Oral Dysbiosis and Systemic Diseases: A Two-Way Relationship?

The human body consists of its own cells, but also of microorganisms that are found both inside and outside the human body [...].

Root Canal Cleaning after Different Irrigation Techniques: An Ex Vivo Analysis.

Background and Objectives: The endodontic space is a complex area on both micro and macro levels; therefore, traditional irrigation techniques may not guarantee a complete cleaning of such a complicated tridimensional system. The presented ex vivo study aimed to evaluate root canal cleanliness, obtained through an equal volume of traditionally applied sodium hypochlorite (NaOCl), compared to ultrasonically activated NaOCl and ultrasonically activated NaOCl that had undergone intracanal heating NaOCl. Materials and Methods: A total of 60 freshly extracted human mandibular premolars underwent root sample length standardization (18 mm), root canal preparation and, based on the irrigation method employed, were randomly and equally assigned to three study groups, composed of root samples treated with ultrasonically activated NaOCl, ultrasonically activated NaOCl that had undergone intracanal heating and traditionally applied NaOCl. The root specimens were subsequently fixated with 4% buffered formalin solution and decalcified in Morse liquid. A total often 6-micron-thick serial cross-sections were obtained, dyed using hematoxylin and eosin and examined through an optical microscope at 40×, 100×, and 200×. Results: Ultrasonically activated NaOCl that had undergone intracanal heating showed a significantly smaller amount of debris compared to ultrasonically activated and traditionally applied NaOCl groups (p value < 0.05). Conclusions: Root canal cleanliness saw significant enhancements by ultrasonically activated NaOCl that had undergone intracanal heating.

Management of Calcified Canals with a New Type of Endodontic Static Guide: A Case Report.

(1) Background: Pulp canal obliteration (PCO) is a common condition characterized by an abnormal dentinal apposition within the canal wall, which often rises as a consequence of dental trauma. In recent years, "guided endodontics" has offered a reliable and safer procedure for endodontic access in case of PCO. The present case report aims to introduce a new endodontic guided system with a sleeveless, open-frame titanium guide designed to reduce costs compared to traditional templates. (2) Methods: The patient is a 19-year-old female who was referred to a private clinic to treat a calcified and symptomatic tooth (3.3) with apical periodontitis. Following the first unsuccessful treatment attempt using the operating microscope, a three-dimensional cone beam computed tomography (CBCT) examination and an optical impression were performed in agreement with the patient. The Digital Imaging and Communications in Medicine (DICOM) and Standard Tessellation Language (STL) files were sent to the lab for the template packaging, and the patient was scheduled for a second appointment. The endodontic guide was accurately positioned, and shaping and filling were concluded with success. The canal was sealed with the single-cone technique and bioceramic sealer. (3) Results: The patient reported no significant post-operative symptoms. Notably, the treatment achieved total symptom resolution, as evidenced by radiographic assessments conducted 3 and 24 months post-treatment, confirming the procedure's success. (4) Conclusions: This innovative sleeveless, open-frame static titanium guide presents a promising advancement in guided endodontics for PCO treatment. The advantages include preserving healthy dental tissue, reduced chairside operating time, and cost savings compared to conventional templates. This approach holds promise for enhancing the quality and efficiency of endodontic procedures in cases of PCO. While the static guide holds promise, larger prospective studies are necessary to validate its efficacy, safety, and broader applicability in routine endodontic procedures.

Cyclic Fatigue of Different Ni-Ti Endodontic Rotary File Alloys: A Comprehensive Review.

INTRODUCTION: Modern endodontics aims to decrease the bacterial load from the complex endodontic space. Over the years, improvements in the operative phases have led to a considerable increase in the success rate of endodontic treatments. The shaping phase has seen the development of new techniques supported by technological innovations that have led to higher treatment predictability. Endodontic instruments have experienced a series of changes that have led to modifications in their design, surface treatments, and heat treatments. The clinical use of rotating nickel-titanium instruments has become widespread and consolidated, a success due primarily to the alloy's mechanical characteristics, which are superior to steel ones, but also to innovations in instrument design. The advent of the Ni-Ti alloy has kept the concepts and requirements of shaping the same but has modified its implementation in endodontics. AIM: The following review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) protocol. The research question focused on Ni-Ti endodontic instruments whose cyclic fatigue was evaluated by analyzing cyclic fatigue strength and the incidence of fracture. RESULTS: At the end of the research, 10 systematic reviews and 1 randomized controlled trial were included in this comprehensive review. The most frequently analysed alloys were M-wire, conventional Ni-Ti, and CM-wire. In seven articles, instruments made of M-wire alloy were used; in eight articles, instruments made of conventional Ni-Ti; and in seven articles, instruments made of CM-wire alloy. CONCLUSIONS: The technological evolution of Ni-Ti alloys has led to the development of increasingly high-performance endodontic files that are resistant to cyclic fatigue during clinical practice and have greater resistance to sterilisation practices, making treatment easier and more predictable over time. In particular, heat-treated nickel-titanium root canal instruments present greater resistance to cyclic fatigue than untreated ones and those used with reciprocating kinematics concerning continuous rotation.

The incidence of dental fractures in the Italian population during the COVID-19 pandemic: An observational study.

Background: The COVID-19 infection has become a pandemic after breaking out in China in the past months of 2019 and spreading rapidly worldwide. To counter this pandemic, several governments worldwide have taken several drastic measures to try to stop the spread of the virus, including a very strict lockdown that has caused a sudden and, in many cases, negative change in people's daily lives. In the literature, several studies have shown how the pandemic has significantly impaired many people's mental health, causing short- and long-term stress, anxiety, and sleep disturbances. Introduction: This study aims to analyze the correlation between the stress caused by the COVID-19 pandemic and the parafunctions of the temporomandibular joint and masticatory muscles, which in turn, have led to an increase in the incidence of fractures and dental injuries. The ultimate goal is to understand the best choice the dentist must make in the preventive and therapeutic fields. Materials and Methods: A questionnaire called "Incidence of tooth fractures during the COVID-19 pandemic" was prepared using the Google® Forms platform. This questionnaire consists of 13 questions. This electronic questionnaire was addressed to all dentists in the Campania Region (ITA) and disseminated through social networks such as WhatsApp® or Facebook® or E-mail. Results: A total of 730 dentists completed the survey. Of these, 450 (61.7%) stated that the number of patients reporting muscle and joint pain in the morning had increased during the COVID-19 pandemic. 414 (56.7%) dentists noted an increase in parafunction and 392 (53.6%) an increase in dental fractures during the pandemic period. Discussion and Conclusions: As can be seen from the study results, an important correlation was found between the stress resulting from the COVID-19 pandemic and dental fractures. The dental elements treated endodontically, depending on the extent of the damage, require restoration, which is also the best preventive strategy in the case of dental fractures.

Pulp regeneration treatment using different bioactive materials in permanent teeth of pediatric subjects.

Background and Objectives: The present systematic review aims to assess the success rate of the pulp regeneration treatment, according to the American Association of Endodontists (AAE) criteria, using different bioactive materials in permanent teeth of pediatric subjects (6-17 years of age). Materials and Methods: The study protocol was registered on PROSPERO and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The question formulation was accomplished using the PICO model, and an electronic search was carried out on Scopus, MEDLINE/PubMed, Web of Science, and Cochrane databases till April 1, 2023. A total of 30 studies were established to fulfill the inclusion criteria of this systematic review. Results: A total of 273 teeth have been treated with pulp regeneration treatment. By comparing different biomaterials and the success criteria defined by the AAE, the material associated with a higher success rate was found to be the white mineral trioxide aggregate. However, the overall success rate of pulp regeneration treatment was reported for 248 out of 273 teeth (91.20%). Conclusions: Data obtained support the potential that regenerative endodontics aids in continuing root development in permanent immature teeth. Further studies are needed for a more extensive evaluation of the use of different biomaterials and the success rate in regenerative endodontics.

Dentinal tubule penetration following ultrasonic, sonic, and single-cone technique of a biosealer: An ex vivo study.

Background: The endodontic space is complex, and using a single-cone obturation technique fails to ensure a complete filling. Introduction: This study aimed to investigate the effect of ultrasonic activation, sonic activation, and single-cone technique of a biosealer on its dentinal tubular penetration. Materials and Methods: In the experiment, single-root mandibular premolars were randomly assigned to three groups (n = 20): group A, ultrasonic activation; Group B, sonic activation; and Group C, single-cone technique. Penetration of the fluorescently labeled biosealer was investigated using a confocal laser scanning microscope. Results: The data were statistically analyzed using Kruskal-Wallis and Mann-Whitney tests (P = 0.05). The highest penetration of biosealer was observed in Group A, followed by Group B (P < 0.05). Conclusions: Dentinal tubule penetration of biosealer was significantly improved by ultrasonic and sonic activation techniques.

Clear Aligners Treatment of Class III Subdivision with an Extraction of a Lower Bicuspid.

The aim of this study was to show a case of a Class III subdivision adult patient treated with clear aligners (CA) and the extraction of a lower bicuspid. A 19-year-old male with a class III canine and molar relationship on the right side and a deviation of lower dental midline to the left asked for an aesthetic treatment. He refused orthognathic surgical procedures, so he was offered a camouflage orthodontic treatment with the extraction of lower right first premolar to achieve a canine Class I relationship and to center the lower midline. The treatment was performed with clear aligners and the use of Class III elastics to maintain distal anchorage on the right side during the canine distalization. At the end of the treatment, the occlusal objectives were achieved.

Is Ozone a Valid Adjuvant Therapy for Periodontitis and Peri-Implantitis? A Systematic Review.

INTRODUCTION: Ozone is a naturally occurring unstable compound with three oxygen atoms that generally transforms into an oxygen molecule, releasing one oxygen atom. This feature has been exploited in dentistry for numerous applications, including for periodontal diseases and peri-implantitis. METHODS: This review was performed in relation to the PRISMA flow chart and was annotated in the PROSPERO register. PICO questions were used as research questions. The risk of bias in the non-randomized clinical trials was appraised using the ROBINS-I tool. RESULTS: An electronic search found a total of 1073 records, in particular, 842 from MEDLINE/PubMed, 13 from Bio Med Central, 160 from Scopus, 1 from the Cochrane library databases, and 57 from the PROSPERO register. A total of 17 studies were included in the present systematic review. Information regarding the characteristics of the periodontal clinical and radiographic parameters for gaseous ozone, ozonate water, ozonate oil, and ozone gel, including clinical attachment loss (CAL) probing depth (PPD), bleeding on probing (BoP), plaque index (PI), gingival index (GI), and marginal bone levels (MBL), were obtained. CONCLUSIONS: The studies included in this systematic review show different results regarding the ozone in periodontal treatment in association with or without SRP.

Traditional and Recent Root Canal Irrigation Methods and Their Effectiveness: A Review.

According to contemporary dental standards, the primary goal of endodontic therapy is the chemo-mechanical cleaning of the complex root canal system. Watering root canals with approved solutions and activating them are essential parts of this operation. This review outlines various irrigant activation methods for root canal therapy. Specifically, a comparison among the methods of manual dynamic activation, sonics (subsonic, sonic, and ultrasonic), internal heating, and lasers, was conducted. The results in this work were gathered using Scopus, Web of Science, Google Scholar, and PubMed databases by searching the following keywords: sodium hypochlorite, cleaning, activation, and irrigation methods. The present work concluded that the use of irrigant activation has a greater benefit than its absence. Regardless, it is impossible to point to a single effective activation method.

RETRACTED: Iandolo et al. Traditional and Recent Root Canal Irrigation Methods and Their Effectiveness: A Review. Clin. Pract. 2023, 13, 1059-1072.

The Clinics and Practice Editorial Office retracts the article titled "Traditional and Recent Root Canal Irrigation Methods and Their Effectiveness: A Review" [...].

Smear Layer and Debris Removal from Root Canals Comparing Traditional Syringe Irrigation and 3D Cleaning: An Ex Vivo Study.

Background: Endodontic treatment objectives comprise eliminating or decreasing bacterial load inside the complex endodontic space. Removing the smear layer and debris becomes mandatory to achieve good three-dimensional (3D) cleaning. Aim: This study assesses the difference in smear layer removal using the 3D cleaning technique and traditional syringe needle irrigation. The 3D cleaning technique includes the ultrasonic activation of intracanal-heated NaOCl. Materials and Methods: Our current study used single-rooted human mandibular premolar teeth to test the earlier-mentioned technique (n = 30). Initially, an endodontic access cavity was performed. Consequently, specimens were randomly distributed into three study groups according to irrigation protocol. The groups were Group 1, where the traditional syringe needle irrigation system was applied; Group 2, where the 3D cleaning technique was performed; and Group 3, in which teeth remained uncleaned as it was regarded as the control group. Once the experiment was completed, the teeth were decoronated at the cementoenamel junction (CEJ) and examined using scanning electron microscopy (SEM). Debris and smear layers were viewed in 1000× magnification and scored. Results: Statistical analysis was performed with a standard statistical software package (SPSS, version 28.0; SPSS IBM, Armonk, NY, USA). Data were analyzed with a nonparametric analysis of variance (Kruskal−Wallis ANOVA) among the groups tested and among the thirds of the canals. The level of significance was set at p < 0.05. A statistically significant (p < 0.05) lower mean smear layer and debris score was observed in both study groups compared to the control group. Group 2 showed better results compared to Group 1. Conclusions: The present study concluded that the 3D cleaning technique is an effective irrigation method for removing debris and smear layers. Future research, such as CLSM (Confocal Laser Scanning Microscopy) and Histological study, should be employed to confirm this study's conclusion.

Oral Candidiasis in Adult and Pediatric Patients with COVID-19.

Oral Candidiasis (OC) is an opportunistic fungal infection of the oral cavity, frequently reported under local and systemic predisposing circumstances. While the recurrence of OC HIV-infected subjects has been well described and reported, the association between oral candidiasis and the SARS-CoV-2 infection is a recent finding that still is worthy of further study. The present paper focuses on this novel association, reporting the incidence and prevalence of OC occurring during and after COVID-19 and the possible etiopathogenic mechanisms underlying the onset of OC in COVID-19 subjects. The work found that the immune inflammatory hypo reactions and immunosuppression found in children and adults with COVID-19 could favor the proliferation colonization of Candida species and the following infection. At the same time, poor oral hygiene and iatrogenic causes seem to be the main risk factors.

Histological Evaluation of Root Canals by Performing a New Cleaning Protocol "RUA" in Endodontic Surgery.

AIM: To enhance cleaning during retro-preparation in endodontic microsurgery. MATERIALS AND METHODS: Forty mandibular premolars were instrumented, filled with a single cone technique, and then retro-preparation was performed and assigned to experiment A. In group A1, the cavity created by the retro preparation was cleansed with 2 mL of normal sterile saline. In group A2, the retro cavity was cleaned with 2 mL of sterile saline after the retro preparation. All the irrigation solutions mentioned above were delivered using an endodontic needle with a lateral vent and a gauge of 30. Subsequently, in group A2, 17% EDTA gel and 5.25% gel were inserted into the cavity and activated using ultrasonic tips. After the irrigation protocols, the specimens were decalcified for histological evaluation. RESULTS: In the experiment, the amount of hard tissue debris was significantly greater in group A1 compared to group A2 (p < 0.05). CONCLUSIONS: The samples in group A2, where the new protocol was performed, showed statistically significant results.

Teledentistry from research to practice: a tale of nineteen countries.

Aim: The COVID-19 pandemic has accelerated teledentistry research with great interest reflected in the increasing number of publications. In many countries, teledentistry programs were established although not much is known about the extent of incorporating teledentistry into practice and healthcare systems. This study aimed to report on policies and strategies related to teledentistry practice as well as barriers and facilitators for this implementation in 19 countries. Methods: Data were presented per country about information and communication technology (ICT) infrastructure, income level, policies for health information system (HIS), eHealth and telemedicine. Researchers were selected based on their previous publications in teledentistry and were invited to report on the situation in their respective countries including Bosnia and Herzegovina, Canada, Chile, China, Egypt, Finland, France, Hong Kong SAR, Iran, Italy, Libya, Mexico, New Zealand, Nigeria, Qatar, Saudi Arabia, South Africa, United Kingdom, Zimbabwe. Results: Ten (52.6%) countries were high income, 11 (57.9%) had eHealth policies, 7 (36.8%) had HIS policies and 5 (26.3%) had telehealth policies. Six (31.6%) countries had policies or strategies for teledentistry and no teledentistry programs were reported in two countries. Teledentistry programs were incorporated into the healthcare systems at national (n = 5), intermediate (provincial) (n = 4) and local (n = 8) levels. These programs were established in three countries, piloted in 5 countries and informal in 9 countries. Conclusion: Despite the growth in teledentistry research during the COVID-19 pandemic, the use of teledentistry in daily clinical practice is still limited in most countries. Few countries have instituted teledentistry programs at national level. Laws, funding schemes and training are needed to support the incorporation of teledentistry into healthcare systems to institutionalize the practice of teledentistry. Mapping teledentistry practices in other countries and extending services to under-covered populations increases the benefit of teledentistry.

Oral Care in a Patient with Long Arm Deletion Syndrome of Chromosome 18: A Narrative Review and Case Presentation.

BACKGROUND Long arm (q) deletion syndrome of chromosome 18 is a congenital chromosomal disorder. The specialist dental management of patients with 18q deletion is a challenge, as these individuals fall into the category of patients with special needs. The aim of this work was to describe the surgical and dental management in hospital of a patient with long arm deletion syndrome of chromosome 18 (18q). CASE REPORT An 8-year-old patient with deletion syndrome of chromosome 18 (18q) was referred to the Department of Dentistry and Oral Surgery. The patient presented dental pain and difficult feeding. The examination of the oral cavity revealed a destructive carious lesion of the lower right second deciduous molar and the need to perform a frenectomy due to the short lingual frenulum, which limited the movements of the tongue. Given the complex management of the patient, it was necessary to carry out surgical procedures in the operating room. Frenectomies of the lower labial and lingual frenulum were carried out with the aid of an electric scalpel with an ultra-sharp microdissection needle. At 2-month follow-up, the patient presented with good extraction site healing and satisfactory lingual mobility, along with improvements of speech and feeding. CONCLUSIONS Dental involvement in patients with deletion syndrome of the long arm of chromosome 18 is poorly documented in the literature. The hospital regimen appears to be the criterion standard for the management of the patient with long arm deletion syndrome of chromosome 18.

Periodontal and Peri-Implant Health Status in Traditional vs. Heat-Not-Burn Tobacco and Electronic Cigarettes Smokers: A Systematic Review.

The aim of the present systematic review was to evaluate and possibly differentiate the effects of traditional cigarettes, heat-not-burn tobacco, and electronic cigarettes on periodontal and peri-implant health status. Electronic cigarettes and heat-not-burn tobacco have become very popular in recent years and have been proposed to consumers as a safer alternative to conventional tobacco smoke, although their effect on periodontal and peri-implant health remains unclear. The study protocol was developed according to PRISMA guidelines, and the focus question was formulated according to the PICO strategy. A literature search was conducted across PubMed/MEDLINE and the COCHRANE library from 2003 to April 2022. From the 1935 titles initially identified, 18 articles were finally included in the study and extracted data were qualitatively synthesized. It may be carefully concluded that e-cigarettes may cause attenuated clinical inflammatory signs of periodontitis and, hypothetically, of peri-implantitis when compared to conventional tobacco smoke. Both alternative smoking products, containing nicotine, may likewise exert negative effects on periodontal and peri-implant health, as demonstrated by in vitro studies. Further investigations are needed to assess the impact of electronic cigarettes and heat-not-burn tobacco products on periodontal and peri-implant health status.

Education during the COVID-19 pandemic: the perception of Italian dental and medical students.

BACKGROUND: During COVID-19 pandemic many dental and medical students continued their education from home. From several studies it emerges that students prefer face-to-face teaching, due to the better interaction with teachers, the least number of distractions and due to the negative effect of social isolation on the psychological aspect. The aim of this study was to evaluate the perception of Italian dentistry and medicine students about teaching and training in this scenario. METHODS: Two online questionnaires were sent to medical and dental students of all Italian universities to investigate the limits and advantages of distance learning and the experience regarding the internship. A chi-square test was used to assess the association between gender, year of the course and region of residence (P<0.05). RESULTS: One thousand one hundred thirty-eight students answered the first survey, and 292 the second one. Most students preferred face-to-face teaching due to the difficult to maintain attention during online lessons. Many students reported that the online internship was not adequate for their education. CONCLUSIONS: Distance learning disadvantages are the greater number of sources of distraction, low level of interaction, and absence of the relationship with the patient during the practical training. Furthermore, isolation has strongly affected psychosocial balance of the students. The advantages are the greater comfort, the reduction of transport costs, the decrease in pollution, and the possibility of reviewing the lessons. Most Italian students considered appropriate to provide distance learning during the pandemic but believed that the best teaching method was teaching in presence.

Intentional Replantation of Single-Rooted and Multi-Rooted Teeth: A Systematic Review.

The technique of intentional replantation can provide a second chance to save teeth that would be destined for extraction. Therefore, the present systematic review aimed primarily to estimate tooth survival after intentional replantation and secondarily to compare treatment outcomes in single-rooted and multi-rooted teeth. The study protocol was developed before the analysis according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Articles were electronically searched in PubMed/MEDLINE, the COCHRANE library and Google Scholar by two independent reviewers, and those that met the eligibility criteria were included. A statistical analysis using the chi-square test with a p-value of <0.05 was performed on the reported outcomes of intentional replantation. A total of 44 single-rooted replanted teeth with five failures (11.36%) and 42 multi-rooted replanted teeth with six failures (14.28%) were reported in the literature, corresponding to a survival rate of 88.64% and 85.57%, respectively. The overall survival rate for the replantation procedure was 86.7%, indicating that intentional replantation can be considered a safe therapeutic choice, with no statistically significant difference between the survival rates of single-rooted and multi-rooted replanted teeth.

Smoking Cessation on Periodontal and Peri-Implant Health Status: A Systematic Review.

Since smoking is considered among the main risk factors for the onset and progression of periodontitis and peri-implantitis, the present systematic review aimed to evaluate the effect of smoking cessation on clinical, radiographic, and gingival crevicular periodontal parameters around natural teeth and dental implants in ex-smokers compared to current and non-smokers. The study protocol was developed based on the PRISMA guidelines, the research question was formulated according to the PICO model, and the literature search was conducted through PubMed/MEDLINE, Cochrane library, and BioMed Central databases. From the 916 title/abstracts initially identified, seven articles were included in the present systematic review and assessed for quality through the ROBINS-I tool. Reported findings on clinical and crevicular periodontal parameters around natural teeth were contrasting when comparing ex-smokers to current and non-smokers; thus, individualized recommendations for previous smoker periodontal patients are currently lacking. No data on radiographic parameters were retrieved. Similarly, data on periodontal parameters around dental implants were not available, highlighting the need for focused investigations assessing the role of both smoking habit and cessation on peri-implant health status and responsiveness to treatment.