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] | 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
presidenza@annalidistomatologia.eu
Fidler Ales Poli Figuereido Jose’ Antonio Managing Editor
University Ljubljana Slovenia University Rio Grande Do Sol Brasil Alessandro Zurli Varesi
info@annalidistomatologia.eu
Foschi Federico Politano Gianfranco
King’s College London Inghilterra University Leuven Managing Office - Sponsor e Marketing
Donatella Alonzi
Franco Vittorio Pongione Giancarlo info@annalidistomatologia.eu
Roma Italy Roma Italy
Publishing Operations Manager
Galli Massimo Pozzi Alessandro Raffaele Salvati
University Sapienza Roma Italy University Tor Vergata Roma Italy salvati@annalidistomatologia.eu
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 - info@annalidistomatologia.ue - 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
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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.
maurilio.dangelo@uniroma1.it
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
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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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] | 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: prasetyanto@atmajaya.ac.id 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
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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].
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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,
andrea.berzaghi@unimore.it 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
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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:
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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
| null |
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https://www.annalidistomatologia.eu/ads/article/view/284 | [
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"Description": "ObjectiveThe study aimed to assess the prevalence of Early Child Caries and its associated risk factors among a group of Lebanese preschool children.Materials and MethodsAn observational, cross-sectional study design that included 388 children recruited from different schools in Beirut, Lebanon. The parents were interviewed to answer a questionnaire developed by the World Health Organization (WHO, 1997) and Caries Assessment Risk tool developed by the American Academy of Pediatric Dentistry (AAPD, 2019). Then, caries prevalence was assessed by examining the children using the WHO decayed, missed or filled primary teeth (dmft) index and the rating scores of dental caries were classified as very low <1.2, low 1.2 – 2.6, moderate 2.7 – 4.4 and high 4.4 (WHO, 1997).ResultsThe mean age of the children was 4.03 ± 0.82 years. The prevalence of ECC was 71.1% and the mean dmft index was noted to be 3.11 ± 3.67. Based on the risk assessment results, 68% of the preschool children had high caries risk whereas 32% had low caries risk. A statistically significant differences in mean dmft scores were noted in which 3-years-old children exhibited a lower mean dmft value compared to 4 and 5 years olds (p<0.001). In addition, a significant difference was also found in dmft scores between middle socioeconomic status (SES) schools and low SES schools (p=0.016).ConclusionOral health promotion programs are to be implemented on regular basis to enhance the oral health status and general well-being of young children.",
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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
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2. Kawashita Y, Kitamura M, Saito T. Early childhood sample of younger adults in Norway. Int J Dent Hyg.
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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):
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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-
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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
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manticscholar.org/CorpusID:230588632
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Dataset Card for Testimole -- A multi-billion tokens Italian text corpus
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
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:
Forum tokens per year:
Usenet tokens per year:
Usenet hierarchies breakdown:
Usenet and Forum in diachronic perspective:
Blogs tokens per year:
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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