Musculoskeletal symptoms are common in both acute COVID-19 disease and post-acute sequelae (Post-Acute COVID Syndrome). The purpose of this study is to investigate whether there are reduced levels of masticatory function in patients with PACS (Post Acute COVID Syndrome) who suffer from sarcopenia, under the hypothesis that the latter may also involve the masticatory muscles. This study includes 23 patients hospitalized for COVID-19 between February 2020 and April 2021 and currently suffering from PACS. Among these PACS patients, 13/23 (56%) suffer from sarcopenia, 5/23 (22%) complain of asthenia but do not suffer from sarcopenia and the remaining 5/23 (22%) do not present muscle symptoms (non-asthenic non-sarcopenic). Oral health indices of all patients were collected. The masticatory strength was assessed with a gnathodynamometer based on piezoresistive sensors, and the masticatory effectiveness was measured by administering the “chewing gum mixing ability test” by having patients perform 20 masticatory cycles on a two-color chewing gum and analyzing the outcome through the ViewGum© software. Moreover, we gathered data with a hand grip test and gait speed test. The data collected in this study show that PACS sarcopenic patients have decreased masticatory effectiveness and strength compared to PACS asthenic non-sarcopenic patients and PACS non-asthenic non-sarcopenic patients.

Background: This pilot study aimed to verify the efficacy of two orthodontic appliances in relation to changes in the lower intercanine distance in growing patients. Methods: Twenty patients aged 10–16 years were enrolled in the study and separated into test and control groups. The test group included 10 patients (5 males, 5 females; mean age, 10.4 ± 1.57 years) who were treated with an elastodontic device. The control group included 10 patients (5 males, 5 females; mean age 10.8 ± 1.53 years) who were treated with clear aligners. The two groups exhibited the same orthodontic features. The orthodontic criteria were: skeletal class I relationship, molar class I relationship, and presence of lower crowding. Patients were evaluated as having mild or moderate crowding according to the Daniels and Richmond index. The lower intercanine distance was evaluated at three timepoints via intraoral scans: T0 (before starting therapy), T1 (after six months), and T2 (after 1 year). Data were analyzed using a nonparametric approach via the Wilcoxon signed-rank test. Results: There was no statistically significant difference between the two groups at T0, T1, or T2 (p < 0.05). Conclusions: elastodontic devices and clear aligners can successfully help the orthodontist conduct lower arch expansion treatment. These appliances are comfortable to wear, simple to clean every day, and reduce the number of dentist appointments. Finally, but not of least importance, these devices have allowed dentists to continue orthodontic treatments during the lockdowns of the COVID-19 pandemic.

Tooth eruption is a complex process, during which a series of factors can cause a failure of it. Among this, primary failure of eruption (PFE) is a non-syndromic condition that leads to an incomplete tooth eruption despite the presence of a clear eruption pathway. The aim of this narrative review is to provide an overall view about clinical considerations, genetics-related aspects, and possible treatments of PFE based on the latest findings. A literature search using the PubMed/Medline and Scopus database was performed. The search terms used were “PFE”, “orthodontics”, “primary failure of eruption”, and “treatment”, and all the articles, according to the inclusion criteria, from 2008 until June 2022 were screened. Among them, 12 articles were considered useful to highlight some of the main genotypical and phenotypical aspects and several treatment options. Indeed, if there is a suspicion of primary failure of eruption, a PTH1R screening should be performed, because a mutation in this gene is responsible for an altered balance between the resorptive and the appositional processes during the eruption. This is important to know before starting an orthodontic treatment because it could lead to ankylosis of the affected tooth, exposing patients to iatrogenic damage. Treatment options depend on the growth phase of the patient and on the clinical situation.

Background: Medication-Related Osteonecrosis of the Jaw (MRONJ) is an adverse drug reaction mainly associated to bone modifying agents (BMAs). Breast cancer (BC) is the most frequent cancer worldwide. Its therapy can cause cancer treatment-induced bone loss (CTIBL), commonly treated with BMAs. The aims of this retrospective study are: to describe characteristics of BC patients under BMAs for CTIBL; to record any switch to high-dose BMAs; to assess MRONJ onset and to identify any factors associated with it. Patients: Authors included patients referred for MRONJ prevention to the Unit of Oral Medicine (University Hospital of Palermo). Results: Fourteen female BC patients under low-dose BMAs for CTIBL were eligible (mean age 66.6 years). Four patients switched to high-dose BMAs for bone metastases. In two of the four, MRONJ developed: one case, in the mandible (risedronate for 48 months then Xgeva® for 60 months); the other case, in the maxilla (Prolia® for 20 months then zoledronate for 16 months). Conclusion: It can be theorized that BC patients under BMAs for CTIBL are likely to have MRONJ risk similar to osteo-metabolic patients. These patients need more careful monitoring of oral health since they may switch, for preventing or treating bone metastases, to heavier BMAs therapy, thus increasing their risk of MRONJ.

Background. Sialadenoma papilliferum (SP) is a rare benign epithelial tumor of salivary gland origin, its diagnosis being potentially challenging. It was first described by Abrams and Finck in 1969 as an analog of the cutaneous syringocystadenoma papilliferum. The aim of this comprehensive review is to highlight the clinical and histopathological diagnostic aspects of intraoral SP, analyzing cases previously described and reporting new cases. Methods. Medline, Scopus, and Web of Science were searched up to February 2022, using as entry term “sialadenoma papilliferum”. No time limits were applied and only studies in English were taken into account. Only cases involving the mouth were included. Conference proceedings, personal communications, and letters to the editor were excluded. Results. In total, 42 out of 234 articles fulfilled the inclusion criteria, with 64 cases reported. Mean age of patients with SP was 57.2 years, with a higher prevalence among males. The most affected site was the palate, particularly the hard palate. Four cases with uncertain malignant features have been reported. While clinical manifestations of SP are rather unspecific (e.g., submucosal swelling with ulceration), histopathological and immunohistochemical features are quite peculiar, SP have a limited growth potential, leading to conservative excision as treatment of choice. Conclusions. SP, though rare, should be taken into consideration in the differential diagnosis of intraoral swellings, particularly those located on the palate.

(1) Background: The aim of this study was to compare the histopathological features of syndromic and non-syndromic odontogenic keratocysts (OKs) using conventional and Confocal Laser Scanning Microscopy (CLSM) with their biological behaviour. (2) Methods: Data from the medical records of 113 patients with histological diagnosis of (single and/or multiple) OKs were collected. Globally, 213 OKs (120 syndromic and 93 sporadic) were retrieved, and their histological slides were re-evaluated with conventional H&E staining and with autofluorescence on the same slides using CLSM (Nikon Eclipse E600 microscope). (3) Results: Syndromic OKs showed more satellite cysts than sporadic cases, as well as a basophilic layer in the basement membrane, which was absent in sporadic OKs; both were highlighted with CLSM. The basement membrane in syndromic OKs appeared amorphous and fragile, thus possibly being responsible for the epithelial detachment and collapse, with scalloped features. Furthermore, the basal epithelial layers in such cases also showed increased cellularity and proliferative activity. All these histological features may possibly justify their higher tendency to recur. (4) Conclusions: CLSM is useful advanced technology that could help to quickly and easily discriminate between syndromic and non-syndromic OKs and to more accurately predict their biological behaviour in order to set fitter clinico-radiological follow-ups for individual patients.

(1) Background: Trismus clinically manifests as a reduction of the buccal opening and restricted mouth opening due to different etiologies, but it is often associated with traumatic phenomena. Several treatments have been proposed such as physiotherapy exercises, cryotherapy, laser therapy, hyaluronic acid and platelet-rich fibrin infiltration, but the gold standard is represented by drug therapy based on corticosteroids and NSAIDs, currently the most documented in the scientific literature. Capacitive-resistive electric transfer (Cret) therapy is used to treat musculoskeletal injuries. Cret is a non-invasive electrothermal treatment classified as deep thermo-therapy. (2) Patient: We would like to document a case of particularly traumatic trismus in a 12-year-old patient, not responsive to previous pharmacological therapy and treated with a radiofrequency device called Velvet temporomandibular joint (TMJ). Five capacitive and resistive diathermy sessions with the device were performed. The first four sessions were performed every 4 days and the fifth after 5 days. (3) Result: The maximum opening of the mouth was 10 mm at the initial stage and 38 mm at the end of the six sessions. Pain regressed after the second appointment. (4) Conclusions: Clinical studies with a good number of samples need to be conducted to evaluate the effectiveness of this device which has proved to be an excellent treatment for this refractory case to conventional therapies. Finally, it may be useful to define precise and replicable protocols to make this therapy suitable for patients with TMJ disorders.

On the 8th and 9th of May 2021, an online conference was organized to connect Italian physicians, dentists and oral care specialists, students, nurses, psychologists, dental hygiene experts, and other professionals to discuss controversial issues about Medication-Related Osteonecrosis of Jaw (MRONJ). The first section evaluated differences between Italian recommendations, released on 2020 by Italian Societies of Oral Pathology and Medicine (SIPMO) and Maxillofacial Surgery (SICMF), and other international practice guidelines or documents. A first round table gathered expert opinions about MRONJ definitions and staging systems. Another round table was dedicated to opinion of drug prescribers (oncologists, hematologists, rheumatologists, and other physicians treating osteoporosis). Educational sessions illustrated the main differences between previous (2013) and more recent (2020) Italian recommendations. A large space was dedicated to the presentation of scientific contributions from centers in Italy, divided in specific sessions (epidemiology; case series; special case reports; prevention experiences; MRONJ treatment). Conclusions: in an innovative web conference, talks and scientific reports underlined importance of adequate imaging study of bone in definition and staging of MRONJ cases, the role of surgery in treatment of the disease, and the value of oral hygiene in the prevention.

Denosumab has proved effective at low doses in increasing bone mineral density in osteoporosis patients. In contrast to high-doses antiresorptive therapy, denosumab has a transient effect on the inhibition of the bone remodeling process, suggesting that denosumab-related osteonecrosis is a self-limiting disease, with a high curative potential of surgery when performed after a proper duration of receptor activator of nuclear factor-kB ligand (RANKL) inhibitor suspension. We report the long-term clinical and radiological (Computed Tomography—CT scan) data of a patient affected by secondary osteoporosis (cancer treatment-induced bone loss—CTIBL for metastatic breast cancer) who underwent surgical treatment for stage II denosumab-related osteonecrosis of the upper maxilla 7 months after denosumab suspension. A minimally invasive approach was performed with the extraction of the first right upper molar and debridement of the surrounding alveolar bone. After surgery, the patient was followed up at three-month intervals up to 1 year, and clinical and radiological data (CT scan) were recorded at each follow-up for the early detection of signs of recurrent disease. The mucosal healing remained stable in the long term, with radiological signs of bone remodeling in the post-operative site since the 6-month follow-up. The presented case strengthens the hypothesis that denosumab induces temporary alterations of bone turnover with a predictable curative effect of minimal surgical procedures in cases of denosumab-related osteonecrosis of the jaw.

The surgical extraction of the lower third molar is widely practiced in oral surgery. Inflammatory complications such as pain, swelling, and trismus can cause discomfort to the patients after third molar extraction. Several methods have been used to reduce these postoperative sequelae, including the use of corticosteroids, nonsteroidal anti-inflammatory drugs, analgesics, antibiotics, less traumatic surgical methods, and the use of photobiomodulation. This narrative review summarizes the current evidence on the effect of photobiomodulation on pain, facial swelling and trismus after third molar surgery. A literature search using MEDLINE (NCBI PubMed and PMC), EMBASE, Scopus, Cochrane library, Web of Science, and Google Scholar was undertaken up to October 2021. Forty-one articles met the inclusion criteria. Photobiomodulation can be considered an alternative and useful method for controlling pain following impacted wisdom tooth surgery. The effectiveness of PBM in reducing swelling and trismus is still controversial. This review highlights the lack of consensus in the literature on protocols used in PBM therapy.

Medication-Related Osteo-Necrosis of the Jaws (MRONJ) is a severe painful complication of the long-lasting administration of bisphosphonates and anti-resorptive and anti-angiogenetic drugs in neoplastic and dysmetabolic patients, secondary to minor surgical oral interventions or chronic epithelial decubitus ulcers. Its pathogenesis is still largely unknown even if the activity change of the osteoclasts plays a relevant role in bone remodeling. The management of these patients aims to prevent the onset of the pathology or to reduce the pain and remove the necrotic bone, promoting the healing of the pathological area. Photobiomodulation therapy (PBMT), the therapeutic application of low-energy laser or LED lights, was recently introduced in the management of this condition. Thanks to its therapeutic and biomodulating action on the irradiated tissues, PBM can be used alone or in combination with antibiotic and antibacterial therapies as a preventive, antalgic or palliative tool, and in support of surgery in a combined multi-protocol that leads to a positive and better resolution and healing of the pathologic process, with great improvement of the Quality of Life (QoL) of the patients. In this narrative review, a wide analysis of the various applications of PBM in MRONJ patients’ management is analyzed, emphasizing its role as supportive care for this condition.

(1) Background: Medication-related osteonecrosis of the jaw (MRONJ) is a potential adverse drug reaction of antiresorptive and/or antiangiogenic treatment. MRONJ is mostly diagnosed by anamnestic data, clinical examination and radiological findings, with signs and symptoms often unspecific. On the other hand, oral squamous cell carcinoma (OSCC) is characteristic for its pleomorphic appearance (e.g., ulcer, mucous dehiscence, non-healing post-extractive socket). We report three cases where OSCC mimicked MRONJ lesions. (2) Patients: Three patients undergoing amino-bisphosphonate treatment for osteoporosis presented with areas of intraorally exposed jawbone and unspecific radiological signs compatible with MRONJ. Due to the clinical suspicious of malignant lesion, incisional biopsy for histological examination was also performed. (3) Results: Histological examination of the tissue specimen revealed the presence of OSCC. All patients underwent cancer treatment. (4) Conclusions: Several signs and symptoms of OSCC may simulate, in patients with a history of anti-resorptive, MRONJ; for these reasons, it is important to perform histologic analysis when clinicians are facing a suspicious malignant lesion.

“Epulis” is a widely used term to describe a localized gingival enlargement. However, a wide range of neoformations might present as localized, slow-growing, asymptomatic gingival masses. A systematic review was conducted to outline the pathological entities that were provisionally dignosed as “epulis” and whose final diagnosis was made after microscopic examination. An electronic search of PubMed, Google Scholar and Scopus databases from January 2000 to February 2021 was performed. An initial search of the databases identified a total of 864 documents, and after a careful process of screening and selection, 14 studies were included in this systematic review and processed for data extraction. The results show that histological examination, sometimes combined with immunohistochemistry, might reveal a wide spectrum of lesions, including hamartomatous lesions, non-neoplastic lesions, benign and malign neoplasms and metastases from distant cancers.

Background: The perception of facial aesthetics is a complex topic due to its subjective nature and it can be influenced by several factors. The purpose of this study was to compare the perception of general dentists, orthodontists, maxillofacial surgeons, and lay people by evaluating facial aesthetics in skeletal class III patients, especially for maxillary sagittal position. Methods: A survey consisting of three sets of pre-treatment photographs of four dysmorphic patients was used. The questionnaire was submitted to a total of 200 participants divided into the following four subgroups: general dentists, orthodontists, maxillofacial surgeons, and lay people. Their opinion on facial disharmony, sagittal position of the jaws, asymmetry of the chin, projection of the cheekbone area, and lip aesthetics was recorded. Results: Significant differences were found between experts and non-experts in the perception of the maxillary position, asymmetry of the chin and zygomatic area (p < 0.01). No statistically significant differences were found among the groups in the perception of mandibular position and lip aesthetics. Conclusion: The respondents with a medical or dental background perceived the presence of maxillary retrusion more than others. Only orthodontists and maxillofacial surgeons have recognized an alteration of the middle facial third as a greater component of skeletal class III malocclusion.

(1) Background: Gingival cancer has a significant incidence and is often diagnosed at advanced stages. The aim of this paper is to highlight its clinical aspects on the basis of a case series analysis in order to promote awareness and improve the diagnosis process. (2) Methods: Oral cancers diagnosed and treated at three Italian University Hospitals over ten years were retrospectively investigated. Cancer location on the gingiva, edentulous ridge, and retromolar pad was addressed. Data regarding clinical features, stage at the diagnosis, and time from presenting symptoms to first medical consultation were retrieved. (3) Results: Thirty-three cancers located on the gingiva, edentulous ridge, and retromolar pad were retrieved from 276 total oral cancer cases (11.9%). A median of 50 days (range 2–300) passed for the patient to seek for a medical evaluation. At the time of diagnosis, 63.3% were advanced stage cancers, mainly located at the mandible (91%), especially in the retromolar pad (48.5%) and the edentulous alveolar ridge (24.2%). Lesions were red (45.5%), red and white (45.4%), or white (9.1%), appearing as an ulcer (69.7%), exophytic mass (12.1%) or flat lesion (12.1%). Sixty-six percent of cancers were completely asymptomatic, regardless their clinical appearance. A statistically significant association between the time from the presentation of symptoms to the first medical consultation and the cancers stage was found. (4) Conclusions: The clinical appearance of gingival cancer is very polymorphous; its understanding may be significant to improve patient education and early medical consultation.

Subcutaneous emphysema is a well-known and recognized complication in oral surgery, due to high pressure rotating instrument use, mostly related to impacted tooth surgery. Although root canal treatment in endodontic therapy is considered as a safe and standard procedure, affected by a low incidence of complication, subcutaneous emphysema due to the choice of mechanical tools or as a consequence of the use of air stream to dry the operating field should be considered as a potential cause. The air can spread through soft tissue from the apex or from an iatrogenic root perforation, suddenly leading to this unusual complication. It is very important for a dental practitioner to promptly identify the adverse event and to know how to manage this situation. We report a case of a 57-year-old woman with immediate subcutaneous cervicofacial emphysema after root canal therapy of the right inferior second premolar and its management. A brief review of the literature is also displayed.

A human papillomavirus (HPV) infection is globally one of the most common causes of sexually transmitted infections of the mucous membranes (genital, anal and oral). Over the last decade, an increasing number of young patients have been infected due to the changes in sexual habits in the general population. The majority of the lesions are benign; however, substantial scientific evidence has suggested a role for the HPV family in the carcinogenesis of squamous cell carcinoma (SCC). It is proposed that dentists, in addition to ENT specialists, should apply standardized management protocols in order to construct a well-defined pathway in terms of diagnosis, which is based on a PCR diagnostic technique and the management of those lesions.

The purpose of this in silico study was to investigate the effect of abutment screw torque and implant-abutment contact surfaces on the stress generation, microgap formation and simulated fatigue life of an external hexagon connection under oblique loading. Three-dimensional numerical models of the external hexagon implant were modeled containing two different implant-abutment contact surfaces (with and without contacting the hexagon axial walls) as well as using screw torques of 20 Ncm or 30 Ncm. Following the ISO 14801, an oblique load of 100 N was applied to the prosthesis. The von Mises stress, microgap formation, safety factor and fatigue life were obtained. The stresses in the abutment screw and implant were minimally influenced by the screw torque. However, this minimal stress in the screw with a 30 Ncm torque reduced the calculated fatigue life in comparison with 20 Ncm when the external hexagon axial walls were not in contact at the implant-abutment interface. The safety factor for the implant was higher when using minimal surfaces at the abutment-interfaces; however, it compromised the screw safety factor increasing its failure probability. The higher the screw torque, the lower was the microgap formation at the implant-abutment interface. However, the calculated residual stress is proportional to the applied torque, reducing the fatigue life in the screw. This effect can be attenuated using an implant-abutment system with more contacting surfaces.

In recent years, calcium silicate cements have been introduced. The purpose of this study is to analyze the main differences between calcium silicate-based cements and epoxy resin-based cements, analyzing the scientific literature of the last year to highlight the main advantages for predictable clinical use. Data collected from the included studies were used in order to analyze different features: chemical-physical properties, cytotoxicity and cell migration, inflammatory response, mineralizing and osteogenic activity, ion release and the filling efficiency of root canals. The calcium silicate cements analyzed in these studies showed good biological and mechanical properties compared to conventional resin-based cements, resulting in better biocompatibility and less cytotoxicity; long-term studies are needed, but these cements have ideal characteristics to allow efficient filling of root canals.

The aim of this study was a comparative statistical analysis of three categories of maxillary odontogenic cysts, evaluating frequency in relation to localization (mandibular or maxillary region), age and gender of patients. The study was a retrospective cohort study conducted at the University Hospital of Messina. Three hundred and fifty-six maxillary odontogenic cysts were classified into 283 inflammatory, 43 developmental and 30 neoplastic cysts. Female patients are more affected by developmental odontogenic cysts, while male patients are more affected by inflammatory odontogenic cysts. Both the mandibular and maxillary regions were affected mainly by inflammatory odontogenic cysts; no significantly statistic relationship was found between lesions and age. A significant association between odontogenic cyst lesions and patient gender was found. No significant association between histological features of lesion and age of patient was observed, nor subtype of odontogenic disease and localization (mandibular or maxillary).