Dental Research Journal
Volume:9 Issue: 8, Nov 2012

Dental caries is one of the most common infectious multifactorial diseases worldwide, characterized by the progressive demineralization of the tooth, following the action of bacterial acid metabolism. The main factors predisposing the onset of the carious process are: 1) the presence of bacterial species able to lower the pH until critical values of 5.5, 2) the absence of adequate oral hygiene, 3) an inefficient immune response anti‑caries, 4) the type of alimentary diet and 5) the structure of the teeth. Among the 200 bacterial species isolated from dental plaque the most pathogenic for dental caries are: Streptococcus mutans, Streptococcus sobrinus, Lactobacillus acidophilus, Actinomices viscusus and Bifidobacterium dentium. Our laboratory (LAB® s.r.l., Codigoro, Ferrara, Italy) has developed a test for absolute and relative quantification of the most common oral cariogenic bacteria. The test uses specific primers and probes for the amplification of bacteria genome sequences in Polymerase Chain Reaction Real Time. The results provide a profile of patient infection, helpful for improving the diagnosis and planning of preventive treatment to reduce the bacterial load.

Titanium dioxide exists in three different crystal lattices, anatase, rutile, and brookite. Anatase coating releases, under ultraviolet (UV) irradiation, free radicals such as •OH, O2 –, HO2 –, and H2O2. This potent oxidizing power characteristically results in the lysis of bacteria and other organic substances. The purpose of this study was to evaluate the bone response to implants made of titanium alloy or coated with a new combination of anatase and Bactercline® product. In the period between July 2009 and June 2010, 26 patients (10 females and 16 males; median age 51 ± 11 years, min. 27 years, max. 72 years) were operated and 62 implants were inserted. Lost fixtures and peri‑implant bone resorption were considered as predictors of clinical outcomes. Pearson χ2‑test was used. Prosthesis and implant failures, any complications after loading, and peri‑implant marginal bone‑level changes were assessed by a masked assessor. All patients were followed up to 1 year after loading. No implant was lost. Average bone resorption around implant was 0.33 mm (both for 25 standard and 37 Bactercline‑coated implants), and thus no statistical difference was detected. These results shown that no adverse effects on osseo‑integration were present.

One‑piece implants (OPIs) incorporate the trans‑mucosal abutment facing the soft tissues as an integral part of the implant. OPIs are usually welded together and loaded immediately. Since no report focuses specifically on OPIs inserted in cuspid sites, a retrospective study is performed. Nineteen patients (10 females and 9 males) with a median age of 62 years (range, 43-80) were admitted at the Dental Clinic, University of Chieti (Italy), for evaluation and implant treatment, by one surgeon between January and December 2010. In our series, the survival rate (SVR) and success rate (SCR) were 96.8% and 100%, respectively. Statistical analysis demonstrated that no studied variable had an impact on the survival (i.e., lost implants) and clinical success (i.e., crestal bone resorption). OPIs are reliable devices for oral rehabilitation in the cuspid sites.

One‑piece implants (OPIs) incorporate the trans‑mucosal abutment facing the soft tissues as an integral part of the implant. Since OPIs become more and more popular and no report specifically focuses on OPIs inserted in incisors’ area, a retrospective study is performed. Fifty‑five OPIs were inserted in incisors’ area in a series of patients admitted at the Dental Clinic, University of Chieti (Italy), for evaluation and implant treatment between January and December 2010. In our study, the survival rate and success rate were 96.2% and 96.1%, respectively. Statistical analysis demonstrated that no studied variable had an impact on the survival (i.e., lost implants) and clinical success (i.e., crestal bone resorption). OPIs are reliable devices for oral rehabilitation in the incisors’ area.

Recently, the use of one‑piece implants (OPI) has become more popular. Since no reports specifically focus on OPIs inserted in molar areas, a retrospective study has been performed. A series of 36 OPIs (Diamond; BIOIMPLANT, Milan, Italy) were inserted into the molar area of patients admitted at the Dental Clinic, University of Chieti, Italy, for oral rehabilitation between January and December 2010. In our series survival rate (SVR) and success rate (SCR) were 91.7% and 97%, respectively. Statistical analysis demonstrated that no studied variable has an impact on survival (i.e., lost implants) as well as on clinical success (i.e., crestal bone resorption). OPIs are reliable devices for oral rehabilitation in the molar areas.

The routine and frequent use of dental implants to replace missing teeth is accompanied by high expectations from patients. These expectations are not limited to function and esthetics but extends to patient comfort and time spent in receiving treatment. Replacement of an unrestorable maxillary premolar can be challenging when considering the concerns of patients. A one‑piece implant (OPI) incorporates the trans‑mucosal abutment facing the soft tissues as an integral part of the implant. Since no report specifically focused on OPIs inserted in premolar areas, a retrospective study was carried out. Nineteen patients (10 females and 9 males) with a median age of 62 years (43‑80) were enrolled and a total of 176 OPIs (Diamond, BIOIMPLANT, Milan, Italy) were inserted. In our series survival rate (SVR) and success rates (SCR) were 90.6% and 97.9%, respectively. Statistical analysis demonstrated that no studied variable had an impact on survival (i.e., lost implants) as well as on clinical success (i.e., crestal bone resorption). OPIs are reliable devices for oral rehabilitation in the premolar areas.

Titanium is used worldwide to make osseointegrable devices, thanks to its favorable characteristics as mechanical proprieties and biocompatibility, demonstrated by in vivo studies with animal models and clinical trials over a forty‑year period. However, the exact genetic effect of the titanium layer on cells is still not well characterized. To investigate how titanium nanotubes stimulate osteoblasts differentiation and proliferation, some osteoblast genes (SP7, RUNX2, COL3A1, COL1A1, ALPL, SPP1 and FOSL1) were analyzed by quantitative Real Time RT‑ PCR. After 15 days, osteoblasts cultivated on titanium naotube showed the up‑regulation of bone related genes SP7, ENG, FOSL1 and SPP1 and the down‑regulation of RUNX2, COL3A1, COL1A1, and ALPL. After 30 days of treatment, the bone related genes SP7, ENG, FOSL1 and RUNX2 were up‑regulated while COL3A1, COL1A1, ALPL and SPP1 were down‑regulated. Our results, demonstrates that titanium nanotubes can lead to osteoblast differentiation and extracellular matrix deposition and mineralization in dental pulp stem cells by the activation of osteoblast related genes SPP1, FOSL1 and RUNX2.

Titanium is the gold standard among materials used for prosthetic devices because of its good mechanical and chemical properties. When exposed to oxygen, titanium becomes an oxide, anatase that is biocompatible and able to induce osseointegration. In this study we compared the expression profiling of stem cells cultivated on two types of surface: Pure titanium disk and nanotube titanium disk in order to detect if nanotube titanium instead (NTD) surface stimulates stem cells towards osteoblast differentiation. Stem cells cultivated on nanotube titanium disks showed the upregulation of bone‑related genes RUNX2, FOSL1 and SPP1. Results demonstrated that nanotube titanium disk surface is more osteo‑induced surface compared to titanium disk, promoting the differentiation of mesenchymal stem cells in osteoblasts.

The concept of osseointegration, i.e., the direct anchorage of endosseous implants made of commercially pure or titanium alloy to the bone caused a breakthrough in oral rehabilitation. The identification of factors for long‑term survival and success rate are the main goal of the recent literature. Several variables can influence the final result, and in general they are grouped in surgery‑, host‑, implant‑, and occlusion‑related factors. A retrospective analysis on a large series of dental implants was performed to detect those variables influencing the clinical outcome. In the period between January 2007 and December 2009, 157 patients were operated. A total of 429 implants were inserted. Dental implants are reliable devices to be used in oral rehabilitation. Globally, very few implants were lost at the end of the follow‑up period. Slight but significant differences existed among different implants types with regard to peri‑implant bone resorption. A better clinical outcome was revealed for Sweden and Martina global implant.

One‑stage surgery with immediate loading is possible, with good clinical results. Many types of dental implants are available in the market. Zimmer Dental Implants (ZDIs) have been used since the nineties, but few reports have analyzed the clinical outcome of these fixtures.We planned a retrospective study on a series 566 ZDIs, to evaluate their clinical outcome. In the period between January 2007 and June 2011, 125 patients were treatetd with ZDIs. The last check‑up was performed in June 2012, with a mean follow‑up period of 17 ± 9 months (minimum − maximum, 8-4 months). ZDIs were inserted as follows: 295 (53.1%) in the maxilla and 261 (46.9%) in the mandible. There were 480 (86.3%) Screw‑vents, 51 (9.2%) Swiss Plusses, and 25 (4.5%) Splines. Sixteen, 355, 34, 90, 55, and six fixtures had a diameter of 3.25, 3.7, 3.75, 4.1, 4.7, and 4.8 mm, respectively. Twenty‑eight, 145, 5, 217, 8, 141, and 12 implants hade a length of 8, 10, 11, 11.5, 12, 13, and 14 mm, respectively. The implants were inserted to replace 136 (24.5%) incisors, 80 (14.4%) cuspids, 198 (35.6%) premolars, and 142 (25.5%) molars. No implants were lost (i.e., SRV = 100%). Among the studied variables, only those for the jaws were statistically significant, with a better outcome for implants inserted in the maxilla (P = 0.017). ZDIs are reliable devices to be used in implantology, althougth a higher marginal bone loss has to be expected when these implants are inserted in mandible.

Recently, various biostimulation’s effects of low energy laser irradiation have been reported. The present study was designed to examine the effects of low‑energy laser irradiation on alveolar bone remodelling during orthodontic tooth movement and finally on formation of new keratinized gingiva. 22 patients and 27 teeth in vestibular mucosal without keratinized gingiva were selected. Every patient was treated with self ligating appliances. In every orthodontic session the patient was treated with Diode laser biostimulation. At the moment of debonding, 27 teeth involved in the research were evaluated in terms of quality and quantity of attached gingiva.BOP and CAL loss were investigated. Every tooth considered at the end of orthodontic treatment showed an attached gingival around the crown: The average of keratinized gingiva at the end of the study was 3.10 mm and the mean increasing at each month was 0,49 mm. The combination between self ligating appliances and laser’s biostimulation could improve the differentiation of periodontal ligaments stem cells in fibroblasts, able to promote attached gingiva around the crown of the teeth erupted in oral vestibular mucosa.

Picibanil (OK‑432) is a lyophilized mixture of group A Streptococcus pyogenes with antineoplastic activity. Because of its capacity to produce a selective fibrosis of lymphangiomas (LMs), it has been approved by Japanese administration in 1995 for the treatment of LMs. We treated 15 children (age range: 6-60 months) affected by head and neck macrocystic LMs with intracystic injections (single dose of 0.2 mL) of Picibanil (1-3 injections). Complete disappearance of the lesion was noticed in eight (53.33%) cases, a marked (>50%) reduction of LMs was found five (33.33%) cases, while a moderate (<50%) response was recorded in two (13.33%) cases. Picibanil side effects included fever, local inflammation, and transitory increase of blood platelets’ concentration; a single case of anemia was resolved with concentrated red blood cells transfusion. Intracystic injection of Picibanil is an effective and safe treatment for macrocystic LMs in pediatric patients and may represent the treatment of choice in such cases, especially where surgical excision is associated with the risk of functional/cosmetic side effects.

Periodontitis is a disease mainly caused by a chronic infection of tissues that support the teeth. Several factors, such as diabetes, smoking and oral care, as well as genetic susceptibility can influence both the risk to develop periodontitis and its progression. The aim of the investigation was to test whether alleles of candidate genes were associated with periodontitis. A case control study was performed with a cohort of 184 patients with chronic periodontitis and 231 healthy controls from the Italian population. A total of six single nucleotide polymorphisms from five candidate genes, i.e., IL1A, IL1B, IL6, IL10 and vitamin D receptor, were investigated. Evidence of association were obtained for rs1800795 mapping in IL6 (P value = 0.01) as well as for the rs1800872 mapping in IL10 (P = 0.04). The rarer variant allele lowered the risk to develop periodontitis at IL6 (Odds Ratio [OR] = 0.69 [95% confidence interval {CI} 0.51-0.93]) and increased the risk at IL10 (OR = 1.38 [95% CI 1.01-1.86]). The present investigation indicated that polymorphisms of IL6 and IL10 constitute risk factors for chronic periodontitis, while there was no evidence implicating a specific IL1A or IL1B genotype.

Periodontitis is a disease that affects and destroys the tissues that support teeth. Tissue damage results from a prolonged inflammatory response to an ecological shift in the composition of subgingival biofilms. Three bacterial species that constitute the red complex group, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, are considered the main pathogens involved in periodontitis. In the present study, a real‑time polymerase chain reaction bases assay was designed to detect and quantify red complex species, then used to investigate 307 periodontal pocket samples from 127 periodontitis patients and 180 controls. Significant higher prevalence of red complex species and increased amount of P. gingivalis and T. denticola were detected in periodontal pocket of periodontitis patients. Results demonstrated that the test is a valuable tool to improve diagnosis of periodontal disease.

Osseointegration is essential for a long‑term successful and inflammation‑free dental implant. Such a result depends on osteoblastic cells growth and differentiation at the tissue‑implant interface. The aim of this study was to compare two different AoN titanium layers (GR4 and GR5) to investigate which one had a greater osteoconductive power using human osteoblasts (HOb) culture at two different time‑points. The expression levels of some bone‑related (ALPL, COL1A1, COL3A1, SPP1, RUNX2, and SPARC) were analyzed using real time reverse transcription‑polymerase chain reaction (real time RT‑PCR). Real‑time RT‑PCR data showed that after 3 days of treatment with TiA4GR, the genes up‑regulated were COL3A1, ALPL, SPP1, and RUNX2. Moreover, no difference in gene expression was noticed 4 days later. On the other hand, the genes that overexpressed after 3 days of treatment with AoN5GR were ALPL, SPP1, and RUNX2. In both cases, the expression of COL1A1 and SPARC was negatively regulated. Our data showed that both titanium surfaces led to osteoblasts recruitment, maturation, and differentiation, thus promoting osseointegration at the tissue‑implant interface.

The main requirements for a good material are its ability to promote attraction and adhesion of bone precursor cells and their proliferation and differentiation. Different biocompatible materials are currently employed as scaffold. Among these, titanium is considered a “gold standard” because of its biocompatibility and good corrosion resistance. The aim of this work was to compare two different AoN titanium layers (GR4 and GR5) to investigate which one had a greater osteoconductive power using human fibroblasts (HFb) culture at two different time‑points. The expression levels of some adhesion and traction‑resistance related genes (COL11A1, COL2A1, COL9A1, DSP, ELN, HAS1, and TFRC) were analyzed using real time reverse transcription‑polymerase chain reaction. After 7 days of treatment with TiA 4GR, the only two up‑regulated genes were COL2A1 and DSP. After 15 days of treatment, none of genes over expressed. Our preliminary results suggest that neither AoN 4GR nor AoN 5GR are able to promote the production of protein involved in cell–cell and cell–matrix adhesion and in stress‑resistance, required for a good outcome in dental implantology.

Herbst appliance is largely used in orthodontics for the correction of Class II. The aim of this paper was to analyze dental and skeletal effects of a splints Herbst-miniscrews combined device in comparison to a mandibular splints Herbst appliance. Fifty Class II division 1 patients (27 males and 23 females with a mean age of 11.8 ± 1.7 years) were included in the study. Lateral headfilms of 25 patients with a mandibular resin splint and a miniscrew anchorage (test group) and of 25 patients with mandibular acrylic resin splints (control group) were analyzed before (T0) and after (T1) the Herbst treatment. The mean and standard deviation (SD) of each variable were calculated; paired t‑test was used to evaluate statistical changes before and after the treatment, in each group and Student t‑test was used to compare the two groups. Significant differences were observed for P < 0.05. At the end of the Herbst treatment, mandibular incisor proclination was significantly lower in the test group (2.8°) in comparison to the control group (7.4°). The miniscrew‑Herbst system, described in the present study, allows correction of Class II malocclusion, with a lower anchorage loss, in form of mandibular incisor proclination, during the treatment, in comparison to mandibular acrylic splints Herbst.

Haemorrhagic‑aneurismal bone cysts (HABCs) are quite rare, benign, non‑neoplastic, expansive, and vascular locally destructive lesions. They are generally considered sequelae of an earlier trauma causing an overflow of blood into the bone. HABCs are classified as pseudocysts and they should be differentiated from true cysts because their treatment is different. Since few of these cysts involve subjective symptoms, most are discovered accidentally during radiography, while a sure diagnosis is likely to be obtained only during surgery, on discovery of a non‑epithelialised cavity. Here, we report a typical case of a haemorrhagic‑mandibular cyst in a 13‑year‑old girl, which was treated by opening the cavity and scraping its walls following diagnostic arteriography and post‑operative transcutaneous intralesional embolization. No further complications were recorded in the post‑operative period, although the convalescence lasted for a time longer than expected, because of anemia. No further surgery was performed. She has been disease‑free for two years. Evaluation of intralesional blood flow is important for HABCs because of the hemorrhagic risk in surgery. Embolization seems to be a useful procedure in the treatment of HABCs and could be tried as the treatment modality in the standard protocol for the treatment of HABCs.

Lipoma arise in almost 50% of all soft tumours. The neck lipomas are rare tumours that may present as painless masses with slow growth, in the lateral portions of the neck. Some lipomas, such as the one studied in our case, grow deep in the subcutaneous tissue, in close contact with muscles. Here, we report a case of lipoma extending from pre‑tragal region up to the ascending branch of the mandible in a 62 year old man, treated with enucleation. The inferior margin of lipoma involved the pharyngeal and the superior margin was achieved by the top of the skull base. The mass of lipoma caused breathing difficulties in the patient, preventing regular sleep. No complication was recorded in the post‑operative period and no further surgery was performed. The complete resolution after one year’s follow‑up, together with the rarity of the anatomical site, makes this case worthy of description. A correct diagnosis facilitated removal of this lesion with a surgical method.

Primary mucosal melanomas (MM) of the head and neck region constitute 0.5-2% of all malignant melanomas. The rynopharynx is a region that is less often involved by malignant melanomas. Because most of mucosal melanotic lesions are painless in their early stages, the diagnosis is unfortunately often delayed until symptoms resulting from ulceration, growth, and/or bleeding are noted. Here, we document the rare case of a malignant rynopharynx melanoma of a 43 year old woman. Its treatment and the pertinent literature are discussed. No complication was recorded in the post‑operative period and no further surgery was performed. The follow up showed no recurrence in the same position and with the same characteristics, even after six years. Mucosal melanomas are aggressive tumours and the prognosis in these patients is poor. Clinicians must use treatment strategies that provide functional benefit, so as to maintain quality of life without excessive toxicity.

The term osteonecrosis has been applied to describe the presence of a persistent inflammation of the mouth, osteomyelitis, delayed healing of extraction sockets, development of sequestra or presence of fistulae from the mouth to the lower skin. Here, we document a case of mandible osteonecrosis that developed in a patient after a severe periimplant infection. Osteonecrosis, severe inflammatory osteolysis, and heavy bacterial colonization were found. Surgical toilette and hyperbaric oxygen therapy permitted complete healing of the case. No complication was recorded in the post‑operative period and no further surgery was performed. The clinical follow up and the imaging after one year showed a complete ‘restitution ad integrum’ of the mandible. Although the risk of developing osteonecrosis of the jaw for oral implants is low, the devastating complications still require caution.

Upper incisors are the most frequently involved teeth in traumatic dental injuries. Soft tissues (lips and/or oral mucosa) adjacent to incisal edge can receive direct and/or indirect traumas. Laceration of the lower lip is a not rare eventuality and teeth fragments could be embedded in labial soft tissue. The reattachment of these fragments, if possible, is the elective treatment choice, thanks to the modern adhesive and restorative techniques. The authors present a case of a white Caucasian 10‑year‑old child, who attended the dental clinic for the treatment of both upper central incisors’ crown fractures. The fragment of the left incisor was retrieved embedded in the lower lip. It was successfully surgically removed and reattached using a composite adhesive technique. A careful clinical and radiographic examination with the surgical removal of tooth fragments could prevent undesirable foreign body reaction, infection and scarring. The authors also reviewed the most relevant literature concerning tooth fragment reattachment after removal from oral soft tissues.

Among complications in orthognathic surgery, the insurgence of pneumothorax is very rare. Pneumothorax is the presence of air or gas in the pleural cavity and it is rare complications in the postoperative oral and maxillofacial surgery patient. The clinical results are dependent on the degree of collapse of the lung on the affected side. Pneumothorax can impair oxygenation and/or ventilation. If the pneumothorax is significant, it can cause a shift of the mediastinum and compromise haemodynamic stability. While 10% of pneumothoraces are asymptomatic, patients often complain of acute chest pain and difficulty breathing. There is a reduction in vital capacity, tachycardia, tachypnoea and a decrease in partial pressure of oxygen with an inability to maintain oxygen saturations. We observed this unusual surgical consequence in a 28‑year‑old female with negative clinical history and instrumental evaluation after Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO). No further consequences, no neurological sequelae, no infections and no other osteotomies sequelae were seen. Sudden post‑surgical dispnea associated to sub‑cutaneous emphysema of the neck and of the thorax must be adequately observed with the aim of monitoring further severe sequelae. The anaesthetic management of the emergency difficult airway in any post‑surgical orthognatic treatment can be extremely difficult requiring a multi‑disciplinary approach.

Although the Le Fort I osteotomy is a safe surgical technique, many complications have been reported. We present a case of an extended cervico‑facial haematoma due to delayed bleeding from the terminal branches of the maxillary artery after orthognatic surgery. A 23‑year‑old man was referred to our observation for the surgical correction of a class III asymmetric malocclusion. The patient underwent a Le Fort I osteotomy, with impaction of the maxilla, associated with an Epker mandibular bilateral sagittal split osteotomy, with maxillary advancement and rigid internal fixation of the mandible with four miniplates and another four for the upper maxilla as well. The first post‑surgery day, the patient developed a gradual dispnea together with neck swelling. By second postoperative day, the patient’s general condition improved with a progressive normalization of laboratory tests values. The Computerised Axial Tomography (CAT) scan confirmed a decrease in the parapharyngeal thickening. Total recovery was achieved within two months, the final clinical check showed a healthy appearance with good occlusion. An increased knowledge of the basic biology of the Le Fort I osteotomy, the development of instruments specially designed for the Le Fort I procedure and the use of hypotensive anaesthesia could reduce the morbidity and duration of this procedure.

This case report describes the surgical‑orthodontic guided‑eruption of a deeply impacted macrodontic maxillary central incisor in a 10‑year‑old patient with Alagille syndrome (ALGS). In the first stage, orthodontic treatment with fixed appliance on deciduous teeth allowed to create enough space for the eruption of the maxillary right central incisor. The second stage included closed surgical exposure and vertical traction. After impacted tooth erupted in the proper position, accessory periodontal treatment and dental reshaping procedures may be indicated to camouflage macrodontic incisor with the adjacent teeth. This is the first report that presents a patient with ALGS undergoing orthodontic and surgical treatment.