Combined Endo-restorative Treatment of a Traumatized Central Incisor: A Five-year Follow-up

Purpose: The management of complicated crown-root fractures is challenging for endodontic restoration. The present case describes a patient who sustained trauma to the maxillary right central incisor. Materials and Methods: Clinical and radiographic examination showed a complicated crown-root fracture and incomplete root development with periapical radiolucency and inadequate endodontic treatment with overfilling. Orthograde retreatment with MTA apical closure combined with a microsurgical approach to remove of extruded material was performed. Coronal sealing was accomplished with a direct adhesive restoration and marginal relocation. Results: A 5-year follow-up showed complete healing of the periapical lesion and correct preservation of function and esthetic parameters. Conclusion: A modern minimally invasive treatment protocol allows the maximum conservation of residual dental tissues

Vitreous Substitutes: Old and New Materials in Vitreoretinal Surgery

Recent developments in vitreoretinal surgery have increased the need for suitable vitreous substitutes. A successful substitute should maintain all the physical and biochemical properties of the original vitreous, be easy to manipulate, and be long lasting. Substitutes can be gaseous or liquid, both of which have associated advantages and disadvantages related to their physical properties and use. Furthermore, new surgical techniques with smaller vitreoretinal instruments have driven the use of more viscous substitutes. In this review, we analyze and discuss the most frequently used vitreous substitutes and look ahead to future alternatives. We classify these compounds based on their composition and structure, discuss their clinical use with respect to their associated advantages and disadvantages, and analyze how new vitreoretinal surgical techniques have modified their use

Choroidal Structure after Half-Dose Photodynamic Therapy in Chronic Central Serous Chorioretinopathy

The study aims to analyze the changes produced by half-dose photodynamic therapy (HD-PDT) in the choroid of eyes with chronic central serous chorioretinopathy (CSC) applying the binarization method to spectral domain optical coherence tomography (SDOCT) and OCT Angiography (OCTA) images. SDOCT and OCTA were performed before, one hour, one week, and one month after HD-PDT. Binarization with a modified Niblack method and analysis by ImageJ were applied. An average ratio between luminal part and total structure was calculated. Twenty-two eyes of 21 patients (20 male and 1 female; mean age 54.8 years) were enrolled. A statistically significant reduction of the central choroidal thickness was observed one week (from 407 µm to 362 µm, p = 0.034) and one month (from 407 µm to 341.5 µm, p = 0.0004) after HD-PDT. The baseline average ratio between luminal part and total structure was 33.4% in SDOCT, and 61.1% in OCTA. These values were 35.3% and 61% one hour, 33.9% and 60.4% one week, and 34.5% and 60.6% one month after HD-PDT, respectively. Overall, PDT seems to produce short-term changes on the luminal component of both choriocapillaris and choroid, which return to baseline status after one month from treatment. However, choroid stays significantly thinner after one month, with both luminal and interstitial components significantly reduced

Working length transfer in the endodontic clinical practice: A comparative study

8The present paper evaluated the accuracy of two different methods for transferring working length (WL) between manual endodontic instruments and nickel–titanium (NiTi) shaping files. Thirty root canals of extracted permanent teeth were used. Root canals were divided according to canal length (CL) and canal curvature (CC). The reference cusp and the root end were flattened to provide reproducible and accurate measurements. During shaping, the WL measurements were obtained with manual k-files (KF) and transferred to WaveOne (W1) NiTi reciprocating files using the traditional method with the endodontic ruler (method I) and an alternative clinical procedure based on the comparison of the instruments side by side from tip to shank (method II). For each file and each tested method, two measures were taken by two examiners using Rhino (ver. 4.0, McNeel, Seattle, WA, USA) software for a total of 360 (30 × 3 × 2 × 2) measures. Analysis of variance was performed by taking the difference in length (Delta WL, DWL) between files used for the same canal. The difference between methods I and II for WL transfer was found to be statistically significant (df = 1; F = 71.52; p < 0.001). The DWL absolute values obtained with method II were found to be closer to 0 mm (i.e., same length as corresponding KF) than those obtained with method I. Both CL (df = 2; F = 1.27; p = 0.300) and CC (df = 1; F = 2.22; p = 0.149) did not significantly influence WL measurements. With respect to WL transfer, method II seemed to better preserve the correct WL transfer between instruments during the clinical endodontic procedures.openopenMario Alovisi; Mario Dioguardi; Massimo Carossa; Giuseppe Troiano; Maria Chiara Domini; Davide Salvatore Paolino; Giorgio Chiandussi; Elio BeruttiAlovisi, Mario; Dioguardi, Mario; Carossa, Massimo; Troiano, Giuseppe; Chiara Domini, Maria; Paolino, DAVIDE SALVATORE; Chiandussi, Giorgio; Berutti, Eli

Management of a Malpractice Dental Implant Case in a Patient with History of Oral Bisphosphonates Intake: A Case Report and Narrative Review of Recent Findings

The present article aims to describe the management of a malpractice dental implant case in a patient with a history of oral bisphosphonates (BF) intake (alendronic acid every 15 days for 20 years) and to perform a narrative review of recently published articles (2019–2023) on the topic. A female patient rehabilitated with 18 nails in the mandible 20 years ago underwent two surgeries; the first one included the explantation of the nails; the second one included the insertion of two implants in the anterior region. At the last follow-up (21 months from the first surgery and 15 months from the second one) no complications nor episodes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) were highlighted. Furthermore, 12 recent articles on the topic were reported and a narrative review was performed. Based on the narrative analysis, the topic related to dental implants in patients with BF intake seems to remain controversial. Most of the findings highlight how the evidence on both the safety of the treatment and the possibility to foresee the risk of onset based on preoperative factors seem to be scarce. The case described in the present article did not report any complications nor episodes of BRONJ. However, evidence from a single case report is scarce and more clinical trials are required to deepen the knowledge on the topic

The effect of ultrasonic access cavity preparation on dentinal inner walls: a micro-CT study on cadaveric samples

ObjectiveThe objective of this study is to evaluate the occurrence of coronal dentinal micro-cracks after access cavity refinement using high-speed burs and ultrasonic tips by means of micro-computed tomography (micro-CT) analysis.MethodsIn this study, 18 mandibular cadaveric incisors were divided into two groups according to the protocol of the preparation of the conventional access cavity. The diamond bur 802 # 12 was used until the perforation of the pulp roof. Then, the Endo-Z bur was used for the group #1 and the ultrasonic tip Start-X # 1 for the group #2 to finish and refine the access cavity. The preparation time of each access cavity has been recorded. The teeth underwent a micro-CT scan before and after the preparation of the access cavity. Fisher's exact test, the Chi-square test, the Kolmogorov-Smirnov test, the Mann-Whitney test, and the Student's test were used for statistical evaluation.ResultsThe percentage of teeth with new micro-cracks is not significantly different between the two groups (-p-value < 0.5). The number of newly formed micro-cracks and extension size were not significantly different between the two groups. The direction of extension of the micro- cracks was occluso-apical. The average duration of the access cavity is significantly smaller with the Endo-Z system (-p- value < 0.001). The roughness of walls surfaces has no statistically difference between the two groups.ConclusionThe use of ultrasound, although slower, is considered safe in the creation of dentinal micro-cracks, in the preparation of the access cavity