Ridge preservation combined with open barrier membrane technique in case of post-extractive oro-antral communication: a case series retrospective study.

After dental extraction a physiological phenomenon of reabsorption of the dentoalveolar process is triggered, especially if periradicular lesions are present, which can sometimes be associated with oro-antral communication in the upper posterior maxilla. With the aim of proposing a minimally invasive approach, 19 patients undergoing tooth extraction in the postero-superior maxilla were recruited. All cases presented an oroantral communication with a diameter of 2-5 mm after tooth extraction and the alveolar process, in some cases, with a partial defect of one or more bony walls. In these cases, a single surgical procedure was used to preserve the alveolar ridge with an open barrier technique with exposed d-PTFE membrane. The bottom of the extraction socket was filled with a collagen fleece and the residual bone process reconstructed using a bio-material based on carbonate-apatite derived from porcine cancellous bone. After 6 months all patients were recalled and subjected to radiographic control associated to an implant-prosthetic rehabilitation plan. Data relating to the sinus health status and the average height and thickness of the regenerated bone were collected. Radiographic evaluation verified the integrity of the maxillary sinus floor with new bone formation, detecting a vertical bone dimension between 3.1mm and 7.4mm (average 5.13mm ± 1.15) and a horizontal thickness between 4.2mm and 9.6mm (average 6.86mm ± 1.55). The goal of this study was to highlight the advantage of managing an oro-antral communication and, at the same time, to obtain the preservation and regeneration of the alveolar bone crest. The open barrier technique appears to be effective for the minimally invasive management of the oro-antral communication up to 5mm in diameter in post-extraction sites, with a good regeneration of hard and soft tissue.

Antibiotic prescribing for endodontic infections: a survey of dental students in Italy.

AIM: To determine the knowledge of final year undergraduate students attending Italian universities on the appropriate use of systemic antibiotics for endodontic infections. METHODOLOGY: Final year dental students from twenty Italian universities completed a one-page questionnaire on antibiotic use for the treatment of endodontic infections. Data were analysed using descriptive statistics and chi-square tests. RESULTS: A total of three hundred and three students completed the questionnaire. The average duration of antibiotic prescription proposed by respondents was 5.48 ± 1.06 days. Amoxicillin with clavulanic acid was the first-choice antibiotic (85.2%) followed by amoxicillin alone (13.5%), azithromycin (1.0%) and clarithromycin (0.3%), for patients not allergic to penicillin. Clarithromycin was the first-choice drug for patients with a penicillin allergy (56.1%), followed from azithromycin (31.7%), clindamycin (11.9%) and levofloxacin (0.3%). Alveolar abscess with systemic manifestations was reported as the principal reason to prescribe antibiotics (97.7%) followed by the same condition without systemic manifestations (85.5%). For the scenario of irreversible pulpitis, 5% of students considered antibiotics necessary. Almost 52% of students would prescribe antibiotics for apical acute periodontitis; 29.7% would prescribe antibiotics for chronic apical periodontitis with sinus tract, and 13.5% indicated these drugs for chronic apical periodontitis without sinus tract. CONCLUSIONS: The results demonstrate that it is necessary to improve the knowledge of Italian students on antibiotics and indications for their use in endodontics.

Maxillary fungus ball: zinc-oxide endodontic materials as a risk factor.

The objective of this study was to demonstrate the correlation between endodontic treatment on maxillary teeth and fungus ball with inductively coupled plasma mass spectrometry measurement of zinc and other metals (barium, lead and copper) in fungus ball samples. Samples of normal maxillary mucosa were used as comparison. Metal concentration was also measured in several endodontic materials. A significant difference was found between the concentration of zinc and copper in fungus ball compared to normal mucosa. Metal distribution was more similar in fungus ball and in the endodontic materials tested than normal mucosa. The similar metal concentration in the endodontic materials and fungus ball suggests that endodontic materials play a role in the pathogenesis of fungus ball. Endodontic materials accidentally pushed into the maxillary sinus during endodontic treatments may play a crucial role. Dentists should be as careful as possible when treating maxillary teeth to avoid perforating the maxillary sinus floor; the use of zinc-free endodontic materials, as zinc is a metal that plays a pivotal role in fungus growth, should be encouraged.

Histomorphometric evaluation of implant design as a key factor in peri-implant bone response: a preliminary study in a dog model.

AIM: Primary implant stability as the establishment of a direct bone-to-implant contact (BIC) plays a major role in long-term successful implant osseointegration. Numerous factors influencing this initial stability have been studied. This preliminary in vivo study on a dog lower jaw aimed to investigate the hypothesis that primary implant stability in low density bone may be influenced by implant design. METHODS: The authors compared two different implant designs with regard to their immediate quantitative relation to host bone (BIC% and gap area, GA%). The screw-shaped implants, manufactured by Or-Vit (Castelmaggiore-Bologna, Italy), exhibited similar microroughness surface and two different thread pitches: ''narrow-pitch'' implants (NP) and ''wide-pitch'' implants (WP) with a 0.5 mm and 1.5 mm thread pitch respectively. Implants were placed in dog jaw after complete osseous healing of the extractive sockets, according to a delayed implantation procedure. Five hours after surgery the animal was sacrificed. Radiographic, histological, morphometric and ultrastructural analysis were performed. RESULTS: An inverse relation existed among the two parameters BIC and GA: GA, as a region with high osteogenetic potentiality, appeared wider in WP implants; BIC, as the expression of primary mechanical stability, was higher in NP implants. CONCLUSION: Based on this results, we could assume that NP implants might be the clinical choice in case of immediate loading.This single case study might be considered a starting point for further long term in vivo investigations aiming to establish the implant design that best favours osseointegration at different bone quality sites.

Prescriptions of NSAIDs to patients undergoing third molar surgery : an observational, prospective, multicentre survey.

BACKGROUND AND OBJECTIVES: Surgical extraction of an impacted third molar is generally followed by acute post-operative pain that has been shown to be primarily inflammatory. Thus, use of NSAIDs in this context is appropriate and has been shown to be effective. Several drugs are employed for this purpose, but no information exists on the reasons why preference is given to one rather than another. The principal objective of this study was to evaluate the pattern of administration of NSAIDs in patients undergoing surgery for impacted third molar extraction. The study also aimed to collect information on the efficacy, onset and duration of the analgesic effect of routinely prescribed NSAIDs and to assess the duration of treatment with these drugs and their tolerability. METHODS: This was an observational, multicentre, prospective survey. A total of 616 patients (38% male and 62% female) from the Italian Stomatology Clinics of the Universities of Bologna, Brescia, Cagliari, Chieti, Pavia, Pisa, Siena and Varese and from the Department of Oral and Maxillo-Facial Surgery of Semmelweis University, Budapest, were eligible for the study. Patients were evaluated over the 7 days following surgical extraction. NSAIDs were prescribed according to the normal prescribing habits of the centre and physician involved. The main outcomes of interest in the survey were the efficacy, onset and duration of analgesic effect, duration of therapy, and tolerability of the NSAIDs prescribed. RESULTS: Nimesulide was the most prescribed NSAID (68%), followed by diclofenac, ketoprofen and ibuprofen. Because of the low proportion of patients receiving other NSAIDs, these patients were considered a single treatment group for evaluation purposes. Nimesulide, especially when given before patients started experiencing pain after surgery, was more effective than other NSAIDs in reducing the severity of pain on the day of surgery, in delaying the time to maximum intensity of pain, in providing complete pain relief and in prolonging the duration of analgesic effect on the day of surgery. These results are consistent with the known anti-inflammatory and analgesic actions of nimesulide and with the important role of inflammation in the onset of pain after this type of surgery. CONCLUSION: These results confirm nimesulide as an effective reference drug for the treatment of post-operative dental pain and show that it has a positive benefit/risk profile in this setting.

[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.

[Nutrition and carious pathology]. / Alimentazione e patologia cariosa.

Recent researches in animals about correlation between decay and sugar, pointed out that frequency of assumption is more important than quantity. The Authors want to have a confirm examining 1810 5-years-aged children, pointing out the relationship among beverages, sugar-containing foods and dmft index. The results show a caries increment drinking soft drinks beverages. The frequency of sugar containing food assumption seems to be strictly related to dental caries improvement and to the reduction of dmft = 0 cases.