Autoimmune diseases and their manifestations on oral cavity: diagnosis and clinical management

Oral signs are frequently the first manifestation of autoimmune diseases. For this reason, dentists play an important role in the detection of emerging autoimmune pathologies. Indeed, an early diagnosis can play a decisive role in improving the quality of treatment strategies as well as quality of life. This can be obtained thanks to specific knowledge of oral manifestations of autoimmune diseases. This review is aimed at describing oral presentations, diagnosis, and treatment strategies for systemic lupus erythematosus, Sjögren syndrome, pemphigus vulgaris, mucous membrane pemphigoid, and Behcet disease

Enamel remineralization and repair results of Biomimetic Hydroxyapatite toothpaste on deciduous teeth: an effective option to fluoride toothpaste

Background: Dental caries is a recognized worldwide public health problem. Despite being one of the most efective strategies against dental caries, the excessive use of fuorine may result in a potential risk of developing dental fuorosis especially in children under age of six. The purpose of this work is to analyze a fuorine-free toothpaste containing Biomimetic Hydroxyapatite to assess enamel re-mineralizing and repairing properties. Results: The study was performed in vitro and in vivo, comparing the hydroxyapatite toothpaste with two others toothpaste containing diferent fuorine concentrations. The coating efect of the micro-structured Hydroxyapatite nanoparticles reintegrates the enamel with a biomimetic flm reproducing the structure and the morphology of the biologic Hydroxyapatite of the enamel. As demonstrated, the coating is due to the deposit of a new layer of apatite, which presents fewer particles than the natural enamel, not based on the chemical—physical changes occurring in fuorinated toothpastes. Moreover, it shows resistance to brushing as a consequence of chemical bonds between the synthetic and natural crystals of the enamel. Conclusions: The use of Biomimetic Hydroxyapatite toothpastes has proven to be a valuable prevention measure against dental caries in primary dentition since it prevents the risk of fuorosis

Bioactive cements: from biological properties to clinical applications

Aim: Calcium silicate-based cements represent safe and predictable materials widely used in different fields of endodontics. They can be applied as pulp dressing agents during vital pulp therapy (VPT) of carious-affected deciduous or permanent teeth with immature roots as well as endodontic cements in case of root perforation or regenerative endodontic procedures. Therefore, it’s crucial to demonstrate biocompatible and antibiofilm properties of bioactive cements (i.e. MTA and Biodentine) in order to support their successful use in the clinical field. Materials and Methods: Biocompatibility of ProRootMTA and Biodentine specimens was assessed through cell culture of Saos-2 cells and both cement extracts by viability assay, oxidative stress analysis and immunofluorescence evaluation; on the other hand, antibiofilm efficacy was assessed by evaluating the biofilm forming ability of Streptococcus mutans onProRootMTA and Biodentine disks using Crystal Violet assay. Results: Cells exposed to ProRootMTA and Biodentine showed a good cell viability, slightly better in presence of the first; moreover, cells seeded on ProRootMTA presented a higher degree of biocompatibility compared to Biodentine. Accordingly, Biodentine demonstrated lightly fewer promising outcomes in terms of oxidative stress and focal adhesions of cells than ProRoot MTA, although the differences were not statistically significant. Inhibition of superficial colonization as well as biofilm forming ability of S. mutants were successfully obtained with both evaluated cements, even though ProRootMTA demonstrated a more efficient time-dependent antibiofilm effect than Biodentine. Conclusion: Bioactive cements proved to be biocompatible and to possess antibiofilm properties. When compared, MTA would seem to perform slightly better and could be considered as the gold standard material in the endodontic procedures

Biomimetic toothpastes: remineralization potential of deciduous teeth

Aim: Primary teeth are subjected to a continuous process of de- and re-mineralization. To prevent loss of dental tissues, fluoride-containing toothpastes have been successfully applied as a global solution to mainly prevent dental caries and promote tooth re-mineralization. However, the swallowing of a high amount of fluoride in younger children would lead to potential risk of fluorosis. Newly developed biomimetic toothpastes have provided promising results in preventive den tistry, therefore, the aim of the present study was to analyse the ability of commercial toothpastes to diffuse into deciduous enamel layer to remineralize the crystal habitat. Materials and Methods: Previously extracted primary teeth (n=8) were manually brushed for 15 days (3 times/day), using 3 different pediatric toothbrushes: (a) commercial toothpaste containing fluorine 500 ppm; (b) commercial toothpaste containing fluorine 1400 ppm; (c) toothpaste containing hydroxyapatite nanocrystal. Elements used as control (n = 2) were subjected to the manual brushing with water. Then, specimens were assessed by means of variable pressure scanning electron microscopy (VP-SEM). Results: Toothpaste containing nanocrystals of hydroxyapatite seemed to better diffuse through the enamel layer of deciduous teeth. This biomimetic toothpaste might contribute to remineralize the loss of the mineral component and play a central role in the prevention of dental caries. Conclusion: Biomimetic toothpastes would be considered a reliable alternative to fluoride-containing toothpaste. These preliminary results not only would improve the synthesis of novel biomaterials for deciduous teeth, but also would represent a positive global economic impact since the wide prevalence of dental caries affecting primary teeth

Peek polymer in orthodontics : a pilot study on children

The purpose of the study has been making the orthodontic space maintainers in PEEK polymer (Polyetheretherketone) through a digital workflow. New digital technologies are taking hold in diagnosis, therapy and in dental laboratories. The digital world can help dentist in diagnosis and therapy: -diagnosis through the acquisition of radiographic images (CBCT) or scanners which allow the creation of 3D digital models ? about therapy thanks to dental CAD CAM system. It consists of design devices through an dedicated software CAD and then realize devices through CAM system. We used digital system to improve the quality of the treatment and reduce costs. Peek polymer, subject of studies in recent years, thanking to its characteristics, resulted useful for this study. According to a nine month- follow up the devices were found comfortable, satisfying, personalized and minimally visible for the patients. These devices were found suitable to maintain the space. About material, thanks to its dimensional stability, mechanical strength but specially, thanks to its biocompatibility, PEEK was found as a very good material to build space maintainers. The workflow allowed a simulation of the treatment plan with a better collaboration and acceptance of the patient. Digital system reduced the systematic mistakes during the various phases and the production time. The digital system saved space creating a virtual plaster casts collection

Graphene-based dental adhesive with anti-biofilm activity

BACKGROUND: Secondary caries are considered the main cause of dental restoration failure. In this context, anti-biofilm and bactericidal properties are desired in dental materials against pathogens such as Streptococcus mutans. To this purpose, graphene based materials can be used as fillers of polymer dental adhesives. In this work, we investigated the possibility to use as filler of dental adhesives, graphene nanoplatelets (GNP), a non toxic hydrophobic nanomaterial with antimicrobial and anti-biofilm properties. RESULTS: Graphene nanoplatelets have been produced starting from graphite intercalated compounds through a process consisting of thermal expansion and liquid exfoliation. Then, a dental adhesive filled with GNPs at different volume fractions has been produced through a solvent evaporation method. The rheological properties of the new experimental adhesives have been assessed experimentally. The adhesive properties have been tested using microtensile bond strength measurements (µ-TBS). Biocidal activity has been studied using the colony forming units count (CFU) method. The anti-biofilm properties have been demonstrated through FE-SEM imaging of the biofilm development after 3 and 24 h of growth. CONCLUSIONS: A significantly lower vitality of S. mutans cells has been demonstrated when in contact with the GNP filled dental adhesives. Biofilm growth on adhesive-covered dentine tissues demonstrated anti-adhesion properties of the produced materials. µ-TBS results demonstrated no significant difference in µ-TBS between the experimental and the control adhesive. The rheology tests highlighted the necessity to avoid low shear rate regimes during adhesive processing and application in clinical protocol, and confirmed that the adhesive containing the 0.2%wt of GNPs possess mechanical properties comparable with the ones of the control adhesive

The application of a fluoride-and-vitamin D solution to deciduous teeth promotes formation of persistent mineral crystals: a morphological ex-vivo study

Background: The use of effective, low-cost, and easy-to-use products for early caries management will avoid loss of dental vitality and impairment in oral function. The ability of fluoride to re-mineralize dental surfaces has been widely reported as well as vitamin D demonstrated to have significant potential in improving the remineralization of early lesions on enamel surfaces. The aim of the present ex vivo study was to evaluate the effect of a fluoride and vitamin D solution in terms of formation of mineral crystals on the enamel of primary teeth, and their permanence over time on dental surfaces. Methods: Sixteen extracted deciduous teeth were cut to obtain 64 specimens that were divided into two groups. The first consisted of immersion of specimens for 4 days in a fluoride solution (T1); in the second group, the specimens were immersed for 4 days (T1) in fluoride and Vitamin D solution, and for a further 2 (T2) and 4 days (T3) in saline solution. Then, samples were morphologically analyzed by using Variable Pressure Scanning Electron Microscope (VPSEM) and underwent 3D surface reconstruction. Results: After a 4-day immersion in both solutions, octahedral-shaped crystals were formed on the enamel surface of primary teeth, demonstrating any statistically significant differences in terms of number, size, and shape. Moreover, the binding of the same crystals seemed to be strong enough to be maintained until 4 days in saline solution. However, a partial dissolution was observed in a time-dependent manner. Conclusions: A topical application of fluoride and Vitamin D promoted the formation of persistent mineral crystals on enamel surfaces of deciduous teeth and should be further studied to be potentially used as an alternative strategy in preventive dentistry

Assessing the Predictive Performance of Probabilistic Caries Risk Assessment Models: The Importance of Calibration

Probabilistic caries risk assessment models (P-CRA), such as the Cariogram, are promising tools to planning treatments in order to control and prevent caries. The usefulness of these models for informing patients and medical decision-making depends on 2 properties known as discrimination and calibration. Current common assessment of P-CRA models, however, ignores calibration, and this can be misleading. The aim of this paper was to provide tools for a proper assessment of calibration of the P-CRA models and improve calibration when lacking. A combination of standard calibration tools (calibration plot, calibration in-the-large, and calibration slope) and 3 novel measures of calibration (the Calibration Index and 2 related metrics, E50 and E90) are proposed to evaluate if a P-CRA model is well calibrated. Moreover, an approach was proposed and validated using data from a previous follow-up study performed on children evaluated by means of a reduced Cariogram model; Platt scaling and isotonic regression were applied showing a lack of calibration. The use of the Cariogram overestimates the actual risk of new caries for forecast probabilities 0.6. Both Platt scaling and isotonic regression were able to significantly improve the calibration of the reduced Cariogram model, preserving its discrimination properties. The average specificity and sensitivity for both Platt scaling and isotonic regression using the cut-off point p= 0.5 were >83 and their sum well exceeded 160. The benefits of the proposed calibration methods are promising, but further research in this field is required

Evaluation of the application of italian national guidelines for prevention and management of dental injuries in developmental age

Background: The objective of this study is to evaluate the application of National guidelines for prevention and clinical management of traumatic dental injuries (NGPCMTDI) in developmental age published by the Italian Ministry of Health. Methods: In the present retrospective and multicenter study, 246 patients who underwent dental injury were selected to assess the management of the traumatic event compiled with the protocol provided by the National guidelines. Each health worker involved completed a form related to the dental injury in order to standardize the collected data. Two reference centers have been identified for data collection. Analyses for comparisons between groups were performed using the X2 test for categorical variables or by Fisher exact test as appropriate. Statistical significance was assumed at p < 0.05. Results: Evaluating the distribution by age we concluded that: 27.24% of the enrolled patients were aged 1-5 years, 51.63% 6-10 years, and 19.92% 11-17 years. The dental injuries occurred in 10.16% of the situations at home, 50.81% at school, 28.86% during recreation, and 9.35% at the gym. The deciduous dentition is involved in 34.96% of the traumas while the permanent dentition is involved in 69.51%. Conclusion: From the present study it emerged that the National guidelines are not uniformly applied

Morpho-chemical observations of human deciduous teeth enamel in response to biomimetic toothpastes treatment

Today, biomaterial research on biomimetic mineralization strategies represents a new challenge in the prevention and cure of enamel mineral loss on delicate deciduous teeth. Distinctive assumptions about the origin, the growth, and the functionalization on the biomimetic materials have been recently proposed by scientific research studies in evaluating the different clinical aspects of treating the deciduous tooth. Therefore, appropriate morpho-chemical observations on delivering specific biomaterials to enamel teeth is the most important factor for controlling biomineralization processes. Detailed morpho-chemical investigations of the treated enamel layer using three commercial toothpastes (Biorepair, F1400, and F500) were performed through variable pressure scanning electron microscopy (VP-SEM) and energy dispersive X-ray spectroscopy (EDS) on deciduous teeth in their native state. A new microscopy methodology allowed us to determine the behaviors of silicate, phosphate, and calcium contents from the early stage, as commercially available toothpastes, to the final stage of delivered diffusion, occurring within the enamel layer together with their penetration depth properties. The reported results represent a valuable background towards full comprehension of the role of organic–inorganic biomaterials for developing a controlled biomimetic toothpaste in biofluid medi