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This paper gathers some contributions concerning survey methodology in dental research, as discussed during the first Workshop of the SISMEC STATDENT working group on statistical methods and applications in dentistry, held in Ancona on the 28th September 2011. The first contribution deals with the European Global Oral Health Indicators Development (EGOHID) Project which proposed a comprehensive and standardized system of epidemiological tools (questionnaires and clinical forms) for national data collection on oral health in Europe. The second contribution regards the design and conduct of trials to evaluate the clinical efficacy and safety of toothbrushes and mouthrinses. Finally, a flexible and effective tool used to trace dental age reference charts tailored to Italian children is presented.

Caries and periodontal diseases are highly neglected disease affecting millions of Italian children; both diseases are preventable and the combination of high prevalence, high morbidity and a relative lack of attention of the Italian National Health Service make caries and periodontal disease a significant public health problem. To date none studies reported epidemiological data of 6–7-year-old-italian-children-population. The aim of this survey was to describe the dental and periodontal health status in 6- and 7-year-old schoolchildren from Palermo and to evaluate the association between socioeconomic determinants and behavioural habits. A sample of 2701 children aged 6 and 7 from the selected public schools in all the eight districts of the town received a clinical intraoral examination carried out by trained dentists. Parents were asked to fill in a questionnaire investigating children’s eating habits, oral health related behaviours and socioeconomic determinants of the household. The percentage of 6- and 7-year-old schoolchildren with at least one carious lesion was found to be 66.5%. A higher mother’s and father’s educational level were a protective factor for carious lesions; conversely, a paternal unemployment was found to be a risk factor. Living in II and VII districts was a risk factor for all stages of carious lesions. KEY WORDS: Dental caries; Schoolchildren; Oral health-related determinants; Caries risk factors; ICDAS II; Caries epidemiology; Deprivation index; Oral health promotion; Dental sealants; Di.Chir.On.S 2021

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents, and it is also a potentially painful and debilitating condition. To date, no specific studies have prospectively evaluated the efficacy of its treatment and no robust standard of care has been established. Therefore, a systematic review (2007–2020) with a pooled analysis was performed in order to compare MRONJ surgical techniques (conservative or aggressive) versus combined surgical procedures (surgery plus a non-invasive procedure), where 1137 patients were included in the pooled analysis. A statistically significant difference in the 6-month improvement rate, comparing combined conservative surgery versus only aggressive (91% versus 72%, p = 0.05), was observed. No significant difference regarding any group with respect to the 6-month total resolution rate (82% versus 72%) was demonstrated. Of note, conservative surgery combined with various, adjuvant, non-invasive procedures (ozone, LLLT or blood component + Nd:YAG) was found to achieve partial or full healing in all stages, with improved results and the amelioration of many variables. In conclusion, specific adjuvant treatments associated with minimally conservative surgery can be considered effective and safe in the treatment of MRONJ, although well-controlled studies are a requisite in arriving at definitive statements

The present study aimed to evaluate the characteristics and quality of statistical methodology used in clinical studies on dentin hypersensitivity management. An electronic search was performed for data published from 2009 to 2014 by using PubMed, Ovid/MEDLINE, and Cochrane Library databases. The primary search terms were used in combination. Eligibility criteria included randomized clinical trials that evaluated the efficacy of desensitizing agents in terms of reducing dentin hypersensitivity. A total of 40 studies were considered eligible for assessment of quality statistical methodology. The four main concerns identified were i) use of nonparametric tests in the presence of large samples, coupled with lack of information about normality and equality of variances of the response; ii) lack of P-value adjustment for multiple comparisons; iii) failure to account for interactions between treatment and follow-up time; and iv) no information about the number of teeth examined per patient and the consequent lack of cluster-specific approach in data analysis. Owing to these concerns, statistical methodology was judged as inappropriate in 77.1% of the 35 studies that used parametric methods. Additional studies with appropriate statistical analysis are required to obtain appropriate assessment of the efficacy of desensitizing agents.

OBIETTIVI Scopo del presente lavoro è fornire agli specialisti della salute orale la descrizione delle caratteristiche del colloquio narrativo, inteso come differente dalla tradizionale anamnesi e in grado di rilevare l’universo del paziente, alla base del processo di umaniz-zazione delle cure in odontostomatologia, e illustrare un modello di umanizzazione di cure odontoiatriche. METODI Nell’articolo vengono descritti i punti chiave del processo di umanizzazione delle cure e come tale pratica sia stata integrata nella U.O. di Medicina Orale, A.O.U. P. Giaccone di Palermo per l’approccio al paziente fragile. La comunità scientifica ha già messo in discussione il tradizionale approccio medico incentrato sulla malattia e pone sempre più attenzione al coinvolgimento del paziente nel processo di diagnosi e cura; nel caso della pratica odontoiatrica, ogni volta che un paziente si siede sulla poltrona porta con sé una storia, la sua e quella del suo apparato stomatognatico. Pertanto, nell’ottica di ottimizzare le cure risulta utile ripensare il rapporto odontoiatra-paziente: non si fa buona pratica clinica senza ascoltare empaticamente la storia dei pazienti, le loro rappresentazioni e percezioni, i loro vissuti. Diventa, così, necessario organizzare setting migliori e più efficaci dove sia possibile inserire, con naturalezza routinaria, un adeguato ascolto attivo e adottare tecniche di comunicazione specifiche. Quindi, l’anamnesi tecnicamente corretta con raccolta asettica di informazioni lascia il posto al colloquio narrativo per permettere all’operatore di riflettere su cosa significa avere a che fare con la tematica illness del paziente oltre che con il problema disease. Gli autori illustrano la loro esperienza e il loro modello di team management odontoiatrico in chiave narrativa per l’umanizzazione delle cure. OBJECTIVES The purpose of this paper is to provide the oral health specialists the characteristics of the narrative interview, understood as different from the traditional anamnesis and able to detect the patient’s universe, basis of the humanization process in dentistry, and to show a clinical model of humanization of dental care. METHODS This article describes the key points of the process of humanization in dentistry and as such practice has been integrated into the Unit of Oral Medicine, at University Hospital of Palermo, in order to support to the patients’ frailty. The scientific community has questioned the traditional medical approach focused on the disease and pays increasing attention to the patient’s involvement in the diagnosis and treatment process. In the case of dental medical practice, every time a patient sits in the dental chair he brings with him a story, that of his stomatognathic system. Therefore, in order to optimize treatments, it is useful to rethink the dentist/patient relationship today: good clinical practice is not done without empathically listening to the patients’ history, their representations, perceptions, and experiences. Thus, it becomes necessary to organize better and more effective settings where it is possible to insert, routinely, adequate active listening and adopt specific communication techniques. So, the anamnesis technically correct as aseptic collection of information, is replaced by the narrative interview, in order to allow the clinicians to truly understand the meaning of patients’ illness, and not only to contemplate the disease features. The authors illustrate their experience of dental team management in a narrative key.

OBIETTIVI Obiettivo di questo lavoro è proporre una revisione critica della letteratura sulle pigmentazioni orali indotte dalla clorexidina, in particolare sul meccanismo di formazione delle pigmentazioni, sulla loro prevalenza, sui fattori che ne influenzano l’insorgenza e la gravità e sull’efficacia clinica del sistema antipigmentazione a base di sodio metabisolfito e di acido ascorbico (ADS). MATERIALI E METODI È stata effettuata una ricerca bibliografica utilizzando in combinazione le seguenti parole chiave: Chlorhexidine, Mouthwash, Staining, Anti-Discoloration System, Gingivitis, Plaque. Sono stati presi in considerazione articoli scientifici e revisioni della letteratura in inglese, in tedesco e in italiano. La valutazione della letteratura sull’efficacia dell’ADS è stata effettuata su 12 studi clinici randomizzati e controllati che valutavano l’efficacia antipigmentante e l’effetto sulla placca e sulla gengivite di collutori contenenti clorexidina e ADS disponibili in commercio sul mercato italiano. Non sono stati presi in considerazione gli studi clinici che hanno testato sistemi antipigmentazione diversi dall’ADS. RISULTATI Sono stati presentati i meccanismi coinvolti nella formazione delle pigmentazioni (reazione di imbrunimento non enzimatico di Maillard, formazione di solfuri di ferro e stagno, precipitazione di cromogeni alimentari, suscettibilità individuale) e la loro prevalenza. I fattori che influenzano insorgenza e gravità delle pigmentazioni sono rappresentati dalla concentrazione della clorexidina, dalla presenza di placca sulle superfici dentarie, dall’assunzione di cibi e bevande cromogene e dal fumo di tabacco, veicolo di sostanze cromogene. L’ADS è un sistema antipigmentazione brevettato a partire dal 2003 e presente in collutori contenenti clorexidina commercializzati in Italia. La sua azione antipigmentante si esplica mediante ini-bizione della reazione di imbrunimento non enzimatico e della for-mazione di solfuri metallici cromogeni. La maggior parte degli studi ha evidenziato che il collutorio contenente ADS è efficace nell’inibire la formazione di pigmentazioni, mantenendo sia l’attività antiplacca che quella inibente l’infiammazione gengivale. Una recente metanalisi, condotta su risultati ottenuti da studi clinici che testavano anche sistemi alternativi all’ADS, ha confermato tali risultati, con qualità delle prove da debole a moderata. CONCLUSIONI Dall’analisi dei 12 studi presi in esame emerge una rilevante variabilità metodologica, che potrebbe essere responsabile della non univocità dei risultati, con particolare riferimento all’attività antiplacca. Sono auspicabili ulteriori studi randomizzati e controllati con disegno omogeneo, soprattutto in relazione alla sospensione delle manovre di igiene orale durante l’utilizzo del collutorio, al controllo dei cromogeni alimentari, al timing della rilevazione degli indici e all’inclusione di pazienti parodontopatici o sottoposti a chirurgia parodontale. SIGNIFICATO CLINICO I risultati di una recente metanalisi indicano che i sistemi antipigmentazione contenuti nei collutori sono efficaci nel prevenire la formazione di pigmentazioni soltanto quando l’uso del collutorio non è associato alle manovre di igiene orale domiciliare (prove di qualità moderata). La metanalisi indica altresì che l’aggiunta di un sistema antipig¬mentazione non influenza negativamente l’efficacia clinica della clorexidina (prove di qualità da debole a moderata). OBJECTIVES To propose a critical review on chlorhexidine-induced oral discoloration, including the mechanisms, the prevalence and the factors influencing onset and severity. Additionally, this paper investigates the clinical efficacy of the Anti-Discoloration System based on sodium metabisulfite and ascorbic acid (ADS). MATERIALS AND METHODS A literature search was conducted using in combination the following keywords: Chlorhexidine, Mouthwash, Staining, Anti- Discoloration System, Gingivitis, Plaque. Scientific papers and literature reviews in English, German and Italian were included. The literature evaluation on the efficacy of ADS was performed including 12 randomized controlled clinical trials designed to assess the anti-plaque, anti-gingivitis and anti-discoloration effects of mouthwashes containing chlorhexidine and ADS. These mouthwash products were commercially available in Italy. Clinical studies that tested Anti- Discoloration Systems different from ADS were not considered. RESULTS The possible mechanisms involved in the development of oral discolorations (non-enzymatic browning reaction, also known as the Maillard reaction, formation of iron and tin sulfides, precipitation of food chromogens, individual susceptibility) and the prevalence of pigmentations were presented. The factors that influence the onset and severity of pigmentations include chlorhexidine concentration, plaque on tooth surfaces, dietary consumption of food and beverages containing chromo¬gens, and tobacco smoking. The ADS is an Anti-Discoloration System patented since 2003 and added to mouthwashes available on the Italian market. The ADS reduces tooth discolorations by inhibiting non-enzymatic browning reaction and formation of chromogenic metal sulphides. Most studies showed that the mouthwash containing ADS is ef¬fective in reducing tooth discolorations while maintaining the ch-lorhexidine efficacy with respect to reduction of plaque and gingivitis. These results were confirmed by a meta-analysis including clinical trials testing both ADS and systems alternative to ADS (qua-lity of the evidence: weak to moderate). CONCLUSIONS In the 12 studies included considerable methodological heterogeneity was observed and this could be responsible for the discrepancy in results, particularly with respect to anti-plaque activity. Further clinical trials, homogenous in design, are needed. The inclusion of periodontitis patients and/or undergoing periodontal surgery, diet restrictions, timing of recording plaque and gingivitis indices, and suspension of oral hygiene are potentially important with respect to design homogeneity. CLINICAL SIGNIFICANCE A recent meta-analysis confir¬med that the addiction of an Anti-Discoloration System to chlorhexidine mouthwash reduces tooth discoloration in situations in which toothbrushing is not involved (quality of the evidence: moderate). Meta-analysis also indicated that the addiction of an Anti-Discoloration System does not affect the anti-plaque and anti-gingivitis efficacy of chlorhexidine (quality of the evidence: weak to moderate).

The aim of this narrative review is to investigate the implication of mesenchymal stem cells harvested from human dental pulp in in vivo bone tissue regeneration. We focused on studies related to roles of human dental pulp stem cells in in vivo bone regeneration. A total of 1021 studies were identified; after the assessment of eligibility, only 39 studies were included in the review. The evaluated information of the studies regards the experimental strategies (e.g., the isolation method, the scaffold, the in vivo animal models). The overall main evidences highlighted from the analysis are that dental pulp stem cells and human-exfoliated deciduous teeth stem cells supported by a suitable scaffold should be considered a valuable source for bone tissue regeneration.

Background Chronic periodontal disease is an infectious disease consisting of prolonged inflammation of the supporting tooth tissue and resulting in bone loss. Guided bone regeneration procedures have become common and safe treatments in dentistry, and in this context dental stem cells would represent the ideal solution as autologous cells. In this study, we verified the ability of dental pulp mesenchymal stem cells (DPSCs) and gingival mesenchymal stem cells (GMSCs) harvested from periodontally affected teeth to produce new mineralized bone tissue in vitro, and compared this to cells from healthy teeth. Methods To characterize DPSCs and GMSCs, we assessed colony-forming assay, immunophenotyping, mesenchymal/stem cell phenotyping, stem gene profiling by means of flow cytometry, and quantitative polymerase chain reaction (qPCR). The effects of proinflammatory cytokines on mesenchymal stem cell (MSC) proliferation and differentiation potential were investigated. We also observed participation of several heat shock proteins (HSPs) and actin-depolymerizing factors (ADFs) during osteogenic differentiation. Results DPSCs and GMSCs were successfully isolated both from periodontally affected dental tissue and controls. Periodontally affected dental MSCs proliferated faster, and the inflamed environment did not affect MSC marker expressions. The calcium deposition was higher in periodontally affected MSCs than in the control group. Proinflammatory cytokines activate a cytoskeleton remodeling, interacting with HSPs including HSP90 and HSPA9, thioredoxin-1, and ADFs such as as profilin-1, cofilin-1, and vinculin that probably mediate the increased acquisition in the inflamed environment. Conclusions Our findings provide evidence that periodontally affected dental tissue (both pulp and gingiva) can be used as a source of MSCs with intact stem cell properties. Moreover, we demonstrated that the osteogenic capability of DPSCs and GMSCs in the test group was not only preserved but increased by the overexpression of several proinflammatory cytokine-dependent chaperones and stress response proteins. Electronic supplementary material The online version of this article (doi:10.1186/s13287-017-0633-z) contains supplementary material, which is available to authorized users.

This retrospective study investigated, in two cohorts of subjects living in Southern Italy and awaiting treatment for oral squamous cell carcinoma (OSCC), the variables related to diagnostic delay ascribable to the patient, with particular reference to the cognitive and psychological ones. A total of 156 patients with OSCC (mean age: 62 years, M/F: 2.39∶1) were recruited at the Universities of Palermo and Naples. Risk factors related to patient delay included: sociodemographic, health-related, cognitive and psychological variables. The analysis was conducted by considering two different delay ranges: dichotomous (≤1 month vs. >1 month) and polytomous (3 months) delay. Data were investigated by univariate and multivariate analyses and a P value ≤0.05 was considered statistically significant. For both delay measurements, the most relevant variables were: 'Personal experience of cancer' (dichotomous delay: P=0.05, odds ratio (OR)=0.33, 95% confidence interval (CI)=0.11-0.99; polytomous delay: P=0.006, Chi-square=10.224) and 'Unawareness' (dichotomous delay: P

Obiettivi. Il fumo di sigaretta, seconda causa di morte nel mondo, e l’abuso di alcol, una delle principali cause di mortalità e morbilità, costituiscono importanti fattori di rischio per le patologie del cavo orale. Scopo di questo lavoro è presentare gli effetti del fumo di sigaretta e dell’abuso di alcol sulla salute orale. Sono inoltre illustrate le modalità di realizzazione di interventi di cessazione dell’abitudine al fumo nell’ambito dell’attività professionale dell’odontoiatra e dell’igienista dentale. Materiali e metodi. Attraverso la banca dati Medline/Pubmed sono stati selezionati i lavori originali, le revisioni della letteratura e le linee guida in lingua inglese e in italiano pubblicati sull’argomento dal 2006 al primo trimestre del 2013. Altre fonti sono state scelte dai riferimenti bibliografici selezionati. Risultati e conclusioni. Il fumo rappresenta il più importante fattore di rischio per il carcinoma a cellule squamose della mucosa orale e per le lesioni potenzialmente maligne; l’abuso di alcol, associato al fumo, aumenta in modo sinergico il rischio di insorgenza del carcinoma orale. Il fumo, inoltre, dopo la placca batterica, è il secondo fattore di rischio per l’insorgenza e la progressione della parodontite cronica, mentre ulteriori studi sono necessari per stabilire un analogo ruolo per il consumo di alcol. L’approccio delle “5 A” rappresenta una modalità di intervento efficace che i componenti del team odontoiatrico possono attuare con tutti i pazienti fumatori. I pazienti impegnati in tentativi di cessazione del fumo dovrebbero far ricorso alla terapia sostitutiva nicotinica, o all’assunzione di bupropione a rilascio controllato o di vareniclina, per incrementare significativamente le probabilità di successo del tentativo di cessazione. Objectives. Cigarette smoking, the second cause of death worldwide, and alcohol abuse, a leading cause of mortality and morbidity, are major risk factors for oral diseases. The aim of this paper is to present the effects of cigarette smoking and alcohol abuse on oral health. Specific strategies are also proposed to develop smoking cessation interventions in the office practice of dentists and dental hygienists providing. Materials and methods. Original papers, reviews and guidelines on this subject, published in English and in Italian from 2006 to the first trimester of 2013, were located in the Medline/Pubmed database. Additional publications were obtained by searching the reference list of retrieved works. Results and conclusions. Cigarette smoking is the most important risk factor for oral squamous cell carcinoma and potentially malignant oral lesions; alcohol abuse increases oral cancer risk in a synergistic fashion. Moreover, cigarette smoking is the second risk factor for chronic periodontitis, after dental plaque, whereas further studies are needed to assess the role of alcohol consumption on onset and progression of chronic periodontitis. The “Five A’s” approach represents an effective protocol for smoking cessation that members of dental team can use with all smoker patients. The patients attempting to quit should use the nicotine replacement therapy, sustained-release bupropion or varenicline in order to significantly increase success rate of quit attempt.

The use of topically applied fluoride has been widely researched as a means to reduce the risk of dental caries in conjunction with other treatment modalities (mechanical oral hygiene, dietary control, antimicrobial intervention, pit and fissure sealants). There is overwhelming evidence that reports not only the significance and importance of the use of fluoride as a caries-preventive agent, but also how safe fluoride application is when used appropriately, particularly in higher risk individuals and populations. This paper reviews the caries-protective benefits of topical fluoride application in children and adolescents, with an emphasis on the clinical efficacy and safety of the vehicles by which fluoride is topically delivered. Fluoride toothpaste represents today the most cost-effective fluoride-delivery system in the oral cavity and its use should be the centerpiece in all caries-preventive strategies. On the other hand, mouthrinses, gels and varnishes currently represent adjuncts to toothpaste use and should be targeted towards individuals and groups at high risk of caries.

Oral Diseases (2012) 18, 396–401 Objective: The aim of this study is to assess the main oral mucosal lesions (OMLs) within a hospital base and to provide an anamnestic, diagnostic model based on homogeneity analysis of some variables. Methods: The demographic and behavioural data (i.e. gender, age, smoking status, alcohol consumption and therapeutic drug usage) of 1753 patients with at least one OML were considered. Multiple correspondence analysis (MCA) and multivariate tests of the simultaneous marginal homogeneity hypothesis (SMH) were used to analyse the evidence of any differences between the demographic and behavioural profiles relating to OMLs diagnoses. Statistical significance of P

Objective: Desquamative gingivitis (DG) represents the gingival manifestation associated with several mucocutaneous disorders and systemic conditions. Little is known of whether or not DG could influence the onset or progression of plaque-related periodontitis. In this study, the potential impact of DG on plaque-related attachment loss and pocket formation has been evaluated. Methods: A cross-sectional evaluation of 12 patients with DG [eight oral lichen planus (OLP), four mucous membrane pemphigoid (MMP)], never treated for DG lesions or plaque-related periodontitis, was carried out. Probing depth (PD), clinical attachment loss (CAL), full-mouth plaque (FMPS), and bleeding (FMBS) scores were evaluated at six sites per tooth. Clinical parameters of sites with DG lesions were compared with that of DG unaffected sites. Results: Median PD and CAL, as well as FMPS and FMBS, were not significantly different (P > 0.05 Mann–Whitney test) for both OLP and MMP patients. However, a negative association between DG lesions and PD 6 mm (only for OLP: OR = 3.83) were found to be significant. Conclusions: The potential interference between DG lesions and periodontitis needs further prospective investigation; nonetheless, a higher level of attention might be prudent.

Background: The side effects of chlorhexidine (CHX) have stimulated the search for alternative antiplaque agents such as amine fluoride/stannous fluoride (ASF) and essential oils (EO). The aim of the study was to investigate the plaqueinhibiting effects of two commercially available mouthrinses containing ASF and EO, respectively. Methods: The study was an observer-masked, randomized, 5 · 5 Latin square cross-over design, balanced for carryover effects, involving 15 volunteers in a 4-day plaque regrowth model. A 0.12% CHX rinse and a saline solution served as positive and negative controls, respectively. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced rinsing with their allocated rinses. On day 5, subjects were scored for disclosed plaque. The ASF rinse was tested at two dosages: 10 and 20 ml (ASF-10 and ASF-20, respectively). Results: The ASF and EO rinses showed a significant inhibition of plaque regrowth compared to saline (P 0.05). There was no correlation between the occurrence of side effects and the use of a particular rinse product (P >0.2). Conclusions: ASF and EO mouthrinses exerted effective and similar plaque inhibition. The two dosages tested for ASF did not differ in plaque reduction. These findings, together with those from long-term trials, suggest that ASF and EO rinses may represent effective alternatives to CHX rinse as adjuncts to oral hygiene.

Background: The main therapeutic approach for periodontal diseases is mechanical treatment of root surfaces via scaling and root planing (SRP). Multicenter clinical trials have demonstrated that the adjunctive use of a chlorhexidine (CHX) chip is effective in improving clinical results compared to SRP alone. However, some recent studies failed to confirm these clinical results, and conflicting results were reported regarding the effects of the CHX chip on subgingival microflora. The aim of this study was to provide further data on the clinical and microbiologic effects of CHX chips when used as an adjunct to SRP. Methods: A total of 116 systemically healthy individuals with moderate to advanced periodontitis, aged 33 to 65 years, were recruited from the Departments of Periodontology of four Italian universities. For each subject, two experimental sites were chosen that had probing depths (PD) >= 5 mm and bleeding on probing (BOP) and were located in two symmetric quadrants. These two sites were randomized at the split-mouth level, with one receiving SRP treatment alone and the other receiving treatment with SRP plus one CHX chip (SRP + CHX). PD, relative attachment level (RAL), and BOP were evaluated at baseline, prior to any treatment, and after 3 and 6 months. Supragingival plaque and the modified gingival index were evaluated at baseline and after 15 days and 1, 3, and 6 months. Subgingival microbiologic samples were harvested at baseline and after 15 days and 1, 3, and 6 months, cultured for total bacterial counts (TBCs), and investigated by polymerase chain reaction analysis for the identification of eight putative periodontopathogens. Results: When all of the pockets were considered, the PD and RAL were significantly less at 3 and 6 months compared to the baseline scores (P= 7 mm were considered. The percentage of sites positive for BOP was similar between the treatments at each time point. At 15 days and I month, the TBC for the SRP + CHX treatment group was significantly lower than for the SRP treatment group (P

Background: Chronic desquamative gingivitis (DG) is a condition characterized by erythema, ulceration, and desquamation of the free and attached gingiva, usually expression of a district-systemic disease, such as oral lichen planus (OLP). Methods: A combined protocol of oral hygiene and topic corticosteroid therapy was applied in 30 patients with DG associated with OLP. Plaque index (PI) and bleeding on probing (BoP) were evaluated at baseline and after 3 months. Results: PI scoring was significantly lower after treatment in anterior, posterior, and all sites (P

Summary Objectives To evaluate the antibacterial activity of four endodontic sealers: one epoxy resin sealer (AH Plus), two zinc oxide eugenol (ZOE)-based sealers (Endomethasone, Pulp Canal Sealer), and one sealer containing both ZOE and orthophenilphenol (Vcanalare). Methods A direct contact test (DCT) was performed. A 10 μl suspension of Enterococcus faecalis was placed on the test material 20 min, 24 h and 7 days after mixing. Bacteria were allowed to directly contact the sealers for 1 h at 37 °C. Bacterial growth was then spectrophotometrically measured every 30 min for 7 h, and again after 24 h as well. Results All freshly mixed sealers showed complete inhibition of bacterial growth. Similar results were obtained with the 24-h-old samples, with the exception of AH Plus. Vcanalare was the only sealer still inhibiting bacterial growth 7 days after mixing. Conclusions The antimicrobial activity of the tested sealers depends on the time interval between mixing and testing. All sealers exhibit bactericidal effect when freshly mixed, but only Vcanalare extended this effect until 7 days after setting.

Candida pararugosa was first isolated from human feces, but after the initial description no further recovery from humans has been reported. During a study on oral Candida colonization in denture wearers living in Palermo (Italy), we isolated C. pararugosa from a 61-year-old woman without signs of oral candidosis. This constitutes, to the authors' knowledge, the first isolation of C. pararugosa from the oral cavity. After six months, colonization by C. pararugosa persisted, suggesting that this species could be a component of the normal oral microbiota. The identification procedure we used could be useful in elucidating the epidemiology of C. pararugosa and for establishing its clinical significance.

Candida dubliniensis, an emerging oral pathogen, phenotypically resembles Candida albicans so closely that it is easily misidentified as such. The aim of the present study was to evaluate the usefulness of two phenotypic methods, growth at 45 degrees C and 2,3,5-triphenyltetrazolium chloride (TTC) reduction, for confirming presumptive identification of C. dubliniensis and C. albicans by colony color on CHROMagar Candida (CAC) medium. A combination of these methods was used to establish the prevalence of oral C. dubliniensis in an Italian population of 45 human immunodeficiency virus (HIV)-infected subjects. Twenty-two samples (48.9%) were positive for yeasts on CAC medium producing a total of 37 fungal isolates. The colony color and 45 degrees C growth ability test correctly identified all C. dubliniensis and C. albicans isolates (5/37, 13.5%, and 16/37, 43.2%, respectively), while assessment of TTC reduction misidentified one C. albicans isolate. The isolation rate of C. dubliniensis was 11.1% (5/45 patients). All of the C. dubliniensis isolates were highly susceptible to fluconazole (MIC = 0.5 microg/ml). The combination of CAC medium screening with growth at 45 degrees C and TTC reduction tests may represent a simple, reliable and inexpensive identification protocol for C. dubliniensis.

Objectives. We sought to assess asymptomatic oral carriage of Candida species and relative density in human immunodeficiency virus-infected (HIV+) subjects, as well as to determine whether yeast carriage is associated with CD4+cell count, HIV-1 RNA quantity, gender, route of HIV transmission, antiretroviral therapy, or smoking. Study Design. A cross-sectional analysis of oral rinses from HIV+ and healthy subjects was undertaken. Oral candidal carriage and relative species were investigated in 42 HIV+ and 41 healthy individuals, all of whom were seen at the Palermo University Department of Oral Sciences, Italy. Data were managed and analyzed by means of the computer software package StatView 5.0.1. Results. Carriage rate was 61.9% and 29.3% (P =.003) among HIV+ and healthy subjects, respectively. Similarly, density carriage in the HIV+ group was found to be significantly higher than in the control group (P =.0002). Among HIV+ subjects, Candida carriage was significantly associated with smoking, whereas density was not. Oral candidal carriage and relative density were not significantly associated with the other 4 parameters evaluated. Candida albicans was the most frequently recovered species. Conclusions. Asymptomatic candidal carriage and relative density were found to be significantly higher in the oral cavity of HIV+ subjects—but not associated with CD4+counts or HIV-1 RNA quantities. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:281-6)

Objective: The purpose of this study was to investigate the relationship between oral lesions and gender, age, CD4+ cell count, human immunodeficiency virus-1 (HIV-1) viral load, antiretroviral therapy, and route of transmission in a group of HIV-infected (HIV+) persons from the Mediterranean region. Study Design: The participants in this study were HIV+ adults who sought dental care between January 1999 and June 1999 in the Department of Oral Medicine (University of Palermo, Italy). Results: One hundred thirty-six HIV+ adults came in for an initial oral examination. Their mean age was 35.2 years (SD ± 7.97), and 33% were women. Their mean CD4+ cell count was 325.3 × 106 /L (SD ± 225.8), and their HIV-1 viral load was 39,168.3 copies/mL (SD ± 144,256.1). Oral lesions were found in 47% of the study group, as well as in 56.5% of women (n = 46) versus 45.5% of men (n = 90; P = .05). Oral candidiasis was the most common disease; it is significantly associated with women (P = .004), CD4+ cell count (P = .005), and HIV-1 viral load (P = .0003). No significant relationships were found between any types of oral lesions and age, antiretroviral therapy, or route of transmission (P > .2). Conclusion: The prevalence of HIV-related oral lesions was significantly higher in women than in men, especially for oral candidiasis, the most common lesion observed related to immune status and HIV-1 viral load.(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:546-51)

Objective. Antimicrobial mouthrinses may represent a valid alternative to topical antifungal agents. However, the action of antimicrobials could be affected by the different ingredients incorporated into mouthrinse products. The purpose of the present study was to investigate the in vitro antifungal and fungicidal activities of antimicrobials alone. Study Design. A broth macrodilution method was used to determine the minimum inhibitory concentration of 4 antimicrobial agents against Candida species. Minimum fungicidal concentration was also determined. Results. All antimicrobials showed antifungal activity against all tested organisms, but cetylpyridinium chloride received significantly lower minimum inhibitory concentrations (P < .005). Cetylpyridinium chloride also showed a greater fungicidal activity than chlorhexidine digluconate and hexetidine (P < .005), whereas sanguinarine chloride appeared to be less fungicidal against most of the isolates tested. Conclusions. These findings suggest that cetylpyridinium chloride may be used as a topical antifungal agent. Clinical trials are now required to assess its value in the management of oral candidosis.(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:44-9)

The factors associated with cyclosporin A (CsA)- and nifedipine (Nif)-induced gingival overgrowth were investigated in 113 renal transplant recipients receiving CsA alone (Group 1) [n = 61], CsA and Nif (Group 2) [n = 28], or azathioprine (Aza) (Control Group) [n = 24]. Periodontal and pharmacological parameters were assessed for each patient. The patients with a gingival overgrowth index (GOI) score1 were considered responders (R); those with a score/= 1 were non-responders (NR). Gingival overgrowth occurred in 33.7% of the patients in Groups 1 and 2; 60% of the responders were receiving CsA+Nif. In R, no relationship was found between the GOI and the periodontal and pharmacological parameters, and although there was a trend towards an increased presence of HLA-A19 antigen (chi-square=4.40; P=0.04; RR=2.86), no significant difference was found between R and NR (Pc0.05). It is concluded that the prevalence and severity of gingival overgrowth are greater in patients receiving CsA+Nif. As overgrowth appeared to be unrelated to local irritants, gingival inflammation or pharmacological parameters, it may be related to individual susceptibility.

Objectives: A series of patients affected by desquamative gingivitis (DG) was investigated in order to evaluate relation patterns among clinical parameters relevant to plaque induced periodontitis, periodontal microbiological data and the presence of DG lesions. Patients and methods: Eight oral lichen planus (OLP) and four mucous membrane pemphigoid (MMP) patients were examined. Periodontal measurements (performed at six sites per tooth on all teeth) included probing depth (PD), gingival recession (REC), clinical attachment loss (CAL) and full mouth plaque (FMPS) and bleeding (FMBS) scores; the presence and the exact location (site by site) of DG lesions were carefully recorded. Sub-gingival plaque samples were collected and examined by means of real-time PCR for the quantitative determination of the six most important marker organisms of periodontitis. Statistically significant differences and correlation of studied variables between DG-positive and DG-negative sites were investigated in MMP and OLP cases using Mann–Whitney test (p

Summary Background The risks/benefits balance of hormone replacement therapy (HRT) is controversial. The aim of this study was to assess the periodontal status of a postmenopausal women group receiving HRT and to determine the effects of HRT on clinical measures of periodontal disease. Material/Methods Ninety-one postmenopausal women, 52 taking HRT (HRT+) and 39 not taking HRT (HRT−), completed the study. Clinical parameters measured included visible supragingival plaque, probing pocket depth (PD) and clinical attachment level (CAL). Gingival status was recorded as gingival bleeding on probing (BOP). Previous oral contraceptive use and current and past smoking status were also assessed. Results Data indicated that PD and CAL were not significantly different between HRT+ patients and HRT− patients (P=0.8067 and P=0.1627, respectively). The HRT+ group exhibited significantly lower visible plaque levels compared to the control group (P

The aim of this study was to evaluate the level of edentulousness and the prosthetic treatment need in a sample of the over 18-year-old inhabitants of Palermo (Italy). A stratified sample of 385 subjects (183 female and 202 male) was taken to represent the population of the city. Each subject included in the study was examined to record the level of edentulousness (complete edentulousness, partial edentulousness, intact dentition) and the level of denture wearing. Requirement for repair of dentures was recorded according to the marginal fitting for fixed dentures, and to the extension, stability and retention for removable dentures. Complete edentulousness of one or both arches was present in 4,6% of the studied population, whereas 184 (34.8%) of the sample population had intact dentition. Partial edentulousness was present in 60.6% of the subjects surveyed, but only the 45.9% of these was wearing dentures. Loss of structural integrity or incongruous marginal fitting was found in the 37.9% of fixed dentures. The majority of partial and complete removable dentures (74.5%) did not ever undergo relining, and the 51.7% of them needed relining or replacement. Statistical analysis (chi-square test) showed that the level of edentulousness was correlated with age; similarly, the frequency of dental visits significantly impacted on the number of missing tooth (P0.01). The results of the present study show that the adult inhabitants of Palermo had high level of partial edentulousness and low level of denture wearing. The majority of existing removable dentures required relining or replacement.

Eosinophilic granuloma (EG) is a clinical variant of the Langerhans cell histiocytosis (LCH) characterized by unifocal or multifocal bone lesions which predominantly affects children, adolescents, and young adults.A case is reported of a 13-year-old Caucasian boy who presented unifocal EG in the mandible as the first clinic manifestation. Radiographic examination and skeletal scintigraphy revealed a further localization with an osteolytic lesion in the right femur. The therapeutic protocol used for the mandibular lesion included causal periodontal therapy, extraction of the compromised teeth, alveolar curettage, and intralesional injections of corticosteroids, in correspondence with femoral and mandibular bone lesions.Early diagnosis of LCH is considered an important factor which can improve the patient's prognosis and quality of life and also the cost-effectiveness of therapy. Dentists could play a fundamental role in the diagnosis and management of EG. The aim of the treatment is to eradicate EG lesions and provide adequate oral rehabilitation after the tooth loss. A careful multidisciplinary follow-up program is mandatory to identify any signs of local recurrence or dissemination.

The aim of this paper was to provide an update on necrotizing periodontal disease (NPD). Original papers on this subject published in English from January 2002 until December 2007 were located in MEDLINE/PubMed database. Other sources were taken from the references of the selected papers. The clinical features of NPD include necrosis and ulceration of the gingival margin and the interdental papilla. These signs are usually associated to halitosis, pain, spontaneous gingival bleeding, malaise and sometimes fever. NPD usually occurs in developing countries, but few cases have also been reported in industrialized nations. The predisposing factors associated with the onset and progression of NPD include immunodeficiency, malnutrition, stress, smoking and poor oral hygiene. The treatment of NPD is dependent on the presence of pain and gingival necrosis. Systemic antibiotic therapy is recommended when a systemic disease is suspected.

The present paper reviews relationship between chronic periodontitis and cardiovascular diseases. Original papers on this subject, published in English in the period between 2001 and the first semester 2006, were located in the MEDLINE/PubMed database. Additional studies were obtained by searching reference lists of previously published papers. Periodontal infection provides a chronic reservoir of inflammatory mediators and cytokines, lipopolysaccharide, which contribute to the formation of atheroma. Moreover, periodontal pathogens can penetrate the epithelial barrier of the periodontal tissues and reach the blood stream, carrying out a local atherogenic activity. Some studies indicated that periodontal treatment could result in reduction of cardiovascular events. If these results are confirmed in further intervention studies, the prevention and the treatment of periodontitis should be considered as factors able to avoid or reduced the onset and/or evolution of cardiovascular diseases.

Surgery, chemotherapy and radiotherapy are different therapeutical options for the management of the head and neck cancers. Their indication is strictly relate to some parameters (macro and microscopic characteristics of the tumor, the patient's general health and the remaining expectations of the life of the patients). Surgical treatment of the cancer, even if it represents the most radical approach and with the most therapeutical index, it always can't be practicable, since, often, it is associated to imposing aesthetical and functional alterations of the interested district. Chemotherapic agents are among the drugs with the lower therapeutical index, that are able to cause side effects, mainly due to the immunosuppression. About radiations, side effects could be indicates as immediates or acutes, and backward or chronic. Among the acute manifestations are enumerated: xerostomia, mucositis, bacterial infections, dysgeusia, dysphagia; among chronic forms: hyposalivation-xerostomia, caries, telangiectasis, infections, osteoradionecrosis, trismus, muscular fibrosis, necrosis of the soft tissues. Mucositis and xerostomia are the most common side effects, and they are a potential source of life-threatening infections. Few interventions are of proven efficacy to reducing severity and duration of mucositis, and there are no universally accepted treatment protocols, but research activity is increasing because of the upward recognition of the importance of mucositis, that need a complex and multidisciplinary clinical management.

Objective To assess a panel of risk factors associated to oral candidosis (OC) onset and its chronic maintenance by means of fuzzy logic (FL) approach and statistical traditional methodology (STM); to investigate their casual relationship within a multifactorial framework. Design Case–control study. Setting One hospital-based clinic. Patients Eighty-nine patients with OC infection microbiologically diagnosed and 98 healthy subjects were consecutively recruited. Outcome measurements Anamnestic and clinical evaluations for OC, microbiological assessment (i.e. culture, CFU/mL counting and identification) were performed. The commonest predisposing factors for OC onset and its chronic status were analysed by FL and STM. Results By means of a twofold analysis (FL and STM) significant associations between OC onset and its chronic maintenance were found with respect to denture wearing and hyposalivation/xerostomia, as local risk factors, and to age and female gender, as socio-demographical variables. Tobacco smoking was found not to be a risk factor. Conclusions The twofold (FL and STM) statistical approach for the identification of OC risk factors has been found useful and accurate in individuating a more selected target population for OC onset and chronic maintenance. The target patient appears to be an elderly person with multiple disease inducing, directly or by medications, hyposalivation/xerostomia. This data could provide to general and dental practitioners a decision-making model finalised to their preventative strategies for the geriatric population.

The aim of this paper was to critically review the current role of community water fluoridation in preventing dental caries. Original articles and reviews published in English language from January 2001 to June 2006 were selected through MEDLINE database. Other sources were taken from the references of the selected papers. For the past 50 years community water fluoridation has been considered the milestone of caries prevention and as one of the major public health measures of the 20th century. However, it is now accepted that the primary cariostatic action of fluoride occurs after tooth eruption. Moreover, the caries reduction directly attributable to water fluoridation have declined in the last decades as the use of topical fluoride had become more widespread, whereas enamel fluorosis has been reported as an emerging problem in fluoridated areas. Several studies conducted in fluoridated and nonfluoridated communities suggested that this method of delivering fluoride may be unnecessary for caries prevention, particularly in the industrialized countries where the caries level has became low. Although water fluoridation may still be a relevant public health measure in poor and disadvantaged populations, the use of topical fluoride offers an optimal opportunity to prevent caries among people living in both industrialized and developing countries.

BACKGROUND: Due to the side effects of chlorhexidine digluconate (CHX) mouthrinsing, a spray has been proposed as an alternative method of CHX delivery to the oral cavity. The aim of this study was to investigate the plaque inhibitory effects of CHX, cetylpyridinium chloride (CPC), and triclosan (TRN) delivered by sprays and mouthrinses. METHODS: The study was an observer-masked, randomized cross-over design balanced for carryover effects, involving 15 healthy volunteers in a 4-day plaque regrowth model. Products being tested (0.2% CHX, 0.12% CHX, 0.05% CPC, and 0.03% TRN) were used both as sprays and mouthrinses. A saline solution served as a negative control. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced using their allocated products. On day 5, subjects were scored for disclosed plaque. RESULTS: CHX sprays (P0.05). TRN spray showed a significant inhibition of plaque regrowth in comparison to the negative control (P0.05). A similar trend of efficacy was detected for rinses. Although the effect on plaque regrowth observed with CHX rinses was superior to that of CHX sprays (P0.2). CONCLUSIONS: These findings, together with those from clinical trials, suggest that the CHX-containing sprays may represent an effective alternative to CHX rinses when mechanical oral hygiene has to be avoided in restricted areas. On the contrary, the TRN and CPC sprays showed little or no plaque inhibitory effects.

BACKGROUND: Chlorhexidine (CHX)-containing mouthrinses are recommended as adjuncts to mechanical oral hygiene. The problem associated with side effects, however, has stimulated the search for alternative antiplaque agents. The aim of this study was to investigate the plaque inhibitory effects of two mouthrinses containing amine fluoride/stannous fluoride (ASF) and antimicrobial host proteins (lactoperoxidase, lysozyme and lactoferrin; LLL), respectively. METHODS: The study was an observer-masked, randomized 4x4 Latin square cross-over design balanced for carryover effects, involving 12 healthy volunteers in a 4-day plaque regrowth model. A 0.12% CHX mouthrinse and a saline solution served as positive and negative controls, respectively. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced rinsing with their allocated rinses. On day 5, subjects were scored for disclosed plaque. RESULTS: The ASF rinse showed a significant inhibition of plaque regrowth in comparison to both saline and LLL solutions, but the lowest plaque indices were obtained with the CHX formulation (P0.05). Such pattern of efficacy was the same in anterior and posterior teeth and in vestibular and lingual surfaces as well, with the exception of the lingual anterior surfaces. In these sites, differences between the CHX and ASF rinses were not significant (P>0.05). A significantly higher prevalence of side effects was found in subjects using the CHX product (P

Noise pollution, caused by traffic, industrial activities is one of the main local environmental problems: actually, about 20 percent of the European population is highly annoyed by environmental noise. The importance of this problem has been fixed by DIR 2002/49/CE, relating to the assessment and management of environmental noise, with the aim of containing and eliminating acoustical impact caused by different sources, to improve or maintain environmental acoustical quality. Italian legislation identifies in the noise mapping, (which consists in the subdivision of a land in areas, acoustically homogeneous, where limit values are fixed) the instrument put in charge for territorial acoustical management: this instrument must be suitable with the existent acoustical conditions to allow favorable development territorial plans and an effective land management. The acoustical planning, in the case of particularly event could have a particular meaning, being not only an answer to territorial management, but also a preliminary acoustical evaluation ex ante. The noise mapping can represent a significant picture of acoustical conditions before the construction of infrastructure, such as roads or railways, to compare with the acoustical predicted impact of the new source. This research is about a study case, which aim is at first the realization of noise mapping for an Italian little town, with a project of a new road infrastructure. The noise mapping which has been done on the whole municipal territory had to confront with two aspects: a new residential urban area and a natural park as protected zone, areas with a good acoustical quality, which will be involved in the construction of a new infrastructure. In fact, the tunnel, which will connect the existing roads and highways, will have the inlet and outlet in these areas. In this research an acoustical analysis of noise mapping has been done, integrated with the new problems, induced by the road variations and by its work construction

Adhesion to epithelial cells is a critical step in successful oral colonization and infection by Candida albicans. Therefore, three mouthrinse products, containing chlorhexidine 0.2% (CHX), cetylpyridinium chloride 0.05% (CPC) or triclosan 0.045% (TRN), were compared for their effects on the in vitro adhesion of C. albicans to human buccal epithelial cells (BEC). Candidal adhesion appeared to be significantly reduced by oral rinsing with the CHX-containing mouthrinse (P0.0001). In vivo exposure of BEC to the CPC mouthrinse also inhibited adhesion of C. albicans (P0.0001). Both CHX and CPC products suppressed adhesion to the same extent (P0.01). On the other hand, the TRN mouthrinse did not significantly affect epithelial adhesion of C. albicans (P0.01). These findings suggest that mouthrinses containing CHX or CPC could be of value in the control of candidal colonization and infection. Clinical trials are warranted on the effectiveness of these products in reducing oral Candida carriage.

Adhesion to epithelial surfaces is considered as a critical step in the pathogenesis of oral candidosis. Therefore, the effects of the most commonly consumed dietary carbohydrates on the adhesion of Candida albicans, Candida tropicalis, and Candida krusei to monolayered HeLa cells were investigated. Adherence of C. albicans and C. tropicalis appeared significantly promoted by incubation in defined medium containing a high concentration (500 mM) of fructose, glucose, maltose, and sucrose (p0.001). C. albicans organisms grown in sucrose elicited maximal increase in adhesion, whereas adhesion of C. tropicalis and C. krusei was enhanced to the greatest extent when cultured in glucose. Maltose and fructose also promoted adherence of C. albicans and C. tropicalis (p0.001), but to a lesser extent than sucrose and glucose. On the other hand, sorbitol-grown yeasts demonstrated a marginal increase in adhesion (p0.01). Xylitol only significantly reduced adherence of C. albicans (p0.001). These results suggest that the frequent consumption of carbohydrates, such as sucrose, glucose, maltose, or fructose, might represent a risk factor for oral candidosis. The limitation of their consumption by substituting xylitol or sorbitol could be of value in the control of oral Candida colonization and infection.

Oral candidosis has emerged as an increasing problem in immunocompromised patients because oral cavity represents an important port of entry for systemic fungal infections.The aim of the present study was to investigate the in vitro antifungal activity of 5 commercial mouthrinses containing chlorhexidine (CHX). The Minimum Fungicidal Concentration (MFC) against six species of yeasts was determined by a broth macrodilution method. The kill-time of mouthrinses at half the concentration of the commercial formulations was also determined.MFCs were achieved with each mouthrinses against all the organisms under test. However, significant differences in MFC values were found for Ebur Os in comparison with Dentosan, Corsodyl and Plak out (p0.001). Kill-times of Corsodyl and Dentosan were less than or equal to 120 sec with all the species of yeasts, except Torulopsis glabrata. Significant differences were found in kill-time values between Dentosan and Broxo Din only (p0.001).These results suggest that CHX-containing mouthrinses may represent an appropriate alternative to conventional antifungal drugs in the management of oral candidosis. Effectiveness in preventing systemic fungal infections in immunocompromised patients requires further in vivo studies.

PURPOSE: To compare two systems used for conditioning the gingival sulcus and exposing the finish line before the final impression for a fixed denture: retraction cords and diode laser. METHODS: All subjects participating in the study had healthy gingival and periodontal status before intervention for fixed prosthesis. 74 abutments for complete crown restoration were randomly divided into two groups for displacing the gingival sulcus before the final impression: gingival retraction cords (RC) and diode laser (DL). The height of the clinical crowns was measured by a blinded examiner in three points of the buccal surface (mesial, midline and distal) at four different times: after tooth preparation (T0), 15 days after tooth preparation, before exposing the finish line with RC or with DL (T1), 10 minutes after exposing the finish line (T2), and 15 days after the final impression was taken (T3). The amount of gingival retraction produced (ΔT2-T1) and restoration to baseline (ΔT3-T1) were calculated. Ease of technique and patient comfort were evaluated through the Visual Analog Scale. The time required to carry out the technique and bleeding during and after the conditioning procedure were also evaluated. RESULTS: There was no difference between the two techniques with regard to the height differences: ΔT2-T1 was 0.65±0.33 for RC and 0.66±0.43 for the DL (P= 0.966), while ΔT3-T1 was 0.03±0.27 for RC and 0.02±0.46 for DL (P= 0.286). DL required less time, was easier for the operator and more comfortable than RC for the patient (all P

BACKGROUND. A fundamental requirement to obtain a correct endodontic preparation depends on the respect, during cleaning and shaping, of the original morphology of the apical foramen, (AF), so that the filling material will form a complete seal. METHODS. In our previous studies, in order to verify if this presumption was respected using rotary NiTi instruments with cutting tip, we instrumented extracted teeth characterised by a different degree of root curvatures. Using a standardized system to replace the sample, the original shape of the apical foramen of each tooth was recorded using a computerised technique and then compared to the shape after instrumentation. The data showed differences on AF shapes depending on the degree of root canal curvatures. In fact, the teeth with straight canals showed the least alterations on the original AF shape; on the contrary, the teeth with curved canals showed apical foramen enlargement or transportation. Therefore, in the current study we aimed to compare the in vitro effects of stainless steel, (Flexofile, Dentsply Maillefer, Baillaigues, Switzerland), vs NiTi safe cutting tip (Quantec SC, (Tycom Dental, Irvine CA, U.S.A.), vs NiTi non cutting tip, (Quantec LX, Tycom Dental, Irvine CA, U.S.A.), instrumentation on original apical foramen shape. We used NiTi instruments according to standard technique suggested by Tycom, and hand steel files, to instrument the apical third, according to the Crown-Down technique. Working length was fixed at -0.5 from AF. RESULTS AND CONCLUSIONS. Our results suggested that in the presence of accentuated canal curves rotary Niti, with cutting tip, cause significantly more enlargement of the AF area. At the same time, we also observed that NiTi rotary files, with both cutting and non-cutting tip, cause eccentric enlargement of AF in curved canals. Therefore, NiTi engine-driven instruments should be used carefully in the presence of accentuated canal curves to avoid enlargement or transportation of AF, probably because rotary NiTi files may slip out of operative control, leaving a mark on the foramen shape. In the presence of severe curves, we suggest modifying the operative sequences by alternating rotary NiTi with hand NiTi or stainless steel instruments, especially in the preparation of apical third.

The aim of this study was to investigate in vitro the antibacterial effect of a dentin/enamel adhesive containing MDPB (Clearfil Protect Bond) after curing and to compare it with an adhesive not containing MDPB (Clearfil SE Bond). The antibacterial effect of the cured adhesives was tested on Enterococcus faecalis by the evaluation of growth inhibition in a 48-h microplate direct contact test (DCT). The presence of antibacterial activity due to soluble components was also investigated by an agar diffusion test (ADT) performed with the adhesives cured on the surface of dentin disks. In the DCT, both the tested materials showed complete inhibition of bacterial growth until the 7-h reading, regardless of whether direct contact with the bacterial inoculum was continued or limited to 1 h. Stationary growth phase turbidity levels were observed at 24 or 48-h incubation. The ADT produced no inhibition areas around the dentin disks. Both adhesives tested in vitro under conditions simulating those encountered in the restorative treatment of dental caries were equally able to delay bacterial growth demonstrating a similar bacteriostatic effect. As suggested by both the DCT and the ADT, the antibacterial effect of the two adhesives depends on direct contact and does not seem to be related to the diffusion of soluble components.