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Introduction. In healthcare, the need to pay more attention to the achievement of two objectives within the society arises: health promotion and prevention in terms of nutrition, good education, sport, and health education. Scientific evidence shows that adequate health standards must be learned since childhood through the help of parents and appropriate school projects. Parental intervention must be appropriate to support the responsibility of their children’s health. In oral health, it has been established for many years that there is a correlation between parental behaviors and lifestyles and children’s attitude. The aim of this study is to verify the close relation between behaviors, habits, lifestyles, and the knowledge of parents about their oral health and, consequently, their focus and care for their own children’s oral health. Furthermore, the awareness of parents about the importance and use of fluorine was to be determined. Materials and Methods. The study lasted 15 months and was conducted from April 2018 to July 2019: an anonymous 29-question questionnaire was administered to all parents who accompanied their children (aged between 3 and 12 years) going under treatment in the Pediatric Dentistry Unit of the University Hospital Policlinico Umberto I, Rome. Anamnestic data, sociodemographic context (e.g., educational level and occupation), oral health habits, and prevention of parents and children and fluoride knowledge were investigated. The study received ethical approval. 204 questionnaires were collected. The data gathered were recorded with a specifically designed computer program and collected and analyzed using a Microsoft Excel 10 database. Data were evaluated using standard statistical analysis software; descriptive statistics including mean ± SD values and percentage were calculated for each variable. The relationship between the age of parents, between mother or father and the parents’ degree of education levels, and the knowledge for their own children’s oral health was explored using the chi-square test of homogeneity and Fisher’s exact test ( P value of < 0.05 considered as statistically significant). Results. From the acquired data, it is possible to deduce that the major respondents were mothers aged from 36 to 45, while only a small part were fathers aged above 45 years. Questions related to parents’ oral hygiene habits were included in the questionnaire, and from the sample taken into consideration, it emerges that 64.7% of the respondents (67.1% mothers and 57.7% fathers) periodically attend a dental office for a checkup, 20.9% tend to postpone the treatment, and 15.2% go there just for emergency. Some of the questions showed that 80% of the interviewed subjects use fluoride toothpaste for their child’s oral hygiene. Conclusion. Prevention in childhood, in addition to being synonymous with monitoring the oral health of the child, means first of all to pay attention to parents who are the main behavioral reference. It emerged that there is no adequate knowledge about fluorine, especially when the subjects have a low educational level. A role of fundamental importance for the diffusion of adequate concepts in the field of oral hygiene is covered, according to the data received from the study carried out, by the dentist and dental hygienist.

PURPOSE: To provide the most relevant aspects of the etiology, prevention, and management of bleeding in routine implant surgery. MATERIALS and METHODS: A comprehensive and systematic electronic search was conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews databases until Jun 2021. Further references of interest were retrieved from bibliographic lists of the selected articles and the “Related Articles” feature of PubMed. Eligibility criteria were papers about bleeding, hemorrhage or hematoma associated with routine implant surgery on human subjects. RESULTS: Twenty reviews and 41 case reports fulfilled eligibility criteria and were included in the scoping review. Involved implants were mandibular in 37 and maxillary in 4 cases. The major number of bleeding complications was in the mandibular canine region. The most injured vessels were sublingual and submental arteries, mainly due to perforation of the lingual cortical plate. Time to bleeding occurred intraoperatively, at suturing, or postoperatively. The most reported clinical manifestations were swelling and elevation of the mouth floor and the tongue with partial or complete airway obstructions. The first aid to manage airway obstruction was intubation and tracheostomy. For active bleeding control, gauze tamponade, manual or digital compression, hemostatic agents and cauterization were applied. When conservative procedures failed, hemorrhage was controlled by intra- or extraoral surgical approaches to ligate injured vessels or by angiographic embolization. CONCLUSIONS: The present scoping review provides knowledge and evidence on the most relevant aspects of the etiology, prevention, and management of implant surgery bleeding complications.

The aim of this study was to evaluate the 2-year follow-up results of early implant placement with simultaneous peri-implant augmentation using an acellular dermal matrix (ADM) and a synthetic bone substitute in the aesthetic zone. Twenty subjects were enrolled in this study, they were either males (eight) or females (12), with a mean age of 47.8±4.45 years and each patient was treated with one implant. Simultaneous contour augmentation with guided bone regeneration was performed using synthetic bone particles (maxresorb®) and an ADM (mucoderm®). Keratinized mucosa width (KMW) and gingival thickness (GT) were assessed at baseline, 1, 3, 6, 12 and 24 months. Marginal bone loss, probing pocket depth, bleeding on probing and plaque index were also recorded. GT and KMW increased between baseline and 1 month, slightly decreased between 1 month and 12 months (P0.001) and remained stable between 12 and 24 months (P0.001). After 2 years, mean marginal bone loss level was 0.51 ± 0.63mm, with no probing pocket depth values5mm and no concomitant signs of inflammation registered. Pink aesthetic score was 8.3. Combining an ADM and guided bone regeneration with early implant placement revealed a significant increase of 1.9mm for GT and 1.6mm for KMW after 2 years, showing good patient satisfaction regarding the aesthetic outcomes of soft tissues and prosthetic crown.

Objective This study aimed to compare the analgesic effect of ibuprofen 400 mg given 30 min before or immediately after third molars surgery under local anaesthesia. Materials and methods The single-centre, randomized, split-mouth, triple-blind, clinical trial involved 38 outpatients, for a total of 76 bilateral symmetrical fully bone impacted mandibular third molars. Each patient was undergone to separate surgical sessions for the right and left side, and ibuprofen was randomly administered 30 min before or immediately after the intervention. Study participants recorded pain intensity using Numerical Rating Scale-11, the timing of rescue therapy intake and overall tablets consumption over 3 days. Results The overall pain intensity score was lower in the group receiving ibuprofen immediately after (3.13 ± 2.46) than before (3.58 ± 2.40) surgery, with statistically significant differences only on the second and third days. The mean time to the first using rescue therapy was longer in the postoperative (598.33 ± 422.62 min) than in the preoperative (406.25 ± 149.79 min) analgesic treatment group (p = .123). The number of supplemented ibuprofen tablets did not differ (p = .530) between both groups. Conclusions Within the limits of the present study, ibuprofen administration immediately after surgery seemed to be more effective than preoperative administration.

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Objective The relationships between oral health habits, dietary practices, and oral health status, as well as general health status, in the population of Italian women, are complex, with many mutual and interrelating factors. The purpose of this study is to investigate oral habits, oral status, and dietary habits of a sample of women in Italy, highlighting the links between nutrition and oral health and discussing how oral health care professionals can integrate nutrition counseling that aimed at improving the oral health of their patients into their practices. Materials and Methods In the period between February 2020 and July 2020, an anonymous questionnaire made up of 20 questions was administered to a randomized sample of 120 Italian women. Results Most of women declare good manual skills in oral hygiene (50%) but just less than half of them brushes their teeth more than three times a day. Statistically significant correlations were found between frequency of dental checkups and dental mobility (p = 0.036), and halitosis (p = 0.006), as well as between frequency of flossing and gum bleeding. Correlation between the type of diet and oral health status showed more halitosis (∼21%), sensitivity (∼26%), and xerostomia (∼53.3%) for vegetarian and vegan women. Conclusion More awareness need to be raised concerning oral hygiene habits, and regarding the importance of regular dental checkups. Brushing at least twice or three times a day needs to be encouraged and the valid support of dental aids has to be in the everyday domestic oral hygiene protocol, as scientific evidence demonstrates. Future clinical studies need to be performed on a more consistent number of vegetarian and vegan patients, to obtain more statistically significant results and support future research that will compare omnivorous, vegetarian, and vegan diets and their influence on oral health status.

Purpose To compare the trueness and precision of 3D-printed versus milled monolithic zirconia crowns (MZCs). Methods A model of a maxilla with a prepared premolar was scanned with an industrial scanner (ATOSQ®, Gom) and an MZC was designed in computer-assisted-design (CAD) software (DentalCad®, Exocad). From that standard tessellation language (STL) file, 10 MZCs (test) were 3D-printed with a Lithography-based Ceramic Manufacturing (LCM) printer (CerafabS65®, Lithoz) and 10 MZCs (control) were milled using a 5-axis machine (DWX-52D®, DGShape). All MZCs were sintered and scanned with the aforementioned scanner. The surface data of each sample (overall crown, marginal area, occlusal surface) were superimposed to the original CAD file (ControlX®, Geomagic) to evaluate trueness: (90-10)/2, absolute average (ABS AVG) and root mean square (RMS) values were obtained for test and control groups (MathLab®, Mathworks) and used for analysis. Finally, the clinical precision (marginal adaptation, interproximal contacts) of test and control MZCs was investigated on a split-cast model printed (Solflex350®, Voco) from the CAD project, and compared. Results The milled MZCs had a significantly higher trueness than the 3D-printed ones, overall [(90-10)/2 printed 37.8 µm vs milled 21.2 µm; ABS AVG printed 27.2 µm vs milled 15.1 µm; RMS printed 33.2 µm vs milled 20.5 µm; p = 0.000005], at the margins [(90-10)/2 printed 25.6 µm vs milled 12.4 µm; ABS AVG printed 17.8 µm vs milled 9.4 µm; RMS printed 22.8 µm vs milled 15.6 µm; p= 0.000011] and at the occlusal level [(90-10)/2 printed 50.4 µm vs milled 21.9 µm; ABS AVG printed 29.6 µm vs milled 14.7 µm; RMS printed 38.9 µm vs milled 22.5 µm; p = 0.000005]. However, with regard to precision, both test and control groups scored highly, with no significant difference either in the quality of interproximal contact points (p = 0.355) or marginal closure (p = 0.355). Conclusions Milled MZCs had a statistically higher trueness than 3D-printed ones; all crowns, however, showed high precision, compatible with the clinical use. Clinical significance Although milled MZCs remain more accurate than 3D-printed ones, the LCM technique seems able to guarantee the production of clinically precise zirconia crowns.

Pterygoid implant placement has not been a common treatment modality to manage the atrophic posterior maxilla. This randomized, controlled clinical trial evaluated the accuracy of dynamic navigation using trace registration (TR) technology in pterygoid implant placement when compared to free-hand surgery. Partially edentulous patients requiring at least one pterygoid implant to rehabilitate the atrophic posterior maxilla were included. Implant accuracy (in a prosthetically directed context) and the relation of the placed implants to the greater palatine canal (GPC) were evaluated using EvaluNav to compare the preoperative CBCT plan with the postoperative CBCT implant location. Osseointegration success, mucosal thickness, implant length, time spent for surgical placement, and ease of prosthetic restorability via degree of multi-unit abutment angulation were assessed. A total of 63 pterygoid implants were placed (31 using TR, 32 using free-hand) in 39 partially edentulous patients. Mean deviations between the planned and actual position for TR-placed implants were 0.66 mm at the coronal level, 1.13 mm at the apical level, 0.67 mm in depth, and 2.64 degrees of angular deviation, compared to 1.54 mm, 2.73 mm, 1.17 mm, and 12.49 degrees, respectively, for free-hand implants. In relation to the GPC, TR implants were more accurate when compared to the presurgical plan and took less surgical time. The mean mucosal thickness measured for all implants was 5.41 mm. Most implants were 15 to 18 mm long, and most prostheses (92%) could be accommodated by a 17- or 30-degree multi-unit screw-retained abutment. TR implants had greater short-term osseointegration success rates than free-hand implants (100% vs 93.75%). Pterygoid implant surgery can be a predictable and successful modality for prosthetically directed implant rehabilitation in the atrophic posterior maxilla, is more accurate than free-hand surgery, and takes less time when using dynamic navigation via TR.

Purpose This systematic review was performed to compare tooth, implant and prosthesis failures and biological and technical complications in toothimplant vs freestanding implant supported fixed partial prostheses, in order to evaluate the effectiveness and predictability in combining teeth and implants in the same fixed partial prosthesis. Study selection A comprehensive and systematic literature research was conducted, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, to identify human trials, with a minimum sample size of 10 patients, comparing tooth-implant to freestanding implant supported fixed partial prostheses. Four groups of meta-analyses were performed based on the patients treated with toothimplant vs freestanding implant-supported fixed partial prostheses: abutment failures, biological and mechanical complications, prosthesis failures, and prosthetic (technical) complications. Results The search yielded 749 records, after removal of duplicates. Based on the title assessment, the abstracts reading and the full-texts evaluation, 8 articles, published between 1999 and 2013, fulfilled the inclusion criteria and were included in the meta-analysis. The studies included were: 4 controlled clinical trials, 2 prospective and 2 retrospective cohort studies. The meta-analysis revealed no significant difference between tooth-implant and implant-implant supported fixed in the number of abutment (implant or tooth) failures, biological complications, prosthesis lost, and prosthetic complications. Conclusions Within the limitations of the present systematic review, although the freestanding implant supported fixed partial prosthesis remains the first choice, joining teeth and implants to support fixed prosthesis in partially edentulous patients becomes a valid alternative with an acceptable success rate.

Efficacy and rapid onset of postsurgical oral pain relief are critical to improve clinical outcomes and reduce the risk of excessive dosing with analgesic drugs.To compare analgesic effects of preoperative administration of paracetamol 500 mg plus codeine 30 mg in single-tablet and effervescent formulation to ibuprofen 400 mg, and placebo in the management of moderate to severe postoperative pain after mandibular third molar surgery.One hundred twenty healthy outpatients aged 15-29 years undergoing surgical removal of 1 bony impacted mandibular third molar were enrolled in this, single-center, prospective, randomized, triple-blind parallel-group, placebo-controlled, clinical trial. Study participants were randomly assigned to three treatment arms. According to the concealed allocation, each patient 30 minutes before surgery received paracetamol 500 mg plus codeine 30 mg (group APAP/COD), ibuprofen 400 mg (group IBU) or placebo (group PLA). Rescue therapy allowed in the postoperative period was paracetamol 500 mg plus codeine 30 mg in groups APAP/COD and PLA and ibuprofen 400 mg in group IBU. Patients recorded on Numerical Rating Scale-11 (NRS-11) the pain intensity, total number of postoperative-supplement medications and time of the first intake, until 12-hours after surgery and over extra 2 days, RESULTS: Over postoperative 3 days, patients in the APAP/COD group (2.33 ± 1.99) displayed significantly (P.001) less pain intensity than IBU (3.43 ± 2.47) and placebo (3.57 ± 2.62) groups. The first-day postoperative pain was significantly (P.001) higher in group PLA than in groups APAP/COD and IBU, but not between the latter 2 groups. However, at 2 hours postdose, the IBU group displayed average pain intensity lower than APAP/COD group (P.05). On the next 2 days, pain intensity was significantly (P.001) lower in group APAP/COD than in groups IBU and PLA but failed to reach statistical significance between groups IBU and PLA. Although the time to the first using rescue therapy was longer (445.88 ± 159.96 minute) in group IBU, compared to groups APAP/COD (392.67 ± 138.90 minutes) and PLA (323.00 ± 143.95 minutes), the number of supplemented tablets was significantly higher in group IBU (2.89 ± 2.13) than in groups APAP/COD (1.24 ± 1.79) (P= .001) and PLA (1.53 ± 1.67) (P = .008). No adverse events were registered for all groups.Within the limits of the present study, over postoperative 3 days, a statistically significant intensity pain reduction and decreased rescue therapy consumption were recorded in the paracetamol-codeine group than to ibuprofen group. Nevertheless, lower pain intensity at 2 hours postdose and longer time using rescue therapy was found in the ibuprofen group without statistical significance. No adverse events occurred over the studied period.

To determine the survival trend of dental implants after functional loading for ≥1 year in diabetic patients.An electronic search of the Cochrane Oral Health Group's Trials Register, Medline and Embase, plus a manual search up to December 2015 was performed. Studies assessing the survival rate of dental implants in patients with a diagnosis of diabetes mellitus were considered eligible. Screening of studies, quality assessment, and data extraction were conducted independently by 2 reviewers. Life-table analysis and Kaplan-Meier survival curves were used to evaluate implant survival and to plot the cumulative survival rate and cumulative hazard ratio.Seven studies, including 1142 implants were identified. The cumulative survival rate was 0.96 ± 0.10 before loading, 0.93 ± 0.10 and 0.91 ± 0.10 at 1 year, and at the end of the follow-up period, respectively. The hazard ratio was 4% during the period of osseointegration, 3% during the first year of loading, and remained constant over the 6-year follow-up.Patients with diabetes mellitus showed an increasing trend of implant failure during the period of osseointegration and the first year of loading.

Glioblastoma multiforme (GBM) represents one of the main frequent and aggressive primary brain neoplasms among adults worldwide. Despite a first-line multimodal treatment, including radical surgery and adjuvant radiation therapy with concomitant temozolomide-based chemotherapy, GBM prognosis continues to be unfavourable. During this decade, different research groups have explored immune check-point inhibitors role in order to improve response to therapy and subsequently prolong survival rate. The aim of this review was to analyze published literature to support immune check-point inhibitors use in the management of patients with GBM diagnosis. The hope was to help physicians for better decision-making.

The aim of this study was to measure the early peri-implant bone level changes before the completion of an implant-abutment connection and to evaluate the influence of demographic, biologically relevant, anatomical, and implant-specific variables on these changes. A prospective cohort study design was used. STROBE guidelines were followed. The sample comprised 493 implants placed using a two-stage surgical procedure. Random allocation was used to determine the implant placement depth. Peri-apical radiographs taken at implant insertion and at the second surgery 2 months later were matched. Kappa statistics were used to compute intra- and inter-examiner reliability. The statistical analysis was performed at the implant level. Two-way analysis of variance (ANOVA) with the Bonferroni adjusted post hoc test was used to evaluate the influence of variables. One-way ANOVA with Tukey's range test and unpaired Student t-tests were used to analyze significant variables. Early marginal bone remodelling was -0.86 mm. The timing of implant placement (P=0.00) and the depth of implant placement (P≤0.05) significantly influenced early bone remodelling. Relevant radiographic early bone loss was found, but implants initially positioned below the alveolar crest and inserted ≥3 months after tooth extraction showed statistically significant higher marginal bone loss during the healing phase.

OBJECTIVES The aim of this study was to evaluate the 5-year clinical and radiographic outcomes following reconstructive therapy of peri-implantitis lesions using mineralized dehydrated bone allograft and resorbable membrane in the nonsubmerged mode of wound healing. MATERIALS AND METHODS Thirty-four patients with at least one implant diagnosed with peri-implantitis were treated by mechanical debridement; chemical decontamination using hydrogen peroxide (3%), chlorhexidine (0.2%), and a tetracycline hydrochloride solution; and bone defect filling with mineralized dehydrated bone allograft and resorbable membrane. Clinical and radiographic assessments were obtained during 5-year follow-up. The primary outcome was the absence of additional marginal peri-implant bone loss ≥1.0 mm after surgery, and the composite outcome included the additional marginal peri-implant bone loss, absence of probing depth (PD) ≥5 mm, and absence of bleeding on probing (BoP)/suppuration. RESULTS According to the primary and composite outcomes, the success rate of 34 implants included in the study was 100% and 91% (N = 31), at 1 year after surgery, and decreased progressively to 77% (N = 26) and to 59% (N = 20) at 5-year follow-up, respectively. Five years following treatment, only the BoP reduction was statistically significant compared to baseline (p

Surgery to the mandibular third molar is common, and injuries to the inferior alveolar nerve and the lingual nerve are well-recognized complications of this procedure. The aim of these technical notes is to describe operative measures for reducing neurological complications during mandibular third molar surgery. The following procedure should be used to prevent damage to the inferior alveolar nerve: a well-designed mucoperiosteal flap, to obtain appropriate access to the surgical area; a conservative ostectomy on the distal and distal-lingual side; tooth sectioning, to facilitate its removal by decreasing the retention zones; tooth dislocation in the path of withdrawal imposed by the curvature of the root apex; and careful socket debridement, when the roots of the extracted tooth are in intimate contact with the mandibular canal. To prevent injury to the lingual nerve, it is important (I) to assess the integrity of the mandibular inner cortex and exclude the presence of fenestration, which could cause the dislocation of the tooth or its fragment into the sublingual or submandibular space; (II) to avoid inappropriate or excessive dislocation proceedings, in order to prevent lingual cortex fracture; (III) to perform horizontal mesial-distal crown sectioning of the lingually inclined tooth; (IV) to protect the lingual flap with a retractor showing the cortical ridge; and (V) to pass the suture not too apically and from the inner side in a buccal-lingual direction in the retromolar area.