Valutazione estetica del sorriso in pazienti con agenesia degli incisivi laterali mascellari: revisione della letteratura

Objectives

Our aim was to identify the aesthetic parameters of the smile that should be assessed in patients with missing maxillary lateral incisors, by means of a review of the most recent literature on this topic.

Materials and methods

Using the most common search engines, such as Pub Med and the Cochrane library, we selected articles published between 1995 and 2010, which were indexed with the following Keywords “congenitally missing lateral incisors”, “aesthetic aspects”, “long-term clinical results”, “smile arc”, and “soft-tissue aspects”. Of the 28 articles selected, 10 were eliminated because they had follow ups <5 years or referred to sponsored studies. The remaining 18 articles only 12 articles were analyzed to identify the aesthetic parameters to evaluate in smile assessment of patients with missing maxillary lateral incisors.

Results

The review showed that when upper incisors are missing, good aesthetic results can be obtained with the traditional space-opening approach or with orthodontic space closure and mesialization of the lateroposterior sectors. However, clinicians currently prefer the orthodontic space closure option.

Conclusions

Treatment options for patients with missing maxillary lateral incisors include either space closure approaches and those based on space reopening and insertion of implants. Both offer good results in terms of smile aesthetics.     

Inclusione dei canini mascellari permanenti e riassorbimento radicolare degli incisivi: prevenzione e aspetti medico-legali

Objectives

To discuss the risk of incisor root resorption in the presence of ectopic eruption of the permanent maxillary canines.

Discussion

Early detection of an anomalous intraosseous position of the maxillary canine is essential. To this end, patients should undergo a comprehensive clinical and radiographic assessment starting at the age 8 years.

Results and conclusions

Eruption of the ectopic permanent canines can be facilitated with early extraction of the primary maxillary canines (and possibly the primary first molars). This approach can prevent impaction (which requires more complicated, prolonged, and biologically expensive treatment) and limit the risk of root resorption involving the adjacent teeth (an event that causes irreversible damage and may give rise to medicolegal litigation).     

Eziopatogenesi e modalità di trattamento delle litiasi salivari sottomandibolari

Objectives. After a brief review of the causes, pathophysiology, and clinical presentation of sialolithiasis, the authors examine the main treatment protocols currently used to treat this condition. They also analyze their own experience in the surgical treatment of submandibular salivary calculi with an intraoral approach. Materials and methods. The authors treated 53 patients with salivary calculi (5 to 35 mm in diameter) located in the Wharton duct. Treatment consisted in enucleation of the calculi, with or without sialodochoplasty. Results. In all cases, normal submandibular gland function was restored. Conclusions. This study shows that surgery is still the most reliable approach for removing intraductal submandibular calculi. This approach provides predictable results and low morbidity that cannot be achieved with other techniques, such as lithotripsy, CO₂ laser therapy, or operative fibroscopy.     

L’impiego del laser nelle patologie delle ossa mascellari

Objectives. Laser-based treatment of jaw bone diseases offers advantages for both clinicians and patients, including mini-invasiveness, facilitated control of hemostasis, and reduced postoperative pain. The aim of the present article is to review the use of laser tools in dentistry, with particular reference to their use in the treatment of diseases involving the jaw bones. Materials and methods. Reducing the intraoperative risks and side effects of laser therapy for the treatment of jaw bone diseases requires complete knowledge of the characteristics of the wavelength used, those of the target tissue, and laser-tissue interactions. Considering these aspects, one can elaborate an appropriate “treatment plan” that includes low level laser therapy and surgical approaches with different degrees of invasiveness. Conclusions. Laser therapy can considerably improve the treatment of jaw bone diseases from a biological point of view and in terms of surgical technique and patient compliance. These advantages are related to its antibacterial and biomodulative properties. The use of lasers requires a period of training to optimize clinical results and to minimize adverse effects, which are mainly caused by the incorrect use of these tools.     

Trauma a carico degli incisivi superiori. Caso clinico

Objectives

The aim of this case report is to illustrate the importance of clinical and radiographic examinations for a correct diagnosis and treatment of dental trauma.

Material and methods

A 27-year-old woman in good health conditions presented to the Emergency Department of the Dental Department of the University of Milan with trauma to the superior maxilla related to a bicycle accident. The clinical examination revealed mobility, extrusive dislocation and uncomplicated crown fracture of the right central upper incisor. A small fracture was also noted in the left upper central incisor, but it was not associated with mobility. The lips presented lacerations and contusions. Endoral X-rays were obtained in the Emergency Department, and the injured incisor was subjected to splinting with an orthodontic wire and temporary reconstruction. After clinical examination, low-dose cone-beam computed tomography was done to exclude the possibility of maxillary fracture.

Results

In the presence of dental trauma, it is important to recall that tooth fragments may be present in the lip or in other soft tissues, giving rise to a foreign body granuloma.

Conclusions

Scrupulous clinical examination of soft tissues is imperative to detect dental fragments or foreign bodies.     

Valutazione strumentale delle malocclusioni di Classe II

Objectives

In the present study, the authors investigated the possible etiological role of the masticatory muscles in the development of Angle class II malocclusion in hypodivergent and hyperdivergent patients.

Materials and methods

Ten patients with Angle class II malocclusion were examined, and each underwent surface electromyography, T-Scanning, and kinesiography.

Results

Compared with the hyperdivergent patients, those who were hypodivergent exhibited increased activation of all the muscles studied, especially the anterior temporalis and masseter, which presented a more anterior occlusal barycenter and higher-velocity opening and closing.

Conclusion

Structural and/or positional changes in the mandibles can be related to dysfunctional muscle activity. The muscle dysfunction can alter the growth pattern, especially in hypodivergent patients.     

Prevenzione delle infezioni in odontoiatria: disinfezione e sterilizzazione

Objectives. The aim of this paper is to provide an easy-to-consult vademecum on methods for protecting patients and members of the dentistry staff from infections. Materials and methods. We conducted a review of the main scientific data evidence related to the prevention of infections in dental patients. Results and conclusions. Dental procedures represent a potential risk of infection for patients and staff members alike. It is difficult, however, to correlate the development of specific infections with specific types of treatment. Furthermore, epidemiologic data are not available on the actual number of infections contracted in the dentistry environment. Nevertheless, it is clear that, alongside technical and operational skills, there is an essential need for knowledge relating to the most basic standards of hygiene, sterilization and disinfection processes, and procedures used to verify the latter.     

Timing terapeutico e concetto di “urgenza” ortodontica. Linee guida e revisione della letteratura

Objectives

The objective of the study is to define the optimal timing of “urgent” orthodontic treatment of malocclusions.

Materials and methods

We conducted a systematic review of the literature that contained quantitative and qualitative data on the timing of orthodontic treatment of various types of malocclusions. Our analysis centered on articles indexed in the Medline database that had been published from 1970 through November 2010, including review articles, meta-analyses, and randomized and controlled clinical trials (RCT and CCT).

Results and conclusions

Our analysis of the literature indicates that there are “urgent” orthodontic problems that require prompt treatment, even if the permanent teeth have not erupted. These cases include crossbites, skeletal class III malocclusion, certain behavioral anomalies, the presence of obstacles to eruption or supernumerary teeth, and early tooth shedding. In these cases, early treatment often prevents the later development of severe, frequently skeletal malocclusions.     

Risultati clinici e istologici delle preparazioni subgengivali a lama di coltello. Casi clinici

Objectives

This article evaluates the correlation between clinical and histological results in teeth prepared for fixed prosthodontics using the Biologically Oriented Preparation Technique (BOPT).

Materials and methods

Clinical cases are presented to illustrate the main steps in the BOPT procedure and the clinical results. Six anterior teeth regarded as “hopeless” were used for histological analysis. Three were prepared according to the BOPT (test), and the other three were prepared with a rounded juxtagingival shoulder (control). Temporary acrylic resin restorations were immediately placed. The teeth were extracted after five weeks.

Results

The junctional epithelium (JE) measured 2.5 ± 0.4 mm (test) and 1.7 ± 0.3 mm (control) (p < 0.001). The area of connective tissue infiltrated by inflammatory cells was 2.7 ± 0.7 mm² (test) and 1.5 ± 0.3 mm² (control) (p < 0.001).

Conclusions

The BOPT appears to favor the formation of a long JE and inflammatory-cell infiltration of the connective tissue, so it should not be used on periodontically sound teeth.     

Cisti del dotto nasopalatino di notevoli dimensioni: presentazione di un caso clinico e follow-up

Objectives

The main objective of this article is to describe the surgical approach used for the enucleation of an unusually large nasopalatine cyst and the long-term results obtained.

Materials and methods

The authors describe a patient with a large nasopalatine cyst. Median involvement was typical, but there was atypical expansion toward the vestibular side with erosion of the vestibular cortical bone and the floor of the nasal cavity. The authors describe the cystectomy procedure used in this case, with emphasis on the vestibular access.

Results

Postoperative radiographic studies performed 6 months and 1, 2, and 3 years after the procedure revealed progressive bone regeneration that was almost complete.

Conclusions

Definitive diagnosis must be based on the results of the clinical examination, radiographic data, and above all histologic findings. On the basis of these data, one can plan appropriate follow-up to exclude the presence of recurrences.     

L’artrocentesi con e senza farmaci aggiuntivi nel trattamento dei processi infiammatori e degenerativi dell’articolazione temporomandibolare: studio clinico-sperimentale

Objectives

The aim of this study was to define the most effective protocol for temporomandibular joint arthrocentesis through comparative efficacy analysis of three different treatment protocols involving joint lavage with or without the use of drugs to manage symptoms of intracapsular disorders.

Materials and methods

The study sample consisted of 31 consecutively enrolled patients with unilateral intracapsular pathology and pain lasting more than 6 months. Criteria for inclusion in the study were the presence of functional limitation and pain that were refractory to conservative treatments and a diagnosis of osteoarthritis based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD, Axis I, Group IIIb). The study design provided a single arthrocentesis procedure associated with single-needle joint lavage using normal saline, low molecular weight hyaluronic acid, or corticosteroids.

Results

Marked improvements were reported for all variables, regardless of the drug injected. Hyaluronic acid produced slightly better outcomes, but the differences with respect to steroids were not statistically significant, except the one regarding improved masticatory efficiency (p = 0.043).

Conclusions

Single-needle viscosupplementation with hyaluronic acid was only slightly more effective that joint lavage with corticosteroids or with normal saline alone. Further investigation is needed to obtain deeper insight into the clinical significance of these findings.     

Tecnica osteotomica piezoelettrica e rotante nella chirurgia dei terzi molari inferiori inclusi: comparazione delle sequele postoperatorie

Objectives

The aim of this study was to compare the outcomes of surgery for impaction of mandibular third molars performed with piezoelectric or high-speed rotatory osteotomy technique.

Materials and methods

One hundred fifty patients with impacted mandibular third molars were included in the study. Seventy-five were treated with a piezoelectric osteotomy technique (group A) and 75 patients were treated with high-speed rotatory osteotomy (group B). The treatment protocol was the same for both groups. Twenty-four hours after surgery, facial swelling and trismus were evaluated in both groups.

Results

Mean procedure duration was 22.65 minutes in group A and 17.56 minutes in group B. Mean facial swelling was 4.44 mm in group A and 6.67 mm in group B; trismus was 12.28 mm in group A and 17.28 mm in group B. Statistical analysis revealed significant reductions (p < 0.001) in postoperative facial swelling and trismus in group A, but the duration of the surgical procedure in this group was also significantly increased (p < 0.001 vs group A).

Conclusions

Compared with high-speed rotatory osteotomy, piezoelectric osteotomy produces less facial swelling and trismus 24 hours after surgery, but it also increases the duration of surgery.     

Valutazione clinica e microbiologica di impianti a connessione conometrica rispetto a impianti a connessione esagonale: caso clinico

Objectives

Dental implant failure secondary to systemic disease, surgical trauma, biomechanical aspects, etc. can be classified as early or late. The aim of the present case report is to compare two different implant-abutment connection systems used in the same patient: an internal-hex system used in the upper arch and a combined morse-taper/internal-hex system in the lower arch.

Material and methods

Two full-arch implant-supported rehabilitations were performed with two different implant systems in a completely edentular 65-year-old man. Impressions were obtained to develop the study models and create prosthetically-guided surgical templates. Three and five months later, samples from the implant-abutment connections and peri-implant soft tissues were subjected to real-time PCR-based microbiological analysis.

Results and conclusions

Microbiological analyses revealed that the compositions of the subgingival peri-implant biofilms were similar with the two implant systems; at the level of the connection, better sealing was observed with the combined morse-taper/internal-hex implant system. The 3- and 5-month follow-up showed no sign of implant failure or complications (biological or mechanical). No clinical and/or radiographic differences were observed between the two implant abutment connections.     

Radiotrasparenza dell’angolo mandibolare. Due casi di lacuna di Stafne

Objectives

To describe two Stafne bone cavity cases, focusing on instrumental investigations besides pathogenesis, in order to reach correct differential diagnosis and therapy.

Materials and methods

In the two presented cases, having acknowledged negative pathological anamnesis and characteristics of lesion, the Authors agreed in formulating a presumptive diagnosis of Stafne bone cavity. Stafne bone cavity is a rare, benign, asymptomatic, hardly noticeable lesion in conducting clinical examination. Pathogenesis is not completely evident yet, and in radiographic examination it displays as a unilocular radio-transparent and well-defined lesion, localized in between the bone adjacent to the first molar and the mandibular angle, underneath the inferior alveolar canal. Diagnosis gets simple as bone cavity shows up in the more frequent and common form, whereas in case of doubt it is important an ulterior diagnostic deepening in order to confirm the presumptive diagnosis.

Results and conclusions

Stafne bone cavity does not require any treament, periodic radiographic follow-up is suggested in order to monitor any modifcation or change in the aspect of lesion, and to avoid eventual degenerations.     

Nuova tecnica per il trattamento dei siti di impianti postestrattivi immediati in zone estetiche. Caso clinico

Objectives

The aim of this report is to present preliminary results of a new surgical approach in immediate implant flap-less post-extraction sites in aesthetic zones.

Materials and methods

A hopeless root was extracted and an immediate implant NobelActive™ (Nobel Biocare, Kloten, Switzerland) placement and loading in 14 position in one case of gingival thin biotype. The socket was object of sinus lift elevation and the gap between facial bone and implant surface was filled with Bio-Oss^® (Geistlich Biomaterials, Wolhusen, Switzerland). Biomaterial, besides, was located onto the implant shoulder of the platform-switched filling the distance between neck of the abutment and the internal surface of buccal-mesial-distal soft tissue of gingival margin, connective tissue and adjacent portion of juntional epithelium. An immediate temporary crown was located and bone and level tissue were registered.

Results

A slightly increased papillary level was noticed from baseline to delivery of definitive crown with a 1,5 mm mesial, 2 mm distal growth and no recession of gingival margins that preserved his initial measure of 10 mm. Distance between the implant platform end most apical mesial and distal bone edge was recorded, and revealed no sign of bone loss with a measure of 4.01 mm and 2.09 mm for either mesial and distal crest to 11 months of normal chewing activity.

Conclusions

In this case report the use of biomaterial, located above the implant platform to support crestal bone and gingival margins in a gingival biotype, was able to prevent bone-tissue recessions.     

Lo stato della ricerca in parodontologia: il panorama italiano

Objectives

To evaluate the scientific production and its impact on the community of Italian researchers and practitioners working in the field of periodontology.

Materials and methods

We evaluated active members of the Italian Society of Periodontology (SIdP) (73 who held academic positions and 71 private practitioners) in terms of the number of scientific publications (total and those related specifically to periodontics), number of citations, and the H-Index.

Results and conclusions

The median number of publications was 16, and 50% of these were in the field of periodontology. The researchers had a median of 4 publications cited at least 4 times (H-Index = 4). Members who held academic positions had a greater scientific production and impact, while the publications of the private practitioners showed a higher specificity for the periodontal field.     

Efficacia di un flow nel gradino cervicale delle II Classi. Analisi sperimentale

Objectives

The aim of this work was exploring and evaluating the effect of using flowable composites as liners on the cervical margin (in enamel) of the II classes (“open sandwich technique”) and comparing it to the traditional use of microhybrid composite only. The samples have been observed using Scanning Electron Microscopy (SEM) in order to see if there were evidence based differences that could push clinicians to prefer flowable composites.

Materials and methods

Fifteen recently extracted teeth were disinfected with NaOCl 5% and prepared for class II restorations MOD (with cervical wall in enamel) with the use of burs. We applied the etching and then the primer and the bonding together. After curing the last one and inserted the matrix, we applied the flowable resin (1 mm) on 15 of the 30 cervical margins and we applied the microfilled composites on the 30 cavities, curing each layer, one by one. The specimens were: thermocycled in baths of 5 degrees C and 55 degrees C for 1,000 cycles, cut up axially and observed by the SEM to verify the presence of gaps.

Results

We obtained 150 images at the SEM observation that allowed a comparison between cervical margin lined with and without flowable composite. Results seem to show that there is no difference between the use of flowable composite and traditional composite on the enamel cervical margin of II classes, since no gap has been observed in any case.

Conclusions

Clinically our study suggests for the complete interchangeability of the use of flowable composite or traditional composite as liner on the enamel cervical margin of II classes.     

La determinazione della lunghezza di lavoro in endodonzia: l’approccio matematico

Objectives

Radiology and electronic apex localization are of primary importance in the measurement of root-canal length in endodontic practice. The purpose of this article is to present an alternative mathematical approach, which can be used for this purpose when other methods are not available.

Materials and methods

The article describes a method for calculating canal length based on the principle of proportions. Examples are provided involving the measurement of different metallic objects (metal spheres, implants, root-canal instruments).

Results and conclusions

The author concludes that radiology, associated with electronic apical localization, remains the method of choice for measuring root-canal lengths, and its correct application is fundamental for successful root canal treatment. The alternative procedure proposed in this article can be useful when there are relative or absolute contraindications to the use of radiography and/or when electronic apex locators are likely to produce inaccurate or unreliable results. Use of this third method, which is based on well-known mathematical principles, can help to reduce the need for radiography, shorten procedure times, lower costs, and last but not least, add a complementary resource to our technical armamentarium.     

Iposcialia: considerazioni eziopatogenetiche e meccanismi farmaco-indotti

Objectives

To review the current hypotheses on the pathogenesis and pharmacodynamic mechanisms involved in hyposalivation induced by different classes of drugs.

Materials and methods

The authors analyze the basic anatomical and functional aspects of drug-induced hyposalivation. Particular emphasis is placed on the classification of xerogenic drugs that are commonly used for the therapy of high-prevalence diseases.

Results

At the dosages normally recommended, most xerogenic drugs are not harmful to the salivary glands. Care should be taken to avoid combining drugs with anticholinergic effects, which can cause hyposalivation in patients who do not experience this effect when treated with a single anticholinergic drug.

Conclusions

In most cases, drug-induced xerostomia can be reversed by discontinuing/replacing the drug responsible for the symptoms. When this is done, the symptom should gradual regress.