In vitro comparison of the bond strength to the enamel of conventional and self-etching dental fissure sealants.

AIM: Dental caries in pits and fissures of molars is still very common in young people, despite a gradual reduction in their incidence and prevalence. Prevention with the aid of dental fissure sealants can help to reduce the onset of decay. In vitro tests were conducted to compare the bond strength to enamel of self-etching sealants versus those applied using the conventional procedure. METHODS: The lingual surface of 40 extracted, caries-free, mandibular third molars was milled to make them flat. The prepared teeth were randomly divided into two groups of 20 teeth each: those in Group A were treated with Clinpro (3M ESPE, St. Paul, MN, USA); those in Group B with Quick Seal (BJM Laboratories Ltd, Or-Yehuda, Israel). Cylinders of sealant were attached to the enamel of the flat surfaces of the samples using a polymerisation process treating the surfaces involved according to the type of material. All samples underwent load testing by means of a universal test machine. RESULTS: The results of the load testing, measured in MPa, were analysed using the Student's t-test for independent samples and the differences proved significant, indicating that the traditionally- applied sealant (mean strength 21.06 MPa) assured a significantly stronger bond (p <.05) than the self-etching sealant (mean strength 10.43 MPa) under our experimental conditions. CONCLUSION Conventional sealants generally provide a considerably higher bond strength than self-etching sealants.

Assessing the need for computed tomography for lower-third-molar extraction: a survey among 322 dentists.

PURPOSE: Orthopantomograms (OPT) are used to assess the anatomical relationship between the inferior alveolar nerves (IAN) and the roots of third molars and the related risk of postextraction iatrogenic neurological lesions. When the risk is high, computed tomography (CT) or conebeam CT may be warranted. We investigated how dentists judged the need for CT from OPT to ascertain whether they comply with criteria of justification, appropriateness and optimisation in prescribing examinations involving radiation. MATERIALS AND METHODS: A total of 2,713 letters were sent to Italian dentists (Veneto region), inviting them to access an Internet Web site showing 20 OPTs and answer a questionnaire on the need for CT or periapical X-ray. The gold standards were CT images corresponding to the OPTs. The respondents' answers were rated for appropriateness and their tendency to over- or underprescribe CT. RESULTS: The questionnaire was completed by 11.9% of the dentists contacted. The response rate was compatible with a Web survey. Their answers generally came close to the gold standard, achieving a mean appropriateness rating of 0.636 (range 0-1). An overlap between the mandibular canal and the third-molar root was the anatomical relationship most often noted. Recommendations for CT were proportional to the number of radiographic signs indicating a risk of inferior alveolar nerve injury. Periapical X-ray was considered useful by 54.9% of dentists not recommending CT. The main reason stated for not recommending CT was that it was unnecessary for the purposes of the extraction. CONCLUSIONS: Our survey revealed a cautious approach among the professionals interviewed, who tended to overprescribe CT.

Comparison by means of bispectral index score, between anxiolysis induced by diazepam and sedation induced by midazolam.

AIM: Bispectral Index Score (BIS) is an objective tool to assess sedation depth. Benzodiazepines have different pharmacological profiles and diazepam may be safer than midazolam in this setting. The aim of this study was to compare BIS values observed during anxiolysis after diazepam versus sedation after midazolam. METHODS: Thirty-six patients were randomly assigned to 3 groups: group 1 was treated with i.v. diazepam, groups 2 and 3 with iv midazolam 1 and 3 mg, respectively. Sedation was monitored clinically and by means of BIS. BIS values were evaluated as area under the curve (AUC) and compared by variance analysis. The statistical comparison of other data was performed by variance analysis or, alternatively, the χ2 according to Yates. The statistical significance was indicated by P values <0.05. RESULTS: AUC values were significantly lower after midazolam when compared to AUC values registered in diazepam treated patients; 22.6% of the group 3 patients showed BIS values <80, versus 0.4% of group 1 patients. CONCLUSION: Diazepam has a safer profile, with BIS values and clinical conditions according to the definition of minimal and/or moderate sedation. Diazepam represents the safer drug for anxiety management in dentistry, because regularly produces a state of sedation during which verbal contact with the patient is maintained and carry a margin of safety wide enough to render loss of consciousness unlikely.

Influence of estroprogestinic therapy on the postoperative course following impacted third molar extraction.

AIM: Female patients on estroprogestinic therapy undergoing extraction of the third lower molar have a higher incidence of postoperative complications (dry socket -DS- pain). The purpose of this study is to verify such data and analyse if there are risk factors for the appearance of other postoperative complications. METHODS: One hundred eighteen non-smoking healthy patients were included who underwent extraction of the impacted third lower molar (38 on oral contraceptives, OC, 80 as control). After the extraction, patients were prescribed with a pharmacological therapy, consisting of a per os antibiotic and antiseptic rinse. Each patient was examined after 7 days following surgery to verify the state of tissues. In addition subjective postoperative pain (VAS - Visual Analogue Scale) and intake of analgesic drugs were recorded. RESULTS: One case of DS (2.64%) occurred in the OC group, and 1 case of DS occurred in control-patients group (1.25%) (P=0.4436). The postoperative pain proved significantly higher in OC compared to control (first and fifth postoperation day). In OC a predisposition to dehiscence of the wound (86.84% P=0.0021) and emergence of laterocervical lymphadenitis (81.57% P=0.0010) was found, while no cases of postextractive abscesses and trismus of the masseter were found. CONCLUSION: Although no correlation between DS and estroprogestinic therapy has been found, a more difficult healing of tissues has been observed as well as a significantly higher subjective pain index in the postoperative days considered in OC patients.

Extraoral endodontic treatment, odontotomy and intentional replantation of a double maxillary lateral permanent incisor: case report and 6-year follow-up.

AIM: To describe combined endodontic, surgical and orthodontic treatment of a maxillary lateral incisor fused with a supernumerary. SUMMARY: Double tooth is a dental irregularity consequent to fusion of two or more teeth or dental gemination. The teeth most commonly involved are deciduous, but in 0.1% of cases permanent teeth are affected, in which case aesthetic, functional and periodontal problems can result. This paper reports a clinical case of a double tooth in the position of the maxillary right lateral permanent incisor. Combined orthodontic, endodontic and surgical treatment (intentional replantation) allowed the tooth to be retained without periodontal compromise and with a positive orthodontic result both immediately and 6 years following intervention. *A conservative approach that addresses periodontal, pulpal and tooth tissues, can result in the retention of a double tooth. *Maintenance of the root and alveolar bone in young adults at least until full skeletal maturation should be the main treatment objective.

Electronic dental anaesthesia for third inferior molar surgery.

AIM: The aim of this study was to evaluate the efficacy of Electronic Dental Anaesthesia (EDA) for third molar surgery. METHODS: Third molar extraction under regional anaesthesia (inferior alveolar and buccal nerve blocks) was performed in 2 groups of 30 patients each: group 1 = controls, group 2 = EDA treatment. Anxiety and pain level were reported by means of Visual Analogue Scale, postoperative pain description with the McGill Pain Questionnaire. A postoperative phone interview to all patients was made. Computerized randomization was performed; values expressed as mean+/-SD, data comparison evaluated by means of ANOVA and chi squared, statistical significance indicated by P values <0.05. RESULTS: Features of the patients and surgical interventions were similar. EDA has determined lower pain level; moreover, the control patients has shown higher values of blood pressure and heart frequency. Phone interview has reported no amnesia about the perioperative events. A smaller number of EDA treated patients has reported pain during needle prick and/or intraoperatively; 80% of the EDA treated patients has reported a good opinion about the treatment, 93% of the patients would repeat the treatment, if needed. CONCLUSION: EDA is a complementary analgesic technique for dental surgery. Cardiovascular changes, frequently observed during third molar extraction, were not present in the EDA treated patients. These data confirm that EDA is able to modify the physiologic responses to stressful events, blunting the adrenergic upset, maybe by means of an analgesic action on A, fiber and an increase of endorphins' central level. These results underline that the complementary use of EDA in the third molar extraction may be better than regional anaesthesia alone.

Bispectral Index in the sedation with intranasal midazolam and intravenous diazepam in dental practice.

AIM: Aim of this study was to assess by clinical evaluation and by Bispectral Index (BIS) the tranquillizing properties of diazepam injected intravenously, and midazolam by intranasal route according to the body weight in dental patients. METHODS: A group of 34 patients undergoing implantology were divided at random into 2 groups of 17. They were evaluated physically, clinically and psychologically. The psychomotor activity was measured by the Newman's test. Preoperative anxiety was treated with chlordemethyldiazepam (CHDDZ) per os, administered before induction of conscious sedation. In the first group, conscious sedation was accomplished by induction with titrated doses of i.v. diazepam, and in the second group with 0.1 mg/kg of intranasal midazolam. BIS values were analysed as Area Under the Curve (AUC). RESULTS: The AUC BIS values after CHDDZ presedation were overlapping in both groups. AUC after midazolam decreased after induction of the conscious sedation (P<0.05), during anesthesia (P<0.01) and during intervention (P<0.01) compared to the diazepam treatment. In the midazolam group the BIS values were on average lower than 90, while in the diazepam group they were on average higher than 95 (P<0.01). The psychomotor recovery was more impaired after midazolam. CONCLUSIONS: The study shows that nasal route ensures the quick absorption of midazolam as revealed during the first 3 min from drug administration. The depressant effect of midazolam increased as a function of time, reaching the highest levels during intervention. The results suggest that midazolam is endowed with sedative effects which may compromise the state of consciousness of the patient and be incompatible with the definition of conscious sedation in dentistry.

Retrieval of blade implants with piezosurgery: two clinical cases.

In this work an ultrasound device was used to perform an ostectomy for the removal of blade implants in order to save as much bone tissue as possible, so that root form implants might later be inserted. Two patients underwent surgery for the removal of two blade implants (one maxillary, the other mandibular) that were no longer functional. The peri-implant ostectomy was carried out with a piezoelectric surgery device. The instrument demonstrated to be effective and precise during ostectomy, providing an extremely thin cutting line. During the course of the operation and at controls after 7 and 30 days, patients did not show any relevant complications and both still had sufficient alveolar bone to be treated with root form implants. The piezosurgery device proved to be an effective instrument in interventions requiring a significant saving of bone tissue, extreme precision in cutting, and respect of soft tissues.

Histomorphometric evaluation of bone grafts harvested by different methods.

AIM: Many studies proposing the use of autologous bone to correct bony defects of the oral district have been published, and numerous protocols have been proposed to simplify the harvesting of particulate bone. However, no qualitative evaluation of the harvested bone has been reported. The study provides a qualitative evaluation of autologous bone harvested by 9 methods: the harvested bone was analysed through microphotography and histomorphometric analysis, measuring the surface area of bone fragments and the percentages of vital and necrotic bone. METHODS: Nine harvesting methods were employed: round bur on low-speed hand-piece (40000 rpm), bur on high-speed hand-piece, spiral implant bur on low-speed hand-piece (1000 rpm), safe scraper, Rhodes' back-action chisel, rongeur pliers, gouge shaped bone chisel, mectron piezosurgery. Ten bone harvests were taken from the retromolar bone using the 9 methods, during extraction of embedded wisdom teeth (indication to extraction was for orthodontic reasons). The histocytological preparations were analysed with microphotography and histomorphometric analysis, evaluating particle size, percentage of vital bone and number of osteocytes per unit of surface area. RESULTS: Histomorphometric analysis showed that non-vital bone accounted for 100% of harvested bone, with a complete absence of osteocytes, in specimens harvested with burs and safe scraper. Percentage of non-vital bone was intermediate, with a low number of cells, in specimens harvested with back-action, gouge shaped bone chisel, spiral bur and piezosurgery. The best results were achieved with rongeur pliers and by en bloc harvesting. CONCLUSIONS: The results show that the best methods to harvest vital bone are: gouge shaped bone chisel, back-action, en bloc harvesting, rongeur pliers and piezosurgery, although the latter method leaves some empty gaps in the tissue. The bone harvested with round bur on low-speed hand-piece, bur on high-speed hand-piece, spiral implant bur, or safe scraper are not suitable for grafting as indicated by the absence of osteocytes and the predominance of non-vital bone.

Analysis of an anxiolytic technique applied in 1179 patients undergoing oral surgery.

AIM: The aim of this study was to evaluate the effects of sedation with benzodiazepines in a large population of patients undergoing oral surgery and age-related implications. METHODS: A group of 1 179 consecutive patients undergoing oral surgery in the Dental Clinic of the University of Padua between 2001 and 2003 was evaluated by analysing their anaesthesiological records. The patients were divided into 5 age groups. All were pre-sedated with chlordemethyldiazepam per os, while induction of maximum subjective tranquillity was obtained with fractionated doses of intravenous diazepam. Arterial pressure (AP), heart rate (HR), anxiety level, pathologies, drugs taken, types of intervention, techniques of loco-regional anaesthesia, immediately preoperative AP and HR and tranquillity, intraoperative AP and HR, data regarding postoperative psychomotor recovery, complications and drugs used for the treatment of perioperative pain, were evaluated in each group. RESULTS: Most of the patients (679) were in the 45-64 year-old group. Cardiovascular, respiratory and digestive pathologies proved to be age-dependent. Control AP and HR respectively increased and decreased with age. The doses of chlordemethyldiazepam used induced age-dependent preoperative tranquillity levels. The doses of i.v. diazepam necessary to obtain maximal preoperative subjective tranquillity fell as a function of age. The AP and HR values respectively increased during intervention and decreased in the first hour of intervention. Normal psychomotor recovery was less evident in older patients. The most significant corrective intraoperative interventions consisted of the administration of sublingual hypotensive drugs and in the immediate treatment of some cases of orthostatic hypotension and vaso-vagal syncope. CONCLUSIONS: The sedation technique and the antistress procedures employed proved safe and the intra- or postoperative complications almost non-existent. The variations observed in the parameters considered are compatible with the greater age of the treated subjects.

In vitro buffering properties of 3 composite resins.

AIM: A dental composite resin, Ariston pHc, has been described as having a cariostatic effect by buffering acid saliva and preventing decalcification and infiltration of restorations. The buffering effect has been reported due to the release of OH- originated from the alkaline glass embedded in the resin. The release would occur only in the presence of low salivary pH values. The aim of this in vitro investigation was to evaluate pH variations induced by Ariston pHc and 2 other composite resins (P60 and Z100). METHODS: Eighteen samples were prepared for each composite and 5 specimens of each brand were embedded in artificial saliva according to Brugirar and Mazille, at 3 different pH values. A 1(st) group of 5 specimens of each tested resin was immersed in neutral artificial saliva at pH 7.7, a 2(nd) group in acidified artificial saliva at pH 5.45 and a 3(rd) group in alkalised saliva at pH 9.25. Three other samples of each resin were immersed in tubes containing distilled water at pH 7.23 and served as controls. Twelve tubes were filled only with neutral, alkalised and acidified artificial saliva and distilled water at the above mentioned pH values. Measurements of pH modifications were taken after 1, 3, 9, 14, 31 days. RESULTS. Ariston pHc raised the pH of distilled water up to 9.59 after 1 day, and to 8.42 after 31 days. This pH modification shown by Ariston pHc in distilled water, compared to those of the other 2 composites were statistically highly significant, with p<0.001, while the pH variations of saliva containing the 3 resins were negligible, except for acidified saliva with Ariston pHc, where a slight pH enhancement with some statistical significance (p=0.04) was found. However, acidified saliva without any resin embedded was found to shift to neutrality as well. CONCLUSION: These results strongly suggest that none of the 3 tested materials can achieve an effective buffering action in vitro on low salivary pH values. However, the ability of Ariston pHc to raise the pH in distilled water, and to a lesser degree in acidified saliva, suggests that an in vivo buffering effect cannot be excluded.

Endoscopic evaluation of the bone-added osteotome sinus floor elevation procedure.

Sinus floor augmentation using the bone-added osteotome technique (BAOSFE) has been advocated as a predictable procedure when initial residual bone height is 4-6mm. In this report, 16 Osseotite implants were placed using the BAOSFE procedure in eight patients under endoscopic control. Intraoperative graft positioning, potential displacement of the graft material, Schneiderian membrane integrity and distension pattern were evaluated. A small-sized perforation of the sinus membrane was visualized during sinuscopic monitoring in two implant sites without significant loss of graft material confinement. Membrane vertical distension was restricted to the area surrounding the implant apices in four implant sites while a larger detachment of the membrane enfolding the implant tips, the in-between and circumferantial areas was observed in the remaining 12 sites. The two perforated sites demonstrated a localized vertical pattern of membrane distension limited to implant apices. None of the cases complicated by perforation showed clinical signs of ongoing sinus pathology throughout the follow-up period. This limited report suggests that: (1) the BAOSFE procedure in combination with implant placement yields various patterns of sinus membrane elevation; (2) potential membrane perforation may be expected when distension follows a localized vertical augmentation pattern; and (3) small membrane perforations during the BAOSFE procedure are compatible with clinically healthy postoperative sinus conditions.

Simple and safe method to prepare patients with prosthetic heart valves for surgical dental procedures.

Temporary discontinuation of high-intensity oral anticoagulant treatment is not recommended in patients undergoing dental surgery. This policy is not based on solid data from randomized clinical trials but on expert consensus. The alternative, i.e., to continue treatment and treat patients with tranexamic acid mouthwash, often is not applicable. A prospective cohort study was carried out to evaluate bleeding and thromboembolic complications in patients bearing prosthetic heart valves and registering International Normalized Ratio (INR) values between 2.0 and 4.5, who underwent dental procedures after a 2-day suspension of warfarin treatment. One hundred four consecutive patients receiving high-intensity anticoagulation underwent 123 dental procedures after 2 days' warfarin withdrawal. No major bleeding complications occurred in the week after the procedure; minor bleeding requiring local measures occurred in two patients. No thromboembolic events and no cases of bacterial endocarditis were recorded in the 3 months after the procedure. A mean decrease in INR by approximately 1.0 U (from 2.95+/-0,59 to 1.87+/-0,46) occurred after 2 days' warfarin suspension. Seven days after reinitiation of warfarin, INR values returned to the therapeutic range in 90% of cases. The calculated average time spent at INR less than 2.0 (critical value) was 28 hours. Two days' warfarin suspension is a simple and safe policy for patients with prosthetic heart valves undergoing dental surgery.

Role of intramarrow penetration in osseous repair: a pilot study in the rabbit calvaria.

BACKGROUND: The use of intramarrow penetration in combination with osseous reconstructive surgery has been recommended in various periodontal and oral surgical applications. The purpose of this pilot study was to evaluate the effect of intramarrow penetration on the rate of bone neogenesis in protected spaces created on the calvarial bone using occlusive titanium domes in 16 adult white rabbits. METHODS: In each rabbit, 2 standardized circular 1 mm deep slits were prepared in the bone, one on each side of the midline using a trephine. Within the perimeter of one of the slits, the external cortical surface of the skull bone was mechanically perforated using a carbide round bur (experimental site), while the bone surface within the other slit (control site) was left intact. Subsequently, 2 prefabricated titanium domes with an inner diameter of 4.8 mm and an inner height of 3.0 mm were anchored in the prepared slits. The animals were divided into 4 groups of 4 rabbits each and were sacrificed at 10, 21, 42, and 60 days. The specimens were assessed for the percentage bone fill and density of the newly formed bone within the boundaries of the domes. RESULTS: Histomorphometric analysis showed significantly increased bone neogenesis within the experimental domes at 10, 21, 42, and 60 days. A mean total area of 29% newly formed bone was demonstrated in the experimental sites at 21 days, while negligible bone formation (9%) occurred with the control domes at the same evaluation interval. Bone density was consistently higher in experimental domes at all healing intervals. CONCLUSIONS: Within the limits of this study, the results demonstrate that intramarrow penetration accelerates initial bone neogenesis and results in increased bone fill and density, suggesting that its use can be beneficial in bone regenerative procedures.

[The operating and preventive dental ergonomic aspects in a public dentistry service]. / Aspetti di operatività ed ergonomia preventodontica in un servizio pubblico di odontostomatologia.

The authors describe some aspects of an activity of prevention directed to a target group in a hospital stomatology department. They describe locations and their operative destination; the time of intervention in different phases; the considerations on the efficiency of a program of prevention constant in time.

[Walled city project: fluoroprophylaxis in the prevention of caries]. / Progetto città murata: la fluoroprofilassi nella prevenzione della carie.

The Authors evaluate some parameters relative to the concentration of fluoride in the potable water and in that bottled available in the territory of the Ussl no. 19. The integration of these parameters with the data that regard some life habits (frequency of assumption of the fluoride compresses, beverages of common use) in a target group, underlines the importance of the educational aspects of a preventive program in a community environment aiming to obtain the benefits of such method.

[Interceptive treatment in pedodontics]. / Il trattamento intercettivo in pedodonzia.

The Authors point out the expedient that support a normal eruption of the teeth when used during secondary dentition avoiding a following orthodontic treatment.

[Prosthetic solution to multiple tooth agenesis]. / Soluzione protesica delle agenesie dentarie multiple.

The authors present a clinical research on the treatment of dental multiple agenesis using the etching bridges. This is a atraumatic, biocompatible, reversible method which can be used to solve the problem with the patient is young. They suggest same expedients to simplify and standardize the clinical procedures.

[Intracoronal tooth fixation with metal and composite wire: longitudinal study]. / La fissazione dentaria intracoronale con filo metallico e composito: controlli longitudinali.

Dental splints with wire and composite resin: longitudinal controls. 126 intracoronal dental splints with wire and composite were performed in nearly ten years. Clinical results were good enough, because less than 20% of patients needed further cares.