Hygienic maintenance in patients with maxillae atrophy and in oncological patients with maxillary resection rehabilitated with zygomatic implants: A nested monocentric prospective cohort study

OBJECTIVE

To assess peri-implant soft tissues condition, comparing clinical parameters of implants placed in patients with atrophic upper jaws and patients who underwent maxillary resection for oncological reasons.

BACKGROUND

Zygomatic implants (ZIs) in oncologic patients could be affected by more complications compared to implants placed in atrophic maxillae. The soft tissue condition is an essential requirement for implant success, but few studies have investigated this topic.

METHODS

A nested monocentric prospective parallel cohort (atrophic vs. oncological patients) study was performed. Clinical visits and professional hygiene sessions were performed every three months, and bleeding on probing (BOP), probing pocket depth (PPD), gingival index (GI), plaque index (PI) and implant mobility were recorded by a blind outcome assessor.

RESULTS

In total, 77 ZIs placed in 21 patients were evaluated: 54 (70.1%) ZIs were inserted in patients belonging to the atrophic cohort (PAM) and 23 (29.9%) ZIs in the oncologic cohort (OP). The probability of having BOP at the considered mean follow-up (27 months) was 24.8% (95% CI 19.0-31.9) for PAM and 22.9% (95% CI 15.1-33.9) OP. The mean PPD values were 2.78 ± 1.28 (range 1-8) in PAM and 2.91 ± 1.98 (range 0-10) in OP. None of the implants showed mobility. No associations between group belongingness and the entity of PPD, PI, GI and the risk of BOP were found, adjusting for the considered confounding factors (age, smoking and implant position).

CONCLUSIONS

Under a strict supportive hygiene therapy protocol ZIs in oncologic patients showed similar peri-implant tissue conditions to that of patients with maxillary atrophy.

Oral and throat microbiological changes after orthodontic debonding

As already known, orthodontic treatment presents a factor of plaque retention, promoting an increase of bacterial growth in the oral cavity. Nevertheless, after orthodontic debonding an alteration of the previous microbiological status may occur. The present study was designed to assess variations among six bacterial species in the oral cavity and the status of oral health after orthodontic debonding. At the end of the fixed orthodontic treatment, 30 patients were divided into three groups based on the type of retention: I - 10 patients were treated with upper and lower fixed retention devices, II - 10 with upper and lower removable retention devices, and III - 10 with lower fixed and upper removable retention devices. To assess the alterations of oral microbiota after orthodontic debonding, two salivary swabs were collected for each individual: the first immediately after debonding (T0) and the other one 6 weeks later (T1). Six species, the ones most correlated with the development of caries and periodontal disease, were selected for microbiological analysis with Real-time PCR: Streptococcus mutans, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Fusobacterium nucleatum. Furthermore, in order to correlate the microbiological outcomes with the clinical condition, oral health indexes at T0 and T1 were assessed for all patients. Six weeks after debonding, the salivary levels of the bacteria investigated tend to decrease and the values of the oral health indexes tend to improve with all types of treatment considered (p<.05). Salivary bacteria levels and oral health are similarly influenced by fixed and/or removable orthodontic retentions.

Stannous Fluoride Preventive Effect on Enamel Erosion: An In Vitro Study

The aim of this in vitro study was to evaluate the effects of a single dose application of two daily toothpastes on enamel exposed to acid attack. The research was conducted on human molars enamel fragments (n = 72). The two different toothpastes active ingredients were sodium fluoride (NaF) and stannous fluoride (SnF₂). They were compared in protecting the surface of the enamel exposed to three acids: citric acid, lactic acid and hydrochloric acid. A spectrophotometer was used to measure the calcium ions and phosphate released in the solutions by the enamel specimens. Afterward, ionic concentrations were analyzed through the t-Student test, in order to estimate the significance level (p < 0.05) of the solubility differences obtained between the treatment and control groups. Finally, sample surfaces were analyzed with scanning electron microscopy and X-ray energy dispersive spectroscopy (SEM/EDX). The two analyzed toothpastes did not reveal any statistically significant variation in the release of calcium and phosphate (p > 0.05). Nevertheless, acid-resistant deposits were detected in samples treated with stannous fluoride and exposed to lactic acid, though the presence of tin ion deposits on samples treated with stannous fluoride was not shown. A single dose of a fluoride-based toothpaste before different acids attack, in simulated oral cavity conditions, did not show a significant preventive effect.

Effects of stannous fluoride on eroded enamel permeability

This study aimed to evaluate the effect in vitro of a single application of a stannous fluoride- (SnF2-) containing toothpaste on eroded enamel. Forty-eight teeth were subjected to three acid treatments: 15% hydrochloric acid for 120 s (HA group); 1% citric acid (pH=4) for 180 s (CA group); 37% phosphoric acid for 30 s (PA group). They were brushed with an electric toothbrush with pressure control and 1 g of SnF2 (1100 ppm) toothpaste for 2 min. Polyether replicas of buccal enamel surfaces were obtained at baseline, after acid exposure and after brushing, gold sputtered and inspected by SEM for fluid droplets presence. Hydrochloric and citric acid treatments increased enamel permeability while, on the contrary, phosphoric acid reduced enamel fluid release. SnF2 application of ameliorated acid induced permeability in citric and hydrochloric treated samples. Permeability in phosphoric treated enamel was unchanged after topical application of SnF2. Our data show specific acid-dependent effects on enamel permeability and demonstrate that SnF2 application can reverse acid-induced permeability.

In vitro effects of fluoride-based and desensitizing toothpastes on dentine permeability

This study aims to evaluate the effectiveness in reducing dentine permeability of three different toothpastes comparing with a sodium fluoride one. Dentine permeability was measured by a fluid filtration system. Dentin discs were randomized in four experimental groups and treated with different commercial toothpastes, as it follows. Group A: Sensodyne® Rapid, with strontium acetate; group B: Elmex Sensitive ProfessionalTM, with arginine and 450 ppm monofluoro-phosphate; group C: Colgate Total Advanced®, with 1450 ppm NaF; group D: AZ Pro-Expert®, with 1100 ppm SnF2. After brushing specimens of each groups were assigned to two subgroups and: 1) stored in artificial saliva (2 h) and treated with 6% citric acid for 1 min; 2) stored in artificial saliva for 24 h. SEM analysis was performed to investigate dentinal tubules occlusion of acid treated and stored in artificial saliva samples. Dentin permeability proved affected by dentifrice treatments. The toothpastes specifically formulated for hypersensitivity showed significant effects concerning decrease of dentine permeability. SEM observations demonstrated the presence of dentifrice particles on dentin surface and inside dentin tubules. Stannous fluoride treated samples exhibited the greater tubules occlusion.

Primary enamel permeability: a SEM evaluation in vivo

AIM

The aim of this study was to evaluate in vivo the occurrence of outward fluid flow on primary tooth sound enamel surface.

MATERIALS AND METHODS

Sixty primary upper canines from preadolescent patients (mean age 8.0±1.9) and 24 retained primary upper canines from adult subjects (mean age 35.0±1.8) were analysed. The enamel surface was gently polished and air dried for 10 s. An impression was immediately obtained by vinyl polyxiloxane. Replicas were then obtained by polyether impression material, gold coated and inspected under SEM. The hydrophobic vinyl polyxiloxane material enabled to obtain in situ a morphological image of the presence of droplets, most likely resulting from outward fluids flow through outer enamel. For each sample three different representative areas of 5μ² in the cervical, medium and incisal third were examined and droplets presence values was recorded. All data were analysed by by Fisher's exact test.

RESULTS

Primary enamel showed a substantial permeability expressed as droplets discharge on its surface. Droplets distribution covered, without any specific localisation, the entire enamel surface in all the samples. No signs of post-eruptive maturation with changes in droplets distribution were observed in samples from adult subjects. No statistically significant differences (P = 0.955) were noted in the percentage distribution of enamel area covered with droplets among the two group studied.

CONCLUSION

SEM evaluation of droplets distribution on enamel surface indicated a substantial enamel permeability in primary teeth, accordingly with histological features, without changes during aging. A relationship between enamel permeability, caries susceptibility and bonding procedures effectiveness could be hypothesised.

Recovery of Enterococcus faecalis in root canal lumen of patients with primary and secondary endodontic lesions

The presence of Enterococcus faecalis in root canal teeth affected by primary and secondary periapical lesions was studied using polymerase chain reaction (PCR) assays. The association between presence of E. faecalis with clinical signs of apical lesions was assessed to evaluate a possible relationship between clinical findings. Microbial samples were obtained from healthy patients affected by different periapical lesions, 79 teeth with primary periapical lesion and 23 with secondary periapical lesion. For each tooth, clinical symptoms and X-ray appearance were examined. E. faecalis was detected in 6 of 79 samples with primary lesion (7.6%), and in 9 of 23 with secondary lesion (39.1%). Suggested association was found between E. faecalis and secondary apical lesions. As regard specific signs and symptoms E. faecalis was more associated with asymptomatic lesions (all p<0.05) than with symptomatic apical lesions. The study confirms the high presence of E. faecalis in secondary apical lesions. However, its effective role in endodontic pathogenesis such as bone periapical lesions needs to be clarified.

The influence of smear layer in lateral channels filling

This in vitro study evaluated the ability of a warm gutta-percha obturation system Thermafil to fill lateral channels in presence/absence of smear layer. Forty single-rooted extracted human teeth were randomly divided into two groups for which different irrigation regimens were used: group A, 5 ml of 5% NaOCl + 2.5 ml of 3.6% H(2)O(2); group B, 5 ml of 5% NaOCl 5% + 2.5 ml of 17% ethylenediamine tetraacetic acid. A conventional crown-down preparation technique was employed. Obturation was performed using epoxy resin-based cement (AH Plus) and a warm gutta-percha plastic carrier system (Thermafil). Specimens were cleared in methyl salicylate and analyzed under a stereomicroscope to evaluate the number, length, and diameter of lateral channels. Lateral channels were identified in both groups at medium and apical thirds. Additional samples were prepared for scanning electron microscopy inspection to confirm the presence of smear layer in group A, and the absence of smear layer in group B. All lateral channels resulted filled in both groups. No statistically significant differences regarding number, length, and diameter were observed between the two groups. Smear layer did not prevent the sealing of lateral channels.

In vivo enamel fluid movement

The aim of this study was to visualize fluid movement through dental enamel in vivo. Fifty permanent upper central incisors, from subjects aged 10-70 yr, and 5 permanent central just-erupted incisors, from subjects aged 6-7 yr, were included in the study. An impression was obtained by vinyl polyxiloxane, and replicas were then obtained by polyether impression material. The hydrophobic vinyl polyxiloxane material yielded a morphological image in situ of outward fluid flow through tooth enamel. The study confirmed in vivo that enamel is a permeable substrate, as shown by the presence of droplets on its surface, and demonstrated that age and enamel permeability are closely related. Samples from subjects of different ages showed a decreasing number and size of droplets with increasing age: freshly erupted permanent teeth showed many droplets covering the entire enamel surface. Droplets in permanent teeth were prominent along enamel perikymata.

Coronoid hyperplasia. A case report

Coronoid hyperplasia is a rare condition which is macroscopically characterized by an increase in the dimensions of the coronoid process resulting from an abnormal bony elongation of histologically normal bone. Unilateral cases are more frequent than bilateral ones and can recognize a number of etiological factors, such as exostoses, osteochondroma, traumatic events, inflammatory reactions, neoplasia and manifestations secondary to other pathologies. Etiopathogenesis of bilateral forms has not yet been clarified: in the literature hints to both developmental and endocrine abnormalities are present, and a familiar pattern of inheritance has been evidenced. The poor specificity of signs and symptoms associated with coronoid hyperplasia, which are similar to those of other more frequent forms of temporomandibular disorders, present some problems of differential diagnosis. An accurate assessment must be based on a clinical and anamnestical approach aiming at the identification of pathognomonic clinical symptoms. Considering its limits (such as the possible presence of artefacts and image distortions), orthopantomography has a poor diagnostic usefulness. In this case, magnetic resonance (MR) allowed to evaluate disk-condyle relationship, but it could be also useful to evaluate post-operative complications. In the case of coronoid hyperplasia, the computed tomography (CT) is fundamental for a correct differential diagnosis. CT also allows surgical planning due to its accuracy to detect coronoid process volume and morphology. The present case report is an example of the need for a correct differential diagnosis between the different types of temporomandibular disorders, and it also lends support to the importance of requesting modern imaging techniques during the diagnostic process of the rare or complex cases.

Diagnosis of temporomandibular disorders according to RDC/TMD axis I findings, a multicenter Italian study

AIM

The aim of the present study was to evaluate the prevalence of the different Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I types of temporomandibular disorders (TMD) in a population of subjects seeking for TMD treatment at 2 University Departments in Italy and to compare it with data from similar studies in the literature, in order to assess the usefulness of the RDC/TMD classification system as a tool for epidemiological data gathering and multicenter and cross-cultural comparison.

METHODS

A total of 210 consecutive patients seeking for TMD treatment at the Section of Prosthetic Dentistry, Department of Neuroscience, University of Pisa, Italy, and 109 consecutive patients seeking treatment at the Section of Prosthetic Dentistry and Temporo-mandibular Disorders, University of Pavia, Italy, were assessed using RDC/TMD.

RESULTS

Only 181 of the patients referring to the University of Pisa and 104 of those referring to the University of Pavia satisfied the criteria for inclusion. Findings from the 2 study populations were very similar. Mean age of the patients was 40 years, with a female:male ratio of 3.5:1 (222 females, 77.9%; 63 males, 22.1%). The prevalence of RDC/TMD Axis I diagnoses was 50.2% (143/285) for Group I disorders (muscle disorders), 38.6% (110/285) for Group II disorders (disc displacement), and 50.2% (143/285) for Group III disorders (arthralgia, osteoarthritis, osteoarthrosis).

CONCLUSION

Results from the present investigation have confirmed the usefulness of the RDC/TMD classification system for research purposes and for data gathering in cross-cultural and multicenter comparisons.