Marginal soft tissue recession after lateral guided bone regeneration at implant site: A long-term study with at least 5 years of loading.

BACKGROUND/AIM: This study evaluated marginal soft tissue recession at implants with simultaneous lateral guided bone regeneration (GBR), at least five years after prosthetic loading. MATERIAL AND METHODS: Patients treated with GBR at the time of implant placement and adherent to supportive periodontal therapy (SPT) program with at least 5 years of follow-up were re-examined in 5 clinical centers. At the last follow-up, clinical and radiographic data on peri-implant hard and soft tissue were collected. Multilevel analysis considering center, patient, and implant (brand, length, diameter, position) was performed. RESULTS: A total of 96 patients and 195 augmented implants were included. The mean duration of SPT was 8.3 ± 3.1 years, while mean recall frequency was 4.5 ± 1.3 months. Sixty-five (33%) implants received soft tissue graft before prosthetic delivery. Twenty-one (11%) implants developed biological complications during the follow-up. No implant failure was reported. Mean difference in bone levels (ΔBL) was -0.7 ± 0.9 mm, while mean difference in keratinized tissue (ΔKT) was -0.4 ± 0.9 mm. Eighty-five (44%) implants showed recession (REC) of soft tissue margin (mean 0.6 ± 0.8 mm). The presence of REC was associated with use of non-resorbable membrane (p < .0001) and wider implant diameter (p = .0305), while use of soft tissue graft significantly predicted higher stability of peri-implant mucosal margin (p = .0003). CONCLUSION: Peri-implant mucosal recession is a common feature 5 years after lateral GBR. The risk of recession may be reduced using GBR with resorbable membranes, small diameter implants, and soft tissue grafting before prosthetic treatment.

A clinical dilemma: Performing or avoiding root instrumentation in the treatment of the acute phase of endodontic-periodontal lesions? A case report.

BACKGROUND: This study presents the diagnois, management, and tissue response to an acute periodontal lesion with deep pocketing affecting a maxillary central incisor in a young patient devoid of caries or a history of periodontitis. METHODS: Clinical and radiographic examinations facilitated the diagnosis of the pathology as an endoperiodontal lesion (EPL) with root damage, exhibiting supracrestal invasive root resorption. Orthograde endodontic therapy was employed to decontaminate and seal the endodontic space. The resorptive site was treated through the endodontic access, debrided, and sealed. No periodontal therapy (surgical or nonsurgical) was performed. No mechanical instrumentation was performed within the pocketed root surface. RESULTS: At 6-month and 1-year follow-ups after endodontic therapy the periodontium displayed a physiologically healthy condition without pus or inflammation, exhibiting a circumferential probing depth of 2 mm, and absence of tooth mobility. These favorable outcomes persisted throughout a 4-year follow-up period. CONCLUSIONS: The spontaneous healing of pocketing and abscess occurred without mechanical root instrumentation following endodontic therapy and treatment of external invasive root resorption in an EPL. KEY POINTS: Accurate diagnosis and identification of relevant etiologic factors are pivotal for effectively managing endodontic-periodontal lesions. Once a diagnosis is established, the therapy focuses on eliminating the primary cause, followed by a subsequent diagnostic phase after healing. The definitive understanding of the diagnosis and etiology of endodontic-periodontal lesions often becomes clear in retrospect, based on the outcomes of the therapy. When probing acute periodontal lesions, deep probing depths may occur without permanent loss of periodontal attachment. If the acute lesion was not induced by a periodontal cause and if no periodontal etiology arises secondarily, resolving the primary cause of the endoperiodontal lesion can lead to the spontaneous resolution of the pocketing. This results in spontaneous healing of periodontium without the need for intentional periodontal therapy. A clinical dilemma arises when considering periodontal treatment during the acute inflammatory phase of endo-periodontal pathology. It is advisable to refrain from mechanical root instrumentation particularly if a clear periodontal cause is not apparent, to prevent from iatrogenic damage to periodontal fibers and the potential risk of gingival recessions. However, this does not imply avoiding periodontal therapy entirely for every case. Rather, it is recommended to delay the decision on root instrumentation until a new diagnostic phase is conducted following the healing of the endodontic etiology.

Translational approach to tooth autotransplantation: A 27-year case study.

BACKGROUND: The aim of this case report was to present a translational approach to tooth autotransplantation using jiggling forces to enlarge the periodontal ligament (PDL) space before autotransplantation, with the goal of improving treatment success and long-term survival. METHODS: A 23-year-old patient, undergoing orthodontic therapy and with an unrestorable maxillary first molar, was proposed to have a healthy and fully-erupted maxillary third molar transplanted in the socket of the first molar. Jiggling forces were applied to the third molar to enlarge the PDL space and facilitate the preservation of PDL fibers on the root surfaces during the extraction. RESULTS: Jiggling forces induced hypermobility and widened PDL space of the third molar. The autotransplantation was successful and the patient was followed regularly over a 27-year period. At the 27-year visit, the patient showed optimal chewing function, oral plaque control, and absence of gingivitis. The transplanted molar exhibited periodontal health and absence of mobility. Probing depth of 5 mm and radiographic external root resorption was noted on a localized area of the transplanted tooth which had experienced traumatic and unintentional removal of PDL fibers during the extraction. CONCLUSIONS: A translational approach was proposed by integrating knowledge from the fields of orthodontics, trauma from occlusion, and replantation. It validated the crucial importance of maintaining healthy PDL fibers on the root surface and demonstrated clinically the successful autotransplantation of a fully formed third molar into the socket of a first molar with a retention of 27 years. KEY POINTS: Why is this case new information? This case provided evidence of successful autotransplantation of a molar with complete root formation. It reported the longest-term follow-up (27 years) present in the literature. Most importantly, it used a translational medicine approach to apply concepts from the fields of orthodontics and traumatic occlusion to improve the success of the autotransplantation procedure. What are the keys to the successful management of this case? Jiggling forces induced tooth hypermobility and increased the PDL space of the tooth planned for autotransplantation. In turn, they facilitated the atraumatic extraction and preservation of the PDL fibers on the transplanted tooth, improving the success of the reattachment of periodontal fibers. What are the primary limitations to success in this case? Traumatic extraction resulting in the unintended removal of PDL fibers from the tooth planned for autotransplantation, or intentional removal of PDL fibers with root planing are expected to decrease the success rate of the autotransplantation procedure. This is due to the lack of viable PDL cells necessary for reattachment.

In Vitro Alteration by Dentine and Protein of the Antimicrobial Activity of Two Endodontic Irrigants: HybenX® and Sodium Hypochlorite.

Irrigant solutions commonly used for the treatment of endodontic infections can be inhibited by both organic and inorganic substances. The aim of this study was to evaluate the in vitro antimicrobial activity of the novel irrigant HybenX® and 2.5% and 5% sodium hypochlorite against Enterococcus faecalis, in presence of dentine powder (DP) or bovine serum albumin 20% (BSA) as inhibitory agents. An E. faecalis American Type Culture Collection (ATCC) 29212 suspension was added to the irrigants (Hybenx® or NaOCl) and one or two different inhibitors (BSA and DP) either after one-hour pre-incubation at 35 ± 1 °C or not. The antimicrobial activity of HybenX® against E. faecalis was already proved at 15 min and was neither affected by BSA nor by DP or combinations thereof. NaOCl 2.5% showed an effective antimicrobial activity starting from 15 min and this activity was partially inhibited by BSA and BSA plus DP combination within one hour when pre-incubation occurred. NaOCl 5% showed antimicrobial activity within 15 min, which was inhibited within one hour only in the presence of both BSA and DP regardless of the pre-incubation period. HybenX® could represent a good alternative to common irrigants for the treatment of E. faecalis endodontic infections, showing a rapid antimicrobial activity not inhibited by organic and inorganic inhibitors.

In Vitro Antimicrobial Activity of the Decontaminant HybenX® Compared to Chlorhexidine and Sodium Hypochlorite against Common Bacterial and Yeast Pathogens.

The recent increase in infections mediated by drug-resistant bacterial and fungal pathogens underlines the urgent need for novel antimicrobial compounds. In this study, the antimicrobial activity (inhibitory and cidal) of HybenX®, a novel dessicating agent, in comparison with commonly used sodium hypochlorite and chlorhexidine, against a collection of bacterial and yeast strains representative of the most common human pathogenic species was evaluated. The minimal inhibitory, bactericidal, and fungicidal concentrations (MIC, MBC, and MFC, respectively) of the three different antimicrobial agents were evaluated by broth microdilution assays, followed by subculturing of suitable dilutions. HybenX® was active against 26 reference strains representative of staphylococci, enterococci, Enterobacterales, Gram-negative nonfermenters, and yeasts, although at higher concentrations than sodium hypochlorite and chlorhexidine. HybenX® MICs were 0.39% for bacteria (with MBCs ranging between 0.39% and 0.78%), and 0.1-0.78% for yeasts (with MFCs ranging between 0.78% and 1.6%). HybenX® exhibited potent inhibitory and cidal activity at low concentrations against several bacterial and yeast pathogens. These findings suggest that HybenX® could be of interest for the treatment of parodontal and endodontic infections and also for bacterial and fungal infections of other mucous membranes and skin as an alternative to sodium hypochlorite and chlorhexidine.

Rehabilitation of severely injured anterior teeth in a young patient using ceramic and FRC: a clinical report.

This clinical report describes the indirect restoration of anterior teeth in a young patient after a severe dental trauma using all-ceramic coronal posts. Step-by-step clinical procedures and their rationale are described. The learning objective of this case report is to outline the principles for the management of traumatic injuries of permanent anterior teeth in young patients to re-establish function and provide good esthetic results.

Influences of 432 Hz Music on the Perception of Anxiety during Endodontic Treatment: A Randomized Controlled Clinical Trial.

INTRODUCTION: Patients undergoing endodontic therapy often have severe perioperative and intraoperative anxiety, which may lead to increased perceptions of pain and vital sign instability throughout treatment. The purpose of this study was to test the influences of music, as a nonpharmacologic adjuvant, in terms of significant changes for systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) before, during, and after endodontic treatment in a population with different levels of anxiety assessed with the Corah Dental Anxiety Scale. METHODS: A total of 100 patients were recruited in the present study; before starting the endodontic treatment, the interviewer administered the Corah Dental Anxiety Scale to the participants to assess the baseline level of anxiety. Patients were randomly divided into 2 groups: the first one listened to the music and the second one did not. Before, during, and after the endodontic procedures, the vital signs (diastolic and systolic blood pressure and heart rate) were recorded. Results were collected and statistically analyzed. RESULTS: Direct contrasts between patients listening or not listening to music showed that all the measured vital signs decreased considering the overall period (during and after the canal therapy) in the group of patients listening to music (P < .05). CONCLUSIONS: This study shows the effects of music therapy on vital values and on subjective perception of anxiety during endodontic therapy. Music and medicine always work together; the soothing effects of sounds and musical frequencies make this union an extraordinary tool of synergistic care. Music therapy is a valid nonpharmacologic adjuvant to anxiety perception in endodontic therapies.

Shaping ability of waveone primary reciprocating files and ProTaper system used in continuous and reciprocating motion.

INTRODUCTION: The purpose of this study was to compare the shaping effects of Wave One (Dentsply Maillefer, Ballaigues, Switzerland) and full-sequence ProTaper nickel-titanium (NiTi) files (Dentsply Maillefer) used in reciprocating and conventional movements in a simulated canal. METHODS: Seventy-five S-shaped canals in resin blocks were randomly allocated to 3 groups (n = 25): WaveOne (group 1), full sequence of ProTaper Universal files in conventional movements (group 2), and full sequence of ProTaper Universal files in reciprocating movements (group 3). Preoperative and postoperative photographs of the simulated canals were taken under standardized conditions, after which they were accurately superimposed. Two methods were adopted to evaluate the shaping ability of the 3 approaches: measuring the differences in apical and coronal curvature modifications and measuring the amount of resin removed for both curvatures on the right and left sides of the simulated canals. Differences in canal curvature modifications and in the amount of resin removed were analyzed using 1-way analysis of variance (P < .0001) followed by a Tukey-Kramer multiple comparison post hoc test and mixed-effects linear model (P < .05), respectively. METHODS: Group 3 maintained better coronal and apical canal curvature and less straightening of the simulated canals with respect to groups 1 and 2. CONCLUSIONS: When preparing S-shaped canals, full-sequence ProTaper Universal NiTi files used in a reciprocating motion exhibited better shaping effects than full-sequence ProTaper Universal NiTi files used in a conventional motion and WaveOne.

Mineral trioxide aggregate as apical plug in teeth with necrotic pulp and immature apices: a 10-year case series.

INTRODUCTION: This 10-year study evaluated the clinical and radiologic outcomes of teeth with necrotic pulp, immature apices, and periapical lesions treated with the mineral trioxide aggregate (MTA) apical plug technique. METHODS: Seventeen single-rooted immature teeth with necrotic pulp and periapical lesion from 17 patients treated between January 2001 and December 2001 were included in this study. Apical obturation on all teeth included in the study was completed in 2 visits: first using calcium hydroxide as an interappointment intracanal medication and a second visit for the creation of the artificial apical barrier with MTA. The outcome, based on clinical and radiographic criteria, was assessed by 2 calibrated investigators using the periapical index (PAI). The Friedman test was used to verify the differences between baseline and the 1-, 5-, and 10-year PAI scores. RESULTS: Of the 17 patients treated, 1 patient dropped out at 5 years. At the 10-year follow-up, 15 teeth were healed (PAI ≤2), and 1 tooth had been extracted because of the presence of a longitudinal root fracture. The PAI score exhibited a significant decrease between baseline and 1 year and between 1 and 5 years. The difference between 5 and 10 years was not significant. CONCLUSIONS: The apical plug with MTA was a successful and effective technique for long-term management of this group of teeth with necrotic pulps with immature root development and periapical lesions.

Endodontic management in oculo-facio-cardio-dental syndrome: a case report.

INTRODUCTION: Oculo-facio-cardio-dental (OFCD) syndrome is an X-linked dominant trait. OFCD syndrome is characterized by congenital cataract with secondary glaucoma ocular defects; ventricular and atrial septal defects or mitral valve prolapses; facial traits such as a long narrow face, a high nasal bridge, a bifid nasal tip; and dental anomalies that include radiculomegaly, oligodontia, root dilacerations, malocclusion and delayed eruption. This clinical report describes the endodontic treatment for a 16-year-old girl who suffers from OFCD syndrome. METHODS: The treatment plan included orthograde re-treatment of #9, #10 with apical plug technique and orthograde retreatment and root canal obturation with modified Thermafil (Dentsply Maillefer, Ballaigues, Switzerland) technique of #21, #22 RESULTS: The modified Thermafil technique makes it possible to reach the working length even in teeth with radiculomegaly. CONCLUSIONS: Prompt treatment of dental caries make it possible to maintain tooth function and prevent difficult root canal procedures with poor prognoses for success.

Effects of pH on surface hardness and microstructure of mineral trioxide aggregate and Aureoseal: an in vitro study.

INTRODUCTION: The aim of the study was to evaluate the surface hardness and the morphologic microstructure of white mineral trioxide aggregate (WMTA) and Aureoseal in acid environment. METHODS: WMTA and Aureoseal were mixed and packed into 64 cylindrical stainless steel molds. Thirty-two of each group were exposed to pH values of 4.4 and 7.4, respectively, for 7 days. Four specimens, 2 exposed to acid pH and 2 exposed to pH of 7.4, were prepared for evaluation under scanning electron microscope by using scattered electron (SE) and backscattered electron (BSE) detectors. Vickers surface hardnesses were measured in the remaining 60 samples. RESULTS: The mean surface hardness values ± standard deviation were 37.54 ± 1.52 and 30.24 ± 1.47 for WMTA and 40.63 ± 1.35 and 28.67 ± 1.07 for Aureoseal after exposure to pH values of 7.4 and 4.4, respectively. WMTA showed higher hardness values in acid environment than Aureoseal, which showed the highest microhardness at pH values of 7.4. The SE detector revealed crystal formation on the WMTA surface at pH values of 7.4 and 4.4. In the WMTA specimens the BSE detector showed more unhydrated structures at pH values of 4.4 than at 7.4. The SE detector did not reveal crystal formation on the Aureoseal specimens at pH 7.4 and 4.4. BSE detection showed amorphous microstructures in the Aureoseal specimens treated in the pH 4.4 acid environment. CONCLUSIONS: There was significant interaction between the cements and the environments where the cements hardened.

Mineral trioxide aggregate as repair material for furcal perforation: case series.

The purpose of treating furcal perforation is to seal the artificial communication between the endodontic space and the periradicular tissue to prevent alveolar bone resorption and damage to the periodontal ligament. These complications are not infrequent in cases of furcal and/or old perforations, which show a worse prognosis than fresh, small, coronal, and apical perforations. Mineral trioxide aggregate (MTA) is widely used to seal perforations because of its biocompatibility and sealability. Ten cases of furcal perforation were selected at the department of Endodontics, University of Florence. All the perforations were cleaned with NaOCl, EDTA, and ultrasonic tips and sealed with MTA without internal matrix. Finally, the teeth were endodontically treated and coronally restored. Clinical and radiographic follow-ups were done at 6 months, 1 year, 2 years, and 5 years. After 5 years, the absence of periradicular radiolucent lesions, pain. and swelling along with functional tooth stability indicated a successful outcome of sealing perforations in 9 out of 10 teeth. One patient dropped out of the study after the 1-year follow-up and could not be contacted for further recalls. The results confirm that MTA without matrix provides an effective seal of root perforations and clinical healing of the surrounding periodontal tissue.

The use of MTA in teeth with necrotic pulps and open apices.

Three clinical cases have been treated with the use of an apical plug of MTA for apexification. All three cases were central incisors that had suffered premature interruption of root development as a consequence of trauma. According to the treatment protocol, the root canals were rinsed with 5% NaOCl; then, calcium hydroxide paste was placed in the canals for 1 week. Consequently, the apical portion of the canal (4 mm) was filled with MTA. The remaining portion of the root canals was then closed with thermoplastic gutta-percha. At 6-month and 1-year follow-up period the clinical and radiographic appearance of the teeth showed resolution of the periapical lesions. MTA appears to be a valid option for apexification with its main advantage being the speed at which the treatment can be completed.