Conservative Therapy of External Invasive Cervical Resorption with Adhesive Systems: A 6-Year Follow-Up Case Report and Literature Review.

The diagnosis and treatment of external invasive cervical resorption (EICR) could be a challenging clinical situation even for the most experienced dentists. It is a fairly rare lesion and a poorly understood phenomenon, and its insidious and aggressive nature can lead to tooth loss. Even in the era of dental implants, trying to save a compromised tooth is imperative for any clinician. This report presents a case of an upper central incisor with a class II Heithersay EICR in which treatment was performed using a multidisciplinary approach and the defect was restored with resin composite. The surgery in which the defect was exposed and repaired was followed by an endodontic treatment and the placement of a fiber-reinforced post. In this case, the use of modern materials, such as resin composites, allowed not only the avoidance of tooth extraction but also the achievement of satisfactory aesthetic results. The 6-year follow-up demonstrated the success of therapy and the resolution of clinical symptoms. This case report highlights the importance of early detection of EICR and how composite resins could provide an effective and aesthetic restauration of the defect, which favors the health of the surrounding gingival tissue.

What Do Mothers (or Caregivers) Know about Their Children's Oral Hygiene? An Update of the Current Evidence.

Tooth decay remains one of the most common diseases in children, although it is a preventable injury and despite significant advances that has been made in terms of attention and care for oral hygiene. Several studies have shown the association between prevalence of tooth decay in children and parents' incorrect oral care habits, with a low educational level and a low socioeconomic background. The question that arises concerns the actual oral hygiene knowledge of mothers, fathers, family members or caregivers of young patients; therefore, the aim of this review is to investigate the genesis of gaps in the topic. A literature search was conducted through the Scopus and PubMed search engine and ended in May 2022; only studies from the past 20 years were included. Current evidence suggests that parents and caregivers still have little knowledge about their children's oral health: there is not enough awareness about the importance of preventing oral diseases, due to poor attention to good oral hygiene but also lack of information from health professionals and institutions. In the future, all the professionals involved in the pregnant woman's care should increase parents' knowledge, solve their doubts, collect and compare data in order to design effective intervention programs.

PHoral: Effects of carnosine supplementation on quantity/quality of oral salivae in healthy volunteer and in subjects affected by common oral pathologies.

BACKGROUND: Diseases of the oral cavity (OC) with an infectious trigger such as caries and periodontal disease are extremely common in the general population and can also have effects at the cardiovascular level. The oral salivary flow, with its buffering capacity, is able to regulate the pH of the OC and, therefore, significantly contribute to the ecological balance of the microenvironment in which the oral microbiome (OM) develops. On the other side, when the quality/quantity of salivary flow is altered it is supposed the disruption of this balance with the potential increase in oral pathogens and triggered diseases. Among the endogenous substances able to exert a significant effect on the salivary flow and its characteristics, carnosine (Car), a dipeptide originally isolated in skeletal muscle, represents, thanks to the known buffering properties, a promising principle. METHODS: We aimed this protocol to evaluate the quantitative/qualitative characteristics of the salivary flow in healthy volunteer subjects (n = 20) and in subjects suffering from common OC pathologies (n = 40), before and after 7 days of supplementation with SaliflussTM (Metis Healthcare srl, Milan, Italy), a Class I medical device on the market as 400 mg mucoadhesive oral tablets that has Car as the main ingredient. DISCUSSION: Combining the characteristics of saliva with the OM and comparing them with OC pathologies, we expect to clarify their reciprocal relationship and, using quantitative proteomics techniques, to help clarify the mechanism of action of Car.

SARS-CoV-2 Infection among the Dental Staff from Lombardy Region, Italy.

Dentists have been supposed to be among the healthcare workers at greatest risk of SARS-CoV-2 infection. However, scant data are available on the issue. The aim of this study is to quantify the SARS-CoV-2 antibody prevalence and determinants in a sample of dentists, dental hygienists, and other personnel employed among the dental staff in Lombardy region. We used an accurate rapid diagnostic test kit detecting immunoglobulins (Ig) in 504 adults. Of the 499 participants who obtained a valid antibody test, 54 (10.8%) had a SARS-CoV-2 positive test (0.4% IgM+, 1.8% both IgM+ and IgG+, and 8.6% IgG+). A statistically significant association with infection was found for geographic area (compared to Milan, adjusted odds ratio was 2.79, 95% confidence interval, CI: 1.01-7.68 for eastern and 2.82, 95% CI: 1.34-5.94, for southern Lombardy). The clinical staff did not result positive to SARS-CoV-2 more frequently than the administrative staff. This is the first study using antibody test in the dental staff personnel. It shows that the prevalence of SARS-CoV-2 infection in Lombardy region was around 10%, in line with estimates on other healthcare professionals. Despite the close physical contact with the patient, dentists have been able to scrupulously manage and effectively use protective devices.

A Possible Relationship between Peri-Implantitis, Titanium Hypersensitivity, and External Tooth Resorption: Metal-Free Alternative to Titanium Implants.

Titanium dental implant surface does not remain unaltered but may corrode and release ions or particles which trigger soft and hard tissue damage. Titanium may induce clinically relevant hypersensitivity in patients chronically exposed. A 56-year-old female patient presented peri-implantitis around a single titanium implant positioned three years earlier. Despite nonsurgical therapy, a rapid bone loss associated with pain and swelling occurred, and adjacent teeth presented external resorption. Compromised teeth were removed, and three titanium implants were inserted. Six months later, the patient complained about high mucosa sensitivity and implant exposure. At clinical and radiographic examinations, tissue inflammation and vertical bone loss involved the new implants and the process of external resorption affected the teeth. The blood test confirmed titanium hypersensitivity. Titanium implants were removed, and 5 zirconia implants were placed. No sign of bone loss or tooth resorption was recorded at clinical and radiographic control during 18 months of follow-up.

A Clinical and Radiographic Evaluation of Zirconia Dental Implants: 10-Year Follow-Up.

PURPOSE: The aim is to evaluate the survival and success rates, as well as the marginal bone loss (MBL) and periodontal indexes, of zirconia implants with 10-year follow-up. MATERIALS AND METHODS: 10 patients were selected and 26 one-piece zirconia implants were used for the rehabilitation of single tooth or partially edentulous ridge. After 10 years, a clinical-radiographic evaluation was performed in order to estimate peri-implant tissue health and marginal bone loss. RESULTS: The survival and success rates were 100%. The average marginal bone loss from baseline to 120 months after surgery was 0.92 ± 0.97 mm. CONCLUSION: One-piece zirconia dental implants are characterised by high biocompatibility, low plaque adhesion, and absence of microgap that can be related to the clinical success of these implants.

Trefoil System for the Treatment of Mandibular Edentulism: A Case Report with 30 Months Follow-Up.

The purpose of this work is to describe a clinical case of full-arch mandible rehabilitation with a fixed prosthesis on three implants. The chosen protocol is the Trefoil system by Nobel (Nobel Biocare, Zurich, Switzerland) that allows to realize a mandibular fixed rehabilitation on three particularly designed fixtures through the use of prefabricated surgical guides and a preassembled bar on which the prosthesis is built. Both surgical and prosthetic procedures were completed without complications, and after 30 months, the rehabilitations are in good health conditions. The patient is able to maintain a good level of hygiene and is satisfied with the work from an aesthetic and functional point of view.

COVID-19 and Dentistry: Prevention in Dental Practice, a Literature Review.

SARS-CoV-2 is a member of the family of coronaviruses. The first cases were recorded in Wuhan, China, between December 2019 and January 2020. Italy is one of the most affected countries in Europe. COVID-19 is a new challenge in modern dentistry. New guidelines are required in dental clinics to avoid contagion caused by cross-infections. A narrative review was performed using both primary sources, such as scientific articles and secondary ones, such as bibliographic indexes, web pages, and databases. The main search engines were PubMed, SciELO, and Google Scholar. Twelve articles were selected to develop the bibliographic review by applying pre-established inclusion and exclusion criteria. Precautionary measures should be applied to control COVID-19 in clinical practice. Several authors have highlighted the importance of telephone triage and/or clinic questionnaires, body temperature measurement, usage of personal protective equipment, surface disinfection with ethanol between 62% and 71%, high-speed instruments equipped with an anti-retraction system, four-handed work, and large-volume cannulas for aspiration. Clinically, the use of a rubber dam is essential. FFP2 (or N95) and FFP3 respirators, if compared to surgical masks, provide greater protection for health workers against viral respiratory infections. Further accurate studies are needed to confirm this.

Natural Tooth Pontic Using Recent Adhesive Technologies: An Esthetic and Minimally Invasive Prosthetic Solution.

An implant-supported crown represents an established and validated option for single-tooth replacement; however, a restorative solution should be selected according to a wide number of factors including patient's desire, expectations, specific clinical conditions, and financial possibilities. The aim of this case report is to describe a conservative rehabilitation strategy for the replacement of a periodontally compromised mandibular incisor: the extracted natural tooth was used as a pontic bonded to adjacent elements with polyethylene fiber and resin composite. This way, a chairside fabrication of a resin-bonded fiber-reinforced prosthesis is possible, using the patient's own tooth. After showing a satisfactory functional and esthetic result, advantages and pitfalls of this technique along with available data on the literature regarding the natural tooth pontic are addressed. Both patients and clinicians should be aware of minimally invasive, successful solutions for single-tooth replacement; whether indicated or necessary, the natural tooth pontic technique leaves open other treatment options for the future.

Undetected Excess Cement at Marginal Areas of Zirconia Crown Copings: In Vitro Analysis of Two Luting Agents and Their Influence on Retention.

PURPOSE: To evaluate the amount of residual cement (ECL) around the margins of zirconia crown copings after careful luting and cleaning procedures and to investigate these factors in relation to two tested luting materials. MATERIALS AND METHODS: An experimental model of a maxillary arch was selected for this in vitro study. The maxillary first molar was prepared to receive an all-ceramic, single, full-crown restoration with a finish line located 1 mm below the artificial gingiva. After scanning of the prepared tooth, 20 paired zirconia coping-abutment assemblies were CAD/CAM fabricated. A slot in the model allowed for insertion and removal of the assemblies for each new test. Specimens were divided into two groups according to the cementation procedure: half (n = 10) were luted using a resin-modified glass-ionomer (RMGI) (Ketac-Cem Plus) (GI group), and the other half with a dual-curing self-adhesive resin agent (RelyX Unicem 2) (UN group). The substructures were loaded with cement, and a customized preseating device was adopted for preliminary reduction of excess. The zirconia copings were finally seated on their respective abutments located on the simulation model. A blinded investigator attempted to remove all excess cement with clinically available instruments. The amount of excess cement left in situ after cleaning procedures was weighed in grams. Dislodging forces of luted coping-abutment assemblies were obtained by using pull-off tests in a universal testing machine (crosshead speed of 0.5 mm/minute) after 24 hours of water storage. Means and standard deviations were calculated for ECL and for retention force values, and Mann-Whitney and ANOVA tests were carried out to detect significant differences (α = .05) among groups. RESULTS: Cement remnants were found in all specimens despite the cleaning procedures, with a typical distribution in interproximal areas. Mean ECL values for the GI and UN groups were 0.0079 ± 0.0060 and 0.0107 ± 0.0081, respectively. No statistically significant differences were found between tested cements (P = .3284). Removal stress values (MPa) were significantly higher (P = .0313) for the UN group (12.4 ± 6.5) than for the GI group (6.57 ± 4.69). CONCLUSION: Similar amounts of undetected cement remnants were discovered around the esthetic margins of zirconia crown copings regardless of cement type. The luting procedure using the self-adhesive resin cement provided significantly higher early retention values than the RMGI material.

Speed bleaching: the importance of temporary filling with hermetic sealing.

The aim of this study was to demonstrate the influence of an adhesive temporary restoration on the effectiveness of the bleaching reaction, regardless of the concentration of the bleaching agent used. Every clinician involved in conservative dentistry understands the incompatibility between 'chemical bond' and 'oxygen.' This awareness often influences clinicians to decide on a temporary 'mechanical retention' filling that is unable to prevent the escape of oxygen ions, forcing the patient into more sessions and therefore raising the risk of complications. The scientific rationale behind the procedure described in this article is based on the bonding capacity of the coronal seal to maintain the rapid dissociation of the hydrogen peroxide exclusively within the pulp chamber, inducing an increase in the internal pressure and a consequent penetration of the oxygen-free radicals directly inside the dentinal tubules. In fact, avoiding the spontaneous dissipation of the oxygen-free radicals in the external environment may limit their effectiveness. This study aimed specifically to prove that it is possible to obtain a rapid bleaching reaction by observing a protocol based on the 'walking bleach' technique, specifically modified not so much by the typology of the mixture used but by fully exploiting the reaction yield of the hydrogen peroxide disproportionation. The results of the documented clinical cases presented here show the effectiveness of this method, which is achieved in a single session, therefore decreasing the possibility of the several operating phases that are necessary with the traditional procedure.

Minimally-invasive dental anesthesia: Patients' preferences and analysis of the willingness-to-pay index.

AIM: The aim of the present prospective study was to evaluate the impact of a computer-controlled anesthesia on patients' comfort and to investigate, through the willingness-to-pay (WTP) index, and patients' acceptance of this new technology. METHODS: Fifty patients undergoing a class I or II restorative procedure were enrolled. A computer-controlled device for anesthetic delivery was utilized, and a questionnaire on the level of discomfort and WTP was given to all patients. RESULTS: A total of 86% of participants declared less discomfort than that perceived during their last traditional procedure for pain control; 58% of patients were willing to pay an additional fee for a modern anesthesia technique, with a median WTP value of 20$. CONCLUSIONS: Computer-controlled systems for local anesthesia represent a relevant tool for reducing patients' discomfort during dental treatment. The WTP index helps to quantify its relevance.

Treatment planning of damaged teeth: to recover or to extract?

BACKGROUND: Planning the treatment of a compromised tooth is challenging but the choice should refer to evidence-based criteria. The literature proved that patient-related factors influence the treatment plan, but what happens when the patient is a dentist? Aim of the study was to observe whether the dentist goes for the same option suggested to a patient in a hypothetical scenario. METHODS: One hundred volunteers were interviewed singularly in a quiet ambient. Radiographs of 15 compromised teeth were shown and were identified as belonging to a hypothetical patient with non-contributory medical history asking for the best treatment. For each clinical case, the dentist could decide between: extraction (E), endorestorative recovery (R); referral to a specialist (S) to save the tooth. After a 15-minute wash-out, the same radiographs were shown again with the question: if this was your tooth, what would you do? The alternatives could be E or R. Statistical analysis was performed in order to evaluate the discordance between the choice taken for the patient and for the dentist's teeth. RESULTS: A constant increase in recovered teeth was observed in group D with the only exception of case 12. Concordance ranged from scarce to substantial, while symmetry showed that, when changing their mind, the dentists recovered their own teeth. CONCLUSIONS: The dentists were more conservative on their teeth: this shows the absence of a coherent decision-making pattern and stresses the need for an improvement in the formation of dental practitioners.

Histological Evaluation and Management of Rare Case of Supernumerary "Ghost" Teeth.

Supernumerary teeth are teeth that exceed the normal dental formula. Their prevalence in the permanent dentition is 1-14% and they occur more frequently in maxilla with a sex ratio of 2 : 1 in favor of males. They are often associated with syndromes but there are examples of nonsyndromic multiple supernumerary teeth reported in the literature. CBCT is usually the best exam for radiographic diagnosis and treatment planning, because it provides 3D information about location and morphology of supernumerary teeth. This paper reports a rare case of four supernumerary teeth in a nonsyndromic 9-year-old boy. The peculiarity of this case is that two more exceeding teeth were found during surgical procedure. After extraction, all the teeth underwent a histological undecalcified processing for light microscopical examination. The two "ghost" supernumerary teeth seemed to be primordial dental germs, possibly resulting from an altered odontogenic process. After supernumerary teeth extraction, X-rays and exfoliation monitoring are recommended, since permanent retained teeth often erupt naturally or, at least, improve their condition. Radiographic follow-up is also useful in order to assess the formation of further teeth due to the hyperactivity of the dental lamina.

Sinus presurgical evaluation: a literature review and a new classification proposal.

INTRODUCTION: Presurgical evaluation with cone beam computed tomography (CBCT) or computed tomography (CT) has become an essential tool for diagnosis and surgical planning, including maxillary sinus floor elevation. Before performing a sinus lift, the clinician's attention should not be only directed to the patency of the ostium through CBCT or CT, because many anatomical features could influence the surgical approach of sinus floor elevation. The goal of this article was to facilitate the communication between clinicians regarding the type of maxillary sinus, encourage in-depth analysis prior to surgery and reduce the risk of complications due to possible underestimation of important parameters. EVIDENCE ACQUISITION: An electronic search was conducted in Pubmed, Embase, Medline and Scopus, matching the following keywords: "sinus lift", "CBCT", "CT", "presurgical" and "evaluation". Clinical Oral Implant Research, Implant Dentistry, International Journal of Periodontics and Restorative Dentistry and Journal of Oral Implantology were hand-searched. The bibliographies of review articles were checked and personal references were also searched. EVIDENCE SYNTHESIS: Eleven parameters, that clinicians must check every time through CBCT or CT, were evaluated from different studies. At the end of the literature review for every single feature, the Authors established a favorable, a normal and an unfavorable situation, in order to provide a new classification. CONCLUSIONS: The grade of the described classification may be useful for clinicians to understand what probably the risk level of the sinus lift surgery could be and it may encourage the surgeon to have a careful pre-operative evaluation through CBCT or CT.

Incidence and characteristics of mandibular accessory canals: A radiographic investigation.

AIM: The aim of the present study was to explore, through tridimensional reconstructions of cone-beam computed tomography (CBCT) scans, the presence and the characteristics of mandibular accessory canals. METHODS: For each included participant, the presence of accessory canals was recorded. The diameter of the canal, as well as the distance between the canal walls and the walls of the mandibular bone (lingual, buccal, cranial and caudal), were measured and recorded. RESULTS: Mandibular accessory canals could be found in 8.8% of participants. Retromolar canals were the most frequently found accessory mandibular canals. CONCLUSIONS: Accessory mandibular canals were found in a relatively high number of participants through the examination of CBCT scans and tridimensional reconstruction. The presence of such structures should be considered cautiously when planning and performing surgical interventions in mandibular area.

CBCT evaluation of the tridimensional relationship between impacted lower third molar and the inferior alveolar nerve position.

BACKGROUND: The aim of this study is to evaluate if the statistical significant relations between the measures taken exists or not and to show how the 3D reconstruction could be help the oral surgeon in all those instances in which it may have a direct impact on the planning of the surgical steps. METHODS: Thanks to use of NobelClinician™ Software it was possible to analyze 200 mandibular tomography computerized, random selected, and create a 3D reconstruction of mandibular bone, point out dental structure of wisdom tooth and the way of IAN. Statistical analysis was performed using the Statistical Package for Social Sciences. One way ANOVA test was used to measure the association between each independent variable and the outcome variable, followed by the post-hoc least significant difference (LSD) test for intergroup differences. RESULTS: Two independent variables were significant predictors for risk to have the distance 0 mm from IAN to apex: "Ramus relationship/space available" and "depth". CONCLUSIONS: The 3D reconstruction software provide surgeons with an additional planning tool, offering: immediate and neat visualization of the noble structures that have to be respected and their localization in the three spatial planes; the exact morphology of the relevant root apex; a 360° view of the relationship between the IAN and the third molar and the exact point in which the root is in relationship with the canal.

Microbiological analysis of bacterial plaque on three different threads in oral surgery.

BACKGROUND: Suture is the final act of most oral surgery procedures. The quality of healing after the operation depends on its efficiency. Sutures must not cause inflammation - neither directly nor indirectly. The objective of this study is to compare the bacterial colonization on different suture materials after a third molar extraction. METHODS: Thirty patients were randomly selected among people going under third molar extraction; they were divided into 3 groups and one suture type was used on each group. After 7 days distal stitches were removed by a single operator, placed in physiologic solution and analyzed after 2 or 3 hours. Patients followed the same postsurgical protocols; materials used were: Ethicon Silk® 4/0, B. Braun Dafilon® 4/0, and B. Braun Safil® 4/0. RESULTS: The amount of cocci and bacilli on the sutures analyzed shows that silk (Ethicon Silk) is the higher level of retention material where monofilament (B. Braun Dafilon) is the lower. There is a difference between monofilament and polyglycolide (B. Braun Safil), as the former is less retentive than the latter, although not significantly so. CONCLUSIONS: A less plaque retention, and consequently a fewer bacterial presence, is crucial to minimize the inflammatory process and allow a better tissue healing. Since the capability of brushing and, of course, the final personal hygiene depends on multiple variables, we must use surgical protocols able to minimize the effect of improper cleaning on the healing process: this statement implies the use of low plaque retention materials. The use of monofilament or polyglycolide threads in sutures can help reducing bacterial concentration and therefore promotes a faster and better healing.

Infection Related Inferior Alveolar Nerve Paresthesia in the Lower Premolar Teeth.

Introduction. The aim of this paper was to describe two cases of IAN infection-induced paresthesia and to discuss the most appropriate treatment solutions. Methods. For two patients, periapical lesions that induced IAN paresthesia were revealed. In the first case, the tooth was previously endodontically treated, whereas in the second case the lesion was due to pulp necrosis. Results. For the first patient, a progressive healing was observed only after the tooth extraction. In the second patient, the paresthesia had resolved after endodontic treatment. Conclusions. The endodontic-related paresthesia is a rare complication that can be the result of a combination of etiopathogenic mechanisms such as mechanical pressure on the nerve fibers due to the expanding infectious process and the production of microbial toxins. Paresthesia resulting from periapical lesions usually subsides through elimination of infection by root canal treatment. However, if there are no signs of enhancement, the immediate extraction of the tooth is the treatment of choice in order to prevent irreversible paresthesia because it was demonstrated that there is a correlation between the duration of mechanical or chemical irritation and the risk of permanent paresthesia.

Crestal sinus lift by using a mini-invasive procedure: a case series.

BACKGROUND: The aim of this study was to present a case series treated with an atraumatic procedure for maxillary sinus lift by crestal approach. This technique avoids the use of classical osteotomes, thus decreasing complications due to percussive and vibratory forces. METHODS: Three cases of partial edentulism in the distal maxillae with inadequate bone volume are treated by using SinCrest procedure (Meta, Reggio Emilia, Italy). With the guide of surgical templates, the sinus lift was performed, and implants were placed during the same procedure. After 6 months an X-ray was taken to check the success of the operation. RESULTS: SinCrest allows the operator to advance progressively, maintaining the correct axis for implant placement. The plane tip of drills prevents accidental perforations of Schneiderian mucose, and the stops, available in different lengths, avoid the overtreatment. The manual screwing of SinCrest osteotome ensures precision during the cortical approach, while the built-in probe allows to check residual strength of sinusal floor, making sure that the Schneiderian mucose is reached and lifted. This technique does not depend on the operator's skills and decreases the onset of adverse effects due to the hammering with classical osteotomes. SinCrest requires a small flap and osteotomy, which means less healing time and more comfort for the patient, both during and after the surgery. CONCLUSIONS: SinCrest is a valid alternative to other mini-invasive procedures for sinus lift in cases with a residual height bone of at least 5 mm, allowing an atraumatic, safe and controlled operation.