Tooth bleaching with hydrogen peroxide and nano-hydroxyapatite: a 9-month follow-up randomized clinical trial

OBJECTIVES

The aim of this study was to compare the amount of tooth colour change, rebound rate and tooth sensitivity in patients submitted to a bleaching technique with 6% hydrogen peroxide (HP) with or without 2% nano-hydroxyapatite (n-HA).

METHODS

Sixty subjects were included in this examiner-blinded, randomized clinical trial using a 6% HP gel with or without 2% n-HA. Tooth colour and tooth sensitivity were analysed before and after treatment. All data were analysed statistically.

RESULTS

After bleaching, both treatments demonstrated significant improvements in tooth shade (P < 0.05 for both groups). At the 9-month recall, tooth shade remained significantly lighter than at baseline (P < 0.05 for both groups). However, a relapse of the tooth shade was observed compared with the immediate post-bleaching result (P < 0.05). 6% HP with 2% n-HA produced significantly lower sensitivity (P < 0.05) than the bleaching product without n-HA. Colour change evaluation resulted in no difference between the two groups.

CONCLUSION

Both treatments demonstrated significant improvements in tooth shade. The bleaching effectiveness of the tested products was comparable. The use of 6% HP with 2% n-HA reduced the incidence of sensitivity during the bleaching treatment compared to a bleaching agent that did not contain n-HA.

Unusual presentation of metastatic adenoid cystic carcinoma: a challenge in aspiration cytology of the thyroid

INTRODUCTION

Adenoid cystic carcinoma is a malignant neoplasm most commonly originating in the salivary glands. Its occurrence elsewhere is rare and its metastasis to the thyroid gland has been described only once.

CASE REPORT

We describe the case of a 66-year-old man who presented for a swelling in the midline neck of six months duration. A solitary palpable nodule was identified in the isthmic region of the thyroid. Fine needle aspiration of the nodule revealed high cellularity, a partial microfollicle-like pattern and the presence of small hyaline globules. The neoplastic population was composed of monomorphic cells with basaloid appearance. Thyroid primitivity was excluded on the basis of the negativity for TTF1 and thyroglobulin. As the patient referred an ulcerative lesion of the inferior lip, fine needle aspiration cytology of the lesion was performed, yielding a diagnosis of adenoid cystic carcinoma.

CONCLUSION

The present case highlights the need to be aware of possible metastatic thyroid localisation of adenoid cystic carcinoma also originating in minor salivary glands of the oral cavity. This is a very rare event, but it should be taken into consideration and clinical and cytological findings must be carefully examined.

The management of hip fracture in the older population. Joint position statement by Gruppo Italiano Ortogeriatria (GIOG)

This document is a Joint Position Statement by Gruppo Italiano di OrtoGeriatria (GIOG) supported by Società Italiana di Gerontologia e Geriatria (SIGG), and Associazione Italiana Psicogeriatria (AIP) on management of hip fracture older patients. Orthogeriatric care is at present the best model of care to improve results in older patients after hip fracture. The implementation of orthogeriatric model of care, based on the collaboration between orthopaedic surgeons and geriatricians, must take into account the local availability of resources and facilities and should be integrated into the local context. At the same time the programme must be based on the best available evidences and planned following accepted quality standards that ensure the efficacy of the intervention. The position paper focused on eight quality standards for the management of hip fracture older patients in orthogeriatric model of care. The GIOG promotes the development of a clinic database with the aim of obtaining a qualitative improvement in the management of hip fracture.

Human papillomavirus-related basaloid squamous cell carcinoma of the bladder associated with genital tract human papillomavirus infection

Basaloid squamous cell carcinoma is a biologically aggressive neoplasm mainly found in the head and neck region. Recently, four cases of basaloid squamous cell carcinoma of the bladder have been reported, and three of them occurred in patients with neurogenic bladder, repeated catheterizations and human papillomavirus infection of the urinary tract. To the best of our knowledge, none of the patients affected by basaloid squamous cell carcinoma of the bladder described in the literature had documented genital involvement by human papillomavirus. Herein, we describe the case of a woman with neurogenic bladder affected by basaloid squamous cell carcinoma of the bladder and by a concomitant genital tract human papillomavirus infection.

Salivary Streptococcus Mutans and Lactobacillus spp. levels in patients during rapid palatal expansion

AIM

To assess the microbial level of Streptococcus Mutans and Lactobacillus spp. during rapid palatal expansion, and compare the data with untreated control patients.

STUDY DESIGN

Thirty patients aged between 6-9 years were enrolled in this study (15 males and 15 females). The patients were divided into three groups: 10 patients were treated with rapid palatal expander (RPE) (Test Group 1), 10 patients were treated with Mc Namara expander, and 10 patients were enrolled in the control untreated group. Whole stimulated saliva was collected from each patient at three time points: before initiation of expansion therapy (baseline at T0), after 3 months (T1), after initiation of treatment, and after 6 months from T0 (T2). The protocol of rapid palatal expansion for the two groups was as follows: at placement of the expander 4 activations were performed by the orthodontist (1 mm expansion), followed by 4 activations per day by the parents (two in the morning and two in the evening, 1 mm per day total) to be repeated for 7 days.

RESULTS

Statistics: In this study a different trend in the microbial colonisation for the two treated groups was observed. In the Test Group 1, in which patients were treated with the RPE, there was a significant difference between Strp T0 T1 and between Strp T0 and T2 (p< 0.05). There was also a significant difference between LAC T1 T0 and LAC T2 and T0 (p<0.05). In the Test Group 2, treated with McNamara expanders, it was found was a significant difference between LAC T2 T0 and LAC T1 T0. In the same group it was also found a significant difference between Strp T2 T0; T1 T0; T1 T2 (p<0.05).

CONCLUSION

The level of the various species of bacteria changes during rapid palatal expansion, and this seems to depend on the type of orthodontic expander. During rapid palatal expansion treatment it is also advisable a periodical microbial monitoring using in-office bacteria tests.

Diffuse panbronchiolitis in a patient with common variable immunodeficiency: a casual association or a pathogenetic correlation?

Diffuse panbronchiolitis (DPB) is an idiopathic inflammatory disease that seems to have an immunological pathogenesis and that causes a severe progressive suppurative and obstructive respiratory disorder. Common variable immunodeficiency (CVID) is the most common serious primary immunodeficiency and it is often associated with respiratory diseases. Herein, we describe a case of DPB in a 41-year-old man affected by CVID. We examined the patient's lungs, focusing on the characteristics of the inflammatory cells and of the foamy macrophagic nodules typical of DPB. Immunohistochemical typing of the lymphocytic infiltrate showed that B-cells were almost absent, matching the immunological profile of CVID. The case described is the first case reported in the literature of DPB in a patient affected by CVID. Moreover it seems to confirm the correlation between an immunodeficiency status and the development of DPB and provides more information on the accumulation of nodules of foamy macrophages in DPB.

VIRTUAL SLIDES

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5310709471138338.

In vivo study of titanium healing screws surface modifications after different debridment procedure

Introduction: Over the years, several different implant systems have been introduced, and the indications for implant rehabilitation have gradually been extended 2. Although an high success rates have consistently been reported for many implant systems, complications leading to loss of osseointegration still occurs 3. Thus, oral hygiene and maintenance are imperative, because implants, as well as teeth, are susceptible to accumulation of bacterial plaque and calculus formation. The aim of the present study was to evaluate and compare the in vivo cleaning efficacy of the three systems (air powder, curette, laser) comparing at the same time the alterations of the titanium abutment surface in terms of roughness. Methods: Forthy-two patients (25 males and 17 females) were included in the study. The 42 healing abutments were treated by the same clinician (UC). Results and conclusions: The rate of debris removal by the air powder was higher than that for the laser and than that for the curettes. The SEM analysis showed that the air powder system did not induce significant differences of the abutment if compared to the curettes as well as to the laser.

Salivary levels of IgA in healthy subjects undergoing active orthodontic treatment

It has been reported that the immune system undergoes changes due to various factors, inflammation, surgery, medication, age and gender. The aim of this study was to investigate therapy-dependent changes of salivary IgA among healthy subjects undergoing active orthodontic treatment. The levels of IgA were determined at the beginning, and after 1,4, 8,16 weeks and 32 weaks of active orthodontic treatment. A total of 100 healthy individuals (aged 15-42 years) were enrolled in the study. Two milliliters of saliva were collected from all participants, and salivary IgA levels were measured by the ELISA technique. Mean salivary IgA levels were significantly higher in subjects after 1 week as compared to subjects at the beginning of orthodontic treatment (P < 0.01).. The mean levels of salivary IgA were significantly higher after 4 and 8 weeks of therapy than those observed in the control group (P < 0.00001 and P < 0.05, respectively) and reached the highest level at 16 weeks and then remained stable during treatment. Gender had no effect on the salivary levels of IgA as any significant differences were observed between men and women. The results highlight the importance of the salivary defense mechanism, translated through the increase in the levels of IgA, once orthodontic treatment is started.

Salivary calcium levels during orthodontic treatment

Saliva contains many defense factors and plays a key role in oral metabolism. Salivary calcium, due to its affinity to be readily taken up by plaque, is an important factor not only with regard to the onset of periodontitis but also significantly with regard to dental health. The aim of this study was to estimate the salivary concentration of calcium, in a group of adults undergoing active orthodontic treatment. The levels of salivary calcium were determined at the beginning, and after 16 weeks of active orthodontic treatment. A total of 40 healthy individuals with a mean age of 23.9 years were enrolled in the study group, while 40 subjects served as controls. Two milliliters of saliva were collected from all participants, and salivary calcium levels were measured by biochemical assay. Mean salivary calcium levels were significantly higher in subjects after 16 weeks as compared to subjects at the beginning of orthodontic treatment and to the control group (p= 0.001). A significant association between higher salivary calcium levels and orthodontic treatment has been established, therefore, monitoring salivary calcium levels might be a useful tool to establish periodontal health status during active orthodontic treatment along with other inflammatory parameters.

Conservative treatment of unicystic odontogenic keratocyst by piezosurgery approach. A case report

The present case report describes the case of a 15-year-old female who was referred with a radiolucent lesion between her mandibular right molars. The original radiographic image suggested the presence of an odontogenic cyst. The surgical enucleation and the following osteotomy of the residual cavity was performed by using the piezoelectric technology. The histological analysis confirmed that the lesion was an odontogenic keratocyst with no evidence of epithelial invasion in the connective tissue wall. The patient refused any further surgical treatment. In consideration of the pathological result - no presence of invasive epithelial cells in the connective tissue wall of the cyst- the patient was suggested a "follow-up and wait-and-see policy", with more extensive surgical treatment to be given only in case of a recurrence. The patient was followed up clinically and radiographically at 6 months intervals for 5 years.

Comparison between oscillating-twisting rotating of brush head vs a characteristic sweeping bristles motion on reducing oral inflammation

Background: The aim of present study was to clinically assess and compare a sonic toothbrush versus a rotating oscillating power toothbrush on plaque removal and gingival health in reducing plaque and bleeding on probing. Methods: Patients were selected according to specific inclusion and exclusion criteria and they were enrolled in test group or control group using Random Allocation Software. Visual score plaque index (PI) was recorded by the same blind operator using a plaque revelator and bleeding on probing (BoP) index was recorded using a periodontal probe at baseline, 15th day and 30th day. Results: The group of patients who used sonic toothbrush showed a greater reduction of PI and BoP comparing with patients who used rotating-oscillating power toothbrush. Conclusions: Although this pilot study has several limitations, it seems to indicate that sonic toothbrushes are capable of removing plaque and reducing bleeding on probing better than electric toothbrushes.

Periodontal maintenance following scaling and root planing. A randomized single-center study comparing minocycline treatment and daily oral irrigation with water

Objective: Trying to limit the use of antimicrobial drugs in periodontitis is a general trend. Thus, the aim of the present study was to assess the efficacy of daily water irrigation in comparison with subgingival minocycline in periodontal maintenance, in subjects with moderate to severe periodontitis. This was done by evaluating probing pocket depth (the primary outcome), other clinical parameters such as clinical attachment level, plaque index and bleeding on probing, and bacterial flora changes inside periodontal pockets. Materials and Methods: In this single-center, parallel, single blind, randomized clinical study, thirty subjects (12 men, mean age 56 ± 2.2 years) with moderate to severe periodontitis were randomized 1:1 into a minocycline-treated group (M-group, n=15) and a water-treated group (W-group, n=15). Clinical and microbiological parameters were measured at baseline. Scaling and root planing were carried out on all subjects, then to M-group patients minocycline was administered inside the pockets. W-group subjects had instead to daily apply oral irrigation with water. Clinical and microbiological measurements were repeated after 30 days. Results: Both water irrigation and minocycline treatment led to a significant reduction of all the clinical parameters tested at t=30 days with respect to baseline. Moreover, both procedures appeared to be able to maintain a low bacterial load inside periodontal pockets, for most of the microorganisms tested. No statistically significant differences were observed between M-group and W-group at t=30 days, concerning both clinical and microbiological parameters. However, further studies are needed to assess the long-term effect. Conclusion: Daily oral irrigation with water showed comparable efficacy to a single administration of minocycline in periodontal maintenance subjects.

Leiomyomatosis peritonealis disseminata: an additional case

Leiomyomatosis peritonealis disseminata (PPD) is a rare smooth muscle tumour of women in the reproductive age. It is characterized by multiple small nodules on the peritoneal surface, mimicking a metastatic process. To date, about 100 cases have been reported in literature. The authors herein present an additional case consisting of multiple nodules located on the surface of the omentum, parietal peritoneum, as well as colon and rectum wall in a patient without signs of excess of estrogen, progesterone, or steroid hormones nor treated with hormones for any reason. The patient has been submitted to laparoscopic myomectomy few years ago. Microscopically, these nodules consisted of bundles of spindle-shaped smooth muscle cells (positive for smooth muscle actin, desmin, estrogen, and progesterone receptor). A brief review of the literature on the pathogenesis of the disease is also added.

Myxoid leiomyosarcoma of the uterus: a case report

Only 30 cases of myxoid leiomyosarcomas (MLMS) have been reported to date. The authors describe a further case in a 66-year-old woman. The main differential diagnoses include: myxoid inflammatory myofibroblastic tumours, mixoid leiomyoma, and endometrial stromal tumours. Surgery remains the appropriate treatment. However, in spite of an aggressive surgical approach and local and systemic control, recurrences and metastasis are frequent.

Lymphoepithelial-like carcinoma of the parotid gland: a case report and a brief review of the western literature

Background

Primary lymphoepithelial-like carcinoma of the parotid gland is a rare tumour with an increased incidence among Eskimos and Orientals. In these populations, it is usually associated with Epstein-Barr virus. In Western countries, salivary gland lymphoepithelial-like carcinomas are uncommon and only 14 cases have been described so far; among these, only five cases showed Epstein-Barr virus positivity.

Case report

A 45-year-old woman was admitted to Siena Hospital for evaluation of a pre-existent (2 years) painless and tender submandibular mass, rapidly enlarging since two months. On physical examination, a 2.5-cm mass was found in the right parotid. It was firm, mobile and non-tender. Laboratory data were within reference range. Nuclear magnetic resonance detected a 2,5×1,5×1-cm well-circumscribed mass in the deep lobe of the right parotid. A total right paroditectomy with dissection of a satellite lymph node was performed. On the basis of morphological, immunohistochemical and molecular biology findings, a diagnosis of stage II (according to TNM7) Epstein Barr-virus positive, undifferentiated lymphoepithelial-like carcinoma of the parotid gland was made. Twenty months after surgery the patient was free of disease.

Conclusions

Further studies seem to be necessary to completely elucidate the oncogenic role of Epstein Barr-virus in these tumors, which have identical morphology but different prognosis and variable presence of the virus.

Virtual Slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1260381551000616

A novel synthetic peptide from a tomato defensin exhibits antibacterial activities against Helicobacter pylori

Defensins are a class of cysteine-rich proteins, which exert broad spectrum antimicrobial activity. In this work, we used a bioinformatic approach to identify putative defensins in the tomato genome. Fifteen proteins had a mature peptide that includes the well-conserved tetradisulfide array. We selected a representative member of the tomato defensin family; we chemically synthesized its γ-motif and tested its antimicrobial activity. Here, we demonstrate that the synthetic peptide exhibits potent antibacterial activity against Gram-positive bacteria, such as Staphylococcus aureus A170, Staphylococcus epidermidis, and Listeria monocytogenes, and Gram-negative bacteria, including Salmonella enterica serovar Paratyphi, Escherichia coli, and Helicobacter pylori. In addition, the synthetic peptide shows minimal (<5%) hemolytic activity and absence of cytotoxic effects against THP-1 cells. Finally, SolyC exerts an anti-inflammatory activity in vitro, as it downregulates the level of the proinflammatory cytokines TNF-α and IFN-γ.

Sub-Micrometric Liposomes as Drug Delivery Systems in the Treatment and Periodontitis

Periodontitis is a complex disease and bacterial infection is one of the most common factors involved in this disease. Current strategies for the local delivery of antibiotics do not allow a complete clearance of bacteria filling dentinal tubules and this limits their therapeutic efficacy. Therefore, there is a strong need for the development of new delivery strategies aimed at improving the efficacy of antibiotic therapy for periodontitis with special reference to their ability to penetrate into the tubules. The aim of the present study is to develop liposome-based delivery systems of sub-micron dimension, able to diffuse into the dentinal tubules. A further aim of the research is to develop a protocol for enhanced diffusion based on the use of magnetic liposomes and magnetic fields. Liposomes were produced by hydration of a pre-liposomal formulation. The vesicles were stabilised with PEG and their re-sizing was achieved by extrusion. Magnetite nanoparticles were synthesized inside the vesicles, i.e., the chemical reaction involving FeCl2, FeCl3 and NH3 occurred within the core of the newly formed liposomes. Dynamic Light Scattering analysis was performed for size characterization. A mathematical model was implemented to predict the diffusion of the liposomes in dentinal tubules. Ex-vivo validation was performed on extracted human teeth. We produced PEG-ylated liposomes (average size 204.3 nm) and PEG-ylated magnetic liposomes (average size 286 nm) and an iron content of 4.2μg/ml. Through mathematical modelling, we deduced that sub-micrometer vesicles are able to penetrate into dentinal tubules. This penetration is considerably more effective when the vesicles are magnetized and subjected to an external magnetic field which accelerates their movement within the tubules. The liposome-based delivery systems developed by the present study are able to penetrate deeply into the tubules, sometimes reaching their terminal ends.

Benign ulcer of the right colon clinically misdiagnosed as carcinoma: an additional case

Benign solitary ulcer of the colon is an uncommon lesion that was originally described by Cruveilhier in 1832. Its aetiology remains unknown, and there are no pathognomonic lesions or symptoms. Diagnosis is made by exclusion; in fact, diseases such as specific infections (cytomegalovirus, campylobacter jejuni, entamoeba histolytica), common clinical conditions (acute appendicitis, diverticulitis, intestinal obstruction, inflammatory bowel disease), pharmacotherapy (non-steroidal anti-inflammatory medications, oral contraceptives, dicumarolic agents) and malignancies should be excluded. We describe the case of a 72-year-old patient admitted for acute bloody diarrhoea, originally misdiagnosed as carcinoma by colonscopy. The histological evaluation demonstrated a benign ulcerative lesion.

Assessment of the 10-year risk of fracture in Italian postmenopausal women using FRAX®: a north Italian multicenter study

The aim of the study was to estimate the absolute risk of fracture in a sample of postmenopausal women with the Italian version of FRAX®, using femoral neck bone mineral density (BMD) and 3 internationally validated clinical risk factors (CRFs) (history of fragility fracture, family history of hip fracture, current smoking). We retrospectively studied 9586 women (mean age 64.1 yr) examined in three osteoporosis centers from Northern Italy over two years (2001-2002). The risk of major osteoporotic (clinical spine, hip, forearm and humerus) and hip fractures was estimated using the online version of the FRAX algorithm adapted for Italy. The median 10-year risk was 7.5% for osteoporotic fracture and 1.7% for hip fracture. 25% of subjects had a 10-year risk ≥ 12.1% for osteoporotic fracture and ≥ 4.1% for hip fracture. The median 10-year risk of fracture increased with the number of prevalent CRFs. For major osteoporotic fractures risk rose from 6.3% to 10.9%, 21.4% and 40.9% with 1, 2 and 3 prevalent CRFs, respectively. For hip fractures the corresponding figures were: 1.3%, 2.7%, 7.0% and 21.9%, respectively. However, it must be emphasized that in 2 out of 3 women, none of the CRFs examined was present and the assessment of risk was limited to age and BMD. Our data provide the first description of the effect of the combination of BMD, age and CRFs on fracture risk stratification in a large sample of Italian postmenopausal women using FRAX®. The results are a useful starting point to define criteria for the application of FRAX® in clinical practice in Italy.