Tailored Brushing Method (TBM): an innovative simple protocol to improve the oral care

Background. The objective of this study is to describe and assess the effectiveness and acceptability of a modern tailored protocol of oral hygiene, based on the concordance between professionals and patients, and based on the proper choice of best tools for oral hygiene regardless of the technique used. This new method has been called Tailored Brushing Method (TBM). Material and methods. Two groups of adult patients (n=200) were involved in this research, according to specific inclusion criteria. Test group followed the indications of the new Tailored Brushing Method, while control group was involved in a standard protocol of oral hygiene with the suggestions of a brushing technique and the typical approach based on the compliance. Plaque Index, bleeding on Probing index and patients' acceptability of the methods (Visual Analog Scale) were assessed at different time points. Descriptive and statistical analyses were performed. Results and conclusions. Test group had statistically lower Plaque Index and Bleeding on Probing after 30 days, in comparison with control group. Test group expressed a better acceptance of the new tailored method. This research suggests to use a tailored approach to oral hygiene, overcoming the need of patient's compliance, often affected by bias such as alteration of the protocols and wrong brushing maneuvers

Monitoring pit and fissures using transparent sealant and fluorescence intraoral camera, 12 months follow up

The aim of this in vivo study is to report on the combined use of a fluorescence intraoral camera and transparent sealant for the clinical monitoring of pits and fissures. 96 permanent molars with a ICDAS II code 0, 1, or 2, (in 48 patients aged 12–14) were registered at the First Observation Unit (Oral and Maxillofacial Sciences Department), Sapienza University, Rome. Clinically selected teeth were double-checked using a VistaCam iX Proof (Durr Dental AG) and sealed with a transparent sealant (ControlSeal, VOCO GmbH), following the established indications for use if a pit and fissure condition was confirmed within the camera’s internal cutoff point of 1.5 (“early enamel demineralization”). Clinical followup was performed using VistaCam at 6 and 12 months to assess sealant retention and any demineralization trend. At baseline, 57.4% of the registered teeth were sound, both visually and when using the fluorescence camera, 42.6% presented an early demineralization (<1.5 with VistaCam and ICDAS II 1- 2). Subsequent VistaCam assessment of surfaces underlying the transparent sealant totally confirmed initial evaluations. Complete sealant retention rated 95% at 6 months, and 91% at 12 months. No case of complete detachment was observed. At the 12-month follow-up, VistaCam measurements resulted stable in the whole sample, except for one permanent molar, which presented a demineralization increment and partial sealant retention. Visual and fluorescence assessments were consistent and feasible. Incomplete sealant retention occurred in 5% of cases at 6 months and 9% of cases at 12 months and was probably due to procedure imperfections. The combined use of transparent sealant and a fluorescence camera shows clinical effectiveness and diagnostic efficacy for occlusal surface monitoring

Evaluation of the esthetic properties of developmental defects of enamel: a spectrophotometric clinical study

Objectives. Detailed clinical quantification of optical properties of developmental defect of enamel is possible with spectropho- tometric evaluation. Developmental defects of enamel (DDE) are daily encountered in clinical practice. DDE are an alteration in quality and quantity of the enamel, caused by disruption and/or damage to the enamel organ during amelogenesis. Methods. Several clinical indices have been developed to categorize enamel defects based on their nature, appearance, microscopic features, or cause. A sample of 39 permanent teeth presenting DDE on labial surface was examined using the DDE Modified Index and SpectroShade evaluation. The spectrophotometric approach quantifies L∗ (luminosity), a∗ (quantity of green-red), and b∗ (quantity of blue- yellow) of different DDE. Conclusions. SpectroShade evaluation of the optical properties of the enamel defect enhances clinical understanding of severity and extent of the defect and characterizes the enamel alteration in terms of color discrepancy and surface characterization

The antimicrobial photodynamic therapy in the treatment of peri-implantitis

The aim of this study is to demonstrate the effectiveness of addition of the antimicrobial photodynamic therapy to the conventional approach in the treatment of peri-implantitis. Materials and Methods. Forty patients were randomly assigned to test or control groups. Patients were assessed at baseline and at six (T1), twelve (T2), and twenty-four (T3) weeks recording plaque index (PlI), probing pocket depth (PPD), and bleeding on probing (BOP); control group received conventional periodontal therapy, while test group received photodynamic therapy in addition to it. Result. Test group showed a 70% reduction in the plaque index values and a 60% reduction in PD values compared to the baseline. BOP and suppuration were not detectable. Control group showed a significative reduction in plaque index and PD. Discussion. Laser therapy has some advantages in comparison to traditional therapy, with faster and greater healing of the wound. Conclusion. Test group showed after 24 weeks a better value in terms of PPD, BOP, and PlI, with an average pocket depth value of 2 mm, if compared with control group (3 mm).Our results suggest that antimicrobial photodynamic therapy with diode laser and phenothiazine chloride represents a reliable adjunctive treatment to conventional therapy. Photodynamic therapy should, however, be considered a coadjuvant in the treatment of peri-implantitis associated with mechanical (scaling) and surgical (grafts) treatments

Evaluation of aesthetic integration between composite restorations and natural tooth in NCCL: a case report

NCCL (non carious cervical lesion) is defined as irreversible loss of dental hard tissue that does not involve bacteria. It consists of erosion, attrition, abrasion and abfraction that rarely occur alone. Dentinal hypersensitivity is an early symptom of NCCL. Preventive measures and restorative treatment can avoid the progress of NCCL. This paper reports a case of NCCL treatment with aesthetic purpose. The aesthetic evaluation was made by means of spectrophotometry as a standardized method. Spectrophotometric measurements such as International Commission on Illumination (CIE-Commission Internationale de l’Eclaraige) CIE L* a* b* and ΔE between the sound enamel and resin restoration, provide all the information about the outcome of the aesthetic restorative treatment

The association between periodontal disease and serum biomarkers levels in haemodialysis patients: a narrative review

The vast majority of studies has demonstrated that periodontal infection promotes significant systemic inflammatory status. The specific effects of these systemic alterations in response to periodontal inflammation have been comprehensively described and appear to be highly stereotyped, and it is well known the pathophysiological mechanism related to immune functioning linking periodontitis and pathologies such as diabetes or cardiovascular diseases, adverse pregnancy outcomes, and rheumatoid arthritis. More recently, it has been proposed that this association could be extended to consider periodontal infection as trigger to complications in maintenance haemodialysis (HD) patients through the establishment of inflammatory status in association to impaired nutritional status, emphasizing the role of periodontal infection in increase of C-reactive protein serum marker, a notably predictor of the cardiovascular risk. The aim of this narrative review was to summarize the currently literature evidence that has developed around the potential impact of periodontal inflammatory status on serum nutritional and inflammatory biomarkers concentration monitoring the severity of systemic conditions in HD patients, in which cardiovascular events and malnutrition are the most common causes of mortality and morbidity. Methods: an electronic PubMed, Google Scholar and Cochrane database search complemented by a manual search of the bibliographies cited in all identified articles was performed between 2012 and 2019. The inclusion criteria were: all types of articles, articles published in PubMed, , Google Scholar and Cochrane and related only to humans. The exclusion criteria were: articles for which full text was not available, were not in English, or were grey literature. Keywords set: hemodialisys serum markers and periodontitis have been combined through the use of Mesh search. The terms then inserted in Pubmed were “serum markers”, “hemodialisys”, “periodontal disease” OR “periodontal infection” OR “periodontal inflammation”. Results: thirteen articles were identified. Studies currently available on the impact of periodontitis on the serum markers level in HD patients are analogous. Results confirmed the impact of subclinical inflammation related to periodontitis on C-reactive protein and albumin serum levels, supporting the emerging hypothesis of relationship between periodontal infection and HD status. Conclusions: although many studies have suggested that the inflammatory cytokines release may play a key role in several clinical alterations related to HD maintenance, further studies are needed to investigate the long-term consequences of chronic inflammation caused by periodontitis. There is a paucity of data concerning to the impact of periodontal disease on maintenance hemodialysis patients and about mechanisms involved

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

Effect of biofilm removal from the occlusal tooth surfaces on fluorescence measurements. A clinical study

Aim: Early diagnosis and monitoring of caries lesions are the most important issues of primary and secondary prevention policies.The intraoral VistaCamiX(DurrDental, Bietigheim‐Bissingen,Germany) uses the fluorescence phenomenon for a non‐invasive, quantitative caries diagnosis. In order to make a precise evaluation the tooth surface must be completely cleaned and without biofilm. The current study aimed to evaluate the effects of biofilm removal, using air‐polishing device (Combi,MectronSpA) with glycine, on fluorescence VistaCam iX camera quantitative measurements of caries. Methods: Patients with complete permanent dentition without any kind of restorative treatments in the lateral and posterior section of upper and lower dental arches were enrolled. The occlusal surfaces of molars and premolars were photographed using the fluorescence terminal Proof of the intraoral camera VistaCam iX before and after air polishing glycine procedures, registering the highest value gained for each occlusal surface. Results:133cuspidate permanent teeth of patients aged between 13 and 25 were analyzed. Descriptive analysis showed an average of 0.82 (SD=0.65; Min=0.00; Max=1.80; Median=1.20) and of 0.93 (SD=0.60; Min=0.00; Max=1.70; Median=1.20) for values before and after treatment, respectively.The scores assigned by VistaCam iX Proof fluorescence based camera to the occlusal surfaces, after the air‐polishing treatment, are averagely higher than those before treatment, especially in the diagnosis of initial tooth decay. Conclusion: Biofilm removal with glycine air‐polishing improves the VistaCam camera accuracy in recognizing healthy tissue from the decayed one, due to the fact that air-polishing treatment increases the decayed tissue reaction to the fluorescence

Correlation between parodontal indexes and orthodontic retainers: prospective study in a group of 16 patients

Purpose. Fixed retainers are used to stabilize dental elements after orthodontic treatment. Being it a permanent treatment, it is necessary to instruct patients about a constant and continuous monitoring of their periodontal conditions and a correct oral hygiene. The aim of this study was to highlight the possible adverse effects of bonded retainers on parameters correlated to the health conditions of periodontal tissues. Materials and methods. We selected 16 patients, under treatment in the Orthodontics Department of University of Bari Dental School, who had undergone a lingual retainer insertion at the end of the orthodontic treatment. The patients were then divided into two groups (Control Group and Study Group) and monitored for 3 and 36 months, respectively. The following indexes were taken into consideration: gingival index (GI), plaque index (PI) and the presence of calculus (Calculus Index, CI), the probing depth and the presence of gingival recession on the six inferior frontal dental elements. Results. After the observation was carried out, any of the patients showed periodontal sockets and gingival recession. In the Study Group, only 1 patient had a PI score=3, the 7 left had scores between 0.66 and 2.83. In the Control Group, one patient had score=0, the other ones showed values between 0.5 and 1.66. The mean GI in the Study Group peaked at a score of 2.83, the minimum was 0.66; whereas in the Control Group the maximum value was 2 and the minimum 0.66. The CI in the Group Study was between 1 and 2. In the Control Group it was absent in only 1 patient, whereas in the remaining 7, it had a value between 0.3 and 1. The clinical data were studied by means of the Wilcoxon test. We found a statistically significant difference for what concerns the Plaque Indexes (PI) (P>0.05) and Calculus Indexes (CI) (P>0.1) in both groups, with higher scores in the Study Group, having retainers for 36 months. Any statistically significant difference was calculated for the GI. Conclusions. We can therefore conclude that patients with lingual retainers need periodontal hygiene and treatment as to prevent, in the course of time, periodontal damages non-detectable in short-term

Remineralization strategies in oral hygiene: a position paper of Italian Society of Oral Hygiene Sciences-S.I.S.I.O. working group

Background/Objective: The clinical conditions that lead to an alteration of the enamel structure are numerous. The diet high in sugars and acidifying substances, psychological stress that triggers parafunctional behaviors, the reduced intake of fiber-rich foods or alkalizing substances, together with other factors, contribute to demineralization of the tooth enamel. Dental mineralizing products on the current market are distinguished according to the dosage form, the active ingredient, the release technology, clinical indications and patient choice. Currently, it is necessary to propose to oral health professionals a guide to orient themselves in this chaotic choice, in order to prefer the most effective product for their own clinical target. Methods: Italian Society of Oral Hygiene Sciences-S.I.S.I.O. is one of the leading scientific Italian societies representing those dental hygienists working with high-quality standards and in agreement with scientific evidence: in the last year, the SISIO working group has carried out a study focused on remineralizing agents in dentistry, in order to give an authoritative point of view to indicate a guideline in the decision process of the choice of a remineralizing agent. We will report the results pointed out from the last consensus meeting in 2017. Results: We have reported the good the bad and the ugly have been discussed in a critical discussion of such topic. Conclusion: The SISIO experience has been reported in this position paper with the aim to serve as a useful aid in the daily choice of the clinical steps to perform, when dental professionals need to treat demineralized teeth. Keywords: Dental Hygiene, Oral health, Dental Remineralizing, Enamel, Toothpaste, Mouthwash