Evaluation of the prevalence of dental agenesis through the use of orthopantomography in a sample of subjects residing in Lombardy and Piedmont regions

AIM

Dental agenesis is one of the most frequent dental anomalies, with a prevalence varying from 1.6% to 36.5%, depending on the populations studied. The patient's age at diagnosis, sex, and ethnic differences are considered possible influenting factors that can explain such a wide range of prevalence. The objective of the study was to define the frequency of dental agenesis in a sample of subjects living in Piedmont and Lombardy regions of Italy.

MATERIALS

X-rays, already taken for other diagnostic purposes, were collected. Orthopantomographies belonging to subjects born after 1995 and aged between 7.9 and 16.9 years were selected. It was assessed the presence of each tooth, except for third molars since they are frequently absent due to their variability. If a tooth was missing and the patient had additional radiographs, the other radiographs were evaluated to confirm the diagnosis or to rule out a delayed calcification or the presence of a malposition tooth.

Results

Orthopantomographies were collected from 1,020 subjects and 98 of them presented agenesis, with a prevalence of 5% for females and 4.61% for males. The most affected teeth were 35 and 45, followed by 12 and 22. The lower arch was more frequently involved by agenesis: there were 107 teeth absent in the mandibular arch and 83 in the maxillary arch.

Caries prevalence and molar incisor hypomineralisation (MIH) in children. Is there an association? A systematic review

AIM

Molar incisor hypomeralisation (MIH) is a dental condition clinically characterised by the presence of morphological and qualitative enamel defects involving the occlusal and/or incisal third of one or more permanent molars or incisors. Its worldwide prevalence ranges between 2.4 and 40%. Several harmful conditions, such as genetic or medical problems during pregnancy, may act together and increase the risk of MIH. The main objective of this systematic review is to assess whether there is a correlation between MIH and dental caries in mixed or permanent dentition.

METHODS

An electronic search was performed on PubMed (Medline), Scopus and Cochrane Library for articles published from August 2022 to April 2023. Cohort, cross-sectional, retrospective and prospective studies were included. In vitro and animal studies, as well as clinical cases and systematic reviews, were excluded. Studies not differentiating between mixed and permanent dentition were excluded. The observed variables were DMFT (Decayed Missed Filled Teeth) score, DMFS (Decayed Missed Filled Surface) and DMF scores related to FPM (First Permanent Molar) and the clinical prevalence of MIH.

CONCLUSION

DMFT, DMFS and DMFT on FPM scores are significantly different between the group of patients with MIH and the control group. The available evidence supports a correlation between MIH lesions and caries. Caries indexes scores increase proportionally to the severity of MIH.

Cone Beam Computed Tomography evaluation of midpalatal suture maturation according to age and sex: A systematic review

AIM

To systematically review and analyse the available evidence and assess if a correlation exists in children and young adults between the chronological age and the degree of midpalatal suture maturation as assessed according to the method proposed by Angelieri et al. [2013].

METHODS

A search was performed in Medline/Pubmed, Scopus, and Web of Science during October 2020 for published studies analysing midpalatal suture maturation through cone beam tomography according to the method proposed by Angelieri et al. [2013]. The review was performed according to the PRISMA protocol and the articles were selected according to the established inclusion and exclusion criteria. To assess the quality of reporting, the STROBE checklist was applied.

CONCLUSION

The high variability of the maturational stages in the studied cohorts, highlights the poor correlation between suture maturation and chronological age in both genders, especially in young adults. According to our findings until the age of 14, the high prevalence of stages related to sutural opening does not justify CBCT assessment of the MPS and supports the use of a conventional protocol for maxillary expansion.

A Clinical and Radiographic Evaluation of Zirconia Dental Implants: 10-Year Follow-Up

PURPOSE

The aim is to evaluate the survival and success rates, as well as the marginal bone loss (MBL) and periodontal indexes, of zirconia implants with 10-year follow-up.

MATERIALS AND METHODS

10 patients were selected and 26 one-piece zirconia implants were used for the rehabilitation of single tooth or partially edentulous ridge. After 10 years, a clinical-radiographic evaluation was performed in order to estimate peri-implant tissue health and marginal bone loss.

RESULTS

The survival and success rates were 100%. The average marginal bone loss from baseline to 120 months after surgery was 0.92 ± 0.97 mm.

CONCLUSION

One-piece zirconia dental implants are characterised by high biocompatibility, low plaque adhesion, and absence of microgap that can be related to the clinical success of these implants.

PHoral: Effects of carnosine supplementation on quantity/quality of oral salivae in healthy volunteer and in subjects affected by common oral pathologies

BACKGROUND

Diseases of the oral cavity (OC) with an infectious trigger such as caries and periodontal disease are extremely common in the general population and can also have effects at the cardiovascular level. The oral salivary flow, with its buffering capacity, is able to regulate the pH of the OC and, therefore, significantly contribute to the ecological balance of the microenvironment in which the oral microbiome (OM) develops. On the other side, when the quality/quantity of salivary flow is altered it is supposed the disruption of this balance with the potential increase in oral pathogens and triggered diseases. Among the endogenous substances able to exert a significant effect on the salivary flow and its characteristics, carnosine (Car), a dipeptide originally isolated in skeletal muscle, represents, thanks to the known buffering properties, a promising principle.

METHODS

We aimed this protocol to evaluate the quantitative/qualitative characteristics of the salivary flow in healthy volunteer subjects (n = 20) and in subjects suffering from common OC pathologies (n = 40), before and after 7 days of supplementation with SaliflussTM (Metis Healthcare srl, Milan, Italy), a Class I medical device on the market as 400 mg mucoadhesive oral tablets that has Car as the main ingredient.

DISCUSSION

Combining the characteristics of saliva with the OM and comparing them with OC pathologies, we expect to clarify their reciprocal relationship and, using quantitative proteomics techniques, to help clarify the mechanism of action of Car.

SARS-CoV-2 Infection among the Dental Staff from Lombardy Region, Italy

Dentists have been supposed to be among the healthcare workers at greatest risk of SARS-CoV-2 infection. However, scant data are available on the issue. The aim of this study is to quantify the SARS-CoV-2 antibody prevalence and determinants in a sample of dentists, dental hygienists, and other personnel employed among the dental staff in Lombardy region. We used an accurate rapid diagnostic test kit detecting immunoglobulins (Ig) in 504 adults. Of the 499 participants who obtained a valid antibody test, 54 (10.8%) had a SARS-CoV-2 positive test (0.4% IgM+, 1.8% both IgM+ and IgG+, and 8.6% IgG+). A statistically significant association with infection was found for geographic area (compared to Milan, adjusted odds ratio was 2.79, 95% confidence interval, CI: 1.01–7.68 for eastern and 2.82, 95% CI: 1.34–5.94, for southern Lombardy). The clinical staff did not result positive to SARS-CoV-2 more frequently than the administrative staff. This is the first study using antibody test in the dental staff personnel. It shows that the prevalence of SARS-CoV-2 infection in Lombardy region was around 10%, in line with estimates on other healthcare professionals. Despite the close physical contact with the patient, dentists have been able to scrupulously manage and effectively use protective devices.

The effect of maxillary protraction, with or without rapid palatal expansion, on airway dimensions: A systematic review and meta-analysis

AIM

The use of maxillary protraction appliances (MPAs) and Facemask (FM), with or without a rapid maxillary expansion (RME), have become a routine orthopaedic treatment procedure for the treatment of Class III in growing individuals; several authors have suggested that maxillary protraction could have a positive impact on airway dimensions. The purpose of this systematic review and meta-analysis was to assess the efficacy of maxillary protraction appliances (MPAs), with or without a rapid maxillary expansion (RME), on airway dimensions in children in mixed or early permanent dentition.

MATERIALS AND METHODS

An electronic search was performed on PubMed, Medline, Scopus, The Cochrane Library, EMBASE and the System for Information on Grey Literature in Europe until November 30th, 2019. The Newcastle-Ottawa (NOS) scale was used to assess the studies' quality. Review Manager 5.3 (provided by the Cochrane Collaboration) was used to synthesize the effects on airway dimensions.

RESULTS

After full text assessment, 8 studies were included in the qualitative and quantitative synthesis. NOS scores ranged 6 to 9 indicating high quality. The effects of two therapeutic protocols were compared, treatment with MPAs only (113 subjects treated - 65 controls) and the treatment with MPAs + RME (137 subjects treated- 87 controls). The MPAs only treatment group displayed a significantly increase in nasopharyngeal airway dimension at PNS-AD1 (random: mean difference, 1.39 mm, 95% CI, 0.32 mm, 2.47 mm, p= 0.01) and at PNS-AD2 (random: mean difference, 1.70 mm, 95% CI, 1.14 mm, 2.26 mm, p= 0.00001). No statistically significant changes were found post treatment in MPAs + RME treatment groups at PNS-AD1 (P= 0.15), PNS-AD2 (P= 0.17), McNamara's upper pharynx (MPAs + RME P= 0.05, MPAs P= 0.99) and McNamara lower pharynx (MPAs + RME P= 0.25, MPAs P= 0.40).

CONCLUSION

MPAs only treatment can increase the pharyngeal thickness after treatment both at PNS-A1 and PNS-AD2. MPA+ RME had no effect on sagittal widths compared with controls, but the effect on the transverse dimension could not be assessed.

Pain perception using a computer-controlled anaesthetic delivery system in paediatric dentistry: A review

AIM

In paediatric dentistry it is essentials to reduce axiety and fear induced by local anaesthetic injection, in order to obtain patient's cooperation and achieve a successful treatment. Hence, this review is aiming to primary evaluate pain perception in paediatric patients when using a computer-controlled local anaesthetic delivery system (C-CLADS) compared to traditional injection.

MATERIALS AND METHODS

A database literature search was conducted on both MEDLINE and Cochrane Central Register of Controlled Trials and a data extraction table was created to perform a critical evaluation of each scientific article. The primary results were the perception of pain during anaesthesia and the patient's behaviour, the secondary the amount of anaesthetic required and its duration over time.

RESULTS

In the review were included 7 clinical studies regarding paediatric patients where split-mouth designs or group division were used. The age range was between 5 and 17 years old. Pain and fear parameters were measured by visual analogue scales, behavioural scales, heart rate and satisfaction questionnaires.

CONCLUSION

Substantial heterogeneity between clinical trials was observed, which led to difficult comparison. Computerised devices have proved to be interesting in reducing pain during anaesthesia, improving the approach to the paediatric patient. It is advisable to conduct research with anxious subjects and patients under the age of 4, because no evidence has been found in the literature. It is recommended to conduct further research with anxious subjects and patients below the age of 4, where Relative Analgesia by Langa or pharmacological anxiolysis are frequently used.

Dental injuries in young athletes, a five-year follow-up study

AIM

The aim of this study is to produce a clinical therapy protocol for a group of 20 athletes between the ages of 8 and 14, who all suffered traumas affecting hard dental and periodontal tissues.

MATERIALS AND METHODS

This study involves a group of 20 athletes (10 male and 10 female) who had suffered dental traumas of varying severity. In order to collect the data, two classification systems were used: one for hard tissue traumas and another for periodontal lesions. The athletes were subdivided into lesion groups, treated depending on the type of lesions and then followed-up over a period of 5 years. A statistical analysis was carried out to study the association between type of lesions, types of sports and the number of teeth involved.

RESULTS

We found that recovery time ranged from 3 to 5 days for uncomplicated fractures and up to 14 days for luxations. Only four complications were registered during the follow-up period and these were most likely due to the severity of the trauma. Out of the 20 athletes, 16 had begun and maintained the habit of using mouth protection devices when practicing their sport. The statistical analysis focused on the possible association between the risk levels of a sport and the typical lesions and complications that usually occur. Due to their high frequency, the two types of lesions taken into account in our study were complicated fractures (FP) and luxated/fractured teeth (LF). The average number of teeth involved varied according to the sport's risk level (medium or high) with averages of 1.6 teeth involved for medium-risk sports and 2.0 teeth for high-risk sports.

CONCLUSIONS

What emerged in particular was the regular progress in the recovery time needed for the injuries sustained, with few complications or delays in rehabilitation; we also noted that the numerous athletes who habitually used mouthguards while competing during the recovery period did not suffer any recurrences of injuries or further complications. Regarding the results of our statistical analysis, no association was found between the sport's risk, the types of lesions and the occurrence of complications. In addition, analysis of the average number of teeth involved showed that there is no statistical evidence to reject the hypothesis that the ratios remain the same in the two groups.

Single tooth anaesthesia: a new approach to the paediatric patient. A clinical experimental study

AIM

The objective of this study is to assess the efficacy of the STA Wand System with respect to pain and fear reduction in paediatric patients and by using the Single Tooth Anaesthesia (STA) technique.

MATERIALS AND METHODS

Patients included children and teenagers between 6 and 17 years of age, who required the administration of local anaesthesia prior to expected treatments. Local anaesthesia was performed by means of the electronic STA Wand System (Milestone scientific., Inc.) adopting the Single Tooth Anaesthesia (STA) technique. Pre- and post-anaesthesia, the patients were asked to complete the Wong-Baker faces image scale and the provider filled in the Frankl Scale.

RESULTS

All treatments were completed successfully and no collaboration issues were recorded. Frankl's assessment showed that 91% of patients regarded dental experience positively. The efficacy of the computer-assisted anaesthesia was at 100% when treating primary teeth, and 70% for procedures on permanent teeth. Almost the totality of treated patients (94%) gave a positive evaluation after having tried the device with STA technique. Only 6% of the patients assessed the procedure negatively.

CONCLUSIONS

The STA technique allows for absence of anticipatory anxiety, absence of physical pain, no anaesthetic effects in the perioral tissues and a controllable, lower dosage of the anaesthetic liquid.

Speed bleaching: the importance of temporary filling with hermetic sealing

The aim of this study was to demonstrate the influence of an adhesive temporary restoration on the effectiveness of the bleaching reaction, regardless of the concentration of the bleaching agent used. Every clinician involved in conservative dentistry understands the incompatibility between 'chemical bond' and 'oxygen.' This awareness often influences clinicians to decide on a temporary 'mechanical retention' filling that is unable to prevent the escape of oxygen ions, forcing the patient into more sessions and therefore raising the risk of complications. The scientific rationale behind the procedure described in this article is based on the bonding capacity of the coronal seal to maintain the rapid dissociation of the hydrogen peroxide exclusively within the pulp chamber, inducing an increase in the internal pressure and a consequent penetration of the oxygen-free radicals directly inside the dentinal tubules. In fact, avoiding the spontaneous dissipation of the oxygen-free radicals in the external environment may limit their effectiveness. This study aimed specifically to prove that it is possible to obtain a rapid bleaching reaction by observing a protocol based on the 'walking bleach' technique, specifically modified not so much by the typology of the mixture used but by fully exploiting the reaction yield of the hydrogen peroxide disproportionation. The results of the documented clinical cases presented here show the effectiveness of this method, which is achieved in a single session, therefore decreasing the possibility of the several operating phases that are necessary with the traditional procedure.

Uncovering and autonomous eruption of palatally impacted canines

BACKGROUND

The palatal impaction of maxillary canine is a quite common yet challenging clinical condition that orthodontists have to face in the everyday practice. The purpose of this report is to describe and discuss a case involving the uncovering of an upper canine and it subsequent spontaneous eruption.

CASE REPORT

The diagnostic and therapeutic protocol of a case with a palatally impacted canine is presented. The upper right canine was uncovered with an open surgical approach. Removal of the attached gingiva and bone covering the crown enhanced the tooth spontaneous eruption, while the first levelling and aligning phase of the treatment was performed. This approach results in a shorter overall treatment time. This protocol produced an aesthetic, healthy and functional result, which was stable at the two-year post-treatment follow-up.

Natural tooth preservation versus extraction and implant placement: patient preferences and analysis of the willingness to pay

Objectives The aim of this study was to evaluate the patients' willingness to pay (WTP) values and preference for the treatment of a tooth with very poor prognosis, among two options: root canal therapy and crown positioning or tooth extraction, implant insertion and crown positioning.Methods A total of 103 patients were recruited from a private dental clinic and interviewed. A questionnaire measured individuals' preferences among the two alternative treatments for a tooth with poor prognosis and the maximum amount of money they would be willing to pay for their choice with a starting bid of [euro]2,000 in [euro]100 increment/decrement. Demographic data, patient choice, median values and WTP association with socio-demographic factors (Student ttest and one-way ANOVA) and correlation between variables (Pearson chi-square test) were revealed.Results Seventy-six percent of patients expressed a preference for root canal therapy, while the remaining 24% chose the dental surgery. A fair agreement between previous experience and current therapeutic choice was found (P = 0.0001). The WTP median value was [euro]2,000 and 46% of participants would pay an additional sum of money for the therapy (median: [euro]300). The preferred treatment was influenced by previous experience, but no association was found between WTP values and socio-demographic factors.Conclusion Patients tend to prefer a conservative approach for the treatment of a tooth with poor prognosis and are willing to pay an additional fee to receive their treatment choice.

Treatment planning of damaged teeth: to recover or to extract?

BACKGROUND

Planning the treatment of a compromised tooth is challenging but the choice should refer to evidence-based criteria. The literature proved that patient-related factors influence the treatment plan, but what happens when the patient is a dentist? Aim of the study was to observe whether the dentist goes for the same option suggested to a patient in a hypothetical scenario.

METHODS

One hundred volunteers were interviewed singularly in a quiet ambient. Radiographs of 15 compromised teeth were shown and were identified as belonging to a hypothetical patient with non-contributory medical history asking for the best treatment. For each clinical case, the dentist could decide between: extraction (E), endorestorative recovery (R); referral to a specialist (S) to save the tooth. After a 15-minute wash-out, the same radiographs were shown again with the question: if this was your tooth, what would you do? The alternatives could be E or R. Statistical analysis was performed in order to evaluate the discordance between the choice taken for the patient and for the dentist's teeth.

RESULTS

A constant increase in recovered teeth was observed in group D with the only exception of case 12. Concordance ranged from scarce to substantial, while symmetry showed that, when changing their mind, the dentists recovered their own teeth.

CONCLUSIONS

The dentists were more conservative on their teeth: this shows the absence of a coherent decision-making pattern and stresses the need for an improvement in the formation of dental practitioners.

Description of late onset neutropenia in indolent lymphoma patients treated with bendamustine plus rituximab

Bendamustine (B) associated with rituximab (R) is widely described in literature for the management of patients with chronic lymphoid leukaemia (CLL) and indolent non-Hodgkin lymphoma. Safety data regarding late hematotoxicity such as late onset neutropenia (LON) are scarce. The aim of our study was to assess the incidence and to identify risk factors for LON in patients with indolent non-Hodgkin lymphoma and CLL treated with B and R (B-R). One hundred forty five patients were treated with B-R as first or second line. Patients with neutropenia prior induction treatment, treated beyond second line and relapsing within 3 months after the end of induction treatment, were excluded. Patients receiving at least 1 cycle of B-R and having LON during follow-up period were included and considered as eligible for toxicity assessment. A complete blood count was performed 4 weeks after the last cycle of induction treatment and thereafter every 3 months for 1 year. Thirty six patients were identified in our cohort (incidence of 25%), mostly affected by CLL (n = 11) and follicular lymphoma (FL) (n = 15). During follow-up, 84 events of LON were recorded, 61% and 39% were of grades 1/2 and 3/4, respectively. No episode of febrile neutropenia was documented. Amongst 13 of the 15 patients with FL undergoing R maintenance, 8 had treatment discontinuation because of LON. Median time for LON (grade > 2) and time to recovery (grade < 3) were of 11.2 and 17.3 weeks, respectively. One year after B-R induction, LON persisted in 4 patients. The risk of LON was increased both in patients with FL or CLL and performance status >1. The LON in B-R treated patients is clinically relevant. Close clinical and biological follow-up and treatment prophylaxis (eg, valaciclovir and cotrimoxazole) especially for FL patients undergoing maintenance with R monotherapy seems relevant.

Minimally-invasive dental anesthesia: Patients' preferences and analysis of the willingness-to-pay index

AIM

The aim of the present prospective study was to evaluate the impact of a computer-controlled anesthesia on patients' comfort and to investigate, through the willingness-to-pay (WTP) index, and patients' acceptance of this new technology.

METHODS

Fifty patients undergoing a class I or II restorative procedure were enrolled. A computer-controlled device for anesthetic delivery was utilized, and a questionnaire on the level of discomfort and WTP was given to all patients.

RESULTS

A total of 86% of participants declared less discomfort than that perceived during their last traditional procedure for pain control; 58% of patients were willing to pay an additional fee for a modern anesthesia technique, with a median WTP value of 20$.

CONCLUSIONS

Computer-controlled systems for local anesthesia represent a relevant tool for reducing patients' discomfort during dental treatment. The WTP index helps to quantify its relevance.

Sinus presurgical evaluation: a literature review and a new classification proposal

INTRODUCTION

Presurgical evaluation with cone beam computed tomography (CBCT) or computed tomography (CT) has become an essential tool for diagnosis and surgical planning, including maxillary sinus floor elevation. Before performing a sinus lift, the clinician's attention should not be only directed to the patency of the ostium through CBCT or CT, because many anatomical features could influence the surgical approach of sinus floor elevation. The goal of this article was to facilitate the communication between clinicians regarding the type of maxillary sinus, encourage in-depth analysis prior to surgery and reduce the risk of complications due to possible underestimation of important parameters.

EVIDENCE ACQUISITION

An electronic search was conducted in Pubmed, Embase, Medline and Scopus, matching the following keywords: "sinus lift", "CBCT", "CT", "presurgical" and "evaluation". Clinical Oral Implant Research, Implant Dentistry, International Journal of Periodontics and Restorative Dentistry and Journal of Oral Implantology were hand-searched. The bibliographies of review articles were checked and personal references were also searched.

EVIDENCE SYNTHESIS

Eleven parameters, that clinicians must check every time through CBCT or CT, were evaluated from different studies. At the end of the literature review for every single feature, the Authors established a favorable, a normal and an unfavorable situation, in order to provide a new classification.

CONCLUSIONS

The grade of the described classification may be useful for clinicians to understand what probably the risk level of the sinus lift surgery could be and it may encourage the surgeon to have a careful pre-operative evaluation through CBCT or CT.

CBCT evaluation of the tridimensional relationship between impacted lower third molar and the inferior alveolar nerve position

BACKGROUND

The aim of this study is to evaluate if the statistical significant relations between the measures taken exists or not and to show how the 3D reconstruction could be help the oral surgeon in all those instances in which it may have a direct impact on the planning of the surgical steps.

METHODS

Thanks to use of NobelClinician™ Software it was possible to analyze 200 mandibular tomography computerized, random selected, and create a 3D reconstruction of mandibular bone, point out dental structure of wisdom tooth and the way of IAN. Statistical analysis was performed using the Statistical Package for Social Sciences. One way ANOVA test was used to measure the association between each independent variable and the outcome variable, followed by the post-hoc least significant difference (LSD) test for intergroup differences.

RESULTS

Two independent variables were significant predictors for risk to have the distance 0 mm from IAN to apex: "Ramus relationship/space available" and "depth".

CONCLUSIONS

The 3D reconstruction software provide surgeons with an additional planning tool, offering: immediate and neat visualization of the noble structures that have to be respected and their localization in the three spatial planes; the exact morphology of the relevant root apex; a 360° view of the relationship between the IAN and the third molar and the exact point in which the root is in relationship with the canal.

Microbiological analysis of bacterial plaque on three different threads in oral surgery

BACKGROUND

Suture is the final act of most oral surgery procedures. The quality of healing after the operation depends on its efficiency. Sutures must not cause inflammation - neither directly nor indirectly. The objective of this study is to compare the bacterial colonization on different suture materials after a third molar extraction.

METHODS

Thirty patients were randomly selected among people going under third molar extraction; they were divided into 3 groups and one suture type was used on each group. After 7 days distal stitches were removed by a single operator, placed in physiologic solution and analyzed after 2 or 3 hours. Patients followed the same postsurgical protocols; materials used were: Ethicon Silk® 4/0, B. Braun Dafilon® 4/0, and B. Braun Safil® 4/0.

RESULTS

The amount of cocci and bacilli on the sutures analyzed shows that silk (Ethicon Silk) is the higher level of retention material where monofilament (B. Braun Dafilon) is the lower. There is a difference between monofilament and polyglycolide (B. Braun Safil), as the former is less retentive than the latter, although not significantly so.

CONCLUSIONS

A less plaque retention, and consequently a fewer bacterial presence, is crucial to minimize the inflammatory process and allow a better tissue healing. Since the capability of brushing and, of course, the final personal hygiene depends on multiple variables, we must use surgical protocols able to minimize the effect of improper cleaning on the healing process: this statement implies the use of low plaque retention materials. The use of monofilament or polyglycolide threads in sutures can help reducing bacterial concentration and therefore promotes a faster and better healing.

Aneurismal bone cyst: a conservative surgical technique. A case report treated with a small access osteotomy

BACKGROUND

Aneurismal bone cysts (ABCs) are benign, non-neoplastic, expansive, and locally destructive lesions that may occur rarely. They are well defined and usually occur in the long bones, pelvis and vertebrae. According to the 2005 World Health Organization (WHO) histological classification of odontogenic tumours, ABC is classified as a bone-related lesion as ossyfing fibroma, fibrous dysplasia, osseous dysplasia, central giant cell lesion (granuloma-CGCL), cherubism and simple bone cyst (SBC). ABCs, as CGCLs and SBCs may arise as a consequence of an earlier trauma causing an overflow of blood into the bone, though a number of pathogenic theories have been put forward. The aim of this study is to present an unusual case of aneurismal bone cyst and to compare the different possibilities of surgical treatment after review of the literature.

CASE REPORT

ABC was localised in the posterior right region of the mandible in an 11-year-old boy, and removed by a surgical procedure involving a small access osteotomy of the mandibular ramus with removal of the cortical bone in order to enucleate the whole lesion, the wisdom tooth and to preserve the healthy bone.

Crestal sinus lift by using a mini-invasive procedure: a case series

BACKGROUND

The aim of this study was to present a case series treated with an atraumatic procedure for maxillary sinus lift by crestal approach. This technique avoids the use of classical osteotomes, thus decreasing complications due to percussive and vibratory forces.

METHODS

Three cases of partial edentulism in the distal maxillae with inadequate bone volume are treated by using SinCrest procedure (Meta, Reggio Emilia, Italy). With the guide of surgical templates, the sinus lift was performed, and implants were placed during the same procedure. After 6 months an X-ray was taken to check the success of the operation.

RESULTS

SinCrest allows the operator to advance progressively, maintaining the correct axis for implant placement. The plane tip of drills prevents accidental perforations of Schneiderian mucose, and the stops, available in different lengths, avoid the overtreatment. The manual screwing of SinCrest osteotome ensures precision during the cortical approach, while the built-in probe allows to check residual strength of sinusal floor, making sure that the Schneiderian mucose is reached and lifted. This technique does not depend on the operator's skills and decreases the onset of adverse effects due to the hammering with classical osteotomes. SinCrest requires a small flap and osteotomy, which means less healing time and more comfort for the patient, both during and after the surgery.

CONCLUSIONS

SinCrest is a valid alternative to other mini-invasive procedures for sinus lift in cases with a residual height bone of at least 5 mm, allowing an atraumatic, safe and controlled operation.

Post-traumatic rehabilitation of anterior teeth with laminates composite veneers in children. Report of two cases

BACKGROUND

When treating children, a conservative and minimally invasive approach is mandatory. In dental traumas with partial coronal destruction, veneers represent the fastest and most effective method to rehabilitate front teeth of a young patient, since these no- or minimal-preparation restorations were proved to have predictable results without reducing the enamel layer. Indirect additive anterior composite restorations, besides being quick and minimally invasive, have to be considered a good treatment option for rehabilitating children, because they are inexpensive and repairable over time. Current laboratory techniques, associated with a strict clinical protocol, satisfy patients' restorative and aesthetic needs in few appointments and in a short time.

CASE REPORT

The cases reported describe the minimally invasive treatment of two lateral incisors with nano-hybrid resin composite veneers after traumatic events. The patient satisfaction and good integration of indirect restorations confirmed the success of this rehabilitation.

Is a new sonic toothbrush more effective in plaque removal than a manual toothbrush?

AIM

Powered or manual toothbrushes are daily-used instrument in the Western area for the control and removal of bacterial biofilm. Among powered-toothbrushes, sonic technology has shown to produce fluid turbulent activity that might assist in plaque removal; however, limited knowledge is available in-vivo. The objectives of this study were to compare the plaque removal efficacy of two different toothbrushes in a population not familiar with sonic technology, and to collect and analyse data regarding oral hygiene habits. The null-hypothesis was that a sonic toothbrush is able to remove a superior amount of plaque compared to the manual type.

MATERIALS AND METHODS

Forty young adult patients were enrolled in the study. A single-cohort crossover clinical trial was designed. For each patient, three appointments were scheduled: the first (T0) was used for oral care education and explanations of toothbrushes techniques, for a preliminary professional hygiene session, and for delivery of a questionnaire; at one week (T1), plaque evaluation was performed (Turesky modification of the Quigley and Hein index) at baseline and after asking patients to brush with the randomly selected manual or sonic device. At the last appointment (week 3, T2), the same plaque evaluations of T1 were repeated asking patients to brush with the other toothbrush. Entire mouth indexes were calculated and mean reductions in whole mouth plaque scores were obtained (pre-brushing minus post-brushing values) for the two tested toothbrushes. Multiple ANOVA tests (p = 0.05 ) were used 1) to compare plaque levels between male and female subjects at baseline and post-brushing, regardless the type of toothbrush, and 2) to differentiate between mean reductions in whole mouth plaque scores according to the type of toothbrush (manual versus sonic). The study population was subjected to descriptive statistical analysis; potential relationships between socio-demographic variables and obtained plaque scores were evaluated (Mann-Whitney and Kruskal-Wallis tests).

RESULTS

Full-mouth plaque levels were reduced at post-brushing sessions, regardless the device, by approximately 62% (p<0.0001). Mean plaque index reductions for manual and sonic toothbrush were of 1.05 ± 0.22 and 1.19 ± 0.37, respectively. A statistically significant difference was found between the two devices (p = 0.0342). The powered sonic toothbrush removed about 10% more plaque than the manual type. From the collected questionnaire financial data, willingness to pay (WTP) values expressing economic efforts of patients for the purchase of toothbrushes were of Euros 4.83 ± 3.86 and of Euros 54.75 ± 36, for the manual and sonic devices, respectively.

CONCLUSION

Within the limitations of the study, in subjects without any previous experience of a similar technology, the single use of the sonic toothbrush showed a significantly greater plaque reduction compared to the manual traditional toothbrush (null-hypothesis accepted).

Digital device in postextraction implantology: a clinical case presentation

Aim. The aim of this work is to describe a case of immediate implant placement after extraction of the upper right first premolar, with the use of CAD/CAM technology, which allows an early digital impression of the implant site with an intraoral scanner (MHT 3D Progress, Verona, Italy). Case Report. A 46-year-old female was referred with a disorder caused by continuous debonding of the prosthetic crown on the upper right first premolar. Clinically, there were no signs, and the evaluation of the periapical radiograph showed a fracture of the root, with a mesial well-defined lesion of the hard tissue of the upper right first premolar, as the radiolucent area affected the root surface of the tooth. It was decided, in accordance with the patient, that the tooth would be extracted and the implant (Primer, Edierre implant system, Genoa, Italy) with diameter of 4.2 mm and length of 13 mm would be inserted. After the insertion of the implant, it was screwed to the scan abutment, and a scan was taken using an intraoral scanner (MHT 3D Progress, Verona, Italy). The scanned images were processed with CAD/CAM software (Exocad DentalCAD, Darmstadt, Germany) and the temporary crown was digitally drawn (Dental Knowledge, Milan, Italy) and then sent to the milling machine for production with a composite monoblock. After 4 months, when the implant was osteointegrated, it was not necessary to take another dental impression, and the definitive crown could be screwed in. Conclusion. The CAD/CAM technology is especially helpful in postextraction implant for aesthetic rehabilitation, as it is possible to immediately fix a provisional crown with an anatomic shape that allows an optimal healing process of the tissues. Moreover, the removal of healing abutments, and the use of impression copings, impression materials, and dental stone became unnecessary, enabling the reduction of the chair time, component cost, and patient's discomfort. However, it is still necessary for scientific research to continue to carry out studies on this procedure, in order to improve the accuracy, the reliability, and the reproducibility of the results.

Large buccal bifurcation cyst in a child: a case report and literature review

BACKGROUND

WHO defines the mandibular buccal bifurcation cyst as a cyst occurring near the cervical margin of the lateral aspect of a root as a consequence of inflammatory process in a periodontal pocket. The pathogenesis of these cysts is still debated, but they are most likely originated from reduced enamel epithelium or from inflammatory proliferation of epithelial cell rests of Malassez that come from the superficial mucosa of a tooth in eruption. The aim of this article was to describe a case of large buccal bifurcation cyst of a permanent mandibular first molar.

CASE REPORT

A 6-year-old boy was referred to Department of Oral Riabilitation of the Istituto Stomatologico Italiano, University of Milan, Italy, with the complaint of hard swelling over the buccal gingiva and a deep probing depth located on the buccal aspect. Radiograph revealed a well-defined semilunar-shaped radiolucency, marked by a fine radiopaque line on the buccal aspect of the partially-erupted lower right first molar and it was large enough to include a small part of the crown of the second right molar. As reported in the literature the treatment of choice is enucleation and curettage of the lesion without extraction of the vital involved tooth. This procedure has shown excellent results in both the short- and long-term. The definitive diagnosis of paradental cysts can be assessed by histopathologic analysis.

Second order root control of self-ligating brackets and traditional brackets: a "typodont" study

AIM

Aim of the study was to evaluate if self-ligating brackets (SLB) and conventional brackets (CB) have the same degree of second order root control in closing extraction spaces.

METHODS

Two resin models, left and right sides of an upper arch, with two wells in the premolar area, were used. Wells have been filled with wax and resin premolars with anatomic root structure were placed in them. Resin premolars were bonded with CB and SLB. We performed 20 pairwise runs: CB on one side against SLB on the other side. We tested 0.018 and 0.016x0.022 stainless steel arches. Models were put in warm water to allow teeth to move in the softened wax by the force excerpted by NiTi coils. Root control in the second order was evaluated with the aid of metallic markers on the roots and digital radiographies taken before and after each run.

RESULTS

On 0.018 wires CB moved 4.0 mm (SD 1.06 mm), mean root control angle was 14.8° (SD 9.15°), while SLB moved 4.1 mm (SD 1.33 mm), mean angle in the second order was 11.8° (SD 5.01°). On 0.016x0.022 wires CB moved 3.6 mm (SD 1.24 mm), mean angle in the second order was 9.7° (SD 5.48°) while SLB moved 3.4 mm (SD 1.05 mm), mean angle was 10.7° (SD 3.92°).

CONCLUSION

It seems that, on typodont, CB and SLB are equally efficient in moving teeth crowns and have the same degree of second order root control, both when 0.018 and 0.016x0.022 stainless steel wires are used.

Treatment of traumatic dental injuries: evaluation of knowledge among Italian dentists

AIM

The aim of this study was to evaluate the degree of knowledge in the management of different scenarios of dental trauma in a population of Italian dentists.

MATERIALS AND METHODS

A closed-ended questionnaire consisting of 5 clinical cases of common traumatic dental injuries was asked to be filled out by dentists in the area of Milan, Italy. A total of 500 questionnaires were collected; after a descriptive analysis of the population, results of correct answers were expressed in frequency distribution and computed in percentages. To examine possible associations between the level of knowledge for each question (number/percentage of correct answers) and independent variables of the population (sex, number of years after graduation, attendance of dental trauma courses, type of clinical activity) appropriate correlation tests were performed (Pearson chi-square, or Fisher's exact; level of significance = 0.05) for identification of statistically significant differences.

RESULTS

More than 75% of participants answered correctly to the questions regarding crown fracture and extrusive luxation injuries; only 40% of dentists responded correctly about the duration and type of splinting following avulsion; 60% of participants incorrectly chose immediate invasive therapies (tooth extraction or endodontic procedures) for horizontal middle-root fracture. There was a trend towards slightly better knowledge (in 7 out of 9 questions) for dentists 1) working in hospitals and 2) who had attended a post-graduate course in traumatology.

CONCLUSION

The level of knowledge in the group of dentists considered was heterogeneous; problems in the management of traumatic dental injuries were restricted to specific clinical cases and topics.

Comparison of marginal fit of Lava CAD/CAM crown-copings with two finish lines

PURPOSE

Marginal fit is valued as one of the most important criteria for the clinical quality and success of all-ceramic crowns. The aim of this in vitro study was to investigate the marginal fit of Lava Zirconia crown-copings on chamfer and shoulder preparations.

METHODS

Two acrylic model teeth were selected to simulate the clinical preparations: one molar was prepared with a chamfer finish line (C) and one premolar was prepared with a rounded shoulder finish line (RS). Each resin model was duplicated 10 times using silicon-based impression material and poured in type IV dental stone for the fabrication of working dies. A total of 20 copings were divided into two groups (n = 10 for each finish line). Fifty measuring locations were chosen randomly along the margin on the dies and the gap width - vertical marginal discrepancy - was measured under a light microscope with a magnification of x100. Measurements were made without cementation. The mean marginal gap widths and standard deviations were calculated and a one-way analysis of variance (ANOVA) was performed for different types of preparations in order to detect differences (α = 0.05).

RESULTS

The mean marginal gap was 30 ± 3 μm for the C group and 28 ± 4 μm for the RS group. The one-way ANOVA showed no statistical significant difference between the two groups (P = 0.23).

CONCLUSIONS

Within the limitations of this study, the marginal discrepancies were all within the clinical acceptable standard set at 120 μm. Chamfer and shoulder preparations did not show differences regarding the gap dimension.

CLINICAL SIGNIFICANCE

Bur design is an easily selected parameter before natural tooth preparation. Both tested finish lines are able to help clinicians in obtaining acceptable marginal fit values for the investigated zirconia copings.

Prosthetic restoration in the single-tooth gap: patient preferences and analysis of the WTP index

OBJECTIVE

The objective of this study was to evaluate the preference of a patients' population, according to the index of willingness to pay (WTP), against two treatments to restore a single-tooth gap: the implant-supported crown (ISC) and the 3-unit fixed partial denture prosthesis (FPDP) on natural teeth.

MATERIALS AND METHODS

Willingness to pay values were recorded on 107 subjects by asking the WTP from a starting bid of €2000 modifiable through monetary increases or decreases (€100). Data were collected through an individually delivered questionnaire. The characteristics of the population and choices made, the median values and WTP associations with socio-demographic parameters (Mann-Whitney and Kruskal-Wallis tests), correlations between variables (chi-square test in contingency tables) and significant parameters for predicting WTP values obtained in a multiple linear regression model were revealed.

RESULTS

The 64% of patients expressed a preference for ISC, while the remaining 36% of the population chose the FPDP. The current therapeutic choice and those carried out in the past were generally in agreement (>70% of cases, P = 0.0001); a relationship was discovered between the anterior and posterior area to the same method of rehabilitation (101 of 107 cases, 94.4%). The WTP median values for ISC were of €3000 and of €2500 in the anterior and posterior areas, respectively. The smallest amount of money has been allocated for FPDP in posterior region (median of €1500). The "importance of oral care" for the patient was a significant predictor, in the regression model analysis, for the estimation of both anterior (P = 0.0003) and posterior (P < 0.0001) WTP values. The "previous therapy" variable reached and was just close to significance in anterior (P = 0.0367) and posterior (P = 0.0511) analyses, respectively.

CONCLUSIONS

Within the limitations of this study, most of the population (64%) surveyed indicated the ISC as a therapeutic solution for the replacement of a single missing tooth, showing a higher WTP index in the anterior area. Among investigated socio-demographic variables, the importance assigned by the patient to oral care appeared to influence WTP values of the rehabilitation, regardless the location of the single gap in the mouth.

Treatment of seriously compromised teeth: decision- making criteria and treatment options

The aim of this article was to describe the case of a patient who presented to our attention with severe periodontal disease, complicated by furcation involvement on elements 16 and 17. In addition, the radiographic exam revealed the presence of a deep intrabony defect distal to tooth 15. Surgical therapy is performed after the resolution of the endodontic component of the intra-bony defect on the element 15 and consists on osteoplasty and ostectomy on 16, guided tissue regeneration (GTR) on 15, extraction of 17 and bi-laminar connective tissue graft for the coverage of the recession on tooth 13. The patient is visited monthly and 9 months after surgery, the definitive metal-ceramic crown is delivered and adapted to tooth 16. At 18 months, the patient's periodontal situation is re-evaluated and the pocket depth results healthy (probing depth of tooth 15=2 mm). The surgical practices reported in this work allowed for functional and esthetic rehabilitation of periodontally compromised teeth. The RSR and the GTR represent conservative surgery that allow the preservation of compromised dental elements and if properly performed, guarantee excellent survival rates of the elements in the arch. For these reasons, when it is possible, the RSR and the GTR are a valid alternative to implantology and are to be considered as the first therapeutic option in the treatment plan.

Behavior of endosseous one-piece yttrium stabilized zirconia dental implants placed in posterior areas

AIM

Considering that zirconia dental implants are indicated for the rehabilitation of highly esthetic areas, the aim of this work was to investigate the functional behavior of these implants positioned in the posterior regions of the jaws.

METHODS

The study included 6 patients with 14 zirconia implants positioned in posterior (molar) areas of the jaws. Immediately after surgery, all implants were restored with temporary crowns or bridges. Clinical radiographic evaluation was performed 6 months after surgery and subsequently every year. At these follow-up visits, periodontal indexes were recorded and peri-apical radiographs were taken in order to calculate marginal bone loss.

RESULTS

The success and survival rates were 100%. The modified bleeding index (mBI) and modified plaque index (mPLI) were respectively equal to 0.57±0.51 and 0.29 ± 0.47 at 4-year follow-up. The overall mean probing depth of the implants was 3.13±0.87 mm. The mean marginal bone loss was +0.665 mm 4 years after surgery.

CONCLUSION

Considering the limits of our study, as regards to the data concerning peri-implant tissue health, marginal bone loss and survival and success rates of zirconium implants placed in posterior areas, we can conclude that the data reported are very encouraging although the number of implants observed is still limited.

BAYPAN study: a double-blind phase III randomized trial comparing gemcitabine plus sorafenib and gemcitabine plus placebo in patients with advanced pancreatic cancer

BACKGROUND

Sorafenib is an oral anticancer agent targeting Ras-dependent signaling and angiogenic pathways. A phase I trial demonstrated that the combination of gemcitabine and sorafenib was well tolerated and had activity in advanced pancreatic cancer (APC) patients. The BAYPAN study was a multicentric, placebo-controlled, double-blind, randomized phase III trial comparing gemcitabine/sorafenib and gemcitabine/placebo in the treatment of APC.

PATIENTS AND METHODS

The patient eligibility criteria were locally advanced or metastatic pancreatic adenocarcinoma, no prior therapy for advanced disease and a performance status of zero to two. The primary end point was progression-free survival (PFS). The patients received gemcitabine 1000 mg/m(2) i.v., weekly seven times followed by 1 rest week, then weekly three times every 4 weeks plus sorafenib 200 mg or placebo, two tablets p.o., twice daily continuously.

RESULTS

Between December 2006 and September 2009, 104 patients were enrolled on the study (52 pts in each arm) and 102 patients were treated. The median and the 6-month PFS were 5.7 months and 48% for gemcitabine/placebo and 3.8 months and 33% for gemcitabine/sorafenib (P = 0.902, stratified log-rank test), respectively. The median overall survivals were 9.2 and 8 months, respectively (P = 0.231, log-rank test). The overall response rates were similar (19 and 23%, respectively).

CONCLUSION

The addition of sorafenib to gemcitabine does not improve PFS in APC patients.

Esthetics in the edentulous: clinical steps for recovering of maxillary anterior teeth harmony

Smile designing for edentulous patients has not been much investigated; the selection of artificial teeth is a task that follows multiple consequential steps such as choosing their form, size, material, color and disposition. Even if smile designing is thought to involve some artistic abilities, specific techniques or suggestions have been proposed in the literature to perform each step of the selection of artificial teeth, keeping in mind the importance of consultation and understanding of the patient preferences. This article will focus on the recovering of maxillary anterior teeth harmony in an edentulous patient; a clinical case report will show the rationale process of anterior teeth selection, supported by scientific guidelines found in the literature.

Early bond strength to low-pressure sandblasted zirconia: evaluation of a self-adhesive cement

The debonding of a densely sintered zirconia prosthesis is a clinically reported, and undesirable event. A standardized, affordable adhesive cementation protocol for zirconia-based restorations is not yet available. The aim of this investigation was to assess the influence of several surface treatments on the initial shear bond strength of self-adhesive resin cement to densely sintered zirconia ceramic. Thirty densely sintered zirconia cylinders were divided into three groups (n = 10). Each of them received a different surface treatment: control (No_T), with the zirconia surface unconditioned; low pressure air abrasion (Sand_S) (50 µm, 1 bar); and standardized air abrasion (Sand_H) (50 µm, 2.8 bar). Three more surface-treated only specimens were addressed to scanning electron microscope (SEM) for qualitative observations. After specimen fabrication, self-adhesive cementceramic interface was analyzed using SBS (shear bond strength) test. Mean shear bond strengths (MPa) obtained for Sand_H and Sand_S were 16.24 ± 2.95 and 16.01 ± 2.68, respectively; no statistically significant difference (P = 0.8580) was found between sandblasted groups. Low-pressure air abrasion positively affected the initial self-adhesive cement adhesion to zirconia with respect to the No_T control group; however it did not prevent scratches and the formation of microcracks on the ceramic surfaces.

In vivo early plaque formation on zirconia and feldspathic ceramic

AIM

Zirconia is a ceramic material with optimal aesthetic and mechanical properties that make it adapt to esthetic recontructions in narrow spaces. Aim of this split mouth clinical trial is to compare amount and structure of early plaque coated to zirconia and feldspathic ceramic.

METHODS

Four patients were included in this study. A removable acrylic device was manufactured for each subject and equipped on the lingual surface in correspondence to molar teeth with eight specimens. Four zirconia samples were positioned on the right side (test) of the device, and 4 feldspathic ceramic samples were positioned on the left side (control). One test and one control samples were harvested from each device at 6, 12, 24 and 36 hours after oral environment exposition. A total of four samples for each group were collected at each timepoint; three of these were used for reverse transcription polymerase chain reaction analysis to evaluate the bacteria plaque amount; the remaining sample was used for scanning electron microscopy analysis to observe the bacteria plaque structure.

RESULTS

No significant differences were detected in terms of bacteria amount between test and control group at each timepoint. At scanning electron microscopy evaluation especially at 36 hou, bacteria plaque structure coated to zirconia surface appeared less uniform and compact compared to feldspathic ceramic.

CONCLUSION

Zirconia material may be considered adapt to prosthetic reconstructions that require high mechanical and aesthetic properties and that are exposed to the oral environment.

The effect of surface treatment on the adhesion of resin cements to Y-TZP

The purpose of the study was to evaluate the shear bond strengths (SBS) of two resin cements to intaglio surfaces of zirconia from two manufacturers after three surface treatment methods. Forty zirconia specimens from one manufacturer (Lava, 3M ESPE) and 40 zirconia specimens from another manufacturer (Cercon, Dentsply), each with system-specific intaglio surfaces, were randomly divided into four treatment groups (20 samples per group, 10 for each manufacturer): no treatment (No_T), sandblasting with 50microm Al2O3 (S_50), sandblasting with 110 microm al2O3 (S_110), and Rocatec silica coating and silanization (ESPE-Sil, 3M ESPE) (Roc). A 5-mm metal ring was fixed upon the zirconia and was filled with one of two different resin composite cements (RelyX Unicem, 3M ESPE and Panavia F 2.0, Kuraray). Samples were stored in distilled water at 37 degrees C for 7 days; SBS was evaluated using a universal testing machine. Values were calculated in MPa and the data were analyzed by ANOVA and Tukey HSD test (P < .05). In the Lava specimens, the three surface treatment methods tested did not increase the bond strength of Panavia compared to the control group (P = .195); using RelyX Unicem, S_50 and Roc, mean SBS values were significantly higher than values for No_T (S50 P = .0048; Roc P < .001). For Lava surfaces treated with Rocatec, there was a statistically significant difference between the two luting cements used (Unicem 11.39 +/- 2.19; Panavia 8.56 +/- 1.17; P = .002). Regarding the Cercon specimens, there was a significant difference between the Unicem and the Panavia control groups (No_T Unicem 1.48 +/- 1.19, No_T Panavia 4.60 +/- 2.75, P = .004). In conclusion, all surface treatments increased the bond strength of RelyX Unicem resin cement to both zirconia substrates. No statistically significant changes were found using Panavia on Lava. Sandblasting with 110 microm Al2O3 provided the highest bond strength for Panavia on Cercon.