National Italian Guidelines for caries prevention in 0 to 12 years-old children.

AIM: Oral and dental health improved tremendously over the last fifty years in Italy but still prevalence of dental caries in children remains a significant clinical problem. This report describes the National Italian Guidelines for caries prevention. METHODOLOGY: A panel of experts coordinated by the Italian Society of Paediatric Dentistry (SIOI) planned to elaborate the national Italian guidelines for caries prevention in children. The structure of the guidelines has been planned to follow the principles of modern caries treatment and management as well as science based dentistry. The main procedure was based on a hierarchic evaluation of literature. CONCLUSION: The guidelines are planned for dentist working in primary dental care, however, they are also designed to be of interest for other care professionals such as paediatricians, gynecologists, pharmacists and general medical practitioners and also for parents and/or guardians of the children.     

Alveolar ridge augmentation using implants coated with recombinant human bone morphogenetic protein-7 (rhBMP-7/rhOP-1): radiographic observations

Aim: The objective of this study was to radiographically evaluate the potential of a purpose‐designed titanium porous‐oxide implant surface coated with recombinant human bone morphogenetic protein‐7 (rhBMP‐7), also known as recombinant human osteogenic protein‐1 (rhOP‐1), to stimulate alveolar ridge augmentation. Material and Methods: Six young‐adult Hound Labrador mongrel dogs were used. Three 10 mm titanium oral implants per jaw quadrant were placed 5 mm into the alveolar ridge in the posterior mandible following surgical extraction of the pre‐molar teeth and reduction of the alveolar ridge leaving 5 mm of the implants in a supra‐alveolar position. The implants had been coated with rhBMP‐7 at 1.5 or 3.0 mg/ml and were randomized to contralateral jaw quadrants using a split‐mouth design. The mucoperiosteal flaps were advanced, adapted, and sutured to submerge the implants. Radiographic registrations were made immediately post‐surgery (baseline), and at weeks 4 and 8 (end of study). Results: rhBMP‐7‐coated implants exhibited robust radiographic bone formation. At 8 weeks, bone formation averaged 4.4 and 4.2 mm for implants coated with rhBMP‐7 at 1.5 and 3.0 mg/ml, respectively. There were no significant differences between the rhBMP‐7 concentrations at any observation interval. A majority of the implant sites showed voids within the newly formed bone at week 4 that generally resolved by week 8. The newly formed bone assumed characteristics of the resident bone. Conclusions: The titanium porous‐oxide implant surface serves as an effective carrier for rhBMP‐7 showing a clinically significant potential to stimulate local bone formation.     

Effect of air-drying temperature on the effectiveness of silane primers and coupling blends in the repair of a microhybrid resin composite

PURPOSE: To evaluate the effect of different silane agents and air-drying temperatures on the repair strength of a microfilled hybrid composite. MATERIALS AND METHODS: Composite cylinders (8 x 4 mm) of Gradia Direct Anterior (GC, N=36), stored in a saline solution at 37 degrees C for 1 month, were sandblasted (50-microm aluminium oxide), cleaned (35% phosphoric acid) and randomly divided into six groups (n=6). Two prehydrolyzed silane primers (Monobond-S, Ivoclar-Vivadent, Porcelain Primer, Bisco), a non prehydrolyzed silane primer (Porcelain Liner M, Sun Medical) and three silane/adhesive coupling agents (Porcelain Bond Activator-PBA/Clearfil New Bond, PBA/Clearfil SE Bond, PBA/Clearfil Tri-S Bond, Kuraray) were investigated. Silane-coated surfaces were air dried at two different temperatures (23 degrees C and 38 degrees C) and repairs (8 x 8 mm) were fabricated (Gradia Direct Anterior). Unrepaired composite cylinders (8 x 8 mm, n=6) were used as control to evaluate the cohesive strength of the material. Microtensile bond strength measurements (microTBS) were performed. Results: The silane agent applied (p < 0.001), the airdrying temperature (p < 0.001) and their interaction (p < 0.001) were significant factors (two-way ANOVA, Tukey test; p < 0.05). Silane primers achieved inferior microTBS when air dried at 23 degrees C as compared to silane/adhesive blends. Warm air-drying was significantly beneficial to composite repairs mediated by silane primers. Comparable results were achieved by silane/adhesive couplings at 23 degrees C and 38 degrees C. At 38 degrees C all the intermediate agents resulted in repair microTBS that were comparable to the 24-h cohesive strength of the composite (one-way ANOVA, Dunnett t-tests; p < 0.05). CONCLUSION: The chemical interactions between silane primers and compozite substrate may be optimized through warm airdrying. Silane/adhesive couplings were not influenced by the air drying temperature.     

The effect of the bite plane splint on the electromyographic silent period duration

An electromyographic study of the masseter and anterior part of the temporalis muscles was performed on ten patients presenting temporomandibular joint dysfunction symptoms. The EMG silent periods (SP) produced in the open-close-clench cycle and jaw-jerk reflex were compared for duration before and after treatment with an occlusal bite splint. Following use of the splint, there was a shortening of SP indicating the possible use of the duration of SP as a diagnostic measurement, and also as an indication of treatment effectiveness.     

Plasma catecholamine and haemodynamic responses to surgical endodontic anaesthetic protocols

The effects of varying clinically relevant patterns of anaesthetic-vasoconstrictor combinations used for peri-radicular surgery on plasma concentrations of catecholamines and haemodynamic responses was studied in the canine model. Five mongrel dogs were anaesthetized with sodium pentobarbital. A femoral canula was inserted to measure central blood pressure and an ECG was used to monitor heart rate and any associated arrhythmias. Femoral venous blood samples were drawn before initial injection and at 3 and 10 min after injections. Plasma catecholamine concentrations were determined using high pressure liquid chromatography (HPLC). Injection protocols used three time periods, 30, 60 and 90s, with solutions containing 1:100000 and 1:50000 adrenaline. No significant changes in heart rates or presence of arrythymias were noted over the experimental protocol. Catecholamine levels in pico moles mL^-1 were within the normal range at the 3-min sample level. At the 10-min sample time there was a more erratic range of concentrations, with most samples within the normal range. This may have been due to endogenous release of catecholamines in specific animals. The data identified trends in both the haemodynamic parameters and plasma catecholamine levels that can legitimately support the careful use of higher levels of a vasoconstrictor when patient profiles and surgical needs dictate.     

Flowable composites as intermediate agents without adhesive application in resin composite repair

PURPOSE: To evaluate the effect of different intermediate resin agents on composite-to-composite microtensile bond strength (microTBS). METHODS: Composite disks (8 x 4 mm) of Gradia Direct Anterior (N = 15) and Filtek Supreme XT (N = 15), stored in a saline solution at 37 degrees C for 1 month, were sandblasted (Microetcher, 50 microm-Al2O3), cleaned (35% H3PO4), and randomly divided into five groups (N = 3) according to the intermediate agent applied. Two flowable composites (Gradia LoFlo; Filtek Supreme XT Flow) and two adhesives (Adper Scotchbond 1XT, Scotchbond Multi-Purpose) were used. As a control, no intermediate agent was applied. Each disk was incrementally repaired (8x8 mm) with the same resin as the respective substrate. By serially cutting each repaired specimen, multiple sticks of about 0.8 mm2 in cross-section were obtained and loaded in tension until failure at a cross-head speed of 0.5 mm/minute. Data were statistically analyzed. Failure mode was examined by stereo- and scanning electron-microscopy (SEM). Additional specimens were prepared to morphologically evaluate the composite-to-composite interfacial quality by SEM analysis. RESULTS: Composite substrate and intermediate agent were significant factors (Two-way ANOVA, P < 0.001). Bond strengths achieved with Gradia Direct Anterior were higher than Filtek Supreme XT. The application of flowable composites resulted in statistically superior microTBS than adhesives and control (Tukey test, P < 0.001). Failure mode was predominantly cohesive (flowable composites), cohesive/adhesive (adhesives) and adhesive (no treatment). Flowable composites and adhesives showed a good interfacial quality.     

Enamel hypoplasia in coeliac children: a potential clinical marker of early diagnosis.

AIM: To assess at the scansion electron microscope (SEM) the structural aspects of enamel hypoplasia (EH) in coeliac disease (CD) with the aim to investigate our hypothesis of a possible significant difference between structural characteristics of EH in CD affected patients and EH of non-coeliac patients. If the presence of specific features of the EH associated with CD were demonstrated, these findings would represent for the dentist early non-invasive clinical markers of diagnosis of CD in case of suspected disease. METHODS: We analysed at SEM two samples of enamel fragments from hypoplasic teeth, both deciduous and permanent, harvested from 10 coeliac children (18 permanent teeth, 6 deciduous teeth; study group) and 10 non-coeliac children (16 permanent teeth, 4 deciduous teeth; control group) treated for dental caries, dental extractions for extensive caries lesions or deciduous teeth exfoliation. RESULTS: Significant structural differences were noted between EH of non-coeliac patients and same dental ? lesion in the group with CD. In the study group, EH defects were predominantly located on the central and lateral incisors, upper and lower, both deciduous and permanent, and on the first permanent molars, and were always simmetrical. EH of permanent teeth of CD affected patients was characterised by prisms more irregularly distributed with irregular margins and less interprismatic substance than observed in non-coeliac EH. The deciduous teeth of the study group showed shorter enamel prisms with a non-parallel direction up to convergence and less interprismatic substance than observed in the control group. CONCLUSION: This morphological analysis at SEM of the hypoplasic enamel defects of a group of coeliac children, the first published in literature, demonstrates that the EH of deciduous and permanent teeth in CD is highly hypomineralised with shorter prisms, more irregularly distributed and less interprismatic substance than observed in the non-coeliac EH. More data are needed to validate the significance OF our observations with the aim to assess if this simple, non-invasive microscopic analysis can be considered effective for the early identification of silent cases of CD that otherwise would not be diagnosed in the paediatric age.     

Prognostic factors for alveolar regeneration: effect of space provision

OBJECTIVES: The role of space provision as an independent prognostic factor for periodontal regeneration remains to be established. The objective of this study was to evaluate the role of space provision on alveolar bone regeneration in periodontal sites. METHODS: Critical size, supra-alveolar, periodontal defects were created in 11 young adult Beagle dogs. Six animals received a porous ePTFE device to provide for space provision. Five animals received sham surgery. The animals were euthanized at 8 weeks post-surgery. A histometric analysis assessed vertical regeneration of alveolar bone and the width of the alveolar crest at the base of the defect. Because of the correlation of within-dog measurements, a mixed model anova/ancova was used to analyse the data. RESULTS: A significant relationship between the width of the alveolar crest at the base of the defect and bone regeneration was observed with no significant difference between sites receiving the different treatments (p=0.84). Bone regeneration at sites treated with the space-providing device was significantly greater compared with that at sites treated with sham surgery (p=0.0003), and the difference remained significant after adjusting for bone width (p=0.0001). CONCLUSIONS: Space provision has a significant effect on alveolar bone regeneration in periodontal sites. The width of the alveolar bone appears to influence space provision effectively supporting bone regeneration.