Laser in periodontal pockets: in vivo and in vitro study.

The aim of this study was to verify the sterilizing effectiveness of the laser in the treatment of the periodontal pockets in vivo, with the recording of clinicians' parameters and microbiological analysis, and in vitro with particular attention to the presence of specific bacterial stocks. During our study, in particular, it has been used the diodes laser. In order to estimate the effectiveness of the treatment of the periodontal pockets with laser, it has been examined the microbial content of the pockets carrying out withdrawals of the sulcular material before, immediately after and twenty minutes from the radiation. The microbiological results of the studies assert that, although substantial qualitative discrepancies between the several colonies of pathogen do not exist, quantitative differences are taken place with respect to the lessening of number and dimension of the present colonie.

Implant-safe test in patients with peri-implantitis.

Matrix metalloproteases (MMPs) are a family of zinc-dependent endopeptidases, produced by numerous cell types including fibroblasts, endothelial cells, osteoblasts, macrophages, lymphocytes and neutrophils, and capable of degrading different components of the extracellular matrix (ECM), but also cytokines, receptors and factors that regulate cell motility (1). MMPs represent the main proteolytic enzymes involved in the remodeling and degradation of the components of the extracellular matrix, in the modifications of interactions between cells, and those between cells and the ECM that regulate, for example, the processes of cell migration (2, 3). Due to these characteristics, the MMPs are involved in numerous physiological processes (angiogenesis, apoptosis, bone remodeling, wound repair, morphogenesis, inflammation, immune response) response to incongruous conservative and endodontic treatments (29-37, 46, 47) and pathological (periodontitis, arthritis, cancer, cardiovascular diseases, neurological diseases, osteoporosis etc.) (5). Metalloproteinase-8 (MMP-8) is an important indicator of tissue decomposition and is present in case of periodontitis in the gingiva and in the sulcular fluid. The concentration of MMP-8 in the sulcular fluid of patients with chronic or aggressive periodontitis is higher than that found in healthy patients (4, 6). MMP-8 was also significantly correlated with gingivitis index, plaque index, probing and clinical attack level. For this reason, the concentration of MMP-8 in the sulcular fluid could constitute a useful index to monitor periodontitis activity and be used to predict disease progression, also because of orthodontic treatments (38-45). Patients with periodontitis had elevated concentrations of MMP-8 salivary compared to patients with gingivitis and healthy tissues. Through this experimentation we wanted to demonstrate the real effectiveness of using this test as a means of preventing peri-implant pathology.

Histomorphometric evaluation of bovine bone and equine bone matrix in maxillary sinus floor augmentation: a systematic review.

The aim of this study was to evaluate the efficiency of bovine and equine bone substitute materials used in sinus augmentation techniques. The research protocol was carried out using the PubMed database, including articles from October 2019 until February 2020 and those in English only. The search on PubMed (MED-LINE) was carried out with the following keywords: sinus augmentation OR sinus lift AND bovine bone graft OR equine bone matrix. The articles identified included randomised clinical trials, cross-sectional studies and case series. Outcomes were the percentage of newly formed bone, remaining graft particles and soft tissue in a follow-up at least of 5 months. The use of bovine bone graft (ABB) as a graft material in maxillary sinus elevation was evaluated in 9 studies. According to the quality assessment, 4 of the 9 studies were analysed and an arithmetic mean was performed showing the following results: newly formed bone (NFB 22.74%), residual grafts (RG 29.36%) and soft tissue percentage (SF 48.51%). The use of equine bone matrix (EBM) was assessed in four different studies including an RCT, a cross-sectional study and two case series; a mean percentage calculated by the extracted data of the four studies was estimated with newly formed bone (NFB 44.51%), residual grafts (RG 17.24%) and soft tissue percentage (SF 36.62%). EBM appears to be as effective as ABB for the maxillary sinus floor augmentation procedure.

The dentist's role in diagnosis and treatment of obstructive sleep apnea syndrome: a literature review.

The purpose of this work was to present a review of the literature concerning obstructive sleep apnea syndrome, and the role of the dentist in this pathology, both to identify elements useful for a good diagnosis and to apply the available therapeutic strategies. In literature there is no unanimous opinion on the treatment of OSAS. The multidisciplinary approach is necessary, creating teams made up of dentists, otolaryngologists and medical experts in sleep disorders, in order to develop a cooperation-based treatment plan for the disease. In this review, the importance of early diagnosis, orthodontic therapy in order to restore normal function is underlined, since OSAS is linked to a high risk of hypertension, cardiovascular diseases, daytime sleepiness, domestic and work accidents, with consequent deterioration of the quality of life.

Bruma MAD: a new way of treating OSAS patients.

The aim of this study was to introduce a new adjustable device in the treatment of obstructive sleep apnea syndrome (OSAS). The new appliance has a different way to regulate and move the mandible through the presence of two occlusal lifts, that can leave an open posterior space, and the complex system formed by the peduncle and the steel plate that can easily move forward the mandible. This system guarantees a posterior space for the tongue but mostly for the passage of air. The principal aim of Bruma MAD is to contrast the pharyngeal collapsing and to prevent hypopnea or apnea. Further clinical studies are needed to confirm and to evaluate the predictability of this new device.

Effect of pressure and light curing of composite micro hardness.

The aim of this study is to evaluate the micro hardness Vickers of a composite micro hybrid polymerized under constant pressure. Twelve experimental samples were made equally divided into two groups: an experimental group and a control. Enamel plus HRi (Micerium) microbiotic composite resin, UD3 colour, was inserted into a syringe heater (ENA HEAT Composite Heating Conditioner) so that the material could be brought to a temperature of 39°C. A defined amount of composite resin is taken from the syringe with a Heidemann spatula and placed between two slides, previously cleaned with 90 ° alcohol. The samples are then inserted one at a time into a special device for constant pressure application. Vickers hardness measurements were made on the top of surfaces. The mean value of the samples belonging to the experimental group is 56.81 ± 0.71. The mean value of the control samples is 52.02 ± 2. The results obtained allow us to state that applying a constant pressure during the cementation phase of indirect adhesive restorations allows to obtain better mechanical characteristics of the composite used as a cementing agent.

Dentinal substrate variability and bonding effectiveness: SEM investigation.

Though the literature reports a well-documented scientific evidence of the performance of modern adhesive systems on normal dentin, few researches are available on the interaction between adhesives and compromised dentin. In this study, the authors analyzed the microscopic structural aspects of the adhesive interface on two common altered dentin substrates: dentin contaminated by metallic oxides and caries affected dentin. Thirty teeth were selected and divided in three groups of ten teeth according to the different dentin substrate they had: (A) normal dentin, (B) caries-affected dentin and (C) dentin contaminated by metallic oxides. The experimental cavity preparation was realised exposing in each sample, portion of pathologic dentin and portion of sound dentin as control. Each cavity was restored with micro-hybrid composite, with total etching and a two-step adhesive system. Each sample was sectioned in two halves analysed with two SEM micro-morphological methods: direct observation and decalcification. SEM investigations were able to show the difference in thickness and morphology of the adhesive interface with the two different dentin variables. Caries affected dentin determined the formation of less distinctive resin tags with few micro-tags. Discoloured dentin showed a poor infiltration with few resin tags probably due to alterations in the tubular structures. The micro-morphological variability of dentin substrate influences the clinical efficacy of bonding restorations determining significant differences in the qualitative and quantitative aspects of resin tags.

Analyze my face.

Plastic surgery is gaining more and more popularity, while stigma and popular myths about it are gradually decreasing. Analyze My Face conjunctly deals with the two main problems of facial plastic surgery: the excessive rate of dissatisfaction, which results in high revision requests and negative psychological side-effects and the “diagnosis by procedure” approach, which leads to erroneous measurements. This new and innovative method of Digital Facial Analysis is a direct non-expensive online service that provides professional and documented in-depth consultation to patients before they decide to undergo any type of facial intervention. The paper thoroughly explains the scientific method with which professionals provide customers with a facial assessment based on specific parameters which will be discussed (height, width, proportions, direction of facial growth, the way they assess each facial area in detail (eyes, mouth, cartilage), and the motivations for which they suggest to correct eventual defects through precise measurements, indicators and suggested interventions. Long-term evaluation of stability of surgical results and patient satisfaction achieved with digital facial analysis has not yet been established and needs further research. However, it is important to underline that the AMF approach tends to consider exclusively possible and feasible procedures that do not compromise functionality and that do not put patients in danger of serious damage. Problems or deformities that cannot be treated are always indicated. AMF aims to maximize professionality by giving practitioners an additional tool to aid their work, give unbiased opinions and look at the overall picture. It also aims to help patients by soothing their way into the complicated world of aesthetic surgery.

Comparison of coronal leakage of different root canal filling techniques: an ex vivo study.

The aim of this study was to compare the quality of the coronal seal, using an in vitro bacterial invasion test, of three different root canal filling systems. Twenty-seven freshly extracted mandibular premolars were selected and divided into three experimental groups (G1, G2 and G3 n=7) and two control groups (Ct+ and Ct- n=3). All teeth in the experimental groups were prepared using NiTi Mtwo rotating instruments and then the endodontic treatments were completed using the three-tested warm guttapercha root filling techniques: Microseal (G1), Thermafil (G2) and System B (G3). All root filling techniques were performed using the same endodontic sealer (Pulp Canal Sealer). Three teeth were instrumented and not filled, serving as positive controls (Ct+) and the last three teeth, with intact crowns and no endodontic treatment, served as negative controls (Ct-). All samples were mounted in a two-chamber apparatus and exposed to Enterococcus faecalis performing a bacterial infiltration test. All samples were observed for a maximum period of 60 days checking for turbidity of the BHI broth on a daily basis recording when contamination occurred. A quantitative evaluation of the bacterial CFU/ml was performed using the URO-QUICK™ system. On day 32 an overall value was recorded of contamination of 42.85% for group G1, 71.42% for G2 and 42.85% for G3; after 60 days, the final contamination result was 85.71% for group G1, and 100% for both G2 and G3 groups. Considering the number of contaminated samples at the end of the observation period, the three techniques showed no statistically significant differences. The study highlighted the bacterial permeability of gutta-percha/seal barrier, underlining the importance of an effective coronal restoration to ensure a durable seal after root canal treatment.

Bruxism in children: Use of the Functional Plane of Monaco (FPM).

BACKGROUND: Bruxism is a condition that results from hyperactivity in the central nervous system, and factors such as stress or other anxious conditions increase the frequency of episodes. When bruxism occurs at a young age, tooth wear can occur. The extent of wear can lead to the need for restorative dentistry and prosthetic treatments to restore the morphological and functional integrity of the teeth, with high costs associated with such treatments. CASE REPORT: A healthy 15-year-old boy presented to the orthodontist observation. His incisal ridges appeared thin, without mamelons, and with increased translucency. For treatment, the authors used only the Functional Plane of Monaco (FPM), a device which he had to wear 16 hours during the day. CONCLUSION: The orthodontist successfully treated an orthopaedic/orthodontic case with the FPM device.

Indirect adhesive rehabilitation by cementation under pressure of a case of Dentinogenesis Imperfecta type II: follow-up after 13 years.

AIM: Dentinogenesis imperfecta (DI) is an autosomal dominant genetic disease that affects both deciduous and permanent teeth, with an incidence of 1 out of 6,000 to 1 out of 8,000. Teeth affected with DI type II present bulbous crowns, short and constricted roots, marked cervical constriction, translucent enamel and amber dentin. Also, they present a partial or total obliteration of pulp space, due to continuous dentin production. SEM analysis has shown an undulated dentin-enamel junction (DEJ) with irregularities and locally wide spaces between the two structures instead of a strict junction and a regular linear surface. Treatment options for patients affected by DI-II are intended to protect and restore function and aesthetics of both posterior and anterior teeth. In literature are presented many different therapies, but mainly centered on cemented prosthetic restorations instead of adhesive restorative procedures. We present in this paper a DI-II case successfully treated in 2005 with extensive adhesive rehabilitation. CONCLUSION: The 13 years follow-up proves the reliability of adhesion to dentine and enamel for indirect adhesive restorations even on this kind of anomalous substrates.

Pain and anxiety associated with Computer-Controlled Local Anaesthesia: systematic review and meta-analysis of cross-over studies.

AIM: This review focuses on Computer-Controlled Local Anaesthesia Delivery systems (CCLAD), in comparison with conventional carpule anaesthesia in means of pain and anxiety. METHODS: Medline, Embase, Web of Science and Cochrane Database for Systematic Reviews were searched up to August 2018. Only cross-over split-mouth design studies aimed to clinically compare CCLAD with a conventional carpule anaesthesia are included. Data about pain and anxiety associated with anaesthesia were sought. The authors performed meta-analysis where appropriate. RESULTS: A total of 20 studies are included in the systematic review (n = 973 subjects). Quantitative synthesis (conducted on VAS scores from 8 studies) shows that pain intensity is over 9 points lower in CCLAD than in conventional anaesthesia on a scale from 0 to 100 (95% confidence interval, ?12.90 to ?5,53; P<.001). The systematic review showed no differences between the two techniques according to the physiological parameters of pain (heart rate or blood pressure), and the data about anxiety are inconsistent. CONCLUSION: CCLAD results in significantly slightly less pain perception with respect to conventional injection and is a promising device to help patients. The literature needs to be expanded, mostly regarding anxiety.

The Two by Four appliance: a nationwide cross-sectional survey.

AIM: The aim of the study was to investigate how widespread is the use of the 2 x 4 appliance among Italian general dentists and specialists in orthodontics, as well as the type of treatment employed and length of use. MATERIALS AND METHODS: We conducted a nationwide cross-sectional survey from July 14, 2016 to January 12, 2017 using an online questionnaire of 8 multiple choice questions, created by the SurveyMonkey® Company, on a population of Italian dentists and specialists in orthodontics affiliated with the Italian Society of Paediatric Dentistry (SIOI). This was made to assess how many clinicians knew and used this device in their clinical practice. We included 200 Italian dentists, 99 specialists in orthodontics and 101 general dentists of a mean age of 45 ± 15 years. RESULTS: Results show that 93.94% of orthodontists have knowledge of and use this device in their clinical practice, while only 51.49% of the general dentists have knowledge of and use it (p<0.001). The 51.92% of dentists and the 52.13% of orthodontists used the 2x4 appliance to treat both space management and incorrect overjet. Most of general dentists and orthodontists combined the 2x4 appliance with pre-adjusted brackets and accessory components such as coil springs and power chains. While most of dentists (45.90%) used the 2x4 in association with appliances for space management, most of specialists (46.15%) applied the 2×4 in combination with both appliances for space management and high-pull headgear. Statistically significant differences were found also for the answers to the question "what is the average time of treatment?" among general dentists: the 32.79% used the 2 x 4 for less than 6 months of treatment, and the 67.21% used the 2 x 4 for more than 6 months of treatment. On the other hand 49.46% of orthodontists used the 2 x 4 for less than 6 months of treatment, and 50.54% of them for more than 6 months of treatment (p=0.041). CONCLUSIONS: We conclude that the 2 x 4 appliance is widespread among orthodontists and about half of the general dentists, 93.94% and 51.49% (p<0.001) respectively. We found that 67.21% of general dentists used the 2 x 4 for a more than 6 months of treatment. As far as the orthodontists, 49.46% used the device for less than 6 months of treatment and 50.54% of them for more than 6 months of treatment. These differences were statistically significant (p=0.041).

Finally in Italy the School of Specialisation in Paediatric Dentistry!

After over two decades of discussions, promises and indecisions, the year 2016 marked the birth of the School of Specialisation in Paediatric Dentistry, which is now a reality. The importance of dental post-graduate specialisation schools has been debated since the Degree Course in Dentistry was established. Previously, in Italy only two dental branches - Oral Surgery and Orthodontics - had obtained the recognition that a School of Specialisation entails. Today, with specific training and the newly- established hyper-specialisation in Paediatric Dentistry, the future of the profession is brighter than ever. This will allow dental professionals to provide the best cure to our young patients but it especially marks and recognises the importance of prevention in general. Having established a Specialty School in Paediatric Dentistry is also important to keep the pace with the other European countries where this postgraduate course has been already offered for many years. In my opinion, training professionals with a solid specialisation based both on cultural insights and hands-on clinical activities translates into the possibility of making true prevention. The ultimate goal of paediatric dentists, as well as paediatricians, is certainly to treat young patients but also and above all to accompany them toward an adulthood possibly free of pathologies. With an eye to a future where Paediatric Dentistry will be at the core of dental and orthodontic prevention, I wish great success to all the many specialisation schools established within the Italian Universities.

Efficacy of two mouthwashes on 3-day supragingival plaque regrowth: a randomized crossover clinical trial.

BACKGROUND: The aim of this study was to evaluate the antiplaque effects of an alcohol-free essential oil (alcohol-free EO) mouthwash and an amine fluoride/stannous fluoride with zinc lactate (SnFl-Zn) mouthwash compared to a positive control of chlorhexidine (CHX) mouthwash, using an in vivo plaque regrowth model of 3 days. MATERIALS AND METHODS: The study was designed as a double-masked, randomized, crossover clinical trial, involving 20 volunteers to compare two different mouthwashes, using a 3-day plaque accumulation model. After receiving thorough professional prophylaxis at baseline, over the next 3 days, each volunteer refrained from all oral hygiene measures and performed two daily rinses with 20 ml of the test mouthwashes. A 0.20% CHX rinse served as a positive control. At the end of each experimental period, plaque was assessed, and the panellists completed a questionnaire. Each subject underwent a 14-day washout period, and then, there was another allocation. RESULTS: The SnFl-Zn mouthwash has shown a better inhibitory activity on plaque regrowth compared to the alcohol-free EO mouthwash in the whole mouth (plaque index = 1.93 against 2.45, respectively), but there was less of an effect compared to the CHX group, with an overall plaque index of 1.41. The differences of 0.52 between alcohol-free EO and SnFl-Zn and between SnFl-Zn and CHX and of 0.96 between alcohol-free EO and CHX were all statistically significant (P < 0.001). CONCLUSION: The alcohol-free EO mouthwash seemed to have less of an inhibiting effect on plaque regrowth than the amine fluoride/SnFl-Zn mouthwash and the CHX control.

Craniofacial morphology in pediatric patients with Prader-Willi syndrome: a retrospective study.

OBJECTIVE: To investigate craniofacial characteristics in pediatric patients with Prader-Willi syndrome (PWS). SETTING AND SAMPLE POPULATION: A retrospective sample of 20 consecutive patients with PWS who had lateral and antero-posterior (AP) cephalograms (14 males and six females; average age 10.2 ± 3 years) was compared to 20 controls matched for age and sex (14 males and six females; average age 10.5 ± 3.7 years). MATERIALS AND METHODS: Cephalometric skeletal measurements were performed twice at a 1-week interval by one calibrated operator, and random error was calculated using Dahlberg's formula. Mean values and standard deviations were computed for all variables. Student's t-test for independent samples was used to determine significant differences between PWS and controls. The level of significance was set at p < 0.05. RESULTS: Cephalometric values for the length of the maxilla (p < 0.01), mandibular length (p < 0.05) at both the ramus (p < 0.05) and the mandibular body (p < 0.01), and posterior and anterior facial height (p < 0.01) were significantly lower in patients with PWS compared to controls. The AP cephalometric analysis revealed a significant reduction (p < 0.01) in maxillary skeletal width, mandibular skeletal width, and interzygomatic distance. CONCLUSIONS: Pediatric patients with PWS seem to have a general reduction in certain craniofacial skeletal parameters (i.e., maxillary and mandibular length) compared to controls, but this study did not assess the overall craniofacial characteristics.

Cone beam computed tomography investigation of the antral artery anastomosis in a population of Central Italy.

BACKGROUND: The arterial vascular supply of maxillary sinus has to be considered in all the surgical procedures where it is involved. In particular, the intraosseous anastomosis between the posterior superior alveolar artery and the infraorbital artery branches in the bony canal can be tricky to a not well aware clinician. The aim of this study is to investigate the arterial blood supply of the maxillary sinus to give clinicians the basis for a better understanding of vascular complications that can derive from surgical procedures at this level. MATERIALS AND METHODS: One hundred cone beam computed tomography were analysed by the Imaging software for three-dimensional images, i-Dixel 2.0. The parameters considered have been the presence (i), the calibre (ii), the dorso-ventral length (iii) and the cranio-caudal distance (iv). The data have been processed with means, standard deviations and verified by T-Student test. RESULTS: The statistical outputs showed that the 38% of samples presented the intraosseous anastomosis. Those anastomosis resulted long in dorso-ventral way both on left (12.55 ± 4.3 mm) and right side (12.4 ± 4.3 mm). The mean cranio- -caudal distance resulted 15.71 ± 5.08 mm on the left and 14.73 ± 4.74 mm on right side. The calibre measurements resulted quite big as well: 1.68 ± 0.3 mm on the left and 1.54 ± 0.38 mm on the right. The differences between the right and left sides were found not statistically significant. CONCLUSIONS: This in vivo investigation shows how a knowledge of the maxillary sinus vascularisation is essential during the programming surgical phase in order to prevent blood complications during the operations involving this region. (.

Electromyographic evaluation of a patient treated with extraoral traction: a case report.

BACKGROUND: This work seeks to provide information on the utility of surface electromyography (SEMG) as an aid for diagnosing orthodontic conditions. Classic orthodontic monitoring by radiography, plaster models, cephalometry, and photography can be improved by using SEMG before and during treatment, to prevent clinical worsening and relapses. CASE REPORT: This paper presents the SEMG results for a 10-year-old female patient, orthodontically treated by extraoral traction (EOT). Significant muscular variations in the patient's EMG were observed as she changed different postures and as headgear device was used. CONCLUSION: SEMG should be performed prior to the orthodontic treatment to assess the neuromuscular patient's pattern, in order to prevent strain induced by extraoral forces. EMG can be a valid aid for evaluating the patient's neuromuscular condition before, during, and after orthodontic treatment.

Familial and dietary risk factors in Early Childhood Caries.

AIM: To evaluate the causes of Early Childhood Caries. STUDY DESIGN: A statistical comparison of two groups of patients, aged between 3 and 6, and their parents, in the 3-year period 2013-2015 was performed. Two groups of patients were selected: 40 children with early childhood caries (ECC group) and 40 children with no decay (controls). Parents were asked to fill out a questionnaire on food habits, oral hygiene habits, fluoride prophylaxis and family history of caries. A dental visit of children and parents was performed (collection of dmft and DMFT index). The saliva features of the two groups of children (concentration of Streptococcus mutans, pH of the oral cavity and buffer capability of stimulated saliva) were examined by means of salivary tests. The distribution of the population was analysed and parametric and non-parametric tests for continuous and non-continuous variables, were used when appropriate. The statistical significance was set at p > 0.005. RESULTS AND STATISTICS: The average age, gender and BMI index of children of the two groups was similar. The difference between the two groups is statistically significant for pH (p=0.000) and buffer capability (p=0.001). The DMFT index in the group of mothers of ECC children is higher compared to the mothers of controls (p=0.004). The comparison among the means, for the parameters connected to the consumption of fruit juice, tea, soft drinks, candies, use of pacifier dipped in sugar or honey and the length (in months) of consumption of candies show statistically significant differences (p>0.05). The pH is higher in those children (24) who never consumed fruit juice, tea, soft drinks before the information received (p<0.05). CONCLUSIONS: Children developing Early Childhood Caries have a diet characterised by high free sugars intake. Diet and, in particular, the consumption of drinks containing free sugars is the most important factor in determining the onset of ECC, being able to affect the oral environment and, in particular, saliva. There is a relationship between maternal and child's oral health, with a DMFT higher in mothers of ECC subjects than in controls' mothers.

Aesthetic rehabilitation in a young patient using a minimally invasive approach. A multidisciplinary case report.

BACKGROUND: Optimal integration and long-term stability of oral rehabilitations require correct diagnostic approach, appropriate pre-prosthetic treatments and accurate therapeutic protocols. Technology provides devices to optimise therapeutic results, according to biologic constraints and aesthetic parameters. CASE REPORT: The present report describes a multidisciplinary management in a young patient affected by lateral incisor agenesis, including pre-prosthetic orthodontic treatment and restorative and implant-supported prosthetic rehabilitation. Minimally invasive clinical procedures with veneer restorations and flapless implant placement, followed by immediate prosthesis delivery, are carried out. Tridimensional diagnostic data and dedicated software were used for treatment planning, allowing to achieve optimal results.