The impact of COVID-19 on Italian dentists: A cross-sectional survey on 2443 participants.

OBJECTIVE: To evaluate the impact of COVID-19 pandemic among a sample of Italian dentists in terms of infection, strategies for infection control, organization of the dental clinic, attitude, and behavior. MATERIAL AND METHODS: This was a cross-sectional survey. The sample consisted of 8000 Italian dentists selected among 63,375 using a computerized random sampling method. An electronic informed consent had to be signed. The questionnaire categories were on demographic, infection risk management, organization, and dentists' attitude and behavior. Geographic macro-areas were used for subgroup analysis. RESULTS: Among 8000 invited dentists, 2443 agreed to participate to the survey (30.6%). Mean age was 51.2 years, women were 34.5%. A total of 6.1% self-reported COVID-19 experience and higher rate of infection was reported in north Italy compared to the south (p < 0.05). FFP2/FFP3 respirators (97.1%) and visors (97.4%) were used by almost all dentists. While, natural ventilation and mouthwashes were the most frequent approaches used to reduce the infection risk. Most of the dentists reported positive attitude, nevertheless 83.6% felt an increased responsibility. CONCLUSION: The self-reported COVID-19 prevalence was 6.1% with some differences among geographic areas. COVID 19 had a deep impact on preventive strategies, dental office organization, and behavior within this sample.

Reliability assessment of the 2018 classification case definitions of peri-implant health, peri-implant mucositis, and peri-implantitis.

BACKGROUND: The purpose of this study was to evaluate the reliability and accuracy in the assignment of the case definitions of peri-implant health and diseases according to the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions. METHODS: Ten undergraduate students, 10 general dentists, and 10 experts in implant dentistry participated in this study. All examiners were provided with clinical and radiographic documentation of 25 dental implants. Eleven out the 25 cases were also accompanied by baseline readings. Examiners were asked to define all cases using the 2018 classification case definitions. Reliability among examiners was evaluated using the Fleiss kappa statistic. Accuracy was estimated using percentage of complete agreement and quadratic weighted kappa for pairwise comparisons between each rater and a gold standard diagnosis. RESULTS: The Fleiss kappa was 0.50 (95% CI: 0.48 to 0.51) and the mean quadratic weighted kappa value was 0.544. Complete agreement with the gold standard diagnosis was achieved in 59.8% of the cases. Expertise in implantology affected accuracy positively (p < 0.001) while the absence of baseline readings affected it negatively (p < 0.001). CONCLUSION: Both reliability and accuracy in assigning case definitions to dental implants according to the 2018 classification were mostly moderate. Some difficulties arose in the presence of specific challenging scenarios.

Practical Guidelines for Patients with Hypertension and Periodontitis.

Arterial hypertension (AH) and periodontitis are among the most common non-communicable chronic diseases worldwide. Besides sharing common risk factors, an increasing body of evidence supports an independent association between the two conditions, with low-grade systemic inflammation acting as the plausible biological link with increased cardiovascular risk. In 2021, the Italian Society of Arterial Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP) have joined forces and published a joint report on the relationships between AH and periodontitis, reviewing the existing scientific evidence and underlining the need to increase awareness of the strong connection between the two conditions and promote treatment strategies for the control of gums inflammation in patients with AH. The current document extends the previous joint report, providing clinical practical guidelines aimed to support clinicians in the management of patients who suffer from or are at risk of being affected by both conditions. These recommendations are based on careful consideration of the available evidence as well as of the current guidelines on the management of periodontitis and AH and are supported by SIIA and SIdP.

Hypertension and periodontitis: A joint report by the Italian society of hypertension (SIIA) and the Italian society of periodontology and implantology (SIdP).

An accumulating body of evidence supports an independent association between high blood pressure (BP) and periodontitis, possibly mediated by low-grade inflammation. This joint report by the Italian Society of Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP) working group on Hypertension and Periodontitis (Hy-Per Group) provides a review of the evidence on this topic encompassing epidemiology, biological plausibility, relevance, magnitude, and treatment management. Consensus recommendations are provided for health professionals on how to manage BP in individuals showing signs of poor oral health. In summary, (1) large epidemiological studies highlight that individuals with periodontal diseases have increased risk for high/uncontrolled BP independent of confounders; (2) mechanistically, low-grade inflammation might have a causal role in the association; (3) BP profile and control might benefit from periodontal treatment in pre-hypertensive and hypertensive individuals; (4) oral health status should be evaluated as a potential risk factor for high/uncontrolled BP, and effective oral care should be included as an adjunct lifestyle measure during hypertension management. Further research is needed to optimize BP management in individuals with poor oral health.

Role of dental training and distance of the observer on the perception of apically shifted gingival margin with increased vertical tooth size in the esthetic zone.

OBJECTIVES: To evaluate the influence of the gingival contour on the smile esthetics. The influence of size, symmetry, teeth involved in apically shifted gingival margins, and the distance and clinical training of the observer were investigated. MATERIALS AND METHODS: Two groups were identified: 33 first-year dental students (inexperienced) and 40 last-year students (trained). Each observer expressed four evaluations on four different images assigning a score from 0 to 10. Using a picture of an "ideal" female smile, 10 variants were virtually created by shifting (2 and 4 mm) the gingival contour apically at different sites of the upper incisors and canines. A total of 292 evaluations were collected. RESULTS: Considering a score >6 for a "pleasant smile," only one 4 mm single alteration at the canine gingival contour obtained an insufficient score. "Observational distance" and "clinical training" did not influence the final score, while size and symmetry of alterations displayed a significant role. CONCLUSIONS: The dental training of the observer and a close interpersonal distance seemed to be irrelevant in the esthetic perception of gingival margin alterations.

Clinical decision-making and management of stage IV periodontitis: A survey.

OBJECTIVE: To investigate the clinical management of stage IV periodontitis patients among clinicians within the Italian Society of Periodontology and Implantology. METHODS: A cross-sectional study was designed on a web-based anonymous survey. Comparison between ordinary members (OMs) versus active and certified members (ACMs) and comparison between members with at least 10 years of experience in periodontology (Ov10) and members with less than 10 years of experience in periodontology (Un10) were performed. RESULTS: A total of 324 out of 1362 members (response rate of 24%) responded to the questionnaire. ACMs and Ov10 more often reported their teams hold adequate skills to manage cases. Step I and II periodontal therapy took more time in the ACMs and Ov10 groups. ACMs used different strategies to perform step I-II therapy, and antibiotics were used less frequently than OMs. Unresponsive sites were treated more often with surgery by ACMs compared to OMs. ACMs adopted different treatment sequences compared to OMs. Ov10 group used more often CBCT, lateral cephalogram, and wax-up while Un10 group tend to avoid orthodontic therapy. CONCLUSIONS: More experienced members spent more time in step I and II of periodontal therapy, used more diagnostic tools, and performed more often surgery and orthodontics in the treatment of stage IV periodontitis patients.

Implementation of a software application in staging and grading of periodontitis cases.

OBJECTIVES: The purpose of this study was to assess the diagnostic accuracy and the inter-rater agreement among general dentists when staging and grading periodontitis cases with the aid of a software application (SA) developed by the Italian Society of Periodontology and Implantology. MATERIALS AND METHODS: Ten general dentists were asked to independently assess 25 periodontitis cases using the SA. Accuracy was estimated using quadratic weighted kappa and examiners' percentage of agreement with a reference diagnosis provided by a gold standard examiner. Inter-rater agreement was evaluated using Fleiss kappa statistics. RESULTS: The overall case definition agreed with the reference diagnosis in 53.6% of cases. The agreements for each general dentist's pairwise comparisons against the reference definition were at least substantial in 100% of cases for stage, in 70% of cases for grade and in none of the cases for extent. Fleiss kappa was 0.818, 0.608, and 0.632 for stage, extent, and grade, respectively. The study recognized possible reasons that could lead to decreased accuracy using the SA. CONCLUSIONS: Supported by the SA, general dentists have reached substantial inter-rater agreement and highly accurate assignments of stage and grade. However, complete case definitions were correctly diagnosed in slightly over half of the cases.

Aerosol transmission for SARS-CoV-2 in the dental practice. A review by SIdP Covid-19 task-force.

Current evidence suggests that SARS-CoV-2, the virus that causes COVID-19, is predominantly spread from person to person. Aim of this narrative review is to explore transmission modality of SARS-CoV-2 to provide appropriate advice to stakeholders, in order to support the implementation of effective public health measures and protect healthcare workers that primary face the disease. "In vivo" and "in vitro" studies from laboratories and hospitals confirmed the presence of surface contamination and provided insight of SARS-CoV-2 detection in the air, particularly in indoor settings with poor ventilation where aerosol-generating procedures were performed. Measures for aerosol reduction, in conjunction with other effective infection control strategies, are needed to prevent the spread of SARS-CoV-2 in dental setting.

Surface disinfection and protective masks for SARS-CoV-2 and other respiratory viruses: A review by SIdP COVID-19 task force.

OBJECTIVES: Primary focused question for this systematic review (SR) was "Which is the evidence about surfaces decontamination and protection masks for SARS-Cov-2 in dental practice?" Secondary question was "Which is the evidence about surfaces decontamination and protection masks against airborne pathogens and directly transmitted viral pathogens causing respiratory infections?" MATERIALS AND METHODS: PRISMA guidelines were used. Studies on surface decontamination and protective masks for SARS-CoV-2 in dental practice were considered. Studies on other respiratory viruses were considered for the secondary question. RESULTS: No studies are available for SARS-CoV-2. Four studies on surface disinfection against respiratory viruses were included. Ethanol 70% and sodium hypochlorite 0,5% seem to be effective in reducing infectivity by > 3log TCID. Four RCTs compared different types of masks on HCW. The single studies reported no difference for laboratory-diagnosed influenza, laboratory-diagnosed respiratory infection, and influenza-like illness. A meta-analysis was not considered appropriate. CONCLUSIONS: There is lack of evidence on the efficacy of surface disinfection and protective masks to reduce the spread of SARS-CoV-2 or other respiratory viruses in dentistry. However, the consistent use of respirator and routine surface disinfection is strongly suggested. There is urgent need of data on the efficacy of specific protection protocols for dental HCW against viral infections.

COVID-19 and dental workers: The Italian Society of Periodontology and Implantology (SIdP) survey.

OBJECTIVES: To evaluate the proportion of COVID-19 infections among a population of Italian Dental workers across different geographical area of Italy and to analyze the impact of both the preventive measures/strategies adopted and the psychological influences. SUBJECTS AND METHODS: The current cross-sectional survey was administered with a web-based form. To be eligible for the study, participants had to be 18 years and being dentists or dental hygienists members of the Italian Society of Periodontology and Implantology (SIdP). A 23-item questionnaire concerning positiveness to COVID-19, clinical strategies and psychological attitude within the pandemic was administered. Sub-group analysis was conducted according to geographical macro-area. RESULTS: A total of 790 dentists and dental hygienists were included. A total of 4.7% participants developed a positive diagnosis to COVID-19. The Northwest of Italy experienced almost double of COVID-19-positive participants (p < 0.05). Preoperatory mouthwashes together with natural air change/ventilation were the most frequent approaches used to prevent COVID-19 outbreak. Positive and proactive attitudes were predominant among participants. Only a reduced proportion feels some concerns for the future. CONCLUSIONS: Prevalence of positive COVID-19 among dental workers in Italy was double in Northwest area in comparison with the whole country proportion. Preventive strategies comprise mainly ultrasound reduction and preoperative mouthwashes.

Hypertension and Periodontitis: A Joint Report by the Italian Society of Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP).

An accumulating body of evidence supports an independent association between high blood pressure (BP) and periodontitis, possibly mediated by low-grade inflammation. This joint report by the Italian Society of Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP) working group on Hypertension and Periodontitis (Hy-Per Group) provides a review of the evidence on this topic encompassing epidemiology, biological plausibility, relevance, magnitude, and treatment management. Consensus recommendations are provided for health professionals on how to manage BP in individuals showing signs of poor oral health. In summary, (1) large epidemiological studies highlight that individuals with periodontal diseases have increased risk for high/uncontrolled BP independent of confounders; (2) mechanistically, low-grade inflammation might have a causal role in the association; (3) BP profile and control might benefit from periodontal treatment in pre-hypertensive and hypertensive individuals; (4) oral health status should be evaluated as a potential risk factor for high/uncontrolled BP, and effective oral care should be included as an adjunct lifestyle measure during hypertension management. Further research is needed to optimize BP management in individuals with poor oral health.

Evaluation of Floss Remnants After Implant Flossing in Three Different Implant Conditions: A Preclinical Study.

PURPOSE: The aim of this preclinical study was to evaluate whether implant flossing could leave floss residues in three different implant-prosthetic conditions. MATERIALS AND METHODS: Using an anatomical model, three different conditions were studied: correct connection between the implant and abutment and complete insertion of the implant threads into the plaster (control group); misfit of approximately 220 to 230 µm between the implant platform and abutment in the absence of any thread exposure (misfit group); partial exposure of implant threads but absence of misfit (thread group). Twenty-one microstructured tapered threaded implants were divided among the three groups. Each sample was subjected to a flossing procedure using spongy floss, standardized in terms of movement, frequency, time, and pressure. Subsequently, a stereomicroscope examination with a standardized magnification of 10× was performed in order to highlight the possible presence of floss residues on the implant surface. RESULTS: No floss residue was ever detected for the control group. Both misfit and thread groups showed floss residues that were discernible in two different types: microfilaments and amorphous particles. Statistical analysis showed a significant difference for the presence of floss remnants between the control group and the other two experimental groups (P = .005). No difference was observed between the misfit and thread groups. CONCLUSION: This study shows that exposed threads and misfit can induce the release of floss residues during maintenance procedures.

The staging and grading system in defining periodontitis cases: consistency and accuracy amongst periodontal experts, general dentists and undergraduate students.

AIM: The objective of this study was to evaluate consistency and accuracy of the periodontitis staging and grading classification system. METHODS: Thirty participants (10 periodontal experts, 10 general dentists and 10 undergraduate students) and a gold-standard examiner were asked to classify 25 fully documented periodontitis cases twice. Fleiss kappa was used to estimate consistency across examiners. Intraclass correlation coefficient (ICC) was used to calculate consistency across time. Quadratic weighted kappa and percentage of complete agreement versus gold standard were computed to assess accuracy. RESULTS: Fleiss kappa for stage, extent and grade were 0.48, 0.37 and 0.45 respectively. The highest ICC was provided by students for stage (0.91), whereas the lowest ICC by general dentists for extent (0.79). Pairwise comparisons against gold standard showed mean value of kappa >0.81 for stage and >0.41 for grade and extent. Agreement with the gold standard for all three components of the case definition was achieved in 47.2% of cases. The study identified specific factors associated with lower consistency and accuracy. CONCLUSIONS: Diagnosis was highly consistent across time and moderately between examiners. Accuracy was almost perfect for stage and moderate for grade and extent. Additional efforts are required to improve training of general dentists.

Computer-guided implant surgery for immediate implanting and loading: The STIL technique.

A method is described for minimizing errors in positioning a surgical template during the insertion of implants immediately after extraction and the placement of interim prostheses with immediate loading. The technique, called sequential template immediate loading (STIL), uses modular templates to fix pins before extracting the teeth, thus giving a reliable position for the subsequent templates for inserting the implant and placing the interim prosthesis.

Marginal soft tissue recession after lateral guided bone regeneration at implant site: A long-term study with at least 5 years of loading.

BACKGROUND/AIM: This study evaluated marginal soft tissue recession at implants with simultaneous lateral guided bone regeneration (GBR), at least five years after prosthetic loading. MATERIAL AND METHODS: Patients treated with GBR at the time of implant placement and adherent to supportive periodontal therapy (SPT) program with at least 5 years of follow-up were re-examined in 5 clinical centers. At the last follow-up, clinical and radiographic data on peri-implant hard and soft tissue were collected. Multilevel analysis considering center, patient, and implant (brand, length, diameter, position) was performed. RESULTS: A total of 96 patients and 195 augmented implants were included. The mean duration of SPT was 8.3 ± 3.1 years, while mean recall frequency was 4.5 ± 1.3 months. Sixty-five (33%) implants received soft tissue graft before prosthetic delivery. Twenty-one (11%) implants developed biological complications during the follow-up. No implant failure was reported. Mean difference in bone levels (ΔBL) was -0.7 ± 0.9 mm, while mean difference in keratinized tissue (ΔKT) was -0.4 ± 0.9 mm. Eighty-five (44%) implants showed recession (REC) of soft tissue margin (mean 0.6 ± 0.8 mm). The presence of REC was associated with use of non-resorbable membrane (p < .0001) and wider implant diameter (p = .0305), while use of soft tissue graft significantly predicted higher stability of peri-implant mucosal margin (p = .0003). CONCLUSION: Peri-implant mucosal recession is a common feature 5 years after lateral GBR. The risk of recession may be reduced using GBR with resorbable membranes, small diameter implants, and soft tissue grafting before prosthetic treatment.

Immediate Postextraction Single-Tooth Implants and Provisional Crowns in the Esthetic Area: 2-year Results of a Cohort Prospective Multicenter Study- Patient-Centered Outcomes.

PURPOSE: A prospective cohort multicenter study was undertaken to identify risk factors for implant survival, complications, and patient-centered outcomes following single-tooth immediate implant placement and loading in esthetic areas. MATERIALS AND METHODS: Consecutive immediate implants placed in incisors, canines, and premolar sites were included. Variables recorded as possible risk factors included smoking habit, systemic conditions or therapies, previous assumption of bisphosphonates, inability to take amoxicillin, untreated periodontitis, thin periodontium, parafunctional habits, suppuration, bone dehiscences, and buccal bone fracture during implant insertion. Outcome variables included implant survival, recession, other complications, and patient satisfaction. RESULTS: Data of 215 implants in 215 patients were collected in 15 centers in 2 years. One implant was seated with a torque < 30 Ncm and was not immediately loaded. It was successfully loaded 10 weeks after placement and was healthy 2 years later. This implant was excluded from subsequent analysis. Potential risk factors were identified in 116 patients (54.21%). There were 11 dropouts after 1 year and 37 after 2 years. Failures were relatively frequent (14.6%) before the delivery of the definitive prosthesis. No significant association was observed between early failures and risk factors. One failure and six recessions were observed after the definitive prosthesis. High satisfaction scores (mean score of 9.47/10 and 9.55/10 for esthetics and function, respectively) were recorded at 2 years. No recession occurred in the no-risk group. Five mucositis cases and one peri-implantitis case were observed in the 2-year follow-up. CONCLUSION: Failures were frequent before the definitive restoration and could not be explained by specific risk factors. Tissues appeared stable after the definitive restoration. Patients were very satisfied during the follow-up.

Oral Care and Quality Evaluation: A Multicentric Study on Periodontal Treatment.

PURPOSE: No information is available on the perception of the quality of care in patients treated for periodontitis. The purpose of this article was to assess how periodontitis-affected patients perceive the quality of periodontal treatment (PT) and to measure the factors which may influence it. MATERIALS AND METHODS: 306 subjects who completed PT were invited to participate. Questionnaires and visual analogic scales (VAS) evaluating perception of quality of care, symptoms, and oral health related quality of life (OHRQoL) were handed out. Oral and periodontal indicators were collected before and after treatment. The impact of different factors on perception of quality was assessed with a regression model. RESULTS: Quality evaluation was high yet unrelated for both patients and clinicians (p = 0.983). Quality was negatively influenced by the number of residual oral infections (p < 0.001), patient's age (p = 0.07) and presence of residual pain at completion of PT (p = 0.02). Professionalism, kindness of the staff and communication skills were the characteristics mostly appreciated. The OHRQoL was influenced by the number of residual teeth (p < 0.001), increasing age of patients (p = 0.08), number of residual infections (p < 0.01) and pain (p = 0.04). CONCLUSIONS: Patients' quality perception appeared to be influenced by clinical and emotional aspects. Oral care providers should be aware of the impact of non-clinical factors in patients' appreciation of quality of treatment.

A rare case of acute abdomen in the adult: The intestinal duplication cyst. case report and review of the literature.

INTRODUCTION: Duplications of the gastrointestinal tract are rare congenital anomalies that can occur anywhere throughout the gastrointestinal tract. The reported incidence is 1/4500, and more than 80% occurs before the age of two as an acute abdomen or bowel obstruction. The most common site is Ileum (60%), while the colonic localisation is reported between 4 and 18%. PRESENTATION OF THE CASE: Herein we report the case of a 35-year-old man, presented at the Emergency Department with fever and localised abdominal pain in the right iliac fossa. Preoperative abdominal ultrasound and CT scan showed a cystic mass of 44 × 43 × 70 mm adjoining the posterior wall of the right colon. He underwent explorative laparoscopy, laparotomy conversion, right hemicolectomy with an intra-operative diagnosis of colonic duplication cyst, confirmed by histology. DISCUSSION: The review of the literature showed as the intestinal duplication cysts are rare congenital anomalies. The clinical presentation is variable and depends on the site and the related complications. A surgical approach based on the resection of the involved bowel tract is the treatment associated with the best long-term outcomes. CONCLUSION: It is important to include intestinal duplication in the differential diagnosis of acute abdomen, to ensure the best therapeutic strategy.

Coronary artery calcium score and coronary computed tomography angiography for patients with asymptomatic polyvascular (non-coronary) atherosclerosis.

INTRODUCTION: The primary endpoint of this study was to determine the prevalence of coronary artery disease (CAD) and coronary artery calcium score (CACS) using coronary computed tomography angiography (CCTA) among patients with polyvascular atherosclerosis (PVA). Secondary endpoints were to evaluate the prevalence of cardiovascular risk factors and determine the predictors of PVA. METHODS: The presence of atherosclerotic disease was assessed using ultrasonographic vascular examination in 515 asymptomatic patients. All patients with presence of stenosis over 50% and moderate-to-severe cardiovascular risk profile underwent CCTA to identify atherosclerotic coronary disease. RESULTS: Among 515 participants, 143 patients had no evidence of atherosclerotic plaque. Of the 372 patients with atherosclerotic plaque, 184 patients had single-vessel disease, 111 patients had double-vessel disease and 77 patients had triple-vessel disease; among these patients, those who also presented with stenosis > 50% underwent CCTA. Coronary stenosis categories included: normal (6.4%); haemodynamically insignificant (34.6%); intermediate (28.7%); significant (26.6%); and total artery occlusion (3.7%). Based on the coronary vessel involved, the patients were categorised as having single- (41.0%), double- (42.0%) or triple- (17.0%) coronary disease. CACS was significantly higher in patients with double- or triple-vessel disease when compared to those with single-vessel disease. CONCLUSION: Our study confirmed not only the high sensitivity of CCTA for highlighting CAD, but also its negative predictive value for excluding the presence of coronary stenosis or ischaemia. We found good correlation between PVA and CACS, and were able to confirm the risk factors for PVA.