Consensus paper on postural dysfunction: recommendations for prevention, diagnosis and therapy

Good fundamentals of posture and balance are essential for the efficient performance of both simple daily tasks and more complex movement patterns. In particular, postural balance is the ability to keep the body in equilibrium and to regain balance after the shift of body segments: postural control mechanisms of integration of the visual, vestibular and foot afferential channels contribute to this. This document provides recommendations based on scientific evidence, clinical practice, and consensus between experts concerning the prevention, diagnosis, and treatment of postural dysfunction at the three stages of life as the developmental age, adult age, and old age > 65 years and follows the "National Guidelines on Classification and Measuring of Posture and its Dysfunctions" per the Italian Ministry of Health (December 2017). The paper answers four main questions: i) "Which measures can be adopted to prevent postural dysfunctions?" ii) "What can we do in order to make a correct diagnosis of postural dysfunction?" iii) "What are the correct treatment programs for postural dysfunctions?" iv) Which professional competencies and experiences are useful for preventing, diagnosing and treating postural dysfunctions? By the Consensus of the Experts and the scientific evidence, emerge that the approach to postural dysfunctions requires a multidisciplinary and interdisciplinary team. Furthermore, rehabilitation treatment interventions must be specific to the age groups that have been indicated, to consider the integration of the main systems and subsystems of postural control that change with age.

Which route of antibiotic administration should be used for third molar surgery? A split-mouth study to compare intramuscular and oral intake

OBJECTIVE

To compare the effectiveness of two different routes of antibiotic administration in preventing septic complications in patients undergoing third molar extraction.

MATERIALS AND METHODS

Twenty-four healthy patients requiring bilateral surgical removal of impacted mandibular third molars were successfully enrolled for this study. Depth of impaction, angulation, and relationship of the lower third molars with the mandibular branch had to be overlapping on both sides. A split-mouth design was chosen, so each patient underwent both the first and second surgeries, having for each extraction a different antibiotic route of administration. The second extraction was carried out 1 month later. To compare the effects of the two routes of antibiotic administration, inflammatory parameters, such as edema, trismus, pain, fever, dysphagia and lymphadenopathy were evaluated 2 and 7 days after surgery. Side effects of each therapy were evaluated 48 h after surgery.

RESULTS

Oral and intramuscular antibiotic therapies overlap in preventing post-operative complications in dental surgery (p>0.05), even if the oral intake, seems to promote the onset of significant gastrointestinal disorders (p=0.003).

CONCLUSIONS

This study could help dentists in their ordinary practice to choose the right route of antibiotic administration in the third molar surgery. At the same effectiveness, the higher cost and the minor compliance of the patient seem not to justify a routine antibiotic intramuscular therapy, reserving it for patients with gastrointestinal disorders.

Comparative molecular analysis of bacterial species associated with periodontal disease

Periodontal disease is an inflammatory disorder affecting the supporting teeth structures, including gingiva, periodontal ligament and alveolar bone, causing loss of connective tissue, reabsorption of alveolar bone and formation of periodontal pockets. The aim of this study is to find a correlation between bacterial growth and periodontal disease. Fifty-seven patients aged between 21 and 65 years, median age 46 years, were enrolled. According to gingival pocket depth, ranging from 3 to 7 mm, patients were divided into two groups: the first (30 patients, 53%) with deep pockets ³ 5 mm and the second (27 patients, 47%) less than 5 mm. The samples taken were processed for microbiological analysis by absolute quantitative real-time Taq-Man technique. Patients affected by periodontal disease were 32 (56%) and patients with gingival bleeding were 35 (61%). This data showed that the presence, the type and the bacterial load in gingival pockets were strongly correlated with gingival depth, periodontal disease and gingival bleeding. Quantitative microbiological analysis is a key point to improve patient compliance, allowing to choose the specific antibiotic treatment. avoiding antibiotic resistance and ensuring the successful outcome of therapy for periodontal disease.

Alkaline phosphatase level in gingival crevicular fluid during treatment with Quad-Helix

The aim of this work is to assess the level of the human alkaline phosphatase enzyme (ALP) during palatal expansion with Quad-Helix (QH) appliance. A total of twenty-two orthodontic patients characterized by contraction of the upper jaw, that needed application of a QH in order to treat their condition, were included in this study. Gingival crevicular fluid (GCF) was collected at four different times: before cementation (T0), after two weeks (T1), after four weeks (T2) and after one year (T3) from application of QH. In each patient maxillary first molars, right (UM-right) and left (UM-left), which were connected with bands to QH, were used for testing; first lower molars were used as Controls (LM-right, LM-left). Data show that ALP level in tension sites was proportional to the average increase of the inter-molar distance; on the contrary, the enzymatic level in compression sites was characterized by an inverse trend. The only exception to this phenomenon was recorded after one year (T3), when the increase of ALP level in both sites of tension and compression was ascribed to a mild inflammation due to bacterial plaque accumulation. The level of ALP in control sites was constant for the whole period of observation. The described ALP fluctuations in accordance with the inter-molar distance increment, shows that the main action of QH on bone remodelling was exerted during the fourth week (T2); for this reason, the monitoring of this enzyme could be used as a marker of effective function of the QH appliance.

Gender assessment through three-dimensional analysis of maxillary sinuses by means of cone beam computed tomography

OBJECTIVE

The availability of a low dose radiation technology such as Cone Beam Computed Tomography (CBCT) in dental practice has increased the number of scans available for forensic purposes. Moreover, specific software allows for three-dimensional (3D) characterization of the maxillary sinuses. This study was performed to determine whether sinus maxillary volumes can be useful to identify gender after validating the use of the Dolphin software as a tool for volumetric estimation of maxillary sinus volumes.

PATIENTS AND METHODS

The validation was performed by four different operators measuring the volume of six phantoms, where the real volume was already known. The maxillary sinus volumes of 52 patients (26 males and 26 females) mean age 24.3 were calculated and compared between genders and sagittal skeletal class subdivision. The measurements for patients and phantoms were based on CBCT scans (ILUMA™) processed by Dolphin 3D software.

RESULTS

No statistical difference was observed between the real volume and the volume measurements performed by the operators. No statistical difference was found in patient's maxillary sinus volumes between gender.

CONCLUSIONS

Based on our results, it is not possible to support the use of maxillary sinuses to discern sexual difference in corpse identification.

Third Class Resolver: a retrospective analysis

AIM

To evaluate the use of Third Class Resolver (TCR), a new fixed and functional orthopaedic appliance for the treatment of skeletal Class III malocclusion in adolescents and young adults.

MATERIALS AND METHODS

Study design: Retrospective analysis. Twenty subjects, 10 females and 10 males, affected by Class III malocclusion were treated with a new fixed orthopaedic appliance: the Third Class Resolver (TCR). The mean age was 7 years at the beginning of treatment and 9 years at the end of treatment. The mean treatment time was 6 months. Digital cephalometric superimpositions on lateral radiographs taken at the start and end of treatment were assessed. The cephalometric values were statistically analysed.

RESULTS

Cephalometric analysis of changes during treatment shows a statistically significant increase of ANB angle (mean 1°) (P = 0.045); increase of Witts Index (mean 3.5 mm) (P = 0.003); decrease of Maxillo-Mandibular angle (MM) (mean -2.3°) (P = 0.047); increase of Upper incisor-Maxilla Plane angle (angle mean 10.5°) (P = 0.02); increase of the distance between Upper Incisor and A-Pg line (mean 2.4 mm) (P = 0.021); increase of the mandibular branch length (mean 4.8 mm) (P = 0.004).

CONCLUSION

TCR can be used fully for treatment of Class III malocclusions.

Second Class Resolver: a retrospective analysis

AIM

To evaluate the use of Second Class Resolver (SCR), a new fixed orthopaedic appliance, for the treatment of skeletal Class II malocclusion in growing subjects.

MATERIALS AND METHODS

Design Retrospective analysis. Forty subjects were treated with Second Class Resolver (SCR). The mean age was 8 years at the beginning of treatment and 10 years at the end of treatment. Digital cephalometric superimpositions on lateral radiographs taken at start and end of treatment were assessed. The cephalometric values were statistically analysed.

RESULTS

Cephalometric analysis of changes during treatment shows reduction of ANB angle (mean 2°); reduction of Witts Index (mean 3 mm); reduction of Maxillo-Mandibular angle (MM) (mean 1°); reduction of SNA (angle mean 3°); reduction of gonial angle (mean 1.8°); increase of the mandibular branch length (mean 5 mm); increase of mandibular body (mean 2.9°).

CONCLUSION

The Second Class Resolver can be beneficially used for the treatment of Class II malocclusion.

[What new fathers know, think and do: a survey about fathering's attitudes, beliefs and behaviors in a sample of 570 men just after the birth of their newborn]

AIM

The aim of this paper was to know and analyze information, attitudes and behaviors related with transformations occurring in men when they become fathers.

METHODS

A self-administered questionnaire has been given out to all men whose newborns were born in the Hospitals located into Borgosesia, Ivrea, Novara, Verbania and Vercelli (Piedmont region in north west of the Italy) in the last quarter of 2006. The questionnaire was created ad hoc and filled out on the day of discharge; results underwent statistical analyses through SPSS system.

RESULTS

For the duration of the research, out of 870 men who became fathers in the hospitals were involved in this study, 570 responded voluntarily to the self-administered questionnaire (65.6% of the total sample). They showed a lack of information about how to take care of their newborns and the emotional turmoil of women after delivery (58% think children are blind when they are born, 52% think it is better to breastfeed newborns at fixed times and 47% ignore that mothers can enter a depression state). Eighty-eight percent of respondents were in the delivery room to see their child's birth, 56% took a leave from job to stay with mother and child in the hospital and 58% of them report the intention to take an additional 2-3 days leave after coming home from the hospital; 27% had trouble sleeping during pregnancy and are afraid not to be good fathers for their child; 90% believe that their newborn will make them change life habits. Most of the new fathers had difficulties in sharing emotions and feelings related with their status of fathers-to-be with other men. Some of these results are significantly different in older fathers, fathers having their first child and fathers with a lesser level of education.

CONCLUSION

During pregnancy and in the first months after their child is born, fathers-to-be and new fathers must be considered a potential target for educational interventions aiming at promoting their parenting information and reinforcing their positive attitudes and beliefs related with their fathering status.

X-ray diagnosis of the pressure induced Mott nonmetal-metal transition

The evolution of the K-edge x-ray absorption near-edge spectroscopy (XANES) spectrum is investigated for an aluminum plasma expanding from the solid density down to 0.5  g/cm{3}, with temperatures lying from 5 down to 2 eV. The dense plasma is generated by nanosecond laser-induced shock compression. These conditions correspond to the density-temperature region where a metal-nonmetal transition occurs as the density decreases. This transition is directly observed in XANES spectra measurements through the progressive formation of a preedge structure for densities around 1.6  g/cm{3}. Ab initio calculations based on density functional theory and a jellium model have been efficiently tested through direct comparison with the experimental measurements and show that this preedge corresponds to the relocalization of the 3p atomic orbital as the system evolves from a dense plasma toward a partially ionized atomic fluid.

Electronic structure investigation of highly compressed aluminum with K edge absorption spectroscopy

The electronic structure evolution of highly compressed aluminum has been investigated using time resolved K edge x-ray absorption spectroscopy. A long laser pulse (500 ps, I(L)≈8×10(13) W/cm(2)) was used to create a uniform shock. A second ps pulse (I(L)≈10(17)  W/cm(2)) generated an ultrashort broadband x-ray source near the Al K edge. The main target was designed to probe aluminum at reshocked conditions up to now unexplored (3 times the solid density and temperatures around 8 eV). The hydrodynamical conditions were obtained using rear side visible diagnostics. Data were compared to ab initio and dense plasma calculations, indicating potential improvements in either description. This comparison shows that x-ray-absorption near-edge structure measurements provide a unique capability to probe matter at these extreme conditions and severally constrains theoretical approaches currently used.

Effects of interceptive orthodontics on orbicular muscle activity: a surface electromyographic study in children

The purpose of this study was to assess by surface electromyography (sEMG) the changes in upper and lower orbicular oris (OO) muscles produced by a preformed functional device in subjects with Class II, division 1 malocclusion, deep bite, and labial incompetence. Twenty-eight subjects were selected: 13 subjects (mean age 9 ± 1.5 years) with Class II malocclusion, deep bite, and labial incompetence were treated with a preformed functional device, while 15 subjects (mean age 9.5 ± 0.8 years) with normal occlusion were used as control. Inclusion criteria for both groups were: presence of mixed dentition, no previous orthodontic treatment, and absence of speech disturbance. sEMG recordings were taken at the time of the first visit (T0), and after 3 (T1) and 6 months (T2) for the treated group, and at T0 and T2 for the control group. The sEMG recording was performed at rest, and while kissing, swallowing, opening the mouth, clenching the teeth, and during protrusion of the mandible, by placing electrodes at the area of muscle contraction. At T0, except during swallowing, the treated group always showed a lower sEMG activity of the lower OO muscle with respect to the control group, with significant differences at rest and during mandibular protrusion (p<0.05). In the treated group, a significant increase in muscle tone was observed for the lower OO muscle from T0 to T1, but only at rest. The upper OO muscle showed a significant increase during the protrusion of the mandible from T1 to T2. No significant change was observed in the control group during the follow-up. Muscular contractility of treated patients at T2 reached the same values as that of the control group at T2. Interceptive orthodontics seems to improve the form and function of the orofacial muscle structure. Improvement in muscle contraction after treatment was demonstrated by sEMG.

Three-dimensional tomographic mapping related to primary stability and structural miniscrew characteristics

OBJECTIVES

To evaluate the maxilla, mandible, and cortical plates on computerized tomographic (CT) scans to achieve accurate three-dimensional bone thickness measurements.

SETTING AND SAMPLE POPULATION

We selected the CT scans of 25 subjects (among 102), aged 18-58 years (10 men, 15 women), with nearly complete dentition.

MATERIAL AND METHODS

We performed interradicular and bucco-lingual (including cortical plate thickness) measurements in dental areas distal to the canines in both alveolar arches, at three levels (5, 8, and 11 mm) from the alveolar ridge.

RESULTS

The mean thicknesses of the cortical plates in the maxilla were 1.10 mm buccally and 1.27 mm on the palatal side (p < 0.05). In the mandible, cortical plates were 2.23 mm buccally and 2.02 mm lingually. Mandibular buccal and lingual cortical plates became thicker distally in the second and third molar areas. There was considerable variation in cortical thickness (from 0.25 to 5.50 mm). Based on interradicular distances, only 13% of measured sites in the maxilla were suitable for miniscrew insertion (≥3.3 mm), but 63% of sites were suitable in the mandible.

CONCLUSION

This study showed considerable individual variation in bone thickness. Our data suggested that the palatal/lingual side may provide greater primary stability for miniscrews. The palatal area, between the second upper bicuspid and the first molar, appeared to be the most suitable area for tapered 7- to 9-mm miniscrews, starting at 1.5-2 mm from the alveolar crest.

The analysis of walking in subjects with and without temporomandibular joint disorders. A cross-sectional analysis

AIM

The aim of this study was to determine if stomatognathic functions correlate with alterations in walking function, that are detectable through the analysis of walking.

METHODS

The study enrolled 24 Caucasian adult females (mean age 27.9+/-4.5), asymptomatic for temporomandibular and muscular disorders and 20 Caucasian adult females with temporomandibular joint disorders (TMDs). The analysis of walking was performed under three different experimental conditions: 1) mandibular rest position (RP); 2) habitual dental occlusion (DO); 3) cotton rolls between the upper and the lower dental arches (CRs).

RESULTS

The mean pressure during walking, measured as g/cm(2), on the theoretical barycentre, the percentage of loading on the left and the right feet (measured as %) and the loading surface, measured as mm(2), under the right and the left feet, were recorded as posturographic parameters. Generally, no difference was found in any of these parameters in the mean pressure during walking in the different considered conditions; only when two cotton rolls were positioned between the dental arches the load pressure was found to be significantly higher in the TMD patients than in the control subjects (P<0.05). In addition, in the same condition, TMD subjects showed a significantly smaller loading surface than control subjects, both under the right and the left feet.

CONCLUSION

TMDs seem to be associated to detectable alterations of the walking function.

Identification of COL6A1 as a differentially expressed gene in human astrocytomas

Diffuse infiltrating gliomas are the most common tumors of the central nervous system. Gliomas are classified by the WHO according to their histopathological and clinical characteristics into four classes: grade I (pilocytic astrocytoma), grade II (diffuse astrocytoma), grade III (anaplastic astrocytoma), and grade IV (glioblastoma multiforme). Several genes have already been correlated with astrocytomas, but many others are yet to be uncovered. By analyzing the public SAGE data from 21 patients, comprising low malignant grade astrocytomas and glioblastomas, we found COL6A1 to be differentially expressed, confirming this finding by real time RT-PCR in 66 surgical samples. To the best of our knowledge, COL6A1 has never been described in gliomas. The expression of this gene has significantly different means when normal glia is compared with low-grade astrocytomas (grades I and II) and high-grade astrocytomas (grades III and IV), with a tendency to be greater in higher grade samples, thus rendering it a powerful tumor marker.

Modification of condyle anatomy following a monolateral bite rise: a histological study in rat

The aim of this study is to evaluate the histologic modifications of rat articular capsules, after compression and strain. Fifty adults Sprague Dawley rats were used in this study. The rats were divided into 3 groups: a dysfunction group, treatment group and a Control group. In the rats in the first two groups an occlusion hump, made of composite and less than 0.5 mm high, was applied to the upper right molar. The rats were anesthetized with an intraperitoneal injection of benzodiazepine (0.5-1 mg for 100 g. of body weight). The composite used consisted of a hollow, plastic cylinder 0.5 mm high, spread over the whole occlusal surface of the right upper molar. The dysfunction group therapy wore the occlusion hump for a week, at the end of which the animals in this group were killed and their temporomandibular joint removed. In the treatment group a second occlusion hump was applied to the left upper molar, in order to obtain a distraction of the previously compressed temporomandibular joint. The rats of the second group wore the second occlusion hump for one week. The rats were then killed with an intraperitoneal injection of Tanax, and the block sections, containing the temporo-mandibolar joint, were retrieved with a diamond disk, and surrounding tissues were washed in saline solution and immediately fixed in 4 percent formalin for 4 days. In the control group, no treatment was applied. In the first group, bone resorption was observed in the left temporomandibular joint; no osteoclast were, however, present. No other tissue alterations were present. Newly formed bone undergoing remodelling was intensely stained with acid fuchsin. In the second and third groups, no bone remodelling areas were observed. In conclusion, the compression of the temporomandibular joint determined a remodelling of the bone structure of the condyle.

Role of the friction free distalize appliance (2FDA)PAT in the molar distalization: photoelastic analysis and alkaline-phosphatase (ALP) activity on first molar and bicuspid

Maxillary molar distalization is an increasingly popular option for the resolution of Class II malocclusions. This study describes the effects of one particular molar distalizing appliance, the Friction Free Distalize Appliance (2FDA), in a sample of 20 consecutively treated and growing patients to verify the osteoblastic activity in the compression and traction sites of both the molars and the bicuspids when used as the anchorage teeth. The 2FDA appliances were constructed utilizing a Nickel Titanium open coil spring of 200 gr force in order to distalize the maxillary first molar. The reaction force was controlled utilizing the principle of low/free friction. The results show that the resin around the root of the bicuspid did not discolour at all, which indicates an absence of a force load. On the other hand, on the molar, the resin around the root of the molar became discoloured due to the fact that an orthodontic force was involved with the tooth. To better understand whether the quantity of force that reached the tooth was able to produce osteoblastic recruitment in the sites of tension of the molar and the bicuspid, we quantified an enzyme, the alkaline phosphatase (ALP), present. This measurement allowed us to verify a regular increase of the ALP on the site of molar traction. We also elaborated a mathematical model to evaluate the quantity of force of reaction that produces the device on the bicuspid. Such force results as being 8.34 grams which equals half the pressure of the capillaries of the parodontal ligament (18 grams). The 2FDA appliance compares favourably with other intra-oral distalization devices for the resolution of patients with Class II malocclusions, and is the only distalizing appliance that does not determine osteoclastic/osteoblastic recruitment on the anchorage tooth.

An electromyographic evaluation of bilateral symmetry of masticatory, neck and trunk muscles activity in patients wearing a positioner

This study was designed to investigate the attitude of a positioner (Finition) or an Hawley's retention appliance to create a symmetric function of the masticatory, neck and trunk muscles during the orthodontic retention phase. Sixteen patients (18.5 +/- 2.2 years) were included in the sample. All the patients received an orthodontic therapy for the treatment of an Angle's class I malocclusion and skeletal class I, for a period of 2 years. After removal of orthodontic brackets, eight patients wore a teeth positioner (group I) as retention appliance and eight subjects wore an Hawley's appliance as upper retention (group II). Surface electromyographic (sEMG) activity was recorded from the bilateral anterior temporal, posterior temporal, masseter, sternocleidomastoid (SCM), upper and lower trapezius and cervical muscles at mandibular rest position and during maximal voluntary clenching (MVC) at T0, i.e. soon after the removal of orthodontic brackets and at T1, i.e. after 3 months of retention treatment. No significant difference was observed between the two groups at T0. At T1, at mandibular rest position, the group I showed a significantly lower sEMG activity of anterior temporal and SCM muscles compared with the group II. During MVC, at T1, the group I showed a significantly lower sEMG activity of the SCM and posterior cervicals, compared with the group II. The positioner seems to show a relevant effect on the sEMG activity of masticatory, neck and trunk muscles.

Enamel surface after debracketing of orthodontic brackets bonded with flowable orthodontic composite. A comparison with a traditional orthodontic composite resin

AIM

Flowable composites showed acceptable shear bond strength for bonding orthodontic brackets, but it still lacks evidence if the routine clean-up of this type of composites from enamel surface after debracketing is susceptible of more difficult procedure, due to their fluidity, and, consequently, more enamel lesions, compared with traditional orthodontic composites. Thus, this in vitro study investigated this point.

METHODS

Stainless steel brackets were bonded to 60 extracted human premolars using: 1) a new flowable composite (Denfil Flow) (group I; N=20); 2) a traditional flowable composite (Dyract Flow) (group II; N:20); 3) Transbond XT adhesive (group III; N=20). Twenty untreated teeth were the control group. After a routine debonding procedure, the adhesive remnant index (ARI) was calculated in each tooth. After the following clean-up procedure, enamel cracks (measurements about their frequency, their position in the tooth crown and their direction) were evaluated using fiber-optic transillumination. Finally, enamel surfaces were analyzed with scanning electron microscope to quantify enamel lesions

RESULTS

A significantly higher frequency of enamel cracks, (from 65% to 80%), mostly in the cervical third of tooth crown (from 65% to 80%) and vertical (from 75% to 80%), were observed in the three study groups, compared with the control group (P<0.05), without difference among the three study groups. The index of enamel lesions was significantly higher in the three study groups, compared with control group (P<0.05), without significant differences among the three study groups.

CONCLUSION

Flowable composites seem to show no relevant differences in terms of enamel lesions and cracks compared with traditional composites.

Relation between cervical posture on lateral skull radiographs and electromyographic activity of masticatory muscles in caucasian adult women: a cross-sectional study

The aim of this study was to evaluate the association between cervical posture on lateral skull radiographs and surface electromyographic recordings (sEMG) of head and neck muscles. The sample comprised 40 Caucasian adult females, average age 26.8 (20-48); lateral skull radiographs were obtained in natural head position (mirror position). sEMG activity was bilaterally investigated for the following muscles: masseter, anterior temporalis, digastric, posterior cervical, sternocleidomastoid and upper and lower trapezius. All muscles were monitored at rest and during maximal voluntary clenching (MVC). A Pearson's correlation coefficient revealed significant correlations (P < 0.01) between cranio-cervical angulations and sEMG activity of masseter, digastric, lower trapezius, during MVC and anterior temporalis at rest. Significant correlations (P < 0.01) were also found between cervical lordosis angle and sEMG activity of masseter (during MVC) and lower trapezius (at rest). In view of transversal method, no conclusion was possible about the mechanism concerning these results. Future longitudinal studies should be directed to understand the extent of environmental and genotype influences by masticatory muscle activity on cervical posture.

Electromyographic activity of masticatory, neck and trunk muscles of subjects with different skeletal facial morphology ? a cross-sectional evaluation

The electromyographic pattern activity of masticatory, neck and trunk muscles was assessed using surface electromyography (sEMG) in 60 Caucasian adult females (20 subjects in skeletal class I, 20 subjects in skeletal class II and 20 subjects in skeletal class III), classified on the base of their skeletal class (ANB angle), corrected on the base of maxillary and mandibular rotations. The sEMG activity was recorded at mandibular rest position and during maximal voluntary clenching. At mandibular rest position, the sEMG activities of masseter and anterior temporal muscles were significantly higher in class III subjects than in class I and class II subjects, that showed no significant difference between them. Then, the sEMG activities of posterior cervicals and upper trapezius were significantly higher in skeletal class III subjects than in the other two groups. During maximal voluntary clenching, no significant difference was observed in the sEMG activity of masticatory muscles among the three considered groups. However, the sEMG activities of posterior cervicals and upper trapezius were significantly higher in skeletal class III subjects than in the other two groups, which showed no significant difference between them. In conclusion, the skeletal class seems to affect the sEMG pattern activity of masticatory, neck and trunk muscles.

Functional infrared imaging in the diagnosis of the myofascial pain

Functional infrared imaging has been used to study 17 patients, affected by myofascial pain, and 19 healthy subjects during maximal voluntary clenching (MCV). Aim of the study was to attempt to discriminate patients from healthy subjects through the analysis of the skin temperature distribution and its change during the clenching. The prestress and the post-stress temperatures were evaluated bilaterally for several regions of interest. We calculated differences in temperature between sides (DeltaTs) at each time (pre and post), and between times (DeltaTt) for each side (left and right). Subsequently, we compared DeltaTs and DeltaTt between the healthy and myofascial pain groups. DeltaTs was significantly higher in sufferers compared to healthy people (p<0.05) for both types of evaluation (by side and by time). DeltaTs was significantly different for masseter and sternocleidomastoid, whereas DeltaTt was higher in almost all sites (masseter, sternocleidomastoid, cervical and upper trapezius). Healthy subjects, undergoing MVC, showed the lowest DeltaT value variability, suggesting that temperature remained constant despite the induced physical exercise. Functional infrared imaging seems to distinguish healthy subjects from the patients suffering myofascial pain in almost all the investigated sites.

Effects of anterior cruciate ligament (ACL) injury on postural control and muscle activity of head, neck and trunk muscles

The aim of the study was to evaluate the effects that an anterior cruciate ligament injury of the knee has on postural control and activity of neck, head and trunk muscles to investigate the existence of connections between the masticatory system and body posture. Surface electromyographic activity of the muscles at mandibular rest position, and during maximal voluntary clenching and posturometric and stabilometric measurements of 25 adult patients having pathology on the left knee were compared with a control non-pathological group. At rest, the patients showed a higher muscular activity of anterior temporalis, masseter, sternocleidomastoid and lower trapezius, compared with the control subjects (P < 0.05). At maximal voluntary clenching, the patients showed a lower muscular activity of the right anterior temporalis and masseter and a higher muscular activity of the lower trapezius, compared with the control subjects. For the stabilometric measurements, all the subjects showed a significant reduction in the postural centre of pressure path length during the test with eyes open and cotton rolls, compared with the test with eyes closed and mandibular rest position (P < 0.05). In addition, the patients showed a significant displacement of the postural centre of pressure in a forward direction (P < 0.05) and into the right side (P < 0.05), compared with the control subjects. Anterior cruciate ligament injury appears to be associated to a change in the activity of head, neck and trunk muscles and to a change in the position of the postural centre of pressure. Cotton rolls seem to improve the stability of the subject.

Gene expression profiles underlying alternative caste phenotypes in a highly eusocial bee, Melipona quadrifasciata

To evaluate caste-biased gene expression in Melipona quadrifasciata, a stingless bee, we generated 1278 ESTs using Representational Difference Analysis. Most annotated sequences were similar to honey bee genes of unknown function. Only few queen-biased sequences had their putative function assigned by sequence comparison, contrasting with the worker-biased ESTs. The expression of six annotated genes connected to caste specificity was validated by real time PCR. Interestingly, queens that were developmentally induced by treatment with a juvenile hormone analogue displayed an expression profile clearly different from natural queens for this set of genes. In summary, this study represents an important first step in applying a comparative genomic approach to queen/worker polyphenism in the bee.

Influence of knee pathology on body posture and muscle activity of head, neck and trunk muscles

AIM

The aim of the study was to evaluate the effects that an anterior cruciate ligament (ACL) injury of the knee has on postural control and activity of neck, head and trunk muscles in order to investigate the existence of connections between the masticatory system and body posture.

METHODS

Surface electromyographic (sEMG) activity of the muscles and their asymmetry index, at mandibular rest position, and during maximal voluntary clenching (MVC), and posturometric and stabilometric measurements of 25 patients (mean age 28+/-9 years) having undergone ACL injury of the left knee were compared with a control non-pathologic group.

RESULTS

At rest, the patients showed a higher sEMG activity of the anterior temporalis, masseter, sternocleidomastoid and lower trapezius, compared with the control subjects (P<0.05). At MVC, the patients showed a lower sEMG activity of the right anterior temporalis and masseter and a higher sEMG activity of the lower trapezius, compared with the control subjects. For the stabilometric measurements, all the subjects showed a significant reduction in the Center of Pressure (CoP) path length during the test with eyes open and cotton rolls, compared with the test with eyes closed and mandibular rest position (P<0.05). In addition, the patients showed a significant displacement of the CoP in a forward direction (P<0.05) and to the righ side (P<0.05), compared with the control-subjects during each test.

CONCLUSIONS

ACL injury appears to be associated to a change in the sEMG activity of head, neck and trunk muscles and to a change in the position of the CoP of the body. Cotton rolls seem to improve the stability of the subject.

A multi-biomarker analysis of DNA damage in automobile painters

The genotoxic effects associated with automobile painting were analyzed using a panel of biomarkers. Chromosomal aberrations (CAs), sister chromatid exchange (SCE), and micronuclei were evaluated in 25 car painters (12 smokers, 13 nonsmokers) working in different automobile paint-shops in Italy and in 37 control subjects. The controls were healthy blood donors (14 smokers, 23 non-smokers) that were matched with the experimental population for gender and age. Air samples were analyzed regularly at the work places, and elevated concentrations of benzene and toluene were detected consistently. The exposed group had higher frequencies of CAs (both chromosome- and chromatid-type), micronuclei, and SCE (P < 0.5 - P < 0.001). Furthermore, exposed and control subjects were also genotyped for GSTM1 and GSTT1 polymorphism. No significant associations were detected between the biomarker responses and either the GSTM1 or GSTT1 genotype of the subjects, but the small sample size does not allow definite conclusions on the relationship between the genetic polymorphism and the biomarkers. The results indicate that automobile painters have increased levels of clastogenic and possible aneugenic damage and that smoking may be a confounding factor for the responses.

Immunohistochemical Evaluation of VEGF Inflamed Cystic Radicular Lesions and in Keratocysts

Vascular Endothelial Growth Factor, also known as Vascular Permeability Factor, is a multifunctional cytokine hyperexpressed during angiogenesis and in numerous physiological and pathological processes characterised by an increase of vascular permeability. The aim of this study was to evaluate the angiogenetic processes which are accompanied by an expansion of cystic radicular lesions and of keratocysts of the jaw bone. 12 subjects were chosen with an average age of 43 years, of whom 8 were males and 4 females. After an accurate history and physical examination, the patients underwent surgery for removal of the cysts. The samples taken were histologically and immunohistochemical examined. The histological exam confirmed the diagnosis of radicular cysts and keratocysts. The immunohistochemical examinations were positive for VEGF in all the lesions analysed, even though they had different immunostaining. Using a semi-quantitative method, in the radicular cyst samples it was possible to highlight a wider expression of the vascular component, both in the inflamed area and the adjacent stroma. The lesions with keratin content showed newly formed and modest vascularisation both in the area showing slight inflammation, where the cellular component was prevalent, and in the adjacent areas showing no inflammation. Therefore, angiogenesis could take on a primary role in the development of cystic lesions of the jaw. However, the differences of expression of the VEGF protein suggest the need for wider monitoring to better evaluate a possible use of such a protein as a diagnostic marker.

Surface electromyographic response of the neck muscles to maximal voluntary clenching of the teeth

The purpose of this study was to evaluate the activity of digastric, sternocleidomastoid, upper trapezius, lower trapezius and cervical muscles in response to maximum voluntary clenching (MVC) of the teeth. Twenty healthy subjects aged 24-31 years were divided into two groups of 10: a resting group and a clenching group. The resting group simply maintained the mandible at rest with teeth apart for two 1-min periods, whereas the clenching group underwent an initial resting period followed after 1-min by a clenching period during which they were required to perform MVC. The electromyography (EMG) responses of each muscle were recorded during all periods, and means and standard deviations of the root mean square EMG were calculated. Within-group and between-group comparisons of EMG activity were made using, respectively, the Sign two-tailed test for two related samples and the Kolmogorov-Smirnov two-tailed test for two independent samples (significance level 0.05). Data indicated a significant increase of EMG activity of the anterior neck muscles (digastric and sternocleidomastoid) during MVC as compared with EMG recorded during resting periods. If confirmed by further research, our findings suggesting an involvement of anterior neck muscles during isometric contraction of the jaw elevator muscles may have clinical implications.

[Opinions and attitudes of youngsters about sexually transmitted diseases]

A group of 1.085 students (582 M, 503 F) attending high school (742) and nursing school (343) filled in an anonymous questionnaire on their sexual habits and their knowledge of contraception and sexually transmitted diseases. Overall, 57% of the study population had already a complete sexual intercourse at a mean age of 16,4 (SD +/- 1,8). 74% had 1-3 sexual partners, whereas 28% had more than 3. All students affirmed that it was possible to prevent sexually transmitted diseases and 92,6% indicated correct methods. However 10% of students did not know that AIDS is transmitted sexually as 47% hepatitis B. The responses made by nursing students were more correct that those of high school students.

The Comet assay for the detection of DNA damage in Mus spretus from Doñana National Park

Doñana Park (Spain), a protected area in Europe, was affected by an environmental disaster in April 1998 that caused the spreading of acidic water and mud full of toxic metals from the Aznalcollar pyrite mine. In order to assess the contamination in the area and to monitor the possible biological effects of the toxic spill, a series of coordinated studies was performed utilizing several animal species living in that area. We performed genotoxicity monitoring using the Comet assay on peripheral blood leukocytes of the Algerian mouse (Mus spretus), a nonprotected rodent suitable as a bioindicator. The mice were sampled in different areas 6 months after the ecological disaster and again 1 year later. Our results showed that in 1998 all the areas examined were contaminated, as determined by an increase in the Comet assay parameters in the analyzed animals, whereas a significant decrease in the values of these parameters was observed in the 1999 samples, which were collected in a riverside area subject to tide flows. Thus, the Comet assay has proven to be an interesting and sensitive tool in studies of environmental genotoxicity.

Cerec 3 for orthodontics: a tool for treating deep bite

Bite-opening procedures are used in the early stages of orthodontic fixed treatment in order to: ease antero-posterior tooth movements; bracket the mandibular arch and level the Curve of Spee; prevent mandibular brackets from debonding; use regular straight archwires to proceed with treatment. For these purposes, removable or bonded biteplanes are universally recognized as very effective when the bite-opening is needed. Conventional orthodontic procedures include clinical solutions which effectively open the bite, but they all lack sufficient hygiene, comfort, and esthetics. The authors propose the use of the CAD-CAM technology with the Cerec 3 system (Sirona, Bensheim, Germany) to create an overcrown able to open the bite through clinical crown lengthening of the mandibular second premolars. The laboratory steps are described and the clinical efficacy is demonstrated with an orthodontic case report.

Strong antioxidant activity of ellagic acid in mammalian cells in vitro revealed by the comet assay

Oxidative stress due to oxygen and various radical species is associated with the induction of DNA single- and double-strand breaks and is considered to be a first step in several human degenerative diseases, cancer and ageing. Naturally occurring antioxidants are being extensively analysed for their ability to protect DNA against such injury. We studied three naturally occuring compounds, Ascorbic Acid, Melatonin and Ellagic acid, for their ability to modulate DNA damage produced by two strong radical oxygen inducers (H2O2 and Bleomycin) in cultured CHO cells. The alkaline Comet assay was used to measure DNA damage and a cytofluorimetric analysis was performed to reveal the intracellular oxidative species. The data showed a marked reduction of H2O2- and Bleomycin-induced DNA damage exerted by Ellagic Acid. On the contrary Ascorbic acid and Melatonin appeared to induce a slight increase in DNA damage per se. In combined treatments, they caused a slight reduction of H2O2-induced damage, but they did not efficiently modulate the Bleomycin-induced one. The Dichlorofluorescein diacetate (DCFH-DA) cytofluorimetric test confirmed the strong scavenging action exerted by Ellagic Acid.

Effects of topical diclofenac (DHEP plaster) on skin, subcutis and muscle pain thresholds in subjects without spontaneous pain

The aim of this study was to determine whether topical application of diclofenac hydroxyethylpyrrolidine (DHEP) modifies somatic pain sensitivity in subjects without spontaneous pain. Twenty male subjects (aged 19-40 years), who had not reported any pain for at least 1 month, underwent measurement of pain thresholds to bilateral electrical stimulation in the quadriceps muscle and overlying subcutis and skin. Following the double-blind study design, one diclofenac adhesive plaster (13 x 10 cm; 180 mg DHEP) was then applied over one quadriceps while a matched placebo plaster was placed contralaterally. Each subject was given two other plasters (diclofenac and placebo) and instructed to substitute those over the quadriceps after 12 h and to wear them for a further 12 h. Thirty minutes after removal of the second plasters, thresholds. were remeasured in all subjects as on the previous day. Thresholds at the first evaluation were within normal range in nine subjects (group 1) and below normal in muscle (hyperalgesia) in the remaining 11 (group 2). No significant changes were observed in skin or subcutis thresholds after diclofenac or placebo treatment in either group. In contrast, muscle thresholds significantly increased after diclofenac compared with placebo treatment (group 1: p < 0.05; group 2: p < 0.007); the increase was significantly higher in group 2 than in group 1 (p < 0.002). Topical application of diclofenac had a selective hypoalgesic effect on muscles, which was more pronounced in the case of hyperalgesia. These results suggest that the preparation is particularly effective in the treatment of algogenic conditions of deep somatic tissues.

[Activation of mandibular growth with the Fräenkel II device: assessment of effects on the vertical plane]

BACKGROUND

The aim of the study was to evaluate if a function Fräenkel II Regulator therapy can increase the vertical dimension of the cranio-facial district. Enlow's cephalometric analysis was used to measure the proportion between cranial and facial components without references to the population average.

METHODS

Twenty patients were selected, with dental class II, skeletal class II and mandibular hypoplasy and normal facial biotype. The patients were treated for 24 months only with Fräenkel II and the appliances was activated 2 mm every 6 months. The follow-up was of the 2 years and cephalometric tracings were made at the beginning and after therapy.

RESULTS

The results showed an increase of vertical dimension and the change of occlusal plane inclination after the therapy. This inclination compensates basal dysarmonies and increases the vertical dimension.

CONCLUSIONS

The results are not statistically significant, but they underline the importance of Fräenkel's regulator function to change negative tendency growth.

How to improve digital dental radiograph reproducibility: an individualized technique

Today, the advantages of the use of digital dental radiography as a valid alternative to conventional techniques are well known. In clinical dental practice, it can be useful to realize intraoral dental x-rays that can be compared, even after some years. The use of a conventional XCP instrument with the "long cone" technique helps to limit image distortion, but the comparison is poor. Moreover, in digital radiography, obtaining almost identical images is essential to superimpose them with dedicated software. The aim of the present work was to obtain fully superimposable and reproducible intraoral digital images through the use of an individual resin positioner. The laboratory phases are all described to create a system that enables exact placement of the digital sensor SIDEXIS (Sirona, Germany) in the mouth of the patient. The authors present a case report where the described technique is applied in the orthodontic field to evaluate molar distalization with a fixed appliance.

Evaluation of genotoxic and cytotoxic properties of pesticides employed in Italian agricultural practices

In a program coordinated by the Italian Ministry of Works, we tested in vitro four pesticides widely employed in a developed agricultural region of central Italy. The four commercial agents were chosen on the basis of their diffusion in agricultural practice, knowledge of their active principle(s), and scant availability of data concerning their toxic and genotoxic activity. The agents were Cirtoxin, Decis, Tramat Combi (TC), and Lasso Micromix (LM). All substances were tested in three in vitro systems: Chinese hamster ovary (CHO) cells, a metabolically competent hamster cell line (Chinese hamster epithelial liver; CHEL), and root tips of Vicia faba (VF). The cytotoxic and genotoxic end points challenged were micronuclei and root tip length (RTL) in VF and mitotic index (MI), proliferation index (PI), cell survival (CS), cell growth (CG), cell cycle length (CCL), sister chromatid exchanges, chromosomal aberrations, and single-cell gel electrophoresis, or comet assay, in CHEL and CHO cells. Tested doses ranged from the field dose up to 200x the field dose to take into account accumulation effects. On the whole, tested agents appear to induce genotoxic damage only at subtoxic or toxic doses, indicating a low clastogenic risk. MI, PI, CS, CG, RTL, and CCL appear to be the less sensitive end points, showing no effects in the presence of a clear positive response in some or all of the other tests. Using cytogenetic tests, we obtained positive results for TC and LM treatments in CHO but not in CHEL cells. These data could be accounted for by postulating a detoxifying activity exerted by this cell line. However, cytogenetic end points appear to be more sensitive than those referring to cytotoxicity.

[Familial variability in the clinical expression of hand-foot-mouth disease]

Aim of the paper is to describe the variability of clinical symptoms in hand, foot and mouth disease, especially among patients belonging to the same family. In spring 1999, during an epidemic of hand, foot and mouth disease, nineteen cases were observed by the authors. In eight cases also some members of the family were affected. A great variability in the clinical expression of the disease, above all among the members of the same family were observed. No cases in children below twelve months or in elderly members of the family were found. Children below three years had more stressed general symptoms, but in no case hospitalization was necessary. Hand, foot and mouth disease does not always show vesicles and aphthae in the affected areas. Clinical expression can also be lacking, but in this case diagnosis can be made easy by the presence of an epidemic or of other cases in the same family.

Site-specific subgingival colonization by Actinobacillus actinomycetemcomitans in orthodontic patients

A high prevalence of Actinobacillus actinomycetemcomitans (Aa) in subgingival plaque in patients for orthodontia already has been observed. The present study had the following aims: 1) to ascertain a direct relationship between the orthodontic appliance placement and the subgingival colonization by Aa, and 2) to determine whether the Aa growth specifically occurred on teeth with braces attached or whether the presence of orthodontic appliances could also cause the isolation of Aa in teeth free from therapeutic appliances. Twenty-four young systemically and periodontally healthy subjects with malaligned and crowded teeth in the anterior sextants of both dental arches participated in this study. After 1 session of ultrasonic scaling with oral hygiene instructions during the first experimental session, the mesiobuccal sites of the first molars and the distobuccal sites of the lateral incisors in both dental arches in each participant were subjected to clinical and microbiologic examination for the recovery of Aa. Clinical examination consisted of recording the presence of plaque and the examination of gingival bleeding on probing and probing depth. Microbiologic sampling was obtained with the insertion of 3 sterile paper points at the deepest part of each gingival sulcus. Altogether, 192 periodontal sites were examined. After the examinations, the patients received fixed orthodontic appliances in only 1 dental arch (test sites) and the other one was left free from appliances (control sites). Clinical examination and microbiologic sampling were repeated in the same experimental test and control sites after 4, 8, and 12 weeks. At the 12-week session, the orthodontic appliance was removed from the test arch, and, 4 weeks later, a further clinical and microbiologic examination was performed. The results showed that, during the period with orthodontic appliances, the presence of plaque scores and the gingival bleeding on probing scores were increased significantly and that Aa, initially absent from all but 1 subject, was isolated in 19 and 20 subjects after 4 and 8 weeks, respectively. Furthermore, no gingival sites from the control teeth (free from Aa colonization at baseline) showed positive results for the sought-after bacterium throughout the entire length of the study. It was concluded that the placement of orthodontic appliances promotes the subgingival growth of Aa; this specific microbial change is specifically restricted to subgingival plaque from orthodontic appliance-bearing teeth. The presence of orthodontic bands and brackets therefore cannot affect the microbiologic condition of the whole mouth.

Inhibitory action of melatonin on H2O2- and cyclophosphamide-induced DNA damage

Melatonin, the pineal gland hormone known for its ability to modulate circadian rhythm, has recently been studied in its several functions. It is believed to inhibit cancer growth, to stimulate the immune system and to act as an antioxidant. In particular, this latter activity is ascribed to two different mechanisms: stimulation of radical detoxifying enzymes and scavenging of free radicals. We used this compound in mammalian cells in vitro to investigate its mechanism of action in modulating DNA damage. Cytogenetic and cytofluorimetric analyses were performed. We show that melatonin is able to modulate chromosome damage (chromosomal aberrations and sister chromatid exchanges) induced by cyclophosphamide. Conversely, its involvement in modulating oxidative processes, thereby reducing DNA damage, is less clear. In particular, melatonin is able to decrease H2O2-induced chromosomal aberrations but not sister chromatid exchanges and has been found to induce oxygen species in a cytofluorimetric test (DCFH assay).

Clinical and experimental study of TMJ distraction: preliminary results

A physiotherapeutic approach, with manual maneuvers and/or distraction appliances, is indicated in the treatment of temporomandibular joint disorders (TMDs) to prevent the progressive fibrosis of the muscle fibers. In this article, the authors report preliminary results of experimental and clinical studies conducted to assess the real effect of distraction in temporomandibular joint disorders. The experimental invivo studies confirmed the structural alteration due to compression and distraction on the capsular and condylar tissues. Clinical cases are reported to show the increase of the intraarticular vertical dimension, with a forward and downward movement of the condyles in a more physiologic condition.

[The clinical and microbiological evaluation of the efficacy of oral irrigation on the periodontal tissues of patients wearing fixed orthodontic appliances]

The aim of the present study has been the evaluation of the effectiveness of oral irrigation with or without toothbrushing and dental flossing, in individuals treated with fixed orthodontic appliances, on controlling the development of dental plaque and, hence, of gingivitis. Eight individuals with a good general and oral status have been chosen. Before the experimental period, they received instructions about oral hygiene with toothbrushing and dental flossing and then they have been monitored to verify they were doing well. At the time T0, the upper tooth have been banded, three Periodontal Indexes (Plaque Index according to Silness and Loe, Modified Gingival Index according to Lobene and Gingival Bleeding Index according to Ainamo and Bay) registered and subgingival plaque samples from the premolars' gingival sulcus collected in order to point out the total anaerobes bacterial counts, the rates of motile bacteria, spirochetes, Gram positive and Gram negative cocci and bacteria, by means of optical and dark field microscopy and of cultural methods. For their oral hygiene, the patients had to use, in the right side toothbrush and dental floss (Control 1), in the left side the oral irrigator alone (Test 1). One month later (time T1), the lower teeth have been banded, too. In the right side the patients had to use toothbrush and dental floss (Control 2), while in the left one they used the same devices as Control 2 plus the oral irrigator (Test 2). At the time T1 Periodontal Indexes and Microbiological analyses have been extended to all the four quadrants.(ABSTRACT TRUNCATED AT 250 WORDS)

[Incidence of enamel fissures in a group of orthodontic patients. In vivo study]

In this paper, the Authors researched the frequence of enamel fissures in a group of 75 individuals. Particular attention was dedicated to the search of such anomalies on teeth treated with multibracket orthodontic appliances, in order to prove a causal nexus between the fissures and the appliances used. After a long term experience, it was found that enamel fissures are a frequent found in almost 60% of the sample examined; moreover, the Authors cannot prove an increment of cracks in subjects treated with multibracket appliances. It was concluded that the whole of the fissures founded, would be considered as preexistent to the positioning of the brackets, even if it cannot be excluded that an excessive torque, or an inadequate debonding technique couldn't produce a mechanical stress on the enamel surface capable to enhance such cracks.

[Clinico-radiographic evaluation of relations between the spinal curve and malocclusion]

Authors examined 36 children with kyphosis, lordosis and malocclusions. Taking also radiographs into account, a statistical study has been done. Three significant correlations were found: between lordosis and ANB, lordosis and SNA and between FR and CV Angle. The last one was a confirmation of a previous study by Solow.