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When exposed to stress, the human body suppresses the parasympathetic nervous system and simultaneously activates the sympathetic nervous system, in order to resist to this condition and acquire energy. Materials and methods. FM5 Sensory® is an innovative technological device that integrates simultaneously: 1) photonic beams emitted by an LED system, 2) acoustic WiFi for listening to musical binaural frequencies and 3) inhaled aro-matherapy with interchangeable disposable diffuser. Aim was to evaluate the cortisol levels in urine collected for 24 hours before and after treatment for 30 minutes in six patients. Results. There was a small not statistical significant drop of urinary cortisol after treatment. Discussion and conclusion. Literature reports show that lighting is able to affect the mood of elderly people. Here a trend is reported although no statistical difference was detected. Additional studies with wide samples are mandatory to verify the real effect of LED therapy on cortisol.

Hemifacial microsomia (HFM) is a sporadic congenital malformation of the craniofacial structures derived from the first and second branchial arches. The incidence of HFM has been reported to range from 1 in 3,0001 to 1 in 26,0002 live births, making HFM the second most common congenital malformation in the face after cleft lip and/or palate. An 11-year-old girl came at Galeazzi Institute (Milan) in January 2017. She presented left hemifacial microsomia with absence of the left ramus of mandible and the left temporomandibular joint (tmj), part of the zygomatic arch, hypoplasia of the lateral and inferior orbital bone and of the zygomatic bone. She also presented a medial canthal dystopia. She underwent to costochondral bone graft and calvaria bone graft for reconstruction of part of the mandible and the TMJ. An emi-Le Fort I, emi-Le Fort III, and sagittal segmental osteotomy of the right mandible were performed to improve the correct occlusion. Traditionally, the costochondral graft has been considered the gold standard for ramus-condyle reconstruction in the pediatric mandible when appropriate. Some studies cite growth unpredictability and ankylosis as concerns with rib. Further studies examining carefully the factors predicting graft growth, such as size of cartilage cap, surgical technique, and postoperative physiotherapy, are warranted.

Various diseases and conditions can cause bony defects in the maxillofacial region. Since microvascular bone graft transfers were introduced in 1970, new possibilities in reconstructive surgery have arisen. Various methods of treatment have been described for severely atrophic mandibles. These methods are: (1) the placement of four endosteal implants of short length, (2) the placement of a trans-mandibular implant (3) the placement of endosteal implants in combination with vertical distraction osteogenesis or (4) the placement of endosteal implants in combination with an onlay or interpositional bone graft. The patient was operated on to harvest bone for dental implant insertion at the Galeazzi Institute (Milan, Italy) in August 2016. He presented high resorption of edentulous mandible. Bone from the anterior approach was harvested started with a saw, and then a chisel and mallet were used. After 6 months removal of the screws of synthesis (1 fractured is left in place). Insertion of endosseous implants After 3 months loading with mixed prosthesis (bar + overdenture) with locator. Several Authors have reported pain on walking, weakness of the abdominal wall, frank herniation, and disturbances of gait. A few other approaches have been suggested to reduce impairments at the donor site such as taking only the inner cortex, which will reduce the amount of bone available and its implantability. Others have suggested leaving the iliac crest and harvesting the underlying bone. It is concluded that in treatment combining an onlay graft and simultaneous implant placement in the extremely resorbed mandible, considerable graft resorption must be anticipated.

Purpose. The surgical-orthodontic treatment of impacted maxillary canine (IMC) remains a challenge to today’s clinicians. The aim of the present paper is to describe an unconventional treatment of IMC with insertion of implant into the retained canine and 3 years follow-up. Case report. A 55-year-old female patient attended to rehabilitate her maxillary left canine site. An unconventional approach was proposed to the patient. A large diameter tapered implant (Ø 5 x 18 mm) was inserted (Nobel Active, Kolten, Swisse). An immediate loading prosthetic rehabilitation was performed. After checking for implant stability the prosthetic steps were carried out and a single crown was delivered with Procera system. Conclusion. The patient was happy of this kind of single non-invasive session for treating IMC. At the 3-year control, the implant did not show any mobility or signs of peri-implantitis clinically or radiographically. In addiction patient was satisfied of aesthetic results

The aerosol produced during the use of dental instruments can spread pathogens potentially harmful to health. Most of the pathogens found in hydraulic system are Gram-negative aerobic heterotrophic environmental bacterial species exhibiting very low pathogenicity, although they may be of concern in the treatment of vulnerable patients, such as immunocompromised, medically compromised individuals and dental team. Dental team can be exposed to pathogenic microorganisms including cytomegalovirus, hepatitis B virus, hepatitis C virus, herpes simplex virus and Legionella spp. Legionella spp. are ubiquitous in hydraulic system, in fact surveys have shown that the percentage of samples taken at different dental chairs that were positive for Legionella spp. and ranged from 0 to 100%. The concentration of Legionella spp. in hydraulic system may reach 1000 organisms per ml. The primary route of Legionella spp. transmission is inhalation or aspiration of environmentally contaminated aerosols. All dentists are required to conduct a statutory risk assessment of their hydraulic system, in fact to comply with their legal duties, dentists must identify and assess the sources of risk and prepare a scheme for preventing and controlling risks. Moreover, they must monitor the quality of their hydraulic system at least annually to ensure that they are “legionellae free”

Purpose. The aim of this paper is to describe epidemiology and clinical manifestations of oral infection by Human papillomavirus (HPV), with particular attention to potential malignant lesions. Materials and methods. A systematic review of the literature was conducted to describe the state of the art about HPV infection in oropharyngeal mucosa and its modalities of transmission, with particular attention to possible simultaneous infection in multiple anatomic sites. The aspects of prevention and control of infection by administering vaccines and the diffusion of sexual education campaigns are discussed also. Therapeutic protocols are also described where necessary. Results. In recent years there has been a growing interest in HPV oral medicine, suggesting a role of such a family of viruses in the development of neoplasms of the oropharyngeal district as well as of the uterine cervix. Even if the mass media have increasingly faced the problem, causing frequent alarming among patients, the dentist therefore needs a complete and up-to-date knowledge of this infectious condition that is one of the most common causes of sexually transmitted mucous membrane infections (e.g. genital, anal and oral). Conclusions. Recent studies about HPV infection are a basic requirement in order to promote the health of patients and provide them with the most exhaustive indications from dentists.

Purpose. This study evaluated the effects of different dowel space (DS) diameters on pull-out bond strength of a cylindrical post, of threaded steel, to dentin. Materials and methods. Forty-five extracted human teeth were divided in 3 groups with DSs, with the same depth (6 mm), differing for the diameter (i.e. 1.5 mm, Group 1; 1.75 mm, Group 2; 2.00 mm, Group 3). Both the diameter of the post (1.3 mm) and the composite resin cement (Panavia 21) were the same for all the samples. The samples were submitted to pull-out test by means an Universal Testing Machine (Mod. 1193, Instron) (1KN load cell, crosshead speed 0.5 mm/min). Results. The mean values of the bond strength (BS) were: Group 1, 442±128.3N; Group 2, 411.3±111N; Group 3, 448.7±142.29N. While the calculated average shear bond strengths (SBSs) were: Group 1, 14.7±4.27MPa; Group 2, 11.6±3.14MPa; Group 3, 11±3.5MPa. ANOVA test showed not significative differences, among the groups, concerning the BS: Group 1 vs Group 2 (p = 0.490); Group 1 vs Group 3 (p = 0.894); Group 2 vs Group 3 (p = 0.431). Significative differences were observed, among the groups, concerning the SBS for Group 1 vs Group 2 (p = 0.032) and Group 1 vs Group 3 (p = 0.014). While a not significative difference was found, concerning this parameter, for Group 2 vs Group 3 (p = 0.641). Conclusion. The cement thickness can influence the SBS of the adhesively luted posts, in our setting, the best values were obtained with a thickness of 100 µm.

Purpose. In this study we wanted to observe the improvement in the healing of periodontal tissues in a group of diabetic patients treated with traditional methods compared to another group treated with the addition of oxygen. The potential of oxygen has long been known in the field of plastic surgery, where it is used to treat burns and skin lesions. Materials and methods. This study consists in a split mouth study which involved 30 patients. We carefully treated them with periodontal therapy using manual and mechanical instrumentation. Then, we applied oxygen in half mouth according to randomization list. Finally we checked up patients after some weeks. Results. Our results highlight that all areas treated with oxygen application healed more rapidly and better than no treated areas. Conclusions. All in all, we have demonstrated that oxygen can improve the outcome of non-surgical periodontal treatment in diabetic subjects.

Purpose. The crestal sinus lifting by means of hydraulic technique associated with a nano-cristalline hydroxyapatite in an aqueous medium is investigated. Materials and methods. A specific purpose-made instrument is used, consisting of a syringe with a micrometrically controlled piston connected to a dispenser used to inject, in a calibrated and precise manner, noted volumes of graft material into the sub-schneiderian space. Adopting such a technique the Authors performed 7 future site developments, on 7 patients (2 males; 5 females; mean age 49.29±8.08 years), using a nanocrystalline hydroxyapatite. In the second stage, performed at 5.71±1.52 months, 7 implants were placed, after harvesting bone biopsies from the regenerated sites. The samples underwent histological and histomorphometric analysis. Results. The average percentage of vital bone was of 33.27±5.98%, while the bone marrow and graft material were 60.84±5.93% and 5.87±3.05%, respectively. Conclusions. The results confirm the effectiveness of this method in restoring bone volume in the sub-antral region. Furthermore nano-cristalline hydroxyapatite is a proper material for sinus floor augmentation.

It is well known in dentistry that there are numerous chronic conditions that require ongoing and constant management over time, the most noteworthy being periodontal disease, gingivitis and periodontitis. Yet, in recent years, with the increase in the number of implants being placed, mucositis and peri-implantitis have become more and more prevalent pathologies. The results of the statistical analysis demonstrate that there was a slight difference between the pocket depth as measured in the treated sites at time 0 (pre-treatment) and time 1 (15 days post-treatment), although the difference was so small as to render it statistically irrelevant. Bleeding on probing as measured at time 0 and time 1 indicated an improvement on both sides, but with no greater improvement noted on the side treated with HA.

The aim of this study was to evaluate the abatement power of oral microbial loading of a new gel formulation based on the complex silver-2-mercaptobenzoate, chlorhexidine digluconate and didecyldimethylammonium chloride (named ADC) through polymerase chain reaction (PCR). The study sample consists of a group of 20 patients with chronic periodontal disease. Patients were over 25 years of age and did not undergo surgical or non-surgical periodontal treatment in the previous 6 months. The study sample was allotted into two groups of 10 patients each, homogeneous by age and sex. The test group received a bottle containing ADC gel, while the control group received an identical one containing placebo, similar to ADC in consistence, colour, taste and odour. Sub-gingival samples of four sites, one in each quadrant, of greatest probing depth in each patient were used. Microbiological analyses were performed at baseline and at day 15. Paired t test was performed to detect statistical significant reduction in total bacterial loading and oral pathogens in the study groups. The analysis showed a statistically significant reduction in the total bacterial loading evaluated pre- and post-treatment (P = 0.029) in the study groups. In the control group, the decrease in total bacterial loading was not significant (P = 0.279). Clinically, ADC gel does not have any side effects and discomfort such as pain, burning, tingling sensation or numbness and produces no adverse reactions in time. Our study aimed to evaluate the efficacy of a new chemical formulation with antibacterial properties to use for daily oral hygiene with a preliminary study. Our results showed a statistically significant reduction in total bacterial loading after treatment, but the limitations of our study do not allow us to demonstrate the clinical efficacy of the ADC gel.

Several distinct classes of drugs, such as anticonvulsants, immunosuppressants, and calcium channel blockers, caused gingival overgrowth. One of the main drugs associated with the gingival overgrowth is the anti-epileptic such as phenytoin, which affects gingival tissues by altering extracellular matrix metabolism. In our study, we evaluate the effect of phenytoin, a drug whose active substance is phenytoin, on gingival fibroblasts of healthy volunteers. Gene expression of 29 genes was investigated in gingival fibroblasts' cell culture treated with phenytoin compared with untreated cells. Among the studied genes, only 13 genes (CXCL5, CXCL10, CCR1, CCR3, CCR5, CCR6, IL-1A, IL-1B, IL-5, IL-7, IL-6R, BMP-2, and TNFSF-10) were statistically significant. All but one gene resulted downregulated after 24 h of treatment with phenytoin. BPM2 was the only, although weakly, up-expressed gene. Probably, we have not highlighted overexpression of the other inflammatory molecules because the study was performed on healthy people. Many studies show that phenytoin induces the overexpression of these cytokines but, probably, in our study, the drug does not have the same effect because we used gingival fibroblasts of healthy people.

Gingival overgrowth is a serious side effect that accompanies the use of amlodipine. Several conflicting theories have been proposed to explain the fibroblast’s function in gingival overgrowth. To determine whether amlodipine alters the inflammatory responses, we investigated its effects on gingival fibroblast gene expression as compared with untreated cells. Fragments of gingival tissue of healthy volunteers (11 years old boy, 68 years old woman, and 20 years old men) were collected during operation. Gene expression of 29 genes was investigated in gingival fibroblast cell culture treated with amlodipine, compared with untreated cells. Among the studied genes, only 15 (CCL1, CCL2D, CCL5, CCL8, CXCL5, CXCL10, CCR1, CCR10, IL1A, IL1B, IL5, IL7, IL8, SPP1, and TNFSF10) were significantly deregulated. In particular, the most evident overexpressed genes in treated cells were CCR10 and IL1A. These results seem to indicate a possible role of amlodipine in the inflammatory response of treated human gingival fibroblasts.

The aim of this issue is to describe endosseous distal extension (EDE) surgical technique. This implant technique was conceived and applied since 1993 by Dr Luca Dal Carlo, as an evolution of the classical ramus blade implant technique. With this technique, you attain great stability of the blade implant, due to the following difference compared with the classical blade implant technique: the hard and soft tissues lying behind implant abutment are not being destroyed at all. A slot is made on the upper side of the bone ridge, and the blade is inserted into it and pushed backwards, so that the implant is embedded under untouched tissues. Using blade implants specially drawn for this particular surgery, the slot’s length turns out to be about half of the implant’s length. Piezo bistoury is useful to facilitate surgical proceedings. If we compare the regenerated bone on the mesial part of the implant and the bone that had remained untouched on the distal side, we will see a difference in the tissue density even after a long time. EDE technique is suitable for those cases in which the lower distal sector is characterized by scarceness of cancellous bone. Data collected during 22 years of clinical practice (97.7% 5-year success rate) allow to suggest employing this technique with asymmetric blades to treat D3-D4 narrow ridges located in the posterior mandible. Soft tissue response results are very good.

Gabapentin is one of the most used drugs to treat postoperative pain with antihyperalgesic properties and has a unique mechanism of action, which differentiates it from other commonly used drugs. Various studies have shown that the perioperative use of gabapentin reduces postoperative pain. In our study, fragments of gingival tissue of healthy volunteers were collected during operation. Gene expression of 29 genes was investigated in gingival fibroblasts cell culture treated with gabapentin, compared with untreated cells. Of the different chemokines and interleukins studied, only 10 were statistically significant (CCL1, CCR1, CCR4, CCR5, CCR6, ILI1A, ILI1B, IL5, IL6R, TNFSF10). The overexpression of these cytokines, obtained in many studies, leads us to think that gabapentin can interact and cause post-inflammatory gingival hyperplasia, but, probably, in our study the gabapentin has not the same effect, because we used gingival fibroblasts of healthy people.

The bacterial biofilm formation in the oral cavity and the microbial activity around the implant tissue represent a potential factor on the interface between bone and implant fixture that could induce an inflammatory phenomenon and generate an increased risk for mucositis and peri-implantitis. The aim of the present clinical trial was to investigate the bacterial quality of a new antibacterial coating of the internal chamber of the implant in vivo at six months. The PIXIT implant (Edierre srl, Genova Italy) is prepared by coating the implant with an alcoholic solution containing polysiloxane oligomers and chlorhexidine gluconate at 1%. A total of 15 healthy patients (60 implants) with non-contributory past medical history (nine women and six men, all non-smokers, mean age of 53 years, ranging from 45–61 years) were scheduled to receive bilateral fixed prostheses or crown restorations supported by an implant fixture. No adverse effects and no implant failure were reported at four months. All experimental sites showed a good soft tissue healing at the experimental point times and no local evidence of inflammation was observed. Real-Time Polymerase Chain Reaction (PCR) analysis on coated and uncoated implants showed a decrease of the bacterial count in the internal part of the implant chamber. The mean of total bacteria loading (TBL) detected in each PCR reaction was lower in treated implants (81,038 units/reaction) compared to untreated implants (90,057 units/reaction) (p < 0.01). The polymeric chlorhexydine coating of the internal chamber of the implant showed the ability to control the bacterial loading at the level of the peri-implant tissue. Moreover, the investigation demonstrated that the coating is able to influence also the quality of the microbiota, in particular on the species involved in the pathogenesis of peri-implantitis that are involved with a higher risk of long-term failure of the dental implant restoration.

The objective of this study was to evaluate the effects of lozenges-containing Lactobacillus reuteri as an adjuvant treatment of peri-implant mucositis and to detect the level of L. reuteri colonization in the peri-implant tissues of treated patients. A total of 10 patients were selected. Subjects with at least one implant affected by peri-implant mucositis, with gingival index (GI) of ≥2 in each quadrant, evaluated at the buccal aspect of all teeth. Patients included in the study were partially edentulous and had implants with mucositis or peri-implantitis. Implants with radiographic bone loss of ≥5 mm and/ or ≥50% of the implant length were excluded, and only one implant per patient was included. Each patient received L. reuteri–containing lozenges. Microbiological sampling was performed at baseline and on day 28 and analysed by polymerase chain reaction (PCR). Our results indicate that the use of the probiotic did not influence the peri-implant microbiota in a statistically significant way, although there was a reduction in the number of periodontal and peri-implant species. The lack of statistically significant microbiological changes could be explained either by the small sample population or by the short evaluation period. Therefore, the poor colonization of L. reuteri in the peri-implant pockets can be explained by the different anatomical and histological characteristics of the interface of the dental–gingival unit with respect to the periodontal sulcus. The administration of a daily lozenge of L. reuteri for 4 weeks had a limited effect on the microbiological analysis. Probiotics provide an alternative therapeutic approach to consider in the prevention and treatment of peri-implant diseases, but further long-term prospective studies with standardized variables are needed.

The use of chemical devices for periodontitis treatment has led to new strategies aiming primarily to control infections. Over the last few years, new chemical devices have been subjected to many scientific and medical studies. The purpose of the present study was to assess the effect of a new silver based chemical devices gel named "Hydrosilver Plus Gel", abbreviated here as Hydrosilver, on the pathogenic microorganisms, using Polymerase Chain Reaction (PCR) for microbiological analysis. Materials and methods: Ten patients with a diagnosis of chronic periodontitis in the age group > 25 years were selected. None of these patients had received any surgical or non-surgical periodontal therapy, and demonstrated radiographic evidence of moderate bone loss. After scaling and root planning, patients received Hydrosilver to be used at home. Four non-adjacent sites in separate quadrants were selected in each patient for monitoring, based on criteria that the sites localise chronic periodontitis. Microbial analysis was analysed at baseline and at Day 15. SPSS program was used for statistical purposes and a paired samples correlation was performed at the end of the observation period. Results: Mean amounts of bacterial loading before and after Hydrosilver treatment reduced statistically significantly (p = 0.002). Conclusions: The present study demonstrated that Hydrosilver has a good impact on oral biofilm. Additional studies are needed to detect the efficacy of this chemical device.

Zinc was known in ancient times, and is diffused in the environment. The potential benefits offered by zinc supplementary therapy have been demonstrated in numerous clinical trials using oral or topical zinc products. The benefit of zinc can be in principle increased through association with other actives. The aim of this study is to evaluate the effect on primary human gingival fibroblast cell of a new formulation containing zinc and octenidine cations. Human gingival fibroblast cells were obtained from three healthy patients (14-year-old man, 15-year-old woman and 20-year-old man) during extraction of teeth. The gene expression of 14 genes (ELANE, FN1, FBN, ITGA1, HAS1, ELN, DSP, ITGB1, HYAL1,TGFB1, TGFB2, TGFB3, TGFBR1 and TGFBR2) was investigated in HGF cell culture treated with 80µM of Octenidine, 1000µM of Zinc, 80µM Octenidine + Zinc solution and the medium alone at 30 min. PrestoBlue™ data showed that as the active concentration increases (Octenidine, Zinc and Octenidine + Zinc) the percentage of cell vitality compared to that of untreated cells decrease. In this study, no statistically significant gene expression was observed between cells, treated with difference substances, and control cells. Our results points out that zinc plus octenidine shows a positive potential in periodontal disease treatment.

Background: This review aims to address procedures and indications for the application of the adipose-derived stem cells (ADSCs) for regenerative dentistry. ADSCs have rarely been used in this particular field; conversely, experience from other clinical fields and basic research seems to recommend the suitability of this application. Aims and Methods: We reviewed 32 out of 193 articles on Medline sorted by the relevance option. The main purpose of this paper is to perform a short review of the application of stem cells in regenerative dentistry, describing a multilineage differentiation as a safe and useful alternative way of harvesting and selection of ADSCs. Results and Conclusion: The most common derivation of stem cells for regenerative dentistry is from the adipose tissue. There are conditions in which the levy adipose cannot be easily achieved, or where large amount of grafting is not needed. For this purpose, the possibility of selecting stromal stem cells directly from the lax subcutaneous connective tissue, preferably of the head region, would allow a technical simplification.

Periodontal treatment has the aim to reduce oral infection, and prevent the progression of the disease. The potential benefits of new chemical devices for periodontal therapy, include improved patient compliance, an easier access to periodontal pocket and a lower dosage of antimicrobial agent. The objective of this study was to explore the efficacy of a chemical device containing zinc and octenidine in the treatment of chronic periodontitis in adult patients. Ten patients with a diagnosis of chronic periodontitis (20 localized chronic periodontitis sites) in the age group of 35 to 55 were selected. None of these patients received any surgical or non-surgical periodontal therapy and demonstrated radiographic evidence of moderate bone loss. The chemical device zinc plus octenedine was used by each patient after daily oral hygiene. Microbial analysis were analyzed at baseline and on the 15th day. After the treatment, a remarkable decrease in bacteria amount, both for some species and for the total count was observed in the study group. Specifically T. forsythia and T. denticola were eradicated whereas Total Bacteria Loading and Fusobacterium Nucleatum showed a reduction of 38% and 55%, respectively. Our study demonstrated the efficacy of the new chemical device containing zinc and octenidine in a sustained release drug delivery system in the management of moderate to severe chronic periodontitis.

Infective endocarditis is a devastating disease with high morbidity and mortality. The link to oral bacteria has been known for many decades and has caused ongoing concern for dentists, patients and cardiologists. The microbiota of the mouth is extremely diverse and more than 700 bacterial species have been detected. Half of them are uncultivable so far. Oral microbiota is not uniform, specific sites exist in the mouth such as tongue, palate, cheek, teeth and periodontal pockets that have their own microbiota. Factors involved in the development of a bacterial endocarditis are difficult to define but a vulnerable surface (i.e. a damaged endocardium) and a high bacterial load in the blood seems to be decisive. The cause of microorganisms, in 90% of cases, are staphylococcus, streptococcus and enterococcus. Oral streptococci belong to viridans group (streptococcus mutans and streptococcus sanguis). As they are part of dental plaque, they could enter the bloodstream causing bacteraemia through daily habits like chewing or tooth brushing. Effective treatment of periodontal infections is important to reduce local inflammation and bacteraemia. In addition, poor periodontal health appears to increase the risk of cardiovascular disease, pulmonary disease, and preterm and low birth weight. Conclusions: Longstanding oral disease prevention protocols reduce the risk of developing periodontal disease. Data suggest that methods used to prevent cases of IE that originate from oral bacteria should focus on improving oral hygiene and reducing or eliminating gingivitis, which should reduce the incidence of bacteraemia after tooth-brushing and the need to extract teeth owing to periodontal disease and caries.