1,721,000 research outputs found
Āsana for Neck, Shoulders, and Wrists to Prevent Musculoskeletal Disorders among Dental Professionals: In-Office Yóga Protocol
Full text linkExtensive literature reports an increase in physical disorders (pain, pathologies, dysfunctions) and mental malaise/uneasiness (stress, burnout) affecting dental professionals in relation to fast and pressing rhythms of work, long working hours, increasingly demanding patients, ever-evolving technologies, etc. This project has been conceived to bring the science of yoga around the world to dental professionals as a preventive (occupational) medicine and to provide knowledge and means for self-care. Yoga is a concentrative self-discipline of the mind, senses, and physical body, that requires regular daily exercise (or meditation), attention, intention, and disciplined action. M&M: The study aimed to design a Yoga protocol specifically devised for dental professionals (dentists, dental hygienists, and dental assistants) including positions (āsana) to be practiced/used in the dental office. The protocol is targeted for the upper body, namely neck, upper back, chest, shoulder girdle, and wrists, being areas greatly affected by work-related musculoskeletal disorders. This paper represents a yoga-based guideline for the self-cure of musculoskeletal disorders among dental professionals. Results: The protocol includes both sitting (Upavistha position) and standing (Utthana or Sama position) āsana, with twisting (Parivrtta), side bending (Parsva), flexion and forward bending (Pashima), and extension and arching (Purva) āsana to mobilize and decompress, and to provide nourishment and oxygen to the musculo-articular system. The paper delivers different concepts and theories developed and deepened by the authors and introduces and spreads yoga as a medical science among dental professionals for the prevention and treatment of work-related musculoskeletal disorders. We articulate notions ranging from stretching out using the vinyāsa method (breath-driven movement) and inward-focused attention to contemplative/concentrative science, interoceptive attention, self-awareness, the mind–body connection, and receptive attitude. The theory of “muscles are bone ties” is coined and delivered with regard to tensegrity musculoskeletal fascial structures connecting, pulling together, and nearing the bone segments where they are anchored. The paper describes over 60 āsana envisaged to be performed on dental stools or using the walls of a dental office or a dental unit chair. A detailed guideline on the work-related disorders that can find relief with the protocol is provided, including the description of breath control for the practice of āsana in vinyāsa. The foundations of the technique reside in the Iyengar Yoga method and Parināma Yoga method. Conclusions: This paper represents a guideline for self-cure in the prevention or treatment of musculoskeletal disorders affecting dental professionals. Yoga is a powerful concentrative self-discipline able to provide physical and mental well-being, representing great help and support in daily life and business for dental professionals. Yógāsana restores retracted and stiff muscles, giving relief to the strained and tired limbs of dental professionals. Yoga is not intended for flexible or physically performing persons but for people who decide to take care of themselves. The practice of specific āsana represents a powerful tool for the prevention or treatment of MSDs related to poor posture, forward head, chronic neck tension (and related headache), depressed chest, compressive disorders on wrists and shoulders as carpal tunnel, impingement syndromes, outlet syndrome, subacromial pain syndrome and spinal disc pathologies. Yoga, as an integrative science in medicine and public health, represents a powerful tool for the prevention and treatment of occupational musculoskeletal disorders and an extraordinary path for the self-care of dental professionals, sitting job workers, and healthcare providers suffering from occupational biomechanical stresses and awkward postures
The efficacy of premixed bioceramic sealers versus standard sealers on root canal treatment outcome, extrusion rate and post‐obturation pain: A systematic review and meta‐analysis
No full textBackground: Limited evidence is available regarding the superior clinical properties of bioceramic sealers comparted with traditional standard sealers. Objectives: This review aimed to answer the following research questions: 'In healthy patients requiring a root canal treatment (P), what is the efficacy of premixed bioceramic sealers (I) compared with traditional root canal epoxy resin-based sealers (C) in terms of survival, success rates (PICO1) sealer extrusion and resorption (PICO2) post-obturation pain (PICO3) (O)?' Methods: Authors independently searched three electronic databases: PubMed (including MEDLINE), Web of Science, Embase and Scopus up to 31 October 2023. This was accompanied by both grey literature and manual search. Detailed selection criteria were applied, namely mature permanent teeth requiring root canal treatment, premixed bioceramic sealer with gutta-percha as an intervention group, a standard filling technique as control group and full-text available in English. A random-effect meta-analysis was used to synthesize the body of evidence regarding the use of bioceramic sealers in root canal treatment and their impact on post-obturation pain. Effect sizes were represented as relative risks on a logarithmic scale for binary outcomes and as mean differences for continuous outcomes. Results: A total of 941 articles were identified. Fifteen Comparative clinical studies were finally included. Eleven were randomized clinical trials, and four were prospective clinical trials with control group. The follow-up of these studies was not greater than 2 years. No publication bias was observed in any study. No significant differences were observed between the two groups in terms of survival and success rates. A small non-significant lower risk of extrusion was observed for bioceramics. A small, non-significantly lower post-operative-pain within 24-h was observed when bioceramics were used. Discussion: The majority of current evidence shows inconsistencies in reporting and is of short-term duration. Robust prospective long-term trials are needed in this area to better support future recommendations. Conclusion: This systematic review is the first to analyse several clinical outcomes using premixed sealers. Included studies differed in terms of clinical protocol and operator expertise, but reported a similar outcome when comparing bioceramic versus standard sealers. Tooth survival, treatment outcome, post-operative pain and periapical extrusion were similar and presented no significant differences between the two sealer types. Registration: PROSPERO database (CRD42023449151)
Retreatment or replacement of previous endodontically treated premolars with recurrent apical periodontitis? An 8-year historical cohort study
Full text linkObjectives: The study evaluated previously-endodontically-treated premolars affected by periapical lesions and/or secondary caries requiring a multidisciplinary decision between (non-surgical) retreatment or extraction and implant replacement over an 8-year minimum follow-up. Materials and methods: The decision-making was performed among a pool of patients attending a University Dental School. All patients presented at least one failing previously endodontically treated premolar. Recorded parameters were: structural conditions (residual coronal-structure, caries), periodontal and endodontic status (CEJ-MBL, initial-PAI, post-presence). Two experienced operators made the decision-making and classified teeth as retreatable and restorable (Endo-group) or suitable for extraction and implant replacement (Implant-group). Logistic regression and Cox-proportional-hazard analyses with clustered-standard-errors compared baseline-characteristics and treatment-outcomes. Odds-ratios (ORs) with 95% confidence-intervals (CIs) were reported for baseline-characteristics. Hazard-ratios (HRs) expressed the association of treatment-groups with time-to-event. Results: Ninety-six patients (n = 124 premolars) were enrolled (49 M;47 F; mean-age 53.1 ± 11.6 years). The decision-making splitted 54.8% treatments to Endo-group (n = 68) and 45.2% to Implant-group (n = 56). The 8-year survival were 85.1% for Endo-group and 98.2% for Implant-group. The 8-year success were 80.5% and 93.9%. The HR from Cox regression favored Implant-group (HR = 0.12, P = 0.049). The Endo-group showed the highest number of critical complications (15%) due to fractures, despite the healing of lesions. Implant-group had a higher percentage of minor prosthetic complications (14%). Conclusions: Endo-group demonstrated higher percentage of critical complications compared to Implant-group during the follow-up. Root fractures were accounted as main responsible, while periapical disease did not affect healing, survival and clinical longevity. Clinical significance: Insufficient crown structure was the major parameter associated with root fracture. In these cases, implant replacement strategy represented an adequate therapy justified by the higher success compared to root canal retreatment
Alveolar osteitis associated with methicillin-resistant Staphylococcus epidermidis
No full textA critical point in dentistry is the empiric prescription of broad-spectrum antibiotics that could increase the levels of antimicrobial resistance. Alveolar osteitis is one of the most common post-op- erative complications in which antibiotic use is controversial. A 35-year-old female, with pain in the right mandibular region and treated with cefixime, was diagnosed with cracked tooth syndrome and pulpitis. The tooth was extracted and a massive purulent bleeding drainage was observed. Irrigation of the socket and a new therapy with azithromycin were done. Bacteriological analysis, a specific mecA gene PCR for the methicillin resistance, and the antimicrobial susceptibility test were per- formed on the bacterial isolate. A Staphylococcus epidermidis isolate was methicillin-resistant and showed resistance to erythromycin, azithromycin, clarithromycin, and sulfamethoxazole + trimeth- oprim. After 7 days, intraoral examination showed a complete resolution. The aim of this report is to suggest that systemic antibiotics may provide insufficient efficacy during alveolar osteitis, especially when caused by a multidrug-resistant organism
Endodonzia: tecniche cliniche, strumenti, materiali e casi complessi – Modulo 5: Endodonzia in presenza di patologie cliniche sistemiche: tecniche operative e loro determinante importanza
No full textOBJECTIVES
The aim is to identify the systemic patologies having the greatest impact in endodontics and dentistry. The anamnesis
procedures, a correct therapy and follow-up are also reported. The different
procedures that must be adopted for a
correct endodontic treatment in presence of a patient with a systemic disease are also clinically discussed.
MATERIALS AND METHODS
Articles, systematic reviews and international guidelines were analysed to describe and discuss the most important
procedures that general dentist/endodontist specialist must adopt when approaching a patient with systemic disease.
RESULTS
Elderly patients and with a systemic pathology often have destructive carious
lesions and a root canal complexities
such as root canal calcifications.
Patient with cardiovascular disease
must be classified in a risk category before performing endodontic treatment.
Patients under bisphosphonate therapy
must perform dental screening to identify teeth with endodontic pathologies.
Endodontic treatment can be useful to
avoid the extraction of compromised
dental elements (and to reduce the risk
of bisphosphonate-induced osteonecrosis). Patients with diabetes, especially if not controlled, have greater susceptibility to develop post-endodontic flareups, a greater percentage of complications (persistent periapical lesions, periodontal abscesses, loss of periodontal
support) and a lower healing rate.
Patients with severe kidney disease
should be adequately monitored prior
any endodontic and surgical treatment.
The coagulation profile must be
checked before each treatment, while
particular attention must be exercised
in the type of antibiotics and painkillers
to be prescribed.
CONCLUSIONS
Endodontists must be prepared for a
constant and massive increase in the
number of systemic pathologies and
complex “personalized” therapies that
are characteristic not only of elderly patients. It is therefore necessary to “personalize” endodontic therapy by adapting it to the clinical needs of the patient.
A constant interaction with the medical
colleagues responsible is needed for
the patient’s internal/cardiovascular/
oncological management.
CLINICAL SIGNIFICANCE
Both endodontist specialist and the
generic dentist must prepare for this
important change in the management
of patients with systemic pathology.
This change is now occurring and involves a great percentage of our patients. However, even younger patients
may present systemic pathology requires a modification of normal endodontic procedure.
Some pathologies and pharmacological therapies – such as bisphosphonates – need great attention. For this
reason, a new concept of “Preventive
Endodontics” or “Endodonzia preventiva” is born
ESEM-EDX Microanalysis at Bone-Implant Region on Immediately Loaded Implants Retrieved Postmortem
No full textPurpose: The aim of the study was to analyze the microchemistry of human bone in different regions of interest (ROIs) on histologic samples of implants retrieved postmortem by the innovative use of an environmental scanning electronic microscope (ESEM) connected to energy-dispersive x-ray spectroscopy (EDX). Materials and Methods: Maxillary and mandibular bone blocks with inserted implants (n =12) were obtained postmortem from a patient. The histologic samples were observed uncoated using ESEM in quadrant backscattered condition. Two ROIs (approximately 750 x 500 mu m) for each implant were analyzed corresponding to the cortical thread (cortical ROI) and the middle part of each implant (approximately 3.0 mm below; middle ROI). Different electron-dense bone tissue areas were detected through grayscale intensity quantification of ESEM images. Calcium (Ca), phosphorous (P), and titanium (Ti; atomic %) were evaluated by EDX, and Ca/P ratios were calculated and used as the index to identify areas with different mineralization. The presence of Ti contaminants was investigated by EDX microanalysis. Additional ROIs approximately 2.0 mm from the implant interface and not in connection with the implant surface were analyzed as the control. Results: Four bone areas (BAs) with different degrees of mineralization (from 1 as the lowest mineralized to 4 as the highest mineralized) were identified by Ca and P content and by tissue electron density. BA1 (bone marrow areas) and BA2 (areas with active bone remodeling) proved to have low levels of Ca and P, while BA3 (mineralized new bone areas) and BA4 (control cortical bone) had higher content of Ca and P and higher electron density. Mandibular ROIs displayed higher percentages of BA3 and BA4, while maxillary ROIs revealed a greater presence of BA2 and moderate presence of BA1. Control bone showed a high percentage of BA4. Cortical and middle ROIs showed similar BA distribution within mandibular bone, whereas in maxillary bone, a slightly higher presence of BA1 was observed. Ti ions were detected in ROIs of all specimens; the atomic % significantly decreased in the most distant areas. Ti particles were observed close to the implant interface. Analyses 2.0 mm distant from the implant thread revealed low traces of Ti in healthy bone tissue. Conclusion: The high percentage of BA3 and BA4 in mandibular blocks associated with low presence of BA2 suggested the fast formation of compact bone tissue after 7 months from the implant placement. The presence of BA2 in maxilla blocks suggested active bone remodeling still present after 7 months. Ti particles were observed throughout the ROIs with and without bone remodeling activity. ESEM-EDX resulted as a suitable technique to obtain more complete information on microchemistry composition and density/ mineralization of bone around implants. For clinical significance, maxillary and mandibular pen-implant bone revealed different mineralization patterns, which means different healing times. The presence of Ti particles at the bone-implant interface and ion translocation, likely due to wear forces in the times following the implant insertion, do not affect the bone remodeling process
Rehabilitation of anterior upper incisor area with combined therapy Maryland Bridge and Prama Implant: two case reports three
No full textBackground: New implant system with an innovative trasmucosal surface profile morphology (BOPT) have been recently developed.
The transmucosal neck surface is characterized by a controlled passivation treatment and a conical morphology to allow a
biological corrected prosthetic form of ceramic crown.
Aim/Hypothesis: The aim of this clinical cases study was to evaluate the marginal crestal bone loss (MBL) and gingival/periodontal
status of transmucosal implant placed in anterior upper area.
Material and methods: Three healthy subjects with acute active periapical lesion of seriously compromised upper incisor requiring
tooth extraction were consecutively included in the study. After tooth extraction, all patients were rehabilitated with the positioning
of a Maryland bridge to preserve the aesthetic line. Approximately 3 months later a transmucosal zirconium blasted acidetched
titanium (ZirTi) implant (PRAMA, Sweden & Martina, ITALY) was positioned with flapless technique. All implants had
insertion torque of 50–65 N/cm. Each implant was finally loaded after 3 months with a provisional resin crown and a di-silicate
ceramic crown as definitive restoration. Clinical and radiographic follow-up (mucosal profile, periodontal indices and MBL) was
performed 1, 2, 3 months after implant placement and 3 and 6 months after loading.
Results: No gingivitis and other complications were observed. No marginal bone loss was observed around the implants before
and after loading. Adequate and corrected aesthetic crown profile was obtained with a reduced compression of mucosal marginal
tissues.
Conclusions and clinical implications: The combined prosthetic and surgery technique and the use of ZirTi implant system with
BOPT profile showed valid aesthetic and biological profile and allow the placement of the ceramic crown with a corrected emergency
profile that may prevent MBL
Dentine surface modification and remineralization induced by bioactive toothpastes
Full text linkObjectiveIn this study, dentine surface was analysed through Environmental-scanning-electron-microscopy (ESEM) with energy-dispersive-X-ray-spectrometry (EDX) and Fourier-transform-infrared-spectroscopy (FTIR) with attenuated total-reflectance (ATR) to assess the morpho-chemical changes and variations in mineralization degree after demineralizing treatment, after five toothpastes application (HA & Citrate toothpaste, Zinc-HA toothpaste, Calcium Sodium Phosphosilicate toothpaste, Arginine & Calcium carbonate toothpaste, Colgate-Triple-Action, and Control toothpaste), after soaking in artificial saliva and after citric acid attack.MethodsCa/P, Ca/N and P/N ratios were calculated from EDX atomic data to evaluate the mineralization degree of dentine surface. The IR calcium phosphate (CaP)/collagen and carbonate/collagen ratios has been evaluated to assess the remineralization changes in dentine; the carbonate/collagen IR ratio was calculated to identify the nucleation of B-type-carbonated apatite and calcium carbonate.ResultsESEM-EDX and ATR-FTIR showed residuals of toothpastes after the treatments in all cases, with a general increase in the mineralization degree after soaking in artificial saliva and a decrease after acid attack.Treatment with Arginine & Calcium carbonate toothpaste showed the highest Ca/P value after treatment (Ca/P 1.62) and acid attack (Ca/P 1.5) in confirmation, IR showed the highest amount of carbonate after treatment and soaking in artificial saliva.Arginine and calcium carbonate toothpaste and HA and citrate toothpaste remained to a higher extent on the dentine surface and revealed a higher remineralization activity. These formulations showed higher resistance to demineralization attack, as demonstrated by a higher I-CaP/I-Amide II intensity ratio than those obtained after EDTA treatment.ConclusionsToothpastes that remained to a higher extent on dentine surface (arginine and calcium carbonate toothpaste in particular) were more able to promote remineralization. The formed calcium phosphate (CaPs) phase was intimately bound to dentine rather than a simple deposit
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