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Tumor heterogeneity results in aggressive cancer phenotypes with acquired resistance. However, combining chemical treatment with adjuvant therapies that cause cellular structure and function perturbations may diminish the ability of cancer cells to resist at chemical treatment and lead to a less aggressive cancer phenotype. Applied treatments on prostate hyperplasia primary cell cultures exerted their antitumor activities through mechanisms including cell cycle blockage, oxidative stress, and cell death induction by flow cytometry methods. A 5.37 mM Chloramphenicol dose acts on prostate hyperplasia cells by increasing the pro-oxidant status, inducing apoptosis, autophagy, and DNA damage, but without ROS changes. Adding 6.30 mM vitamin C or 622 µM vitamin E as a supplement to 859.33 µM Chloramphenicol dose in prostate hyperplasia cells determines a significant increase of ROS level for a part of cells. However, other cells remain refractory to initial ROS, with significant changes in apoptosis, autophagy, and cell cycle arrest in G0/G1 or G2/M. When the dose of Chloramphenicol was increased to 5.37 mM for 6.30 mM of vitamin C, prostate hyperplasia cells reacted by ROS level drastically decreased, cell cycle arrest in G2/M, active apoptosis, and autophagy. The pro-oxidant action of 1.51 mM Erythromycin dose in prostate hyperplasia cell cultures induces changes in the apoptosis mechanisms and cell cycle arrest in G0/G1. Addition of 6.30 mM vitamin C to 1.51 mM Erythromycin dose in hyperplasia cell cultures, the pro-oxidant status determines diminished caspase 3/7 mechanism activation, but ROS level presents similar changes as Chloramphenicol dose and cell cycle arrest in G2/M. Flow cytometric analysis of cell death, oxidative stress, and cell cycle are recommended as laboratory techniques in therapeutic and diagnostic fields., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Aim: Dental caries is a common oral disease in children with special needs such as those with autism spectrum disorders (ASDs). The aim is to assess whether the type and survival of three caries management, conventional resin restorations (CR), ART technique (ART) and SDF application without caries removal (SDF), in primary teeth carried out at the Pediatric Dentistry Department of San Paolo Hospital (University of Milan) differed between children with ASDs and unaffected peers., Methods: Data from a convenience sample of children with and without ASDs, who have received dental care for caries in primary teeth from January 2019 to June 2022, were analysed. Medical history, age, sex, teeth treated, and type of treatment were collected from dental charts. Data on success and minor and major failures of each treatment were also collected. Two survival analysis were performed, one considering both major and minor failures, a second considering only major failures. Cox Proportional Hazards multivariate logistic models were run to assess factors associated with failures. The statistical significance was set at 5% (p< 0.05)., Conclusion: In children with autism, the different techniques for approaching caries lesions seem to have the same probability of success. Therefore, the choice of treatment should be patient-oriented rather than lesion-oriented. In unaffected children, the gold standard always seems to be traditional restorative treatment.

Cellulose nanocrystals (CNCs) are cellulose-derived nanomaterials that can be easily obtained, e.g., from vegetable waste produced by circular economies. They show promising antimicrobial activity and an absence of side effects and toxicity. This study investigated the ability of CNCs to reduce microbial adherence and biofilm formation using in vitro microbiological models reproducing the oral environment. Microbial adherence by microbial strains of oral interest, Streptococcus mutans and Candida albicans, was evaluated on the surfaces of salivary pellicle-coated enamel disks in the presence of different aqueous solutions of CNCs. The anti-biofilm activity of the same CNC solutions was tested against S. mutans and an oral microcosm model based on mixed plaque inoculum using a continuous-flow bioreactor. Results showed the excellent anti-adherent activity of the CNCs against the tested strains from the lowest concentration tested (0.032 wt. %, p < 0.001). Such activity was significantly higher against S. mutans than against C. albicans ( p < 0.01), suggesting a selective anti-adherent activity against pathogenic strains. At the same time, there was a minimal, albeit significant, anti-biofilm activity (0.5 and 4 wt. % CNC solution for S. mutans and oral microcosm, respectively, p = 0.01). This makes CNCs particularly interesting as anticaries agents, encouraging their use in the oral field.

Objectives: A calcium phosphate extracted from fish bones (CaP-N) was evaluated for enamel remineralization and dentinal tubules occlusion., Methods: CaP-N was characterized by assessing morphology by SEM, crystallinity by PXRD, and composition by ICP-OES. CaP-N morphology, crystallinity, ion release, and pH changes over time in neutral and acidic solutions were studied. CaP-N was then tested to assess remineralization and dentinal tubules occlusion on demineralized human enamel and dentin specimens (n = 6). Synthetic calcium phosphate in form of stoichiometric hydroxyapatite nanoparticles (CaP-S) and tap water were positive and negative controls, respectively. After treatment (brush every 12 h for 5d and storage in Dulbecco's modified PBS), specimens' morphology and surface composition were assessed (by SEM-EDS), while the viscoelastic behavior was evaluated with microindentation and DMA., Results: CaP-N consisted of rounded microparticles (200 nm - 1 µm) composed of 33 wt% hydroxyapatite and 67 wt% β-tricalcium phosphate. In acidic solution, CaP-N released calcium and phosphate ions thanks to the preferential β-tricalcium phosphate phase dissolution. Enamel remineralization was induced by CaP-N comparably to CaP-S, while CaP-N exhibited a superior dentinal tubule occlusion than CaP-S, forming mineral plugs and depositing new nanoparticles onto demineralized collagen. This behavior was attributed to its bigger particle size and increased solubility. DMA depth profiling and SEM showed an excellent interaction between the newly formed mineralized structures and the pristine tissue, particularly at the exposed collagen fibrils., Significance: CaP-N demonstrated very good remineralizing and occlusive activity in vitro, comparable to CaP-S, thus could be a promising circular economy alternative therapeutic agent for dentistry., Competing Interests: Declaration of Competing Interest There are no conflicts to declare., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Recent epidemiologic studies carried out in Romania confirmed an ascending trend for cardiovascular disease (CVD) risk factor prevalence such as diabetes mellitus (DM), obesity and dyslipidemia. The aim of this study is to describe the CVD risk factor profile and preventative behavior in a representative sample of the general adult population of an Eastern Romanian urban area. More than 70% of the studied population had a body mass index (BMI) above the normal range for their age, with 36.7% of the subjects residing in obesity and severe obesity clusters. For overweight and obese subjects, the number of comorbidities (CVD, arterial hypertension and DM type 2) was higher than in the population with normal weight (44% vs. 31%, 22% vs. 14% and 18% vs. 10%, respectively). The prevalence of high blood pressure was almost double that reported in previous Romanian studies (69.3% vs. 36.6%) and higher than expected, based on self-reported known CVD diagnoses (37.5%). There was a visible difference between the results obtained for quantifiable CVD risk factors and self-reported lifestyle ones. Routine blood test monitoring may be an easy and inexpensive tool to guide educational and medical interventions to address modifiable CV risk factors in the adult population in order to prevent the fatal consequences of cardiovascular disease.

Background: Life-long healthy behaviors are established during pregnancy and the first years of life. In this cross-sectional survey, new mothers with a high level of schooling living in Northern Italy (Lombardy Region) were interviewed to assess their knowledge and attitudes towards their and child oral health., Methods: A questionnaire (27 items) was developed to assess socio-demographic factors, knowledge, and attitudes towards maternal and child oral health. The questionnaire was disseminated in perinatal courses, private gynecological clinics, and via social media. Mothers aged ≥18 years, with at least a child aged 0-36 months, with a high school diploma or higher, were included in the survey., Results: A total of 1340 women completed the questionnaire, 1297 of whom had a child aged 0-36 months, 792 lived in Lombardy, and 600 had a high level of education and were finally included. About half of the sample (44.67%) was aged between 31 and 35 years, 76.50% were employed, and the majority had only one child (81.50%). During pregnancy, 28.33% of the sample reported problems with teeth and gums, while only 36.00% visited a dentist. More than 40% of the sample said they were not aware of a possible link between oral health and pregnancy, and 73.17% had not received any advice about their oral health or the future health of their baby's mouth. Less than 20% of women were aware of the increased caries risk associated with prolonged or night-time breastfeeding. Better knowledge/attitude was associated with the age of the child (p < 0.05), the number of children (p < 0.05) and whether the mother had received advice during pregnancy (p < 0.05)., Conclusions: The results of this survey show a lack of dental care during pregnancy, a lack of information about oral health from health professionals during and after pregnancy, and consequently gaps in the knowledge needed to care for the oral health of the woman and her child. There is a need for training in oral health for pregnant women and new mothers, but also a need for behavioural change among health professionals who care for pregnant women., (© 2023. The Author(s).)

Aerosols produced by dental handpieces represent a permanent risk of disease transmission in the dental environment. The current study evaluated the effects of natural ventilation (open windows) on Streptococcus mutans airborne contamination by dental handpieces in simulated clinical conditions. A dental phantom was placed on a dental chair at a standard university dental clinic operatory. An S. mutans suspension was infused into the phantom's mouth while an operator performed standardized dental procedures using low (contra-angle) and high speed (turbine) dental handpieces or an ultrasonic scaler, with windows open or closed. Selective medium Petri dishes were placed in 18 sites of the operatory environment to evaluate contamination topographically. Sites were clustered as: wall, floor, ceiling, dental chair, and cabinet. Contamination was expressed as log 10 CFU/cm 2 . A linear mixed model analysis was used, nesting the sites within each ventilation and handpiece combination. Open windows significantly reduced contamination. The high-speed handpiece provided the highest contamination, followed by the ultrasonic scaler and the low-speed handpiece. Contamination values were much smaller at the ceiling, and much larger at the chair. Opening windows produced more homogeneous contamination of the operatory compared to closed windows. Natural ventilation during dental procedures decreases contamination and affects its topographical distribution., (© 2023 Scandinavian Division of the International Association for Dental Research. Published by John Wiley & Sons Ltd.)

Modern light-cured, resin-based composites are offered in a wide range of shades and translucencies. This large variation, created by varying the amount and type of pigmentation and opacifiers, is essential to enable an esthetic restoration in each patient situation, but may affect light transmission in the deeper layers during curing. We quantified optical parameters and their real-time variation during curing for a 13-shade composite palette of identical chemical composition and microstructure. Incident irradiance and real-time light transmission through 2 mm thick samples were recorded to calculate absorbance, transmittance, and the kinetic of transmitted irradiance. Data were supplemented by the characterization of cellular toxicity to human gingival fibroblasts up to 3 months. The study highlights a strong dependence of light transmission and its kinetic as a function of shade, with the largest changes occurring within the first second of exposure; the faster changes, the darker and more opaque the material. Transmission differences within progressively darker shades of a pigmentation type (hue) followed a hue-specific, non-linear relationship. Shades with similar transmittance but belonging to different hues were identified, while the corresponding kinetic was identical only up to a transmittance threshold. A slight drop in absorbance was registered with increasing wavelength. None of the shades were cytotoxic.

Objectives: The current study aimed to compare the efficacy of two in vitro microbiological models based on open and closed systems designed to obtain secondary caries in an accelerated and reproducible way., Methods: A conventional resin-based composite (RBC - Majesty ES-2; Kuraray, Japan) and a resin-modified glass-ionomer cement (RMGIC - Ionolux; VOCO, Germany) were used to restore standardized class II cavities (n = 4/tooth, cervical margin in dentin) in 16 human molars. The ability to produce secondary caries with Streptococcus mutans biofilms was tested using either an open-cycle or closed-cycle bioreactor (n = 8 specimens/model). Specimens were scanned before and after the biofilm exposure using micro-CT (Skyscan 1176, 9 µm resolution, 80 kV, 300 mA). Image reconstruction was performed, and demineralization depths (µm) were evaluated at the restoration margins and a distance of 1.0 mm., Results: Dentin demineralization could be observed in all specimens, and enamel demineralization in 50% of the specimens. The open system bioreactor produced lesions with significantly higher overall demineralization depths (p < .001). However, demineralization depths at a 1.0 mm distance from the restoration margins showed no difference between open and closed systems or materials. In the open system, significantly lower demineralization depths were observed in proximity to RMGIC than RBC (p < .001), which was not significantly different in the closed system (p = .382)., Conclusions: Both systems produced in vitro secondary caries in an accelerated way. However, the open-cycle bioreactor system confirmed the caries-protective activity exerted by the RMGIC material in contrast to the RBC, better simulating materials' clinical behavior., Clinical Significance: The possibility of obtaining accelerated and reproducible secondary caries development in vitro is fundamental in testing the behavior of conventional and yet-to-come restorative dental materials. Such systems can provide faster outcomes regarding the performance of dental restorative materials compared to clinical studies, notwithstanding the importance of the latter., Competing Interests: Declaration of competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier Ltd.)

This study evaluated the efficacy of experimental TEGDMA-functionalized dicalcium phosphate dihydrate (T-DCPD) filler-based resin-based composites (RBC) in preventing caries lesions around the restoration margins (secondary caries, SC). Standardized Class-II cavities were made in sound molars with the cervical margin in dentin. Cavities were filled with a commercial resin-modified glass-ionomer cement (RMGIC) or experimental RBCs containing a bisGMA-TEGDMA resin blend and one of the following inorganic fractions: 60 wt.% Ba glass (RBC-0); 40 wt.% Ba glass and 20 wt.% T-DCPD (RBC-20); or 20 wt.% Ba glass and 40 wt.% T-DCPD (RBC-40). An open-system bioreactor produced Streptococcus mutans biofilm-driven SC. Specimens were scanned using micro-CT to evaluate demineralization depths. Scanning electron microscopy and energy-dispersive X-ray spectroscopy characterized the specimen surfaces, and antimicrobial activity, buffering effect, and ion uptake by the biofilms were also evaluated. ANOVA and Tukey’s tests were applied at p < 0.05. RBC-0 and RBC-20 showed SC development in dentin, while RBC-40 and RMGIC significantly reduced the lesion depth at the restoration margin (p < 0.0001). Initial enamel demineralization could be observed only around the RBC-0 and RBC-20 restorations. Direct antibiofilm activity can explain SC reduction by RMGIC, whereas a buffering effect on the acidogenicity of biofilm can explain the behavior of RBC-40. Experimental RBC with CaP-releasing functionalized T-DCPD filler could prevent SC with the same efficacy as F-releasing materials.

One of the recent trends in the development of resin-based composites (RBCs) focuses on universal coloring to avoid time-consuming color matching and RBC layering for a clinically appropriate esthetic impact. We evaluated an experimental material for posterior restorations combining universal coloring with the possibility of bulk-fill placement. Clinically established materials were analyzed as a reference, including a bulk-fill and a universal chromatic RBC. Microstructural features were described using scanning electron microscopy and related to macroscopic and microscopic mechanical behavior. Standards to be met before market launch were supplemented by fractography, Weibull analysis, and aging behavior assessment. Quasi-static and viscoelastic behavior were evaluated on a microscopic scale, incorporating a large number of parameters and increasingly aggressive immersion media. All materials complied with the standard requirements even after aging. The latter had little impact on the measured parameters, except for strength. Strength, modulus of elasticity, and hardness parameters on the one hand and damping behavior on the other were mutually exclusive. Despite considerable differences in the microstructure and type of filler, an increased filler amount remained critical for better mechanical properties. The lower proportion of inorganic fillers was directly transferred to the elastic modulus values, which, in turn, restricts the experimental material in its clinical applications to smaller occlusal fillings.

Objectives: Evaluate the ability of current ion-releasing materials to remineralise bacteria-driven artificial caries lesions., Materials and Methods: Standardised class I cavities were obtained in 60 extracted human molars. Specimens underwent a microbiological cariogenic protocol (28 days) to generate artificial caries lesions and then were randomly divided into four restorative groups: adhesive + composite (negative control); glass ionomer cement (GIC); calcium silicate cement (MTA); and resin-modified calcium silicate cement (RMTA). Microhardness analysis (ΔKHN) was performed on 40 specimens (10/group, t = 30 days, 45 days, 60 days in artificial saliva, AS). Micro-CT scans were acquired (3/group, t = 0 days, 30 days, and 90 days in AS). Confocal microscopy was employed for interfacial ultra-morphology analysis (2/group, t = 0 days and 60 days in AS). Additional specimens were prepared and processed for scanning electron microscopy (SEM) and FTIR (n = 3/group + control) to analyse the ability of the tested materials to induce apatite formation on totally demineralised dentine discs (60 days in AS). Statistical analyses were performed with a significance level of 5%., Results: Adhesive + composite specimens showed the lowest ΔKHN values and the presence of gaps at the interface when assessed through micro-CT even after storage in AS. Conversely, all the tested ion-releasing materials presented an increase in ΔKHN after storage (p < 0.05), while MTA best reduced the demineralised artificial carious lesions gap at the interface. MTA and RMTA also showed apatite deposition on totally demineralised dentine surfaces (SEM and FTIR)., Conclusions: All tested ion-releasing materials expressed mineral precipitation in demineralised dentine. Additionally, calcium silicate-based materials induced apatite precipitation and hardness recovery of artificial carious dentine lesions over time., Clinical Relevance: Current ion-releasing materials can induce remineralisation of carious dentine. MTA shows enhanced ability of nucleation/precipitation of hydroxyapatite compared to RMTA and GIC, which may be more appropriate to recover severe mineral-depleted dentine., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Few data are available on the long-term efficacy of mineral trioxide aggregate (MTA) in treating root canal perforations. This prospective cohort study builds on a previously reported trial to determine the outcome for teeth with root perforations treated with orthograde MTA after longer follow-up and identify potential prognostic factors., Methods: A prospective cohort study was performed, enrolling (1999-2009) patients with a single dental perforation treated with MTA. Preoperative, intraoperative, and postoperative information was evaluated, and the outcomes were dichotomized as healed or nonhealing. Patients were followed up yearly until 2018 for a maximum of 17 years after treatment, with controls carried out until 14 years. Clinical and radiographic outcomes were evaluated using standardized follow-up protocols., Results: Of the 124 entrolled patients (median age = 36.5 years, 53.2% male), 115 were healed at the first (n = 110, 89%) or second (n = 5, 4%) annual posttreatment checkup, while 9 subjects (7%, 4 females, 18-65 years old) did not heal. Characteristics significantly associated with nonhealing were gender, positive probing, size, and perforation site. Perforations recurred in 48 teeth during the follow-up with the estimated probability of reversal at 5, 10, and 14 years of 6% (95% confidence interval [CI], 2%-10%), 30% (95% CI, 20%-38%), and 62% (95% CI, 46%-73%), respectively. Positive probing had a higher reversal risk (hazard ratio = 3.3, P ≤ .001), and perforations >3 mm were more likely to have a reversal (hazard ratio = 4.1, P < .001)., Conclusions: The risk of reversal for healed MTA-treated root canal perforations, initially relatively low, vastly increases over time., (Copyright © 2022 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: Innovative, nanotechnologies-featuring dental materials for CAD/CAM applications are becoming available. However, the interaction with the oral environment poses critical challenges to their longevity. The present study evaluated specific physical-chemical properties and antimicrobial potential of a CAD/CAM graphene-doped resin before and after accelerated aging protocols., Methods: Graphene nanofibers (GNF)-doped (<50 ppm) PMMA (GPMMA) and control PMMA CAD/CAM discs were used. Specimens underwent aging procedures of their bulk (thermo- and load-cycling) and surface (24 h-immersion in absolute ethanol), then they were tested for flexural strength, ultimate tensile strength, sorption/solubility, and methyl-methacrylate elution. Surface characterization included x-ray diffraction, Fourier-transform infrared spectroscopy, X-ray photoelectron spectroscopy, surface roughness, microhardness, and scanning electron microscopy (SEM). Adherence of Streptococcus mutans and Candida albicans, and biofilm formation (continuous-flow bioreactor) by the same strains and an artificial oral microcosm were investigated., Results: GNF-doping improved the physical-chemical bulk properties of the PMMA resin. Surface aging reduced microhardness and increased the roughness of both test and control materials. Surfaces displayed signs of swelling and degradation at SEM. Microbiological data of non-aged surfaces showed that GNF-doping significantly reduced biofilm formation by all tested strains despite having no impact on microbial adherence. After aging, microbial adherence was higher on GPMMA surfaces, while biofilm formation was not promoted., Significance: GNF-doping improved the material's performance and influenced its antimicrobial potential. This strategy seems a valuable option to overcome the effects of surface degradation induced by aging on the antimicrobial potential of PMMA resin., (Copyright © 2022 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.)

Recent health care products are based on formulations claimed to provide enamel remineralization and dentinal tubules occlusion through calcium-phosphate bioactive nanocompounds (ion-doped hydroxyapatite and precursor, amorphous calcium phosphate nanoparticles). This study aimed to characterize, test, and compare for the first time the structure and performance of a representative, market-available sample of remineralizing toothpastes and topical mousses. Formulations were characterized to determine their composition and investigate the presence of bioactive compounds and doping elements. A conventional fluoride-containing toothpaste was used as reference. The enamel remineralization and efficacy of dentinal tubules occlusion by tested formulations were investigated ex vivo on human hard tissues. All formulations containing Ca-P bioactive nanocompounds showed remineralizing ability by epitaxial growth of a layer showing the morphology and composition of human hydroxyapatite. Such layers also embedded nanosilica clusters. The presence of doping elements or casein phosphopeptide seemed essential to allow such performances, especially when hydroxyapatite and amorphous calcium phosphate compounds were doped with small amounts of CO 3 2- , F - , Mg 2+ , and Sr 2+ . Topical mousse formulations showed a higher tubules occlusion capability than toothpastes, independently from their composition. Therefore, all tested formulations could be useful in restoring tooth structures in a biomimetic way, contrasting dental demineralization processes leading to caries., (© 2022. The Author(s).)

Purpose: To quantify the biological contamination of a dental operatory environment using a biological tracer., Methods: A Streptococcus mutans suspension was infused into the mouth of a phantom, and an operator performed standardized dental procedures using an air turbine, a contra-angle handpiece, or an ultrasonic scaler either with windows open or closed. The presence of the tracer was measured by placing Petri dishes with a selective medium at 18 sites on the dental unit and 38 sites in the surrounding operatory environment., Results: The contamination was drastically reduced when windows were opened, no matter which handpiece was used. Air turbine spread significantly higher contamination compared to contra-angle and scaler. All tested instruments spread the tracer over the entire dental unit and the surrounding environment, including the walls and ceiling; however, higher contamination levels were detected on the dental unit compared to the operatory surfaces. Opening windows during dental operative procedures greatly reduced contamination levels for all handpieces and can be recommended for reducing airborne contamination levels., Clinical Significance: The significant levels of airborne contamination produced when operating dental handpieces can be significantly reduced by natural ventilation, i.e., simply opening the windows., Competing Interests: The authors declared no conflict of interest., (Copyright©American Journal of Dentistry.)

Objectives: A current trend to simplify dental restorative procedures is toward using universal chromatic light-cured resin-based composites (RBCs) designed to adapt esthetically to various clinical situations. This study offers a comparative characterization of the mechanical and cytotoxic behavior of such materials that use different techniques to adjust their optical properties (e.g., structural color instead of pigment addition), have different filler systems but are based on a comparable organic matrix., Methods: The structural appearance of the filler systems was assessed by scanning electron microscopy. Various quasi-static and viscoelastic parameters were evaluated at clinically relevant frequencies (0.5-5 Hz) using an instrumented indentation test with a Dynamic Mechanical Analysis (DMA) module. Cytotoxicity on human gingival fibroblasts (HGF-1), when exposed to eluates from tested RBCs specimens (up to one month), was assessed using a WST-1 colorimetric proliferation assay. Multifactor analysis of variance was applied to compare the parameters of interest (Martens, Vickers, and indentation hardness; elastic and total indentation work; creep, indentation depth; storage, loss, and indentation moduli; loss factor; cell viability) between analyzed RBCs, loading frequencies, and eluate age., Results: Structural particularities of the filler systems are directly reflected in the mechanical behavior of the analyzed materials. Changes in the filler system, necessary to achieve structural color, generally resulted in lower mechanical properties but a better ability to absorb shock. In contrast, the cytotoxicity was comparable., Significance: Based on the performed characterization, universal chromatic RBCs fits in the conventional RBCs class to expect comparable clinical behavior., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: Second-trimester anomaly scan was introduced as a regulated practice in Romania in 2019, causing misperceptions and unrealistic expectations about this examination among pregnant women. This study aimed to assess whether second trimester anomaly scan is a reason "per se" for maternal anxiety., Design: A prospective type 1 cohort study was conducted in a tertiary prenatal diagnosis center with three locations in Bucharest, Romania, among pregnant women who underwent a second trimester anomaly scan between 1 December 2019 and 29 February 2020., Main Outcome Measure: Anxiety at the time of prenatal anomaly scan., Results: Out of the 138 participants, 32.6% believed that the anomaly scan could detect all fetus defects, 13.8% considered that the baby is bothered by the probe "light", 8.7% believed that the scan could harm the fetus, 96.4% reported that it was a pleasant experience, and 95% felt that it strengthened their bond with the fetus. The State-Trait Anxiety Inventory (STAI) score revealed that women with high state anxiety were more anxious at pre-scan ( p = 0.001)., Conclusion: Ultrasound scan in the second trimester is correlated with a significant anxiety for women who are prone to this psychological trait. It is also a good opportunity to screen for highly anxious women who could benefit from prenatal psychological counseling to facilitate timely recognition and prevention of postpartum psychiatric disorders such as depression.

This in vitro study aimed to evaluate the influence of curing time on surface characteristics and microbiological behavior of three bulk-fill resin-based composites (RBCs). Materials were light-cured for either 10 s or 80 s, then finished using a standard clinical procedure. They were characterized by surface morphology (SEM), surface elemental composition (EDS), surface roughness (SR), and surface free energy (SFE). Microbiological behavior was assessed as S. mutans adherence (2 h) and biofilm formation (24 h) using a continuous-flow bioreactor. Statistical analysis included a two-way ANOVA and Tukey's test ( p < 0.05). Materials differed substantially as filler shape, dimension, elemental composition and resin matrix composition. Significant differences between materials were found for SR, SFE, and microbiological behavior. Such differences were less pronounced or disappeared after prolonged photocuring. The latter yielded significantly lower adherence and biofilm formation on all tested materials, similar to conventional RBCs. Improved photoinitiators and UDMA-based resin matrix composition may explain these results. No correlation between surface characteristics and microbiological behavior can explain the similar microbiological behavior of bulk-fill materials after prolonged photocuring. This different performance of bulk-fill materials compared with conventional RBCs, where surface characteristics, especially surface chemistry, influence microbiological behavior, may have important implications for secondary caries occurrence and restoration longevity.

Aim: To evaluate the performance of a new catheter design based on different hydrodynamics aiming to reduce the development of biofilm, and compare it with a conventional Foley catheter (FC)., Methods: The new proposed design (NPD) catheter is a modification of the FC, based on asymmetric positioning of the balloon and additional drainage holes allowing continuous urine drainage and complete voiding of the bladder. A first experiment was undertaken to assess drainage capability, and a second experiment was performed using a bioreactor with a set-up simulating the bladder and using the test catheter as a flow-through system. The biofilm formation of five bacterial species associated with catheter-associated urinary tract infection (CAUTI) was determined after 24 h of incubation using an MTT assay. Morphological evaluation was performed using scanning electron microscopy. In-vitro determination of residual fluid, and quantitative and morphological data on biofilm formation on the intravesical and intraluminal parts of the tested catheters were assessed., Results: Residual fluid was significantly higher in the FC (5.60 ± 0.43 mL) compared with the NPD catheter (0.2 ± 0.03 mL). The NPD catheter showed significantly less biofilm formation (P<0.0001) than the FC. Catheter design had a variable effect on biofilm formation depending on the bacterial strain tested. There was significantly less intraluminal biomass compared with intravesical biomass in both catheters (P<0.0001). Multi-layered biofilms that covered the FC surfaces completely were seen for all tested strains, while the NPD catheter surfaces showed reduced biofilm formation., Conclusions: Modifications of the hydrodynamic characteristics of a catheter can significantly reduce bacterial colonization. Integrated design approaches combining chemical, mechanical and topographical elements can help to reduce the occurrence of CAUTI., (Copyright © 2021 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Background: This laboratory study was done to evaluate the efficacy of personal protective equipment (PPE) and high-volume evacuation (HVE) against the spread of human coronavirus type 229E (HCoV-229E) during a standard dental procedure., Methods: Patient and operator manikins were used to recreate a dental setting inside a custom-built class III cabinet-like chamber. The mouth of the patient manikin was inoculated with an HCoV-229E suspension, the viral load of which was similar to that of asymptomatic people infected with severe acute respiratory syndrome coronavirus 2. The dental procedure was performed with an air turbine handpiece and HVE for 10 seconds. The efficacy of surgical masks, N95 (filtering facepiece class 2) and filtering facepiece class 3 respirators, and face shields was tested via quantitative real-time polymerase chain reaction., Results: The wide surface on which the inoculum was spread caused low contamination. Over the external surfaces of masks and respirators, when a face shield was not worn, viral loads ranged from 1.2 through 1.4 log 10 mean gene copies per cm 2 . When the shield was worn, viral loads dropped below the detection limit (< 0.317 log 10 gene copies/cm 2 ) for all PPE. On the operator's forehead, viral loads were 0.6 through 0.8 log 10 gene copies/cm 2 . Inside the operator manikin's mouth, viral loads were under the detection limit when using any PPE, with or without the shield. HVE did not significantly change viral loads., Conclusions: All PPE combinations significantly reduced viral loads in the operator manikin's mouth to below the detection limit, but HVE did not decrease viral contamination., Practical Implications: Although caution is suggested when removing and disposing of PPE to avoid self-contamination, the combination of PPE and face shields drastically decreases the risk of transmitting human coronavirus during aerosol-generating dental procedures., (Copyright © 2021 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Aims: This study compared the effectiveness and safety of cervical cerclage combined with cervical pessary in the treatment of cervical incompetence and that of cervical cerclage alone and cervical pessary alone., Methods: We performed a prospective cohort study of women with cervical incontinence. Subjects were randomized into three groups: cerclage, pessary, and cerclage and pessary combined., Results: A total of 75 patients with cervical incompetence were enrolled: 37.3% patients had a cervical length <15 mm, and 62.5% had a cervical length of 15-25 mm. Patients with increased body mass index were significantly likely to have a short cervix ( p  = .06); patients with a short cervix had earlier rupture of the membrane. The cerclage and pessary groups had more spontaneous abortions than the combined treatment group, which had no abortions or premature births. The mean gestational ages at delivery for the cerclage group (37.82 weeks) and the pessary group (35.73 weeks) were smaller than for the combined treatment group (38.33 weeks). The premature rupture of membranes that was correlated with cervical length had a higher incidence in the pessary group (26.9%)., Conclusion: Placement of a cervical cerclage combined with a cervical pessary is a safe technique and has a high success rate in the treatment of cervical incompetence.

Background: DNA-RNA compounds have shown promising protection against cell oxidative stress. This study aimed to assess the cytotoxicity, protective, or preventive effect of different experimental formulations on oral epithelia's oxidative stress in vitro., Methods: Reconstituted human oral epithelia (RHOE) were grown air-lifted in a continuous-flow bioreactor. Mouthwashes and gels containing DNA-RNA compounds and other bioactive molecules were tested on a model of oxidative stress generated by hydrogen peroxide treatment. Epithelia viability was evaluated using a biochemical MTT-based assay and confocal microscopy; structural and ultrastructural morphology was evaluated by light microscopy and TEM., Results: DNA-RNA showed non-cytotoxic activity and effectively protected against oxidative stress, but did not help in its prevention. Gel formulations did not express adequate activity compared to the mouthwashes. Excipients played a fundamental role in enhancing or even decreasing the bioactive molecules' effect., Conclusion: A mouthwash formulation with hydrolyzed DNA-RNA effectively protected against oxidative stress without additional enhancement by other bioactive molecules. Active compounds, such as hyaluronic acid, β-Glucan, allantoin, bisabolol, ruscogenin, and essential oils, showed a protective effect against oxidative stress, which was not synergistic with the one of DNA-RNA. Incorporation of surfactant agents showed a reduced, yet significant, cytotoxic effect.

This ex vivo study aimed to compare the microtensile bond strength of fiber-reinforced and particulate filler composite to coronal and pulp chamber floor dentin using a self-etching adhesive system. Coronal dentin of 40 human molar teeth was exposed by cutting occlusal enamel with a low-speed saw. Teeth were then randomly divided into two groups (n = 20). The first group was left as is, while in the second group, pulp chamber floor dentin was exposed by trepanation. After placement of a self-etching adhesive system (G-aenial Bond, GC, Tokyo, Japan), groups were further divided into two sub-groups (n = 10) according to the type of composite: fiber-reinforced composite (EP, everX Posterior, GC, Tokyo, Japan) and particulate filler composite (GP, G-aenial Posterior, GC, Tokyo, Japan). Then, composite blocks were built up. Sticks (1.0 × 1.0 mm 2 ) were obtained from each specimen by sectioning, then microtensile bond strength (μTBS) test was performed. Statistical analysis included one-way ANOVA test and Student's t -test ( p < 0.05). μTBS values were 22.91 ± 14.66 and 24.44 ± 13.72 MPa on coronal dentin, 14.00 ± 5.83 and 12.10 ± 8.89 MPa on pulp chamber floor dentin for EP and GP, respectively. Coronal dentin yielded significantly higher μTBS than pulp chamber floor dentin ( p < 0.05), independently from the tested composites.

Objective: Most of the infections of the upper respiratory tract are caused by biofilm-forming microorganisms belonging to the Pseudomonas, Streptococcus, Staphylococcus, and Enterobacter genus. Many of these microorganisms also show antibiotic resistance, partly related to biofilm formation. The treatment of these affections may include inhalation of radioactive thermal water (RTW). The present study aimed to evaluate the in vitro antibiofilm effect of RTW collected from Merano springs, Italy., Materials and Methods: A series of experiments were performed evaluating the effect of RTW against planktonic cultures (1 h exposure) and on biofilms (10 min and 1 h exposure) formed by Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Escherichia coli. Viable biomass was assessed using a colorimetric assay. A model based on the infection by the same strains of a reconstituted human respiratory epithelium (RHRE) was used to morphologically evaluate the antibiofilm effect of RTW., Results: RTW decreased the viability of S. aureus and S. pneumoniae planktonic cultures by about 20%. RTW also decreased biofilm viability by all strains except for E. coli at both time points. In the RHRE model, bacterial adherence and colonization occurred in all specimens, showing a particular affinity for the epithelium's cilia. Bacterial infections caused significant alterations in the epithelium structure, showing enlargement of the intercellular spaces, and damage to the cell structure. Specimens infected with S. aureus showed slightly lower colonization levels after RTW treatment., Conclusions: Results of this in vitro study showed a significant effect of RTW against Gram-positive planktonic bacterial cells as well as a significant antibiofilm activity.

Objective : We designed an in vitro study to evaluate the efficiency of an 0.5 vol% hydrogen peroxide-based spray in reducing Coronavirus 229E spread during a conventional dental procedure. Methods : A class III cabinet-like chamber was custom-built, using phantoms for both patient and operator. A suspension of HCoV-229E in artificial saliva having a similar viral load to SARS-CoV-2 asymptomatic patients was inoculated inside the patient's phantom mouth. A 10 s-lasting dental procedure was performed using an aerosol-generating air-turbine, with or without high-volume evacuation (HVE). The effect of 0.5 vol% H 2 O 2 cooling spray in reducing viral loads was tested. Viral presence on the operator phantom was assessed by Real-Time quantitative PCR on the mask's outer surface, on the phantom's forehead, and inside its mouth. Results : When the H 2 O 2 cooling spray was used, as compared to the conventional spray, viral loads were significantly lower on all tested sites, falling below the detection limit. Viral loads did not significantly change in any tested site when HVE was used. Conclusion : The use of 0.5 vol% H 2 O 2 cooling spray by dental handpieces drastically reduced the possibility of coronaviruses spread during aerosol-generating dental procedures. This strategy deserves further consideration among the preventive measures to be adopted during the SARS-CoV-2 pandemic., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Objectives: This study aimed to morphologically investigate the distribution of the adhesive layer when placed prior, or subsequent, to matrix positioning in direct-bonded Class II RBC restorations. Additional aim was to evaluate possible differences when using two-steps (CSE, Clearfil SE Bond2) or one-step adhesive system (CU, Clearfil Universal Bond Quick)., Methods: Standardized mesio-occlusal and disto-occlusal cavities were prepared on 20 human molars. Teeth were randomly allocated to two protocols according to the positioning of contoured sectional metal matrices before (M->A, n = 10), or after adhesive application (A->M, n = 10). Both adhesive systems were additioned with crystal violet dye (CV, 10 vol%). Specimen sections were evaluated using optical and scanning electron microscopy (SEM). Dynamic viscosity, pH, microshear bond strength test (μ-SBS) on enamel and dentin, and three-point bend test (3PB) of polymerized adhesive rods, were performed on both pristine and CV-additioned adhesives., Results: M->A produced a layer of adhesive both on tooth-restoration interface and on external restoration surfaces in contact with the matrix. A->M produced a thin layer of adhesive on external tooth surfaces, well beyond cavity and RBC restoration margins. In all restorations, excess RBC material with uneven margins was observed protruding over the cervical margin. CV addition slightly increased pH and decreased viscosity. μ-SBS: CU + CV showed a 10-fold reduction in adhesion forces on dentine. 3PB: CSE yielded higher flexural strength values than CU. CV addition reduced flexural strength of CSE., Conclusions: Both M > A and A > M generated adhesive placement disadvantages with adhesive materials being expressed in difficult to reach locations that may jeopardize complete adhesive polymerization., Clinical Significance: All cervical margins of RBC restorations should be carefully finished to improve longevity, no matter the clinical protocol adopted. CV addition labelled the tested adhesives without compromising their performances considerably., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: To investigate whether the addition of sodium-DNA (Na-DNA) to chlorhexidine (CHX)-containing mouthwash influenced morphology and viability of a reconstituted human oral epithelium (ROE), and protects ROE against oxidative stress., Methods: Multi-layered 0.5 cm² ROE specimens were positioned inside a continuous flow bioreactor and grown air-lifted for 24 hours. They were treated with phosphate-buffered saline (PBS) (n= 16) or 1 vol% H₂O₂ for 1 minute (n= 16). Then, they were treated for 5 (n= 8) or 30 minutes (n= 8) with the experimental mouthwash solutions containing: 0.2 wt% CHX, 0.2 wt% CHX + 0.2 wt% Na-DNA, 0.2 wt% Na-DNA, PBS. After 60 minutes washout specimens were subjected to tetrazolium-based viability assay (MTT) confocal laser-scanning microscopy (CLSM), and histological evaluation using optical microscopy and transmission electron microscopy (TEM)., Results: ROE treated with Na-DNA for 30 minutes revealed significantly higher viability than PBS, and CHX + Na-DNA showed higher viability after 30-minute treatment than after 5 minutes, suggesting a significant protective activity of Na-DNA. Moreover, the protective effect of Na-DNA on cell viability was higher after the induction of oxidative stress. After treatment with CHX, CLSM revealed cell stress, leading to cell death in the outer layer. On the contrary, specimens treated with Na-DNA showed a much lower number of dead cells compared to PBS, both in the absence or presence of oxidative stress. Histological examination showed that the protective action of Na-DNA formulations reached more in-depth into the epithelium exposed to oxidative stress, due to intercellular spaces opening in the outer epithelium layers, giving way to Na-DNA to the inner parts of the epithelium. It can be concluded that Na-DNA had a topical protective activity when applied for 30 minutes unless the epithelium barrier is damaged, allowing it to act more in-depth., Clinical Significance: Na-DNA showed a clear and protective action against cellular degeneration due to oxidative stress and, partly, to the exposure to CHX. Its addition to chlorhexidine mouthwash or gels could be clinically helpful in contrasting the detrimental activity of CHX on oral tissues, and in the preservation of cell viability, control of inflammation and wound healing., Competing Interests: The authors declared no conflict of interest., (Copyright©American Journal of Dentistry.)

Background: The use of dental handpieces produces aerosols containing microbial agents, bacteria, and viruses representing a high-risk situation for airborne cross infections. The aim of this study was to map and quantify the biological contamination of a dental operatory environment using a biological tracer., Methods: Streptococcus mutans suspension was infused into the mouth of a manikin, and an operator performed standardized dental procedures using an air turbine, a contra-angle handpiece, or an ultrasonic scaler. The presence of the tracer was measured at 90 sites on the dental unit and the surrounding surfaces of the operatory environment., Results: All tested instruments spread the tracer over the entire dental unit and the surrounding environment, including the walls and ceiling. The pattern and degree of contamination were related to the distance from the infection source. The maximum distance of tracer detection was 360 centimeters for air turbine, 300 cm for contra-angle handpiece, and 240 cm for ultrasonic scaler. No surface of the operative environment was free from the tracer after the use of the air turbine., Conclusions: Attention should be paid to minimize or avoid the use of rotary and ultrasonic instruments when concerns for the airborne spreading of pandemic disease agents are present., Practical Implications: This study supports the recommendations of dental associations to avoid treatments generating aerosols, especially during pandemic periods. Guidelines for the management of dental procedures involving aerosols, as well as methods for the modification of aerosols aimed to inactivate the infective agent, are urgently needed., (Copyright © 2020 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Demineralization of dental hard tissues is a well-known health issue and the primary mechanism responsible for caries and dentinal hypersensitivity. Remineralizing toothpastes are nowadays available to improve conventional oral care formulations regarding the prevention and repair of demineralization. In this paper, we analyzed the chemical-physical features of a commercial toothpaste (Biosmalto Caries Abrasion and Erosion, Curasept S.p.A., Saronno, Italy), with particular attention paid to the water-insoluble fraction which contains the remineralizing bioactive ingredients. Moreover, the efficacy of the toothpaste to induce enamel remineralization and to occlude dentinal tubules has been qualitatively and semiquantitatively tested in vitro on human dental tissues using scanning electron microscopy and X-ray microanalysis. Our results demonstrated that the water-insoluble fraction contained silica as well as chitosan and poorly crystalline biomimetic hydroxyapatite doped with carbonate, magnesium, strontium, and fluoride ions. The formulation showed excellent ability to restore demineralized enamel into its native structure by epitaxial deposition of a new crystalline phase in continuity with the native one. It was also able to occlude the dentinal tubules exposed completely by acid-etching. Overall, this study demonstrated that the tested toothpaste contained a biomimetic ionic-substituted hydroxyapatite-based active principle and that, within the in vitro conditions analyzed in this study, it was effective in dental hard tissue remineralization.

Background : Toothpastes containing nano-hydroxyapatite (n-HAp) substituted with metal ions provide calcium and phosphate ions to dental hard tissues, reducing demineralization, and promoting remineralization. Few data are available about the effect of these bioactive compounds on oral microbiota. Methods : This in vitro study evaluated the influence of two commercially-available substituted n-HAp-based toothpastes (α: Zn-carbonate substituted n-HAp; β: F, Mg, Sr-carbonate substituted n-HAp) on early colonization (EC, 12 h) and biofilm formation (BF, 24 h) by oral microbiota. Controls were brushed with distilled water. Artificial oral microcosm and Streptococcus mutans biofilms were developed using human enamel and a resin-based composite (RBC) as adherence surfaces. Two test setups, a shaking multiwell plate and a modified drip-flow reactor (MDFR), were used to simulate clinical conditions during the night (low salivary flow and clearance) and daytime, respectively. Energy-dispersive X-ray spectrometry (EDS) was used to evaluate specimens' surfaces after toothpaste treatment. Fluoride release from β toothpaste was evaluated. Viable adherent biomass was quantified by MTT assay, and biofilms' morphology was highlighted using confocal microscopy. Results : EDS showed the presence of remnants from the tested toothpastes on both adherence surfaces. β toothpaste showed significantly lower EC and BF compared to control using the artificial oral microcosm model, while α toothpaste showed lower EC and BF compared to control, but higher EC and BF compared to β toothpaste. The effect shown by β toothpaste was, to a minimal extent, due to fluoride release. Interestingly, this result was seen on both adherence surfaces, meaning that the tested toothpastes significantly influenced EC and BF even on RBC surfaces. Furthermore, the effect of toothpaste treatments was higher after 12 h than 24 h, suggesting that toothbrushing twice a day is more effective than brushing once. Conclusions : The efficacy of these treatments in reducing microbial colonization of RBC surfaces may represent a promising possibility in the prevention of secondary caries.

Peri-implantitis is a biofilm-related disease whose characteristics are peri-implant tissues inflammation and bone resorption. Some clinical trials report beneficial effects after implantoplasty, namely the surgical smoothening of the implant surface, but there is a lack of data about the development of the bacterial biofilm on those smoothened surfaces. The aim of this study is to evaluate how implantoplasty influences biofilm formation. Three implants with moderately rough surfaces (control) and three implants treated with implantoplasty (test) were set on a tray reproducing the supra- and sub-gingival environment. One volunteer wore this tray for five days. Every 24 h, plaque coverage was measured and, at the end of the period of observartion, the implant surfaces were analyzed using scanning electron microscopy and confocal laser scanning microscopy. The proportion of implant surface covered with plaque was 65% (SD = 7.07) of the control implants and 16% (SD = 0) of the test implants. Untreated surfaces showed mature, complex biofilm structures with wide morphological diversity, and treated surfaces did not show the formation of mature biofilm structures. This study supports the efficacy of implantoplasty in reducing plaque adhesion and influencing biofilm formation. These results can be considered a preliminary proof of concept, but they may encourage further studies about the effects of implantoplasty on biofilm formation.

Objectives: Modern dentistry is increasingly focusing on digital procedures, including CAD/CAM technologies. New materials have to resist in a demanding environment that includes secondary caries occurrence. The current study hypothesized that the microbiological behavior of different RBCs for CAD/CAM applications is better than that of their counterparts for direct restorations due to differences in the surface characteristics., Methods: Both direct and CAD/CAM RBCs were tested. Specimens were obtained from each group, polished, cleaned, stored in artificial saliva (1w), then sterilized under UV (24h). Specimens' surface was assessed using profilometry, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and X-ray diffraction; resin/filler content was assessed using thermogravimetry. After pre-incubation with sterile human saliva (24h), the microbiological behavior of the materials was assessed using four models: Streptococcus mutans adherence (2h), S. mutans biofilm formation in an orbital shaking bioreactor (24h), S. mutans biofilm formation in a continuous-flow bioreactor simulating shear forces (24h), and mixed-plaque formation in the bioreactor (24h). The viable biomass adhering to the specimens' surfaces was measured using a tetrazolium dye-based test. Statistical analysis included verification of normality of distribution and homoscedasticity, then Oneway ANOVA and Tukey's test (α=5%)., Results: When using the bioreactor setup, CAD/CAM RBCs generally yielded lower S. mutans and mixed-plaque biofilm formation compared to direct RBCs. This difference was not evidenced in the first two microbiological models. Differences in manufacturing and curing processes rather than in materials' surface roughness and composition could explain these results., Significance: CAD/CAM RBCs are promising materials from a microbiological point of view, featuring reduced biofilm formation on their surfaces when shear conditions similar to in vivo ones are present., (Copyright © 2020 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.)

The purposes of the study were to evaluate the bond strength of bioceramic TotalFill root repair material (RRM) in retrograde cavities prepared using Er:YAG and Er,Cr:YSGG laser and steel bur, and to analyze failure modes. The root canals of 30 single-rooted teeth were endodontically treated, their root-ends were resected using a diamond bur, and the teeth were randomly divided into three groups (N = 10) according to the retrograde cavity preparation technique: (1) Er:YAG laser, (2) Er,Cr:YSGG laser, and (3) steel bur. All retrograde cavities were filled with the TotalFill RRM which was prepared according to the manufacturers' instructions. Push-out test was performed using universal testing machine, and failure mode was analyzed using a scanning electron microscope. The data were analyzed using one-way ANOVA, post hoc analysis with Bonferroni correction, and Fisher-Freeman-Halton exact test (p < 0.05). In the Er:YAG-, Er,Cr:YSGG-, and steel bur-prepared cavities, mean bond strengths (MPa) were 12.76, 8.44, and 6.01, respectively. The bond strength of the TotalFill RRM to dentin was significantly higher in the Er:YAG laser compared with the steel bur-prepared cavities (p = 0.004). The bond strength was not significantly different between the Er:YAG and Er,Cr:YSGG cavities (p = 0.074) and between the Er,Cr:YSGG and bur cavities (p = 0.648). In the cavities prepared by the Er,Cr:YSGG laser and bur, the failure mode of the TotalFill RRM was predominantly mixed, then adhesive and cohesive. In the Er:YAG laser-prepared cavities, the most common failure mode was adhesive, followed by mixed type and no cohesive failure. The bond strength of the TotalFill RRM to dentin was highest in the group of retrograde cavities prepared by the Er:YAG laser.

Background and Objectives: Warts are the most common lesions caused by human papillomavirus (HPV). Recent research suggests that oxidative stress and inflammation are involved in the pathogenesis of HPV-related lesions. It has been shown that the soluble receptor for advanced glycation end products (sRAGE) may act as a protective factor against the deleterious effects of inflammation and oxidative stress, two interconnected processes. However, in HPV infection, the role of sRAGE, constitutively expressed in the skin, has not been investigated in previous studies., Materials and Methods: In order to analyze the role of sRAGE in warts, we investigated the link between sRAGE and the inflammatory response on one hand, and the relationship between sRAGE and the total oxidant/antioxidant status (TOS/TAS) on the other hand, in both patients with palmoplantar warts ( n = 24) and healthy subjects as controls ( n = 28)., Results: Compared to the control group, our results showed that patients with warts had lower levels of sRAGE (1036.50 ± 207.60 pg/mL vs. 1215.32 ± 266.12 pg/mL, p < 0.05), higher serum levels of TOS (3.17 ± 0.27 vs. 2.93 ± 0.22 µmol H2O2 Eq/L, p < 0.01), lower serum levels of TAS (1.85 ± 0.12 vs. 2.03 ± 0.14 µmol Trolox Eq/L, p < 0.01) and minor variations of the inflammation parameters (high sensitivity-CRP, interleukin-6, fibrinogen, and erythrocyte sedimentation rate). Moreover, in patients with warts, sRAGE positively correlated with TAS (r = 0.43, p < 0.05), negatively correlated with TOS (r = -0.90, p < 0.01), and there was no significant correlation with inflammation parameters. There were no significant differences regarding the studied parameters between groups when we stratified the patients according to the number of the lesions and disease duration., Conclusions: Our results suggest that sRAGE acts as a negative regulator of oxidative stress and could represent a mediator involved in the development of warts. However, we consider that the level of sRAGE cannot be used as a biomarker for the severity of warts. To the best of our knowledge, this is the first study to demonstrate that sRAGE could be involved in HPV pathogenesis and represent a marker of oxidative stress in patients with warts.

Male germ cell development is a critical period during which epigenetic patterns are established and maintained. The progression from diploid spermatogonia to haploid spermatozoa involves the incorporation of testis-specific histone variants, mitotic and meiotic divisions, haploid gene expression, histone-protamine transitions and massive epigenetic reprogramming. Understanding the protein players and the epigenetic mark network involved in the setting of the epigenetic programme in spermatogenesis is an exciting new clue in the field of reproductive biology with translational outcomes. As information in the existing literature regarding cross-talk between DNA methylation and histone hyperacetylation in the advanced stages of murine spermatogenesis is still scarce and controversial we have investigated the effect of a DNA-methyltransferase inhibitor, 5-aza-2'-deoxycytidine, at the cytological and molecular level (by transmission electron microscopy, immunocytochemistry and immunoprecipitation methods). Our results revealed an important role for regulation of DNA methylation in controlling histone hyperacetylation and chromatin remodelling during spermatogenesis.

Purpose: To investigate the micro push-out bond strength of individually formed (everStick Post) and prefabricated (GC Fiber Post) fiber-reinforced composite (FRC) posts cemented with three different types of self-adhesive composite cements., Materials and Methods: Forty-two single-rooted human teeth were decoronated, endodontically treated, and had post spaces prepared for everStick Post (n = 21) or GC Fiber Post (n = 21). The teeth were randomly divided into three subgroups (n = 7), and posts were cemented either with G-CEM LinkAce (GC), SpeedCEM (Ivoclar Vivadent) or RelyX U200 (3M Oral Care). Specimens were then perpendicularly sectioned and divided at the cementoenamel junction into two root levels: coronal or apical. A micro push-out test was performed using an 0.8-mm-wide stainless steel plunger. Bond strength was calculated in MPa by dividing the fracture load (N) by the bonded surface area (mm2). Log-transformed data was statistically analyzed using factorial ANOVA and Tukey's post-hoc test (α < 0.05). Fracture modes were determined employing a stereomicroscope, and differences were evaluated using a likelihood ratio test and Pearson's chi-squared test. Specimens were also observed using SEM., Results: Bond strengths were significantly affected by both post type and root level (p < 0.05), but not by self-adhesive cement (p > 0.05). Fracture types showed a significantly higher prevalence of adhesive fractures at the apical level, with all fractures starting at the cement-dentin interface., Conclusion: Individually formed FRC posts demonstrated greater bond strength than their prefabricated FRC counterparts. The apical level of the luted posts yielded lower bond strengths than the coronal level. Failures were predominantly adhesive at the cement-dentin interface.

Demineralization of dental hard tissue is a widespread problem and the main responsible for dental caries and dentin hypersensitivity. The most promising strategies to induce the precipitation of new mineral phase are the application of materials releasing gradually Ca 2+ and PO 4 3- ions or mimicking the mineral phase of the host tissue. However, the design of formulations covering both processes is so far a challenge in preventive dentistry. In this work, we have synthesized innovative biomimetic amorphous calcium phosphate (ACP), which has been, for the first time, doped with fluoride ions (FACP) to obtain materials with enhanced anti-caries and remineralizing properties. Significantly, the doping with fluoride (F) did not vary the physico-chemical features of ACP but resulted in a faster conversion to the crystalline apatite phase in water, as observed by in-situ time-dependent Raman experiments. The efficacy of the as synthesized ACP and FACP samples to occlude dentinal tubules and induce enamel remineralization has been tested in vitro in human molar teeth. The samples showed good ability to partially occlude the tubules of acid-etched dentin and to restore demineralized enamel into its native structure. Results demonstrate that ACP and FACP are promising biomimetic materials in preventive dentistry to hinder demineralization of dental hard tissues.

Objective: To compare the shear bond strength (SBS) values of orthodontic brackets luted using a resin-modified glass ionomer cement (RMGIC) on enamel surfaces etched using either an Er:YAG laser in two different working modes, or a conventional etching protocol, including phosphoric acid., Materials and Methods: Sixty healthy human premolars were randomly allocated to three experimental groups (n = 20) and etched with: Group 1: Er:YAG laser in super-short pulse (SSP) mode (100 mJ, 20 Hz, 2 W); Group 2: Er:YAG laser in quantum square pulse mode (120 mJ, 10 Hz, 1.2 W) using a digitally controlled handpiece ("X-Runner"); Group 3 (control): 5.25% sodium hypochlorite pretreatment, then 37% phosphoric acid for 15 sec. Stainless steel brackets were bonded using light-curing RMGIC for orthodontic bonding. After term cycling (1800 cycles), SBS testing was performed using a universal testing machine. After debonding, both enamel and bracket surfaces were examined to determine the amount of RMGIC still present on the surfaces., Results: Group 3 surfaces gave the lowest mean SBS (10.6104 ± 2.66196 MPa), whereas Group 1 provided the highest 1 (13.1795 ± 3.37904 MPa), which was significantly different from the control (Group 3, p = 0.0226). Group 2 provided intermediate values (11.8486 ± 0.59832 MPa) nonsignificantly different from the control or from SSP (p = 0.4215 and p = 0.3082, respectively)., Conclusions: Er:YAG laser treatment in SSP mode of enamel surfaces for orthodontic bonding provided higher SBS and a shear behavior of the luting material similar to the conventional acid-etching procedures, making it a viable alternative to acid etching.

Objectives: The interfacial conditions occurring during light-curing procedures of resin-based composites (RBCs) influence their surface properties and therefore the biological behavior of the material. This study aimed to evaluate the influence of different surface curing conditions on in vitro biofilm formation by Streptococcus mutans and mixed oral microflora, in the presence or absence of surface salivary pre-conditioning., Methods: Two nanohybrid RBCs and four interfacial curing conditions (open air, argon, nitrogen and glycerin) were evaluated. Surface roughness (SR), surface elemental composition (energy-dispersive X-ray spectrometry, EDS) and biofilm formation (S. mutans and oral microcosm) were assessed. Surfaces were observed using scanning electron microscopy (SEM). Microbiological tests were performed with and without saliva pre-conditioning of the surfaces. EDS analysis was performed before and after biofilm formation, and biofilm morphology was evaluated using confocal laser scanning microscopy (CLSM). Data were analyzed using multi-way ANOVA and Tukey post-hoc test (p < 0.05)., Results: Interfacial curing conditions significantly influenced SR depending on the tested RBC. EDS analysis showed that surface elemental composition was significantly influenced by the interfacial curing condition depending on the tested RBC. Interfacial curing conditions significantly influenced biofilm formation in both microbiological models in the absence of saliva pre-conditioning, depending on the tested RBC, whereas saliva pre-conditioning abrogated these effects., Conclusions: Surface curing conditions significantly impacted biofilm formation in a material-dependent manner, which was abrogated when surfaces were pre-conditioned with saliva., Clinical Significance: Curing under glycerin did not improve the microbiological performances of the tested RBCs. These results, needing to be confirmed by in vivo data, have the potential to simplify operative procedures in restorative dentistry., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: Micro- or nano-topography can both provide antimicrobial properties and improve osseointegration of dental implant titanium surfaces. Laser treatment is one of the best surface microtexturing techniques. The aim of this study was to evaluate in vitro and in situ biofilm formation on a laser-treated titanium surface, comparing it with two conventional surfaces, machined and grit-blasted., Methods: For the in vitro experiment, an oral microcosm biofilm model was developed on the surface of titanium disks and reference human enamel using a bioreactor for 48 h. For the in situ experiment, titanium implants with laser-treated, machined and grit-blasted surfaces were mounted on intraoral trays and worn by ten volunteers for 48 h. Biofilm formation was quantitatively evaluated, and surfaces were analyzed using confocal laser scanning microscopy, scanning electron microscopy and energy-dispersive X-ray spectroscopy., Results–in Vitro Study: Biofilm structures with a prevalence of viable cells covered most of the machined, grit-blasted and human enamel surfaces, whereas less dense biofilm structures with non-confluent microcolonies were observed on the laser-treated titanium. Laser-treated titanium showed the lowest biofilm formation, where microorganisms colonized the edges of the laser-created pits, with very few or no biofilm formation observed inside the pits., Results–in Situ Study: The biofilm formation pattern observed was similar to that in the in vitro experiment. Confocal laser scanning microscopy showed complete coverage of the implant threads, with mostly viable cells in grit-blasted and machined specimens. Unexpectedly, laser-treated specimens showed few dead microbial cells colonizing the bottom of the threads, while an intense colonization was found on the threading sides., Conclusion: This data suggests that laser-created microtopography can reduce biofilm formation, with a maximum effect when the surface is blasted orthogonally by the laser beam. In this sense the orientation of the laser beam seems to be relevant for the biological interaction with biofilms., Competing Interests: The authors have declared that no competing interests exist.

The objective of the study was to synthesis silica nanoparticles modified with (i) a tertiary amine bearing two t-cinnamaldehyde substituents or (ii) dimethyl-octyl ammonium, alongside the well-studied quaternary ammonium polyethyleneimine nanoparticles. These were to be evaluated for their chemical and mechanical properties, as well for antibacterial and antibiofilm activity. Samples were incorporated in commercial dental resin material and the degree of monomer conversion, mechanical strength, and water contact angle were tested to characterize the effect of the nanoparticles on resin material. Antibacterial activity was evaluated with the direct contact test and the biofilm inhibition test against Streptococcus mutans. Addition of cinnamaldehyde-modified particles preserved the degree of conversion and compressive strength of the base material and increased surface hydrophobicity. Quaternary ammonium functional groups led to a decrease in the degree of conversion and to low compressive strength, without altering the hydrophilic nature of the base material. In the direct contact test and the anti-biofilm test, the polyethyleneimine particles exhibited the strongest antibacterial effect. The cinnamaldehyde-modified particles displayed antibiofilm activity, silica particles with quaternary ammonium were ineffective. Immobilization of t-cinnamaldehyde onto a solid surface via amine linkers provided a better alternative to the well-known quaternary ammonium bactericides.

Objectives: To evaluate the influence of surface treatments of different resin-based composites (RBCs) on S. mutans biofilm formation., Methods: 4 RBCs (microhybrid, nanohybrid, nanofilled, bulk-filled) and 6 finishing-polishing (F/P) procedures (open-air light-curing, light-curing against Mylar strip, aluminum oxide discs, one-step rubber point, diamond bur, multi-blade carbide bur) were evaluated. Surface roughness (SR) (n=5/group), gloss (n=5/group), scanning electron microscopy morphological analysis (SEM), energy-dispersive X-ray spectrometry (EDS) (n=3/group), and S. mutans biofilm formation (n=16/group) were assessed. EDS analysis was repeated after the biofilm assay. A morphological evaluation of S. mutans biofilm was also performed using confocal laser-scanning microscopy (CLSM) (n=2/group). The data were analyzed using Wilcoxon (SR, gloss) and two-way ANOVA with Tukey as post-hoc tests (EDS, biofilm formation)., Results: F/P procedures as well as RBCs significantly influenced SR and gloss. While F/P procedures did not significantly influence S. mutans biofilm formation, a significant influence of RBCs on the same parameter was found. Different RBCs showed different surface elemental composition. Both F/P procedures and S. mutans biofilm formation significantly modified this parameter., Conclusions: The tested F/P procedures significantly influenced RBCs surface properties but did not significantly affect S. mutans biofilm formation. The significant influence of the different RBCs tested on S. mutans biofilm formation suggests that material characteristics and composition play a greater role than SR., Clinical Significance: F/P procedures of RBCs may unexpectedly play a minor role compared to that of the restoration material itself in bacterial colonization., (Copyright © 2017 Elsevier Ltd. All rights reserved.)