A short-term study of the effects of ozone irrigation in an orthodontic population with fixed appliances.

AIM: The aim of the present study was to compare the clinical efficacy of chlorhexidine and ozonised water in the oral hygiene maintenance of orthodontic patients. MATERIALS AND METHODS: Study design: This is a prospective clinical study. Thirty patients with orthodontic brackets were selected at the Versilia General Hospital (Lido di Camaiore, Italy). Patients were randomly allocated to one of two groups: standard oral hygiene session followed by prescription of either chlorhexidine mouth-rinse or ozonated water. At each moment of the follow-up, the following parameters were recorded: pocket probing depth (PPD), full-mouth plaque index (FMPI), and full mouth bleeding score (FMBS). STATISTICS: Sample size was computed according to previously published data. Significance level was set at 0.05 for all analyses, and non-parametric Wilcoxon signed rank test was used for comparisons. RESULTS: At baseline, mean PPD was 1.89 ± 0.13 mm for the control group and 1.95 ± 0.10 mm for the test group. Mean FMPI was 63.9 ± 16.5% and 68.7 ± 10.33% respectively. Mean FMBS was 31.5 ± 15.6% and 32.8 ± 8.85 respectively. One month after treatment (T2), both groups showed a significant improvement of FMPI and FMBS. Mean FMPI was 42.8 ± 14.3% and 24.3 ± 6.41% respectively. Mean FMBS was 19.5 ±12.6% and 4.70 ± 3.56% respectively. The test group treated with ozone exhibited a greater improvement of FMPI and FMBS. CONCLUSIONS: Ozone yielded better outcomes than chlorhexidine in the management of gingivitis in orthodontic patients. Ozone should be further investigated in longitudinal studies with larger samples.

The efficacy of 0.12% chlorhexidine versus 0.12% chlorhexidine plus hyaluronic acid mouthwash on healing of submerged single implant insertion areas: a short-term randomized controlled clinical trial.

OBJECTIVES: The study was performed to evaluate the incidence of post-surgical adverse events at submerged implant sites as well as the antiplaque, antigingivitis and antistaining effects in the entire dentition of patients treated with two mouthwashes. METHODS: The present randomized controlled clinical study considered 40 patients subjected to dental implant treatment. Two 0.12% chlorhexidine mouthwashes were compared for 15 days: one with 0.1% hyaluronic acid (CHX⊗HYL group) and one without it (CHX group). Surgical outcome variables, and plaque, gingival, and staining indexes were recorded. RESULTS: Significant differences were found between the two rinses regarding the presence of oedema within 2 days after surgery (20% for the CHX⊗HYL group and 78% for the CHX group). No other significant differences were recorded between the two mouthwashes. No intergroup differences in plaque, staining and gingivitis indexes were registered. The intragroup analysis revealed that for the plaque and gingival indexes, the differences between the baseline values (before surgery) and those at 15 days were all found to be significant just for CHX⊗HYL rinse, with final values ranging from 0.18 to 0.23 for the plaque index and from 0.06 to 0.07 for the gingival index. The staining index increased for both mouthwash types with significant results (with final value of 0.19 and 0.31 for CHX⊗HYL and CHX groups, respectively). CONCLUSIONS: In the sites of patients subjected to dental implant placement, an additional anti-oedematigenous effect in early healing seemed to be disclosed for 0.12% CHX⊗HYL mouthwash. Regarding antiplaque and antigingivitis activities, HYL seemed to be ineffective.

Tooth bleaching with hydrogen peroxide and nano-hydroxyapatite: a 9-month follow-up randomized clinical trial.

OBJECTIVES: The aim of this study was to compare the amount of tooth colour change, rebound rate and tooth sensitivity in patients submitted to a bleaching technique with 6% hydrogen peroxide (HP) with or without 2% nano-hydroxyapatite (n-HA). METHODS: Sixty subjects were included in this examiner-blinded, randomized clinical trial using a 6% HP gel with or without 2% n-HA. Tooth colour and tooth sensitivity were analysed before and after treatment. All data were analysed statistically. RESULTS: After bleaching, both treatments demonstrated significant improvements in tooth shade (P < 0.05 for both groups). At the 9-month recall, tooth shade remained significantly lighter than at baseline (P < 0.05 for both groups). However, a relapse of the tooth shade was observed compared with the immediate post-bleaching result (P < 0.05). 6% HP with 2% n-HA produced significantly lower sensitivity (P < 0.05) than the bleaching product without n-HA. Colour change evaluation resulted in no difference between the two groups. CONCLUSION: Both treatments demonstrated significant improvements in tooth shade. The bleaching effectiveness of the tested products was comparable. The use of 6% HP with 2% n-HA reduced the incidence of sensitivity during the bleaching treatment compared to a bleaching agent that did not contain n-HA.

Pediatric emergency care capabilities of Indian Health Service emergency medical service agencies serving American Indians/Alaska Natives in rural and frontier areas.

INTRODUCTION: In the USA, the emergency medical services (EMS) system is vital for American Indians and Alaska Natives, who are disproportionately burdened by injuries and diseases and often live in rural areas geographically far from hospitals. In rural areas, where significant health disparities exist, EMS is often a primary source of healthcare providing a safety net for uninsured individuals or families who otherwise lack access to health-related services. EMS is frequently the first entry point for children and their families into the healthcare system. The Indian Health Service (IHS) supports the federally funded, tribally operated EMS agencies to help meet the affiliated American Indian and Alaska Natives' pre-hospital needs. While periodic assessments of state EMS agencies capabilities to care for children occur, it appears a systematic assessment of IHS EMS agencies in regards to children had not been previously conducted. METHODS: A consensus process, involving stakeholders, was used to identify topic areas for a survey for assessing the pediatric capabilities of IHS EMS. The survey was sent to 75 of 88 IHS EMS agency contacts. RESULTS: Sixty-one agencies (81%) responded. Nine agencies (15%) did not have a medical director. Agencies without a medical director were less likely to report the availability of online (p=0.1) or offline (p<0.01) pediatric medical direction. Half (51%) of the agencies had a mass casualties plan; however, 29% reported responding to a mass casualty incident, involving a large number of pediatric patients, that overwhelmed their service. Most agencies were well integrated with their state EMS system with almost all (95%) collecting EMS patient care data and 47% using national standard data elements. CONCLUSIONS: In some areas, IHS EMS agencies did not have the infrastructure to treat pediatric patients during day-to-day operations as well as disasters. Similar to operational challenges faced by rural EMS agencies, the IHS agencies lacked a medical director, were unable to provide pediatric continuing education, and were overwhelmed during mass casualty incidents. Moreover, the overall ratio of IHS EMS to service population is almost double that for other EMS agencies. In other areas, agencies were well integrated with their state EMS system. One possible solution to increase capabilities to care for pediatric patients is combining and sharing of common resources including medical directors with their state EMS systems and authorities.

Periodontal maintenance following scaling and root planing. A randomized single-center study comparing minocycline treatment and daily oral irrigation with water.

Objective: Trying to limit the use of antimicrobial drugs in periodontitis is a general trend. Thus, the aim of the present study was to assess the efficacy of daily water irrigation in comparison with subgingival minocycline in periodontal maintenance, in subjects with moderate to severe periodontitis. This was done by evaluating probing pocket depth (the primary outcome), other clinical parameters such as clinical attachment level, plaque index and bleeding on probing, and bacterial flora changes inside periodontal pockets. Materials and Methods: In this single-center, parallel, single blind, randomized clinical study, thirty subjects (12 men, mean age 56 ± 2.2 years) with moderate to severe periodontitis were randomized 1:1 into a minocycline-treated group (M-group, n=15) and a water-treated group (W-group, n=15). Clinical and microbiological parameters were measured at baseline. Scaling and root planing were carried out on all subjects, then to M-group patients minocycline was administered inside the pockets. W-group subjects had instead to daily apply oral irrigation with water. Clinical and microbiological measurements were repeated after 30 days. Results: Both water irrigation and minocycline treatment led to a significant reduction of all the clinical parameters tested at t=30 days with respect to baseline. Moreover, both procedures appeared to be able to maintain a low bacterial load inside periodontal pockets, for most of the microorganisms tested. No statistically significant differences were observed between M-group and W-group at t=30 days, concerning both clinical and microbiological parameters. However, further studies are needed to assess the long-term effect. Conclusion: Daily oral irrigation with water showed comparable efficacy to a single administration of minocycline in periodontal maintenance subjects.

Comparison between oscillating-twisting rotating of brush head vs a characteristic sweeping bristles motion on reducing oral inflammation.

Background: The aim of present study was to clinically assess and compare a sonic toothbrush versus a rotating oscillating power toothbrush on plaque removal and gingival health in reducing plaque and bleeding on probing. Methods: Patients were selected according to specific inclusion and exclusion criteria and they were enrolled in test group or control group using Random Allocation Software. Visual score plaque index (PI) was recorded by the same blind operator using a plaque revelator and bleeding on probing (BoP) index was recorded using a periodontal probe at baseline, 15th day and 30th day. Results: The group of patients who used sonic toothbrush showed a greater reduction of PI and BoP comparing with patients who used rotating-oscillating power toothbrush. Conclusions: Although this pilot study has several limitations, it seems to indicate that sonic toothbrushes are capable of removing plaque and reducing bleeding on probing better than electric toothbrushes.

In vivo study of titanium healing screws surface modifications after different debridment procedure.

Introduction: Over the years, several different implant systems have been introduced, and the indications for implant rehabilitation have gradually been extended 2. Although an high success rates have consistently been reported for many implant systems, complications leading to loss of osseointegration still occurs 3. Thus, oral hygiene and maintenance are imperative, because implants, as well as teeth, are susceptible to accumulation of bacterial plaque and calculus formation. The aim of the present study was to evaluate and compare the in vivo cleaning efficacy of the three systems (air powder, curette, laser) comparing at the same time the alterations of the titanium abutment surface in terms of roughness. Methods: Forthy-two patients (25 males and 17 females) were included in the study. The 42 healing abutments were treated by the same clinician (UC). Results and conclusions: The rate of debris removal by the air powder was higher than that for the laser and than that for the curettes. The SEM analysis showed that the air powder system did not induce significant differences of the abutment if compared to the curettes as well as to the laser.

Periodontal dressing may influence the clinical outcome of non-surgical periodontal treatment: a split-mouth study.

INTRODUCTION: After scaling and root planning (SRP), healing induces the formation of a junctional long epithelium rather than a new connective attachment. We hypothesize that the placement of a periodontal dressing will be able to prevent detachment of coagulum inducing proper healing and improving periodontal parameters. MATERIALS AND METHODS: This split-mouth study included 30 patients with periodontitis with ages ranging from 35 to 70 years. Probing pocket depth (PD), probing attachment level (PAL), bleeding on probing index (BoP) and plaque index (PI) were assessed before and after therapy. The group of patients received SRP in a span of 24 h. Then, a periodontal dressing was applied on the test side and it was removed after 1 week. CONTROL GROUP: The difference between PD values at baseline and after therapy was 1.6 ± 0.6 mm. The difference in PAL (ΔPAL) measurement was 1.4 ± 0.4. Test group: there was a greater PD reduction, this being 2.4 ± 0.6 mm on average. The difference in PAL was 2.5 ± 0.4 mm. CONCLUSIONS: Our results clearly suggest that the use of a periodontal dressing improves the periodontal parameters after an SRP procedure. This is probably due to clot stabilization and prevention of bacterial colonization during wound healing.

Association between genetic risk score and periodontitis onset and progression: a pilot study.

AIM: Recent research has focused attention on the single nucleotide polymorphisms (SNPs) involved in the host response in periodontitis. However, so as to combine the relatively small effects of individual genes the use of multi locus genetic risk (GRS) has been proposed. This study aims to evaluate whether the genetic risk score may predict periodontitis onset and progression. MATERIALS AND METHODS: Fifty patients were divided into various groups according to periodontal status. Total DNA was isolated from epithelial oral cells by a masked operator and the selected SNPs were analysed. A GRS was calculated using an additive model. RESULTS: We found a strong association only between TNF rs1800629 and diffused forms of periodontitis. Data show that GRS is able to discriminate diffused forms of periodontitis from localized ones. Finally, a progressive increase of the GRS is evident in advanced periodontitis in comparison with early forms. DISCUSSION: In recent years, research on genetic polymorphism has had limited success in predicting the susceptibility to periodontal disease. However, our results indicate that the use of the genetic risk score could be promising. Further studies are necessary to include data from multiple genes so as to confirm our result.

CODE 75: Operative protocols and a case report in preventive dental care in a department of neurorehabilitation for acquired cerebral lesions.

UNLABELLED: CODE 75 is a neurorehabilitation department at the General Hospital of Versilia, which specializes in serious acquired cerebral lesions. OBJECTIVES: The therapy and the maintenance of oral hygiene in patients with cerebral lesions are critical to the overall success of the rehabilitation therapy. The purpose of our project was to improve patients' quality of life, reducing the quantity of oral bacteria caused by the presence of layers of plaque on the tooth surfaces and in the oral mucosa. METHODS: The dental department of Versilia Hospital conducted a 1 year follow-up study to develop specific protocols designed to obtain and improve the maintenance of these patients' oral hygiene. The oral prevention project was directed primarily at the department's medical staff and carers, and focused on improving the information available to the medical team and their direct involvement. A case report is described to show an application of the protocol. Data were recorded before the start of the protocol (T0) and after 1 month (T1). RESULTS: The analysis of the periodontal parameters shows a difference in values between T0 and T1. In T1 no bleeding on probing was recorded. After the causal therapy, the gingival hypertrophy and oedema disappeared as confirmed by the absence of BOP. DISCUSSIONS: Results show that teamwork plays a fundamental role in this multi-professional approach for the rehabilitation of patients with acquired cerebral lesions. The success of this protocol depends on the cooperation between personnel with specific skills in the department.

Salivary pH level and bacterial plaque evaluation in orthodontic patients treated with Recaldent products.

Dental caries and resulting tooth decay can produce a multifactorial destructive process with a very high incidence. Cariogenic bacteria attack enamel with acids that produce subsurface lesions, thereby weakening the enamel and allowing bacterial progression into the dentin. The formation of dental decay, because of demineralization of the tooth structure, can be prevented or delayed by increasing the rate of the tooth's remineralization and replacement relative to the tooth's rate of demineralization. This rebuilding of enamel may be accelerated by the addition of amorphous calcium phosphate (ACP) with the aid of casein phosphopeptide (CPP) (Recaldent molecule). In this study, the role of CPP in stabilizing and releasing ACP on the tooth surface has been investigated to better understand its efficacy in the prevention of tooth demineralization in orthodontic patients. Twenty-five patients who wore fixed orthodontic appliances were enrolled in this clinical trial. It was explained to the patients that CPP-ACP would be used for 3 weeks and then suspended for an additional 3 weeks. Salivary pH evaluation, plaque pH evaluation and oral hygiene index (OHI) were performed at T0, T1 and T2. Results showed an increase in OHI level and an increase of the salivary pH (76% of the patients). Instead of plaque pH level that showed trivial results, only 48% of the patients showed a bacterial plaque pH increase. In conclusion, this study has not provided unequivocal evidence for the protective properties of Recaldent molecule. Long-term studies are necessary to better understand the role of this molecule.

Dynamical model development and parameter identification for an anaerobic wastewater treatment process.

This paper deals with the development and the parameter identification of an anaerobic digestion process model. A two-step (acidogenesis-methanization) mass-balance model has been considered. The model incorporates electrochemical equilibria in order to include the alkalinity, which has to play a central role in the related monitoring and control strategy of a treatment plant. The identification is based on a set of dynamical experiments designed to cover a wide spectrum of operating conditions that are likely to take place in the practical operation of the plant. A step by step identification procedure to estimate the model parameters is presented. The results of 70 days of experiments in a 1-m(3) fermenter are then used to validate the model.

Advanced monitoring and control of anaerobic wastewater treatment plants: fault detection and isolation.

In this paper, a fault detection and isolation approach using fuzzy logic is described for on-line analysis of problems occurring in anaerobic digestion processes. The measurements available on the process are preprocessed to build a vector of fault residuals indicating the magnitude of the problems. This vector is classified into a prespecified category (i.e., a class) which is a state of the system, according to discrimination fuzzy rules. Three different types of classes were defined in a hierarchical structure: sensors faults, sub-process faults and process faults. This approach was developed to handle in real time both technical and biological problems. Demonstration of the practical interest of this study was made using real life experiments and large improvement of the reliability and safety of the process was obtained, thus optimizing the overall wastewater treatment.

Hybrid modelling of anaerobic wastewater treatment processes.

This paper presents a hybrid approach for the modelling of an anaerobic digestion process. The hybrid model combines a feed-forward network, describing the bacterial kinetics, and the a priori knowledge based on the mass balances of the process components. We have considered an architecture which incorporates the neural network as a static model of unmeasured process parameters (kinetic growth rate) and an integrator for the dynamic representation of the process using a set of dynamic differential equations. The paper contains a description of the neural network component training procedure. The performance of this approach is illustrated with experimental data.

Influence of formulation and process parameters on pellet production by powder layering technique.

The goal of the present study was to evaluate the influence of the formulation and operating conditions on pellet preparation by pan technique. To this end, a new pelletization process, typified by the application of powdered drug on sugar-based cores using the GS coating system was studied. Inert cores were intermittently treated with micronized drug powder and adhesive solution. This treatment led to the formation of multiple layers of drug particles around an inert core resulting in the production of pellets that can further be coated by different polymers to obtain modified release formulations. Different procedures have been used to evaluate a series of important parameters such as initial core weight; speed of powder application; speed, type, and position of the atomizers; atomization degree; temperature; and air cap. Good yield of drug layering was obtained by adjusting the quantity of both the drug powder to apply and the binder solution. Pellets obtained following the optimal operating conditions (defined in a pre-formulation study) were film coated with the acrylic polymer Eudragit L30D in order to produce a model formulation consisting of enteric polymer-coated pellets containing ibuprofen. During its preparation, the formulation showed no degradation of the drug; moreover, a low percentage of residual humidity was obtained, indicating that this system is very efficient for the production of highly stable formulations. This study showed the good performance of the GS automated pan-coating system in obtaining enteric coated pellets prepared by powder layering technique using aqueous solutions.

[Clinical evaluation of the therapeutic effect of D-L-carnitine in the acute phase of myocardial infarct in relation to the behavior of the serum myoglobin concentration curve]. / Valutazione clinica dell'effetto terapeutico della D-L-carnitina nella fase acuta dell'infarto del miocardio in riferimento al comportamento della curva di concentrazione serica della mioglobina.

Clinical experience carried out on 40 patients with AMI - 22 of them treated with 15 g daily of D-L-Carnitine and 18 untreated - is reported. Our interest was to study the therapeutic action of this drug evaluating if it was able to modify the curve of serum myoglobin level released from necrotic or ischaemic areas. The conclusion is drawn that this drug could act feebly only during the earlier stages of AMI, but many reserves are expressed.