Neuroprem: the Neuro-developmental outcome of very low birth weight infants in an Italian region.

INTRODUCTION: The survival of preterm babies has increased worldwide, but the risk of neuro-developmental disabilities remains high, which is of concern to both the public and professionals. The early identification of children at risk of neuro-developmental disabilities may increase access to intervention, potentially influencing the outcome. AIMS: Neuroprem is an area-based prospective cohort study on the neuro-developmental outcome of very low birth weight (VLBW) infants that aims to define severe functional disability at 2 years of age. METHODS: Surviving VLBW infants from an Italian network of 7 neonatal intensive care units (NICUs) were assessed for 24 months through the Griffiths Mental Developmental Scales (GMDS-R) or the Bayley Scales of Infant and Toddler Development (BSDI III) and neuro-functional evaluation according to the International Classification of Disability and Health (ICF-CY). The primary outcome measure was severe functional disability at 2 years of age, defined as cerebral palsy, a BSDI III cognitive composite score < 2 standard deviation (SD) or a GMDS-R global quotients score < 2 SD, bilateral blindness or deafness. RESULTS: Among 211 surviving VLBW infants, 153 completed follow-up at 24 months (72.5%). Thirteen patients (8.5%) developed a severe functional disability, of whom 7 presented with cerebral palsy (overall rate of 4.5%). Patients with cerebral palsy were all classified with ICF-CY scores of 3 or 4. BSDI III composite scores and GMDS-R subscales were significantly correlated with ICF-CY scores (p < 0.01). CONCLUSION: Neuroprem represents an Italian network of NICUs aiming to work together to ensure preterm neuro-developmental assessment. This study updates information on VLBW outcomes in an Italian region, showing a rate of cerebral palsy and major developmental disabilities in line with or even lower than those of similar international studies. Therefore, Neuroprem provides encouraging data on VLBW neurological outcomes and supports the implementation of a preterm follow-up programme from a national network perspective.

Long-term evaluation (20 years) of the outcomes of coronally advanced flap in the treatment of single recession-type defects.

BACKGROUND: Coronally advanced flap (CAF) has been considered as one of the most predictable and versatile root coverage procedures. Thus, the aims of this study are two-fold: 1) to evaluate the long-term outcomes following CAF in the treatment of gingival recession (GR); and 2) to explore the influence of several tooth/patient-related factors on the stability of gingival margin at 5, 10, and 20 years after surgery. METHODS: Ninety-four patients with 97 GR (73 Miller`s Class I and 24 Miller's Class III) were treated with CAF in a private practice between 1984 and 1996. Recession depth (RD), probing depth (PD), keratinized tissue (KT) width and patient/tooth-associated variables were recorded for each GR at baseline, 1 year, 5 years, 10 years, 15 years and 20 years after surgery. Parametric, non-parametric, and logistic regression statistics were used throughout the study RESULTS: A total of 72 patients with 72 GR were available for analysis at the 20-year follow-up examination (final patients' dropout rate = 23.4%). Statistically significant improvements were found for RD in all evaluations (P < 0.05). Little more than a half (56%) of the sites treated with CAF did not display RD changes between the short-term (i.e., 1 year) and long-term (i.e., 20 years) examinations. Overall, mean root coverage (MRC) decreased from 68.59% to 56.11%. The achievement of complete root coverage (CRC) 1 year after treatment was associated to GR not presenting interdental tissue loss (P = 0.001), the root condition (i.e., lack of non-carious cervical lesion [step] - P < 0.001), an attached KT band ≥ 2 mm (P = 0.019), and baseline RD (P = 0.020). GR recurrence seemed to be influenced by age, RD at 1-year follow-up, sites displaying an attached KT < 2 mm and interdental tissue loss. CONCLUSIONS: The aging process, the condition of the interdental periodontal tissue, and the presence of an attached KT band < 2 mm seem to be negative factors influencing the stability of the gingival margin during the 20-year observation period.

Nonsurgical Treatment of Peri-implantitis Using the Biofilm Decontamination Approach: A Case Report Study.

The aim of this preliminary study is to show the effect of the biofilm decontamination approach on peri-implantitis treatment. Clinical cases showing peri-implantitis were treated using an oral tissue decontaminant material that contains a concentrated aqueous mixture of hydroxybenzenesulfonic and hydroxymethoxybenzenesulfonic acids and sulfuric acid. The material was positioned in the pocket around the implant without anesthesia in nonsurgically treated cases. No instrumentation and no systemic or local antibiotics were used in any of the cases. A questionnaire was used for each patient to record the pain/discomfort felt when the material was administered. All of the treated cases healed well and rapidly. The infections were quickly resolved without complications. The momentary pain on introduction of the material was generally well tolerated and completely disappeared after a few seconds. The biofilm decontamination approach seems to be a very promising technique for the treatment of peri-implantitis. The local application of this material avoids the use of systemic or local antibiotics.

Treatment of Acute Periodontal Abscesses Using the Biofilm Decontamination Approach: A Case Report Study.

The aim of this preliminary study was to show the treatment effect of the biofilm decontamination approach on acute periodontal abscesses. Clinical cases showing acute periodontitis were treated using an oral tissue decontaminant material that contains a concentrated aqueous mixture of hydroxybenzenesulfonic and hydroxymethoxybenzene acids and sulfuric acid. The material was positioned into the pocket on the root surface and left in the site for 30 seconds. No instrumentation was performed before the treatment. No systemic or local antibiotics were used in any of the cases. A questionnaire was used for each patient to record the pain/discomfort felt when the material was administered. All of the treated cases healed well and very rapidly. The infections were quickly resolved without complications, and the pockets associated with marginal tissue recession were also reduced. The momentary pain upon introduction of the material was generally well tolerated in the nonsurgically treated cases, and it completely disappeared after a few seconds. The biofilm decontamination approach seems to be a very promising technique for the treatment of acute periodontal abscess. The local application of this material avoids the use of systemic or local antibiotics.

Critical Evaluation of Complete Root Coverage as a Successful Endpoint of Treatment for Gingival Recessions.

Two differing evaluation criteria for complete root coverage (CRC) were used to compare incidence of CRC after root coverage procedures. Clinical records of 363 patients (386 single recessions) treated between 1984 and 2012 were screened. CRC was assessed 1 year after surgery using two separate evaluation criteria: CRC1, in which the gingival margin was at or above the cementoenamel junction (CEJ), measured using a periodontal probe directly on patients by a single examiner; and CRC2, in which the gingival margin was above the CEJ, rendering it completely invisible based on a visual assessment of high-magnification digitalized images by two calibrated examiners. Descriptive and inferential statistics were performed. The k statistic was also calculated to test the agreement between the two examiners. Four treatment groups were identified: free gingival graft (FGG; n = 116), coronally advanced flap (CAF; n = 107), CAF + connective tissue graft (CTG; n = 131) and guided tissue regeneration (GTR; n = 32). The overall difference between the proportion of CRC1 and CRC2 was statistically significant (P < .0001), as were the intragroup differences for FGG (P = .0002), CAF (P = .0009), and CTG (P = .0002). Treatment of gingival recessions should only be deemed completely successful when root coverage is associated with a gingival margin and a crevice probing depth that is coronal to the CEJ. When root coverage is regarded as complete with gingival margin located at the level of CEJ, it does not represent complete treatment success.

Influence of inter-dental tissues and root surface condition on complete root coverage following treatment of gingival recessions: a 1-year retrospective study.

AIM: To explore the influence of inter-dental tissues and root surface condition on complete root coverage following surgical treatment of gingival recessions. METHODS: Three hundred and eighty-six single recessions treated over 28 years were assessed. Patient-level and periodontal variables, presence/loss of inter-dental tissues, and presence/absence of non-carious cervical lesions (NCCLs) were recorded. Root coverage was assessed 1-year post-surgery. Multilevel analysis was performed to identify predictors of CRC. RESULTS: Based on type of root coverage procedure four patient groups were created: free gingival graft (FGG) (n = 116), coronally advanced flap (CAF) (n = 107), CAF+connective tissue graft (CTG) (n = 131), and guided tissue regeneration (GTR) (n = 32). Percentages of complete root coverage (CRC) were 18.1% for FGG, 35.5% for CAF, 35.1% for CAF+CTG, and 18.8% for GTR. There was an OR = 0.26 (p < 0.0001) of achieving CRC in cases with loss of inter-dental tissue compared with cases with no inter-dental tissue loss. Similarly, cases with presence of NCCL showed an OR = 0.28 (p < 0.0001) of achieving CRC compared with cases without a NCCL. FGG achieved less CRC then CAF+CTG (p = 0.0012; OR = 0.32). CONCLUSIONS: NCCLs, just like inter-dental tissue loss, are significant negative prognostic factors in achieving CRC following root coverage procedures.

Healing of gingival recession following orthodontic treatment: a 30-year case report.

This case report describes the healing of gingival recessions on mandibular incisors resulting from orthodontic treatment of a deep bite malocclusion at a 30-year follow-up observation. The marked improvement in the severe recessions was a consequence of the elimination of the direct trauma, orthodontic intrusion of the affected teeth, and subsequent creeping attachment over time. No periodontal treatment was performed before or after orthodontic treatment.

Análise in vitro da resistência de união ao cisalhamento de uma resina composta à dentina humana e à bovina, tratadas com diferentes sistemas adesivos / In vitro evaluation of the shear bond strength of a composite resin to human and bovine dentin treated with different adhesive systems

O presente trabalho teve por objetivo avaliar, comparativamente, in vitro, a resistência de união ao cisalhamento de uma resina composta à dentina humana e à dentina bovina, submetidas ao tratamento com dois sistemas adesivos convencionais simplificados (Prime Bond NT®, Dentsply e Single Bond®/3M) e dois sistemas adesivos autocondicionantes (AdheSE®/Ivoclar-Vivadent e Adpper Prompt-L-Pop®/ 3M). Para a confecção dos corpos-de-prova, foram utilizadas as superfícies vestibulares de 40 dentes molares humanos e de 40 dentes incisivos bovinos, as quais foram divididas aleatoriamente em 8 grupos de 10 amostras cada, de acordo com o tipo de substrato e o sistema adesivo utilizado: Grupo 1 ­ dentina humana tratada com o sistema adesivo Single Bond; Grupo 2 ­ dentina humana tratada com o sistema adesivo Prime Bond NT; Grupo 3 ­ dentina humana tratada com o sistema adesivo AdheSE; Grupo 4 ­ dentina humana tratada com o sistema adesivo Adpper Prompt-L-Pop; Grupo 5 ­ dentina bovina tratada com o sistema adesivo Single Bond; Grupo 6 ­ dentina bovina tratada com o sistema adesivo Prime Bond NT; Grupo 7 ­ dentina bovina tratada com o sistema adesivo AdheSE; Grupo 8 ­ dentina bovina tratada com o sistema adesivo Adpper Prompt-L-Pop. Após o tratamento das superfícies, com o auxílio de uma matriz bipartida, foram confeccionados cilindros de resina composta Tetric Ceram apresentando 3mm de diâmetro e 4mm de altura. Os corpos-de-prova foram então armazenados em água destilada a 37ºC por 24 horas e submetidos a termociclagem (550 ciclos à temperatura de 10ºC e 55ºC). Após 48 horas de armazenamento em água destilada a 37ºC, foram levados a uma Máquina de Teste Universal para a realização do teste de cisalhamento utilizando-se uma ponta em forma de cinzel e velocidade do atuador de 0,5 mm/min. Os tipos de fratura foram analisados em lupa estereoscópica com 40X de aumento. Os resultados obtidos foram submetidos à análise de variância, ao nível de 5% de significância. Os sistemas adesivos Single Bond e Prime Bond NT apresentaram valores de resistência adesiva semelhantes entre si e significativamente maiores que os sistemas adesivos AdheSE e Adper Prompt-L-Pop, independentemente do tipo de substrato dentinário. A maioria das fraturas encontradas em todos os grupos foi do tipo adesiva. A partir da metodologia e dos resultados obtidos neste trabalho pode-se concluir que o desempenho dos sistemas adesivos autocondicionantes com relação à resistência adesiva foi inferior ao dos adesivos convencionais e que a substituição da dentina humana permanente pela dentina bovina é viável para o teste de resistência de união ao cisalhamento

The purpose of this in vitro study was to evaluate, comparatively, the shear bond strength of a composite resin to human and bovine dentin treated with two conventional simplified adhesive systems (Prime Bond NT®/Dentsply and Single Bond®/3M) and two self-etching adhesive systems (AdheSE®/Ivoclar-Vivadent and Adpper Prompt-L-Pop®/3M). For preparation of specimens, the buccal surface of 40 human molars and 40 bovine incisors were obtained and randomly assigned to 8 groups (n=10), according to the type of substrate and adhesive system used. Group1 - human dentin treated with Single Bond; Group 2 - human dentin treated with Prime Bond NT; Group 3 - human dentin treated with AdheSE; Group 4 - human dentin treated with Adpper Prompt-L-Pop; Group 5 - bovine dentin treated with Single Bond; Group 6 - bovine dentin treated with Prime Bond NT; Group 7 - bovine dentin treated with AdheSE; Group 8 - bovine dentin treated with Adpper Prompt-L-Pop. After treatment with the adhesive systems, composite resin (Tetric Ceram) cylinders (3 mm in diameter and 4 mm high) were fabricated using a split matrix and were bonded to the dentin surfaces. The specimens were stored in distilled water at 37ºC for 24 hours and then submitted to a thermocycling regimen (550 cycles between 10ºC and 55ºC). After 48-hour storage in distilled water at 37ºC, the specimens were taken to a universal testing machine and loaded in shear strength until failure using knife-edgeshearing blade running at a crosshead speed of 0.5 mm/min. Failure mode was analyzed using a stereomicroscope at X40. Data were submitted to statistical analysis by analysis of variance at 5% significance level. The results showed that Single Bond and Prime Bond NT adhesive systems presented similar shear bond strength to each other (p>0.05) and significantly higher means than AdheSE and Adper Prompt-L-Pop (p<0.05), regardless of the type of substrate. An adhesive-failure mode was predominantly observed for all groups. According to the methodology proposed and based on the results of this study, it may be concluded that: the performance of the self-etching systems relative to bond strength was worse than that of the conventional adhesive systems; that the replacement of permanent human dentin by bovine dentin is a viable option for use in shear bond testing

Análise in vitro da resistência de união ao cisalhamento de uma resina composta à dentina humana e à bovina, tratadas com diferentes sistemas adesivos / In vitro evaluation of the shear bond strength of a composite resin to human and bovine dentin treated with different adhesive systems

O presente trabalho teve por objetivo avaliar, comparativamente, in vitro, a resistência de união ao cisalhamento de uma resina composta à dentina humana e à dentina bovina, submetidas ao tratamento com dois sistemas adesivos convencionais simplificados (Prime Bond NT®, Dentsply e Single Bond®/3M) e dois sistemas adesivos autocondicionantes (AdheSE®/Ivoclar-Vivadent e Adpper Prompt-L-Pop®/ 3M). Para a confecção dos corpos-de-prova, foram utilizadas as superfícies vestibulares de 40 dentes molares humanos e de 40 dentes incisivos bovinos, as quais foram divididas aleatoriamente em 8 grupos de 10 amostras cada, de acordo com o tipo de substrato e o sistema adesivo utilizado: Grupo 1 – dentina humana tratada com o sistema adesivo Single Bond; Grupo 2 – dentina humana tratada com o sistema adesivo Prime Bond NT; Grupo 3 – dentina humana tratada com o sistema adesivo AdheSE; Grupo 4 – dentina humana tratada com o sistema adesivo Adpper Prompt-L-Pop; Grupo 5 – dentina bovina tratada com o sistema adesivo Single Bond; Grupo 6 – dentina bovina tratada com o sistema adesivo Prime Bond NT; Grupo 7 – dentina bovina tratada com o sistema adesivo AdheSE; Grupo 8 – dentina bovina tratada com o sistema adesivo Adpper Prompt-L-Pop.

An autologous cell hyaluronic acid graft technique for gingival augmentation: a case series.

BACKGROUND: An autologous cell hyaluronic acid graft was used for gingival augmentation in mucogingival surgery. METHODS: Seven sites from 6 patients were used in this study. Five patients (5 sites) needed gingival augmentation prior to prosthetic rehabilitation, and one patient (2 sites) needed augmentation because of pain during daily toothbrushing. Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depth (PD), and clinical attachment level (CAL) were recorded for the sites at baseline and 3 months after surgery. The amount of keratinized tissue (KT) was measured in the mesial, middle, and distal sites of each involved tooth. A small 2 x 1 x 1 mm portion of gingiva (epithelium and connective tissue) was removed from each patient, placed in a nutritional medium, and sent to the laboratory. The gingival tissue was processed: keratinocytes and fibroblasts were separated and only fibroblasts were cultivated. They were cultured on a scaffold of fully esterified benzyl ester hyaluronic acid (HA) and returned to the periodontal office under sterile conditions. During the gingival augmentation procedure, the periosteum of the selected teeth was exposed, and the membrane containing cultivated fibroblasts was adapted to and positioned on the site. RESULTS: Three months after surgery, an increased amount of gingiva was obtained, and the histological examination revealed a fully keratinized tissue on all the treated sites. CONCLUSION: Tissue engineering technology using an autologous cell hyaluronic acid graft was applied in gingival augmentation procedures and provides an increase of gingiva in a very short time without any discomfort for the patient.