Atomic force microscopy of bacteria from periodontal subgingival biofilm: Preliminary study results

How to study biofilms: technological advancements in clinical biofilm research

Biofilm formation is an important survival strategy commonly used by bacteria and fungi, which are embedded in a protective extracellular matrix of organic polymers. They are ubiquitous in nature, including humans and other animals, and they can be surface- and non-surface-associated, making them capable of growing in and on many different parts of the body. Biofilms are also complex, forming polymicrobial communities that are difficult to eradicate due to their unique growth dynamics, and clinical infections associated with biofilms are a huge burden in the healthcare setting, as they are often difficult to diagnose and to treat. Our understanding of biofilm formation and development is a fast-paced and important research focus. This review aims to describe the advancements in clinical biofilm research, including both in vitro and in vivo biofilm models, imaging techniques and techniques to analyse the biological functions of the biofilm.

Periodontal Disease and Pregnancy: Correlation with Underweight Birth

Periodontal disease is a risk factor for many systemic diseases including preterm birth and underweight birth. The purpose of this systematic review is to analyze the literature and to highlight any clinical correlation. Information sources such as PubMed, MEDLINE, and Web of Science were consulted to obtain our results with these keywords "periodontal disease," "pregnancy," "weight loss" using the connector "AND." After the first screening by authors, only 27 articles were included in this review. From the analysis of the literature, it was noted that the presence of periodontal disease could have a correlation with underweight birth. Surely, control oral hygiene and oral health is essential during pregnancy to reduce risks, and these results should be essential in establishing a protocol to be maintained during pregnancy.

A Bibliometric Study on the Top 101 Most-Cited Articles of Dental Journals of the Middle East/North Africa Countries From 2011 to 2021

Introduction: This retrospective descriptive study evaluated the Scopus-indexed dental journals and their most-cited documents affiliated with the Middle East and North Africa (MENA) countries from 2011 to 2021. Methods: Dental journals affiliated with MENA countries, their bibliometric indicators (SJR, CiteScore, SNIP, and H-index), and the 101 most cited articles of the considered journals were extracted and studied through descriptive statistics. In addition, the "citation per year" of each top 101 articles was calculated. Spearman's rho test was used for pairwise comparisons of the correlation coefficient values between each two of the considered bibliometric indicators. Results: The number of citations of the 101 most-cited papers ranged from 35 to 203. The mean (SD) citations of studied articles were 61.33 (37.58) and the median was 46. Furthermore, CiteScore had the highest significant correlation with SJR (r=0.828, P˂0.001). Moreover, the citation per year of the top 101 documents had no significant relationship with any of the journals' bibliometric indicators. Conclusion: Because journal performance and citation rate are multi-dimensional concepts, a single metric cannot express them thoroughly despite correlations between indices. "European Journal of Dentistry" from Turkey, "Saudi Dental Journal" from Saudi Arabia, and "Iranian Endodontic Journal" and "Journal of Lasers in Medical Sciences" both from Iran had the highest ranks in the SCImago portal and the highest scores in bibliometric indices amongst the MENA dental journals.

Preliminary Evaluation of a NitrAdine-Based Brushing Solution for Patients Suffering from Gingivitis: A Prospective Clinical Case-Control Study

OBJECTIVES

 This article aimed to evaluate the clinical efficacy of a nonantibiotic biofilm-removal formulation based on NitrAdine (PerioTabs), combined with a regular home oral hygiene regimen, in Caucasian patients with gingivitis.

MATERIALS AND METHODS

 A sample of 60 patients were included in this clinical prospective study. All selected subjects underwent regular prophylaxis and professional oral hygiene at baseline; 30 days later, they were recalled for the measurements of the reference parameters about bleeding on probing (full-mouth bleeding upon probing score [FMBS]) and plaque index (full-mouth plaque score [FMPS]); no other clinical procedure was performed. Consequently, half of the patients (n = 30) were instructed to use PerioTabs for 10 days. The remaining patients (n = 30) were used as the negative control, only instructed to continue with their usual oral hygiene regimen. Fifteen days after, the clinical parameters of FMBS and FMPS were re-evaluated in both groups.

RESULTS

 Changes in the scores of clinical indices FMBS and FMPS were calculated and compared. A significant difference between pre- and post-values, for both FMBS and FMPS, was noticed in the test group; in particular, the bleeding index value demonstrated the more significant changes: 22 participants showed a clinically meaningful improvement, and 5 had a small improvement. Only three patients had no evidence of change. In addition, 50% of patients had a reduction in plaque levels. No side effects were reported.

CONCLUSIONS

 The adjunctive use of 10-day PerioTabs treatment in the daily oral hygiene routine seemed to be efficient in reducing gingival bleeding and plaque accumulation, with absence of adverse effects. These results should be confirmed in studies with a larger number of participants following a controlled-blinded design.

Fusobacterium nucleatum Subspecies Differ in Biofilm Forming Ability in vitro

Development of dysbiosis in complex multispecies bacterial biofilms forming on teeth, known as dental plaque, is one of the factors causing periodontitis. Fusobacterium nucleatum (F. nucleatum) is recognised as a key microorganism in subgingival dental plaque, and is linked to periodontitis as well as colorectal cancer and systemic diseases. Five subspecies of F. nucleatum have been identified: animalis, fusiforme, nucleatum, polymorphum, and vincentii. Differential integration of subspecies into multispecies biofilm models has been reported, however, biofilm forming ability of individual F. nucleatum subspecies is largely unknown. The aim of this study was to determine the single-subspecies biofilm forming abilities of F. nucleatum ATCC type strains. Static single subspecies F. nucleatum biofilms were grown anaerobically for 3 days on untreated or surface-modified (sandblasting, artificial saliva, fibronectin, gelatin, or poly-L-lysine coating) plastic and glass coverslips. Biofilm mass was quantified using crystal violet (CV) staining. Biofilm architecture and thickness were analysed by scanning electron microscopy and confocal laser scanning microscopy. Bioinformatic analysis was performed to identify orthologues of known adhesion proteins in F. nucleatum subspecies. Surface type and treatment significantly influenced single-subspecies biofilm formation. Biofilm formation was overall highest on poly-L-lysine coated surfaces and sandblasted glass surfaces. Biofilm thickness and stability, as well as architecture, varied amongst the subspecies. Interestingly, F. nucleatum ssp. polymorphum did not form a detectable, continuous layer of biofilm on any of the tested substrates. Consistent with limited biofilm forming ability in vitro, F. nucleatum ssp. polymorphum showed the least conservation of the adhesion proteins CmpA and Fap2 in silico. Here, we show that biofilm formation by F. nucleatum in vitro is subspecies- and substrate-specific. Additionally, F. nucleatum ssp. polymorphum does not appear to form stable single-subspecies continuous layers of biofilm in vitro. Understanding the differences in F. nucleatum single-subspecies biofilm formation may shed light on multi-species biofilm formation mechanisms and may reveal new virulence factors as novel therapeutic targets for prevention and treatment of F. nucleatum-mediated infections and diseases.

Surface Treatment of the Dental Implant with Hyaluronic Acid: An Overview of Recent Data

Recently, interest has grown by focusing on the evaluation of a molecule already produced in the human body such as hyaluronic acid (HA), as an application to the surface of the titanium implant. Its osteo-conductive characteristics and positive interaction with the progenitor cells responsible for bone formation, consequently, make it responsible for secondary stability. The aim of this work was to analyze the various surface treatments in titanium implants, demonstrating that the topography and surface chemistry of biomaterials can correlate with the host response; also focusing on the addition of HA to the implant surface and assessing the biological implications during early stages of recovery. Used as a coating, HA acts on the migration, adhesion, proliferation and differentiation of cell precursors on titanium implants by improving the connection between implant and bone. Furthermore, the improvement of the bioactivity of the implant surfaces through HA could therefore facilitate the positioning of the dental prosthesis precisely in the early loading phase, thus satisfying the patients’ requests. It is important to note that all the findings should be supported by further experimental studies in animals as well as humans to evaluate and confirm the use of HA in any field of dentistry.

Three-Dimensional Evaluation on Cortical Bone During Orthodontic Surgical Treatment

Adult patients' severe malocclusions, especially the skeletal ones, cannot be exclusively solved by the orthodontic treatment and therefore a combined orthodontic-surgical treatment is necessary. Today, numerous software allows to plane and to visualize the final treatment results simulating the best therapeutic option. This is a retrospective experimental study that aims to analyze the changes in the buccal cortical bone in patients undergoing orthodontics surgeries and to evaluate the correlation between the dental movement and the changes in the relative bone cortex. The study sample consists of 32 subjects. By applying the CBCT radiographic examinations, the measurements were made in well-defined points of reference. The 3D study of the dental changes of position and the cortical buccal bone related variation, suggests how the determined orthodontic movement of the dental element does not achieve an easily predictable bone variation. Therefore, it also suggests that there is no direct proportionality relationship between the extent of bone apposition/reabsorption and dental movement.

The Role of Coconut Oil in Treating Patients Affected by Plaque-Induced Gingivitis: A Pilot Study

Objectives  The aim of the study was to evaluate the coconut oil pulling efficacy as adjuvant in reducing plaque formation and in treating plaque-induced gingivitis.

Materials and Methods  A sample of 20 patients was divided into two groups: a study and a control group. In the study group, coconut oil, in form of mouthwash, was administered to a sample of patients affected by gingivitis, aged between 18 and 35. The protocol established a daily application of the product for 30 days, where clinical parameters for plaque formation and gingivitis—plaque index (PI), bleeding index (BI)—will be evaluated during the recalls on a specific periodontal chart. The control group did not associate a coadjuvant to the normal daily oral health procedures and the same clinical parameters were evaluated at t0 and after 30 days (t1). The data were statistically analyzed using Student’s t -test, establishing the significance level as p < 0.05.

Results  PI and BI decreased in both groups, with a more relevant and significant drop in the study group, from a mean value of PI of 58.0 to 19.3 and a mean value of BI of 33.5 to 5.0. In the control group, the values decreased, respectively, from 53.9 to 29.1 for PI, and from 33.5 to 16.2. Furthermore, no significant side effect was reported during coconut oil pulling therapy.

Conclusions  The collected data showed significant and promising improvements in reducing plaque formation and gingivitis. However, further researches have to be performed to have more consistent and statistically significant data on larger samples and to fully understand the mechanisms of action and effectiveness.

Transcortical bone capillary vessels network: implication on the maxillofacial district

INTRODUCTION

The field of medicine takes steps forward every day. Although some aspects of our organism seem clear, scientific discoveries also affect fields such as anatomy. Recently, transcortical vessels (TCVs) have been debated, although it was thought that cortical bones were not interested by these structures. This would upset some concepts of oral surgery, maxillofacial surgery, periodontics and implantology.

EVIDENCE ACQUSITION

In this study an analysis of the literature on this topic was carried out, and it is proposed to understand the possible implications of TCVs to the oral health.

EVIDENCE SYNTHESIS

Being a current topic, the aim of the study is to promote research in this field, leading to the evidence of these anatomical structures in the maxillofacial district. This study is of a prospective type, there are no other results that speak of these vessels in the maxillofacial district, waiting for a histological study.

CONCLUSIONS

The purpose of the study, therefore, is to shed light on this topic, so that the research could move in this direction.

Socioeconomic behaviors on dental professions: a Google Trends investigation in Italy

INTRODUCTION

Dental profession has expanded, and the knowledge that oral health affects systemic health is of greater concern to patients. The purpose of this study is to understand the demand for dental treatments in Italy, knowing if there is any correlation between socioeconomic condition and oral rehabilitation typology. Moreover, focusing on the requested rehabilitations type and on finding alternatives, unconventional solutions.

EVIDENCE ACQUISITION

The research was conducted using an important research database defined Google Trends, with search terms such as "dolore denti" (toothache). A statistical analysis has been conducted in this study evaluation Pearson Correlation Coefficient.

EVIDENCE SYNTHESIS

The results divided region by region provide data that reflect the socio-economic conditions of the population concerned. Other results have been obtained from government source, to learn about the economic situations of the individual regions, for this reason the GDP was examined. Furthermore, there are important results regarding the parasanitary professions to which patients, for economic reasons, tend to refer.

CONCLUSIONS

This study will surely be an excellent starting point to investigate professional abuse and above all to assess the needs of the different regions.

Periodontal parameters in adult patients with clear aligners orthodontics treatment versus three other types of brackets: A cross-sectional study

OBJECTIVE:

To assess the gingival parameters in the clear aligner treatment versus the three other types of brackets, i.e., conventional metal, conventional ceramic, and metal self-ligating.

MATERIALS AND METHODS:

Eighty patients coming for regular appointments undergoing orthodontic treatment were included. They were further divided into four groups with 20 patients in each: Group one underwent conventional brackets (CB) treatment; Group two had conventional ceramic brackets (CCB); Group three was treated with self-ligating (SL) brackets; Group four underwent with clear aligner (CA) treatment. Inclusion criteria were any patient with a minimum age of 18 years having Class II, Class III skeletal relationship, undergoing orthodontic treatment for at least 6 months with fixed orthodontic appliances (FOA) on both arches. While smokers, pregnant, diabetics, or those taking medication affecting gingival health or having cardiovascular diseases were excluded. Also excluded were patients who used antiseptic solutions or mouthwash during the past 6 months, underwent any periodontal treatments in the past 6 months, or who had fixed bridges and crowns or extensive restorations close to the gingival margins. Seven indices, namely plaque index, gingival index, gingival bleeding index, sulcus bleeding index, papillary bleeding index, basic periodontal examination index, and bleeding on probing index, were recorded for all groups.

RESULTS:

Mean age for Group 1 with CB was 26.65 ± 5.15 years, whereas it was 27.65 ± 8.15 years for Group 2 with CCB, and 26.85 ± 5.19 for Group 3 with SB. Group-4 with CA treatment had a mean age of 26.85 ± 4.83 years. Multivariate analysis and a Bonferroni correction was performed (P = 0.008). CA treatment has better periodontal parameter values compared with the CB and the CCB groups, and no significance difference with the SL brackets group.

CONCLUSION:

CA treatment has better periodontal indices levels compared to other types of orthodontic treatments such as CB and the CCB groups; no significant difference with the SL brackets group. Importance should be given to oral hygiene instructions before, during, and after the treatment.

Tea Tree Oil versus Chlorhexidine Mouthwash in Treatment of Gingivitis: A Pilot Randomized, Double Blinded Clinical Trial

Objective  The study evaluated the efficacy of tea tree oil for the treatment of gingivitis.

Materials and Methods  The tea tree oil was administered in the form of mouthwash and then compared with a mouthwash with chlorhexidine 0.12%. Both treatments were domestic and lasted for 14 days. Patients were chosen according to random criteria, aged between 18 and 60 years, and who showed a clinically evident gingivitis. In clinical evaluation, the following clinical criteria were taken into consideration: gingival index (GI), plaque index (PI), bleeding index (BI), probing depth (PD), the presence of dental dyschromia, and the presence of taste alteration. The subjects were evaluated before (T0) and after the treatment (T1), and the data collected for each patient were recorded on a periodontal chart.

Results  The comparison showed that tea tree oil offered a better improvement in the evaluation of PI, BOP, and PD; furthermore, it did not cause dental dyschromia and taste alteration. In group A, treated with tea tree oil, PI decreased from 53.25 to 5.50% and BI from 38.41 to 4.22%. In group B, treated with chlorhexidine PI decreased from 47.69 to 2.37% and BI from 32.93 to 6.28%. Instead, the subjects using chlorhexidine 0.12% blamed a distaste for the product that caused a slight taste alteration; 20% of them showed iatrogenic dental dyschromia.

Conclusions  The collected data showed the efficacy of both treatments. Although further research works will be necessary, this study showed that tea tree oil could be an effective nontoxic substitute for the therapy of gingivitis.

Water Contamination Risks at the Dental Clinic

Dental clinics, furnished with an array of specialized equipment, are commonplace, particularly in industrialized countries. Minimizing the risk of infection at the dental practice requires the formulation and implementation of strict protocols. These protocols must address the real risk posed by water contamination, particularly given that water is both integral to the function of some dental equipment, and is typically administered directly to the patient. The water in the dental clinic may be of local origin or from a water main, this can be problematic since the clinician often has little assurance regarding the quality of water reaching the dental chair. Though most modern dental equipment includes self-sterilization protocols, care must be taken that water does not stagnate anywhere in the dental equipment or clinic. The management of water quality at the dental clinic is an important part of respecting the protocols needed to manage the risk of patient infections.

Implant-Supported Prosthesis for Edentulous Patient Rehabilitation. From Temporary Prosthesis to Definitive with a New Protocol: A Single Case Report

This case study concerns a patient who had lost all of his teeth, needing a rehabilitation with total prosthesis, who went to the dentist looking for help to overcome psycho-physical trauma and to overcome functional and social problems related to being a prosthesis wearer. Tooth loss occurs most in old age, even if it is not a direct consequence of aging. The rehabilitation of oral functions allows the patient to speak, chew, smile and feel confident in his own aesthetics and therefore improve, even a lot, his well-being in social relations. It is very important in oral rehabilitations to evaluate their type and therapeutic timing. This study stems from the idealization of a new protocol to simplify the supported oral rehabilitations. In this manuscript, a patient was considered and shown according to a complete photographical documentation all the phases. Rehabilitation included the use of Osstem (Osstem, Seoul, Korea) and equator type abutments (Rhein83, Bologna, Italy). This manuscript claims to represent the first of a whole series of cases demonstrating the utility of this protocol.

We Do Not Eat Alone: Formation and Maturation of the Oral Microbiota

From the earliest moments of life, contact with the outside world and with other individuals invalidates the sterility of the oral cavity. The oral cavity passes from a sterility condition, that is present only during intrauterine life, to a condition in which a microbiota organizes and evolves itself, accompanying the person throughout their life. Depending on a patient’s age, systemic conditions and/or oral conditions, different characteristics of the oral microbiome are shown. By verifying and analyzing this process it is possible to understand what is at the basis of the etiopathogenesis of some oral pathologies, and also the function of the oral microbiome.

Between Innovation and Standardization, Is There Still a Room for Scientific Reports? The Rise of a Formatting Tradition in Periodontal Research

Everybody, regardless of their role, is aware that biomedical research is rapidly evolving, and the demand for reproducibility is increasing together with the amount of novel information. “Before reproducibility must come pre-producibility” “Checklists work to improve science”, just to quote some of the articles querying how to find a new bridge between ethics in science and the urgency for publishing. Looking for papers on anti-inflammatory compounds in periodontics, we came across a significant number of articles that could be considered a prototype of a consistent study format. The literature on the testing of active compounds on lipopolysaccharides- (LPS)-induced inflammation in gingival fibroblasts was searched to identify studies that followed a consistent format, to better understand their similarities and assess the appropriateness of their methods. Several studies were identified with a degree of similarity in their methods and formatting that was so high that it was possible to rule out that it was due to chance, and a format template common to these studies was outlined. Although this was most likely beyond the intentions of their authors, these studies may pose the basis for an in-vitro testing standard for anti-inflammatory compounds; however, the dangers of acritical uniformity are also apparent.

Reliability of a Virtual Prosthodontic Project Realized through a 2D and 3D Photographic Acquisition: An Experimental Study on the Accuracy of Different Digital Systems

AIMS

The study aims to assess the accuracy of digital planning in dentistry, evaluating the characteristics of different intraoral 3D scanners and comparing it with traditional imaging 2D recording methods. Specifically, using computer aided design (CAD) software and measuring inside CAD software, authors want to verify the reliability of different models obtained with different techniques and machines.

METHODS

12 patients that needed aesthetic restorative treatment were enrolled in the study. All the patients underwent recording data of the height and width dental elements 1.1, 1.2, and 1.3 size using different technologies and comparing 2D with 3D methods. A T test was then applied in order to verify whether there was a statistically significant difference between the measurements obtained, comparing the different tools data (Emerald, TRIOS, Photogrammetry and DSS (Digital Smile System)) with the reference values.

RESULTS

No significant differences emerged in the measurements made with the different scanners (Trios 3Shape ®, Planmeca Emerald ®) and photogrammetry. Therefore, what should be underlined regarding the 2D measurements is the speed and simplicity compared to all 3D techniques, so this work can help to better define the field of application and the limits connected to 2D techniques, giving a good window of the technique.

CONCLUSIONS

The low number of patients is not sufficient to provide statistically significant results, but the digital planning future prospects seem to be promising. This study results highlighted how a photogrammetric scanner for dental arches would only have a much smaller shooting field size and greater accuracy. Despite these considerations, the photogrammetric facial scanner provided excellent results for the measurement of individual teeth, showing a great versatility of use.

Salivary Biomarkers and Oral Microbial Load in Relation to the Dental Status of Adults with Cystic Fibrosis

The mutation of cystic fibrosis transmembrane conductance regulator (CFTR) can modify the physical and chemical properties of saliva, which in turn can affect the oral microflora and oral health in patients with cystic fibrosis (CF). The aim of the study was to examine oral health status, salivary properties, and total oral bacteria count in CF adults. Dental status was assessed using the decayed missing filled surfaces (DMF-S) index, and oral clearness using the approximal plaque index (API). The Saliva-Check BUFFER test was used to assess saliva, and real-time polymerase chain reaction (PCR) test to determine the total oral bacteria count. CF patients in comparison to healthy controls showed a higher level of examined clinical indices, higher total oral bacteria count, lower salivary flow rate, lower salivary pH, and increased viscosity. Conclusions: In CF patients, saliva properties, accompanied by insufficient dental care, might be an essential dental caries risk factor. In CF patients, among the etiological factors for dental caries, the bacterial agent seems to be less significant. The frequent and long-term infectious pharmacotherapy can probably explain that. A great deal of the information collected on the oral environment in CF patients, which has helped us understand the etiological conditions for inflammation and infection in this area of the body, indicates that proper dental care can mostly counteract these pathologies.

Porphyromonas gingivalis, Periodontal and Systemic Implications: A Systematic Review

In recent scientific literature, oral infections and systemic manifestations, or correlations between oral health and systemic diseases are a topic of discussion. Porphyromonas gingivalis is one of the bacteria implicated in the biofilm formation of bacterial plaque, and plays an important role in the progression of periodontal disease. In this systematic review authors have evaluated the literature of the last 10 years on P. gingivalis and all the systemic implications proven. This study therefore evaluates all the districts of the organism in which this bacterium may have implications. From the results it emerges that P. gingivalis has implications in the onset of different systemic pathologies, including rheumatoid arthritis, cardiovascular pathologies, and neurodegenerative pathologies. Surely, understanding the mechanisms of diffusion of this bacterium, it would be possible to prevent a series of pathologies. Thus, putting the dentist clinician at the center of prevention for these diseases.

Milestones of Dentistry: Advent of Anesthetics in Oral Surgery

The history of dentistry, of course, has followed a constant development since the dawn of society. The dental profession, reserved in ancient times to people with special skills and high rank, after the Middle Ages was diminished and practiced by barbers. The pharmacological evolution of oral surgery techniques has led this branch, today as never before, to obtain a level of specialization and preparation comparable to all other specialist medical branches. Some milestones in the history of dentistry will be considered so as to finally understand how the importance of anesthetic drugs was of primary importance, and which drugs are used today.

Conscious Sedation in Dentistry

Invasive dental procedures can be performed only with local anesthesia; in some cases, it may be useful to combine the administration of drugs to obtain anxiolysis with local anesthesia. Sedation required level should be individually adjusted to achieve a proper balance between the needs of the patient, the operator, and the safety of the procedure. Surgical time is an important factor for post-operative phases, and this could be greatly increased by whether the patient interrupts the surgeon or if it is not collaborative. In this manuscript some dentistry-used methods to practice conscious sedation have been evaluated. This manuscript could be a useful reading on the current state of conscious sedation in dentistry and an important starting point for future perspectives. Surely the search for safer drugs for our patients could have beneficial effects for them and for the clinicians.

Comparison of Two Low-Profile Prosthetic Retention System Interfaces: Preliminary Data of an In Vitro Study

In recent years, a major research goal of companies has been to create mechanical components suitable for rehabilitation that are safer and more reliable. Evaluating their biomechanical features could be a way to improve them. The purpose of this study was to evaluate the different biomechanical features of low-profile retentive systems (Rhein®). Two different attachment systems were tested: OT Equator® Smart Box and Locator® R-TX. Once a machine was created for the simulation of the connection and disconnection of the attacks in a combined manner, it was possible to evaluate these parameters over time. Attachments were mounted in two different configurations of the divergence angle: 10° and 50°. The drop retention force proved to be stable over time. The Locator® R-TX attachment experienced a more rapid decrement of the retention force than the OT Equator® Smart Box. Both tested systems experienced a high drop in retention; this drop tended to stabilize after 1.5 years of use, and it was correlated with the divergence angle. The OT Equator® Smart Box system underwent this loss of retention more gradually than the Locator® R-TX. This study demonstrates preliminary results from a bioengineering and biomechanical point of view, providing useful information for the continuous improvement of these devices and, therefore, for the quality of patients' oral health.

Prosthetic and Mechanical Parameters of the Facial Bone under the Load of Different Dental Implant Shapes: A Parametric Study

In recent years the science of dental materials and implantology have taken many steps forward. In particular, it has tended to optimize the implant design, the implant surface, or the connection between implant and abutment. All these features have been improved or modified to obtain a better response from the body, better biomechanics, increased bone implant contact surface, and better immunological response. The purpose of this article, carried out by a multidisciplinary team, is to evaluate and understand, through the use also of bioengineering tests, the biomechanical aspects, and those induced on the patient's tissues, by dental implants. A comparative analysis on different dental implants of the same manufacturer was carried out to evaluate biomechanical and molecular features. Von Mises analysis has given results regarding the biomechanical behavior of these implants and above all the repercussions on the patient's tissues. Knowing and understanding the biomechanical characteristics with studies of this type could help improve their characteristics in order to have more predictable oral rehabilitations.

Properties of Nanohydroxyapatite Coatings Doped with Nanocopper, Obtained by Electrophoretic Deposition on Ti13Zr13Nb Alloy

Nowadays, hydroxyapatite coatings are the most common surface modification of long-term implants. These coatings are characterized by high thickness and poor adhesion to the metallic substrate. The present research is aimed at characterizing the properties of nanohydroxyapatite (nanoHAp) with the addition of copper nanoparticle (nanoCu) coatings deposited on the Ti13Zr13Nb alloy by an electrophoresis process. The deposition of coatings was carried out for various amounts of nanoCu powder and various average particle sizes. Microstructure, topography, phase, and chemical composition were examined with scanning electron microscopy, atomic force microscopy, and X-ray diffraction. Corrosion properties were determined by potentiodynamic polarization technique in simulated body fluid. Nanomechanical properties were determined based on nanoindentation and scratch tests. The wettability of coatings was defined by the contact angle. It was proven that nanoHAp coatings containing nanocopper, compared to nanoHAp coatings without nanometals, demonstrated smaller number of cracks, lower thickness, and higher nanomechanical properties. The influence of the content and the average size of nanoCu on the quality of the coatings was observed. All coatings exhibited hydrophilic properties. The deposition of nanohydroxyapatite coatings doped with nanocopper may be a promising way to improve the antibacterial properties and mechanical stability of coatings.

Psychological Factors in Dental Patient Care: Odontophobia

Dentistry and oral health are at the heart of the systemic health of humans. Often this branch of medicine is underestimated either due to socioeconomic reasons or due to fear. In fact, in dentistry, there is often a widespread condition of odontophobia among patients. A clinician's knowledge of this condition, and an accompanying understanding of how to successfully manage it, is surely one of the first steps to gaining a patient's trust and maintaining his or her patronage. Being able to manage a dental phobic patient in the best way is the key to successful therapy. Psychological techniques often have to work alongside dentistry in managing these patients. A future perspective concerns precisely the implementation of non-invasive practices such as hypnosis in the management of the latter.

Peri-implantitis and extracellular matrix antibodies: A case-control study

OBJECTIVE

The aim of this case-control study was to compare patients with a healthy peri-implant environment and patients affected by peri-implantitis, evaluating the occurrence of antibodies to extracellular matrix (ECM) molecules. The authors hypothesized the presence of ECM autoantibodies in serum of peri-implantitis patients.

MATERIALS AND METHODS

Patients were divided into two groups: one with dental implants with a diagnosis of peri-implantitis and one control group with implants classified as being "healthy." Enzyme-linked immunosorbent assay was performed on patients' sera to detect human antibodies to type I, III, IV, and V collagens, laminin, and fibronectin. Fisher exact test was performed to evaluate statistical association, with a significant P < 0.05.

RESULTS

Forty-two patients were enrolled in this study, 27 females (64.28%) and 15 males (35.72%) with a mean age of 53 ± 29.69 years (age range 32-74). The presence of antibodies to CIII was recorded in 6/21 (28.57%) patients of test group, compared to just 2/21 (9.52%) for the control group, showing a statistically significant difference (P < 0.05). Other antibodies tested were found to be not statistically significant or absent.

CONCLUSIONS

Within the limitations of this study, it can be concluded that further studies, with larger sample and different design, are necessary to address the research purpose, evaluating possible associations between anti-ECM antibodies and peri-implantitis.

Shifts of subgingival bacterial population after nonsurgical and pharmacological therapy of localized aggressive periodontitis, followed for 1 year by Ion Torrent PGM platform

The possibility of targeting the hypervariable region V3 of the 16S rRNA gene using Ion Torrent Personal Genome Machine (PGM) could provide a complete analysis of subgingival plaque samples, potentially able to identify microbiological species missed by culture-based methods. A 16-year-old female smoker patient, affected by localized aggressive periodontitis, underwent a full-mouth disinfection protocol and was inserted in a 3-month recall program. Microbiological samples were collected at baseline and at 30, 100, 365 days follow-up and analyzed by Ion Torrent PGM. Capnocytophaga, Fusobacterium, Prevotella, and Treponema were the most represented pathogens at baseline. Nonsurgical treatment and systemic antibiotics drastically lowered the anaerobic species, and their presence remained limited after 100 days, while a consistent recolonization by anaerobic bacteria was detected at 365 days. The patient showed a general improvement of periodontal conditions. Differently from polymerase chain reaction and other microarray techniques, Ion Torrent performs a quantitative analysis of the microbiota, irrespective of the searched species. An accurate definition of the shifts of the bacterial community might help periodontal researchers for a better understanding of the impact of different treatment approaches or in intercepting nonresponsive conditions.

Dentists' knowledge and practice regarding prevention of infective endocarditis

Objectives:

The objective of this study is to assess the knowledge and practice of dentists from Jordan, regarding prevention of infective endocarditis (IE) in dental practice.

Materials and Methods:

A sample of Jordanian dentists was interviewed regarding their IE knowledge and practice using a validated and pretested survey instrument.

Results:

Most of the dentists have encountered a patient with IE who needed prophylactic antibiotic (PA) and have prescribed antibiotics to prevent IE. Jordanian dentists’ approach to patients in need for PA varied between the National Institute for Health and Clinical Excellence recommendations and the American Heart Association to a lesser degree, but still a relatively high percent (39%) did not know any guidelines to follow although 74% have encountered patients who needed endocarditis prophylaxis. Patients with prosthetic heart valve were ranked on top of medical conditions that required PA (87.4%), and most dentists (94.5%) thought that dental extractions need PA followed by periodontal surgery (88.2%).

Conclusion:

There is a lack of consistency in the knowledge and practice of Jordanian dentists with regard to IE. There is a need to take actions to improve dentist's knowledge regarding this topic.

Early Diagnosis on Oral and Potentially Oral Malignant Lesions: A Systematic Review on the VELscope® Fluorescence Method

The fluorescence method is an innovative technique used by pathologists for examining body mucosa, and for the abnormalities tissue screening, potentially leading to the earlier discovery of pre-cancer, cancer or other disease processes. The early detection is one of the best mechanisms for enabling treatment success, increasing survival rates and maintaining a high quality of life. The purpose of this review is to evaluate the clinical efficiency of this diagnostic tool applied to the oral cavity (VELscope^®). A literature systematic review has been performed. The initial research provided 53 results after applying the inclusion and exclusion criteria, and after a manual screening of the abstracts by the authors, only 25 results were eligible for review. The results and data contained in all the researches, no older than 10 years, were manually evaluated, and provided useful information on this diagnostic method. The VELscope^® mean value about sensitivity and specificity resulted of 70.19% and 65.95%, respectively, by results analysis, but despite this some studies disagree about its clinical effectiveness, and this diagnostic method is still much debated in scientific and clinical medical literature. Surely being able to have efficient and effective tools from this point of view could help the clinician in the diagnosis, and also make timelier the pharmacological or surgical therapy, improving the quality of life of the patient, and in some cases guaranteeing a longer survival term.

Advances in Antiplatelet Therapy for Dentofacial Surgery Patients: Focus on Past and Present Strategies

BACKGROUND

Nowadays, patients involved in antiplatelet therapy required special attention during oral surgery procedures, due to the antiplatelet drugs assumption. The motivations of the assumption may be different and related to the patient's different systemic condition. For this reason, accordingly to the current international guidelines, different protocols can be followed. The aim of this work is to analyze how the dentist's approach to these patients has changed from the past to the present, evaluating the risk exposure for the patients.

METHODS

This review paper considered different published papers in literature through quoted scientific channels, going in search of "ancient" works in such a way as to highlight the differences in the protocols undertaken. The analyzed manuscripts are in the English language, taking into consideration reviews, case reports, and case series in such a way as to extrapolate a sufficient amount of data and for evaluating the past therapeutic approaches compared to those of today.

RESULTS

Colleagues in the past preferred to subject patients to substitution therapy with low molecular weight anticoagulants, by suspending antiplatelet agents to treatment patients, often for an arbitrary number of days. The new guidelines clarify everything, without highlighting an increased risk of bleeding during simple oral surgery in patients undergoing antiplatelet therapy.

CONCLUSION

Either patients take these medications for different reasons, because of cardiovascular pathologies, recent cardiovascular events, or even for simple prevention, although the latest research shows that there is no decrease of cardiovascular accidents in patients who carry out preventive therapy. Surely, it will be at the expense of the doctor to assess the patient's situation and risk according to the guidelines. For simple oral surgery, it is not necessary to stop therapy with antiplatelet agents because the risk of bleeding has not increased, and is localized to a post-extraction alveolus or to an implant preparation, compared to patients who do not carry out this therapy. From an analysis of the results it emerges that the substitutive therapy should no longer be performed and that it is possible to perform oral surgery safely in patients who take antiplatelet drugs, after a thorough medical history. Furthermore, by suspending therapy, we expose our patients to more serious risks, concerning their main pathology, where present.

Bioactive Titanium Surfaces: Interactions of Eukaryotic and Prokaryotic Cells of Nano Devices Applied to Dental Practice

Background: In recent years, many advances have been made in the fields of bioengineering and biotechnology. Many methods have been proposed for the in vitro study of anatomical structures and alloplastic structures. Many steps forward have been made in the field of prosthetics and grafts and one of the most debated problems lies in the biomimetics and biocompatibility of the materials used. The contact surfaces between alloplastic material and fabric are under study, and this has meant that the surfaces were significantly improved. To ensure a good contact surface with the cells of our body and be able to respond to an attack by a biofilm or prevent the formation, this is the true gold standard. In the dental field, the study of the surfaces of contact with the bone tissue of the implants is the most debated, starting from the first concepts of osteointegration. Method: The study searched MEDLINE databases from January 2008 to November 2018. We considered all the studies that talk about nanosurface and the biological response of the latter, considering only avant-garde works in this field. Results: The ultimate aim of this study is to point out all the progress made in the field of bioengineering and biotechnologies about nanosurface. Surface studies allow you to have alloplastic materials that integrate better with our body and allow more predictable rehabilitations. Particularly in the field of dental implantology the study of surfaces has allowed us to make huge steps forward in times of rehabilitation. Overcoming this obstacle linked to the time of osseointegration, however, today the real problem seems to be linked to the “pathologies of these surfaces”, or the possible infiltration, and formation of a biofilm, difficult to eliminate, being the implant surface, inert. Conclusions: The results of the present investigation demonstrated how nanotechnologies contribute substantially to the development of new materials in the biomedical field, being able to perform a large number of tests on the surface to advance research. Thanks to 3D technology and to the reconstructions of both the anatomical structures and eventually the alloplastic structures used in rehabilitation it is possible to consider all the mechanical characteristics too. Recent published papers highlighted how the close interaction between cells and the biomaterial applied to the human body is the main objective in the final integration of the device placed to manage pathologies or for rehabilitation after a surgical tumor is removed.

Oral Health Impact Profile in Celiac Patients: Analysis of Recent Findings in a Literature Review

The increment of recording atypical oral manifestation in young patients often related to systematic disease is today a challenge for the therapists. Sometime, the presence of tooth enamel lesions correlated with soft tissue lesions is just a symptom or a trigger sign for a deeper and undetermined disease. Recently, high impact has been developed toward the influence of the diet as a controlled and modifiable factor in patients affected by celiac pathologies. The celiac disease (CD) is a chronic immune-mediated disorder triggered by the ingestion of gluten that appears in genetically predisposed patients. Gluten is a proline-rich and glutamine-rich protein present in wheat (gliadin), barley (hordein), and rye (secalin). The gluten-free diet (GFD) seems to better influence the oral health status of the CD patients. For this reason, the main objective of this revision was to analyze the international data highlighting the relationship between celiac patients and the oral health impact profile. A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed database. Authors conducted the search of articles in the English language published from 2008 to 2018. The first analysis with filters recorded 67 manuscripts accordingly with the selected keywords. Finally, a number of 16 appropriate published papers were comprehended in the review. The studies were different in terms of the structure, findings, outcomes, and diet quality evaluation, and for this reason, it was not possible to accomplish a meta-analysis of the recorded data. This manuscript offers some observational evidence to justify the advantages of gluten-free diets related to a better oral health status in the patients involved.

In vitro evaluation of microbial adhesion on the different surface roughness of acrylic resin specific for ocular prosthesis

OBJECTIVE

The purpose of this study was to evaluate the influence of surface roughness in biofilm formation of four microorganisms (Staphylococcus epidermidis, Staphylococcus aureus, Enterococcus faecalis, and Candida albicans) on acrylic resin surface of ocular prostheses.

MATERIALS AND METHODS

Acrylic resin samples were divided into six groups according to polishing: Group 1200S (1200 grit + silica solution); Group 1200; Group 800; Group 400; Group 120 and Group unpolished. Surface roughness was measured using a profilometer and surface images obtained with atomic force microscopy. Microbial growth was evaluated after 4, 24, and 48 hours of incubation by counting colony-forming units.

STATISTICAL ANALYSIS USED

For roughness, it was performed 1-way ANOVA and parametric Tukey test α5% (P ≤ 0.05). For CFU data found, it was applied Kruskal-Wallis and Mann-Whitney tests.

RESULTS

Group 120 and 400 presented the highest roughness values. For S. epidermidis and S. aureus, Group 1200S presented the lowest values of microbial growth. For E. faecalis at 4 hour, microbial growth was not observed. C. albicans did not adhere to the acrylic resin. Except for Group 1200S, different surface roughnesses did not statistically interfere with microbial adhesion and growth on acrylic surfaces of ocular prostheses.

CONCLUSIONS

The roughness did not interfere with the microbial adhesion of the microorganisms evaluated. The use of silica decreases significantly microbial growth.

Atomic Force Microscopy: A three-dimensional reconstructive tool of oral microbiota in gingivitis and periodontitis

Aim:

This study aims to ascertain the advantages of Atomic Force Microscopy (AFM) in the morphologic study of microorganisms and their interactions within the subgingival biofilm in patients with gingivitis and periodontitis.

Settings and Design:

Conducted a study on twenty patients, ten patients with severe periodontitis with probing the pocket depth of ≥8 mm, with a clinical attachment loss (CAL) of ≥6 mm CAL and ten patients with gingivitis: ≥5 mm pocket depth, and no attachment loss, was selected for the study.

Materials and Methods:

Bacterial biofilms were collected and slide preparation done. Morphological study was done using AFM. AFM consists of a cantilever-mounted tip, a piezoelectric scanner, a photodetector diode, a laser diode, and a feedback control. The laser beam is reflected from back of the cantilever into the quadrant of the photodetector. AFM works on the principle of interaction between the tip and the sample which causes the cantilever to deflect, thereby changing the position of laser onto the photodetector. Methodology used for studying the bacteria through AFM includes the following: (1) Probe type: Platinum coated silicon nitrate tip. (2) Probe force: 0.11 N/m. (3) Probe geometry: Triangular shaped tip. (4) Probe frequency: 22 KHz. (5) Probe immobilization: Used in Contact mode. AFM Solver Pro-M (NT-MDT) equipped with ETALON probe was used to take images in Nova software.

Results:

The investigation showed various morphological features, such as shape, size, and secretory product-like vesicles of the bacterial species involved in gingivitis and periodontitis. More bacterial surface details were studied by reproducing a three-dimensional reconstruction using AFM.

Conclusions:

The morphological variations of bacteria of different sizes, and shapes, cell wall structures, secretory product-like vesicles flagellated and filamentous microorganisms, polymorphonuclear leukocytes, and bacterial coaggregation analysis were done by AFM. Results of the present study conclude that AFM is a quite a reliable method for studying morphology of bacterial species involving periodontal diseases and is also used to study microbial interactions in biofilm.

Soft-Tissue Enhancement Combined With Biologically Oriented Preparation Technique to Correct Volumetric Bone Defects: A Clinical Case Report

The aim of the present case report was to illustrate how to obtain an ideal alveolar ridge contour by means of peri-implant soft-tissue management combined with the prosthetic approach of the biologically oriented preparation technique (BOPT). A patient presenting a moderate vertical and horizontal bone loss in the posterior maxilla was treated with sinus floor elevation and simultaneous implant placement. During the reentry procedure, the horizontal defect was corrected with an apically repositioned flap combined with a connective tissue graft. To increase the volume of the interimplant papillae, a pedunculated flap originating from the primary flap was turned within the interimplant space. BOPT one-time abutments have been employed to maximize the space available for the papilla-like tissues. A focused and combined surgical and prosthetic procedure has permitted enhancement of both peri-implant esthetics and function without the need for further invasive and costly bone regeneration techniques.

Management and control of isotonic contraction generated stress: evaluation of masseter muscle deformation pattern by means of ecography

PURPOSE

The objective of the following study is to observe the behavior of the six layers of the masseter during an isometric contraction at maximum exertion with the deformation pattern analysis method.

MATERIALS AND METHODS

This study has been conducted by use of an ultrasound machine (MicrUs ext-1H Telemed Medical Systems Milano) and a linear probe (L12-5l40S-3 5-12 MHz 40 mm) which allowed us to record a video (DCM) comprised of 45 frames per second. The probe was fixed to a brace and the patient was asked to clench their teeth as hard as possible, obtain the muscle's maximum exertion, for 5 seconds three times, with 30 seconds intervals in between. Both right and left masseter muscles were analyzed. Then we applied to the resulting video a software (Mudy 1.7.7.2 AMID Sulmona Italy) for the analysis of muscle deformation patterns (contraction, dilatation, cross-plane, vertical strain, horizontal strain, vertical shear, horizontal shear, horizontal displacement, vertical displacement). The number of videos of masseter muscles in contraction at maximum exertion due to dental clenching made during this research is around 12,000. Out of these we chose 1,200 videos which examine 200 patients (100 females, 100 males).

RESULTS

The analysis of the deformation patterns of the masseter allows us to observe how the six layers of the muscle have different and specific functions each, which vary depending on the applied force (application point, magnitude and direction) so that we find it impossible to assign to one of the three sections of the muscle a mechanical predominance. Therefore it appears that the three parts of the muscle have specific and synergistic tasks.

Ultrasound and analysis of the deformation patterns of the masseter muscle: comparing surgical anatomy, ultrasound and functional anatomy

PURPOSE

We have tried to demonstrate whether the analysis of the muscle strain allows us to identify the three distinct functional areas of the architecture of the masseter, as one would see them by performing or viewing an anatomical dissection of said muscle, and whether these sections have behave differently in terms of origin and coping of the strain they face (quantitative analysis).

MATERIALS AND METHODS

This work has been elaborated by the use of an ultrasound machine (MicrUs ext-1H Telemed Medical Systems Milano) and a linear probe (L12-5l40S-3 5-12 MHz 40 mm) which allowed us to record a 45 frame per second video (DCM). Videos has been elaborated by use of an ultrasound machine (MicrUs ext-1H Telemed Medical Systems Milano) and a linear probe (L12-5l40S-3 5-12 MHz 40 mm) which allowed us to record a 45 frame per second video (DCM). We applied to the resulting video a software (Mudy 1.7.7.2 AMID Sulmona Italy) for the analysis of muscle deformation patters (contraction, dilatation, cross-plane, vertical strain, horizontal strain, vertical shear, horizontal shear, horizontal displacement, vertical displacement). The number of videos of masseter muscles in contraction at maximum exertion due to dental clenching made during this research is around 12,000. Out of these we chose 1,200 videos which examine 200 patients (100 females, 100 males).

RESULTS

The deformation pattern analysis of the skeletal muscle on ultrasound basis seems to be an adequate instrument to use during the investigation of the functional structure of the masseter muscle given its ability to highlight the distinct activity of each separate part of the muscle.

CONCLUSIONS

Moreover the strain does not apply to the muscle uniformly; instead it varies according to the observed area.

Light diffusion through composite restorations added with spherical glass mega fillers

PURPOSE

Evaluate how the spherical glass mega fillers (SGMFs) can positively interfere with light diffusion when incorporated in a composite restoration.

MATERIALS AND METHODS

30 samples (Ss) were performed, applying 2 composite layers of 3 mm each: 6 were made with composite only; 6 with a layer of SGMFs of O1.5mm within the first layer of composite; 6 with 2 overlapping layers of SGMFs of O1.5mm; 6 with a layer of SGMFs of O2mm; 6 with 2 overlapping layers of SGMFs of O2mm. The curing time was set at 40s for the first layer, and 120s for the second layer, transilluminated through the first layer. Digital pictures were taken, in standardized settings, during the transillumination, and the light intensity was measured with a digital image analysis software.

RESULTS

From a lateral view the Ss with a single layer of SGMFs of O1.5mm and O2mm, the relative increments of light intensity, were of 24.37% and 33.33% respectively. Concerning the Ss made with 2 layers of SGMFs, the relative increments were of 67.99% and 66.4% respectively. In front view has emerged a relative increase rate of light intensity of 53.66% and 79.58%, in the Ss with a single layer of SGMFs of O1.5mm and of O2mm respectively. Furthermore, in the Ss with two layers of SGMFs of O1.5mm and O2mm the relative increments were of 267.53 and 319.63% respectively.

CONCLUSION

The SGMFs are reliable in facilitating light diffusion within the light-curing composite resins.

Laser Assisted Non-surgical Periodontal Therapy: A Double Blind, Randomized Clinical Trial

The objective of this study was to examine potential benefits of using laser therapy for secular decontamination in conjunction with scaling and root planing in the treatment of chronic periodontitis. The study was performed on 173 teeth in 14 patients in a split-mouth design, one side received scaling and root planing followed by laser therapy using a carbon dioxide (CO2) laser with an ablative handpiece (test group); the contralateral side received scaling and root planing without laser (control group). Clinical and laboratory parameters were evaluated prior to treatment and at 3 and 6 months following therapy; clinical measurements were performed by two blinded examiners. The clinical parameters included measurement of gingival recession (REC), bleeding on probing (BOP), clinical attachment level (CAL), pocket depth (PD), furcation involvement (FUR), and tooth mobility (MOB). Laboratory testing to determine the levels of periodontal pathogens was performed using PCR techniques. The results of the study revealed statistically significant differences in clinical and laboratory parameters at 3 and 6 months after therapy for both test and control groups, but no significant difference was observed between the two groups. However, sites receiving laser therapy tended to show a greater decrease in probing depths, gain in clinical attachment level, and reduced bacterial levels. In conclusion, the overall results of the study suggest a potential benefit of using laser therapy in conjunction with scaling and root planing for the treatment of chronic periodontitis.

Cationic Lipid Content in Liposome-Encapsulated Nisin Improves Sustainable Bactericidal Activity against Streptococcus mutans

An oral infectious disease, dental caries, is caused by the cariogenic streptococci Streptococcus mutans. The expected preventive efficiency for prophylactics against dental caries is not yet completely observed. Nisin, a bacteriocin, has been demonstrated to be microbicidal against S. mutans, and liposome-encapsulated nisin improves preventive features that may be exploited for human oral health. Here we examined the bactericidal effect of charged lipids on nisin-loaded liposomes against S. mutans and inhibitory efficiency for insoluble glucan synthesis by the streptococci for prevention of dental caries. Cationic liposome, nisin-loaded dipalmitoylphosphatidylcholine/phytosphingosine, exhibited higher bactericidal activities than those of electroneutral liposome and anionic liposome. Bactericidal efficiency of the cationic liposome revealed that the vesicles exhibited sustained inhibition of glucan synthesis and the lowest rate of release of nisin from the vesicles. The optimizing ability of cationic liposome-encapsulated nisin that exploit the sustained preventive features of an anti-streptococcal strategy may improve prevention of dental caries.

Polymerization shrinkage and spherical glass mega fillers: effects on cuspal deflection

PURPOSE

The Authors analyzed the effect of spherical glass mega fillers (SGMF) on reducing contraction stress in dental composite resins, by means of a cavity model simulating the cuspal deflection which occurs on filled tooth cavity walls in clinical condition.

MATERIALS AND METHODS

20 stylized MOD cavities (C-factor = 0.83) were performed in acrylic resin. The inner surface of each cavity was sand blasted and adhesively treated in order to ensure a valid bond with the composite resin. Three different diameter of SGMF were used (i.e. 1, 1,5, 2 mm). The samples were divided in 4 groups of 5 each: Group 1 samples filled with the composite only; Group 2 samples filled with composite added with SGMFs, Ø1mm (16 spheres for each sample); Group 3 samples filled with composite added with SGMFs, Ø1,5 mm (5 spheres for each sample); Group 4 samples filled with composite added with SGMFs, Ø2 mm (2 spheres for each sample). Digital pictures were taken, in standardized settings, before and immediately after the polymerization of the composite material, placed into the cavities. With a digital image analysis software the distances from the coronal reference points of the cavity walls were measured. Then the difference between the first and second measurement was calculated. The data were analyzed by means of the ANOVA test.

RESULTS

A significative reduction on cavity walls deflection, when the composite resin is used in addiction with the SGMFs was observed. The SGMFs of smallest diameter (1mm) showed the better outcome.

CONCLUSION

The SGMFs are reliable in reducing contraction stress in dental composite resins.

Analysis of masseter deformation patterns during a maximum exertion clenching in patients with unilateral chewing

PURPOSE

The aim of the following study is to examine both masseter muscles (left/right) in a group of patients suffering from unilateral chewing during a maximum exertion isometric contraction using the deformation pattern analysis of ultrasound videos and compare them with the results obtained by studying patients with alternate bilateral chewing patterns.

MATERIALS AND METHODS

This study has been conducted by use of an ultrasound machine and a linear probe which allowed us to record a video (DCM) comprised of 45 frames per second (MicrUs ext-1H Telemed Medical Systems Milano) and a linear probe (L12-5l40S-3 5-12 MHz 40 mm). The probe was fixed to a brace and the patients were asked to clench their teeth as hard as possible, obtain the muscle's maximum exertion, for 5 seconds three times, with 30 seconds intervals in between. Both right and left masseter muscles were analyzed. We applied to the ultrasound video a dedicated software (Mudy 1.7.7.2 AMID Sulmona Italy) for the analysis of muscle deformation patterns. The total number of patients for this study is 150. Out of this number, 50 belong to Group A, mono lateral chewing on the left side arch, and 50 to Group B, mono lateral chewing on the right side arch. The remains patients belong to Group C, bilateral alternate chewing. The deformation pattern analysis of the skeletal muscles on ultrasound videos allows us to highlight with ease the clear difference in the clenching capabilities and strain management between the dominant masseter and the subordinate masseter in a unilaterally chewing patient.

RESULTS

In the sample investigated both in Group A and Group B the unilateral chewing is associated with a series of parameters (number, shape, volume, position and orientation of the teeth) and is also associated with the extension of the cutting surface really available.

General Overview on Nontuberculous Mycobacteria, Biofilms, and Human Infection

Nontuberculous mycobacteria (NTM) are emergent pathogens whose importance in human health has been growing. After being regarded mainly as etiological agents of opportunist infections in HIV patients, they have also been recognized as etiological agents of several infections on immune-competent individuals and healthcare-associated infections. The environmental nature of NTM and their ability to assemble biofilms on different surfaces play a key role in their pathogenesis. Here, we review the clinical manifestations attributed to NTM giving particular importance to the role played by biofilm assembly.

Periodontal health status in patients treated with the Invisalign(®) system and fixed orthodontic appliances: A 3 months clinical and microbiological evaluation

OBJECTIVE

The aim of this prospective study was to compare the periodontal health and the microbiological changes via real-time polymerase chain reaction (PCR) in patients treated with fixed orthodontic appliances and Invisalign(®) system (Align Technology, Santa Clara, California).

MATERIALS AND METHODS

Seventy-seven patients were enrolled in this study and divided into three groups (Invisalign(®) group, fixed orthodontic appliances group and control group). Plaque index, probing depth, bleeding on probing were assessed. Total biofilm mass and periodontal pathogens were analyzed and detected via real-time PCR. All these data were analyzed at the T0 (beginning of the treatment) T1 (1-month) and T2 (3 months); and statistically compared using the Mann-Whitney test for independent groups.

RESULTS

After 1-month and after 3 months of treatment there was only one sample with periodontopathic anaerobes found in patient treated using fixed orthodontic appliances. The Invisalign(®) group showed better results in terms of periodontal health and total biofilm mass compared to the fixed orthodontic appliance group. A statistical significant difference (P < 0.05) at the T2 in the total biofilm mass was found between the two groups.

CONCLUSION

Patients undergoing orthodontic treatment with the Invisalign(®) System show a superior periodontal health in the short-term when compared to patients in treatment with fixed orthodontic appliances. Invisalign(®) should be considered as a first treatment option in patients with risk of developing periodontal disease.

Salivary Thiocyanate, Uric Acid and pH as Biomarkers of Periodontal Disease in Tobacco Users and Non-Users- An In-Vitro Study

INTRODUCTION

Biomarkers of tobacco exposure are used to confirm the absorption of specific smoke constituents in a quantitative manner.

MATERIALS AND METHODS

Periodontal status was measured by Community periodontal Index (WHO). Salivary thiocyanate was determined using spectrophotometric analysis, Salivary uric acid concentration was determined using the enzymatic uric acid assay reagent. pH was measured using pH strips.

RESULTS

Proportion of participants with periodontal pockets of 4-5mm was highest among tobacco smokers (80.0%) and periodontal pockets of 6mm or more were observed to be higher among tobacco chewers (26.67%). When LOA scores among tobacco chewers were recorded 26.7% of them presented with attachment loss of 0-3mm. 46.7% of them were affected with loss of attachment of 4-5mm and loss of attachment 6-8mm was found in 16.7%. 6.7% of them were found to be having loss of attachment of 9-11mm. 3.3% of them were found to be having loss of attachment of 12mm or more. The LOA scores in non- tobacco users showed 46.7% of 0-3mm, 50.0% of 4-5mm and 3.33% of 6-8mm attachment loss. The mean level of thiocyanate level detected in saliva of tobacco smokers was 172 ± 54.7 μg/ml and 203.70± 45.7 μg/ml in tobacco chewers. The mean uric acid levels was found to be 2.54 ±0.63 (μg/dl) in smokers and 2.65 ± 0.37(μg/dl) in chewers and in non tobacco users it was 2.33 ± 0.47 μg/dl.

CONCLUSION

Tobacco users had significantly higher concentration of SCN levels than non-users.

Development of In Vitro Denture Biofilm Models for Halitosis Related Bacteria and their Application in Testing the Efficacy of Antimicrobial Agents

Objective : Since dentures can serve as a reservoir for halitosis-causing oral bacteria, halitosis development is a concern for denture wearers. In this study, we surveyed the prevalence of four selected halitosis-related species (Fusobacterium nucleatum, Tannerella forsythia, Veillonella atypica and Klebsiella pneumoniae) in clinical denture plaque samples, and developed denture biofilm models for these species in vitro to facilitate assessment of antimicrobial treatment efficacy. Design : Denture plaque from ten healthy and ten denture stomatitis patients was screened for the presence of aforementioned four species by PCR. Biofilm formation by these halitosis-associated species on the surfaces of denture base resin (DBR) discs was evaluated by crystal violet staining and confocal laser scanning microscopy. The efficacy of denture cleanser treatment on these mono-species biofilms was evaluated by colony counting. Results : 80% of the subjects in the denture stomatitis group and 60% in the healthy group contained at least one of the targeted halitosis-related species in their denture plaque. All halitosis species tested were able to form biofilms on DBR disc surfaces to varying degrees. These in vitro mono-species resin biofilm models were used to evaluate the efficacy of denture cleansers, which exhibited differential efficacies. When forming biofilms on resin surfaces, the halitosis-related species displayed enhanced resistance to denture cleansers compared with their planktonic counterparts. Conclusion : The four selected halitosis-related bacterial species examined in this study are present on the majority of dentures. The mono-species biofilm models established on DBR discs for these species are an efficient screening tool for dental product evaluation.

Effect of fluoride and chlorhexidine digluconate mouthrinses on plaque biofilms

Objective : To develop a model in which to investigate the architecture of plaque biofilms formed on enamel surfaces in vivo and to compare the effects of anti-microbial agents of relevance for caries on biofilm vitality. Materials and Methodology : Enamel discs mounted on healing abutments in the pre-molar region were worn by three subjects for 7 days. Control discs were removed before subjects rinsed with 0.1% chlorhexidine digluconate (CHX) or 0.2% sodium fluoride (NaF) for 1 minute. Biofilms were stained with Baclight Live/Dead and z-stacks of images created using confocal scanning laser micoscopy. The levels of vital and dead/damaged bacteria in the biofilms, assessed as the proportion of green and red pixels respectively, were analysed using ImageTrak^® software. Results : The subjects showed individual differences in biofilm architecture. The thickness of the biofilms varied from 28-96µm although cell density was always the greatest in the middle layers. In control biofilms, the overall levels of vitality were high (71-98%) especially in the area closest to the enamel interface. Rinsing with either CHX or NaF caused a similar reduction in overall vitality. CHX exerted an effect throughout the biofilm, particularly on the surface of cell clusters whereas NaF caused cell damage/death mainly in the middle to lower biofilm layers. Conclusion : We describe a model that allows the formation of mature, undisturbed oral biofilms on human enamel surfaces in vivo and show that CHX and NaF have a similar effect on overall vitality but differ in their sites of action.

Application of the novel method in the diagnosis and treatment of median rhomboid glossitis Candida-associated

The aim of this work is to demonstrate how current molecular techniques should be integrated in the diagnostic process and can have a crucial role in the management of oral fungal infections. A case of median rhomboid glossitis Candida-associated and its resolution will be described step by step. At the time of the first observation, the lesion on the surface of the tongue did not respond to the previous administration of topical antifungal agent, such a nystatin. Firstly, in order to identify the causative agent and confirm Candida albicans infection, a brushing of the lesion was performed and polymerase chain reaction analysis was carried out. In addition, deoxyribonucleic acid sequencing method, known as Pyrosequencing^®, was used in the detection of point mutations commonly associated with fluconazole resistance and consequently, in the prediction of susceptibility to azole agents. According to molecular findings, the administration of fluconazole has therefore led to resolution of the case in 2 weeks. This case highlights how the use of molecular techniques, now-a-days, can assist the clinicians to quickly obtain the report with highly accurate and precise results and appropriately support them in the diagnosis and therapeutic process.