A review on the prevention of inflammatory periimplant diseases

Background: An impressive number of dental implants are inserted worldwide. Evolution in dental implants and simplification of surgical techniques allowed a significant increase in the number of dentists involved in implant surgery. Most of them are general dentists, are not always sufficiently formed and experienced, frequently use low-quality implants, do not adopt the proper patient selective criteria, do not adequately monitor and maintain the inserted implants, and do not report their own statistics to the dental community. Consequently, the incidence of inflammatory periimplant diseases (IPDs) has progressively increased to values significantly higher than those previously indicated by the scientific literature. Materials and Methods: Two main literature searches were undertaken in October 2018 in the PubMed Website database. Only articles written in English and published from 2008 onward were considered; 'Clinical Trial,' 'Meta analysis,' 'Observational study,' 'Review,' and 'Validation study' were selected as article type filters. The following keywords were used in the searches: 'Peri implantitis prevention' and 'Dental implant failure prevention.'Results: Preventive measures are analyzed according to the different factors that can favor the occurrence of an infection. The factors are divided into (i) implant dependent, (ii) patient dependent, and (iii) surgeon dependent. Conclusions: Scientific and clinical data confirm that when materials are selected with care, patients are carefully evaluated for factors of risk and attitude to adhere to the necessary maintenance program, and operative protocols and maintenance programs are respected dental implants can be attractive and effective tools for oral rehabilitation. Nevertheless, dentists and patients should have greater awareness that in many cases the decision to utilize dental implants cannot be taken lightly

In vivo evaluation of operative torque generated by two Nickel-Titanium rotary instruments during root canal preparation

Objectives This in vivo study evaluated the operative torque and preparation time of ProTaper NEXT (Dentsply Maillefer; Ballaigues, Switzerland) and EdgeFile X7 (EdgeEndo; Albuquerque, New Mexico, United States) rotary systems during root canal preparation of maxillary premolars. Materials and Methods Ten double-rooted maxillary premolars with independent canals were selected. Each canal in each tooth was prepared with one of the rotary systems (n = 10), ProTaper NEXT or EdgeFile X7. The instruments were rotated at 300 rpm with maximum torque set at 2 N.cm using an electric motor (KaVo; Biberach, Germany) that automatically recorded torque values at every 1/10th of a second (ds). Statistical Analysis Operative torque (N.cm) and preparation time (s) of the first shaping instrument (size 17/.04) of both rotary systems were recorded and statistically compared using the Mann-Whiney U test with a significance level set at 5%. Results No instrument exhibited flute deformation or underwent intracanal failure. No differences were found between the instruments regarding the maximum (peak) torque values (p > 0.05). EdgeFile X7 17/.04 required significantly less preparation time (3.75 seconds interquartile range [IQR]: 3.2-9.0) than ProTaper NEXT X1 (15.45 seconds IQR: 8.35-21.1) (p < 0.05). The median operative torque values of ProTaper NEXT X1 (0.26 N.cm; IQR: 0.18-0.49) were significantly higher compared with EdgeFile X7 17/.04 (0.09 N.cm; IQR: 0.05-0.17) (p < 0.05). Conclusions Although no difference was found between the median peak torque values of ProTaper NEXT X1 and EdgeFile X7 17/.04 instruments, the operative torque and instrumentation time results were impacted by their different designs and alloys during clinical preparation of root canals

Fatigue resistance of new and used nickel-titanium rotary instruments: a comparative study

Aim of the present study was twofold. First, to evaluate in vitro, the performance of two different NiTi rotary instruments in one molar case; then, to evaluate their resistance to cyclic fatigue, compared to new ones

Inflammatory periimplant diseases and the periodontal connection question

Implant therapy has become a widespread reality in modern dentistry. Nevertheless, dental implants can fail due to different causes, among which inflammatory peri-implant diseases (IPDs) are a major challenge, with prevalences that are much higher than previously believed. Specific searches were undertaken for each question raised between October and November 2017, in the PubMed website database (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland, United States). Only articles written in English and published from 2007 onward were considered initially. The following keywords were used in the searches periimplantitis (PI), periimplant mucositis (PM), dental implant failure, periimplant microbiota, periodontal microbiota, implant failure (no temporal limit), and foreign body reaction (no temporal limit). The selection process resulted in the selection of 239 articles that were analyzed in detail in elaborating this review. The reference list was limited to the 47 most relevant articles due to editorial limits of this Journal. Intrinsic differences between natural teeth and dental implants are able to give rise to inflammatory diseases that share only minor and scarcely relevant characters, and would consequently deserve different and specifically designed instruments and strategies, for both diagnosis and therapy

Role of the flat-designed surface in improving the cyclic fatigue resistance of endodontic NiTi rotary instruments

The aim of this study was to investigate the role of the flat-designed surface in improving the resistance to cyclic fatigue by comparing heat-treated F-One (Fanta Dental, Shanghai, China) nickel-titanium (NiTi) rotary instruments and similar prototypes, differing only by the absence of the flat side. The null hypothesis was that there were no differences between the two tested instruments in terms of cyclic fatigue lifespan. A total of 40 new NiTi instruments (20 F-One and 20 prototypes) were tested in the present study. The instruments were rotated with the same speed (500 rpm) and torque (2 N) using an endodontic motor (Elements Motor, Kerr, Orange, CA, USA) in the same stainless steel, artificial canal (90° angle of curvature and 5 mm radius). A Wilcoxon-Mann-Whitney test was performed to assess the differences in terms of time to fracture and the length of the fractured segment between the flat- and non-flat-sided instruments. Significance was set at p = 0.05. The differences in terms of time to fracture between non-flat and flat were statistically significant (p < 0.001). In addition, the differences in terms of fractured segment length were statistically significant (p = 0.034). The results of this study highlight the importance of flat-sided design in increasing the cyclic fatigue lifespan of NiTi rotary instruments

The influence of a new clinical motion for endodontic instruments on the incidence of postoperative pain

Previous studies showed that motor motions play an important role in determining apical extrusion of debris. Therefore a new clinical motion (MIMERACI) has been proposed. The basic idea is to progress slowly (1mm advancement), and after each 1mm, to remove the instrument from the canal, clean flutes and irrigate. The aim of the study was to prove whether the clinical use of MIMERACI technique would influence or not postoperative pain.MATERIALS AND METHODS: 100 teeth requesting endodontic treatment were selected for the study and divided into two similar groups based on anatomy, pre-operative symptoms and vitality, presence or absence of periapical lesion. All teeth were shaped, cleaned and obturated by the same operator, using the same NiTi instruments. The only difference between the two groups was the instrumentation technique: tradional (group A) vs MIMERACI (group B). Assessment of postoperative pain was performed 3 days after treatment. Presence, absence and degree of pain were recorded with a visual analogue scale (VAS), validated in previous studies. Collected data statistically analyzed using one-way ANOVA post hoc Tukey test. RESULTS: For VAS pain scores MIMERACI technique showed significantly better results than group A (p=0,031). Overall, both incidence and intensity of symptoms were significantly lower. Flare ups occurred in 3 patients, but none treated with the MIMERACI Technique. CONCLUSIONS: Since extruded debris can elicit more postoperative pain, results obtained by using MIMERACI technique are probably due to many factors: better mechanical removal and less production of debris and more efficient irrigation during instrumentation

Comparison of the pharyngeal airway in snoring and non-snoring patients based on the lateral cephalometric study: a case-control study

BACKGROUND: Normal airways are a key factor during the craniofacial growth of the young. Therefore, sleep-disordered breathing (SDB) without treatment can have harmful consequences for development and health. OBJECTIVES: This study aimed to evaluate the cephalometric characteristics in non-snoring individuals and snoring subjects, and investigate differences in the pharyngeal airway space between the 2 groups. MATERIAL AND METHODS: This case-control study included 70 patients aged over 18 years, selected from a radiology center. The patients were divided into 2 groups: case (35 patients with a history of habitual snoring); and control (35 healthy patients). The Berlin sleep questionnaire was administered to the parents of the patients. The nasopharyngeal airway was measured according to the analysis of Linder-Aronson (1970), and 4 indices were measured and analyzed in each of the lateral cephalometric radiographs. RESULTS: No statistically significant differences were observed in the pharyngeal measurements between the 2 groups, although all means in the control group were higher than in the experimental group. However, there was a significant relationship between gender and the Ba-S-PNS and PNS-AD2 indices. CONCLUSIONS: Although the patients with nocturnal snoring had smaller airway dimensions, their pharyngeal measurements were not significantly different from the control group

Harnessing the power of biologic agents on the oral microbiota: a way to promote oral and systemic health?

During the long history of their evolution, higher organisms, including mammals, have learnt to take great advantage from living in close contact with selected populations of microbes.1 By living in close contact, animals and microbes underwent a progressive and mutual co-evolutive process that is believed to be a major driving force in the development of adaptive immunity of vertebrates.2 As a result of this co-evolutive process, humans and other animals are characterized by their own unique microbiomes, each consisting of many hundred species of viruses, bacteria, archaea, fungi, and protozoa, unevenly distributed to colonize the different accessible regions of the body.3 The human microbiome is believed to account for 1-3% of body weight and to comprise more than 100 trillion cells.4 The microbiota is involved in complex host-microbe and microbe-microbe interactions, thus modulating nutrient acquisition, adjusting immune system development and general homeostasis (via epigenetic modifications of host genes5), and playing the role of protective barrier to pathogens.4 When a microbiota undergoes qualitative and quantitative changes with regard to distribution in a site and metabolic activity, this condition is defined dysbiosis and is expected to be associated with local and/ or distant pathologic signs.6 Bacterial products released by a dysbiotic microbiota interact with homeostatic mechanisms of the human host and cooperate to the pathogenesis of major human diseases, including diabetes mellitus, inflammatory bowel syndrome, atherosclerosis, obesity, liver disease, and cancer.4,7 he oral microbiota is the second more abundant and one of the most diverse and unique microbial communities in the human body.8 Although many of the most relevant oral and dental diseases, including caries, periodontal and peri-implant diseases, have been long recognized as of microbial origin, only recently the application of culture independent molecular methods using 16S rRNA gene comparative analyzes enabled us to understand that they are caused by dysbiosis rather than by the action of specific pathogens.9-11 The effects of oral dysbiosis are not limited to oral tissues: periodontal diseases, for example, are among the most common human diseases and their associations with diabetes, cardiovascular disease, metabolic disease and obesity, rheumatoid arthritis, certain cancers, respiratory diseases, and cognitive disorders is now supported by increasing evidence.12 Recent molecular investigations showed that some potentially pathogenic oral bacteria (named pathobionts), as for example Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Fusobacterium nucleatum, colonize in low numbers the oral cavity of healthy individuals, without alerting sentinel systems of mucosal defences.13,14 Conditions able to disrupt the eubiotic equilibrium promote the overgrowth of pathobionts, which suddenly become pathogens (with support from commensal

Probiotic streptococcus salivarius reduces symptoms of denture stomatitis and oral colonization by Candida Albicans

Denture stomatitis (DS) is an inflammatory status of oral mucosae frequently observed in denture wearers, and mainly associated with oral overgrowth of Candida albicans. DS is the cause of multiple visits to the dental office and is thought to enhance the risk of systemic infections. The treatment of DS mainly relies upon improvement of oral hygiene measures and prescription of topical or systemic antifungal agents, and disinfectants that, although effective, are not without drawbacks. Since, in recent years, some probiotics were investigated as a means to contrast oral colonization by Candida spp., this study was designed to preliminarily evaluate the effects of probiotic strain Streptococcus salivarius K12, in subjects affected by DS, and the duration of these effects. Fifty adult denture wearers affected by DS were enrolled and randomly divided into two groups: the experimental group was instructed to perform careful oral and denture hygiene and to assume the probiotic preparation for 30 days; the control group received only oral hygiene instructions. Patients were evaluated for signs of DS at the beginning of the study, at the end of treatment and 30 days later. Microbiological samples were obtained at the beginning of the study and at the end of treatment to quantify Candida albicans cells. Experimental treatment reduced clinical signs and symptoms of DS and the count of C. albicans. The clinical effects of experimental treatment were still evident after 30 days, suggesting that administration of probiotic strain Streptococcus salivarius K12 could be a promising approach in the treatment of DS