Multivariate analysis of the influence of peri-implant clinical parameters and local factors on radiographic bone loss in the posterior maxilla: a retrospective study on 277 dental implants.

OBJECTIVES: The aim of the present study was to investigate whether peri-implant clinical parameters (modified plaque index (mPI), bleeding and/or suppuration on probing (B/SOP)) and local factors (type of prostheses, screw emergence, platform diameter, and abutment angulation) might contribute to the development of additional bone loss and peri-implantitis around dental implants. MATERIALS AND METHODS: Two hundred seventy-seven external hex connection implants placed in the posterior maxilla of 124 patients were retrospectively evaluated. They were divided into two groups: physiologic bone loss < 2 mm (PBL) or additional bone loss ≥ 2 mm (ABL). GEE logistic regression was applied to evaluate the influence of type of prostheses (implant-supported single crown (ISSC), fixed partial denture (ISFPD), and full denture (ISFD)) and clinical parameters (mPI and S/BOP) on bone loss. RESULTS: Among the 277 implants, 159 (57.4%) presented PBL and 118 (42.6%) presented ABL. Within the ABL group, 20.6% implants were diagnosed with peri-implantitis. mPI significantly correlated with the type of prosthesis and the highest value of mPI (index = 3) was observed in ISFD (23.8%). Moreover, peri-implantitis was more frequently associated with ISFD (32.79%) than ISSC and ISFDP (13.79% and 13.48, respectively) CONCLUSIONS: ISFD in the posterior maxilla presented high rates of ABL and showed a higher prevalence of peri-implantitis. None of the local factors seemed to contribute to the development of these conditions. Further investigations are needed to prospectively support the results of the present study. CLINICAL RELEVANCE: Patients rehabilitated with ISFD should be carefully monitored and have more frequent maintenance visits to prevent or control peri-implant bone loss.

The impact of non-surgical therapy of periodontal disease on surrogate markers for cardiovascular disease: A literature review.

PURPOSE: To review the literature on the effects of non-surgical periodontal treatment on surrogate markers of cardiovascular diseases (CVDs) and to clarify the impact of periodontal disease on systemic inflammation. METHODS: PRISMA guidelines for systematic reviews and meta-analyses have been adopted. An electronic search in PubMed up to December 2018 was performed using the following search terms and keywords alone or in combination: non surgical periodontal therapy, atherosclerotic vascular disease (AVD), operative surgical procedures, CVD, IL-6, CRP, cholesterol, LDL, oxidized low density lipoprotein, HDL, endothelial dysfunction, dependent dilatation, carotid intima media thickness, periodontitis, tunica intima. RESULTS: The electronic search resulted in the inclusion of 28 articles that were grouped and discussed based on the investigated surrogate markers. Meta-analysis was not carried out due to the heterogeneity of the results. The included studies demonstrated that periodontal treatments contribute to the resolution of oral inflammation and in turn might positively modulate the levels of systemic inflammatory markers. The initial phase of periodontal therapy has a positive impact on the short-term reduction of a series of systemic markers that are considered as surrogate markers of AVD. CLINICAL SIGNIFICANCE: The non-surgical therapy of periodontal disease would positively reduce the levels of systemic inflammation markers, decreasing the vascular risk and the possibility of developing CVD or the subclinical progression of the disease.

Effectiveness of Different Commercial Chlorhexidine-Based Mouthwashes After Periodontal and Implant Surgery: A Systematic Review.

OBJECTIVES: The aim of the present study was to review the effectiveness, side effects, and patient acceptance of different concentrations and formulation of chlorhexidine-based mouthwashes used after periodontal and implant surgery. MATERIALS AND METHODS: The PRISMA guideline was adopted in the search strategy using electronic databases PubMed and MEDLINE to identify randomized and case-control prospective studies on humans written in English language and published up to September 2017. RESULTS: A total of 10 articles were selected for a total of 344 patients. Because of the significant heterogeneity of the outcome measures, meta-analysis was not performed, and the data were summarized in a table. A positive relationship between the use of chlorhexidine and reduction of plaque was found, demonstrating the effectiveness of the substance in terms of antisepsis and decrease of inflammation after periodontal and implant surgery. CONCLUSION: Chlorhexidine is recognized as the primary agent for plaque control and the gold standard in preventing infection, although the presence of largely known side effects would affect patient compliance. Future research should be directed at finding chlorhexidine formulation with negligible adverse effects, without compromising or even increasing its effectiveness as the antiseptics and antiplaque agent.

Bacterial leakage in external hexagon implants with and without the interposition of a sealing-connector.

PURPOSE: To investigate whether the interposition of a sealing-connector was able to reduce the bacterial leakage in external hexagon implants. METHODS: 20 implants with external hexagon connection were used. Ten Test implant-abutment assemblies were connected with the interposition of a sealing-connector molded in the exact shape of the two opposed surfaces. Ten Control implant-abutment assemblies were connected with no sealing-connector interposed. Two types of bacteria were introduced into the internal portion of the implant, before placing the connector. The study lasted 28 days. RESULTS: All control specimens, seeded with P. aeruginosa (PA) and A. actynomycetemcomitans (AA), showed contamination of the culture medium, indicative of microbial leakage. In the Test specimens, three instances of contaminated specimens were found in the samples seeded with PA and two contaminated specimens in the ones seeded with AA, for a total of five contaminated samples out of 10. The use of the sealing-connector was able to prevent bacterial leakage in half of the samples (50%). The leakage in both groups occurred mainly in the last week of the experiment. Probably, a longer period, under the conditions of this experiment, is necessary for the migration of the bacteria, and, furthermore, an observation period of 7 or 14 days may not be enough to show microbial contamination. CLINICAL SIGNIFICANCE: Using an interface under in vitro non-loading experimental conditions, could sometimes (50%) prevent bacterial microleakage and thus possibly the risk of peri-implant site infection. Moreover, less bone resorption and the maintenance of soft tissues and esthetics might be achieved in those cases where bacterial leakage does not occur.

Rehabilitation of Postextractive Socket in the Premaxilla: A 12-Year Study on 27 Titanium Plasma Spray Resorbable Calcium Phosphate Coated Single Implants.

OBJECTIVES: The purpose of this study was to evaluate the peri-implant bone tissue level on postextractive resorbable calcium phosphate coated single implants placed in premaxillary sites grafted with autologous bone, anorganic bovine bone (ABB), platelet-rich plasma (PRP), and keratinized epithelial connective graft over 12 years. MATERIALS AND METHODS: A total of 27 patients received a postextractive single implant in premaxillary sites grafted with ABB and PRP. Two months later, a keratinized epithelial connective graft was applied and the implants loaded. Clinical and radiographical evaluations were performed at baseline, 6 and 18 months, 4 and 6 years after the implant insertion, and then every 2 years up to the 12th year. RESULTS: After 12 years, a total of 22 implants (81.48%), were available for the final data analysis; the implants achieved a 100% cumulative survival rate, and only a mild degree of periodontal tissue inflammation was recorded. The radiographic evaluation revealed a physiological marginal bone remodeling over the follow-up. CONCLUSION: Although a good preservation of the residual bone tissue in postextraction implant sites treated with keratinized epithelial connective tissue grafts was observed, the low number of treated cases does not allow us to propose this experimental protocol to all cases of bone defects but it certainly represents a new option. Further studies on a greater number of patients and using implants with different surface characteristics should be conducted for a better understanding of the indications of the proposed treatment.

Analysis of Effectiveness of Different Rotational Instruments in Implantoplasty: An In Vitro Study.

OBJECTIVE: To analyze the temperature increase in the implant, adjacent bone, procedure time, and roughness provided by different rotatory instruments in the implantoplasty procedure. MATERIAL AND METHODS: Three types of rotational instruments were used to evaluate the implant surface wear, divided according to their surface features: Group 1 (G1) diamond, Group 2 (G2) tungsten carbide, and Group 3 (G3) multilaminar. For the roughness test, a control group was included for comparison with the test groups. RESULTS: The temperature variation was statistically significant in the implant (P < 0.05) where G2 showed the lowest variation. There was no statistically significant difference between the 3 groups regarding the temperature increase measured in the bone (P > 0.05). The difference of wear time was statistically significant (P < 0.05) with faster results for G3. In the surface roughness analyses, there was a statistically significant difference (P < 0.05) between the control group and the test groups. Among the 3 test groups, the difference between measurements was not statistically significant (P > 0.05). CONCLUSION: All tested rotatory instruments performed the same level of surface roughness in the implantoplasty. The tungsten carbide bur caused a minor change in the implant temperature. The multilaminar bur performed a faster wear time. More in vivo studies are necessary to conclude which is the best rotatory instrument for implantoplasty.

Fixed restorations supported by Morse-taper connection implants: a retrospective clinical study with 10-20 years of follow-up.

OBJECTIVES: Rehabilitation with implant-supported fixed prostheses is a predictable modality to restore lost function and esthetics; however, fixed restorations are subject to biological and prosthetic complications, which may represent a problem in the long-term. The aim of this study was to evaluate the long-term survival and complication rates of fixed restorations supported by Morse-taper connection implants. MATERIALS AND METHODS: Between January 1992 and December 2002, 49 patients (age range 22-70 years), were included in this study. The restorations involved 58 fixed reconstructions (15 single crowns [SCS], 29 partial prostheses, 14 full-arches), supported by 178 Morse-taper connection implants with a follow-up ranging from 10 to 20 years. Outcomes such as implant survival, marginal bone loss, frequency of biological and prosthetic complications as well as "complication-free" survival of restorations were investigated. RESULTS: The 20-year overall cumulative implant survival was 97.2%. A few biological (3.4%) and prosthetic (10.3%) complications were reported. The "complication-free" survival rate of restorations was 85.5%. No statistically significant differences were observed among patients' gender, age, smoking or parafunctional habits, prosthesis site and type. CONCLUSIONS: Satisfactory "complication-free" survival rates can be achieved after 20 years for fixed restorations supported by Morse-taper connection implants, with minimal marginal bone loss and complications.

Short (8-mm) locking-taper implants supporting single crowns in posterior region: a prospective clinical study with 1-to 10-years of follow-up.

OBJECTIVE: The aim of this study was to evaluate the long-term outcome of short (8-mm) locking-taper implants supporting single crowns in the posterior regions and to analyze the influence of different factors on implant survival and implant-crown success rates. MATERIALS AND METHODS: Between June 2002 and September 2011, all patients referred to two private practices for treatment with short (8-mm) implants supporting single tooth restorations in posterior areas of both jaws were considered for inclusion in this study. At each annual follow-up session, clinical and radiographic parameters were assessed. Implant-crown success criteria included absence of pain, suppuration, mobility, and peri-implant radiolucency, distance between the implant shoulder and the first visible bone-to-implant contact (DIB) <1.5 mm after 12 months and not exceeding 0.2 mm for each following year, absence of prosthetic complications. The cumulative survival and implant-crown success were assessed using the Kaplan-Meier survival estimator; Chi-square test was applied to evaluate correlations between the study variables. The statistical analysis was performed at the patient and at the implant level. RESULTS: Two hundred and fifteen implants (124 maxilla; 91 mandible) were placed in 194 patients (104 men; 90 women). Three implants failed (2 maxilla; 1 mandible). The 10-year cumulative survival rate was 98.4% (patient-based) and 98.5% (implant-based). Among the surviving implants, the mean DIB was 0.31 (±0.24), 0.43 (±0.29), and 0.62 (±0.31) mm at the 1-, 5-, and 10-year follow-up session; two biologic and three prosthetic complications were reported, for a 10-year cumulative implant-crown success rate of 95.8% (patient-based) and 95.9% (implant-based). The implant survival and implant-crown success rates did not differ significantly with respect to patients' gender, age, smoking habit, parafunctional habit, implant location, implant diameter, and bone type. CONCLUSIONS: The use of short (8-mm) locking-taper implants is a predictable treatment modality for the restoration of single tooth gaps of posterior segments of dentition.

Hemostasis control in dental extractions in patients receiving oral anticoagulant therapy: an approach with calcium sulfate.

The aim of this study was to evaluate the use of calcium sulfate (CaS) as a hemostatic agent after tooth extraction in patients with anticoagulant drug therapy. A total of 30 patients undergoing anticoagulant therapy (22 women and 8 men) with a mean age of 54.6 years (SD = 9.2 years), needing dental extractions, were selected for this study. They were divided into 2 groups, control (group 1) and test (group 2), in a randomized way. In group 1 patients, the postextraction socket was managed with obliterative suture only. Group 2 patients were treated with CaS placed into the postextraction sockets. All the patients did not interrupt the anticoagulant therapy during the dental treatment. The healing pattern was found to be approximately similar in all treatment groups, showing significant improvement at each consecutive visit. However, a statistically significant difference in the adequate hemostasis was evident between groups 1 and 2 (P = 0.0056). The use of CaS helped to control the bleeding from inside the socket, producing instantly a very good hemostasis. Further studies are necessary to confirm the simplicity, possibilities, and limits of the proposed procedure.

Relationship between the surface energy and the histologic results of different titanium surfaces.

The aim of this study was to evaluate, through in vitro and in vivo studies, the existence of a relationship between surface energy, for wettability, and the clinical behavior of dental implants with different surfaces, one with a surface treated by sandblasting with titanium oxide microparticles followed by acid-etching treatment (experimental group) and another with a machined surface (control group). For the in vitro tests, a total of 30 titanium disks (15 disks for each group) were evaluated by scanning electron microscopy and dispersive energy spectroscopy and for surface roughness and wettability. For the in vivo tests, a total of 24 implants (12 implants for each group) were inserted in the tibiae of 6 rabbits and were removed after 30 and 60 days for histologic analysis. The results showed that the implants with the experimental surface presented a low wettability, and it also resulted in highly stimulated new bone formation in vivo, when compared with the control group dental implant. As for the bone formation, differences between the different surfaces seemed evident, both in quantity and in quality, as implants from the experimental group showed a higher new bone deposition than that from the control group. Thus, in vitro and in vivo tests demonstrated an excellent biologic response of the surfaces treated by sandblasting with microparticles of titanium oxide followed by acid etching.

Functionalized magnesium alloys obtained by superplastic forming process retain osteoinductive and antibacterial properties: An in-vitro study.

OBJECTIVES: This study aimed to investigate the biocompatibility, osteogenic and antibacterial activity of biomedical devices based on Magnesium (Mg) Alloys manufactured by Superplastic Forming process (SPF) and subjected to Hydrothermal (HT) and Sol-Gel Treatment (Sol-Gel). METHODS: Mg-SPF devices subjected to Hydrothermal (Mg-SPF+HT) and Sol-Gel Treatment (Mg-SPF+Sol-Gel) were investigated. The biocompatibility of Mg-SPF+Sol-Gel and Mg-SPF+HT devices was observed by indirect and direct cytotoxicity assays, whereas the colonization of sample surfaces was assessed by confocal microscopy. qRT-PCR analysis and microbial growth curve analyses were employed to evaluate the osteogenic and antibacterial activity of both SPF-Mg treated devices, respectively. RESULTS: Mg-SPF+HT and Mg-SPF+Sol-Gel showed a high degree of biocompatibility. Analysis of mRNA expression of osteogenic genes in cells cultured on Mg-treated devices revealed a significant upregulation of the expression levels of BMP2 and Runx-2. Furthermore, the bacterial growth in strains developed in contact with both the Mg-SPF+HT and Mg-SPF+Sol-Gel devices was lower than that observed in the control. SIGNIFICANCE: Hydrothermal and Sol-Gel Treatments of Mg alloys obtained through the SPF process demonstrated bioactive, osteogenic and antibacterial activity, offering a promising alternative to conventional Mg-based devices. The obtained Mg-based materials may have the potential to enhance the tunability of temporary devices in maxillary reconstruction, eliminating the need for second surgeries, and ensuring a good bone reconstruction and a reduced implant failure rate due to bacterial infections.

Surface Treatment of Dental Mini-Sized Implants and Screws: A Systematic Review with Meta-Analysis.

Miniscrews are devices that allow for absolute skeletal anchorage. However, their use has a higher failure rate (10-30%) than dental implants (10%). To overcome these flaws, chemical and/or mechanical treatment of the surface of miniscrews has been suggested. There is no consensus in the current literature about which of these methods is the gold standard; thus, our objective was to carry out a systematic review and meta-analysis of the literature on surface treatments of miniscrews. The review protocol was registered (PROSPERO CRD42023408011) and is in accordance with the PRISMA guidelines. A bibliographic search was carried out on PubMed via MEDLINE, Cochrane Library, Embase and Web of Science. The initial search of the databases yielded 1684 results, with 98 studies included in the review, with one article originating from the search in the bibliographic references of the included studies. The results of this systematic review show that the protocols of miniscrew surface treatments, such as acid-etching; sandblasting, large-grit and acid-etching; photofunctionalization with ultraviolet light; and photobiomodulation, can increase stability and the success of orthodontic treatment. The meta-analysis revealed that the treatment with the highest removal torque is SLA, followed by acid-etching. On the other hand, techniques such as oxidative anodization, anodization with pre-calcification and heat treatment, as well as deposition of chemical compounds, require further investigation to confirm their effectiveness.

Dye Laser to Treat an Arteriovenous Malformation of the Tongue: 40-Month Follow-Up.

Arteriovenous malformations (AVMs) are abnormal connections between blood vessels that bypass the normal capillary bed. To avoid the invasiveness of the gold standard surgical excision, the use of dye laser has been suggested as an alternative. A 53-year-old man in good overall health presented with a large bluish-red nodular growth covered by intact mucosa on the left side of his tongue. The growth had a hard-elastic consistency and was not painful to touch. Imaging investigations revealed a capsulated growth consistent with a diagnosis of AVM. The patient underwent two sessions of rhodamine dye laser treatment using the following parameters: fluence of 12 J/cm2, 6 mm laser spot, a single pulse with repetition up to 1.0 Hz, and a pulse duration of 3.0 ms. Follow-up examinations were conducted at 12, 24, 36, and 40 months after the treatment. At the 40-month follow-up, the lesion had reduced in size, with a more organized vascular network, and was not clinically detectable. Considering the limitations of this case report, the application of dye laser appears to be a potentially successful treatment option for AVMs.

The Application of a Fluoride-and-Vitamin D Solution to Deciduous Teeth Promotes Formation of Persistent Mineral Crystals: A Morphological Ex-Vivo Study.

Background: The use of effective, low-cost, and easy-to-use products for early caries management will avoid loss of dental vitality and impairment in oral function. The ability of fluoride to re-mineralize dental surfaces has been widely reported as well as vitamin D demonstrated to have significant potential in improving the remineralization of early lesions on enamel surfaces. The aim of the present ex vivo study was to evaluate the effect of a fluoride and vitamin D solution in terms of formation of mineral crystals on the enamel of primary teeth, and their permanence over time on dental surfaces. Methods: Sixteen extracted deciduous teeth were cut to obtain 64 specimens that were divided into two groups. The first consisted of immersion of specimens for 4 days in a fluoride solution (T1); in the second group, the specimens were immersed for 4 days (T1) in fluoride and Vitamin D solution, and for a further 2 (T2) and 4 days (T3) in saline solution. Then, samples were morphologically analyzed by using Variable Pressure Scanning Electron Microscope (VPSEM) and underwent 3D surface reconstruction. Results: After a 4-day immersion in both solutions, octahedral-shaped crystals were formed on the enamel surface of primary teeth, demonstrating any statistically significant differences in terms of number, size, and shape. Moreover, the binding of the same crystals seemed to be strong enough to be maintained until 4 days in saline solution. However, a partial dissolution was observed in a time-dependent manner. Conclusions: A topical application of fluoride and Vitamin D promoted the formation of persistent mineral crystals on enamel surfaces of deciduous teeth and should be further studied to be potentially used as an alternative strategy in preventive dentistry.

Regeneration of dentin-pulp complex: Effect of calcium-based materials on hDPSCs differentiation and gene expression.

OBJECTIVE: Dentin-pulp complex is object of interest in the regenerative endodontic field as well as the natural function of human dental pulp stem cells (hDPSCs) that may differentiate into specific cells able to repair and/or regenerate both hard and soft dental structures. The aim of the present study was to evaluate the capacity of hDPSCs to differentiate in odontoblastic-like cells by evaluating the expression of specific odontogenic-related genes and to prove the ability of treatment with calcium-based materials such as calcium carbonate (CaCO3), calcium hydroxide (Ca(OH)2), and mineral trioxide aggregate (MTA). METHODS: hDPSCs were obtained and isolated from a third molar of a young patient. Odontogenic-related gene expression was assessed unti1 28 days of culture as well as alkaline phosphatase activity (ALP). hDPSCs were cultured in odontoblastic-induction medium used as control, and in presence of different concentrations of CaCO3, Ca(OH)2, and MTA. RESULTS: The results demonstrated an upregulation in odontoblastic cell-related genes, in particular of the early differentiation marker known as matrix extracellular phosphoglycoprotein (MEPE), as well as increased ALP activity and the presence of calcium deposits, mainly by stimulation with calcium derivatives. In this regard, treatment of pulp tissue with CaCO3, Ca(OH)2 and even better with MTA seemed to be effective for dentinogenesis. SIGNIFICANCE: The ease of isolation of hDPSCs from discarded or extracted teeth offers a promising source of autologous cells that may be applied for regenerative purpose in combination with selected bioactive materials. However, further investigations should be conducted to confirm the obtained results.

Application of Platelet-Rich Fibrin and Bone Morphogenetic Protein for Full-Mouth Implant-Based Oral Rehabilitation in a Case of Mandibular Osteoradionecrosis.

Osteoradionecrosis (ORN) is a debilitating complication following radiation therapy, which in the head and neck region, occurs most frequently in the mandible. Although ORN is rare, it is complex and multifactorial and requires appropriate management. Manipulation of bone in patients with head and neck cancers before radiotherapy can cause ORN. In this report, we aim to present successful insertion of four dental implants in the interforaminal segment combined with application of platelet-rich fibrin and bone morphogenetic protein in a 60-year-old male with stable ORN in the posterior regions of the mandible.

Titanium Surface Decontamination: A Systematic Review of In Vitro Comparative Studies.

PURPOSE: To achieve high plaque removal around peri-implant tissues, noninvasive cleaning methods that guarantee the long-term success and survival of titanium implants should be established. This systematic review aimed to systematically evaluate in vitro investigations assessing different treatment modalities to decontaminate titanium surfaces, with special focus on the most effective cleaning procedures. MATERIALS AND METHODS: PRISMA guidelines were adopted in an electronic search conducted through MEDLINE, Scopus, and Google Scholar databases to identify studies on mechanical, chemical, or laser decontamination modalities up to November 2019. RESULTS: The search resulted in 326 articles; after removing duplicates and reading titles, abstracts, and full texts, 38 articles were ultimately processed for data extraction. Mechanical decontamination provided better results in comparison to laser and chemical procedures. Among mechanical modalities, air abrasion showed the best cleaning effectiveness. Conversely, upon comparison of the chemical methods, chlorhexidine demonstrated comparable results with all tested substances and even with photodynamic therapy. Among different lasers, the results showed that the diode was more promising compared with the other tested lasers. CONCLUSION: This review demonstrated that there is still no consensus on which technique performs better. However, mechanical decontamination yielded more favorable results than laser and chemical methods. This aspect would support the hypothesis that decontamination procedures adopted in a combination fashion, which includes mechanical procedures, may provide better clinical results than when used alone.

Transepithelial Gingival Depigmentation Using a New Protocol with Q-Switched Nd:YAG: An In Vivo Observational Study.

Gingival melanin hyperpigmentation is a para-physiological condition that may have a negative impact on smile esthetics. In the present study, the use of the Q-Switched Nd:YAG laser, according to a defined protocol, was proposed to treat Gingival Melanin Hyperpigmentation with a transepithelial approach. A total of 10 Patients with different grades of gingival hyperpigmentation were treated with Q-Switched Nd:YAG in one to four laser sessions without local anesthesia. The grade of depigmentation was evaluated by comparing Oral Pigmentation Index (OPI) and Melanin Pigmentation Index (MPI) at baseline and three weeks after the laser session. Additionally, oral discomfort rated by the Numeric Rating Scale (NRS) was recorded one, three, and five days after the procedure. Complete depigmentation was achieved in all cases. Patients reported no-little discomfort (NRS 0 to 3) during the laser session that lasted a maximum of five days. No major complications were reported, and no recurrences were observed at least after one year of follow-up. In addition, patients were available to be re-treated if necessary. These findings suggested that the Q-Switched Nd:YAG could be an effective and well-tolerated approach in the treatment of gingival melanin hyperpigmentation.

Minimization of Adverse Effects Associated with Dental Alloys.

Metal alloys are one of the most popular materials used in current dental practice. In the oral cavity, metal structures are exposed to various mechanical and chemical factors. Consequently, metal ions are released into the oral fluid, which may negatively affect the surrounding tissues and even internal organs. Adverse effects associated with metallic oral appliances may have various local and systemic manifestations, such as mouth burning, potentially malignant oral lesions, and local or systemic hypersensitivity. However, clear diagnostic criteria and treatment guidelines for adverse effects associated with dental alloys have not been developed yet. The present comprehensive literature review aims (1) to summarize the current information related to possible side effects of metallic oral appliances; (2) to analyze the risk factors aggravating the negative effects of dental alloys; and (3) to develop recommendations for diagnosis, management, and prevention of pathological conditions associated with metallic oral appliances.

Vital Pulp Therapy of Permanent Teeth with Reversible or Irreversible Pulpitis: An Overview of the Literature.

Vital pulp therapy (VPT) has been recently proposed as an alternative approach even in symptomatic mature permanent teeth with deep caries' lesions, aiming to maintain the pulp vitality over time and/or to avoid non-surgical root canal therapy (NSRCT). However, to date, the diagnosis of reversible or irreversible pulpitis is only based on clinical pain quantity and quality, without precisely reflecting the pulp inflammation status. Therefore, the aim of the present study was to provide an overview based on the current scientific literature to demonstrate the clinical effectiveness of VPT on mature permanent teeth, validating the use of hydraulic calcium silicate-based cements and their role in pain management. VPT may be successfully applied not only in mature permanent teeth diagnosed with reversible pulpitis, but also in permanent dental elements with signs and symptoms of irreversible pulpitis. Hydraulic cements showed favorable outcomes in terms of decrease of pro-inflammatory mediators and of post-operative pain. Pain plays a central role in the chance to perform VPT in mature permanent teeth, since it may be considered as a pre-operative diagnostic criterion as well as a treatment success parameter. In addition, proper assessment of pulp inflammation and choice of appropriate materials are key factors in enhancing VPT success.