Cone beam computed tomography role in diagnosis and treatment of impacted canine patient's: a case report.

A tooth is impacted when its apex is formed but does not erupt as expected during the physiological timeframe of eruption. The frequency with which the upper canine is impacted in the sample examined varies from 1% to 5% of the population in the second decade of life. The most frequent causes of inclusion of the upper canine are: lack of resorption or precocious loss of the root of the deciduous, agenesis of the lateral, an anomaly in its shape, lack of space in the arch, presence of a mechanical obstacle to the eruption, and lastly due to hereditary factors. When dental impaction is suspected, radiographic examination is indicated to evaluate the effect that the impacted element is having in the context of the osseous structure and to evaluate its relationships with adjacent teeth, the presence of mechanical obstacles, the placement of the inclusion and its orientation in space, how well developed the root is, and any anomalies in its shape. In addition to the classic orthopantomography (OPT), endoral radiography, teleradiography, can be used in order to obtain three-dimensional and life-size images, techniques of computed tomography (CT). In particular, cone beam CT, obtains this type of image using a radioactive dose comparable to that obtained summarizing the classic radiographic examinations requested by an orthodontist and moreover less that that administered when using classic multi-layer spiral CT medical equipment. This case report describes the diagnostic iter and orthodontic-surgical treatment of a patient with enclosure of the right upper canine.

National Italian Guidelines for caries prevention in 0 to 12 years-old children.

AIM: Oral and dental health improved tremendously over the last fifty years in Italy but still prevalence of dental caries in children remains a significant clinical problem. This report describes the National Italian Guidelines for caries prevention. METHODOLOGY: A panel of experts coordinated by the Italian Society of Paediatric Dentistry (SIOI) planned to elaborate the national Italian guidelines for caries prevention in children. The structure of the guidelines has been planned to follow the principles of modern caries treatment and management as well as science based dentistry. The main procedure was based on a hierarchic evaluation of literature. CONCLUSION: The guidelines are planned for dentist working in primary dental care, however, they are also designed to be of interest for other care professionals such as paediatricians, gynecologists, pharmacists and general medical practitioners and also for parents and/or guardians of the children.

Role of mast cells in wound healing process after glass-fiber composite implant in rats.

Glass-fiber composites are frequently used in dentistry. In order to evaluate their biocompatibility we tested, in an experimental model "in vivo", their tissue response pointing our attention on presence of mast cells (MCs) and fibrotic process. Sprague Dawley rats were used for the experimental design. The fibers were introduced in a subcutaneous pocket along the middle dorsal line between the two scapulas for 7, 14 or 21 days. At the end of the treatments the skins were excised and then processed for Toluidine Blue, to determine the presence of MCs, and Picrosirius Red staining, to evaluate the presence of fibrotic tissue. Our preliminary results showed and increase of both MC number and deposition of collagen type I, which characterized the fibrotic tissue. So, subsequent aims of our study were to evaluate the role played by MCs in tissue fibrosis and to give a possible explanation regarding the mechanisms that were responsible of biological response observed, through the analyses of some proteins, such as metalloproteinase-2 (MMP-2), its inhibitor (TIMP-2) and transforming growth factor-beta (TGF-beta). Our data confirmed the involvement of TGF-beta, released by MCs, in the disruption of the equilibrium between MMP-2 and TIMP-2 that were implicated in the enhancement of fibrosis. In summary, this study demonstrate that this type of materials induced an inflammatory response at the site of implant and help to clarify what type of mechanism and which proteins are involved in this biological response. Nevertheless, more extensive investigations are in progress to better evaluate the inflammatory process.

Indications on suitable scaffold as carrier of stem cells in the alveoloplasty of cleft palate.

Autologous iliac crest bone is used to close the residual alveolar bone defect in cleft palate patients during late mixed dentition. Surgery involves physical and anaesthesiologic risks, long-time hospitalization, high costs and not always good results (15% failure rate). Alternatives to iliac crest bone grafting are going to be evaluated: synthetic, xenograft and allograft matrices combined with platelet-rich plasma or recombined bone morphogenic proteins for osteoinductivity are commercially available. These alternatives have not yet been determined to be equivalent to the previous treatment. A new field of research is represented by stem cells, which have been also used to regenerate ischaemic cardiac tissue after heart attack, to treat hypophosphatasia and osteoporosis. Our aim was to use osteoblasts from stem cells to close the residual palate cleft in association with a suitable carrier. Stem cells are expanded in the Aastrom bioreactor, differentiated into osteoblasts and positioned in the bone defect by means of a Spongostan scaffold. This scaffold has the best characteristics as commercial availability, low cost, good manageability, absence of allergic reactions or other side effects on patient, biocompatibility, imbibition, radiotransparency, reabsorbability and osteoinductivity. Previous studies encourage Spongostan scaffold application.

Mast cells and the inflammatory response to different implanted biomaterials.

The biocompatibility of dental materials is a topic of increasing importance for dentists. We investigated the effects of alloys for ceramic crowns and removable prostheses on the skin and lymphoid organs of rats. We used three groups of Sprague Dawley rats: group I as the control, with groups II and III implanted with different biomaterials into subcutaneous pockets. After sacrifice, the rat skin around the implant and the lymph nodes was studied. The tissues of implanted rats were morphologically different from the control animals as they showed a number of mast cells that increased 7 days after the implant with both alloys. These cells decreased 14 days after the implant with alloy for ceramic crowns whereas they were still high 28 days after the implant with alloy for removable prostheses. The findings suggest that both alloys induced different and time-dependent inflammatory reactions. Our findings have importance in the future rational design of biocompatible implantable and blood-contact biomaterials.

[Environmental monitoring of infective risks in Italian dental offices]. / Monitoraggio ambientale dei rischi infettivi legati all'assistenza odontoiatrica.

BACKGROUND: Bacterial contamination in dental offices plays a primary role in the evaluation of infective risks for patients and dental personnel. The aim of the research was to study bacterial contamination in eight Italian dental offices by investigating the water of dental units, the air and certain surfaces (push-button panel and instrument cabinet) in order to evaluate potential risks in dental practices. METHODS: The water underwent a microbiological test as specified by Italian law (DPR 236/88). The water was sampled from the hoses and air/water syringes of twenty dental units. The microbiological analysis of the air was performed using sedimentation plates to evaluate microbial fall-out. The microbiological analysis of the surfaces was performed using membrane filters to evaluate microbial accumulation. RESULTS: The research showed bacteriological contamination of the dental unit water in all the dental offices. During the working activity total bacteriological counts in the air fall-out were fairly high and the surfaces examined showed some widespread bacterial contamination in dental practices. The results of this study show the importance of routine monitoring of microbial contamination of dental offices and, in case of contamination, the need to apply disinfection treatments for the waterlines and preventive measures for the aerosol reduction. CONCLUSIONS: Our research was used to work out a program for the prevention of environmental contamination in dental offices.

[In vitro study of amalgam corrosion]. / Studio in vitro sulla corrosione di amalgami.

AIMS: In the dental field, the aim of the research was to evaluate, through a standardized system, the factors influencing the corrosion of dental alloys in different clinical conditions with various types of amalgams and/or solution parameters. METHODS: A 6-hole corrosion cell was used according to ASTM G5-95 protocol. RESULTS AND CONCLUSIONS: It is well known that free surface corrosion is uncommon in the oral cavity in the case of most dental alloys. But localized corrosion, either as pitting or as crevice corrosion, might occur. The clinical conditions affecting amalgam corrosion may be detectable in localized corrosion, in particular because of cathodic/anodic surface behaviour coupling.

[Decontamination of dental unit waterlines using disinfectants and filters]. / Decontaminazione del sistema idrico del riunito mediante disinfezione e filtrazione.

Bacterial contamination of the dental unit water system can become a health problem for patients, particularly if they are immunodepressed. The present study has had the purpose of evaluating the effectiveness of methods of chemical decontamination using different disinfectants (peracetic acid, hydrogen peroxide, silver salts, chloramine T, glutaraldehyde T4) and methods of physical decontamination using synthetic membranes for the filtration of water. A preliminary removal procedure of the biofilm present in the waterline has been followed in a dental unit prepared on purpose for the research; subsequently different 2-week long maintenance procedures were applied using disinfectants injected by a pump and finally the bacterial contamination of the water flowing from the waterline was evaluated. The physical decontamination was performed using 0.22 mm membrane filters, which have been installed also in another dental unit, and the filtered water was analyzed to detect bacterial contamination. The preliminary procedure of biofilm removal succeeded obtaining germ-free water. Among the disinfectants used for the maintenance of the water quality only glutaraldehyde T4 was able to reduce the bacterial contamination under the limit suggested by the ADA. The membrane filter system was not able to purify the water, but when a disinfectant (peracetic acid) was used in the last part of the waterline good results were obtained. At present no decontamination system of dental waterline is available, and glutaraldehyde T4 seems to be the best disinfectant only if integrated with periodic biofilm removal for the maintenance of the water quality.

HCV-RNA occurrence in saliva of odontoiatric HCV seropositive patients.

BACKGROUND: HCV-RNA occurrence in saliva of patients suffering from C hepatitis induced to consider saliva as a possible diffusion mean of this disease. METHODS: Saliva and blood samples from 32 C hepatitis seropositive patients, followed for odontostomatologic problems in Odontoiatric Clinic of Brescia University were obtained. In every blood and saliva sample HCV-RNA concentration was evaluated following HCV-RNA 2.0 Assay (bDNA) Quantiplex test (Chiron), in Microbiology Institute of Brescia University. RESULTS: All patients showing HCV-RNA in serum presented virus in saliva also; two patients with negative HCV-RNA serum presented virus in saliva. In latter cases, we supposed that viral concentration in serum was under sensibility threshold of employed method. CONCLUSIONS: Saliva appears an easily and not invasively obtainable medium for epidemiological studies on HCV diffusion in humans. Its role in C hepatitis transmission, on the contrary, has not been cleared till now.

Evaluation of environmental bacterial contamination and procedures to control cross infection in a sample of Italian dental surgeries.

OBJECTIVES: To perform a pilot study on bacterial contamination in some dental surgeries (n=51) in a local health unit in Brescia (Lombardy Region, Italy) and to evaluate the procedures to control cross infection used by the personnel to reduce the risk of infection in dental practice. METHODS: A survey was carried out by interviewing 133 dental personnel with a questionnaire on the procedures used to control infection. The autoclaves, chemical baths (chemiclaves), and ovens present in the surgeries were tested for sterilisation efficiency with a spore test, and already packed and sterilised instruments were randomly sampled and tested for sterility. Microbial contamination of air, surface, and dental unit water samples were also studied. RESULTS: The dental personnel did not generally follow the principal procedures for infection control: 30% of personnel were not vaccinated against hepatitis B virus, infected instruments were often not decontaminated, periodic checks of autoclave efficiency were lacking, and the knowledge of disinfection mechanisms and procedures was incomplete. High bacteriological contamination of water at dental surgeries was often found and total bacteriological counts in air samples were high. Surface studies showed widespread bacterial contamination. CONCLUSIONS: On the basis of these results, an educational programme for the prevention of infective hazards has been prepared and carried out. The results of this pilot study will be used for planning a national survey.

Non-specific influx of T-cell receptor alpha/beta and gamma/delta lymphocytes in mucosal biopsies from a patient with orofacial granulomatosis.

Orofacial granulomatosis (OFG) represents an inflammatory disorder of the facial and oral mucosa, histologically characterized by non-caseating epithelioid cell granulomas. Since other granulomatous diseases have been shown to be characterized by a limited heterogeneity of alpha/beta and gamma/delta T cells, we investigated the T-cell diversity of both types of lymphocytes obtained from the same OFG patient. When we compared the T-cell receptor diversity of the lymphocytes accumulating at the site of the lesions with that of the peripheral blood counterpart, we did not find significant differences. Furthermore, no exclusive expansions of different T-cell clones were seen in the patient. From these data we conclude that, in this OFG patient, the majority of T cells have no specificity for a single or for a few antigens and that tissue accumulation of T lymphocytes is the result of a random influx of cells at the site of inflammation.

Oral complications of pediatric hematopoietic cell transplantation: diagnosis and management.

Oral complications are a significant cause of morbidity and potential mortality for children undergoing hematopoietic cell transplant (HCT). Oral complications can occur at all stages of HCT and can interfere significantly with transplant recovery. Mucosal disease caused by conditioning regimen toxicity and infection are frequent clinical problems. Untreated dental caries and periodontal disease may result in severe infections of the mouth and/or life-threatening systemic spread of the microbial pathogens. In the course of chronic graft-versus-host disease (GVHD), which can complicate HCT, lichenoid and ulcerative lesions of the mucosa are observed. Furthermore, total-body irradiation utilized in the conditioning regimens can cause early xerostomia and consequent dental decay and also result in significant dental and skeletal developmental anomalies. The dental health care team should have a key role in the support of HCT patients. The team's primary responsibilities are those related to the prevention of severe infections originating in the mouth, which includes providing instruction on oral prophylaxis and hygiene as well as direct intervention. Prevention and/or diagnosis and management of oral complications of HCT by the dental team can improve the success of a transplant by reducing morbidity, improving the quality of life, and reducing the cost of care. The authors present specific protocols for the diagnosis and prevention and for the management of oral complications in pediatric HCT.

Absence of Helicobacter pylori in dental plaque determined by immunoperoxidase.

BACKGROUND: Attempts to detect Helicobacter pylori in dental plaque have given contrasting results, and the possibility of an oral-oral transmission of the infection remains unclear. In this study, a sensitive and specific immunoperoxidase method has been employed to assess the presence of H. pylori in dental plaque. METHODS: Dental plaque smears from 80 patients undergoing gastroscopy were analyzed by an indirect immunoperoxidase test, employing a mixture of two monoclonal antibodies against H. pylori. RESULTS: No immunostained bacteria were shown in any of the examined dental plaque samples. CONCLUSIONS: H. pylori is not usually present in dental plaque, indicating that oral-oral transmission of the infection could be due to intermittent esophageal reflux only.

[Carious pathology in selective IgA deficit]. / Patologia cariosa nel deficit selettivo di IgA.

The relationship between levels of secretory IgA and incidence of dental caries has been the object of controversial studies. Selective IgA deficiency (SIgAD) is the commonest primary immunodeficiency and may be found in apparently healthy individuals but is also associated with a variety of diseases. In the present study the authors evaluated the prevalence [correction of incidence] of caries by means of caries indexes in a group of children with severe and partial SIgAD and in a group of children age-matched healthy control. Evaluated caries indexes were significantly higher in children with severe SIgAD as compared to control groups.

[Celiac disease and recurrent aphthous stomatitis. The clinical and immunogenetic aspects]. / Malattia celiaca e stomatite aftosa ricorrente. Aspetti clinici ed immunogenetici.

The frequency of HLA class II (DR and DQ) antigens is analyzed in 113 subjects affected by coeliac disease, nineteen of them suffering from recurrent aphthous stomatitis. A significant association was found between DRw10 and DQw1 HLA antigens and the two diseases in the 19 subjects suffering from both diseases.

HTLV-1 seroprevalence in AIDS patients and in HIV-1 seropositive and seronegative subjects at risk for AIDS in northern Italy.

Sera of 1023 subjects belonging to categories at risk for AIDS, positive for HIV-1, were tested for antibodies to human T-cell leukemia virus (HTLV-1) by ELISA, Western blotting, and radioimmunoprecipitation (RIP) assay. Sera of these subjects were positive for antibodies to HTLV-1 in a percentage of 18.54%. Nine out of 18 sera from patients with AIDS had antibodies to HTLV-1 (50%). Sera of 207 intravenous drug abusers and 64 homosexual males, seronegative for HIV-1, were tested for antibodies to HTLV-1 and 6.7% of intravenous drug abusers and 7.8% of homosexual males were found to be HTLV-1 antibody positive, showing that HTLV-1 infection occurred independently of HIV-1 and HIV-2 infections. In fact the same HIV-1 seronegative patients were also tested for the presence of antibodies to HIV-2 and none of them was found to be positive.