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Purpose: To propose a method to measure the esthetics of the smile and to report its validation by means of an intra-rater and inter-rater agreement analysis., Materials and Methods: Ten variables were chosen as determinants for the esthetics of a smile: smile line and facial midline, tooth alignment, tooth deformity, tooth dischromy, gingival dischromy, gingival recession, gingival excess, gingival scars and diastema/missing papillae. One examiner consecutively selected seventy smile pictures, which were in the frontal view. Ten examiners, with different levels of clinical experience and specialties, applied the proposed assessment method twice on the selected pictures, independently and blindly. Intraclass correlation coefficient (ICC) and Fleiss' kappa) statistics were performed to analyse the intra-rater and inter-rater agreement., Results: Considering the cumulative assessment of the Smile Esthetic Index (SEI), the ICC value for the inter-rater agreement of the 10 examiners was 0.62 (95% CI: 0.51 to 0.72), representing a substantial agreement. Intra-rater agreement ranged from 0.86 to 0.99. Inter-rater agreement (Fleiss' kappa statistics) calculated for each variable ranged from 0.17 to 0.75., Conclusion: The SEI was a reproducible method, to assess the esthetic component of the smile, useful for the diagnostic phase and for setting appropriate treatment plans.

Purpose: The purpose of this clinical guidelines project was to determine the most appropriate surgical techniques, in terms of efficacy, complications, and patient opinions, for the treatment of buccal single gingival recessions without loss of interproximal soft and hard tissues., Methods: Literature searches were performed (electronically and manually) for entries up to 28 February, 2013 concerning the surgical approaches for the treatment of gingival recessions. Systematic reviews (SRs) of randomised controlled trials (RCTs) and individual RCTs that reported at least 6 months of follow-up of surgical treatment of single gingival recessions were included. The full texts of the selected SRs and RCTs were analysed using checklists for qualitative evaluation according to the Scottish Intercollegiate Guidelines Network (SIGN) method. The following variables were evaluated: Complete Root Coverage (CRC); Recession Reduction (RecRed); complications; functional and aesthetic satisfaction of the patients; and costs of therapies., Results: Out of 30 systematic reviews, 3 SRs and 16 out of 313 RCTs were judged to have a low risk for bias (SIGN code: 1+). At a short-term evaluation, the coronally advanced flap plus connective tissue graft method (CAF+CTG) resulted in the best treatment in terms of CRC and/or RecRed; in case of cervical abrasion and presence of root sensitivity CAF + CTG + Restoration caused less sensitivity than CAF+CTG. CAF produced less postoperative discomfort for patients. Limited information is available regarding postoperative dental hypersensitivity and aesthetic satisfaction of the patients., Conclusion: In presence of aesthetic demands or tooth hypersensitivity, the best way to surgically treat single gingival recessions without loss of interproximal tissues is achieved using the CAF procedure associated with CTG. Considering postoperative discomfort, the CAF procedure is the less painful surgical approach, while the level of aesthetic satisfaction resulted higher after CAF either alone or with CTG. It is unclear how much tooth hypersensitivity is reduced by surgically covering buccal recessions. It is important to note that the present recommendations are based on short-term data (less than 1 year)., Source of Funding: The guidelines project was made possible through self-financing by the authors.

Purpose: Toothbrushes are manufactured in different designs but it is unclear whether these differences may lead to improvement in the removal of bacterial plaque or make the toothbrushes more appealing to users. The aim of this study is to compare the efficacy of 11 toothbrushes in terms of plaque removal and their acceptance by patients., Materials and Methods: Eleven toothbrushes were randomly assigned to one of the 12 sectors of the mouth of 48 patients. Each patient underwent one plaque recording before and after toothbrushing. Eleven sectors of the mouth were brushed by 11 different toothbrushes, while one sector was used as a control (no toothbrushing). Two questionnaires were also administered to investigate the aesthetic and comfort preference by each participant., Results: All 11 toothbrushes resulted in effective plaque reduction with respect to the control sector (P < 0.0001). No significant differences were found between them. Colgate Massager showed the highest score for aesthetic preference by the patients when compared with Butler 311 and Gum Super Tip 463 (P = 0.0148). Oral-B Indicator 35 exhibited the highest score in terms of comfort felt by the patients compared to Colgate Omni and Gum Technique 493 (P = 0.0095)., Conclusions: All of the tested toothbrushes, even though different with respect to shape and scope of function, demonstrated efficacious plaque removal.

Purpose: To compare 100% deproteinised bovine bone matrix (DBBM) grafts (test group) with 100% autogenous bone (AB) grafts (control group) for lateral maxillary sinus floor elevation in a parallel group, superiority, randomised controlled trial., Materials and Methods: Patients with 1 to 3 mm of residual bone height below the maxillary sinus were randomised for sinus floor elevation with DBBM and AB grafts and simultaneous implant placement. Randomisation was computer generated with allocation concealment by sealed envelopes and the radiographic examiner was blinded to group assignment. The abutment connection was performed 8 months after surgery and insertion of the provisional prostheses was performed 9 months after surgery. Outcome variables were implant failures, prosthetic failures, complications, chair time, postoperative pain and radiographic bone level 6 months after loading., Results: Forty patients were randomised: 20 (32 implants) to the DBBM group and 20 (27 implants) to the AB group. One patient from the AB group dropped out. Two implant failures occurred in the DBBM group and no implant failure occurred in the AB group (P = 0.4872). All of the planned prostheses could be delivered. One complication occurred in the DBBM group and 2 in the AB group (P = 0.6050). Chair time was shorter for the DBBM group, with a difference of 27.3 minutes (P = 0.0428). Pain difference measured with a visual analogue scale for 6 days post-surgery was 0.2 in favour of the DBBM group (P = 0.6838). The difference in vertical bone height was 0.0 mm (95% CI -1.1, 1.1; P = 0.9703) and the difference in marginal bone level was 0.3 in favour of AB (95% CI -0.3, 0.9; P = 0.3220)., Conclusions: No differences apart from chair time were observed when comparing DBBM and AB grafts with simultaneous implant placement in sinus elevation.

Purpose: Several classification systems have been proposed in the literature, but none of them has been validated by means of an appropriate statistical analysis and, therefore, it is unknown whether these systems work in the same manner among different clinicians. The aim of the present study is to investigate the intra- and inter-rater agreement of a new system to classify gingival recession defects and to evaluate its agreement among different clinicians., Materials and Methods: A new classification system was proposed and tested considering the following three factors: the amount of keratinised tissue ( <2 or ≥2 mm), the presence / absence of non carious cervical lesions and the presence/ absence of interproximal attachment loss. Kappa-statistics were performed to analyse the intra-rater and inter-rater agreement among three blinded examiners., Results: A total of 120 gingival recessions were evaluated using the new classification system. The intra-rater agreement ranged from 0.74 to 0.96 for the variable keratinised tissue, from 0.67 to 0.94 for the variable non-carious cervical lesions and from 0.70 to 0.92 for the variable interproximal attachment loss. The inter-rater agreement values ranged from 0.70 to 0.85 for keratinised tissue, from 0.54 to 0.59 for non-carious cervical lesions and from 0.54 to 0.77 for the interproximal attachment loss., Conclusions: Based on the results of this study, the proposed new classification system showed moderate to substantial agreement among investigators when used in the present study population and was therefore able to diagnose the severity of gingival recession defects.

Purpose: The aim of this survey is to assess the different radiographic interpretations of simulated dental implant cases among a group of specialists in oral surgery., Material and Methods: A total of 76 active members of the Italian Society of Oral Surgery and Implantology were recruited for the study. The participants in the study were requested to assign scores to radiographic images of 12 simulated cases of dental implants: a baseline and follow-up image for cases with different bone loss (0, 1 or 5 mm), implant length (8 or 12 mm) and years of follow-up (1 or 5 years)., Results: In total, 63 active members agreed to participate in the survey. The inter-rater agreement was 0.86 (CI 95% 0.74; 0.95). In cases where the bone loss was absent (0 mm) no difference was detected at 1 or 5 years of follow-up. In contrast, when bone loss was present (1 or 5 mm) the longer follow-up (5 years) revealed the highest score. The lowest score was attributed to 5 mm of bone loss and 1 year of follow-up. Moreover, a significant difference between the short (8 mm) and the long (12 mm) implant was observed (score difference 0.45; CI 95% 0.28; 0.63)., Conclusions: This investigation suggests that subjective evaluation of radiographs on simulated implants by skilled clinicians is rather uniform, and bone loss, follow-up and implant length are factors considered in the perception of implant success.

Aim: The aim of the present explorative cross-sectional study was to evaluate the potential role of some periodontal variables in predicting sub-clinical atherosclerosis and systemic inflammation in young adults (