In this manuscript, the authors propose a new technique for inserting implants immediately into the sockets corresponding to the lower first molars and, in any case, in the sockets in which the alveolar septum is still present. Immediate post-extraction implants are a widely discussed topic in the literature. Most authors currently consider the insertion of implants immediately after extraction less useful in terms of the procedure’s questionable benefits in maintaining the height of the alveolar bone and more useful in terms of lessening patients’ discomfort. Due to the anatomy of the post-extraction socket and its traditionally cylindrical geometry, this procedure is not always possible.: Next-generation REX-type blade implants were used via their insertion into the septum accompanied by a cortical lamina for periosteal inhibition without filling any of the alveoli.: In the 20 patients treated, the REX implant proved to be stable and surrounded by newly formed bone at the 18-month follow-up. This simple, easily employable technique allows an implant to be inserted immediately after extraction and in the same surgical session, with good patient compliance and good preservation of the alveolus due to the facilitation of periosteal inhibition. The excellent clinical results obtained with the use of a blade implant in the posterior sectors suggest that it is possible to reduce surgical sessions even in conditions of post-extraction sockets whose septum alone can ensure the primary stability essential for osseointegration. The use of a larger number of patients will also provide us with significant statistical results in support of this preliminary clinical work. New clinical studies are needed to understand the true potential of this method for application in daily clinical practice. Full article

Background: Alveolar socket preservation is a topic of serious interest, and researchers have investigated this problem quite extensively. In terms of aesthetics, it is very important to avoid bone resorption if the clinician decides to insert the implant immediately after the extraction. Recently, a new approach utilizing a barrier external to the socket has been developed, which has advanced the evolution of this technique. Immediate implants have also created some difficulty when re-evaluated in long-term follow-up, especially when an aesthetic result is part of the goal of the procedure. Methods: The modified periosteal inhibition (MPI) technique, which has shown interesting outcomes, is evaluated in this paper on a large group of patients. In this case series, among 14 patients, 11 received immediate implants using the MPI technique and immediate provisionalization, and 3 received immediate implants using the MPI technique and customized healing abutment. All patients showed ridge preservation to different degrees, ranging from 0.02 to 1.17 mm, with an average gain of 0.51 mm. Results: all of the 14 patients maintained the original ridge shape, and 1 showed an increase in bucco-lingual size. Conclusions: This case series confirms the promising information reported in earlier studies on this technique. Larger samples will be necessary to confirm the predictability of this new approach. Full article

Daily use of mouthwash is generally recommended to control dental plaque development and limit further adhesion of oral bacteria. To this purpose, Chlorhexidine di-gluconate (CHG)-containing products are still the most used antiseptic in oral health. The aim of this study was to compare the antimicrobial and antibiofilm activity of three different mouthwash commercial formulations containing CHG at the same concentration (0.2%) on the main etiological agent of dental plaque, Streptococcus mutans (S. mutans). Liquid Chromatography coupled with tandem mass spectrometry (LC-MS/MS) was used to confirm the CHG concentration in the commercial formulations. The Minimal Inhibitory Concentration (MIC) and Minimal Bactericidal concentration (MBC) were measured to evaluate the antimicrobial activity of mouthwashes on planktonic cells. The biofilm prevention concentration (BPC) and CHG formulation activity towards mature biofilm were investigated. Both total cell titer and viability in S. mutans pregrown biofilms were evaluated after treatment with formulations at different time points and concentrations, using Crystal Violet (CV) and tetrazolium dye assay (MTT). The Shapiro–Wilk and Levene tests were used to evaluate the normality and overall homogeneity of the datasets, respectively. The chi-square test, Fischer’s exact test and Student’s t-test were used to evaluate the inhibitory capacity of the commercial formulations in CV and MTT assays. Results showed that even though only slight differences in MIC and MBC values were found on planktonic bacteria, the antibiofilm effect of the different formulations exhibited wide variation when mature biofilms were treated. In addition, results were discussed based on the different compositions of the three formulations, suggesting that herbal extracts, when present in mouthwash formulations, may not always have a beneficial effect, especially when mature biofilms are concerned. Full article

Lymph node density (LND)—the proportion of positive nodes among the total number of resected nodes—has emerged as a reliable prognostic factor in solid tumors. This study aims to assess the importance of LND in lingual squamous cell carcinoma (LSCC) and its prognostic involvement. A retrospective longitudinal study with 62 patients was performed. All patients were diagnosed with LSCC and submitted for tumor resection and neck dissection. Patients were stratified into low (<0.04) and high risk (≥0.04) based on LND. We analyzed the impact of LND on overall survival (OS) and disease-free survival (DFS), as well as the relationship between LND and the pathological staging, the involvement of positive margins, depth of invasion (DOI) and perineural infiltration. This study provides a substantial relationship between lymph node density (LND), overall survival (OS) and disease-free survival (DFS) in lingual squamous cell carcinoma (LSCC). A statistically significant distribution was found between LND, perineural infiltration and pathological staging, whereas no association was found with the rest of the prognostic variables analyzed. Full article

Introduction: The need of accurate three-dimensional data of anatomical structures is increasing in the surgical field. The development of convolutional neural networks (CNNs) has been helping to fill this gap by trying to provide efficient tools to clinicians. Nonetheless, the lack of a fully accessible datasets and open-source algorithms is slowing the improvements in this field. In this paper, we focus on the fully automatic segmentation of the Inferior Alveolar Canal (IAC), which is of immense interest in the dental and maxillo-facial surgeries. Conventionally, only a bidimensional annotation of the IAC is used in common clinical practice. A reliable convolutional neural network (CNNs) might be timesaving in daily practice and improve the quality of assistance. Materials and methods: Cone Beam Computed Tomography (CBCT) volumes obtained from a single radiological center using the same machine were gathered and annotated. The course of the IAC was annotated on the CBCT volumes. A secondary dataset with sparse annotations and a primary dataset with both dense and sparse annotations were generated. Three separate experiments were conducted in order to evaluate the CNN. The IoU and Dice scores of every experiment were recorded as the primary endpoint, while the time needed to achieve the annotation was assessed as the secondary end-point. Results: A total of 347 CBCT volumes were collected, then divided into primary and secondary datasets. Among the three experiments, an IoU score of 0.64 and a Dice score of 0.79 were obtained thanks to the pre-training of the CNN on the secondary dataset and the creation of a novel deep label propagation model, followed by proper training on the primary dataset. To the best of our knowledge, these results are the best ever published in the segmentation of the IAC. The datasets is publicly available and algorithm is published as open-source software. On average, the CNN could produce a 3D annotation of the IAC in 6.33 s, compared to 87.3 s needed by the radiology technician to produce a bidimensional annotation. Conclusions: To resume, the following achievements have been reached. A new state of the art in terms of Dice score was achieved, overcoming the threshold commonly considered of 0.75 for the use in clinical practice. The CNN could fully automatically produce accurate three-dimensional segmentation of the IAC in a rapid setting, compared to the bidimensional annotations commonly used in the clinical practice and generated in a time-consuming manner. We introduced our innovative deep label propagation method to optimize the performance of the CNN in the segmentation of the IAC. For the first time in this field, the datasets and the source codes used were publicly released, granting reproducibility of the experiments and helping in the improvement of IAC segmentation. Full article

This in vitro study aimed to evaluate the fracture resistance and mode of failure of endocrowns with proximal extension design compared to the conventional design, and to assess the agreement of evaluators on the failure mode. Twenty mandibular third molars free of caries with approximately similar root lengths and crown dimensions were sectioned parallel to the occlusal plane 2 mm above the cementoenamel junction (CEJ). Then, pulp chambers and canals were accessed, cleaned, and smoothed for the path of insertion. To achieve a symmetrical pulp chamber with an average depth of 3 mm, chambers were filled with flowable resin composite. Then, teeth were randomly divided into two groups (n = 10). The control group has all the walls at the same level. The test group had a box extension on the proximal wall 2 mm apical to the buccal and lingual wall level. Endocrowns (n = 20) of two different designs (conventional and proximal extensions) were fabricated using lithium disilicate (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein). After cementation, specimens were loaded with a round-end vertical loading tip at a rate of 0.5 mm per minute until fracture (INSTRON, Norwood, MA, USA). Then, the fractured specimens were collected for evaluation and assessment. Statistical analyses were performed using the Mann-Whitney U-test (α = 0.05) for fracture test analysis and Cohen’s Kappa for inter-rater reliability. The Mann-Whitney U-test showed a non-significant difference between the two groups (p = 0.142). However, the mode of failure of the endocrown with proximal extension showed more catastrophic failures than the conventional design. Adding proximal boxes to the endocrown design did not negatively impact the fracture resistance of the restoration. Visualization of the fracture line and tracing their apical end by direct vision or other diagnostic tools is an essential part of the evaluation of failures of endocrowns. Endodontically treated molar teeth with proximal caries extension might be restored with an endocrown with proximal extension. Clinicians should take extra care when visualizing the fracture lines and tracing their apical end as it might be very misleading. Full article

Previous study suggested that fixed dental prostheses (crowns) increase oral malodor production. There might be a role to temporary acrylic crowns contributing to oral malodor. In the current study, we analyzed the microbiome associated with malodorous temporary dental crowns. The study population comprised nineteen patients (mean age 45.8 ± 10.9, 8 females) who visited the Tel Aviv University dental clinic. Temporary crowns were scored by an odor judge using a 6-point malodor organoleptic scale (0–5) and temporary crowns that were scored 2 and above were assigned as malodor positive. Microbial DNA was extracted from the temporary dental crowns and analyzed using next generation 16S rDNA sequencing. Taxa identified could be classified into 11 phyla, 50 genera and 119 core species. Malodor positive samples demonstrated higher abundance of the phyla Proteobacteria and Actinobacteria and the genera Tannerella, Alloprevotella, Treponema, Olsenella and Bifidobacterium. Malodorous samples showed higher bacterial diversity and significant differences in microbial population. Taken together these results suggest a difference between the microbial populations of malodorous and non-malodorous temporary dental crowns both in composition and diversity. Full article

Dental anxiety is a common problem in younger children, especially those who have had traumatic or perceived traumatic dental treatments. Nitrous oxide (N₂O) and oxygen (O₂) have been recommended by the American Academy of Pediatric Dentistry as the optimal approach for uncooperative or anxious patients. The study aimed to evaluate the cooperation of children treated on deciduous teeth without local anesthesia and with rubber dam. A retrospective study was conducted from January 2019 to December 2020 in a private dental practice on children aged 4–10 years who had previously reported cases of dental anxiety during dental procedures or refused to undergo them. After an initial cognitive examination, the children underwent conservative treatment lasting a maximum of 30 min. Initially, 100% O₂ was administered, then N₂O dose was gradually increased to 35%. At the end of the treatment, 100% pure O₂ was administered for 5 min. Children’s cooperation was assessed by Venham score before treatment (T0), at the end of induction (T1), and during the treatment (T2). A total of 371 children (age: 6.3 ± 1.7 years) were included in the study. Cooperation increased significantly from baseline at T1 (p < 0.001) and T2 (p < 0.001). Younger children (4–6 years) showed lower levels of cooperation at baseline (p < 0.001) but achieved optimal levels of cooperation at T1 (p = 0.022). Only 2.7% of children reported side effects. N₂O/O₂ proved to be an effective and safe method in achieving a good level of cooperation in younger children. Full article

Background: Orthodontic treatment in adult patients is hindered by several problems, such as little time for regular dental visits and financial costs. In recent years, photobiomodulation (PBM) has been shown to significantly reduce the duration of orthodontic treatment and significantly increase patient compliance. Objective: This study aimed to investigate the efficacy of PBM in shortening the orthodontic treatment duration in adult patients while ensuring optimal patient compliance. Methods: A total of 170 orthodontic patients with a Little’s irregularity index (LII) ≥ 3 mm treated with Invisalign clear aligners (Align Technology, Santa Clara, CA, USA) were included. The treatment group (PBM) (n = 90 patients) was trained in the use of the OrthopulseTM device (Biolux Research, Vancouver, Canada) according to an application protocol of 5 min per day. The control group (n = 80 patients) was treated with transparent Invisalign^® without PBM applications. The LII was measured at a baseline and each aligner change until the end of the treatment when the LII was less than 1 mm. The crowding resolution rate (CRR), expressed in mm/week, and the total treatment time were measured. Results: The alignment rate of the PBM group was significantly higher than that of the control group (0.33 mm/week vs. 0.21 mm/week) with a reduction in the treatment time of 57.5 weeks in the PBM group compared with the control group. Conclusion: The PBM performed with the Orthopulse™ is shown to be an effective and noninvasive technique for accelerating teeth movements and can contribute in a relevant way to increase access to orthodontic treatment by the adult population as well as increase its compliance. Full article

(1) Background: Bone Lamina Technique and Guided Bone Regeneration (GBR) are commonly used for horizontally-deficient maxillary ridge reconstruction, although more detailed evaluation to assess the differences between such techniques is necessitated. (2) Methods: In this retrospective study, patients having a horizontal bone width of ≤4 mm in the maxilla, who were treated with Cortical Strut (CS), were collected to represent the “test group”, and those treated with GBR with no CS involvement represented the “control group”. A 1:1 mixture of autogenous bone (AB) and anorganic bovine bone (ABB) with resorbable collagen membrane was applied to both groups. Volumetric changes between groups were measured with cone-beam computed tomography (CBCT). The primary outcome represented volumetric graft resorption rate whilst the secondary outcomes represented any probable complications and implant insertion torque. (3) Results: A total of 36 patients were included in this study (36 grafted sites; 18 for CS group and 18 for GBR group). Mean bone graft volume reduction in the CS and GBR groups was 8.26 ± 1.60% and 14.36 ± 3.55%, respectively. The GBR group showed significantly more bone resorption than the CS group (p < 0.001). Complications and insertion torque were similar between the groups (p > 0.05). (4) Conclusions: Both CS and GBR techniques for hard-tissue augmentation provided sufficient bone graft mass volume for implant insertion, whereas CS demonstrated lower resorption rate at maxillary augmented sites, compared to GBR. Full article

(1) Background: To improve endodontic treatments, it is necessary to find good irrigant solutions that balance potential toxic effects with optimal antimicrobial capacity. The aim of this laboratory study was to assess the cytotoxic and antimicrobial capacity of phytic acid (IP6) and BioAkt^TM in a laboratory setting to determine their suitability prior to endodontic evaluation. (2) Methods: The antimicrobial and cytotoxic effects of IP6 and BioAkt^TM were compared with those of 1.5% NaOCl. Cytotoxicity was evaluated via crystal violet assay and CellTiter-Glo^® 2.0 assay, while antimicrobial capacity was tested via disk diffusion and the effect of a 1-h treatment on Enterococcus faecalis. (3) Results: A crystal violet test and CellTiter-Glo^® 2.0 assay showed statistically significant differences in cell viability and cell activity after 4 and 24 h for all tested solutions (p < 0.05). The antimicrobial activity of BioAkt^TM was similar to that of 1.5% NaOCl, while phytic acid showed the lowest antimicrobial activity compared to BioAkt^TM (p < 0.05) and 1.5% NaOCl (p < 0.05). (4) Conclusion: BioAkt^TM showed an optimal balance between antimicrobial activity and cytotoxicity. Full article

(1) Background: In endodontics, anatomical complexities and irregularities in the root canal system may interfere with sealer penetration, increasing the risk of treatment failure. This work aimed to investigate the effects of sonicated Thermafil (Dentsply, Tulsa Dental Specialties, Johnson City, TN, USA) on sealer penetration into the dentinal tubules. (2) Methods: Thirty teeth with single round-shaped root canals were used to compare Sonicated Thermafil with sonication (ST—10 teeth), System B (EIE Analytical Technology, Orange, CE, USA) (SB—10 teeth), and Thermafil without sonication (T—10 teeth). A confocal laser scanning microscope (CLSM) was used to determine the depth, area, and percentage of sealer penetration into the dentinal tubules. (3) Results: ST showed the deepest average penetration at 6 mm from the apex compared to SB (p < 0.01) and T (p < 0.01) and at 3 mm compared to SB (p < 0.01). In addition, it had the highest penetration values at both levels compared to SB (p < 0.01) and T (p < 0.05) and a higher penetration area at 6 mm compared to T (p < 0.05) and SB (p < 0.05). (4) Conclusion: Sonic activation can improve the carrier-based obturation technique thanks to deeper sealer penetration and thus better retention of materials. Full article

Hypochlorite accidents are relatively rare events. Therefore, there is a lack of precise and accurate reports in the scientific literature that could help clinicians better understand the phenomenon and associated risk factors. This study reported four hypochlorite accidents attributable to 5% NaOCl extrusion in patients who had undergone treatment of the maxillary elements canal treatments. In all cases, the accidents occurred during the irrigation phase and were characterised by intracanal bleeding, ecchymosis, and swelling on the hemiface corresponding to the treated tooth. Antibiotics, paracetamol, NSAID, corticosteroids, and cold or warm compresses for oedema were prescribed to treat the symptoms of the accidents. Significant improvement of symptoms was observed in all patients after 5–6 days. Anatomic risk factors such as apical fenestration, root perforation, and large foramina were identified as possible risk factors for the accidents. After the accidents, clinicians applied endodontic procedures for which there is no scientific evidence to continue endodontic treatments, such as changing the type of irrigant or the irrigation method. Our results suggest that using a standardised approach to document each hypochlorite accident will allow researchers to collect more accurate and detailed data that can subsequently be used to identify potential risk factors and better manage the symptomatology of hypochlorite accidents. Full article

We assessed the impact of regenerative endodontic procedures (REP) using a platelet-rich fibrin (PRF) scaffold on necrotic immature permanent anterior and posterior teeth based on the following parameters: periapical healing, changes in root development, and associations between increases in the radiographic root area (RRA), and degree of root to apical closure. The study included 50 teeth consisting of 57 roots (36 anterior and 21 posterior) treated between 2017 and 2019, with an average follow-up of two years. Complete periapical healing was achieved in 91.2% teeth, and uncertain healing was achieved in 8.8%. RRA increased in 95% of teeth and root lengthening was achieved in 86% teeth (without any mutual effect). Apical closure was significantly associated with tooth location (89% and 30% of the posterior and anterior roots, respectively). Trauma was the most common aetiology of necrotic anterior teeth, whereas caries was the only aetiology of necrotic posterior teeth. REP using PRF scaffold achieved a high success rate for periapical healing and root maturation in both anterior and posterior necrotic immature teeth. The favourable results obtained in posterior teeth may encourage the use of REP for treating necrotic immature permanent posterior teeth. Full article

The current study investigated the coexistence of temporomandibular disorder (TMD) and/or bruxism among 51 individuals seeking treatment in a tinnitus clinic. All participants completed a Hebrew version of the Tinnitus Handicap Inventory (THI), depression and anxiety questionnaires, and the diagnostic criteria TMD (DC/TMD) questionnaire. In addition to questionnaires, the participants underwent a clinical evaluation of the oral cavity, facial muscles, and the temporomandibular joint (TMJ). Thirty-four participants (66.7%) were diagnosed with bruxism, while TMD was found in 14 (27.5%) of the cases. Patients with both tinnitus, TMD and bruxism scored the highest in the anxiety questionnaire. The severity of depression was found to be significantly associated with the tinnitus severity. These results emphasize the clinical bond between tinnitus, TMD, and bruxism. Full article

The growing demand for re-treatment of existing implant supported restorations in the anterior area due to esthetic complications poses a clinical challenge. One-piece implant supported restoration adds to the clinical complexity. Single implant crown restorations appear short as a result of expected cranio-facial changes. In the presented clinical case, a minimally invasive approach is offered as a solution for such an esthetic difficulty. The clinical old crown was prepared to receive an anterior incisal onlay (AIO) made from lithium disilicate and felspathic porcelain. The manufactured addition was adhesively cemented, presenting a simple prosthetic solution for an esthetic complaint, with no need for surgical procedure, while not challenging the one-piece implant body. As the variety of materials and methods for predictable adhesion increases, non-surgical and non-invasive treatment options will receive high priority. When correctly diagnosed and meticulously performed, the presented solution will meet the patient expectations and provide a satisfying result. Full article

Tooth gemination is often presented clinically and radiologically as merged crowns or “megadonts” with or without a longitudinal fissure, single root, and a single pulp chamber. The increased mesiodistal width of these teeth results in poor anterior aesthetics, anterior crowding, and incisor rotation. Our aim is to present a conservative non-extraction orthodontic approach that provides both good aesthetics and long-term stability. It aims to achieve extra space to incorporate the megadonts into the dental arch and to exceed “super” class I dental relationships. Accordingly, this study shows that geminated teeth were successfully retained by means of conservative non-extraction orthodontic mechanotherapy and without premolar extractions or enamel reduction. It demonstrated stability during a long-term 15-year follow-up, in addition to high patient satisfaction, good aesthetics, and periodontal health. The solution protocol is definitive and achieved the aesthetic, psychological, and functional objectives at a feasible cost. Thus, this treatment has proven to be preferable to other alternative surgical prosthodontic and endodontic approaches in terms of its long-term stability, and by providing a solution that does not necessitate further multidisciplinary interventions. Dental practitioners in the fields of pediatric dentistry, endodontics and prosthodontics should be well aware of this option. Full article

Taurodontism, a known morpho-anatomic variation in the shape of teeth, has already attracted substantial attention. The aim of this study is to contribute to this by discussing its direct impact on the dental practitioner via an evaluation of the prevalence of taurodontism in molars in Ashkelon, Israel. This retrospective study analyzed panoramic radiographs of 624 patients (330 males, 294 females), aged of 9–29 years—2849; first and second permanent molars were screened. Objective measurements and variables were used and analyzed using statistical SPSS version 27 (IBM, Chicago, IL, USA). Taurodontism was observed in 33.6% of the patients and was more prevalent among females (53% vs. 47%) and in maxillary molars compared to mandibular molars (57% vs. 43%). The overall prevalence of hypotaurodontism, mesotaurodontism, and hypertaurodontism was 10.8%, 0.5%, and 0.2%, respectively. No statistical difference between right and left sides was discovered, however, taurodont teeth in the upper left side exhibited the highest frequency, while the lower left side had the least. The highest occurrence of hypotaurodontism was on the upper right second molar followed by upper left first and second molars. The clinical challenge posed in endodontic, orthodontic, and restorative dentistry is discussed, and suitable alternative approaches are proposed for dental practitioners. Full article

Supernumerary teeth and odontomas are obstacles for spontaneous tooth eruption and may result in impaction. The aim of the study is to present a conservative treatment approach for impacted teeth following surgical obstruction removal by reviewing three treatment modalities: surgery only, which involves the surgical removal of the obstruction and the spontaneous eruption; surgery with immediate traction, which includes surgery combined with immediate active orthodontic brace cementation and traction; and surgery with delayed traction, which combines a surgical procedure of obstacle removal and orthodontic brace cementation with follow-up for the spontaneous eruption. The first two modalities require orthodontic traction either by an additional surgical procedure for orthodontic brace cementation, or combined with the surgical obstacle removal. With the third approach, clinical follow-up is performed via connected ligature wire elongation applied during the surgical procedure for the spontaneous emergence of the impacted tooth. Active orthodontic traction is only employed if the tooth fails to erupt. The visual follow-up via wire elongation serves as a reference during the emergence of the impacted teeth and reduces the need for radiographic examination. The surgical-orthodontic approach saves both further surgery and orthodontics (spontaneous eruption) or further surgery (in failure to erupt). Full article

Burning mouth syndrome (BMS) is considered an atypical oral clinical-symptomatological condition because its etiopathogenesis is not yet fully clarified. It is mainly characterized by the symptom of burning, which occurs chronically and with various intensities. It is essential for making a diagnosis of BMS, clinical negativities, and instrumental investigations. It mainly affects the female sex, in the pre-post-climactic phases. A peripheral neuropathic matrix of the pain symptoms has been repeatedly demonstrated. However, this subjectivity is associated with personalities with anxiety-depressive traits, affective-behavioral difficulties, and disorders of the psycho-algogenic sphere. Numerous treatments are reported in the literature, which have rarely met lasting healing parameters. In this clinical landscape, photobiomodulation therapy (PBMT) can be considered a possible therapeutic alternative. Our study aims to present a scoping review of how photobiomodulation is used in BMS therapy and to analyze the outcome of the therapy. A literature review focused on the photobiomodulation treatment for burning mouth syndrome was conducted in the main scientific databases: PubMed, SCOPUS, and Web of Science. The results of our research highlight encouraging results regarding photobiomodulation, as in all studies, there is a reduction in symptoms. Full article

Nowadays, the “pink” aesthetic possesses a significant role in the success of a dental treatment. Extended or small recessions should be solved to achieve harmony between tooth and gingival tissue. Gingival cleft (GC) is a condition that can lead to unpleasant gingival recession in the anterior area. The etiology of GC is still not clear and is often resolved using surgical treatments that, although minimal, are still interventions which can cause risks and discomfort to the patient. Therefore, this case report aims to propose a non-invasive treatment for GC, consisting of a combination of a non-surgical technique with herbal extracts therapy. A non-smoker, healthy patient was subjected to professional oral hygiene treatment supported by Croton Lechleri resin application and at-home supplementation with natural vitamin C (Myrciaria Dubia). The patient entirely followed the instructions and, after 12 months, the GC almost disappeared. In spite of its limitations, since further clinical cases are needed, the proposed non-surgical periodontal technique combined with herbal extracts therapy can represent a promising way to solve or at least reduce GC, before considering surgical treatment. Full article

Severe positional obstructive sleep apnea syndrome (POSAS) is a common clinical respiratory disorder with an incidence of 26.7% to 74.5%. Continuous positive airway pressure (CPAP) combined with positional therapy is the gold standard of treatment. However, a mandibular advancement device (MAD) is an effective alternative to CPAP when compliance with CPAP is low or if CPAP is rejected by the patient. A 63-year-old Caucasian male (BMI 26.1 kg/m²) complaining of repeated episodes of daytime sleepiness and heavy snoring was diagnosed with POSAS and treated with a MAD. After two years, polysomnographic (PSG) control analysis showed a significant reduction in the number of obstructive sleep apnea/hypopnea episodes per hour (AHI) by 58.9% in the lateral position and 75.5% in the supine position, complete remission of symptoms, a significant reduction in the severity of POSAS, and an overall improvement in quality of life. No adverse events or reduction in compliance were observed during the follow-up period. For severe POSAS, MADs may be an alternative method that is well tolerated by patients and has a good safety profile. Full article