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Luigi GENERALI
Professore Associato
Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa
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Pubblicazioni
2024
- Assessment of colour modifications in two different composite resins induced by the influence of chlorhexidine mouthwashes and gels, with and without anti-staining properties: An in vitro study
[Articolo su rivista]
Checchi, V.; Forabosco, E.; Dall'Olio, F.; Kaleci, S.; Giannetti, L.; Generali, L.
abstract
Objectives: Chlorhexidine (CHX)-based products are the most effective chemical agents used in plaque control and oral disinfection. One of their side effects is tooth and restoration staining. For this reason, CHX products with anti-discolouration systems (ADS) have been developed. The aim of this in vitro study was to compare different CHX-based products (gel and mouthwash) with or without ADS in composite colour modification.Methods: Two hundred specimens were created, 100 of which were made of packable composite and 100 of flowable composite. After 24 h, colour coordinates (L*, a*, b*, C*, h degrees) were recorded using a spectrophotometer (T0). Then, all samples were subjected to a CHX/tea staining model and immersed in human saliva for 2 min. Composite specimens were divided in 10 groups (N = 20). Control groups (PC, FC) were soaked in distilled water and test groups (PG, PGads, FG, FGads, PM, PMads, FM and FMads) were immersed in CHX-based solutions or brushed with CHX gel. Then the cycle was repeated 6 times, and colour differences (Delta E-ab and Delta E-00) were finally calculated.Results: Through flowable composites, FC and FG showed the highest colour differences, respectively Delta E-ab = 3.48 +/- 1.0, Delta E-00 = 2.24 +/- 0.6 and Delta E-ab = 2.95 +/- 1.3, Delta E-00 = 1.53 +/- 0.6. In the composite groups instead, PM and PMads showed the highest colour differences, respectively Delta Eab = 2.78 +/- 1.3,Delta E00 = 1.94 +/- 0.8 and Delta E-ab = 2.71 +/- 1.4, Delta E-00 = 1.84 +/- 0.9.Conclusions: CHX-containing products are able to cause stains on restorative composite materials. Discolouration is more likely to occur in flowable composites than packable composites, and ADS-containing products cause fewer pigmentations than CHX products without ADS. Packable composites showed more staining after mouthwash treatment, whereas flowable composites underwent higher discolouration after treatment with gels.
2024
- Changes in Oral Health and Dental Esthetic in Smokers Switching to Combustion-Free Nicotine Alternatives: Protocol for a Multicenter and Prospective Randomized Controlled Trial
[Articolo su rivista]
Conte, Gianluca; Pacino, Sebastiano Antonio; Urso, Salvatore; Greiling, Doris; Caponnetto, Pasquale; Pedullà, Eugenio; Generali, Luigi; Consolo, Ugo; Checchi, Vittorio; Gospodaru, Stefan; Bordeniuc, Gheorghe; Fala, Valeriu; Kowalski, Jan; Nowak, Maciej; Górska, Renata; Amaliya, Amaliya; Chapple, Iain; Milward, Michael; Maclure, Robert; Nardi, Gianna Maria; Polosa, Riccardo
abstract
Background: Although the detrimental effects of conventional combustible cigarettes on oral health and dental esthetics are well known, there is limited information about the long-term impact of combustion-free nicotine alternatives (C-F NA) such as e-cigarettes or heated tobacco products. Objective: This multicenter, prospective, 3-parallel-arm randomized controlled trial will investigate whether switching from combustible cigarettes to C-F NA will lead to measurable improvements in oral health parameters and dental esthetics over 18 months in adult smokers with limited gum disease. Methods: Regular smokers not intending to quit and without clinical signs of periodontitis will be randomly assigned (1:4 ratio) to either standard of care with brief cessation advice (control group; arm A) or C-F NA use (intervention group; arm B). The study will also include a reference group of never smokers (reference group; arm C). The primary end point is the change in the Modified Gingival Index (MGI) score from baseline between the control arm (arm A) and the intervention arm (arm B) at the 18-month follow-up. In addition, the study will analyze the within- and between-group (arms A, B, and C) changes in MGI assessment, plaque imaging, dental shade quantitation, tooth stain scores, and oral health-related quality of life questionnaires measured at each study time point. All participants will attend a total of 7 clinic visits: screening, enrollment, and randomization (visit 0); baseline visit-day 14 (visit 1); day 90 (visit 2); day 180 (visit 3); day 360 (visit 4); and day 540 (visit 5). This multicenter study will be conducted in 4 dental clinics in 4 countries. The statistical analysis will involve descriptive statistics for continuous and categorical data. Primary end points will undergo tests for normality and, based on distribution, either a 2-sided t test or Mann-Whitney U test. Linear mixed model with random factors center and study arms by center will also be applied. Secondary end points, including MGI assessment and quality of life, will be subjected to similar tests and comparisons. Only if one value of the parameter MGI is missing after day 1, the last available observation will be carried forward. The analysis will be performed on the substituted data. Secondary parameters will not have missing value replacement. Results: Participant recruitment began in October 2021, and enrollment was completed in June 2023. Results will be reported in 2025. Conclusions: This will be the first study to provide key insights into oral health benefits or risks associated with using C-F NA in smokers who are seeking alternatives to cigarette smoking. Trial registration: ClinicalTrials.gov NCT04649645; https://clinicaltrials.gov/ct2/show/NCT04649645. International registered report identifier (irrid): DERR1-10.2196/53222.
2024
- Color match of single-shade restorations after professional dental bleaching: An in vitro study
[Articolo su rivista]
Forabosco, Eleonora; Generali, Luigi; Mancuso, Edoardo; Kaleci, Shaniko; Consolo, Ugo; Checchi, Vittorio
abstract
Background: Restorative dentistry aims to reproduce natural tooth shades through resin composites that must be layered to obtain colors, opacities, and translucencies, and therefore, clinical success is operator skill dependent. Aims: The purpose of this study is to evaluate the color shift of single-shade composite restorations before and after dental bleaching. Materials and methods: Eighty human extracted posterior teeth were restored with four single-shade composites (Omnichroma OM; Clearfil Majesty ES-2 Universal CL; Essentia Universal ES; Venus Diamond One VE) (n = 20 each). Standardized V class cavities were prepared on buccal side. VITA Easyshade V spectrophotometer was used to register VITA color and color coordinates 24 h before (T0), 24 h after (T1), and 1 week after (T2) dental bleaching (Opalescence Boost PF 40%). Color differences (ΔEab) and (ΔWID) were calculated and subjected to statistical analysis. Statistical analysis: Categorical variables were analyzed using Pearson Chi-square, and data from color coordinates were analyzed using one-way analysis of variance and Tukey's multiple comparison test with Bonferroni correction. Paired t-tests were performed to compare continuous measures between groups and treatment time. Results: Instrumental evaluations revealed statistically significant differences between materials (P < 0.05) with lower values for ES and VE samples followed by CL and OM at T0 and T1. At T2, OM and CL ΔEab values decrease getting closer to ES and VE. Conclusion: Single-shade composites seem to match with the surrounding bleached tooth.
2024
- Comparisons of ammonia- and water-based silver-containing solutions on dentin bonding and enzymatic activity: 1-yr evaluation
[Articolo su rivista]
D' Alessandro, C.; Mancuso, E.; Mazzitelli, C.; Maravic, T.; Josic, U.; D' Urso, D.; Forte, A.; Florenzano, F.; Generali, L.; Checchi, V.; Mazzoni, A.; Breschi, L.
abstract
Objective: To evaluate the effects of an ammonia-based and a water-based silver-containing solutions on bonding performance and matrix-metalloproteinases (MMPs) activity of a universal adhesive to dentin after 1 year of artificial aging. Methods: Mid-coronal dentin surfaces of 60 sound human molars were exposed and the following groups were formed according to the surface pre-treatment and etching mode of the universal adhesive (Zipbond Universal, SDI) (n = 10): G1) Zipbond in the self-etch mode (ZSE); G2) Riva Star (SDI) applied before ZSE; G3) Riva Star Aqua (SDI) applied before ZSE; G4) Zipbond in the etch-and-rinse mode (ZER); G5) Riva Star applied before ZER; G6) Riva Star Aqua applied before ZER. The specimens were sectioned and subjected to microtensile bond strength (µTBS) test at baseline (T0) and after 12 months (T12) of artificial storage. Scanning electron microscope (SEM) and energy dispersive spectroscopy analysis (EDS) were also conducted. Three additional molars per group were processed for the in situ zymography analysis at T0 and T12. Data were statistically analyzed (p < 0.05). Results: Dentin pre-treatments and aging decreased bonding values, regardless of the etching mode (p < 0.05). No differences in µTBS were observed between the two silver-containing solutions, both at T0 and T12. Riva Star Aqua and etching significantly increased the MMPs activity, independent of the storage period (p < 0.05). Significance: Dentin surface pre-treatment with silver-containing solutions negatively affects the bonding performances of resin composite restorations placed with a universal adhesive. However, the ammonia-based product Riva Star might show better stability in the long term, due to lower activation of MMPs.
2024
- Early fluoride intake and Molar Incisor Hypomineralisation (MIH) defects: A systematic review and dose-response meta-analysis
[Articolo su rivista]
Veneri, F.; Filippini, T.; Cecchini, M.; Vinceti, M.; Consolo, U.; Generali, L.
abstract
Background: Excessive intake of fluoride has been implicated in the complex multifactorial etiology of hypomineralisation (MIH) defects. Objective: To study the possible effect of early exposure to fluoride on the risk of molar incisor hypomineralisation, also through a dose-response approach. Methods: Observational and clinical studies investigating the relation between fluoride exposure from any source or evaluating exposure biomarkers and MIH defects. PubMed MEDLINE, Embase and Web of Science databases were con-sulted up to December 1, 2023, using terms related to “fluoride”, “enamel defects” and “demarcated opacities”. We performed a meta-analysis comparing the highest versus lowest fluoride exposure using a random-effects model, and we quantitively assessed this relation using piece-wise linear meta-regression. Results: Thirteen studies were included in the meta-analysis, 12 of which were eligible for the dose-response analysis, all regarding exposure from fluoride in drinking water. Three of them specifically addressed MIH, while the remaining concerned “demarcated opacities”, yet with features attributable to MIH. Comparing the highest versus lowest water fluoride exposure categories, virtually no evidence of a fluoride effect was identified, with an overall odds ratio of 0.93 [95% confidence interval 0.60; 1.45]. The dose-response meta-regression showed a decreasing risk for MIH defects exposure up to 1 mg/L, whereas an increase in risk emerged at higher exposure levels. Conclusions: This meta-analysis suggests that early systemic exposure to fluoride may affect the occurrence of MIH defects differently depending on fluoride concentration. However, these results need to be evaluated with caution due to potential methodological limitations of the studies included. (www.actabiomedica.it).
2024
- Ozone Treatment for the Management of Caries in Primary Dentition: A Systematic Review of Clinical Studies
[Articolo su rivista]
Veneri, F.; Filippini, T.; Consolo, U.; Vinceti, M.; Generali, L.
abstract
Dental caries in children is a frequent and debilitating condition, whose management is often challenging. The aim of this systematic review was to investigate the effectiveness of ozone applications for the treatment of caries in primary dentition. According to PRISMA guidelines, a systematic literature search was performed up to 6 January 2024. Clinical studies using ozone to treat caries of deciduous teeth were considered for inclusion. Out of the 215 records retrieved, seven studies were eventually included in the review, all of which used gaseous ozone. Four studies were judged at high risk of bias, two at low risk, and one of some concerns. The great heterogeneity of designs, outcomes, and protocols made it impossible to conduct a meta-analysis. Despite some limitations, the evidence yielded by the included studies suggests that ozone application, regardless of the protocol applied, is comparable to other interventions in terms of clinical outcomes and anti-bacterial activity, with no reported adverse effects and good patient acceptance. Therefore, ozone application may be a non-invasive approach to treat caries in primary dentition, especially in very young and poorly cooperative patients. Further standardized and rigorous studies are, however, needed to identify the best clinical protocols for this specific field.
2024
- Physico-mechanical properties of two different heat treated Nickel-Titanium instruments: in-vitro study
[Articolo su rivista]
Schiavon, R.; Pelliccioni, G. A.; Zamparini, F.; Bolelli, G.; Spinelli, A.; Pirani, C.; Iacono, F.; Gandolfi, M. G.; Prati, C.; Generali, L.
abstract
Aim: This study aimed to define physico-mechanical properties of recently introduced thermally treated Edge Taper Platinum (ET Platinum) Nickel-Titanium (NiTi) instruments compared to conventional NiTi Edge Taper (ET) to disclose improvements obtained by heat-treatments. Methods: ET and ET Platinum instruments (n=30/each) were rotated until fracture in a stainless-steel canal with 90°curvature angle and 5mm curvature radius. Time to fracture (TtF) and number of cycles to fracture (NCF) were calculated and results were analyzed using Mann-Whitney test (p=0.05). Fractured instruments underwent fractographic analysis under Field-Emission-Gun Scanning Electron Microscope (FEG-SEM). Superficial features of additional new ET and ET Platinum instruments were analyzed under SEM at increasing magnification with standardized angulations and positions. After inspection, ET and ET Platinum instruments were used in extracted teeth to shape 4 straight canals each to simulate clinical conditions and re-evaluated under SEM at the same points to detect superficial wear features. ET and ET Platinum brand new instruments were examined by differential scanning calorimetry (DSC) to assess transformation temperatures. Results: Cyclic fatigue test showed a significant increase of fatigue resistance on ET Platinum compared to ET instruments (p=0.05). Fractographic analysis demonstrated a pattern of fatigue propagation on both instruments. SEM analysis on brand new instruments revealed a more regular surface of ET Platinum compared with ET and both instruments appeared with minimal alterations after the simulated clinical use. DSC analysis demonstrated higher amounts of martensite at 37°C in ET Platinum compared to ET instruments. Conclusions: ET Platinum instruments displayed an improved mechanical behavior, possibly related to modified phase transformation temperatures induced by thermal treatment of the alloy during manufacturing process. These results suggest a safe use in clinical conditions.
2024
- Push-out bond strength and SEM fractographical analysis of hollow fibre posts used with self-adhesive resin cement: a pilot study
[Articolo su rivista]
Generali, Luigi; Veneri, Federica; Forabosco, Eleonora; Cavani, Francesco; Piergianni, Veronica; Sassatelli, Paolo; Checchi, Vittorio; Pedullà, Eugenio
abstract
Detachment is the major cause of failure of endodontic fibre posts. Hollow posts have been recently introduced to overcome such issue. The primary aim of this pilot study was to compare the push-out bond strength of hollow posts and traditional solid posts. Eight round-shaped single-canal premolars extracted for periodontal reason were selected as sample and equally randomized into two groups: (i) traditional solid fibre posts-TECH21xop and ii) hollow fibre posts-TECHOLE. A dual-curing self-adhesive cement (new TECHCEM) was used for posts placement. Six horizontal sections-two from each portion of the root (coronal, middle and apical)-were obtained from each sample root, yielding a total of 24 sections for each group. Push-out test was performed on the sections and bond strength values were compared between groups and within each group. Scanning electron microscope (SEM) fractographical analysis was conducted on each section. Additional SEM and EDX analyses were performed on new samples of both posts, to assess fibres density and distribution, and the chemical composition of the fibres and the matrix. Hollow posts showed a significantly higher push-out bond strength (6.36 +/- 1.22 MPa) than solid posts (3.64 +/- 1.62 MPa). Among the three root portions of the same group, there was no significant difference in bond strength. In both groups, the most frequent type of fracture was a mixed adhesive failure with the cement covering 0 to 50% of the post perimeter. Hollow post fibres appear more similar in size and have a more homogeneous distribution, compared to solid posts. The two post types also have different chemical compositions.
2024
- Ulcerative oral lesions: an overview of non-pharmacologic treatment options
[Articolo su rivista]
Veneri, F.; Filippini, T.; Bellini, P.; Consolo, U.; Generali, L.
abstract
Background and Objective: Ulcerative diseases frequently affect the oral cavity and are disabling conditions. The management is challenging, and traditional treatments are associated with potential side effects. Alternative non-pharmacologic strategies have become available to effectively manage these conditions. This review aims at providing a synthesis of the most common erosive-ulcerative oral diseases and an updated overview of the main non-pharmacologic options for their management, such as laser therapy, ozone applications, and photodynamic therapy. Methods: A narrative review was conducted by searching PubMed/MEDLINE for the most recent relevant systematic reviews or, alternatively, clinical trials or case reports. Results: Laser photobiomodulation therapy (PBMT), ozone therapy and photodynamic therapy (PDT) generally resulted in rapid relief of painful symptoms, reduced healing time and improved oral functions and patients’ quality of life. No major side-effects were reported. Regardless of the primary etiology, photodynamic therapy proved particularly effective in case of infections. Ozone was used in gaseous, ozonized water and oil formulations. The most used light sources were Nd:YAG, He:Ne, Er,Cr:YSGG, red and infrared diode lasers and LED for PBMT, while red diode lasers prevailed for PDT. The most common photosensitizers were methylene blue and toluidine blue O. Conclusions: There is growing evidence for an efficacy of PBMT, ozone and PDT for the treatment of ulcerative oral lesions, and therefore these approaches should be considered as valid non-pharmacologic strategies. However, due to the great heterogeneity of protocols, additional well-designed research to identify the best therapeutic protocols is needed. (www.actabiomedica.it).
2023
- BONDING PERFORMANCE OF A HEMA-FREE UNIVERSAL
ADHESIVE TO DENTIN
[Abstract in Rivista]
Claretti, P; Maravic, T; Josic, U; D’Alessandro, C; D’Urso, D; Forte, A; Mazzitelli, C; Generali, L; Checchi, V; Del Bianco, F; Mancuso, E; Breschi, L; Mazzoni, A
abstract
2023
- Does fluoride exposure affect thyroid function? A systematic review and dose-response meta-analysis
[Articolo su rivista]
Iamandii, Inga; De Pasquale, Lisa; Giannone, Maria Edvige; Veneri, Federica; Generali, Luigi; Consolo, Ugo; Birnbaum, Linda S; Castenmiller, Jacqueline; Halldorsson, Thorhallur I; Filippini, Tommaso; Vinceti, Marco
abstract
Introduction: Fluoride exposure may have various adverse health effects, including affecting thyroid function and disease risk, but the pattern of such relation is still uncertain. Methods: We systematically searched human studies assessing the relation between fluoride exposure and thyroid function and disease. We compared the highest versus the lowest fluoride category across these studies, and we performed a one-stage dose-response meta-analysis for aggregated data to explore the shape of the association. Results: Most retrieved studies (27 of which with a cross-sectional design) were conducted in Asia and in children, assessing fluoride exposure through its concentrations in drinking water, urine, serum, or dietary intake. Twenty-four studies reported data on thyroid function by measuring thyroid-related hormones in blood (mainly thyroid-stimulating-hormone - TSH), 9 reported data on thyroid disease, and 4 on thyroid volume. By comparing the highest versus the lowest fluoride categories, overall mean TSH difference was 1.05 μIU/mL. Dose-response curve showed no change in TSH concentrations in the lowest water fluoride exposure range, while the hormone levels started to linearly increase around 2.5 mg/L, also dependending on the risk of bias of the included studies. The association between biomarkers of fluoride exposure and TSH was also positive, with little evidence of a threshold. Evidence for an association between fluoride exposure and blood concentrations of thyroid hormones was less evident, though there was an indication of inverse association with triiodothyronine. For thyroid disease, the few available studies suggested a positive association with goiter and with hypothyroidism in both children and adults. Conclusions: Overall, exposure to high-fluoride drinking water appears to non-linearly affect thyroid function and increase TSH release in children, starting above a threshold of exposure, and to increase the risk of some thyroid diseases.
2023
- EFFECTS OF CYCLING LOADING ON SURFACE ROUGHNESS
OF HIGHLY-FILLED FLOWABLE COMPOSITE
[Abstract in Rivista]
Checchi, V; Corciolani, L; Maravic, T; Generali, L; Breschi, L; Mazzitelli, C
abstract
2023
- Effect of adhesive strategy on resin cement bonding to dentin
[Articolo su rivista]
Mazzitelli, C; Maravic, T; Josic, U; Mancuso, E; Generali, L; Checchi, V; Breschi, L; Mazzoni, A
abstract
Objective: The cement bonding strategy and the polymerization mode can influence the prognosis of indirect restorations. The microtensile bond strength (μTBS) and dentin endogenous enzymatic activity of a dual-cure resin cement (PV5) used in com- bination with two dentin surface conditioners (accelerator-enhancer primer, TP or universal adhesive, UA) were evaluated.
Materials and Methods: PV5 was used to lute composite overlays after dentin treat- ment with TP or UA. The resin cement was self-cured, SC (1h at 37 C) or dual-cured, DC (20 s light-cure followed by 15 min self-cure at 37 C). The μTBS test, fractographic analysis, and the in situ zymography evaluations were performed after 24 h (T0) or 1 yr (T12) of artificial storage. Data were statistically analyzed (α = 0.05). Results: TP/DC obtained the highest adhesive strengths (45 ± 9 and 36.6 ± 8), while UA/SC (17 ± 8 and 11 ± 4) the lowest, both at T0 and T12, respectively. DC resulted in superior bonding values than the SC, independent of the dentin surface treatment (p < 0.05). The type of adhesive, curing mode and aging influenced the gelatinolytic activity (p < 0.05).
Conclusions: The dual-cure resin cement used in combination with its accelerator- enhancer primer showed superior bonding performances with respect to universal adhesive. Dual-curing the resin cement was determinant to enhance bonding capabil- ity over time, independent of the adhesive strategy.
Clinical Relevance: Clinicians must be aware to faithfully follow manufacturer's rec- ommendation regarding the adhesive strategy suggested with the resin cement used.
2023
- Effect of bleaching on the color match of single-shade resin composites
[Articolo su rivista]
Forabosco, E.; Consolo, U.; Mazzitelli, C.; Kaleci, S.; Generali, L.; Checchi, V.
abstract
2023
- Fluoride Exposure and ADHD: A Systematic Review of Epidemiological Studies
[Articolo su rivista]
Fiore, Gianluca; Veneri, Federica; Di Lorenzo, Rosaria; Generali, Luigi; Vinceti, Marco; Filippini, Tommaso
abstract
Background and objectives: Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental disorder characterized by two dimensions: inattentiveness and hyperactivity/impulsivity. ADHD may be the result of complex interactions between genetic, biological and environmental factors possibly including fluoride exposure. Materials and methods: A literature search was performed on 31 March 2023 in the following databases: PubMed, Embase and Web of Science. We defined the following inclusion criteria according to the PECOS statement: a healthy child and adolescent population (P), fluoride exposure of any type (E), comparison with low or null exposure (C), ADHD spectrum disorder (O), and ecological, cross-sectional, case-control and cohort studies (S). Results: We found eight eligible records corresponding to seven different studies investigating the effect of fluoride exposure on children and adolescents. One study had a cohort design and one a case-control one, while five were cross-sectional. Only three studies applied validated questionnaires for the purpose of ADHD diagnosis. As regards exposure assessment, levels of fluoride in urine and tap water were, respectively used in three and two studies, while two used both. Three studies reported a positive association with ADHD risk, all assessing exposure through fluoride levels. By using urinary fluoride, conversely, a positive correlation with inattention, internalizing symptoms, cognitive and psychosomatic problems was found in three studies, but no relation was found in the other one. Conclusions: The present review suggests that early exposure to fluoride may have neurotoxic effects on neurodevelopment affecting behavioral, cognitive and psychosomatic symptoms related to ADHD diagnosis. However, due to the heterogeneity of the studies included, current evidence does not allow to conclusively confirm that fluoride exposure is specifically linked to ADHD development.
2023
- Fluoride Exposure and Skeletal Fluorosis: a Systematic Review and Dose-response Meta-analysis
[Articolo su rivista]
Veneri, F.; Iamandii, I.; Vinceti, M.; Birnbaum, L. S.; Generali, L.; Consolo, U.; Filippini, T.
abstract
Purpose of Review: We performed a systematic review and meta-analysis on the relation between fluoride exposure and skeletal fluorosis (SF) using a novel statistical methodology for dose-response modeling. Recent Findings: Skeletal fluorosis, a major health issue that is endemic in some regions, affects millions of people worldwide. However, data regarding the dose-response relation between fluoride exposure and SF are limited and outdated. Summary: We included twenty-three studies in the meta-analysis. When comparing the highest versus the lowest fluoride category, the summary risk ratio (RR) for SF prevalence was 2.05 (95% CI 1.60; 2.64), with a value of 2.73 (95% CI 1.92; 3.90) for drinking water and 1.40 (95% CI 0.90; 2.17) for urinary fluoride. The RR by the risk of bias (RoB) was 2.37 (95% CI 1.56; 3.58) and 1.78 (95% CI 1.34; 2.36) for moderate and high RoB studies, respectively. The dose-response curve based on a one-stage cubic spline regression model showed an almost linear positive relation between exposure and SF occurrence starting from relatively low concentrations up to 5 mg/L and 2.5 mg/L, respectively, for water and urinary fluoride, with no substantial increase above this threshold. The RR for developing moderate-severe forms increases at 5.00 mg/L and 2.5 mg/L of water and urinary fluoride, respectively. Better-quality studies are needed to confirm these results, but greater attention should be given to water fluoride levels to prevent SF, in addition to the other potential adverse effects of fluoride exposure.
2023
- Fluoride exposure and cognitive neurodevelopment: Systematic review and dose-response meta-analysis
[Articolo su rivista]
Veneri, Federica; Vinceti, Marco; Generali, Luigi; Giannone, Maria Edvige; Mazzoleni, Elena; Birnbaum, Linda S; Consolo, Ugo; Filippini, Tommaso
abstract
: Many uncertainties still surround the possible harmful effect of fluoride exposure on cognitive neurodevelopment in children. The aim of this systematic review and meta-analysis was to characterize this relation through a dose-response approach, by comparing the intelligence quotient (IQ) scores in the highest versus the lowest fluoride exposure category with a random-effects model, within a one-stage dose-response meta-analysis based on a cubic spline random-effects model. Out of 1996 potentially relevant literature records, 33 studies were eligible for this review, 30 of which were also suitable for meta-analysis. The summary mean difference of IQ score, comparing highest versus lowest fluoride categories and considering all types of exposure, was -4.68 (95% confidence interval-CI -6.45; -2.92), with a value of -5.60 (95% CI -7.76; -3.44) for drinking water fluoride and -3.84 (95% CI -7.93; 0.24) for urinary fluoride. Dose-response analysis showed a substantially linear IQ decrease for increasing water fluoride above 1 mg/L, with -3.05 (95% CI -4.06; -2.04) IQ points per 1 mg/L up to 2 mg/L, becoming steeper above such level. A weaker and substantially linear decrease of -2.15 (95% CI -4.48; 0.18) IQ points with increasing urinary fluoride emerged above 0.28 mg/L (approximately reflecting a water fluoride content of 0.7 mg/L). The inverse association between fluoride exposure and IQ was particularly strong in the studies at high risk of bias, while no adverse effect emerged in the only study judged at low risk of bias. Overall, most studies suggested an adverse effect of fluoride exposure on children's IQ, starting at low levels of exposure. However, a major role of residual confounding could not be ruled out, thus indicating the need of additional prospective studies at low risk of bias to conclusively assess the relation between fluoride exposure and cognitive neurodevelopment.
2023
- Glutaraldehyde-based desensitizers’ influence on bonding performances and dentin enzymatic activity of universal adhesives
[Articolo su rivista]
Mancuso, E.; Durso, D.; Mazzitelli, C.; Maravic, T.; Josic, U.; D'Alessandro, C.; Generali, L.; Checchi, V.; Breschi, L.; Mazzoni, A.
abstract
Objectives: To evaluate the influence of two glutaraldehyde-based desensitizers (L: GLUMA Desensitizer, Heraeus Kulzer and G: GLUMA Desensitizer PowerGel) prior to the adhesive procedures on microtensile bond strength (µTBS) to dentin and endogenous enzymatic activity. Methods: Noncarious human third molars (N = 48) were cut to expose middle coronal dentin. Six experimental groups were formed according to the dentin pre-treatment (L or G) and the universal adhesives (IBU - iBond universal, Kulzer or AU - Adhese Universal, Ivoclar Vivadent) used in the self-etch mode (n = 8): 1) L/IBU; 2) G/IBU; 3) IBU; 4) L/AU; 5) G/AU; 6) AU. Specimens were cut into sticks and stressed until failure after 24 h (T0) or 1 yr of aging (T12). Additional 4 teeth were used for in situ zymography evaluation and data were statistically analyzed (α = 0.05). Results: Dentin pre-treatment, adhesive and aging statistically influenced bond strength and enzymatic activity (P<0.001). AU demonstrated higher bond strength values than IBU (P<0.001). The L resulted in higher bond strength compared to the G and control groups (P<0.001). aging statistically influenced bonding performance, especially when no dentin pre-treatment was performed (P<0.001). In situ zymography revealed that at baseline the control groups exhibited lower interfacial fluorescence compared to the experimental groups, irrespective of the adhesive used (P<0,001). However, after 1 yr of artificial storage, no differences were found among the groups (P>0.05). Conclusions: : Glutharldeadeyde-based products increased bond strength and determined a stabilization of the adhesive interface over time apparently not related to the MMPs inhibition. Clinical Significance: The results of this in vitro study suggest that the application of glutaraldehyde-based desensitizers prior to the adhesive procedures when associated with universal adhesives could result in increased bond strength and stabilization of the adhesive interface over time.
2023
- INFLUENCE OF A CHLORHEXIDINE-BASED GEL ON CHROMATIC
VARIATIONS OF TWO COMPOSITE RESINS
[Abstract in Rivista]
Checchi, V; Forabosco, E; Dall’Olio, F; Veneri, F; Generali, L
abstract
2023
- Influence of heat treatment on fatigue resistance of two NiTi endodontic files
[Articolo su rivista]
Generali, Luigi; Veneri, Federica; Barbieri, Marco; Bolelli, Giovanni; Lusvraghi, Luca; Cavani, Francesco; Matteucci, Tommaso; Pedullà, Eugenio
abstract
OBJECTIVES To evaluate the cyclic, torsional fatigue resistance and phase transformation of two heat-treated and non-heat-treated nickel-titanium reciprocating instruments. MATERIALS AND METHODS Twenty non-heat-treated (Procodile, Komet, Brasseler GmbH & Co., Lemgo, Germany) and 20 heat-treated (Procodile Q, Komet, Brasseler GmbH & Co., Lemgo, Germany) files (25 mm length, #25 apical diameter and 0.6 taper) were subjected to fatigue resistance tests. The dynamic cyclic fatigue was tested at 35 & PLUSMN;1 & DEG;C, using a dedicated patented device, in an artificial stainless-steel canal with a 60 & DEG; angle of curvature, the plate containing the artificial canal performing a controlled axial upand-down movement at 8 mm/s speed. The instruments were operated with a specific reciprocating motion (Reflex Dynamic & REG;, Komet, Breasseler GmbH & Co., Lemgo, Germany). Time to fracture (TtF) was recorded and the length of the fractured tips was measured. The torsional fatigue resistance was tested at room temperature (21 & PLUSMN;1 & DEG;C) using a custom-made device manufactured according to ISO 3630-1. The instruments were fixed 3 mm from the tip and their shafts were rotated counterclockwise at a speed of 2 rpm until fracture. The maximum torque load (Ncm) and corresponding rotation angle at fracture were recorded. All the results were statistically analysed (p <0.05). Fractographic analysis was performed using a field emission gun scanning electron microscope (FEG-SEM) to disclose the fractured surface characteristics. To assess the temperature range for phase transformations, differential scanning calorimetry (DSC) was performed on small segments of & AP;20 mg mass subjected to 2 heating and 2 cooling thermal cycles at rates of 5 & DEG;C min-1 in flowing N2 atmosphere over a temperature range of-40 & DEG;C to +110 & DEG;C. RESULTS The heat-treated instruments showed a greater resistance to dynamic cyclic fatigue as compared to the non-heat-treated sample (TtF 303 & PLUSMN;18.5 s vs 220 & PLUSMN;18.4 s; p <0.05) and a higher resistance to torsional fracture, bearing a greater maximum torque load (1.67 & PLUSMN;0.16 vs 0.82 & PLUSMN;0.07 Ncm; p <0.05). No significant differences were detected between heat-treated and non-heat-treated samples in mean angular rotation to fracture (298 & PLUSMN;25 & DEG; i,�312 & PLUSMN;32 & DEG;; p >0.05) and in the mean length of the fractured fragments (p >0.05). All instruments showed both ductile and brittle fracture patterns. According to the DSC, the direct (cooling) and reverse (heating) transformations of the non-heat-treated files occurred at lower temperatures (<25 & DEG;C) than those of the heat-treated files (& AP;50 & DEG;C), the latter thus not being austenitic at room and body temperatures at which they are operated. Also, the different transformation enthalpies suggest a multi-step transformation, likely involving R-phase formation, for heat-treat-ed files, against a direct transition between austenitic and martensi-tic phase for non-heat-treated files. CONCLUSIONS According to these findings, heat treatment of the tested files pro-vides them with microstructural properties more suited to the clin-ical operating conditions and im-proved performances in terms of torsional and flexural strength. CLINICA L SIGNIFICANCE Heat-treated files might be the best choice, over the traditional non-heat-treated files, when fac-ing challenging clinical condi-tions, such as curved and con-stricted canals.
2023
- Metabolic Profile of Whole Unstimulated Saliva in Patients with Sjögren's Syndrome
[Articolo su rivista]
Setti, Giacomo; Righi, Valeria; Mucci, Adele; Panari, Lucia; Bernardelli, Giuditta; Tarentini, Elisabetta; Gambini, Anna; Consolo, Ugo; Generali, Luigi; Magnoni, Cristina; Meleti, Marco; Sandri, Gilda; Bellini, Pierantonio
abstract
: Primary Sjögren's Syndrome (pSS) is a multi-system autoimmune disease that involves the exocrine glands. Lymphocytes infiltrate the gland tissue, leading to anatomical modification and hypofunction. Even if the prognosis of pSS is favorable, quality of life is typically reduced due to the diverse manifestations of the disease. The aim of this study is to compare the salivary metabolomes of pSS with healthy controls (HCs). Seven cases were selected from a cohort of pSS patients, and six age- and sex-matched HCs were recruited from a cohort of volunteers. Whole unstimulated saliva was collected for NMR analysis. Our metabolomic analysis focused on 360 ms total echo 1D 1H NMR CPMG spectra. Metabolites detected with CPMG NMR spectra were assigned through 2D NMR spectra (COSY, TOCSY, and HSQC). About 50 metabolites were detected and assigned. Unsupervised exploratory PCA returned partial clustering, and PLS-DA improved the separation between pSS and HCs, highlighting a pool of metabolites distinctly describing each group. Despite the limited number of samples, the presented preliminary data are promising. PLS-DA indicated well-defined group separation, suggesting that the application of 1H-NMR metabolomics is suitable for the study of pSS.
2023
- Shaping ability of Procodile and R6 Reziflow nickel-titanium reciprocating instruments in curved mesial root canals of mandibular molars: A MicroCT study
[Articolo su rivista]
Generali, Luigi; Checchi, Vittorio; Borghi, Alessia; La Rosa, Giusy Rita Maria; Conte, Gianluca; Zavattini, Angelo; Mannocci, Francesco; Angerame, Daniele; Consolo, Ugo; Pedullà, Eugenio
abstract
To compare the shaping ability of Procodileand R6 Reziflow instruments used in reciprocating motion in severely curved root canals, assessed with micro-computed tomography (mu CT). Fourteen extracted human mandibular first molars were randomly assigned to two instrumentation techniques (n = 14 mesial root canals): Procodile or R6 Reziflow. For both groups, root canals were prepared to the working length up to a size 25,.06 taper. Molars were virtually divided into apical, middle and coronal thirds and mu CT was used to scan all samples pre- and post-root canal. Canal transportation, centring ability, volume, surface area and unprepared area were evaluated. Geometrical parameter changes were compared with preoperative values (one-way analyses of variance and Tukey multiple comparison post-hoc test) between groups and Student t-test within groups (alpha = 0.05) Significantly less transportation was observed associated with the Procodile technique in the molar's coronal third compared to the R6 Reziflow technique (p <.05). No significant differences in root canal centring ability, volume, surface area and unprepared area were observed. Procodile showed a lower percentage increase of surface area compared to R6 Reziflow (p <.05). The Procodile and R6 Reziflow techniques applied to first molar root canal performed similarly except for the less transportation observed in the coronal third using Procodile.Research Highlights MicroCT analysis of canal geometry before and after instrumentation revealed that Procodile and R6 Reziflow showed a similar shaping ability to shape curved root canals without substantially modifications of the original tooth anatomy.
2022
- A Systematic Review and Dose-response Meta-analysis on Fluoride Exposure and Neurodevelopmental Toxicity in Children
[Abstract in Atti di Convegno]
Veneri, Federica; Giannone, Maria Edvige; Mazzoleni, Elena; Filippini, Tommaso; Consolo, Ugo; Generali, Luigi; Vinceti, Marco
abstract
Background
The possible harmful effect of fluoride exposure on neurodevelopment in children is widely discussed, however, the magnitude of this relation is still controversial. The aim of this systematic review and meta-analysis was to characterize this relation through a dose-response approach.
Methods/Approach
We performed an online literature search in PubMed, Web of Science and Embase up to September 10, 2022. From each eligible study we extracted the effect size as a mean difference (MD) of intelligence quotient (IQ) scores and its 95% confidence intervals (CI). We performed a meta-analysis comparing the highest versus lowest fluoride exposure using a random-effects model, stratifying for type of exposure (fluoride in drinking water or urinary fluoride). Finally, we quantitively assessed such relation by performing a one-stage dose-response meta-analysis based on a cubic spline random-effects model.
Results
Out of 1955 potentially relevant records retrieved through a systematic literature search, we identified 34 eligible studies for review; 32 were also included for meta-analysis. The analysis comparing the highest-versus-lowest exposure showed decreased IQ scores for both water and urinary fluoride with MD of -6.62 (95% CI -8.61, -4.63) and -3.58 (95% CI -7.28, 0.12), respectively. The dose-response analysis showed a decrease in IQ score from 1 mg/L, considerably steeper above 2.5 mg/L for water fluoride. The dose-response curve for urinary fluoride showed a weaker but constant decrease in IQ scores with increasing fluoride levels.
Conclusions
Overall, a substantial consistency in the effect direction emerged, with adverse effects of different magnitude on children’s intelligence, arising from rather low fluoride exposure previously considered safe from a public health perspective. However, potential methodological limitations, such as heterogeneity in outcome measures and lack of consideration of possible confounders in some of the studies, may have affected these findings.
2022
- A micro-computed tomographic analysis of obturation quality and retreatability of an epoxy resin-based sealer
[Articolo su rivista]
Abiad, Rs; Neelakantan, P; Buscema, I; Ali, Ia; Conte, G; La Rosa, Grm; Generali, L; Cicciù, M; Pedullà, E
abstract
BacKGrOUND: to evaluate the voids percentage and the retreatability by different supplementary irrigation tech- niques of a matched-taper single cone and epoxy resin-based sealer.
METHODS: A total of 72 single-rooted premolars were prepared and filled with gutta-percha and MM-Seal. The per- centage of voids in the whole root canal and each anatomical part were evaluated by Micro-CT scans. After root filling removal, the teeth were randomly allocated (N.=24) to group a, syringe irrigation; group B, tornado Brush, and group C, ultrasonically activated irrigation and re-scanned to establish the volume of remnant root filling material. The data relative to voids and retreatment techniques were established by the Kruskal-Wallis test. Differences in retreatment time were examined using one-way aNOVa and tukey’s test (P<0.05).
RESULTS: No significant difference was found in the voids percentage between the different root-thirds and between the supplementary irrigation groups in the MM-Seal remnants for the whole root canal and each section. in all groups, the coronal region exhibited more remaining material than other sections.
CONCLUSIONS: MM-Seal showed low voids percentage and its removal was not significantly improved by supplemen- tary irrigation techniques.
2022
- Analisi morfologica e ultrastrutturale dei file Procodile Q 25.06
[Capitolo/Saggio]
Generali, L; Bolelli, G; Lusvarghi, L; Pedullà, E
abstract
2022
- Application of Tribology Concept in Dental Composites Field: A Scoping Review
[Articolo su rivista]
La Rosa, Grm; Generali, L; Bugea, C; Ounsi, Hf; Benyocs, G; Neelakantan, P; Pedullà, E
abstract
Tribology is the discipline concerning the application of friction, lubrication, and wear concepts of interacting surfaces in relative motion. A growing interest has developed in tribology application in medical biomaterials, such as resin composites used in restorative dentistry. Yet, the keywords “tribology” and “biotribology” are little applied in the pertinent publications. The aim of this scoping review was to offer an overview of tribology application in dental composites research and to identify knowledge gaps and address future research. A literature search was conducted on Pubmed and Scopus databases and the studies investigating the tribological behavior of resin composites were included for qualitative synthesis. The majority of studies on dental tribology were published in the research areas of mechanical engineering/nanotechnology and differed in several methodological aspects. The preponderant engineering approach and the lack of standardized testing make the laboratory findings poorly informative for clinicians. Future research should focus on the tribological behavior of dental materials composites by means of an integrated approach, i.e., engineering and clinical, for improving development and advancement in this field of research.
2022
- COLOR MATCH EVALUATION OF TWO SINGLE SHADE COMPOSITES BEFORE AND AFTER BLEACHING PROCEDURE
[Abstract in Rivista]
Forabosco, E.; Generali, L.; Consolo, U.; Checchi, V.
abstract
Aim: the aim of this case report was to evaluate instrumental and visual color match of two single shade resin-based com- posites in human extracted teeth before and after bleaching treatments.
Methods: two extracted human posterior sound teeth were used. Round shaped V class cavities (2x2x4mm) were prepa- red buccally 2mm away from the CEJ. Two single shade resin composites (ES-Essentia Universal, GC and CL-Clearfill Maje- sty ES2 Universal, Kuraray) were used for the restorations. To- oth color was measured 1mm beside the cavity and in the cen- ter of the restoration using a spectrophotometer (VITA Easysha- de V, VITA Zahnfabrik). Visual analysis were carried out by 16 calibrated observers and differences were graded as 0:excel- lent match; 1:very good match; 2:not so good match; 3:obvious
mismatch; 4:huge mismatch. Teeth were then bleached using 40% H2O2 (Opalescence Boost PF, Ultradent) and instrumental and visual evaluations were replied after 24 hours.
Results: at baseline, both ES restoration and tooth showed an A3 VITA scale grade, and respectively A2 and C2 after blea- ching. Color match visual analysis showed a mean value of 0.25 both prior and after bleaching. At baseline, both CL resto- ration and tooth showed an A4VITA scale grade, and respecti- vely A3 and C3 after bleaching. Color match visual analysis showed a mean value of 0.87 before and 0.31 after bleaching. Conclusions: within the limits of a single case report, both composites seem to have excellent color match properties with the surrounding tooth structure, from both instrumental and visual points of view.
2022
- Calcium hydroxide removal using four different irrigation systems: A quantitative evaluation by scanning electron microscopy
[Articolo su rivista]
Generali, L.; Cavani, F.; Franceschetti, F.; Sassatelli, P.; Giardino, L.; Pirani, C.; Iacono, F.; Bertoldi, C.; Angerame, D.; Checchi, V.; Pedulla, E.
abstract
This study compares conventional endodontic needle irrigation, passive ultrasonic irriga-tion, apical negative pressure irrigation, and mechanical activation to remove calcium hydroxide from single straight root canals. Eighty-four mandibular premolars were prepared in a crown-down manner up to size #40. Two teeth represented a negative control, and another two served as a positive control. Calcium hydroxide paste was placed inside root canals. The remaining eighty samples were analyzed based on the activation techniques, and the cleanliness of the canals was quantified using Fiji’s software on 500× magnified SEM backscattered electron micrographs. Considering the whole canal, all instruments showed better performance than conventional endodontic needle irrigation in removing calcium hydroxide (p < 0.05). Irrisafe and XP-endo Finisher could remove a significantly higher amount of calcium hydroxide than Endovac (p < 0.05). Irrisafe and XP-endo Finisher have been able to remove more calcium hydroxide than EndoVac.
2022
- Can the concentration of citric acid affects its cytotoxicity and antimicrobial activity?
[Articolo su rivista]
Giardino, L; Generali, L; Savadori, P; Barros, Mc; de Melo Simas, Ll; Pytko-Polonczyk, J; Wilkonski, W; Ballal, V; Andrade, Fb
abstract
Background: There has been no unanimity concerning the ideal concentration of citric acid for safe use in clinical practice. This study evaluated the cytotoxicity and the antibacterial activity in infected dentinal tubules of 10% and 1% citric acid (CA) solutions. Methods: The cytotoxicity of CA solutions in DMEM (diluted 1/10, 1/100) was assessed in L-929 fibroblasts. A broth macrodilution method (MIC and MBC) was used to assess CA antibacterial concentration. The antimicrobial activity of CA solutions was also evaluated after their final rinse inside root canals in previously Enterococcus faecalis-contaminated dentinal tubules. Ten infected dentine samples were rinsed for 5 min with 5% NaOCl and subsequently with 1% citric acid for 3 min. Another 10 were rinsed with 5% NaOCl and 10% citric acid for 3 min; the remaining four specimens were utilized as positive controls. Two uncontaminated specimens were used as negative controls. After LIVE/DEAD BacLight staining, the samples were assessed using CLSM to analyze the percentage of residual live and dead cells. Results: Both undiluted and diluted CA solutions showed severe toxicity; no changes from normal morphology were displayed when diluted 1/100. The MIC and MBC of CA were 6.25 mg/mL and 12.50 mg/mL, respectively. CA solutions demonstrated significantly low levels of bacterial counts than the positive control group, reporting a value of 9.3% for the 10% solution versus the 1% solution (35.2%). Conclusions: Despite its valuable antimicrobial properties, the cytotoxic effects of citric acid should be considered during endodontic treatment.
2022
- Evaluation of the root filling quality with experimental carrier-based obturators: a CLSM and FEG-SEM analysis
[Articolo su rivista]
Pirani, C.; Generali, L.; Iacono, F.; Cavani, F.; Prati, C.
abstract
This study evaluated tubule penetration of GuttaFlow Bioseal with cold single cone or carrier-based technique, under confocal laser scanning microscopy (CLSM). Twenty straight single-rooted teeth were instrumented with Hyflex CM and divided in two groups (n = 10) according to the obturation method: single cold gutta-percha cones; experimental carrier-based obturators. GuttaFlow Bioseal, labelled with Rhodamine B dye, was used as sealer in both groups. Teeth transversally sectioned were observed under CLSM. Percentage of sealer penetration and integrity of sealer layer perimeter were measured. Surface and microstructural characteristics of obturators and gutta-percha cones were compared by FEG-SEM and EDX analysis. No significant differences were found between groups for each examined parameter. Significant differences (P < 0.05) were reported mainly within groups. Integrity was similar among and within groups. FEG-SEM/EDX analysis of obturators revealed the presence of Ba and Zn. Carrier-based obturation technique associated with GuttaFlow Bioseal does not seem to affect sealer penetration into dentinal tubules.
2022
- Finite element and in vitro study on biomechanics behavior of endodontically treated premolars restored with direct or indirect composite restorations
[Articolo su rivista]
Maravic, T; Comba, A; Mazzitelli, C; Bartoletti, L; Balla, I; di Pietro, E; Josic, U; Generali, L; Vasiljevic, D; Blazic, L; Breschi, L; Mazzoni, A
abstract
Objectives of the study were to investigate biomechanical properties of severely compromised premolars restored with composite restorations using finite element analysis (FEA), and in vitro fracture resistance test. A 3-D model of an endodontically treated premolar was created in Solidworks. Different composite restorations were modelled (direct restoration-DR; endo-crown-EC; post, core, and crown-C) with two different supporting tissues: periodontal ligament/alveolar bone (B), and polymethyl methacrylate (PMMA). Models were two-point axially loaded occlusally (850 N). Von Mises stresses and strains were calculated. The same groups were further tested for static fracture resistance in vitro (n = 5, 6.0 mm-diameter ball indenter, vertical load). Fracture resistance data were statistically analyzed (p < 0.050). The highest stresses and strains in all FEA models were observed on occlusal and vestibular cervical surfaces, corresponding to fracture propagation demonstrated in vitro. C showed the lowest stress in dentin, while EC showed lower stresses and strains in crown cement. B models demonstrated larger high stress areas in the root than PMMA models. No significant differences
in fracture resistance (N) were observed between groups (DR: 747.7 ± 164.0, EC: 867.3 ± 108.1, C: 866.9 ± 126.3; p = 0.307). More conservative restorations seem a feasible alternative for endodontically treated premolars to conventional post-core-crown.
2022
- Influence of NiTi wire diameter on cyclic and torsional fatigue resistance of different heat-treated endodontic instruments
[Articolo su rivista]
Pedullà, E; Canova, Fs; La Rosa, Grm; Naaman, A; Diemer, F; Generali, L; Nehme, W
abstract
We compared the mechanical properties of 2Shape mini TS2 (Micro-Mega, Besançon, France) obtained from 1.0 diameter nickel-titanium (NiTi) wires and 2Shape TS2 from 1.2 diameter nickel-titanium (NiTi) wires differently thermally treated at room and body temperature. We used 120 NiTi TS2 1.0 and TS2 1.2 files made from controlled memory (CM) wire and T-wire (n = 10). Cyclic fatigue resistance was tested by recording the number of cycles to fracture (NCF) at room and body temperatures using a customized testing device. Maximum torque and angle of rotation at failure were recorded, according to ISO 3630-1. Data were analyzed by a two-way ANOVA (p < 0.05). The CM-wire files had significantly higher NCFs at both temperatures, independent of wire dimensions. Testing at body temperature negatively affected cyclic fatigue of all files. The 1.0-mm diameter T-wire instruments showed higher NCF than the 1.2-mm diameter, whereas no significant differences emerged between the two CM wires at either temperature. The maximum torque was not significantly different across files. The TS2 CM-wire files showed significantly higher angular rotation to fracture than T-wire files. The TS2 CM-wire prototypes showed higher cyclic fatigue resistance than T-wire prototypes, regardless of wire size, exhibiting suitable torsional properties. Torsional behavior appears to not be affected by NiTi wire size.
2022
- Influence of kinematics and incidence angles on the cutting efficiency of two single-file nickel-titanium rotary instruments
[Articolo su rivista]
Pedullà, E; La Rosa, Grm; Romano, G; Leanza, G; Rapisarda, S; Isola, G; Ferlito, S; Neelakantan, P; Generali, L
abstract
To compare the cutting efficiency of F6 Sky Taper (F6ST) and One Curve (OC) with different kinematics and cutting inclinations. Cutting efficiency of 80 new F6ST and OC was tested at 90° and 70° inclination in relation to the sample, in continuous rotation and reciprocation, against standardised gypsum samples for 120 seconds using a customised device. Data expressed as weight loss and length of the sample cut were analysed using two-way analysis of variance and Tukey t-test (P<.05). F6ST showed significantly higher cutting efficiency in reciprocation, while OC in continuous rotation. Regardless of inclination, F6ST showed statistically higher values than OC in reciprocation, while OC exhibited higher cutting ability in continuous rotation. The 70° inclination significantly improved the cutting efficiency of both files. Reciprocation improved the cutting efficiency of F6ST while continuous rotation enhanced cutting ability of OC. An inclined insertion improved the cutting ability, independently from the movement.
2022
- Influence of the activation mode on long-term bond strength and endogenous enzymatic activity of dual-cure resin cements
[Articolo su rivista]
Mazzitelli, C; Maravic, T; Mancuso, E; Josic, U; Generali, L; Allegra, C; Mazzoni, A; Breschi, L
abstract
Objective: To investigate the long-term microtensile bond strength (µTBS), interfacial nanoleakage expression (NL), and adhesive stability of dual-cure resin cements with/out light activation to dentin. Materials and methods: Composite overlays (N = 20) were luted to deep dentin surfaces with RelyX Ultimate (RXU, 3M) or Variolink EstheticDC (VAR, Ivoclar-Vivadent). A universal adhesive was used for bonding procedures (iBond universal, Heraeus Kulzer). The resin cements were either self-cured (SC; 1 h at 37 °C) or dual-cured (DC; 20s light-cure followed by 15 min self-cure at 37 °C). Specimens were submitted to µTBS immediately (T0) or after 1 year of laboratory storage (T12). The fracture pattern was evaluated using scanning electron microscopy (SEM). Data were statistically analyzed with two-way ANOVA/Tukey test. Further, the NL was quantified and analyzed (chi-square test) and in situ zymography was performed to evaluate the endogenous enzymatic activity within the hybrid layer (HL) at T0 and T12 (Mann–Whitney test). The significance level for all statistical tests was set at p = 0.05. Results: DC resulted in higher bond strength and decreased fluorescence at the adhesive interface, irrespective of the material and the storage period (p < 0.05). Significantly lower bonding performances (p < 0.05) and higher endogenous enzymatic activity (p < 0.05) were observed within the HL at T12 compared to T0 in all tested groups. Conclusions: Light-curing the dual-cure resin cements, more than the cement materials, accounted for good bonding performances and higher HL stability over time when used with a universal adhesive. Clinical significance The curing condition influences the bonding performances of dual-cure resin cements to dentin when used with a universal adhesive.
2022
- Lifestyle changes during the first and second waves of the
COVID-19 pandemic in medical college students: are there
gender-related differences?
[Articolo su rivista]
Coppi, Francesca; Nasi, Milena; Sabatini, Silvia; Bellini, Pierantonio; Generali, Luigi; Mecugni, Daniela; Farinetti, Alberto; Consolo, Ugo; Mattioli, Anna Vittoria
abstract
Background and aims: The COVID-19 pandemic has seriously affected young people. The present
study aims to explore the effects of COVID-19 on lifestyle in 500 undergraduate students both during the
acute phase of the pandemic (so-called “first wave”) and during the second spread of infections (so-called
“second wave”). Gender differences were also explored. Methods and results: During the first wave we found
weight gain in 48.6% of subjects, a switch to an unhealthy diet (43%), and an increase in the amount of food
introduced (35%). Interestingly, women showed higher intake of food in order to cope, while men privileged
higher wine consumption as a coping mechanism. We observed a sharp reduction in physical activity,
increased
sedentary behaviours and deterioration in sleep quality. Stress correlates with eating to cope (r=0.86;
p<0.001); drinking to cope (r=0.83; p<0.001). Contrary to expectations, the second wave led to a situation
similar to the first. We have detected a further deterioration in quality of sleep (67% vs 77%; p<0.01) and also
a reduction in sleeping time (68.6% vs 77.7; p<0.01). Conclusions: The long pandemic has led to unhealthy
lifestyle changes in the student population of our municipality in Northern Italy. There are gender differences
in lifestyle modifications developed during the pandemic that suggest a different response to stress. Moreover,
the persistence of pandemic-related stress due to the “second wave” has severely affected the lifestyle habits of
undergraduate student. (www.actabiomedica.it)
2022
- Oral health habits during COVID-19 pandemic in university medical students
[Articolo su rivista]
Bellini, Pierantonio; Sabatini, Silvia; Nasi, Milena; Dall’Olio, Lucia; Generali, Luigi; Mecugni, Daniela; Consolo, Ugo; Mattioli, Anna Vittoria
abstract
2022
- Root-end resection with or without retrograde obturation after orthograde filling with two techniques: A micro-CT study
[Articolo su rivista]
Angerame, D.; De Biasi, M.; Lenhardt, M.; Porrelli, D.; Bevilacqua, L.; Generali, L.; La Rosa, G. R. M.; Pedulla, E.
abstract
To evaluate the filling ability of two orthograde obturation techniques followed by the apical resection with or without retrograde obturation through micro-computed tomography (CT). Thirty-two single-rooted permanent teeth were prepared and randomised into four groups (n = 8) according to the orthograde obturation technique (single cone technique [SCT] and mineral trioxide aggregate placement) combined or not with retrograde obturation. The volume of voids (VoV) within the entire endodontic space, the apical 3 mm, and 1 mm after root resection was calculated by micro-CT. Statistical analysis showed no significant difference among the groups regarding the total VoV in all root canals, as well as within the apical 1 mm after root resection. The SCT and apical resection without retrograde filling showed significantly better results in terms of VoV at the apical 3 mm after root resection. Within the study limitations, SCT associated with apical resection without retrograde preparation exhibited a similar or less amount of voids than the other groups.
2021
- A Proteomic Analysis of Discolored Tooth Surfaces after the Use of 0.12% Chlorhexidine (CHX) Mouthwash and CHX Provided with an Anti-Discoloration System (ADS)
[Articolo su rivista]
Bergamini, Stefania; Bellei, Elisa; Generali, Luigi; Tomasi, Aldo; Bertoldi, Carlo
abstract
Chlorhexidine (CHX) is considered the gold standard for the chemical control of bacterial plaque and is often used after surgical treatment. However, CHX employment over an extended time is responsible for side effects such as the appearance of pigmentations on the teeth and tongue; the discoloration effects are less pronounced when using a CHX-based mouthwash with added an anti-discoloration system (ADS). The aim of this study was to evaluate, using one- and two-dimensional gel electrophoresis combined with mass spectrometry, the possible proteomic changes induced by CHX and CHX+ADS in the supragingival dental sites susceptible to a discoloration effect. The tooth surface collected material (TSCM) was obtained by curettage after resective bone surgery from three groups of patients following a supportive therapy protocol in which a mechanical control was combined with placebo rinses or CHX or a CHX+ADS mouthwash. The proteomic analysis was performed before surgery (basal conditions) and four weeks after surgery when CHX was used (or not) as chemical plaque control. Changes in the TSCM proteome were only revealed following CHX treatment: glycolytic enzymes, molecular chaperones and elongation factors were identified as more expressed. These changes were not detected after CHX+ADS treatment. An ADS could directly limit TSCM forming and also the CHX antiseptic effect reduces its ability to alter bacterial cell permeability. However, Maillard's reaction produces high molecular weight molecules that change the surface properties and could facilitate bacterial adhesion.
2021
- Comparative evaluation of the penetration depth into dentinal tubules of three endodontic irrigants
[Articolo su rivista]
Giardino, L.; Pedullà, E.; Cavani, F.; Bisciotti, F.; Giannetti, L.; Checchi, V.; Angerame, D.; Consolo, U.; Generali, L.
abstract
This study aimed to examine the penetration depth into dentinal tubules of some chelating agents. The 17% EDTA and two preparations containing surfactants (Smear Clear, Bioakt Endo) were tested. Surface tension and liquid viscosity were measured using a Dynamic Contact Angle Analyzer and a Haake rotational rheometer. To measure the penetration depth inside dentinal tubules, thirty maxillary central incisors were selected from a pool of extracted human permanent teeth and allocated to three experimental groups (10 samples each), as well as were mechanically shaped and cleansed with 5.25% NaOCl, followed by each of the chelators being labeled with 0.1 wt % Rhodamine B according to final irrigation protocol established. The samples were embedded in an epoxy resin, after which 200 μm thick transverse sections were obtained at 2, 5, and 8 mm from the apex with a saw microtome. The specimens were then observed using a confocal laser microscope (CLSM) and the penetration of the labeled solution was measured in every third of each sample. Statistical analysis was performed using ANOVA or Kruskal–Wallis tests according to the distribution of data, evaluated with the Shapiro–Wilk normality test. Viscosity and surface tension tests have shown that BioAKT Endo has the lowest values compared to EDTA and Smear Clear. The medium penetration depth did not significantly differ among the three irrigants, while it increased considerably from the apical to the coronal level in all groups. Additionally, the maximum penetration depth increased significantly from the apical to coronal level, while among groups, BioAKT Endo showed the highest values at the apical and middle level compared to the other irrigants. No significant differences were observed among the three groups in medium and maximum penetration depths when the entire root was considered. New irrigants containing surfactants show reduced surface tension and, in one case (BioAKT Endo), viscosity. The lowering of the surface tension allows for better penetration of liquids into dentinal tubules than EDTA alone, thus improving the cleaning of the root canal system.
2021
- Dentin Cross-linking Effect of Carbodiimide After 5 Years
[Articolo su rivista]
Maravic, T; Mancuso, E; Comba, A; Checchi, V; Generali, L; Mazzitelli, C; Josic, U; Hass, V; Reis, A; Loguercio, A D; Tay, F R; Breschi, L; Mazzoni, A
abstract
Carbodiimide (EDC)-based dentin primers preserve hybrid layer (HL) integrity. However, aging >1 y has not been investigated. The present study examined whether the cross-linking effect of EDC was reflected in dentin bond strength, endogenous enzymatic activity, and the chemical profile of the HL after 5-y aging in artificial saliva. Noncarious human third molars (N = 42) were cut to expose middle/deep coronal dentin and treated as follows: group 1, dentin etched with 35% H3PO4, pretreated with a 0.3M aqueous EDC primer for 1 min and restored with XP Bond (Dentsply Sirona); group 2, as in group 1 but without EDC pretreatment; group 3, Clearfil SE Bond (Kuraray-Noritake) primer applied to dentin surface, followed by EDC pretreatment as in group 1 and application of bond; group 4, as in group 3 without EDC pretreatment. After composite buildup, the specimens were cut into sticks or slabs, depending on the experiment. All tests were performed at baseline (T0) and after 5 y of aging (T5) in artificial saliva at 37 °C. Microtensile bond strength (µTBS) was tested at a crosshead speed of 1 mm/min until failure. Endogenous enzymatic activity was investigated with in situ zymography. The chemical profile of HL was determined via Raman spectroscopy. Three-way analysis of variance and post hoc Tukey test were used to analyze µTBS and in situ zymography data (α = 0.05). EDC pretreatment and aging significantly influenced µTBS and in situ zymography results (P < 0.05). Higher bond strength and lower gelatinolytic activity were identified in the EDC-treated groups at T5 (P < 0.05), especially in the etch-and-rinse groups. Raman spectra revealed less defined amide III peaks in control specimens at T5. The EDC cross-linking effect persisted in the HL for 5 y in terms of bond strength, collagen structure preservation, and dentinal enzyme silencing.
2021
- Endogenous Enzymatic Activity of Primary and Permanent Dentine
[Articolo su rivista]
Maravic, Tatjana; Breschi, Lorenzo; Paganelli, Federica; Bonetti, Giulio Alessandri; Martina, Stefano; Di Giorgio, Gianni; Bossù, Maurizio; Polimeni, Antonella; Checchi, Vittorio; Generali, Luigi; Tay, Franklin R; Cadenaro, Milena; Mazzoni, Annalisa
abstract
Matrix metalloproteinases (MMPs) play an important role in tooth development and influence caries development and hybrid layer degradation. Literature is scant on the differences in the activity of MMPs between primary and permanent dentine. Accordingly, the aim of the present study was to investigate endogenous gelatinolytic activity in primary and permanent dentine. Separate batches of dentine powder were obtained from intact human primary and permanent molars (n = 6). Each batch was divided in two subgroups: (1) mineralised; and (2) demineralised with 10% H3PO4. After protein extraction, gelatine zymography was performed. Furthermore, in situ zymography was performed on dentine sections of the same groups (n = 3). The slices were polished, covered with fluorescein-conjugated gelatine and evaluated using a confocal microscope. In situ zymography data were analysed using two-way analysis of variance and post hoc Holm-Šidák statistics (α = 0.05). Primary dentine showed poorly defined bands in the zymograms that vaguely corresponded to the pro-form and active form of MMP-2 and the pro-form of MMP-9. In permanent dentine, demineralised powder demonstrated stronger gelatinolytic activity than mineralised powder. In situ zymography identified stronger enzymatic activity in primary etched dentine (p < 0.05). Stronger enzymatic activity recorded in primary dentine may be related to the differences in morphology and composition between primary and permanent dentine.
2021
- Endogenous enzymatic activity in dentin treated with a chitosan primer
[Articolo su rivista]
Maravic, T.; Baena, E.; Mazzitelli, C.; Josic, U.; Mancuso, E.; Checchi, V.; Generali, L.; Ceballos, L.; Breschi, L.; Mazzoni, A.
abstract
The aim of this study was to evaluate the effect of different concentrations of chitosan polymer on dentinal enzymatic activity by means of gelatin and in situ zymography. Human dentin was frozen and ground in a miller. Dentin powder aliquots were demineralized with phosphoric acid and treated with three different concentrations of lyophilized chitosan polymer (1, 0.5 and 0.1 wt%) dissolved in distilled water. Dentin proteins were extracted from each experimental group and electrophoresed under non-reducing conditions in 10% SDS-PAGE containing fluoresceinlabeled gelatin. After 48 h in the incubation buffer at 37 °C, proteolytic activity was registered under long-wave UV light scanner and quantified by using Image J software. Furthermore, additional teeth (n = 4) were prepared for the in situ zymographic analysis in unrestored as well as restored dentin pretreated with the same chitosan primers. The registered enzymatic activity was directly proportional to the chitosan concentration and higher in the restored dentin groups (p < 0.05), except for the 0.1% chitosan primer. Chitosan 0.1% only showed faint expression of enzymatic activity compared to 1% and 0.5% concentrations. Chitosan 0.1% dissolved in water can produce significant reduction in MMPs activity and could possibly contribute to bond strength preservation over time.
2021
- In-depth metallurgical and microstructural analysis of oneshape and heat treated onecurve instruments
[Articolo su rivista]
Azizi, A.; Prati, C.; Schiavon, R.; Fitzgibbon, R.; Pirani, C.; Iacono, F.; Pelliccioni, G. A.; Spinelli, A.; Zamparini, F.; Puddu, P.; Bolelli, G.; Generali, L.
abstract
Objective: To define surface, mechanical, microstructural and metallurgical features of conventional OneShape (OShape) and heat-treated OneCurve (OCurve) nickel-titanium instruments. Methods: Instruments were analysed by scanning electron microscopy (SEM) on new instruments and after simulated clinical use (SCU). Cyclic fatigue testing was performed and the number of cycles to fracture (NCF) and the length of the fractured instruments were measured (Mann-Whitney test). Fractured instruments during cyclic fatigue testing were then inspected by SEM fractographic analysis. Field emission gun scanning scanning electron microscopy (FEG-SEM), energy-dispersive X-ray spectroscopy (EDX) and micro-Raman spectroscopy were used to assess alloy surface chemistry. Focused ion beam (FIB) was performed to analyse the oxide layer on the surface of OCurve before and after SCU. X-Ray diffraction (XRD), metallographic evaluation and differential scanning calorimetry (DSC) were used to determine martensitic/austenitic phase transformation temperatures. Results: SEM observations on new instruments revealed a smooth regular surface with flattened milling grooves. No wear features were detected after SCU. OCurve exhibited a higher cyclic fatigue resistance (P<0.05), slower crack propagation and a surface layer of TiO2. Metallographic analysis and XRD showed the prevalence of martensitic grains on OCurve instruments that were stable at body temperature as confirmed by DSC analysis. Furthermore, DSC demonstrated a shift in the temperature transformation ranges suggesting an increase of martensite phase in autoclaved OCurve instruments. Conclusion: Heat treatment processes were confirmed as a valid enhancement of the properties of the new generation NiTi instruments. OCurve presented a significant improvement over OShape regarding both mechanical and metallurgical characteristics.
2021
- Influence of thickness and shade on the color of layered novel nanohybrid composite systems
[Articolo su rivista]
Angerame, D.; Fanfoni, L.; de Biasi, M.; Bevilacqua, L.; Generali, L.
abstract
The influence of the layer thickness and composite shade on the final color of Ceram.X composites (Dentsply Sirona) was tested, selecting five intermediate-translucency Ceram.X Universal shades, three high-translucency Ceram.X Duo “enamel” shades, and four low-translucency Ceram.X Duo “dentin” shades. Using cylindrical molds, 850 specimens were obtained, representing the whole array of possible Universal single specimens (in seven thicknesses, ranging from 1.0 to 4.0 mm in 0.5-mm increments) and Duo combinations. The CIELAB coordinates of each specimen were determined with a spectrophotometer. Different thicknesses and composites were compared with Clark's ∆E. The difference in color among specimens of different thicknesses was material-dependent. The thickness and shade of the composite markedly affected the color yield of the Ceram.X system. For each shade of the Universal systems, only one Duo enamel-dentin combination corresponded.
2021
- Influence of tooth-brushing on early healing after access flap surgery: A randomized controlled preliminary study
[Articolo su rivista]
Bertoldi, C.; Generali, L.; Cortellini, P.; Lalla, M.; Luppi, S.; Tomasi, A.; Zaffe, D.; Salvatori, R.; Bergamini, S.
abstract
In the present study, the clinical outcomes obtained using three different protocols of post-operative plaque control for the 4 weeks after surgery were compared. Thirty healthy subjects, presenting at least one periodontal pocket requiring resective surgery, were selected and randomly distributed to three different groups corresponding to respective post-surgical protocols: (A) toothbrushes + chlorhexidine + anti-discoloration system (ADS + CHX); (B) toothbrushes + chlorhexidine (CHX); (C) only toothbrushes. The full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing pocket depth (PPD), recession depth (REC), clinical attachment level (CAL), and bleeding on probing (BoP) were measured in six aspects per tooth (mesio-buccal (MB), buccal (B), disto-buccal (DB), disto-lingual (DL), lingual (L), and mesio-lingual (ML)) at baseline, 3 months, and 6 months after surgery. FMPS and FMBS did not significantly change (p > 0.05), whereas PPD and CAL significantly decreased, and REC significantly increased in all groups during the study (p < 0.05). Clinical results were satisfactory in all cases, with no significant differences between groups 3 months after surgery. Six months after surgery, only PPD-MB was significantly different in the three groups (p < 0.05). Nevertheless, this value was not clinically relevant because the value of PPD-B (about 2 mm) in group C was physiologic. The mechanical plaque control was proven to be fundamental and sufficient in all the six aspects per tooth to guarantee an excellent clinical outcome without the need of chemical plaque control.
2021
- Isolation through rubber dam to prevent COVID-19 exposure during flapless trans-crestal sinus lift procedures
[Articolo su rivista]
Checchi, Vittorio; Generali, Luigi; Generali, Paolo
abstract
In 2020, a highly infective new pathogen (Sars-CoV-2) spread from China to the whole globe, and became responsible of an acute respiratory syndrome, often asymptomatic but potentially lethal, named COVID-19. Airborne and direct contact contamination are the major infection pathways of Sars-CoV-2 and it has been shown that virus spread can also happen in absence of clinical symptoms. SARS-CoV-2 transmission during dental procedures can happen through inhalation of droplets from infected patients or direct contact with mucous membranes, oral fluids, and contaminated instruments. Both sinus lift and implant surgeries often involve bleeding and exposure to oral fluids, and a rubber dam could be used to reduce direct contact and the amount of potentially infected aerosol. The aim of this short case presentation is to illustrate how the use of a rubber dam could be extremely useful in preventing COVID-19 exposure during flapless trans-crestal sinus lift procedures.
2021
- Micro-nano surface characterization and bioactivity of a calcium phosphate-incorporated titanium implant surface
[Articolo su rivista]
Zamparini, F; Prati, C; Generali, L; Spinelli, A; Taddei, P; Gandolfi, Mg
abstract
The surface topography of dental implants and micro-nano surface characterization have gained particular interest for the improvement of the osseointegration phases. The aim of this study was to evaluate the surface micro-nanomorphology and bioactivity (apatite forming ability) of Ossean® surface, a resorbable blast medium (RBM) blasted surface further processed through the incorporation of a low amount of calcium phosphate. The implants were analyzed using environ- mental scanning electronic microscopy (ESEM), connected to Energy dispersive X-ray spectroscopy (EDX), field emission gun SEM-EDX (SEM-FEG) micro-Raman spectroscopy and X-ray photoelectron spectroscopy (XPS) before and after immersion in weekly refreshed Hank’s balanced salt solution (HBSS) for 28 days. The analysis of the samples before immersion showed a moderately rough surface, with micropits and microgrooves distributed on all of the surface; EDX microanalysis re- vealed the constitutional elements of the implant surface, namely titanium (Ti), aluminum (Al) and vanadium (V). Limited traces of calcium (Ca) and phosphorous (P) were detected, attributable to the incorporated calcium phosphate. No traces of calcium phosphate phases were detected by micro-Raman spectroscopy. ESEM analysis of the implant aged in HBSS for 28 days revealed a significantly different surface, compared to the implant before immersion. At original magnifica- tions <2000⇥, a homogeneous mineral layer was present on all the surface, covering all the pits and microgrooves. At original magnifications 10,000⇥, the mineral layer revealed the presence of small microspherulites. The structure of these spherulites (approx. 2 μm diameter) was observed in nanoim- mersion mode revealing a regular shape with a hairy-like contour. Micro-Raman analysis showed the presence of B-type carbonated apatite on the implant surface, which was further confirmed by XPS analysis. This implant showed a micro-nano-textured surface supporting the formation of a biocompatible apatite when immersed in HBSS. These properties may likely favor bone anchorage and healing by stimulation of mineralizing cells.
2021
- Peri-implantitis regenerative therapy: A review
[Articolo su rivista]
Mordini, L.; Sun, N.; Chang, N.; De Guzman, J. -P.; Generali, L.; Consolo, U.
abstract
The surgical techniques available to clinicians to treat peri-implant diseases can be divided into resective and regenerative. Peri-implant diseases are inflammatory conditions affecting the soft and hard tissues around dental implants. Despite the large number of investigations aimed at identifying the best approach to treat these conditions, there is still no universally recognized protocol to solve these complications successfully and predictably. This review will focus on the regenerative treatment of peri-implant osseous defects in order to provide some evidence that can aid clinicians in the approach to peri-implant disease treatment.
2021
- Retreatment of Experimental Carrier-Based Obturators with the Remover NiTi Instrument: Evaluation of Apical Extrusion and Effects of New Kinematics
[Articolo su rivista]
Pirani, C.; Iacono, F.; Zamparini, F.; Generali, L.; Prati, C.
abstract
The objective of this study is to evaluate the retreatment time and weight of apically extruded debris yielded by two different kinematics during the removal of different root canal filling materials. Forty straight single-rooted extracted teeth were instrumented with HyFlex CM files and obturated with two different techniques: 25.04 HyFlex experimental carrier-based obturators (Coltène/Whaledent, Altstätten, Switzerland) (group 1) or 25.04 single gutta-percha cones (Roeko Coltène/Whaledent, Altstätten, Switzerland) (group 2) and Guttaflow Bioseal as the sealer. Samples were divided into four subgroups (n = 10) according to the used kinematics for the removal of root canal filling materials: continuous rotation (A) or retreatment motion (B) with a Remover and HyFlex EDM Nickel-Titanium instruments activated with a CanalPro Jeni micromotor (Coltène/Whaledent, Altstätten, Switzerland). Time for retreatment was digitally recorded, and debris extruded from the apex was collected in Eppendorf tubes and weighted with an analytical balance. Data on retreatment time and apical extrusion were statistically analyzed with the Kruskal-Wallis test (p<0.05). Working length was achieved in all the retreated samples. The removal of root filling material resulted significantly faster with the Jeni mode (p<0.001), and the difference was significant for the removal of both filling materials (p<0.05). No significant differences on debris extrusion between single cone and experimental obturators groups were noted (p>0.05), and no significant differences between kinematics (continuous rotation vs. Jeni motion) were observed (p>0.05). All the tested retreatment strategies lead to an extrusion of material from the apex, and the weight of apically extruded debris was similar. The use of the innovative CanalPro Jeni kinematics accelerates the time for the removal of root filling materials.
2021
- The perceived impact of the COVID-19 pandemic on dental undergraduate students in the Italian region of Emilia-Romagna
[Articolo su rivista]
Generali, L.; Iani, C.; Macaluso, G. M.; Montebugnoli, L.; Siciliani, G.; Consolo, U.
abstract
Introduction: The outbreak and diffusion of the novel SARS-CoV2 coronavirus have caused an emergency status in the dental education system. Materials and methods: An anonymous survey composed of 34 questions was delivered to students of the Master Degree Programme in Dentistry and Dental Prosthodontics of the Universities of Emilia-Romagna, the fifth Italian region most affected by the pandemic. The psychological impact of COVID-19 was assessed by means of the Generalised Anxiety Disorder-7 scale (GAD-7). Numerically recoded data were analysed using the Analysis of Variance (ANOVA), whilst to investigate the association between quantitative variables, the Pearson correlation coefficient (R) was computed. Results: The questionnaire was completed by 399 students (75%) out of 532. Most students experienced difficulties in working at the thesis during the COVID-19 emergency. For over half of them, online teaching could only partially replace traditional face-to-face lessons. The negative impact on the study career was judged as particularly high by sixth-year students. Clinical training activities were considered as exposing to the risk of contracting COVID-19 infection by the majority of the students. The level of concern of contracting COVID-19 infections during future university activities was positively correlated to risk perception related to clinical training. Conclusion: The results of this survey could be used to train students to a correct risk assessment. Students reported experiencing concern whilst thinking of COVID-19 and 6.5% of them showed symptoms related to high levels of anxiety. These data may guide Universities in trying to reduce students' anxiety by means of correct communication strategies.
2021
- Traumatic Dental Injuries: Clinical Case Presentation and a 10-Year Epidemiological Investigation in an Italian Dental Emergency Service
[Articolo su rivista]
Murri Dello Diago, A.; Generali, L.; Apponi, R.; Colombini, V.; Checchi, V.
abstract
Traumatic dental injuries (TDIs) are very common in the world population, and international literature reports several studies which helped in the definition of international guidelines. The aim of this study is to present two clinical cases of TDI and to investigate epidemiological and etiological aspects of TDIs in patients treated in Modena, Italy, between January 2010 and December 2020. The presented case reports are two explicative clinical cases of successful TDI management with a long-Term follow-up. The epidemiological analysis was performed on patients who visited the Dental Emergency Service of the Dentistry and Oral-Maxillo-Facial Surgery Unit of Modena (Italy) over a period of 10 years. Data relating to age, gender, type of trauma, and place of accident were collected. Five-hundred-sixty-five TDIs that occurred to patients from 1 to 68 years old were reported, with a total of 860 injured teeth. The peak age at which TDIs are most represented varies between 2 and 3 years old, and they occurred frequently from 1 up to 7 years old. 57.5% were male, while 42.5% were female. The most common trauma resulted to be the uncomplicated crown fracture (20%), immediately followed by lateral luxation (19%), intrusive luxation (18%), avulsion (17%), and complicated crown fracture (15%). TDIs occurred at home in 44% of cases. The need for more prevention training must be highlighted, due to the fact that many TDIs occur at home and in a preschool age.
2020
- Antimicrobial effectiveness of etidronate powder (Dual Rinse® HEDP) and two EDTA preparations against Enterococcus faecalis: a preliminary laboratory study
[Articolo su rivista]
Giardino, L.; Savadori, P.; Generali, L.; Mohammadi, Z.; Del Fabbro, M.; De Vecchi, E.; Bidossi, A.
abstract
This study aimed to evaluate the antimicrobial and antibiofilm activity of two chelating agents: ethylenediaminetetraacetic acid (EDTA) combined or not with detergents, and etidronic acid combined with sterile saline. The bacterial inhibitory and bactericidal concentrations (MIC and MBC, respectively) were determined on Enterococcus faecalis ATCC 4083 strain. Antimicrobial tests were performed on a biofilm model after treatment with the chelating agents at different times (1, 3, and 5 min) using a biofilm eradication concentration (MBEC) and confocal laser scanning microscope (CLSM) assays. Quantification of cell biomass and percentage of live and dead cells in the biomass was assessed for each group. The normality of the distributions for each variable was assessed using the D’Agostino and Pearson’s omnibus normality test. The comparison of bacterial viability among groups and between any two groups was performed using the non-parametric Kruskal–Wallis one-way analysis of variance and the Dunn’s test, respectively. No significant between-group difference was observed regarding biomass reduction. On the other hand, EDTA combined with detergents displayed a substantial increase of the dead bacteria ranging between 35 and 43%; whereas, the number of cells killed in the control group and in the other treated groups always ranged between 1 and 6%, at all experimental times. The addition of detergents to EDTA can improve its anti-biofilm activity by reducing EPS production and enhancing the killing of sessile bacterial cells. Clinical relevance EDTA presents a relevant antimicrobial activity when combined with surface-active agents.
2020
- Behavior of Two Resin Composites after Aging in Drink Solutions
[Abstract in Rivista]
Generali, L; Vignudini, G; Maravic, T; Puddu, P; Bolelli, G; Lusvarghi, L; Breschi, L; Consolo, U; Checchi, V
abstract
Objectives: The aim of this study was to investigate the effects of artificial saliva and drink solutions on colorimetric variations and wear resistance of 2 composites: Herculite XRV Ultra (HXRVU) and Harmonize (HZ) (Kavo-Kerr), after one month aging
Methods: Forty composite specimens were prepared in an oxygen-free environment and polymerized. Four specimens were immedialtely investigated (T0), while thirty-six specimens were soaked into different drink solutions (artificial saliva, cola, ethanol), sealed into PET bottles and incubated at 37°C. Control specimens were kept in air. Specimens evaluation was made at T0, after 1 week (T1) and 1 month (T2). Twenty-four samples (12 HXRVU, 12 HZ) were analyzed using a spectrophotometer to assay three color-identifying values: L, a and b. To evaluate wear resistance, the remaining sixteen samples (8 HXRVU, 8 HZ) were fitted into a rotary tribometer, placed into a food-like bolus-simulating slurry and wear rate was evaluated with a profilometer.
Results: L values for all specimens of both groups did not show differences between T0 and T2. All a values showed an increase compared to control group. b values for HXRVU specimens did not show differences between T0 and T2, whereas b values for HZ specimens decreased, compared to control group. HXRVU specimens were more wear resistant than HZ group at T0 and seemed to be less susceptible to modifications in different drink solutions. Ethanol solution produced a marked increase of wear rate in HZ specimens at T2.
Conclusions: Aging effects on chromatic variations of composites placed into different drink solutions were demonstrated only for a value, resulting in a slightly change into red color. Wear rate was composite related. Additional in vivo testing is needed to clarify the clinical behaviour of the tested composite materials in terms of color changes and wear rate.
2020
- Clinical and histological reaction of periodontal tissues to subgingival resin composite restorations
[Articolo su rivista]
Bertoldi, C; Monari, E; Cortellini, P; Generali, L; Lucchi, A; Spinato, S; Zaffe, D
abstract
Objectives: To compare the clinical and histological response of supracrestal periodontal tissues to subgingival composite restorations versus natural root surfaces Material and methods: In 29 subjects with a single tooth requiring subgingival restorations, a deep margin elevation (DME) procedure with composite resin was applied. Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), and focal probing depth (PD) were measured at baseline, before DME, and after 3 months. The distance between the coronal marked (CM) point to the apical margin of the composite reconstruction (AMR), at baseline, and to the tip of the periodontal probe inserted to reach the bottom of the sulcus (APP), 3 months later, was measured. An all-around secondary flap, harvested to ensure the subsequent single-crown prosthetic rehabilitation was histologically processed. The histological inflammation degree was evaluated in areas of gingival tissues adjacent to the composite (group B) and adjacent to the natural surface of each single tooth (group A). Results: Significant FMPS, FMBS, and PD decreases were observed (p < 0.05). CM-AMR and CM-APP were significantly different (p < 0.05), suggesting an attachment gain after 3-months. The inflammation level of gingival tissue was similar in groups A and B (p > 0.05). Conclusions: For the first time, this topic was clinically and histologically studied in humans. Subgingival restorations resulted compatible with gingival health, with levels similar to that of untreated root surfaces. Clinical relevance: Deep margin elevation procedure produces favorable clinical and histological outcomes allowing a routine utilization in reconstructive dentistry.
2020
- Computer-guided implant placement in contact with root remnants in the esthetic area
[Articolo su rivista]
Checchi, Vittorio; Bertani, Pio; Generali, Paolo; Generali, Luigi
abstract
The extraction of a tooth with root resorption can be a complicated procedure and can result in the removal of a significant amount of alveolar bone. In the anterior maxilla, esthetic rehabilitation of damaged sites with implant-supported crown could require multiple surgeries. Patients often ask for an alternative, and minimally invasive treatments are generally preferred. In this paper, a clinical case of implant-supported crown in a site affected by root resorption is described. Immediate implant was placed leaving some root fragments in the osteotomy site, thus avoiding invasive extractive surgeries. A minimally invasive flapless technique with a computer-guided implant placement procedure was used. After 8 years, clinical and radiologic data were stable, gingival tissues around the implant appeared healthy, no dark translucency appeared through marginal gingiva around the implant, and there was no pathologic probing pocket depth or bleeding on probing. In the presence of root resorption and ankylosis, computer-guided surgery could be helpful to prepare a precise implant site through various tissues, such as partially resorbed root remnants.
2020
- Cyclic fatigue resistance of nickel-titanium rotary instruments according to the angle of file access and radius of root canal.
[Articolo su rivista]
Pedullà, E; La Rosa, Grm; Virgilio, C; Rapisarda, E; Kim, Hc; Generali, L
abstract
INTRODUCTION:
The aim of this study was to compare the influences from different access angles and curvature radii on cyclic fatigue resistance of nickel-titanium rotary files.
METHODS:
Two file systems (2Shape [TS; MicroMega, Besançon, France] and HyFlex CM [HCM; Coltène/Whaledent, Allstätten, Switzerland]) were used. A total of 192 instruments of TS #25/.04 (TS1), TS #25/.06 (TS2), HCM #25/.04, and HCM #25/.06 were evaluated at 3 insertion angles (0°, 10°, and 20°) and 2 radii (5 mm and 3 mm) in 16-mm stainless steel artificial canals with a 60° curvature. Cyclic fatigue resistance was determined by the number of cycles to failure (NCF) using a customized testing device. Data were analyzed statistically with the significance level established at 95%.
RESULTS:
In the 3-mm radius canal, the instruments showed lower cyclic fatigue resistance than in the 5-mm radius canal (P < .05). HCM #25/.06 and all .04 taper instruments had a significant NCF reduction at 20° and 10° in the 3-mm radius canal (P < .05), whereas TS2 showed no significant differences. In the 5-mm radius of curvature, although .06 taper instruments had no significant NCF reduction for each angle tested, .04 taper files exhibited significant NCF reduction when tested at 20° (P < .05). Comparing the same size instruments, HCM had higher NCF than TS (P < .05). Instruments with a .04 taper exhibited higher NCF than the .06 ones with the same heat treatment (P < .05).
CONCLUSIONS:
An inclined insertion into the canals decreased cyclic fatigue resistance of thermal-treated instruments with a .04 taper at all radii of curvature tested. The synergistic effect of a small radius of curvature and access angulation of heat-treated instruments decreases their fatigue resistance.
2020
- Effects of simultaneous liquid or gel sodium hypochlorite irrigation on the cyclic fatigue of two single-file nickel-titanium instruments
[Articolo su rivista]
Pedulla, E.; La Rosa, G. R. M.; Albani, M. S.; Isola, G.; Ozyurek, T.; Generali, L.
abstract
To evaluate the effect of simultaneous liquid or gel sodium hypochlorite (NaOCl) irrigation on cyclic fatigue of F6 SkyTaper (F6ST) and OneCurve (OC) single files, 180 new 25/0.06 F6ST and OC files were divided into 6 groups (n = 15) for each brand. Groups 1 and 4 included new instruments not exposed to NaOCl at 20 °C and 37 °C, respectively. Groups 2 and 5 included files activated with liquid NaOCl at 20 °C and 37 °C, respectively. Groups 3 and 6 consisted of instruments tested with NaOCl gel at 20 °C and 37 °C, respectively. Instruments were subjected to a fatigue test using a novel customized device. Data were expressed as time to fracture (TtF) and statistically analyzed (p < 0.05) after checking their normality through the Shapiro-Wilk test. Because they were normally distributed, 2-way analyses of variance (ANOVA) and the Tukey multiple comparison post-hoc test were used. Time to fracture of all tested instruments decreased at 37 °C (p < 0.05). At 20 °C, NaOCl improved TtF of F6ST and OC (p < 0.05). NaOCl liquid increased TtF of F6ST (p < 0.05) in comparison with gel, while there was no difference between the two formulations for OC. At 37 °C, both NaOCl formulations had no significant influence on TtF for F6ST, while they increased TtF of OC (p < 0.05). NaOCl improved the cyclic fatigue resistance of OC, independently of the temperature, while for F6ST the negative impact of higher temperature reduced the irrigant benefits.
2020
- Evaluation of cytotoxicity and antibacterial activity of a new class of silver citrate-based compounds as endodontic Irrigants
[Articolo su rivista]
Generali, Luigi; Bertoldi, Carlo; Bidossi, Alessandro; Cassinelli, Clara; Morra, Marco; Del Fabbro, Massimo; Savadori, Paolo; Ballal Nidambur, Vasudev; Giardino, Luciano
abstract
In the present study, the cytotoxicity and the antimicrobial activity of two silver citrate-based irrigant solutions were investigated. Cytotoxicity of various concentrations (0.25%, 0.5%, 1%, 2.5%, 5%) of both solutions (BioAKT and BioAKT Endo) was assessed on L-929 mouse fibroblasts using the MTT assay. For the quantitative analysis of components, an infrared (I.R.) spectroscopy was performed. The minimum inhibitory and minimal bactericidal concentrations (M.I.C. and M.B.C., respectively) were ascertained on Enterococcus faecalis strain ATCC 4083. For biofilm susceptibility after treatment with the irrigating agent, a minimum biofilm eradication concentration (M.B.E.C.) and confocal laser scanning microscope (C.L.S.M.) assays were performed. Quantification of E. faecalis cell biomass and percentage of live and dead cells in the biomass was appraised. Normality of data was analyzed using the D’Agostino & Pearson’s test and the Shapiro–Wilk test. Statistical analysis was performed using one-way analysis of variance (ANOVA) and Tukey’s test. Both silver citrate solutions showed mouse fibroblasts viability >70% when diluted to 0.25% and 0.5%. Conversely, at higher concentrations, they were extremely cytotoxic. F.T.-IR spectroscopy measurements of both liquids showed the same spectra, indicating similar chemical characteristics. No substantial contrast in antimicrobial activity was observed among the two silver citrate solutions by using broth microdilution methods, biofilm susceptibility (MBEC-HTP device), and biomass screening using confocal laser scanning microscopy (C.L.S.M.) technique. Both solutions, used as root canal irrigants, exhibited significant antimicrobial activity and low cytocompatibility at dilutions greater than 0.5%.
2020
- Extraction socket healing in leukemic patients: a preliminary radiographic evaluation
[Articolo su rivista]
Bertoldi, C; Generali, L; Forabosco, A; Zaffe, D; Ferrari, M; Narni, F
abstract
2020
- Influence of Light-curing on Endogenous Dentinal Enzymatic Activity.
[Abstract in Rivista]
Mazzitelli, Claudia; Maravic, Tatjana; Comba, Allegra; Mancuso, Edoardo; Josic, Uros; Checchi, Vittorio; Generali, Luigi; Mazzoni, Annalisa; Breschi, Lorenzo
abstract
Objectives: Dentin collagen fibrils exposed after bonding procedures are possibly subject to degradation through a mechanism mediated by dentinal endogenous enzymes, thus impairing the longevity of the hybrid layer (HL). The aim of this in vitro study was to investigate the ability of a universal adhesive used in combination with dual-cure resin cements with/out light-activation to inhibit enzymatic activity, using in situ zymography.
Methods:
Composite overlays were prepared to be luted to middle/deep dentin surfaces of non-carious human molars. After bonding application (iBond universal adhesive used in the self-etch modality), the following resin cements were used for luting procedures: 1) RelyX Ultimate (RXU); 2) Panavia V5 (PAN); 3) Variolink EstheticDC (VAR). Resin cements were either used in the self-cure mode (SC; 1h at 37°C) or in the dual-cure mode (DC; 20s light-cure followed by 15 min self-cure at 37°C). After 24h, specimens were cut to expose the HL, glued to glass slides, polished and prepared for in situ zymography. Self-quenched fluorescein-conjugated gelatine mixture was placed on top of each specimen, protected with a cover slip and incubated in a dark humidified chamber at 37°C for 12h. Detection of endogenous gelatinolytic enzyme activity within the HL was evaluated with a multi-photon confocal laser scanning microscope.
Results:
The enzymatic activity, as showed by in situ zymography, was dependent to the polymerization mode of the resin cement. A lower level of fluorescence was present for RXU when DC, and this was statistically significant among all the groups (p<0.05). PAN demonstrated inferior enzymatic activity when only SC (P<0.05). VAR specimens in the SC group completely fractured during preparation procedures.
Conclusions: Light-cure influences the dentinal enzymatic activity when a simplified bonding system is used in combination with dual-cure resin cements with a material-dependent trend. Further studies are necessary to investigate whether the enzymatic activity would change over time.
2020
- Mechanical Properties and Metallurgical Features of New Green NiTi Reciprocating Instruments
[Articolo su rivista]
Generali, Luigi; Malovo, Anastasiya; Bolelli, Giovanni; Borghi, Alessia; La Rosa, Giusy Rita Maria; Puddu, Pietro; Lusvarghi, Luca; Rota, Alberto; Consolo, Ugo; Pedullà, Eugenio
abstract
To evaluate the properties of two nickel-titanium (NiTi) reciprocating endodontic instruments (commercially known as Procodile and Reziflow), a total of 40 size 25 and 0.06 taper new Procodile and Reziflow instruments (n = 20) were subjected to cyclic fatigue tests (60° angle of curvature, 5-mm radius) at 20 °C and 37 °C and a torsional test based on ISO 3630-1. The fracture surface of each fragment was examined. The morphological, mechanical, chemical, thermal, and phase composition characteristics of the files were investigated by field-emission gun scanning electron microscopy (FEG-SEM) equipped with an energy-dispersive X-ray (EDX) detector, focused ion beam analysis (FIB), micro-Raman spectroscopy, X-ray diffraction (XRD), differential scanning calorimetry (DSC), and Auger electron spectroscopy (AES). Reziflow showed higher cyclic fatigue resistance than Procodile at 37 °C (p < 0.05). The maximum torsional strength of Procodile was lower than that of Reziflow (p < 0.05). No difference was found between their angular rotations to fracture (p > 0.05). SEM, FIB, Micro-Raman, and AES analyses revealed the presence of an Nb/Nb2O5 coating on the Procodile surface. DSC and XRD analysis confirmed that both files consist of an almost austenitic phase structure at 37 °C. The cyclic fatigue resistance of Procodile and Reziflow significantly decreases upon exposure to body temperature.
2020
- Mechanical properties and metallurgical features of new and ex vivo used reciproc blue and reciproc
[Articolo su rivista]
Generali, L; Puddu, P; Borghi, A; Brancolini, S; Lusvarghi, L; Bolelli, G; Consolo, U; Pedullà, E
abstract
AIM: To compare the mechanical properties and metallurgic features of new and used Reciproc Blue and Reciproc instruments. METHODOLOGY: A total of 120 R25Reciproc Blue and R25 Reciproc instruments were used. The morphological, chemical, mechanical, thermal and phase composition characteristics of new and ex vivo used files were investigated by scanning electron microscopy (SEM) with energy dispersive X-ray spectroscopy (EDS), focused ions beam analysis (FIB), micro-Raman spectroscopy, optical and SEM metallography, X-ray diffraction (XRD), differential scanning calorimetry (DSC) and indentation tests. Usage-induce degradation was evaluated. Ten new and ten used instruments per type were run until fracture occurred in a stainless-steel artificial canal (60° angle of curvature, 4-mm radius). Time to fracture and the length of the fractured fragment were recorded. Torque and angle of rotation at failure of ten new and ten used instruments for each type were measured according to ISO 3630-1. The fracture surface of each fragment was examined. Analyses of variance and Bonferroni post hoc tests were used to analyse the data statistically (α-level 0.05). RESULTS: SEM analysis revealed microcracks near the tip on both files after ex vivo usage tests. FIB imaging and micro-Raman spectroscopy confirmed the presence of an oxide layer on the Reciproc Blue surface. There was no thinning of the coating after use. The area of grains of Reciproc detected by metallographic analysis was significantly wider than Reciproc Blue (P<0.05). XRD revealed a reduction of martensite and R-phase in Reciproc Blue after use. DSC analysis revealed different transformation temperatures for the instruments analysed. Reciproc Blue was significantly more flexible than Reciproc for both new and used samples (P<0.05) and they were significantly more resistant to cyclic fatigue than Reciproc (P<0.05). Ex vivo usage reduced the fatigue resistance of both files. Torsional resistance of Reciproc and Reciproc blue was not reduced by the simulated use (P>0.05). CONCLUSIONS: The thermal treatment of Reciproc Blue produced a finer structure with smaller grains than Reciproc, which increased its fracture resistance and was also responsible for its reduced hardness and lower elastic modulus. Both files were safe during ex vivo usage in severely curved canals
2020
- Metodo e dispositivo per la prova di file endodontici
[Brevetto]
Barbieri, Marco; Bolelli, Giovanni; Generali, Luigi; Lusvarghi, Luca; Puddu, Pietro
abstract
RIASSUNTO
Sono descritti un metodo, ed un dispositivo
per l’attuazione di detto metodo, per realizzare
prove di fatica, su file endodontici (2) rotanti o 5 reciprocanti in leghe Ni-Ti a memoria di forma.
Il metodo è del tipo che prevede l’inserimento di detto file (2) in canali artificiali (3), ed è caratterizzato dal fatto di effettuare:
- prove di fatica statica, ponendo in rotazione
10 detto file (2) e obbligandolo a deformarsi ciclicamente ad ogni rotazione del file (2) stesso; - prove di fatica dinamica, mediante un inserimento del file (2) in profondità in un canale (3), detta placchetta (4) venendo allontanata e
15 riavvicinata di una corsa predefinita.
Il dispositivo è del tipo che comprende uno o
più canali artificiali (3), ed è caratterizzato dal fatto di comprendere:
- primi mezzi (5) atti a posizionare il file (2)
20 rispetto a detti canali artificiali (3);
- secondi mezzi (6) atti a fare in modo tale che il file (2) entri ed esca da detti canali (3), per effettuare una prova di fatica dinamica;
- terzi mezzi (7) per imprimere al file (2) un moto
25 rotatorio, per effettuare una prova di fatica statica. 1
2020
- Multidisciplinary management and pulp vitality preservation of a tooth with extensive iatrogenic furcal root perforation and biologic width violation
[Articolo su rivista]
Angerame, D.; de Biasi, M.; Franco, V.; Generali, L.
abstract
This article describes the case of a vital molar tooth with a vast furcal iatrogenic root perforation and biologic width violation, which was successfully managed by a multidisciplinary approach aimed at preserving pulp vitality. The root perforation was cleaned and then sealed with mineral trioxide aggregate, which was positioned onto the pulp at the canal orifices. After one month, the patient was not reporting symptoms, and the tooth was positively responding to the thermal test. The tooth was orthodontically extruded, subjected to minimally invasive crown lengthening, and prepared to receive a full-crown restoration. Radiotransparent composite resin was chosen as a permanent restorative material to better monitor possible endodontic complications at the coronal level. The patient's tooth was followed up for eight years uneventfully. The present case is an example of the possibility to subject a root-repaired tooth with fully formed apices to conservative yet complex multidisciplinary treatment while maintaining pulp vitality.
2020
- The role of matrix metalloproteinases in periodontal disease
[Articolo su rivista]
Checchi, V.; Maravic, T.; Bellini, P.; Generali, L.; Consolo, U.; Breschi, L.; Mazzoni, A.
abstract
This review provides a detailed description of matrix metalloproteinases (MMPs), focusing on those that are known to have critical roles in bone and periodontal disease. Periodontal disease is an inflammatory process initiated by anaerobic bacteria, which promote the host immune response in the form of a complex network of molecular pathways involving proinflammatory mediators such as cytokines, growth factors, and MMPs. MMPs are a family of 23 endopeptidases, collectively capable of degrading virtually all extracellular matrix (ECM) components. This study critically discusses the available research concerning the involvement of the MMPs in periodontal disease development and progression and presents possible therapeutic strategies. MMPs participate in morphogenesis, physiological tissue turnover, and pathological tissue destruction. Alterations in the regulation of MMP activity are implicated in the manifestation of oral diseases, and MMPs comprise the most important pathway in tissue destruction associated with periodontal disease. MMPs can be considered a risk factor for periodontal disease, and measurements of MMP levels may be useful markers for early detection of periodontitis and as a tool to assess prognostic follow-ups. Detection and inhibition of MMPs could, therefore, be useful in periodontal disease prevention or be an essential part of periodontal disease therapy, which, considering the huge incidence of the disease, may greatly improve oral health globally.
2019
- Correction to: The fate of root canals obturated with Thermafil: 10-year data for patients treated in a master’s program (Clinical Oral Investigations, (2019), 23, 8, (3367-3377), 10.1007/s00784-018-2756-8)
[Articolo su rivista]
Pirani, C; Zamparini, F; Peters, Oa; Iacono, F; Gatto, Mr; Generali, L; Gandolfi, Mg; Prati, C
abstract
Objectives Retrospective description of the 10-year success rate of endodontic treatments with Thermafil (TF).
Materials and methods Patients treated by postgraduate students in an Endodontics Master’s Program (2006–2008) were enrolled. All treated root canals were filled with TF and AH Plus. Teeth satisfying the inclusion criteria (206 teeth in 89 patients) were reexamined clinically and radiographically to estimate a 10-year survival and periapical health. Demographic and medical data were registered; collected information included pre-, intra-, and postoperative variables. Teeth were classified as Bhealthy^ (PAI ≤ 2 in absence of signs/symptoms), Bendodontically diseased^ (presenting at least one of the following: PAI ≥ 3, signs/ symptoms, retreated in the course of the follow-up, or extracted for endodontic reasons), or Bnon-endodontically diseased^ (extracted for non-restorable fractures or periodontal disease). For teeth lost during the 10-year follow-up, details and reason of extraction were analyzed. Two PAI-calibrated examiners assessed outcomes blinded to preoperative status. Bivariate and multilevel analyses were performed (α level set at 0.05).
Results At 10 years, 179 (87%) teeth survived and 27 were extracted: 20 for non-endodontic reasons (excluded from success analysis) and 7 for endodontic reasons (considered Bendodontically diseased^). Multilevel analysis revealed that the probability of extraction was increased by the presence of preoperative pain (odds ratio = 6.720; 95% confidence interval, 1.483–30.448) and by maxillary location (odds ratio = 2.950; 95% confidence interval, 1.043–8.347). Concerning periapical status, 159/186 teeth (85%) were assessed as Bhealthy.^ Multilevel analysis confirmed that maxillary location (odds ratio = 3.908; 95% confidence interval, 1.370–11.146), presence of flare up (odds ratio = 9.914; 95% confidence interval, 2.388–41.163), and fracture occur- rence (odds ratio = 35.412; 95% confidence interval, 3.366–372.555) decreased the odds of healing, respectively.
Conclusions After 10 years, teeth filled with Thermafil in a specialist master’s program presented a survival and a periapical health comparable to cohorts where root canals were filled with other obturation techniques.
Clinical relevance Carrier-based techniques provide time savings for clinicians while satisfying clinical quality criteria for the root filling and consequently the clinical outcome.
2019
- DELAYED TOOTH REPLANTATION AND INFLAMMATORY ROOT RESORPTION IN CHILDHOOD AND ADOLESCENCE
[Articolo su rivista]
Spinas, E; Generali, L; Mameli, A; Demontis, C; Martinelli, D; Giannetti, L
abstract
Avulsion of one or more permanent teeth represents an emergency in dentistry. The main treatment is the replantation of the tooth/teeth as soon as possible to decrease possible complications. However, this is not always possible, and, in many cases, the patient undergoes a delayed replantation and subsequently prosthetic and implant treatments. This becomes problematic when the traumatized patient is a child; in this case, the goal is to maintain the space for the subsequent implant positioning and to give an adequate aesthetic result until the bone growth has ceased. A review on the incidence of the inflammatory root resorption onset after delayed replantation was carried out to check the frequency and severity of these complications.
2019
- DENTAL ROOT SURFACE TREATMENT WITH ETHYLENEDIAMINETETRAACETIC ACID DOES NOT IMPROVE ENAMEL MATRIX DERIVATIVE PEPTIDE TREATMENT WITHIN INTRABONY DEFECTS: A RETROSPECTIVE STUDY
[Articolo su rivista]
Bertoldi, C; Labriola, A; Generali, L
abstract
Introduction
The dental root surface treatment is quite often considered a key factor in achieving regeneration of the periodontal defect. The aim of this retrospective study was to compare the 12-month clinical outcomes obtained by the application of enamel matrix derivative peptide (EMP) with and without EDTA dental root conditioning in intrabony 2-3-wall defect treated by minimally invasive surgical therapy (MIST).
Material and Methods
Twenty-two healthy patients, affected from moderate or severe chronic periodontitis, with a 2-3-wall intrabony defect (≥4 mm deep and ≥2 mm wide), were selected. Each patient was treated by MIST Technique and EMP was applied into the defect during the surgery, on the dental roots. However, in the treatment group-1 (TG1) the root surfaces were not previously conditioned whilst in the treatment group-2 (TG2) root surfaces were conditioned by EDTA. Immediately before surgery (T0) and 12-month after (T2) the probing depth (PD) and gingival recession (GR) were registered at the experimental sites and the full-mouth plaque score (FMPS) and full-mouth bleeding score (FMBS) were also registered.
Results
No statistically significant differences were shown between TG1 and TG2 at T0 and T1 in term of PD, GR, FMPS while a statistically significant greater FMBS was recorded in TG2 at T1. PD, FMPS and FMBS indices significantly decreased between T0 and T1 both in TG1 and TG2 (p<0.05). GR increase resulted not statistically significant both in TG1 and TG2 (p<0.05) between T0 and T1.
Conclusions
In this retrospective study both the treatments achieved favourable and comparable clinical results. The PD and GR were similar between the two treatment groups (TG1 and TG2) in the single phases considered (T0 and T1) and during the follow-up (T0-T1). The EDTA conditioning of dental root surfaces did not seem efficient to improve the clinical results in the treatment of 2-3-wall periodontal defects.
2019
- Dual Rinse® HEDP increases the surface tension of NaOCl but may increase its dentin disinfection efficacy
[Articolo su rivista]
Giardino, L; Del Fabbro, M; Morra, M; Pereira, T; Bombarda de Andrade, F; Savadori, P; Generali, L
abstract
The aim of this study was to evaluate the surface tension and the antimicrobial activity in infected dentin of a NaOCl solution combined with an etidronate powder (Dual Rinse® HEDP), compared to pure NaOCl and the classic NaOCl + EDTA irrigating sequence, respectively. The surface tension of three irrigants was measured by Wilhelmy technique. To evaluate the antimicrobial activity of the solutions, 26 human teeth were contaminated for 5 days with E. faecalis. After bacterial contamination, ten samples were irrigated with NaOCl followed by EDTA, another ten with NaOCl/Dual Rinse® HEDP, and four were used as positive controls. Two specimens not contaminated were used as negative controls. After live/dead BacLight staining, samples were examined by CLSM for analyzing % of residual live and dead cells. Comparison of bacterial viability between and within groups was performed using the Mann–Whitney test for independent samples and the Wilcoxon signed-rank test, respectively. The mean surface tension of EDTA was significantly lower than that of the other irrigants tested (p < 0.001). Conversely, the surface tension of NaOCl/Dual Rinse® HEDP solution was significantly higher than that of all the other solutions (p < 0.001). Residual bacterial viability in the NaOCl/Dual Rinse® HEDP (1.71%) was significantly lower (p = 0.019) than in the NaOCl + EDTA group (3.77%). All of the experimental groups showed significantly lower proportion of viable bacterial cells than the positive control group (p < 0.01). Clinical relevance adding etidronate to NaOCl increases its antimicrobial effect in dentinal tubules even though increases its surface tension.
2019
- Evaluation of the usage-induced degradation of Genius and Reciproc nickel–titanium reciprocating instruments
[Articolo su rivista]
Generali, Luigi; Borghi, Alessia; Lusvarghi, Luca; Bolelli, Giovanni; Veronesi, Paolo; Vecchi, Andrea; Consolo, Ugo; Becce, Carlo; Bertoldi, Carlo; Sassatelli, Paolo
abstract
The aim of this study was to characterize the main features and the usage-induced degradation of the Genius file after four severely curved root canal instrumentations and to compare their properties to the Reciproc files. Brand new and ex vivo used files were analysed by scanning electron microscopy (SEM) with energy-dispersive X-ray spectrometry (EDS), differential scanning calorimetry (DSC), X-ray diffraction (XRD), optical metallography, and nano-indentation to disclose their morphological, chemical, mechanical, thermal, and phase composition features. Nano-indentation data were statistically analysed using the Student’s t test for normal distribution or the Kolmogorov–Smirnov test for not-normal distributions. SEM analysis showed the presence of micro-cracks near the tip on both files after ex vivo usage test. EDS analysis confirmed that both files are manufactured from an almost equiatomic NiTi alloy. DSC analysis revealed that the transition temperature of the Genius is below 20 °C, while that of the Reciproc is above 20 °C. XRD analysis of Genius files identified cubic B2 austenite with minor peaks of residual monoclinic B19 martensite, while the contemporaneous presence of martensite, austenite and hexagonal R-phase was observed in the Reciproc files. Significant differences in nanohardness and modulus of elasticity (P <.05) were observed in both Genius and Reciproc files before and after use. The collected results showed that both instruments can be safely used as single-use files.
2019
- From Osteoclast Differentiation to Osteonecrosis
of the Jaw: Molecular and Clinical Insights
[Articolo su rivista]
Anesi, Alexandre; Generali, Luigi; Sandoni, Laura; Pozzi, Samantha; Grande, Alexis
abstract
Bone physiology relies on the delicate balance between resorption and formation of its tissue. Bone resorption depends on a process called osteoclastogenesis in which bone-resorbing cells, i.e., osteoclasts, are produced by the differentiation of more undifferentiated progenitors and precursors. This process is governed by two main factors, monocyte colony-stimulating factor (M-CSF) and receptor activator of NFκB ligand (RANKL). While the former exerts a proliferating effect on progenitors/precursors, the latter triggers a differentiation effect on more mature cells of the same lineage. Bone homeostasis requires a perfect space–time coordination of the involved signals. When osteoclastogenesis is poorly balanced with the differentiation of the bone forming counterparts, i.e., osteoblasts, physiological bone remodelling can turn into a pathological state, causing the systematic disruption of bone tissue which results in osteopenia or osteolysis. Examples of these conditions are represented by osteoporosis, Paget’s disease, bone metastasis, and multiple myeloma. Therefore, drugs targeting osteoclastogenesis, such as bisphosphonates and an anti-RANKL monoclonal antibody, have been developed and are currently used in the treatment of such diseases. Despite their demonstrated therapeutic efficacy, these agents are unfortunately not devoid of side effects. In this regard, a condition called osteonecrosis of the jaw (ONJ) has been recently correlated with anti-resorptive therapy. In this review we will address the involvement of osteoclasts and osteoclast-related factors in the pathogenesis of ONJ. It is to be hoped that a better understanding of the biological mechanisms underlying bone remodelling will help in the design a medical therapeutic approach for ONJ as an alternative to surgical procedures.
2019
- Impact of a modified motion on the fatigue life of NiTi reciprocating instruments: a Weibull analysis
[Articolo su rivista]
Iacono, F; Pirani, C; Arias, A; de la Macorra, Jc; Generali, L; Gandolfi, Mg; Prati, C
abstract
Objectives To evaluate the impact of a modified motion on the fatigue life of four brands of nickel–titanium (NiTi) reciprocating instruments.
Materials and methods Cyclic fatigue (CF) resistance of 160 instruments was evaluated in an artificial stainless-steel canal (90° angle, 5-mm radius of curvature). WaveOne and WaveOne Gold (Denstply Maillefer, Baillagues, Switzerland) and Reciproc and Reciproc Blue (VDW, Munich, Germany) were tested with two different motions: (1) X-Smart Plus (Denstply Maillefer) endodontic motor and (2) a 4:1 contra-angle with an experimental motion (EVO) with different rotation angles and based on a sinusoidal acceleration. Motions with X-Smart Plus and EVO were recorded and analyzed at a reduced speed with VLC Media Player software for a more accurate analysis. Mean half-life, beta, and eta Weibull parameters were determined and compared. Results Reciproc Blue resulted the most resistant instruments either with EVO or X-Smart. WaveOne Gold lasted significantly longer than WaveOne with EVO (probability of 91%) while no significant differences were found with X-Smart. Considering NCF, Reciproc, WaveOne Gold, and Reciproc Blue lasted significantly longer with EVO (prob- abilities of 66%, 80%, and 89% respectively). WaveOne Gold showed the highest beta parameter.
Conclusions The experimental motion was found to have a positive impact on fatigue lifetime of reciprocating instruments.
Clinical relevance Current findings provide insight for future improvements in the clinical use of reciprocating files. Experimental motions may be considered when searching for additional strategies in order to increase the safer use of NiTi files during endodontic procedures.
2019
- Implant conometric connection through innovative prosthetic abutment: Biological, clinical, surgical, and prosthetic aspects
[Articolo su rivista]
Giannetti, L.; Spinas, Enrico.; Diago, A. Murri Dello; Consolo, U.; Generali, Luigi
abstract
The aim of this work was to describe the rehabilitation of a superior monoedentulia by positioning a conometric connection implant and a prosthetic crown using CAD/CAM technique. Surgical steps are explained and the biological aspects of this particular morse conometrical connection are evaluated, with particular attention to the possibility of removing the crown by means of an innovative attachment hole in the abutment. This type of monoedentulia can now be solved by implant-prosthetic replacement, and the dentist must choose the most suitable implant for each individual case, the most favorable connection and the most appropriate prosthetic material with regard to bone and soft tissue biology.
2019
- Influence of different angles of file access on cyclic fatigue resistance of 2shape rotary instruments in different artificial canals
[Abstract in Rivista]
La Rosa, Grm; La Paglia, P; Conte, G; Lazaridis, K; Isola, G; Pedullà, E; Ferlito, S; Generali, L; Verzì, P
abstract
Aim: Several parameters including extent of the curvature and angulated insertion of file into the canal could influence cyclic fatigue of nickel-titanium files. The purpose of this study was to compare the influence of different access angles associated to different curvature radii on cyclic fatigue resistance of 2Shape (TS; Micro-Mega, Besancon, France) rotary instruments. Methods: 60 instruments were tested in two 16mm- stainless steel artificial canals with angle of curvature of 60° and 5mm or 3mm radius of curvature respectively. 2Shape TS2 #25.06 and 2Shape TS1 #25.04 were evaluated at 0°, 10° and 20° insertion angles (n=10 for each angle of access). Cyclic fatigue resistance was determined by Number of Cycles to Failure (NCF) using a new testing device machine. This device consists of a platform composed of a block containing the electric handpiece and a mobile support on rails for insertion/disconnection of the file. Moreover, a metal mobile platform is connected to the mobile support. This second platform with the artificial canal produces the different inclination of insertion of tested file maintaining the entrance of instrument perpendicular to the canal. Each instrument was tested in continuous rotation (300 rpm) following the manufacturer’s instructions. Fracture surface was examined with a scanning electron microscope. Data were statistically analyzed using 2-way analysis of variance and the Bonferroni multiple comparison post-hoc test (Prism 7.0; GraphPad Software, Inc, La Jolla, CA) with a significance level of P<0.05. Results: TS1 (#25.04) exhibited higher cyclic fatigue resistance than TS2 (#25.06) for each angle and radius tested (P<0.05). When files were tested inside 3mm- radius canal, independently from taper, they recorded lower cyclic fatigue resistance than in 5mm-radius one (P<0.05). Considering canal with 5mm-radius of curvature, no significant cyclic fatigue resistance reduction was observed for .06 taper-instruments for each angle tested (P>0.05), while files with .04 taper exhibited significant lower NCF when tested at 20° (P<0.05). In canals with 3mm radius of curvature, TS2 (#25.06) showed no significant differences for each angle tested (P>0.05). TS1 (#25.04) exhibited significant resistance reduction between 0° and 10° as well as between 0° and 20° (P<0.05), with no difference between 10° and 20° (P>0.05). Conclusion: Inclined angle of file access into the canals decreased cyclic fatigue resistance of #25.04 files especially when the radius of curvature is reduced. Cyclic fatigue resistance of #25.04 instruments was higher than #25.06 files made with the same thermal treatment. Independently from taper, each file tested in 3mm-radius canal showed lower cyclic fatigue resistance than instruments tested in 5mm-radius canal.
2019
- Influence of different motions on the cyclic fatigue resistance of Reciproc and Reciproc Blue endodontic instruments
[Articolo su rivista]
Serafin, M.; Biasi, M.; Franco, V.; Generali, L.; Angerame, D.
abstract
The aim of this study was to evaluate the cyclic fatigue resistance of Reciproc (RCP) and RPC Blue (RCPB) instruments used in continuous rotation, RECIPROC mode, and WAVEONE mode. Materials and Methods: Sixty RCP and 60 RCPB R25 files were used. For each file type, three groups (n = 20) were defined depending on the used kinematics: continuous rotation, RECIPROC mode, and WAVEONE mode. A stainless-steel artificial canal with 60 angle and 5-mm radius of curvature was milled reproducing the size and taper of the used files. The test device was electrically heated to 35C to simulate the clinical environment. All files were reciprocated or rotated until fracture. The time to failure and the length of the fractured fragments were measured. A fractographic examination was performed by scanning the electron microscopy to confirm the cause of fracture. Collected data underwent a two-way analysis of variance (a = 0.05). Results: RCPB files exhibited better cyclic fatigue resistance than RCP. The RECIPROC motion yielded greater cyclic fatigue resistance than the WAVEONE movement; the least resistance was observed in the continuous rotation groups. No significant differences were found among groups in terms of length of the fractured fragment. The fractographic analysis confirmed that all scanned samples separated due to cyclic fatigue. Conclusions: Within the limitation of the present study, the RECIPROC mode increased the cyclic fatigue resistance of the tested instruments compared to WAVEONE mode and continuous rotation. To prevent RCP and RCPB file separation, motion kinematics other than the native RECIPROC movement should be discouraged in the clinical setting.
2019
- Metallurgical characterization of Reciproc and Reciproc Blue Ni-Ti instruments
[Abstract in Rivista]
Generali, Luigi; Borghi, Alessia; Puddu, Pietro; Lusvarghi, Luca; Brancolini, SIMONE DOMENICO; Bertoldi, Carlo; Giannetti, Luca; Consolo, Ugo; Eugenio, Pedullà
abstract
Reciproc and Reciproc Blue files are composed of the same NiTi alloy but they undergo different thermal treatment. The Reciproc Blue show a titanium oxide superficial layer as confirmed by Raman spectroscopy and are more flexible than Reciproc M-Wire due to their different thermal treatment. The smaller and denser grains of Reciproc Blue files are responsible for the different transition temperatures of the two instruments.
2019
- The comparison of the proteomic profile of periodontal pocket and of corresponding gingival crevicular fluid to study periodontal disease biomarkers: feasibility study. biomarkers: feasibility study
[Abstract in Rivista]
Bertoldi, Carlo; Franceschetti, Filippo; Bergamini, Stefania; Giannetti, Luca; Generali, Luigi; Bellini, Pierantonio; Consolo, Ugo
abstract
Aim: Periodontitis is a set of inflammatory disorders characterized by periodontal attachment loss by periodontal pocket development, leading to tooth loss if remain untreated. The etiology and progress of periodontal disease is complex and remains mostly unknown. So, periodontal disease therapy has considerable limitations. The easy, reliable and correct early detection and control of the disease, markedly reduces biological and social costs. However, the diagnosis of periodontitis is established exclusively by clinical criteria based on probing to assess periodontal pockets, which are the pathognomonic expression of periodontal disease. The -omic sciences acquired substantial significance of late years and, in particular, proteomic seemed to be the more promising in this initial stage. Most proteomic analysis regarding periodontal diseases have been performed on saliva, crevicular fluid samples, peripheral blood or periodontal plaque samples which are more easily to harvest than the tissue of the periodontal pocket. However, they failed to provide reliable results for clinical applications. On the contrary, very few studies were directly performed on the periodontal pocket.
So, the aim of this study was to compare the proteomic profile of interproximal pocket tissues with that of GCF, and to analyze if they show a significant similarity in the proteomic profile.
Methods: in this preliminary study, we enrolled 3 healthy subjects affected by severe periodontitis needing of periodontal surgery. Immediately before the surgery, GCF samples were taken by means of filter paper strips positioned in the gingival sulcus correspondent to periodontal pockets. Then, periodontal pocket tissue, harvested during surgery, was adequately stored for proteomic analyses. All samples were immediately frozen at –80°C and maintained until further analysis. Tissue samples were mechanically disrupted and incubated in lysis buffer, while GCF was obtained incubating the collecting paper in phosphate buffered. In both cases, after centrifugation, the supernatant was precipitated in cold acetone overnight and protein content were pelleted by centrifugation and then dissolved in a rehydration buffer. Mono-dimensional gel electrophoresis was used to separate protein content. After staining gel images were acquired and compared. Liquid chromatography coupled to mass spectrometry (LC-MS/MS) analysis was performed to allow protein spot identification.
Results: 1-DE gels from periodontal pocket tissue and the correspondent GCF was analyzed by software Quantity One. Almost the same qualitative protein expression profile in pocket tissue and GCF was found from each patient. However, no statistical significant correlation between the quantitative proteomic profile of pocket tissue and GCF was found. Only one band (that of K immunoglobulin) resulted statistically significant between GCF and pocket tissue proteome in all patients.
Conclusions To date, this is the first study comparing the proteome of periodontal pocket tissue and corresponding GCF. The periodontal pocket and the GCF are similar as proteomic networks, but the protein network of the periodontal pocket does not influence significantly the GCF protein network and the other way around. So, with the limitations of this study, the preliminary results seem to indicate that the GCF does not seem suitable to study on the pathogenesis of periodontal disease explaining the reason for the failure of studies based only on GCF to control the periodontal disease in real-time.
2019
- The fate of root canals obturated with Thermafil: 10-year data for patients treated in a master’s program
[Articolo su rivista]
Pirani, C.; Zamparini, F.; Peters, O. A.; Iacono, F.; Gatto, M. R.; Generali, L.; Gandolfi, M. G.; Prati, C.
abstract
Objectives: Retrospective description of the 10-year success rate of endodontic treatments with Thermafil (TF). Materials and methods: Patients treated by postgraduate students in an Endodontics Master’s Program (2006–2008) were enrolled. All treated root canals were filled with TF and AH Plus. Teeth satisfying the inclusion criteria (206 teeth in 89 patients) were reexamined clinically and radiographically to estimate a 10-year survival and periapical health. Demographic and medical data were registered; collected information included pre-, intra-, and postoperative variables. Teeth were classified as “healthy” (PAI ≤ 2 in absence of signs/symptoms), “endodontically diseased” (presenting at least one of the following: PAI ≥ 3, signs/symptoms, retreated in the course of the follow-up, or extracted for endodontic reasons), or “non-endodontically diseased” (extracted for non-restorable fractures or periodontal disease). For teeth lost during the 10-year follow-up, details and reason of extraction were analyzed. Two PAI-calibrated examiners assessed outcomes blinded to preoperative status. Bivariate and multilevel analyses were performed (α level set at 0.05). Results: At 10 years, 179 (87%) teeth survived and 27 were extracted: 20 for non-endodontic reasons (excluded from success analysis) and 7 for endodontic reasons (considered “endodontically diseased”). Multilevel analysis revealed that the probability of extraction was increased by the presence of preoperative pain (odds ratio = 6.720; 95% confidence interval, 1.483–30.448) and by maxillary location (odds ratio = 2.950; 95% confidence interval, 1.043–8.347). Concerning periapical status, 159/186 teeth (85%) were assessed as “healthy.” Multilevel analysis confirmed that maxillary location (odds ratio = 3.908; 95% confidence interval, 1.370–11.146), presence of flare up (odds ratio = 9.914; 95% confidence interval, 2.388–41.163), and fracture occurrence (odds ratio = 35.412; 95% confidence interval, 3.366–372.555) decreased the odds of healing, respectively. Conclusions: After 10 years, teeth filled with Thermafil in a specialist master’s program presented a survival and a periapical health comparable to cohorts where root canals were filled with other obturation techniques. Clinical relevance: Carrier-based techniques provide time savings for clinicians while satisfying clinical quality criteria for the root filling and consequently the clinical outcome.
2018
- Are periodontal outcomes affected by personality patterns? A 18-month follow-up study
[Articolo su rivista]
Bertoldi, Carlo; Venuta, Marco; Guaraldi, Gianpaolo; Lalla, Michele; Guaitolini, Stefania; Generali, Luigi; Monzani, Daniele; Cortellini, Pierpaolo; Zaffe, Davide
abstract
OBJECTIVES: This research aims to study the relationship between personality traits and periodontal clinical outcomes by taking into account the level of anxiety and depression, periodontal health and oral hygiene behaviour of patients affected with gingivitis or moderate periodontitis requiring periodontal therapy.
MATERIAL AND METHODS: The periodontal data of 40 systemically healthy patients affected by gingivitis or moderate periodontitis were collected at baseline and 18 months later. The psychological variables, dental awareness and adherence intent of the patients were assessed through questionnaires, and only those patients that exhibited a higher degree of compliance were included in the study. The personality traits (cluster A: paranoid, schizoid, schizotypal; cluster B: borderline, antisocial, narcissistic, and histrionic; cluster C: avoidant, dependent, and obsessive-compulsive) and the level of anxiety and depression of the patients were assessed. Patients were instructed with oral hygiene measures and were treated with periodontal therapy.
RESULTS: Clusters A and B showed a consistent tendency for reduced levels of oral hygiene (increased full-mouth plaque score - FMPS). The results from cluster B were found to be significantly related to deep periodontal pockets at baseline. On the contrary, cluster C seemed to be linked to clinically better indices, particularly in terms of full-mouth-bleeding-score and pocket depth, both at baseline and 18 months later. The results collected from clusters B and C were directly correlated with anxiety, depression and FMPS. Moreover, anxiety was directly correlated with the patient's need for professional oral-care.
CONCLUSIONS: Personality traits appear to play a significant role in determining the therapeutic outcomes of periodontal therapy in themselves. Thus, it is ideal for several important psychological, affective or behavioural factors to be associated with various personality traits so as to orient the outcome of periodontal therapy.
2018
- BIOACTIVITY (APATITE FORMING ABILITY) OF COMMERCIAL AND EXPERIMENTAL POLYSILOXANE-GUTTAPERCHA ENDODONTIC SEALERS. CALCIUM RELEASING, ALKALINIZING ACTIVITY, ESEM-EDX MORPHOLOGICAL ANALYSIS
[Abstract in Atti di Convegno]
Prati, Carlo; Renzi, Teo; Zamparini, Fausto; Generali, Luigi; Giovanna Gandolfi, Maria
abstract
INTRODUCTION
There is a growing interest in sealers with bioactive (apatite forming) and biointeractive (release of biologically relevant ions) properties, especially when dealing with wide apices of immature and retreated teeth, root internal resorptions, blood contamination and refractory periapical lesions with large bone defects.
OBJECTIVES
The aim of this study was to assess the chemical properties (alkalinizing activity, calcium release) and the bioac- tivity (apatite forming ability) of experimental Polysiloxane-guttapercha Calcium Silicate-containing cements in simulated wet root canals.
The ability to nucleate calcium phosphate on their surface upon immersion in a simulated body fluid (SBF) has been evaluated using Environmental Scanning Electronic Microscopy (ESEM) and Energy-dispersive X-ray analy- sis (EDX).
MATERIALS AND METHODS
A polysiloxane-guttapercha based sealer (GuttaFlow 2, Coltène/Whaledent Inc.) was mixed with three different calcium silicates materials, namely Calcium Silicates and Di Calcium Phosphate (CaSi/DCPD), Calcium Silicates (CaSi) and Hydroxyapatite (CaSi/HA) and Bioroot RCS (Septodont, Saint-Maur-de-Fosses, France).
4 experimental formulations were obtained:
GuttaFlow 2 + 20% CaSi/DC GuttaFlow 2 + 20% CaSi/HAGuttaFlow 2 + 20% BioRoot RCS
GuttaFlow 2 + 30% BioRoot RCS
Materials were compacted into polyvinylchloride molds (8 mm diameter, 1.6 mm height; n=8 per group), imme- diately immersed in 10 mL of deionized water (pH 7.18) into polypropylene sealed containers and stored at 37°C. The soaking water was replaced at each endpoint (3 h and 1,3,7,14,28 days) and analyzed for pH and calcium content. Analyses were carried out under magnetic stirring at room temperature (24°C) by using a multiparameter laboratory meter (inoLab 750, WTW, Weilheim, Germany) connected to a selective electrode (Sen Tix Sur; WTW) for pH measurements or a calcium probe (Calcium ion electrode, Eutech Instruments Pte Ldt, Singapore.
ESEM (Zeiss EVO 50; Carl Zeiss, Oberkochen, Germany) connected to a secondary electron detector for energy dispersive X-ray analysis (EDX; Oxford INCA 350 EDS, Abingdon, UK) was used to investigate apatite forming abil- ity on samples immediately immersed in Hank Balanced Saline Solution (HBSS), after 3 and 28 days.
RESULTS
All the materials demonstrated the ability to alkalinize the pH from 3 hours to 24 hours. These values were con- stant until 28 days. Calcium release demonstrated a progressive increase from 3 hours to 28 days. After 28 days immersion in HBSS, a layer of CaP was detected on all the experimental samples.
DISCUSSION
Conventional Guttaflow 2 does not release calcium ions, nor proved to alkalinize the local environment. Sealers with bioactive (apatite forming) and biointeractive properties may represent a new frontier for endodontic ther- apy. Release of biologically relevant ions (i.e Ca++ and OH-) may be useful for mineralizing cells activation and proving a slight antibacterial activity. Moreover, an alkaline environment favours apatite precipitation. All these conditions may allow a faster healing of the periapical bone.
CONCLUSION
Nano spherulites particles were detected in all formulations. Their composition was mainly calcium-phosphate and apatite. EDX confirmed the presence of calcium and phosphate.
2018
- Cyclic Fatigue Resistance of Heat-treated Nickel-titanium Instruments after Immersion in Sodium Hypochlorite and/or Sterilization
[Articolo su rivista]
Pedullà, E; Benites, A; La Rosa, Gm; Plotino, G; Grande, Nm; Rapisarda, E; Generali, L
abstract
INTRODUCTION:
The purpose of this study was to assess the effects of sodium hypochlorite (NaOCl) immersion and sterilization on the cyclic fatigue resistance of heat-treated nickel-titanium (NiTi) rotary instruments.
METHODS:
Two hundred ten new 25/.06 Twisted Files (TFs; SybronEndo, Orange, CA) and Hyflex CM (Coltene Whaledent, Cuyahoga Falls, OH) files were divided into 7 groups (n = 15) for each brand. Group 1 (control group) included new instruments that were not immersed in NaOCl or subjected to autoclave sterilization. Groups 2 and 3 were composed of instruments dynamically immersed for 3 minutes in 5% NaOCl solution 1 and 3 times, respectively. Groups 4 and 5 consisted of instruments only autoclaved 1 and 3 times, respectively. Groups 6 and 7 recruited instruments that received a cycle of both immersion in NaOCl and sterilization 1 and 3 times, respectively. Instruments were subsequently subjected to a fatigue test. The surface morphology of fractured instruments was studied by field-emission scanning electron microscopy and x-ray energy-dispersive spectrometric (EDS) analyses. The means and standard deviations of the number of cycles to failure (NCF) were calculated and statistically analyzed using 2-way analysis of variance (P < .05).
RESULTS:
Comparison among groups indicated no significant difference of NCF (P > .05) except for the groups of TFs sterilized 3 times without and with immersion in NaOCl (P < .05). HyFlex CM files exhibited higher cyclic fatigue resistance than TFs when files were sterilized 3 times, independently from immersion in NaOCl (P < .05). EDS analysis showed the presence of an oxide-rich layer on the Hyflex CM files' external surface. No morphologic or chemical differences were found between files of the same brand subjected to different treatments.
CONCLUSIONS:
Repeated cycles of sterilization did not influence the cyclic fatigue of NiTi files except for TFs, which showed a significant decrease of flexural resistance after 3 cycles of sterilization. Immersion in NaOCl did not reduce significantly the cyclic fatigue resistance of all heat-treated NiTi files tested.
2018
- Cyclic fatigue resistance of Nickel-Titanium reciprocating instruments tested with an innovative kinematics
[Articolo su rivista]
Iacono, Francesco; Pirani, Chiara; Generali, Luigi; Rosaria Gatto, Maria; Giovanna Gandolfi, Maria; Prati, Carlo
abstract
Aim: To evaluate cyclic fatigue resistance of different Nickel-Titanium instruments tested with an innovative reciprocating kinematics.
Methodology: Eighty Nickel-Titanium reciprocating instruments were tested in cyclic fatigue resistance: WaveOne Primary (n = 20), WaveOne Gold Primary (n = 20), Reciproc R25 (n = 20) and Reciproc Blue R25 (n = 20). The cyclic fatigue of each brand was measured with two different motors and kinematics settings: (1) X-Smart Plus (Denstply Maillefer) used in ‘‘WaveOne All’’ or ‘‘Reciproc All’’ setting, according to manufacturer’s instruction; (2) a 4:1 contra-angle (Cefla, Imola, Italy) with an experimental kinematics (Goldspeed EVOE4 — Cefla, Italy) (EVO) with different rotation angles and based on a sinusoidal acceleration. The time to fracture in an artificial stainless-steel canal (908 angle and a 5-mm radius of curvature) was digitally recorded. Mean life, beta (failure rate) and eta (characteristic life i.e. the number of seconds at which 63.2% of the product has failed) were calculated for each group and compared with Weibull analysis. Results: InstrumentstestedwiththekinematicsEVOpresentedhighervaluesofetainallgroups. Reciproc Blue showed the highest eta value (233.05) and Wave One Gold the lower failure probability (46.98%). Wave One instruments showed similar fatigue resistance when tested with EVO or X-Smart.
Conclusion: Tested kinematics with different angles and based on sinusoidal reciprocating acceleration had a positive impact on fatigue lifetime of reciprocating instruments. Present findings suggest the possibility of future improvements in the clinical use of reciprocating files.
2018
- Effect of Self-Adjusting file and WaveOne reciprocating file on the filling ability of oval-shaped canals with thermoplasticized gutta-percha
[Articolo su rivista]
Generali, L; Cavani, F; Righi, E; Murri Dello Diago, A; Spinas, E; Giannetti, L
abstract
The aim of the study was to compare the effect of Self-Adjusting Files (SAF) and WaveOne Primary file with syringe and needle irrigation on the filling ability of oval-shaped root canals obturated with thermoplasticized gutta-percha. Twenty-four single root teeth with single oval-shaped root canals were distributed in two experimental homogeneous group. One group was instrumented and cleansed using the SAF system while in the other group the WaveOne system with syringe and needle irrigation was used. After instrumentation, the roots were filled by Thermafil Obturators and TopSeal sealer. Specimens were transversally sectioned at 2-, 5- and 7-mm levels from the apex and observed under light microscope. The percentage of gutta-percha filled area (PGFA), the percentage of sealer filled area (PSFA) and the percentage of voids area (PVA) were measured for each section, moreover the percentage of completely filled sections was evaluated. At all levels, no significant differences in terms of PGFA, PSFA, PVA and percentage of completely filled canals between groups were obtained (P > .05). On the contrary, when the data were pooled, the mean PGFA in the SAF group was 95.8%, whereas it was 93.2% in the WaveOne group (P < 0.05). The percentage of sections completely filled was 77.8% in the SAF group, while 52.8% in the WaveOne group (P < 0.05). Overall, the use of the SAF system in oval canals allows to obtain a significantly greater complete filling than the use of the WaveOne system.
2018
- Gingival tissue reaction to direct adhesive restoration: A preliminary study
[Articolo su rivista]
Bertoldi, C.; Zaffe, D.; Generali, L.; Lucchi, A.; Cortellini, P.; Monari, E.
abstract
Introduction: It is debated whether composite resin marginal/submarginal direct restoration can be usefully performed without inflammatory consequences. This histological study is the first human analysis aimed to compare, in the same tooth, the gingival tissue close to composite resin restorations with gingival tissue close to hard tissue. Methods: Eight healthy patients with almost a residual strategic tooth needing endodontic therapy, and post-and-core restoration, then indirect prosthetic restoration, were selected. Direct margin relocation with composite resin was necessary to perform endodontic treatment. The crown lengthening with a secondary flap harvested was necessary to perform prosthetic rehabilitation. Three months after marginal relocation, the secondary flap was harvested, embedded in PMMA, 4-μm sectioned, and stained to analyze the inflammation degree. Results: All patients completed post-and-core reconstruction and the planned prosthetic therapy, maintaining the stringent hygienic protocol plan. The inflammation level comparison, slightly lower in gingiva close to the teeth (3.62 ± 0.38) than in gingiva close to the composite (3.75 ± 0.26), results in a p-value of 0.11 after Wilcoxon test. Conclusions: Results highlight a minimal, statistically not significant difference in the inflammation degree after margin relocation, conceivably due to patients, teeth and cases selection, together with adopted stringent methodological and supportive measures.
2018
- Oral pemphigus
[Articolo su rivista]
Giannetti, Luca; Generali, Luigi; Bertoldi, Carlo
abstract
The involvement of the oral mucosa in patients affected by pemphigus vulgaris (PV), paraneoplastic, IgA pemphigus, and in some cases iatrogenic pemphigus is common and often a prelude to skin lesions. Intraepidermal bullae are caused by acantholysis, induced by IgG autoantibodies directed against the desmosomes and the domain of numerous keratinocytes self-antigens desmogleins (namely cadherins), thus supporting the autoimmune nature of the disease. Apoptosis may contribute to the acantholysis. Oral mucosal lesions are more commonly refractory to treatment compared to skin lesions and have been associated with disease duration, disease location and possibly the presence of HSV DNA in the oral cavity. Recent publications have stressed the positive role of Rituximab in early disease treatment.
2018
- Plaque accumulation on titanium disks with different surface treatments: an in vivo investigation
[Articolo su rivista]
Conserva, Enrico; Generali, Luigi; Bandieri, Alberto; Cavani, Francesco; Borghi, Francesco; Consolo, Ugo
abstract
Implants with rough surfaces are today widely used. It has been speculated that rough surfaces (Ra [ 0.2 lm) provide a better ‘‘substrate’’ for retention and accumulation of plaque in terms of area, thickness and colony- forming unit that can eventually lead to peri mucositis and/or peri-implantitis. The aim of this investigation was to evaluate in vivo the plaque accumulation after 48 h on three implant surfaces with different treatments. For this investigation, we used 21 sterilized titanium disks, with a diameter of 8mm and a thickness of 3 mm, provided by the manufacturer: 7 with machined surface, as smooth control, 7 with HA grit sand- blasted RBM surface and 7 with Ca?? incorporated in tita- nium Xpeed surface. One disk for each surface treatment was characterized at time 0 by SEM and AFM to study, respec- tively, the surface morphology and roughness. The other 18 disks were mounted randomly on three upper acrylic bites in a buccal lateral position, worn for 48 h by three volunteer stu- dents for plaque accumulation. After 48 h each disk was removed and analyzed qualitatively and quantitatively by an independent operator, not involved into the study, in order to avoid bias. Data collected were statistically analyzed by one- way ANOVA. The qualitative analysis showed no differences in terms of total plaque accumulation between the surfaces. Data from quantitative analysis using Anova Test showed no significance between all groups. In this in vivo investigation all the surfaces studied promoted plaque formation. The degree of surface roughness seems not to be a critical factor for plaque accumulation.
2018
- Sodium hypochlorite penetration into dentinal tubules after manual dynamic agitation and ultrasonic activation: a histochemical evaluation
[Articolo su rivista]
Generali, Luigi; Campolongo, Erica; Consolo, Ugo; Bertoldi, Carlo; Giardino, Luciano; Cavani, Francesco
abstract
The aim of this study was to compare the effects of Manual Dynamic Agitation and Passive Ultrasonic Irrigation on sodium hypochlorite (NaOCl) penetration into dentinal tubules using its bleaching ability. Thirty-four single-rooted teeth with round- shaped root canals were distributed in two homogeneous groups and one control group, characterized by different NaOCl activation systems: Manual Dynamic Agitation and Passive Ultrasonic Irrigation. After instrumentation, all root canals were stained with 10% copper sulphate solution followed by 1% rubeanic acid alcohol solution under vacuum. Final irrigation was performed with 5 mL of 5.25% NaOCl solution for 1 min and activated with Manual Dynamic Agitation or Passive Ultrasonic Irrigation for another 1 min depending on the treatment group. The teeth were transversely sectioned at the middle portion of the apical, middle, and coronal thirds and observed under light microscope. NaOCl solution penetration was evaluated by measuring the percentage of bleached circumference of the root canal relative to the stained circumference, bleached areas, mean, and maximum penetration depth. No differences in the evaluated parameters were observed between groups (p > 0.05). Within groups, an increase of values was recorded from apical to coronal direction as for percentage of staining, percentage of bleaching and bleached area. NaOCl penetration into dentinal tubules did not significantly vary among the three levels. No significant differences in penetration of sodium hypochlorite into dentinal tubules when activated by means of Manual Dynamic Agitation or Passive Ultrasonic Irrigation were observed in the apical, middle, and coronal thirds of teeth with single straight round root canals.
2018
- THE EVALUATION OF POST-OPERATIVE PAIN AFTER MULTIPLE-VISIT ROOT CANAL TREATMENTS WITH 2 DIFFERENT ROTARY NI-TI INSTRUMENT TYPES: A CLINICAL PROSPECTIVE STUDY
[Abstract in Atti di Convegno]
Pirani, Chiara; Karami Shabankare, Ashkan; Iacono, Francesco; Generali, Luigi; Zamparini, Fausto; Giovanna Gandolfi, Maria; Prati, Carlo
abstract
INTRODUCTION
The post-operative pain (PP) of mild intensity is a common consequence of root canal preparation and is con- sidered a complex multifactorial process. Many factors inherent to patients, to the tooth and to the skills of the operator can influence the prevalence of PP.
OBJECTIVES OF THE STUDY
To investigate the incidence of and the factors influencing the PP after root canal treatments (RCT) associated to 2 different NiTi rotary instruments and to test the study method on a pilot sample.
MATERIALS AND METHODS
This observational prospective study was conducted in the Endodontic Department, University of Bologna. Thir- ty-three consecutive patients requiring management of endodontic disease and responding to the inclusion cri- teria were selected. Written informed consent was obtained from every involved patient. RCT were performed in multiple-visit, avoiding the risk that post-obturation pain could alter the results. Patients were given a ques- tionnaire to record the intensity and duration of post-endodontic pain, to be returned during the following set- ting. The enrolled clinicians were both endodontists (n=2) and postgraduate master’s students (n=14) operating under the supervision of trained tutors. The patient was questioned about the presence of preoperative pain in the previous 24 hours. The presence of Peri-Apical Lesion was assured by a value of Peri-Apical Index (PAI) ≥ 3, following Ørstavik et al. directives. The Curvature Radius was divided in 3 groups (straight, moderate or severe). After gaining straight access and removing interferences, the working length was electronically established and confirmed by an intraoperative radiograph. A manual glide path was then achieved using K-files up to 20 size. Mechanical preparation was performed using 2 different NiTi rotary systems with rotational speed and torque value adjusted according to manufacturer instructions. Used irrigant solutions were 5% NaOCl alternated with 1 to 3 mL of 10% EDTA. Obturation of the canal space with resin cement and carrier-based system was performed after 7 days and the PP was recorded as described. Both demographic and clinical variables were recorded in order to study their correlation in the aetiology of PP: patient, shaping and tooth-related factors were registered and statistically analysed. Distribution, intensity and duration of PP were evaluated with the aid of a 100 mm Visual Analogue Scale (VAS) at 24, 48, 72 hours and 7 days after initial appointment. Mean value or frequency distribution were carried out to describe quantitative or categorical parameters. Friedman test and Wilcoxon tests were used in comparison of VAS among time and between values (instrumentation and obturation at each time). Kruskal-Wallis test was performed aiming to compare VAS among curvature degree. level was set at 0.05.
RESULTS
Mean value of preoperative VAS was equal to 3.4±3.5 cm. Preoperative visual analogue scale measurements were always significantly different from Vas instrumentation and for obturation at each time (p=0.001), except at 24h. Significant differences were observed concerning the presence of pre-operative pain among the PP curvature (p=0.02). As for VAS relative to instrumentation in comparison with obturation, the only significant difference was observed at 24h, being the first higher than the second (p=0.024). Generally VAS mean values relative to instrumentation are higher than those of obturation. No significant differences were observed in VAS among dif- ferent curvature degrees.
DISCUSSION
The VAS is commonly used to represent pain intensity because of its reliability and validity. The use of more flex- ible NiTi instruments can be considered an important factor in determining a lower incidence and intensity of PP, by reducing apical transportation and by avoiding to push debris apically.
CONCLUSION
The prevalence of PP after RCT was significantly affected by the presence of pre-operative pain.
2017
- Double dye technique and fluid filtration test to evaluate early sealing ability of an endodontic sealer
[Articolo su rivista]
Generali, Luigi; Prati, C; Pirani, Chiara; Cavani, Francesco; Gatto, M. R; Gandolfi, M. G.
abstract
Objectives
The aim of the present study is to evaluate the possible correlation between sealer penetration into dentinal tubules and sealing ability both in presence and absence of smear layer.
Materials and methods
Fourteen maxillary central incisors were treated with 5.25 % NaOCl +10 % EDTA to remove the smear layer (SL-free group) or 5.25 % NaOCl without EDTA (SL group). Root canals were filled using #25 Thermafil Obturators with Topseal sealer labelled with 0.1 wt% rhodamine B. Sealing ability was measured as fluid filtration rate with a fluid-flow meter using water supplemented with 0.3 % calcein fluorescent dye. Specimens were sectioned, observed under confocal microscope to co-localize the presence of sealer (rhodamine B labelling) into dentinal tubules and gaps (calcein labelling) into the root canal. The depth of sealer penetration into dentinal tubules and the percentage of sealer penetration around the root canal were measured at 3, 5 and 8 mm from the apex.
Results
No significant differences between groups were observed in fluid filtration rate nor in depth of calcein penetration. Sealer penetration depth and percentage into dentinal tubules were not significantly different between groups, except at 8-mm level in absence of smear layer.
Conclusion
Sealer penetration at 3- and 5-mm levels was not influenced by smear layer while it was significantly reduced at 8-mm level. Fluid filtration rate was not correlated either with depth of calcein penetration nor with sealer penetration into dentinal tubules.
2017
- Effect of Different Irrigation Systems on Sealer Penetration into Dentinal Tubules
[Articolo su rivista]
Generali, Luigi; Cavani, Francesco; Serena, Valentina; Pettenati, Corinne; Righi, Elena; Bertoldi, Carlo
abstract
Introduction: Different irrigation systems have been developed to improve the efficacy and distribution of the irrigants. The aim of this study was to compare the effect of conventional endodontic needle irrigation with other irrigant delivery and/or agitation systems on sealer penetration into dentinal tubules. Methods: Fifty single-rooted teeth with round-shaped root canals were distributed in 5 homogeneous groups character- ized by the different cleansing system used: conven- tional endodontic needle irrigation, EndoActivator, Irrisafe, Self-Adjusting File, and EndoVac. After instru- mentation, all teeth were filled by Thermafil obturators and rhodamine B dye labeled TopSeal sealer. Teeth were transversally sectioned at 2-, 5-, and 7-mm levels from the apex and observed under confocal laser scanning microscope. Maximum, mean, and percentage of sealer penetration inside tubules around the root canal were measured. Moreover, the integrity of the sealer layer perimeter was evaluated. Results: No significant differ- ences both in mean (p > .05) and in maximum penetra- tion depth (p > .05) were observed among groups, whereas both parameters showed an increased trend within each group from the 2- to the 7-mm level from apex. Similarly, the percentage of penetration around the root canal wall did not differ among groups (p > .05) and showed an increasing trend within each group from the apical to the coronal portion of the canal. Conclusions: Sealer penetration into dentinal tubules is not affected by the irrigant delivery and/or agitation sys- tems studied. Thermafil with TopSeal technique achieves complete sealer perimeter integrity in all groups.
2017
- Histochemical evaluation of activated sodium hypochlorite into human dentin
[Abstract in Rivista]
Generali, Luigi; Cavani, Francesco; Campolongo, Erica; Bertoldi, Carlo; Consolo, Ugo
abstract
Aim: The aim of this study was to evaluate ex vivo the penetration depth of sodium hypochlorite in human dentin, with manual and ultrasonic activation, using a histochemical staining technique under vacuum and the bleaching ability of NaOCl.
Methods: The root canals of 36 extracted single canal teeth were shaped to a size 30. .07 taper. Dentinal tubules were stained with 8% copper sulphate solution and 5% ammonium hydroxide followed by a 1% rubeanic acid alcohol solution under vacuum. The samples were irrigated for 1 min with 5mL of 5.25% sodium hypochlorite solution, then the irrigant was activated for 1 minute by Manual Dynamic Agitation (MAD) with K-file (Kerr, Italy) or Passive Ultrasonic Activation (PUI) with Irrisafe insert (Satelec Acteon group, Merignac, France), according to the corresponding treatment group. A cross-section was obtained in the central portion of each root third. Under microscopic examination, sodium hypochlorite penetration into dentin was evaluated by measuring the following parameters: bleached circumference of the root canal with respect to the stained circumference; bleached areas, mean and maximum penetration depth. For statistical analysis, Pearson’s chi-squared test and one-way ANOVA were used.
Results: Only 58% of the apical sections showed stained dentinal tubules; therefore, these were excluded from further comparisons. The percentage of copper sulphate-stained circumference of the root canals increased from the middle to coronal level in both groups, with a statistically significant difference (P<0.001).
In the middle and coronal third, the average root canal bleached circumference was 98-100% of the stained circumference, with no difference within and between groups, and the bleached area was 125490-298290 μm², respectively. The bleached circumference values (also those related to root canal) and bleaching areas of the coronal third were significantly higher than those recorded in the middle third in each group, while no differences between groups at the same level were observed. The mean penetration depth ranged from 63 to 69 μm and the maximum was from 96 to 106 μm, without inter- and intra-group differences (P = 1).
Conclusion: No differences in dentinal tubules penetration of 5.25% sodium hypochlorite solution were observed with manual and ultrasonic activation in the middle and coronal root thirds of single canal teeth.
2017
- How Intraday Index Changes Influence Periodontal Assessment: A Preliminary Study
[Articolo su rivista]
Bertoldi, Carlo; Forabosco, Andrea; Lalla, Michele; Generali, Luigi; Zaffe, Davide; Cortellini, Pierpaolo
abstract
It is reputed that periodontal indices remain unchanged over a 24-hour period, with great clinical significance. This preliminary study analyzes daily index changes. In 56 selected patients, full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), periodontal screening and recording (PSR) indices, and periodontal risk assessment (PRA) were recorded at baseline and three times per day (check-I: 08.30, check-II: 11.30, and check-III: 14.30), after appropriate cause-related therapy. Correlation between variables was statistically analyzed by Stata. All periodontal indices improved at the examination phase. Statistical differences were detected for FMPS comparing all thrice daily checks. Statistical differences were detected for FMBS and PRA comparing check-III with check-I and check-II. PSR showed no significant changes. The worst baseline indices produced the widest daily fluctuation at the examination phase. Significant variation of indices is directly related to clinical severity of periodontal conditions at baseline. Patients affected by severe periodontal disease may show significantly greater index changes. As indices are routinely recorded only once per day, the index daily variation has clinical significance. This greatly affects therapeutic strategy as correct periodontal assessment requires multiple evaluations at standardized times, particularly when baseline conditions are severe.
2017
- Impact of a modified kinematic on the fatigue life of reciprocating instruments
[Abstract in Atti di Convegno]
Pirani, C; Iacono, F; Generali, L; Gatto, Mr; Gandolfi, Mg; Prati, C.
abstract
Aim To evaluate the impact of a modified kinematic on the fatigue life of the existing reciprocating instruments.
Summary Cyclic fatigue of 80 nickel-titanium reciprocating instruments was tested by measuring the time to fracture in an artificial stainless steel canal with an angle of 90° and a 5-mm radius of curvature, using two different kinematics. Instruments were divided as follows: Group 1 (n=10) WaveOne Primary; Group 2 (n=10) WaveOne Gold Primary; Group 3 (n=10) Reciproc R25; Group 4 (n=10) Reciproc Blue R25. X-Smart Plus (Maillefer) endodontic motor was used respectively in “WaveOne All” or “Reciproc All” setting, according to manufacturer’s instruction. Other four groups of the same instruments (n=10) were tested using an innovative reciprocating kinematics (EVO) with different rotation angles and based on a sinusoidal acceleration, using a specific motor handpiece with a 4:1 contra-angle (CEFLA, Imola, Italy). The mean half-life, beta (failure rate) and eta (characteristic life i.e. the number of seconds at which 63.2% of the product has failed) were
calculated for each group and compared with Weibull analysis. At a number of seconds corresponding to the mean half-life, instruments tested with the kinematics EVO presented higher values of eta in all groups. Reciproc Blue showed the highest eta value (233.05) and Wave One Gold the lower failure probability (46.98%).
Key Learning Points
• The modified kinematic with different angles and based on sinusoidal reciprocating acceleration had a positive impact on fatigue lifetime of reciprocating instruments.
• Present findings suggest the possibility of future improvements in the clinical use of reciprocating files.
2017
- Impatto di una nuova cinematica sulla resistenza in fatica ciclica di strumenti reciprocanti
[Abstract in Atti di Convegno]
Iacono, Francesco; Pirani, Chiara; Generali, Luigi; Prati, Carlo
abstract
INTRODUZIONE
Il movimento reciprocante, introdotto negli anni '60 e ampiamente studiato dal prof. Riitano dagli inizi degli anni '70, è stato riproposto nel 2008 come alternativa alla rotazione continua degli strumenti NiTi. Due di erenti si- stematiche sono state introdotte sul mercato: Reciproc (VDW, Germany) e WaveOne (Dentsply, Switzerland), con modalità di reciprocazione prestabilite e motori dedicati. Recentemente è stata ideata un’innovativa cinematica reciprocante con accelerazione sinusoidale e angoli di erenti (EVO E4, Cefla, Italy), con l’obiettivo di migliorare gli aspetti dinamici della reciprocazione.
OBIETTIVI
Valutare l’impatto di una nuova cinematica sugli strumenti disegnati per il movimento di reciprocazione.
MATERIALI E METODI
La resistenza alla fatica ciclica di 80 strumenti NiTi reciprocanti è stata misurata in un canale arti ciale (ango- lo:90°; raggio 5mm) con diverse cinematiche di reciprocazione.
Sono stati testati 8 gruppi di strumenti (n=10): Gruppo 1 WaveOne Primary in "WaveOne All" con motore X-Smart Plus (Dentsply); Gruppo 2 WaveOne Gold Primary (Dentsply) in "WaveOne All" con X-Smart Plus; Gruppo 3 Reci- proc R25 (VDW) in "Reciproc All" con X-Smart Plus; Gruppo 4 Reciproc Blue (VDW) R25 in "Reciproc All" con X-Smart Plus. Altri 4 gruppi sono stati testati utilizzando la nuova cinematica di reciprocazione (EVO E4, Cefla), con angoli di erenti e basata sul concetto di accelerazione sinusoidale, utilizzando uno speci co motore sperimentale con contrangolo 4:1 (CEFLA). Gruppo 5 WaveOne Primary in modalità "WaveOne" con sistema EVO E4 (CEFLA); Gruppo 6 WaveOne Gold Primary in "WaveOne" con EVO E4; Gruppo 7 Reciproc R25 in modalità "Reciproc" con EVO E4; Gruppo 8 Reciproc Blue R25 in "Reciproc" con EVO E4. L’analisi statistica Weibull è stata utilizzata per calcolare e confrontare la media (mean life), beta (failure rate) e eta (il numero di secondi cui il 63.2% degli strumenti ha fallito).
RISULTATI E DISCUSSIONE
In ogni gruppo, gli strumenti testati con innovativa cinematica EVO E4 hanno dimostrato un tempo medio (mean life) di frattura superiore agli strumenti testati con cinematiche convenzionali. I Reciproc Blue hanno mostra- to i più elevati valori di resistenza (233.05, eta) mentre i WaveOne Gold la più bassa probabilità di fallimento (46,98%). I risultati hanno confermato che le leghe trattate termicamente (Blue e Gold) hanno migliori proprietà meccaniche rispetto alle leghe della generazione precedente (M-Wire). La nuova cinematica di reciprocazione ha dimostrato avere un impatto positivo sulla fatica ciclica.
I risultati di questo studio aprono nuovi scenari sulle dinamiche di utilizzo dei sistemi reciprocanti ad oggi di- sponibili.
2017
- Push-out bond strength of traditional and hollow fiber post cemented with a dual-curing self-adhesive resin
[Abstract in Rivista]
Generali, Luigi; Sassatelli, Paolo; Piergianni, V; Lusvarghi, Luca; Bertoldi, Carlo; Consolo, Ugo
abstract
Aim: The purpose of this study was to evaluate the push-out bond strength of traditional glass fiber post and newly marketed glass fiber hollow post, both cemented using a dual-curing self-adhesive resin.
Methods: Seven extracted human premolars with single canals were selected for the study. The crowns were removed using a size 701 high speed fissure bur. The root canals were mechanically prepared using ProTaper Universal until #F4 instrument and they were obturated using Thermafil Obturator #F4. A post space was obtained drilling a 7mm depth hole with a pre-calibrated 1.2mm diameter tip. Prepared teeth were randomly divided in two groups: a full post was luted in Group 1 (n=3), while a hollow post in Group 2 (n=4) by using a dual-curing self-adhesive resin cement. Treated tooth were mounted in resin blocks and sectioned perpendicular to the long axis of the root canal. Six 500 µm thick slices were obtained from each specimen. The push-out test was performed on each slice. Student’s t-test was used to compare push-out bond strength values between the two group. While comparisons of push out bond strength values among root region (cervical, middle and apical part), for each group, were performed with one-way ANOVA test. After the push-out test all specimens were analysed by scanning electron microscope (SEM) to determine the fracture patterns.
The cross section of both the full and hollow posts were studied by SEM and EDS analysis to evaluate the amount and distribution of the glass fiber, as well as their chemical composition. The cross sections were prepared by embedding the samples into epoxy resin., The embedded samples were then grounded and polished on a plane orthogonal to the long axes of the sample until a complete exposure of the post cross section.
Results: Push-out bond strength of Group 2 was significantly higher than that of group 1, respectively 6.38 MPa ±1.59 and 2.23 ± 3.64 MPa. No differences were observed between the three root regions (cervical, middle and apical part) in the same group. In both group the predominant failure mode, observed in 50% of the samples in Group 1 and in 44.4% of the samples in Group 2, was represented by mixed fracture, with resin cement covering 0-50% of the post diameter. In the hollow post, the glass fibers appeared of similar to each other and homogeneously arranged within the matrix. Differently, in the full post, fibers with different size with a lower homogenous arrangement where observed. Also, a different chemical composition of the glass fiber in the two posts was observed. The hollow post contain mainly SiO2, Al2O3 e CaO, whereas full post are predominantly composed of silica.
Conclusion: The glass fiber hollow post showed significantly higher bond strength values compared to the glass fiber full post cemented using the same dual-curing self-adhesive resin.
2017
- Sodium hypochlorite solution penetration into human dentine: a histochemical evaluation
[Articolo su rivista]
Giardino, L.; Cavani, Francesco; Generali, Luigi
abstract
Aim To evaluate ex vivo the penetration depth of sodium hypochlorite solutions, with and without surfactants, into human dentine using a histochemical stain and the bleaching ability of NaOCl. Methodology Extracted maxillary central incisors were decoronated and their root canals shaped to a size 30, .07 taper. Dentinal tubules were stained with 10% copper sulphate solution followed by a 1% rubeanic acid alcohol solution under vacuum. Specimens were irrigated with 5 mL of Niclor 5 (5.25% NaOCl solution) or 5 mL of Hypoclean (5.25% NaOCl solution + surfactants) according to the corresponding treatment group, for 2 minutes. A transverse section was obtained in the middle portion of the apical, middle and coronal third of each tooth. Under microscopic examination irrigant penetration was evaluated by measuring: the bleached circumference of the root canal with respect to the stained circumference; bleached areas, mean and maximum penetration depth. For statistical analysis, Pearson Chi-squared test and one-way ANOVA were used.
Results Only 30% of dentine tubules in the apical portions were stained, therefore these were excluded from further comparisons. In the middle and coronal thirds the average bleached circumference of the root canal was 80-99% of the stained circumference, the bleached area was 73757 - 135107 μm2. The average penetration depth ranged from 39 to 62 μm and maximum penetration from 74 to 131 μm. For all reported results no differences within and between groups were found (P = 1).
Conclusion No differences in penetration of irrigants with and without surfactants into dentinal tubules were found in middle and coronal third of incisor teeth.
2017
- Structural analysis of HyFlex EDM instruments
[Articolo su rivista]
Iacono, F.; Pirani, C; Generali, Luigi; Bolelli, Giovanni; Sassatelli, Paolo; Lusvarghi, Luca; Gandolfi, M. G.; Giorgini, L.; Prati, C.
abstract
Aim To compare the phase transformation behaviour, the microstructure, the nano-hardness and the surface chemistry of electro-discharge machined HyFlex EDM instruments with conventionally manufactured HyFlex CM.
Methodology New and laboratory used HyFlex EDM were examined by X-ray diffraction (XRD) and differential scanning calorimetry (DSC). Nano-hard- ness and modulus of elasticity were also investigated using a maximum load of 20 mN with a minimum of 40 significant indentations for each sample. Raman spectroscopy and field emission-scanning electron microscope (FE-SEM) were used to assess the surface chemistry of HyFlex EDM. HyFlex CM were subjected to the same investigations and used as a comparison. Nano-indentation data were statistically analysed using the Student’s t-test.Results XRD analysis on HyFlex EDM revealed the presence of martensite and rhombohedral R-phase, while a mixture of martensite and austenite structure was identified in HyFlex CM. DSC analysis also dis- closed higher austenite finish (Af) temperatures for electro-discharge machining (EDM) instruments. Significant differences in nano-hardness and modulus of elasticity were found between EDM and CM files (P < 0.05). FE-SEM and EDS analyses confirmed that both new EDM and CM files were covered by an oxide layer. Micro-Raman spectroscopy assessed the presence of rutile-TiO2.
Conclusions HyFlex EDM revealed peculiar structural properties, such as increased phase transformation temperatures and hardness. Present results corroborated previous findings and shed light on the enhanced mechanical behaviour of these instruments.
2017
- The personality traits, anxiety and depression, produce different periodontal outcomes: a 18-month follow-up study
[Abstract in Rivista]
Bertoldi, Carlo; Generali, Luigi; Ferrari, M; Lalla, Michele; Venuta, Marco; Consolo, Ugo
abstract
Aim: Psychological attitude, depression, anxiety and oral hygiene on oral health have been recorded and correlated in subjects with untreated periodontal conditions. Methods: Periodontal data of forty systemically healthy-patients, affected by moderate periodontitis, were collected at baseline and 18 months later. The dental belief (DBQ) was self-administered to patients: a health-value scale (HV); two adherence-intent scales (AI1, AI2), were scored separately. The psychological variables were assessed by questionnaires administered by one expert operator. Personality traits were grouped into cluster including all the personality traits (cluster-A: paranoid, schizoid, schizotypal; cluster-B: borderline, antisocial, narcissistic, histrionic; cluster-C: avoidant, dependent, obsessive-compulsive) anxiety and depression were also assessed. Patients were instructed to oral hygiene measures, treated with cause-related therapy and with adjunctive surgical therapy, when needed. Data were expressed as mean ± standard deviation (m±SD). The comparisons were performed by nonparametric tests, Spearman correlation coefficients between variables were calculated and the relationships between the dependent variables and the independent ones were examined through the standard multiple regression models. The alpha Cronbach reliability coefficient for each HV, AI1 and AI2 scales was calculated by the item analysis procedure of Stata. The level of significance of the applied tests was the standard value P=0.05. Statistical analysis was performed by Stata, version 14.00. Results: Cluster-A and B showed a consistent tendency for reduced levels of oral hygiene (increased full-mouth-plaque-score -FMPS), independently by therapy and supportive periodontal therapy scheme applied. This effect appeared particularly enhanced in correlation with poorly compliant attitude and unfavorable baseline dental indices. On the contrary, cluster-C seemed to be linked to clinically better indices, particularly in terms of full-mouth-bleeding-score (FMBS) and pocket depth. Anxiety resulted directly correlated with depression, cluster-B and C, but inversely with FMPS and the patient’s requirement for professional oral-care. Additionally, depression was directly correlated with FMBS. Conclusions: Anxiety and depression, both affective disturbances, have a reciprocal link, and opposite effect on plaque and bleeding score. Personality traits (stable throughout life) play a significant role in periodontal condition and therapy outcomes that are not entirely ascribable to the lack of observance of oral hygiene rules, since study design and statistical analysis take in account also hygienic and behavior parameters. The knowledge of psychological traits of patients but also of anxiety and depression score, could greatly improve periodontal treatment outcomes.
2016
- Effects of titanium brushes on different implant surfaces: an in vivo investigation
[Abstract in Rivista]
Conserva, Enrico; Bandieri, A.; Bellini, Pierantonio; Generali, Luigi; Sabbadini, L.; Agnini, A.; Consolo, Ugo
abstract
BACKGROUND: Recently, rotating brushes with titanium bristles have been introduced for the debridement of implant surfaces when peri implant problems occur. This study inves- tigated the effects induced by titanium brushes on different implant surfaces previously contaminated in vivo METHODS: n°9 disks, going sterilized directly from manu- facturer, (Megagen Implant Co, Ltd, Korea) (n=3 with HA grit sandblasted RBM surface; n=3 with a Ca2+ incorporated in titanium XPEED surface and n=3 with machined surface) Ø 8mm x 3mm were used for this investigation. N°1 disk for each surface treatment (tot. n°3 disks) were characterized at time 0 by SEM to study the surface morphology and by AFM to study the surface roughness. The other six disks were mounted on an acrylic bite embedded in a buccal lateral posi- tion (three for each side) worn for 48 hours by a student from Dental School, for biofilm accumulation. After 48 hours each disk was removed and randomly assigned to the control group (to study only plaque accumulation) and to the test group (toinvestigate the effects of the cleaning procedure using tita- nium brushes). All disks were treated by the same operator. The Nickel-Titanium brushes (I.C.T. De Ore, Verona, Italy) were used (one for each disk treated) mounted on a handpiece at 500 rpm speed and 100 N torque for 60 sec time with a calibrated pressure of 25 gr and a continue irrigation of NaCl 0.9%. All disks were then analyzed by SEM at 40x, 500x and 2000x, also in backscattering, and by AFM for the Ra (medium value of roughness) and Rp-v (max peak-max depth value) measurement. All Ni-Ti brushes used were analyzed by SEM and compared to a no used one.
RESULTS: The MACHINED surface, after instrumentation, appeared well cleansed. However, the SEM images, revealed considerable surface alterations following treatment. The roughness values increased. The RBM surface showed a mini- mum percentage of residual material and after cleaning had some morphological changes. The typical RBM sandblasted structure appear flattened. The roughness values confirm this change by the reduction in value of R p-v. The cleaning effi- cacy of the brush on the XPEED surface was excellent but the surface morphology changed. The SEM images showed the presence of grooves and flattening caused by the use of brush that have eliminated most of the irregularities and of the peaks, confirmed by the roughness values measured. The EDX spectroscopy provided the evidence that part of the Ca ++ ions coating remains on the surface even after treatment. The statistical analysis shows that the Ra difference was statis- tically significant. (p<0.5) The brush used for Xpeed surface is the only one, among those used, that appeared more com- promised after its use. The bristles are very twisted. CONCLUSIONS: In conclusion we can say that the trial of toothbrushes NiTi has shown a good efficacy of cleansing on rough and smooth surfaces. The efficiency of the treatment was, however, accompanied by a visible change in the surface characteristics. While the machined surface at the end of treat- ment showed an increase of roughness values, the rough sur- faces undergo a flattening process with consequent decrease of the roughness measurements. Further studies will be needed to verify if and how these morphological changes will affect biological processes of healing.
2016
- Efficacy of three different irrigation systems on calcium hydroxide removal from round and oval canals: a scanning electron microscopy study
[Abstract in Rivista]
Generali, Luigi; Franceschetti, F.; Cavani, Francesco; Pettenati, C. .; Bellini, Pierantonio; Conserva, Enrico; Consolo, Ugo
abstract
BACKGROUND: To evaluate by means of scanning electron microscopy the effectiveness of different irrigation systems in the removal of calcium hydroxide from round and oval canals. METHODS: 76 extracted single-rooted teeth were selected. Criteria for tooth selection included one single root canal; no visible root caries, fractures, or cracks; and a completely formed apex under light microscope examination (10x). Radiographs in bucco-lingual and mesio-distal direction were taken to cal- culate the ratio between canal diameters measured in the two projections. If ratio was less than or equal to 2.5, the canal was considered round, otherwise was considered oval. According to ratio and root length teeth were divided into 8 groups, with 2 control samples. After access cavity preparation, working length was determined 1 mm short of the length where the file extruded the apical foramen. To simulate clinical conditions the apex was sealed with glue. Glide path and canal instrumentation were performed with Path File size 13, 16, 19 and ProTaper Universal rotary system in a crown-down sequence to size 40 at the WL. A size 25 lentulo spiral was used to fill teeth with calci- um hydroxide. Radiographs were taken to confirm the complete filling of the canals. Samples were kept in an incubator at 37° C for a week. Canals were cleaned with Irrisafe, Endovac, Xp Endo Finisher and conventional endodontic needle irrigation. Teeth were split along their long axis in a bucco-lingual direc- tion into 2 halves. For scanning electron microscopic analysis, tooth halves were fixed on aluminum stubs, gold sputter coated and observed with a scanning electron microscope. Apical, middle, and coronal thirds were established by dividing the roots according to their length. The center of each third was examined at 500x magnification. Images were taken using backscattered mode and analyzed with a digital processing software (ImageJ v. 1.49, National Institutes of Health, NIH, USA) for a quantitative analysis. The efficacy of the irriga- tion system was evaluated calculating the amount of calcium hydroxide left inside the canal, expressed as percentage of the total area of the image. To compare the 8 groups, the results were statistically analyzed using the analysis of variance test (ANOVA) with Bonferroni test or T-test (P<0.05). RESULTS: No statistically significant differences were observed among different thirds for each group. Comparing canal shape for each instrument, significant differences were found only for Endovac, where coronal and middle thirds of oval canals were cleaner than round ones.
Analyzing the whole canal, significant difference can be found between irrigation systems and conventional irrigation in the oval ones. In round canals Irrisafe and Xp Endo Finisher are more effective compared to conventional irrigation, but only Irrisafe is more effective compared to Endovac. No statistical- ly significant differences can be observed between Endovac and conventional irrigation.
CONCLUSIONS: None of the investigated techniques removed the calcium hydroxide completely. However, the results demonstrate greater removal of calcium hydroxide if the irrigant solutions are activated, compared with conven- tional endodontic irrigation. Therefore, it is recommended to activate the irrigant solutions to enhance chemical debride- ment of the root canal system.
2016
- Epithelioid hemangioendothelioma of the mandibular gingiva: report of a case and literature review
[Abstract in Rivista]
Bellini, Pierantonio; Setti, G; Borghi, F; Conserva, Enrico; Bertoldi, Carlo; Generali, Luigi; Consolo, Ugo
abstract
BACKGROUND: Malignant epithelioid hemangioendothelioma, or high-risk epithelioid hemangioendothelioma, is a low- to intermediate-grade vascular malignancy originally described by Weiss and Enzinger in 1982 as a vascular neo- plasm of endothelial origin. Epithelioid hemangioendothelio- mas have been reported in numerous locations, particularly the lungs, liver, soft tissues, viscera, skin, and bone. The World Health Organisation describes MEH as an intermedi- ate malignant neoplasm. MEHs are extremely rare in the oral cavity. Only eleven cases referred to MEH of the maxillary or mandibular gingiva.
CASE REPORT: A 33-year-old male was referred to our Oral and Maxillofacial Service in 2009 for the evaluation of a forma- tion on the alveolar mucosa. A panoramic radiograph review showed a radiolucency between lateral incisor and second pre- molar roots. CT scans showed diffuse cortical bone loss. No signs of radiographic root resorption were detected. The patient denied any history of pain or swelling. A tissue punch biopsy was performed by removing two punches of tissue.
A microscopic evaluation revealed fragments composed of a proliferation of spindled, ovoid, and epithelioid cells arranged in nests, cords, and short strands. The neoplastic cells were large and polygonal with an abundant and granular cytoplasm, nuclear pleomorphism, and nuclear hyperchromatism. The lesion exhibited small vascular channels with a moderate cel- lular inflammatory infiltrate, composed mainly of lympho- cytes, plasma cells, and eosinophils surrounding the vessels. Focal mitotic activity was identified, and the Ki-67 percentage score was 20%. After immunohistochemistry a diagnosis of MEH was made. No signs of metastasis were detected (cN0) by an investigation of the patient’s neck nodes, computed tomography, and ultrasonography.
Anterior mandibular bone excision, including eight teeth and all related soft tissues, was performed under general anesthesia. A histologic examination of the lesion confirmed the diagnosis of MEH. The limits of resection were investigated to ensure clean and safe excision margins. No neck dissection was performed at this time.
The patient was followed up at 15 days, 1 month, 3 months, 6 months, and then every 6 months for 4 years with a clinical investigation of soft tissues, clinical and ultrasonographic evaluations of lymph nodes, and radiographic assessment of bone healing. The entire follow-up period was 46 months. DISCUSSION: No consistent clinical or histologic criteria for predicting the biologic behavior of MEHs have been identified. A higher mortality rate is observed when epithelioid hemangioendotheliomas occur in bone, liver, or the lungs; therefore, the importance of immunohistochemical analyses to establish a definitive diagnosis should be emphasised. In this context, the majority of intraoral epithelioid hemangioendothelioma lesions were immunoreactive for CD34, CD31, fac- tor VIII-Rag, and vimentin, which characterise the epithelioid endothelial origin of this entity.
It was not possible to identify common risk factors for MEH. The literature review indicated a mean age at diagnosis for MEH of 17±13.01 years, suggesting a predisposition to dis- ease in young people.
Systemic metastases have been described in the literature at a rate of 21%, and a mortality rate of 17% has been described for cutaneous MEH, in accordance with the histological aspects of the malignancy. In gingival MEH no metastases has been described in literature before our report.
Due to the potential malignancy of epithelioid hemangioen- dotheliomas, wide local excision is the treatment of choice for oral cavity cases according to the literature.
The mean recurrence time was 21.33±23.44 months. Given the possibility of recurrence and metastasis several years after clean and safe excision, clinicians should apply at least 5 years of follow-up.
2016
- HyFlex EDM: superficial features, metallurgical analysis and fatigue resistance of innovative electro discharge machined NiTi rotary instruments
[Articolo su rivista]
Pirani, C.; Iacono, F.; Generali, Luigi; Sassatelli, Paolo; Nucci, C.; Lusvarghi, Luca; Gandolfi, M. G.; Prati, C.
abstract
Aim
To evaluate the surface and microstructural alterations of new and used HyFlex EDM prototypes and to test their fatigue resistance.
Methodology
Fifteen HyFlex EDM prototypes were used for in vitro instrumentation of severely curved root canals. Surface and microstructural characteristics of new and used files were compared by ESEM analysis equipped with energy dispersive X-ray spectrophotometry (EDS) and optical metallographic imaging. Usage-induced degradation was assessed. Thirty additional HyFlex EDM prototypes and 20 standard manufactured HyFlex CM files were subjected to cyclic fatigue tests. Time to fracture was recorded, and results were validated using the Kruskal–Wallis test (α-level 0.05). Fatigued files were analysed by ESEM for fractographic evaluation.
Results
Surface and microstructural characterization of EDM prototypes revealed the typical spark-machined surface of a NiTi EDM alloy. No fractures were registered during root canal instrumentation. No evident surface alterations and minor degradation were observed between new and used instruments. The metallographic analysis of new and used files disclosed a homogeneous structure, mostly composed of lenticular martensite grains, and some residual austenite. The cyclic fatigue test showed an increase of fatigue resistance up to 700% on the EDM compared to CM files.
Conclusions
Spark-machined peculiar surface is the main feature of HyFlex EDM. Low degradation was observed after multiple canal instrumentations. Prototypes exhibited surprising high values of cyclic fatigue resistance and a safe in vitro use in severely curved canals.
2016
- Influence of Temperature on the Antibacterial Activity of Sodium Hypochlorite
[Articolo su rivista]
Giardino, Luciano; Mohammadi, Zahed; Beltrami, Riccardo; Poggio, Claudio; Estrela, Carlos; Generali, Luigi
abstract
The aim of this study was to compare the antimicrobial activity of 5.25% NaOCl, Hypoclean and Chlor-Xtra at 20 °C and 45 °C in bovine root dentin. One-hundred-and-seventy dentin tubes prepared from bovine maxillary incisors were infected for 21 days with Enterococcus faecalis. The specimens were divided into the following groups: 1. 5.25% NaOCl 20 °C; 2. Hypoclean 20 °C; 3. Chlor-Xtra 20 °C; 4. 5.25% % NaOCl 45 °C; 5. Hypoclean 45 °C; 6. Chlor-Xtra 45 °C; 7. positive control; 8. negative control. Dentin chips were collected with round burs into Brain Heart Infusion (BHI) broth. After culturing, the number of colony- forming units (CFU) was counted. Statistical analyses were performed using descriptive statistics (mean, standard deviation, median), Shapiro-Wilk test, ANOVA and Tukey test. Significance level was set at p<0.05. In all experimental groups, CFU was minimum after treatment (day 0) and the obtained results were significantly different from each other at any period (p<0.05). After treatment, the Hypoclean and Chlor-Xtra showed the lowest numbers of CFU at 20 °C and 45 °C, whereas 5.25% NaOCl showed the highest number of CFU at both temperatures. In each group, the number of CFUs increased significantly with time (p<0.05). The antibacterial activity of Hypoclean and Chlor-Xtra at 45 °C were significantly greater than other tested solutions.
2016
- Influence of different irrigation techniques on sealer penetration into dentinal tubules: a confocal laser scanning microscope analysis
[Abstract in Rivista]
Generali, Luigi; Serena, V; Cavani, Francesco; Righi, Elena; Pettenati, C; Bellini, Pierantonio; Consolo, Ugo
abstract
BACKGROUND: The instrumentation of roots canals pro- duces smear layer, which consists of organic and inorganic material and may also contain bacteria and they by-products. This layer covers the root canal walls, could obliterate den- tinal tubules and consequently can inhibit the penetration of irrigants and endodontic sealers. To obtain a good seal is necessary to use an endodontic sealer in association with a core filling material in order to fill any voids, morphological irregularities, apical deltas and dentinal tubules and to create an obturation as much as possible impervious. The aim of the study was to compare the effect of conventional endodontic needle irrigation and different irrigation systems on sealer penetration into dentinal tubules.
METHODS: 40 single round root canals were selected and divided into four groups (n=10) before root canal preparation according to the final irrigation protocol: group 1 (conventional endodontic needle irrigation), group 2 (EndoActivator) group 3 (Irrisafe) group 4 (EndoVac). The root canal were shaped using Path File and ProTaper Universal rotary system in a crown-down sequence to size #40 at the WL. Obturation of the teeth was done with Thermafil Obturators size 40 with TopSeal sealer labeled with 0,1% wt Rhodamin B dye. Transverse sec- tion at 2-, 5- and 7-mm from the apex were analyzed by means of confocal laser scanning microscopy. Percentage of pen- etration around the root canal and the mean penetration into dentinal tubules at eight standardized points were calculated. RESULTS: No significant differences in percentage of pen- etration around the root canal and mean penetration depth into dentinal tubules were observed among groups when same levels were compared. Within each group both variables are significantly higher at the coronal and middle level with respect to the apical one.
CONCLUSIONS: The use of the techniques employed in the present study did not significantly improve the sealer pen- etration into dentinal tubules compared with conventional endodontic needle irrigation.
2016
- Oral atrophic lichen planus and oral lichenoid lesion malignant transformation: report and management of two cases
[Abstract in Rivista]
Bellini, Pierantonio; Setti, G; Mataca, E; Conserva, Enrico; Bertoldi, Carlo; Generali, Luigi; Consolo, Ugo
abstract
BACKGROUND: There is an ongoing debate in the literature whether patients with oral lichen planus (OLP) carry an increased risk of developing a squamous cell carcinomas. Nevertheless, there is a tendency to accept that there is. The annual malignant transformation rate amounting less than 0.5%. This chronic disorder mainly affects middle-aged people. The etiopathogenesis is still poorly understood. There is no effective treatment and there are no preventive measures either. An important obstacle in the discussion on the possible potentially malignant character of oral lichen planus is caused by the lack of clear clinical and histopathologic diag- nostic criteria of oral lichen planus, resulting in a poor clin- icopathologic correlation in the diagnosis. One of the major problems of interpretation of malignant potential studies of OLP is the inexistence of strict diagnostic criteria to differentiate lichenoid processes. Some studies have included cases of OLP with OLL and vice versa. The differentiation between OLP and OLL has become important, since the latter might have a greater malignant potential. For this reason, it is important to establish precise clinical and histopathological criteria of differentiation of the lesions.
CASE REPORT: 1st) A 73 years old woman with a 12 months histological diagnosis of oral lichen planus localized on tongue dorsum, previously biopsied and studied in a differ- ent structure, came to our attention to investigate an ulcerative lesion on tongue midline. No smoking habit, alcohol abuse, anemia or previous malignancies diagnosis were referred; topical corticosteroid therapy was referred.
An incisional biopsy was performed showing lichenoid lesion, atypia and high grade of dysplasia at histological examination. Subsequently, lesion was radically removed with wide excision margins. Microscopic examination returned diagnosis of mild differentiated squamous cell carcinoma arose on lichenoid lesion. Resection margins were clean without perineural or vascular invasion.
After 18 months follow-up, symptoms of dull pain and burn sensation were referred. Tongue dorsum was macroscopically altered, with an ulcer-like lesion surrounded by edematous mucosa. Consequently, an incisional biopsy was performed showing the presence of a low differentiated squamous cell carcinoma. Lesion was radically excised, margins were widened and examined with frozen sections. Patient underwent to bilateral SND (level I-III) and RTP.
Histological examination returns a diagnosis of recurrent pT1 pN1 micro-invasive squamous cell carcinoma. Microscopic signs of lichenoid lesion were still evident.
2nd) A 74 years old woman, with a 20 months history of
2016
- The protein expression network in periodontal pocket tissue: a preliminary study
[Abstract in Rivista]
Bertoldi, C; Monari, E; Generali, L; Franceschetti, F; Bellini, P; Salgarelli, Ac; Consolo, U
abstract
Background and Objective
The periodontal disease (PD) is caused by a set of inflammatory disorders characterized by periodontal pocket formation that lead to tooth loss if untreated.
Periodontitis diagnosis is only based on clinical assessment only, in the absence of a reliable pathogenic check based on appropriate interpretation of inflammation.
A modern pathogenic model based on a multilevel framework including disease-initiating and -resolving mechanisms is requested. Studies on PD utilizing proteomic analysis have been performed on saliva or crevicular fluid samples, peripheral blood or periodontal plaque samples, but not on the pathologic tissue of the periodontal pocket, which is the key lesion of the PD.
The aim of this work was to compare the proteomic profile of the pathologic interproximal gingival pocket tissue with the corresponding of interproximal gingival healthy tissue, obtained from sites where no periodontal-pathogenic bacteria were detectable.
Materials and methods
Twenty healthy subjects (T, test group), affected by chronic PD and twenty periodontally healthy subjects (C, control group), were enrolled in the study. T subjects underwent to the periodontal resective treatment, while C subjects underwent to the crown lengthening surgical treatment. To characterize the proteomic profile of periodontally-affected patients, their interproximal periodontal pocket tissue was compared with that of periodontally-healthy patients. Pocket-associated and healthy tissue samples, harvested during surgical therapy, were treated to extract the protein content. Tissues were always collected at sites where no periodontal-pathogenic bacteria were detectable. 2DE (Two-dimensional gel electrophoresis) and LC-MS/MS (Liquid Chromatography-tandem mass spectrometry) analysis were performed for T and C gingival tissue samples to separate and identify the proteins. Web-based bioinformatics tools (iPROClass and CateGOrize) were employed to investigate all potential localizations, molecular functions and biological processes of the identified proteins. After identification, proteins were selected for subsequent Western Blot quantitation both in pathological and healthy tissues.
Results
The identified proteins are mainly involved in metabolism (32 %), transport (13 %) and cell organization and biogenesis (13 %). A significant unbalance in protein expression between healthy and pathological sites was recorded. Thirty-two protein spots were overall identified, and four proteins, the protein S100-A9 (S100A9), heat shock protein beta-1 (HSPB1), Galectin-7 (LEG7) and 14-3-3 protein zeta/delta (14-3-3) were selected for Western blot analysis of both periodontally-affected and healthy patients. The four selected proteins resulted extremely over-expressed in periodontal pocket tissue when compared with the corresponding tissue of periodontally-healthy patients.
Discussion:
S100A9 is involved in the regulation of inflammatory processes, immune response, oxidant-scavenging and apoptosis-inducing activities. HSPB1 synthesis increases in response to a variety of stresses (e.g. elevated temperatures, heavy metals, toxins, oxidants, bacterial and viral infections) in order to minimize the attendant deleterious consequences. LEG7 expression contributes to the tissue remodeling processes following tissue damage and protects cell from death. The 14-3-3 proteins are involved in the control of several cell cycle checkpoint, connective tissue remodeling, apoptosis signaling, during inflammation response. The Western blot and proteomic analyses are congruent with the reaction of injured periodontal tissues in PD. The proteomic analysis was performed for the first time directly on periodontal pocket tissue. The proteomic network highlighted enhances the understanding of PD pathogenesis revealing a defensive protein strategy which, however, evidently fails in patients affected by PD. Further study are requested also for specific therapeutic strateg
2016
- Wear analysis and cyclic fatigue resistance of electro discharge machined NiTi rotary instruments
[Articolo su rivista]
Iacono, F.; Pirani, C.; Generali, Luigi; Sassatelli, Paolo; Nucci, C.; Gandolfi, M. G.; Prati, C.
abstract
Aim: To evaluate the wear of new rotary instruments produced via electro discharge machining and to test their fatigue resistance.
Methodology: Twenty-one HyFlex EDM (Colte`ne/Whaledent, Switzerland) files were used for laboratory instrumentation of curved root canals of extracted teeth. Superficial characteristics were analyzed pre- and postoperatively by scanning electron microscopy (SEM) (JSM-5200, JEOL, Tokyo, Japan) at same points and with same angulations to identify the wear features. Number of fractures, microcracks blunt/disruption of cutting edge and tip deformations were reported. Twenty HyFlex EDM and 20 HyFlex CM (Colte`ne/Whaledent, Switzerland) were subjected to cyclic fatigue test in a 708 artificial metal canal. Results were statistically analyzed using Mann—Whitney tests.
Results: Nofractureswereregisteredduringlaboratorycanalinstrumentation.Nowearandno degradation of the 25.12 and 25.08 files were reported. Slight plastic deformations were only observed in three 10.05 files. The cyclic fatigue test revealed a significant increase of fatigue resistance of EDM files compared to CM ( p = 0.0001).
Conclusions: The typical irregular surface of HyFlex EDM remained unaffected after multiple uses, confirming a high wear resistance. The new manufacturing process of electrical discharge machining had a substantial impact on fatigue lifetime of EDM files when compared with HyFlex CM. Within limitations of the present in vitro results, EDM files appeared suitable in shaping severely curved canals.
ß 2016 Societ`a Italiana di Endodonzia. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc- nd/4.0/).
2015
- Chirurgia piezoelettrica
[Capitolo/Saggio]
Consolo, Ugo; Bandieri, Alberto; Generali, Luigi
abstract
Il capitolo si apre con alcuni cenni storici inerenti l'utilizzo degli ultrasuoni in odontoiatria fino ad arrivare alla definizione della moderna chirurgia ossea piezoelettrica. I vantaggi e le caratteristiche cliniche peculiari della chirurgia piezoelettrica sono descritte nella prima parte del testo che prosegue con la dissertazione dei protocolli operativi in chirurgia orale. Diverse figure e disegni corredate di didascalie permettono al lettore di comprendere i passaggi per ogni tipologia di intervento eseguito con tecnica piezoelettrica.
2015
- Comparison on sealer penetration into dentinal tubules using self-adjusting file cleaning- shaping-irrigation system and conventional endodontic needle irrigation
[Abstract in Rivista]
Generali, Luigi; Pettenati, C.; Righi, Elena; Bertoldi, Carlo; Consolo, Ugo
abstract
2015
- Endodonzia chirurgica
[Capitolo/Saggio]
Generali, Luigi; Consolo, Ugo
abstract
Dopo una breve introduzione e definizione di endodonzia chirurgica, il capitolo di questo libro espone le indicazioni e le controindicazioni a questo intervento secondo i dati più aggiornati della letteratura scientifica del settore. La tecnica endodontico-chirurgica è descritta dettagliatamente step by step.
2015
- HyFlex EDM rotary Ni-Ti prototypes: the effect of an innovative machining technology on Ni-Ti wear
[Abstract in Rivista]
Pirani, C.; Generali, Luigi; Iacono, F.; Sassatelli, Paolo; Prati, C.
abstract
Aim. HyFlex EDM files were recently introduced pre- senting an innovative electro discharge machining (EDM) process of fabrication. The aim of this study was to evalua- te the surface and microstructural alterations of new and in vitro used HyFlex EDM Ni-Ti rotary prototypes.
Methods. The surface and microstructural characteristi- cs of 15 new HyFlex EDM instruments were analyzed by ESEM equipped with energy dispersive x-ray spectropho- tometry (EDS) and optical metallographic imaging. Instru- ments were subjected to instrumentation tests on severely curved root canals (ranging between 50° and 70°) of ex- tracted multi-rooted teeth. Once that canal patency was verified with a #10 K-file, the working length was determi- ned by subtracting 1mm. HyFlex EDM files were used with a 16:1 reduction handpiece X-Smart (Dentsply Maillefer, Baillagues, Switzerland) following the manufacture’s direc- tion, at 500 rpm and 2.5Ncm, with slightly apical pressure and pecking motion. The operative sequence was: 25/12 at 2/3 of the WL, 10/05 and 25/08 at WL. Irrigation was per- formed at every change of instrument, with a total amount of3mlof5%NaOCland3mlof10%EDTA(Ogna,Mug- giò, Italy). Each instrument was used in 10 curved canals, washed in an ultrasonic bath containing detergent for 10 min and then autoclaved at 134°C. Surface and microstruc- tural characterizations were repeated on used instruments at same points and with same angulations to compare the pre- and postoperative micrographs, in order to verify the appearance of fractures, unwinding, microcracks, blade di- sruption and tip deformation.
Results. Surface and microstructural characteriza- tion of new instruments revealed the typical features of a NiTi ED-Machined alloy with an irregular and “craters-like” surface. High magnification microgra- phs disclosed a non-uniform structure were pits, po- res and voids caused the peculiar aspect of a “rough- spark-machined” surface. No fractures were registered during instrumentation of curved canals. Surface and microstructural characterization of used files revealed no wear and no degradation of the 25.12 and 25.08 files. The tip segment was confirmed as the most me- chanically stressed portion of 10.05 prototypes. All the instruments, after several uses, well-preserved the “craters-like” irregular surface without cutting edge al- terations. The metallographic inspection on the cross section of brand new HyFlex EDM files showed an homogeneous martensitic phase. The microstructure appeared uniform from the surface to the bulk, and no microcracks or defect were identified, even at high optical magnification (1000X).
Conclusion. Unaltered spark-machined surface and low microstructural degradation are the main features of recently introduced HyFlex EDM. Caution would be re- commended regarding reuse of small HyFlex EDM files. Instruments exhibited a safe in vitro use in presence of severely curved canals.
2015
- HyFlex EDM: caratteristiche superficiali e resistenza alla fatica ciclica di innovativi strumenti rotanti NiTi prodotti per elettroerosione
[Abstract in Atti di Convegno]
Iacono, F; Pirani, C; Generali, L; Prati, C.
abstract
INTRODUZIONE
Gli strumenti endodontici in Controlled Memory Wire hanno mostrato flessibilità e comportamenti meccanici superiori alle leghe NiTi convenzionali. Gli HyFlex EDM (Colténe/Whaledent, Switzerland) sono prodotti con un innovativo processo di fabbricazione per elettroerosione (electro discharge machining-EDM) mediante scariche elettriche generate da un elettrodo in prossimità dello strumento.
OBIETTIVI
Esaminare la morfologia super ciale e la microstruttura interna di prototipi HyFlex EDM nuovi e usati in vitro e testare la loro resistenza in fatica ciclica.
MATERIALI E METODI
Quindici prototipi HyFlex EDM sono stati utilizzati per la strumentazione in vitro di 10 canali curvi. La morfologia di super cie e la microstruttura interna di strumenti nuovi e usati sono state indagate con un Microscopio Elet- tronico a Scansione (ESEM-EVO50 EP, Carl Zeiss, Germany) con Spettroscopia EDS e con un microscopio ottico metallogra co (Leica DMI5000 M, Germany). Altri 30 HyFlex EDM e 20 HyFlex CM sono stati testati in fatica ciclica in un canale arti ciale con angolo di curvatura di 70°. I dati ottenuti sono stati validati con il test di Kruskal-Wallis e glistrumenti fratturati sono stati sottoposti ad analisi frattogra ca con ESEM.
RISULTATI E DISCUSSIONE
Le indagini all’ESEM hanno rivelato una speci ca struttura irregolare caratterizzata da una super cie con mor- fologia a “cratere”. Non sono state evidenziate alterazioni super ciali nei prototipi utilizzati. Tutti gli strumenti, dopo diversi utilizzi, hanno preservato il loro peculiare aspetto crateriforme e non hanno mostrato appiattimento dell’angolo di taglio delle lame. Non si è veri cata nessuna frattura. L‘analisi metallogra ca sulla sezione trasver- sale degli strumenti ha mostrato la presenza di una microstruttura uniforme con un’omogenea fase martensitica. I test di fatica ciclica hanno evidenziato una resistenza superiore degli HyFlex EDM rispetto agli HyFlex CM, pari a circa il 700% quando strumenti di stessa conicità e diametro in punta sono stati esaminati. Gli HyFlex EDM hanno dimostrato un a dabile comportamento in vitro quando sottoposti a strumentazione di canali molto curvi. La caratteristica principale di tali strumenti è la super cie crateriforme che ben si conserva dopo ripetuti utilizzi. Gli strumenti di diametro minore sono apparsi quelli maggiormente stressati. La resistenza in fatica ciclica di stru- menti della stessa lega sembra essere notevolmente aumentata dal di erente processo di produzione.
Se da una parte l’implantologia o re al clinico un’opzione terapeutica altamente predicibile, in particolar modo nella sostituzione degli elementi naturali mancanti o irrecuperabili, dall’altra la terapia endodontica e restaura- tiva deve rappresentare la prima strada da percorrere in ogni piano di trattamento interdisciplinare.
OBIETTIVI
Il mantenimento dell’elemento naturale è oggi possibile in virtù di strumenti sempre più a dabili e di tecniche sempre più conservative sia in ambito endodontico che in ambito restaurativo. La letteratura scienti ca riporta percentuali di successo paragonabili tra trattamento endodontico e trattamento implantare. Pertanto la scelta conservativa o estrattiva-implantare non deve dipendere da particolari attitudini del clinico, ma dalla gestione del caso con la tecnica migliore in termini di costi-bene ci.
MATERIALI E METODI
Vengono presentati e discussi casi clinici complessi gestiti con approccio interdiciplinare. Vengono descritti gli aspetti diagnostici che hanno indotto il clinico all’opzione estrattiva ed alla sostituzione con un impianto osteo-integrato. Vengono riportati casi di elementi gravemente compromessi, recuperati attraverso ritrattamenti endodontici e terapie restaurative adesive. La presentazione di follow-up a distanza testimonia la correttezza dell’opzione terapeutica scelta.
RISULTATI E DISCUSSIONE
Il mantenimento dell’elemento naturale, con il r
2015
- HyFlex EDM: innovative electro discharge machined rotary instruments. Fatigue testing, superficial and microstructural characterization
[Abstract in Rivista]
Pirani, Chiara; Iacono, Francesco; Generali, Luigi; Sassatelli, Paolo; Nucci, Cesare; Gandolfi, Maria Giovanna; Prati, Carlo
abstract
Aim To test the fatigue resistance and to evaluate the surface and microstructural alterations of new and in vitro used HyFlex EDM NiTi rotary prototypes.
Methodology Thirty electro discharge machined HyFlex EDM (Colt ene/Whaledent, Switzerland) prototypes, and 20 HyFlex CM (Colt ene/Whaledent, Switzerland) files were subjected to cyclic fatigue test in a standardized 70° artificial metal canal. Results were validated using Mann-Whitney tests (a-level 0.05). Fractographic analysis on broken samples was conducted using environmental scanning electron microscopy (ESEM) imaging. Fifteen new HyFlex EDM prototypes were used for in vitro instrumenta- tion of severely curved root canals of extracted multi-rooted teeth. Surface and microstructural characteristics of files were analyzed by ESEM equipped with energy dispersive x-ray spectrophotometry (EDS) and optical metallographic imaging. The same analysis was conducted on new and used instruments to assess the usage- induced degradation.
Results The cyclic fatigue test revealed an increase of fatigue resistance up to 700% of EDM files compared to CM (P = 0.0001). Fractographic analysis of fatigued EDM instruments disclosed multiple crack origins in correspondence of the cutting edges, with a limited fatigue striation zone and a noteworthy dimpled area. Surface and microstructural characterization of new instruments revealed the typical features of a NiTi ED-Machined alloy with a ‘crater-like’ surface. No fractures were registered during instrumentation of curved canals. Surface and microstructural characterization of used files revealed no wear and no degradation of the size 25, .12 taper and size 25, .08 taper files. The tip segment was confirmed as the most mechanically stressed portion of size 10, .05 taper files. The metallographic inspection on the cross section of brand new HyFlex EDM files showed an homoge- neous martensitic phase. The microstructure appeared uniform from the surface to the bulk, and no microcracks or defect were identified, even at high optical magnification (1000X). Conclusions HyFlex EDM exhibited high values of cyclic fatigue resistance and a safe in vitro use in severely curved canals. Unaltered spark-machined surface and low microstructural degradation are the main features of HyFlex EDM.
Acknowledgements The authors deny any conflict of interest related to this study and would thank Coltene Whaledent for providing the test material.
2015
- The in vitro effect of irrigants with low surface tension on enterococcus faecalis
[Articolo su rivista]
Giardino, Luciano; Estrela, Carlos; Generali, Luigi; Mohammadi, Zahed; Asgary, Saeed
abstract
Introduction: Due to the complex anatomy of the root canal system and high surface tension of common root canal irrigants (RCI), conducting an investigation on RCIs containing surfactants is a priority. The aim of this in vitro study was to verify the antibacterial potential of RCI with low surface tension in root canals infected with Enterococcus faecalis (E. faecalis). Methods and Materials: Thirty-five extracted human maxillary anterior teeth were prepared and inoculated with E. faecalis for 60 days. After root canal preparation, the teeth were randomly divided to one positive and one negative control groups and 5 experimental groups: Hypoclean/Tetraclean NA, Hypoclean, Tetraclean, NaOCl/Tetraclean and NaOCl. Bacterial growth was observed by turbidity of culture medium and then measured using a UV spectrophotometer. Data were analyzed in three time intervals (pre-instrumentation and, 20 min and 72 h after canal preparation) using the ANOVA and post hoc Tukey’s tests. The level of significance was set at 0.05. Results: The results indicated the presence of E. faecalis in all post-irrigation samples irrespective of the RCI. However, the optical densities in both post- irrigation periods showed bacterial reduction and significant differences between groups. Conclusion: RCI with low surface tension showed antibacterial potential in E. faecalis infected roots.
2015
- The influence of composite resin restoration on gingival tissue: a pilot study
[Abstract in Rivista]
Bertoldi, Carlo; Martani, M.; Generali, Luigi; Lucchi, A.; Zaffe, Davide; Consolo, Ugo
abstract
2014
- A confocal microscopic evaluation of dentinal tubule penetration and percentage of root canal sealer using three different instrumentation techniques
[Abstract in Rivista]
Generali, Luigi; Pettenati, C.; Gandolfi, M. G.; Righi, Elena; Franchi, I.; Bertoldi, Carlo; Giannetti, Luca; Consolo, Ugo
abstract
Vedasi l'allegato
2014
- Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ)
[Capitolo/Saggio]
Pozzi, Samantha; Anesi, Alexandre; Generali, Luigi; Bari, Alessia; Consolo, Ugo; Chiarini, Luigi
abstract
Osteonecrosis of the jaw (ONJ) is a rare condition that has been mainly related to the treatment with i.v. bisphosphonates in patients affected by cancer bone disease. The ethiopathology is still unknown and the frequency is between 0.8 and 12 %. It can appear in edentulous patients, but invasive procedures have been demonstrated to increase the risk of developing this complication. Few cases have been described in the endodontic literature. In the next chapter, we will describe ONJ, will analyze the data from literature, and will report expert opinions and guidelines about the best clinical practice in the endodontic fi eld. Finally, since data in this field are limited, we would like to underline that the best treatment plan for cancer patients receiving bisphosphonates and requiring dental procedures is a multidisciplinary, case-by-case approach.
2014
- Canal shaping with WaveOne reciprocating files: influence of operator experience on instrument breakage and canal preparation time
[Articolo su rivista]
Generali, Luigi; Righi, Elena; Maria Vittoria, Todesca; Consolo, Ugo
abstract
The aim of this study was to determine the fracture incidence of WaveOne Primary reciprocating files and the time required for shaping of curved canals based on the experience of the operator. A total of 109 mesiobuccal canals of permanent molars extracted with an angle of curvature of[25°–45° according to Schneider were ran- domly assigned to four groups. An experienced operator (endodontist) and an inexperienced operator (student) each shaped one of two groups: one with the instrument WaveOne Primary to WL and the other after creation of a glide path with PathFile 1, 2 and 3 at the WL. Any frac- tures or visible deformations of the instruments during the shaping phase and the effective time required to prepare the canals for each instrument were recorded. No visible deformation or fracture was observed. The experienced operator tended to finish their shape faster than the inex- perienced operator regardless of the technique applied. For the inexperienced operator, the usage time with only WaveOne Primary was significantly lower when the canals were preliminarily instrumented with the PathFile than when these instruments were not used (average time, 22.03 vs. 36.22 s, respectively; p \ 0.001). The experience of the operator did not influence fracture of the WaveOne Pri- mary instruments. The time required to prepare the canals was instead inversely proportional to the experience of the operator. However, the creation of a glide path with PathFile instruments reduced the time required by the inexperienced operator to prepare the canal.
2014
- Differential efficacy of endodontic obturation procedures: an ex vivo study
[Articolo su rivista]
Ardizzoni, Andrea; Generali, Luigi; Righi, Elena; Baschieri, MARIA CRISTINA; Cavani, Francesco; Manca, Lidia; Lugli, Eleonora; Migliarese, Luigi; Blasi, Elisabetta; Neglia, Rachele Giovanna
abstract
By means of a double-chamber model, different root canal filling materials and procedures were compared. Briefly, the root canals of single-rooted human teeth, extracted for periodontal reasons, were instrumented and obturated by gutta-percha/Pulp Canal Sealer EWT (PCS) or by Resilon, in association with different sealers (Real Seal, RelyX Unicem or Meta). Obturation was achieved by traditional continuous wave of condensation technique (TCWCT), a modified version of it (MCWCT), or single cone technique (SCT). The obturated roots, inserted in a double-chamber model, were sterilized by gamma irradiation. Next, Enterococcus faecalis was added to the upper chamber and the specimens were incubated at 37 °C for up to 120 days; the development of turbidity in the lower chambers' broths indicated bacterial leakage through the obturated root canals. The kinetics of leakage were analyzed in different groups by means of Kaplan-Meier statistics and compared by log-rank test. The results showed that root canals obturated with either gutta-percha/PCS using the MCWCT, Resilon/Real Seal SCT or Resilon/RelyX Unicem using the TCWCT displayed significantly better performance than the remaining groups (p < 0.01). Histological evaluation, performed to investigate microbial localization inside specimens, confirmed that this parameter varied according to the obturation procedures and materials employed. This ex vivo study indicates that gutta-percha/PCS, if used with the MCWCT, is as effective as Resilon when coupled to Real Seal with the SCT or, interestingly, to RelyX Unicem with the TCWCT. These data suggest that further improvement of the currently employed root canal filling procedures is achievable, depending on both the filling materials and the technique employed, thus encouraging clinical studies in this direction.
2014
- Filling ability of carrier-based obturation system in oval-shaped canals prepared with reciprocating and adaptative instruments.
[Abstract in Rivista]
Generali, Luigi; L., Pastorello; M. G., Gandolfi; Righi, Elena; Giannetti, Luca; Bertoldi, Carlo; C., Prati
abstract
Vedi Allegato
2014
- Foreign body mimicking an oral pathology
[Abstract in Rivista]
Bellini, Pierantonio; Salgarelli, Attilio Carlo; Bertoldi, Carlo; Generali, Luigi; Giannetti, Luca; Consolo, Ugo
abstract
vedasi l'allegato
2014
- Implant surface alterations following the use of three instrumentation systems: 1 - effects of a standard cleaning
[Abstract in Rivista]
Bertoldi, Carlo; Battarra, F.; Lusuardi, D.; Giannetti, Luca; Generali, Luigi; Consolo, Ugo; Zaffe, Davide
abstract
Vedasi l'allegato
2014
- Implant surface alterations following the use of three instrumentation systems: 2 - simulation of an extended treatment
[Abstract in Rivista]
Bertoldi, Carlo; Ventura, S.; Lusuardi, D.; Sassatelli, Paolo; Generali, Luigi; Giannetti, Luca; Consolo, Ugo; Zaffe, Davide
abstract
Vedasi l'allegato
2014
- Open and closed sandwich technique in class II restorations. Evaluation of marginal integrity bi SEM analysis.
[Abstract in Rivista]
Giannetti, Luca; E., Gelati; E., Spinas; Generali, Luigi; Bertoldi, Carlo; A. B., Murri Dello Diago
abstract
Vedi allegato
2014
- The peripheral seal concept in adhesive dentistry: A clinical application.
[Abstract in Rivista]
Giannetti, Luca; A., Bassoli; Generali, Luigi; E., Spinas; Bertoldi, Carlo; A., Murri Dello Diago
abstract
Vedi allegato
2013
- Arginine-Based Toothpaste Induces Calcium-Phosphates Deposits on Dentin Surface and Tubules
[Abstract in Rivista]
Gandolfi, Mg; Pelliccioni, Ga; Generali, Luigi; Ferri, A; Gatto, Mra; Ottolenghi, L; Prati, C.
abstract
Objective: To test the ability of a calcium carbonate-containing toothpaste for dentinal hypersensitivity to occlude the exposed open tubules of dentin surface.
Method: Dentine slices (0.9±0.1 thick) and crown segments (1.5±0.3 cm thick) from human third molars were used.
Elmex Sensitive Professional toothpaste (GABA Int AG, Therwill, Switzerland) containing as main active ingredients arginine (8%), sodium
monofluorophosphate (1450 ppm Fˉ) and calcium carbonate, was applied (3 min) on coronal dentin surface.
Fluid flow/permeation through the dentin thickness (i.e. permeability or hydraulic conductance, Lp in microliters/min) was evaluated using a digital fluid flow-meter after smear layer formation, after EDTA treatment, after Elmex toothpaste treatment (t=0) and after soaking for 1, 7, 28 days in simulated body fluid (HBSS). Tubules occlusion, elemental analysis and mineral content were studied by ESEM-EDX.
Toothpaste penetration inside dentinal tubules was analyzed by laser confocal microscopy using calcein as tracer.
Result: Lp of EDTA-treated dentin significantly decreased after treatment with Elmex toothpaste (-73,32% at t=0) and after soaking in HBSS the Lp values further decreased (-77,69% at 24h, -78,18% at 7d, -83,01% at 28d).
After 24h and 7d in HBSS, ESEM on Elmex-treated dentin showed the presence of precipitates on dentin surface and in the dentinal tubules; EDX revealed N (from arginine) and F (from monofluorophosphate) of the toothpaste. Lp remained significantly lower (-78,18%) than EDTA- treated control dentin.
After 28d in HBSS, a calcium phosphate layer was detected on dentin surface so tubules were not visible. EDX detected F and no N. No CaP deposits were found on EDTA-treated dentin soaked in HBSS.
Confocal microscopy showed an average penetration depth of the toothpaste into the dentinal tubules of ~85 microns.
Conclusion: Elmex sensitive toothpaste can reduce the fluid movement into the exposed dentinal tubules and favour the formation of calcium phosphate minerals.
2013
- Arginine-calcium carbonate professional treatment for tubules occlusion in hypersensitive dentin
[Abstract in Rivista]
Gandolfi, Mg; Ferri, A; Generali, Luigi; Polimeni, A; Ottolenghi, L; Aparicio, Cj; Prati, C.
abstract
Objective: To test the tubules occlusion of an arginine-based professional treatment for hypersensitive dentin.
Method: Dentin segments/discs were prepared from erupted sound molars. Elmex sensitive professional desensitizing paste (GABA Int. by Colgate Oral Pharmaceuticals, Dallas, USA) containing arginine 8% and calcium carbonate was applied on EDTA-treated dentin for 20s at 1000rpm using a prophy cup, following the manufacturer directions. The excess was removed using a microbrush then the dentin disc was gently rinsed and immersed in 20mL of simulated body fluid (Hank’s Balanced Salt Solution, HBSS) at 37°C. After 24h, 7 and 28d the dentin surface was analyzed by ESEM-EDX to evaluate the tubules occlusion and the mineral content. Elmex paste mixed with calcein solution 1% was used to evaluate its penetration depth into the tubules by confocal microscopy.
Result: After 24h in HBSS, ESEM-EDX analyses on Elmex-treated dentin showed the presence of precipitates on dentin surface and in the dentinal tubules, relevant amount of N(16-19 wt%, demonstrating the presence of arginine and Ca/P molar ratio ≥3.0. Confocal microscopy showed a penetration of the paste into the dentinal tubules to a mean depth of approx 50 microns (maximum depth penetration 100 microns).
ESEM showed the presence of many tubules still obturated by material after 7d in HBSS; EDX found N (approx 19 wt%) and Ca/P molar ratio was 2.43.
After 28d in HBSS a coating of calcium phosphate deposits covered the dentin surface so tubules were not visible; EDX detected N (6-7 wt%) and showed a Ca/P molar ratio of 2.14.
Conclusion: Elmex sensitive professional paste can obturate the dentinal tubules and adhere to the dentin surface. Evidences of mineralizing properties have been found by the deposition of calcium and phosphate-containing minerals within the dentinal tubules and the formation of a calcium phosphate protective layer on the dentin surface.
2013
- Correlation between Microleakage and Tubules Penetration of an Endodontic Sealer
[Abstract in Rivista]
Gandolfi, Mg; Generali, Luigi; Ferri, A; Pelliccioni, Ga; Consolo, Ugo; Prati, C.
abstract
Objective: The aim of the study was to verify the existence of a correlation between fluid filtration and tubular penetration of an endodontic sealer.
Methods: Ten pairs of maxillary incisors with a single root canal, circular cross-section, similar sizes and dimensions were selected from a collection. Teeth from each pair were randomly divided in 2 groups. All canals were instrumented using NiTi WaveOne Primary instrument (#25) (Dentsply, Maillefer). In the group 1 all canals were irrigated with 1 mL of 5,25% NaOCl for 30s (Ogna, Muggiò, Italy), followed by 0.5 mL of 10% EDTA for 30 s (Ogna). In the group 2 it’s used the same protocol but without the EDTA. A final irrigation of 2.0 mL 5,25% NaOCl for 3m was performed. Root filling was performed with Thermafil-obturators (Dentsply Tulsa, Tulsa, OK) with TopSeal (Dentsply, Maillefer) mixed with 0.1 wt% alizarin to evaluate the penetration depth of the sealer into tubules with confocal microscope (Leica, Wetzlar, Germany).
Microleakage i.e. the volume of a calcein solution infiltrated into the root canal and tubules were evaluated using a digital fluid flow-meter and a confocal microscope.
Results: Confocal microscopy showed a penetration of the sealer into tubules in group 1 of approx. 370 μm at 3 mm from the apex and 630 μm at 5 mm while in group 2 of approx. 22 μm at 3 mm and 37 μm at 5 mm from the apex. The volume of the infiltrated fluid was 0.353 x
10-4 mm3 for group 1 and 0.397 x 10-4 mm3 for group 2. The data of calcein penetration into the root canal were in agreement with the fluid filtration results.
Conclusion: A correlation seems to be present between sealer penetration into dentinal tubules and sealability of Thermafil-obturators and TopSeal in root canal shaped with WaveOne Primary file.
2012
- Cementazione adesiva di restauri indiretti nel settore anteriore con cemento duale altamente caricato
[Articolo su rivista]
Franchi, I.; Vanini, L.; Rossi, R.; Generali, Luigi; Consolo, Ugo
abstract
Vedasi l'allegato
2012
- Eighteen months SDR clinical performance in class II cavities. Valutazione delle performance di SDR nei restauri di classe II a 18 mesi.
[Relazione in Atti di Convegno]
Lucchi, A.; Pellacani, C.; Generali, Luigi; Bertoldi, Carlo; Giannetti, Luca
abstract
Vedi allegato
2012
- Mini implant rehabilitation in growing patient following traumatic avulsion
[Abstract in Atti di Convegno]
MURRI DELLO DIAGO, Alberto; Bertoldi, Carlo; Generali, Luigi; Consolo, Ugo; Giannetti, Luca
abstract
Vedi allegato
2012
- Replantation of immature permanent central incisors following traumatic avulsion: pulp revascularization.
[Abstract in Atti di Convegno]
MURRI DELLO DIAGO, Alberto; Bertoldi, Carlo; Generali, Luigi; Consolo, Ugo; Giannetti, Luca
abstract
Vedi allegato
2012
- Variazione degli indici parodontali durante la giornata. Studio pilota in fase di mantenimento.
[Articolo su rivista]
Bertoldi, Carlo; Pellacani, Chiara; Generali, Luigi; Ponzini, V.; Lucchi, A.; Guaitolini, S.; Forabosco, Andrea
abstract
Summary:
Objectives: The aim was to determine if periodontal indexes, on which we choose the treatment of periodontal therapy, can be influenced by the time of day they are collected.
Materials and Methods: Using specific inclusion and exclusion criteria, we enrolled 11 patients. We evaluated the full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS) and periodontal screening and recording (PSR) index at baseline (T0). The study involved the comparison of the same periodontal indexes in three successive stages of the same day, (8.30-T1, 11.30-T2, 14.00-T3) during the maintenance phase.
Results: All indexes improved significantly from T0 through to the final three revaluations. Comparing T1, T2 and T3 amongst each other points out that the T1-FMBS (m ± SD - 4.82 ± 2.95) was significantly greater than that detected in T2 (2.69 ± 1.49) and T3 (2.03 ± 1.51). Considering only non-smokers, they showed a significant improvement of indexes from T0 to the final re-evaluations without difference amongst them, whilst FMBS did not improve significantly from T0 to T1 and T1 was greater than T2 and T3 in smokers.
Conclusions: While considering the limitations of our study, the index FMBS is not significantly stable within the same day. Approximately, this result is particularly relevant in smokers, also suggesting a further inflammatory pathogenic way of periodontal damage in smokers.
Riassunto:
Obiettivi: Lo scopo è verificare se gli indici parodontali, su cui si basa in gran parte la scelta terapeutica parodontologica, possano essere influenzati dal periodo della giornata in cui sono rilevati.
Materiali e Metodi: Arruolamento, secondo precisi criteri di inclusione ed esclusione, di 11 pazienti. Venivano valutati il full-mouth plaque score (FMPS), il full-mouth bleeding score (FMBS) ed il periodontal screening and recording (PSR) al baseline (T0); la sperimentazione prevedeva il confronto delle misurazioni dei suddetti indici in tre momenti successivi della stessa giornata (8,30-T1; 11,30-T2; 14.00-T3) in fase di mantenimento.
Risultati: Tutti gli indici considerati miglioravano significativamente passando da T0 alle 3 rivalutazioni finali. Confrontando tra di loro T1,T2 e T3 si rileva che l’FMBS rilevato in T1 (m±ds - 4,82±2,95) risulta significativamente maggiore rispetto a quello rilevato in T2 (2,69±1,49) e T3 (2,03±1,51). Considerando i soli non-fumatori si denota il significativo miglioramento degli indici da T0 alle rivalutazioni finali senza significatività tra le 3 rivalutazioni mentre l’FMBS non migliora significativamente da T0 a T1 e in T1 è maggiore rispetto a T2 e T3 nei fumatori.
Conclusioni: Pur considerando i limiti di questo studio, l’indice FMBS non si dimostra significativamente stabile nell’ambito della stessa giornata. Indicativamente tale risultato è particolarmente rilevante nei tabagisti suggerendo anche una ulteriore via patogenetica infiammatoria al danno parodontale.
2011
- A RCT on paediatric patients: a new flowable resin-based composite vs traditional composite.
[Abstract in Rivista]
MURRI DELLO DIAGO, Alberto; Generali, Luigi; Lucchi, A.; Bertoldi, Carlo; Consolo, Ugo; Giannetti, Luca
abstract
Vedi allegato
2011
- A new flowable resin-based composite clinical performance in Class II cavities: a split-mouth study.
[Abstract in Rivista]
Guaitolini, S.; Bertoldi, Carlo; Giannetti, Luca; MURRI DELLO DIAGO, Alberto; Generali, Luigi; Consolo, Ugo
abstract
Vedi allegato
2011
- Direct composite reconstruction of fractured teeth: case report.
[Abstract in Rivista]
Mancuso, R.; Franchi, I.; Bertoldi, Carlo; Giannetti, Luca; Murri Dello Diago, A.; Dotti, A.; Consolo, Ugo; Generali, Luigi
abstract
Vedi allegato
2011
- Is the subepithelial connective tissue graft technique more predictive than coronally advanced flap in the treatment of multiple gingival recessions? A randomized study.
[Abstract in Rivista]
Guaitolini, S.; Giannetti, Luca; Generali, Luigi; Pellacani, C.; Dotti, A.; Consolo, Ugo; Bertoldi, Carlo
abstract
Vedi allegato
2011
- Marginal integrity evaluation of class II composite restoration: a sem analysis.
[Abstract in Rivista]
Generali, Luigi; Bertoldi, Carlo; Giannetti, Luca; Murri Dello Diago, A.; Lucchi, A.; Pellacani, C.; Franchi, I.; Mancuso, R.
abstract
Vedi allegato
2011
- Modena dental emergency service: a retrospective study of traumatic dental injuries.
[Abstract in Rivista]
MURRI DELLO DIAGO, Alberto; Generali, Luigi; Bertoldi, Carlo; Lucchi, A.; Consolo, Ugo
abstract
Vedi allegato
2011
- Riabilitazione funzionale del settore posteriore tramite ricostruzione indiretta: case reprt
[Articolo su rivista]
Franchi, Irene; Generali, Luigi; Rossi, Renato; Consolo, Ugo
abstract
Vedasi l'allegato
2011
- Ricostruzione prospettica con perno in vetro step by step
[Articolo su rivista]
Vanini, L.; Franchi, I.; Generali, Luigi; Pisacane, C.; Consolo, Ugo
abstract
Vedasi l'allegato
2010
- Autotransplanted premolars replacing maxillary incisors: Esthetic outcome.
[Relazione in Atti di Convegno]
MURRI DELLO DIAGO, Alberto; Lucchi, A.; Generali, Luigi; Bertoldi, Carlo; Giannetti, Luca
abstract
RIASSUNTO
Ragioni
L’autotrapiato è sicuramente una scelta biologicamente ottimale e di sicure possibilità prognostiche. Lo scopo del presente studio è quello di valutare sia dal punto di vista del clinico che da quello del paziente il valore estetico dell’elemento auto trapiantato.
Materiali e Metodi
Sono stati selezionati 25 pazienti che in seguito a trauma abbiano eseguito l’autotrapianto di un premolare in regione mascellare superiore e che abbiano eseguito un reshaping della morfologia incisale con restauro diretto o indiretto in composito. Viene eseguita una valutazione professionale associata ad un questionario compilato dai pazienti stessi allo scopo di poter quantificare il valore estetico raggiunto.
Risultati
64 % degli elementi osservati viene valutato sovrapponibile nell’analisi professionale a fronte di un 68% di pazienti pienamente soddisfatti. Il 16 % viene valutato discordante, e due pazienti si dicono insoddisfatti.
Conclusioni
L’autotrapianto è un’opzione terapeutica di prima scelta nella riabilitazione del trauma dento-alveolare. Essa è una metodica complessa e ricca di variabili che rappresenta però vantaggi biologici unici.
Dal punto di vista estetico essa è parzialmente carente rispetto ad altre opzioni, ma se affrontata in maniera multidisciplinare permette di raggiungere ugualmente il successo a breve e lungo termine.
ABSTRACT
Background
Autotransplantation of teeth appears to be the most biologic approach. The aim of this study is to evaluate the esthetic outcome of the auto transplanted element.
Methods and Materials
25 patients have been selected after dental trauma and autotransplantation of a premolar in the maxillary region by a reshaping of the coronal morphology with direct or indirect composite restoration. It has been performed a professional assessment associated with a questionnaire filled in by patients themselves in order to be able to quantify the aesthetic outcome.
Results
64% of observed elements have been evaluated as match in the professional evaluation against a 68% of patients fully satisfied. The 16% is categorizes as mismatch, and two patients reported dissatisfaction.
Conclusions
Autotransplantation is an optimal therapeutic option after dental-alveolar trauma. It is a complex technique with unique biological advantage.
From the aesthetic point of view it is partially lacking in comparison to other options, but if approached in a multidisciplinary approach it can also achieve success in the short and long term.
2010
- Correlazione fra amalgama dentale e patologie sistemiche: analisi della letteratura.
[Relazione in Atti di Convegno]
Guaitolini, S.; Franchi, I.; Generali, Luigi; Bertoldi, Carlo; Giannetti, Luca
abstract
RIASSUNTO
RAGIONI: L’uomo è esposto a due distinte forme di mercurio: il metilmercurio (CH3Hg) e l’etilmercurio (CH3CH2Hg+). Questo articolo riporta, attraverso l’analisi della letteratura, i possibili effetti sistemici causati dal mercurio proveniente dall’amalgama dentale.
MATERIALI E METODI: Attraverso l’analisi della letteratura si evince che il mercurio liberato dalle otturazioni in amalgama può determinare seri problemi neurologici.
RISULTATI: Tra i bersagli preferenziali del deposito di questo metallo si annoverano il sistema nervoso centrale e il rene.
CONCLUSIONI: I primi effetti dell’esposizione a lungo termine a vapori di mercurio sono non specifici; i sintomi possono iniziare pochi giorni dopo l’esposizione o possono passare molti anni dall’esposizione iniziale affinchè gli effetti tossici si manifestino.
Tra i danni neurologici più citati è stata riportata una correlazione fra amalgama presente nel cavo orale e patologie neurologiche degenerative.
ABSTRACT
BACKGROUND: The mercury pass along the food chain and, eventually, to man as methilmercury (CH3Hg) or ethilmercury (CH3CH2Hg+).
This article addresses the possibility that dental materials, specifically those including mercury, may be an important factor systemic diseases.
MATERIAL AND METHODS: dental amalgam mercury exposure results in neurologic disorders.
RESULTS: Human exposure to mercury results in neurologic and kidney disorder.
CONCLUSION:Several investigations have shown that elemental mercury vapour can be released from hardened dental amalgam, and it is directly related to the number of filling surfaces and may contribuite to neurologic disease.
2010
- Knowledge of the management of tooth avulsion by non-dental professionals in Modena, Italy.
[Abstract in Rivista]
MURRI DELLO DIAGO, Alberto; Generali, Luigi; Bertoldi, Carlo; Consolo, Ugo; Giannetti, Luca
abstract
Vedi allegato
2010
- La resezione dell’apice radicolare con strumenti piezoelettrici in endodonzia chirurgica: studio in vitro
[Relazione in Atti di Convegno]
Generali, Luigi; Franchi, I; Bertoldi, Carlo; Giannetti, Luca; Consolo, Ugo
abstract
RIASSUNTO
RAGIONI: L’evoluzione tecnologica degli ultimi anni ha fornito all’Odontoiatra strumenti piezoelettrici che permettono di intervenire sui tessuti duri eseguendo tagli di precisione micrometrica, di rispettare i tessuti molli e le strutture anatomiche e di ottenere siti operatori pressoché esangui. Gli Autori hanno sperimentato, nell’ambito dell’endodonzia chirurgica, la resezione dell’apice radicolare con inserti piezolettrici al fine di valutare la reale possibilità di utilizzare questa tecnologia come valido sostituto dei convenzionali strumenti rotanti.
MATERIALI E METODI: sono stati selezionati 30 elementi dentari monoradicolati estratti per motivi parodontali o ortodontici e poi suddivisi in 3 gruppi di 10 elementi dentari. È stata eseguita resezione dell’apice radicolare di ogni elemento dentario nel seguente modo:
Gruppo 1: resezione apice con manipolo anello rosso fresa Komet H269 314 016;
Gruppo 2: resezione apice con turbina fresa Komet H 269 314 016;
Gruppo 3: resezione apice con sorgente piezoelettrica Mectron inserto Mectron OT1.
I campioni sono stati processati per osservazione al microscopio elettronico a scansione al fine di valutare il numero e la tipologia di crack dentinali secondo la seguente scala:
- Numero di crack: A) assenza di crack; B) da 1 a 3; C) da 4 a 6; D) 7 e oltre;
- Tipologia di crack: completo, incompleto, intradentinale.
È stata effettuata analisi statistica con Test esatto di Fischer per valutare le differenze tra i gruppi.
RISULTATI: Non sono state apprezzate differenze statistiche tra i 3 gruppi.
CONCLUSIONI: l’assenza di differenze statistiche tra i tre gruppi dimostra la reale possibilità di utilizzare la tecnologia piezoelettrica come sostituto dei tradizionali strumenti rotanti convenzionali nella fase di resezione dell’apice radicolare in endodonzia chirurgica.
ABSTRACT
BACKGROUND:
In recent years, technology of has provided new piezoelectric devices which allow the dentist to focus on hard tissue by performing precision cuts micrometer, to respect soft tissues and anatomical structures and to obtain almost bloodless surgical sites. The authors have tested, focusing on endodontic surgery, cutting efficacy of piezoelectric inserts on the root apical tissue: the aim of the study was to compare piezoelectric devices to conventional rotary instruments in endodontic surgery.
MATERIAL AND METHODS:
30 monoradicular teeth were selected and extracted for orthodontic or periodontal reasons, and divided into 3 groups of 10 dental elements. Resection of the root apex of each tooth was performed as follows:
Group 1: apical resection with red ring handpiece, Komet H269 314 016 bur;
Group 2: apical resection with turbine, Komet H 269 314 016 bur;
Group 3: apical resection with Mectron piezoelectric device, Mectron OT1 insert.
The samples were processed for electronic scanning microscope observation in order to assess the number and type of dentinal crack using the following scale:
- Number of crack: a) absence of crack B) 1 to 3, C) from 4 to 6 d) 7 and beyond;
- Type of crack: complete, incomplete, limited to dentine structure.
RESULTS: There were no significant differences among the 3 groups.
CONCLUSION: The absence of statistical differences among the three groups demonstrated the possibility of using the piezoelectric technology as a substitute for traditional conventional rotary instruments during the surgical resection of the root apex in endodontic surgery.
2010
- L’adesione a perni in fibre di vetro pre-impregnate.
[Relazione in Atti di Convegno]
Pellacani, C.; Dotti, A.; Generali, Luigi; Bertoldi, Carlo; Giannetti, Luca
abstract
RIASSUNTO
RAGIONI: I perni endocanalare in fibre di vetro preimpregnae (FRC) presentano vantaggi biomeccanici rispetto ai tradizionali perni metallici (ad esempio le proprietà di flessione e una morfologia personalizzabile); per quanto concerne l’adesione alle resine composite, le analisi di laboratorio si sono concentrate soprattutto su prove di push-out, trascurando la mappatura delle tensioni che si generano sulla superficie della fibra.
MATERIALI E METODI:L'obiettivo di questo studio è stato quello di valutare l’adesione dei perni FRC nei confronti di un cemento in resina composita e un composito microibrido attraverso test di laboratorio. I provini sono stati realizzati interfacciando il perno FRC con un adesivo ed immergendo ciascuna estremità in un volume di cemento composito duale o composito per ricostruzioni per una lunghezza nota. Sui campioni sono state effettuate prove di sforzo di taglio a trazione (tensile shear stress) parallelamente all’asse lungo del perno. Il test terminava al momento della rottura dell’interfaccia tra perno e cemento composito, consentendo di apprezzare la forza massima di rottura di ciascun provino. La successiva analisi al Microscopio Elettronico a Scansione (SEM) ha evidenziato le caratteristiche morfologiche delle fibre dopo la rottura dell’interfaccia.
RISULTATI:Dai test di laboratorio si possono apprezzare elevate capacità di resistenza alla trazione dell’interfaccia tra i perni FRC ed entrambi i compositi, confermando l’affinità della matrice del sistema adesivo con la matrice del perno stesso. Le analisi al SEM sottolineano questo dato, mostrando una rottura all’interno del perno stesso piuttosto che nell’interfaccia tra i materiali impiegati.
CONCLUSIONI: Questo studio conferma le possibilità di applicazione delle fibre di vetro immerse in una matrice polimerica nel campo dei perni endocanalari non solo per il loro modulo elastico, ma anche in considerazione della loro affinità alla matrice in BisGMA dei compositi.
TITLE
ADHESION TO PRE-IMPREGNATED GLASS FIBER POSTS
ABSTRACT
BACKGROUND:
Fiber-reinforced composite (FRC) root canal posts have biomechanical advantages when compared to traditional metallic posts (i.e. flexural properties and a customizable framework); considering their adhesion to resin composites, laboratory analysis have mostly concentrated on push out tests rather than mapping tensile stress on the surface of the fiber.
MATERIAL AND METHODS:
The objective of this study was to evaluate the adhesion of FRC posts to composite resin cements and micro hybrid composite material through laboratory tests. Specimens were realized interfacing FRC posts with adhesive and dipping each end in a volume composite cement or micro hybrid composite for a known length. The specimens were test trough a pull out test parallel to the long axis of the posts (analyzing tensile shear stress). The test ended at the time of rupture of the interface between pin and cement composite, underlining the peak of rupture of each specimen. The subsequent analysis at the Scanning Electron Microscope (SEM) showed the morphological characteristics of the fibers after the rupture of the interface.
RESULTS:
Laboratory tests show high tensile capacity of the interface between FRC posts and composite, confirming the affinity of the matrix of the adhesive system with the matrix of the these fibers. SEM analysis emphasize this result, showing a break in the pin itself, rather than the interface between the materials used
CONCLUSION:
This study confirms the possibility to glass fibers with a polymer matrix as root canal post material not just because of their flexural properties, but also considering their analogy to composite BisGMA matrix.
2010
- Mini-implants in growing patients. A new protocol.
[Abstract in Rivista]
MURRI DELLO DIAGO, Alberto; Generali, Luigi; Bertoldi, Carlo; Consolo, Ugo; Giannetti, Luca
abstract
Vedi allegato
2010
- Modified conservative and periodontal treatment in gingival buccal single recessions associated with non-carious lesions: a randomized clinical trial.
[Abstract in Rivista]
Lucchi, A.; Pellacani, C.; Bertoldi, Carlo; Allegretti, F.; Generali, Luigi; Giannetti, Luca; Consolo, Ugo
abstract
Vedi allegato
2010
- Multiple gingival recession treatment by coronally advanced flap alone or coronally advanced flap plus connective tissue graft: a randomized clinical trial.
[Abstract in Rivista]
Bertoldi, Carlo; Casto, C.; Pellacani, C.; Lucchi, A.; Generali, Luigi; Giannetti, Luca; Consolo, Ugo
abstract
Vedi allegato
2010
- Pulp extirpation for replanted avulsed teeth: a 6 years follow up.
[Abstract in Rivista]
MURRI DELLO DIAGO, Alberto; Generali, Luigi; Bertoldi, Carlo; Consolo, Ugo; Giannetti, Luca
abstract
Vedi allegato
2010
- Sealing ability of gutta-percha in root canals obturated by a modified continuous wave of condensation technique.
[Abstract in Rivista]
Generali, Luigi; Mancuso, R.; Travaglini, Domenico; Ardizzoni, Andrea; Giannetti, Luca; Bertoldi, Carlo; Ambu, E.
abstract
Vedi allegato
2010
- Single gingival recession treatment by coronally advanced flap alone or coronally advanced flap plus connective tissue graft: a randomized clinical trial
[Abstract in Rivista]
Bertoldi, Carlo; Spagnolo, L.; Dalmonego, S.; Lucchi, A.; Giannetti, Luca; Generali, Luigi; Consolo, Ugo
abstract
Vedi allegato
2010
- Temperature changes in guttapercha using two different heat sources: a preliminary in vitro study.
[Abstract in Rivista]
Generali, Luigi; Ambu, E.; DEL GIOVANE, Cinzia; Giannetti, Luca; Bertoldi, Carlo; Consolo, Ugo
abstract
Vedi allegato
2010
- The release of mercury from dental amalgam and potential systemic diseases: a letterature review.
[Abstract in Rivista]
Franchi, I.; Guaitolini, S.; Giannetti, Luca; Bertoldi, Carlo; Dotti, A.; Generali, Luigi
abstract
Vedi allegato
2010
- The use of piezoelectric devices in oral surgery: advantages and disadvantages
[Abstract in Rivista]
Dotti, D.; Travaglini, Domenico; Bellini, Pierantonio; Generali, Luigi; Consolo, Ugo
abstract
Vedasi l'allegato
2010
- Trattamento di lesioni non cariose di V classe in associazione a chirurgia plastica mucogengivale.
[Relazione in Atti di Convegno]
Lucchi, A.; Bertoldi, Carlo; MURRI DELLO DIAGO, Alberto; Generali, Luigi; Giannetti, Luca
abstract
RIASSUNTO
Ragioni: Lo scopo di questo studio era valutare il trattamento clinico delle recessioni gengivali associate a lesioni non cariose di V classe trattate mediante otturazione in resina composita con lembo ad avanzamento coronale più innesto di gengiva cheratinizzata (CAF+CTG).
Materiali e metodi: Otto pazienti che presentavano recessioni gengivali di I e II classe di Miller, sono state trattate mediante il medesimo protocollo che consisteva in: - pretrattamento per elimanare fattori eziologici legati alla recessione -otturazione in composito - intervento di chirurgia parodontale (CAF+CTG) a 15 giorni di distanza. Le misurazioni cliniche svolte a T0 baseline e T1 (12mesi) comprendevano: Profondità di sondaggio (PD); Profondità della recessioni (Rec depth); Ampiezza della recessione (Rec width); Ammanco tissutale latero-mediale; Livello di attacco clinico (CAL);Ampiezza della gengiva cheratinizzata (KT); Ipersensibilità dentinale(IP); Presenza di un gradino (GRAD); un criterio qualitativo di soddisfazione estetica (S)
Risultati:
Il confronto longitudinale tra i dati raccolti aT0 (baseline) e a T1 (12 mesi) presentava una rilevanza statistica per i parametri Rec depth, Rec width, Rec thickness, CAL e presenza di gradino(GRAD), e un miglioramento della soddisfazione estetica per tutti i pazienti considerati. La ricopertura radicolare risultava essere pari a.89,6% SD19,8%.
Conclusioni: Tutti i casi trattati hanno mostrato un miglioramento dei parametri clinici considerati con un ottima soddisfazione estetica, supportando l’utilizzo di questa tecnica conservativo parodontale per il trattamentamento delle recessioni associate a lesioni non cariose.
ABSRACT
Background: The purpose of this study was to assess the treatment of gum recession associated with non-decaying lesions of V classed, treated by means of a resin filling composed of an advanced coronal flap, plus a graft of the keritanized gum (CAF + CTG).
Methods and Materials: Eight patients, for a total of eight gum recessions of Class I and II of Miller in association with enamel erosions, were treated using the same method, consisting of;
Pre-treatment to eliminate etiological factors relating to the recession.
Composite fillings.
Periodontal surgery (CAF + CTG) after fifteen days.
The clinical measurements are made to T0 baseline and T1 (12 months), comprising;
Depth of drilling (PD)
Depth of recession (Rec depth)
Width of recession (Rec width)
The absence of lateral-medial tissue
The severity of the treatment (CAL)
Width of keritanized gum (KT)
Hypersensitivity of the teeth
Presence of a step (GRAD)
A criteria qualitative if aesthetic satisfaction (S)
Results: The longitudinal comparison between the data collected from T0 (baseline) and from T1 (12 months) shows an important statistic for the parameters Rec depth, Rec width, Rec thickness, CAL and step presence, and an improvement in the aesthetic satisfaction for all the patients considered. The radicular covering resulted to be equal to 89.6% +SD19.8%
Conclusions: All the cases treated have demonstrated an improvement of the clinical parameters considered with an excellent aesthetic satisfaction, supporting the use of this conventional periodontal technique for the treatment of recessions associated with non-decaying lesions.
2010
- Trattamento di recessioni gengivali mediante chirurgia plastica mucogengivale in lesioni cariose di V classe.
[Articolo su rivista]
Bertoldi, Carlo; Lucchi, A.; Generali, Luigi; Pellacani, C.; Guaitolini, S.; Giannetti, Luca; Consolo, Ugo
abstract
Questo studio è diretto a valutare i risultati conseguibili mediante l’impiego di moderni criteri di previsione di rigenerazione tissutale che potrebbero permettere di anticipare efficientemente la fase conservativa su quella parodontale chirurgica.
Materiali e Metodi: Sono stati selezionati dei pazienti che presentavano recessioni di Miller di I e II classe associate a carie cervicale. La lesione cariosa è stata trattata mediante ricostruzione conservativa di V classe con l’utilizzo di compositi nanoriempiti previa valutazione del livello più fisiologicamente corretto di posizionamento della CEJ in previsione del futuro trattamento di chirurgia plastica mucogengivale.
Due settimane dopo la terapia conservativa è stato trattata la recessione mediante terapia chirurgica plastica mucogengivale mediante tecnica bilaminare costituita da coronally advanced flap con innesto connettivale come precedentemente descritto.
Il paziente è stato richiamato per sedute di controllo post-chirurgico a 1, 2, 3 e 4 settimane.
Le misurazioni cliniche sono state eseguite a T0 (baseline) e a T1 (12 mesi);
Risultati: Sono stati inclusi nello studio complessivamente 6 pazienti, di età compresa tra i 20 ed i 44 anni costituito da 3 individui di sesso femminile e 3 di sesso maschile. In particolare il confronto longitudinale tra i dati raccolti aT1 (baseline) e a T2 (12 mesi) presentava una rilevanza statistica di risoluzione clinica per i parametri Rec depth, Rec width, Rec thickness, CAL e presenza di gradino.
Conclusioni: La sola terapia conservativa così come quella parodontale non riescono a risolvere separatamente completamente il problema estetico in un elemento che presenta recessione e di conseguenza una corona clinica eccessivamente lunga. Per questo motivo è necessario utilizzare una tecnica combinata chirurgico-conservativa. Il nostro studio longitudinale dimostra che l’esecuzione conservativa anticipatamente alla fase chirurgica permette di poter agire in modo meno traumatico sui tessuti rigenerati e di aver a disposizione maggiori spazi per eseguire un restauro più preciso in rapporto al rispetto dei margini dente/materiale ed anche in correlazione ai parametri estetici del restauro stesso. Per converso un errore nella impostazione della fase conservative (soprattutto nella definizione corretta della CEJ) potrebbe portare ad una facile sottostima del problema recessorio e quindi ad una serie di facili quanto incongruenti “falsi” successi terapeutici.
2009
- Esostosi multipla mascellare e mandibolare: a case report.
[Abstract in Atti di Convegno]
Dotti, A.; Travaglini, D.; Bertoldi, Carlo; Bortolini, Sergio; Generali, Luigi
abstract
Vedi allegato
2009
- L’importanza del modello tridimensionale nella ricostruzione delle creste alveolari.
[Abstract in Atti di Convegno]
Travaglini, Domenico; Dotti, A.; Generali, Luigi; Bertoldi, Carlo; Consolo, Ugo
abstract
Vedi allegato
2008
- Avulsione dentale e rivascolarizzazione pulpare in seguito a reimpianto: caso clinico.
[Articolo su rivista]
A., Murri; A., Odorici; Generali, Luigi; F., Vecci; Giannetti, Luca
abstract
Lo scopo di questo studio è quello di presentare un caso clinico di rivascolarizzazione pulpare in seguito a reimpianto dentale.Il paziente, di 9 anni, presenta entrambi gli incisivi centrali superiori avulsi in seguito ad un incidente sportivo.Giunge all’osservazione 30 minuti dopo il trauma, con gli elementi dentari conservati in soluzione fisiologica sin dai primi istanti. Entrambi gli elementi presentano apice beante e non completa formazione della radice.Seguendo le linee guida della IADT si decide di reimpiantare gli elementi e di eseguire uno splintaggio semi-flessibile.Si eseguono successivi controlli clinici e radiografici a 1-3-6-12 e 24 mesi.Nei denti con incompleta formazione radicolare è possibile andare incontro a rivascolarizzazione; tuttavia i test elettrici e termici non sono affidabili in seguito a traumi dentali, in quanto possono dare falsi negativi. La valutazione clinica di un dente traumatizzato però richiede uno studio sintomatico, visivo e radiografico. Se il dente diviene necrotico o infetto si può andare incontro ad un processo di riassorbimento radicolare che può condurre alla perdita del dente in breve tempo.Una diminuzione della dimensione della camera pulpare o del canale radicolare sull’immagine radiografica è un segno affidabile della vitalità pulpare.Il caso discusso rappresenta la possibilità di rivascolarizzazione in seguito a reimpianto a breve termine.
2008
- Condizionamento radicolare EDTA nel trattamento dei difetti intraossei mediante MIST.
[Abstract in Rivista]
Bertoldi, Carlo; Veneziani, A; Giannetti, Luca; Bencivenni, D.; Generali, Luigi
abstract
Vedi allegato
2008
- Efficienza e qualità di taglio di due unità ultrasoniche dedicate all chirurgia oro-maxillo-facciale.
[Abstract in Rivista]
Travaglini, D.; Generali, Luigi; Giannetti, Luca; Bertoldi, Carlo; Consolo, Ugo
abstract
Vedi allegato
2008
- Piezoelectric devices and rotative instruments: cutting efficacy
[Articolo su rivista]
Generali, Luigi; Travaglini, Domenico; Bellini, Pierantonio; Consolo, Ugo
abstract
Vedasi l'allegato
2008
- Resistenza alla trazione di ricostruzione di denti devitalizzati.
[Abstract in Rivista]
Dotti, A.; Bertani, P.; Generali, Luigi; Generali, P.; Bertoldi, Carlo
abstract
Vedi allegato
2008
- Trattamento rigenerativo dei difetti intraossei mediante chirurgia minimamente invasiva.
[Abstract in Rivista]
Bertoldi, Carlo; Giannetti, Luca; Guaitolini, S.; Generali, Luigi; Consolo, Ugo
abstract
Vedi allegato
2007
- Avulsione dentaria e OHRQoL.
[Abstract in Rivista]
Murri, A.; Vecci, F.; Bertoldi, Carlo; Generali, Luigi; Giannetti, Luca
abstract
Scopo del presente lavoro è quello di descrivere l’OHRQoL su di una popolazione che è andata incontro ad avulsione dentaria. Lo studio inoltre si pone l’obiettivo di identificare evidenze cliniche, associate all’OHRQoL, e di identificare la riabilitazione ideale in seguito ad avulsione in pazienti minorenni.Lo studio rientra in un più ampio clinical trial effettuato presso l’Università degli Studi di Modena e Reggio Emilia nel triennio 2003-2006 che ha interessato una popolazione di 101 pazienti.Ciascun paziente ha ricevuto una precisa terapia, specifica per il singolo caso, laddove possibile si è intervenuti con il reimpianto immediato, laddove invece questi non era possibile, o era andato incontro a fallimento, si è intervenuti con differenti presidi.La popolazione di pazienti è stata sottoposta all’OHIP-14, indice della percezione di malattia sull’impatto sociale di affezioni orali.Si sono evidenziati 7 gruppi di studio indicanti le diverse tipologie di riabilitazione.Il 21.2% dei soggetti studiati ha riportato una o più risposte affermative all’OHIP-14 nei 12 mesi precedenti. Le percentuali più basse si sono riscontrate a carico dei pazienti con reimpianto immediato, mentre il maggior discomfort è stato rilevato a carico dei pazienti con chiusura ortodontica degli spazi. Le apparecchiature parziali adesive, tipo Maryland, o ricostruzioni con fibre di composito hanno dimostrato un certo livello di discomfort con valori pari al 20%.Gli apparecchi funzionali e le apparecchiature parziali rimovibili hanno invece dimostrato un buon livello di qualità della vita percepita, confermandosi quindi dei validi presidi, laddove il reimpianto non fosse possibile.
2007
- Enucleazione conservativa di un fibro-odontoma amelobblastico: caso clinico
[Articolo su rivista]
Generali, Luigi; Giannetti, Luca; Bellini, Pierantonio; Consolo, Ugo
abstract
■ Scopo del lavoro è quello di presentare la tecnica chirurgica utilizzata dagli Autori per l’asportazione, mediante utilizzo di microscopio operatorio, di una neoformazione gigante localizzata a livello del tuber mascellare ed estrinse- cantesi a livello del processo alveolare e nella cavità sinusale. La lesione è stata inquadrata istologicamente come fibro-odontoma ameloblastico.
2007
- L'anatomia endodontica dei secondi molari superiori: ricerca ex vivo
[Articolo su rivista]
Ambu, E; Chiari, S; Cascino, E; Stasi, Pl; Generali, Luigi
abstract
Aim: of the present study was to deter- mine anatomic complexities which can be seen in maxillary second molars, with a specific attention to the presence of MB2 (second mesio-buccal) canals. Methodology: 50 maxillary second molars, which had been extracted for periodontal reasons, were selected for the study, following strict exclusion cri- teria. After determining the different roots, only the mesio-buccal one was examined. Location and number of canals were determined (i) after a normal access cavity, (ii) after a wider removal of dentine from the chamber floor, and (iii) after sectioning the root 4 mm be- low the cementum-enamel junction. Data were collected and analyzed. Results: MB2 canals were present in 44% of the examined teeth (20% of ca- ses showed Weine 2 configuration, while the remaining 24% showed Weine 3 configuration). It was possible to estabilish patency in MB2 canals only in 28% of cases.
Conclusions: MB2 canals are often present in maxillary second molars, being individuated in nearly half cases. This possibility and the presence of an indipendent apex make the research of MB2 canals mandatory during the endodontic treatment.
2007
- Utilizzo di Mineral Trioxide Aggregate nella riparazione di perforazioni della forcazione: due casi clinici
[Articolo su rivista]
Generali, Luigi; Giannetti, Luca; Ambu, E.
abstract
Aims: Mineral Trioxide Aggregate (MTA), a Portland Cement-like materi- al, developed in 1993 by M. Torabine- jad, has been suggested in the treat- ment of furcal perforation. The aim of this study is to describe two case reports of teeth with furcal perforation treated with mineral trioxide aggre- gate.
Clinical cases: two molars with a furcal perforation, due to decay and iatro- genic mistake, respectively, were treated with Mineral Trioxide Aggregate during the conventional retreatment. Clinical and radiological controls show the healing of periodontal tissues.
Conclusions: the MTA seems to be the best material in the treatment of furcal perforation. Its excellent action may be connected with highly reduced quantity of liquid and bacterial leak- age, and this clinical condition seems to allow the healing of periodontal tissues.
2006
- Aesthetic rehabilitation after a dento-alveolar trauma with indirect composite reconstruction
[Articolo su rivista]
Giannetti, Luca; A., Murri; L., Gallottini; Generali, Luigi
abstract
The aim of this study is to present a technique to establish a functional and aesthetic rehabilitation after a dento-alveolar trauma with uncomplicated crown fracture and to establish a predictable reproduction of the natural anatomy and nuance colour characteristics exhibited by natural dentition.
2006
- Analisi al SEM sull’accumulo di placca in differenti fili di sutura.
[Abstract in Rivista]
Buffagni, S.; Murri, A.; Bertoldi, Carlo; Generali, Luigi; Giannetti, Luca
abstract
Lo scopo del presente lavoro è quello di esaminare l’accumulo di placca su differenti tipi di fili da sutura, comunemente usati in chirurgia orale, mediante una analisi al microscopio elettronico a scansione.Sono stati esaminati venti pazienti, che presentano la necessità di estrarre tre elementi dentari monoradicolati mandibolari e/o mascellari.Tutti i pazienti selezionati nello studio non presentano patologie sistemiche di rilievo non sono fumatori ed il range di età è compreso tra i 30 e 50 anni.Si provvede ad impostare un protocollo igienico finalizzato volto al raggiungimento di un GI = 0 ed un PLI = 0 in modo tale da ridurre l’Alpha Error Level. In seguito all’estrazione degli stessi si suturano i tre alveoli rispettivamente con: Seta 3/0, Polyglactin 910 3/0, Poliglecaprone 3/0. A distanza di sette giorni si provvede alla rimozione delle suture, le si processa e le si esamina al microscopio elettronico a scansione. Per ciascun campione analizzato si valuta la presenza di placca batterica, di cellule sanguigne, di detriti e di microrganismi.Si osservano significative differenze tra i fili da sutura monofilamento rispetto ai plurifilamento, questi ultimi infatti presentano un evidente strato di placca batterica. Tra i fili plurifilamento utilizzati nel nostro studio emerge che il Polyglactin 910 risulta meno contaminato rispetto alla seta.
2006
- Effectivness of cleaning procedures on rotary nickel-titanium files: a SEM analysis.
[Articolo su rivista]
Generali, Luigi; Ciacci, L; Generali, P; Giannetti, Luca; Dettori, C.
abstract
AIM:The purpose of the present study was to quantify the surface debris on endodontic nickel-titanium rotary files after cleaning procedures.MATERIALS AND METHODS:Rotary nickel-titanium files (ProFiles and MTwo) were examined after removal from the packaging, after instrumentation in human teeth, and after various cleaning procedures. The cleaning procedures consisted of either ultrasonication with the files placed in a perforated container or ultrasonication with the files loosely placed in a beaker, with various cleaning agents. The presence of debris was evaluated using scanning electron microscopy. Specimens were scored accordingly to a 0-4 scale by two independent observers, whose agreement was previously evaluated using Cohen-K test. Data were analyzed with Kruskal Wallis and Mann-Whitney test for significativity. RESULTS:Some files were delivered from the factory with machining debris. The effectiveness of cleaning procedures with or without enzymatic products was different with p<0,001. Cleaning the files by ultrasonication within a container did not consistently achieve complete removal of debris. Placing the files loosely in the ultrasonic bath achieved the most effective cleaning.CONCLUSIONS:A conventional cleaning method is capable of effectively removing debris from endodontic files.
2006
- Effetto antimicrobico di due nuovi irriganti nei confronti dell'Enterococcus faecalis: studio comparativo in vitro
[Articolo su rivista]
Giardino, L; Ambu, E; Generali, Luigi; Savoldi, E.
abstract
Introduction: the antibacteric action of irri- gants in the endodontic therapy could be in- hibited by many factors. The most important one is the presence of bacterial strain (e.g. En- terococcus faecalis) resistant to irrigants and intracanal dressing action. Two new irrigants, based on antibiotics, Tetraclean and Bio Pure MTAD have been recently proposed to face this problem. The aim of this study is to com- pare the antibiotic action of these new irrig- ants.
Methodology: according to NCCLS guide- lines the MIC of Tetraclean and MTAD against Enterococcus faecalis ATCC 29212 strain were determined, using dilutions from 1:2 to 1:2048.
Results: Bio Pure MTAD killed all bacteria until a dilution of 1:256; Tetraclean has shown better results, until 1:1024.
Conclusions: both Bio Pure MTAD and Tetr- aclean proved effective antibacteric action as compared to the Enterococcus faecalis strain examined. Tetraclean was better than MTAD. Other in vitro and in vivo studies should be performed to confirm these data.
2006
- Fibro-odontoma ameloblastico localizzato nel seno mascellare: caso clinico
[Abstract in Rivista]
Generali, Luigi; Bellini, Pierantonio; Giannetti, Luca; Generali, P.; Consolo, Ugo
abstract
Vedasi l'allegato
2006
- In vitro and ex vivo studies on the antibacterial efficacy of sodium hypochlorite and two new generation endodontic irrigants, Tetraclean® and MTAD, in comparison with sodium hypochlorite.
[Relazione in Atti di Convegno]
C., Rimoldi; Ardizzoni, Andrea; Neglia, Rachele Giovanna; Blasi, Elisabetta; Generali, Luigi; E., Ambu
abstract
The aim of this work was to compare the efficacy of two endodontic iorrigants of new generation, Tetraclean and MTAD. Their antimicrobial effectiveness was assessed by in vitro and in vivo studies. Sodium hypochlorite was included as standard reference irrigant.
2006
- Rivascolarizzazione pulpare in seguito a reimpianto dentale: caso clinico.
[Articolo su rivista]
F., Magagna; MURRI DELLO DIAGO, Alberto; Generali, Luigi; E., Ambu; Giannetti, Luca
abstract
INTRODUZIONE E SCOPO DELLO STUDIO In seguito ad avulsione dentaria il processo di guarigione del fascio vascolo-nervoso determina il piano terapeutico.Studi effettuati sulla reazione della polpa hanno permesso di identificare diversi processi di guarigione.Numerosi studi eseguiti hanno portato ad osservare la formazione di tessuto duro lungo le pareti dentinali circa 17 giorni dopo il reimpianto; mentre si osservano nuove fibre nervose circa un mese dopo. Studi di tipo microangiografico hanno dimostrato la presenza di nuovi vasi già a 4 giorni dal reimpianto; dopo 10 giorni sono stati rilevati vasi nel terzo apicale e dopo 30 giorni nell’intera camera pulpare. Lo scopo di questo studio è quello di presentare un caso clinico di rivascolarizzazione pulpare in seguito a reimpianto.MATERIALI E METODI Il paziente, di 8 anni, presenta entrambi gli incisivi centrali superiori avulsi in seguito ad un incidente sportivo.Giunge all’osservazione 30 minuti dopo il trauma, con gli elementi dentari conservati in soluzione fisiologica sin dai primi istanti. Entrambi gli elementi presentano apice beante e non completa formazione della radice.Seguendo le linee guida della IADT si decide di reimpiantare gli elementi e di eseguire uno splintaggio semi-flessibile.Si eseguono successivi controlli clinici e radiografici a 1-3-6 e 12 mesi.CONCLUSIONI Nei denti con incompleta formazione radicolare è possibile andare incontro a rivascolarizzazione; tuttavia i test elettrici e termici non sono affidabili in seguito a traumi dentali, in quanto possono dare falsi negativi. La valutazione clinica di un dente traumatizzato però richiede uno studio sintomatico, visivo e radiografico. Se il dente diviene necrotico o infetto si può andare incontro ad un processo di riassorbimento radicolare che può condurre alla perdita del dente in breve tempo.Una diminuzione della dimensione della camera pulpare o del canale radicolare sull’immagine radiografica è un segno affidabile della vitalità pulpare.Il caso discusso rappresenta la possibilità di rivascolarizzazione in seguito a reimpianto a breve termine.
2006
- Terapia endodontica in seguito ad avulsione dentaria: revisione della letteratura.
[Articolo su rivista]
MURRI DELLO DIAGO, Alberto; Generali, Luigi; E., Ambu; Giannetti, Luca
abstract
INTRODUZIONE E SCOPO DELLO STUDIO In seguito al reimpianto di un elemento dentario avulso è facile incorrere in processi infettivi e di riassorbimento. A tal proposito critica è la condizione endodontica; la polpa necrotica può infatti facilmente infettarsi. Un’adeguata terapia endodontica si rileva quindi fondamentale per impedire o arrestare le possibili complicanze. Questo studio si pone l’obiettivo di eseguire una revisione sistematica della letteratura e di valutare quale debba essere la corretta gestione endodontica in seguito a reimpianto.MATERIALI E METODI Si esegue una ricerca della letteratura ponendo come domanda chiave quale debba essere la terapia endodontica del dente avulso e reimpiantato.Utilizzando quindi il catalogo MeSH si restringe il campo di ricerca tramite il termine booleano AND e lo si limita ai Major Topics. La stringa ottenuta viene applicata a PubMed.Gli item ricavati vengono sottoposti quindi ad una ulteriore analisi effettuata tramite valori descritti dal Center for Evidence-Based Medicine e dal Clinical Appraisal Skill Programme del National Health Service (UK).CONCLUSIONI La revisione della letteratura di tipo sistematico permette di vagliare oggettivamente la moltitudine di articoli oggi disponibili rendendo quindi più semplice il compito al clinico che quotidianamente affronta le diverse tematiche.Questo studio ha posto un quesito che è però rimasto irrisolto, in quanto la terapia endodontica dell’elemento avulso con dry-time > 1 ora permane argomento di discussione.Esiste una dicotomia tra chi sostiene la necessità di intervenire extra-oralmente e chi invece intra-oralmente. Si pone quindi la necessità di eseguire ulteriori studi clinici con rigidi protocolli.
2006
- Trasporto del forame apicale durante la sagomatura con gli strumenti rotanti K3endo: studio sperimentale in vitro
[Articolo su rivista]
Pigoni, T; Stasi, Pl; Pasqui, M; Generali, Luigi; Cascino, E; Cuppini, E; Ambu, E.
abstract
Gli strumenti in Nichel Titanio di ultima generazione consentono una sagomatura rapida ed efficiente del sistema dei canali radicolari ma alcuni dubbi rimangono riguardo alla possibilità che, soprattutto nei diametri maggiori, inducano stiramenti del forame apicale. Scopo di questo lavoro è quello di verificare l’azione dei K3endo sul forame apicale.
Materiali e metodi: Il forame apicale di 12 elementi dentari monoradicolati è stato fotografato allo stereomicroscopio prima e dopo la sagomatura con strumenti rotanti K3endo. I risultati sono stati registrati ed analizzati.
Conclusioni: l’utilizzo degli strumenti rotanti K3endo non produce trasporti del forame apicale, se non minimi ed insignificanti dal punto di vista clinico.
2006
- Valutazione al SEM di file endodontici dopo procedure di detersione
[Articolo su rivista]
Generali, Luigi; Ambu, E.; Giannetti, Luca; Murri dello, Diago; Generali, P.
abstract
Il presente lavoro valuta la morfologia dei file endodontici dopo aver subito dievsre procedure di detersione
2005
- Ectopic localization of Carabelli's tubercle. Review of the literature and description of two clinical cases.
[Articolo su rivista]
E., Ambu; B., Dallari; Generali, Luigi; Consolo, Ugo
abstract
The aim of this study is to describe 2 ectopic localizations of Carabelli's tubercle. Carabelli's tubercle or cusp is present, in a fair number of cases, in the vestibular walls of both first upper molars. Its size may vary. It is named after the Italian scientist Antonio Carabelli who first had described it in the first half of the 19(th) century. Carabelli's cusp has been often detected and studied in not hybridized ethnical groups, especially Eastern and Central Ameri-can groups, in which the evaluation of heritability and sex distribution is easier. It has been found that this cusp is not clinically important, it may only sometimes interfere with orthodontic treatments. It is seldom present in the second upper molars and almost never in the vestibular walls of either side of the second upper or lower molars. After a review of the literature showing that this cusp is more rarely present in Caucasian peoples, the authors describe 2 case reports with ectopic localization. This has never been found in recent literature and therefore it is to be considered absolutely rare.
2005
- Valutazione comparativa delle lesioni periapicali da Actinomyces: studio preliminare.
[Abstract in Rivista]
Lucchi, A.; Ambu, E.; Bertoldi, Carlo; Generali, Luigi; Consolo, Ugo
abstract
Vedi allegato
2004
- Actinomicetoma del mascellare superiore: due casi clinici
[Abstract in Rivista]
Generali, Luigi; Lucchi, A.; Ambu, E.; Giannetti, Luca; Consolo, Ugo
abstract
Vedasi l'allegato
2004
- Aumenti ossei al mascellare superiore con prelievo dall’ulna: analisi clinica
[Abstract in Rivista]
Consolo, Ugo; Cannizzaro, G.; Verri, V.; Leone, M.; Generali, Luigi
abstract
Vedasi l'allegato
2004
- Possibilità di riabilitazione protesica nei traumi mascellari
[Abstract in Rivista]
Giannetti, Luca; Generali, Luigi; Bortolini, Sergio; Bellini, Pierantonio; Consolo, Ugo
abstract
Vedasi l'allegato
2004
- Utilizzo di calvaria per riabilitazione impianto-protesica della mandibola edentula: descrizione di un caso clinico
[Abstract in Rivista]
Bellini, Pierantonio; Generali, Luigi; Giannetti, Luca; Bortolini, Sergio; Consolo, Ugo
abstract
Vedsai l'allegato
2004
- Valutazione comparativa in vitro di un nuovo plugger per il System B
[Articolo su rivista]
Ambu, E; Serafini, E; Stasi, Pl; Generali, Luigi; Pasqui, M; Rimondini, L.
abstract
A i m: t h e c o n t i n u o u s w a v e o f o b t u r a t i o n t e c h - nique requires adequate canal enlargement to insert the smallest Buchanan plugger (fine 50/06) to the ideal length, in order to prop- erly compact guttapercha in the root canal sys- tem. Due to the introduction of a new small- er plugger (30/04) shaping and obturation procedures are expected to be easier. The aim of the study was to evaluate in vitro how deep apically the new plugger penetrates and com- pare penetration with the “fine” plugger.
Me t h o d o l o g y : t w o t e s t s w e r e c a r r i e d o u t , o n 10 extracted molars and on 5 mesial roots of lower molars, respectively. All canals were shaped up to apical diameter of 25 and .06 ta- p e r. I n t h e f i r s t t e s t , t h e n e w p l u g g e r w a s i n - serted as deep as possible. In the second test, initially two 30/04 pluggers and then two 50/06 pluggers were inserted in the mesial canals as deep as clinically required. Radi- ograms were taken of all samples by means of a millimetric grid. Pictures were scanned, and digitally analized.
R e s u l t s : t h e f i r s t t e s t s h o w e d t h a t t h e me a n maximum depth reached by 30/04 pluggers is 1.35 mm shorter from the root canal radi- ographic terminus; in the second test 30/04 pluggers showed mean penetration values sig- nificantly deeper than those reached by 50/06 pluggers.
C o n c l u s i o n s : t h e n e w 3 0/ 0 4 p l u g g e r – w hi c h is smaller and more flexible than the 50/06 one – can easily be inserted up to 2 mm from the root canal apex without removing large amounts of dentin.