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https://www.annalidistomatologia.eu/ads/article/view/280
[ { "Alternative": null, "Coverage": null, "DOI": "10.59987/ads/2024.1.1-1", "Description": "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", "Format": "text/html", "ISSN": "1971-1441", "Identifier": "280", "Issue": "1", "Language": "en", "NBN": null, "PersonalName": "Gianluca Gambarini", "Rights": "https://creativecommons.org/licenses/by-nc-nd/4.0", "Source": "Annali di stomatologia", "Sponsor": null, "Subject": null, "Title": "Editorial", "Type": "Text.Serial.Journal", "URI": "https://www.annalidistomatologia.eu/ads", "Volume": "15", "abbrev": null, "abstract": null, "articleType": "Editorial", "author": null, "authors": null, "available": null, "created": "2024-03-28", "date": null, "dateSubmitted": "2024-03-26", "doi": null, "firstpage": null, "institution": null, "issn": null, "issue": null, "issued": "2024-03-28", "keywords": null, "language": null, "lastpage": null, "modified": "2024-04-17", "nbn": null, "pageNumber": "1", "readable": null, "reference": null, "spatial": null, "temporal": null, "title": null, "url": null, "volume": null }, { "Alternative": null, "Coverage": null, "DOI": null, "Description": null, "Format": null, "ISSN": null, "Identifier": null, "Issue": null, "Language": null, "NBN": null, "PersonalName": null, "Rights": null, "Source": null, "Sponsor": null, "Subject": null, "Title": null, "Type": null, "URI": null, "Volume": null, "abbrev": "Ann Stomatol (Roma)", "abstract": null, "articleType": null, "author": "Gianluca Gambarini", "authors": null, "available": null, "created": null, "date": "2024/03/28", "dateSubmitted": null, "doi": "10.59987/ads/2024.1.1-1", "firstpage": "1", "institution": "Editor in Chief Annali di Stomatologia", "issn": "1971-1441", "issue": "1", "issued": null, "keywords": null, "language": "en", "lastpage": "1", "modified": null, "nbn": null, "pageNumber": null, "readable": null, "reference": null, "spatial": null, "temporal": null, "title": "Editorial", "url": "https://www.annalidistomatologia.eu/ads/article/view/280/291", "volume": "15" } ]
A NNALI DI STOMATOLOGIA www.annalidistomatologia.eu VOLUME 15 NUMERO 1 - 2024 A Journal of Odontostomatologic Sciences PublyMed srls A Annali............. EDITOR IN CHIEF Gambarini Gianluca NNALI DI STOMATOLOGIA Generali Luigi University Modena Italy Quinzi Vincenzo University l’Aquila Italy University Sapienza Roma Italy Giancotti Aldo Scopelliti Domenico University Tor Vergata Roma Italy Dir. Uoc Maxillosurgery Surgery Asl Roma 1 Signorini Luca University UniCamillus Roma Italy Semper Marc Grande Nicola Maria University Cattolica Sacro Cuore Roma Italy Bremen Germany ASSOCIATE EDITORS Isufi Almira Severino Marco Abiad Roula University Perugia Italy University Beirut Arabia University Boston Usa Terauchi Yoshi Atav Ayfer Jantarat Jeeraphat University Tokio Japan University Istambul Turkey University Bangkok Thailand Testarelli Luca Basilicata Michele Jaramillo David University Sapienza Roma Italy University Tor Vergata Roma Italy University Texas Usa Valentini Valentino Benedicenti Stefano Kaitsas Vassilios University Sapienza Roma Italy University Genova Italy Roma Italy Wei Xi Bouquot Jerry Krishna Gopi Guanghua University China West Virginia University University Calcut India Laganà Giuseppina ASSISTANT EDITORS Chaniotis Antonis University Athens Greece University Tor Vergata Roma Italy Brauner Edoardo University Sapienza Roma Italy Consolo Ugo Manzo Paolo University Modena Italy Member Ebo-Ibo Italy D’Angelo Maurilio University Sapienza Roma Italy Cotti Elisabetta Marsili Domenico University Cagliari Italy Roma Italy Di Nardo Dario University Sapienza Roma Italy D’Addona Antonio Nagni Matteo University Cattolica Sacro Cuore Roma Italy University San Raffaele Milano Italy Miccoli Gabriele University Sapienza Roma Italy De Angelis Francesca Nassen Allen Ali University Sapienza Roma Italy University Harward Usa Piccoli Luca University Sapienza Roma Italy De Biase Alberto Olivi Giovanni University Sapienza Roma Italy Roma Italy Reda Rodolfo University Sapienza Roma Italy De Nuccio Claudio Pedullà Eugenio University Catania Italy Seracchiani Marco University Cattolica Sacro Cuore Roma Italy University Sapienza Roma Italy Dettori Claudia Perez Ruth Alfayate University Europea Madrid Zanza Alessio University Cagliari Italy University Sapienza Roma Italy Docimo Raffaella Piasecki Lucila University Tor Vergata Roma Italy University Buffalo Usa CONTACTS Dorn Samuel Pistilli Roberto Editor in Chief West Virginia University Hospital San Camillo Roma Italy Gianluca Gambarini [email protected] Fidler Ales Poli Figuereido Jose’ Antonio Managing Editor University Ljubljana Slovenia University Rio Grande Do Sol Brasil Alessandro Zurli Varesi [email protected] Foschi Federico Politano Gianfranco King’s College London Inghilterra University Leuven Managing Office - Sponsor e Marketing Donatella Alonzi Franco Vittorio Pongione Giancarlo [email protected] Roma Italy Roma Italy Publishing Operations Manager Galli Massimo Pozzi Alessandro Raffaele Salvati University Sapienza Roma Italy University Tor Vergata Roma Italy [email protected] IIANNALI DI STOMATOLOGIA Annali di Stomatologia 2018; IX (4): 141 Trimestrale edito da PublyMed srls, Via Treviso, 17/A - 00161 Roma - P.I. 16532301005 +39 06 44.24.99.41 - [email protected] - www.annalidistomatologia.eu Reg. Trib. Roma n. 421 18/12/2009 Editorial Dear Colleagues, Esteemed Readers and Friends It is an honor and privilege to introduce myself as the new Editor-in-Chief of “An- nali 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 cham- pions 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 insight- ful 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, collabora- tion, 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 stan- dards 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 evalu- ation 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 emerg- ing 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 Gianluca Gambarini Editor in Chief Annali di Stomatologia 10.59987/ads/2024.1.1-1 1
null
https://www.annalidistomatologia.eu/ads/article/view/281
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A Comprehensive Multimethod Analysis of Mechanical Properties of two different heat treatments for endodontic Nickel-titanium instruments Nicola Maria Grande1 Authors Krithika Datta2 Nicola Maria Grande -Università Cattolica Lucila Piasecki3 del Sacro Cuore, Roma. Maurilio D’Angelo4 Krithika Datta - Saveetha Dental Institute, Edit Xhaijanka5 Chennai, India. Luca Testarelli4 Lucila Piasecki - New York University at Dario di Nardo4 Buffalo, USA. 1 Università Cattolica del Sacro Cuore, Roma Maurilio D’Angelo - Sapienza, Università di Roma. 2 Saveetha Dental Institute, Chennai, India 3 New York University at Buffalo, USA Edit Xhaijanka - Università di Tirana, 4 Sapienza, Università di Roma Albania. 5 Università di Tirana, Albania Luca Testarelli - Sapienza, Università di Roma. Corresponding author: Maurilio D’Angelo Dario di Nardo - Sapienza, Università di Roma. [email protected] Abstract The purpose of the present study was to evaluate the influence of the two different heat treatments of the mechanical properties of two commercial products: X7 Fire- License wire and X7 Utopia Nickel-titanium rotary instruments (EdgeEndo, Albuquerque, New This work is licensed under a Creative Mexico). The present article was written following the guidelines of PRILE (Prefered Commons Attribution-NonCommercial- Reporting Items for Laboratory studies in Endodontology). Since both instruments NoDerivatives 4.0 International License. are available with same design, size and taper the influence of the two different heat Authors contributing to Annali di treatments on various mechanical properties could be properly evaluated. 50 instru- Stomatologia agree to publish ments for each group, as determined by power analysis, were selected and tested their articles under the Creative using methods and devices validated in previous studies. Data were collected and Commons Attribution-NonCommercial- statistically analyzed using a 1-way ANOVA test followed by the post hoc Tukey test NoDerivatives 4.0 International License, with significance set to a 95% confidence level. Results showed that X7 Utopia were which allows third parties to copy and redistribute the material providing found to be more rigid, with a statistically significant difference when compared to appropriate credit and a link to the X7 Firewire. Similarly, X7 Utopia were found to be significantly more resistant to tor- license but does not allow to use the sion, while no statistically significant difference was found between the two tested material for commercial purposes and to instruments when subjected to a cyclic fatigue test. Cutting efficiency was signifi- use the material if it has been remixed, cantly higher for X7 Utopia instruments, and also instrumentation time was signifi- transformed or built upon. cantly shorter when compared with X7 Firewire. X7 Firewire instruments showed a How to Cite higher tendency to flues deformations during usage. We can conclude that thermal NM Grande, K Datta, L Piasecki, treatments of nickel-titanium instruments can significantly impact all their mechan- M D’Angelo, E Xhaijanka, L Testarelli, ical properties in vitro and overall performance in root canal procedures. Therefore, D di Nardo. understanding the differences in thermal treatments is crucial for manufacturers to A Comprehensive Multimethod Analysis improve instruments and for dental professionals to tailor these instruments to spe- of Mechanical Properties of two different cific clinical requirements. heat treatments for endodontic Nickel-titanium instruments Annali Di Stomatologia, 15(1), 3-8. Key words: endodontic instruments, nickel-titanium, heat treatment https://doi.org/10.59987/ads/2024.1.3-8 Introduction Nickel-titanium (NiTi) instruments are widely used in endodontics due to their flexibil- ity, shape memory, and resistance to cyclic fatigue. In the last decades NITi rotary in- strumentation technique have been considered as golden standard to achieve proper canal shaping with a more efficient, rapid and simple clinical approach, even if intra- canal separation or rotary instruments is still a major concern for the majority of cli- nicians (1). In the last decades improvements in design, motions and manufacturing have been proposed to provide clinicians with safer and more efficient NiTi rotary in- struments. In recent years, however, the majority of manufacturers have focused their interest in improving heat treatment (HT) procedures before, during or after the grinding process (1,2) . Several studies have shown the benefits of such treatments; however, 10.59987/ads/2024.1.3-8 3 A Comprehensive Multimethod Analysis of Mechanical Properties of two different heat treatments for endodontic Nickel-titanium instruments they are proprietary and not disclosed by manufactur- querque, New Mexico, USA) and have a constant taper, ers (3-5).It has been shown that many mechanical prop- a parabolic cross-section, a non cutting tip and a 1mm erties can be influenced by the heat treatments, even maximum flute diameter. Even if design and dimensions if overall performance is still a combination of instru- are same the X7 NiTi rotary instruments are currently ments’ design, dimensions, motions and alloy (6-8) commercialized with two different names, due to two Currently the heat treatment of endodontic NiTi instru- different types of heat treatment. “Fire-Wire” X7 instru- ments has become a crucial aspect of their manufac- ments are made of an Annealed Heat Treated (AHT) turing process, playing a pivotal role in enhancing their nickel-titanium alloy brand named Fire-Wire (more duc- mechanical properties and overall performance in root tile). According to the manufacturer (11) such alloy im- canal procedures. Heat treatment involves subjecting proves flexibility, resistance to cyclic fatigue and reduces the NiTi alloy to specific temperature and time condi- bounce-back effect inside curvatures, and instruments tions to modify its microstructure. The primary goals of closely follow the anatomy of the canal without straight- heat treatment for endodontic NiTi instruments are to ening out, reducing the risk of ledging, transportation, enhance their flexibility, resistance to fracture, and to es- and perforation. It also allows the NiTi rotary instru- t0ablish a balanced combination of hardness and tough- ments to be easily straightened with clinicians fingers ness (5-8). (prebendable). The EdgeX7 “Utopia” is a more recently The process typically involves a sequence of steps, commercialized, NITi rotary instrument that, according including solution treatment, quenching, and aging. to manufacturer,provides all of the benefits of the origi- During solution treatment, the NiTi alloy is heated to a nal Firewire X7 blade design while taking performance temperature where it transitions from a martensitic to to a different level with more cutting efficiency, due to a an austenitic phase. This phase transition is critical for different proprietary heat -treatment (11). imparting the desired shape memory and superelas- Since both instruments are available with same design, ticity to the instruments. Quenching follows, where sizes and tapers, and are meant to be used with the the heated alloy is rapidly cooled to lock in the austen- same protocol and same motion’s parameters (rotational itic phase and achieve the desired mechanical prop- speed and torque), the purpose of the present study was erties. Subsequently, aging is performed to optimize to evaluate the influence of the two different heat treat- the balance between hardness and toughness, ensur- ments of the mechanical properties of the two commer- ing the instrument’s durability during clinical use (1,7). cial products (X7 Firewire and X7 Utopia instruments). The controlled application of heat treatment mainly ad- The null hypothesis was that no changes in the in vitro dresses some of the challenges associated with NiTi mechanical properties were provided by the different instruments, such as their susceptibility to cyclic fatigue heat treatments. and potential for breakage. The process enhances the instruments’ fatigue resistance by refining the grain struc- Materials and Methods ture and controlling phase transformations, leading to a The present article was written following the guidelines more robust and reliable endodontic tool (9). Manufactur- of PRILE ( Prefered Reporting Items for Laboratory stud- ers continually refine heat treatment processes to tailor ies in Endodontology (Nagendrabu 2021) , as shown in NiTi instruments for specific clinical applications (10). the flow chart of the study (Fig.1). X7 instruments are manufactured by Edge Endo (Albu- Figure 1. 4 10.59987/ads/2024.1.3-8 N.M. Grande et al. Sample selection length of the fragments (FL) was measured with a digital caliber and statistically analyzed to evaluate the correct A total of 50 new X7 NiTi instruments and 50 new XT positioning of the instruments inside the artificial canal Utopia NiTi instruments size 25 and .04 taper (Edg- and to verify the comparability of the results of the cyclic eEndo, Albuquerque, New Mexico, USA) were selected fatigue test. All data were statistically analyzed using a for the study and divided in 5 groups of ten each (Fig 1-way ANOVA test followed by the post hoc Tukey test 2a). Each group was then subjected to one of the follow- with significance set to a 95% confidence level. Mean ing mechanical tests: stiffness, cyclic fatigue, torsional values, the standard deviations and statistical signifi- resistance, cutting efficiency, durability. According to cance of the cyclic fatigue tests are displayed in table 1. manufacturer all the instruments have same design and dimensions, while they differ only due to different heat Torsional test treatments, even if such manufacturing processes are proprietary and not disclosed (11). Ten instruments for each product underwent the torsion- Before starting the laboratory assessment all the 100 al resistance test using a methodology which has been instruments were examined under dental stereomicro- validated by studies published in peer-review indexed scope (Kaps,Asslar,Germany) at x10 magnification to journals (16) and follows iSO Guidelines 3630-1. Tests identify major irregularities or defects in the blade de- were performed with a custom-made torsiometer-like sign, which could affect properties of the NiTi instru- device at 300 rpm, because it has been demonstrated ments and make them not valid for the investigation. No that rotational speed does not affect the results. The instrument was discarded and all 100 samples were ac- device allowed to avoid the bending of the coronal part cepted for the study. of the instrument and to have a straight angle of inser- Sample size for each mechanical test was determined tion, since it has been demonstrated that such coronal by power analysis and calculated based on preliminar intereferences and stresses can deeply influence the data obtained after 6 initial measurements with a power torsional resistance. The test was performed blocking of 80% and a 0,05 alpha type of error. For the five previ- the tip of the instrument with a vise at 3 mm from the tip ously mentioned tests sample size calculations were 3. (fig 2d) and rotating it at 300 rpm in the clockwise direc- 4, 3, 4 and 6 respectively and, consequently, a total num- tion with a dedicated electronic motor (Kavo, Biberach, ber of 10 instruments per group was considered more Germany) allowing a real-time (0.1 seconds) recording than enough for each dependent variable. of the torque with a sensitivity of 0.05 Ncm. The torque at fracture results were collected on a spreadsheet. The Stiffness Test length of the fragments (FL) was measured with a digital caliber and statistically analyzed to evaluate the correct Ten instruments for each product underwent the stiff- positioning of the instruments’ tip inside the torsiometer ness test (resistance to bending stress). The stiffness and to verify the comparability of the results of the tor- tests were performed using a device, which has been sional test. used in previously published peer-review studies (12) All data were statistically analyzed using a 1-way ANO- and follows ISO 3630-1 international standard guidelines VA test followed by the post hoc Tukey test with signifi- for mechanical tests of endodontic instruments (fig 2b). cance set to a 95% confidence level. Mean values, the The device consists of a load cell, an electronic display, standard deviations and statistical significance of the and a mobile holder to allow repeatable positioning of torsional tests are displayed in table 1 the instruments on the load cell. The stiffness tests were performed by bending each file at a 45° angle at 3 mm Cutting efficiency test from its tip and recording the applied force (g). The mea- surements indicated by the electronic display connected Ten instruments for each product underwent the cut- to the load cell were recorded. The higher the values, the ting efficiency test using a methodology (Fig 2e) which stiffer (less flexibile) the instrument was. Mean values,the has been validated by studies published (17,18) in standard deviations and statistical significance of the cy- peer-review indexed journals. The device consisted clic fatigue tests are displayed in table 1. of a main frame to which a mobile plastic support for the handpiece was connected and a stainless-steel Cyclic fatigue test block containing the Plexiglas plates (Inplex, Rome, Italy), against which the cutting efficiency of the instru- Ten instruments for each product were subjected to the ments was tested. A notch 1 mm in depth and width test . All instruments were rotated in a stainless-steel ar- had been created on the lateral wall of the Plexiglas tificial canal of 16 mm characterized by a 90° angle of plate that measured 1 mm in thickness, to prevent the curvature and a 2-mm radius of curvature (fig 2c) using instruments from slipping out the smooth surface of glycerin as a lubricant to avoid any friction between the the plastic. The dental handpiece was mounted upon a files and the artificial canal. The methodology has been mobile device connected to a fixed weight (150 g), that validated by many studies published in peer-review in- for gravity drove the horizontal instrument against the dexed journals (13-15). Speed ( 300 rpm clockwise) and Plexiglas block in a precise and reproducible way. The torque (2N) were selected according to the manufactur- plastic support for the handpiece allowed for precise ers’ recommendation and each test was performed by and simple three-dimensional alignment and position- the same expert operator. Each instrument was carefully ing of the instrument, as soon as it came perpendicu- inserted at the same length (16mm) and rotated inside larly into contact with the notch created on the wall of the canal until a visible and/or audible sign of fracture the Plexiglas specimen without bending. Once every- was detected. The time to fracture (TtF) was measured thing was fixed, the motor of the testing device was using a digital chronometer with a sensitivity of 0.01 sec- switched on and the instrument removed material and onds. The test was performed at room temperature. The penetrated actively The cutting efficiency was tested 6 10.59987/ads/2024.1.3-8 5 A Comprehensive Multimethod Analysis of Mechanical Properties of two different heat treatments for endodontic Nickel-titanium instruments Figure 2. mm from the tip of each instrument (max diameter = speed and 2,5 N torque). Overall, each instrument was 0,49 mm) and instruments were rotated at 350 rpm and supposed to prepare 20 canals (19) to working length 2,5 N torque setting for 30 seconds. Each instrument without any breakage or deformation of flutes (fig 2g). was tested in linear cutting unidirectional lateral mo- An initial manual glide-path using a manual k-file n.15 tion and the maximum penetration depth of the instru- was performed to ensure patency and a slight preliminar ments was the criterion for cutting Each plastic block enlargement to facilitate the .04 25 instruments progres- was used to test one instrument from each of the two sion to the working length. All canals were prepared by groups tested. The precise length of the plastic block the same expert clinicians using Mimeraci technique cut in 1 min was measured in mm for all groups tested in steps: manual insertion, activation and progression using a computerized program (Adobe Photoshop CS4) in small steps (1-2 mm) , removal of the file from ca- with a precision of 0.1 mm. The 1 mm notch was sub- nal, cleaning of flutes and irrigation with distilled water. tracted to the length obtained. Maximum penetration Each step of the technique was repeated till working depth was calculated, mean and standard deviations of length was reached.The total instrumentation time, the each group were calculated and data were statistically incidence of instruments ‘ separation or deformation of analyzed with a one-way ANOVA test with significance flutes ( under microscope inspection at x10 magnifica- set at 95 % confidence interval. tion) were recorded. For the instrumentation time mean and standard deviations of each group were calculated Durability test and data were statistically analyzed with a one-way Each instrument was used to prepare five artificial 3d ANOVA test with significance set at 95 % confidence plastic (Fig 2f) molar tooth (Orodeka,Firenze, Italia) with interval. Data concerning separated or deformed instru- the same motor and the same parameters (350 rpm ments were only recorded. Table 1. Mean (standard deviation) results of different tests for the two instruments Test Parameters x7 firewire x7 utopia P-values Stiffness maximum load 131,3 +/- 9,2 84, 2 +/- 6,5 <.001 Cyclic fatigue time to fracture (s) 19,6 +/- 2,9 20,3 +/- 3,9 .412 Torsional resistance Maximum torque (N. cm) 1, 34 +/- 0,28 1.01 +/- 0,19 <.001 Cutting ability Penetration (cm) 13,4 +/- 2,6 9,8 +/- 3,9 <.001 Instrumentation time Seconds (s) 12,9 +/- 7,7 16,1 +/- 9,2 <.001 Intracanal breakage number of instruments 0 0 NA Flute Deformation number of instruments 4 0 NA 6 10.59987/ads/2024.1.3-8 N.M. Grande et al. Results Differences in thermal treatments of NiTi endodontic in- struments stem from variations in methods and objec- Results are summarized in table 1. For the stiffness test tives (10). A relevant topic is in the pursuit of a balance X7 Utopia were found to be more rigid, with a statistically between flexibility and resistance to cyclic fatigue. Heat significant difference when compared to X7 Firewire. treatment seeks to achieve this equilibrium through care- X7 Utopia were also found to be more resistant to tor- ful control of temperature and time during the thermal sion, showing significantly higher values for maximum processes. The challenge is to prevent excessive hard- torque at failure when compared to X7 Firewire, while ness that could compromise flexibility while ensuring no statistically significant difference was found between sufficient toughness to resist cyclic loading, by creating the two tested instruments when subjected to a cyclic gradient structures within the material to optimize both fatigue test. For both torsional and cyclic fatigue tests no flexibility and fatigue resistance. significant differences were noted in the two groups con- In the present study all the tested instruments had a simi- cerning fragment lengths, demonstrating a correct test- lar resistance to a cyclic fatigue test which was performed ing procedure. Under the conditions of the present test, in a very challenging complex ,abrupt apical curvature. cutting efficiency was significantly higher for X7 Utopia Differences in the thermal treatment protocols contrib- instruments, and also instrumentation time was signifi- ute to the development of NiTi instruments with specific cantly shorter when compared with X7 Firewire. During characteristics for various clinical applications (1,7). For durability tests all instruments were able to reach work- instance, instruments designed for shaping procedures ing length without any intracanal breakage. On the con- may undergo thermal treatments that prioritize flexibility trary four X7 Firewire instruments which exhibited visible to navigate curved root canals efficiently. In contrast, in- signs of flute deformation were discarded and were not struments intended for more simple and rapid techniques able to prepare all the 20 canals, while no X7 Utopia in- may prioritize durability and cutting efficiency. Results strument showed any sign of plastic deformation. from the present study confirmed the significant impact of the different heat treatments. They showed that the Discussion X7 Utopia were less flexible, but more resistant to tor- sion and efficient in cutting when compared to Firewire The results of the present study showed that thermal X7. This property may be also more helpful in retreat- treatment of nickel-titanium endodontic instruments in- ment cases, making removal of gutta-percha easier and volveing intricate processes can significantly impact all faster. Moreover less plastic deformation of flutes were their in vitro mechanical properties (flexibility, strength observed after clinical use, leading to more durability. and cutting ability) and overall performance in root canal The question whether such plastic deformations are a procedures (10, 20). Even if many factors contribute to the weak point or not is still open. Obviously permanently success of endodontic therapy, root canal instrumenta- deformed rotary instruments should be discarded (which tion has a relevant role, because it create a proper shape negatively affects durability), but such feature is also to perform both final irrigation and obturation procedures considered beneficial, since it is a clinical warning that correctly (21-25). Understanding the in vitro differences could prevent sudden, unexpected intracanal failure. It in thermal treatments is crucial for manufacturers to is considered a warning because such plastic deforma- provide instruments with different properties and dental tions usually occurs immediately prior to breakage. professionals to tailor these instruments to specific clini- In summary we may conclude that heat treatment meth- cal requirements (1,5). In the present study two different ods provide a well-established positive approach, and heat treatments from the same manufacturer and applied new technologies offer more sophisticated and targeted to the same instrument design were tested and results modifications, like the differences shown between the two showed significant differences between the two groups. tested X7 instruments. Such avenues contribute to the As dimensions and designs were same these difference ongoing evolution of NiTi rotary instruments, continually are only related to the difference in the heat treatments. improving their performance and expanding their appli- Heat treatment typically involves processes like aus- cability in endodontic practice, ultimately benefiting den- tenitization, quenching, and aging (9). Austenitization tal practitioners and patients alike by providing tailored involves heating the NiTi alloy to a specific temperature instruments for the case and overall by enhancing the to transform it from a martensitic to an austenitic phase. efficiency and safety of endodontic shaping procedures. Subsequent quenching rapidly cools the alloy, fixing the desired phase and enhancing properties like shape References memory. Aging, the final step, optimizes the balance 1. Zupanc J, Vahdat-Pajouh N, Schäfer E. New thermome- between hardness and toughness. Variations in time, chanically treated NiTi alloys - a review. Int Endod J. 2018 temperatures, heating and cooling processes may differ- Oct;51(10):1088-1103. doi: 10.1111/iej.12924. Epub 2018 entiate the heat treatments and ideally these advanced Apr 19. PMID: 29574784. 2. Kim E, Ha JH, Dorn SO, Shen Y, Kim HC, Kwak SW. techniques should allow for precise control over specific Effect of Heat Treatment on Mechanical Properties of attributes, offering a more tailored approach to perfor- Nickel-Titanium Instruments. J Endod. 2023 Nov 2:S0099- mance (5). Unfortunately heat treatments are proprietary 2399(23)00713-6. doi: 10.1016/j.joen.2023.10.018. Epub and not disclosed by manufacturers in details. Manufac- ahead of print. PMID: 37924940 turers only state the improvements in clinical or in vitro 3. Plotino G, Grande NM, Testarelli L, Gambarini G, Cast- performance of the commercial instruments by mention- agnola R, Rossetti A, Özyürek T, Cordaro M, Fortunato L. Cyclic Fatigue of Reciproc and Reciproc Blue Nickel- ing the different applied HTs. They usually focus only on titanium Reciprocating Files at Different Environmental a few main properties, avoiding to mention all the differ- Temperatures. J Endod. 2018 Oct;44(10):1549-1552. doi: ences (advantages and disadvantages) in performance 10.1016/j.joen.2018.06.006. Epub 2018 Aug 23. PMID: 30 related to these changes (10). As a consequence, clini- 4. Gambarini G, Galli M, Di Nardo D, Seracchiani M, Don- cians are not aware of all proerties which could affect francesco O, Testarelli L. Differences in cyclic fatigue lifes- clinical performance in a positive or negative way (2). pan between two different heat treated NiTi endodontic 10.59987/ads/2024.1.3-8 7 A Comprehensive Multimethod Analysis of Mechanical Properties of two different heat treatments for endodontic Nickel-titanium instruments rotary instruments: WaveOne Gold vs EdgeOne Fire. J 15. Gambarini G, Miccoli G, Seracchiani M, Khrenova T, Don- Clin Exp Dent. 2019 Jul 1;11(7):e609-e613. doi: 10.4317/ francesco O, D&#39;Angelo M, Galli M, Di Nardo D, Testarelli jced.55839. PMID: 31516658; PMCID: PMC6731004. L. Role of the Flat-Designed Surface in Improving the Cyclic 5. Kasuga Y, Kimura S, Maki K, Unno H, Omori S, Hirano K, Fatigue Resistance of Endodontic NiTi Rotary Instruments. Ebihara A, Okiji T. Phase transformation and mechanical Materials (Basel). 2019 Aug 8;12(16):2523. doi: 10.3390/ properties of heat-treated nickel-titanium rotary endodon- ma12162523. PMID: 31398814; PMCID: PMC6720207. tic instruments at room and body temperatures. BMC Oral 16. Zanza A, Seracchiani M, Di Nardo D, Reda R, Gambarini Health. 2023 Oct 30;23(1):825. doi: 10.1186/s12903-023- G, Testarelli L. A Paradigm Shift for Torsional Stiffness of 03550-6. PMID: 37904159; PMCID: PMC10614384. Nickel-Titanium Rotary Instruments: A Finite Element Anal- 6. Martins JNR, Martins RF, Braz Fernandes FM, Silva ysis. J Endod. 2021 Jul;47(7):1149-1156. doi: 10.1016/j. EJNL. What Meaningful Information Are the Instruments joen.2021.04.017. Epub 2021 Apr 27. PMID: 33915175. Mechanical Testing Giving Us? A Comprehensive Re- 17. Giansiracusa Rubini A, Plotino G, Al-Sudani D, Grande NM, view. J Endod. 2022 Aug;48(8):985-1004. doi: 10.1016/j. Sonnino G, Putorti E, Cotti E, Testarelli L, Gambarini G. A joen.2022.05.007. Epub 2022 Jun 3. PMID: 35667567. new device to test cutting efficiency of mechanical end- 7. Martins JNR, Silva EJNL, Marques D, Pereira MR, Vieira odontic instruments. Med Sci Monit. 2014 Mar 6;20:374- VTL, Arantes-Oliveira S, Martins RF, Braz Fernandes F, 8. doi: 10.12659/MSM.890119. PMID: 24603777; PMCID: Versiani M. Design, Metallurgical Features, and Mechani- PMC3948890. cal Behaviour of NiTi Endodontic Instruments from Five 18. Plotino G, Giansiracusa Rubini A, Grande NM, Testarelli L, Different Heat-Treated Rotary Systems. Materials (Ba- Gambarini G. Cutting efficiency of Reciproc and waveOne sel). 2022 Jan 28;15(3):1009. doi: 10.3390/ma15031009. reciprocating instruments. J Endod 2014;40:1228–30. PMID: 35160955; PMCID: PMC8840527. https://doi.org/10.1016/j.joen.2014.01.041 8. Campos GO, Fontana CE, Vieira VTL, Elias CN, de Martin 19. Gambarini G, Miccoli G, Seracchiani M, Morese A, Piasecki AS, Bueno CEDS. Influence of Heat Treatment of Nickel- L, Gaimari G, Di Nardo D, Testarelli L. Fatigue Resistance Titanium Instruments on Cyclic Fatigue Resistance in Sim- of New and Used Nickel-Titanium Rotary Instruments: a ulated Curved Canals. Eur J Dent. 2023 May;17(2):472- Comparative Study. Clin Ter. 2018 May-Jun;169(3):e96- 477. doi: 10.1055/s-0042-1747952. Epub 2022 Oct 4. e101. doi: 10.7417/T.2018.2061. PMID: 29938739. 20. Gambarini G, Galli M, Di Nardo D, Seracchiani M, Don- PMID: 36195211; PMCID: PMC10329553. francesco O, Testarelli L. Differences in cyclic fatigue lifes- 9. Nehme W, Naaman A, Diemer F, Leotta ML, La Rosa pan between two different heat treated NiTi endodontic GRM, Pedullà E. Influence of different heat treatments and rotary instruments: WaveOne Gold vs EdgeOne Fire. J temperatures on the cyclic fatigue resistance of endodontic Clin Exp Dent. 2019 Jul 1;11(7):e609-e613. doi: 10.4317/ instruments with the same design. Clin Oral Investig. 2023 jced.55839. PMID: 31516658; PMCID: PMC6731004. Apr;27(4):1793-1798. doi: 10.1007/s00784-022-04808-z. 21. Valenti-Obino F, Di Nardo D, Quero L, Miccoli G, Gam- Epub 2022 Dec 1. PMID: 36454355. barini G, Testarelli L, Galli M. Symmetry of root and root 10. Zanza, A.; D’Angelo, M.; Reda, R.; Gambarini, G.; Testarel- canal morphology of mandibular incisors: A cone-beam li, L.; Di Nardo, D. An Update on Nickel-Titanium Rotary computed tomography study in vivo. J Clin Exp Dent. 2019 Instruments in Endodontics: Mechanical Characteristics, Jun 1;11(6):e527-e533. doi: 10.4317/jced.55629. PMID: Testing and Future Perspective—An Overview. Bioengi- 31346372; PMCID: PMC6645266. neering 2021, 8, 218. https://doi.org/10.3390/bioengineer- 22. Gambarini G, Testarelli L, Pongione G, Gerosa R, Gagliani ing8120218 M. Radiographic and rheological properties of a new end- 11. X7 instruments. Available at: https://www.edgeendo.com. odontic sealer. Aust Endod J. 2006 Apr;32(1):31-4. doi: Accessed November 27, 2023, n.d. 10.1111/j.1747-4477.2006.00005.x. PMID: 16603043. 12. Testarelli L, Plotino G, Al-Sudani D, Vincenzi V, Giansir- 23. Gambarini G, Di Nardo D, Miccoli G, Guerra F, Di Gior- acusa A, Grande NM, Gambarini G. Bending properties of gio R, Di Giorgio G, Glassman G, Piasecki L, Testarelli a new nickel-titanium alloy with a lower percent by weight L. The Influence of a New Clinical Motion for Endodon- of nickel. J Endod. 2011 Sep;37(9):1293-5. doi: 10.1016/j. tic Instruments on the Incidence of Postoperative Pain. joen.2011.05.023. Epub 2011 Jul 16. Erratum in: J Endod. Clin Ter. 2017 Jan-Feb;168(1):e23-e27. doi: 10.7417/ 2014 Dec;40(12):2086. PMID: 21846552. CT.2017.1977. PMID: 28240758. 13. Gambarini G, Miccoli G, Seracchiani M, Morese A, Piasecki 24. Rubini AG, Sannino G, Pongione G, Testarelli L, Al Su- L, Gaimari G, Di Nardo D, Testarelli L. Fatigue Resistance dani D, Jantarat J, De Luca M, Gambarini G. Influence of New and Used Nickel-Titanium Rotary Instruments: a of file motion on cyclic fatigue of new nickel titanium in- Comparative Study. Clin Ter. 2018 May-Jun;169(3):e96- struments. Ann Stomatol (Roma). 2013 Mar 20;4(1):149- e101. doi: 10.7417/T.2018.2061. PMID: 29938739. 51. doi: 10.11138/ads.0149. PMID: 23741535; PMCID: 14. Plotino G, Grande NM, Mazza C, Petrovic R, Testarelli PMC3671806. L, Gambarini G. Influence of size and taper of artificial 25. Gambarini G, Plotino G, Piasecki L, Al-Sudani D, Testarelli canals on the trajectory of NiTi rotary instruments in cy- L, Sannino G. Deformations and cyclic fatigue resistance clic fatigue studies. Oral Surg Oral Med Oral Pathol Oral of nickel-titanium instruments inside a sequence. Ann Sto- Radiol Endod. 2010 Jan;109(1):e60-6. doi: 10.1016/j.tri- matol (Roma). 2015 May 18;6(1):6-9. PMID: 26161246; pleo.2009.08.009. Epub 2009 Nov 17. PMID: PMCID: PMC4475905. Contributions Conceptualization Methodology Validation Data Writing– Writing– Supervision Curation Original draft review Author 1 Author 2 Author 3 Author 4 Author 5 Author 6 Author 7 Funding: This research was partially funded from Sapienza University of Rome “ Progetto Medio di Ateneo 2020 su test per strumenti endodontici” Conflicts of Interest: The authors declare no conflict of interest. 8 10.59987/ads/2024.1.3-8
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https://www.annalidistomatologia.eu/ads/article/view/282
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In Vivo Biocompatibility Authors Machiavelli Clavesia - School of Medicine and Biodegradation Test of Two and Health Sciences, Atma Jaya Catholic University of Indonesia, Pluit Raya No. 2, North Jakarta, 14440 Barrier Membranes for Guided Stephani Dwiyanti - Department of Dental Medicine, School of Medicine and Tissue Regeneration Health Sciences, Atma Jaya Catholic University of Indonesia, Pluit Raya No. 2, North Jakarta, 14440 Veronika Maria Sidharta - Department of Machiavelli Clavesia1 Histology, School of Medicine and Health Stephani Dwiyanti2 Sciences, Veronika Maria Sidharta3 Atma Jaya Catholic University Dyonesia Ary Harjanti4 of Indonesia, Pluit Raya No. 2, Mora Octavia2 North Jakarta, 14440 Eko Adi Prasetyanto5 Dyonesia Ary Harjanti - Department Tena Djuartina6 of Anatomical Pathology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, 1 School of Medicine and Health Sciences, Atma Jaya Catholic Pluit Raya No. 2, North Jakarta, 14440 University of Indonesia, Pluit Raya No. 2, North Jakarta, 14440 Mora Octavia - Department of Dental 2 Department of Dental Medicine, School of Medicine and Health Sciences, Medicine, School of Medicine and Health Atma Jaya Catholic University of Indonesia, Pluit Raya No. 2, North Jakarta, 14440 Sciences, 3 Department of Histology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Atma Jaya Catholic University of Indonesia, Pluit Raya No. 2, North Jakarta, 14440 Indonesia, Pluit Raya No. 2, North 4 Department of Anatomical Pathology, School of Medicine and Health Sciences, Jakarta, 14440 Atma Jaya Catholic University of Indonesia, Pluit Raya No. 2, North Jakarta, 14440 Eko Adi Prasetyanto - Department of 5 Department of Pharmacy, School of Medicine and Health Sciences, Pharmacy, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Pluit Raya No. 2, North Jakarta, 14440 Atma Jaya Catholic University of 6 Department of Biomedical and Anatomy, School of Medicine and Health Sciences, Indonesia, Pluit Raya No. 2, North Atma Jaya Catholic University of Indonesia, Pluit Raya No. 2, North Jakarta, 14440 Jakarta, 14440 Tena Djuartina - Department of Corresponding author: Yohanes Eko Adi Prasetyanto Biomedical and Anatomy, School of E-mail: [email protected] Medicine and Health Sciences, Atma Jaya Catholic University Abstract of Indonesia, Pluit Raya No. 2, North Jakarta, 14440 This study evaluates biocompatibility and biodegradation properties of PCL/Chi- tosan/BG-NP/Tetracycline and compares them with commercially available Sure- Derm membrane in Sprague Dawley Rats.Two different membranes (PCL/Chitosan/ BG-NP/Tetracycline membrane and SureDerm membrane) were randomly inserted into subcutaneous pouches in the backs of 54 Sprague Dawley rats. The animals License were sacrificed at day 7, 21, and 63. Biocompatibility properties (number and distri- This work is licensed under a Creative bution of inflammatory cells, necrosis, neovascularisation, fibrosis, fatty infiltrate, Commons Attribution-NonCommercial- tissue integration, tissue ingrowth) was assessed according to DIN EN ISO 10993- NoDerivatives 4.0 International License. 6. Biodegradation property was assessed macroscopically to check for membrane degradation rate. In terms of biocompatibility properties, the test membrane had Authors contributing to Annali di Stomatologia agree to publish overall irritancy score of 0 at day 7 and 21, and 0.66 at day 63, and it is considered their articles under the Creative non-irritant. Biodegradation of test membrane is faster compared to SureDerm at Commons Attribution-NonCommercial- day 7 and 21. However, there is no significant difference between the two mem- NoDerivatives 4.0 International License, branes at day 63. The GTR membrane PCL/Chitosan/BG-NP/Tetracycline is a good which allows third parties to copy and membrane with comparable biocompatibility and biodegradation properties to the redistribute the material providing SureDerm membrane. appropriate credit and a link to the license but does not allow to use the material for commercial purposes and to Key words: Biocompatibility, Biodegradation, In Vivo, Polycaprolactone, Guided Tis- use the material if it has been remixed, sue Regeneration transformed or built upon. Introduction How to Cite C Machiavelli, S Dwiyanti,VM Sidharta, D Periodontitis is the main cause of tooth loss in adults. Research conducted in Jember Re- Ary Harjanti, M Octavia, gency for the period January-December 2014, several reasons for tooth extraction were E Adi Prasetyanto, T Djuartina. found, such as periodontitis (583 cases), caries (302 cases), impaction (58 cases), and In Vivo Biocompatibility and Biodegradation Test of Two Barrier persistence (1 case) [1]. Periodontitis was responsible for the largest number of extracted Membranes for Guided Tissue tooth in all sociodemographic groups [1]. Regeneration Periodontitis affects many people throughout the world. According to the Ministry of Annali Di Stomatologia, 15(1), 9-16. Health of the Republic of Indonesia (Depkes RI), periodontitis ranks second in Indone- https://doi.org/10.59987/ads/2024.1.9-16 sia [2]. 10.59987/ads/2024.1.9-16 9 In Vivo Biocompatibility and Biodegradation Test of Two Barrier Membranes for Guided Tissue Regeneration Periodontitis is a serious infectious disease and if not Materials and Methods treated properly it can result in tooth loss [3]. The buildup of plaque bacteria on the surface of the teeth is the main Research Design cause of periodontitis [3]. Plaque buildup initially causes This is an in vivo experimental research using Sprague gingivitis, which further develop into periodontitis result- Dawley rats. ing in tissue damage periodontal support in the form of Ethical clearance for this research was granted prior to damage to the fibers, periodontal ligament and alveolar the commencement of the study by the Research Ethics bone. It can eventually cause mobility and tooth loss [3]. Committee of the School of Medicine and Health Sci- One of the surgical treatment of periodontitis is carried ences Atma Jaya Catholic University of Indonesia. All out using the Guided Tissue Regeneration (GTR) [4]. rats were kept under standard conditions in a purpose- This GTR method uses a barrier membrane which pre- designed room for experimental animals. They were vent epithelial tissue invasion and ensure the growth of treated according to the Animals in Research: Reporting periodontal ligament cells in the defect area [4]. GTR In Vivo Experiments guidelines for animal care, with free membrane should have a good biocompatibility, mechan- access to water and a standard diet. ical strength, biodegradability and antibacterial proper- ties. Barrier membranes are also useful for wound heal- Study Materials ing, isolation of gingival defects and clots stabilisation [5]. Numerous investigations have focused on the develop- In this research, there were 2 types of membranes used: ment of resorbable materials for GTR membranes, ex- test membranes with the composition PCL/Chitosan/BG- emplified in the research conducted by Dikici et al [6]. NP/Tetracycline and commercially available SureDerm This research used polycaprolactone (PCL) which show as control membrane (Table 1). a good results because it has better biological properties For negative control, the sham group was used. There than other polymers [6]. The PCL membrane also has were 9 groups in this study, namely; good mechanical, biocompatibility properties, and slow 1. Positive Control 1: Rat inserted with SureDerm degradation rate [6]. This supports the use PCL as one membrane, terminated at day 7. of the composition for GTR membranes. However, our 2. Positive Control 2: Rat inserted with SureDerm research combines two polymers so that the hydropho- membrane, terminated at day 21. bic nature of PCL can be overcome [6]. 3. Positive Control 3: Rat inserted with SureDerm Chitosan is chosen as another polymer because it has membrane, terminated at day 63. good hydrophilic properties [7]. Chitosan also has an- 4. Experimental Group 1: Rat inserted with PCL/Chi- tibacterial, anti-fungal, and wound healing properties tosan/BG-NP/Tetracycline membrane, terminated [8]. Another component, Bioactive Glass Nanoparticles at day 7. (BG-NP), is added to increase membrane stiffness. BG- 5. Experimental Group 2: Rat inserted with PCL/Chi- NP also shows adequate extensibility in wet conditions tosan/BG-NP/Tetracycline membrane, terminated and is osteoconductive [9]. at day 21. An alternative way to increase the antibacterial effect of a 6. Experimental Group 3: Rat inserted with PCL/Chi- membrane is with the help of antibiotics [10]. Several re- tosan/BG-NP/Tetracycline membrane, terminated searchers have succeeded in combining tetracycline into at day 63. a polymer solution to develop a membrane barrier [11]. 7. Negative Control 1: Sham group, no membrane in- serted, but still undergo incision and suture, termi- Tetracycline is an effective bacteriostatic agent against nated at day 7. many Gram-negative species including periodontopatho- 8. Negative Control 2: Sham group, no membrane in- gens such as Aggregatibacter actinomycetemcomitans serted, but still undergo incision and suture, termi- [12]. Tetracycline acts as a collagenase inhibitor, has nated at day 21. anti-inflammatory action, bone resorption inhibitor, and 9. Negative Control 3: Sham group, no membrane in- increases the attachment of fibroblasts to the root surface serted, but still undergo incision and suture, termi- which increases periodontal tissue regeneration [12]. nated at day 63. Based on the description above, we fabricate barrier membranes containing PCL/Chitosan/BG-NP/Tetracy- Animals cline using electrospinning method. The objective of this research is to evaluate biocompatibility and biodegrada- Fifty-four Sprague Dawley rats (mass, ± 100-300 g) were tion properties of PCL/Chitosan/BG-NP/Tetracycline and used in this study. Each group contained six rats allo- to compare them with commercially available SureDerm cated to each of 3 observation time points (7, 21, and membrane in Sprague Dawley Rats. 63 days). Table 1. Test and Control Article Descriptions Function Name Description Implant Sizes (mm x mm) PCL/Chitosan/BG-NP/ PCL/Chitosan/BG-NP/ Test Membrane 10.0 x 10.0 Tetracycline Membrane Tetracycline Membrane Homologous acellular dermis Positive Control SureDerm Membrane 10.0 x 10.0 and penicillin Negative Control Sham Operation Without biomaterial insertion 10.0 x 10.0 10 10.59987/ads/2024.1.9-16 M. Clavesia et al. Biocompatibility properties were tested according to the Explantation and Biodegradation Test DIN EN International Organization for Standardization (ISO) 10993-6 standard for investigating the effects of After trial periods of 7, 21, and 63 days, each group re- subcutaneous implantation on local tissues. Assess- ceived an overdose of Ketamine/Xylazine for euthana- ment of biodegradation was done with the help of 10x10 sia. By adding a safety margin of approximately 5 mm mm mica plastic, which was further divided into 9 small on each side of the implanted membrane, a 20x20 mm boxes. If the membrane covered <1/2 of the small box, sample was removed from the back of the rat using a a degradation value of 11.11% is given. If the membrane scalpel, blade, and blunt scissors. Mica plastic was put covered >1/2 of the small box, a degradation value of on top of the biopsied sample to measure the degrada- 0% was given. tion value of the membrane (Figure 2). Subcutaneous Implantation Fixation and Histopathological Staining The rat was anesthetized intramuscularly using a sy- The sample was placed in a 10% Neutral Buffered For- ringe containing a combination of ketamine [90 mg/kg] malin solution for 24 hours for fixation and were then and xylazine [10 mg/kg]. The rat were then shaved and sent for histological processing [13,15]. After fixation, disinfected in the upper back area, and a transverse each sample was dehydrated in a series of alcohol so- incision was made on the rat’s backs with a scalpel. A lutions of increasing concentration and subsequently 10x10 mm of GTR membrane was inserted into the back embedded in paraffin [15]. The samples were cut into 4 subcutaneously [13] (Figure 1). The incision was closed parts using a scalpel, after which they were further cut with standard suture material (Prolene 6.0) [13]. Beta- into 4 µm thick sections and stained with Hematoxylin dine and gauze was applied on the wound. The rat was and Eosin and Masson Trichrome for descriptive and housed in separate cage until it was in stable condition, semiquantitative histological evaluation [15]. after which the rats were moved back into their respec- tive cages [13]. Semiquantitative Histological Analysis Ac- cording to DIN EN ISO 10993-6 Semiquantitative histological analysis was performed on each subcutaneous slide scanned according to the area of interest, without overlap, and captured at 400× magni- fication producing a score value indicating greater domi- nance among them. The response of tissue-membrane biological parameters is evaluated and assessed, as fol- lows: (Table 2) [14]. 1. The number and distribution of inflammatory cells semiquantitatively by looking at changes in neu- trophils, lymphocytes, plasma cells, macrophages, and giant cells as a function of distance from the material/tissue [14]. 2. Presence and extent of necrosis [14]. Figure 1. Membrane Implantation into the Subcutaneous 3. Inflammatory response parameters (neovascu- Back of Rats larization, capillaries with supporting fibroblas- tic structures, degree of fibrous capsule fibrosis stained with Masson Trichrome staining, and fat infiltration) [14]. Measurements were scored according to ISO 10993-6 guidelines: 0, none; 1, slight; 2, moderate; 3, marked; 4, complete/severe [15].Neovascularization was scored according to capillaries present: 0, none; 1, minimal cap- illary proliferation; 2, groups of 4–7 capillaries ; 3, broad band of capillaries; 4, an extensive band of capillaries [15]. Inflammation is descriptively assessed based on the number of macrophages, polymorphonuclear cells, lymphocytes, plasma cells, and giant cells present [15]. Graded using the following scoring system: 1, Rare, 1-5/ phf; 2, 6-10/phf; 3. heavy infiltrate; 4, packed [15]. Ne- crosis was evaluated, with the following grading system: 1, minimal; 2, mild; 3. moderate; 4, marked [15]. Fibro- sis was evaluated, with the following grading system 1, narrow band; 2, moderately thick band; 3, thick band; 4, extensive band [15]. Finally, fatty infiltrate is assessed us- ing the following scoring system 1, minimum amount of fat; 2, several layers of fat; 3, elongated and widespread accumulation of fat cells; 4, extensive fat completely [15]. Irritation score is obtained by adding up scores of PMN Figure 2. Macroscopic Aspects of Tissue Re- cells, lymphocytes, plasma cells, macrophages, giant sponse to Different Membranes After Implantation cells, necrosis which will then multiplied by two, then 10.59987/ads/2024.1.9-16 11 In Vivo Biocompatibility and Biodegradation Test of Two Barrier Membranes for Guided Tissue Regeneration adding up with scores of neovascularization, fibrosis, Results and fatty infiltrate. The overall irritancy score of the test article at each Biocompatibility Test study time point was calculated as follows: Overall irri- Data of the biocompatibility test in the form of mean tancy score = test membrane irritancy score (PCL/Chito- histological evaluation for irritation/reactivity-cell type/ san/BG-NP/Tetracycline membrane) – average irritancy respone according to ISO 10993-6 for day 7,21, and score of control membrane (Surederm membrane) If the 63 is presented in Table 4,5, and 6. [15]. Lymphocyte result was a negative number, the irritancy score was cells, plasma cells, and macrophage cells were found considered to be 0.0. The irritancy grade was then deter- on the SureDerm membrane and PCL/Chitosan/BG- mined according to Table 3. NP/Tetracycline membrane on day 7 and day 21 (Table Table 2. Histological Evaluation System for Irritation/Reactivity – Cell Type/Response [13] Score (phf = Per High Powered (x400) Field) Respone 0 1 2 3 4 PMN cells 0 Rare, 1-5/phf 6-10/phf Heavy infiltrate Packed Lymphocytes 0 Rare, 1-5/phf 6-10/phf Heavy infiltrate Packed Plasma cells 0 Rare, 1-5/phf 6-10/phf Heavy infiltrate Packed Macrophages 0 Rare, 1-5/phf 6-10/phf Heavy infiltrate Packed Giant cells 0 Rare, 1-2/phf 3-5/phf Heavy infiltrate Packed Necrosis 0 Minimal Mild Moderate Packed Neovascularization 0 Minimal capillary Groups of 4-7 Broad band Extensive band proliferation capillaries with of capillaries of capillaries focal, 1-3 buds supporting with supporting with supporting fibroblastic structures fibroblastic Fibrocytes/ 0 Narrow band Moderately Thick band Extensive band fibroconnective tissue, thick band fibrosis Fatty infiltrate 0 Minimal amount Several layers of Elongated and Extensive fat of fat associated fat and fibrosis broad accumulation surrounding the with fibrosis of fat cells about the implant implant site Table 3. Irritancy/Reactivity Grade. Adapted from DIN EN ISO 10993-6 [13] Overall Irritancy Score Irritancy/Reactivity Status 0.0 to 2.9 Minimal or no reaction (non irritant) 3.0 to 8.9 Slight reaction (slight irritant) 9.0 to 15.0 Moderate reaction (moderate irritant) >15.1 Severe reaction (severe irritant) - Irritation Score: (PMN Cells + Lymphocytes + Plasma Cells + Macrophages + Giant Cells + Necrosis) x 2 + (Neovascularization + Fibrosis + Fatty Infiltrate) - Overall Irritation Score: PCL/Chitosan/BG-NP/Tetracycline Membrane Irritation Score – SureDerm Membrane Irritation Score Table 4. Mean Histological Evaluation for Irritation / Reactivity – Cell Type / Response According to ISO 10993-6 Guide- lines for Day 7 Neovas- Tissue Tissue PMN Lympho- Plasma Macro- Giant Ne- Fatty cularisa- Fibrosis Integra- In- Cell cytes Cell phages Cells crosis Infiltrate tion tion growth SureDerm 0.5 ± 0.67 ± 0.5 ± 0 0 0 0 0 0 0 0 Membrane 0.84 1.21 0.84 Negative 0.33 ± 0 0 0 0 0 0 0 0 0 0 Control 0.52 PCL/ Chitosan/ 0.33 ± 0.33 ± 1.17± BG-NP/ 0 0 0 0 0 0 0 0 0.52 0.52 1.33 Tetracycline membrane 12 10.59987/ads/2024.1.9-16 M. Clavesia et al. 4 & 5). On the other hand, there were no cells found irritant status of non irritant on day 7, day 21, and day on day 7, day 21, and day 63 for the negative control 63 (Table 7). Exemplary histological images stained with (Table 4, 5, 6). Hematoxylin and Eosin as well as Masson Trichrome of The PCL/Chitosan/BG-NP/Tetracycline membrane has a the three groups at day 7, 21, and 63 can be seen in comparable irritation score as SureDerm membrane and Figure 3 and 4. Table 5. Mean Histological Evaluation for Irritation / Reactivity – Cell Type / Response According to ISO 10993-6 Guide- lines for Day 21 Neovas- Tissue Tissue PMN Lympho- Plasma Macro- Giant Ne- Fatty cularisa- Fibrosis Integra- In- Cell cytes Cell phages Cells crosis Infiltrate tion tion growth SureDerm 0.5 ± 0.33 ± 0 1± 1.27 0 0 0 3± 1.10 0 0 0 Membrane 0.84 0.82 Negative 2.67 ± 0 0 0 0 0 0 0 0 0 0 Control 1.51 PCL/ Chitosan/ 0.5 ± 0.5 ± 2.33 ± BG-NP/ 0 0 0 0 0 0 0 0 0.55 0.55 1.37 Tetracycline membrane Table 6. Mean Histological Evaluation for Irritation / Reactivity – Cell Type / Response According to ISO 10993-6 Guide- lines for Day 63 Neovas- Tissue Tissue PMN Lympho- Plasma Macro- Giant Ne- Fatty cularisa- Fibrosis Integra- In- Cell cytes Cell phages Cells crosis Infiltrate tion tion growth SureDerm 1.67 ± 0 0 0 0 0 0 0 0 0 0 Membrane 1.86 Negative 1.67 ± 0 0 0 0 0 0 0 0 0 0 Control 0.82 PCL/ Chitosan/ 2.33 ± BG-NP/ 0 0 0 0 0 0 0 0 0 0 1.03 Tetracycline membrane Figure 3. Exemplary Histological Images Stained with He- Figure 4. Exemplary Histological Images Stained with matoxylin and Eosin of the Three Groups at Day 7, 21, Masson Trichrome for Fibrosis Evaluation of the Three and 63. Groups at Day 7, 21, and 63 A. Negative Control, Day 7; B. Negative Control, Day 21; C. Nega- A. Scoring 0, Negative Control, Day 7; B. Scoring 0, Negative Con- tive Control, Day 63; D. SureDerm Membrane, Day 7; E. SureDerm trol, Day 21; C. Scoring 1, Negative Control, Day 63; D. Scoring 2, Membrane, Day 21; F. SureDerm Membrane, Day 63; G. PCL/Chi- SureDerm Membrane, Day 7; E. Scoring 3, SureDerm Membrane, tosan/BG-NP/Tetracycline Membrane, Day 7, H. PCL/Chitosan/BG- Day 21; F. Scoring 4, SureDerm Membrane, Day 63; G. Scoring 3, NP/Tetracycline Membrane, Day 21; I. PCL/Chitosan/BG-NP/Tetra- PCL/Chitosan/BG-NP/Tetracycline Membrane, Day 7, H. Scoring 2, cycline Membrane, Day 63 PCL/Chitosan/BG-NP/Tetracycline Membrane, Day 21; I. Scoring 3, PCL/Chitosan/BG-NP/Tetracycline Membrane, Day 63 10.59987/ads/2024.1.9-16 13 In Vivo Biocompatibility and Biodegradation Test of Two Barrier Membranes for Guided Tissue Regeneration Biodegradation Test Discussion Based on the results of biodegradation tests, it can be Biocompatibility Test seen that the commercial SureDerm membrane was The GTR membrane has several criteria or requirements only slightly degraded on day 7 (27.5 ± 6.12%) and day to be called an ideal membrane. The first requirement is 21 (28.33 ± 14.02%), while the PCL/Chitosan/BG-NP/ to have biocompatibility properties [16]. Biocompatibility Tetracycline membrane has greater degradation on day is the ability of the material to adapt to the environment 7 (50 ± 6.32%) and day 21 (50 ± 6.32%) (Table 7). where the membrane must not harm the body and have The percentage degradation test of SureDerm mem- non-toxic properties [16]. The membrane must not trig- brane and PCL/Chitosan/BG-NP/Tetracycline mem- ger the host’s immune system, sensitization, or chronic brane was compared using independent t-test for each inflammatory reactions [17]. Based on the results of the timeline. It was found that percentage degradation of the biocompatibility test, it can be seen that the GTR mem- two membranes were statistically significant for day 7 brane with the composition (g) PCL/Chitosan/BG-NP/ and day 21 in which PCL/Chitosan/BG-NP/Tetracycline Tetracycline = 11/0.5/0.5/0.04 has comparable irritancy membrane was degraded more quickly, but not signifi- score as the SureDerm commercial membrane and the cant for day 63. irritancy score overall non-irritant or non-irritating. Rate of degradation of the two membranes was faster This testing is in line with the research of Osathanon et al in the first 21 days, after which the degradation became [18]. Osathanon et al’s research discusses the biological more slowly (Figure 5). basis of GTR membranes in periodontal tissue healing Table 7. Mean Irritation Score After Membrane Implantation Day 7, Day 21, Day 63 Overall Study Group Irritation Score Irritation Status Irritation Score SureDerm Membrane 2.84 ± 0.87 Negative Control 0.33 ± 0.39 Day 7 0 Non Irritant PCL/Chitosan/BG-NP/Tetracycline 2.49 ± 0.60 membrane SureDerm Membrane 6.66 ± 0.87 Negative Control 2.67 ± 0.39 Day 21 0 Non Irritant PCL/Chitosan/BG-NP/Tetracycline 4.33 ± 0.60 membrane SureDerm Membrane 1.67 ± 0.87 Negative Control 1.67 ± 0.39 Day 63 0.66 Non Irritant PCL/Chitosan/BG-NP/Tetracycline 2.33 ± 0.60 membrane Irritation Score: (PMN Cells + Lymphocytes + Plasma Cells + Macrophages + Giant Cells + Necrosis) x 2 + (Neovascularization + Fibrosis + Fatty Infiltrate) - Overall Irritation Score: PCL/Chitosan/BG-NP/Tetracycline Membrane Irritation Score – SureDerm Membrane Irritation Score Figure 5. Biodegradation Test Chart 14 10.59987/ads/2024.1.9-16 M. Clavesia et al. Table 8. Mean Biodegradation Test Data Post Membrane Implantation Day 7, Day 21, Day 63 Biodegradation Percentage (%) Sample Day 0 Day 7 Day 21 Day 63 SureDerm Membrane 0 27.5 ± 6.12 28.33 ± 14.02 91.25 ± 7.50 PCL/Chitosan/BG-NP/Tetracycline 0 50 ± 6.32 50 ± 6.32 95 ± 5.48 membrane P-value - <0.01** <0.05* >0.05 ns Note: ns: Non-Significant (p-value >0.05); * : Significant (p-value <0.05); ** : Very Significant (p-value <0.01) and regeneration [18]. Bioactive GTR membranes have ideal criteria of a GTR membrane, but further observa- been investigated and developed with the aim of creat- tions need to be made to determine the time needed for ing membranes that not only act as a physical barrier all samples to be completely degraded. but also induce biologics to enhance periodontal tissue Compared to SureDerm membrane, the test membrane regeneration [18]. PCL has been introduced as a candi- is thinner. The SureDerm commercial membrane has a date material for bioactive GTR membranes due to its thickness of 0.26 mm [23]. The test membrane has a biocompatibility and simple fabrication procedures [18]. thickness of 0.13 ± 0.03 mm [23]. A thicker membrane Modification with other agents or biomolecules can be will have stronger mechanical strength than a thin one. easily made [18]. PCL can be useful for promoting peri- Therefore SureDerm membrane degrade less rapidly odontal tissue formation [18]. due to its thicker thickness compared to the PCL/Chito- Sarasam et al used a PCL/chitosan membrane which san/BG-NP/Tetracycline coated GTR membrane. improves mechanical properties and cell viability com- pared to pure chitosan [19]. Chitosan is a polysaccharide Research Limitations that is much sought after in biomedical applications and has been mixed with various macromolecules to reduce The research has limitations. This research model, us- undesirable properties [19]. Dissolved chitosan and PCL ing a subcutaneous pouch of rats does not fully reflect homogeneously in various mass ratios in a mixture of the conditions of the oral cavity and the oral microbi- 77% acetic acid in water and processed into uniform ome, so there could be variation in biocompatibility and membranes [19]. Dynamic mechanical and thermal anal- biodegradation properties. ysis shows that the crystallinity of PCL is suppressed The subcutaneous model is also less representative of and its storage modulus is increased by the addition of the actual condition of GTR, in which the membrane chitosan [19]. should be placed on a bone defect that has been filled Another component of the membrane, bioactive glass is with bone graft, it is recommended that futher research a promising material for tissue regeneration due to its can be carried out on more representative model, such controlled degradability and ability to stimulate the for- as in bone defect on larger animals such as monkeys. mation of new tissue [20]. Bioactive glass has demon- strated excellent bioactivity and biocompatibility when Conclusion implanted in bone defects [9]. Bioactive glass degrada- The GTR membrane PCL/Chitosan/BG-NP/Tetracycline tion promotes osteogenesis by stimulating ions. stimu- composition (g) 11/0.5/0.5/0.04 is ideal as a GTR mem- lates osteoconductivity [20]. PCL (polycaprolactone) brane because it has a good biocompatibility properties. which is hydrophobic in nature was mixed with chitosan The PCL/Chitosan/BG-NP/Tetracycline membrane has a which has hydrophilic properties [20]. PCL, known for its comparable irritation score as SureDerm membrane and robust mechanical strength, can contribute to enhanc- irritant status of non irritant. The PCL/Chitosan/BG-NP/ ing the mechanical properties of chitosan, which tends Tetracycline membrane also has good biodegradation to be inherently brittle [20]. A mixture of the two materi- properties which allows sufficient time for periodontal tis- als shows good biocompatibility with each other because sue formation. However, the degradation rate is faster PCL’s low melting point makes it easier to mix the two compared to SureDerm membrane. polymers [19]. References Biodegradation Test 1. Fithri Z, Rochim A, Cholid Z. Distribusi pencabutan gigi Based on the biodegradation test results listed in Table berdasarkan karakteristik sosiodemografi pada pasien 7, it can be seen that all samples were not completely RSGM universitas jember periode januari-desember 2014 (Distribution of tooth extraction based on sociodemograph- degraded on days 7 and 21 therefore they act as good ic characteristic of dental hospital of university of jember barrier and allow sufficient rate of periodontal tissue Pat. Pustaka Kesehatan. 2017 Aug 11;5(1):177–84. formation of 4-6 weeks [22]. The addition of BG-NP in- 2. Badan Penelitian dan Pengembangan Kesehatan -. Lapo- crease the stiffness of the membrane so that it does ran Nasional Riskesdas 2018 [Internet]. Jakarta: Lembaga not decompose or degrade easily. BG-NPs caused a Penerbit Badan Penelitian dan Pengembangan Kesehat- significant increase in membrane thickness and surface an; 2020. Available from: https://repository.badankebi- jakan.kemkes.go.id/id/eprint/3514/ area [21]. Samples on day 63 was completely degraded 3. American Academy of Periodontology. The American and invisible to the naked eye. This shows that the test Academy of Periodontology statement regarding gingival membrane has a degradation capability that meets the curettage. J Periodontol. 2002 Oct;73(10):1229–30. 10.59987/ads/2024.1.9-16 15 In Vivo Biocompatibility and Biodegradation Test of Two Barrier Membranes for Guided Tissue Regeneration 4. Ziccardi VB, Buchbinder D. Guided tissue regeneration in 14. Neto AM, Sartoretto SC, Duarte IM, Resende RF, Alves dentistry. N Y State Dent J. 1996 Dec;62(10):48–51. AT, Mourao CF, et al. In vivo comparative evaluation of 5. Bottino MC, Thomas V, Schmidt G, Vohra YK, Chu biocompatibility and biodegradation of bovine and porcine TMG, Kowolik MJ, et al. Recent advances in the devel- collagen membranes. Membranes. 2020 Dec;10(12):423. opment of GTR/GBR membranes for periodontal regen- 15. Naenni N, Lim HC, Strauss FJ, Jung RE, Hammerle CH, eration—A materials perspective. Dental Materials. 2012 Thoma DS. Local tissue effects of various barrier mem- Jul;28(7):703 21. branes in a rat subcutaneous model. Journal of Periodon- 6. Aldemir Dikici B, Dikici S, Reilly GC, MacNeil S, Claeys- tal; Implant Science. 2020 Oct;50(5):327. sens F. A novel bilayer polycaprolactone membrane for 16. Matyjaszewski K, Möller M, editors. Polymer science: a guided bone regeneration: combining electrospinning and comprehensive reference. Amsterdam: Elsevier; 2012. emulsion templating. Materials. 2019 Aug 20;12(16):2643. 17. Sam G, BRM P. Evolution of barrier membranes in peri- 7. Zhang L, Dong Y, Zhang N, Shi J, Zhang X, Qi C, et al. Po- odontal regeneration-”Are the third generation membranes tentials of sandwich-like chitosan/polycaprolactone/gelatin really here?”. Journal of Clinical and Diagnostic Research. scaffolds for guided tissue regeneration membrane. Mate- 2014 Dec 5;8:12. rials Science and Engineering: C. 2020 Apr;109:110618. 18. Osathanon T, Chanjavanakul P, Kongdecha P, Clayhan 8. Xu C, Lei C, Meng L, Wang C, Song Y. Chitosan as a bar- P, Huynh NC-N. Polycaprolactone-based biomaterials for rier membrane material in periodontal tissue regeneration. guided tissue regeneration membrane. Periodontitis - A Journal of Biomedical Materials Research Part B: Applied Useful Reference. 2017 Biomaterials. 2012 Jul;100(5):1435–43. 19. Sarasam AR, Krishnaswamy RK, Madihally SV. Blending 9. Mota J, Yu N, Caridade SG, Luz GM, Gomes ME, Reis chitosan with polycaprolactone: Effects on physicochemi- RL, et al. Chitosan/bioactive glass nanoparticle composite cal and antibacterial properties. Biomacromolecules. 2006 membranes for periodontal regeneration. Acta Biomateria- Apr;7(4):1131–8. lia. 2012 Nov;8(11):4173–80. 20. Pajares-Chamorro N, Chatzistavrou X. Bioactive glass 10. Yilmaz Atay H. Antibacterial activity of chitosan-based nanoparticles for tissue regeneration. ACS Omega. 2020 systems. In: Jana S, Jana S, editors. Functional Chitosan. Jun 9;5(22):12716–26. Singapore: Springer Singapore; 2019;457–89. 21. Lin S, Ionescu C, Pike KJ, Smith ME, Jones JR. Nano- 11. Mad Jin R, Sultana N, Baba S, Hamdan S, Ismail AF. Po- structure evolution and calcium distribution in sol–gel de- rous PCL/chitosan and nHA/PCL/chitosan scaffolds for tis- rived bioactive glass. J Mater Chem. 2009;19(9):1276. sue engineering applications: fabrication and evaluation. 22. Fraser D, Caton J, Benoit DSW. Periodontal wound heal- Journal of Nanomaterials. 2015;2015:1–8. ing and regeneration: insights for engineering new thera- 12. Seymour RA, Heasman PA. Tetracyclines in the manage- peutic approaches. Frontiers in Dental Medicine. 2022 Mar ment of periodontal diseases. Journal of Clinical Periodon- 2;3:815810. tology. 1995;22(1):22–35. 23. Kandelousi PS, Rabiee SM, Jahanshahi M, Nasiri F. The 13. Lindner C, Alkildani S, Stojanovic S, Najman S, Jung O, effect of bioactive glass nanoparticles on polycaprolac- Barbeck M. In vivo biocompatibility analysis of a novel bar- tone/chitosan scaffold: Melting enthalpy and cell viabil- rier membrane based on bovine dermis-derived collagen ity. Journal of Bioactive and Compatible Polymers. 2019 for guided bone regeneration (GBR). Membranes. 2022 Jan;34(1):97–111. Mar;12(4):378. 16 10.59987/ads/2024.1.9-16
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Double Full-Arch Implant-Supported Fixed Complete Dental Prostheses (IFCDPs): advanced monolithic zirconia solutions Andrea Berzaghi1 DDS, MSc, PhD Authors Sergio Bortolini1 DDS, Associate Professor Andrea Berzaghi, DDS, MSc, PhD - Department of Surgery, Medicine, Dentistry and Morphological Sciences Department of Surgery, Medicine, Dentistry and Morphological 1 with Interest in Transplant, Oncology and Sciences with Interest in Transplant, Oncology and Regenerative Medicine, Regenerative Medicine, University of University of Modena and Reggio Emilia (UNIMORE), Modena and Reggio Emilia (UNIMORE), Via del Pozzo 71, 41125 Modena, Italy. Via del Pozzo 71, 41125 Modena, Italy. Sergio Bortolini, DDS, Associate Corresponding author: Andrea Berzaghi Professor - Department of Surgery, [email protected] Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, Abstract University of Modena and Reggio Emilia Among the latest generation of prosthetic materials, zirconia represents one of the (UNIMORE), Via del Pozzo 71, 41125 Modena, Italy. most versatile ceramic materials offering options for rehabilitation of both anterior and posterior sectors. In the last two decades, zirconia frameworks have become increasingly popular in the implant prosthesis and the introduction of CAD/CAM technology has made it possible to approach full-arch restorations in a different way and with promising success rates. In this case report we present Double Full- Arch Implant-Supported Fixed Complete Dental Prostheses (IFCDPs) using digital License technology to fabricate advanced monolithic zirconia solutions. We report a brief This work is licensed under a Creative examination of the advantages of the two solutions in comparison. Commons Attribution-NonCommercial- NoDerivatives 4.0 International License. Key words: Zirconia, monolithic zirconia, metal bar, Implant-supported fixed com- Authors contributing to Annali di plete dental prostheses. Stomatologia agree to publish their articles under the Creative Commons Attribution-NonCommercial- Introduction NoDerivatives 4.0 International License, which allows third parties to copy and The recent evolution of ceramic materials in prosthetic dentistry is aimed at increas- redistribute the material providing ing the mechanical and aesthetic properties and simplifying the manufacturing and appropriate credit and a link to the decision-making processes for clinicians and technicians. Until a few years ago it was license but does not allow to use the universally recognized in the literature that the most mechanically resistant ceramics of- material for commercial purposes and to use the material if it has been remixed, fered less advanced aesthetic characteristics, most of the time resulting more opaque, transformed or built upon. therefore less translucent and attractive1. In the panorama of the latest generation of prosthetic materials, zirconia represents one of the most versatile ceramic materials of- How to Cite fering options for rehabilitation of both anterior and posterior sectors. The 3mol% Y-TZP A. Berzaghi, S Bortolini. and the recent 4/5mol% Y-TZP are heterogeneous materials in composition, structure, Double Full-Arch Implant-Supported mechanical and optical properties and offer dentists and laboratories solutions that Fixed Complete Dental Prostheses (IFCDPs): advanced monolithic zirconia can be layered or monolithic with a different compromise between strength and aes- solutions thetics1-6. In particular, the introduction of monolithic zirconia for its characteristics of Annali Di Stomatologia, 15(1), 17-20. reliability and practicality has led to a downsizing in prosthetic design with indisputable https://doi.org/10.59987/ads/2024.1.17-20 advantages for clinicians and technicians7-9. In the last two decades, zirconia frame- works have become increasingly popular in the implant prosthesis and the introduction of CAD/CAM technology has made it possible to approach full-arch restorations in a different way and with promising success rates10-13. The aim of this clinical report is to describe the prosthodontic management of a female patient with Double Full-Arch Implant-Supported Fixed Complete Dental Prostheses (IFCDPs) using digital technology to fabricate advanced monolithic zirconia solutions: monolithic screw-retained zirconia design in the upper jaw compared to the innovative design which features monolithic zirconia supported by a metal bar made of cobalt chromium (Co-Cr) in inferior arch. We report a brief examination of the advantages of the two solutions in comparison. 10.59987/ads/2024.1.17-20 17 Double Full-Arch Implant-Supported Fixed Complete Dental Prostheses (IFCDPs): advanced monolithic zirconia solutions Figure 4. Zirconia superstructure coupled to the metal bar. Zirconia Ceramotion Z Hybrid 1300/1020 Mpa (Dentaurum s.p.a) was chosen for the superstructure. man), both arches were loaded immediately using stan- dardized prosthodontic techniques to produce an interim resin prosthesis. The definitive prosthodontic treatment was initiated after 10 weeks of loading the maxillary and mandibular implants. Appropriate abutments were placed on the implants to obtain parallelism and path of draw. Final impression of the implants were made us- ing polyether impression material after rigidly splinting all impression copings. Using standard prosthodontic pro- tocols, maxillomandibular relationships and trial denture procedures were accomplished to fabricate prototype prosthesis (interim acrylic resin prosthesis) using CAD/ CAM technology. In maxilla a screw-retained interim acrylic resin prosthesis while in the mandible an interim acrylic resin prosthesis supported by a Co-Cr metal bar were made. Minor adjustments were made to prosthetic contours, occlusion and esthetics. The bar was milled from a solid block of Co-Cr. The bar was planned on incorporating a zirconia overlay prosthesis (Fig. 4) only up to the last tooth on either side. After confirmation of the aesthetic and functional result, patient’s written ap- proval was obtained in order to use this for copy milling the definitive zirconia prosthesis (Zirconia Ceramotion Figure 1-3. Panoramic radiograph and photos of the initial Z Hybrid 1300/1020 Mpa, Dentaurum s.p.a). The over- case. Patient comes to our observation with incongruous lay mandibular prosthesis and the maxillary monolithic complete dentures. screw-retained zirconia was milled from a solid blank of pre-sintered zirconia, which was then infiltrated with Case Report stains and veneered with feldspathic porcelain at aes- thetic and gingival region (Figg. 5-7). Passive fit of both An 80-year-old female patient, an edentulous patient prostheses was confirmed. A post-treatment panoramic with Complete Dental Prostheses, comes to our obser- radiograph was taken to confirm seating of the prosthe- vation requesting a fixed Double Full-Arch prosthodontic ses (Fig.8). solution. Patient’s existing complete dentures made by monolithic zirconia: zirconia on a metal bar in lower arch, his general dentist was deemed unsatisfactory to the screw-retained zirconia in upper arch. Gingival and den- patient and the clinician (Figg.1-3). Patient’s medical tal aesthetic ceramization with Ceramotion One Touch history revealed that she had a history of multiple im- ceramic pastes (Dentaurum s.p.a). Dental technician plant failures. Patient also had a history of smoking for Mdt Germano Rossi. several decades and was aware of his bruxism. Based on patient’s history, clinical and radiographic findings, Discussion the patient was diagnosed with a Class C Classifica- tion System ABC14. 8 implants were planned for being The advantages of the monolithic screw-retained restored with a maxillary screw-retained monolithic zir- prosthesis are many. The screw-retained prosthesis conia IFCDP. 6 mandibular implants were planned on traditionally represents the first choice in full-arch im- being restored with Metal-Zirconia Implant Fixed Hybrid plant-prosthetic rehabilitation for fewer biological com- Full-Arch Prosthesis: restoration that provides monolith- plications and easier management of complications15,16. ic zirconia supported by cobalt chromium bar. After the Zirconia guarantees advanced mechanical properties surgical implant placement (implants Even Mech & Hu- with a low complication rate; excellent biocompatibility; 18 10.59987/ads/2024.1.17-20 A. Berzaghi et al. favorable wear characteristics; reduced accumulation of plaque and biofilm; satisfactory gingival and dental aesthetics associated with minimal ceramization of non-functional areas; reduced pigmentation compared to acrylic resin. The CAD-CAM design and production of zirconia has led to further advantages: better preci- sion of the prosthesis thanks to modern manufacturing systems; availability of a permanent digital file with the possibility of duplicating the prosthetic restoration; pos- sibility of making temporary posts in PMMA. However, the monolithic zirconia screw-retained design remains a complex prosthetic solution, in which clinical suc- cess is linked to the knowledge of the materials and the high precision required by 3Y-TZP17,18,19. The need to guarantee the framework suitable dimensions in ar- eas at risk of fracture, the impossibility of recovery of the structure in the event of failure, the low tolerance to imprecision imprecisions and the opacity of the high- strength material represent the current limits of this prosthesis17,20. Metal-Zirconia Implant Fixed Hybrid Full-Arch Prosthesis currently represents the most ad- vanced implant-prosthetic design in the field of implant- supported restorations and represents the evolution of screw-retained monolithic solutions, potentially able to solve some critical issues21,22. The metal bar gives stiff- ness, excellent tensile strength, high fracture strength, passive fit and allows you to manage long spans be- tween adjacent implants and extend cantilevers. It also allows versatile use on different implant platforms, com- pensates for problems of unfavorable angles and of- fers the possibility, if necessary, to be segmented. The metal frameworks obtained by laser sintering/melting procedures have improved the “fit”, the “bonding” and the corrosion resistance compared to the bars obtained by casting23. The monolithic zirconia in this prosthetic design represents the first choice solution for reasons related to the intrinsic characteristics of the material and to the prosthetic technologies. From an aesthetic point of view, the metal framework gives the possibility to take full advantage of the new generations of trans- Figure 5-7 Case concluded. Double Full-Arch Implant-Sup- lucent zirconia without risk of structural failure. Starting ported Fixed Complete Dental Prostheses in monolithic zir- from the CAD design information on the bar, we can conia: zirconia on a metal bar in lower arch, screw-retained create PMMA provisionals that act as prototype pros- zirconia in upper arch. Gingival and dental aesthetic cerami- theses useful in the preliminary evaluation and approv- zation with Ceramotion One Touch ceramic pastes (Dentau- rum s.p.a). Dental technician Mdt Germano Rossi. al phase17,20. Figure 8 End of case panoramic radiograph. 10.59987/ads/2024.1.17-20 19 Double Full-Arch Implant-Supported Fixed Complete Dental Prostheses (IFCDPs): advanced monolithic zirconia solutions Conclusion 9. Candido LM, Miotto LN, Fais L, Cesar PF, Pinelli L. Me- chanical and Surface Properties of Monolithic Zirconia. The innovative design of the implant-supported re- Oper Dent. 2018 May/Jun;43(3):E119-E128. habilitation of the lower arch that uses a monolithic 10. Al‐Amleh B, Lyons K, & Swain M. Clinical trials in zirco- structure in zirconia on a metal bar was born to ex- nia: A systematic review. Journal of Oral Rehabilitation 2010;37:641-652. ploit the aesthetic potential of the latest generation zir- 11. Raigrodski A J, Hillstead MB, Meng, GK, Chung K H. conia even in the presence of extensive cantilevers. Survival and complications of zirconia‐based fixed den- The diffusion of CAD/CAM technology together with tal prostheses: A systematic review. Journal of Prosthetic the promising characteristics of aesthetics, reliability Dentistry 2012;107:170-177. and versatility of this advanced solution make mono- 12. Mendez Caramês JM, Sola Pereira da Mata AD, da Silva lithic zirconia on bar a successful and widespread re- Marques D N, de Oliveira Francisco H C. Ceramic‐Ve- neered Zirconia frameworks in full‐arch implant rehabili- habilitation in the coming years. The use of the latest tations: A 6‐month to 5‐year retrospective cohort study. generation multilayered zirconia for the construction of International Journal of Oral and Maxillofacial Implants monolithic structures allows to overcome the limits of 2016;31:1407-1414. the traditional 3Y-TZP. The incorporation of 4Y-TZP in 13. Abdulmajeed AA, Lim KG, Närhi TO, Cooper LF. Complete‐ multi-translucent implant-prosthetic structures allows arch implant‐supported monolithic zirconia fixed dental to provide degrees of aesthetics and reliability unthink- prostheses: A systematic review. Journal of Prosthetic Den- tistry 2016;115(6):672-677. able until two years ago for monolithic screw-retained 14. Bortolini S, Berzaghi A et al. Classification system for par- structures. The new generations of 4Y-TZP and multi- tial edentulism: ABC classification. Annali di Stomatologia translucent monolithic zirconia materials, incorporating 2022; XIII (1-4): 21-26 3Y, 4Y and 5Y-TZP with varying translucency levels, 15. Sailer I, Muhlemann S, Zwahlen M, Hammerle CHF, appear to be promising in these designs as well. In Schneider D. Cemented and screw-retained implant re- particular, some types of 4Y-TZP with high mechanical con- structions: a systematic review of the survival and complication rates. Clinical Oral Implants Research 2012; performance24,25 can represent promising materials in 23:163–201. this sense. 16. Sherif S, Susarla HK, Kapos T, Munoz D, Chang BM, Wright RF. A systematic review of screw-versus cement- Acknowledgments retained implant-supported fixed restorations. Journal of Prosthodontics 2014;23(1):1-9. The authors would like to thank Dentaurum Italia S.p.a. 17. Rojas Vizcaya F. Retrospective 2- to 7-Year Follow-Up for supporting this article. Study of 20 Double Full-Arch Implant-Supported Mono- We thank for the technical realization Mdt Germano Ros- lithic Zirconia Fixed Prostheses: Measurements and Rec- si, Alba Adriatica (Te). ommendations for Optimal Design. J Prosthodont. 2018 Jul;27(6):501-508. 18. Worni A, Kolgeci L, Rentsch-Kollar A, Katsoulis J, Meric- References ske- Stern R. Zirconia-Based Screw-Retained Prostheses 1. Kontonasaki E, Giasimakopoulos P, Rigos AE. Strength Supported by Implants: A Retrospective Study on Techni- and aging resistance of monolithic zirconia: an update to cal Complications and Failures. Clin Implant Dent Relat current knowledge. Jpn Dent Sci Rev. 2020 Dec;56(1):1- Res 2015;17:1073-1081. 23. 19. Amin S, Weber HP, Kudara Y, Papaspyridakos P. Full- 2. Zhang Y, Kelly JR. Dental Ceramics for Restoration and Mouth Implant Rehabilitation With Monolithic Zirconia: Metal Veneering. Dent Clin North Am. 2017 Oct;61(4):797- Benefits and Limitations. Compend Contin Educ Dent 819. 2017 Jan;38(1):e1-e4. 3. Zhang Y, Lawn BR. Novel zirconia materials in dentistry. J 20. Carames J, Tovar Suinaga L, Yu YC, Pérez A, Kang M. Dent Res 2018;97:140–7. Clinical Advantages and Limitations of Monolithic Zirconia 4. Güth JF, Stawarczyk B, Edelhoff D, Liebermann A. Zirco- Restorations Full Arch Implant Supported Reconstruction: nia and its novel compositions: What do clinicians need to Case Series. Int J Dent 2015;2015:392-496. know? Quintessence Int. 2019;50 (7):512-520. 21. Stumpel LJ, Haechler W: The Metal-Zirconia Implant Fixed 5. Camposilvan E, Leone R, Gremillard L, Sorrentino R, Hybrid Full-Arch Prosthesis: An Alternative Technique for Zarone F, Ferrari M, Chevalier J. Aging resistance, me- Fabrication. Compend Contin Educ Dent 2018;39:176- chanical properties and translucency of different yttria- 181. stabilized zirconia ceramics for monolithic dental crown 22. Bidra AS. Complete Arch Monolithic Zirconia Prosthesis applications. Dent Mater. 2018;34:879–90. Supported By Cobalt Chromium Metal Bar: A Clinical Re- 6. Zhang F, Reveron H, Spies BC, Van Meerbeek B, Cheva- port. J Prosthodont. 2020 Apr 1. lier J. Trade-off between fracture resistance and translu- 23. Abduo J. Fit of CAD/CAM implant frameworks: a compre- cency of zirconia and lithium-disilicate glass ceramics for hensive review. J Oral Implantol. 2014 Dec;40(6):758-66. monolithic restorations. Acta Biomater 2019;91:24–34. 24. Spies BC, Zhang F, Wesemann C, Li M, Rosentritt M. Reli- 7. Stawarczyk B, Keul C, Eichberger M, Figge D, Edel- ability and aging behavior of three different zirconia grades hoff D, Lümkemann N. Three generations of zirconia: used for monolithic four-unit fixed dental prostheses. Dent From veneered to monolithic. Part I. Quintessence Int. Mater. 2020 Sep 15:S0109-5641(20)30213-X. 2017;48(5):369-380. 25. Chiari A, Mantovani S, Berzaghi A, Bellucci D, Bortolini S, 8. Stawarczyk B, Keul C, Eichberger M, Figge D, Edel- Cannillo V. (2023). Load bearing capability of three-units hoff D, Lümkemann N. Three generations of zirconia: 4Y-TZP monolithic fixed dental prostheses: An innova- From veneered to monolithic. Part II. Quintessence Int. tive model for reliable testing. Materials & Design March 2017;48(6):441-450 2023;227:111751. 20 10.59987/ads/2024.1.17-20
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https://www.annalidistomatologia.eu/ads/article/view/284
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Early Childhood Caries Assessment and Related Risk Factors among a Group of Lebanese Preschool Children: A Cross-Sectional Study Ahmad Tarabaih Authors Ahmad Tarabaih - Assistant Professor of Pedodontics, Faculty of Dentistry, Assistant Professor of Pedodontics, Faculty of Dentistry, Beirut Arab University, Beirut, Beirut Arab University, Beirut, LebanonMaster in Pediatric Dentistry, Faculty of Dentistry, Beirut Arab University, Beirut, LebanonMaster in Pediatric Dentistry, Lebanon. Faculty of Dentistry, Beirut Arab University, Beirut, Lebanon. Corresponding author: Ahmad Tarabaih ABSTRACT Objective License The study aimed to assess the prevalence of Early Child Caries and its associated This work is licensed under a Creative risk factors among a group of Lebanese preschool children. Commons Attribution-NonCommercial- NoDerivatives 4.0 International License. Materials and Methods Authors contributing to Annali di An observational, cross-sectional study design that included 388 children recruited Stomatologia agree to publish from different schools in Beirut, Lebanon. The parents were interviewed to answer their articles under the Creative Commons Attribution-NonCommercial- a questionnaire developed by the World Health Organization (WHO, 1997) and Car- NoDerivatives 4.0 International License, ies Assessment Risk tool developed by the American Academy of Pediatric Dentist- which allows third parties to copy and ry (AAPD, 2019). Then, caries prevalence was assessed by examining the children redistribute the material providing using the WHO decayed, missed or filled primary teeth (dmft) index and the rating appropriate credit and a link to the scores of dental caries were classified as very low <1.2, low 1.2 – 2.6, moderate 2.7 license but does not allow to use the – 4.4 and high 4.4 (WHO, 1997). material for commercial purposes and to use the material if it has been remixed, transformed or built upon. Results How to Cite The mean age of the children was 4.03 ± 0.82 years. The prevalence of ECC was A Tarabaih. 71.1% and the mean dmft index was noted to be 3.11 ± 3.67. Based on the risk as- Early Childhood Caries Assessment and sessment results, 68% of the preschool children had high caries risk whereas 32% Related Risk Factors among a Group of had low caries risk. A statistically significant differences in mean dmft scores were Lebanese Preschool Children: A Cross- noted in which 3-years-old children exhibited a lower mean dmft value compared Sectional Study to 4 and 5 years olds (p<0.001). In addition, a significant difference was also found Annali Di Stomatologia, 15(1), 21-26. https://doi.org/10.59987/ads/2024.1.21-26 in dmft scores between middle socioeconomic status (SES) schools and low SES schools (p=0.016). Conclusion Oral health promotion programs are to be implemented on regular basis to enhance the oral health status and general well-being of young children. Key words: Early Childhood Caries, Children, Risk Assessment, Socio-demo- graphic Factors INTRODUCTION ECC is defined as the presence of one or more decayed, missed or filled primary tooth in children under six years old [1]. ECC starts as white spot lesions along the gingival margin of maxillary deciduous incisors, leading to a complete crown destruction in the progression of caries [2]. The main risk factors in the development of ECC can be cat- egorized as microbiological, dietary, and environmental risk factors [3]. ECC affects both the child’s oral and general health. Although it is largely a preventable condition, it is considered as a major oral health problem, mainly in socially disadvantaged populations and remains one of the most common childhood diseases worldwide [4]. 10.59987/ads/2024.1.21-26 21 Early Childhood Caries Assessment and Related Risk Factors among a Group of Lebanese Preschool Children: A Cross-Sectional Study The ECC prevalence has been reported between 1% developed the Caries Risk Assessment (CRA) tool to and 12% in developed countries but is as high as 70% help in assessing the caries development risk levels and in developing countries. The underlying risk factors for identifying individual’s specific behaviors or risk factors ECC in different populations have been studied through- [6]. The CRA tool includes risk factors (social, behavior- out different developed countries [5]; however, minimal al, medical, clinical factors), protective factors and dis- epidemiological studies described the status of ECC in ease indicators. The WHO questionnaire demonstrates Lebanon. It is of prime importance to build strong base- the assessment of associated risk factors through gath- line data that can help in identifying ECC and, further- ering data that focuses on socioenvironmental determi- more, aid in planning appropriate treatment plans and nants and modifiable risk factors of oral health in children implementing essential preventive measures. [9]. The questionnaire includes questions concerning the The risk assessment techniques utilized in medical prac- child’s gender and age, place of residence, oral health tices can provide enough data to precisely measure a status and oral hygiene habits. It also includes dietary person’s susceptibility to disease and allow for preven- habits, personal or social issues experienced due to tive interventions. Caries risk assessment (CRA), how- oral cavity problems and parents’ educational level. ever, (1) enhances the treatment process of the disease The Kolmogorov-Smirnov normality test was conducted rather than treating its outcome, (2) aids in individual- and showed that our data were not normally distributed. izing preventive discussions as it allows an understand- Qualitative data were presented as frequencies and per- ing of the disease factors for a specific patient, (3) in- centages whereas quantitative data were presented as dividualizes, chooses, and decides on the frequency of median, range, mean, and standard deviation values. a patient’s preventive and restorative treatment and (4) The Mann-Whitney U test and Kruskal-Wallis test were predicts the progression or stability of caries [6]. used for comparisons between two groups and more Therefore, the purpose of the present study is to as- than two groups respectively. Furthermore, Dunn’s test sess the ECC prevalence and its associated risk factors was used for pair-wise comparisons when the Kruskal- among a group of Lebanese preschool children from Wallis test was significant. The significance level was set different SES schools, assuming that ECC don’t differ at p ≤ 0.05 and statistical analysis was performed with among different study variables. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp [10]. MATERIALS AND METHODS Study Settings RESULTS This is an observational, cross-sectional study to de- Demographic Data termine the status of ECC among a group of Lebanese preschoolers. The study was conducted between De- The study sample included 388 children where 193 chil- cember 2021 and March 2022 in which four schools in dren were boys (49.7%) and 195 children were girls Beirut, Lebanon, were enrolled from two socioeconomic (50.3%). The mean age of the children was 4.03 ± 0.82 classes (middle and low). All children between the ages years. As for the geographic location, 62.6% and 37.4% of 3 and 5 years were randomly selected. The study was of participants lived in urban and peri-urban areas respec- approved by the scientific and ethical review committee tively. The demographic variables are presented in table 1. and institutional review board at Beirut Arab University (BAU IRB code: 2022-H-0098-D-M-0480). Clinical Examination Among clinical examination, 9% of participants had Population Settings non-cavitated (incipient/white spot) lesions or enamel The sample size was calculated using the free calcu- defects, 71.7% of participants had previous history of lator on Raosoft.com. The total sample size required caries (visible cavities/ fillings/ missing teeth) with mean was 388 participants considering a 5% margin of error, dmft index of 3.12 ± 3.67 (Table 2). 95% confidence level and estimated population size of 445,000. Dental Caries Index All children who were medically compromised, defi- The present study showed a statistically significant nitely negatively cooperated - based on Frankl clas- difference in mean dmft values between age groups sification- during the dental examination [7], or whose where 3-year-old children exhibited the lowest value parents refused to participate in study were excluded. compared to older groups (p<0.001). Also the mean value of dmft scores were significantly lower among Data Collection middle SES schools in compared to low class group (p=0.016). (Tables 3 and 4) Clinical examination was done by one trained and cali- brated examiner (κ=87%). The examiner interviewed Dental Care the preschool children’s parents at school premises to ensure that the questionnaires were understood and Dental care had also revealed that 36.4% of the par- completed. The child’s dental status was then evaluated ticipants had dental visits in the past 12 months, 63.1% using the dmft index described by the WHO. The dental didn’t had have visits or received dental care in the past status was evaluated using dmft index according to the 12 months. The common reason for last dental visit was World Health Organization oral health surveys and the pain or troubles with teeth, gum or mouth in which 45.4% rating scores of dental caries were classified as very low was shown in responses. As regards to the frequency <1.2, low 1.2 – 2.6, moderate 2.7 – 4.4 and high 4.4 [8]. of dental cleaning, it was common to clean once/day The American Academy of Pediatric Dentistry (AAPD) (43.3%) followed by twice or more times/day (21.9%). 22 10.59987/ads/2024.1.21-26 A. Tarabaih Table 1. Frequencies (n) and percentages (%) for demographic data of the study participants Demographic Data n % Gender Boy 193 49.7 Girl 195 50.3 Age 3y 125 32.2 4y 126 32.5 5y 137 35.3 Location Urban 243 62.6 Peri-urban 145 37.4 School Middle Socioeconomic Status 175 45.1 Low Socioeconomic Status 213 54.9 Table 2. Descriptive statistics for clinical examination Clinical Examination n % 1. Child has non-cavitated (incipient/white spot) caries or enamel 35 9 defects 2. Child has visible cavities or fillings or missing teeth due to caries 276 71.7 3. Child has visible plaque on teeth 40 10.3 4. Decayed teeth (d): [Mean (SD), Median (Range)] 2.86 (3.44), 2 (0-18) 5. Missing teeth (m): [Mean (SD), Median (Range)] 0.06 (0.29), 0 (0-3) 6. Filled teeth (f): [Mean (SD), Median (Range)] 0.19 (0.67), 0 (0-6) 7. dmft index: [Mean (SD), Median (Range)] 3.11 (3.67), 2 (0-18) Table 3. Frequencies (n) and percentages (%) for dmft dmft = 0 dmft >0 Mean ± SD p-value n% n% Gender Boy 48 12.4 145 37.4 3.06 ± 3.18 p = 0.765 Girl 62 15.9 133 34.3 3.16 ± 3.53 Age 3y 51 13.1 74 19.1 0.85 ± 0.86 4y 31 8.0 95 24.5 3.66 ± 3.07 p<0.001* 5y 28 7.2 109 28.1 4.68 ± 3.91 School Middle SES 57 14.7 118 30.4 45.1 p = 0.016* Low SES 53 13.6 160 41.3 54.9 10.59987/ads/2024.1.21-26 23 Early Childhood Caries Assessment and Related Risk Factors among a Group of Lebanese Preschool Children: A Cross-Sectional Study Table 4. Multiple Comparison between Age and dmft Multiple Comparisons Dependent Variable: dmft Mean 95% Confidence Interval (I) Age (J) Age Std. Error Sig. Difference (I-J) Lower Bound Upper Bound 4 years -2.81073* .28395 .000 -3.4964 -2.1251 3 years 5 years -3.83083* .34320 .000 -4.6592 -3.0025 3 years 2.81073* .28395 .000 2.1251 3.4964 Dunnett T3 4 years 5 years -1.02010 .43189 .056 -2.0579 .0177 3 years 3.83083* .34320 .000 3.0025 4.6592 5 years 1.02010 .43189 .056 -.0177 2.0579 *The mean difference is significant at the 0.05 level. Tooth brush and toothpaste were the only cleaning Children with low SES had significantly higher dmft scores method reported by all participants. Moreover, 35.7% of compared to children from middle SES (p<0.001). SES participants reported using fluoridated tooth paste while influences dental caries and is determined by the educa- 42.1% didn’t know if the used toothpaste was fluoridated tional level, health beliefs and accessibility to health care or not. information [13]. In addition, the low frequency of tooth brushing can be contributed to the low SES in the current Dietary Habits study. In contrary, a higher frequency of tooth brushing was seen in Freire and colleagues’ study due to parental The majority of participants consumed cariogenic food, supervision and guidance during teeth brushing [14]. in which 88.9% of the participants had biscuits, cakes, The majority of the participants (45.3%) visited a den- cream cakes, sweet pies, buns and 62.3% of the par- tist due to pain but only 19% continued the treatment. ticipants had sweets/candy several times. The major- This is reflected by the participants’ inability to afford ity of participants had high consumptions of fresh fruits non-urgent treatments or receive dental care in the past (89.7%) several times, while those who consumed tea 12 months (63.1%) due to the severe economic crisis with sugar were low (24.8%). Moreover, almost half of that Lebanon was going through and therefore, not all the participants (49.8%) were given milk daily. participants were capable of continuing their dental treat- ments or receive dental care as costs of treatments were Risk Factors, Protective Factors and Risk expensive. This result corroborates with results of other Assessment studies [15,16,17]. In contrary, free regular check-ups Children who had snacks between meals showed the are offered in countries with free public dental health highest percentage of participants (68.3%) in risk factors care services, allowing 90% of children to attend regular and 42.5% of the mother/primary caregiver had active checkup appointments as in Norway [18]. decay in the past 12 months. Regarding the protective The importance of fluoride lies in the exertion of its anti- factors, 21.9% of the participants brushed daily and cariogenic action through inhibiting tooth demineraliza- 6.7% of the participants received fluoride varnish in the tion, promoting tooth remineralization and inhibiting past 6 months. As for the risk assessment, 32% of the plaque bacteria [19]. Participants reported that they nei- participants had a low caries risk compared to 68% of ther used nor knew if they used fluoridated toothpaste the participants who had a high caries risk. which is a reflection of parental limited knowledge about fluoride which interprets the high caries level in the cur- DISCUSSION rent study. However, children having lower prevalence of dental caries was a reflection of parents having a better ECC is recognized as a major public health problem due awareness regarding fluoride. to its high prevalence and negative health impacts if left The revealed results of the dietary habits explain the untreated [11]. The present study assessed the preva- high caries prevalence and the high risk of forming ini- lence of ECC and its associated risk factors among a tial lesions. Children usually do not have control over group of Lebanese preschool children who aged be- their food choices as their eating habits were shaped tween 3 and 5 years. by their parents [20], and parents pamper their children The mean dmft value of children aged between 4 and 5 with inexpensive, high-sugar-content snacks that con- years were significantly higher than 3 years old children tribute to tooth decay [21]. One assumption regarding (p<0.001), indicating that the level of caries increases these findings could be attributed to cultural factors, as with age. Also, the current study’s prevalence of ECC Middle Eastern countries including Lebanon, habitually was still high (71.7%) and yet is similar to that reported include high sugar snacks in children’s diet intake [22]. in 2023 by Tabbara (70.4%) [12]. This is reflected by the The frequent consumption of sugary snacks and bever- fact that as children increase in age, they become more ages causes a frequent drop in the saliva’s pH and its susceptible to certain dietary and behavioral attitudes, acidic media to attack the tooth surface, breaking down which increase their teeth’s susceptibility to decay. the enamel and developing dental caries. Furthermore, 24 10.59987/ads/2024.1.21-26 A. Tarabaih snacks such as sweets and candies can adhere to the 2017;5:157. Published 2017 Jul 18. doi:10.3389/ teeth surface for a period of time, causing an interac- fped.2017.00157 tion between the bacteria and these sugars, leading to 4. Goswami P. Early childhood caries- a review of its caries development. In addition, children were exposed aetiology, classification, consequences, preven- to high-risk factors associated with dental caries, noting tion and management. J. Evolution Med. Dent. that their mothers had active dental caries and those Sci. 2020;9(10):798-803, DOI: 10.14260/jemds/ children had frequent sugar exposure per day. Moth- 2020/173 ers are the primary source of Streptococcus mutans, 5. Rai NK and Tiwari T. Parental Factors Influencing the and during the first two years of a child’s life, the degree Development of Early Childhood Caries in Devel- of vertical transfer of bacteria increases in response to oping Nations: A Systematic Review. Front. Public the mother’s poor oral hygiene, exposure to sugar, and Health 2018; 6:64. doi: 10.3389/fpubh.2018.00064 snacking frequency [3]. 6. Caries-risk Assessment and Management for In- A significant deficiency concerning the protective factors fants, Children, and Adolescents. Pediatr Dent. in relation to dental caries was present in brushing daily 2017;39(6):197-204. using fluoridated toothpaste, which was a reflection of 7. Frankl, S. N. “Should the parent remain with the parents’ lack of supervision and parental awareness. child in the dental operatory?.” J. Dent. Child. 29 Another protective factor deficiency was observed in (1962): 150-163. receiving fluoride from a health professional, which re- 8. World Health Organization. (‎1997)‎. Oral health sur- sulted from Lebanon’s economic crisis that left parents veys: basic methods, 4th ed. World Health Organi- unable to afford the costs of topical fluoride treatments. zation. https://iris.who.int/handle/10665/41905 The high caries risk percentage can be explained by the 9. World Health Organization. (2013). Oral health sur- presence of visible cavities or fillings or missing teeth veys: basic methods, 5th ed. World Health Organi- due to caries, visible plaque and non-cavitated (incipi- zation. ent/white spot caries) or enamel defects. In contrary, a 10. IBM Corp. Released 2015. IBM SPSS Statistics for study reported that the majority of their participants were Windows, Version 23.0. Armonk, NY: IBM Corp. of moderate risk (71.3%) with less missing teeth due to caries and less visible plaque [23]. 11. Naidu R, Nunn J, Donnelly-Swift E. Oral health- In conclusion, ECC among children is certainly a global related quality of life and early childhood caries problem, with consequences extending beyond its clini- among preschool children in Trinidad. BMC Oral cal signs and symptoms. Our results revealed a defi- Health. 2016;16(1):128. Published 2016 Dec 7. ciency in oral health care knowledge, and therefore, oral doi:10.1186/s12903-016-0324-7 hygiene education through awareness campaigns and 12. Hisham Hassan Tabbara. The Impact of Selected educational programs is mandatory, along with nutrition Social Determinants on the Prevalence and Sevirity promotion campaigns that aim in providing consultation of Early Childhood Caries among a Group of Leba- on dietary habits. nese Preschool Children. Sch J Dent Sci, 2023 Apr 10(4): 60-68. 13. T S, Kumar B S, Datta M, V T H, Nisha V A. Prevalence, LIMITATIONS severity and associated factors of dental caries in 3-6 This cross sectional study was conducted between De- year old children. J Clin Diagn Res. 2013;7(8):1789- cember 2021 and March 2022 where the pandemic dis- 1792. doi:10.7860/JCDR/2013/6201.3277. ease - Covid-19; was still restricting the country. There- 14. Freire M, Graça SR, Dias S, Mendes S. Oral health- fore, difficulties were faced in getting access to variety related quality of life in portuguese pre-school chil- of schools from different socioeconomic statuses and in dren: a cross-sectional study. Eur Arch Paediatr different locations in Beirut. Moreover, due to the fear of Dent. 2022;23(6):945-952. doi:10.1007/s40368- spreading Covid-19, many schools rejected the request 022-00741-7 of being part of the study. 15. Bulut G, Bulut H. Zero to five years: First dental visit. Eur J Paediatr Dent. 2020;21(4):326-330. Informed Consent Statement: Informed consent was doi:10.23804/ejpd.2020.21.04.13 obtained from all subjects involved in the study. Written 16. Alshahrani NF, Alshahrani ANA, Alahmari MA, informed consent has been obtained from the patients to Almanie AM, Alosbi AM, Togoo RA. First dental publish this paper. visit: Age, reason, and experiences of Saudi chil- dren. Eur J Dent. 2018;12(4):579-584. doi:10.4103/ Conflicts of Interest: The authors declare no conflict ejd.ejd_426_17 of interest. 17. Murshid EZ. Children’s ages and reasons for re- ceiving their first dental visit in a Saudi communi- ty. Saudi Dent J. 2016;28(3):142-147. doi:10.1016/j. References sdentj.2015.12.003 1. Policy on Early Childhood Caries (ECC): Classifi- 18. Åstrøm AN, Agdal ML, Sulo G. Exploring avoid- cations, Consequences, and Preventive Strate- ance of dental care due to dental fear and eco- gies. Pediatr Dent. 2018;40(6):60-62. nomic burden -A cross-sectional study in a national 2. Kawashita Y, Kitamura M, Saito T. Early childhood sample of younger adults in Norway. Int J Dent Hyg. caries. Int J Dent. 2011;2011:725320. doi:10.1155/ 2024;22(1):148-157. doi:10.1111/idh.12657 2011/725320 19. Nassar Y, Brizuela M. The Role of Fluoride on Car- 3. Anil S, Anand PS. Early Childhood Caries: Preva- ies Prevention. In: StatPearls. Treasure Island (FL): lence, Risk Factors, and Prevention. Front Pediatr. StatPearls Publishing; March 19, 2023. 10.59987/ads/2024.1.21-26 25 Early Childhood Caries Assessment and Related Risk Factors among a Group of Lebanese Preschool Children: A Cross-Sectional Study 20. Samaddar A, Shrikrishna SB, Moza A, Shenoy R. 22. Elamin A, Garemo M, Gardner A. Dental caries Association of parental food choice motives, at- and their association with socioeconomic charac- titudes, and sugar exposure in the diet with early teristics, oral hygiene practices and eating habits childhood caries: Case-control study. J Indian Soc among preschool children in Abu Dhabi, United Pedod Prev Dent. 2021;39(2):171-177. doi:10.4103/ Arab Emirates - the NOPLAS project. BMC Oral jisppd.jisppd_104_21 Health. 2018;18(1):104. Published 2018 Jun 8. 21. Athavale P, Khadka N, Roy S, et al. Early Child- doi:10.1186/s12903-018-0557-8 hood Junk Food Consumption, Severe Dental Car- 23. Muhson, Z. N., Thabit, S., Al-ward, F. S., & Al Shatari, ies, and Undernutrition: A Mixed-Methods Study S. A. (2020). Caries risk assessment of a sample from Mumbai, India. Int J Environ Res Public of children attending preventive specialized dental Health. 2020;17(22):8629. Published 2020 Nov 20. center in Al Resafa, Baghdad. Journal of Baghdad doi:10.3390/ijerph17228629 College of Dentistry, 32(4), 17-24. https://api.se- manticscholar.org/CorpusID:230588632 26 10.59987/ads/2024.1.21-26
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Dataset Card for Testimole -- A multi-billion tokens Italian text corpus

image/jpeg

Testimole is a large linguistic resource for Italian obtained through a massive web scraping effort. As of June 2024, it is one of the largest datasets for the Italian language, if not the largest, publicly available, consisting of almost 100B tokens counted with the Tiktoken cl100k BPE tokenizer. It consists mainly of conversational data (Italian Usenet hierarchies, Italian message boards, Italian subreddits) but also contains other textual data derived from blogs, wikis, websites, and academic journals. Each data source is separated into a different dataset split.

Testimole is a wordplay combining "Testi" (texts) and "Mole." "Mole" refers to one of the most famous monuments of Torino, the Mole Antonelliana, where this dataset was conceived and built. Moreover, "mole" means "mass" or "bulk" in Italian, highlighting the large size of this dataset. Testimole is also similar to the word "Testimone" (witness), emphasizing the diachronic quality of the data, thus being a witness of the passage of time in the Italian webosphere.

Dataset Details

Dataset Description

The goal of this work is to create a huge linguistic resource for the Italian language that can be used for several NLP applications, including but not limited to language modelling. The dataset is the result of a massive web scraping effort going on from February 2024 to May 2024, so the resources have a cut-off date comprised within this time span. There is a project to further expand the dataset, as explained in the "Future Plans" section.

To create the dataset, I developed several scripts using Python3 and libraries such as BeautifulSoup and Selenium; the scripts were mostly written and executed manually, making it an extremely time-consuming project. The texts span different topics and periods, containing several divergent opinions and beliefs, in accordance with the main ideas of the "Perspective Data Manifesto" [1]. It is important to note that these data alone are not enough to train an Italian large language model from scratch, mainly not due to the size of the data but because, even if they span different topics, they are far from covering the broad range of subjects, information, culture, and techniques required to train a state-of-the-art model. Also, as will be better pointed out later, while it is safe to use these data under Fair Use for research purposes, users must investigate potential copyright infringement for other possible purposes. The Tiktoken BPE tokenizer with the cl100k_base model [2] was used for tokenization. This dataset is composed of several sub-datasets, each with different types of data and goals.

Uses

Because this dataset consists of a large amount of texts in the Italian language, it can be used for all Natural Language applications that seek to improve support for Italian in a multilingual context and require data for training. This includes, but is not limited to, training large language models. Other possible uses are sentiment analysis, diachronic data classification (as the majority of the data is date-tagged), and text classification. Researchers are invited to annotate even small parts of this dataset. In such cases, the data could be used for other tasks as well, such as Named Entity Recognition (NER), Part-of-Speech (POS) tagging, information retrieval, summarization, and more. This versatility makes the dataset a valuable resource for various NLP projects and research endeavors.

Out-of-Scope Use

By downloading this dataset, users agree not to attempt to identify specific users. This includes refraining from cross-referencing the dataset with other information to ascertain personal identities.

Dataset Structure

Conversational (~ 85 Billions tokens):

UsenetArchiveIT

This is the project that started the entire work: the goal was to collect the largest possible amount of Usenet posts published in the hierachies it.* and italia.* [3], as they were listed on "www.eternal-september.org" and gathered mainly from Google Groups archive.

This split contains 19.395.579.455 tokens. Texts were not checked for language, but it is a safe assumption that most of the text contained is in Italian as the selected Usenet hierarchies target only Italian users.

General stats:

"chars": 59389804791,

"tokens": 19395579455,

"sentences": 519535427,

"posts": 89499446,

"threads": 14521548

Columns of the dataset

  • Title: The original title of the thread
  • Author: Author of the post
  • ID: a unique identifier of the post for the specific newsgroup
  • Progressive_id: the progressive id of the single message in the thread
  • Timestamp: the time and data of creation of the post, in ISO-8601 format
  • Newsgroup: the name of the newsgroup in which the post belong
  • Original_url: the URL of the thread
  • Text: the text of the message

83GB of JSONL file before the conversion to HuggingFace dataset

Forum

The second part of the project is the one that produced the largest amount of data (62.415.825.978 tokens) A list of Italian message boards based on different platforms (phpBB, vBulletin, Simple Machines, Invision, Snitz, XenForo...) was created using both manual and semi-automatic web searches. Then, for each forum, a generic script (forum_scraper.py) using Python3 and BeautifulSoup was adapted to fit the characteristics of the forum (such as correct div classes for the different fields and multiple page mechanisms). Then, the script ran over the entire range of available pages and output a JSONL file with one post per line.

General stats: {

"chars": 199436329709,

"tokens": 62415825978,

"sentences": 1673025712,

"posts": 468391746,

"threads": 25280745,

"hasImage": 46071

}

Columns of the dataset

  • Title: The original title of the thread
  • Author: Author of the post
  • post_id: a unique identifier of the post for the specific forum
  • Progressive_id: the progressive id of the single message in the thread
  • Timestamp: the time and data of creation of the post. In the majority of cases, it is in ISO-8601 format but sometime it could be not converted to ISO-8601 and so being in other formats (a good future work is to convert everything to ISO-8601). In rare cases, it is set to None.
  • Forum: the name of the forum. If the forum belongs to the Forumfree or Forumcommunity circuit, the name of the circuit is appended to the name of the forum. There are cases of forums belonging to the Forumfree circuit where Forumfree is not appended. This should be fixed in a future release.
  • Text: the text of the message
  • image_list: experimental multimodal support
  • image_file: experimental multimodal support

303GB of JSONL files before the conversion to HuggingFace dataset.

Regarding multimodality, in short: this feature is not very well implemented. More details will follow, but do not expect too much regarding this point.

General notes on conversational datasets:

The data contained in the "usenet" and "forums" splits were generated by Italian users of the Internet between 1995 and 2024. For this reason, they may contain biases, problematic stances with respect to ethics, grammatically wrong sentences and non-factually true information. On the other hand, the kind of data can be considered safer than a random crawl of the Internet, in particular regarding the "forum" subset because in many forums there is a strict system of moderation that prohibit posts to go beyond a certain treshold of acceptance (different from forum to forum) with regards to language and thematics. Because the name of the forum/newsgroup is always present in the dataset, it is possible for the users of this dataset to filter the sources of data according to their needs.

It is also important to note, for people less accustomed to internet conversations, that data coming from forums are not just generic conversations but are often a real goldmine of detailed and extremely specific information about several topics written by people who are often passionate and very knowledgeable about what they are discussing. This is especially true for forums that discuss technical and scientific topics.

This collection of conversational data is useful not only for general language modelling but also for many NLP tasks that could take advantages from a very large amount of conversational data, such as sentiment analysis, hate/misoginy speech detection, parsing and so on; on the other hand, the diacronic nature of data permits interesting analysis on diachronic phenomena such as anaylysis of how the Italian language used in the Internet changed over the year and the most discussed topics for each historical period, just to mention a couple of examples.

The post should not contain personal information as in all the forums internal rules was asked to the user not to share personal information as they would have been publicly available on the web.

General

OJS

This split of the dataset contains articles published as Open Access using the platform OJS. It comprised mainly academic journals from Italian universities, so it can be considered as a very high-quality dataset and not problematic regarding biases, apart from very generic biases that may be present in the Italian language in itself or in Academia environments. All the articles are published with Creative Commons licenses, and the license used for the single article can be retrieved from the metadata. Columns of the dataset

  • Journal:
  • url:
  • metadata:
  • text:
  • platform:

Blogs

This resource was gathered by scraping data from blogs and on-line newspapers written in Italian.

This sub-project started with the goal of collecting only blogs released under Public Domain or Creative Commons license. However, due do the automatic nature of the list creation process, I noticed that some blog having an "All right reserved" license were scraped too. Some of these license permits the reuse of the information with the only obligation of mentioning the URL, and the URL is always present in the rows of the dataset. I created a simple script that tried to guess from the home page of the blog, but the results are not optimal and a better pipeline should be implemented. This means that the direct use of this resource is fine under Fair-Use for research purposes but the possibility of usage should be checked by whom wants to use this dataset for other purposes, especially for commercial purposes.

The project started with a collection of blogs regarding left-wing activism, in order to help another person for his research project, that it is still work in progress. The list of these blog was obtained on a blog aggregator. The blogs that fall under this category are labelled with the category "pol/ant" (Poltics/Antagonism). Because from a quick analysis it seems that data coming from the "forum" category are mainly biased toward right political stances (data about this statement will follow in the next weeks), it could be useful to integrate these data in a general language-modelling task in the optic of the "Perspectivist Data Manifesto" [1]. The other two categories are "let/litblog", containing blogs about literature (the list was obtained from another aggregator) and "inf/linux", a very small category containing blog posts from Italian Linux User Groups. The rest of the data, which account for the majority of tokens, is not categorized.

This resource can be considered as a "medium-high" quality dataset, because it mostly contain blogs post, often from good sources with very informative content. It is not possible to guarantee a total absence of undesired content inside the resource, but this, depending from the use case, probably constitutes a minority.

As for the Conversational data split, also this split is diachronically annotated so it could be used for diachronic analysis of language and topics too.

Finally, the blog split contains also an annotation for the language used, as identified by the FastText library.

Columns of the dataset

  • title: The title of the article/post
  • name: The name of the blog
  • author: The author of the article/post, if available
  • date: The date of the article/post in ISO-8601, if available if not None
  • url: The original URL
  • text: The text of the article/post
  • category: The category of the blog. Only a few blogs are annotated for category up to now.
  • license_guess: A guess of the original license of the blog made by an automated and non-perfect script
  • fasttext_langid: The most probable language as identified by fasttext
  • fasttext_langprob: The probability of the most probable language as identified by fasttext

Wikimedia

This split doesn't need many explanation as it is simply a dump of wikimedia resources in Italian (Wikipedia, Wikibooks, Wikinews, Wikiquote, Wikisource, Wikiversity, Wikivoyage and Wiktionary) as of May 2024. It can be very important to include this resource in the training data of a language model because it contains information, presented in a mostly neutral language, about many possible subjects and topics that are not covered by the rest of the dataset.

I decided to create also a category called "wikimedia_others" containing data from Wikimedia projects of other regional languages related with Italian and spoken in Italy, as well as Latin for its historical importance for Italian language and culture. Languages code included in this split are: eml (emilian e rumagno) ,fur (furlan) ,la (latin) ,lij (ligure) ,lld (ladin) ,lmo (lombarda) ,nap (napolitan) ,scn (sicilianu) ,sc (sardu) and vec (veneto). Using this data, depending from the goal of the project, could produce very interesting results.

Columns of the dataset

  • title
  • text
  • wiki

Books

This collection contains mainly the books coming from LiberLiber's project "Manuzio" [2]. The books were downloaded from the website in many formats and converted to text. Liber Liber is a project akin to Project Gutenberg as it contains many books with expired copyright and thus in Public Domain. Many of these books are considered cornerstones of Italian culture.

The collection contains also a smaller amount of data coming from other sources, such as the Creative Commons licensed school books of "Matematicamente" [3] and Oilproject-Weschool [4] as well as some other CC and PD licenses book found online.

Columns of the dataset

  • title
  • author
  • url
  • text

Websites

I created a very generic script that is able to extract all the text of a website as well as the text contained in Office, PDF and TeX documents. Now, the websites section is mainly composed of three very high-quality and freely licensed websites: ArchivioAntimafia [5], that contains many official documents about Mafia persecution in Italy, Peacelink [6], an historical Italian website about peace activism and HomoLaicus [7] a big collection of texts about various topics (mainly history and politics) released under a CC license. Also other smaller and randomly selected (but filtered for quality) websites are included in this collection. This section has to be considered experimental for two reasons: (1) It containly only a very small subset of the entire high-quality Italian web landscape and it could be increased and improved "ad libitum" (2) It is the only section that can have some bigger issue with deduplication, that we will discuss in the appropriate section.

Despite these two point, users are encouraged to use this section as it is composed of medium-high and high quality contents.

Columns of the dataset

  • url
  • text

Reddit

It contains a small subsets (4192672 messages) of conversations in some Italian subreddits.

Italatex Still work in progress. A collection of materials written in LaTeX.

Dataset Creation

Curation Rationale

Multilinguality is one of the main challenges for the new AI and NLP revolution that is taking place in the 2020s. Until now, the most advanced models are mostly trained on English or a few other languages, creating a dangerous gap for people speaking other languages (that is, 81.2% of the world population, according to the CIA Factbook of 2022) in accessing these new advanced instruments. Translations from English are not enough to capture the cultural differences of peoples that do not belong to the Anglo-American culture. Thus, it is important for a general model to be truly inclusive by including data that can capture different views of the world and uses of language. These data are not only useful for modeling the Italian language itself but also for gaining insights into Italian culture and the way in which Italian-speaking people engage with various topics.

Source Data

  • Usenet
  • Message boards
  • Blogs
  • Websites
  • Open Journal System platforms hosted by Italian universities or included in DOAJ
  • LiberLiber
  • Wikimedia

Data Collection and Processing

The dataset is the result of a massive web scraping effort that was carried out using manually created Python3 scripts using libraries such as BeautifulSoup for HTML parsing and Selenium in the few cases in which Javascript support or browser automatization was required. I have created blueprints of the script, such a generic "forum scraper" or "blog scraper" script but then I had to adapt them almost manually for each resource included in the dataset. Some resources were sharing the same technical platform, so it was trivial to adapt the script, in other case a significant reverse-engineering effort was required. The scraping took place on very simple resources: a very old unused 2006 Sony Vaio laptop with an Intel Core2Duo processor connected to a domestic FTTC connection was enough for the majority of websites, while in other cases other resources were rented or borrowed in order to have a speed-up or to aggregate and analyse the entire collection of data. Using such a simple setup was also a way to have a "natural" anti-overload system. Because many web scraping instances were running in parallel, websites were not loaded so much and often timeouts were implemented in order to protect smaller servers. It never happened that a website was slowed down due to this scraping process, that was crafted to be as gentle and slow as possible. Considering an average power consumption of the laptop of 40W and 100 days of running, circa 96Kwh were used to power the laptop. The laptop was plugged in the Italian-Centre electricity zone, with an average electricity/co2 ratio of 250g per KW with more than 60% of power coming from renewable sources. This means that the laptop Co2 emissions were circa 24KG of Co2, equivalent to a short 150km trip on a small car with emissions of 160g/km. All the data were collected in a JSONL format and then merged, cleaned, analyzed and converted to an Hugging Face dataset using an HPC resource that was gently provided to the author. The vast majority of data coming from forums undergone a process of deduplication in order to avoid the case of having two instances of the same message.

Who are the source data producers?

Data is produced by users of the Italian Internet mostly between 1995 and 2024. This resource also contains texts produced before 1995, such as the content of public domain books written by authors from any historical period.

Recommendations

This dataset could be used along with other Italian natural language resources. A very good list of them is available at the address [https://huggingface.co/collections/gsarti/italian-nlp-resources-64fc606927fb3a92e9ea72f2]. For example, gsarti/clean_mc4_it [https://huggingface.co/datasets/gsarti/clean_mc4_it], being the biggest as-to-date cleaned version of Common Crawl for Italian, could be used to increase the variety of the data for the training of a Large Language Model.

Deduplication

The presence of duplicate text can be, depending from the use cases, a big problem for several machine learning tasks. I tried to avoid as much as possible the presence of duplicate text in the dataset but still there are some potential issues to be took into consideration. We will distinguish two kind of duplications: (A): Full document duplication, for example, if the same forum post is present more than one time (B): Strings duplication: if some strings (often garbage) recurr several times in the data.

Usenet: Safe regarding A-types of duplications; Could contain B-types duplications, for example: - Users signatures; - Headers such as "reply to message posted by X at Y";

Forums: Safe regarding A-types of duplications. The most problematic forums under this respect were deduplicated using an ad-hoc created script. It shares the same potential problems of Usenet with regard to B-type duplications;

OJS: it should be safe regarding both A-type and B-type duplications;

Blogs: Safe regarding A-types of duplications and mostly safe regarding B-type duplications. However, I noticed that some blogs were scraped along with some html garbage at the beginning or end of the text blob, that should be identified and removed

Wikimedia: it should be mostly safe, with the exception of the recurrence of some Wikipedia-specific lexicon such as "this page is a stub", "this page needs references" and so on;

Books: it should be safe regarding A-types of duplication, but there is a very simple to identify B-type duplication, that is, the header of Liber Liber books with a short presentation of the community-driven project;

Websites: In this case A-type duplication could be in theory present if some pages share the same content, but it should be rare (with the exception of Archivio Antimafia, where files to download are often available in PDF and Word Processing format, so they were downloaded twice). B-type duplication here could be an issue as it is very present in the form of 1) header of the website 2) list of links 3) footer of the website. All the HTML was converted using HTML2TEXT so it should not contain html code.

Citation

Citation Information

@software{testimole,
  author = {Rinaldi},
  title = {TestiMole},
  month = May,
  year = 2024,
  url = {https://huggingface.co/datasets/mrinaldi/TestiMole}
}

Future work

The dataset could be enhanced in several ways:

  • Increasing the amount of data (scraping): this could be done both by recycling the same scripts for other forums, blogs and websites or by writing new scraping scripts. It is important to understand that, even if the dataset is big, it only capture a small amount of the entire Italian webosphere;
  • Increasing the amount of data (not by scraping): we have projects in mind to increase the dataset with high quality contents coming from different sources, expecially from Italian Universities;
  • Cleaning the data: deduplication, as explained in the appropriate section, is probably the top-priority work that should be done on this dataset;
  • Much more :) You are warmly invited to collaborate with me in this effort.

Statistics

More statistics will be added in the near future. In the "asset" directory, JSONL files contain precomputed token counts for each subcategory (e.g., single forum, newsgroup, or blog), allowing anyone interested to easily craft more detailed statistics.

Conversational aggregated tokens per year:

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Forum tokens per year:

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Usenet tokens per year:

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Usenet hierarchies breakdown:

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Usenet and Forum in diachronic perspective:

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Blogs tokens per year:

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Contributions

Special thanks to Viviana Patti and Valerio Basile, professors at the Computer Science Department, NLP group, at the University of Turin, Italy who are significantly supporting me and my projects. Grazie mille :) Thanks also to ruggsea, who helped in the first stage of the creation of the Usenet dataset by converting the first JSONL files to parquet and giving some resources to download part of the dataset. Thanks to the entire mii-community who supported and expressed interest in the project. Thanks to Luisa for plugging the old laptop, giving me SSH access and reboot it in cases such as power surges or crashes.

References (partial)

* [1] https://pdai.info/

* [2] https://github.com/openai/tiktoken

* [3] https://xmau.com/usenet/

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