Stefano Benedicenti

Background/Objectives: Single-retainer Maryland adhesive restorations provide a minimally invasive fixed option for replacing missing anterior teeth in young patients. When congenital absence of a maxillary lateral incisor is associated with a contralateral conoid lateral incisor, the clinical problem extends beyond tooth replacement to bilateral symmetry management. This case report describes a digital-restorative workflow combining a single-retainer lithium disilicate Maryland adhesive restoration with a pontic-derived stamp technique for contralateral symmetry correction. Methods: A medically healthy 13-year-old patient presented with congenital absence of the maxillary left lateral incisor (FDI 22; Universal 10) after orthodontic treatment and had been wearing a removable appliance to replace the single missing tooth. The contralateral maxillary right lateral incisor (FDI 12; Universal 7) presented with conoid morphology, further compromising anterior symmetry. Clinical assessment confirmed ideal mesiodistal space at FDI 22, a vital and unrestored FDI 21 with intact enamel and healthy periodontal support, and the absence of abnormal overjet, overbite, or excursive contact pattern. Based on the findings, a single-retainer Maryland adhesive restoration was fabricated from lithium disilicate (IPS e.max CAD) and bonded to the maxillary left central incisor (FDI 21; Universal 9) using an enamel-only preparation and adhesive cementation protocol. The fixed restoration was combined with a pontic-derived stamp workflow to guide direct composite reshaping of the contralateral conoid lateral incisor. Results: At 1-year follow-up, no debonding, sensitivity, marginal discoloration, or soft-tissue inflammation was observed. The contralateral composite reshaping remained clinically stable, and the patient and guardian reported improved comfort and esthetic satisfaction compared with the previous removable appliance. Conclusions: This case suggests the short-term clinical feasibility of combining a single-retainer lithium disilicate Maryland adhesive restoration with a pontic-derived stamp workflow to achieve minimally invasive tooth replacement and contralateral symmetry correction. Longer follow-up and broader case series are required to confirm the long-term predictability and reproducibility of this approach.

Background/Objectives: Metabolic dormancy in biofilms leads to reduced drug efficacy in these communities. Different pharmacokinetics and adverse side effects complicate the simultaneous delivery of multiple drugs at appropriate concentrations to the infection site. This study aimed to develop chitosan-coated mesoporous silica nanoparticles loaded with curcumin and amphotericin B (CS@MSNs-Cur-AmB) and to evaluate their antibiofilm activity combined with antimicrobial photodynamic therapy (PDT) against Streptococcus mutans and Candida albicans dual-species biofilms. Methods: CS@MSNs-Cur-AmB were developed. The structure and morphology of the nanoparticles were evaluated using Fourier transform-infrared spectroscopy (FTIR), zeta potential, field emission scanning electron microscopy (FESEM), and thermogravimetric analysis (TGA). Cytotoxicity toward human gingival fibroblasts was assessed. Colony-forming units per milliliter (CFU/mL) were determined. The metabolic activity of biofilm-forming cells was measured using the tetrazolium (MTT) assay. Results: Physicochemical analyses confirmed the synthesis of CS@MSNs-Cur-AmB, revealing a particle size of 228 nm and thermal stability up to 600 °C. Cytotoxicity assays showed that CS@MSNs-Cur-AmB exhibited good biocompatibility (>90%). CS@MSNs-Cur-AmB improved antimicrobial activity, which was further enhanced by blue light-emitting diode (LED) irradiation. CS@MSNs-Cur-AmB under LED irradiation showed the strongest effect, reducing metabolic activity to 27.74 ± 4.08% (1 W/cm², 1 min), p < 0.001). Conclusions: Formulating two drugs in nanocarrier systems may improve therapeutic efficacy by increasing local concentration and reducing systemic exposure. This offers an effective strategy for combating oral biofilms.

Photobiomodulation (PBM) has shown promising potential to enhance bone regeneration; however, its optimal delivery parameters and interactions with osteoconductive scaffolds remain insufficiently defined. This preclinical study is the first to incorporate a pilot dosimetry evaluation to standardize 980-nm PBM delivery and ensure that effective irradiance reached the target surface of critical-size calvarial defects in mice. The primary aim was to evaluate the effectiveness of this novel 980-nm PBM protocol delivered using either flat-top (FT) or standard Gaussian (ST) handpieces in enhancing bone regeneration in critical-size defects (CSDs), both with and without Bio-Oss^® grafting. A total of 120 adult mice were allocated into twelve experimental groups (n = 10 per group): untreated (control), Bio-Oss^® alone, PBM alone, and PBM combined with Bio-Oss^®, using either FT or ST handpieces, and evaluated at 30 and 60 days. Animals received 980 nm irradiation at 0.6 W (nominal power output–set on laser interface) in continuous-wave mode for 60 s, three times per week, for two consecutive weeks. Pilot dosimetry included power meter measurements to determine the therapeutic power reaching the defect surface area and temperature monitoring to ensure safe energy delivery. The dosimetry study demonstrated that, after accounting for the optical properties of mouse shaved skin and the Bio-Oss^® graft covered with Bio-Gide^® membrane, the effective irradiance reaching the base of the defect surface area was 1.131 W/cm² for the FT handpiece and 0.413 W/cm² for the ST handpiece. This dose was sufficient to induce significant regenerative effects. Histological, Masson’s trichrome, and immunohistochemical analyses for Runx2, OCN, GLI1, CD34, and CTSK were performed to characterize early and late osteogenic events. The combination of PBM and Bio-Oss^® significantly accelerated bone regeneration compared with PBM alone, with the FT handpiece producing the most uniform and advanced osteogenesis. PBM enhanced progenitor activation, osteoblast differentiation, angiogenesis, matrix deposition, and late-stage remodeling, demonstrating a synergistic effect with the scaffold, whereas Bio-Oss^® alone or defect alone showed limited early regenerative potential. These findings highlight the effectiveness of this novel standardized PBM dosimetry and uniform beam profile (FT), supporting their use as a foundation for future randomized controlled trials in craniofacial bone repair.

Sterilization of medical devices is a critical process to ensure patient safety. However, traditional steam autoclaves may be unsuitable for heat-sensitive materials. In this study, we evaluated an innovative cold sterilization system based on the controlled generation of free radicals with reducing properties. The system has already been validated and marketed following the completion of numerous microbiological tests in compliance with UNI EN standards (13727, 13624, 17126, 14476, 14348). A quantitative suspension test was conducted under controlled conditions, comparing the microbial reduction achieved with the cold system to that obtained with a standard autoclave cycle. The system demonstrated bactericidal efficacy exceeding 6 log₁₀, comparable to that of the autoclave cycle. The results suggest that the free radical system represents a safe, rapid, and effective alternative for the sterilization of heat-sensitive materials, with potential applications in both healthcare and industrial settings.

Sterilization of medical devices is a critical process to ensure patient safety. However, traditional steam autoclaves may be unsuitable for heat-sensitive materials. In this study, we evaluated an innovative cold sterilization system based on the controlled generation of free radicals with reducing properties. The system has already been val-idated and marketed following the completion of numerous microbiological tests in compliance with UNI EN standards (13727, 13624, 17126, 14476, 14348). A quantitative suspension test was conducted under controlled conditions, comparing the microbial reduction achieved with the cold system to that obtained with a standard autoclave cycle. The system demonstrated bactericidal efficacy exceeding 6 log10, comparable to that of the autoclave cycle. The results suggest that the free radical system represents a safe, rapid, and effective alternative for the sterilization of heat-sensitive materials, with potential applications in both healthcare and industrial settings.

Objectives: The synergistic effect of shock wave-enhanced emission photoacoustic streaming (SWEEPS) and antimicrobial photodynamic therapy (aPDT) in mandibular molar root canal disinfection remains underexplored, particularly against dual-species biofilms that better simulate clinical conditions. This study evaluates their combined antimicrobial efficacy against Enterococcus faecalis and Candida albicans biofilms and assesses potential tooth discoloration caused by riboflavin and nano-curcumin. Materials and Methods: The mesiobuccal canals of 57 extracted mandibular molars were inoculated with E. faecalis and C. albicans biofilms. The antimicrobial effects were assessed using riboflavin or nano-curcumin with a 450 nm diode laser (BDL), SWEEPS, or their combinations, compared to 5.25% NaOCl (positive control) and saline (negative control). Biofilm reduction was quantified by colony-forming units (CFUs/mL), and discoloration was evaluated using the ΔE metric in the CIE L*a*b* color space. Results: Both microorganisms showed a significant decrease in colony numbers in all experimental groups compared to the negative control (p < 0.001), except for E. faecalis, where no significant difference was observed between the riboflavin/nano-curcumin groups and the negative control. Combining riboflavin or nano-curcumin with SWEEPS or BDL significantly enhanced antimicrobial efficacy compared to individual treatments (p < 0.001). The combined photodynamic therapy and SWEEPS groups showed the lowest colony counts. The ΔE values were, on average, 1.81 for riboflavin and 1.09 for nano-curcumin. Conclusions: The combination of SWEEPS and aPDT effectively reduces E. faecalis and C. albicans biofilms in molars, supporting its potential as an adjunct in endodontic disinfection. Minimal discoloration further highlights its clinical applicability.

Background/Objectives: This study assessed the efficacy of photobiomodulation therapy (PBM) by 808 nm and 660 nm alone and in combination for the treatment of paresthesia in rats. Methods: This animal study was conducted on 36 adult male Wistar rats. After general anesthesia, the facial nerve of the right side of the face of rats was surgically exposed and pinched, returned in place, and sutured. The rats were randomly assigned to six groups (n = 6) of (I) no-intervention (control), (II) no-laser, (III) 808 nm laser (250 mW, 4 W/cm², 20 s, 8 J/cm², (IV) 660 nm laser (150 mW, 0.25 W/cm², 32 s, 8 J/cm², (V) 808 nm plus 660 nm laser with the original settings, and (VI) 808 nm plus 660 nm laser with half of the time and energy density. After 16 days, a biopsy sample was taken from the nerve injury site and underwent histological, histometric, and immunohistochemical assessments. Results: Significantly lower edema and congestion were seen in the combined laser group with original settings (p < 0.05); this group had no significant difference with the control group regarding degenerative changes of the nerve fibers and Schwann cells (p > 0.05). The 660 nm, and combined laser groups, had a significantly lower accumulation of inflammatory cells (p < 0.05). The number of blood vessels in combined laser groups was significantly lower than that in the no-laser group (p < 0.05). Conclusions: The results showed the positive efficacy of PBM by 808 nm and 660 nm lasers in resolution of inflammation and reduction of degenerative changes of Schwann cells and nerve fibers.

Background: The aim of this study was to investigate the effects of retro-cavity preconditioning with or without 17% ethylenediaminetetraacetic acid (EDTA) solution on root surface pH as well as dislodgement resistance of NeoMTA2 and MTA Flow retro-fills. Methods: Forty-eight single-rooted human incisors were selected. After completion of endodontic treatment, root-end resections were performed, and retro-cavities were prepared. The samples were randomly divided into two groups of A and B (n = 24 each). In group A, retro-cavities were preconditioned with 2.5% NaOCl, followed by 17% EDTA solution, whereas in group B, preconditioning was performed using 2.5% NaOCl before final irrigation with normal saline. Samples in each group were randomly subdivided into two subgroups of 1 and 2. Retro-fillings in the A1 and B1 subgroups were performed with MTA Flow, and in the A2 and B2 subgroups, they were performed with NeoMTA2. Root surface pH was measured in each sample at three different stages: before preparation of retro-cavities (pH0), after retro-cavity preconditioning (pH1), and three days after retro-filling (pH2). Subsequently, the push-out bond strength (PBS) of the retro-filling materials was measured by a universal testing machine, and their failure modes were visualized under 64× magnification. Results: Preconditioning with EDTA caused a significant increase in PBS for both NeoMTA2 and MTA Flow (p < 0.001). There was no significant difference between the average bond strength of MTA Flow and Neo MTA2 (p = 0.271). There was a significant increase in the average pH2 compared to pH1 and pH0 across all groups (p < 0.001). Specifically, the use of EDTA led to a notable increase in the average pH2 in the MTA Flow group compared to the Neo MTA2 group (p = 0.027). Groups preconditioned with EDTA more frequently indicated a cohesive failure mode. Conclusions: The use of EDTA significantly increased the push-out bond strength of retro-fill materials to dentin. However, it did not prevent the ultimate alkalinity of retro-filled cavities.

Aim: To compare shock wave-enhanced emission photoacoustic streaming (SWEEPS) with sonic- and ultrasonically activated irrigation systems in removing Enterococcus faecalis biofilm from the root canal system. Methodology: Fifty human single-canalled mandibular premolars were included in the study. After access cavity preparation, the root canals were prepared to a standardized size and taper. Then, the entire root surface was covered with two layers of resin, and the root apices were sealed before sterilization. All root canals were inoculated with E. faecalis biofilm, and the samples were incubated aerobically for 2 weeks at 37 °C. Biofilm formation was confirmed by scanning electron microscopy. All samples were randomly divided into five groups (n = 10 each) based on their irrigation activation method as A (no treatment or negative control), B (no irrigation or positive control), C (sonically activated irrigation (SAI)), D (ultrasonically activated irrigation (UAI)), and E (needle irrigation activated by an Er: YAG laser device using a SWEEPS quartz tip (SWEEPS)). Then, dentine chips were retrieved, vortexed, and diluted for colony-forming unit counts. Data were analysed using analysis of variance and post-hoc Tukey tests (α = 5%). Results: All methods could significantly reduce E. faecalis biofilm compared with control so that the UAI, SWEEPS, and SAI groups indicated a 23.54%, 14.89%, and 7.81% biofilm reduction, respectively. UAI demonstrated a significantly more effective reduction of E. faecalis biofilm than SAI (p = 0.004). Conclusions: All irrigation activation methods significantly reduced E. faecalis biofilm, with ultrasonic use being the most effective.

This review aims to compare the effect of photobiomodulation therapy (PBMT) using visible and near-infrared diode laser wavelengths to that of the dry needling technique (DNT) on the management of orofacial pain in patients with Temporomandibular Disorder Myofascial Pain Syndrome (TMD/MPS) in term of effectiveness, speed of recovery, and lasting of treatment. A systematic search of multiple electronic databases was carried out to identify the relevant clinical trials published between 1 January 2010 and 1 January 2024. The included studies were limited to human subjects who had orofacial pain associated with Axis 1 of TMD/MPS, involving two genders with age >18 years and were treated either with photobiomodulation using diode laser with wavelengths ranging from 600 up to 1200 nanometer (nm), or with the dry needling (DN) technique (superficial SDN or deep DDN), as a non-pharmacological therapies to decrease the intensity of orofacial pain associated with TMD/MPS. The risk of bias for included studies was assessed using the Cochrane RoB tool (for randomized studies). Three distinct meta-analyses were performed to quantify the pooled effects of PBM and DN in the management of TMD/MPS myofascial pain and deactivation of myofascial trigger points (MTPs). The meta-analyses were performed using Review Manager (RevMan) 5.3 from Cochrane. The confidence interval (CI) was established at 95% and p-values of less than 0.05 (p < 0.05) were considered statistically significant. Statistical heterogeneity was assessed using I2. Qualitative data were extracted and summarized in tables for each group study, while quantitative data were reported as Mean and Standard Deviation (SD) values for assessment variables in each sub-group study. The results among groups were systematically evaluated to draw the final conclusion. A rigorous electronic and manual search revealed 4150 possible articles. Following the application of the inclusion and exclusion criteria, twelve eligible studies were included in the analysis. Both PBMT and DNT were found to be effective in controlling the myalgia pain and primary symptoms associated with TMD/MPS, as well as deactivating the MTPs. DNT was statistically superior in terms of recovery time while PBMT was the more effective long-term therapy.