Diagnosis and treatment of dens invaginatus with open apex in a young adult patient by using cone-beam computed tomography and operative microscope.

BACKGROUND: Dens invaginatus is a developmental anomaly that can affect both deciduous and permanent dentition. The anomaly is caused by the invagination of the enamel organ into the dental papilla prior to the calcification of the dental tissues. The treatment option changes according to the classification, from the simple filling of the invaginated enamel area to root canal treatment with or without retrograde surgery, intentional re-implantation, or the extraction of the affected tooth. CASE REPORT: In this study we report a case of a maxillary lateral incisor invaginatus in a young adult patient. The periapical endoral X-ray showed the presence of a periapical radiolucency in tooth 22, that had a structure similar to a tooth inside it and an immature apex. Cold thermal testing showed that it was not a vital tooth. CBCT confirmed the diagnosis of Oehler Class II dens invaginatus. The treatment plan involved root canal treatment of both the "true" and the "invaginated" canal using calcium hydroxide-based intermediate medication. Then, after removing the hard internal structure with the aid of an operative microscope, MTA was used to close the immature apex. Finally, the large endodontic space was filled with self-etching, self-adhesive, dual curing resin cement. The patient was included in a follow-up programme to monitor and verify the complete healing of the periapical bone of the affected tooth. CONCLUSION: The use of technology and of special materials allowed an adequate management and resolution of the case reported.

In vivo evaluation of periodontal microcirculatory changes associated with endodontic treatment.

AIM: The purpose of this study was to investigate in vivo the gingival microcirculatory changes associated with endodontic treatment using the continuous wave of condensation technique. MATERIALS AND METHODS: Twenty necrotic one canal roots of 20 cooperative patients of both sexes, aged between 20 and 43 years, were selected. All patients were examined by capillaroscopy before, immediately after endodontic treatment, and after 7 days. The last examination was carried out by the same operator, and repeated twice for each examined area: masticatory, buccal and labial mucosa corresponding to the endodontically treated root. All canals were prepared using a simultaneous technique with Ni-Ti files (MTwo files). RESULTS: The images of the masticatory mucosa after root canal obturation showed evident micro-areas of extravasation, with significant bleeding and angio-morphological alterations due to heat. One hour after the endodontic treatment evident extravasation was observed, but a decrease of all altered parameters, was present. After seven days from treatment, in the periodontal tissues, a complete healing was observed. The in vivo evaluation of the vascular pattern during root canal obturation with System B showed that the high temperature in the canal determines visible effects on the vasculature of adjacent sites. It was found that microangiotectonic alterations decrease up to a complete healing after 7 days from treatment. CONCLUSION: All the changes in microcirculation, due to thermal shock of periodontal tissues, are reversible.

Evaluation of gingival microcirculation in patients undergoing fixed orthodontic treatment: a pilot study.

AIM: Among the many biological effects which occur during orthodontic movement, we decided to investigate gingival microcirculation. The aim of the study was to evaluate the biological microvascular response to the application of orthodontic force in vivo. MATERIALS AND METHODS: Forty patients (case group) between 9-22 years of age (average± DS 12±3.01) were selected for the study (M/F ratio: 20/20). They needed fixed orthodontic treatment due to several types of malocclusion. Forty healthy subjects (control group) were also recruited (M/F ratio 20/20; average age 12 years ± 4.01; Mean±SD =10.04±1.7). A videocapillaroscopic examination was performed on each patient on the buccal alveolar mucosa at the pre- treatment time (t0), 1 month after the beginning of the treatment (t1), after 2 months (t2), after 6 months (t3), and after 12 months (t4). RESULTS: Capillary density increases significantly from t0 to t1. Between t1 to t2, t2 to t3 the density underwent another increase. Between t3 and t4 (69.22 ± 3.63) the density showed no increase. In the control group no statistical differences were observed. CONCLUSION: Videocapillaroscopy allows the in vivo evaluation and quantification of the microcirculatory changes consequent to the application of orthodontic force, managing to detect subclinical changes in angiogenesis. In fact, the study revealed an increase in the density of the capillaries which is directly proportionate to the application time of the orthodontic device, i.e. the exogenous mechanical force. This research offers new perspectives for the future of monitoring fixed orthodontic therapy.

Microcirculation in the healing of surgical wounds in the oral cavity.

The aim of this research is to evaluate in vivo the characteristics of microcirculation after taking a biopsy sample from the oral mucosa. 20 patients were recruited to the study and all underwent an oral mucosa biopsy for the excision of benign neoformations. The modifications in the oral microcirculation were evaluated in vivo in correspondence to the surgical site through videocapillaroscopy at three different times: 30 min before the biopsy; 48 h after the biopsy; and 7 days after the biopsy. The statistical significance was checked with the Mann-Whitney U-test (P<0.05). The analysis of videocapillaroscopic patterns showed statistically significant variations relative to the capillary loop density; the diameter of the outgoing loop; and the length of the capillary loop. In conclusion, the study describes a simple and reproducible model for the study of wound healing from a microcirculatory point of view.

Good oral health and diet.

An unhealthy diet has been implicated as risk factors for several chronic diseases that are known to be associated with oral diseases. Studies investigating the relationship between oral diseases and diet are limited. Therefore, this study was conducted to describe the relationship between healthy eating habits and oral health status. The dentistry has an important role in the diagnosis of oral diseases correlated with diet. Consistent nutrition guidelines are essential to improve health. A poor diet was significantly associated with increased odds of oral disease. Dietary advice for the prevention of oral diseases has to be a part of routine patient education practices. Inconsistencies in dietary advice may be linked to inadequate training of professionals. Literature suggests that the nutrition training of dentists and oral health training of dietitians and nutritionists is limited.

In vivo evaluation of labial microcirculation in diabetics: a comparison with healthy subjects.

AIM: Diabetes mellitus, a systemic chronic disease considered an epidemic by the World Health Organization (WHO) due to the rate of increase in the prevalence of diabetes, is a cause of microvascular and macrovascular complications leading to a significant burden for the individual and society. The aim of this study was to evaluate in vivo the effects of type II diabetes mellitus on the microcirculation of oral mucosa. METHODS: Forty-six subjects, 23 patients with type II diabetes mellitus (10 men, 13 women) and 23 healthy patients (9 men, 14 women) were examined in our laboratory. Oral microcirculation was evaluated on labial mucosa using oral video-capillaroscopy: a diagnostic method that permits the in vivo analysis of oral microcirculation. RESULTS: Capillary density, total loop length and total diameter resulted significantly altered in diabetics. The density of loops, observed on labial mucosa, is on average lower in diabetics than in healthy patients. The length and total diameter of loops are increased in diabetics. CONCLUSION: This study shows the capillary alterations that occur in the oral mucosa of diabetics. The loop density decrease is probably a symptom of peripheral microangiopathy. Ultimately, this study demonstrates that there is peripheral damage to microcirculation at the level of the labial mucosa in diabetic subjects and that these alterations are instrumentally "objectivable" and "quantifiable" through the videocapillaroscope technique.

"In vivo" evaluation of the vascular pattern in oral peri-implant tissues.

INTRODUCTION: The vascularisation of the peri-implant tissue represents the key factor in obtaining a successful result in implantology, since an adequate vascular supply allows wound healing and the presence of numerous growth factors that promote osteogenesis. The aim of this study was to analyse "in vivo" the vascular pattern of the peri-implant mucosa in subjects that received implant treatment. MATERIALS AND METHODS: In the study 22 subjects were examined, 11 of whom (test group) received dental implants (Straumann Dental Implant System) while 11 were in the control group; the analysis was performed in the peri-implant masticatory mucosa. The evaluation of the microcirculation was performed "in vivo" using the optical probe videocapillaroscopy technique equipped with 200× lenses. The following parameters were recorded: capillary density, vascular areas, microhaemorrhages and angioarchitecture. RESULTS: The values indicating the capillary density were significantly different in the test group compared to the control group, indicating an angiogenic process taking place "in vivo". In the test group the capillary loops were arranged parallel (30%) as well as perpendicular to the surface; in contrast, in the control group the gingival margin was always perpendicular to the surface (100%). CONCLUSIONS: The peri-implant vascular pattern exhibits special characteristics that differ both in morphology and density from the gingival one.

Risk of periodontal disease: is there a correlation with the type of antihypertensive medication?

INTRODUCTION: The purpose of this study was to evaluate the effects of long-term oral antihypertensive treatment using centrally acting sympatho-inhibitory drugs (clonidine) and beta-blockers (metoprolol) on capillary microcirculation in the labial and periodontal mucosa. METHODS: Sixty subjects were recruited for the study: 20 patients affected by hypertension in treatment with centrally-acting sympatho-inhibitory drugs (64.28 ± 11.78 years); 20 patients in treatment with beta-blockers (62.03 ± 9.84 years) and 20 healthy subjects (62.06 ± 6.72 years). We use the videocapillaroscopic technique to evaluate in vivo the microcirculation of the labial mucosa corresponding to the lower lip and of the periodontal mucosa corresponding to the central superior incisor. RESULTS: Capillaroscopy revealed a significant increase in the length, diameter, tortuousity and density (P <0.05) of capillaries in patients affected by hypertension in treatment with centrally acting sympatho-inhibitory drugs, while beta-blockers had a lower effect on the labial and periodontal microcirculation compared to the healthy population. CONCLUSIONS: The capillaroscopic has revealed substantial modifications of the oral microcirculatory pattern in hypertensive patients in treatment with centrally-acting sympatho-inhibitory drugs than with beta-blockers.

Burning mouth syndrome: is acupuncture a therapeutic possibility?

BACKGROUND: Burning mouth syndrome is a chronic pathology of unknown ethiopathogenesis. The aim of this study was to evaluate whether acupuncture can produce a reduction of the burning sensation by influencing the oral microcirculation. METHODS: Thirty patients (10 male and 20 female; mean age +/- SD = 65.4 +/- 2.17) and 30 healthy subjects (10 male and 20 female; mean age +/- SD = 62.06 +/- 6.72) were recruited for the study. The patients were treated with acupunctural techniques based on traditional Chinese medicine. Microcirculation was observed in vivo using videocapillaroscopy at three different times: t(0)) in the absence of acupuncture; t(1)) 1 minute after the insertion of the needles; and t(2)) 5 minutes after the insertion of the needles and following their stimulation. RESULTS: The capillaroscopic observation revealed a significant increase of the capillary tortuousness and density, a reduction of the arborescence and a reduction of burning sensation in such patients. CONCLUSION: The study shows that acupuncture influences oral microcirculation, resulting in a significant variation of the vascular pattern to which is associated a significant reduction of the burning sensation after three weeks of therapy. Such reduction of the burning sensation has been permanent for the 18 months following the acupuncture therapy. Acupuncture appears a valid therapeutic choice in the management of such patients.

Evaluation of labial microvessels in Sjogren syndrome: a videocapillaroscopic study.

UNLABELLED: Sjögren's syndrome (SS) is a chronic autoimmune rheumatic disease characterized by a progressive lymphocytic infiltration of exocrine glands, especially salivary and lachrymal ones, leading to xerostomia, parotid gland enlargement, and xerophtalmia. SS may occur alone (primary) or in association with almost any of the autoimmune rheumatic diseases (secondary), the most frequent being rheumatoid arthritis. The aim of this study is to describe the capillaroscopic pattern of the labial mucosa in patients with SS. METHODS: A total of 20 patients affected by SS and 20 healthy controls were examined. The patients with conditions that compromise microcirculation, such as diabetes, hypertension, hyperlipidemia or some pharmacological treatments, were not included in the study. All the patients were non-smokers. Labial capillaroscopy has been used to investigate the features of microcirculation. Visibility, course, tortuosity, as well as the possible presence of microhemorrhage, the average calibre of the capillary loops and the number of visible capillary loops per square millimetre were evaluated for each patient. RESULTS: The results show evident alterations in the capillaries and a typical conformation of the labial microcirculation in SS patients. CONCLUSION: Labial microcirculation alterations occur in SS patients. The study of the microcirculation in autoimmune pathology such as SS could provide new understanding on the dynamics of the pathology and could help to complete the diagnosis.

Correlation of " in vivo" microcirculation and degeneration of the basal cells of the epithelium in lingual lichen planus.

BACKGROUND: Oral lichen planus is an inflammatory chronic disease with an autimmune pathogenesis and unknown etiology that affects oral mucosa, with or without the involvement of the skin and other mucous membranes. The principal histological characteristics are the degeneration of the basal cell layer and the abnormal infiltration of inflammatory cells into the subepithelial layer of connective tissue. OBJECTIVES: This study is aimed to appraise if lingual lichen planus (LLP) is sustained by alteration of the oral microcirculation and if this abnormal vascularisation increases the degeneration of basal keratinocytes and the disruption of the basement membrane. MATERIALS AND METHODS: Fifteen patients with a histological diagnosis of LLP with higher degree of degeneration of the basement membrane, fifteen LLP patients with lower degree of basement membrane (BM) degeneration and fifteen healthy patients were included in the study. The microcirculation of the left margin of the lingual mucosa of all the patients and subjects was analysed with the videocapillaroscopy. The following parameters were analyzed on each capillaroscopic image: c0 apillary loop length, loop diameter, and capillary density. The results obtained by videocapillaroscopy software were subjected to statistical analysis using Mann Whitney U-test (P < 0.001). Statistical analysis was performed using PAST software, v. 1.53. RESULTS: Capillary density, loop length, and total diameter showed statistically significant differences between LLP patients with histologically lower degree of BM degeneration and healthy subjects and a meaningful significant difference between LLP patients with higher degree of BM degeneration. CONCLUSIONS: A remarkable increase in capillary density was showed by videocapillaroscopic exam. The increased value of the density could be associated with angiogenesis mechanism and it could be an indicator of the evolutionary condition of LLP. Videocapillaroscopy may be useful for the evaluation of the evolution or regression of the disease.

Microvascular periodontal alterations: A possible relationship between periodontitis and rheumatoid arthritis.

BACKGROUND: Microvascular involvements represent one of the first steps in many autoimmune diseases such as rheumatoid arthritis (RA). The aim of this study was to investigate the differences in periodontal microcirculation between healthy subjects and patients suffering from RA. METHODS: Thirty healthy subjects and 30 patients suffering from RA were examined. The patients who showed conditions known to compromise microcirculation, such as diabetes, hypertension, pharmacological treatments, were not included in the group of healthy patients. All the patients were non-smokers. Periodontal capillaroscopy was used to investigate the characteristics of microcirculation. Visibility, course, tortuosity, as well as the possible presence of microhemorrhages, the average caliber of the capillary loops and the number of visible capillary loops per square millimeter were evaluated for each patient. RESULTS: Microcirculation architecture in the healthy and in the RA patients was characterized by a network of capillaries in polygonal mesh with parallel orientation as regards the surface. In patients suffering from RA, it was possible to observe a reduced caliber of capillaries, as well as a greater number and elongated capillaries. No significant differences relating to oral capillaroscopic pattern were detected between RA patients that were rheumatoid factor, ANA, RANA positive and RA patients that were rheumatoid factor, ANA, RANA negative. CONCLUSIONS: This study shows that capillary alterations in patients suffering from RA occur in periodontal microcirculation; such evidence could be extremely important, suggesting that microvascular periodontal alterations may play a crucial part in the complex activity associated with periodontal disease in AR patients.

Microvascular characteristics of the human interdental papilla.

The aim of this study was to observe the microcirculation characteristics of the human interdental papilla in healthy patients in vivo. Twenty healthy patients were examined. Capillaroscopy was used to investigate the characteristics of microcirculation of the human periodontal mucosa. Visibility, course, tortuosity, as well as the average caliber of the capillary loops and the number of visible capillary loops per square millimeter were evaluated for each patient. The investigation of gingival mucosa revealed capillary loops with a course both parallel and perpendicular to the surface. Our study has pointed out that capillaroscopy is a reliable method to study periodontal microcirculation in vivo. This method could be applied to the study of microcirculation in periodontal diseases. Future studies might evaluate whether microcirculation in that area is compromised or not during systemic pathologies involving peripheral microcirculation alterations.

Oral diseases in a patient affected with Prader-Willi syndrome.

BACKGROUND: A case of Prader-Willi syndrome (PWS) in a 13-year-old girl is reported. The patient presents with systemic and oral manifestations of the disease. Case report The patient shows: obesity, hypotonia, mental retardation, small hands, prominent forehead, strabismus, hypoplastic teeth, poor oral hygiene, caries, oral candidiasis and thick, sticky saliva. This case is reported to underline the importance of the oral and dental problems of these patients. Caries and oral candidiasis are correlated with the reduced secretion of saliva and with poor oral hygiene. The role of paediatric dentistry is considered to be necessary for the prevention of oral complications of this syndrome.

Tiroiditis de Hashimoto: microcirculación lingual y labial en pacientes afectados por macroglosia / Hashimoto's thyroiditis: lingual and labial capillary microcirculation in patients affected by macroglossia

The aim of this study is to estudy lingual and labial microcirculation differences among healthy subjects and those with Hashimoto's thyroiditis affected by macroglossia. Twenty healthy patients and 20 patients suffering from Hashimoto's thyroiditis were examined. Labial and lingual capiUaroscopy were used to investigate the characteristics of microcirculation. For each patient we evaluated visibility, course, tortuosity and the possible presence of microhaemorrhages, average calibre of capillary loops and the number of visible capillary loops per square millimetre. The investigations of the labial and lingual mucous were simple, non invasive and repeatable for each patient. In Hashimoto's thyroiditis patients it was possible to observe a wide vascular architectural disorganisation, morphologic anomalies of the capillary loops, loosening of the U shape, reduced capillary diameter This study shows that capillary alterations in patients suffering from Hashimoto's thyroiditis occur in the labial and lingual mucous microcirculation. In the patients affected by macroglossia a reduced number of capillary density was observed and it was correlated to the deposition of proteinaceous ground substance.

El objetivo de este estudio fue verificar las diferencias en la microcirculación lingual y labial entre sujetos sanos y con tiroiditis de Hashimoto afectados por macroglosia. Fueron examinados 20 pacientes sanos y 20 que sufrían de tiroiditis de Hashimoto. Fue utilizada capiloroscopía labial y lingual para investigar las características de la microcirculación. Para cada paciente examinamos visibilidad, curso, tortuosidad y la posible presencia de microhemorragias, el calibre medio de curvaturas capilares y el número visible de curvaturas capilares por milímetro cuadrado. La investigación de la mucosa labial y lingual fue simple, no invasiva y repetible para cada paciente. En pacientes con tiroiditis de Hashimoto fue posible observar una desorganización arquitectónica vascular, anomalías morfológicas de las curvaturas capilares, pérdida de la forma de U y reducción del diámetro capilar. Este estudio demuestra que las alteraciones capilares en pacientes que sufren de tiroiditis de Hashimoto ocurren en la microcirculación de la mucosa labial y lingual. En los pacientes afectados por macroglosia fue observada una reducción de la densidad capilar y esto está correlacionado a la deposición de...

Microvascular characteristics of the human filiform papillae: a videocapillaroscopic study.

The aim of this study was to observe the microcirculation characteristics of the human filiform papillae in healthy patients in vivo. Twenty healthy patients were examined using lingual capillaroscopy to investigate the characteristics of microcirculation of the human filiform papillae. Visibility, course, tortuosity, as well as the possible presence of microhemorrhages, the average caliber of the capillary loops and the number of visible capillary loops per square millimeter were evaluated for each patient. The investigation was simple, non-invasive and repeatable for each patient. Microcirculation architecture was characterized by a network of capillaries in polygonal mesh with parallel orientation in regard to the surface. Rare microhemorrhages were observed. The caliber of visible capillary loops was 12.50 +/- 1.46 microm (mean +/- SD). The number of visible capillaries was 9.88 +/- 1.06 (mean +/- SD). Our study shows that capillaroscopy of lingual filiform papillae is a practicable method. Future studies might evaluate whether microcirculation in that area is compromised or not during systemic pathologies involving peripheral microcirculation alterations. This method could also be applied to the study of microcirculation in pathologies which strictly pertain to the dental stomatological field.

A randomized trial assessing the effectiveness of different concentrations of isotretinoin in the management of lichen planus.

The aim of our 10-year study was to test the effectiveness of topical therapy based on 0.18% isotretinoin, comparing it with that most frequently used, i.e. at 0.05% concentration. Seventy patients with an established diagnosis of oral lichen planus were involved in the study. The patients were randomly divided into two groups, and the drug was administered topically at 0.05% and 0.18% concentrations. The drug at the higher concentration, according to the same protocol, was administered to the patients who did not benefit from the therapy at the lower concentration. None of the cases of reticular lichen planus showed clinical or histological improvement. In contrast, the atrophic-erosive forms showed a significant improvement, both clinical and histological: in 26 patients (at 0.18% concentration) and in nine patients (at 0.05% concentration), the symptoms, as well as the erosions or ulcers observed, disappeared. The disappearance of dysplasic phenomena was observed at 0.18% concentration. Topical application of the drug was accompanied by an increase in soreness and pain, as well as greater sensitivity to hot foods. However, these side effects were transitory, and considered acceptable by the patients. The proposed therapeutic protocol was effective towards highly active atrophic-erosive oral lichen planus with dysplasic phenomena, which is the form of the disease at higher risk of malignant evolution.

Topical capsaicin application and axon reflex vasodilatation of the tongue: neurogenic involvement in burning mouth syndrome.

The aim of this study was to evaluate the effects of topical capsaicin application on human lingual mucosa and to assess if neurogenic inflammation might have a role in the pathogenesis of lingual diseases. Thirty patients (16 males and 14 females; mean age: 41.46 +/- 11.8 years; range: 23-60) were examined in our laboratory. The neurogenic inflammation was experimentally induced in the lingual mucosa close to 1) the left margin of the tongue and 2) the right margin of the tongue after ipsilateral nerve trunk anesthesia. The characteristics of lingual microcirculation were observed using computerized videocapillaroscopic techniques. The vasodilatation was observed close to the left margin of the tongue, and an important correlation was observed between capsaicin application and capillary tortuosity. No significant modifications in vascular diameter and tortuosity were observed after capsaicin application close to the right margin of the tongue. The results of the present study are of interest, in particular, in regard to recent studies pointing to neurogenic involvement in oral diseases such as burning mouth syndrome.

[Oral capillaroscopy: a new diagnostic method]. / L'esame capillaroscopico orale: nuova metodica diagnostica.

The morphological-functional study of microcirculation is of fundamental importance; in fact, the microvascular bed is directly involved both in autoimmune etiopathogenesis pathologies, and in acute and chronic inflammatory etiopathogenesis pathologies. Oral capillaroscopy is a very stimulating method for studying microcirculation, because of the possibility of studying small vessels in vivo by means of a microscope. Today, it is becoming more reliable thanks to the improvement of the observation tools (photography, videomicroscopy).

Periodontal microcirculatory abnormalities in patients with systemic sclerosis.

BACKGROUND: The aim of this study was to observe the differences in periodontal microcirculation between healthy patients and patients with systemic sclerosis (SSc). METHODS: Fifteen healthy patients and 15 patients with SSc were examined. Periodontal capillaroscopy was used to investigate the characteristics of microcirculation. The visibility, course, tortuosity, possible presence of microhemorrhages, average caliber of the capillary loops, and number of visible capillary loops per square millimeter were evaluated for each patient. RESULTS: The investigation was simple, non-invasive, and repeatable for each patient. In patients with SSc, it was possible to observe a reduced number of capillaries and a greater capillary diameter and tortuosity. CONCLUSIONS: Capillary alterations in patients with SSc are not limited to the nailfold bed but also occur in periodontal mucosa microcirculation. Such evidence could be extremely important in the pathogenesis and treatment of periodontal diseases in patients with SSc.