Francesco Riccitiello

Calcium silicate and calcium hydroxide materials for pulp capping: Biointeractivity, porosity, solubility and bioactivity of current formulations

Aim The chemical-physical properties of novel and long-standing calcium silicate cements versus conventional pulp capping calcium hydroxide biomaterials were compared. Methods Calcium hydroxide–based (Calxyl, Dycal, Life, Lime-Lite) and calcium silicate–based (ProRoot MTA, MTA Angelus, MTA Plus, Biodentine, Tech Biosealer capping, TheraCal) biomaterials were examined. Calcium and hydroxyl ion release, water sorption, interconnected open pores, apparent porosity, solubility and apatite-forming ability in simulated body fluid were evaluated. Results All calcium silicate materials released more calcium. Tech Biosealer capping, MTA Plus gel and Biodentine showed the highest values of calcium release, while Lime-Lite the lowest. All the materials showed alkalizing activity except for Life and Lime-Lite. Calcium silicate materials showed high porosity values: Tech Biosealer capping, MTA Plus gel and MTA Angelus showed the highest values of porosity, water sorption and solubility, while TheraCal the lowest. The solubility of water-containing materials was higher and correlated with the liquid-to-powder ratio. Calcium phosphate (CaP) deposits were noted on materials surfaces after short aging times. Scant deposits were detected on Lime-Lite. A CaP coating composed of spherulites was detected on all calcium silicate materials and Dycal after 28 days. The thickness, continuity and Ca/P ratio differed markedly among the materials. MTA Plus showed the thickest coating, ProRoot MTA showed large spherulitic deposits, while TheraCal presented very small dense spherulites. Conclusions calcium silicate-based cements are biointeractive (ion-releasing) bioactive (apatite-forming) functional biomaterials. The high rate of calcium release and the fast formation of apatite may well explain the role of calcium silicate biomaterials as scaffold to induce new dentin bridge formation and clinical healing.

Evaluation of Leakage of Bacteria and Endotoxins in Teeth Treated Endodontically by Two Different Techniques

Root canal recontamination occurs after contact between oral-bacterial flora and the coronal extremity of the root canal. The aim of this study was to evaluate the time required for endotoxins and bacteria to penetrate through root-canal obturations performed with vertical and lateral gutta-percha condensation techniques. Specimens prepared by the two alternative methods were exposed to contaminated saliva, and leakage into the root was evaluated over time. None of the obturated roots was infiltrated by endotoxins after 31 days. On the contrary, between day 13 and day 37 bacteria had infiltrated all specimens.

Influence of Leukocyte- and Platelet-Rich Fibrin (L-PRF) in the Healing of Simple Postextraction Sockets: A Split-Mouth Study

The aim of this study was to evaluate the effects of leukocyte- and platelet-rich fibrin (L-PRF) on the pain and soft tissue healing after tooth extractions. Twenty-six patients (9 males and 17 females) were treated with multiple extractions (2 to 8), with a total of 108 extractions. This was an exploratory single blinded randomized clinical trial with a split-mouth design. The pain after the surgery was assessed in each patient by the VAS scale (1 to 10) at intervals of 24-48-72-96 hours. The soft tissue healing was clinically evaluated at 3, 7, 14, and 21 days after surgery by the same examiner surgeon, using the modified Healing Index (4 to 12). The mean value of postextraction pain was 3.2 ± 0.3 in the experimental sides and 4.1 ± 0.1 in the control sides. After 7 days from the extractions, the values of modified Healing Index in the experimental and control groups were, respectively, 4.8 ± 0.6 and 5.1 ± 0.9. The use of L-PRF in postextraction sockets filling can be proposed as a useful procedure in order to manage the postoperative pain and to promote the soft tissue healing process, reducing the early adverse effects of the inflammation.

Mechanical strength of tooth fragment reattachment

The aim of this study was static and fatigue test investigation of the strength of a tooth fragment reattached with adhesives to the tooth body. Central bovine incisor teeth were used, and standardized fragments were obtained by cutting the incisal edge of the selected teeth. All the fragments were reattached using a multistep dentine adhesive system, and the specimens were randomly divided into two groups (A and B). Group B specimens underwent a further dental treatment: a circumferential double chamfer prepared around the external cut interface was filled with light cured composite restorative resin. Static and fatigue bending tests were performed and linear elastic equations were used to analyze and compare the strength of the treated teeth. The results indicated that the static and fatigue bending properties were improved by using reinforcement with composite restorative resin.

Effect of layered double hydroxide intercalated with fluoride ions on the physical, biological and release properties of a dental composite resin

OBJECTIVES The aim of this work was the preparation of a new fluoride-releasing dental material characterized by a release of fluoride relatively constant over time without any initial toxic burst effect. This type of delivery is obtained by a matrix controlled elution and elicits the beneficial effect of a low amount of fluoride on human dental pulp stem cells (hDPSCs) towards mature phenotype. METHODS The modified hydrotalcite intercalated with fluoride ions (LDH-F), used as filler, was prepared via ion exchange procedure and characterized by X-ray diffraction and FT-IR spectroscopy. The LDH-F inorganic particles (0.7, 5, 10, 20wt.%) were mixed with a photo-activated Bis-GMA/TEGDMA (45/55wt/wt) matrix and novel visible-light cured composites were prepared. The dynamic thermo-mechanical properties were determined by dynamic mechanical analyzer. The release of fluoride ions in physiological solution was determined using a ionometer. Total DNA content was measured by a PicoGreen dsDNA quantification kit to assess the proliferation rate of hDPSCs. Alkaline phosphatase activity (ALP) was measured in presence of fluoride resins. RESULTS Incorporation of even small mass fractions (e.g. 0.7 and 5wt.%) of the fluoride LDH in Bis-GMA/TEGDMA dental resin significantly improved the mechanical properties of the pristine resin, in particular at 37°C. The observed reinforcement increases on increasing the filler concentration. The release of fluoride ions resulted very slow, lasting months. ALP activity gradually increased for 28 days in hDPSCs cell grown, demonstrating that low concentrations of fluoride contributed to the cell differentiation. CONCLUSIONS The prepared composites containing different amount of hydrotalcite filler showed improved mechanical properties, slow fluoride release and promoted hDPSCs cell proliferation and cell differentiation.

µCT analysis of mandibular molars before and after instrumentation by Reciproc files

Cleaning and shaping are important section for the root canal treatment. A number of different methodologies have been developed to overcome these problems, including the introduction of rotary instruments nickel-titanium (NiTi). In endodontics NiTi have been shown to significantly reduce procedural errors compared to manual techniques of instrumentation. The efficiency of files is related to many factor. Although previous investigations that have used µCT analysis were hampered by insufficient resolution or projection incorrect. The new generation of μCT performance best offer, as micron resolution and accurate measurement software for evaluating the accurate anatomy of the root canal. The aim the paper was to evaluate the efficiency of Reciproc files in root canal treatment, evaluated before and after instrumentation by using μ-CT analysis.

Glottic-SubGlottic adenoid cystic carcinoma. A case report and review of the literature

BackgroundMalignant tumours of minor salivary glands are uncommon, representing only 2-4% of all head and neck cancers. In the larynx, minor salivary gland tumours rarely occur and constitute less than 1% of laryngeal neoplasm. Most of the minor salivary gland tumours arise in the subglottis; however, they can also occur in the supraglottis, in the false vocal cords, aryepiglottic folds and caudal portion of the epiglottis. The most common type of malignant minor salivary gland tumour is adenoid cystic carcinoma.MethodsWe present a unusual case of adenoid cystic carcinoma of glottic-subglottic region in a 61-year-old woman. Follow-up endoscopy and laryngeal magnetic resonance imaging (MRI) at three years after treatment showed no recurrence of the tumour.ResultsThe diagnosis of glottic-subglottic adenoid cystic carcinoma should be considered in patients who are characterized by dyspnea, cough and stridor, but do not respond to pharmacologic approach.ConclusionsAdenoid cystic carcinoma is usually a very slow growing cancer, invested by an apparently normal laryngeal mucosa, so that it can show no clear symptoms for a long time. For these reasons the increasing number of diagnostic mistakes or late diagnosis that may be fatal in some cases.

Reverse engineering of mandible and prosthetic framework: Effect of titanium implants in conjunction with titanium milled full arch bridge prostheses on the biomechanics of the mandible

This study aimed at investigating the effects of titanium implants and different configurations of full-arch prostheses on the biomechanics of edentulous mandibles. Reverse engineered, composite, anisotropic, edentulous mandibles made of a poly(methylmethacrylate) core and a glass fibre reinforced outer shell were rapid prototyped and instrumented with strain gauges. Brånemark implants RP platforms in conjunction with titanium Procera one-piece or two-piece bridges were used to simulate oral rehabilitations. A lateral load through the gonion regions was used to test the biomechanical effects of the rehabilitations. In addition, strains due to misfit of the one-piece titanium bridge were compared to those produced by one-piece cast gold bridges. Milled titanium bridges had a better fit than cast gold bridges. The stress distribution in mandibular bone rehabilitated with a one-piece bridge was more perturbed than that observed with a two-piece bridge. In particular the former induced a stress concentration and stress shielding in the molar and symphysis regions, while for the latter design these stresses were strongly reduced. In conclusion, prosthetic frameworks changed the biomechanics of the mandible as a result of both their design and manufacturing technology.

Repair of a root perforation by using MTA: a case report

Root perforations are accidental events that may occur during the treatment, causing tissue inflammation and alveolar bone loss of integrity of the periodontium. In such cases, the radiological evidence is fundamental in the formulation of the diagnosis, in the choice of therapy (surgical or non-surgical) and finally for the assessment of prognosis of the dental element. In non-surgical treatment of endodontic lesions, the material used for the repair of the defect root should have biocompatibility, antibacterial activity, ability to induce healing of periodontal tissues and radiopacity. The Mineral Trioxide Aggregate (MTA) is a silicate-based cement introduced in dental clinical practice with good radiopacity, biocompatibility and bone induction. This article describes the use of MTA in endodontic repair of a perforation of the middle third root and the success of non-surgical treatment was dimonstrated radiographicaly.

Fine tuning of metal-specific activity in the Mn-like group of cambialistic superoxide dismutases

Among Fe/Mn superoxide dismutases (SODs) a very peculiar sub-class is that of cambialistic SODs. These proteins are active with either Fe or Mn in the active site, in contrast with the other SODs that are strictly metal-specific. Here we report the metal-dependent regulation of the activity and the crystallographic structure of the cambialistic SODs from the dental pathogen Streptococcus mutans (SmSOD) and the food-industry bacterium Streptococcus thermophilus (StSOD). The two enzymes share a high sequence identity (86.2%) and present very similar three-dimensional structures. A detailed comparison with the other cambialistic SODs, found in the Protein Data Bank, allowed the identification of two sub-groups of cambialistic enzymes, the Fe-like and the Mn-like. In particular, SmSOD and StSOD were classified as belonging to the Mn-like sub-group; this assignment was in good agreement with the activity data, showing a significantly higher catalysis in Mn-bound forms of SmSOD and StSOD with respect to their Fe-forms. However, in spite of a very similar Mn-dependent activity, SmSOD and StSOD display a consistently different Fe-dependent activity, SmSOD being three-times less efficient than StSOD in the Fe-bound form. The analysis of the X-ray structures suggests that this difference could be related to the effect of a fraction of enzyme molecules possessing an atypical hexa-coordinated iron ion in the active site of SmSOD. These new structural data provide deeper insights into the family of cambialistic SODs.