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The aim of this study is to evaluate the effects of orthodontic traction, by means of light and controlled forces, on root length in impacted maxillary canines and physiologically erupted maxillary canines. Disinclusion of impacted maxillary canines is a frequent procedure in orthodontics due to their higher incidence of impaction. The effects of orthodontic traction, by means of light and controlled forces, can lead to a resorption of the root length in impacted and physiologically erupted teeth. Therefore, apical root resorption is a common phenomenon that must be taken into consideration. Apical root resorption measurements were taken using pre-treatment CBCTs and pre-treatment and post-treatment digital panoramic radiographs of 52 patients who underwent fixed-appliance treatment by using light and controlled orthodontic forces. The experimental group consisted of 26 patients with one impacted maxillary canine. The control group consisted of 26 patients without any impaction. Apical root resorption was calculated from root lengths before and after orthodontic treatment. In the experimental group, impacted canines with incomplete apical formation underwent root elongation, while impacted canines with completed root formation went through apical root resorption. The latter showed a slightly greater apical root resorption (0.2 mm) compared to the control group (95% confidence interval; p = 0.04). The extent of root resorption of impacted canines was significantly higher than that of physiologically erupted ones. However, this differential resorption did not compromise the structural and functional integrity of the involved teeth. The orthodontic treatment performed with light and controlled forces is, therefore, a procedure to be considered acceptable and safe.

Aim: Growth measurement has always been essential to identify the best time to employ orthopedic or orthodontic appliances. Optimal timing for orthodontic treatment is strictly linked to the identification of periods of craniofacial growth when treatment is more effective. The aim of this study was to compare two different methods, middle phalanx maturation (MPM) and cervical vertebrae maturation (CVM), used to evaluate the stage of facial growth. Materials and methods: The research data was collected from July 2018 to April 2019 at the Dental Clinic of the San Gerardo Hospital in Monza. The study included a sample of 98 patients—46 males and 52 females. For each patient, a latero-lateral teleradiography of the skull and an X-ray on the middle finger of the right hand were obtained. The statistical analysis of the comparison of the stages of skeletal maturation obtained by the MPM and CVM methods was performed using the correlation coefficient for ranks of Spearman. Results: A descriptive statistical analysis of the entire sample of 98 patients was performed (mean age of 12.2 years and median of 12.2 years). The average age of females in every single stage of MPM was significantly lower than the average age of males. Of the total sample, 87 patients (88.8%) showed complete agreement between the two methods. Conclusion: The results obtained from the statistical analysis of this study allowed us to confirm a satisfactory agreement between the two methods. The intermediate phalanx method is a valid and alternative indicator to CVM for the identification of the puberty growth peak. We can, therefore, consider the MPM method a valid indicator of skeletal maturity.

Aim: The aim of this study was to evaluate clinical features that might be related to success rates of autotransplantation of molars with complete root formation. Materials and methods: A group of 60 patients with completely formed third molars autotransplanted to a different molar socket was followed for a medium period of 5 years and 5 months. Extreme care was used in order to preserve the vitality of the periodontal ligament cells. The same technique was applied for all teeth despite different anatomies. Descriptive statistics was performed. The association of the various factors with failures was assessed by using the Fisher’s exact test and a p-value of 0.05 was considered as significance threshold. Results: Autotransplantation was found to be a reliable method to replace extracted molar teeth with closed apices. The two major factors that positively influenced the outcomes were fixation with splint and a periodontal probing pocket depth less than 4 mm after the initial healing period. The technique resulted in a suitable well-conserved socket and donor tooth, after the extraction. Conclusion: An accurate case evaluation was critically important in order to identify the risks prior to surgery and to select the right patients for this procedure. Autotransplantation of third molar teeth is a feasible approach to replace compromised mature molars. Proper stabilization of the transplanted tooth is strategical for the success of this procedure. A conservative approach to unerupted wisdom teeth is also recommended. Clinical significance: Dental implants and fixed prostheses have been utilized to replace missing teeth, and orthodontic space closure can be sometimes an effective treatment option. Tooth autotransplantation can be a reliable and less invasive clinical alternative when an appropriate donor site is available

Aim: Evaluation of oral lesions in COVID-hospitalized patients, analyzing the potential etiopathogenetic mechanisms. Materials and methods: We evaluated a total of 58 hospitalized COVID patients in the time span from April 2021 to May 2021. The group analyzed consists of 38 male patients (66%) and 20 female patients (34%), aged between 22 and 92, with a preponderance of 60–80 years. All patients underwent an oral evaluation in order to detect the various oral manifestations; moreover, the onset time of these lesions has been correlated with the time of manifestation of the general symptoms of COVID infection. Results: Xerostomia has been the most frequent oral manifestation detected (30 patients, 51.7% of the sample), followed by ageusia (16 patients, 27.6%), and white tongue (13 patients, 22.4%). Other oral manifestations observed were aphthous lesions, fissured tongue, metallic taste, tingling in the lip and chin, and burning mouth syndrome. Conclusion: Our findings show a significant correlation between the oral manifestations and the burst of viral replication phase in COVID patients. Clinical significance: Awareness of the possible oral manifestations of COVID infection is important to conduct a correct diagnosis in oral pathology.

Background: Oral appliances embedding sensors can be interesting tools for monitoring tooth contact bruxism in a home environment, as they address some of the usability limitations of portable electromyography (EMG) systems. In this study, an oral appliance for sleep bruxism monitoring was compared to an electromyograph. Methods: Simulated bruxism events with tooth contact, specifically clenching and grinding, and other occlusal activities unrelated to bruxism, were measured in 23 subjects with the two instruments simultaneously. The recordings were analyzed automatically by a computer program in order to compare the two techniques. Results: The two instruments were found to be strongly correlated in terms of detecting events (r = 0.89), and estimating their duration (r = 0.88) and their intensity (r = 0.83). Conclusions: The two techniques were in agreement in measuring event frequency, duration and intensity in the studied group, suggesting that force-sensing oral appliances have the potential to be easy-to-use tools for home monitoring of bruxism, alone or as complements to portable EMGs.

Aim: This pilot study aimed to evaluate the effectiveness of an oral probiotic, Lactobacillus reuteri DSM 17938 and L. reuteri ATCC PTA 5289 (ProDentis®, BioGaia), to avoid the recurrence of black stains (BS) in children and young adults. The purpose of this work is also to propose an oral hygiene protocol that could hinder or slow down the formation of these pigments. Materials and methods: Twenty patients aged between 8 years and 24 years with extrinsic pigmentations on one or more dental elements and with black lines attributable to chromogenic bacteria were divided into two groups randomly: the first (group I with 10 patients, test group) received a professional oral hygiene session and a therapy with a probiotic food supply containing L. reuteri for a duration of 2 months. The second group (group II with 10 patients, control group) received only a professional oral hygiene session. Data were collected using the Lobene modified index. Results: The mean Lobene index is lower in the test group compared to the control group after both 1 and 2 months from the beginning of the treatment. Conclusion: Black stain formation could be prevented by administering an L. reuteri-based probiotic food supply. Clinical significance: The use of probiotics is a relatively undeveloped strategy for the prevention and treatment of BS.

Aim: Nowadays, guided bone regeneration (GBR) is a predictable technique in both vertical and horizontal bone defects treatment. GBR Pocket Technique is an original surgical approach adopted in order to reduce the invasiveness of traditional procedures. The aim of this work is to describe the surgical procedure of GBR Pocket Technique in vertical bone augmentation and to compare the clinical outcomes of this technique with the results reported in literature of vertical bone augmentation and crestal bone remodeling achieved after 1 year after implants insertion. Materials and methods: Twenty-eight patients were recruited for this study and received 28 GBR procedures in the posterior region due to vertical and horizontal defects. A 50/50 mixture of autologous bone component and heterologous bone of equine origin was then made with the use of a bone scraper tunnel with internal reservoir. A PTFE-d membrane with titanium reinforcement was then fixed to the residual bone structure with screws in order to maintain the graft in place. Radiographic checks were made before graft procedures and implants insertion, then 6 months later and 1 year after implants placement. Results: The average bone augmentation after surgery seems to be aligned, or even better, than the average reported in literature with alternative surgical approach; in addition, the mean crestal remodeling after 1 year and the rate of complications are aligned with other previous surgical techniques with a vertical bone augmentation of 8.78 mm ± SD 2.39 and a bone remodeling after 1 year of 0.59 mm ± SD 0.29. Conclusions: The advantages of this technique are preservation of blood circulation and consequently risk of flap necrosis, dehiscence, and graft exposure. This technique also reduces mucosal healing times even if it takes longer surgical time. Clinical significance: GBR Pocket Technique is the use of a minimal-invasive surgical wound to reduce patient morbidity and compliance.

Aim: The purpose of this research is to analyze and compare the dental and skeletal changes induced by two functional devices, Andreasen Activator and Clark’s twin block, on the sagittal and vertical plane, by means of cephalometric analysis, of the lateral cephalograms prescribed at the beginning and at the end of the treatment for a second skeletal class, first division with normal or deep bite. Materials and methods: Twenty patients, 8 females and 12 males, fulfilling criteria for inclusion, were divided randomly into two groups: group I was treated with Andreasen activator, the second group with Clark’s twin block. The duration of the therapy was about 18 months plus less 2 months. Pretreatment and posttreatment cephalometric radiographs were analyzed using angular (SNA, SNB, ANB, SnaSnp–GoGn angles), linear (Sna–Snp, Co–Gn, Co–Go, Go–Gn) skeletal parameters and dental one (U1–SnaSnp angle, L1–GoGn angle, Overjet and Overbite). To evaluate the posttreatment changes in the single groups and between them, paired and unpaired t-test was used. Results: In both of the two groups analyzed, all the sagittal and vertical, angular and linear, skeletal measurements appear to be increased in a statistically significant way, except SNA angle and the distance Sna–Snp. Regarding the dental parameters, in the group treated with Andreasen activator, only Overjet and Overbite showed statistically significant differences. On the other hand, twin block induced statistical changes about Overjet, Overbite and also U1/SnaSnp, but not about L1/GoGn. The advancement of the mandible determines a greater prominence of the chin and lower lip, an increment of the labial mental angle and a reduction of the convexity of the profile. Also, the decrease of the overjet and, consequently, of the dental exposure improve the esthetic appearance of the patient’s face. Conclusion: Both functional treatments showed a lower jaw advanced on the sagittal plane and increased in size. In the upper jaw no

Aim and objective: The purpose of this work is to investigate by electromyographic (EMG) surface analysis whether and how the variations in the occlusion due to the correction of the posterior crossbite using a rapid palatal expander (RPE) is accompanied by changes in the activity of the elevator muscles in the pediatric patients. Background: Posterior crossbite is a disgnathic jaw relationship common in patients undergoing growth. In the last 10 years, several studies demonstrated the effectiveness and reproducibility of surface EMG in the objective evaluation of temporal muscle and masseter activity and how this evidence can bean interesting aid in dental clinical practice. Case description: The case subject BF is an 11-year-old boy with a right I class relationship and a left II class relationship treated with a rapid palatal expansion protocol with a turn of the transversal screw twice a day (0.25 mm each turn) for a week. In this case report, EMG was used to evaluate the temporal muscle and masseter activity immediately before, immediately after, and 4 months after the RPE protocol. Conclusion: Four months after the treatment, a condition of well-being and neuromuscular equilibrium such as that of starting was preserved. Clinical significance: Electromyography is a noninvasive exam which evaluates the masticatory muscle activity by facial application of electrodes on masseter and temporal muscles. It can be an interesting aid in orthodontic clinical practice to evaluate preservation of a good muscular balance following orthodontic and orthognathic movements.

Aim: The development of a class II malocclusion is usually related to a reduced oropharyngeal airway space. In order to prevent airway obstruction, functional appliances are commonly used for orthodontic therapy. The aim of the article is to verify if these appliances could positively influence oropharyngeal diameters preventing the onset of future respiratory disorders. Materials and methods: A group of 10 patients treated at the Dental Clinic of San Gerardo Hospital in Monza with mandibular activator was selected. Ten similar untreated class II subjects with retrognathic mandible were used as control group. The cephalometric tracings were made on lateral teleradiographs of the skull before and after the active therapy with functional devices for the treated group and before and after growth peak for the control one. Descriptive statistical analysis was calculated for all the cephalometric values in both study cases and control group using Excel worksheet. The data distribution was evaluated with Shapiro-Wilk test and the in-between group discrepancies were evaluated with Mann-Whitney U test. Results: At T1 period, both case and control groups showed a class II pattern. At T2 period, the study group shows an improvement in bones relationship with reduced ANB angles and OVJ measurements. The control group otherwise did not show any important changes in maxillo-mandibular discrepancies. The airway size increased in either group in most cases. No significant differences between the treated and control groups were detected for airway size neither in the upper, middle, nor lower level at the T1-T2 interval. Conclusion: The upper airway values did not show any significant discrepancies between the two groups during the observation period. Clinical significance: Functional devices were effective in solving class II relationships, but there is no evidence of successful breathing disorders prevention by using mandibular activators, probably due to the stability of airway ti

Introduction: Alveolar split crest is an established surgical technique to enable implant insertion into narrow and atrophic alveolar crest. This surgical technique is adopted to position standard or large implants so that postextractive anatomy compromises with this attempt. The aim of this study was to evaluate the horizontal alveolar bone augmentation and its stability along time with a minimally invasive flapless technique. Materials and methods: Twenty-four implants were inserted in 10 patients during a 15-month period. Clinical parameters such as horizontal bone augmentation, intrasurgical complications, patient morbidity, implant loss, and vertical bone loss (VBL) were recorded in the first 3 years after surgery. Using cone beam computerized tomography (CBCT), alveolar bone width was measured for both implants position and bone reconstructions. 6 months later, at the time of implant integration, a new low-dose CBCT was performed. Implant survival (IS) and VBL were evaluated radiographically for 3 years. Results: The initial bone thickness measured on the ridge is between 0.82 mm and 5.40 mm (average 2.43 mm), after the split crest the bone width is between 4.65 mm and 8.09 mm (average 6.39 mm). This leads to an increase in the alveolar bone width of between 0.80 mm and 6.01 mm (average 3.71 mm) on the ridge. No implant was lost at 3 years, and all implants are stable at the end of the study. Three years after the surgery, controls showed a VBL of between 0.0 mm and 1.2 mm (average 0.63 mm) around the inserted implants. These parameters suggest using a flapless technique to reduce bone resorption around the implant neck. Conclusion: A minimally invasive approach allows to reduce the surgical trauma and postsurgical discomfort. The complete vascular supply is maintained, the bone resorption is reduced, and the connective epithelium does not undergo postsurgical retraction, achieving the full maintenance of the residual keratinized gingiva. Clinical significance

This study aimed to assess ex vivo the accuracy of cone-beam computed tomography (CBCT), as compared to operative microscope, for evaluating pulp chamber size. A total of forty teeth were extracted for periodontal reasons and a horizontal section was done at the most apical level of the cement–enamel junction. The pulp chamber was photographed using a digital camera connected to an optical microscope. Then, the tooth was scanned with CBCT and the horizontal slide matching the anatomical section of pulp chamber was digitally stored. The pulp chamber section area was measured through image analysis software. The two methods provided similar results, either for monoradicular (P = 0.14) or multiradicular teeth (P = 0.93). Correlation was statistically significant (P < 0.0001), being the coefficient r = 0.89 and 0.94 for monoradicular and multiradicular teeth, respectively. Conclusively, CBCT is suitable for pulp chamber morphology evaluation. However, it has limitations in detecting the anatomical variability of small branches in root canal system.

Aim: To determine if botulinum injections in masseters could be an option to avoid surgery and prolonged treatment with occlusal splints and/or drugs to care for both painful bruxism and cosmetic improvement in a patient with a square jaw, bruxism, and orofacial pain. Background: Masseter muscle hypertrophy (MMH) is a benign, unilateral, or bilateral, painless enlargement in the lower face. It presents as a symmetrical or asymmetrical increase in the masseter muscle. Masseter muscle hypertrophy (MMH) sometimes can be related to bruxism symptoms like muscle and/or temporomandibular joint (TMJ) pain. Case description: A 38-year-old woman complained of bilateral pain at palpation in the masseter body. She also complained about esthetics because of the prominent masseter muscle in the face and square face shape. A diagnosis of bruxism-related myalgia was performed, and treatment with botulinum injections into the masseter muscles was opted for. An oral electromyography was performed to detect the electrical muscular activity of masseter muscles over time. Conclusion: After a drastic reduction in the mean electrical activity immediately after the botulinum injections, a progressive increase in strength over time was noted, testifying about the decrease in the effect of botulinum over time. The pain disappeared for 5 months after the injections of botulinum. The reduction of the masseter muscle mass led to a softening of the face shape. Clinical significance: This case report shows that treatment with botulinum can lead, in the short term, to a reduction in orofacial pain due to a decrease in muscle electrical activity.

Aim: The aim of this work was to evaluate if the use of a silicone device for muscular rebalancing (Alifix®) can be useful in treating of temporomandibular disorders (TMD) of muscular origin and improving the electromyographic indexes of the chewing muscles. Materials and methods: Thirteen patients (11 F and 2 M aged between 24 years and 65 years) with TMD of muscular origin according to diagnostic criteria (DC)/TMD were involved. At the first visit (T0), each patient reported the pain intensity of masseters and temporal muscles. A surface electromyography (EMG) was performed using Teethan® (Teethan S.p.A.) and then Alifix® was delivered instructing the patient on its use. Each subject was visited again after 1 month (T1) and 2 months (T2). New EMG had been made at T1 and T2, and patients were asked again to report the pain intensity. Statistical analysis was calculated between T0 and T1, T1 and T2, and T0 and T2 for all EMG, and muscle pain measurements by Wilcoxon test with statistical significance p < 0.05. Results: Regarding the pain values between T0 and T1, T1 and T2, and T0 and T2, the difference is statistically significant, since the intensity of pain between T0 and T2 is decreased, if not disappeared, in 90% of cases. The use of Alifix® also determined a gradual improvement in the values of the EMG indexes, which, however, is not statistically significant. Conclusion: The effectiveness of Alifix® is demonstrated clinically but not at an instrumental level. Further studies involving a larger sample and taking longer therapy duration are needed. Clinical significance: Alifix® works by improving the blood circulation of the muscle, which allows the removal of catabolites with a consequent reduction of the algic symptomatology and promotes a greater supply of oxygen. It also encourages a conversion of IIA type muscle fibers into slow-twitch type I fibers that are more resistant to neuromuscular fatigue

Objectives The main purpose was to evaluate the recurrence rate after surgery for antrochoanal polyps (ACPs) in children; secondly, we have analyzed the rate of recurrence for different types of surgery and the risk factors involved. Methods We performed a systematic review searching PubMed and MEDLINE databases including English-language published studies from June 1989 to October 2017 regarding surgical treatment of ACPs in children. Results We included thirteen studies, eight were retrospective and five prospective, with 285 participants, the mean rate of recurrence after ACPs surgery was 15.0% (95% CI:11.0–20.0). Functional endoscopic sinus surgery (FESS) was the main type of surgery used for primary cases (75.4%) followed by the combined approach i.e. FESS with a transcanine sinusoscopy or mini Caldwell-Luc (14%), the Caldwell-Luc (CWL) (8%) and simple polypectomy (SP) (2.8%). Our analysis has demonstrated a significant reduction of recurrences using the combined approach 0% (95% CI: 0.0–8.0) compared with FESS 17.7% (95% CI: 12.8–23.4) or SP 50% (95% CI:15.7–84.3) (p <.05) but no significant differences with CWL 9.1% (95% CI: 1.1–29.2) and others surgical approaches (p >.05). The analysis of the possible risk factors involved in recurrences are inconclusive. Conclusion Recurrences of ACPs in children are still high. The endoscopic sinus surgery is considered the first choice for primary treatment, whilst the external approach may be a valid option in case of recurrence. It seems that the combined approach could reduce recurrence rates in selected patients that cannot be completely managed with endoscopy.

Aim: To evaluate retrospectively the prevalence of vertical root fractures (VRFs) in a cohort of patients during apical surgery and the factors possibly associated with VRF. Methodology: The sample consisted of 944 root filled teeth belonging to 768 patients (49.3% males and 50.7% females; mean age 43.5 ± 11.2 years, range 22–68 years), consecutively referred for endodontic surgery over a six-year period. All patients underwent a clinical assessment of their signs and symptoms. Periapical radiographs of teeth that were candidates for endodontic surgery were taken. Sixty-eight teeth with VRF were identified. Vertical root fractures were identified in pre-surgical screenings in 32 cases (47.1%), and these did not undergo surgery. Another 36 cases of VRF were noted during the intervention for root-end resection. The influence of posts, post type, tooth type, periodontal probing defects, spontaneous pain, sinus tract and follow-up duration was assessed using a logistic regression analysis. Results: Vertical root fractures occurred significantly more frequently (P < 0.001) when a post was present (61 VRF out of 377 teeth with post, prevalence 16.2%) than in teeth without a post (1.2%). Threaded posts and cast posts were significantly more involved in VRF than fibre, silica or carbide posts (P < 0.001). Most fractures (80.9%) occurred 1–5 years after root canal treatment. Sinus tracts, probing defects and spontaneous pain were significantly more associated with VRF cases than with nonfractured teeth. Conclusions: In the present group of teeth, the major risk for VRF was represented by posts retained by actively engaging the canal via mechanical design (thread) or by frictional fit (cast).

Background: Lateral approach to maxillary sinus floor elevation (LSFE) with autologous bone grafts and simultaneous implant insertion is a widespread technique for prosthetic rehabilitation of the atrophic maxilla. Purpose: To analyze implant survival and autologous bone graft resorption after LSFE, in patients with at least 5 years follow-up. Materials and Methods: Thirty-three patients (mean age 56 years, range 46-68 years) who had undergone LSFE with intraoral autologous bone graft from mandibular ramus and simultaneous implant insertion were included. A minimum of 5 years of follow-up was required. The total peri-implant bone height was measured at mesial and distal aspects of the implants immediately after surgery (T0) and after a period ranging from 5 to 11.5 years after surgery (mean 7.65 ± 1.80 years) (T1) on digital panoramic and periapical radiographs. Wilcoxon matched-pairs signed rank test was used to compare bone graft height at T0 and T1. The influence of patient-, surgery-, and implant-related factors on the outcomes was investigated. Results: Of the 58 implants placed, no one was lost. All prostheses were in function, and no biological or mechanical complications occurred. The residual ridge height at the involved sites averaged 6.48 ± 1.72 mm. The mean bone height at grafted regions was 12.05 ± 2.47 mm at T0 and 12.13 ± 2.39 mm at T1 (not statistically significant). Marginal bone level change at T1 averaged −1.22 ± 1.60 mm. None of the evaluated factors significantly affected the results. Conclusion: Autologous bone grafts from intraoral donor sites display excellent volume stability over time that may contribute to optimal outcomes of the procedure.

Aim: To evaluate the antimicrobial, toxicity and cleaning effectiveness of ethylenediaminetetraacetic acid (EDTA) and maleic acid (MA) alone and combined with cetrimide (CTR). Methodology: Cytotoxic and genotoxic effects were assessed on Chinese hamster cells V79 using the MTT, clonogenic and micronucleus assays, respectively. The bacterial inhibitory and bactericidal concentrations (MIC and MBC, respectively) were determined on a strain of Enterococcus faecalis. Antimicrobial tests were performed on a biofilm model after treatment with the chelating agents by using a biofilm eradication concentration (MBEC) and confocal laser scanning microscope (CLSM) assays. Quantification of cell biomass and percentage of live and dead cells in the biomass were assessed for each group. The percentage reduction of accumulated hard-tissue debris (AHTD) after root canal preparation and final irrigation protocols was evaluated by micro-CT. Statistical tests of one-way analysis of variance (anova), Bonferroni test, Kruskal–Wallis test, Dunn’s multiple comparison test and Wilcoxon matched-pairs signed-rank tests were used. Results: Cetrimide alone as well as in combination with EDTA and MA at dilutions of 1/10 and 1/100 was significantly more toxic as compared to untreated controls (P < 0.001). All tested mixtures were nontoxic at a dilution of 1/1000. EDTA retained a weak inhibitory and bactericidal effect against planktonic cells, whilst MA inhibited cells growth and killed 99.9% of the cells when diluted. CTR revealed the most prominent effect, being inhibitory and bactericidal, also when diluted. Cetrimide alone or combined with EDTA was able to remove, respectively, 40% (P < 0.01) and 60% (P < 0.001) of the entire biomass after 1 min. Conversely, MA alone and in combination with CTR did not have a significant effect on biomass reduction. After final irrigation, the AHTD volume was significantly decreased in all groups (P < 0.05). EDTA + CTR and MA + CTR were associated with a sig

Aim: The aim of this work is to investigate the quality of root canal seals obtained by comparing two bioceramic cements, GuttaFlow bioseal and BioRoot RCS, focusing on the presence of voids created during the canal obturation procedure. Materials and methods: The voids are analyzed using a micro-computed tomography (micro-CT) device. The study will be performed using images of the endodontic space before and after filling of a selected group of elements. Furthermore, the average thickness of the cement, the average quantity of gutta-percha compared to the total shaped volume, and the average quantity of the two cements, GuttaFlow bioseal and BioRoot RCS, with respect to the total shaped volume were considered. The apical, middle, and coronal thirds will also be investigated in a sectorial manner. Images have been analyzed using a CT-An™ software and visualized through a three-dimensional (3D) reconstruction of the slices by the software CT-Vol™. Shapiro–Wilk test/Test D’Agostino-Pearson/Kolmogorov–Smirnov test were used to ensure the reliability of results. Results: No significant differences were observed in the amount of gutta-percha compared to the shaped volume between the GuttaFlow bioseal group and BioRoot RCS. No statistically significant difference was observed between the two groups in terms of voids. Conclusion: The data obtained from this study allowed to conclude that the samples filled with GuttaFlow bioseal and BioRoot RCS have a similar seal capacity since no statistically significant differences were observed between the two groups. No sample showed the absence of voids within the root canal obturation. Clinical significance: Even if the two cements tested showed differences in terms of void volume and ability to fill thin spaces, they should be considered both acceptable and equivalent in terms of clinical sealing ability.

Aim: The purpose of this study was to evaluate the degree of vertical peri-implant resorption around implants inserted with an inclination increased more than 10° at a distance of at least 1 year from insertion. Materials and methods: For the realization of the study, a sample consisting of 47 patients for a total of 115 implants was selected. We excluded all those subjects whose conditions could have compromised the outcome of the treatment. An orthopantomography of the dental arches was made using Orthophos XG 3D Sirona at time T0 (at the end of definitive insertion of prosthesis) and at time T1 (at least 1 year after T0) with the aim of an individualized positioner. In this study, all the implants with inclination equal to or greater than 10° were subdivided into three groups, and the implants with inclination between 0 and 10 were used as control sample. Results: In group I, there is a statistically significant difference in at least one of the two sides (distal one) between T0 and T1. In groups II and III, there is a statistically significant difference in the degree of bone resorption on the mesial side with respect to distal side. In group IV, a statistically significant difference on both sides was evidenced. The implant survival at a distance of 1 year was equal to 100% of cases. Conclusion: Surgeons must take into account the possibility that an increase in inclination of implants may lead to a more rapid resorption of bone mesially or distally. Clinical significance: The direction of the prosthetic load transmitted to the fixture is a variable that could influence the degree of reabsorption of both mesial and distal bone structures according to both laboratory and clinical data.

Aim: Osteoradionecrosis of the jaws (ORNJs) is aseptic bone necrosis that develops in post-irradiated bone tissue of patients who underwent radiotherapy for head-neck tumors. The present study aims to clinically assess the regenerative ability of the ozone in the form of oil-based gel applied to the exposed bone area in the treatment of ORNJ. Materials and methods: Eight patients who underwent radiotherapy for the treatment of cervical or neck cancer were diagnosed with ORN of the jaws at our Department, for a total of 11 sites of necrotic bone exposure (3 patients were diagnosed with more than one site of osteoradionecrosis). In the therapeutic protocol, the exposed bone lesion and osteomucosal margin were cleaned with manual debridement. Then the ORN lesion was treated with topical applications of ozone delivered as oil suspension (Ozosan® - Sanipan, Clivio, Italy) on the exposed bone for 10 minutes. The application was repeated each week until movement of the necrotic fragment was noted Results: In six patients on 8 (75%) lesions resolved with complete mucosal healing with 3 to 19 ozone applications. Total sequestration of the necrotic bone with spontaneous expulsion was observed. One patient improved his conditions shifting from a stage B2S1 to B1S1 according to He et al. classification. A patient only worsened his conditions with treatment. No toxicity was reported or observed. Conclusion: These results showed the efficacy of ozone oil suspensions in the non-invasive treatment of ORN, probably related to its properties of stimulation of local revascularization and antibacterial activity, and the good tolerability of the related protocol used.

Aim: Cone beam computed tomography (CBCT) is the most refined and affordable method available today for the examination of an incoming patient for different dental pathologies. The aim of this paper is to evaluate the significance of some factors influencing the prevalence of apical periodontitis. Materials and methods: An ortopantomography (OPT) and CBCT scan of the dental arches were examined for each of the selected 45 patients. The presence of apical periodontitis (AP) was compared for CBCT and OPT examination. Sensitivity, specificity, predictive values, and accuracy were calculated for CBCT, using OPT as a reference. The impact of protective/risk factors on the development of AP was examined. Results: CBCT showed higher sensitivity (250%), predictive values (111%), accuracy (111%), and specificity (101%) than OPT. It was found to have higher sensitivity in all the dentition areas, especially where empty anatomical spaces or more radiotransparent structures have a strict relationship with the tooth apex and periapical structures like upper front area, premolar areas, and, especially, in the upper molar area. The prevalence of AP increased from 16 to 17% in the case of insufficient conservative restoration or 25% in the case of microleakage, 35-42% in the case of prosthetic restoration, 56-67% for posts, and 60 and 85%, respectively, for inadequate endodontic treatment and missed canals. Conclusion: CBCT plays a decisive role in the evaluation of molar areas and in the endodontic treatment planning, when a close relationship between the apex and important anatomical structures exists. Different risk factors with different relevance are identified. Clinical significance: As CBCT-examined results show, coronal restorations are moderate-risk factors, while insufficient endodontic treatments and posts are high-risk factors for the development of AP.

Aim: Digital orthopantomography (OPT) is usually the first examination step in supervising an incoming patient. Cone beam computed tomography (CBCT) is the most refined and affordable method to search for different dental lesions. The aim of this paper is to evaluate the effectiveness of OPT and CBCT in detecting periapical lesions in different dental groups. Materials and methods: An OPT and a CBCT scan of the dental arches of 45 patients were examined. The presence of AP was pointed out for OPT and CBCT. Sensitivity, specificity, predictive values, and accuracy were calculated for OPT, using CBCT as the reference standard. Results: OPT showed low sensitivity (40.0), positive predictive value (90.4), negative predictive value (90.0), accuracy (90.0), and high specificity (99.2). It was found to have higher sensitivity in the lower front and premolar areas, while the lowest was found in the upper molar area. Conclusions: OPT can be used for endodontic diagnosis in the lower central and premolar sections, but CBCT plays a decisive role in the evaluation of molar areas and in the endodontic treatment planning, when a close relationship between apex and important anatomical structures exists. Clinical significance: CBCT exposes the patient to higher doses of radiations when compared with OPT, but CBCT, with its more selective sensitivity and the possibility to offer a three-dimensional (3D) rendering of dental and periodontal structures, is an elective choice for uncertain cases and for specific dental areas.

Aim: the aim of this article is to assess the importance of masticatory muscles balance evaluation before improving vertical dimension through conservative and restorative techniques. It also shows how a multidisciplinary approach is needed to obtain a better result for the patient. Background: Bruxism is defined as the parafunctional activity of grinding or clenching of teeth. Management of severe worn dentition in patients with bruxism is challenging since this condition can lead to loss of tooth structure and occlusal vertical dimension (OVD). In some cases the impossibility to correct the proclination of the maxillary incisors occurs due to the posterior tooth wear. Case Description: an orthodontic alignment was obtained after having improved posterior vertical dimension according to an electromyographical analysis using Teethan® electromyographic system. The activity of anterior temporals and masseters was controlled and balanced by electromyography at every step of the treatment. Conclusion: an unbalanced dental occlusal function can compromise the stability of an orthodontic treatment; it is important an evaluation from different points of view in order to rehabilitate the patient in his complex. Clinical significance: electromyography proved itself to be a useful tool in the hands of the clinician to check the oral muscles balance and to avoid temporomandibular joint (TMJ) overload in restorative dentistry, prosthodontics and orthodontics.

Background/purpose: In order to prevent reinfection of the pulp canal space and dressing for regenerative purpose, the coronal seal should have a perfect marginal adaptation. Mineral trioxide aggregate (MTA) and Biodentine are among the most popular sealing materials. These are commonly used in combination with antibiotic medicaments, to ensure disinfection. Aim of the present study was to evaluate the effect of 3 different medicaments on the marginal adaptation of MTA and Biodentine to the dentin. Materials and methods: Teeth were divided into 4 groups (n = 20) that were treated with the following medicaments; triple antibiotic paste (TAP), double antibiotic paste (DAP), a calcium hydroxide (CH) and a control group. The specimens were then assigned into two subgroups (n = 10), which received a coronal barrier of MTA or Biodentine. The specimens were scanned using an ex vivo micro-CT scanner. The data were statistically analysed using one-way ANOVA and the unpaired Student's t-test (P < 0.05). Results: Percentage volume of external voids in the MTA group was as follows: DAP > TAP > Control > CH. In the Biodentine group, the percentage of voids was determined in the following order: TAP ≥ DAP > CH > Control. Significantly lower percentage of voids was observed in the CH-medicated specimens in the MTA group when compared to all test groups (P = 0.04). Conclusion: The application of CH as an intracanal medicament reduced the void occurrence between the ProRoot MTA and root dentin. However, TAP and or DAP decreased the marginal adaptation in both ProRoot MTA and Biodentine.

AIM: The purpose of this study was to evaluate the surgical options for supernumerary teeth (SNT) in the premaxillary region of children. MATERIALS AND METHODS: A total of 69 patients with 82 partially or completely formed SNT in the anterior maxillary region were identified over a 3-year period. All selected patients were assessed for the number, location, and family history of SNT, damage to adjacent roots, and associated symptoms. The surgical approaches used for removal were recorded. Postoperative clinical sequelae (loss of vitality, periodontal problems, pain, bleeding, and enanthema) were evaluated. RESULTS: A total of 43, 30, and 9 SNT were extracted with palatal, buccal, and bicortical approaches respectively. Peri-odontal and vitality assessments revealed no problems in adjacent teeth at 6 months after surgery. Postoperative pain was within acceptable levels in all patients and subsided within 3 to 7 days. Mild postoperative bleeding occurred in eight patients. Enanthema subsided within 10 days in all patients. CONCLUSION: Our results suggest that early diagnosis and appropriate surgical treatment of SNT are important to decrease the risk of clinical complications.How to cite this article: Maddalone M, Rota E, Amosso E, Porcaro G, Mirabelli L. Evaluation of Surgical Options for Supernumerary Teeth in the Anterior Maxilla. Int J Clin Pediatr Dent 2018;11(4):294-298

Persistent hiccup can conceal life-threatening clinical conditions of highly heterogeneous nature. Here, we report a case of a persistent hiccup that has been temporally associated with dental implant insertion in a patient with paroxysmal atrial fibrillation. This 67-year-old patient underwent dental implant in area 36 and the procedure was performed without acute complications. A prolonged hiccup started ~48 h after the procedure: it failed to respond to several medications and it lasted for ~18 days, after which it spontaneously disappeared. Brain imaging and neurological examination were conducted in order to rule out organic conditions, even though all the investigations resulted to be negative. We suggest that the surgical procedure might have triggered a prolonged reflex activation. Knowledge about this complication of oral surgery procedure might be useful for avoiding unnecessary hospitalization or diagnostic tests.

Objectives: The aim of this study is to assess the morphology, the prevalence and the topography of the apical constriction (AC) through a tridimensional analysis and compare the results with the available data reported in the literature. Materials and methods: 15 teeth were selected. The teeth were intact and atraumatically extracted, without signs of radicular resorption or previous root canal treatments. Each tooth was scanned with the micro-computed tomography at a resolution of 9 mm. Through computer reconstruction the roots were made transparent, in order to reveal the endodontic anatomy; two calibrated examiners assessed the prevalence and the morphology of the AC on two different projections for each tooth. The AC was classified as present (single, multiple, tapered) or absent (flaring, parallel, apical delta). Inter-rater agreement was computed applying Cohen's kappa. The distance between the AC and the apical foramen was determined by means of a digital ruler. Results and conclusion: 52.6% of the observed ACs was ambiguous (present on one projection but not on the other one). Only 21.0% of the canals showed a tridimensional AC (present on both projections). Inter-rater agreement was very good (k = 0.839). The morphology, from greater to least, was flaring (25%), single (21.1%), parallel (21.1%), tapered (19.7%), apical delta (10.5%) and multiple (2.6%). Inter-rater agreement was again very good (kappa = 0.869). Root canal anatomy as described in the literature is more conceptual than real. The presence of AC appears to be an exception rather than a canon. © 2014 Società Italiana di Endodonzia. Production and hosting by Elsevier B.V. All rights reserved

Introduction: Guided bone regeneration (GBR) aims to restore adequate bone volume for the placement of implants in an ideal location. In this article, we analyze different surgical techniques for tissue management during GBR and a modified partialthickness surgical approach. Materials and methods: In a year's time span, five patients were enrolled in the study: Four women and one man (aged 44-59 years). In four patients, a GBR with simultaneous implant placement was adopted, whereas in another patient, a delayed implant placement was done. The flap was of full thickness and overturned on the side palatal with the aim of a retractor, thus exposing the bone crest. The graft material was covered and protected with a resorbable collagen membrane (Geistlich Bio- Gide®, Switzerland). The periosteal layer of the flap was then positioned above the resorbable membrane without traction. The sutures as vertical mattress were then positioned. Each patient received an intramuscular betamethasone dose (4 mg/50 kg) and antibiotic therapy for 7 days (amoxicillin + clavulanic acid 1 gm every 12 hours) and was instructed to maintain oral hygiene and appropriate wound cleaning. The patients were recalled at different times to monitor the healing. Results: No cases of tissue dehiscence were observed during the period of wound healing. One patient, however, showed a delayed exposure 4 months after surgery. This occurrence was managed without complications for the patient. Conclusion: The design of proposed flap seems to be effective in controlling the risk of dehiscence during the healing time in the GBR. The vascular supply was rarely compromised. The results we obtained are encouraging even if further studies on this technique are needed. Clinical significance: Lateral partial-thickness flaps seem to be effective in controlling tissue tension and consequently the risk of dehiscence. The incision vestibularly performed should favor the soft tissue healing.

Objective: To assess if low-level laser therapy (LLLT) enhances the efficiency of orthodontic dental alignment. Background: There is no evidence of the effect of LLLT on the orthodontic treatment time from randomized clinical trials. Methods: Thirty-six subjects were included in this interventional pilot study and randomly assigned for treatment with fixed appliance and LLLT (test group) or with fixed appliance only (control group). A single monthly administration of LLLT was performed intraorally using a Diode laser (980 nm, 1 W, continuous wave, total energy density = 150 J/cm2; Doctor Smile-Lambda Spa). The date of brackets bonding (T1) and the date of complete resolution of dental crowding (T2) were recorded. The alignment treatment time was defined in days as T2 - T1. The number of monthly scheduled control visits was also recorded. Treatment time duration was assessed in both groups with the log-rank (Mantel-Cox) Test for survival analysis. Mann-Whitney U tests was used to compare the number of control visits from T1 to T2 between the two groups. Results: Patients' age, sex, and amount of crowding were equally distributed between the two groups. The alignment treatment time was significantly shorter (p < 0.001) in the tested group (211.8 days) compared to the control (284.1 days). Consequently, control visits (p < 0.001) were lower in the test group (7 visits, median value) compared to the control group (9.5 visits, median value). Conclusions: The results of this pilot study suggest that the administration of LLLT might significantly increase the efficiency of orthodontic treatment during dental alignment.

Osteoradionecrosis (ORN) of the jaw is a complication of radiation therapy for head and neck cancers. We report a case of ORN of the posterior maxilla treated with Er: YAG laser and a pedicled buccal fat pad (bichat bulla adipose) flap. A 69-year-old man presented complaining of pain on left maxilla. He had received high-dose radiotherapy (90 Gy) for squamous cell carcinoma of the left soft palate 2 years earlier. Clinical and radiographic examinations revealed ORN of the left maxillary molar region and maxillary sinusitis. Daily home care consisted of 0.9% saline irrigation and 0.8% H2O2 gel application. Sequestrectomy and tooth extraction were followed by debridement with Er: YAG laser and repair with a pedicled buccal fat pad flap. Complete resolution of ORN and maxillary sinusitis was established one year postsurgically. The excellent clinical outcome suggests that Er: YAG laser debridement and pedicled buccal fat pad flap are a viable option to treat ORN of the posterior maxilla.

Tads Allow a Rapid and Safe Intrusion in Posterior Area of Dentition, Avoiding Problems Due to Lack of Anchorage

Scopo dello studio: Questo lavoro intende fornire ai sanitari, attraverso l'analisi dei principali motivi di contenzioso per responsabilità professionale di origine ortodontica, informazioni di comportamento utili a ridurne l'incidenza e le conseguenze. Verranno presentati casi di situazioni di conflitto medico-paziente nei quali, grazie ad una corretta gestione , non sono derivate conseguenze in ambito giudiziario e casi nei quali, invece, proprio a causa di errori di gestione, si sono instaurati contenziosi giudiziari con obbligo di risarcimento del sanitario. Materiali e metodi. Nel lavoro vengono evidenziati, con il supporto iconografico di molteplici casi clinici giunti all'osservazione in ambito di responsabilità professionale, i momenti critici del trattamento ortodontico in cui si possono verificare conseguenze indesiderate, suddividendole in complicanze non altrimenti evitabili (in cui non vi è colpa professionale del sanitario) e in errore secondari invece un incongruo trattamento. Risultati e conclusioni. La maggior parte dei casi giudiziari è dovuta non solo a un errore nel trattamento, ma soprattutto ad un'incongrua gestione del contenzioso per un inadeguato comportamento del sanitario. E' quindi evidente che, a parte l'utilizzo di corrette tecniche ortodontiche, requisito base per una ortodonzia di qualità, è fondamentale per i sanitari conoscere non solo le conseguenze negative che possono verificarsi , ma anche, gli errori comportamentali nel rapporto medico-paziente che sfociano inevitabilmente nel contenzioso, il più delle volte a esito sfavorevole per il sanitario., Purpose: The purpose of this study is the evaluation of the reasons of the litigation for "malpractice" in dentistry coming out from orthodontic therapy offering to clinician information about the behavior to be assumed in case of litigation and used to minimize the legal consequences. We will show cases that, correctly managed, didn't lead to legal litigations ore were solved quickly before a court and instead cases that, incorrectly managed , led to long and difficult legal acts, ended with unsuccess of the clinician in the court. Materials and methods. In thies study we 'll show, with the use of iconographic support of many forensic cases, the critical steps of the orthodontic therapy in which unwanted consequences may happen subdividing them in "not otherwise avoidable" complications (there's no responsibility for the clinician) or in professional error for uncorrected treatment ("malpractice"). Results and conclusions. Most part of forensic case in a court are not due to errors in treatment only, but especially to an incorrect management of the litigation because of the wrong behavior of the clinician. Therefore it's clear that, using a correct endodontic therapy (main requirement for quality results), it's so important for the clinician to know not only the inspected consequences that may happen but also the errors in clinician's behavior in the relationship between dentist and patient, errors leading unavoidably into a court of the times with the clinician leavening in the litigation.

Scopo del lavoro: l'obiettivo di questo lavoro è stato quello di monitorare in due gruppi di pazienti come l'applicazione di un adeguato protocollo di mantenimento possa influenzare la colonizzazione batterica del solco gengivale in corso di terapia ortodontica. Materiali e metodi: sono stati selezionati 50 pazienti afferenti al reparto di ortodontia dell'Università Milano-Bicocca e poi suddivisi casualmente in due gruppi: uno periodicamente seguito da un team di igienisti durante le visite di controllo (gruppo di studio) e l'altro non è stato sottoposto ad alcun protocollo di prevenzione (controllo). I campioni di liquido crevicolare ottenuti in corso di trattamento sono stati esaminati con metodica PCR real-time al fine di monitorare la contaminazione batterica del solco gengivale. Risultati e conclusioni: Il monitoraggio microbiologico dei pazienti ha mostrato come il gruppo di studio ha presentato valori di conta batterica costantemente inferiori a quelli del gruppo di controllo. Sulla base dei risultati conseguiti si può pertanto affermare che il protocollo adottato può positivamente influenzare lo stato di salute dentoparodentale dei pazienti in corso di terapia ortodontica., AIM The purpose of this paper was to compare in two groups of patients the results of a hygiene protocol in order to asses its ability to reduce bacterial contamination in the gingival sulcus during orthodontic therapy. MATERIAL AND METHODS Fifty patients referred to the orthodontic department of Milano-Bicocca University where randomly divided in two groups: one followed by a team of dental hygienists et each orthodontic control, the other one did not receive any particular preventive treatment. Crevicular fluid samples obtained during treatment were examined with the real-time PCR to monitor bacterial contamination of the gingival sulcus. RESULTS AND CONCLUSION The microbiological analysis showed that the patients in the group followed by the dental hygienists had constantly lower bacterial counts than the control group. On the basis of the data obtained it is possible to state that the dental hygiene protocol adopted can positively influence the dental periodontal status of patients during orthodontic therapy.

Objective: To evaluate the psychological status and correlate it with the severity of facial deformities of patients with skeletal malocclusions before orthognathic treatment. Materials and Methods: A total of 96 patients aged 15 to 47 with skeletal malocclusions were examined before orthognathic treatment was provided. A photographic analysis was carried out to determine the severity of facial deformity according to the Facial Aesthetic Index (FA1). All patients were divided into three groups according to the FAI score: light (0 to 9), moderate (10 to 19), and severe (>19) facial deformities. Thirty subjects aged 17 to 39 with normal occlusion and attractive harmonious faces without previous orthodontic and/or surgical history were taken as controls. Psychological testing of controls and patients in the study group was performed before orthognathic treatment was provided. Results: Psychological testing showed no statistically significant differences among groups with light and moderate facial deformity and subjects in the control group. Significant differences were encountered among patients with severe facial deformities compared with controls in a series of personality traits, including introversion, neuroticism, trait anxiety, dependency, unsociability, and leadership. Conclusions: Orthognathic patients with different degrees of facial deformity have different psychological profiles. Patients with light and moderate facial deformity have no significant psychological problems. Patients with severe facial deformity show a significantly higher prevalence of emotional instability, introversion, anxiety, and unsociability. Such psychological profiles make orthognathic patients with severe facial deformity prone to psychological distress, depression, and adverse psychological reactions. (Angle Orthod. 2012;82:396-402.)© 2012 by The EH Angle Education and Research Foundation, Inc.