Grafting after sinus lift with anorganic bovine bone alone compared with 50:50 anorganic bovine bone and autologous bone: results of a pilot randomised trial at one year.

Our aim was to compare the outcome of implants inserted in maxillary sinuses augmented with anorganic bovine bone grafts compared with those augmented with mixed 50:50 bovine and autologous bone grafts. Twenty sinuses with 1-4mm of residual crestal height below the maxillary sinuses were randomised into two groups according to a parallel group design (n=10 in each). Sinuses were grafted using a lateral approach. In one group the grafts were 50:50 anorganic bovine bone and autologous bone and in the other anorganic bovine bone alone. After 7 months, 32 implants had been inserted. Outcome measures were survival of implants, complications, marginal changes in the height of the bone, and soft tissue variables (pocket probing depth and bleeding on probing). Probabilities of less than 0.05 were accepted as significant. No patient failed to complete the trial and no implant had failed at 1 year. There were some minor complications. After 12 months, the mean (SD) marginal bone loss (mm) was 1.06 (0.61) in the 50:50 group and 1.19 (0.53) in the anorganic bovine group. The mean (SD) values for pocket probing depth (mm) and bleeding on probing (score) were 2.49 (0.38) and 1.59 (0.82) in the 50:50 group and 2.31 (0.64) and 1.36 (0.87) in the anorganic bovine group (neither difference was significant). The present data are consistent with the hypothesis that the outcome of implants inserted in sinuses grafted with either material is comparable.

Accessory foramina in the furcation area of primary molars. A SEM investigation.

AIM: The accessory canals in the furcation of primary molars can explain the frequent presence of radiolucency in the furcation area in case of pulpitis and necrosis of teeth. In fact these canals can represent a communication between periodontium and pulp tissue allowing bacteria to enter. The aim of this study was to determine the prevalence of foramina in the furcation area of primary molars. MATERIALS AND METHODS: The presence of foramina was assessed using extracted deciduous molars examined with Scanning Electron Microscope (SEM) evaluation. Thirty extracted human primary molars (15 upper deciduous molars and 15 lower deciduous molars) were selected to evaluate the presence of extra foramina in their furcation. All teeth were prepared according to Koenigs' technique: the roots were cut in the furcation area perpendicular to the canals (1.5 mm apical to the external surface of the furcation and 1 mm apical to the cervical line) and then analysed with an electronic scanning microscope. RESULTS AND CONCLUSION: This study demonstrated that 23 teeth (77% of the samples) had one or more extra foramina near the furcation.

Sodium iodide associated to salicylic acid in the topical management of chronic oral candidiasis: a randomized trial.

Candidiasis is a relevant problem in oral medicine practice. We compared the antimycotic activity of nystatin with a solution of sodium iodide associated to salicylic acid (SISA) in the topical management of chronic candidiasis. Consecutive patients affected by chronic candidiasis were randomly allocated to SISA (group A) or nystatin (group B). VAS and swab scores were recorded at the beginning and at the end of the study while the healing index was evaluated at the end of the study only. Data were analyzed by STATA 10 MP. Forty patients (20 male, 20 female) were randomized. SIAS was as effective as nystatin in affecting VAS (p greater than 0.05) and swab score (p greater than 0.05). A statistically significant reduction (p less than 0.05) of healing index was observed in both groups. No side effects were reported. SISA topical application, shows a comparable efficacy to the nystatin in the management of chronic oral candidiasis. Its use could represent an adequate alternative to the nystatin above all in the cases of drug-resistance. Further large scale randomized trials are warranted to confirm these preliminary findings.

Oral features in Kabuki make-up Syndrome.

AIM: Kabuki make-up Syndrome is so named because of the characteristic facies of the affected patient. The face is similar to a Kabuki actor's mask. The main aim of this report was to describe the oral features in Kabuki Syndrome, focusing on the tooth anomalies. PATIENTS AND METHODS: Five subjects with Kabuki Syndrome, identified by the Child Neuropsychiatric Clinic of the University of Sassari, Italy, were enrolled. Their medical records were reviewed and oral and dental examinations were completed. The diagnosis was based upon the typical pattern of malformations and dysmorphic features reviewed by Matsumoto and Niikawa. RESULTS: All patients showed typical characteristics of the Syndrome such as a long palpebral fissure, lower palpebral eversion, arched eyebrows, short nasal septum, prominent and large ears, fingertip pads, mental retardation, and paramedian elevation of the lower lip. CONCLUSION: Kabuki make-up Syndrome is of unknown origin but a genetic aetiopathogenesis has been proposed. It is extremely rare; in Japan, where it is most frequent, it affects 1:32000 newborns. The typical facies of the syndrome, combined with general medical and dental examinations, are very important for diagnosis confirmation.

Ethics: problems of clinical conduct.

The study provides a framework for ethical medical conduct. A number of articles of International Law, the Italian Constitution, the Penal Code and the Medical Code of Conduct have therefore been taken into consideration. Art. 32 of the Italian Constitution, relating to the ''right to health'' is examined, paying particular attention to certain parts, and is related to Art. 35 of the European Union Charter of Fundamental Rights. In considering Art. 43 of the Penal Code, which addresses the psychological element of criminal acts, reference is made to the Medical Code of Conduct and to the Hippocratic Oath. The considerations made point up the importance of a relationship of trust and esteem between doctor and patient in clinical practice, and that this approach must be cultivated starting from the first year of university studies.

Oral condition, chemistry of saliva, and salivary levels of Streptococcus mutans in thalassemic patients.

The purpose of this investigation was to determine the oral status in a group of patients with thalassemia major (TM). Eighteen TM patients (15 M, three F) and 18 healthy controls randomly matched for age and sex were examined for dental caries using the decayed, missing, and filled teeth (DMFT) index and for oral hygiene conditions using the oral hygiene index (OHI)-S. Spontaneous saliva was collected from each subject, and the biochemical composition (calcium, phosphorous, potassium, sodium, urea) was determined. Furthermore, salivary Streptococcus mutans levels were evaluated. Statistical analysis (Student's t-test) were performed for means comparison, while independence among categorical variables was assessed using the chi(2) test. Fisher's exact test was used when expected cell values were less than 5. Dental status (DMFT index) was almost equal in the two groups (10.3 in TM vs 9.4 in controls, P=0.34). The occurrence of plaque (OHI-S 2) was higher in the control group, but no statistically significant association was observed between oral hygiene conditions in the two groups (Fisher's exact test 0.47, P=0.79). Biochemical saliva composition was very similar in the two groups; only the urea concentration was lower in TM, and this difference was statistically significant ( P=0.002). The TM patients had an increased presence of mutans streptococci at detectable levels. Our findings confirm that, although no substantial differences were found between the two observed groups, further investigations are needed to determine the theoretical risk of oral diseases in thalassemic patients.

[Prevention of periodontopathy and oral mucositis during antineoplastic chemotherapy. Clinical study]. / Prevenzione delle parodontopatie e delle stomatomucositi in corso di chemioterapia antineoplastica. Studio clinico.

BACKGROUND: Oral mucositis is a common side effect of chemotherapy, with a multifactorial etiology: the direct toxicity of cancer therapy on the normal cells, reduced immunitary defences, presence of bacteria in the oral cavity. The aim of this study is to assess the clinical effectiveness of a preventive protocol of oral mucositis and periodontopathy during antineoplastic chemotherapy. METHODS: The design of the study was a longitudinal evaluation of 30 patients undergoing antineoplastic chemotherapy at the out-patients Department of Oncology of the University of Sassari. The study lasted one year and was carried out at the Dentistry Department of the University of Sassari. The patients were motivated to home oral hygiene, underwent professional oral hygiene and clorexidine rinses were prescribed. Visible plaque index (VPI) and gingival bleeding index (GBI) were taken from each patient as periodontal indices, and the state of the mucosa was evaluated according to the WHO recommendations (1975). The control group was composed by 33 patients. RESULTS: The values of the bleeding and plaque indices were considerably diminished between the first and the last visit, in nearly all the patients; the incidence of oral mucositis in the treated group was 20%, while in the control group it was 66%. 5-fluoruracil was always involved. CONCLUSIONS: According to the results observed, the conclusion is drawn that the professional and home oral hygiene and the use of clorexidine, can reduce the incidence of oral mucositis as a side effect of antineoplastic chemotherapy.

[In vivo evaluation of carbon fiber posts]. / Valutazione dell'affidabilità clinica dei perni di terza generazione.

BACKGROUND: The use of carbon fiber posts allows morpho-functional restoration of endodontically treated teeth with an assembly of materials of a modulus of elasticity similar to that of dentin. The study clinically evaluated the percentage of survival of dental elements treated and reconstructed with endocanal carbon fiber posts. METHODS: At the Dentistry Clinic of the University of Sassari 60 dental elements were selected from 46 subjects. The teeth, which had been treated endodontically with success for at least six months, were classified by parameters taken from the international literature and reconstructed using Tech 2000 carbon fiber posts and adhesive resinous systems recommended by the post manufacturer. RESULTS: The success rate was 98.4%. Almost half (49%) of the samples were single-rooted elements, 37.4% of the posts were 1.2 mm in diameter; in 78.3% the opposing contact was with a natural tooth; 100% of the elements had a type A dental structure. CONCLUSIONS: Third generation posts are a valid alternative to metallic posts and improve the prognosis of the treated element. The carbon fiber posts fixed with the composite, forming a single unit with the dental element, thus improving mid-term RESULTS. The technique is easy to use under clinical conditions and can be performed in a single session. So far, the method has provided promising clinical results, as this study demonstrated.

[SEM study of morphologyc and incidence of accessory canals in the furcation region of permanent molars]. / Studio al SEM sulla morfologia ed incidenza dei canali laterali nella zona della forcazione molare.

BACKGROUND: The lateral canals in the molar furcation region could represent a connection, well separated from the apical region, between dental pulp and periodontal tissues and may be used by bacteria or toxins both in an endodontic-periodontal direction and vice versa. A SEM study was carried out on the furcation region of permanent molars to evaluate the morphology and incidence of lateral canals. METHODS: A total of 53 permanent molars were selected. The microinfiltration test was performed on each sample using methylene blue 1% before being sectioned and examined using a Zeiss Opmi 9-FC stereomicroscope and SEM ISI DS 130. RESULTS: Openings of lateral canals were found in the furcation region of 50.94% of the samples examined. The mean diameter of the orifices was 130 mm. The apertures were elliptical and flared. The holes occasionally appeared to be the end of probable single or double canals, but were not always patent. CONCLUSIONS: In the light of these findings, the authors advise disinfecting and filling the dental pulp cavity during root treatment and, in the event of severe periodontal disease, evaluating the vitality of dental elements before surgery, thus ensuring a correct therapeutic approach by not overlooking the possibility of combined lesions.

[Mercury determination in human amniotic fluid]. / Dosaggio del mercurio nel liquido amniotico umano.

BACKGROUND: One of the components of Ag amalgam is mercury which, owing to its organic derivatives, can pass into the organs and biological fluids. One particularly interesting but worrying aspect of this transition is the possibility that mercury may pass through the placental barrier and reach the fetus. The aim of this study was to evaluate the concentration of total mercury in human amniotic fluid and compare it with the number and occlusal extension of fillings using Ag amalgam. METHODS: A group of 56 pregnant women were selected due to undergo amniocentesis. A dental check-up was carried out in each patient to identify the number and extension of amalgam fillings. Mercury levels in the amniotic liquid were assayed using a spectrophotometer with atomic absorption and a FIAS-amalgam technique. RESULTS: Mercury concentrations in the samples examined ranged from a minimum of 0.00 ng/ml to a maximum of 2.55 ng/ml, mean 0.44 +/- 0.53 ng/ml. The correlations between the variables examined were evaluated by calculating the coefficient of linear regression. No direct relationship was found with mercury levels. The data obtained were used to construct a model of logistic regression showing scant statistical significance (p = 0.05) between the number of fillings and mercury levels, whereas the occlusal extension of dental repairs was significantly correlated with metal concentrations (p < 0.05). CONCLUSIONS: The authors recommend that silver amalgam should be used with considerable caution during pregnancy.

[In vitro evaluation of mercury leakage from dental amalgam using atomic absorption spectrophotometry]. / Valutazione in vitro del rilascio di mercurio dall'amalgama dentale mediante spettrofotometro ad assorbimento atomico.

OBJECTIVE: The use of silver amalgam as a tooth filler is under constant critical review because of its mercury content. After a review of the literature on this subject, in vitro spectrophotometry was used to assay the release of mercury by these amalgams in basal conditions. METHODS: The experiment was conducted in two phases using standard doses of amalgam. In Phase 1 Black Class I cavities were created in extracted teeth that were big enough to take the required dose of amalgam. In some cases the material was inserted in a single operation, while in others the amalgam was introduced in three stages. Some of the cavities were cleansed with cotton buds bathed in ethyl alcohol, while others were not. All the drilled teeth were imbued in a bath of artificial saliva held at a constant temperature. In the second experiment, crushed amalgam was immersed in a similar bath of artificial saliva but otherwise untreated. The saliva was assayed after different time lapses using atomic absorption spectrophotometry and the FIAS technique. RESULTS: The results showed extremely variable but always modest quantities of free mercury in the artificial saliva. CONCLUSIONS: The findings suggest that not all the mercury available in the amalgamation phase is involved in the formation of the crystalline reticulum and that the percentage of mercury bonded is different every time. While the titre of free mercury encountered was always extremely low and hard to predict, it cannot be ignored.

[An in-vivo bacteriological study on the effects of acid etching at the bottom of cavities]. / Studio batteriologico in vivo sugli effetti della mordenzatura acida nei fondi cavitari.

BACKGROUND AND AIMS: The authors evaluate the effect of etching on the presence of bacterial colonies at the bottom of sockets. METHODS: For this purpose, 19 molars with first class carious lesions were selected belonging to patients age between 20 and 26 years old, referred for treatment at the outpatient clinics of the Dentistry Clinic. The teeth were due to undergo repair with amalgam using, as a foundation, fourth generation dentinal enamel adhesives. The clinical trial, which was performed in strict conditions of asepsis, included the preparation of Black's first class sockets at the bottom of which the author's looked for the mark of the "cri dentinaire". Samples were collected of dentin presenting these characteristics before and after etching treatment. The latter consisted in the application of 37% orthophosphoric acid to dentin for 10 seconds; this served to remove the smear layer. The samples obtained in this way were sent to the Institute of Microbiology and Virology to undergo culture tests. RESULTS: The results obtained show that before etching 75% of the sample was positive for the presence of bacteria; this percentage fell to 53% of the sample after treatment. CONCLUSIONS: The authors conclude that prepared sockets, even if ready for restoration, are in the majority of cases still septic and that the total etch technique is not capable of fully removing any bacteria present. Given that the effects of acid mordanting on dental tissues are well known, the authors recommended paying particular attention to dentinal disinfection before using an adhesive system that involves the removal of the smear layer.

[Intermediate medications in endodontics: a quantitative in-vitro evaluation of 2 phenolic derivatives]. / Medicazioni intermedie in endodonzia: valutazione quantitativa in vitro di due derivati fenolici.

In a series of in vitro experiments with dental elements obtained after an extraction, the persistence in the pulpal chamber of two phenolic compounds largely used as dental medicaments has been evaluated. The substances, p-chlorophenol and eugenol were put in a small piece of cotton inside the dental elements where they were left for 7 days. Spectrophotometric UV determination of p-chlorophenol and eugenol were made after 3 and 7 days. Our results indicate that 25% of the initial amount of p-chlorophenol is found after three days and nearly 1/5 after 7 days. The figures for eugenol are: 1/3 after three days and 1/6 of the initial amount after 7 days. The authors therefore suggest the substances under study be used as dental medicaments with an optimum of three days of interval between two medications, even if a longer interval may be observed due to the good in situ persistence of the two phenols.

[Phenolic derivatives in intermediate medications in endodontics. 1. A review of the literature]. / I derivati fenolici nelle medicazioni intermedie in endodonzia. Nota 1: Revisione della letteratura.

The authors review the literature on phenolic derivatives, a widely used compound antiseptic for intermediate endodontic medication. There is interest in these substances owing to the frequency of their clinical application in order to maintain the antiseptic conditions obtained during the course of the chemico-mechanical preparation of the radicular canal.

[The evaluation of the size variations in alginate subjected to the sterilizing action of glutaraldehyde]. / Valutazione sulle variazioni dimensionali dell'alginato sottoposto all'azione sterilizzante della glutaraldeide.

The work takes into consideration the changes of dimension undergone by alginate submitted to the sterilizing action of aldehyde glutarate, after the impression. Trough the use of computerized analyser of images, samples of sterilized alginate have been compared with control samples. The results obtained can give a useful contribution to the prophylaxis of the crossed transmission of infection in the dental field.

[A clinical contribution to the conservative surgical therapy of giant follicular cysts of the mandible]. / Contributo clinico alla terapia conservativo-chirurgica delle cisti follicolari giganti del mascellare inferiore.

Three clinical cases of mandibular giant follicular cyst were described. Personal experience with an initial conservative approach is described and some interesting conclusions about the short time of bone new generation of maxillary are presented. As soon as possible, the extraction of impacted tooth will be made without the risk of mandibular fracture or vascular-nervous lesions.

[Behavior factors in pedodontic practice]. / Fattori del comportamento nella practica pedodontica.

In order to get success in pedodontic activity fundamental qualifications are knowledge of young patient and comprehension of his eventual problems. In fact personal character, age and then mature level and ambient influences due to education affect children's manners. The A.A., on the basis of personal experiences, value salient characteristics of pedodontic patient's manners and they point out different aspects of children under observation.

[Metabolism of ornithine in human gingival tissue]. / Metabolismo dell'ornitina in tessuto gengivale umano.

The behavior of two enzymes of the ornithine pathway, leading to the formation of proline and, eventually, of collagen, arginase and ornithine oxo-acid aminotransferase has been investigated in normal and inflamed gingival tissue. Both enzymatic activities show a statistically significant decrease in pathological samples as compared to normal ones. The data on arginase activity may be in agreement with the already documented low level of urea in pathological gingival fluid, while a decrease of the ornithine aminotransferase activity could be linked to the phenomenon of gingival retraction, i.e. the lack of complete regeneration of gingival tissue usually observed in chronically inflamed subjects, that would be reasonably parallel to a decreased proline/collagen synthesis.

[Dental caries and socioeconomic development of Sardinian population]. / Carie dentaria e sviluppo socio-economico della popolazione sarda.

A statistical survey has been carried out on the incidence of caries in the population of Sardinia. It is shown that the DMF index has grown steadily from 2.6 among the young (0-12 year old) to 13.07 in the group aged between 20.1 and 30. The socioeconomic changes of the past thirty years in Sardinia are looked at in an attempt to explain this phenomenon.