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Aim: Cyst-like lesions in the mandible rarely develop into malignancies, and the re- ported incidence is between 0.3% and 2%. The present study describes a rare case of primary intraosseous squamous cell carcinoma of the mandible arising from an odon- togenic cyst. Materials and Methods: An 80-year-old male was referred to Trieste University Maggiore Hospital (Trieste, Italy), with acute pain in the left retromolar area. An initial examination revealed extra oral swelling without paresthesia of the IAN. Following an intraoral examination, the oral mucosa was edematous, percussion pain was experienced on the lower left second molar. Panoramic radiography revealed a re- tained lower left wisdom tooth and an irregular radiolucent area between the lower left second molar and the mandibular angle with clear margins. Computed tomography re- vealed diffuse bone resorption and an extensive loss of cortical bone on the lingual side. Results: A biopsy was performed during the surgery to remove the second lower left molar and the wisdom tooth, the pathological diagnosis was of squamous cell carcinoma arising from the epithelial lining of the odontogenic cyst. MRI with contrast agent was also performed. Shortly after the patient has been proposed a complete resective surgery of the mass including the infiltrated areas and then a reconstructive part to restore the function and aesthetic. Conclusion: The follow-up of a large inflammatory cyst is essential for early diagnosis of malignant neoplasm. This approach allows lower invasive treatments and major survival of these patients.

The success in acquiring a precision impression in the dental field is a compromise between the processing time and the setting time of the impression material. A device called "Impression Heater" (EU application n ° EP20186042.6) has recently been patented, which consists of a self-heating disposable adhesive patch with an exothermic chemical reaction to be placed on the dental impression tray. The aim of the study was to evaluate the effectiveness of a thermal impression accelerator in reducing the setting time of different elastomers.3 samples of 5 different elastomeric materials (width 6 mm x length 50 mm x depth 3-5-7 mm) the hardening of the material was evaluated at intervals of 15 seconds using an ASTM 2240 Shore-A durometer at 20°C. The same procedure was replicated 3 times after positioning on a Impression Heater at temperatures of 35 °C, 50 °C and 65 °C, for each material.An increase in the impression material temperature from 35 °C to 50 °C reduces the setting time of an amount between 38.1% and 45.8%. Increasing the temperature from 35 °C to 65 °C results in a reduction of the setting time between 52.4% and 66.9%. At higher temperatures, the greater thickness of the impression material requires longer hardening times.The tests carried out confirm the validity of the patented idea which reduces the time of impression taking while keeping the working time sufficiently long for the operator to manoeuvre.

Objective Resin coating in implants rehabilitation not always can be aesthetic, durable and comfortable for the patient mainly due to the limited dimensions of the final structure. Intraoral welding technique and computer-aided designed prosthetic shells may be a solution.This in vitro study evaluates the capacity of load and the weakest point of implant-supported provisional prosthesis using welded titanium framework.Methods Twelve samples were produced to simulate an implant supported fixed prosthetic bridge. Two implants (Ankylos; Dentsply Implant Manufacturing; Germany) were inserted inside blocks of nanoceramic material produced with a stereolithographic 3D printer. A polymethylmethacrylate (PMMA) resin shell was performed with CAD/CAM and relined on welded framework. Six samples were performed with the same procedure reducing resin thickness. The samples were subjected to fatigue test (6’500’000 cycles) using ElectroForce 3310 fatigue machine (t1); subsequently a mechanical compression test using a universal Shimadzu AGS-X 10 machine (t2). The samples were analyzed with photographic and radiographic documentation at t0, t1 and t2.Results The samples survived mechanical fatigue test without evidence of failure. The radiographic and photographic evaluation revealed the fracture of resin coating after mechanical compression test. The samples with minimal resin thickness fracture first.Conclusion Adequate assessment of the resin thickness is mandatory for the improve the longevity of this rehabilitations.Clinical Relevance CAD-CAM digital prosthetic design allows us to optimize the thicknesses and the prosthetic shapes, allowing us to obtain good degrees of resistance even in the presence of reduced prosthetic spaces

A insuficiência renal crônica é uma doença progressiva caracterizada por uma destruição gradual dos néfrons e uma conseqüente redução da função renal. A doença renal em estágio terminal (DRT) requer terapia de substituição renal como diálise peritoneal, hemodiálise ou transplante. Os pacientes afetados pela DRT ou em hemodiálise correm risco de desenvolver uma série de comorbidades, incluindo hipertensão, anemia, risco de sangramento, suscetibilidade à infecção, efeitos colaterais dos medicamentos e manifestações orais associadas à própria doença e ao tratamento em hemodiálise. Nesse contexto, as doenças bucais representam uma causa potencial e evitável de maus resultados de saúde em pessoas com DRT devido à sua relação com infecção, inflamação e desnutrição.

The aim of this study is to evaluate if the risk of neurological injury to the inferior alveolar nerve (IAN) and the lingual nerve (LN), following the extraction of lower third molars are influenced by the anesthetic modality (local anesthesia (LA) vs. general anesthesia (GA)). A systematic search was performed through the PubMed, Scopus, Cochrane Library, an Web of Science databases; furthermore, a manual search was performed by analyzing the references of full-text articles. From a total of 309 studies (collected after the removal of duplicates), 6 studies were selected. Of these, 4 reported a correlation between GA and nerve damage, while the other 2 did not show an obvious as- sociation. The level of bias in the studies was also calculated. Only 2 studies showed a medium risk of bias, while 4 studies showed a high risk of bias; no study showed a low risk of bias. Four of the 6 studies high- lighted a higher incidence of IAN and LN injury, following the extractions performed under GA. Although no scientific evidence is yet available, due to the scarcity and the limited quality of the studies in the literature, considering the risk–benefit ratio, LA should be the first choice in lower third molar surgery.

This study analysed the bioceramic sealer cleaning ability of two chemo-mechanical systems in intact and restored teeth. Thirty-two single-rooted teeth were used, and half of them restored with a pre-endodontic composite restoration (PCR). All samples were instrumented with a size 40 Reciproc Blue file and filled with BioRoot RCS. Canals were retreated using the R40 and then R50 Reciproc Blue. The samples were divided into four experimental groups (n = 8): intact teeth/passive ultrasonic irrigation (PUI) (G1), intact teeth/shock wave-enhanced emission photoacoustic streaming (SWEEPS) (G2), PCR/PUI (G3) and PCR/SWEEPS (G4). The samples were scanned by micro-CT before and after retreatment, and the volume of remaining filling material was evaluated. The minor percentage of residues were observed in G2, with a volume of 0.447 +/- 0.356% of the endodontic space (P < 0.001). The Reciproc/SWEEPS technique showed the better performance in intact teeth compared with PUI technique. Pre-endodontic restoration did not significantly affect the effectiveness of sealer removal.

To evaluate the filling ability of two orthograde obturation techniques followed by the apical resection with or without retrograde obturation through micro-computed tomography (CT). Thirty-two single-rooted permanent teeth were prepared and randomised into four groups (n = 8) according to the orthograde obturation technique (single cone technique [SCT] and mineral trioxide aggregate placement) combined or not with retrograde obturation. The volume of voids (VoV) within the entire endodontic space, the apical 3 mm, and 1 mm after root resection was calculated by micro-CT. Statistical analysis showed no significant difference among the groups regarding the total VoV in all root canals, as well as within the apical 1 mm after root resection. The SCT and apical resection without retrograde filling showed significantly better results in terms of VoV at the apical 3 mm after root resection. Within the study limitations, SCT associated with apical resection without retrograde preparation exhibited a similar or less amount of voids than the other groups.

Purpose: A retrospective clinical study was performed to compare the post-operative sequelae of the submucosal administration of two different low dosages of dexamethasone, after the surgical extraction of lower third molars. Methods: Data regarding edema, trismus, pain and analgesic consumption were collected from 150 subjects, selecting three equal groups (n= 50): a control group with no administered dexamethasone (G1); submucosal injection of dexamethasone 2 mg/0.5 ml (G2) and submucosal injection of dexamethasone 4 mg/1 ml (G3). Collected data were evaluated at three different time points: T0 before surgery, T1 on the third day after surgery and T2 on the 7th day after surgery. Patients’ gender and age were also considered for statistical purposes. Results: The effects on facial swelling reduction were statistically significant in G2 at T1 in the male subgroup. With trismus, the differences between the time points considered were statistically significant in G2 in the subgroup of subjects younger than 25 years old. Differences in analgesics taken were statistically significant when G1 and G2 were compared at T1. (Am J Dent 2022;35:233-237).

BACKGROUND The aim of this study was to determine the knowledge of periodontal health and prevention of periodontal diseases of a pool of pharmacists working in Friuli Venezia Giulia. METHODS A 22-questions questionnaire about oral health was sent by mail to all the pharmacies working in Friuli Venezia Giulia and to the most known associations of pharmacists. The data were collected and analyzed by Google Forms software. RESULTS One-hundred sixty-four questionnaires were analyzed. Ninety-one percent of the pharmacists assert to give advice about prevention and treatment of oral affection during professional practice, but 97% never attended university courses about it. Only 21% took part in postgraduate courses about oral health. Most of them have not enough notions about periodontal disease. CONCLUSIONS The findings from this study highlight that pharmacists have not enough knowledge about periodontal disease and its treatment but every day they provide advice about oral health. It would be appropriate a better organization of postgraduate courses about oral health and prevention of periodontal diseases.

Purpose: To assess the effects of grade IV titanium ultrasonic tip instrumentation on different grade IV titanium implant surfaces and compare the decontamination of different implant surfaces using chlorhexidine, blue laser, or ozone. Materials and methods: Profilometry and energy-dispersive x-ray spectroscopy (EDS) analyses were performed on smooth, laser-micropatterned, and sandblasted grade IV titanium sample disks before (t0) and after (t1) ultrasonic instrumentation with an ultrasonic grade IV titanium tip. Samples were also incubated with a Streptococcus sanguinis culture. Each surface type was then treated with chlorhexidine, blue laser, or ozone (three test groups + control group). Scanning electron microscopy (SEM) images were taken after bacterial growth and after decontamination. Results: After ultrasonic instrumentation, surface roughness (Ra) decreased on sandblasted and micropatterned surfaces, whereas it remained substantially unvaried on the smooth surface. SEM images revealed that the laser-micropatterned structure remained substantially unvaried after instrumentation. EDS revealed a minimal quantity of carbon and iron, found in the laser-treated and sandblasted group at t0. A minimal quantity of aluminum and oxygen was found on the sandblasted surface at t0 and t1. Ozone therapy achieved the highest decontaminating effect, regardless of implant surface topography. Conclusion: Among the alternative therapies to ultrasonic instrumentation with titanium tips, ozone appears to be effective regardless of the type of implant surface; it can be used for the decontamination treatment of implants without altering the surface structure.

Background: The blood wettability of titanium implant surfaces favors primary osseointegration and tissue healing in peri-implantitis. The current study aims to evaluate this property on the main different kinds of surfaces, brand new and after treatments. Methods: grade IV titanium disks were used, five machined, five laser-treated, five sandblasted. The experiment was on four steps. Between each step, specimens were sterilized. At the end of each step, a 4 µL blood drop was put on the samples, and contact angles were calculated. The steps consisted of—1: no treatment, 2: surface instrumentation with an ultrasonic titanium tip, 3: platelet-rich fibrin (PRF) coating and drying with sterile gauze, 4: etching with phosphoric acid, rinse and saline solution and air-drying. At the end of each phase, a blood drop was placed on the surfaces. Blood for PRF preparation and for calculation of contact angles was collected from a single source. Results: average wettability decreased after instrumentation, and increased after the PRF application to a superior level both to the first and second steps. The highest wettability was obtained after etching. This trend is statistically significant for machined and sandblasted surfaces. Conclusions: In the clinical environment, PRF and phosphoric acid used for conditioning exposed implant surfaces can be used for the healing of peri-implant tissues.

The influence of the layer thickness and composite shade on the final color of Ceram.X composites (Dentsply Sirona) was tested, selecting five intermediate-translucency Ceram.X Universal shades, three high-translucency Ceram.X Duo "enamel" shades, and four low-translucency Ceram.X Duo "dentin" shades. Using cylindrical molds, 850 specimens were obtained, representing the whole array of possible Universal single specimens (in seven thicknesses, ranging from 1.0 to 4.0 mm in 0.5-mm increments) and Duo combinations. The CIELAB coordinates of each specimen were determined with a spectrophotometer. Different thicknesses and composites were compared with Clark's ΔE. The difference in color among specimens of different thicknesses was material-dependent. The thickness and shade of the composite markedly affected the color yield of the Ceram.X system. For each shade of the Universal systems, only one Duo enamel-dentin combination corresponded.

Periodontitis is a common inflammatory disease characterized by a complex etiology, which is the result of a combination of genetic and environmental factors. Genetic variants linked to the periodontitis disease were already investigated, however, little was known regarding the severity of this disease. Recently, long runs of homozygosity (ROH) were associated with several multifactorial diseases. Therefore, in our work, we tried to assess the role of ROH and periodontitis status. We found an association between the excess of homozygosity owing to ROH and staging of periodontitis. More in detail, the total amount of homozygosity owing to ROH is positively associated with an increased severity of periodontitis (P = 0.0001). Regression tree analysis showed the impact of ROH burden in discriminating individuals with mild periodontitis stages I and II and periodontitis stages III and IV (P 1). Among them, we found a total of 33 genes. Interestingly, some of these genes were previously associated with granulocyte or platelet measures, both linked to the onset and the progression of periodontal disease. Our results suggest the not only single variants association test could help to risk assessment but even individual genomic features; furthermore, our ROH mapping highlighted the possible role of multiple genes in periodontal development.

Among the materials available for implant production, titanium is the most used while polyetheretherketone (PEEK) is emerging thanks to its stability and to the mechanical properties similar to the ones of the bone tissue. Material surface properties like roughness and wettability play a paramount role in cell adhesion, cell proliferation, osteointegration and implant stability. Moreover, the bacterial adhesion to the biomaterial and the biofilm formation depend on surface smoothness and hydrophobicity. In this work, two different treatments, sandblasting and air plasma, were used to increase respectively roughness and wettability of two materials: titanium and PEEK. Their effects were analyzed with profilometry and contact angle measurements. The biological properties of the material surfaces were also investigated in terms of cell adhesion and proliferation of NIH-3T3 cells, MG63 cells and human Dental Pulp Stem Cells. Moreover, the ability of Staphylococcus aureus to adhere and form a viable biofilm on the samples was evaluated. The biological properties of both treatments and both materials were compared with samples of Synthegra® titanium, which underwent laser ablation to obtain a porous micropatterning, characterized by a smooth surface to discourage bacterial adhesion. All cell types used were able to adhere and proliferate on samples of the tested materials. Cell adhesion was higher on sandblasted PEEK samples for both MG63 and NIH-3T3 cell lines, on the contrary, the highest proliferation rate was observed on sandblasted titanium and was only slightly dependent on wettability; hDPSCs were able to proliferate similarly on sandblasted samples of both tested materials. The highest osteoblast differentiation was observed on laser micropatterned titanium samples, but similar effects, even if limited, were also observed on both sandblasted materials and air plasma treated titanium. The lowest bacterial adhesion and biofilm formation was observed on micropatterned titanium samples whereas, the highest biofilm formation was detected on sandblasted PEEK samples, and in particular on samples not treated with air-plasma, which displayed the highest hydrophobicity. The results of this work showed that all the tested materials were able to sustain osteoblast adhesion and promote cell proliferation; moreover, this work highlights the feasible PEEK treatments which allow to obtain surface properties similar to those of titanium. The results here reported, clearly show that cell behavior depends on a complex combination of surface properties like wettability and roughness and material nature, and while a rough surface is optimal for cell adhesion, a smooth and less hydrophilic surface is the best choice to limit bacterial adhesion and biofilm formation.

Background: Neurological alterations are one of the main complications occurring after the third molar extractions. The aim of this prospective multicenter cohort study was to find out Cone Beam Computed Tomography (CBCT) features and distribution of neurological complications in patients undergoing lower third molar surgery and to determine the radiological and patient-related factors that could be correlated to the occurrence of inferior alveolar and lingual nerves injury. Material and Methods: 378 patients who underwent lower third molar extraction from March 2018 to March 2019 were included. Clinical and radiological data were collected. CBCT features were recorded following Maglione et al. classification. Symptoms and characteristics of patients who experienced neurological alterations were evaluated. Results: 193 patients needed a second-level radiological exam (CBCT). In these patients, the most common feature was Maglione class 3: a higher frequency of apical or buccal mandibular canals in direct contact with the tooth was observed. 3.17% of the patients developed a neurological complication. Maglione class 4, increased age, and operative time were all positively correlated with neurological alterations. Conclusions: while the buccal or apical position of the mandibular canal was the more common findings, the lingual position was found to have a higher correlation with a negative outcome. Age and operative time were also found to be risk factors for developing nerve injury in the considered population.

Objectives Chronic periodontitis is a common pathological condition that affects the supporting tissue of the teeth, leading to progressive alveolar bone destruction and teeth loss. The disease is caused by bacteria and derives from an altered host immune and inflammatory response, also involving different factors such as the oral hygiene, smoking, genetic background etc. The innate immune response, the first line of host defense, could also play an important role in the susceptibility to chronic periodontitis. In this study, we evaluated the possible association between periodontal disease and seven genetic variations within DEFB1 and LTF genes, encoding for β-defensins 1 and lactoferrin (two members of oral innate immune system), in an Italian isolated population. Subjects and Methods DEFB1 5’UTR g.-52G>A (rs1799946), g.-44C>G (rs1800972), g.-20G>A (rs11362), 3’UTR c*5G>A (rs1047031), c*87A>G (rs1800971), LTF p.Ala29Thr (rs1126477) and p.Lys47Arg and (rs1126478) were analyzed in 155 healthy individuals and 439 chronic periodontitis patients from North East Italy. Results Significant associations were found between periodontitis and g.-20G>A (rs11362) and g.-44C>G (rs1800972) SNPs in DEFB1 gene as well as p.Ala29Thr (rs1126477) and p.Lys47Arg (rs1126478) SNPs in LTF gene. Discussion Our results suggest the involvement of DEFB1 and LTF genetic variations in the susceptibility towards development of periodontitis. This article is protected by copyright. All rights reserved.

Aim To assess the 18-month success rate of root canal treatment with two integrated shaping and filling systems on upper central incisors with chronic periapical pathosis. Methodology Sixty patients with an upper central incisors with a chronic periapical lesion smaller than 5 mm in diameter were randomly allocated to two treatment groups, which only differed in terms of canal shaping and filling protocol: G1 (n = 30), Revo-S/One Step Obturator; G2 (n = 30) GTX/GTX Obturator. The patients underwent clinical assessment at baseline and after 6, 12 and 18 months. Radiographic healing was scored according to a previously described scale by two independent examiners, who analysed the periapical radiographs taken at the recall visits. Intra- and inter-observer reliability was tested with Kappa statistics. The significance of the differences between the two groups and among time points with regard to clinical and radiographic data was evaluated with non-parametric tests (p Results All enrolled patients were available for re-evaluation. At the final recall, the cases were scored as total healing, partial healing and failure with the following frequencies: 93.3%, 3.3% and 3.3% of cases in G1 and in 93.3%, 0% and 6.7% of cases in G2. Radiographic healing scores were similar in the two groups irrespective of the experimental time point. The prevalence of symptoms was scarce (0–10%), stable over time and similar in the two groups. Conclusions The clinical performance of two considered integrated systems for the endodontic treatment of upper central incisors with periapical lesion was comparable and allowed for high success rates after 18 months.

The aim of this study was to investigate which factors play a major role in the healing of Class II mandibular furcation defects treated with different surgical techniques. Twenty-five systemically healthy subjects with periodontitis stage III grade B and Class II buccal mandibular furcation involvement received one of the following open flap debridement approaches: Group 1 (n = 10), no further treatment; Group 2 (n = 10), piezoelectric contouring of the furcation roof; Group 3 (n = 9), piezoelectric contouring of the furcation roof and bone grafting; Group 4 (n = 10), piezoelectric contouring of the furcation roof and bone grafting with coronally positioned flap. Clinical and radiologic variables-bleeding on probing, probing depth (PPD), vertical and horizontal bone level (CAL and PH), gingival recession, root trunk length, radicular separation, and furcation perimeter (FP)-were evaluated at baseline and 180 days and 1 year after surgery. All clinical parameters were statistically analyzed. Surgical techniques caused clinical (CAL, PPD, PH) and radiographic (FP) improvements. Regenerative techniques and the coronally positioned flap yielded a major radiographic reduction of furcation areas. All therapies resulted in significant horizontal and vertical PPD reduction and CAL gain.

Lack of adequate amount of keratinized gingiva around dental or implants is generally treated with coronally advanced flap in combination with connective tissue graft. The procedures of harvesting the soft tissue grafting are usually associated with a certain degree of morbidity; for this reason xenogenic collagen matrix was proposed to be used as an option to reduce morbidity. This collagen matrix quickly stabilizes the blood clot and promotes rapid vascularization. Moreover, this product promotes root coverage, reduction of recession and regeneration of keratinized gingiva both in width and thickness. Recently, xenogenic collagen matrix was also proposed as a biological material able to regenerate keratinized gingiva around implants. In this review, the role of xenogenic collagen matrix (Mucograft®) has been critically analyzed to evaluate its effectiveness and predictability in keratinized tissue augmentation around implants supporting prosthetic restorations. Most of the studies showed that xenogenic collagen matrix was effective in increasing the thickness of the peri-implant mucosa and in the gaining of keratinized gingiva with comparable or slightly lower results than autologous connective tissue grafts. From the aesthetics point of view, the gold standard appeared to be the autologous connective tissue graft. Histologic analysis showed a good integration of the collagen membrane that matures into a healthy tissue. Mucograft® seems an effective alternative to the autologous connective tissue graft with regard to the gain of keratinized tissue and the increase in thickness of peri-implant soft tissues, with less post-operative morbidity and reduced operative times.

Studies have investigated the relationship between periodontitis and the decrement of the bone mineral density (BMD). However, there is limited knowledge on the possible association between BMD-related genes and susceptibility to periodontitis development. To fill this gap, a total of 157 genes, previously associated with BMD, were analyzed in 442 subjects affected by chronic periodontitis. Candidate gene analyses resulted in two RBMS3 deleterious variants, rs55872743 and rs7636555, significantly associated (p-value < 3.28 × 10−06) with periodontitis status. These results will shed new light on the possible role of genes linked to BMD affecting periodontitis.

Defining the role of oral health evaluation in prediction of mortality in a cohort of patients admitted to an acute geriatric unit. Plaque Index and periodontal disease are independent predictors of 1-year mortality and improve accuracy of a Multidimensional Prognostic Index. Oral health evaluation, if integrated in a comprehensive assessment, adds significant information to estimate prognosis of hospitalized patients. Predicting mortality of older patients is a difficult, yet crucial task, which has lead to development of several prognostic tools. We hypothesized that the evaluation of oral health, which is often neglected, might be helpful to improve 1-year mortality prediction in a cohort of patients > 65 years admitted to an acute geriatric unit. We assessed 200 patients using the Decayed, Missing or Filled Teeth tool, the Periodontal Screening and Recording tool and the Plaque Index. A comprehensive geriatric assessment was performed to measure functional, cognitive, nutritional and comorbidity status and to calculate the Multidimensional Prognostic Index (MPI). An age- and sex-adjusted regression model was used to identify independent predictors of 1-year mortality. Area under ROC curve (AUROC) was calculated to assess predictive accuracy of MPI risk groups before and after correction for dental examination results. Plaque Index and Periodontal Screening and Recording tool were associated with 1-year mortality. Participants with periodontal disease had a fivefold higher risk of death (p

Purpose. Recent advances show that ultrasonic implant site osteotomy is related to a decreased trauma and a better postoperative healing of the surgical site when compared to traditional drilling techniques. The micrometric bone cutting control and the operative advantages related to the piezoelectric approach are also characterized by a learning curve for the clinician in surgical practice and an increased operative duration of the procedure. The aim of this investigation is to compare the operative time, the postoperative pain, and the amount of painkillers taken by the patient during the healing period. Methods. A total of 65 patients were treated at the Unit of Oral Surgery (Department of Medical Sciences, Surgery and Health, University of Trieste, Italy) using a split mouth model: 75 drill-inserted implants (G1) and 75 piezoelectric device-inserted implants (G2) were placed. The Visual Analogue Scale (VAS) was performed to evaluate the postoperative pain at 15 days from surgery. The operative time and frequency of intake of painkillers were measured. Results. The G1 and G2 groups showed a significant difference with a higher use of painkillers observed for G1. The G2 patients showed a lower level of pain (VAS) at all experimental times between 8 hours to 7 days (p<0.01) postsurgery. At 15 days, the pain levels were similar for both groups. No differences were found in site preparation duration between the study groups. Conclusions. The evidence supports the application of the piezoelectric approach compared to the drill’s osteotomy as a useful technique for implant site preparation. This trial is registered with NCT03978923.

Aim To assess preliminarily the success rate of the root canal treatment with two integrated shaping and filling systems of upper central incisors with chronic periapical pathosis. Methodology Sixty adult subjects with an untreated maxillary central incisor presenting a chronic periapical lesion smaller than 5 mm in diameter were recruited for the present study. The patients were randomly divided into two treatment groups: G1 ( n = 30), Revo-S/One Step Obturator; G2 ( n = 30) GTX/GTX Obturator. All root canal treatments were performed in a single session by the same operator. Sensitivity to palpation and percussion was registered at baseline and at the six-month recall. Radiographic healing was scored by two blind examiners according to a previously described scale. The absence of statistically significant differences in terms of baseline clinical parameters between the two groups was assessed by means of a Mann–Whitney test (age, apical gauging) and χ 2 test (sensitivity to percussion and palpation). The radiographic scores attributed to the two groups were compared with a Mann–Whitney test, while a χ 2 test served to compare the clinical data gathered after six months ( p Results Baseline clinical parameters registered in the two groups were found to be comparable. All patients attended the six-month recall and all the teeth were referred to be negative to sensitivity, with the exemption of two subjects per group. The periapical lesions were scored as totally healed, partially healed and not healed in 43.4%, 53.3% and 3.3% of cases in G1 and in 43.3%, 50.0% and 6.7% of cases in G2. The differences between the groups were not significant. Conclusions Tough cases scored as incomplete healing should be further followed up, the present study attests that the two tested integrated shaping and filling systems are capable of high and comparable six-month success rate in upper central incisors with periapical pathosis.

Background:Researchers have recently drawn attention to the analysis of gingival crevicular fluid (GCF) and peri-implant sulcus fluid (PISF) for the implementation of the diagnosis of periodontal and peri-implant disease. Nevertheless, the measurements of volume and biomarkers concentration can be critically biased when data collected from studies with parallel group design are compared, given the technical difficulties, methodological variables, as well as the variability of crevicular fluid characteristics among different individuals.Objective:The aim of the present study was to assess the GCF and PISF volumes in healthy and diseased sites belonging to the same patient.Method:Ten patients presenting a periodontally healthy tooth, a tooth with periodontitis, an implant with healthy peri-implant tissues and an implant with peri-implantitis were enrolled. Samples of GCF and PISF were collected from each site of interest and their volume measured with a Periotron 8000 device. Non-parametric statistical analysis was performed to test the significance of the differences in GCF and PISF volumes between i) sites of teeth and dental implants with the same condition of health or disease and ii) healthy and diseased sites of both teeth and dental implants subgroups. The correlation between probing pocket depth (PPD) and fluid production was also tested (pResults:Healthy periodontal and peri-implant tissues produced comparable amounts of fluid that was significantly lower than in diseased sites (pConclusion:The periodontal and peri-implant tissues behaved similarly in terms of fluid production in condition of both health and active disease.

Objective: Olmesartan Medoxomil is a type 1 receptor antagonist an antagonist of type 1 receptor (AT1) of angiotensin II (A-II) that inhibits numerous actions of A-II in the renin-angiotensin-aldosterone system (RAAS). A-II is a significant and multifunctional peptide involved in the pathophysiology of blood hypertension and for this reason it represents the main target in several classes of drugs used to treat and control arterial hypertension, such as angiotensin converting enzyme inhibitors (ACE-i), angiotensin receptor blockers (ARB) and renin direct inhibitors. The aim of the study is to evaluate whether the two drugs that have as an active principle Olmesartan Medoxomil, with and without the diuretic hydrochlorothiazide, are able to determine gingival overgrowth. Study Design: 108 subjects were examined and divided into three groups: G1, subjects treated with Olmesartan Medoxomil and hydrochlorothiazide (n=60); G2, subjects received only Olmesartan Medoxomil (n=24); G3, control group without pharmacological therapies (n=24). The plaque index (IP) and the gingival overgrowth index (OI) were recorded, considering the vertical and horizontal components. Results: Vertical overgrowth averaged between 0.17 ± 0.15 (G3) and 0.34 ± 0.26 (G2) showing statistically significant differences (p

It has been shown that stem cells are able to calcify both in vitro and in vivo once implanted under the skin, if conveniently differentiated. Nowadays, however, a study on their efficiency in osseous regeneration does not exist in scientific literature and this very task is the real aim of the present experimentation. Five different defects of 6 mm in diameter and 2 mm in depth were created in the calvaria of 8 white New Zealand rabbits. Four defects were regenerated using 2 different conveniently modified scaffolds (Bio-Oss® Block and Bio-Oss Collagen®, Geistlich), with and without the aid of stem cells. After the insertion, the part was covered with a collagen membrane fixed by 5 modified titan pins (Altapin®). The defect in the front was left empty on purpose as an internal control to each animal. Two animals were sacrificed respectively after 2, 4, 6, 10 weeks. The samples were evaluated with micro-CT and histological analysis. Micro-CT analysis revealed that the quantity of new bone for samples with Bio-Oss® Block and stem cells was higher than for samples with Bio-Oss® Block alone. Histological analysis showed that regeneration occurred in an optimal way in every sample treated with scaffolds. The findings indicated that the use of adult stem cells combined with scaffolds accelerated some steps in normal osseous regeneration.

Aims: Apraxia may hinder oral self-care and is associated with poor oral hygiene. Intersecting Pentagons Test (IPT) is a simple screening tool for constructional apraxia (CA) that tests the ability to copy a bidimensional figure. In this study we investigated whether IPT is useful to identify subjects that need interventions to support oral health in a cohort of geriatric inpatients. Methods and results: We assessed oral health through the decayed, missing or filled teeth index, plaque index, and periodontal screening and recording tool. We inquired about autonomy in oral hygiene activities through a standardized question- naire. Among subjects with CA (273 out of 478 hospitalized subjects aged > 65 years) we found a higher prevalence of edentulism (P = 0.04), periodontal disease (PD) (P = 0.03), and dependence in oral hygiene activities (P < 0.001). Only 34.8% of nonautonomous apraxic patients had a caregiver that supplied oral care. In an age and sex-adjusted generalized linear model, IPT proved to be an independent predictor of dependence in oral care, reaching 61.5% sensitivity in identifying dependent patients. Conclusion: Among elderly inpatients, there is a significant association between IPT results, poor oral health status, and dependence in oral hygiene activities. Positivity to IPT should prompt proper device counseling and caregiver education.

Background: Piezosurgery is a surgical procedure that is able to perform osteotomies by a micrometric and selective cut of the bone tissue. The objective of this investigation was to evaluate two different techniques, an ultrasonic device, and a drill approach for implant site preparation. Methods: A total of fifty patients were recruited for the randomized clinical trial to receive dental implants for fixed prosthetic restoration in the posterior mandible and were allotted to two groups. In Group A the implant site was prepared following a drilling technique, while in Group B the implant site was prepared using an ultrasonic device, moreover, the operative duration was recorded. Postoperative pain and swelling were evaluated at 1, 2, 4, and 6 days. The crestal bone resorption was measured at 3 months from implant placement by a three-dimensional tomography evaluation. Results: The findings suggest that osteotomies performed by an ultrasonic device cause less pain and swelling. On the other hand, the piezoelectric preparation was characterized by a significative increase in the operative time. No statistical differences in crestal bone resorption were evident in the two different approaches. Conclusions: According to the outcome of the study, ultrasonic implant bed preparation can be used with success in implantology and could be considered a suitable alternative to traditional drilling techniques for dental fixture placement.

Background: The DEFB1 gene, encoding for the constitutively expressed human β-defensin 1 (hBD1) antimicrobial peptide is a potential candidate when studying genetic susceptibility to caries. DEFB1 genetic variations have been reported as contributing to hBD1 production impairment, leading to a greater susceptibility to be infected by oral pathogens, also leading to periodontitis. Methods: We analysed 5 DEFB1 polymorphisms, namely 3 functional single-nucleotide polymorphisms (SNPs) at the 5′-untranslated region (UTR), -52G>A (rs1799946), -44C>G (rs1800972), and -20G>A (rs11362), 2 SNPs at the 3′-UTR, c*5G>A (rs1047031) and c*87A>G (rs1800971) SNP located in potential miRNA binding sites, looking for possible correlations with the risk to develop caries in 654 adult subjects from isolated populations of north-eastern Italy. Dental caries prevalence was evaluated with the DMFT (decayed, missing, filled teeth) index, calculated after an accurate oral examination. DEFB1 SNP genotyping was performed with an Illumina 370k high-density SNP array. Results: Two DEFB1 SNPs were significantly associated with the DMFT index: the strongest association emerged from rs11362 SNP (p = 0.008). In particular G/G homozygous individuals showed a higher DMFT index compared to both G/A heterozygous and A/A homozygous individuals; rs1799946 SNP was also significantly associated with DMFT (p = 0.030), and individuals homozygous for the T allele had a higher DMFT value compared to heterozygous C/T and homozygous C/C individuals. Conclusions: Our study replicated, on a larger number of individuals, previous findings showing the association between two 5′-UTR SNPs in the DEFB1 gene and DMFT, suggesting that these polymorphisms could be considered as potential markers for assessing the risk to develop caries.

Microbial biofilms developed on dental implants play a major role in perimplantitis' pathogenesis. Many studies have indicated that surface roughness is the main feature favoring biofilm development in vitro, but its actual influence in vivo has still to be confirmed. In this study, the amount of biofilm formed on differently treated titanium surfaces, showing distinct roughness, has been examined both in vivo and in vitro by Confocal Laser Scanning Microscopy. In vitro studies availed of biofilm developed by Pseudomonas aeruginosa or by salivary bacteria from volunteer donors. In vivo biofilm production was obtained by exposing titanium discs to the oral cavity of healthy volunteers. In vitro experiments showed that P. aeruginosa and, to a lesser extent, salivary bacteria produce more biomass and develop thicker biofilms on laser-treated and sandblasted titanium surfaces with respect to machined ones. In vivo experiments confirmed that bacterial colonization starts on sites of surface unevenness, but failed to disclose biomass differences among biofilms formed on surfaces with different roughness. Our study revealed that biofilm developed in vitro is more easily influenced by surface features than biofilm formed by complex communities in the mouth, where the cooperation of a variety of bacterial species and the presence of a wide range of nutrients and conditions allow bacteria to optimize substrate colonization. Therefore, quantitative differences observed in vitro among surfaces with different characteristics may not be predictive of different colonization rates in vivo.

Purpose The aim of this work was to prove the synergic complementarity of attenuated total reflection Fourier transform infrared microspectroscopy (micro-ATR FTIR), scanning electron microscopy (SEM) coupled with energy-dispersive x-ray spectroscopy (EDS) and x-ray computed microtomography (micro-CT) by studying implant samples with bone affected by peri-implantitis. Materials and methods Six samples of implanted bone affected by peri-implantitis and one control healthy bone were analyzed. Thick bone sections included in epoxy-resin and removed implants were analyzed by micro-ATR FTIR, SEM-EDS, and micro-CT. Results Micro-ATR FTIR revealed the complex nature of the bone composition. Vibrational bands characteristic of both mineral bone phase (acidic phosphates, CO32- groups) and organic bone phase (mostly collagen) could be recognized, and their proportion could be seen to change accordingly with the bone degradation. Similarly, SEM-EDS clearly revealed the cortical nature of the control mandible and its homogenous mineral composition. On the contrary, EDS analyses performed over relevant portions of pathologic samples revealed that defective areas were almost Ca and P free. Micro-CT data showed that the morphology of the interface was smooth and linear in the physiologic periimplant bone, while in the pathologic samples, an altered morphology was evident. Conclusion This study demonstrated that morphologic, elemental, and biochemical modifications of periimplant bone can be studied using micro-ATR FTIR, SEM-EDS, and micro-CT. The complement of these techniques can be considered a new multipurpose approach to investigate bone affected by peri-implantitis.

Chronic renal failure is a progressive disease characterized by a gradual destruction of nephrons and a consequent reduction of kidney function. End-stage renal disease (ESRD) necessitates renal replacement therapy as peritoneal dialysis, hemodialysis, or transplantation. Patients affected by ESRD or in hemodialysis are at risk for developing a number of comorbidities including hypertension, anemia, risk of bleeding, susceptibility to infection, medication side effects, and oral manifestations associated with the disease itself and with hemodialysis treatment. In this context, oral diseases represent a potential and preventable cause of poor health outcomes in people with ESRD due to their relation to infection, inflammation, and malnutrition. The aim of this article was to review ESRD and hemodialysis-associated manifestations and to describe the dental operative protocols for patients awaiting kidney transplantation in light of the most recent literature.

BACKGROUND AND OBJECTIVE: Periodontitis in one of the most prevalent dental diseases. Despite numerous studies have investigated its aetiopathogenetic factors, few works have focused on its genetic predisposition and most of them took into account only candidate genes. Therefore, we conducted a Genome Wide Association Study in an Italian isolated population aimed at uncovering genetic variants that predispose to this disorder.METHODS: Diagnosis of chronic periodontitis was made following the criteria of the American Academy of Periodontology. Patients with chronic periodontitis were grouped into different categories: slight, severe, localized and generalized. A control group composed by people without signs of periodontitis or gingivitis was defined. DNA was genotyped using 370k Illumina chips. Linear mixed model regression was used to test the association between each single nucleotide polymorphism (SNP) (independent variable) and the periodontitis status (dependent variable), controlling for confounders sex, age and smoking. The genomic kinship matrix was also used as random effect.RESULTS: Four SNPs on the gene EFCAB4B resulted significantly associated to localized periodontitis (P < 5 × 10-8 ), with the best hit on the rs242016 SNP (P = 1.5 × 10-8 ).CONCLUSIONS: We have identified a novel significant association between the EFCAB4B gene and localized periodontitis. These results open a new perspective in the understanding of genetic factors contributing to this common disorder.

Background: Periodontitis is a common oral disease caused by host inflammatory response towards bacteria biofilm. The chronic activation of immune response leads to destruction of teeth supporting tissue, bone loss and tooth detachment. Different factors could be involved in the development and severity of the disease; among them the host genetic background should be considered. Objectives: In our study, we analysed haploblocks in a genomic region within major histocompatibility complex (MHC) locus aimed at disclosing a possible correlation with the risk of periodontal disease in 602 adult subjects from North- East Italy. Results: The CTTAC haploblock (formed by LTA-rs2857709, LTA-rs2844484, LTA- rs2229094, LTA-rs2229092 and LTA-rs1041981 polymorphisms) correlated with pro- tection towards periodontitis condition, after regression analysis including age and smoking status as covariates (P-value = 0.015). Conclusion: Our results suggest that a haplotype within LTA gene (encoding for lym- photoxin alpha) is involved in the susceptibility towards chronic periodontitis.

Periodontitis is a chronic oral pathology caused by impaired immune response against oral bacteria resulting in tissue inflammation and damage. Among the members of innate immune response, the first line of defence against pathogens, inflammasomes are macro-molecular protein complexes that can be activated by different stimuli, comprised bacteria infections. Different proteins are involved in inflammasoma formation; the most important are molecules belonging from the family of nucleotide-binding and oligomerization domain (NOD)-like receptors (NLRs). In this study, polymorphisms within 20 NLRs related genes were analysed in order to investigate their possible association with periodontitis susceptibility in a population from North-East Italy. One polymorphism, namely rs289723, in NLRC5 gene resulted associated with chronic slight and chronic localized periodontitis susceptibility, specifically A/A genotype was correlated with increased risk of disease development. Our study, for the first time, identified the possible involvement of a polymorphism within NLRC5 gene as a possible biomarker for periodontitis condition susceptibility among Italian individuals from genetic isolates.

BACKGROUND: Scoring systems have been widely used to evaluate the severity and activity of oral lichen planus (OLP). The aim of the present study was to compare two existing (one modified) scoring systems in the evaluation of OLP severity and correlation with pain. Three differently experienced raters were involved. MATERIALS AND METHODS: Consecutive patients with OLP were assessed for pain using the Visual Analogue Scale and examined at 10 intraoral sites before starting (T0) and three weeks after (T1) steroid therapy (Clobetasol). Three differently experienced raters evaluated photographs using two scoring systems designated White-Erosive-Atrophic (WEA) modified from an older WEA system (WEA-MOD) and Reticular-erythematous-Ulcerative (REU) systems. WEA-MOD Kendall's W and interclass correlation coefficient were calculated and correlation between REU/WEA-MOD and pain was calculated using Spearman coefficient. RESULTS: Most patients showed lesions on buccal mucosa (85-93,5%) and maxillary/mandibular gingivae (31,8-31,2%), predominantly reticular. At T0, Kendall-W coefficients of 0.89 and 0.74 were obtained for the REU and WEA respectively. At T1, Kendall-W coefficients of 0.83 and 0.58 were obtained for the REU and WEA respectively. Interclass correlation coefficient ranged from 0.87 to 0.90 for REU and from 0.58 to 0.87 for WEA. REU and WEA scores significantly decreased after therapy (p