Abstract

New Quality Guidelines For the Endodontic Treatment
The European Society of Endodontology (ESE ) has recently published new quality guidelines for endodontic treatment , with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany. ESE utilized the GRADE process and an innovative approach in consensus and guideline development processes, which resulted in the development of the first S3-level clinical practice guidelines (CPG) in Endodontics. The final goal of the new S3-level CPG in endodontics was to inform clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and apical periodontitis in order to preserve teeth over a patient’s lifetime, according to the best comparative evidence currently available.
More precisely, the CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and apical periodontitis, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus non-vital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of apical periodontitis.
It must be underlined that the new guidelines are based on a comprehensive systematic and methodologically robust guideline consultation process was followed in provide evidence-based recommendations for the management of patients presenting with pulpal and apical disease. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert-based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders.
The CPG can be downloaded online freely through the ESE website in English language ( https://drive.google.com/file/d/1Y-KEyVwExsb8Fw4u8-d74LcsfPCoruVz/view?usp=drive_link) and are currently being translated in many languages to be adopted to the national endodontic societies including the two Italian ones : SIE and AIE . Being Annali di Stomatologia the official journal of AIE (Accademia Italiana di Endodonzia) we proudly announce that the Italian translation is now currently available through AIE website (https://www.accademiaitalianaendodonzia.it/media/tab6iqz.pdf)

Abstract

As President of the Italian Academy of Endodontics (AIE) , and on behalf of the Board of Directors, I am pleased to announce the beginning of an important and prestigious scientific collaboration with Annali di Stomatologia, a historical scientific journal in the Italian landscape with significant international implications. The possibility to have an official journal, moreover with a great history, is for a Scientific Society today an unmissable opportunity and at the same time an essential requirement for the consolidation of the societary structure. The very essence of academic reality must be based on the possibility of making known and consultable the ideas, clinical expertize, scientific and clinical research findings obtained by AIE members. The possibility to have the scientific works of our Congresses published in a peer review journal is a crucial step forward in making our Academy a hub of Italian scientific resources in the field of endodontics and a realhome of comparison and growth open to all clinicians, researchers, companies engaged in research, and the excellences that our country generously generates in our field. I want to underline how still today in many aspects of our practice there is a huge need for scientifically supported “evidence” from high-level clinical studies and how the realization of multicenter studies with adequate numbers can only come through the collaboration of researchers and clinicians. This urgent need is at the same time a magnificent opportunity that we face to aggregate and coordinate the resources necessary to achieve scientific landmarks and in the drafting of reliable guidelines in the endodontic field. The Italian Academy of Endodontics aims to lay the foundations for creating a new network in the development of quality research with the coordination of our Commissions, which are the beating heart of these activities. Having a platform in our official journal today further amplifies these potentialities. We thank the Publisher, the Editorial Board and the Editor in Chief for giving us this opportunity and I take this space to affirm that the growth of the AIE family, as the unique Home for all Italian Endodontics with its distinctive signs of human brotherhood preceding the professional ones, can only draw new vital energy from this prestigious editorial adventure. Ad maiora

Abstract

It is an honor and privilege to introduce myself as the new Editor-in-Chief of “Annali di Stomatologia”, one of the oldest and most important Italian scientific dental journal, which is now aiming at regaining a relevant role in the international dental community as well. With a background deeply rooted in dental research and a passion for advancing the field, I am committed to fostering a platform that champions innovation, excellence, and the exchange of cutting-edge ideas. This journal seeks to be a beacon for dental professionals, researchers, and scholars, providing a space where original, innovative studies, comprehensive reviews, and insightful commentaries converge to shape the future of dental science. In office since January 1st,2024, I am eager to embark on this journey of exploration, collaboration, and knowledge dissemination within the dynamic realm of dental sciences. I am also glad to introduce our new Editorial Board, which comprehends both well-known Italian and international experts and young researchers, all of them dedicated to ensuring the highest standards of peer-reviewed content, encompassing a wide spectrum of dental specialties. From clinical breakthroughs to fundamental research, we aim to showcase the diverse facets of modern dentistry. Our commitment to rigorous evaluation and constructive feedback will uphold the integrity of the scientific process and contribute to the advancement of dental knowledge. We all understand the pivotal role dental research plays in improving patient care, addressing emerging challenges, and driving innovation in oral health. As we embark on this exciting venture, we invite researchers, clinicians, academicians, and all stakeholders in dental sciences to contribute to the journal by sharing their expertise and insights. I am enthusiastic about the potential growth of “Annali di Stomatologia” in the next years, and I look forward to your valuable contributions, engagement, and support.
With warmest regards

Abstract

We live in the digital era. The digital devices have become part of our lives and we are using them every day.They involve dentistry too.A frequent mistake is to consider oral surgery and implantology as independent procedures not integrated with the comprehensive treatment plan and above all the prosthetic planning.Our patients ask us for teeth, not implants and that’s why we have to plan prosthet-ics first.The digital approach helps a lot in this field.When we start a surgical plane on e new patient data we need DICOM files from a CBCT and STL files from an intraoral scanner. We can acquire other digital data about occlusion to design the shape and position of new teeth. At this point, we have a digital project that the patient can approve. We can use programs that are also shared to match DICOM and STL files to create a digital patient. Only after that, we can design the artificial roots (dental implant) and if we need, a new bone volume to regenerate. To create this volume we can use free programs available on the net and export files to create devices like grids useful for the regeneration. Obviously, the implant insertion is made by 3D printed surgical stents or navigation to precisely replicate the planning.The whole process is exactly contrary to what we did in the past: the bone volume to regenerate is dictated by the implant position that is designed as a consequence of the prosthetic planning. Further developments will be due to the implementation of Artificial Intelligence (A. I.). Already programs exploit the AI for segmentation and basic diagnostic processes (like detectection of the inferior alveo-lar nerve).Shortly, the A.I. will substitute human judgment for more complex processes in medicine reducing mistakes.Also, medical journals are preparing to receive this revolution. The New English Journal of Medicine, the most important medical review in the world, will present in 2024 NEMJ AI for international researchers.Some are scared of this revolution, but I think that, under human control, this will be a great opportunity to improve the treatment of our patients

Abstract

In the light of considerable commitment and aided by the essential support of a high-profile scientific team, I managed to restore the consequentiality of our Jour-nal, which was resumed after a few years of editorial suspension.“Annali di Stomatologia” was founded in 1971 – year of registration is to be con-sidered the “historical” dental magazine with the greatest presence on the na-tional scene.Following a complex editorial process that began in 2019, thanks to the commit-ment and professionalism of my scientific group, I managed to restore the DOI on all the scientific articles published to date.The next step, which will take place shortly, will be to be included in one of the main databases in the biomedical field: PubMed.We are currently in the process of starting the conversion of scientific works into HTML format so that the journal’s indexing practice can be perfected.First of all, I would like to thank Prof. Roberto Gatto and his staff for their commitment and high professionalism, without which I would not have been able to achieve such excellent results.A special thank you must be dedicated to the priceless commitment of the entire Editorial Board and to the authors of the articles published in recent months, who believed in the growth process of Annali di Stomatologia, submitting their valuable articles and helping me to bring the Journal back to its former glory . Finally, a special recognition is addressed to the Sponsors who in recent years have supported and still financially sup-port my entrepreneurial project, believing in the realization of what was defined as a utopian dream of mine

Abstract

Digital dentistry is a constantly growing field, combining digital technologies with traditional dental practice. This innovative approach has revolutionized the way dental treatments are carried out, improving efficiency, accuracy and overall preci-sion. Digitalization has had a significant impact in several areas of dentistry, in-cluding diagnostics, treatment planning, design and manufacturing, as well as in patient management from all points of view, which is why the term “virtual patient” is already in use. Digital dentistry, in addition to acting in purely clinical areas, as mentioned above, also acts on the communicative sphere between patient and dentist. This happens, for example, when we use those software that, through the acquisition of patient data and images, are able to simulate a dental treatment before surgery, but as we will see later, also through devices designed for diagnostic use only. In Orthodontics the digital revolution was started by the advent of transparent aligners produced by Align Technology more than 25 years ago. Much has changed in this time, the technique has become increasingly predictable and performing and aligners have gained an important part of the market today. They are no longer used only for aesthetic corrections but also in the in-terceptive orthodontic treatment of the growing patient. The innovation was not only dedicated to the materials used for the production of aligners, but above all to the Clincheck software, a powerful diagnostic tool and to the implementation with the Itero intraoral scanner. The scannner is an integral part of the digital flow, it is able not only to help the special-ist in communicating with the patient with the various simulation software but also to be more performing in monitoring the therapy with the integrated digital monitoring tools. We can say that the constant digital evolution, not only in Or-thodontics, but also in the other branches of Dentistry, will involve not only the specialist but will guide and develop him “digitally” also broadening the views to interdisciplinary treatment and in the treatment of the growing patient. Sometimes the digital revolution may seem slow, but it is certainly tireless and more and more than we can imagine. Artificial intel-ligence will become an important integral part of development software and will increasingly support dentistry. All that remains is to live this evolution and digital revolution, in Orthodontics and dentistry in general, aware that it will change often and will not stop, but will allow us to integrate basic knowledge and clinical practice into a digital system that will al-low patients to be treated in a more predictable way and with more effective communication. My advice? Have fun being an integral part of this digital revolution and keep your mind open to continuous innovations, software and techniques, never being frightened, but absolutely fascinated, because your human intelligentsia will guide you.

Abstract

Innovative “prescriptions”, to improve the treatment of the citizen in need of odontostomatological care, are published daily on dental journals. These “prescriptions” are mostly indications from The Experts who have the aim of favouring citizens’ access to dental care in the dental facilities of the Servizio Sanitario Nazionale (SSN), which is constantly grappling with the long-standing and never solved problems of waiting lists and staff shortages. Beyond the goodness of the initiative, the arranged action plans always need the commitment of financial resources, nowadays not widely available. The question then arises as to how a project is feasible without the appropriate financial backing or, better yet, how economic resources can be found. However, the reason why the suggestions are never related to structures, technologies and personnel optimization, is not known. One example among many is the appointment agendas of outpatient visits and services, which punctuate the work activity of every health professional, both public and private. Are we sure that the visits' and services' scheduling is calibrated based on actual staff availability and patient demand? A study conducted a few years ago by the WHO Collaborating Centre for Epidemiology and Community Dentistry showed that the average daily time spent using a dental unit in the Public Service is about 3 hours. The time spent on the dental unit turns out to be about half that of a health professionals’ work shift (7.36 hours) established for medical management by the CCNL’s health area (this is not valid for departmental chiefs). The same concept is true for the assistance staff, of the health care professionals, (7.12 hours) working in the dental team. In addition, once the opening time of the dental service is defined, the agendas must be set based on the time space established for each service, which is characterized by a known execution time. This execution time considers not only the average medical time but also some corrections (ancillary times). However, many times this approach is still not used, indeed, in various situations what is seen is an “agenda personalization”. All of this shows that only with the application of simple scheduling rules, accompanied by the system's monitoring and control, we can ensure the delivery of the required services and expand the number of beneficiaries without the need of further monetary expenses for the structure.

Abstract

The average age and life expectancy of the population is constantly increasing, and a great challenge for the healthcare systems around the globe will be to ensure a healthy aging for the future generations.

The dentist must also be prepared and trained to know how to enhance and maintain a “healthy” smile in the different age groups and promote all the actions necessary to im- prove the health of the oral cavity and dental solutions effective from a biological point of view but also financially sustainable.

So far, oral health has been largely neglected on the global health agenda. Yet, most dental disorders are mostly preventable and treatable.

A good prevention campaign will have to play an increasingly indispensable role, thus allowing huge economic sav- ings and improving the quality of life of the population.

A new approach to “senior” dentistry is being born and will need to be developed, with solutions designed specifically for the resolution of functional problems, but increasingly also aesthetic.

It should not be forgotten that among professionals, doctors and dentists, we notice the same effects of the aging of the general population, with an increasingly high average age. Professional updating, new technologies and different models in the interpretation of medicine are outlining the study of the future: an interconnection of numerous profes- sionals who will exchange information on the state of health and well-being of their patients.

The change is also taking place on management models that, in the near future, will have to integrate with modern technologies and new forms of communication and relationship with patients.

Ensuring effective treatment in a safe and controlled environment is equivalent to ensuring “longevity” also to our studies.

Abstract

In an age in which digital overspreads in every area of the social, personal, and working life, the dental field is certainly not an exception. What, not so long ago, seemed to be “the future”, now constitutes the “present” of our daily work. The digital revolution has undergone a rapid development up to our days, in which we can make use of a real digital workflow, which changes totally what was the used to be plan, from the first steps of data collection to the diagnosis and design of a plan, to the diagnos- tic and communicative simulation, up to the realization of the treatment. In other words, digital dentistry is today a mature and complete workflow that leverages multiple tools and systems to create 3D models of the patient’s dental anatomy and it can produce accurate digital dental restorations leading to a huge paradigm shift in all aspects of dentistry. In contemporary dentistry, digital technologies such as conical beam computed tomography (CBCT), mandibular movement scanning, intraoral 3D scanning, facial scanning, 3D printing, and personalized treatment planning have taken on an important role in both research and clinical practice toward the goal of precise medicine. These technologies are having a major impact on processes and procedures, as well as workflows and time spent in clinical procedures, resulting in more personalized, predictable, and effective treatment by reducing iatrogenic complications. Fingerprints with intraoral scanners (IOS), digitally made prostheses, augmented reality and virtual patients have become a reality today. All this information interconnects with each other, making it much easier to include all the dental specialties involved in multidisciplinary treatments and even to make use of advanced artificial intelligence (AI) and Machine Learning (ML) tools in the planning process of the treatment. The current digital revolution is different from the previous ones, because we find the emergence of artificial intel- ligence as an element that seeks to complement or replace the human factor. Many healthcare professionals have already integrated digital technologies into practical workflows, which reduce reliance on manual skills and visual recognition. Although the principles on which clinical decisions are based remain the same, the incorporation of digital technology is bringing about radical changes in the relationship and communication with the patient and with other members of the working group, in procedures and in clinical materials. Today we can say that every branch of dentistry has been strongly influenced by digital technology and has had a significant impact on dentistry like never before, and this has led to a radical change in the way we work by facilitating care and improving the results of clinical treatment. Also in dental research, we can see the continuous growth of many new articles and the birth of new journals focused on digital dentistry and this is favoring the constant discovery of new therapeutic possibilities. Despite all this, even today among dentists there is a certain confusion and perplexity when it comes to introducing new tools and digital processes in their clinics. As industry professionals we should always make sure that our knowl- edge and skills are up to date to improve our ability to care for our patients. The digitalization of dentistry is having a huge impact on workflows and time spent on clinical procedures. Make no mistake: The digital revolution has now reached dentistry, it is not the future, it is now the present. Enter the world of Digital Dentistry now!

Abstract

Dentistry in Italy have been through many changes during the last 20 year. Dental tourism and dental clinics and social media have totally inverted the patients’ focus on dental care. Moreover, toaday dentistry is not only a matter of clinical approach, but also management, intended as financial, human resources and patient’s of course, which is the dentists’ main asset. However, this is the fact: dentists are not trained on management during the dental school. Nowadays, to achieve coherence between results and busy agenda, dentists need to put clinical training right aside management one, empowering 2 of the master soft skills, able to generate a meaningful difference both for the dentist practice as well as the patient experience. We are referring to Communication and Negotiating. Between them, negotiation represents a crucial skill to be trained and acted throughout the dental office, since it is meant to bring a brand new approach to dental treatment presentation and patient experience. Negotiation allows dentists to differentiate from their competing collegues in the field. Some dentists are successful thanks to their personal talent in treating and giving care to their patient, simply because they have naturally developed such communicating and negotiating skills. For those who do not have such talent, there is a way: the so called negotiation protocol. These are the main features of the negotiation protocol: 1. It is indipendent from any personal talent, since it implies a scientific approach to negotiation, due the specific steps to be held; 2. It allows the dentist have a more specific patient profile; 3. It allows the dentist communicating the treatment to the patient with a deepest clearness and fullfilling comprehension. 4. It allows the dentist access to a detailed financial planning of the cures towards the patient’s commitment; 5. The protocoll make it possible to hire new personnel or change it if necessary, guaranteeing continuity with the process itself, thank to the scientific approach. It is remarkable how negotiation itself is a process, asking to involve the whole human resources working on and for the patient in the office: dentist, lab operators, assistants and of course the dental office secretary. Negotiating protocol enphasizes the role of the dentist and his team, acting to give the patient the best medical result and human experience ever, and yet allowing the dentist as manager to get hold on those precious data, able to develop the dental office performances.

Abstract

In the recent years I have witnessed the constant growth of some young colleagues who, thanks to a widespread, open, and constant sharing of experience, have actively entered our editorial project and today constitute a key figure and are surely part of the esprit de corps that led us to the publication of the second issue of Annali di Stomatologia. Joining our working group means sharing its values but, not only! “The more people who share knowledge, the more the community benefits from it” and it is in this spirit, that we want to give back to our readers this final product of a high-level research that aims to represent a point of reference in the affirmation of knowledge in our sector. Including many young people in our team of researchers has been a challenge, but it is returning a great satisfaction, indeed. A great number of people, motivated to increase their knowledge without fear of discussion, sometimes even in opposition to the traditional techniques and rules, has given new life to new debates. And it is from there that we have started, walking together the path of a shared plan and a mutual exchange of ideas and knowledge, aiming to the excellence without ever taking anything for granted. Young editors who question them- selves about their knowledge, lead us to a great challenge with ourselves, sometimes breaking down barriers that open us and new possible horizons of research. As part of our goals, we enhance the quality of information, we favor the cultural growth of the Dental community and we open to the principles of modernity and technical evolution, improving a change in action while also maintaining constant attention on possible translations with respect to the current practices. Scenarios in a swift and constant evolution are for us a further stimulus to continue with passion and perseverance and while we are about to start a new chapter of our work, I would like to address a thank you to all the professionals who have worked with incessant commitment and have renewed daily their will to guarantee us a spot on the inter- national level. Happy reading!

Abstract

It is with a great deal of satisfaction and pride that I present, as Editor in Chief, the first new edition of Annals of Stomatology. A scientific magazine, founded in 1959, which after a period of pause, is ready to return pursuing its original mission with passion and renewed enthusiasm; seeking growth, im- provement, and innovation. Our magazine offers itself, in the international scene, as a tool for Research, analysis, and scientific dissemination, thanks to the knowledge and contribute of many scholars and re- searchers in the Sector. With a solid base of teamwork, sharing the same goals and purposes, exchanging dynamic and transversal knowledge, we will work with commitment, determination and constancy to deliver a great magazine to support Research and Innovation. Thanks to our professional background, we will be able to offer the consulting of updated and rigorous works as well as the dwelling on the in-depth treatment of individual clinical cases, received and characterized by elements of greater interest. Through a screening of carefully analyzed data we will evaluate a selection of papers, these will also include a study review from dental schools. On top of that we will present protocols and treatment procedures, also done through the most modern technologies; we aspire to possible new development and innovation projects. Being an editor puts forward numerous possibilities, but above all, it offers a privileged approach to Research. I am grateful for this role and certificate of esteem, that I wish to be able to honor and share with the entire team. My fellow colleagues returned a great deal of enthusiasm, starting from the beginning of the project and along the route of our path. We hope for an ever more widespread participation, openness to discussion and constructive exchange; if we will man- age to turn our work into a tool of support and cultural and scientific enrichment, then we will have achieved our goal! Enjoy this reading!