Although treatment with fixed or mobile appliances has become an important part of modern orthodontics, side effects such as white spot lesions (WSLs) have a negative impact on the aesthetic outcome of orthodontic treatment. The purpose of this article was to review current evidence on the diagnosis, risk assessment, prevention, management and post-orthodontic treatment of these lesions. Data collection was performed electronically, and the initial search using the keywords “white spot lesions”, “orthodontics”, “WSL”, “enamel” and “demineralization” in different combinations resulted in 1032 articles for the two electronic databases used. Ultimately, a total of 47 manuscripts were considered relevant to the aim of this research and included in this review. The results of the review indicate that WSLs remain a significant problem during orthodontic treatment. According to studies in the literature, the severity of WSLs correlates to the duration of treatment. Using toothpaste with more than 1000 ppm fluoride at home reduces the frequency of WSL separation and regular application of varnishes in the office reduces the frequency of the occurrence of WSLs only in the context of maintaining a strict hygiene regime. The old hypothesis that elastomeric ligatures retain more dental plaque than metal ones has been refuted. There are no differences in the appearance of WSLs between conventional brackets and self-ligating brackets. Clear aligner mobile devices develop fewer WSLs but are more extensive as opposed to conventional fixed devices, while lingual orthodontic appliances have a lower incidence of WSLs, and the most effective device for preventing these lesions is WIN, followed by Incognito.

Fixed orthodontic therapies include several procedures that can affect the enamel surface. The aim of this study was to assess the action of composite resin on the surface of the tooth through variation of enamel changes after debonding metal and ceramic brackets, by means of scanning electron microscopy. An in vitro study was conducted on 48 human premolar specimens, which were extracted within a period of two months for orthodontic purposes. On half of them, metal brackets were bonded, and on the other half, ceramic brackets (Al₂O₃) were bonded, using light cure adhesive paste and a two-step, etch-and-bonding technique. The brackets were debonded after 24 h using a straight debonding plier. The adhesive remnant index (ARI) was determined by visual observation of the specimen. Post-debonding scans were aligned with the baseline, and the surfaces’ changes were quantified. A quantitative analysis was made on the debonded brackets to determine the presence or absence of enamel on the base pad. Evaluation of pre-bonded and post-clean-up enamel surface revealed no crack and increased roughness in both ceramic and metal brackets, which was higher for the ceramic ones. The enameled band (perikymata), artificial caries, or the superficial fissures revealed in the pretreatment stage were replaced with the loss of the prismatic structure and the presence of remnant adhesive. No enamel substance was found on the base pad. The ARI_tooth was higher for metallic brackets than for ceramic ones. Metallic brackets and ceramic brackets have undergone mechanical changes by showing fractures in their structure. According to our present investigation, we can conclude that the adhesive composite resin is safe for use on both metal and ceramic brackets in orthodontic treatments, with no iatrogenic enamel damages.

Additive manufacturing is a technology that has many uses across a variety of fields. Its usage spans many fields, including the fields of art, design, architecture, engineering and medicine, including dentistry. The study aims to evaluate and compare the accuracy of three-dimensional printed dental models based on ethylene di-methacrylate using the SLA and DLP techniques. For evaluation, a reference model containing 16 maxillary permanent molars was chosen. An ATOS Capsule 3D scanner was used to scan the reference model. Using a photo-cured liquid resin, eight three-dimensional printed models were obtained using the reference model as benchmark. Four of the models (A1–A4) were obtained using SLA printing technology and four models (B1–B4) were manufactured using DLP printing technology. A standard best fit method was used to pre-align the reference and the printed model surfaces. The height of the teeth, and the mesial–distal and buccal–lingual distances were analyzed. The assessment of the two manufacturing methods was achieved by using non-parametric tests to compare the mean ranks for the assessed features. The results show that models obtained through DLP had a higher precision but also a higher bias. Both methods still are within the required accuracy range for dental models.

The present study aimed to investigate the link between the severity of periodontal disease (PD), coronary calcifications and unstable plaque features in patients who underwent coronary computed tomography for unstable angina (UA). Fifty-two patients with UA, included in the ATHERODENT trial (NCT03395041), underwent computed tomographic coronary angiography (CCTA) and dental examination. Based on the median value of the periodontal index (PI), patients were assigned to the low periodontal index (LPI) group (PI < 22) and a high periodontal index (HPI) group (PI > 22). Patients with HPI had higher plaque volume (p = 0.013) and noncalcified plaque volume (p = 0.0003) at CCTA. In addition, the presence of vulnerability features in the atheromatous plaques was significantly correlated with PI (p = 0.001). Among periodontal indices, loss of gingival attachment (p = 0.009) and papillary bleeding index (p = 0.002) were strongly associated with high-risk plaques. PI significantly correlated with coronary calcium score (r = 0.45, p = 0.0008), but not with traditional markers of subclinical atherosclerosis. Overall, this subgroup analysis of the ATHERODENT study indicates that patients with advanced PD and UA present a higher amount of calcium in the coronary tree and have a more vulnerable phenotype of their culprit plaques.

Both periodontal disease and atherosclerosis are chronic disorders with an inflammatory substrate that leads to alteration of the host’s immune response. In PD, inflammation is responsible for bone tissue destruction, while in atherosclerosis, it leads to atheromatous plaque formation. These modifications result from the action of pro-inflammatory cytokines that are secreted both locally at gingival or coronary sites, and systemically. Recently, it was observed that in patients with PD or with cardiovascular disease, COVID-19 infection is prone to be more severe. While the association between PD, inflammation and cardiovascular disease is well-known, the impact of COVID-19-related inflammation on the systemic complications of these conditions has not been established yet. The purpose of this review is to bring light upon the latest advances in understanding the link between periodontal–cardiovascular diseases and COVID-19 infection.