed.

Linear photogrammetric analysis of the soft tissue facial profile.

This study digitally analyzes the soft tissue facial profile of a European white population of young adults by means of linear measurements made on standardized photographic records taken in natural head position. The application of the Student t test showed sexual dimorphism in most parameters of the labial, nasal, and chin areas. In general, males had greater heights and lengths as well as greater prominences of these 3 areas. They also had greater nasal and facial depths at the level of the tragus point.

La extracción de un incisivo inferior en el tratamiento ortodóncico: a propósito de dos casos / Lower incisor extraction in orthodontic treatment: two clinical reports

La mayoría de ortodoncistas han tratado al menos un paciente en el que un incisivo inferior estaba ausente o seriamente dañado por caries o enfermedad periodontal donde su extracción parece ser la mejor solución para el paciente Estas experiencias hacen a uno consciente de la desfavorable discrepancia de tamaño dentario anterior que puede existir en tales casos, y las dificultades que esto representa para conseguir un buen resultado oclusal. Sin embargo, en algunos casos, la extracción Intencional de un incisivo inferior puede permitir al ortodoncista producir una oclusión funcional aceptable y unos buenos resultados estéticos con el mínimo de manipulación ortodóncica. Presentamos dos casos en los cuales el plan de tratamiento incluye la extracción de un incisivo inferior (AU)