Effect of Probiotics Lactobacillus rhamnosus and Lactobacillus plantarum on Caries and Periodontal Diseases: A Systematic Review

Caries and periodontitis are the most prevalent oral diseases worldwide. Major factors contributing to the development of these oral conditions include poor oral hygiene, dental biofilm formation, high carbohydrates diet, smoking, other systemic diseases, and genetic factors. Various preventive measures have been established to mitigate the risk of caries and periodontal disease development. The present review aims to discuss the role of the probiotics Lactobacillus rhamnosus and Lactobacillus plantarum in the prevention and treatment of caries and periodontal diseases. The study was conducted in accordance with PRISMA guidelines and was registered on PROSPERO. The search involved PubMed, Web of Science, and Scopus and considered the PICO format. Studies were screened by two reviewers independently, and disagreements were solved by consensus with a third reviewer. Data extraction included details about the type of probiotics, strains, and purpose of administration. A total of 15 RCTs were included, of which just 1 was about tooth cavities. Overall, 87% of the included studies were good-quality papers regarding the Jadad Scale. Several studies agreed on the potential of probiotics L. rhamnosus and L. plantarum, both alone and combined, to prevent and improve clinical outcomes in caries and periodontal treatments, weaker evidence is provided for the microbiological benefit.

Exploring Interleukin Levels in Type 1 Diabetes and Periodontitis: A Review with a Focus on Childhood

Diabetes can trigger an increase in cytokine levels leading to the production of C-reactive protein and fibrinogen. These molecules promote subclinical inflammation, causing the expression of adhesive molecules and endothelial dysfunction. Despite the lack of a comprehensive panel for single-nucleotide polymorphisms (SNPs) for interleukins associated with type 1 diabetes mellitus (T1DM), understanding the inflammatory role of SNPs is crucial because periodontitis, the sixth complication of diabetes, is influenced via these genetic variations. This review focuses on the interleukin levels in T1DM patients with and without periodontitis, with a particular focus on childhood and on SNPs when reported. A search of PubMed and Scopus identified 21 relevant studies from the past five years. Several ILs were analyzed, emphasizing that T1DM still needs to be thoroughly explored regarding an IL polymorphisms panel; however, the last five years have led to the increased independence of this condition, causing autonomous inflammatory effects, which require further investigation. The periodontitis and T1DM association in children and adolescents represents a severe gap in the literature that should be filled; this scarce presence of studies serves as motivation for further clinical research.

Medication-related osteonecrosis of the jaw triggered by endodontic failure in oncologic patients

OBJECTIVES

To describe the association between endodontic treatment failure and medication-related osteonecrosis of the jaw (MRONJ) in a cohort of oncologic patients in therapy with antiresorptive and antiangiogenic drugs.

MATERIALS AND METHODS

Patients were selected as affected by MRONJ in absence of the common local risk factors (oral surgical procedures or ill-fitting dentures) but showing failure of previous endodontic treatment performed at least 6 months before the starting of antiresorptive/antiangiogenic therapies. Jaw lesions were all surgically treated and patients underwent a strict clinical and radiological follow-up.

RESULTS

Among 18 patients, who developed 18 MRONJ, the only detectable local risk factor was the presence of teeth with failed endodontic treatment (more precisely, root canal underfilling in eight cases, root canal overfilling in two cases, root perforation in three cases, root fracture in five cases). All patients completely healed after surgical procedure and no recurrence was observed.

CONCLUSIONS

Endodontic treatment failure should be considered a local risk factor for MRONJ development in oncologic patients. For such reason, it is mandatory to carefully evaluate them prior than the beginning of antiresorptive and antiangiogenic drugs administration.

Mandibular Crowding: Diagnosis and Management-A Scoping Review

BACKGROUND

Crowding is the most frequent malocclusion in orthodontics, with a strong hereditary tendency. It already occurs in pediatric age and is mainly hereditary. It is a sign of a lack of space in the arches, and is not self-correcting, but can worsen over time. The main cause of the worsening of this malocclusion is a progressive and physiological decrease in the arch perimeter.

METHODS

To identify relevant studies investigating the most common possible treatments for mandibular dental crowding, a comprehensive search of PubMed, Scopus and Web of Science was conducted encompassing the last 5 years (2018-2023) using the following MeSH: "mandibular crowding AND treatment" and "mandibular crowding AND therapy ".

RESULTS

A total of 12 studies were finally included. An orthodontic treatment cannot ignore the concept of "guide arch", which concerns the lower arch, because of the objective difficulty in increasing its perimeter; the bone structure of the lower jaw is more compact than that of the upper one. Its expansion, in fact, is limited to a slight vestibularization of the incisors and lateral sectors that may be associated with a limited distalization of the molars.

CONCLUSIONS

There are various therapeutic solutions available to the orthodontist, and a correct diagnosis through clinical examination, radiographs and model analysis are essential. The decision of how to deal with crowding cannot be separated from an overall assessment of the malocclusion to be treated.

Potential Relationship between Poor Oral Hygiene and MRONJ: An Observational Retrospective Study

Medication-related osteonecrosis of the jaw (MRONJ) is a drug-related side effect linked but not limited to antiresorptive and antiangiogenic molecules. It recognizes several triggers in dental procedures, such as surgery, endodontic treatments, and root planing, but also prosthesis decubitus or with a spontaneous onset. Although there are many reports about the onset of this pathology, oral hygiene status is mainly described as a consequence of MRONJ. Not so much is known about the oral hygiene situation as a concurrent factor in the pathogenesis of severe stages and about non-surgical periodontal therapy in patients affected by MRONJ. Actually, clear instructions for non-surgical periodontal therapy are poor in the literature. The primary outcome of the present study is to evaluate the oral hygiene status in MRONJ patients. In addition, a secondary outcome is to review the factor of poor oral hygiene as a cause or worsening aspect for MRONJ. A total of 45 subjects (19 males and 26 females) with a mean age of 59 ± 12 were enrolled. The Pearson correlation coefficient showed no significant results for the variable of the Simplified Oral Hygiene Index (OHI-S) and the American Association of Oral and Maxillofacial Surgeons (AAOMS) stage, although the majority of patients showed poor oral hygiene with an OHI-S average of 3.39 ± 1.83. As stated by the last AAOMS position paper, poor plaque control is related to a worsened MRONJ stage. The relation between the lack of oral hygiene and MRONJ onset is still unclear.

Root planing strategies: a comparative ex vivo study

BACKGROUND

As oral health has gained a crucial role in low grade inflammation control, new techniques were tested to achieve a better control of periodontal homeostasis. Ultrasound scaling and root planing by means of Gracey curettes were the established techniques, while air-polishing was mostly used on prosthetic surfaces.

METHODS

In the present study, an in-vitro comparison between roughness of enamel and root surfaces after air polishing and curettes was performed. Six extracted teeth were examined for air polishing effects and curettes effects at Scanning Electron Microscope to evaluate the superficial roughness. This aspect was assessed by a dedicated software analyzing roughness indexes such as Ra, Rq, Sa and fractal dimension.

RESULTS

According to our results, air polishing produced a smoother root surface in comparison with the curette's root planing. Although Gracey curette scaling represent the gold-standard so far. Moreover, air polishing did not produce root cementum damage or scratches, as with curette's scaling, and this aspect seems to be related to particles diameter and nature.

CONCLUSIONS

Further studies, both in vitro and in vivo, are needed to better evaluate the real outcome of this kind of management.

Exploring Oral Microbiome in Healthy Infants and Children: A Systematic Review

Recent advances in the development of next-generation sequencing (NGS) technologies, such as the 16S rRNA gene sequencing, have enabled significant progress in characterizing the architecture of the oral microbiome. Understanding the taxonomic and functional components of the oral microbiome, especially during early childhood development, is becoming critical for identifying the interactions and adaptations of bacterial communities to dynamic conditions that may lead to the dysfunction of the host environment, thereby contributing to the onset and/or progression of a wide range of pathological conditions. We aimed to provide a comprehensive overview of the most recent evidence from studies of the oral microbiome of infants and young children, focusing on the development of oral microbiome in the window of birth to 18 years, focusing on infants. A systematic literature search was conducted in PubMed, Scopus, WOS, and the WHO clinical trial website for relevant articles published between 2006 to 2022 to identify studies that examined genome-wide transcriptome of the oral microbiome in birth, early childhood, and adolescence performed via 16s rRNA sequence analysis. In addition, the references of selected articles were screened for other relevant studies. This systematic review was performed in accordance PRISMA guidelines. Data extraction and quality assessment were independently conducted by two authors, and a third author resolved discrepancies. Overall, 34 studies were included in this systematic review. Due to a considerable heterogeneity in study population, design, and outcome measures, a formal meta-analysis was not carried out. The current evidence indicates that a core microbiome is present in newborns, and it is stable in species number. Disparity about delivery mode influence are found. Further investigations are needed.

Protection Measures, Dental Education, and Covid-19 Spread: A Brief Narrative Review

Objectives

The aim of the study was to evaluate and check the international literature for Covid-19 prevention and dental education.

Materials and Methods

A review of the international literature was performed, including articles in English about different aspects of transmission, preventive actions, and educational topics.

Results

As a result, it seems that the better way to avoid contagion was represented by the use of personal protective equipment and handwashing in conjunction with social distancing and treatment limitation.

Conclusions

Dental treatment limitation to emergencies, social distancing, and online teaching seemed to be the key to limit the Covid-19 outbreak, although there was no evidence of a universal guideline. This suggests that we have to establish general guidelines to avoid a second rush of contagion and limit the spread of infection in the future.

Diode Laser Management of Primary Extranasopharyngeal Angiofibroma Presenting as Maxillary Epulis: Report of a Case and Literature Review

Juvenile nasopharyngeal angiofibroma is a rare vascular neoplasm, mostly occurring in adolescent males, and representing 0.05% of all head and neck tumors. Nevertheless, it is usually recognized as the most common benign mesenchymal neoplasm of the nasopharynx. Usually, it originates from the posterolateral wall of the nasopharynx and, although histologically benign, classically shows a locally aggressive behavior with bone destruction as well as spreading through natural foramina and/or fissures to the nasopharynx, nasal and paranasal cavities, spheno-palatine foramen, infratemporal fossa and, very rarely, to the cranial cavity. Extranasopharyngeal angiofibroma is considered a distinct entity due to older age at presentation, different localizations (outside the nasopharyngeal pterygopalatine fossa) and attenuated clinical course. Extranasopharyngeal angiofibroma has been sporadically described in the oral cavity. We report a case of extranasopharyngeal angiofibroma with primary and exclusive involvement of the adherent gingiva of the anterior maxilla, managed by preoperative diode laser trans-mucosal photocoagulation and subsequent surgical removal. The current literature on primary extranasopharyngeal angiofibroma is also reviewed.

A Minimally Invasive Technique for Short Spiral Implant Insertion with Contextual Crestal Sinus Lifting in the Atrophic Maxilla: A Preliminary Report

The most recently reported techniques for the rehabilitation of the atrophic posterior maxilla are increasingly less invasive, as they are generally oriented to avoid sinus floor elevation with lateral access. The authors describe a mini-invasive surgical technique for short spiral implant insertion for the prosthetic rehabilitation of the atrophic posterior maxilla, which could be considered a combination of several previously described techniques based on the under-preparation of the implant site to improve fixture primary stability and crestal approach to the sinus floor elevation without heterologous bone graft. Eighty short spiral implants were inserted in the molar area of the maxilla in patients with 4.5–6 mm of alveolar bone, measured on pre-operative computed tomography. The surgical technique involved careful drilling for the preparation of implant sites at differentiated depths, allowing bone dislocation in the apical direction, traumatic crestal sinus membrane elevation, and insertion of an implant (with spiral morphology) longer than pre-operative measurements. Prostheses were all single crowns. In all cases, a spiral implant 2–4 mm longer than the residual bone was placed. Only two implants were lost due to peri-implantitis but subsequently replaced and followed-up. Bone loss values around the implants after three months (at the re-opening) ranged from 0 to 0.6 mm, (median value: 0.1 mm), while after two years, the same values ranged from 0.4 to 1.3 mm (median value: 0.7 mm). Clinical post-operative complications did not occur. After ten years, no implant has been lost. Overall, the described protocol seems to show good results in terms of predictability and patient compliance.

Comparison between three glass fiber post cementation techniques

OBJECTIVE

The aim of this experimental study was to compare the traditional cement systems with those of the latest generation, to assess if indeed these could represent of viable substitutes in the cementation of indirect restorations, and in the specific case of endodontic posts.

METHODS

The assessment of the validity of the cementing methods was performed according to the test of the push-out, conducted on sections obtained from the roots of treated teeth. The samples were divided into three groups. Group A (10 samples): etching for 30 seconds with 37% orthophosphoric acid (Superlux-Thixo-etch-DMG) combined with a dual-curing adhesive system (LuxaBond-Total Etch-DMG), dual-cured resin-composite cement (LuxaCore-DMG) and glass fiber posts (LuxaPost-DMG). Group B (10 samples): self-adhesive resin cement (Breeze-Pentron Clinical) and glass fiber posts (LuxaPost-DMG). Group C (10 samples): 3 steps light-curing, self-etching, self-conditioning bonding agent (Contax-Total-etch-DMG), dual-cured resin-composite cement (LuxaCore-DMG) and glass fiber posts (LuxaPost-DMG). The survey was conducted by examining the breaking resistance of the post-cement-tooth complex, subjected to a mechanical force. Statistical analysis was performed using SPSS Inc. ver. 13.0, Chicago, IL, USA.

RESULTS

Group A values of bond strenth ranged from a minimum of 10.14 Mpa to a maximum value of 14.73 Mpa with a mean value of 12.58 Mpa. In Group B the highest value of bond strength was 6.54 Mpa and the minimum 5.55 Mpa. The mean value of the bond strength for the entire group was 6.58 Mpa. In Group C the highest bond strength was 6.59 Mpa whereas the lowest bond strength was 4.84 Mpa. Mean value of the bond strength of Group C was calculated at 5.7 Mpa.

CONCLUSIONS

Etching with orthophosphoric acid combined with a dual-curing adhesive system and a dual-cured resin-composite cement was the technique that guaranteed the highest bond strength. Lowest bond strength values were obtained when dual self-adhesive cement was used.

Enzymatic Analysis of the Gingival Crevicular Fluid in Hypoxia of High Altitude (Everest)

The aim of this study is to determine the qualitative and quantitative changes of alkaline phosphatase (ALP) that occur in the Gingival Crevicular Fluid (GCF) in hypobaric-hypoxic conditions (high altitude). Hypoxia affects systemic adaptation responses in different organs. We examined 17 Caucasians subjects, of whom 13 were mountain climbers (1 female and 12 males), and 4 Tibetans (2 females and 2 males) following exposure to the hypoxia environment of high altitude. The study was conducted at different altitudes (0 m control, 1000 m, 5200 m above sea level) on Mount Everest. The protocol consisted of withdrawing crevicular fluid through the use of cones made of endodontic paper size 30 sectioned to 15 mm from the apex, inserted for 30 seconds in the gingival sulcus (about 2 mm). The analyzed sites were the mesial and distal, buccal and palatal of tooth 1.1 and 2.1. Blood exams were performed on the subjects using I-Stat, furnishing analysis in real time (about 2 mins). In agreement with other results reported in literature, in all the subjects we found an increase in the hematocrit and hemoglobin with a large range of values between them, and with significant differences, as analysed with the Fisher, Scheffe and Bonferroni/Dunn statistical methods. The enzymatic analysis of the GFC showed an increase of the levels of ALP at each altitude studied. With this preliminary study we show that hypoxic environment determines not only the well known cardiovascular systemic responses, but also crevicular fluid adaptation.

Surgery on burns sequelae in developing countries

The purpose of this study is to analyze the effectiveness of surgery and follow-up of children operated on for burn sequelae. For many years, we have organized two missions per year to Benin and Togo, one for surgery and one for follow-up. We analyzed the files of children born in Africa and victims of burns from the years 2002 to 2011. Children were referred through a non-governmental organization (NGO) and assessed in Africa by local paediatricians before and after surgery. Treatment consisted in operating on burn sequelae such as contractures, hypertrophic scars and hard cords. Impaired mobility was our only indication for the operation. We kept a database on all patients. Sixty files were reviewed, of which fifty were deemed suitable for analysis. The most common methods of surgery were skin grafting and Z-plasty. There were no complications, such as infection or graft/flap necrosis after immediate surgery. Long-term follow-up revealed a recurrence of hypertrophic scarring (47%), retractions (24%) and hard cords (2%) due to a lack of occupational therapy and physiotherapy treatment. Partnership with an NGO and a local team allows us to treat children with burn injury sequelae in Western Africa. A continued and often long-lasting follow-up by occupational therapists and physiotherapists is highly mandatory in order to guarantee good long-term results. In 2010, we initiated local rehabilitation therapy.

Vascular Endothelial Growth Factor (VEGF) in Human Tooth Germ Center

Many oncogenis and tumour suppressor genes found inside normal and pathological cells are fundamental for the processes of development, proliferation and tissue differentiation. The purpose of our study is to show the presence and a possible relationship of the VEGF protein during different phases of the development of human dental germ centers. After cephalometric investigation in 8 orthodontic patients with a mean age of 13 years, (4 females and 4 males), hyperdivergence of the third molars were extracted. The 40 surgical samples were tested with monoclonal human anti-VEGFs antibodies carrying out a semi-quantitative analysis to look for a positive reaction. Reaction for anti-VEGF antibodies was detected in normal embryological tissues and in microvessels near odontogenic cells. During different phases of embryologic development of the dental bud our search showed intracytoplasmatic positive immunoreactions both in the ameloblastic and odontoblastic cells. Additionally, a positive reaction was observed for the VEGF protein in the cells of the stellate reticulum and in those endothelial tissue surrounding the microvessels in all the samples examined.

Potential Markers of Tongue Tumor Progression Selected by cDNA Micro Array

Squamous cell carcinoma (SCC), the most frequent malignant tumor of the oral cavity, generally exhibits a poor prognosis and metastases are the main cause of death. This tumor often arises from pre-malignant lesions. To date, it is difficult to predict if and which pre-malignant lesions may progress into oral SCC using traditional methods. For these reasons, several studies are trying to identify markers useful in the progression of pre-malignant lesions and tumors. To define the genetic expression profile of tongue tumor progression we compared 9 dysplasias (DS), 8 tumors without metastasis (TWM), 11 metastasizing SCCs (MT) of the tongue, and a baseline of 11 normal tissues by using cDNA microarray containing 19.2 K clones. We initially applied hierarchical agglomerative clustering based on information from all 6026 clones. Results were obtained by performing a two steps analysis: a Significance Analysis of Microarray (SAM) and a Gene Ontology search. One hundred and five clones have statistically significant different expression levels (FDR <0.01) between DS and TWM, whereas 570 genes have statistically significant difference expression levels between TWM and MT (FDR <0.01) as detected by SAM. By filtering with FatiGo only 33 genes were differentially expressed in TWN, respect to DS, whereas 155 genes were differentially expressed in MT respect to TWM. We detected some genes which encode for oncogenes, transcription factors and cell cycle regulators as potential markers of DS progression. Examples are BAG4, PAX3 and CCNI, respectively. Among potential markers of metastases are some genes related to cell mobility (TSPAN-2 and SNTA1), intercellular adhesion (integrin alpha 7) or extracellular matrix components (ADAMTS2 and cathepsin O). Additionally, under-expressed genes encoded apoptosis-related proteins (PDCD4 and CASP4). In conclusion, we identified several genes differentially expressed in tumor progression which can potentially help in better classifying premalignant lesions and tongue SCCs.

Prevalence and distribution of endodontic treatments and apical periodontitis in an Italian population sample

This study was undertaken to investigate for the first time the distribution and prevalence of apical periodontitis and its determinants in an Italian population. A total of 312 participants (191 women, 121 men) received free clinical examination and full-mouth digital X-ray. Data regarding the oral health status of the patients were collected such as the reason for the visit and the incidence of lesions. We examined 8101 teeth, 6.59% of which had been submitted to endodontic treatment and 15.02% of which were lower molars. Lower molars were reported missing more frequently, in detail 16.24%. Moreover 3.89% of the lower molars had developed an apical lesion, whereas only 0.08% of the lower incisors. Periapical lesions were present in 0.29% of not endodontically treated teeth, while in endodontically treated teeth lesions were present in 17.04%. Additionally, 15.65% of the endodontically treated teeth showed incongruous (long or short) seals. A prevalence of women (61.21%) over men (38.78%) was reported indicating that women attend to their oral health more. Endodontic treatment success and failure in over- or under-filled teeth was evaluated with success being verified in 97% of appropriately treated teeth; the success rate decreases in inappropriately treated teeth (by 72.73% in over-filled and 77.71% under-filled teeth). The prevalence of teeth with periapical lesions amounted to 1.35%. Finally, endodontically treated teeth with periapical lesions amounted to 17.04%. Successful treatment can be achieved when disease is intercepted at an early stage while prevention still remains better than cure.

The Role of Positron Emission Tomography in Inflammatory Bowel Disease

Inflammatory bowel diseases (IBD) are a group of pathological conditions characterized by chronic inflammation of the gastrointestinal tract, including Crohn's disease and ulcerative colitis. To date, imaging of IBD is based on several radiological techniques such as barium studies, magnetic resonance imaging, and computed tomography (CT). Endoscopy is the gold standard for the assessment of the large bowel and proximal small intestine in patients with IBD allowing the biopsy of the visualized bowel. Positron emission tomography (PET) and PET/CT with Fluorine-18-fluoro-2-deoxy-D-glucose (FDG) is a functional imaging method used to detect abnormalities in glucose metabolism in a variety of disorders. FDG accumulates mainly in tumours, but increased uptake and retention has been shown also in lesions with a high concentration of inflammatory cells, such as granulocytes and activated macrophages. Recent literature data demonstrate that FDG-PET and PET/CT may be useful noninvasive tools for identifying and localizing active IBD. In patients with an established diagnosis of IBD, FDG-PET and PET/CT may provide information about disease activity, location and extent of the disease within the intestinal tract, allowing early recognition of disease relapse and possible complications. Furthermore, these techniques may play a role in assessing the treatment response to medical therapy in patients with IBD.

Aesthetic restoration of upper lip after removal of post-trauma foreign body (orthodontic bracket)

AIM

Approach to dental trauma should always be based on a careful examination of the traumatised area, including both hard and soft tissues, to ascertain the presence of a foreign body and to assess the best treatment and follow-up. In this work a case of an orthodontic bracket migrated to the upper lip and retained there for 10 years, following a trauma is discussed.

CASE REPORT

The patient complained symptomatic swelling of the upper lip; palpation and x-rays showed the presence of a foreign body, identified as an orthodontic bracket. Medical history revealed that patient had a dental trauma 10 years prior. The foreign body was localised and removed. At the two week follow-up visit after surgical incision of the lip, signs and symptoms (i.e. the swollen lip) were resolved. This case emphasises the importance of accurate management of the traumatic event, through proper diagnosis and therapy of both hard and soft tissues, even if the examination if the patient is performed years after the dental trauma.

Use of endosseous one-piece yttrium-stabilized zirconia dental implants in premolar region: a two-year clinical preliminary report

AIM

The aim of this work was to clinically and radiographically evaluate survival and success rate of zirconia dental implants positioned in premolar area during a follow-up period of at least 12 months up to 24 months.

METHODS

Sixteen patients were treated with 26 zirconia implants. All implants received immediate temporary restorations and 6 months after surgery were definitively restored. Twelve to 14 months after implant insertion, a clinical-radiographical evaluation was performed in order to estimate peri-implant tissues health and peri-implant marginal bone loss.

RESULTS

The survival rate was 96.16%. The success rate was 91.6%.

CONCLUSION

Because of the limited number of implants, conclusions may not be considered significant even if results are encouraging. Further scientific information regarding clinical use of zirconia dental implants are needed, as well as prospective long-term clinical studies in order to understand if zirconia implants may represent a valid alternative to titanium implants.

Edentulous jaws rehabilitation with yttrium-stabilized zirconium dioxide implants: two years follow-up experience

AIM

The aim of this study was to present authors' two-year clinical experience with Yttrium-stabilized zirconium dioxide implants placed in native bone or regenerated bone.

METHODS

Yttrium-stabilized zirconium dioxide implants made of brezirkon (whiteSKY, Bredent medical, Senden, Germany) were used for the treatment of edentulous ridge rehabilitation in the Dental Clinic of the University of Milan (Head of the Department, Prof. F. Santoro). Zirconium dioxide is a highly resistant ceramic material obtained by cleaning zirconium dioxide and zirconium silicate. The implant used in the clinical study featured a conical one piece implant with double cylindrical thread with a sandblasted rough surface. The prosthetic section was smooth.

RESULTS

Forty-six implants have been inserted in 18 patients from January 2007 to January 2009, the follow-up period was comprised between 6 and 24 months. The overall success rate was 89%; the success rate in native bone was 97% and 74% in augmented bone. It can be stated that the success rate is comparable to titanium fixtures.

CONCLUSION

It would be logical to use a ceramic material for the esthetic regions; zirconium dioxide is particularly suitable since it features tissue friendliness and resistance comparable to titanium. The good mechanical properties, possibility of easy fabrication of the prosthetic restoration and the good integration into the tissue and the esthetics provide perfect preconditions for yttrium-stabilized zirconium dioxide to become the most commonly used material in implant dentistry.

Displacement of a dental implant into the maxillary sinus: case series

Dental implants placed in the maxilla risk failure because of the low density of the maxillary bone and the shortness of the maxillary ridge. Moreover, inadequate implant preparation, drilling or installation can easily lead to complications related to the maxillary sinuses. Displacement of dental implants into the maxillary sinus can cause serious complications, but there are few reports of such cases. The aim of this paper is to present three cases of a migrated dental implants into the maxillary sinus: in the first two cases the dental implant was found close to the medial wall of the maxillary sinus and was removed through a surgical approach, whereas in the third case the dental implant was spontaneously expelled from the nasal cavities through the mucociliary clearance. The most frequent adverse effect is the local infection of tissue around the implant. For this reason, implants placed close to the maxillary sinus offer a route for infection from the oral cavity to the sinus. While in some cases implant migration causes sinusitis in other, the patients remain asymptomatic; anyway, the treatment depends on the symptoms of maxillary sinusitis. In the third case the dental implant was spontaneously expelled from the nasal graves. Our report illustrates that a powerful mechanism of mucociliary action can cause relatively heavy objects within the maxillary sinus to migrate naturally to the sinus ostia against gravitational force and then to be expelled from the nasal cavities.

Bevacizumab-Related Osteneocrosis of the Jaw

We describe a case of jaw bone necrosis after a lung adenocarcinoma bone metastasis, treated the first time in 2004 by means of pneumonectomy and lymph node ablation. One week after a dental extraction, the patient experienced pain in the mandibular region, in conjunction with alveolar bone exposure. Treatment with amoxicillin and clavulanate every 12 hours for 15 days and 0.2% chlorhexidine rinses was administered and there was a remission of infective complications, but not the closure of the exposed alveolar bone. Only at this time did the patient refer that he was treated with bevacizumab therapy immediately after the extraction. A preventive dental assessment of patients scheduled for bevacizumab therapy should be useful as for the zoledronic acid therapy. Dental surgery procedures for patients during bevacizumab therapy should be carefully evaluated and considered as the last choice, to reduce all possible risks and prevent complications.

Effect of a subgingival chlorhexidine chip on the clinical parameters and the levels of alkaline phosphatase activity in gingival crevicular fluid during the non-surgical treatment of periodontitis

The main therapeutic approaches for inflammatory periodontal diseases include the mechanical treatment of root surfaces. Multi-center clinical trials have demonstrated that the adjunctive use of a chlorhexidine (CHX) chip is effective in improving clinical results compared to scaling and root planing (SRP) alone. However, some recent studies failed to confirm these clinical results, nor have any data been reported regarding the capability of the CHX chip in affecting the activity of alkaline phosphatase (ALP) in the gingival crevicular fluid (GCF). This enzyme has been related to a condition of destructive activity of periodontitis. The aim of this study is to provide further data on the clinical and biochemical effects of CHX chips when used as an adjunct to SRP. Eighty-two systemically healthy patients, aged 31-63, with moderate and advanced periodontitis were recruited from the departments of Periodontology of the University of Chieti. In each patient 2 experimental sites, located in two symmetric quadrants, were chosen with a probing depth of > or = 5 mm and bleeding on probing. The 2 sites were selected randomly at the split-mouth level; control sites received SRP alone, and test sites SRP plus 1 CHX chip. Clinical indices, including probing depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and the ALP activity in GCF were evaluated at baseline and after 6 months. Alkaline phosphatase activity was assayed spectrophotometrically. The PPD and CAL were significantly lower at 6 months as compared to the baseline scores in both treatments (p less than 0.01). The PPD reduction was 2.7 mm in the CHX+SRP group and 1.9 mm in the SRP alone group. The CHX+SRP group showed a significantly greater gain of clinical attachment (mean: 1.4 mm) in comparison with the SRP group (mean: 0.9; p less than 0.05). No differences were observed in the decrease of the percent of BOP-positive sites between the experimental groups. Conversely, the CHX+SRP group underwent a significantly greater decrease (p less than 0.01) of the GCF-ALP activity 6 months after treatment in comparison with the SRP alone group. The adjunctive use of the CHX chip resulted in a significant improvement of pocket reduction and clinical attachment gain as compared with SRP alone. These results were concomitant with a significantly greater reduction of the GCF-ALP activity levels.

SEM analysis of oral lichen planus before and after treatment with 13 cis-retinoic acid

Cancer of the oral cavity is a frequent worldwide neoplasia, averaging 4% in men and 2% in women. Cancer of the oral cavity is often preceded by particular epithelial lesions, called precancerous lesions. The aim of this study is to evaluate, by SEM microscope analysis, before and after treatment with 0.1% 13-cis-retinoic, the morphostructural variation of the surface of the oral mucous affected by lichen planus in respect to healthy oral mucous. Following topical therapy with 0.1% 13-cis-retinoic acid for 8 weeks, a restoration of the physiological morphostructure was observed by SEM, demonstrating the efficaciousness of the treatment and the SEM analysis for identifying the lesions of oral epithelium.

Occipital condyle fracture: An unusual airbag injury

The installation of airbags in motor vehicles, in association with the use of seat belts, has reduced the incidence of head injuries, as well as significantly decreasing morbidity and mortality in motor vehicle accidents. Nevertheless, the literature on the subject increasingly refers to lesions related to airbag deployment. These are usually minor, but in certain circumstances, severe and fatal injuries can result. This is a case report of serious injury due to airbag deployment, involving a restrained driver who suffered occipital condylar injury when his airbag deployed in a frontal collision. The range of airbag associated injuries is reported and predisposing factors, such as the probable proximity to the airbag housing, is discussed.

Immunohistochemical Evaluation of VEGF Inflamed Cystic Radicular Lesions and in Keratocysts

Vascular Endothelial Growth Factor, also known as Vascular Permeability Factor, is a multifunctional cytokine hyperexpressed during angiogenesis and in numerous physiological and pathological processes characterised by an increase of vascular permeability. The aim of this study was to evaluate the angiogenetic processes which are accompanied by an expansion of cystic radicular lesions and of keratocysts of the jaw bone. 12 subjects were chosen with an average age of 43 years, of whom 8 were males and 4 females. After an accurate history and physical examination, the patients underwent surgery for removal of the cysts. The samples taken were histologically and immunohistochemical examined. The histological exam confirmed the diagnosis of radicular cysts and keratocysts. The immunohistochemical examinations were positive for VEGF in all the lesions analysed, even though they had different immunostaining. Using a semi-quantitative method, in the radicular cyst samples it was possible to highlight a wider expression of the vascular component, both in the inflamed area and the adjacent stroma. The lesions with keratin content showed newly formed and modest vascularisation both in the area showing slight inflammation, where the cellular component was prevalent, and in the adjacent areas showing no inflammation. Therefore, angiogenesis could take on a primary role in the development of cystic lesions of the jaw. However, the differences of expression of the VEGF protein suggest the need for wider monitoring to better evaluate a possible use of such a protein as a diagnostic marker.

Immunohistochemical evaluation of CD31 in human cystic radicular lesions and in keratocysts

Platelet-endothelial cell adhesion molecule-1 protein (PECAM-1/CD31) is expressed in numerous physiological and pathological processes characterized by an increase of vascular permeability, and in normal and tumour tissues. CD31, member of the immunoglobulin super-family that mediates cell-to-cell adhesion, is a transmembrane glycoprotein, 130-140 kDa, also know as platelet-endothelium cell adhesion molecule (PECAM-1). CD31 is a ligand for CD38 and plays a role in thrombosis and angiogenesis. CD31 is strongly expressed in endothelial cells and weakly expressed in megakaryocytes, platelets, occasional plasma cells, lymphocytes (marginal zone B-cells, peripheral T-cells) and neutrophils. The present study evaluates the angiogenetic processes which are accompanied by an expansion of cystic radicular and keratocystic lesions of the jaw bone. Twelve subjects with maxillary cysts (8 males and 4 females) with an average age of 43 years were selected by the Chieti University Oral Surgery Department. The surgical samples taken were subjected to histological and immunohistochemical analysis. The histological evaluation confirmed the diagnosis of radicular cystisis and keratocystisis. The immunohistochemical analyses were positive for CD31 protein in all the lesions analysed, even though they had different intensities. Using a semiquantive analysis it was possible to highlight, in the radicular cyst samples, an intense expression of the vascular component both in the inflamed area and the adjacent stroma. The lesions with cheratin content showed newly-formed, rather modest, vascularity both in the area showing slight inflammation, where the cellular component is prevalent, and in the adjacent areas showing no sign of inflammation. Therefore, in our observations, angiogenesis could take on a primary role in the development of cystic lesions of the jaw bones. The differences of CD31 expression, in all samples, would advise for a wider monitoring able to evaluate the possible use of such a protein as a diagnostic marker.

P-cadherin expression predicts clinical outcome in oral squamous cell carcinomas

P-cadherin, a transmembrane molecule similar to E-cadherin involved in the cell-cell adhesion, and catenins form complexes between its cytoplasmic domain and the cytoskeleton. Five cell lines, 108 specimens of oral squamous cell carcinomas (OSCC), 9 metastasis and 10 of normal oral mucosa were examined to evaluate P-cadherin expression and cellular localization by immunohistochemistry and western-blotting. In normal oral mucosa there was a membranous expression only in basal and parabasal layers. 91 cases (84%) showed membranous/cytoplasmic positivity, whereas 17 cases (16%) were negative. In particular, while well-differentiated carcinomas showed P-cadherin upregulation, the protein was homogeneously hypo- or unexpressed in low-differentiated carcinomas. There was a statistically significant correlation between P-cadherin expression and tumour grading: G3 tumours had a lower score than G1-G2 tumours (P<0.05). When analysed for prognostic significance, patients with no P-cadherin expression (score 0) had poorer overall and diseases-free survival rates than the P-cadherin-expressing group (score 1) (P=0.0463 and P=0.0471, respectively). Western blotting analysis of cell lines and tissue samples confirmed immunohistochemical findings. When cell staining pattern of positive cases was examined, 52 cases showed a prevalent membranous pattern, while 39 had a prevalent cytoplasmic pattern. Cases with prevalent cytoplasmic staining showed high rates of lymph node metastases (P>0.05), and regional relapse (P <0.05) and poorer survival rates than the group with prevalent membranous expression (P<0.0001). An absent P-cadherin expression could constitute a hallmark of aggressive biological behaviour in oral squamous cell carcinoma.

Cyclic GMP phosphodiesterase activity role in normal and inflamed human dental pulp

Cyclic GMP phosphodiesterase (cGMP PDE) plays an important role in pulp tissues. High levels of cGMP PDE are found in dental pulp cells. In the present study cGMP PDE activity was analyzed in normal healthy human dental pulps, in reversible pulpitis and in irreversible pulpitis. Enzymatic cGMP PDE control values for normal healthy pulps were 4.74+/-0.32 nmol/mg of proteins. In reversible pulpitis the cGMP PDE activity increased almost 3 times. In irreversible pulpitis specimens the values increased 4.5 times compared with the normal healthy pulps activity. The differences between the groups (control vs. reversible pulpitis and vs. irreversible pulpitis) were statistically significant. These results point to a role of cGMP PDE in the initial pulp response after injury.

Keratosis follicularis of the oral mucosa with oral squamous cell carcinoma

Darier's disease or keratosis follicularis is a genodermatosis which may involve the oral mucosa. Malignant degeneration is rare. We report the first case of the combined manifestation of oral keratosis follicularis and oral squamous cell carcinoma and discuss the possible involvement of ATP2A2 (located in 12q23-24.1) which encodes the sarco/endoplasmic reticulum Ca(2+)-ATP isoform 2 (SERCA2), in the pathogenesis.

Cervical lordosis angle measured on lateral cephalograms; findings in skeletal class II female subjects with and without TMD: a cross sectional study

The literature reports evidence of various types of correlations between cervical alterations and cervical pain, and the existence of cervical pain in subjects with temporomandibular joint internal derangement (TMD). The hypothesis of this study is that cervical lordosis angle (CVT/EVT angle) alteration on cephalometrics could be correlated to the presence of TMD. The cephalometric records of 50 females with documented TMD were compared with those of a control group of 50 females. The subjects in the sample were 25-35 years of age, average 28.9 years (SD, 3.2). Radiographs were taken in mirror position, and seventeen variables, including the CVT/EVT angle, were traced. Double measurements were made to evaluate method error using Dahlberg's formula. Pearson's correlation coefficient and Mann-Whitney's t-test were used to evaluate the data. Intra-group analysis showed significant correlations between the CVT/EVT angle and mandibular length (p<0.01), mandibular position (p<0.05), mandibular divergence (p<0.01), and overjet (p<0.01) in both groups. Between groups, the analysis showed significant differences in CVT/EVT angle (p<0.05), maxillary protrusion (p<0.01), mandibular protrusion (p<0.01), mandibular length (p<0.01), mandibular divergence (p<0.05), and overbite (p<0.05).

[Parotid tumors: a diagnostic and therapeutic protocol in 81 surgical cases]

AIM

In the last five years we cured 81 patients divided in two groups: the first was managed inordinately, the second according to a diagnostic and therapeutic protocol.

METHODS

The first 23 patients were differently evaluated, before surgery, by means of traditional sialography, US, CT, CT sialography, MR, larger bore needles and FNAB. Neoplasm enucleations, atipic resections, superficial and total conservative parotidectomies were performed. The following 58 patients were evaluated and cured according to a diagnostic and therapeutic protocol.

RESULTS

Diagnostic and therapeutic time were shortened, patients endurance improved and cost lowered.

DISCUSSION

We think that many diagnostic procedures are useless and delay operation that, if possible, must be performed according to principles of radical extirpation.

Aspartate aminotransferase activity in gingival crevicular fluid during orthodontic treatment. A controlled short-term longitudinal study

BACKGROUND

During orthodontic tooth movement, the early response of periodontal tissues to mechanical stress involves an acute inflammatory response, with a sequence characterized by periods of activation, resorption, reversal, and formation in both tension and compression sites. This study used a longitudinal design to examine aspartate aminotransferase (AST) activity in gingival crevicular fluid (GCF) in order to assess whether AST in GCF has potential as a possible diagnostic aid to monitor tooth movement and tissue response during orthodontic treatment.

METHODS

Eighteen patients (mean age, 16.1 years) participated in the study. An upper first molar from each patient undergoing treatment for distal movement served as the test tooth (TT), with its contralateral (CC) and antagonist (AC) first molars used as controls. The CC was included in the orthodontic appliance, but was not subjected to the orthodontic force; the AC was free from any orthodontic appliance. The GCF around the experimental teeth was collected from both mesial and distal tooth sites immediately before appliance activation, 1 hour after, and weekly over the following 4 weeks. Clinical gingival condition was evaluated at baseline and at the end of the experimental period. AST activity was determined spectrophotometrically at 30 degrees C, and the results were expressed as total AST activity (mU/sample).

RESULTS

Throughout the experiment, AST levels were significantly elevated in all sites from the TT and CC groups compared to the AC group where, conversely, AST activity remained at the baseline level. However, enzyme levels in the TT group were significantly greater than in the CCs at tension sites on day 14, and in compression sites on days 7 and 14. Moreover, AST activity from the TT group was significantly greater in compression sites than in tension sites on day 7; this was not observed for the CCs.

CONCLUSIONS

Our results suggest that AST levels in GCF reflect the biological activity which occurs in the periodontium during controlled occlusal trauma and, therefore, should be further evaluated as a diagnostic tool for monitoring correct orthodontic tooth movement in clinical practice.

Relationship between cervical lordosis and facial morphology in Caucasian women with a skeletal class II malocclusion: a cross-sectional study

Several published studies show a relationship between craniofacial morphology and head posture. The aim of this study was to evaluate the association between cervical lordosis angle and mandibular length from lateral skull radiographs, and to investigate the relationship between mandibular retrusion and cervical lordosis angle decreasing. The sample comprised 70 Caucasian adult women, average 27.4, in skeletal class II and Angle class II. Lateral skull radiographs were obtained in natural head position (mirror position). Ten morphological variables were individuated on tracings. In order to assess errors due to landmark identification, double measurements were made in ten randomly selected radiographs and were compared with Dahlberg's formula. A Sperman's rank correlation test showed a negative correlation (P < 0.01) between cervical lordosis and mandibular length (compensatory curvature of the cervical spine) and positive correlation between anterior cranial base and maxillary length (P < 0.05). Based upon the cross-sectional method, no conclusion was possible about the mechanism concerning these results. Future longitudinal studies in growing patients should be directed to understanding the extent of environmental and genotype influences on cervical lordosis angle.

Subpedicle acellular dermal matrix graft and autogenous connective tissue graft in the treatment of gingival recessions: a comparative 1-year clinical study

BACKGROUND

Many surgical techniques have been proposed for the correction of dental root exposition. Among these, bilaminar techniques (BTs) have been reported as offering the best results in terms of root coverage (RC). However, BTs require a second surgical site to harvest the graft, with discomfort for the patient. The use of an acellular dermal matrix (ADM) avoids the need for a donor site. The aim of this study was to compare the clinical results of 2 BTs by autogenous connective tissue (CT) or ADM.

METHODS

In 30 systemically healthy, non-smoking patients aged 34.5 +/- 5.2 years, who showed no periodontal pockets >4 mm after a hygienic phase, a Miller's class I or II gingival recession was treated for root coverage. All patients underwent a BT: in 15 patients, an autogenous connective tissue graft was employed (CT group); in the other 15 subjects, ADM was used as a subepithelial graft (ADM group). Prior to and 1 year after surgical treatment, the following clinical parameters were recorded: gingival recession (GR), probing depth (PD), clinical attachment level (CAL), width of keratinized tissue (KT), and gingival thickness (GT); the percentage of RC (%RC) was also calculated, and the data were statistically analyzed. The number of weeks needed to obtain complete healing with mature tissue appearance was also recorded.

RESULTS

Both groups yielded significant improvements in terms of GR decrease, CAL and KT gain, and GT increase as compared to baseline values. The mean %RCs were 88.80 +/- 11.65% and 83.33 +/- 11.40% in the CT and ADM groups, respectively. Complete RC was observed in 46.6% of patients from the CT group, and 26.6% of the ADM group patients. No significant differences were observed between the two techniques for GR, CAL, and GT improvements; however, the CT group produced a significantly (P <0.01) greater increase in KT as compared to the ADM group. Complete healing of the surgical procedure was observed 6.20 +/- 1.01 and 8.93 +/- 1.33 weeks after suture removal in the CT and ADM groups, respectively (P <0.001).

CONCLUSIONS

The CT and ADM subepithelial grafts were similarly able to successfully treat gingival recession defects; however, the CT group obtained a significantly greater increase in KT, and showed a quicker complete healing.

Immediate implantation in fresh extraction sockets. A controlled clinical and histological study in man

BACKGROUND

Early implantation may preserve the alveolar anatomy, and the placement of a fixture in a fresh extraction socket helps to maintain the bony crest. Although a number of clinical studies exist, no histological reports show the outcome of implantation in fresh extraction sockets without the use of membranes in humans compared to implants placed in mature bone.

METHODS

Forty-eight healthy patients, receiving at least 4 fixtures in each of 2 symmetrical quadrants, underwent placement of 1 experimental fixture placed in a fresh extraction socket (TI) and 1 contralateral fixture in mature bone (CI). TI were placed after atraumatical tooth extraction, with a surgical site at the apex of the socket and a tight contact between the fixture and the socket's walls, but without the use of filling materials or membranes. The flap was coronally repositioned to obtain primary wound closure. Immediately after surgical intervention, a standardized periapical radiograph was taken. Second-stage surgery was done after 6 months. Six months after the second surgery, a second standardized periapical radiograph was taken and clinical parameters (bleeding and plaque index) recorded. Marginal bone loss (MBL) from the time of implant placement to the time of fixture removal was calculated by comparing periapical radiographs. TI and CI were then removed by a hollow drill to obtain histological specimens. Non-demineralized sections were stained by acid fuchsin and toluidine blue, and by von Kossa to evaluate the degree of bone mineralization. The percentage of direct implant-bone contact (DBC) was calculated by a computerized microscopic digitizer.

RESULTS

No significant differences in the clinical and radiographic parameters were observed between the 2 experimental categories. There was no statistically significant difference between TI and CI for DBC either in the maxilla or in the mandible. No connective or fibrous tissues were present around TI or CI. Bone resorption was not present in any of the histological sections.

CONCLUSIONS

The present study shows that when a screw-type dental implant is placed without the use of barrier membranes or other regenerative materials into a fresh extraction socket with a bone-to-implant gap of 2 mm or less, the clinical outcome and degree of osteointegration does not differ from implants placed in healed, mature bone.

Kaempferide triglycoside: a possible factor of resistance of carnation (Dianthus caryophyllus) to Fusarium oxysporum f. sp. dianthi

A kaempferide triglycoside has been found as a constitutive component in an uninfected carnation (Dianthus caryophyllus) of the cultivar Novada. The chemical structure has been determined mainly by the use of spectroscopic methods, including 2D NMR experiments. It showed a strong activity in restricting fungal parasite development, which could contribute to the known ability of carnation cv. Novada to resist to Fusarium oxysporum f. sp. dianthi infection.

[Intraoperative lesions of the maxillary artery and its immediate treatment. Presentation of a clinical case]

The authors discuss the possible vascular lesions that may occur during mandibular sagittal split ramus osteotomies with particular regard to the maxillary artery. A case of surgical lesion of the maxillary artery is presented and its course and anastomoses are analyzed. The ligation of the external carotid artery and its principal branches is the treatment of choice in case of maxillary artery lesion which is a life threatening event and needs immediate intervention.

[Registry of genetic and malformative diseases in the province of Macerata]

OBJECTIVES

The aim of this epidemiological research is to evaluate the prevalence of genetic diseases and malformative syndromes in paediatric population living in the Macerata county.

MATERIAL AND METHODS

All the data were collected through a careful analysis of a specific questionnaire sent to all the family paediatricians.

RESULTS

23,379 children living in Macerata county, aged 0 to 9 years, were evaluated (93.8% of all this paediatric population). Among those were found N 400 cases of genetic diseases and malformative syndromes: Malformations Tot.N. 255 cases (63.3% of the reported cases); Malformative Syndromes Tot. N. 55 cases (27.8% of the reported cases); Endocrinology and Metabolic Diseases Tot. N. 41 cases (10.3% of the reported cases); Osteochondrodysplasia Tot. N. 22 cases (5.7% of the reported cases); Other Tot. N. 28 cases (7.0% of the reported cases); Male population was found more affected than female: M/F ratio = 1.4. The analysis of the data showed an increasing trend in detecting these pathological conditions, consistent with the increase in geographic altitude (3 areas considered): 0-100 meter = 0.88%; 100-600 m.a.s. = 1.34%; over 600 m.a.s. = 1.88%.

CONCLUSION

The knowledge of the number of children affected by genetic and malformative diseases in the Macerata county is relevant in order to establish a Genetic Service with the aim to better support the medical assistance of these patients and counselling service for the families.

Comparison among 18 hexyl esters of 1-naphthylacetic acid used on grapevine

Eighteen esters derived from 1-naphthylacetic acid (NAA) and from hexyl isomer alcohols were synthesized and sprayed on grapevine suckers at 1, 2, 4, and 8% w/w concentrations to test their sucker control efficiency 2, 10, and 30 days and 1 year after their application. All compounds gave a prompt control of suckers. After 1 year, sucker growth was inhibited by the derivatives from primary and secondary alcohols, whereas the number of suckers was reduced only by application of naphthyl acetates of tertiary alcohols.