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Even if the relationship between immunosuppression and increased incidence of systemic cancers is well known, there is less awareness about the risk of developing oral cancer in immunosuppressed patients. The aim of this review was to evaluate the association between immunosuppression and the development of oral cancer. Two authors independently and, in duplicate, conducted a systematic literature review of international journals and electronic databases (MEDLINE via OVID, Scopus, and Web of Science) from their inception to 28 April 2023. The assessment of risk of bias and overall quality of evidence was performed using the Newcastle–Ottawa Scale and GRADE system. A total of 2843 articles was identified, of which 44 met the inclusion criteria and were included in either the qualitative or quantitative analysis. The methodological quality of the included studies was generally high or moderate. The quantitative analysis of the studies revealed that immunosuppression should be considered a risk factor for the development of oral cancer, with a percentage of increased risk ranging from 0.2% to 1% (95% CI: 0.2% to 1.4%). In conclusion, the results suggest that a constant and accurate follow-up should be reserved for all immunosuppressed patients as a crucial strategy to intercept lesions that have an increased potential to evolve into oral cancer.

Venous thromboembolism (VTE) disease is the second leading cause of mortality in cancer patients. In the general population, the annual incidence of a thromboembolic event is about 117 cases per 100,000 persons, but cancer increases this risk about fourfold, while in patients receiving chemotherapy and surgical treatment, it is about sevenfold. Oral squamous cell carcinoma (OSCC) is the most common form of oral cancer and represents a multistep process in which environmental factors and genetic alterations are implicated. Thrombotic risk is considered empirically low in OSCC patients, although few data are available. Having limited information available may result in poor awareness of VTE prevention in OSCC, risking jeopardising the oncologic treatment and increasing the morbidity and mortality among these patients. In this paper, the topic of OSCC-associated thrombosis will be discussed.

Diagnosis and management of sinonasal complications of dental diseases or treatment (SCDDT) may be challenging. We aimed to report our real-life experience in patients treated with endoscopic endonasal approach describing data about symptoms, etiology, extension of the disease and success rate. We evaluated retrospectively data about 262 patients diagnosed as SCDDT and managed from August 2015 to May 2022. In 44.65% cases, maxillary sinus complications were determined by a dental disorder; the remaining 55.34% of cases were iatrogenic. Patients were managed according to our multidisciplinary protocol including ENT, dental, and radiological evaluation. Treatments were planned with a personalized approach, based on the patient’s clinical characteristics; all patients were treated with an endonasal endoscopic mini-invasive conservative approach. Combined dental treatment was performed simultaneously in 152/262 (58%) of patients; in the remaining cases, it was postponed after surgery. The overall treatment success rate (symptom resolution and endoscopically observed maxillary sinus healing) was 96.5%. At 15 days after surgery, we observed a significant improvement in the quality of life. The mean post-operative Sinonasal outcome test-22 (SNOT-22) score was significantly lower compared to baseline (6 versus 43.4; p < 0.05). Our study showed that endoscopic sinus surgery can be a successful procedure for treatment of SCDDT, leading to fast resolution of sinonasal symptoms and improving the quality of life. Furthermore, the technique allows removal of migrated dental material or dental implants even in challenging cases.

This review aims to analyze the multiple factors affecting patients' level of compliance (how much they wear removable devices/clear aligners) during orthodontic treatments and to investigate the available methods and devices to monitor the appliance wearing time and to improve it. A literature search was conducted on electronic databases (Pubmed, Scopus, and Google Scholar). The results of the present study suggest that compliance indicators may misestimate the intraoral wearing time. Compliance is affected by patient-related factors (age, personality traits, the importance of personal appearance, self-perception of malocclusion), appliance-related factors (visibility, pain/discomfort), and clinician-related factors (trust, clear and complete communication, motivation). The motivation of pre-pubertal patients is mostly external, while adolescents/young adults have intrinsic motivation for orthodontic treatment. Patients' self-reports tend to overestimate the appliance wearing time. Even if there is a lack of evidence, teledentistry might improve patients' awareness of being monitored, thus increasing the time for which orthodontic devices are worn. Compliance is a key factor for clear aligner treatments, but high-quality studies focusing on this aspect are missing. Further studies should focus on how to handle the lack of cooperation and how to increase compliance in order to maximize the treatment's results.

The aim of this study was to analyse the cytocompatibility of Surefil One (SuO) with respect to the release of monomers from the material. The following reference materials were chosen: SDR Flow Plus (SDR, Dentsply Sirona, Konstanz, Germany), One Q Bond (Q, Dentalica, Milan, Italy), and Ketac (K, 3M-ESPE, USA). Fifteen dentin discs (2 mm thickness and diameter) were obtained from 15 third molars and were used in this study. After dentin disc permeability measurement, murine fibroblasts were grown, and the pulp surface of the dentinal disc was placed in direct contact with the cells immersed in DMEM. The experimental materials were positioned on the occlusal side of each dentinal disc until a uniform thickness of 2 mm was obtained. Then, the discs were inserted into an artificial pulp chamber for 24 hours to assess the cytocompatibility. Afterwards, the moles of monomers leached from the specimens in DMEM were determined using HPLC. Statistical analysis was performed using ANOVA (p < 0.05). Under the experimental conditions, the toxic effect induced by all tested materials was slight or absent. Diurethane dimethacrylate and acrylic acid were not found in the culture media. It is concluded that all materials have good cytocompatibility consistent with the nondeterminability of the monomers released after polymerization.

The need to rehabilitate severely compromised teeth is frequent in daily clinical practice. Tooth extraction and replacement with dental implant represents a common treatment choice. However, the survival rate for implants is inferior to teeth, even if severely damaged but properly treated. In order to reestablish a physiological supracrestal tissue attachment of damaged teeth and to arrange an efficient ferrule effect, three options can be considered: crown lengthening, orthodontic extrusion and surgical extrusion. Crown lengthening is considered an invasive technique that causes the removal of part of the bony support, while both orthodontic and surgical extrusion can avoid this inconvenience and can be used successfully in the treatment of severely damaged teeth. The aim of the present narrative review is to compare advantages, disadvantages, time of therapy required, contraindications and complications of both techniques.

Purpose: The aim of the present study was to detect the prevalence of temporomandibular disorders (TMD) in patients with untreated obstructive sleep apnea (OSA) and to compare the results with healthy controls, matched for sex and age. Methods: Forty-one consecutive patients with OSA were prospectively recruited from the Department of Otorhinolaryngology at the A. Gemelli Hospital prior to undergoing any treatment for OSA and independently of OSA severity. All patients underwent a complete TMD examination according to the diagnostic criteria for temporomandibular disorders (DC/TMD) protocol. The same examination was performed on 41 healthy controls matched for sex and age. Chi-squared test was used to compare results between the two groups. Results: Of the 41 patients with OSA, 21 (51%) presented signs and/or symptoms of TMD compared to 13 of 41 subjects (32%) from the control group. Headache attributed to TMD and disc displacement with reduction were the most common diagnoses, with a statistically significant difference between the two groups (p<0.05). Conclusions: The prevalence of TMD signs and symptoms is significantly higher in untreated patients with OSA compared to healthy controls.

Objective: The aim of this study was to evaluate the postoperative course in patients undergoing oral mucosal biopsies, considering clinical and patient’s perception variables potentially correlated to poor healing. Subjects and methods: Eighty patients underwent oral biopsies. All the variables connected with the surgery were recorded, and the harvested volume was calculated through image software (ImageJ, NIH, Betesda, USA). To evaluate the postoperative discomfort, the OHIP-14 and the numeric rating scale of pain (NRS) were administered at 6 h, 7 days and 21 days after biopsy. Results: Six hours after the biopsy, 22 (OHIP-14 ≥ 20) and 24 (NRS ≥ 4) patients experienced a troublesome or painful healing, respectively. A significant statistical correlation between poor healing and high scores of NRS and OHIP was detected (Pearson’s correlation test p < 0.05). Higher values of OHIP-14 were correlated to the type of lesion (OR = 1.165; p < 0.05), whereas high values of NRS were correlated to the use of systemic drugs (p < 0.05). No surgical variable had a significant statistical correlation with any of the outcomes. Conclusions: The clinical evaluation was correlated with the patient’s perception of pain and discomfort. This finding could be suggestive of the fact that wound healing can be reliably monitored with the help of these tools. Clinical relevance: Patient perception can be a predictor of the healing of biopsied tissues.

AIM: This study aimed to determine the impact of laser surgical tongue-tie, lip-tie, buccal tie release on breastfeeding and Gastroesophageal Reflux Disease (GERD) in a prospective cohort study conducted from June 2019 to June 2020 in a private general dental practice. MATERIALS AND METHODS: Preoperative, one-week and one-month postoperative surveys were completed, consisting of Visual Analogue Scale (VAS) for nipple pain severity, Breastfeeding Self-Efficacy Scale Short Form (BSES-SF), and the Revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R). All study participants were breastfeeding dyads (0-12 weeks of age) with untreated ankyloglossia and/or tethered maxillary/buccal frena. The laser surgery was completed using 2 different near- infrared diode lasers with 300µm diameter fibre: a 980 nm wavelength diode laser (Lasotronix Smart Pro, Piaseczno Poland) was used at 4.0 W, gated with 100 µs t/on and 100 µs t/off, and a 1470 nm wavelength diode laser (Pioon S1, Wuhan Pioon Tech Co Ltd., Wuhan, China), used at 3.5W, gated with 50 ms t/on and 50 ms t/off. RESULTS: Statistically significant improvement was noted in VAS, I-GERQ-R and BSES-SF comparing preoperative scores to both one-week and one-month scores. The study had 132 breastfeeding dyads enrolled. Posterior tongue-tie was noted in 71% of this cohort. CONCLUSION: This study confirms the need for functional assessment of tongue and lip movement for this significantly affected cohort. Laser surgical release (frenotomy) of tongue-tie, lip-tie, buccal-tie resulted in significant improvement in breastfeeding outcomes. These improvements (VAS, I-GERQ-R and BSES-SF) in breastfeeding outcomes were found for cohorts of the classically recognised anterior tongue-tie and the less obvious (without functional assessment) submucosal tongue-tie were found.

Aim: While the short-term effects of hormonal events on gingival inflammation have been well described, long-term effects on the periodontium have received less attention. The aim of this cross-sectional population-based study was to evaluate the association between hormone-related events and periodontitis in a representative sample of the postmenopausal women of South Korea. Materials and Methods: A total of 10,273 postmenopausal women representative of 6.1 million of Koreans were examined. Periodontitis and severe periodontitis were defined according to the Community Periodontal Index (CPI ≧ 3 and CPI = 4, respectively). Univariate and multivariate regression analyses using 3 different models were applied controlling for age, smoking, marital status, educational level, income, BMI, hypertension, stress and frequency of toothbrushing. Results: Severe periodontitis was directly associated with a longer reproductive life (p-trend =.027) and with a longer duration of breastfeeding (48–72 vs. 1–17 months: OR = 1.49; 95% CI: 1.01–2.21). Conversely, early menopausal age (<46 vs. 49–50 years: OR = 0.74; 95% CI: 0.56–0.97), history of artificial menopause (OR = 0.72; 95% CI: 0.53–0.97), having had more than 6 pregnancies (vs. 4: OR = 0.73; 95% CI: 0.55–0.97), having had more than three abortions (vs. 0: OR = 0.51; 95% CI: 0.28–0.93) and having had the first birth age >26 years (vs. <21 years: OR = 0.71; 95% CI: 0.52–0.97) were inversely associated with severe periodontitis. Conclusions: In this large nationally representative population, severe periodontitis was related to menopausal age, reproductive life length, number of pregnancies/abortions, first birth age and breastfeeding duration, while it was not to oral contraceptive and hormone replacement therapy usages.

Objectives: The aim of this systematic review was to estimate the osteoradionecrosis rate in patients with head and neck cancer due to teeth extraction performed before radiotherapy and to identify possible risk factors. Material and Methods: PRISMA protocol was used to evaluate and present the results. PubMed, Scopus and Web of Science were used as search engines: English full-length papers of clinical studies, in peer-reviewed journals, were investigated. Cumulative meta-analysis was performed with a random effects model (PROSPERO registration code: CRD42018079986). Results: Among 2,020 records screened, 8 were included in this review. Sixteen of 494 patients who underwent tooth extraction before radiotherapy developed osteoradionecrosis, with an osteoradionecrosis incidence of 2.2% (95% Confidence of Interval = 0.6–3.9, p <.185, I2 = 3,044%). All cases were reported in the mandible. No other clinical risk factor for osteoradionecrosis was detected. Conclusions: Even if it is generally recommended to remove oral foci before radiotherapy, this systematic review confirmed that teeth extractions before radiotherapy represent a risk factor for osteoradionecrosis; the considerable amount of missing data prevented us from identifying other possible risk factors for osteoradionecrosis onset. Major efforts should be done to perform sounder methodological clinical investigations.

The purpose of this study was to evaluate the shear bond strength and adhesive remnant index ARI) of orthodontic brackets following enamel conditioning with acid etching, hydroabrasion, and with both procedures. Thirty extracted human premolars were divided into three groups and received either acid etching, hydroabrasion or both procedures. Orthodontic brackets were bonded with composite resin. Shear bond strength was tested with a tensile machine, then the teeth were observed under a stereomicroscope to evaluate ARI scores. The enamel morphology after each conditioning method was evaluated with scanning electron microscope imaging. A one-way ANOVA and a Kruskal-Wallis H test were used to compare the bond strength and the ARI scores among the three groups. Hydroabrasion alone produced shear bond strength values below clinical acceptability, while the combination of acid etching and hydroabrasion produced the highest values. The ARI scores in the hydroabrasion group were significantly different from the other groups. Hydroabrasion followed by acid etching was effective in increasing the shear bond strength of orthodontic brackets. Further in vivo studies are needed to confirm the cost and benefits of this technique.

Objectives: The aim of this systematic review was to estimate the osteoradionecrosis rate in patients with head and neck cancer due to teeth extraction performed before radiotherapy and to identify possible risk factors. Material and Methods: PRISMA protocol was used to evaluate and present the results. PubMed, Scopus and Web of Science were used as search engines: English full-length papers of clinical studies, in peer-reviewed journals, were investigated. Cumulative meta-analysis was performed with a random effects model (PROSPERO registration code: CRD42018079986). Results: Among 2,020 records screened, 8 were included in this review. Sixteen of 494 patients who underwent tooth extraction before radiotherapy developed osteoradionecrosis, with an osteoradionecrosis incidence of 2.2% (95% Confidence of Interval = 0.6–3.9, p <.185, I2 = 3,044%). All cases were reported in the mandible. No other clinical risk factor for osteoradionecrosis was detected. Conclusions: Even if it is generally recommended to remove oral foci before radiotherapy, this systematic review confirmed that teeth extractions before radiotherapy represent a risk factor for osteoradionecrosis; the considerable amount of missing data prevented us from identifying other possible risk factors for osteoradionecrosis onset. Major efforts should be done to perform sounder methodological clinical investigations.

The aim of this study was to evaluate the antibacterial properties of graphene oxide (GO) against Enterococcus faecalis in vitro conditions and when used to coat dentin surface to prevent E. faecalis adhesion. The ATCC strain of E. faecalis 29212 has been used to perform a viability test. The pellet was suspended in ultrapure water, NaCl, PBS buffer, CaCl2 and MgCl2, Luria−Bertani broth solutions. The viability was evaluated by the colony forming unit counting method. Atomic force microscopy images and the measure of surface zeta potential variation were analyzed. Dentin discs were covered with a film of GO (n = 15) or were not treated (n = 15). Bacterial suspension was added to each sample of dentine discs and microbial counts were calculated. Statistically significant differences between two groups were assessed by a two‐tailed unpaired t‐test. Bacteria cell morphology was investigated with scanning electron microscopy. The highest growth inhibition was obtained in ddH2O and CaCl2 solution while, in PBS and NaCl, GO had poor antibacterial efficacy with a growth enhancing effect in the latter. GO on dentin discs demonstrated high antibacterial activity. GO film has demonstrated acceptable adhesion properties to root dentin and a role in the inhibition of bacterial film proliferation and biofilm formation.

The clinical practice guidelines do not give precise indications on the use of mandibular advancement devices (MAD) for obstructive sleep apnea (OSA) patients when they suffer from temporomandibular disorders (TMD). The aim of this systematic review was to evaluate the effects of MADs on prevalence of TMD signs and symptoms in adult OSA patients. The study protocol was registered under the PROSPERO register and an electronic search was performed in several databases. All types of studies evaluating TMD prevalence on adult patients wearing MAD for OSA were included and independently evaluated by two investigators. The quality of evidence was evaluated using the grading of recommendations assessment, development and evaluation and the risk of bias by the risk of bias in non-randomized studies of interventions tool or the Cochrane collaboration's tool. For each study included, the difference in means and 95% CI was calculated between baseline and follow-up. Twelve studies were included. The meta-regression analysis showed that patients with pre-existing signs and symptoms of TMD do not experience significant exacerbation of symptoms using the MAD. The presence of TMD does not appear to be routine contraindication for the use of MAD used for the management of OSA.

Aim: This case report presents a root canal retreatment distinguished by a canal perforation successfully treated with a calcium-silicate based sealer (EndoSequence BC sealer, Brasseler USA, Savannah, GA, USA) with a 4 year follow-up. Summary: Root canal retreatment of a lower left second molar was performed in 80 years old patient because of a periapical chronic periodontitis with buccal fistula. The scouting of the mesio-lingual and distal canal was obtained with a k-file #10, while the mesio-buccal was not negotiable because of a perforation in the middle third of the root. Instrumentation of patent root canal was performed and the distal canal was filled with AH Plus (Dentsply DeTrey GmbH, Konstanz, Germany) and Thermafil Obturator (Dentsply Maillefer, Ballaigues, Switzerland) whereas the mesial canals and the perforation were sealed using EndoSequence BC Sealer and dedicated EndoSequence BC Points in order to perform a successive apical surgery. The improvement of clinical conditions and, successively, the gradual bone healing, confirmed with analogical radiographs, led to avoid the complicated endodontic surgery on this lower second molar, having already an acceptable clinical success. Key Learning Points: This case report confirmed the favorable physical and biological properties of calcium-silicate based sealers and, most of all, the handling properties of the EndoSequence BC sealer. In selected cases these type of sealers might lead to resolve complex treatments without using specialistic equipments like microscope and help general clinicians to approach complicated endodontic cases in an easier way.

Objectives: To evaluate whether changes in the concentration of different biomarkers in the gingival crevicular fluid (GCF) can be used to detect the root resorption process in adult or adolescent patients undergoing treatment with a fixed appliance, in comparison with untreated subjects or treated patients not showing signs of root resorption. Material and Methods: The following databases were analysed in the period between June 2017 and March 2018, without any language and initial date restrictions: PubMed, EMBASE, Scopus, Web of Science and Cochrane Library. A quality assessment instrument (QAI) was developed to establish the risk of bias. Results: A total of 1127 articles were analysed. Based on the inclusion and exclusion criteria, seven studies qualified for the final review. The QAI tool revealed that five articles were at a moderate risk of bias and two articles were at a low risk of bias. Conclusion: Dentine phosphoprotein (DPP) may be considered a relatively useful marker for root resorption. Dentinal sialoprotein (DSP) could be a potential biomarker but is not highly helpful at detecting root shortening. Inflammatory cytokines (pro- and anti-resorption), osteopontin (OPN), osteoprotegerin (OPG), RANKL and alkaline phosphatase (ALP) are useful biomarkers to explain the biological mechanisms that occur during orthodontic movement but are not specific enough. Further studies are required to clarify the role of GM-CSF as a potential biomarker to distinguish subjects at a risk of severe root resorption in the early phase.

PURPOSE: To quantify and compare pre-operative and post-operative volumetric adjustments of the upper lip tissues in patients with cleft lip. METHODS: The authors performed an anthropometric study and a quantitative analysis of the differences based on three-dimensional morphology of the nasolabial area. Twenty facial images using the three-dimensional stereophotogrammetry were taken from ten selected subjects on two separate occasions, sitting in natural head position. Facial landmarks were marked and measurements recorded, in order to calculate the volumetric adjustments in the soft tissues of the upper lip, comparing the preoperative and postoperative results. Student test and p-Value were performed for statistical analysis. RESULTS: The analysis of the 3D images showed variability with the pre-and postoperative volumes of the nasolabial area with: an increase of upper lip volume all patients; a complete view of the severity in the preoperative; and an improvement of the appearance in the postoperative. The amount of increase of the upper lip volume was established about 29,7%. For all measurements, the variability between pre-and post-operative was significant (p < 0.01). CONCLUSION: The 3D stereophotogrammetry technique allows a detailed preoperative evaluation and an accurate assessment of the surgical outcomes. The study provides a value of volumetric variation of the upper lip in individuals with cleft lip.

BACKGROUND: The soft tissue profile outcome after functional treatment of Class II malocclusion is important for a patient's aesthetic and psychosocial results. The soft tissue effects of the Sander bite-jumping appliance (BJA), which is the device that produces the greatest mandibular advancement according to a systematic review, have never been investigated. The aim of the present study was to assess the soft tissue effects of the BJA in comparison to matched untreated controls. METHODS: A total of 19 patients treated with BJA during puberty were retrospectively recruited, and 15 untreated controls were retrieved from a previous growth study to match the treated group. Lateral cephalograms were used to evaluate the pre- and post-treatment differences in the ANB angle, the inclination of the upper and lower incisors, facial convexity, the nasolabial angle and the sagittal position of the skeletal and soft tissue at points A and B. Independent t-tests or Mann-Whitney U tests were used to detect differences between the two groups. RESULTS: Statistically significant differences were found for the ANB angle, the inclination of the upper incisors and facial convexity. CONCLUSIONS: Functional treatment of Class II patients with the Sander BJA during puberty was effective at improving the profile and reducing the facial convexity angle in the short term.

Brain abscesses (BAs) are rare but life-threatening infections. BAs of an odontogenic origin should always be considered as a possible aetiological factor, especially when other infectious foci are not present. Clinical presentation in children may be ambiguous and pose a difficult differential diagnosis: the identification of causal bacteria can be difficult and odontogenic origin is often a diagnosis of exclusion. The aim of this paper was to systematically review the literature reports with particular emphasis on therapy and propose a diagnostic flowchart for odontogenic brain abscess in children. A systematic literature review was performed on PubMed, Scopus and ISI Web of Science to identify cases of BAs in children and discuss clinical management: only human research articles, published in peer-reviewed English language journals, were included. Among 109 articles, 7 publications were selected for data analysis: clinical data could be extracted for only 8 subjects; different clinical approaches are descripted in the reports, even if therapy should be started as soon as possible to prevent rapid diffusion to the rest of the central nervous system. Due to their rarity and ambiguous clinical presentation in children, BAs of odontogenic origin are difficult to diagnose. A thorough oral-maxillofacial investigation should always be performed to exclude an oral origin.

Objectives: This review investigated the effects of orthodontic or functional orthopedic therapy on masseter muscle thickness through the use of ultrasonography (US) in growing subjects when compared with untreated subjects. Materials and Methods: This review systematically assessed studies that investigated growing subjects undergoing orthopedic therapy for the correction of malocclusion of vertical, sagittal and transversal plane. Electronic databases (CENTRAL, MEDLINE-PubMed, Scopus and Web of Science) were searched up to February 2019, including available RCTs and CCTs, without language restrictions. The primary outcome was the effect of orthopedic or functional treatment on masseter muscle thickness. The risk of bias of included studies was assessed through the Newcastle-Ottawa quality assessment scale with the aim of defining their methodological quality. A random-effects meta-analysis analyzing mean differences with 95% confidence intervals was used for quantitative analysis. Results: The search retrieved 749 titles, but the studies selection resulted in a final sample of 5 CCTs. The studies retrieved data from 233 children (age range: 5-22 years) and were conducted at university dental clinics. Children were treated for Class II malocclusion, increased vertical dimension or lateral cross-bite variably with rapid or slow maxillary expansion, twin block, bite block, mandibular activators, quad helix, alone or in combination. Risk of bias was assessed as medium for three studies, low for one and high for another. The meta-analysis determined that at the end of orthopedic or functional treatment masseter muscle thickness, measured through the use of US, is significantly reduced (MD -0.79 mm; 95% CI -1.28 to -0.31). The reduction in muscle thickness, therefore, could be considered an indicator for the evaluation of the success of therapy with orthodontic appliances. Conclusions: Although the meta-analysis revealed that US could be considered a less invasive and e

The microbial infection of the endodontic space occurs in a necrotic tooth as a result of dental caries, trauma, periodontal disease, or previous root canal therapy. The disruption of the biofilms and the reduction of the bacterial load inside root canals are crucial for the success of root canal therapy. The aim of this study was to compare, in vitro, the antibiofilm efficacy of a novel passive sonic irrigation (PSI) device with passive ultrasonic irrigation (PUI) and conventional needle irrigation (CNI). Forty-four single-rooted human teeth were inoculated with a culture of E. faecalis for 28 days. The specimens were randomly divided into three groups: PUI, CNI, and PSI (n = 12). The activation protocols were performed using both 17% EDTA and 5.25% NaOCl. Residual bacterial biofilm was taken by means of a canal brush and colony-forming unit (CFU) were counted. The data were analyzed using one-way ANOVA and Games-Howell's post hoc tests. A major reduction in CFU was observed in the PSI and PUI groups, in comparison with the CNI group. No difference was found (p > 0.05) in terms of CFU reduction between PSI and PUI. PSI could be as effective as PUI in the removal of bacterial biofilms from straight root canals.

OBJECTIVE: To compare in vivo Titanium Alloy (TiA) with Stainless Steel (SS) miniscrews Temporary Anchorage Devices (TADs) using removal torque and Scanning Electron Microscopic (SEM) analysis. PATIENTS AND METHODS: 15 subjects (6 males and 9 females) who required maximum anchorage were recruited. For each patient, a TiA TAD and a SS TAD with same length and width were implanted following a randomized splitmouth study design. Retraction was carried out with nickel-titanium spring ligated directly from the anterior hooks of the archwire to the TADs to produce 90 to 100 g of force. When no further anchorage supplementation was needed, the TADs were removed. The removal torque values were registered with a digital screwdriver. After removal, the TADs were collected in a fixed solution and examined using SEM and X-ray microanalysis. RESULTS: All TADs remained intact, with a 100% success rate. There was no difference in removal torque between TiA and SS miniscrews (4.4 ± 1.3 N-cm and 5.1 ± 0.7 N-cm, respectively). All specimens' loss of gloss with signs of biological contaminations resulted in a dull implant surface. SEM photomicrographs of TiA miniscrews showed predominantly blood cells while SS miniscrews showed the precipitation of an amorphous layer with low cellular component. There was no difference in spectroscopic analysis between TiA and SS miniscrews. CONCLUSIONS: TiA and SS miniscrews had comparable removal torque values. SEM photomicrographs showed no evidence of osteointegration with both TADs having similar biological responses. © 2018 Verduci Editore. All rights reserved.

Introduction: The aim of the present study was to investigate the impact of ambient temperature on the life span of nickel-titanium (NiTi) files. Methods: Cyclic fatigue testing of NiTi instruments was performed in a stainless steel artificial canal. During the experiment, 4 different temperatures (0°C, 20°C, 35°C, and 39°C) were used in a thermostatic bath controlled using electronic and infrared controls. Eighty R25 Reciproc Blue (VDW, Munich, Germany) and 80 R25 Reciproc (VDW) instruments were reciprocated in the artificial canal until fracture occurred, and the time to fracture and the length of the fractured fragment were recorded. The phase transformation temperature for 3 instruments of each type was analyzed by differential scanning calorimetry. One-way analysis of variance and Bonferroni tests were used to statistically analyze the data at a 5% significance level (P <.05). Results: Reciproc Blue instruments were significantly more resistant to cyclic fatigue than Reciproc at all the temperatures tested (P <.05). Fatigue resistance was proportionally higher as the environmental temperature decreased (0°C > 20°C > 35°C > 39°C). No significant difference was registered for the length of the fractured fragment of both instruments tested at all temperatures tested (P >.05). Conclusions: Blue alloy significantly increases the cyclic fatigue resistance of Reciproc files compared with M-Wire alloy. Temperature significantly affects the life span of NiTi files. When the ambient temperature increases between 0°C and 35°C, the fatigue resistance of the files statistically decreases.

OBJECTIVE: In recent years metagenomic analysis has become more accessible for the characterization of biological specimens. There has been an important increase of studies using this technique for subgingival human samples. To date, there are no updated systematic reviews on the relationship between oral microbiota and periodontal disease. The aim of the present systematic review was to update data about studies concerning the influences of changes in oral microbiota composition on the periodontal status in human subjects. MATERIALS AND METHODS: An electronic search was conducted in four databases (MEDLINE, Scopus, CENTRAL and Web of Science) for articles published in English from January 2014 to April 2018. In vitro or animal studies, case reports, case series, retrospective studies, review articles, abstracts and discussions were excluded. Also, studies that evaluated less than 5 microbial species, only viruses or already known periodontal pathogens were excluded. Two independent researches selected the studies and extracted the data. The quality of evidence was assessed as high, moderate or low for each microorganism. RESULTS: Eight studies and three additional publications recovered from the bibliography search of the selected articles were included in the review. The Bacteria domain was the main detected among the others and it included 53 species. The review confirmed the presence of recognized periodontal pathogens such as the members of the red complex but also identified, with high weight of evidence, the presence of new pathogens. CONCLUSIONS: The results of this systematic review support high evidence for the association of 3 new species/genera with the etiology of periodontitis. Future investigations on the actual role of these new pathogens in the onset and progression of the disease are needed.

BACKGROUND: The term Pseudohypoparathiroidism indicates a group of rare conditions characterised by end-organ resistance to the action of parathyroid hormone (PTH). Ossifying epulis (OE) is a exophytic gingival lesion characterised by spontaneous bone formation beneath the mucosa, which may affect children and adults: the exophytic, calcified outgrowths can occur in any bone and generally have favorable prognosis. Drug therapy may normalise calcium serum levels, but not completely avoid the occurrence of peripheral ossifying epulis. CASE REPORT: We report a representative case of a peripheral ossifying epulis in the mouth of a patient following a drug treatment protocol for her pseudohypoparathyroidism and to optimise serum markers. An 11-year-old girl was referred to our department, showing a bulky neoformation on the gingival margin of 0.6 mm diameter with sharp margins. The mass was completely excised. Histological analysis revealed distinctive features of a chronic and acute inflammatory microenvironment with plasma cells (positivity for CD38, MUM1, Lambda and Kappa chains) and bone tissue fragments with remodeling aspects referable to flogistic osteolysis. The biopsy result leads to hypothese a change in the patient's drug therapy. Multidisciplinary screening and individualised pharmacological treatment are strongly recommended in the clinical practice in order to improve the therapeutic results

Background: To evaluate the facial aesthetic effects of orthodontic treatment performed with clear aligners and to compare it to an untreated control group, on lower third facial ageing in adult patients through the use of the Wrinkle Severity Rating Scale (WSRS) at the beginning (T0) and at the end (T1) of the study period. Material and Methods: A clear aligners treated group (TG) of 68 patients was compared to a control group of 33 untreated patients (UG). Each group was divided in 2 subgroups according to age: subgroup 1 if under 40 years of age and subgroup 2 if over. Facial aesthetics of the lower third was evaluated at T0 and T1 by a panel of five aesthetic experts with WSRS. Results: Statistically significant changes were found in all subgroups comparing WSRS scores at T0 and T1. The between group comparisons revealed that wearing clear aligners produces a statistically relevant improvement in lower third facial aesthetics both in younger (p < 0.05) and older (p < 0.001) patients. Conclusions: The present retrospective cohort study has successfully shown that malocclusion therapy conducted through the use of clear aligners in a population of adults affected by dental crowding has beneficial effects on lower third facial ageing.

Introduction The purposes of the study were to investigate and evaluate the differences detected by the patients between the traditional orthognathic approach and the surgery-first one in terms of level of satisfaction and quality of life. Methods A total of 30 patients who underwent orthognathic surgery for correction of malocclusions were selected and included in this study. Fifteen patients were treated with the conventional orthognathic surgery approach, and 15 patients with the surgery-first approach. Variables were assessed through the Orthognathic Quality of Life Questionnaire and the Oral Health Impact Profile questionnaire and analyzed with 2-way repeated-measures analysis of variance. Results The results showed significant differences in terms of the Orthognathic Quality of Life Questionnaire (P <0.001) and the Oral Health Impact Profile (P <0.001) scores within groups between the first and last administrations of both questionnaires. Differences in the control group between first and second administrations were also significant. Questionnaire scores showed an immediate increase of quality of life after surgery in the surgery-first group and an initial worsening during orthodontic treatment in the traditional approach group followed by postoperative improvement. Conclusions This study showed that the worsening of the facial profile during the traditional orthognathic surgery approach decompensation phase has a negative impact on the perception of patients’ quality of life. Surgeons should consider the possibility of a surgery-first approach to prevent this occurrence.

Objective: The objective of this study was to investigate the trajectory of NiTi rotary instruments of the same size but different design in an artificial root canal manufactured for cyclic fatigue test. Study design: Eight groups of instruments with tip size 25, 0.06 taper with different design were tested in a simulated root canal with an angle of curvature of 60 degrees and radius of curvature of 5 mm milled in a stainless steel block with a tapered shape corresponding to the dimensions of the instruments tested. Geometric analysis of the trajectory that each instrument followed inside the artificial canal was performed on digital images, determining 3 parameters: angle and radius of the curvature and the position of the center of the curvature. Mean values were then calculated for each group. Data were analyzed using 1-way ANOVA and Holm t test to determine any statistical difference (P < .05). Results: All the instruments tested followed the curvature established with little variations and ANOVA test did not show significant difference among the different groups for all the parameters analyzed (P > .05). Conclusions: The results of the present study emphasized the importance of using an artificial canal specifically constructed on the dimensions of the instrument tested to reduce this approximation in cyclic fatigue tests. The artificial canal manufactured for the present study seems to guarantee that different NiTi rotary instruments may follow a precise and repeteable trajectory in terms of radius and angle of curvature. © 2009 Mosby, Inc. All rights reserved.

Introduction: Fractured rotary nickel-titanium (NiTi) instruments have been classified into those that fail as a result of cyclic flexural fatigue or torsional failure or a combination of both. Clinically, NiTi rotary instruments are subjected to both torsional load and cyclic fatigue, and ongoing research aims to clarify the relative contributions of both factors to instrument separation. Methods: To date, there is no specification or international standard to test cyclic fatigue resistance of endodontic rotary instruments. As a consequence, several devices and methods have been used to investigate in vitro cyclic fatigue fracture resistance of NiTi rotary endodontic instruments. In nearly all studies reported in the endodontic literature, the rotating instrument was either confined in a glass or metal tube, in a grooved block-and-rod assembly, or in a sloped metal block. Results: There has been no mention of the "fit" of the instrument in the tube or groove. As the instrument is likely to be fitting loosely, the description of the radius of curvature in those studies is likely to be overstated (ie, the file was actually bent less severely than reported, adding a variability in the amount of flexural stress). Conclusions: This review analyzed several devices that have been used in endodontic literature for cyclic fatigue testing and found that differences in the methodology affected the fatigue behavior of rotary instruments and, consequently, the outcome of these studies. An international standard for cyclic fatigue testing of NiTi rotary instruments is required to ensure uniformity of methodology and comparable results. © 2009 American Association of Endodontists.

Human saliva from a healthy donor was subjected to fractionation by gel chromatography and six pools were collected and analysed by MALDI-TOF-MS and HPLC-ESI-MS. Three peptides, corresponding to 888.3, 687.3, and 524.1 amu and SNYLYDN, YLYDN, and LYDN sequences (determined by automated Edman sequencing), were isolated from pool 4. YLYDN was not previously described in human saliva. The peptides show the common C-terminal sequence of histatin 3 and histatin 1. To exclude the possibility that the three peptides were an artifact of the purification procedure, nine samples of human saliva were collected from healthy donors, immediately acidified with 0.2% TFA, and analysed by RP-HPLC-ESI-MS. The three peptides were detected in all the analyzed samples. SNYLYDN was always found at a concentration higher than that of YLYDN and LYDN. A correlation analysis performed on quantitative data indicated that the three peptides derive only from histatin 3. Other already known histatins also were searched for in the chromatogram. Histatins 1, 2, 3, 5, 6, 7, 8, and 10 were observed, although not in all samples analyzed, whereas other minor histatins were not detected.

Anorexia nervosa (AN) is an eating disorder (ED) identified using DSM-IV criteria. Eating disorders are occurring increasingly earlier in childhood and can lead to a series of oral manifestations. The aim of this study was to evaluate the correlation-between stomatognathic lesions and eating disorders in 80 young patients (76 females and 4 males aged 9-18 years) with restricting or binge-eating/purging AN. The results confirm the close correlation between ED and oral lesions, the most common of which were dental erosion, dentinal hypersensitivity, the extrusion of amalgam restorations and xerostomia. The authors conclude by emphasising the importance of involving dentists in the diagnosis and treatment of ED. © 2004, Editrice Kurtis.

A group of 15 partially edentulous patients who needed alveolar ridge augmentation for implant placement, were consecutively treated using a two-stage technique in an outpatient environment. A total of 18 alveolar segments were grafted. During the first operation bone blocks harvested from the mandibular ramus or symphysis were placed as lateral or vertical onlay grafts and fixed with titanium osteosynthesis screws after exposure of the deficient alveolar ridge. After 6 months of healing the flap was re-opened, the screws were removed and the implants placed. Twelve months after the first operation implant-supported fixed bridges could be provided to the patients. Mean lateral augmentation obtained at the time of bone grafting was 6.5±0.33 mm, that reduced during healing because of graft resorption to a mean of 5.0±0.23 mm. Mean vertical augmentation obtained in the 9 sites where it was needed was 3.4±0.66 mm at bone grafting and 2.2±0.66 mm at implant placement. Mean lateral and vertical augmentation decreased by 23.5% and 42%, respectively, during bone graft healing (before implant insertion). Mandibular sites showed a larger amount of bone graft resorption than maxillary sites. All the 40 implants placed were integrated at the abutment connection and after prosthetic loading (mean follow-up was 12 months). No major complications were recorded at donor or recipient sites. Soft tissue healing was uneventful, and pain and swelling were comparable to usual dentoalveolar procedures. A visible ecchymosis was present for 4 to 7 days when the bone was harvested from the mandibular symphysis. From a clinical point of view this procedure appears to be simple, safe and effective for treating localised alveolar ridge defects in partially edentulous patients. Copyright © Munksgaard 2002.

The cranial base of 60 adults affected by mandibular prognathism was studied with the aid of a computerized cephalometric analysis. The means and standard deviations of the values measured on the sample where compared with the cephalometric standards of the University of Michigan. The studied sample showed a significant reduction in length of the floor of the anterior cranial fossa, the cranial base angle showed no deviation from the control but the whole cranial base was backward and upward rotated in relation to the Frankfurt plane. The cranial base morphology was similar in patients with or without maxillary retrusion. The data in our possession may indicate that mid-facial sagittal growth in patients affected by mandibular prognathism is somehow impaired by altered cranial base growth. In any case the sagittal projection of the frontal and nasal bones appears to be reduced in our patients and this data must be kept in mind when studying these patients with the aid of cephalometry.

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This article describes the dental skeletal and aesthetic features that characterize Mandibulo-facial dysostosis and Hemifacial microsomia. Each patient has been studied with three different cephalometric analysis in the laterolateral projection. The data are fully reported and discussed. Particular emphasis is put on the differences and correlations between the two syndromes from the point of view both of morphology and physiopathology.

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