Il restauro ceramico parziale e adesivo nei settori posteriori

ObjectivesThe purpose of this article is to assess what are the indications for partial bonded ceramic restoration in the posterior teeth vs composite direct restoration and full-crown approach.Materials and methodsThe article evaluate which are the ceramic materials that can be used for partial restoration in the posterior teeth about their mechanical properties, aesthetic features and their susceptibility to adhesive procedures. An examination is made on the principles of cavity preparation for indirect partial restoration and a final discussion based on the survival of these device over time based on data from clinical prospective studies.Results and conclusionsThe ceramic partial restoration appear suitable for restoration of posterior teeth, allowing a considerable saving of healthy tooth tissue. The data from the literature indicate a good survival of these device when followed longitudinally over time.     

Il ruolo della strumentazione meccanica nei ritrattamenti endodontici

Objectives

Endodontic retreatments are performed when endodontic therapy fails and the tooth is considered restorable. They include orthograde, surgical, and combined approaches. The primary objective of orthograde retreatment is the complete removal of the old filling material from the root canal. The purpose of this paper is to describe an orthograde endodontic retreatment technique performed with specific mechanical instruments made of nickel-titanium (NiTi).

Materials and methods

For retreatment, the root canal filling can be removed with traditional methods, such as heat carriers, Largo or Gates burs, and hand-held steel instruments, or newer methods, such as ultrasonic inserts, laser tips, and NiTi files (manual or mechanical). The orthograde retreatment technique presented here uses specific NiTi endodontic rotary instruments (Mtwo R^®). We describe its use in two cases involving retreatment of teeth 4.6 and 2.5, whose root canals had been filled using thermoplastic gutta-percha, plastic carrier and endodontic sealer, and a single gutta-percha point.

Results and conclusions

The success of orthograde endodontic retreatment depends on many factors, including correct and complete removal of old filling material from the root canal. The specific NiTi endodontic rotary instruments (taper .05) we used are very sharp at the level of the blades and the tip, and they allow rapid, safe removal of commonly used endodontic filling materials, even in the presence of a plastic carrier. As illustrated by the two cases presented, we used NiTi endodontic rotary instruments specifically designed for retreatment in the coronal two thirds of the canal, manual instruments in the apical third, and simultaneous technique after the filling material had been removed. This approach allowed acceptable preservation of the original anatomy of the canal and effective sealing by the new filling material.     

Osteonecrosi dei mascellari associata a bisfosfonati,denosumab e farmaci anti-angiogenetici nei pazienti oncologici e osteoporotici: diagnosi e terapia

Objectives

The present work aims at providing clinicians with a useful guide for diagnosis and management of osteonecrosis of the jaws (usually defined ONJ).

Materials and methods

The authors, directly involved with the recent publication of the Raccomandazioni clinico-terapeutiche sull’osteonecrosi delle ossa mascellari associata a bisfosfonati e sua prevenzione, endorsed by Società Italiana di Chirurgia Maxillo-Facciale (SICMF) and Società Italiana di Patologia e Medicina Orale (SIPMO), reviewed the relevant literature on ONJ associated with bisphosphonates, denosumab and anti-angiogenic drugs. They report all known epidemiological data and describe the clinical features of the disease; they also display the local and systemic risk factors associated with ONJ development, and present novel criteria for the diagnosis and staging of ONJ. Finally, they provide recommendations for prevention and dental management of cancer and non-cancer, mainly osteoporotic, patients, and summarize the medical and surgical therapies to be used in case of established ONJ.

Results and conclusions

ONJ, which is usually associated with bisphosphonates and more recently also with denosumab and anti-angiogenic drugs, is one of the most emergent among severe oral diseases, with important implications for the patient's quality of life: in the last decade, thousands of cases have been reported in the literature. The medical and dental communities fear the severity of this condition and solicit for rules, protocols, preventive measures for patients at risk of bisphosphonate related ONJ occurrence, as well as therapies for established ONJ. This effort has been carried out extensively in several countries, including Italy with the support of the Italian SICMF and SIPMO, leading to the publication of expert panel recommendations for prevention and therapy of ONJ, both in cancer and less frequently non-cancer (mainly osteoporotic) patients.     

Valutazione e trattamento gnato-posturale nei piloti militari dell’Aeronautica: un caso clinico

Objectives

As a result of the stress they are subjected to, Air Force pilots have a higher incidence of oral parafunctions, such as bruxism, than the normal population. Furthermore, their duties are associated with particular stress on the craniocervical-mandibular system. The purpose of this report is to analyze the case of an Air Force pilot who is receiving gnathological postural treatment to achieve an improved occlusal balance.

Materials and methods

The patient was selected from the large population of Air Force pilots being treated at the “A. Mosso” Legal Medicine Institute in Milan. The protocol provided for clinical assessment of the stomatognathic apparatus and postural system and instrumental analysis that included computerized occlusion analysis, the Postural Stabilometric Test, and the Dynamic Posturographic Test (EquiTest).

Results

The Dynamic Posturographic Test (EquiTest) score recorded with the splint inserted in the oral cavity showed very high postural and vestibular performance.

Discussion and conclusions

The clinical-instrumental and gnathological postural treatment used on Italian Air Force pilots protects the masticatory system from dental abrasion and, in this particular case, it seemed to improve the patient's posture as reflected by the Dynamic Posturographic Test (EquiTest) scores.     

Tipologie di cementi nel fissaggio di corone in zirconia-ceramica: revisione della letteratura

Objectives

The purpose of this article is to present a review of the literature about surface treatments and methods of cementation of zirconia.

Materials and methods

We undertook a review of international literature considering dental journals as well as international PubMed database.

Results and conclusions

The sandblasting is considered the best treatment for zirconia, which is followed by using auto-curing or dual-curing resin cements. The choice of the type of material used is in accordance with the clinical conditions.     

Il trattamento chirurgico delle III Classi

Objectives

Aim of the study is to identify the basic criteria to choose a surgical treatment for Class III malocclusions together with the fundamental principles of surgical-orthodontic treatment.

Materials and methods

In planning the treatment, the clinician must consider the type and severity of the malocclusion, the age of the patient, aesthetic demands and/or functional needs. The choice of osteotomy must be based on aesthetical and morphological considerations, rather than cephalometric measurements. The orthodontic treatment before surgery has to be functional and fit the scheduled ostetomy.

Results

The authors report some cases treated with different surgical options, with a follow-up of 2, 5, and 15 years.

Conclusions

Surgical treatment is indicated in a very high number of patients affected by Class III malocclusions. A comprehensive surgical-orthodontic approach allows to obtain very satisfactory long-term results from both an aesthetical and functional point of view.     

La frequenza delle anomalie dentarie nei pazienti affetti da cheilognatopalatoschisi

Objectives

The purpose of this study was to investigate dental abnormalities in children with cleft lip and palate (CLP) in order to identify the most prevalent anomalies and the teeth most frequently affected.

Materials and methods

We analyzed orthopanoramics X-rays (OPT), computed tomography Dental Scans, clinical records, and dental casts from 18 consecutive patients (10 boys, 8 girls; mean age 11.2 years, range: 6 to 18), with CLP (complete or incomplete, mono- or bilateral) and recorded the presence of the following anomalies: supernumerary teeth, agenesis, shape and size anomalies, ectopic and dystopic eruptions, rotations and retained teeth.

Results

The most frequent abnormalities were: agenesis (prevalence: 22.5%), ectopic and dystopic eruption (19.3%), rotations (17.7%), shape and size anomalies (16.1%), and retained teeth (14.5%). The most frequently affected teeth were the lateral (45.1%) and central incisors (32.2%), the cuspids (14.5%), and the second bicuspid (6.4%). Lateral incisors were usually missing (39.2%) or retained (21.4%), while central incisors were more often rotated (50%) or deformed (25%). The cuspids were ectopic (66.6%) or retained (23%), while the bicuspids were missing (25%), retained (25%), or presented alterations in number (25%) or shape/size (25%).

Conclusions

Each subject presented at least one dental anomaly. This high frequency indicates that identification of these anomalies is fundamental for appropriate management of cleft lip and palate.     

Il metodo UniFe per la valutazione del rischio parodontale

Objectives

Periodontitis progression varies widely among individuals, either with or without treatment. Not all risk determinants for periodontitis are relevant for diagnosing the disease. The purpose of the present report is to present two cases, which show how a simplified method for periodontal risk assessment (UniFe), developed by the Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, can identify differences in periodontal risk among individuals with similar severity of periodontitis.

Materials and methods

The UniFe method is described in detail, and its use is illustrated for calculating periodontal risk in two patients with similarly severe periodontitis.

Results

Periodontal risk assessment with the UniFe method revealed different risk levels in the two patients. The UniFe method revealed that the worse prognosis in one of the patients was due to exposure to environmental risk factors (i.e., smoking) and a higher prevalence of gingival bleeding.

Conclusions

Preliminary data suggest that the UniFe method is a simple and reliable tool for periodontal risk assessment and that it can identify differences in periodontal risk among individuals with similar severity of periodontitis.     

Il danno dentale in protesi fissa: aspetti valutativi medico-legali

Objectives

Through a critical review of the most recent literature about fixed prosthesis on natural pillars, the authors discuss the quantification of permanent biological damage of the teeth used as prosthetic abutments.

Materials and methods

In cases of traditional fixed prosthetic rehabilitation, preparation of the natural elements that serve as a pillar inevitably shapes an irreversible injury of the coronal hard tissues, recognized by the customary forensic evaluation even if in the absence of specific tabular values. However, what is not taken into account usually is the share of permanent biological damage resulting from the reprocessing of stumps needed for a new prosthetic rehabilitation, whether it is a future renewal in civil liability cases or a remake of structure considered incongruous in professional liability cases. The physiological changes of the periodontal tissues of the tooth, resulting in a progressive exposure of the prosthetic margin and of the root tissue, or the design of a prosthetic device with overhanging margins and incongruous emergency profiles require the clinician to re-prepare the abutment before the implementation of the new manufacture.

Results

The loss of dental hard tissue caused by multiple prosthetic filings correlates with a progressive reduction in the size of the abutment, with its consequent weakening and exposure to an increased risk of fracture. This condition inevitably affects the degree of survival of the corresponding prosthetic device, which must be replaced by a prosthesis longer than the previous one, or even another type of prosthesis, if not more repeatable with the same characteristics.

Conclusions

The irreversible loss of dental tissue resulting after prosthetic reprocessing makes necessary an adequate medicolegal evaluation of the damage, which aims to identify the clinical expression of the injury and resulting impairment in its fullness.     

Il consenso informato in igiene dentale: proposta di una modulistica

Objectives

The purpose of this report is to highlight the need of obtaining a valid informed consent from patients undergoing dental hygiene procedures and the responsibilities and obligations of the hygienist in such context.

Materials and methods

Building on the existing informed consent forms used for dental procedures, the authors have developed treatment-specific forms geared to the needs of the dental hygienist. They include 4 sections: 1) patient data; 2) clinical history; 3) information on the treatment being proposed by the doctor/dentist, techniques and/or materials that will be used in the treatment, contraindications to such treatment, the results that can be obtained, and instructions for post-procedure care to avoid complications; 4) a statement to be signed by the patient and dental hygienist in which the former affirms that he/she received the information listed above and that he/she accepts or refuses to undergo the proposed treatment.

Results

The proposed form can be very useful to dental hygienists attempting to implement current regulations regarding patient information and consent to treatment.

Conclusions

The signed form must be saved since it constitutes evidence that may prove relevant in any lawsuits either arising over unsuccessful treatment or other claims filed by the patient.     

Il ruolo dei probiotici nella prevenzione delle pigmentazioni del cavo orale

Objectives

The purpose of this study is to verify the efficacy of a probiotic product in the selection of the oral flora and to ascertain if chromogenic bacteria could be eliminated through professional oral hygiene procedures in combination with chlorhexidine.

Materials and Methods

The study is a randomized controlled clinical trial. Ten patients aged between 25 and 35 years were examined (5 males and 5 females).They presented extrinsic pigmentations with a black line presumably to be ascribed to chromogenic bacteria.

Results and Conclusions

The results obtained by splitting the sample into two groups are presented.Probiotics are efficient when combined with a correct professional and home care protocol of oral hygiene.It is assumed, however, that the effect of the probiotic persists until it is administered and wanes when the administration is suspended.     

Malattia celiaca e manifestazioni intraorali

Objectives

The aim of the study is to present a review of literature concerning the oral manifestations of celiac disease and the evaluation of dental screening as an important diagnostic tool, particularly in relation to all that subjects affected by the atypical forms of the disease, which would not be otherwise possible to diagnosticate due to the lack of the typical symptomatology and clinical picture.

Materials

Celiac disease is a complex pathological condition that can affect genetically predisposed subjects, which is characterized by a permanent intolerance to a particular class of proteins (prolamins) included in some cereals (grain, rye, barley, oat), leading to an alteration of the jejunal mucosa. The high prevalence of such pathology affects 1:100 of the general population, but frequently a correct diagnosis is omitted or late, especially in relation to latent, hidden or potential forms the disease.

Conclusions

Early diagnosis is therefore of primary importance. In effect, the key of therapeutic success is represented by the early treatment, which is essential to avoid any deficiency of development and prevents the manifestation of symptoms in the different areas of the celiac disease, and eventually the potential intestinal neoplastic evolution.     

Osteonecrosi dei mascellari e bisfosfonati: terapia e follow-up a lungo termine in 160 pazienti

ObjectivesOsteonecrosis of the jaw (ONJ) is a side effect of bisphosphonate therapy (BPT) that was first described in 2003. The etiology of BPT-associated ONJ (BRONJ) remains unknown, but the pathogenesis seems to be related to multiple local and general factors. Several groups of experts have developed prevention protocols to facilitate specialists involved in the multidisciplinary management of patients with BRONJ. This paper provides a concise review of the literature on BRONJ and describes our experience at the University of Parma with 160 patients who received BPT for neoplastic and non-neoplastic diseases.Materials and methods139 BRONJ sites in 160 patients were treated with 5 different approaches, as follows: Group 1, 28 sites treated with medical therapy alone; Group 2, 32 sites treated with medical therapy and Low-Level Laser Therapy (LLLT); Group 3, 17 sites treated with medical therapy and conventional surgery; Group 4, 33 sites treated with medical therapy, surgery, and traditional LLLT; and Group 5, 29 sites treated with medical therapy, laser-assisted surgery, and LLLT.Results and conclusionsIn terms of clinical improvement, statistically significant differences were found between the different treatment groups and those treated with medical therapy alone. The introduction of laser-assisted therapy and surgical approaches seem to produce better results in terms of complete healing.     

Odontoiatria e nutraceutica: applicazioni cliniche

Objectives

The work proposes suggestions for the dentist as to the potential utilities of plant-derived products, in terms of oral disease prevention and therapy. Nutraceuticals are bioactive phytochemicals able to prevent and/or treat diseases by virtue of their biological activities.

Materials and methods

The international scientific studies were carefully examined in order to identify strengths and weaknesses of the different nutraceuticals used, such as in particular phenolic compounds, isoprenoids and alkaloids, and, therefore, obtain recommendations useful for the clinician.

Results and conclusions

Data show a general lack of randomized clinical allowing to draw conclusive clinical recommendations. High intake of fruits and vegetables is inversely associated to oral cancer as well as the antibacterial and wound-healing properties of essential oils and Aloe vera, respectively, are well-documented. The dentist plays a pivotal role in providing the patient with dietary guidelines which, if combined with a regular and moderate physical activity, may improve both general and oral health conditions.     

Fumo,alcol e salute orale

Objectives

Cigarette smoking, the second cause of death worldwide, and alcohol abuse, a leading cause of mortality and morbidity, are major risk factors for oral diseases. The aim of this paper is to present the effects of cigarette smoking and alcohol abuse on oral health. Specific strategies are also proposed to develop smoking cessation interventions in the office practice of dentists and dental hygienists providing.

Materials and methods

Original papers, reviews and guidelines on this subject, published in English and in Italian from 2006 to the first trimester of 2013, were located in the Medline/Pubmed database. Additional publications were obtained by searching the reference list of retrieved works.

Results and conclusions

Cigarette smoking is the most important risk factor for oral squamous cell carcinoma and potentially malignant oral lesions; alcohol abuse increases oral cancer risk in a synergistic fashion. Moreover, cigarette smoking is the second risk factor for chronic periodontitis, after dental plaque, whereas further studies are needed to assess the role of alcohol consumption on onset and progression of chronic periodontitis. The “Five A's” approach represents an effective protocol for smoking cessation that members of dental team can use with all smoker patients. The patients attempting to quit should use the nicotine replacement therapy, sustained-release bupropion or varenicline in order to significantly increase success rate of quit attempt.