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Objectives To evaluate the proportion of COVID‐19 infections among a population of Italian Dental workers across different geographical area of Italy and to analyze the impact of both the preventive measures/strategies adopted and the psychological influences. Subjects and Methods The current cross‐sectional survey was administered with a web‐based form. To be eligible for the study, participants had to be 18 years and being dentists or dental hygienists members of the Italian Society of Periodontology and Implantology (SIdP). A 23‐item questionnaire concerning positiveness to COVID‐19, clinical strategies and psychological attitude within the pandemic was administered. Sub‐group analysis was conducted according to geographical macro‐area. Results A total of 790 dentists and dental hygienists were included. A total of 4.7% participants developed a positive diagnosis to COVID‐19. The Northwest of Italy experienced almost double of COVID‐19‐positive participants (p

Objectives Primary focused question for this systematic review (SR) was “Which is the evidence about surfaces decontamination and protection masks for SARS‐Cov‐2 in dental practice?” Secondary question was “Which is the evidence about surfaces decontamination and protection masks against airborne pathogens and directly transmitted viral pathogens causing respiratory infections?” Materials and Methods PRISMA guidelines were used. Studies on surface decontamination and protective masks for SARS‐CoV‐2 in dental practice were considered. Studies on other respiratory viruses were considered for the secondary question. Results No studies are available for SARS‐CoV‐2. Four studies on surface disinfection against respiratory viruses were included. Ethanol 70% and sodium hypochlorite 0,5% seem to be effective in reducing infectivity by > 3log TCID. Four RCTs compared different types of masks on HCW. The single studies reported no difference for laboratory‐diagnosed influenza, laboratory‐diagnosed respiratory infection, and influenza‐like illness. A meta‐analysis was not considered appropriate. Conclusions There is lack of evidence on the efficacy of surface disinfection and protective masks to reduce the spread of SARS‐CoV‐2 or other respiratory viruses in dentistry. However, the consistent use of respirator and routine surface disinfection is strongly suggested. There is urgent need of data on the efficacy of specific protection protocols for dental HCW against viral infections.

BACKGROUND/AIM This study evaluated marginal soft tissue recession at implants with simultaneous lateral guided bone regeneration (GBR), at least five years after prosthetic loading. MATERIAL AND METHODS Patients treated with GBR at the time of implant placement and adherent to supportive periodontal therapy (SPT) program with at least 5 years of follow-up were re-examined in 5 clinical centers. At the last follow-up, clinical and radiographic data on peri-implant hard and soft tissue were collected. Multilevel analysis considering center, patient, and implant (brand, length, diameter, position) was performed. RESULTS A total of 96 patients and 195 augmented implants were included. The mean duration of SPT was 8.3 ± 3.1 years, while mean recall frequency was 4.5 ± 1.3 months. Sixty-five (33%) implants received soft tissue graft before prosthetic delivery. Twenty-one (11%) implants developed biological complications during the follow-up. No implant failure was reported. Mean difference in bone levels (ΔBL) was -0.7 ± 0.9 mm, while mean difference in keratinized tissue (ΔKT) was -0.4 ± 0.9 mm. Eighty-five (44%) implants showed recession (REC) of soft tissue margin (mean 0.6 ± 0.8 mm). The presence of REC was associated with use of non-resorbable membrane (p

Effective methods for vibration-based damage diagnosis in building structures are based on the estimation of structural deflections from identified modal flexibility (MF) matrices. However, most of the existing methods and previous studies that use MF-based deflections were developed by considering the case of buildings that can be modeled as planar structures (e.g. plan-symmetric buildings) both in the baseline and possibly damaged states. In an attempt to fill this research gap, a deflection-based method for output-only damage diagnosis in building structures tested under ambient vibrations is proposed in this paper. The method is applicable for simple rectangular plan-symmetric “box type” 3D building structures which may experience asymmetric damage, and it can be used for detecting, localizing and quantifying the damage. One of the main differences between the proposed and the existing methods is related to the inspection loads adopted to estimate the MF-based deflections. The inspection loads of the proposed method are more complex than the uniform translational loads adopted in the existing methods. Such proposed loads in fact can be assembled only after having estimated the position of the center of stiffness for each story of the structure. According to the proposed approach, the locations of the centers of stiffness are extracted from the experimentally-derived modal flexibility matrices, before performing the damage diagnosis process. The effectiveness and validity of the proposed method was demonstrated both through numerical analyses and by executing experimental ambient vibration tests on a frame building. The results of the proposed method were also compared with the existing approach which was developed for planar structures. This comparison (made both through numerical and experimental analyses) demonstrated that only the proposed approach can be used to perform a correct damage diagnosis process in plan-symmetric buildings which may experience asymmetric damage, especially when considering the damage quantification problem.

The purpose of the present study was to evaluate the radiographical outcomes, survival rate, and amount of bone formation around implants placed during graftless lateral sinus lift approach (GLSLA). Five patients (6 sinus augmentations) were consecutively treated with GLSLA. After Schneiderian membrane elevation and implant insertion, only blood clot was left to fill the new sinus compartment. After 4 months of healing, implants were functionally loaded. In all cases, samples were taken for biopsy at the time of second-stage surgery. The radiographical marginal bone variations and apical bone gain were assessed using cone beam-computed tomography taken 4 months after the surgery (at crown insertion) and after 4 years of loading. A total of 14 implants were placed in a mean initial residual bone height of 3.1 mm (range 1.6-4 mm). No failure was recorded, and all the implants were successfully loaded yielding a 100% survival rate. Vital bone formation was 33% according to the histomorphometry data. Four years after loading the mean radiographic bone remodeling was 1.3 mm. The mean ridge height was 7.6 mm and the mean apical bone gain amounted for 3.8 mm. Within the limitations of this study, the placement of dental implants in conjunction with GLSLA seems to be feasible and accompanied by high implant survival rate.

In civil engineering structures it is highly desirable to detect the presence of damage and changes in the global structural behavior at the earliest possible stage, and, among the many existing strategies for vibration-based damage detection, modal flexibility (MF)-based approaches are promising tools. However, in most of the existing studies, the experimental validation of such approaches has been performed on small-scale laboratory structures, where damage has been artificially imposed as stiffness reductions, for example by substituting some structural elements. It is thus important to continue to test the effectiveness of such MF-based approaches on full-scale structures characterized by more realistic damaged conditions. This paper focuses on the methods for output-only damage detection and localization that are based on the estimation of structural deflections from modal flexibility, and the objective of this paper is to test the applicability of such methods for locating damage in a full-scale reinforced concrete (RC) structure that has experienced earthquake-induced damage. The considered structure is a shear wall building that can be modeled as a bending moment-deflecting cantilever structure, and was tested on the large-scale University of California, San Diego—Network for Earthquake Engineering Simulation (UCSD-NEES) shaking table. Two approaches, which are based, respectively, on the estimation of the curvature and the damage-induced rotation from the deflections, have been applied and compared on the data of the considered case study. These approaches have been applied in different scenarios characterized by different data sets and by a different number of degrees-of-freedom measured on the considered structure.

An accumulating body of evidence supports an independent association between high blood pressure (BP) and periodontitis, possibly mediated by low-grade inflammation. This joint report by the Italian Society of Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP) working group on Hypertension and Periodontitis (Hy-Per Group) provides a review of the evidence on this topic encompassing epidemiology, biological plausibility, relevance, magnitude, and treatment management. Consensus recommendations are provided for health professionals on how to manage BP in individuals showing signs of poor oral health. In summary, (1) large epidemiological studies highlight that individuals with periodontal diseases have increased risk for high/uncontrolled BP independent of confounders; (2) mechanistically, low-grade inflammation might have a causal role in the association; (3) BP profile and control might benefit from periodontal treatment in pre-hypertensive and hypertensive individuals; (4) oral health status should be evaluated as a potential risk factor for high/uncontrolled BP, and effective oral care should be included as an adjunct lifestyle measure during hypertension management. Further research is needed to optimize BP management in individuals with poor oral health.

Introduction Open pyeloplasty has been the first-line treatment for uretero-pelvic junction obstruction for decades. In the last years, minimally-invasive surgery (MIS) has gained popularity in the pediatric's field. Furthermore, recently, a great extension of Robot-assisted laparoscopic pyeloplasty (RALP) has been seen in younger and lighter-weight children as well as in redo cases. Herein we provided a comprehensive review of primary and redo RALP performed in children, particularly focusing on the different distribution of outcomes among the ages. Evidence acquisition A systematic review of the literature was performed according to PRISMA recommendations and was conducted on surgical indication and technique, intraoperative nuances, peri- and postoperative outcomes of primary and redo RALP. Evidence synthesis Overall, 33 studies with 1448 patients were included for primary RALP and 7 studies with 101 patients for redo cases between 2000 and 2019. In particular, 4 studies aimed to compare RALP in different cohorts of children grouped on ages or weight and 4 studies evaluated technical feasibility and safety of RALP over laparoscopic and open approach in very young populations. Success rate for primary RALP was found >90% in all studies but one, with low complication rate and reoperative indication. In redo series, 96% of patients revealed a decreased hydronephrosis on postoperative imaging. Conclusions RALP offers excellent outcomes in the pediatric population. However, there is still a strong need for higher quality evidence in the form of prospective observational studies and clinical trials. The rising of new robotic systems, such as single-port platform, might further enhance the applications of RALP in children.

The purpose of the present study was to evaluate the radiographical outcomes and survival rate of implants placed during graftless lateral sinus lift approach (GLSLA) using an absorbable collagen sponge. Fourteen patients (14 sinus augmentations) were consecutively treated with GLSLA. After Schneiderian membrane elevation and implant insertion, only collagen sponges were used to fill the new sinus compartment. After 4 months of healing, implants were functionally loaded. The radiographical marginal bone variation and apical bone gain were assessed on periapical radiographs taken 4 months after the surgery (at crown insertion) and at 12 months post-loading. A total of 41 implants were placed in a mean initial residual bone height of 3.5 mm (range 1.6–6.7 mm). No failure was recorded and all the implants were successfully loaded with fixed prosthesis. Twelve months post-loading the mean radiographic bone remodeling was 2.22 mm. The mean ridge height was 8.4 mm and the mean apical bone gain amounted for 4.4 mm. Within the limitations of this study, the placement of dental implants in conjunction with GLSLA using only a collagen sponge to fill the sinus compartment seems to be feasible and accompanied by a high implant survival rate. Further studies on a large population and with a longer follow-up are warranted to drawn definitive conclusions.

Summary Introduction Anterior urethral valves (AUV) are a rare cause of lower urinary tract obstruction which could progress to renal damage, Clinical presentation varies according with patient's age and severity of obstruction, but, in most cases, diagnosis is based on voiding cysto-urethrogram (VCUG). To date, the treatment of choice is endoscopic ablation even if approved guidelines about the overall management of AUVs, including the recognition and treatment of residual valves, are not available. Objective We describe our protocol for AUV treatment based on primary endoscopic valve ablation followed by check cystoscopy 15 days later. Study design Medical records of 5 patients with AUVs admitted from 2008 to 2018 to our Pediatric Urology Unit were retrospectively reviewed. Blood tests, urinalysis, renal US and VCUG were performed in all children, while urodynamic evaluation was performed in the 3/5 patients who could void spontaneously. All patients underwent endoscopic valves ablation and after 15 days after a second look cystoscopy was performed. Follow up was based on clinical and radiological evaluation with US, urinalysis and blood tests. Postoperative non-invasive urodynamic studies were performed in the 3/5 patient toilet-trained patients and VCUG was performed in 1/5 patient. Results and Discussion: At primary endoscopic ablation cystoscopy revealed AUVs in the penile urethra in three patients, in the penoscrotal urethra in one case, in the bulbar urethra in another case. In 3/5 patients check cystoscopy found residual valves and a second endoscopic ablation was performed. All patients achieved symptoms release and improved urodynamic parameters. No intra or post-operative complication were reported. The assessment of residual valves is variable in literature and it is usually described for posterior urethral valves (PUVs). Few series report the use of VCUG within the first week after valve ablation, our experience instead suggests that performing a second look cystoscopy, is very effective to evaluate the presence of residual AUVs and eventually proceed with further ablation. Conclusion Endoscopic ablation is the gold standard treatment for AUV, but residual valves management is not clearly defined. According to our experience, a check cystoscopy 15 days after primary ablation allows to identify and treat possible residual valves showing good results in terms of safety and efficacy.

Aim To reach a consensus on a consistent strategy to adopt when screening patients for dental/periodontal infections, and on the feasibility of providing dental treatment before cardiothoracic surgery, cardiovascular surgery or other cardiovascular invasive procedures. Methodology A panel of experts from six Italian scientific societies was created. The deliberations of the panel were based on the RAND method. From an initial systematic literature review, it became clear that a consensually validated protocol for the reproducible dental screening of patients awaiting cardiac interventions was considered mandatory by professionals with expertise in the dental, cardiologic and cardiac surgery areas. However, systematic review also concluded that the treatment options to be provided, their prognosis and timing in relation to the physical condition of patients had never been defined. Following the systematic review several fundamental questions were generated. The panel was divided into two working groups each of which produced documents that addressed the topic and which were subsequently used to generate a questionnaire. Each member of the panel completed the questionnaire independently and then a panel discussion was held to reach a consensus on how best to manage patients with dental/periodontal infections who were awaiting invasive cardiac procedures. Results A high level of agreement was reached regarding all the items on the questionnaire, and each of the clinical questions formulated were answered. Three tables were created which can be used to generate a useful tool to provide standardized dental/periodontal screening of patients undergoing elective cardiovascular interventions, and to summarize both the possible oral and cardiovascular conditions of the patient and the timing available for the procedures considered. Conclusions Upon publication of this consensus document, the dissemination of the information to a wide dental and cardiac audience should commence. The authors hope that this consensus can become a model for the development of a dedicated protocol, ideally usable by heart and dental teams in the pre-interventional preparation phase.

Treatment of complex perioprosthetic cases is one of the clinical challenges of everyday practice. Only a complete and thorough diagnostic setup may allow the clinician to formulate a realistic prognosis to select the abutments to support prosthetic rehabilitation. Clinical, radiographic, or laboratory parameters used separately are useless to correctly assign a reliable prognosis to single teeth except in the case of a clearly hopeless tooth. Therefore, it is crucial to gather the greatest quantity of data to determine the role that every single element can play in the prosthetic rehabilitation of the case. The following report deals with the management of a multidisciplinary periodontally compromised case in which a treatment strategy and chronology were designed to reach clinical predictability while reducing the duration of the therapy.

This paper describes a simplified procedure to calculate the supplemental damping ratio that must be provided in order to rehabilitate existing buildings with viscous dampers. The proposed method has been developed according to both analytical and graphical approaches. The graphical formulation is based on the construction of constant design acceleration or constant design displacement curves. These curves allow to estimate the required effective damping as a function of the effective period, associated to the secant stiffness at maximum displacement. Combining these curves with constant ductility curves, which provide a correlation between the effective damping and the supplemental damping for given available ductility and damper typology, it is possible to determine the required supplemental damping and to design the damping system. The proposed method has then been verified through nonlinear dynamic analyses considering a set of RC plane frames. Finally it has been applied to a case study regarding an existing building located in Italy and designed without considering the earthquake action.

A displacement-based method for the design of an energy dissipating system is proposed in this article. The device, which is composed of added concrete walls equipped with hysteretic Added Damping and Stiffness (ADAS) dampers, is aimed at upgrading the seismic behavior of existing masonry structures. The design method is based upon a simplified model of the overall structure-dissipating system. The proposed displacement-based design procedure was tested by means of inelastic response-time history analyses considering different masonry structures. The results of the analyses were compared with the seismic behavior expected from the design.

Purpose Sinus elevation via the lateral approach for implant rehabilitation of atrophic posterior maxillae is considered a safe and predictable therapy. Several xenogeneic biomaterials of different biologic origin have been used as valid and predictable alternatives to autogenous bone. This multicenter randomized controlled double-blind prospective clinical trial aimed to compare histomorphometrically two xenogeneic grafting materials used for sinus elevation with simultaneous implant placement. Materials and methods Seven private practices in Italy were involved. Patients presenting at least one site with a residual bone crest height between 2 and 4 mm were treated. Control sites were grafted with 100% deproteinated particulated bovine bone (DPBB), while test sites were grafted with prehydrated corticocancellous porcine bone (PCPB). Root-form implants were placed simultaneously. Insertion torque and clinical stability were assessed and recorded. At 6 months, a biopsy specimen was harvested from each site, and histomorphometric analyses were performed. Results Thirty-seven patients received 42 sinus elevations (24 test and 18 control). Eighty-two implants with adequate primary stability were placed. Fifty-five implants were placed in residual bone crests greater than 2 mm but less than 4 mm (average 2.7 mm) and achieved an average insertion torque of 22.8 ± 11.3 N/cm. Nineteen implants were placed in ridges greater than 3 mm but less than 5 mm, and eight were placed in ridges with more than 5 mm remaining. After 6 months, three implants had failed to integrate, leading to a survival rate of 96.34%. Forty-two specimens were analyzed histomorphometrically. No significant differences in total bone volume (PCPB 37.43%, DPBB 37.52%) or residual grafting material (PCPB 13.55%, DPBB 16.44%) were detected. Conclusions In this study, PCPB compared well with DPBB as a grafting material for lateral sinus elevation.

Summary Introduction and objective A great variety of different surgical techniques has been described for proximal hypospadias repair and an ideal tissue has not been determined yet. We present our 10 years of surgical experience using a bladder mucosal graft for urethroplasty. Study design Bladder mucosal graft urethroplasty was performed between 2005 and 2015 in 50 patients with severe proximal hypospadias. The mean age of patients was 45.1 months (range 24–164 months). Hypospadias were perineal in 18 patients, scrotal in 22, and penoscrotal in 10. In all cases a chordee correction was performed and median time between the first and the second stages was 12 months (mean 17 months, range 4–68 months). Both foley catheter and a suprapubic cystostomy were positioned and maintained for 2–4 weeks. Follow-up was performed at 1–3 and 6–12 months after surgery, and afterwards annually with clinical examination and flowmetry test. Results Mean follow-up was 5.3 years (median 5, range 1–10 years). Mean graft length was 57.4 mm (median 55 mm, range 35–85 mm). Among all the only early complication registered was a postoperative infection in one patient (2%) at the site of anastomosis. The long-term complications observed were urethrocutaneous fistula in nine patients (18%), urethral stricture in 15 patients (30%), meatal stricture in four patients (8%), and prolapse of meatus in seven patients (14%). The mean time of complication occurrence was 15 months (median 15.5 months, range 1–96 months). The functional and cosmetic appearance after surgery was satisfactory in 42/50 patients (84%) during the follow-up period. Discussion There is still an open debate regarding the optimal surgical approach for management of severe proximal hypospadias. Compared with other approaches, our technique showed acceptable results even though encumbered by slightly higher complication rates. Conclusion Our results show that bladder mucosal graft for primary severe proximal hypospadias in selected patients is a possible alternative to other commonly used techniques, with the aim of restoring recovery of the normal continuity of the distal urinary tract see figure below. Download : Download high-res image (93KB) Download : Download full-size image Figure . Urethral micturition after bladder graft mucosa urethroplasty.

The present work aims at applying and comparing some methods for vibration-based damage detection of civil structures starting from ambient vibration data. The analyzed procedures are based on a dynamic identification of the modal parameters that is performed in output-only conditions; this is a typical situation that occurs when structural health monitoring strategies are applied to civil structures. The here investigated damage-sensitive features are the modal parameters, the modal flexibility matrix and the damage-induced deflection, due to unitary inspection loads, of the identified structure; possible variations in these parameters can be adopted in order to detect, localize and quantify the damage. A damaged condition is analytically simulated through a stiffness reduction in the elements of a RC shear-type plane frame. The output-only modal identification is performed through the Eigensystem Realization Algorithm, combined with the Random Decrement technique, on the simulated responses due to a white noise ground motion of both the undamaged and the damaged structures. At the end, the effectiveness of the different identified damage features is evaluated and the accuracy related to the identified modifications, due to damage, is determined through a comparison with the initially assumed variations in the structural model.

OBJECTIVES To report our experience with the endoscopic treatment of ectopic ureterocele to demonstrate its long-term effectiveness. Endoscopic treatment is often recommended as the initial and definitive treatment in patients with ureterocele. METHODS A total of 46 children with ectopic ureterocele in a duplex system underwent primary endoscopic incision from January 1998 to January 2006. The mean follow-up was 3.8 years. Of the 46 children, 35 had been diagnosed prenatally and 11 had been diagnosed after birth because of a urinary tract infection. Low-dose antibiotic prophylaxis was administered to all children and was maintained until voiding cystourethrography showed no reflux. The pre- and postoperative evaluation included clinical assessment, ultrasound evaluation, diethylenetriaminepentacetic acid renography, and cyclic voiding cystourethrography. RESULTS Ureterocele decompression was achieved in 43 patients (93%). Three patients required additional surgery for persistent ureterocele (1 underwent ureteroureterostomy and 2 ureteropyelostomy). None of our patients showed deterioration of renal function after the procedures. Vesicoureteral reflux was seen in the lower moiety of the ipsilateral kidney in 14 patients (30%). Of the 14 patients with vesicoureteral reflux, 10 had spontaneous resolution. The remaining 4 underwent endoscopic correction. Five patients (10%) developed de novo vesicoureteral reflux in the ipsilateral ureterocele moiety. Of these 5 patients, 3 were treated with endoscopic injection and 2 had spontaneous resolution after 6 months of follow-up. CONCLUSIONS Our data have shown that primary endoscopic puncture of a ureterocele is a simple, long-term, effective, and safe procedure, avoiding complete reconstruction in most patients.

Objective We present our experience in the treatment of distal hypospadias using a modified Koff procedure, emphasizing the importance of patient selection for a good outcome. Materials and methods In 2003–2008, 90 patients, mean age 52.1 months, underwent surgical repair of distal hypospadias using urethral advancement according to Koff, modified with a Ψ incision on the tip of the glans. Meatal defect was glanular in six (8%), subglanular in 24 (26%) and coronal in 60 (66%) cases. Mild chordee was present in 19 patients (21%). Follow-up was 8–66 months. All patients were evaluated in terms of cosmetic results, and early and late postoperative complications. Results All patients showed excellent cosmetic results with urethral meatus on the tip. There was only one postoperative fistula due to extensive use of electrocautery during urethral mobilization that was surgically corrected 8 months after appearance. One patient had a postoperative meatal stenosis treated conservatively. No cases of residual chordee were detected. Conclusions Successful use of the modified Koff procedure depends on careful selection of patients. Good candidates are those with distal or mid-shaft hypospadias, presenting with: (1) absence or low degree of ventral chordee; (2) distal plate of urethra well developed; (3) distance between meatus and tip of glans at most 10–12 mm; and (4) glanular morphology preserved.

The effectiveness of viscous dampers in mitigating the seismic excitation impacts upon building structures has been widely proved. Recently, with reference to the specific case of equal mass, equal stiffness, shear-type structures, the authors developed a direct practical procedure which gives the mechanical characteristics of the manufactured viscous dampers capable of providing the frame structure with a prescribed value of the first damping ratio. In this paper, a comprehensive rational framework is presented, which allows to formally extend the validity of the proposed procedure to the more realistic case of a generic moment-resisting frame structure. Also the influence of various lateral stiffness distributions is investigated.

The main objective of this study was to evaluate clinical and radiographic outcomes of implant-supported fixed partial prostheses, comparing platform switching and standard platform concepts. Patients with single or multiple partial edentulism were included in this prospective multicenter study. Success rate, as well as crestal bone loss and occurrence of complications were evaluated over time, for a minimum of 3 years after prosthesis delivery. Radiographic and clinical examination served to evaluate implant and prosthesis conditions. A total of 51 patients with 117 implants (55 in the centralized platform group and 62 in the standard platform group) were considered in the analysis. After 3 years of loading, the cumulative implant survival in test group was 90.3 %, while in the control group, it was 96.5 % without any statistically significant difference. After 3 years of function, the bone loss was 0.33 ± 0.19 mm in the test group and 0.48 ± 0.26 mm, revealing a significant difference. Platform switching concept may lead to a reduction of marginal bone loss over time if compared to standardized one. Such effect seemed not to be related to a reduction of overall success rate of the treatment. Platform switching could be a viable prosthetic option for implant treatment of partial edentulism.

Surgical lengthening of clinical crowns representsone of the most commonly used procedures in con-temporary periodontics. Indications include: (1) lack ofsufficient length of a clinical crown to ensure a toothpreparation for fixed prosthodontics with retentive andresistance form; (2) preexisting dental caries or restora-tions in the vicinity of the free gingival margins thatprevent preparation of finish lines for restorative mar-gins coronal to the biologic width; (3) the need todevelop a ferrule for pulpless teeth restored withposts

Purpose Extraction of impacted mandibular third molars (M3s) may cause temporary or permanent neurosensorial disturbances of the inferior alveolar nerve (IAN). Although the incidence of this complication is low, a great range of variability has been reported in the literature. Several methods to reduce or eliminate this complication have been proposed, such as orthodontic-assisted extraction, extraction of the second molar, or intentional odontoectomy. The purpose of this series of cases is to present a novel approach for a riskless extraction of impacted mandibular M3s in contact with the IAN. Materials and Methods Nine consecutive patients (4 male and 5 female; mean age 24.9 years, range 18-43 years) required the extraction of 10 horizontally or mesioangular impacted mandibular M3s. In all cases the M3 was in contact with the IAN with a high risk of nerve injury. A staged approached was proposed and accepted by the patients. This approach consisted in the surgical removal of the mesial portion of the anatomic crown to create adequate space for mesial M3 migration. After the migration of the M3 had taken place, the extraction could then be accomplished in a second surgical session minimizing neurological risks. Results All M3s moved mesially within 6 months (mean 174.1 days, range 92-354 days) and could be successfully removed without any neurological consequences. Conclusion This technique may be considered as an alternative approach to the extraction of horizontally or mesioangular impacted M3s in proximity to the IAN.

Damage to the inferior alveolar nerve (IAN) during third molar extraction is a major concern for patients and clinicians. A wide range of the incidence of temporary and permanent neurologic disturbances of the IAN as a consequence of mandibular impacted third molar extraction has been reported in the literature. The incidence of IAN injury reported in the literature ranges from 1.3% to 5.3%. The risk of this complication depends mainly on the position of the impacted tooth in relation to the inferior alveolar canal. To reduce this risk, several approaches have been proposed. Some authors advocated orthodontic-assisted extraction of the impacted mandibular third molars. Others introduced partial odontectomy, that is, the surgical removal of the anatomic crown leaving the roots in place. This case report describes a novel approach to the extraction of horizontally and mesially inclined impacted third molars with the root apexes in close contact with the IAN.

Few investigations can be found in the literature on the histological nature of the attachment of connective tissue grafts to root surfaces previously exposed by recession.In this case report, a 24-year-old patient was treated with a connective tissue graft combined with a partial-thickness coronally positioned flap for root coverage of Class I Miller recessions at the maxillary right and left canines and first premolars. The treated sites exhibited 83% and 100% root coverage on the right and left sides, respectively. Twelve months later, the case required extraction of all 4 first premolars for orthodontic reasons. Two conservative block sections including the maxillary first premolars with the buccal soft tissues were obtained and processed histologically in a bucco-palatal plane.Histological analysis showed that healing occurred via a long junctional epithelium throughout the major portion of the previous recession site. Only minimal signs of new cementum-like tissue formation could be seen in the apical portion of the recession area coronal to the base of the instrumented root surface. No root resorption or ankylosis could be detected in any of the serial sections.The findings of this case report outline the possible variations in the histological outcome of connective tissue grafts. These variations can be attributed to differences in size and shape of the recession defects and flap positioning at the end of surgery.