Dietary Fluoride Intake by Children: When to Use a Fluoride Toothpaste?

Fluoride is recommended for its cariostatic effect, but excessive fluoride intake may have health risks. Increased prevalence of dental fluorosis in areas with low fluoride content in drinking water has been attributed to the inappropriate excessive intake of fluoride supplements (tablets and drops) and toothpaste ingestion. The aim of the present study was to estimate the fluoride intake and the risk of fluorosis in children (6 months-6 years) in the Castelli Romani area (province of Rome, Italy), which is volcanic, therefore with a higher concentration of fluorine. Measurements of the fluoride content in drinking water, mineral waters, vegetables and commercial toothpaste for children were performed. The fluoride concentrations of all samples were determined using a Fluoride Ion Selective Electrode (GLP 22, Crison, Esp). Data were analyzed by descriptive statistics. Differences between samples were determined by Student's t-test. The fluoride content in tap water samples collected from public sources averaged from 0.35 to 1.11 ppm. The Pavona area showed the highest content of fluoride with respect to the others (p ≤ 0.05). The fluoride content in mineral water samples averaged from 0.07 to 1.50 ppm. The fluoride content of some vegetables showed increased mean values when compared to control vegetables (p ≤ 0.05). Within the limitations of the present study, considerations should be made when prescribing fluoride toothpaste for infants (6 months-4 years) in the areas with high fluoride content, because involuntary ingestion is consistent.

In Vitro Evaluation of Structural Factors Favouring Bacterial Adhesion on Orthodontic Adhesive Resins.

Bacterial adhesion to the surface of orthodontic materials is an important step in the formation and proliferation of plaque bacteria, which is responsible for enamel demineralization and periodontium pathologies. With the intent of investigating if adhesive resins used for bracket bonding are prone to bacteria colonization, the surface roughness of these materials has been analyzed, combining information with a novel methodology to observe the internal structures of orthodontic composites. Scanning electron microscopy, combined with focus ion bean micromachining and stylus profilometry analyses, were performed to evaluate the compositional factors that can influence specific pivotal properties facilitating the adhesion of bacteria to the surface, such as surface roughness and robustness of three orthodontic adhesive composite resins. To confirm these findings, contact angle measurements and bacteria incubation on resin slide have been performed, evaluating similarities and differences in the final achievement. In particular, the morphological features that determine an increase in the resins surface wettability and influence the bacterial adhesion are the subject of speculation. Finally, the focused ion beam technique has been proposed as a valuable tool to combine information coming from surface roughness with specific the internal structures of the polymers.

SEM characterization and ageing analysis on two generation of invisible aligners.

BACKGROUND: The purpose of the in vitro study is to investigate and compare the morphological features and the chemical stability in weight of two different polyurethane-based blends, Smart Track (LD30) and Exceed30 (EX30), used for orthodontic aligners manufacture before and after the oral usage. METHODS: Twenty orthodontic aligners were randomly selected: 10 LD30 and 10 EX30, each group was divided in two subgroups, never used and intra-orally aged. By the employment of a Stereomicroscope, a section of 5 × 5 mm was cut from the buccal surface of the incisal region of each aligner. All samples were subjected to Scanning Electron Microscopy and Ageing tests in different solutions to simulate the hostility of the oral environment. The statistical method used was t-test. RESULTS: At SEM images, LD30 appears more homogeneous in texture respect to EX30. However, after clinical usage, both materials show significant structural alterations: findings have been supported by higher magnifications at SEM, by which it is clearly to observe many superficial cracks cross through the polymer structures of LD30U, absent in never used samples. LD30U surface becomes also smoother due to the disappearance of most of the conglomerates, but at the same time also rougher while EX30U shows a greater irregularity and porosity in which large and deep cracks are also highlighted. Although these changes occur persistently, in the aging tests no significant weight loss from both materials has been found, confirming the initial hypothesis of a good chemical stability and safety of both polyurethane mixtures even in conditions of severe hostility. CONCLUSION: LD30 is the expression of the technological evolution of EX30, this is made evident above all by its morphological architecture, more homogeneous and defined but also by the chemical stability that can be appreciated even in evident critic situations.

Use of PRP, PRF and CGF in Periodontal Regeneration and Facial Rejuvenation-A Narrative Review.

Growth factors (GFs) play a vital role in cell proliferation, migration, differentiation and angiogenesis. Autologous platelet concentrates (APCs) which contain high levels of GFs make them especially suitable for periodontal regeneration and facial rejuvenation. The main generations of APCs presented are platelet-rich plasma (PRP), platelet-rich fibrin (PRF) and concentrated growth factor (CGF) techniques. The purpose of this review is to provide the clinician with an overview of APCs' evolution over the past decade in order to give reliable and useful information to be used in clinical work. This review summarizes the most interesting and novel articles published between 1997 and 2020. Electronic and manual searches were conducted in the following databases: Pubmed, Scopus, Cochrane Library and Embase. The following keywords were used: growth factors, VEGF, TGF-b1, PRP, PRF, CGF and periodontal regeneration and/or facial rejuvenation. A total of 73 articles were finally included. The review then addresses the uses of the three different techniques in the two disciplines, as well as the advantages and limitations of each technique. Overall, PRP is mainly used in cases of hard and soft tissue procedures, while PRF is used in gingival recession and the treatment of furcation and intrabony defects; CGF is mainly used in bone regeneration.

FESEM evaluation of smear layer removal from conservatively shaped canals: laser activated irrigation (PIPS and SWEEPS) compared to sonic and passive ultrasonic activation-an ex vivo study.

BACKGROUND: Irrigation of the pulp space is a mandatory step to get rid of all its organic and inorganic content. Activation of the irrigants play a key role in the era of minimally invasive endodontics. The aim of this study was to assess the effectiveness of different irrigants activation methods in removing the smear layer at 1, 3, 5 and 8 mm from the apex from conservatively shaped canals. METHODS: Eighty-five human mandibular premolars were selected. Specimens were shaped to TruShape 25/.06 and divided into 5 groups (1 control and 4 test groups) according to the final activation technique (EndoActivator, EA), Ultrasonic (EndoUltra, PUI) and Laser (PIPS and SWEEPS). EDTA (Ethylenediaminetetraacetic acid) followed by NaOCl (Sodium Hypochlorite) and again EDTA were activated for each test group. Specimens were then split longitudinally and observed by Field Emission Scanning Electron Microscopy (FESEM). Blinded evaluation of the presence of smear layer was performed at 1000X magnification, according to a 5-score index system. Comparison between groups were analysed statistically using the Kruskal-Wallis non-parametric analysis of variance. Bonferroni multiple comparison tests were used. RESULTS: At 1 mm only PIPS and SWEEPS performed better than the control group. At 3, 5 and 8 mm from the apex, every activation technique showed statistically significant reduction of smear layer when compared to the control group. PIPS and SWEEPS obtained better cleanliness result compared to EA, while only PIPS was superior to PUI in terms of cleanliness. CONCLUSIONS: PIPS and SWEEPS showed the best results in conservative canal preparations. Nowadays, contemporary rotary instruments allow fast and minimally invasive shaping of the endodontic space. In this scenario irrigants' activation may be regarded as a mandatory step to a favourable clinical outcome.

Orthodontic Fixed Appliance and Periodontal Status: An Updated Systematic Review.

BACKGROUND: Periodontal implications of orthodontic therapy are frequent, gingival and periodontal conditions need to be evaluated for every appointment. Several studies have analyzed the effects of fixed appliance on periodontal health. OBJECTIVE: To evaluate whether there is updated scientific evidence on the relationship between fixed orthodontic therapy and periodontal health. METHODS: A literature search was performed using the Pubmed and Cochrane databases and manual search; the search was carried out using the keywords "orthodontic" and "periodontal". Articles published only in the English language from January 1997 to April 2017 were included. The inclusion criteria were: RCTs, cohort studies, cross-sectional studies and case-control studies only in English language; only studies on humans, with a minimum sample size of 20 patients and no restriction in terms of patient ages; orthodontic fixed appliances placed into the buccal tooth surface; standardization and training in oral hygiene; Periodontal Index (PI), Gingival Index (GI), Bleeding on Probing (BOP), Pocket Probing Depth (PPD), at least at baseline (before appliance was placed) and after follow up (with a minimum period of 3 months). The exclusion criteria were as follows: absence of baseline data before fixed appliances was placed; patients with systemic diseases, periodontal disease or craniofacial anomalies; removable appliances or orthodontic appliance on the lingual dental surface; and no standardization or training in oral hygiene.Studies were selected by abstract and title; then, inclusion and exclusion criteria were applied. The studies that satisfied the inclusion criteria were evaluated and classified as having low, moderate or high methodology quality. RESULTS: Fifty-five records were reviewed on the basis of title and abstract. After full-text reading, 47 full texts were excluded, and 3 articles were classified as having low methodological quality and 5 as having moderate methodological quality. CONCLUSIONS: The present systematic analysis suggests that there is moderate scientific evidence that a fixed appliance influences periodontal status; no article reported a high score.

Mechanical properties of "two generations" of teeth aligners: Change analysis during oral permanence.

Aim of this in vitro study was to analyze structural properties of two different polymeric orthodontic aligners, Exceed30 (EX30) and Smart Track (LD30), before and after use. Forty patterns of aligners were randomly selected: 20 LD30 and 20 EX30, worn intra-orally for 14±3 days, 22 h/day. From each aligner, 10 specimens were prepared from buccal surfaces of the incisor region by the cutting of samples 5×5 mm under a stereomicroscope. All samples were subjected to Fourier transform infrared spectroscopy, micro-Raman spectroscopy, X-ray diffraction, tensile and indentation strength test. LD30 appeared more homogeneous, with a crystalline fraction lower than EX30 and exhibited a higher elastic behavior and a lower tendency to warp after use than EX30. LD30 demonstrated better adaptability to the dental arch and greater consistency of application of orthodontic forces than produced with EX30. However, both materials showed structural modifications that resulted in increased sample hardness and hyper-plasticity.

Orofacial signs and dental abnormalities in patients with Mulvihill-Smith syndrome: A literature review on this rare progeroid pathology.

BACKGROUND: Mulvihill-Smith syndrome is a rare sporadic condition that was first recognized in 1975. A total of 11 cases have been described in the literature. The aim of this study was to describe the orofacial signs and dental anomalies, their frequency, and the relationship between Mulvihill-Smith syndrome and other progeroid syndromes via a review of the literature. METHODS: A systematic PubMed search was performed to retrieve articles published between 1975 and the present day that described patients affected by Mulvihill-Smith syndrome. The search identified 14 articles, and data on 11 patients were extracted from the selected articles. RESULTS: A total of 7 patients (63.6%) affected by Mulvihill-Smith syndrome were described as having a typical "bird" face. Dental abnormalities, including irregular shape, enamel defects, hypodontia, and taurodontism, were described in 6 patients (54.5%). All patients (100%) had multiple pigmented nevi on the face and a lack or thinning of subcutaneous tissue around the neck and face. Three patients with Mulvihill-Smith syndrome exhibited early onset of tumors of the gastrointestinal tract, including the tongue. CONCLUSION: Mulvihill-Smith syndrome is a clinically complex disease that may be caused by a single gene mutation. Numerous different tissues of the body are affected. This analysis of the orofacial signs may help clinicians to diagnose this rare pathology.

FESEM evaluation of smear layer removal using different irrigant activation methods (EndoActivator, EndoVac, PUI and LAI). An in vitro study.

OBJECTIVES: This study was to compare the efficacy of EndoActivator, EndoVac, PUI, and LAI methods in removing the smear layer from root canals. MATERIALS AND METHODS: Eighty single-rooted mandibular premolars were decoronated to a standardized length of 15 mm. Specimens were shaped to ProTaper F4 (Dentsply Maillefer) and irrigated with 5.25% NaOCl at 37 °C. Teeth were divided into six groups (two control groups [n = 10] and four test groups [n = 15]) according to the final irrigation activation/delivering technique (sonic irrigation [EndoActivator], passive ultrasonic irrigation [PUI], negative apical pressure [EndoVac], and laser activated irrigation [LAI]). Root canals were then split longitudinally and observed with field emission scanning electron microscopy to evaluate the presence of smear layer at 1, 3, 5, and 8 mm from the apex. Scores were analyzed by Kruskal-Wallis and Mann-Whitney U tests. RESULTS: The EndoActivator was significantly more efficient than PUI, LAI, and control groups in removing the smear layer at 3, 5, and 8 mm from the apex. The EndoVac System removed statistically significantly more smear layer than all groups at 1 mm from the apex. At 5 mm from the apex, EndoActivator and EndoVac removed more smear layer than LAI and control groups. At 5 and 8 mm from the apex, PUI and EndoVac did not differ statistically, but both performed statistically better than the control groups. CONCLUSION: In our study, none of the activation/delivery systems completely removed the smear layer from the root canal walls; nevertheless, EV and EA showed, respectively, statistically significant better results at 1, 3, 5, and 8 mm and 3, 5, and 8 mm from the apex.

Autogenous Tooth Fragment Adhesive Reattachment for a Complicated Crown Root Fracture: Two Interdisciplinary Case Reports.

Trauma of anterior teeth is quite a common occurrence in both children and adults. Various degrees of trauma leading to fracture may affect teeth in different ways depending on the age of the patient and extent of fracture and other factors that will be discussed. Guidelines have been given as to how each of these situations should be treated. In the past, often more aggressive restorations were performed to restore fractured teeth. However improved and more efficient adhesion may affect the type of treatment we decide to carry out, leading to more conservative therapies through an increased preservation of tooth structures.

Genotypic and phenotypic heterogeneity in Streptococcus mutans isolated from diabetic patients in Rome, Italy.

Our study focuses on the antimicrobial susceptibility, genotypic and phenotypic heterogeneity, and serotype classification of the Streptococcus mutans isolated from type II diabetic patients (n = 25; age 42-68). Eighty-two percent of isolates were classified as serotype c. No serotype k was present. Macrorestriction analysis of genomic DNA of the isolates exhibited a clonal diversity that paralleled the phenotypic heterogeneity, which was also assessed in terms of biofilm forming ability. Isolates were susceptible to all the classes of antibiotics. In conclusion a great heterogeneity and no antimicrobial resistance were apparent in the considered S. mutans strains from diabetic patients.

Immediate Nonfunctional Loading of Two Single-Maxillary Postextractive Implants: 6-Year Postloading Results of Two Case Reports.

Objectives. The aim of the study was to evaluate and compare crestal bone loss of single-maxillary immediate postextractive implants and immediate nonfunctional loading (INFL) during 72 months of follow-up. Material and Methods. Two single titanium implants (Certain Prevail, Biomet 3I, USA) were placed in two patients using INFL technique. Implant stability and crestal bone level were measured on periapical radiographs at 1, 3, and 6 months after surgery. Results. All osseointegrated implants were clinically successful after 6 years of functional loading. Conclusion. Within the limit of the present case report, the paper supports the concept that INFL of single dental implant can be a successful treatment procedure.

Root Canal Irrigation: Chemical Agents and Plant Extracts Against Enterococcus faecalis.

BACKGROUND: There are various microorganisms related to intra and extra-radicular infections and many of these are involved in persistent infections. Bacterial elimination from the root canal is achieved by means of the mechanical action of instruments and irrigation as well as the antibacterial effects of the irrigating solutions. Enterococcus faecalis can frequently be isolated from root canals in cases of failed root canal treatments. Antimicrobial agents have often been developed and optimized for their activity against endodontic bacteria. An ideal root canal irrigant should be biocompatible, because of its close contact with the periodontal tissues during endodontic treatment. Sodium hypoclorite (NaOCl) is one of the most widely recommended and used endodontic irrigants but it is highly toxic to periapical tissues. OBJECTIVES: To analyze the literature on the chemotherapeutic agent and plant extracts studied as root canal irrigants. In particularly, the study is focused on their effect on Enterococcus faecalis. METHOD: Literature search was performed electronically in PubMed (PubMed Central, MEDLINE) for articles published in English from 1982 to April 2015. The searched keywords were "endodontic irrigants" and "Enterococcus faecalis" and "essential oil" and "plant extracts". RESULTS: Many of the studied chemotherapeutic agents and plant extracts have shown promising results in vitro. CONCLUSION: Some of the considered phytotherapic substances, could be a potential alternative to NaOCl for the biomechanical treatment of the endodontic space.

The gingival Stillman's clefts: histopathology and cellular characteristics.

AIM OF THE STUDY: Stillman's cleft is a mucogingival triangular-shaped defect on the buccal surface of a root with unknown etiology and pathogenesis. The aim of this study is to examine the Stillman's cleft obtained from excision during root coverage surgical procedures at an histopathological level. MATERIALS AND METHOD: Harvesting of cleft was obtained from two periodontally healthy patients with a scalpel and a bevel incision and then placed in a test tube with buffered solution to be processed for light microscopy. RESULTS: Microscopic analysis has shown that Stillman's cleft presented a lichenoid hand-like inflammatory infiltration, while in the periodontal patient an inflammatory fibrous hyperplasia was identified. CONCLUSION: Stillman's cleft remains to be investigated as for the possible causes of such lesion of the gingival margin, although an inflammatory response seems to be evident and active from a strictly histopathological standpoint.

Smear layer removal and canal cleanliness using different irrigation systems (EndoActivator, EndoVac, and passive ultrasonic irrigation): field emission scanning electron microscopic evaluation in an in vitro study.

INTRODUCTION: The purpose of this study was to evaluate the effectiveness of different irrigating methods in removing the smear layer at 1, 3, 5, and 8 mm from the apex of endodontic canals. METHODS: Sixty-five extracted single-rooted human mandibular premolars were decoronated to a standardized length of 16 mm. Specimens were shaped to ProTaper F4 (Dentsply Maillefer, Ballaigues, Switzerland) and irrigated with 5.25% NaOCl at 37°C. Teeth were divided into 5 groups (2 control groups [n = 10] and 3 test groups [n = 15]) according to the final irrigant activation/delivering technique (ie, sonic irrigation, passive ultrasonic irrigation [PUI], or apical negative pressure). Root canals were then split longitudinally and observed by field emission scanning electron microscopy. The presence of debris and a smear layer at 1, 3, 5, and 8 mm from the apex was evaluated. Scores were analyzed by Kruskal-Wallis and Mann-Whitney U tests. RESULTS: The EndoActivator System (Dentsply Tulsa Dental Specialties, Tulsa, OK) was significantly more efficient than PUI and the control groups in removing the smear layer at 3, 5, and 8 mm from the apex. The EndoVac System (Discus Dental, Culver City, CA) removed statistically significantly more smear layer than all groups at 1, 3, 5, and 8 mm from the apex. At 5 and 8 mm from the apex, PUI and the EndoVac did not differ statistically significantly, but both performed statistically better than the control groups. CONCLUSIONS: In our study, none of the activation/delivery systems completely removed the smear layer from the endodontic dentine walls; nevertheless, the EndoActivator and EndoVac showed the best results at 3, 5, and 8 mm (EndoActivator) and 1, 3, 5, and 8 mm (EndoVac) from the apex.

A comparative study of smear layer removal and erosion in apical intraradicular dentine with three irrigating solutions: a scanning electron microscopy evaluation.

INTRODUCTION: This study compared the efficacy of BioPure MTAD (Dentsply Tulsa, Tulsa, OK), 17% EDTA, and 42% citric acid in endodontic smear layer removal and degree of erosion in the apical third of endodontic canals. METHODS: Ninety-six extracted single-rooted human teeth were randomized into four groups (n = 24) and instrumented using System GT nickel-titanium rotary instruments (Dentsply Tulsa, Tulsa, OK). Each canal was irrigated with one of the following solutions: BioPure MTAD, 17% EDTA, 42% citric acid, or 5.25% NaOCl (control). Next, all specimens were irrigated with 5.25% NaOCl. RESULTS: Evaluation by scanning electron microscopy showed no significant differences among test irrigants in removing the smear layer. However, the efficacy of BioPure MTAD and 17% EDTA in removing the smear layer was significantly greater than 5.25% NaOCl (control). The erosive effects of irrigating solutions could not be evaluated. CONCLUSIONS: In conclusion, the protocols used in this study were not sufficient to completely remove the smear layer in the apical third of prepared root canals.

Bacterial colonization of zirconia ceramic surfaces: an in vitro and in vivo study.

PURPOSE: The microbial colonization of new ceramic materials developed for abutment manufacturing was assessed. MATERIALS AND METHODS: The materials used in these experiments were disks of 'as-fired' and 'rectified' ceramic material made of tetragonal zirconia polycrystals stabilized with yttrium (Y-TZP) and commercially pure grade 2 titanium (Ti) with corresponding eluates. They were tested in vitro with the following bacteria: Streptococcus mutans, S. sanguis, Actinomyces viscosus, A. naeslundii, and Porphyromonas gingivalis. Proliferation was evaluated on plates by inhibitory halos around pits, previously inoculated with eluates obtained from the materials. Bacterial adhesion on materials was quantified by spectrophotometric evaluation of the slime production by the same bacteria. Moreover, early bacterial adhesion was evaluated in human volunteers and observed with SEM. RESULTS: No inhibition of bacterial proliferation using eluates was observed. In vitro as-fired and rectified Y-TZP showed significantly more adherent S. mutans than did Ti disks, while S. sanguis seemed to adhere easily to Ti specimens. No differences were noted for Actinomyces spp and P. gingivalis. In vivo Y-TZP accumulated fewer bacteria than Ti in terms of the total number of bacteria and presence of potential putative pathogens such as rods. No differences were observed between rectified and as-fired Y-TZP. DISCUSSION: Overall, Y-TZP accumulates fewer bacteria than Ti. CONCLUSION: Y-TZP may be considered as a promising material for abutment manufacturing.