Carlo Lajolo

The Thickness of Facial Alveolar Bone Overlying Healthy Maxillary Anterior Teeth

BACKGROUND A facial bone (<2 mm) overlying maxillary anterior teeth may be prone to resorptive processes after extraction and immediate implant placement. A thin bone contributes to risk of bone fenestration, dehiscence, and soft-tissue recession. This study measures the distance between the cemento-enamel junction (CEJ) and alveolar bone crest and the thickness of facial alveolar bone at points 1 to 5 mm from the bone crest for the six maxillary anterior teeth. METHODS Sixty-six tomographic scans (31 males and 35 females; aged 17 to 69 years; mean age: 39.9 years) of intact anterior maxilla were randomly selected and evaluated by two calibrated and independent examiners (MG and TP). RESULTS A high variation of CEJ-bone crest (0.8 to 7.2 mm) was detected. A significantly larger CEJ-bone crest was measured in smokers (P <0.05) and patients who were ≥50 years old (P <0.05). The average bone thickness at 3 mm from the CEJ for the maxillary right central incisor was 1.41 mm and for the maxillary left central incisor was 1.45 mm. For the maxillary right and left lateral incisors, the crestal bone thickness averaged 1.73 and 1.59 mm, respectively. For the maxillary right and left canines, the crestal bone thickness averaged 1.47 and 1.60 mm, respectively. CONCLUSIONS The present study supports the finding of a predominantly thin facial bone overlying the six maxillary anterior teeth. Therefore, it is essential to make informed treatment decisions based on thorough site evaluation before immediate implant placement.

Efficacy and safety of various active irrigation devices when used with either positive or negative pressure: an in vitro study

INTRODUCTION The purpose of this in vitro study was to evaluate and compare the efficacy and safety of different devices available for canal cleansing. METHODS The following systems were tested: passive ultrasonic irrigation, EndoVac (Discus Dental, Culver City, CA), and the irrigation ultrasonic needle (ProUltra PiezoFlow Irrigation Ultrasonic Needle; Dentsply Tulsa Dental Specialties, Tulsa, OK) used in both the injection mode (IUNI) and the aspiration mode (IUNA). In the control group, traditional irrigation with a syringe and side-vented needle was used. A resin model was used with 4 lateral canals (respectively at 2, 5, 8, and 11 mm from the apical foramen) filled with bovine pulp stained with fuchsin. The model also included a 2-mm chamber in communication with the apex, again filled with bovine pulp, which enabled the measurement of the extrusion of NaOCl beyond the apex. RESULTS With regard to efficacy, the most effective systems were found to be those using the ultrasonic needle, either in aspiration or injection modes; EndoVac was the least effective. Conversely, IUNI was found to bring the highest risk with regard to the extrusion of sodium hypochlorite beyond the apex. EndoVac was the safest but only by a slight margin compared with IUNA and passive ultrasonic irrigation. CONCLUSIONS Based on this study, the system that best reconciles efficacy and safety appears to be IUNA.

Root caries: a periodontal perspective.

BACKGROUND AND OBJECTIVE A prevailing dental problem in the periodontal patient is root caries. Specifically, periodontal involvement often results in root surfaces becoming exposed and at risk for this condition. Periodontal therapy often leads to increased gingival recession as well, and the associated increased root caries risk may compromise the long-term success and survival of periodontally treated teeth.This narrative review will address the topic of root caries in the periodontal patient, focusing on unmet research needs. MATERIAL AND METHODS The Medline database was searched to identify items dealing with root caries, in terms of clinical features, diagnosis, pathogenic mechanisms and histopathology, as well as epidemiology, focusing then on the relationship between root caries and periodontal disorders. RESULTS Although there is extensive literature on root caries, consensus is lacking regarding certain aspects, such as diagnostic criteria, prevalence within populations and indisputable risk factors. Advancing age could be an aggravating factor in susceptibility to root caries for the periodontal patient; however, definitive evidence in this regard is still missing. Similarly, full awareness of the increased risk of root caries in patients with periodontal disease or long-term periodontal treatment appears to be still lacking. CONCLUSION Research regarding root caries in age-specific (elderly) periodontal patients is needed. Improved oral hygiene practices, locally applied preventive measures, good dietary habits and regular dental check-ups are crucial approaches to prevent both periodontal disease progression and root caries. Periodontal patients with root exposure should follow a strict root caries prevention protocol, as an integral component of their periodontal maintenance therapy.

In vivo accuracy of three electronic root canal length measurement devices: Dentaport ZX, Raypex 5 and ProPex II.

AIM To compare in vivo three different electronic root canal length measurement devices: Dentaport ZX, Raypex 5 and ProPex II. METHODOLOGY Thirty single-rooted permanent teeth scheduled for extraction because of periodontal disease were selected from 10 adult patients (ranging from 45 to 67 years) and divided into three groups of 10 teeth. Before the extraction, an access cavity was prepared and the crown was adjusted to establish a stable reference point for all measurements. The working length in Group 1 was determined using the Dentaport ZX apex locator. A K-file with the largest diameter that could reach the last green bar on the screen was stabilized in the canal using a dual-curable flow resin composite. The same procedure was used for the Raypex 5 (the file reached the last yellow bar) and Propex II (0.0 orange bar) apex locators. The teeth were then extracted and cleared. The distance between the tip of the file and the major foramen was then calculated for each tooth using digital photography according to Axiovision AC software (Carl Zeiss). Positive values were assigned when the file tip passed beyond the major foramen, negative values when the tip was short of the foramen and zero value when the file tip and the foramen coincided. Statistical analysis was performed using the chi-squared test or Fishers exact test (P ≤ 0.05). RESULTS   Dentaport ZX, Raypex 5 and ProPex ΙΙ produced, respectively, 6, 2 and 4 out of 10 correct measurements, 0, 6 and 5 long measurements and 4, 2, and 1 short measurements. The differences between the three electronic root canal length measurement devices were not significant (P = 0.507). CONCLUSIONS Under the in vivo conditions of this study, the three electronic root canal length measurement devices were not significantly different in terms of locating the major foramen.

Could local anesthesia while breast-feeding be harmful to infants?

Background Few studies have been carried out on the levels and possible toxicity of local anesthetics in breast milk after parenteral administration. The purpose of this study is to determine the amount of lidocaine and its metabolite monoethylglycinexylidide (MEGX) in breast milk after local anesthesia during dental procedures. Methods The study population consisted of seven nursing mothers (age, 23–39 years) who received 3.6 to 7.2 mL 2% lidocaine without adrenaline. Blood and milk concentrations of lidocaine and its metabolite MEGX were assayed using high-performance liquid chromatography. The milk-to-plasma ratio and the possible daily doses in infants for both lidocaine and MEGX were calculated. Results The lidocaine concentration in maternal plasma 2 hours after injection was 347.6 ± 221.8 &mgr;g/L, the lidocaine concentration in maternal milk ranged from 120.5 ± 54.1 &mgr;g/L (3 hours after injection) to 58.3 ± 22.8 &mgr;g/L (6 hours after injection), the MEGX concentration in maternal plasma 2 hours after injection was 58.9 ± 30.3 &mgr;g/L, and the MEGX concentration in maternal milk ranged from 97.5 ± 39.6 &mgr;g/L (3 hours after injection) to 52.7 ± 23.8 &mgr;g/L (6 hours after injection). According to these data and considering an intake of 90 mL breast milk every 3 hours, the daily infant dosages of lidocaine and MEGX were 73.41± 38.94 &mgr;g/L/day and 66.1 ± 28.5 &mgr;g/L/day respectively. Conclusions This study suggests that even if a nursing mother undergoes dental treatment with local anesthesia using lidocaine without adrenaline, she can safely continue breast-feeding.

Langerhans's cell histiocytosis in old subjects: two rare case reports and review of the literature

BACKGROUND Langerhans cell histiocytosis (LCH) is a proliferative disease of histiocyte-like cells that generally affects children; LCH onset is rare in adults; immunohistochemistry is essential to obtain the correct diagnosis, and treatment protocols are controversial. OBJECTIVE To describe two new cases of adult onset oral LCH. CASE REPORTS Case 1: a 71-year-old woman, complaining of diffuse oral pain, presented with erythematous mucosal lesions; the panoramic radiograph and CT scan showed multiple mandible radiolucent areas. Immunohistochemical assay for S-100, CD1a and langerin test was essential in reaching the correct diagnosis. Case 2: a 77-year-old female patient presented with a non-painful, non-bleeding, slightly elevated erythematous palatal lesion of 6 months duration, together with a genital vulvar lesion of uncertain nature. The pathology confirmed the diagnosis of LCH. Many therapies (etoposid, radiotherapy) could induce only a clinical partial remission; Cladribine induced a complete recovery. CONCLUSION The first case was difficult to diagnose: the clinical presentation and course of the disease (LCH) in the elderly are multiple and unpredictable. An immunohistochemistry study is often essential to obtain the correct diagnosis. The second case required several therapeutic interventions: even though some cases regress spontaneously, others require systemic chemotherapy.

Oral lichenoid lesions in HIV-HCV-coinfected subjects during antiviral therapy: 2 cases and review of the literature.

Some dental materials and certain drugs may induce epithelial alterations, which clinically resemble oral lichen planus (OLP), on oral mucosa. But these alterations do not have all the clinical and/or the histological features of OLP; these lesions are known as oral lichenoid lesions (OLLs). Some researchers describe the onset and/or the worsening of OLL/OLP after the administration of anti-hepatitis C virus (HCV) therapy. In this article, we describe the development of symptomatic OLLs, as a consequence of anti-HCV therapy (interferon-alpha and ribavirine), in 2 human immunodeficiency virus-HCV-coinfected subjects. An immunological cause related to coinfection and administration of different medications could be responsible for the onset of OLLs. These new cases, together with the previous reports of a possible association between OLP and/or OLL and anti-HCV therapy, highlight the absolute need to monitor carefully the human immunodeficiency virus-HCV-coinfected subjects who are about to start the anti-HCV therapy and to define better the clinical and histopathological criteria to distinguish OLP from OLL.

Calcifying Odontogenic Cysts Associated with Odontomas: Confocal Laser Scanning Microscopy Analysis of 13 Cases

The so-called calcifying odontogenic cyst (COC) represents a heterogeneous group of lesions that exhibit a variety of clinico-pathologic features. It is an uncommon lesion and represents less than 2% of all odontogenic cysts and tumors. Recently, these lesions have been reclassified as calcifying cystic odontogenic tumors (CCOT), according to the new World Health Organization (WHO) classification. CCOT are frequently found in association with, or containing areas histologically identical to, various types of odontogenic tumors, such as complex/compound odontomas. This work analyzed clinical and histological data deriving from 13 patients affected by CCOT associated with odontomas. Moreover, a confocal laser scanning microscope (CLSM) analysis was undertaken to further a better understanding of the nature of this peculiar lesion.

Topical Retinoids in Oral Lichen Planus Treatment: An Overview

Background: Treatment of oral lichen planus (OLP) is a major challenge for clinicians and patients. There is limited scientific evidence about topical treatment with retinoids. We conducted a literature review of data on the effectiveness and safety of topical retinoids in OLP patients. Materials and Methods: We searched the MEDLINE, Embase and Cochrane databases for articles on topical retinoids treatment on OLP patients (searches from 1970 to February 2012). Results: Sixteen studies (280 OLP patients topically treated with different classes of retinoids) met the inclusion criteria. Isotretinoin was the most frequently employed retinoid in the treatment of OLP. The clinical and/or histopathological efficacy of retinoids was recorded in the majority of the selected studies. A transient and moderate burning sensation was the most frequently reported side effect. Conclusions: Topical retinoids appear as an alternative choice in OLP treatment. Whether keratotic OLP better responds to topical retinoids than erosive OLP is still an open question that deserves further comparative and controlled clinical trials. The benefits and harms of using topical retinoids in people with OLP require thorough evaluation in properly designed controlled studies.

Oral lesions in HIV and HCV co‐infected individuals in HAART era

BACKGROUND During recent years, a new population of HIV and HCV co-infected subjects has emerged presenting particular oral problems. The aim of our study was to determine the prevalence of oral lesions in HIV+ subjects and HIV and HCV co-infected subjects, to assess whether co-infection is a risk factor for the presence of oral lesions. METHODS 200 HIV+ subjects were consecutively enrolled, divided into two groups: Group 1 (130 HIV+ subjects) and Group 2 (70 HIV-HCV co-infected subjects) and visited by two oral medicine specialists. Epidemiological, laboratory and clinical parameters were gathered to determine the possible risk factors for oral lesions. RESULTS 52 on 200 subjects (26%) presented oral lesions: in Group 1, 25 on 130 subjects (19.23%) presented oral lesions, whereas in Group 2, 27 on 70 subjects (38.57%) presented oral lesions. Multivariate analysis showed that the following variables are statistically associated with the presence of oral lesions: HIV-HCV co-infection (OR = 2.32; 95% CI = 1.01-5.33: P < 0.05) and the use of drugs for the treatment of systemic diseases not associated with HIV (OR = 4.34; 95% CI = 1.78-5.33: P = 0.005). CONCLUSIONS It is possible to assess, on the basis of our results, that co-infected patients are more prone than HIV mono-infected patients to develop oral lesions and thus should undergo strict oral medicine monitoring.