Maternal mental health and children oral health: a literature review

AIM

Recently, serious considerations regarding mental health conditions and their impact on the whole organism have been made. This area is still quite unknown within the dental community, despite the potential impact these conditions can have on both oral care and health. Previous studies have concluded that both pregnant women and mothers have been found to be particularly sensitive to the risk of developing mental disorders such as anxiety and major depression. There is a very high possibility for the children of these mothers to experience neglect and disregard due to of the development of these conditions, which will negatively affect their behavioural and physical growth as a result. This impact stretches into oral health as well, as these children have been reported to be more inclined to develop early childhood caries, bruxism, and after-birth enamel defects, in addition to illnesses like diabetes and disabilities.

MATERIALS

A literature search was conducted in Pubmed, Medline, and Scopus for the keywords 'maternal depression', 'oral health' and 'children', combined with 'AND' or 'OR' Boolean Operators.

CONCLUSION

The results of the present literature suggest a strong connection between maternal mental disorders and poor children's oral care, and as a result, dental professionals should be extremely careful when treating and communicating with these patients.

Preventive oral hygiene and ventilator-associated pneumonia in paediatric intensive care unit

AIM

Data indicate a tendency towards an increased incidence through the last decades of various forms of pneumonia. Among these, nosocomial pneumonia in patients who have been on mechanical ventilation support (increased after the Covid-19 pandemic) is a condition that must be addressed as soon as possible to avoid complications. Current literature lacks an in-depth analysis of the potential correlation between ventilator-associated pneumonia and poor oral hygiene, especially in children. The aim of this literature review is to investigate if improving oral hygiene could affect the onset of nosocomial pneumonia in children.

METHODS

A search was performed in Pubmed, Medline, and Scopus for the keywords: oral care, children, neonates, ventilator-associated pneumonia, combined with 'AND' or 'OR' Boolean Operators.

CONCLUSION

The relevant papers retrieved in the scientific literature emphasised the importante of good oral care bundles to mitigate the bacteria proliferation in the bloodstream, and to prevent the development of ventilator-associated pneumonia.

Nasal function before and after rapid maxillary expansion in children: A randomized, prospective, controlled study

OBJECTIVES

Children can well detect and respond to odours in order to have information about food and environment. Rapid Maxillary Expansion seems to improve dental and skeletal crossbite and increase nasal patency correcting oral respiration in children. A previous pilot study suggested that Rapid Maxillary Expansion may lead to improved N-Butanol olfactory thresholds, and peak nasal inspiratory flow values (PNIF). The aim of the present study was to prospectively evaluate olfactory threshold, nasal flows and nasal resistances in children aged from 6 to 11 years before and after Rapid Maxillary Expansion, comparing treated children with a control group of similar age, growth stage (prepubertal) and transversal skeletal deficiency.

METHODS

N-butanol olfactory thresholds, anterior active rhinomanometry (AAR) and PNIF were measured in 11 children (6-11 years) before (T0), immediately and 6 months after Rapid Maxillary Expansion application (T1 and T2 respectively), and in a control group of 11 children (6-11 years) whose members remained under observation for the period of the study.

RESULTS

Considering the study group, PNIF values improved at T1 respect to the T0 values (p = 0.003), while T2 values were significantly higher than T0 ones (p = 0.0002). N-Butanol Olfactory Threshold significantly improved at each control (p = 0.01, p = 0,01 and p = 0.0003, for T1 vs T0, T2 vs T1, T2 vs T0 respectively). No differences on AAR values were found during the six months follow-up in this group. Considering the control group, no significant differences were found for any of the considered variables during the time of the study. Comparing the two groups, there was a significant increase of PNIF values in the study group compared to the control group (p = 0.003) at T1, which was even more evident six months after Rapid Maxillary Expansion (p = 0.0005). This improvement was not shown by AAR values. N-Butanol Olfactory Threshold showed a significant improvement at T2 respect to T1 (p = 0.002) and T0 (p = 0.0005).

CONCLUSION

Rapid Maxillary Expansion seems to significantly improve the respiratory capacity of treated patients, at least in terms of PNIF, and their olfactory function, measured by N-Butanol Olfactory Threshold Test. Further studies should be performed to evaluate if also changes in nasal resistances, measured by AAR, could occur, maybe considering a larger group of subjects and possibly using 4-phase rhinomanometry in order to evaluate the effective resistances during the entire breath.

Prevalence of occlusal traits and orthodontic treatment need in 14 year-old adolescents in Northeast Italy

AIM

Studies on prevalence of malocclusion support the planning and provision of public dental services. The aim of the study was to assess the prevalence of malocclusion and occlusal traits in adolescents aged 14 years from public secondary schools in the area of Health District n.15 - Veneto region, Italy.

STUDY DESIGN

Cross-sectional survey.

METHODS

Out of a randomly selected sample of 1187 subjects, 444 adolescents (55% males, 45% females) were evaluated in the school settings according to the criteria adopted by Brunelle et al. [1996]. Alginate impressions were then taken for 380 students together with a wax bite. The occlusal traits of the cast were analysed and IOTN was established.

RESULTS

The most common occlusal traits measured on casts were overjet >3 mm (48%), overbite >3 mm (39%), midline misalignment (32%), crowding (30%), 99% of the sample showed at least one occlusal trait. Class I molar relationship prevailed (75.5%) and the prevalence of molar asymmetries was 21.9%. The prevalence of anterior and posterior crossbite and open bite was significantly higher in females, while the mean values of overjet and overbite were higher in males. The distribution of IOTN in the study population showed that only 49.5% had no or little need of treatment, and more than one third (35.8%) were assigned a 4 or 5 score.

STATISTICS

Descriptive statistics are expressed as a percentage (± confidence interval) or mean ± standard deviation, according to the nature of the variable.

CONCLUSIONS

These outcomes indicate a high prevalence of the aforementioned occlusal traits and also a high need for orthodontic treatment among adolescents in Northeast Italy.

Modified Dental Anxiety Scale: validation of the Italian version

AIM

Anxiety is a relevant problem in dental practice. The Modified Dental Anxiety Scale (MDAS) is a brief, simple questionnaire consisting of five questions with a total score ranging from 5 to 25, the Italian version of which is not available yet. The aim of the study was to provide an Italian version of the MDAS and check its reliability in oral surgery, which is a major cause of dental anxiety due to the expected perception of pain and suffering.

METHODS

The Italian version of the test was administered to 230 patients (98 male and 132 female patients, ages 14-88 years) undergoing oral surgery. Further recorded data were: American Society of Anaesthesiologists physical status classification (ASA-PS), frequency of visiting the dentist and any previous distressing experiences in dental or medical setting.

RESULTS

The internal consistency of the test was high, with a Cronbach's alpha=0.92. The MDAS score was significantly higher in females (P<0.0001) and in patients with previous distressing experiences in medical and/or dental settings (P<0.0001); the correlation with age (P=0.01) and frequency on visiting the dentist (P=0.02) were also significant.

CONCLUSIONS

The patients' selection (oral surgery only) may be a limit of the study, which might not provide an estimation of anxiety prevalence in the general dental population; however our result agree with those of studies performed in other Countries in the generic population, suggesting the absence of major differences with respect to the surgical setting and show the reliability and manageability of the Italian version of MDAS.

Modified dental anxiety scale: validation of the italian version

AIM

Anxiety is a relevant problem in dental practice. The Modified Dental Anxiety Scale (MDAS) is a brief, simple questionnaire consisting of five questions with a total score ranging from 5 to 25, the Italian version of which is not available yet. The aim of the study was to provide an Italian version of the MDAS and check its reliability in oral surgery, which is a major cause of dental anxiety due to the expected perception of pain and suffering.

METHODS

The Italian version of the test was administered to 230 patients (98 male and 132 female patients, ages 14-88 years) undergoing oral surgery. Further recorded data were: American Society of Anaesthesiologists physical status classification (ASA-PS), frequency of visiting the dentist and any previous distressing experiences in dental or medical setting.

RESULTS

The internal consistency of the test was high, with a Cronbach's alpha=0.92. The MDAS score was significantly higher in females (p<0.0001) and in patients with previous distressing experiences in medical and/or dental settings (p<0.0001); the correlation with age (p=0.01) and frequency on visiting the dentist (p=0.02) were also significant.

CONCLUSIONS

The patients' selection (oral surgery only) may be a limit of the study, which might not provide an estimation of anxiety prevalence in the general dental population; however our result agree with those of studies performed in other Countries in the generic population, suggesting the absence of major differences with respect to the surgical setting and show the reliability and manageability of the Italian version of MDAS.

Evaluation of three different manual techniques of sharpening curettes through a scanning electron microscope: a randomized controlled experimental study

OBJECTIVE

The purpose of this study was to compare the effectiveness of three different techniques for manually sharpening of periodontal curettes (PCs) by examining the blades with the aid of scanning electron microscope (SEM).

METHODS

Three groups were considered based on three sharpening methods used: group A (moving a PC over a stationary stone); group B (moving a stone over a stationary PC) and group C (moving a PC over a stone fixed, placed on a 'sharpening horse'). After the sharpening, the blades were examined using SEM. The SEM images were assessed independently by five different independent observers. An evaluation board was used to assign a value to each image. A preliminary pilot study was conducted to establish the number of samples. Pearson's correlation test was used to assess the correlations between measurements. anova test with Bonferroni's post hoc test was used to compare the three groups.

RESULTS

Sixty PCs (20 PCs per group) were used in this study. Statistically significant differences emerged between the three groups (P-value = 0.001). Bonferroni's test showed that the difference between groups A and B was not statistically significant (P-value = 0.80), while it was significant for the comparisons between groups A and C (P-value = 0.005) and between groups B and C (P-value = 0.001).

CONCLUSIONS

The sharpening technique used in group C, which involved the use of the sharpening horse, proved the most effective.

N-butanol olfactory threshold and nasal patency before and after palatal expansion in children. A preliminary study

OBJECTIVES

Olfaction is based on the function of the nasal olfactory receptors. Children can well detect and respond to odors in order to have information about food and environment. Rapid maxillary expansion seems to improve dental class and increase nasal patency correcting oral respiration in children. Nevertheless, there are no studies demonstrating that expansion in pediatric patients could influence olfactory sensitivity. The aim of this study was to evaluate olfactory threshold and nasal patency in children aged from 6 to 12 years before and after rapid maxillary expansion.

METHOD

N-butanol olfactory thresholds, anterior active rhinomanometry, and peak nasal inspiratory flow were measured in 12 children (6-12 years) before (T0), 20 days (T1), and 6 months after rapid maxillary expansion application (T2).

RESULTS

A significant lower olfactory threshold was found comparing T2 and T0 N-butanol olfactory threshold values (p=0.038). Peak nasal inspiratory flow showed a significant improvement both at T1 and T2, with respect to T0 values (p=0.043 and p=0.0001, respectively). T2 nasal resistances showed a trend towards a significant reduction when compared with T1 values (p=0.15).

CONCLUSION

This pilot study suggested that rapid maxillary expansion may lead to improved N-butanol olfactory thresholds, at least 6 months after palatal expansion. Furthermore, rapid maxillary expansion seems to improve peak nasal inspiratory flow values, and finally although with lower sensitivity, reduce nasal resistances as measured by rhinomanometry.

Lateral periodontal cyst (LPC) mimicking periodontal socket in a young patient: report of a case and review of the literature

Background: Lateral Periodontal cyst (LPC) is an uncommon development odontogenic cyst. Most papers are single case reports or series. Methods: We present a case of LPC occurred in a patient which symptoms and signs could mislead the diagnosis. A review of the literature is reported, emphasizing the clinical, radiographic and histopathological features of LPC. Results: A 28-years old female patient presented reporting pain and swelling at the lingual site of the #31.Spot lingual probing depth was 9 mm; sulcus bleeding and suppuration were found at probing. Radiographically well-defined radiolucency appeared in periodontal foramen area. The patient was treated with non-surgical and surgical therapy. Conclusions: LPC is an infrequent cystic lesion that occurs on lateral root vital tooth. In this case, the cyst mimicked a periodontal lesion. The surgical LPC excision solved the symptoms reported by the patient and improved periodontal parameters of the dental element. After 18 months since surgical treatment there aren't signs or symptoms of recurrence.

In vitro comparison of the bond strength to the enamel of conventional and self-etching dental fissure sealants

AIM

Dental caries in pits and fissures of molars is still very common in young people, despite a gradual reduction in their incidence and prevalence. Prevention with the aid of dental fissure sealants can help to reduce the onset of decay. In vitro tests were conducted to compare the bond strength to enamel of self-etching sealants versus those applied using the conventional procedure.

METHODS

The lingual surface of 40 extracted, caries-free, mandibular third molars was milled to make them flat. The prepared teeth were randomly divided into two groups of 20 teeth each: those in Group A were treated with Clinpro (3M ESPE, St. Paul, MN, USA); those in Group B with Quick Seal (BJM Laboratories Ltd, Or-Yehuda, Israel). Cylinders of sealant were attached to the enamel of the flat surfaces of the samples using a polymerisation process treating the surfaces involved according to the type of material. All samples underwent load testing by means of a universal test machine.

RESULTS

The results of the load testing, measured in MPa, were analysed using the Student's t-test for independent samples and the differences proved significant, indicating that the traditionally- applied sealant (mean strength 21.06 MPa) assured a significantly stronger bond (p <.05) than the self-etching sealant (mean strength 10.43 MPa) under our experimental conditions. CONCLUSION Conventional sealants generally provide a considerably higher bond strength than self-etching sealants.

Validation of visual analogue scale for anxiety (VAS-A) in preanesthesia evaluation

BACKGROUND

Anxiety is a relevant but still underscored perioperative problem. The Visual Analogue Scale for Anxiety (VAS-A) seems to be effective, fast and manageable, but has not been fully validated yet. The aim of this study is to validate VAS-A comparing it to, Corah's Dental Anxiety Scale (CDAS) Spielberger's State Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI).

METHODS

One hundred consecutive patients (38 males and 62 females, median age 49 years) submitted to oral surgery filled out the VAS-A, CDAS, STAI forms Y1 and Y2, and BDI at preoperative examination; the order of administration of tests was randomized.

RESULTS

VAS-A score was significantly correlated to CDAS (P<0.0001), STAI-Y1 (P<0.0001), STAI-Y2 (P<0.002) but not to BDI (P=0.18). ROC curve analysis suggested VAS-A equal to 46 mm as threshold for anxiety when using STAI Y1 equal to 40 as reference cutoff.

CONCLUSION

Our study confirms that VAS-A is a reliable indicator of preoperative anxiety and may detect patients with depressive symptoms also. Values of VAS-A around 50 mm are a reliable threshold for a clinically meaningful level of preoperative anxiety.

Experimental assessment of oral hygiene achieved by children wearing rapid palatal expanders, comparing manual and electric toothbrushes

OBJECTIVES

The aim was to compare the efficacy of the electric versus the manual toothbrush in terms of the oral hygiene achieved by patients wearing rapid palatal expanders (RPEs).

METHODS

Forty patients were randomly divided into two groups; one equipped with a manual toothbrush (Group A), the other with an electric toothbrush (Group B). Each child's plaque index (PI) and gingival index (GI) were calculated at banded molar level at times T0 (before banding), T1 (a month later), T2 (3 months later) and T3 (when the expander was removed). At each appointment, the PI and GI were recorded and the patient was remotivated.

RESULTS

The level of oral hygiene achieved by the group using an electric toothbrush produced a greater improvement in the two indexes than in the group using the manual toothbrush that showed no statistically significant improvement (PI T0-T3: P = 0.309; GI T0-T3: P = 0.141). Both indexes dropped considerably in both groups from T0 to T2, but more so in the group B. From T2 to T3, although the electric toothbrush continued to be substantially more effective, Group B showed a statistically significant deterioration in the oral hygiene (PI +20%; GI +33%). Other assessments conducted on particular areas of the tooth showed improvements in the PI (-33%) for the vestibular region, and for the GI (-57%) in the palatal region among the patients in Group B, while there were no significant changes in these indexes in Group A.

CONCLUSIONS

Our findings show that the electric toothbrush is statistically more efficient in performing an adequate level of oral hygiene in children wearing RPE.

Conscious sedation with diazepam and midazolam for dental patient: priority to diazepam

AIM

The aim of this paper was to determine whether the use of midazolam is a better technique than the use of diazepam, in relation with the definition of conscious sedation in dentistry.

METHODS

Eighty-eight patients undergoing oral surgery were divided into 2 groups in which the sedation was randomly achieved with equipotent cumulative doses of diazepam and midazolam, up to a maximum dose of 8 and 4 mg respectively. Patient's tranquillity was assessed after every dose, using a visual analogue score to ten points and the sedation was evaluated as mild, moderate or deep. Blood pressure, heart rate and SpO2 were also recorded. Psychomotor conditions, by Newman test, and the incidence of amnesia and the patient's satisfaction, by telephone interview, were both evaluated.

RESULTS

The number of patients who reached maximum subjective tranquillity was greater already after the third dose of diazepam. The average scores of tranquillity were higher after diazepam. Patients treated with diazepam experienced a higher incidence of mild sedation, patients treated with midazolam a higher incidence of moderate and deep sedation. In patients treated with midazolam blood pressure, heart rate and SpO2 were lower. Postoperative recovery was similar in the 2 groups. After midazolam patients experienced greater amnesia for local anesthesia and drowsiness. Satisfaction was high with both treatments.

CONCLUSION

The study shows that sedation with diazepam is more in line with the definition of conscious sedation in dentistry. Diazepam guarantees the persistence of consciousness and maximum subjective tranquillity levels. The recovery and satisfaction were comparable in the 2 groups.

Nasopalatine duct cyst as a complication of dental implant placement: a case report

This report demonstrates the association between the development of a nasopalatine duct cyst and implant surgery, involving 2 implants positioned 4 years after teeth extraction at a site unaffected by any prior local endodontic disease or radiolucency. The cyst was removed and the residual void was filled with deproteinized bovine bone. Two-year follow-up showed no cyst recurrence, the normal anatomy was partly restored, and one of the implants showed clinical signs of re-osseointegration.

Relationships between different tooth shapes and patient's periodontal phenotype

BACKGROUND AND OBJECTIVE

The purpose of the present study was to establish whether any correlation exists between tooth shapes and patient-related factors such as gingival and periodontal characteristics.

MATERIAL AND METHODS

Clinical measurements, including the width and the height of maxillary central incisor crowns, the apico incisal height of the keratinized mucosa (KM), the buccal gingival thickness (GT), the depth of the sulcus (SD), the bone-sounding depth (BS) and the height of the interproximal maxillary central papilla (Ph), were investigated in 50 healthy individuals. These individuals were then divided into three groups based on the shape of their maxillary central incisor crowns: triangular; square; or square-tapered. The three groups were analyzed to determine any significant differences among the groups in the values obtained for clinical measurements.

RESULTS

There were no significant differences among the three groups in terms of the SD (p = 0.11) or the BS (p = 0.54), whilst statistically significant differences were observed for the KM (p < 0.001), the GT (p = 0.012) and the Ph (p < 0.001).

CONCLUSION

The results of this study indicate that different tooth shapes are associated with significantly different values for the extent of the KM, its bucco-lingual thickness and the height of the interproximal maxillary central papilla.

Dental treatment in Angelman syndrome patients. 8 case reports

AIM

Angelman syndrome is a rare neurogenetic disorder resulting in delayed neuropsychological development, intellectual disability, speech impairment, movement or balance disorder and a behavioural uniqueness. It is caused by deletion of maternal chromosome 15q11-13. The syndrome has oral manifestations such as diastemas, tongue thrusting, sucking/swallowing disorder, mandibular prognathism, and wide mouth. The dental literature on the syndrome is scarce.

CASE REPORT

We report our approach to dental procedures in Angelman syndrome patients, and the relationship between the dental staff and the patient and his family. The purpose of this paper is to highlight the possibility of dental treatment in general anaesthesia, due to the lack of cooperation of some of these patients.

A rare case of unerupted second deciduous molar located inferior to the second premolar: case report

AIM

Tooth eruption is defined as the movement of a tooth from its site of development within the alveolar process to its functional position in the oral cavity [Massler et al., 1941]. The process of tooth eruption can be divided into different phases: pre-eruptive bone stage, alveolar bone stage, mucosal stage, preocclusal stage, occlusal stage and maturation stage [Andreasen et al., 1997]. Any disturbance in these phases can lead to eruptive anomalies. The incidence of unerupted teeth is usually higher among permanent teeth than among deciduous ones [Walker et al., 2004; Otsuka et al., 2001; Amir et al., 1982; Broadway, 1976; Pinborg et al., 1970]. Of the primary teeth reported as unerupted, second primary molars are the teeth most frequently involved [Walker et al., 2004; Otsuka et al., 2001; Bianchi et al., 1991; Ranta et al., 1988; Tsukamoto et al., 1986; Amir et al., 1982], followed by primary central incisors [Otsuka et al., 2001].

CASE REPORT

This paper presents a case of inversion of the intraosseous position of a second unerupted deciduous molar and the succedaneous second premolar.

Experimental evaluation of two methodologies for the restoration of crown fracture in permanent anterior teeth

AIM

The purpose of this study is to compare, by means of mechanical tests, the resistance of two types of dental restoration in the uncomplicated crown fracture of human permanent maxillary central incisor: rebonding of the fractured tooth fragment and application of ceramic veneers.

MATERIALS AND METHODS

Thirty human maxillary central incisors were divided into three groups of ten teeth each. The teeth of the first group (Group A) were kept intact and used as controls, while the remaining teeth were sectioned, in order to simulate a crown fracture, and restored respectively with either the rebonding of the fragment (Group B) or with the use of ceramic veneers (Group C). All samples underwent mechanical tests by means of a universal test machine.

RESULTS

The mean resistance to fracture recorded is respectively 425.2N for Group A, 233.3N for Group B, and 347.3N for Group C. One-way ANOVA analysis demonstrates statistical significance for at least one couple of values (Group B compared to Group A). The group of restorations with rebonding of fractured fragments has a mean value of resistance to fracture that is lower than both intact teeth and teeth restored with ceramic veneers. The resistance of teeth with rebonded restorations is 54.9% of that of, intact teeth, and resistance increases for teeth restored with ceramic veneers (81.8% of that of intact teeth).

CONCLUSION

Ceramic veneers showed a higher resistance than rebonding and resulted to be more reliable in case of further trauma.

Caries experience in 14-year-olds from Northeast Italy. Is socioeconomic-status (SES) still a risk factor?

AIM

Prevalence and severity of dental caries in 14-year-olds of Northeast Italy were estimated, evaluating the dependence to SES.

MATERIALS AND METHODS

An epidemiological survey was performed among a randomised cluster sample of 560 (290 M and 270 F) 14-year-olds attending secondary schools, to evaluate DMFS following WHO indications. Association between caries occurrence and SES was evaluated in a logistic regression model. To account for high proportion of zero scores (DMFS and DS distribution highly positively skewed) data was moreover modelled with negative binomial regression and zero-inflated models.

RESULTS

Caries prevalence was 63.4% with a mean DMFS of 3.0 ± 3.8. A significant trend between means was observed regarding DS in the different SES levels: z = 2.22 p = 0.03 (occupational level) and z = 3.45 p<0.01 when SES was based on educational level. The Negative Binomial Regression model resulted more appropriate than the Poisson model because the dispersion parameter was significantly different from zero (alpha=1.5, 95% CI=1.3-1.8). Working class status showed significant association with DMFS (p=0.04) while using DS as dependent variable, working class subjects and subjects with medium-low and low educational level, showed a statistically significant association.

CONCLUSION

Socioeconomic status is still a predictor for dental decay in the Italian 14-year-olds.

Comparison by means of bispectral index score, between anxiolysis induced by diazepam and sedation induced by midazolam

AIM

Bispectral Index Score (BIS) is an objective tool to assess sedation depth. Benzodiazepines have different pharmacological profiles and diazepam may be safer than midazolam in this setting. The aim of this study was to compare BIS values observed during anxiolysis after diazepam versus sedation after midazolam.

METHODS

Thirty-six patients were randomly assigned to 3 groups: group 1 was treated with i.v. diazepam, groups 2 and 3 with iv midazolam 1 and 3 mg, respectively. Sedation was monitored clinically and by means of BIS. BIS values were evaluated as area under the curve (AUC) and compared by variance analysis. The statistical comparison of other data was performed by variance analysis or, alternatively, the χ2 according to Yates. The statistical significance was indicated by P values <0.05.

RESULTS

AUC values were significantly lower after midazolam when compared to AUC values registered in diazepam treated patients; 22.6% of the group 3 patients showed BIS values <80, versus 0.4% of group 1 patients.

CONCLUSION

Diazepam has a safer profile, with BIS values and clinical conditions according to the definition of minimal and/or moderate sedation. Diazepam represents the safer drug for anxiety management in dentistry, because regularly produces a state of sedation during which verbal contact with the patient is maintained and carry a margin of safety wide enough to render loss of consciousness unlikely.

Reliability and reproducibility of linear mandible measurements with the use of a cone-beam computed tomography and two object inclinations

OBJECTIVE

The aim of this study was to assess the influence of inclination of the object on the reliability and reproducibility of linear measurements of anatomic structures of the mandible on images obtained using cone-beam CT (CBCT).

METHODS

Ten linear dimensions between anatomical landmarks were measured in a dry mandible. The measurements were performed with a manual calliper three times by three observers. The mandible was scanned with Planmeca Promax 3D cone-beam CT (Planmeca Oy, Helsinki, Finland) with the base of the mandible parallel as well as tilted 45° to the horizontal plane. Computer measurements of the linear dimension were performed by three observers. The radiographic measurements were performed four times for each experimental setting. A total of 240 measurements were performed. Reproducibility was evaluated through comparison of standard deviation (SD) and estimation of intraclass correlation coefficient (ICC). The error was estimated as the absolute difference between the radiographic measurements and the mean manual calliper measurements.

RESULTS

The mean SD for the radiographic measurements was 0.36 mm for the horizontally positioned mandible and 0.48 mm for the inclined mandible. The ICC between examiners was 0.996 mm, between sessions was 0.990 mm and between CBCT measurements and calliper was 0.992 mm. The overall absolute mean measurement error was 0.40 mm (SD 0.39 mm). The percentage of errors that exceeded 1 mm was 6.7%.

CONCLUSION

The results revealed high reliability of measurements performed on CBCT images independently from object position, examiner's experience and high reproducibility in repeated measurements settings.

Influence of estroprogestinic therapy on the postoperative course following impacted third molar extraction

AIM

Female patients on estroprogestinic therapy undergoing extraction of the third lower molar have a higher incidence of postoperative complications (dry socket -DS- pain). The purpose of this study is to verify such data and analyse if there are risk factors for the appearance of other postoperative complications.

METHODS

One hundred eighteen non-smoking healthy patients were included who underwent extraction of the impacted third lower molar (38 on oral contraceptives, OC, 80 as control). After the extraction, patients were prescribed with a pharmacological therapy, consisting of a per os antibiotic and antiseptic rinse. Each patient was examined after 7 days following surgery to verify the state of tissues. In addition subjective postoperative pain (VAS - Visual Analogue Scale) and intake of analgesic drugs were recorded.

RESULTS

One case of DS (2.64%) occurred in the OC group, and 1 case of DS occurred in control-patients group (1.25%) (P=0.4436). The postoperative pain proved significantly higher in OC compared to control (first and fifth postoperation day). In OC a predisposition to dehiscence of the wound (86.84% P=0.0021) and emergence of laterocervical lymphadenitis (81.57% P=0.0010) was found, while no cases of postextractive abscesses and trismus of the masseter were found.

CONCLUSION

Although no correlation between DS and estroprogestinic therapy has been found, a more difficult healing of tissues has been observed as well as a significantly higher subjective pain index in the postoperative days considered in OC patients.

Patients appreciation for information on anesthesia and anxiolysis in dentistry

AIM

The research regards information on anesthesia to patients undergoing oral surgery. Every patient evaluated the information received at the end of the preoperative visit and in the postoperative period.

METHODS

One hundred-fifty dental patients were asked about the most appreciated information received in the preoperative visit on the anxiolytic technique, local anesthesia and treatment of the perioperative pain. Afterwards the patients had to report on their reaction to the content of the preoperative visit and information quality. On a phone interview they had to evaluate their appreciation of the anxiolytic technique, their perception during loco-regional anesthesia and incidence of pain and edema.

RESULTS

The most appreciated details were those on the intervention, pharmacologic treatment, postoperative complicances, postoperative pain and operative competence; less appreciated were those on loco-regional anesthesia, duration of the intervention, anxiolytic techniques, hospital reception and permanence in the hospital. Ninety-eight percent of the patients considered to have been adequately informed on a context judged to be extraordinary (99.3%), 96.6% indicated the information as necessary, 98.6% appreciated the treatment of the intraoperative and postoperative (99.3%) pain and 99.3% the anxiolytic treatment. On the telephone interview, 100% of patients expressed satisfaction for the experienced intraoperative tranquillity, 91.3% complained for not having received in the past a similar preoperative visit, 99.3% wished a diffused application of the information. The loco-regional anesthesia was associated to psychological detachment in 84% of the cases and the incidence of postoperative pain was of 36%.

CONCLUSION

The information on the anxiolytic techniques, loco-regional anesthesia, treatment of perioperative pain and postoperative distress was enthusiastically accepted and albeit initially induced feelings of astonishment resulted to be appreciated and preferred in the whole of the patients.

Social differences in tooth decay occurrence in a sample of children aged 3 to 5 in north-east Italy

OBJECTIVE

To correlate the occurrence of tooth decay with a social class indicator (occupational level) and the immigrant status in a sample of pre-school children in Veneto region.

BASIC RESEARCH DESIGN

Cross-sectional survey.

CLINICAL SETTING

Twenty nursery schools in the area of Health District n.15.

PARTICIPANTS

A total of 1,410 children aged 3 to 5 years old visited between September 2005-May 2006.

OUTCOMES

Occurrence of dental caries into dentine threshold was made visually and confirmed with a probe when necessary by two calibrated examiners. Information on immigrant status and occupational level of parents was obtained by a questionnaire. Children were categorized as immigrant or non-immigrant on the basis of their mother's country of origin. Means and standard deviation were calculated for continuous variables; for categorical variables the results were provided as proportions. Comparisons between groups were made using Pearson chi-square test. The association between caries occurrence and the independent variables gender, age, immigrant status and family social class was evaluated by means of a logistic regression model.

RESULTS

Caries occurrence was higher among children from lower social class families (1.7 +/- 3.2) than among children from higher social class (0.8 +/- 2.1). The prevalence of dental caries in immigrant preschool children was significantly higher than in indigenous ones (15% vs 40%; p = 0.000) while the severity in immigrants was almost 4 times higher (2.2 +/- 3.6 vs 0.6 +/- 1.8).

CONCLUSIONS

Our data on preschoolers confirm the worldwide literature shared statement that social class as well as immigration status are determinants of oral health.

Tooth fragment reattachment through the use of a nanofilled composite resin

AIM

The purpose of this study is to evaluate resistance to fracture with static tests of dental fragments reattached through the use of different light-curing composite resins. For this purpose 40 bovine inferior incisors were utilised, which were randomised into 4 groups; one control group and 3 experimental groups.

MATERIALS AND METHODS

All teeth of the 3 experimental groups were sawed at 3 mm from the incisal margin, and the respective fragments were then reattached utilizing different composite resins: in group 2_EI the hybrid composite Tetric EvoCeram (Ivoclar Vivadent AG) was used, in group 3_ZI the hybrid composite FiltekTM Z250 (3M ESPE) was used, and in group 4_SN the nanofilled composite FiltekTM Supreme (3M ESPE) was used. After reattachment, on each tooth were performed a chamfer on the buccal surface and an overcontour on the lingual surface along the fracture line, which were then filled with the composite resin corresponding to the respective group. Finally, all teeth were embedded in plaster blocks, and a force was applied on the buccal surface.

RESULTS

All teeth in groups 2, 3, and 4 showed a significant loss of resistance to fracture compared to the teeth of the control group (P<0.0001). Resistance to fracture of the teeth belonging to groups 2_EI and 3_ZI was 37.35% and 47.35% of that of intact teeth respectively; in group 4_SN resistance to fracture reached 60.05%. Teeth of group 2 exhibited values of resistance to fracture statistically significant from those of group 4 (P=0.024), but no difference was found between group 2 and group 3 (P=0.298). The difference in resistance between group 3 and group 4 was not statistically significant (P=0.199).

CONCLUSION

Static test showed that reattachment of coronal fragments do not restore resistance to fracture to the value of intact teeth. Resistance to fracture in in vitro studies is influenced by the type of composite resin utilised.

Solitary neurofibroma of the palate. A case report

The neurofibroma is a benign tumor of neuronal origin not frequently located in the oral cavity. The possible association of this neoplasia with systemic pathologies, such as Von Recklinghausen's disease and multiple endocrine neoplasia, makes its diagnosis fundamental. The diagnosis is, in most cases, quite complex, because of the neurofibroma's strong similarities with a great number of benign neoformations of the connective tissue, of the epithelium, and of the bone. The histology represents, therefore, the fundamental diagnostic criterion, in particular, through the use of appropriate immunohistochemical analysis. This articles presents the case of a solitary neurofibroma, subtype I (common Schwann cell type), detected on the left-hand side of the posterior region of the palate in a 56-year-old woman, which presented itself as an otherwise non-symptomatic ulcerated mass. After a careful anamnesis, an incisional biopsy was performed in order to establish the histological nature of the neoformation. The immunohistochemical test, which resulted positive for S-100 and negative for the epithelial membrane antigen and keratin, allowed the diagnosis of a presumably benign lesion deriving from a neural differentiation. The surgical excision of the entire mass was accompanied by the extraction of the upper left-hand second molar, which was attached to the mass through its palatal root.

Oral health problems and needs in nursing home residents in Northern Italy

OBJECTIVE

To describe the oral health status and treatment needs of a sample of elderly people residing in nursing homes in Northern Italy.

RESEARCH DESIGN

a sample of 595 elderly residents (mean age 83.2+/-9.2 yrs), with adequate cognitive skills were examined by six calibrated dentists.

RESULTS

The sample (82% women) was divided into two groups: edentulous (43%) and dentate. In the edentulous group 58% wore dentures in both jaws, 8% in only one jaw and 34% had no dentures. The main problems were dirty or loose dentures and poor oral hygiene. In the dentate group the mean number of teeth was 8.4+/-7.4, 53% wore dentures (removable, fixed or a combination). Poor oral hygiene was found in 86%, root caries in 51% and coronal caries in 46%. Their main needs were professional cleaning (72%), oral hygiene instructions (62%) and tooth/root extractions (56%). While normative needs were noted for 82% of the whole sample, oral treatment needs were accurately perceived by only 20% of residents, poorly by 24%, while 46% indicated that they had no oral treatment needs.

Dental caries in children with asthma undergoing treatment with short-acting beta2-agonists

AIM

This study sought to evaluate possible higher risk for dental caries among asthmatic children undergoing treatment with short-acting beta2-agonists.

METHODS

Dental clinical assessments, saliva analysis and a questionnaire survey were carried out on 60 children aged 6-12, of whom 30 were asthmatic subjects undergoing treatment with short-acting beta2-agonists and 30 were used as controls. The obtained data for DMFT/dmft scores, Silness-Löe plaque index, buffer capacity and bacteria counts for Streptococcus mutans and Lactobacillus in the saliva, oral hygiene and dietary habits were compared using Student t-test and Pearson chi-square test.

RESULTS

We registered a higher DMFT score among asthmatics of 1.2-/+1.8 (SD) and 0.3-/+0.8 among non-asthmatic patients (p<0.05), while comparison of dmft scores between the examined groups showed not significant (Student t-test). Saliva analysis revealed lower buffer capacity in 43.3% of the asthmatic children, followed by higher cariogenic bacteria counts in their saliva (p<0.05 Student t-test). These results show the lower plaque index in the asthmatic group (1.6+/-0.4) compared with the control (2.1+/-0.3). Asthmatic children expressed better oral-health habits with more frequent tooth- brushing and usage of fluorides.

CONCLUSION

The results from our study suggest a higher caries-susceptibility among asthmatic children undergoing treatment with short-acting beta2-agonists, but a clear association between these drugs, salivary changes and dental caries among children, still remains to be demonstrated.

Maxillary sinus lift through heterologous bone grafts and simultaneous acid-etched implants placement. Five year follow-up

AIM

The aim of this study was to assess retrospectively at 5 years the clinical outcome of bone regeneration in patients who underwent maxillary sinus lift with different equine-derived, enzyme-deantigenated equine bone grafts, and simultaneous placement of acid-etched surface implants.

METHODS

Eighteen patients (10 males and 8 females, age between 55 and 61 years) were considered. They were divided into 2 groups according to the type of bone graft used: a combination of an equine flexible heterologous spongy bone layer (Osteoplant Flex, Bioteck) and equine heterologous cortical and spongy granules (Bio-Gen Mix, Bioteck), group A, or a block of equine heterologous spongy bone (Bio-Gen Block, Bioteck), group B. Surface-treated implants (''TRE'' type, Biotec) were placed simultaneously to sinus augmentations and usual clinical and radiological tests were performed at 6 months and every year up to 5 years after surgery.

RESULTS

At 5 years, 45 out of 49 total implants placed (91.8%) were successful according to the Albrektsson and Zarb criteria. The loss of the 4 failed implants was observed in 2 patients of group B during the first days following surgery.

CONCLUSION

These results show that the heterologous bone grafts supported properly the bone regeneration inside the sinuses, and that the type of implants used allowed to achieve a satisfying rate of success according to the current standards in implantology.

Extraoral endodontic treatment, odontotomy and intentional replantation of a double maxillary lateral permanent incisor: case report and 6-year follow-up

AIM

To describe combined endodontic, surgical and orthodontic treatment of a maxillary lateral incisor fused with a supernumerary.

SUMMARY

Double tooth is a dental irregularity consequent to fusion of two or more teeth or dental gemination. The teeth most commonly involved are deciduous, but in 0.1% of cases permanent teeth are affected, in which case aesthetic, functional and periodontal problems can result. This paper reports a clinical case of a double tooth in the position of the maxillary right lateral permanent incisor. Combined orthodontic, endodontic and surgical treatment (intentional replantation) allowed the tooth to be retained without periodontal compromise and with a positive orthodontic result both immediately and 6 years following intervention. *A conservative approach that addresses periodontal, pulpal and tooth tissues, can result in the retention of a double tooth. *Maintenance of the root and alveolar bone in young adults at least until full skeletal maturation should be the main treatment objective.

Preschoolers' dental caries experience and its trend over 20 years in a North-East Italian Health District

AIM

To describe dental caries occurrence among preschool children in a Health District in the North-East of Italy by age, gender and immigrant background; 2) to plot a trend of primary dentition dental caries over a 20 year time span.

STUDY DESIGN

Observational cross-sectional survey.

METHODS

41 out of 88 kindergartens were randomly selected, originating a sample of 3470 preschoolers out of 7,061 overall school attenders. Dentinal caries occurrence was evaluated by 2 calibrated examiners at school on 2,524 3-5-year-olds from October 2004 to June 2005. The participants were divided into 2 subgroups depending on the country of origin of their mothers: non-western (IG or immigrant group) and western (WG). Two previous surveys performed in the same area were used to plot a trend over a 20 year period.

STATISTICS

Comparisons between groups were made using the Pearson chi-squared test and caries risk estimation was established by logistic regression analysis to assess the influence of sex, age and ethnicity (independent variables) on caries experience (dependent variable). Risk was summarised as odds ratio plus 95% CI.

RESULTS

Prevalence (%) and severity (mean dmft +/- SD) increased by age (15% - 0.6 +/- 1.9 at 3 years of age; 25% - 1.1 +/- 2.6 at 4; 32% - 1.3 +/- 2.7 at 5) and were significantly different (p<0.01) between the two groups: 23% (WG) vs 54% (IG) and 0.9 +/- 2.2. (WG) vs 3.4 +/- 4.3. The level of untreated caries was high: 88.9% in WG vs 97.1% in IG. From 1984 to 2004 prevalence and severity of dental caries declined at all examined ages.

CONCLUSION

The current dental scores in preschoolers are low and similar to those reported in other Western European countries. These good scores have been achieved through a strong decline occurred over the last two decades. As regards the Italian recent social phenomenon of immigration, nowadays being an immigrant child is a strong determinant of dental caries.

Comparative evaluation of different techniques of surface preparation for occlusal sealing

AIM

Aim of this experiment is the efficacy evaluation of three different types of surface preparation techniques by microleakage assessment of two different sealing materials.

MATERIALS AND METHODS

Sixty teeth were used for the experiment: half were treated with Admira seal (Voco) and the remaining half with Delton FS+ (Dentsply). Each group was then divided into three subgroups, which underwent three different preparation techniques before sealant placement: mechanical brushing, air abrasion and Intensive bur FG 40D4, respectively. After immersion of the specimens in methylene blue solution, the degree of microleakage was assessed by mean of optic microscope.

RESULTS

Results show no microleakage in samples treated with air abrasion, followed by the samples treated with mechanical brushing. The teeth prepared by bur treatment before sealant application show a significant number and degree of marginal infiltration.

CONCLUSION

It can be concluded that air abrasion technique is able to guarantee a reliable seal of occlusal surfaces.

Prevalence and severity of dental caries in 5- and 12-year old children in the Veneto Region (Italy)

OBJECTIVES

To evaluate the occurrence of dental caries among 5- and 12-year-old children in Northeastern Italy and to compare dental status between immigrants and native-born children.

BASIC RESEARCH DESIGN AND PARTICIPANTS

A cross-sectional survey of 260 5-year-olds and 862 12-year-olds was carried out between October 2003 and May 2004. Dental caries were diagnosed at the caries into dentine (D3) threshold. Differences in dental health status were compared between immigrant and native-born children for both age groups.

RESULTS

Among 5-year-old children, mean dmft was 1.45 (SD=2.69), SiC=4.31, 65.8% had no caries. Immigrant 5-year-olds (6.2%) scored more poorly than their Italian counterparts: mean dmft was 5.12 (vs. 1.21; p<0.001) and only 25.0% were caries free (vs. 68.4%; p<0.001). Among 12-year-olds, mean DMFT was 1.44 (SD=2.00), SiC=3.88, 55.1% had DMFT=0: 5.6% also had poorer dental status: mean DMFT was 3.23 (vs. 1.33; p<0.001), SiC=6.69 (vs. 3.66), and only 17.1% had DMFT 0 (vs. 56.8%).

CONCLUSIONS

The prevalence of dental caries and care obtained for both age groups are similar to those of other industrialised countries. When our results for 12-year-olds were compared with those of two previous surveys (1984 and 1994), a major decline in the prevalence of dental caries was observed. Being immigrant was a strong determinant in caries occurrence.

Oral health inequalities in preschool children in North-Eastern Italy as reflected by caries prevalence

AIM

To investigate dental caries experience among preschool children aged 3-5 years living in 2 Health Districts in North- Eastern Italy and to compare caries experience between indigenous and immigrant children.

STUDY DESIGN

Cross-sectional observational survey. METHODS AND STATISTICS: In this study 4,198, 3-5-year-old children, drawn from a total population of 9,829 were asked to participate. The examinations were performed at school between October 2004 and June 2005 and only lesions that penetrate the dentine were recorded (according to the BASCD criteria, 1997), by 2 calibrated examiners using artificial light, mouth mirrors and dental probes. The participants were categorised into 2 subgroups according to the country of origin of their mothers: indigenous mothers, almost all born in Italy, plus a very small number of mothers born in other highly developed western countries--"western origin"--(Nordic countries, Western Europe, North America, New Zealand and Australia), and immigrant mothers from Eastern Europe, Asia, Africa, Turkey, South and Central America, "non-western origin". Comparisons between groups were made using Pearson chi-squared test. Caries risk estimation was established by logistic regression analysis to assess the influence of gender, age and ethnicity on caries experience. Risk was summarised as odds ratio plus 95% CI.

RESULTS

A total of 3,401 pre-school children were examined. The overall prevalence of dentinal caries was: 15.4% in 3-year-olds, 24.2% in 4-year-olds and 31.1% in 5-year-olds. At the same ages, children of immigrant mothers ("non-western origin") showed a significantly higher prevalence of caries compared with their counterparts of "western origin". As expected, older children had more caries. "Non-western origin" had a negative effect on caries experience.

CONCLUSIONS

Inequalities associated with mothers with an immigrant background were observed in the distribution of caries experience among the children. These children represent the first generation settling in and growing up in Italy, and their dental status-related data are comparable to those observed at the same ages in first generation "non-western" children living in other industrialised countries.

CD10 expression in stromal cells of oral cavity squamous cell carcinoma: a clinic and pathologic correlation

OBJECTIVE

CD10 is expressed on the majority of follicle-center lymphomas and Burkitt lymphomas. CD10 has also been shown to be present in a variety of other neoplasms.

DESIGN

The aim of this study was a correlation of CD10 and several parameters: age, tumor size, presence of lymph node metastases, clinic stage, histologic grading, presence of local recurrences.

MATERIALS AND METHODS

The tissues of 77 consecutive patients with oral cavity squamous cell carcinoma were evaluated using immunostaining with monoclonal antibody for CD10.

MAIN OUTCOME MEASURES

Highly significant correlations were found with the lymph node status, the presence of local recurrences and the histologic grading. The presence of CD10-positive cells was not correlated with the age of patients, tumor size and clinic stage.

RESULTS

The results of the present study show that in oral squamous cell carcinoma CD10 positivity is an indicator of worse prognosis. Another strong correlation was found with the presence of local recurrences. Also the histologic grade was significantly correlated with the CD10 positivity.

CONCLUSION

Our results point to the fact that CD10 expression can, perhaps, have an important role in tumor invasion, probably facilitating the occurrence of metastases.

Laboratory comparison of a titanium trauma splint with three conventional ones for the treatment of dental trauma

AIM

This was to evaluate the efficacy of a Titanium Trauma Splint (TTS) by comparing it with three other devices commonly used in the care of dental trauma, a Resin Splint (RS), Button-Bracket Splint (BS) and a Wire- Composite Splint (WCS).

METHODS

The four types of splints were applied on experimental dental models, including in the splints the teeth from canine to canine of each maxilla. Two load-tests for each device were applied with the dental model inclined to 45 degrees or less, and increasing forces were applied to the incisal edges from 0N to 50N, in the first test, and from 0N to 100N in the second. At the same time the displacement involved of the splinted teeth was assessed and then the ratio between the two measured sizes was graphically represented.

RESULTS

In the level tests the displacements of the splinted teeth caused by the force of 80N were: 0.39 mm for the BS, 0.37 mm for the TTS, 0.35 mm for the WCS and 0.30 mm for the RS. In the inclined tests, the splints under the effect of 40N, showed displacements as: 1.65 mm RS, 1.83 mm BS, 1.89 mm TTS and 2.16 mm WCS.

CONCLUSION

With the exception of RS as to rigidity, the other three splints were practically the same in response. Considering other characteristics, the TTS proved to be a promising device for the treatment of dental traumas.

Analysis of an anxiolytic technique applied in 1179 patients undergoing oral surgery

AIM

The aim of this study was to evaluate the effects of sedation with benzodiazepines in a large population of patients undergoing oral surgery and age-related implications.

METHODS

A group of 1 179 consecutive patients undergoing oral surgery in the Dental Clinic of the University of Padua between 2001 and 2003 was evaluated by analysing their anaesthesiological records. The patients were divided into 5 age groups. All were pre-sedated with chlordemethyldiazepam per os, while induction of maximum subjective tranquillity was obtained with fractionated doses of intravenous diazepam. Arterial pressure (AP), heart rate (HR), anxiety level, pathologies, drugs taken, types of intervention, techniques of loco-regional anaesthesia, immediately preoperative AP and HR and tranquillity, intraoperative AP and HR, data regarding postoperative psychomotor recovery, complications and drugs used for the treatment of perioperative pain, were evaluated in each group.

RESULTS

Most of the patients (679) were in the 45-64 year-old group. Cardiovascular, respiratory and digestive pathologies proved to be age-dependent. Control AP and HR respectively increased and decreased with age. The doses of chlordemethyldiazepam used induced age-dependent preoperative tranquillity levels. The doses of i.v. diazepam necessary to obtain maximal preoperative subjective tranquillity fell as a function of age. The AP and HR values respectively increased during intervention and decreased in the first hour of intervention. Normal psychomotor recovery was less evident in older patients. The most significant corrective intraoperative interventions consisted of the administration of sublingual hypotensive drugs and in the immediate treatment of some cases of orthostatic hypotension and vaso-vagal syncope.

CONCLUSIONS

The sedation technique and the antistress procedures employed proved safe and the intra- or postoperative complications almost non-existent. The variations observed in the parameters considered are compatible with the greater age of the treated subjects.

[Systemic antimicrobial treatment of prosthesis related infections: a comparative study of ornidazole and minocycline. A microbiological evaluation and experimental protocol]

BACKGROUND

The aim of this study was to evaluate the efficacy of two chemotherapeutic agents against bacterial forms responsible for prosthesis-related infections.

METHODS

The evaluation was made on the basis of a count using optical microscope 1000x after GRAM staining of the main bacterial forms found in periprosthetic inflammatory exudate both before and after treatment. Two drugs used: ornidazole and minocycline. A group of 20 patients were studied (12 women and 8 men) aged between 42 and 71 years old with an advanced stage of periprosthetic inflammatory pathology. The pharmacological protocol was administered to the two groups of patients for a period of approximately 15 days.

RESULTS

At the end of treatment there was a marked reduction in all the bacterial forms involved in periprosthetic pathology in both groups, with a gradual recovery of normal bacterial flora (gram forms) coupled with a clinical improvement in the implant sites examined.

CONCLUSIONS

Given the specificity of action shown by ornidazole against pathogenic anaerobic, gram-; bacteroides and sporigenic forms, it is recommended for systemic use against prosthesis-related inflammatory disease.

[Topical treatment of peri-implantitis with metronidazole dental gel 25%. Clinical analysis and microbiological control]

BACKGROUND

Aim of this research is to verify the efficacy of metronidazole dental gel 25%, used as a topical antibiotic for the treatment of peri-implantitis. The efficacy of the medicine in the starting phase of the disease (mucositis), as well as during peri-implantitis involving bone-bearing loss has been evaluated.

METHODS

Twenty patients were chosen as a sample for the study. After careful evaluation of the several protocols concerning peri-implantitis treatment, some diagnostic clinical parameters have been recorded for each patient and metronidazole dental gel 25% (Elyzol Cabon) has been administered in two applications at perimplants pocket (one after a week). For each patient 3 microbiological drawings were made for the evaluation of the bacterial population around the implant site.

RESULTS

From the microbiological examination a decrease of Gram- and an increase of Gram+ which returned in almost all the patients to normal levels have been observed; moreover, in all the patients a gradual decrease of PMN, resolution index of the inflammatory process was obtained, confirmed also by a remarkable improvement of all the observed diagnostic parameters, except for the peri-implants bone radiotransparency which was unchanged.

CONCLUSIONS

The research showed that the peri-implant diseases can be positively resolved by using the metronidazole dental gel 25% topical antibiotic. This drug led to a 60-70% decrease of Gram-, and 40-50% increase for Gram+, bringing these back to normal values in almost all the patients. Moreover, a good recovery of the peri-implants soft tissues has been observed.