Correlazione tra alitosi e trattamento ortodontico? Questioni di corretti stili di igiene orale. Case report

Nel trattamento delle malocclusioni, la terapia ortodontica fissa è la più suffragata (Fig. 1a). Anche se uno degli obiettivi del trattamento ortodontico in soggetti con malocclusioni è migliorare oltre che la funzione anche la salute parodontale, la terapia stessa può provocare una maggiore incidenza di infiammazioni con conseguente sanguinamento gengivale, recessioni e la ritenzione di placca1. Poiché la rugosità superficiale e l’energia libera di superficie sono correlati con l’accumulo di placca2, la presenza di un dispositivo ortodontico aumenta tale deposito con conseguente infiammazione gengivale in soggetti con malocclusione3. È ben documentato che il trattamento ortodontico con apparecchi fissi si accompagni a un aumentato rischio di gengiviti dovuto all’accumulo di placca batterica attorno agli attacchi2,3 (Figg. 1b-1d). L’alitosi di origine orale è associata con il metabolismo microbico sul dorso lingua, nella saliva e nella placca dentale4 (Figg. 2a-2b); dunque l’intensità dell’alito cattivo è significativamente associata con la quantità di composti volatili endorali contenenti solfuro. Questi composti sono prodotti da batteri gram-negativi orali che metabolizzano aminoacidi presenti nella dieta e producono gas, come solfuro di idrogeno (H2S)5. Ci sono generalmente tre metodi accettati per la valutazione del cattivo odore orale: misurazione organolettica, gas cromatografia (GC) e monitoraggio solfuro portatile6. Studi hanno dimostrato la correlazione a breve termine del cattivo odore orale nella terapia ortodontica fissa, mentre effetti a lungo termine non sono ancora stati documentati7-10

Antimicrobial photodynamic therapy (aPDT) HELBO in bacterial decontamination of the site pre-implant and post-extraction in the treatment of peri-implantitis

Aim: For several years we have known the therapeutic successes of antimicrobial photodynamic therapy (aPDT) Helbo as adjunctive therapy minimally invasive. Thanks to this therapy is possible to obtain an effective reduction of bacteria normally 2-4 decimal powers in the areas reached by a special dye and then exposed to a laser light of low intensity. The aim of our study was to evaluate the efficacy of antimicrobial photodynamic therapy (aPDT) Helbo in bacterial decontamination of the site pre-implant and post-extraction in the treatment of peri-implantitis. Methods: As demonstrated in many studies, photodynamic therapy helps efficiently the long-term maintenance of teeth, favors a reduction in pain, a rapid remission of inflammation and tissue regeneration interested. In our study we want to demonstrate how Helbo photodynamic therapy in patients with periodontal disease overt and in case of peri-implantitis can be effective for disinfection of the contaminated site. For all patients the diagnosis was made of chronic persistent or aggressive periodontitis (40 patients) or peri-implantitis (35 patients). All patients were treated with antimicrobial photodynamic therapy (aPDT) Helbo. Clinical signs of peri-implantitis were observed: increased probing depth with a marginal bone resorption > 1.5 mm 1 year after loading and 0.2 mm for year (> 5 mm) associated to defects with craters formed, bleeding and/or suppuration in the survey; therefore disagree with the criteria for implant success established by Albrektsson et al. Photodynamic therapy acts through the inactivation of cells, microrganisms or molecules, induced by light and not by heat reducing bacteria of 99%. This therapy involves the application of the chromophore Helbo Blue photosensitize (Bredent) which is left to act for at least one minute at each site by trattatare, increasing the time of permanence into the deepest pockets. Then proceed to rinse the excess liquid and exposure of the laser. The exhibition is made within 6 points of the tooth (buccal: mesial, central and distal; oral: mesial, central, distal) in a circular motion around the implant, never out of the rut, with dwell time of 10 seconds site. Were carried out periodic follow-up up to 3 years from the treatments. Results: After Photodynamic Therapy (aPDT) Helbo we found no cases of implant failure in cases of post-extraction implants, in addition, it was found to maintain the level of attack peri-implant bone in cases of peri-implantitis and in some cases there was a restitutio ad integrum with bone regeneration around the implant. Conclusions: Our study has demonstrated that the antimicrobial photodynamic therapy Helbo is able to determine a bacterial decontamination significant, then it can be regarded as an adjuvant in the therapy of peri-implantitis and bacterial decontamination of post-extraction sites preimplantari. Antimicrobial photodynamic therapy (aPDT) Helbo allows a reduction of the bacterial load without administration of local anesthesia and can be repeated without side effects. This method allows a minimally invasive way to treat the peri-implantitis, achieving reduction or abatement of the clinical indices of bleeding and pocket depth

Tecnica innovativa split crest per posizionamento implantare: case series.

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Terapia rigenerativa del sito post-estrattivo e contemporaneo inserimento implantare

In questo case report abbiamo voluto testare l'efficacia di un materiale da innesto ad indurimento in situ per la rigenerazione di un difetto osseo senza l'utilizzo di membrane

CHANGES IN SALIVARY ANTIOXIDANT CAPACITY AFTER ORAL SUPPLEMENTATION IN DENTAL IMPLANTS

Aim. Oxidative stress i. e. the unbalance between the production and elimination of reactive oxidant species by antioxidant systems plays a relevant role in the pathophysiology of many oral diseases like periodontitis as well as in tissue regeneration and osteointegration after dent implantation. On the other hand growing evidence suggests the potential usefulness of antioxidant formulas as preventive or adjunctive treatment to improve the success of implantations. The aim of the present study was to evaluate the effects of a combined local (toothpaste) and systemic (oral supplementation) antioxidant treatment on total salivary antioxidant capacity and some clinical outcomes in patients undergoing delayed dental implantations. Materials and methods. In this perspective case-control clinical trial 50 apparently healthy peoples candidates to a conventional delayed implantation were randomised to receive an antioxidant treatment (test group, TG, N=25, 13 F and 12 M, average 52 year old) or nothing (control group, CG, N=25, 10 F and 15 M, average 50 year old). The antioxidant treatment included the combination of a pomegranate-based toothpaste and a liquid oral antioxidant supplement (containing selenium, vitamin C, E and A, b-carotene, red fruits extracts, Zn, L-cysteine, coenzyme Q10, and pirydoxin). Salivary total antioxidant capacity to be intended as iron reducing capacity was measured by a photometric assay (optimal value 1,000 to 1,500 mM, using vitamin C as standard), before, after and four times during the follow-up (2nd, 3rd, 4th and 5th week). A visual analogical scale was administered to the all recruited subjects in order to evaluate the degree of oral inflammation (as rubor, calor, dolor, and tumor). Results. No statistically significant difference was found at the recruitment time between TG and CG except for the different M:F ratio. All the subjects completed the study and achieved the success of the implant (after 24 Months of treatment). Salivary total antioxidant capacity increased significantly before implantation compared to the first visit, (1530 ± 89 vs. 1270 ± 97 mM, p<0.05) only in the TG while it remained unchanged in the CC and picked in both groups immediately after intervention with the TG showing the highest increase during the follow-up period. Daily measurements up to ten days after implantation showed a faster significant decrease of all inflammation symptoms in the TG compared to the CG (p<0.05). The combined treatment of toothpaste and oral supplement was safe and well tolerated; no unwanted side effect were reported by the subject who completed all the 5-week treatment. Conclusions. The integration of dental implantation protocol with antioxidants as toothpaste and oral formula was associated to a significant increase of salivary total antioxidant capacity after one week of treatment before implantation and immediately after intervention compared to controls. Although preliminarily these findings suggest that the control of oxidative stress and local inflammation by antioxidant supplementation may optimize the efficacy of classical protocol of delayed dental implantations