Periodontal diseases include a mild and reversible form named gingivitis (GI), and periodontitis (PD) that is the main cause of tooth loss in adults. GI, that affects gums and coronal junctional epithelium, as well as periodontitis, that is characterized by loss of connective tissue attachment, are caused by a persistent inflammatory response promoted by alteration of periodontal biofilm. The aim of the study was to test whether the prevalence of each species was associated with a particular clinical condition. Periodontal evaluation of 756 unrelated patients was performed by the Periodontal Screening and Recording (PSR) system. Subgingival samples were obtained from the site with the worst PSR score. A selection of eleven bacterial species was evaluated by quantitative real time PCR. Quantitative and qualitative analyses help to better understand the microbial changes associated with different stages of periodontal disease.
Stem cells of dental pulp (SCDPs) are multipotent stem cells with the potential to differentiate into various cell types. For this reason, they have been proposed as an alternative source for mesenchymal stem cells. Somatostatin (ST) is a peptide hormone with an inhibitory effect on several endogenous hormones. The aim of our study is to investigate whether somatostatin can promote or inhibit differentiation of SCDPs in osteoblasts and bone tissue. SCDPs were extracted from third molars of healthy subjects and were treated with ST at the concentration of 100 ng/ml for 24 and 48 h. Gene expression in treated SCDPs was compared with untreated cells (control) to check the effect of somatostatin on stem cell differentiation. After 24 h of treatment many genes investigated were downregulated in treated SCDPs vs untreated SCDPs. Significantly up-regulated gene (Fold change >2) was the Bone Morphogenetic Protein BMP4. On the contrary ST induced the over-expression of bone related genes after 48 h of treatment. TGFB family genes and their receptors were also significantly upregulated after 48 h of treatment. ST demonstrated to promote the self-renewal of SCDPs: in our experiments somatostatin mainly acted on TGFB family genes. Further studies are needed to explore this new way of creating bone tissue.
The purpose of this paper is to evaluate the role of hyaluronic acid in bio-revitalization (HABR) by testing several extracellular matrix biological parameters in cultured dermal fibroblasts. To this aim, fibroblastic expressed genes after exposition to three HABR medical devices were evaluated. Cells were seeded on a layer of three different medical devices containing 6.2, 10 and 20 mg/ml of HABR for 24 h. Real Time Polymerase Chain Reaction was performed to investigate gene expressions. Genes encoding HABR synthesis and degradation, Metalloproteinases 2 and 3 and Desmoplakin production as well as GDF6, and IGF1 were activated by hyaluronic acid products. The in vitro study showed similar effects on tested genes despite a different concentration of hyaluronic acid contained in the medical devices and the simultaneous presence of other additives. Based on the reported data, gene activations are an aspect of metabolic modulation of signalling pathways rather than the proportional production of a specific connective tissue molecule. Indeed, different HABR concentration and the presence of other additives did not change the overall effect on the studied genes. We believe that the optimization of extracellular matrix micro-environment, obtained by enhanced structural support with HABR, leads to functional and metabolic improvement.
The purpose of this work was to assess the discomfort perceived by the patient during the intraoral scan procedure using the iTero Scanner. A sample of 33 patients was selected on the basis of parameters that identify a complete dentition. All treated patients underwent a traditional polyvinylsiloxane impression with double procedure and an intraoral scan in the same session. Subsequently they were given a questionnaire concerning the discomfort perceived by both procedures. Once the completed questionnaires were obtained, preliminary statistical tests were carried out to check if the distribution of scores assigned by patients to the two procedures differed significantly from a Gaussian distribution. Furthermore, the discomfort/preference indexes for the two procedures were compared using the Wilcoxon test for paired data. Finally, the Spearman correlation test was used. From the results of the preliminary normality tests, it was decided to use nonparametric type tests that gives the intraoral scan procedure more favorable scores relative to a minor discomfort. The use of intraoral scanning and more specifically of the iTero 2.9 scanner (despite a not small wand), represents an option largely preferred by patients in terms of reduction of discomfort and classic discomfort related to relief systems traditional imprint.
The case report aims to describe the parameters of performing upper labial frenectomy with the use of diode laser beams without infiltrated local anaesthesia. A 6-year-old patient was referred by the orthodontist for assessment of the upper anterior labial frenum. The dental treatment plan reported only the presence of caries on deciduous teeth and seals on the first permanent molars. The clinical examination reported the presence of a high attachments of labial frenum with a pathologically attachment and the presence of a diastema supports this theory. The laser used to remove the frenulum was a diode laser used with a wavelength of 980 nm with 320 microns of fiber in contact with a power of 2.0 W in continuous wave mode. The clinical examination showed an acceptable healing by secondary intention of the wound and the initial functional recovery of a physiological upper lip movements. The patient reported that the procedure was well tolerated. The diode laser can be used with good result for the removal of pathological frenum. The diode laser can be used in pediatric dentistry because of its application, adequate coagulation, no need for sutures and less inflammation and pain.
The aim of this study was to establish the role of Porphyromonas gingivalis in Alzheimer's disease. An electronic search of publications was established from three electronic databases: Cochrane, PubMed and Web of Science. The search strategy used a combination of controlled vocabulary and free-text words. Inclusion and exclusion criteria were defined by the authors before the start of the study. The inclusion criteria were: all studies published in English language; in vitro analysis; in vivo on animals and postmortem biopsies on humans; studies analyzing the correlation between periodontal disease and Alzheimer. The search resulted in 262 titles. Only 9 articles were included in the quantitative analysis. An inflammatory status in the oral cavity might be connect to a brain degeneration syndrome such as dementia and AD. However, a strictly connection is still not evincible. More trials are recommended in order to investigate the role of periodontal bacteria and Porphyromonas gingivalis in AD pathogenesis and aggravation.
The purpose of this review was twofold. The first aim was to show predictable protocols of guided endodontic microsurgery (EMS) and to describe its clinical outcomes. The second aim was to verify the accuracy of this technique compared to the traditional pathway. An electronic search of publications was established from two electronic databases, Cochrane and PubMed, by two independent researchers. The search strategy used a combination of controlled vocabulary and free-text words. Inclusion and exclusion criteria were defined by the authors before the start of the study. Inclusion criteria were: all studies published in English language; studies in vivo on humans; human cadaver studies; studies analyzing guided surgery in apicoectomy. The initial search yielded 67 citations, of which 10 were included. The studies included in this review analysis have shown two different technique both for digitization of dental arch and for surgical procedures too. Guided endodontic micro-surgery is a more predictable technique with less intra-operative and post-operative complications compared to the "freehand" technique and this procedure has shown a greater accuracy.
The aim of this study was to assess the soft tissues health around the implant/abutment interfaces of fixed screw-retained prosthesis supported by four dental implants after at least 1-year in function. All the implants were placed between December 1, 2015 and April 30, 2019. Digital implant surgical planning was performed for all the complete-arch rehabilitations and then full-guided surgery was performed. The fixed-interim prostheses were delivered the day of the surgery and replaced by definitive prostheses after the healing period. Patients were followed-up to determinate peri-implant scores, such as Plaque Score (PS) and Bleeding on Probing (BoP). A total of 160 implants were placed in 37 patients, whereas 3 patients received both arches rehabilitated. A total of 40 complete-arch rehabilitations were performed, 26 in the maxilla and 14 in the mandible. Only 5 implants failed resulting in an overall implant survival rate of 96.9%. BoP was detected around 6 implants (3.7%) and 16 implants showed a superficial amount of plaque resulting a Plaque Score of 10%. Within the limitation of this study, it seems that the use of a fixed screw-retained prostheses supported by four dental implants to rehabilitate edentulous jaws could be a valid treatment option in the short and medium term without critical peri-implant issues. However, several perspective studies with longer follow-up are needed to achieve more predictable results.
The aim of this study is to compare bacterial leakage of MicroHeat and continuous wave with and without endodontic sealer. Thirty-eight single-rooted extracted mandibular premolars were selected and randomly divided into four experimental groups (n=8) and two control groups (n=3). Teeth were prepared with Mtwo NiTi files and obturated with MicroHeat or System B with or without endodontic sealer. Three teeth were used as positive controls (Ct+) and three intact teeth served as negative controls (Ct-). All samples were tested for bacterial infiltration every day for 60 days. On day 32 overall contamination value was 62.5% for Mseal, 75% for Mnoseal, 75% for SBseal and 37.8% for SBnoseal; after 60 days, the final contamination result was 100% for Mseal, Mnoseal and SBseal and 87.5% for SBnoseal. At the end of the observation period, groups showed no statistically significant differences.
The aim of this study is to compare the working length measured with Root ZX (EAL1), Propex II (EAL2) and Endo Analyzer Model 8005 (EAL3) with radiographic measurements during endodontic treatment. Fifty single canal teeth scheduled for endodontic treatment were selected for the study. After endodontic access preparation, pulp chamber was irrigated with 5mL of 5% sodium hypochlorite (NaOCl). The canal was scouted with a size 10 K-file introduced slightly over the apex to verify the canal patency. The working length (WL) was measured using all three EAL devices and radiographically. All measured working lengths were recorded and compared using ANOVA for repeated measures considering the multiple comparison of paired data Least Significant Difference (LSD). The WL mean values for EAL1 were 19.1 ± 1.7 mm; for EAL2 were 19.4 ± 1.7; for EAL3 were 19.4 ± 1.6 and for RG were 19.2 ± 1.7. The Pearson correlation coefficients indicated that the following correlation between electronic devices and radiographic WL: EAL1- 0.986, EAL2- 0.953 and EAL3- 0.931. Considering the mean values compared to radiographic measures, Root ZX gave better results than the other tested EAL devices. Endo Analyzer Model 8005 showed the worst performance.
The importance of intraoral periapical radiography is crucial as it represents a fundamental mean of evaluation and diagnosis for supporting bone and teeth hard tissues diseases and pathologies. Even though conventional film technology is still widespread, presently there are many digital radiography alternatives. Direct digital systems are devices with an intraoral sensor wired or paired wireless with a computer. These devices do generate an image immediately during exposure and acquisition. The semi direct digital systems instead are based on phosphor image plates. Digital radiography offers many chances to improve our patient's healthcare standards reducing exposition to X-rays and the related stochastic radiation risk. Aim of this study is to compare the quality of images for endodontic purposes comparing three systems: conventional films, direct digital radiography and semidirect digital radiography.
Craniofacial features of 18 individuals with Turner Syndrome (TS) were compared with age and gender matched healthy individuals. Dental history, panoramic radiograph, dental casts and cephalometric measurements were assessed. The dental casts analysis showed a significantly higher PH/PW ratio in individuals with TS under GH therapy compared to healthy individuals (p=0.004; paired t-test). This data objectively supported the definition of a high-narrow palate. The ANB angle and the Wits index were similar in the two group, showing a skeletal class I malocclusion. The vertical characteristics did not differ between the two groups, showing a mesofacial growth pattern. Our results showed similar cephalometric characteristics in individuals with TS treated with GH and healthy controls.
The aim of the present prospective study was to evaluate periodontal health and subgingival microbiological alterations in adolescents treated with fixed self ligating orthodontic brackets in comparison to subject without any orthodontic appliance. A total of 40 adolescents (23 females and 17 males; mean age: 13.2 ± 3.2 years) were included: 30 subjects with self ligating brackets (test group) and 10 patients without orthodontic appliances (control group). Follow-ups were as follows: T1 (1 month), T2 (3 months), T3 (6 months) from the beginning of the orthodontic therapy. Clinical parameters (plaque index, gingival index and clinical attachment level) were measured for every patient and a microbiological analysis was performed. Mann Whitney test was performed to evaluate clinical parameters between test and control group and Friedman test and Fisher test were adopted to evaluate intra group differences at different follow-ups. Student T-test was performed to compare clinical attachment level between the two groups. Significance level was set at p<0.05. No periodontal pathogens and no clinical attachment loss were found in the whole sample. A slightly higher plaque index and gingival inflammation were recorded in the test group in comparison to the controls.
It is well known that greenish pigmentation of the teeth is seen in children following remission of severe jaundice and clinical and serum bilirubin, a degradation product of haemoglobin, may be permanently trapped in forming dental hard tissues causing discolouration and enamel and dentine hypoplasia. Neonatal jaundice is the most common cause of hyperbilirubinemia and pigmentation of the deciduous teeth is the consequence of this condition. Various hepatobiliary pathologies may have a clinical finding in the oral cavity; furthermore, oral manifestations of hepatic pathologies are not just limited to the pigmentation of the deciduous teeth but also the permanent dentition and the mucous membranes can be affected.
The aesthetic goals of implant dentistry should be similar to those of conventional prostheses. In implant-prosthetic rehabilitations of the anterior sectors, the quantity and quality of hard and soft tissue play a fundamental role in achieving the desired aesthetics and in integrating the restoration in a complete and harmonious way into the existing anterior dentition. Post-extraction implantology is a treatment option for implant therapy after the extraction of a single tooth in the anterior jaw. This article presents some key factors to analyze and follow in order to achieve a predictable and acceptable aesthetic result. The creation of a predictable peri-implant aesthetics requires adequate preservation of the bone and soft tissues around the teeth that will be extracted and a correct positioning of the 3D implant. Furthermore, aesthetic success requires the creation of a correct transmucosal path, during the provisional prosthetic phases, which must be replicated and maintained with the definitive crowns.
The sinus lift with lateral approach is a regenerative technique nowadays considered predictable to increase the height of bone in the atrophic posterior maxilla. Knowledge of sinus anatomy and evaluation of risk factors are the basis of regenerative and rehabilitative surgical success. The positioning and size of the lateral antrostomy represent critical factors in the execution of regenerative surgery, due to the difficulty in transferring radiological information to the lateral wall of the maxillary sinus even for skilled surgeons. The knowhow of guided implant surgery in recent years is also finding use in planning and precisely delineating the lateral access to the maxillary sinus using CBCT imaging and dimensional reconstruction software, through the realization of surgical guides with 3D printing, as shown in the presented case.
The success rate in endodontic retreatment can be significantly boosted by using materials that guarantee both intimate adhesion to the canal walls and long-term stability. Bioceramic cements used in root filling show interesting properties including extraordinary sealing capacities, antimicrobial activity that stimulates periapical healing and the continuous production of hydroxyopathitis for a long time. This case report deals with the application of bioceramic cement in endodontic retreatment. The Bioroot RCS (Septodont), thanks to its ability to firmly adhere both to the gutta-percha and to the walls of the canal and to definitively seal the apical third, can allow to obtain extraordinary healing in a relatively short time by exploiting its antimicrobial abilities. However, further studies are needed to assess the effectiveness of this technique over the long term.
It is widely recognized that the physiology of childbirth labor largely depends on the interaction between three factors: a) the force generated by uterine contractions; b) the structure and characteristics of the birth canal and c) the fetus. Harmony between these three variables determines the initiation of maternal dynamic phenomena and the establishment of an optimal maternal-fetal balance in which both warrant for a correct delivery timing. The present study considered the above known factors and assessed if any other factor, still not recognized, could also play a role, and eventually modify the timing of delivery during the expulsive period. In particular, we focused our attention on the role played by the temporomandibular joint and dental occlusion on maternal body balance and on the stability of muscular reflected forces. The importance of assessing the temporomandibular function and the dental occlusion lies in the fact that any alteration in chewing or in temporomandibular joint (TMJ) mobility and occlusion brings to relevant modifications on the vertebral column and pelvic girdle. Our hypothesis is based on the evidence that those women who have any kind of alteration in their dental occlusion, can have an altered capability of pushing during the expulsive period, as the force applied on the pelvic floor is not expressed. Moreover, recent studies have highlighted a relationship between temporomandibular dysfunctions and sleep apnea syndrome and between sleep apnea syndromes and pregnancy. These relationships are explored in this study.
The practice of piercing has been used since ancient times, and nowadays is coming back in fashion among adolescents and young adults. Teenagers wearing oral piercings are frequently observed during routine examination, and there are, also, recurrent harmful consequences attributed to the devices. Unfortunately, piercings are usually placed by unlicensed individuals, lacking the appropriate anatomical knowledge, and therefore unable to provide sufficient information regarding the potential risks, especially when compared to the ones known by the patients. In this regard, the relevant legislation is frayed both vertically (that is within the framework of State and Regional competences), and horizontally (within the competences between the various regions). With the present study, through an accurate review of the literature and the description of two case reports, we underline the importance of informing both the patients and the dental professionals about the dental consequences undergoing the application of piercing. Both patients examined presented the common complications related to the application of piercing. The aim of this study is to underline the importance of being informed for both the dental professional and the person who undergoes piercing about its consequences for the whole oral system as well as the possible risks of infections and complications. We want to underline the key role of the dentist as a promoter of prevention of oral disorders as well as being able to deal with the possible complications which may occur.
The review of literature shows that 48,22% of the autotranspated teeth were orthodontically treated. A 13-year-old male patient presented a destructive decay in the element 3.6, which was underoccluded. To maintain the arch space and the quantity of bone necessary for a potential implant, it was decided to perform an autotransplantation of the impacted element 3.8. Tooth autotransplantation is a valid and durable alternative to the prosthetic and the implant solutions with high success rate.
The factors that characterize posture are neurophysiological, biomechanical, psychoemotional. Neurophysiological factors concern the modulation of tone, muscle tone is the result of a series of neuropsychological processes within the tonic-postural system. The tonic-postural system can become unbalanced for various reasons, including a tight lingual frenum. The aim of this pilot study was to evaluate the benefits of frenulectomy by laser on body posture and on the scapular (shoulders) anteroposterior movement. Twenty-four healthy subjects were selected, between the ages of 10 and 26 years (mean age 15.22) who presented a short lingual frenum and a low posture of the tongue and jaw. They were examined using the Marchesan Protocol for Lingual Frenum and the Spinometry® Formetric and underwent laser frenectomy by diode laser (Siro Laser Blu. 660 nm) without any post-surgery complications. The release of the frenulum immediately brought benefits to patients, reorganizing the physiological modulation, and the movement of the tongue within the normal parameters of temporomandibular kinematics which were within physiological parameters. Frenectomy improved the anterior-posterior flexion of the scapulas (shoulders) in the sagittal plane but a larger sample is required to have statistically significant results.
The study analyzes how and if temporomandibular joint symptoms are influenced by different types of orthodontic therapy. Two-hundred-and-thirty-six adult orthodontic patients treated by different clinicians, were asked to complete a survey in which factors as the age, the gender and the type of device were considered. The questions were about the typical symptoms of temporomandibular disorders, in particular headache, bruxism, clenching, pain while opening the mouth and joint's noise. It was highlighted if these symptoms changed during the therapy and if they increased or decreased. The answers to our questionnaire revealed that the only statistically significative difference was related to bruxism, because we found a higher rate in patients treated with aligners than patients treated with metal braces, so we can suggest the fixed technique in the orthodontic patient who suffers of bruxism, even if further studies are required.
The aim of this clinical study is to evaluate, through some clinical and radiographic tests, the different biological responses of hard and soft tissues adjacent to the standard or to reduced-length implants in smokers, non-smokers and former smokers. This study was a comparative analysis of three groups of patients. Patients were eligible if they needed an implant in the posterior areas of the maxilla and mandible, both with a sufficient amount of bone, using implants that are standard or with small heights, and using small implants so that they could avoid any regenerative bone therapy aimed at increasing vertical size. The clinical and X-ray assessment was performed after 4/6 months (T1) and after one year (T2). The main results were recordings of clinical aspects such as presence of inflammation, color and gum appearance assessments, and X-ray assessment differentiating maxilla and mandible implants. Averages were conducted to estimate differences between study groups. One-hundred patients were included, with a total of 200 implants: 100 standard sized implants and 100 short implants. In the individual study groups, there is no difference between the types of implants, and we have favorable and unfavorable conditions. The reported data and the analyzed studies are insufficient to define the influence of smoking in the assessment of the long-term predictability of implants.
The loss of dental substance due to the presence of decay, to wide conservative repairs, to the preparation of prosthetics or to enamel-dentine fractures, often causes an important structural weakening in the element that is endodontically treated (1-15). It is therefore necessary to use endocanal posts in the coronal reconstruction. Mineral fibre posts and epoxy resins that are available at present, fixed with resinous cements, thanks to their excellent integration, exceed the concept of reconstruction, meant as assembly of heterogeneous materials, arranging homogeneous materials according to a similar flexibility module (16-18). This allows to get a "post dentine cement monobloc", which is ideal for the morphofunctional tooth resetting (19-35). The aim of our experimental study was to analyse and compare the surface characteristics of same posts that are available at present by observing them in their relationship with cement and dental materials (36-44).
The aim of this systematic review was to determinate the true value of C-terminal crosslinking telopeptide test (CTX) in patient who takes Bisphosphonate. A comprehensive search of studies published up to March 2020 and listed in the PubMed/MEDLINE and Cochrane Library databases, was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines. The search identified 99 publications; 6 studies were finally deemed eligible for inclusion according to the study criteria. These studies included a total 104 patients and was selected 101. The CTX value in the various study groups is less than 150 pg/ml. There is a difference between the age of the patient and the period of taking the drug. This systematic review indicates that the CTX test has diffent predictive value in determining the risk of osteonecrosis in patients taking bisphosphonate compared to previus standard.
Early Childhood Caries (ECC) is a destructive form of caries that affects the temporary teeth and may be present in children of very young age as early as teeth erupt. The distinctive characteristic of caries in this age is that it affects initially a limited number of teeth which if not treated in time spread rapidly across all deciduous teeth. The purpose of this study is to determine the prevalence and severity of early childhood caries in children 3-5 years old in the public kindergartens in Tirana.