A new software architecture proposal for an evidence-based Decision Support System in dentistry.

BACKGROUND: in dentistry, clinical problems could be resolved using many therapeutic approaches that may results in very different therapies. In order to choose the best option, a good evaluation of therapy long-term survival and success rate is mandatory. The routine use of a decision support analysis software is nowadays limited due to the lack of software's flexibility especially when a variety of possible therapeutic option are present. The aim of this research was to develop a new algorithm model for a Decision Support System software to give diagnosis support in dentistry. METHODS: Beta tests were designed to study the computer software in different clinical situations based on clinical data. The therapeutic options can be conservative/endodontic or extractive/prosthetic therapies. In two of clinical situation selected could be possible to choose both therapies. RESULTS: in clinical situations tested, the DDS software correctly identified the several therapeutic options. When multiple treatments were possible the beta test showed an output mask that correctly showed a range of options with their corresponding survival and success rate. CONCLUSIONS: The software architecture proposed by the authors is technically feasible, can support the clinician choices based on scientific evidence and up-to-date references and gain informed consent based on data easily understandable for the patient.

The IG- file use to Gauge the Apical Diameter in Endodontics: An In Vitro Study.

AIM: The aim of this study was to evaluate the efficacy of the IG-file, a new instrument designed for apical diameter gauging. MATERIALS AND METHODS: After shaping with F1 Universal Protaper, 60 roots were randomly divided into two groups and assigned to two operators, One Expert in Endodontics (EO) and One Unexpert (UO).In each sample, after canal curvatures have been detected, the apical diameters were measured with the IG-file and the K-NiTi. The results were compared with the reference value obtained by retrograde apical gauging. The data were statistically analyzed. RESULTS: Among 60 samples, 10% of errors were recorded when the IG-files were used; in the K-NiTi group the incorrect measurements were 70%.In both groups (expert and unexpert) the IG-file measurements were more accurate than the K-NiTi (90 vs 33 and 90 vs 26,7). The differences were statistically significant.In curved canals, the difference between measurement rates performed with both instruments was statistically significant (85,7% IG-file vs 28,6% K-NiTi) as well as for the samples without curvatures (92,3% IG file vs 30,8% NiTi file).In root canals without curvatures overestimation errors in K-NiTi file group are more frequent than underestimation errors. This difference was statistically significant. CONCLUSION: A proper gauging of the apical diameter has a key role in endodontic therapy; an incorrect measurement can lead to clinical failures. This "in vitro" study highlights that IG-file improves measurement accuracy independently from clinician experience. Furthermore, in curved canals, the IG-file is more accurate than K-NiTi.

The Horizontal Root Fractures. Diagnosis, Clinical Management and Three-Year Follow-Up.

OBJECTIVE: The aim of this retrospective analysis is to describe and to evaluate the middle third horizontal root fractures, long term clinical management results and to estimate the effect of treatments factors upon healing and survival rate. METHODS: Our clinical study included 42 patients presenting a middle third horizontal root fracture in permanent dentition. For each patient at t0 the parameters recorded were: diastasis, mobility, sensibility, periodontal inflammation, pulpal pathology, associated fracture and dislocation of the coronal fragment. The follow-up was performed after 6 (t1), 12 (t2) and 36 (t3) months after the trauma, both clinically and radiologically. Clinical examination, vitality tests and a radiological evaluation (periapical x-ray) were performed. RESULTS: At t0 it was observed: diastasis (14, 3%), mobility (28, 6%), thermal sensibility (61, 9%), periodontal inflammation (4, 8%), pulpal pathology (38, 1%) and dislocation of the coronal fragment (47, 6%) of the patients. The treatment plan started with the coronal fragment repositioning and the blockage (splint) with the adjacent teeth in 47, 6% of cases.A root canal treatment was performed at t0 in 52,4% of the fractured teeth. Statistical analysis showed the highest level of significance between pulpal lesions (t0) and associated fractures. The mobility, sensibility and pulpar lesions parameters, showed a reduction in relation to the follow up timing, with a main variation remarkably evident between t0 and t1. The ratio between observation time and the presence of diastasis was statistically significant. CONCLUSION: The analysis of the clinical results exhibits the high success rate of a conservative approach in the treatment of teeth fractured in the middle third of the root.

The Effect of Different Cleaning Protocols on Post Space: A SEM Study.

Aim. Purpose of the present paper is to analyze the efficiency of different post-space irrigation protocols. Methods. 28 single rooted teeth were endodontically treated. After post-space preparation every sample was assigned to one of three experimental groups and to one control group. In each group different irrigation protocols were performed as follows: EDTA (Group A), 37% orthophosphoric acid (Group B), and EDTA + 37% orthophosphoric acid with ultrasounds activation (Group C). In the control group (Group D) the irrigate association was not activated by ultrasounds. Three zones (coronal, middle, and apical) of each sample were analyzed by using Scan Electron Microscopy (SEM) without any metallization procedures. The presence of smear layer on the canal surface was qualitatively evaluated by applying Serafino's score with values included between 0 and 2. Results. The results of the research showed how Group C recorded the better results (0.81 ± 0.72). Group A and Group B showed lower mean scores (1.06 ± 0.69 and 1.08 ± 0.77); Group D showed the lowest mean score of 1.30 ± 0.69. The SEM observation analysis demonstrated how the smear layer presence decreased in the crown-apical direction. Conclusions. The different post-space treatments statistically determine significant differences on the dentinal surfaces cleansing. The absence of ultrasonic activation lowers the cleansing efficacy of endocanalar irrigants, showing sensible differences among each post-space zone.

Invasive Cervical Resorption: A Case Series with 3-Year Follow-Up.

Invasive cervical resorption (ICR) lesion is an aggressive form of tooth destruction that usually begins immediately below the epithelial attachment. It has been described as a purely inflammatory reaction that can be started by microorganism infection, or an aseptic resorptive process that can be secondarily infected. The potential etiologic and predisposing factors for ICR are orthodontic treatment, traumatic injuries, bleaching, periodontal therapy, and idiopathic factors. This case series with a 3-year follow-up shows that Class 2 ICR lesions have a good prognosis in 100% of cases. Class 3 ICR lesions should be considered at risk. However, in the authors' experience, the treatment of Class 3 ICR lesions is compatible with tooth maintenance.

Tooth fragment reattachment technique on a pluri traumatized tooth.

This case report describes and analyses a tooth fragment reattachment technique used to resolve crown fractures of the anterior teeth. This treatment allows a conservative approach to traumatic coronal lesions offering a better possibility of maintaining aesthetics and function. The authors have illustrated here a clinical case of a fractured incisor. This case is characterized by several traumas on the same tooth that required different therapeutic solutions. We used an easy and ultra-conservative technique without any tooth preparation in the first and third traumatic injuries. In the second trauma, a direct restoration of the fractured tooth was performed. The adhesive reattachment is a simple system to achieve good aesthetic and functional results.Our clinical experiences demonstrated that, when tooth and fragment margins are intact, the reattachment technique without any tooth preparation is a simple and predictable procedure. Quality of adhesion is shown by the retention of the reattached fragment in the second trauma that caused only partial enamel fractures.