Fracture strenght and ribbond fibers: In vitro analysis of mod restorations

Background

Ribbond fibers are supposed to be a reinforcing material in restoration of compromised teeth. This study aims to compare MOD restorations with and without Ribbond Fiber in terms of fracture strength under axial loading; to identify the minimum depth of MOD cavities to use Ribbond Fiber (to improve the fracture strength under axial load.

Material and Methods

20 upper and lower molars extracted intact were used for the experiment. The teeth were prepared with 2 types of cavities and then divided into 4 groups: 1) 5 mm deep MOD cavities with residual interaxial dentin restored without Ribbond; 2) 5 mm deep MOD cavities with residual interaxial dentin restored with Ribbond; 3) 5 mm deep MOD cavities without residual interaxial dentin, restored without Ribbond; 4) 5 mm deep MOD cavities without residual interaxial dentin restored with Ribbond. The restored teeth were then subjected to thermal cycling and their fracture strength was evaluated using an Instron device. The Mann-Whitney statistical test was used to compare fracture strength among groups. Finally, a descriptive analysis of the verified fractures was performed.

Results

There was a statistically significant difference between groups 1 and 2 (P = 0.0090) in the loading force required for a fracture. In contrast, there was no statistically significant difference between groups 3 and 4 (P = 0.7540). Groups 1 and 2 had the fewest non-restorable fractures, in contrast to groups 3 and 4.

Conclusions

Ribbond fiber application in MOD cavities seems to be more effective in terms of strengthening where cavities have interaxial dentinal tissue. Key words:Ribbond fibers, fracture strenght, direct dental restorations.

C64 UNMASKING THE PREVALENCE OF AMYLOID CARDIOMYOPATHY IN THE REAL WORLD: RESULTS FROM PHASE 2 OF AC–TIVE STUDY, AN ITALIAN NATIONWIDE SURVEY

Background

Clinicians need to identify patients with amyloid cardiomyopathy (AC) at an early stage, due to the availability of disease–modifying therapies. Some echocardiographic findings may rise the suspicion of AC, also in patients with mild or no symptoms, addressing second level diagnostic tests.

Aim

To investigate the prevalence of AC in consecutive patients ≥55 years undergoing clinically indicated, routine transthoracic echocardiogram in Italy and presenting echocardiographic signs suggestive of AC.

Methods

This is a prospective multicentric study conducted in Italy. It comprises two phases: 1) a recording phase consisting in a national survey on prevalence of possible echocardiographic red flags of AC in consecutive unselected patients ≥55 years undergoing routine echocardiogram (previously published) and 2) an AC diagnostic phase involving a diagnostic work–up for AC to investigate AC prevalence among patients with at least one echocardiographic red flag (herein presented). Patients that in Phase 1 presented an “AC suggestive” echocardiogram (i.e., at least one red flag of AC in hypertrophic, non–dilated left ventricles with preserved ejection fraction) underwent clinical evaluation, blood and urine tests and scintigraphy with bone tracer. Diagnosis of transthyretin related–AC (ATTR–AC) was made in presence of grade 2–3 Perugini uptake at scintigraphy and absence of monoclonal protein. The study was registered at ClinicalTrials.gov (#NCT04738266).

Results

Of the 5315 screened echocardiograms, 381 exams (7.2%) were classified as “AC suggestive” and proceeded to Phase 2. 217 patients completed Phase 2 investigations. Main reasons for the 164 non–entering patients into Phase 2 were death (n = 49) and refusal to participate (n = 66). A final diagnosis of AC was made in 62 patients with an estimated prevalence of 28,6% (95% CI: 22,5%–34,7%). ATTR–AC was diagnosed in 51 and AL–AC in 11 patients, ascertaining a prevalence of 23,5% (95% CI: 17,8%–29,2%) and 5,1% (95% CI: 2,2%–8,0%), respectively.

Conclusion

Among a cohort of consecutive unselected patients ≥55 years with echocardiographic findings suggestive of AC, the prevalence of AC ranged from 23% up to 35%. Although ATTR–AC was predominant, AL–AC was diagnosed in a significant number of cases. Echocardiography has a fundamental role in screening patients, raising the suspicion of disease and orienting diagnostic work–up for AC.

Link between gut microbiota dysbiosis and chronic kidney disease

During chronic kidney disease (CKD), typical alterations in the gut microbiota are observed. The kidney no longer plays the role of the main excretory organ as this function is performed by the intestine. In CKD patients, an alteration of intestinal permeability and a degradation of the protective mucous layer are observed. These changes in the intestinal barrier allow the passage of bacterial material from the intestine to the bloodstream through the intestinal wall. This phenomenon contributes to the induction of the chronic inflammatory state, typical of CKD. In nephropathic patients, there is an increase in circulation of p-cresyl sulfate (p-CS), indoxyl sulphate (IS), indole-3 acetic acid (IAA) and trimethylamine-N-oxide (TMAO), all gut-derived uremic toxins. The changes in gut microbiota composition are related to CKD stage and this phenomenon is exacerbated in hemodialysis (HD) adult and pediatric patients. Interestingly, it is observed a positive shift in gut microbiota composition after renal transplantation and at the same time a reduction of circulating gut-derived uremic toxins. Either gut dysbiosis or uremic toxins accumulation contribute to the CKD onset and progression.

Gut-oriented interventions in patients with multiple sclerosis: fact or fiction?

OBJECTIVE

Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating, disimmune disease of the central nervous system whose etiology and pathogenesis remain poorly understood, due to its complex and multifactorial nature. Evidence of a bidirectional connection linking the gut microbiome with the intestinal barrier and the immune system (the gut-brain axis) may have implications for the pathogenesis of inflammatory demyelinating diseases such as MS. This narrative review summarizes the evidence for the gut-brain axis involvement in the pathogenesis of MS and examines the role of gut-oriented interventions in MS.

PATIENTS AND METHODS

We reviewed all available studies in PubMed concerning gut-directed interventions and MS. This research was conducted using different combinations of pertinent keywords (multiple sclerosis, immune-mediated inflammatory diseases, autoimmune diseases, first demyelinating event, neurocognition, neurological disorders, neurology practice, risk factors, taxonomic biomarkers, nutrition, diet, dietary additives, complementary treatment, gut bacteria, gut microbiome, microbiome, gut-brain axis, epidemiology, alpha-linolenic acid, fermentative metabolites, fat, saturated fat, monounsaturated fat, polyunsaturated fat, omega-3 fatty acids, calorie restricted diet, fasting, fecal microbiome, fecal microbiota transplantation, animal testing).

RESULTS

There is an emerging evidence that alterations in the gut microbiome and increased intestinal permeability may be causative factors in the complex interplay between nutrition, metabolic status and the immune-inflammatory response in patients with MS. This suggests the possibility that modification of lifestyle and the microbiome, for example by specific diets or fecal microbiota transplantation, supplementation with bile acids and intestinal barrier enhancers, may positively influence the pathogenesis of MS.

CONCLUSIONS

Although the role of nutritional factors in the pathogenesis of MS remains to be established, there is evidence that appropriate gut-directed interventions such as diet, nutritional supplementation or fecal transplantation may modulate the inflammatory response and improve the course of MS as a complementary treatment in the disease.

Nightmare Rescripting: Using Imagery Techniques to Treat Sleep Disturbances in Post-traumatic Stress Disorder

Besides affecting 8% of the general population, nightmares are one of the most frequent symptoms of traumatized individuals. This can be a significant factor in the treatment of post-traumatic disorders; indeed, several studies demonstrated its strong predictive and prognostic value. Sleep disorders, nightmares in particular, could be very distressing for individuals and need targeted interventions, especially if they are associated with a PTSD diagnosis. To date, the best technique for the treatment of traumatic sleep disturbances seems to be Imagery Rehearsal Therapy (IRT), an empirically supported method. Through a review of the literature on this matter, this article aims to outline the incidence and consequences of nightmares in PTSD, illustrate how IRT could prove useful in their treatment, and investigate its clinical applications.

Left atrial remodeling after Mitraclip implantation

Objective

Changes in left atrial (LA) size and function are associated with major adverse cardiovascular outcomes such as atrial fibrillation, heart failure, stroke, and death. Reverse LA remodelling occurs after successful surgical mitral valve repair for severe MR. Changes in LA volumes after MV repair have reported in several studies. However, LA data are limited in the setting of transcatheter repair.

Materials an methods

From November 2016 to July 2018, clinical and echocardiographic data of 42 patients with mitral regurgitation who underwent Mitraclip implantation in our division were evaluated for LA function: LA global longitudinal strain (LA GLS); LAESV (Left atrial end-systolic volume), LAEDV (Left atrial end-diastolic volume); LA emptying Fraction at baseline, at 1 month, at 6 months and 1 year of follow up were assessed. The variation of continuous variables was evaluated using a student T test for paired data or the Wilcoxon matched-pair signed rank test when appropriate. The categorical variables between two groups were evaluated using the chi-square test (χ2). P values <0.05 were considered significant.

Results

The etiology of the mitral regurgitation was primary in 33,3% and secondary in 66,7% of the included patients. The MR degree was 3+ in 21,4% of patients and 4+ in 78,6%. When compared to baseline at 6 months and 1 year a statistically significant reduction was observed for both LAESV (p<0.001) and LAEDV (p<0.001). At 6 months, compared to baseline, the LA GLS reached statistic relevance (p 0.05) with a significant improvement at 1 year (p 0.001). Finally, we did not find significant differences in LA emptying fraction at different time point analyzed.

Conclusions

A successful MitraClip procedure can reverse the process of LA remodeling within 12 months, and this can be detected by Two-dimensional speckle tracking echocardiography (2D STE) through an improvement in the LA reservoir function. These data generate the hypothesis that the GLS, compared to conventional echocardiographic parameters, represents an advanced method that quantify atrial function in Mitraclip implanted patients.

Funding Acknowledgement

Type of funding source: Public hospital(s)

Trans-nasal endoscopic and intra-oral combined approach for odontogenic cysts

Maxillary cysts are a common finding in maxillofacial surgery, dentistry and otolaryngology. Treatment is surgical; a traditional approach includes Caldwell-Luc and other intra-oral approaches. In this article, we analyse the outcomes of 9 patients operated on using a combined intra-oral and trans-nasal approach to the aforementioned disease. Although the number of patients is small, the good results of this study suggest that the combined approach might be a reliable treatment option.

Evaluation of pain, swelling and trismus after extraction of impacted third molars relative to the use of betamethasone in submucusal infiltration

The aim of this study was to evaluate the anti-inflammatory effect of a single 4 mg injection of submucosal betamethasone after extraction of impacted third molars. Single-centre, single-blinded, parallel group study; Forty-three patients were submitted to impacted third molar extraction. In this study, 4 mg single-dose submucosal betamethasone was injected in the interventional group, while in the control group nothing was injected. Postoperative measurement included pain via the VAS scale, swelling and trismus with facial measurements and maximum mouth openings, and finally nerve sensitivity. There was a significant difference between the two groups regarding trismic pain and edema. The use of a single 4 mg submucosal betamethasone injection leads to a reduction of oedema, trismus and pain in patients undergoing impacted third molar extraction. .

Bi-layered collagen nano-structured membrane prototype collagen matrix CM-10826 for oral soft tissue regeneration: an in vivo ultrastructural study on 13 patients

A new developed collagen matrix CM-10826 (CM) of porcine origin designed to be used as oral soft tissue substitute was investigated before and after implantation by light microscopy (LM), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). In a case series biopsy specimens were harvested from thirteen patients at 10, 20, 30, 43 days after abutment surgery for uncovering dental implants. The in vivo histological evaluations of each patient were performed via micro-coring of newly formed oral mucosa in the area covered by CM (test side) or left uncovered (control). Results showed that CM can be integrated in connective and epithelial tissues within 10 days, can be completely resorbed within 20 days and it is able to reduce inflammatory infiltrates and to stimulate both fibroblast/epithelial cell proliferation and neo-angiogenesis. Generally it seems to be superior in promoting soft tissue healing compared to that induced by secondary intention healing. Furthermore, it is able to act as a scaffold for soft-tissue regeneration, allowing the proliferation of keratinocytes from the wound edges and favoring neovascularization and growth of connective tissue in the mesh of porous layer. It appears that a CM might function in oral surgery as a substitute for autologous grafts and to avoid secondary intention healing in soft tissue defects.

An overview of socket preservation

Socket preservation is a surgical procedure whose aim is to limit the physiological resorption of the alveolar ridge that occurs after a dental extraction, in order to have sufficient bone to perform an implant placement. 16 articles regarding socket preservation procedures were identified through scientific archives and analysed. The biological rationale, the graft materials and the predictive factors are identified to help the clinicians in their practice. Socket preservation is an effective treatment to prevent bone resorption if performed after an atraumatic extraction with the use of biomaterials and membranes. It is also important not to forget local and systemic predictive factors.

Efficacy of the Andresen activator before peak growth in class II patients

Andresen activator (AA) is a functional appliance used to correct Class II malocclusion in growing patients. It corrects the malocclusion stimulating mandibular growth and determining a palatoversion of the upper incisors and a vestibularization of the lower incisors. The aim of this study was to analyze the treatment efficacy of class II malocclusion due to mandibular hypodevelopment before peak growth. Fourteen subjects with class II relationship of the skeletal bases and cervical vertebrae maturation stage 1 or 2 were enrolled in the study. Cephalometric analyses were carried out using landmarks derived from the analyses of Pancherz, Ricketts, Tweed and Steiner. A significant decrease (P less than 0.05) in ANB angle was found (-2.29±3.05°) after treatment, which was expression of an improvement in maxillo-mandibular sagittal skeletal relationships. There was also a significant reduction of OJ after treatment (-4.44±2.36 mm; P less than 0.001), indicating a vestibularization of the mandibular incisors and a palatoversion of the maxillary incisors, and a correction of the molar relationship. The favorable effects of the Andresen activator for the correction of the mandibular defect can be found even prior to peak growth; the achieved class I relationship maintains a correct mandible position in time, ensuring a proper skeletal growth. .

Tooth agenesis: part 2. Orthodontic treatment and prosthetic possibilities

Dental agenesis has a great clinical significance due to its frequency during daily practice and the therapeutic problems that can arise from it. This paper will explore all the aspects to consider in order creating a proper multidisciplinary treatment plan: in particular, orthodontic, prosthetic and implantologic therapeutic alternatives are described for the rehabilitation of the different areas of the dental arches. In fact, dental agenesis is a problem that often requires the intervention of specialists from the different fields of dentistry and its treatment must meet aesthetics needs, stomatognathic function and patient satisfaction.

Tooth agenesis: part 1. Incidence and diagnosis in orthodontics

Dental agenesis has a great clinical significance due to its frequency during daily practice and the therapeutic problems that can arise from it. This paper will explore the incidence of dental agenesis, its diagnosis and how this anomaly affects the teeth differently. The second subsequent paper will look at its treatment and management.

Predicting seizures in untreated temporal lobe epilepsy using point-process nonlinear models of heartbeat dynamics

Symptoms of temporal lobe epilepsy (TLE) are frequently associated with autonomic dysregulation, whose underlying biological processes are thought to strongly contribute to sudden unexpected death in epilepsy (SUDEP). While abnormal cardiovascular patterns commonly occur during ictal events, putative patterns of autonomic cardiac effects during pre-ictal (PRE) periods (i.e. periods preceding seizures) are still unknown. In this study, we investigated TLE-related heart rate variability (HRV) through instantaneous, nonlinear estimates of cardiovascular oscillations during inter-ictal (INT) and PRE periods. ECG recordings from 12 patients with TLE were processed to extract standard HRV indices, as well as indices of instantaneous HRV complexity (dominant Lyapunov exponent and entropy) and higher-order statistics (bispectra) obtained through definition of inhomogeneous point-process nonlinear models, employing Volterra-Laguerre expansions of linear, quadratic, and cubic kernels. Experimental results demonstrate that the best INT vs. PRE classification performance (balanced accuracy: 73.91%) was achieved only when retaining the time-varying, nonlinear, and non-stationary structure of heartbeat dynamical features. The proposed approach opens novel important avenues in predicting ictal events using information gathered from cardiovascular signals exclusively.

Inclusion of all permanent mandibular molars and all maxillary second and third molars: a case report and review of the literature

Simultaneous impactions of first, second, and third permanent molars on both mandibular sides together with the all maxillary second and third molars is a clinical situation never reported before in the literature and it might be a difficult challenge for maxillofacial surgeons and dentists. Early diagnosis and treatment of eruption disturbances contributes to optimal outcomes. This article reports the treatment of an adult with severe impaction of all mandibular first, second, and third molars together with all maxillary second and third molars, which limits the masticatory function and dental arch integrity. The impacted molars were surgically removed as the patients declined orthodontic treatment. The combined surgical-orthodontic approach represents a challenging treatment and the optimal one as it eliminates the need for prosthetic rehabilitation and implant replacement of the impacted molars, when accepted.

Blood levels of interleukins in patients with ameloblastoma

The aim of study was to determine and compare serum concentrations of interleukin 1 beta (IL-1β), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) in patients with oral ameloblastoma and healthy controls. Sixteen patients with ameloblastoma and 16 healthy controls were enrolled in this study. Cytokine concentrations were measured by chemiluminescent enzyme linked immunoassay. Serum concentrations of IL-1β were below level of detection in all but four participants. No significant differences between the groups were observed in serum concentrations of IL-6. Serum TNF-α was significantly higher in control subjects than in ameloblastoma patients. Patients diagnosed with ameloblastoma have relatively normal levels of inflammatory cytokines in their blood and thus cannot be used as indicators of disease severity or for monitoring the treatment outcomes.

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.

The benefits of Quercitin for dentistry and maxillofacial surgery: a systematic review

Quercetin (3,3',4',5,7-pentahydroxyflavone) is the major bioflavonoid in the human diet and belongs to an extensive class of polyphenolic flavonoid compounds almost ubiquitous in plants and plant food sources. The estimated average daily dietary intake of quercetin by an individual in the United States is 25 mg. In recent years, research about quercetin has evolved from animal studies to in vitro and in vivo studies and to human clinical studies and trials in order to establish its real properties and effects. In oral medicine, quercetin has been extensively studied, as a real increase in major diseases like cancers, periodontal disease, oral lesions, tooth decay and infections have been reported worldwide by health providers.It has been thus established that quercetin exhibits beneficial effects on oral health with its broad pharmacological properties, as preventive and therapeutic agent in dental caries with anti-inflammatory effect against oral pathogens, as well as an antioxidant and anti-cancer agent .The aim of the review is to present evidence-based aspect of treatment with quercetin in order to validate its tremendous role in dentistry and maxillofacial surgery.

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.

Bimaxillary distraction osteogenesis used for treatment of crowding in non-growing individuals. Case report

Dental crowding is frequently associated with transverse jaw discrepancies, resulting in a less-than-ideal position of the teeth in the basal bone. The classic aproach for correcting bimaxillary crowding are extractions or arch expansion. Rapid maxilla-mandibular expansion was used to treat transverse discrepancies in growing patients, but with aging, the upper and lower jaw bones become increasingly resistant to expansion. The surgically assisted rapid maxillary expansion (SARME) and the mandibular midsymphyseal distraction osteogenesis procedure overcome this age limitation and are of great importance for the treatment of transverse discrepancies in adults. The aim of this paper is to report a case with a severe transverse deficiency treated with SARME, mandibular midsymphyseal distraction together with orthodontic treatment in an adult patient. The case highlights the esthetic advantages of increasing the transversal dimension of both jaws in patients with severe crowding associated with constricted dental arches and recommends the maxillo-mandibular transverse distraction osteogenesis as an and effective form of surgical treatment for patients with malocclusions or dentofacial deformities featuring severe transverse discrepancies, combined with a carefully monitored orthodontic treatment.

Dental white spots associated with bulimia nervosa in orthodontic patients

Bulimia nervosa is an eating disorder characterized by consuming a large amount of food in a short amount of time followed by an attempt to rid oneself of the food consumed (purging), typically by vomiting, taking a laxative, diuretic, or stimulant, and/or excessive exercise, because of an extensive concern for body weight. The frequent contact between teeth and gastric acid, in particular, may cause: severe dental erosion, perimolysis, or the erosion of tooth enamel and swollen salivary glands. Constant vomiting can lead to gastroesophageal reflux. The aim of this article is to report two cases of patients with severe dental demineralization associated with bulimia nervosa during orthodontic treatment. Diagnosis and prevention aspects are highlighted and discussed.

Non-traumatic unilateral bifid mandibular condyle and multiple inclusions: a case report

Simultaneous impactions of first, second, and third permanent molars on both mandibular sides together with the all maxillary second and third molars is a clinical situation never reported before in the literature and it might be a difficult challenge for maxillofacial surgeons and dentists. Early diagnosis and treatment of eruption disturbances contributes to optimal outcomes. This article reports the treatment of an adult with severe impaction of all mandibular first, second, and third molars together with all maxillary second and third molars, which limits the masticatory function and dental arch integrity. The impacted molars were surgically removed as the patients declined orthodontic treatment. The combined surgical-orthodontic approach represents a challenging treatment and the optimal one as it eliminates the need for prosthetic rehabilitation and implant replacement of the impacted molars, when accepted.

Tongue flap to treat a severe case of Miescher's cheilitis granulomatosa

Miescher's cheilitis granulomatosa is the monosymptomatic form of Melkersson-Rosenthal Syndrome. Severe macrocheilitis often causes a functional and esthetical impairment of the lip. Conservative treatment represents the first option to face this rare disease. Unfortunately, medical treatment is often ineffective without any significant result as far as swelling and disfigurement are concerned. Reductive cheiloplasty is indicated in all those patients who have failed to respond to medical treatment. Excision of excess tissue may be obtained by means of several surgical techniques. We report a case of a 55-year-old man affected by severe granulomatous cheilitis refractory to any medical treatment and then treated with the use of tongue flap for the reconstruction of the excised lower lip.

Full vestibular approach in pre-prosthetic surgery: retrospective evaluation of 90 patients and literature review

Atrophy of the jaws could represent a challenge in maxillofacial and oral surgery. The correction of bone defects due to the atrophic process is frequently achieved by means of onlay bone grafting. In the present note, a technique of flap designing to approach the alveolar atrophic crest will be discussed. The primary incision is sculpted in the vestibular aspect of the oral fornix, apically to the mucogengival junction. A full thickness mucosal flap is then lifted to expose the maxillary or mandibular lateral wall, and the alveolar crest is reached after the deglovement of the atrophic edentulous crest. This technique aims to decrease the incidence of dehiscence and consequent infection in the area of bone grafts, in order to provide a feasible and safe procedure to perform bone grafting and preserve the overlying soft tissues. This technique of flap design has been applied on 90 cases (167 sites) to face mild to severe jaw atrophy obtaining good results in comparison with the traditional crestal incision technique.

STABLE: an innovative device for three-part maxillary osteotomy

Le Fort I osteotomy of the maxilla continues to be one of the most common techniques used in the surgical correction of a variety of dento-midfacial deformities. Occasionaly, however, surgeons may encounter difficulties during three-pieces Le Fort I procedures because the surgical movements are also prone to adverse movement and subsequent relapse. This case report describes a 26 year old man, who presented with a skeletal Class III malocclusion and a transverse maxillary deficency. The malocclusion was corrected with a bilateral sagittal split osteotomy (BSSO) and a segmental Le Fort I and post-treatment stabilization was achieved with the STABLE (Surgical Tripartition Auxiliary Block Element), a new and innovative device usefull after three-part maxillary Le Fort I surgery.

Expression of Vascular Endothelial Growth Factor (VEGF) mRNA in healthy bone tissue around implants and in peri-implantitis

Peri-implantitis is an inflammatory process involving peri-implant bone. Angiogenesis is critical for the development, remodeling and healing of bone. Vascular Endothelial Growth Factor (VEGF) is a glycoprotein that induces endothelial cell proliferation, angiogenesis and capillary permeability. VEGF is expressed in a variety of highly vascularized tissues and seems to be a prerequisite for tumor growth and invasion. VEGF takes part in bone cell differentiation and by promoting angiogenesis at the site of bone formation. Aim of the present study was an evaluation of VEGF mRNA in bone around healthy and failing dental implants. Twenty patients participated in this study. Twenty bone biopsies were obtained, 10 at second-stage surgery from bone covering the healing screws (control), and 10 from implants presenting the typical signs and symptoms for peri-implantitis lesions (test). VEGF mRNA levels were not present in any of the controls, while it was identified in all tissues obtained from test implants. The difference was statistically significant (p < 0.05). Our results point to the fact that VEGF may be important in the regulation of tissue healing and bone remodeling in the peri-implantitis lesions because VEGF has been reported to play a role in the formation and attraction of osteoclasts, and osteoclasts have been shown to be a prominent feature of the peri-implantitis lesions.

Reconstruction of congenital isolated absent columella: a case report

Congenital isolated absent columella is a rare event in population, with an aetiology that is still unclear. Reconstruction remains a challenging problem. A single case is presented with the description of an original single stage surgical technique to restore it.

Spasticity as an ictal pattern due to excitotoxic upper motor neuron damage

We describe the case of a man who presented with spasticity and aphasia related to continuous electroencephalographic epileptic activity in the left frontal-temporal regions. Magnetic resonance imaging (MRI) documented in diffusion-weighted images (DWI) two areas of restricted diffusion in the left frontal and temporal cortex. After starting treatment with levetiracetam 3000 mg/day there was progressive recovery of the clinical picture as well as the gradual disappearance of the electroencephalographic seizure activity and the vanishing of areas of restricted diffusion in brain MRI. Based on the clinical, EEG and MRI data, we hypothesized that both aphasia and spasticity represented ictal signs. To our knowledge, this is the first case report of ictal spasticity.

Ectopic mandibular third molar: report of two cases by intraoral and extraoral access

Ectopic third molar displacement is a rare event in the population. The etiology of this infrequent condition has not been completely clarified. Optimal management is still unclear. In symptomatic patients surgical removal, after a careful preoperative planning, is the recommended treatment. Several surgical approaches, both extraoral and intraoral, have been described, depending on the ectopic molar position. This paper reports two cases of ectopic third molar, one located in the coronoid process and the other one in the lower edge of the mandibular body. Both teeth were removed successfully by an intraoral and extraoral approach respectively.

Sleep disorders in adult-onset myotonic dystrophy type 1: a controlled polysomnographic study

BACKGROUND

  Sleep disturbances and excessive daytime somnolence are common and disabling features in adult-onset myotonic dystrophy type 1 (DM1).

METHODS

  Our study used questionnaires, ambulatory polysomnography and the multiple sleep latency test to evaluate sleep-wake cycle and daytime sleepiness in unselected adult-onset DM1 patients. We recruited 18 patients affected by adult-onset DM1 and 18 matched controls.

RESULTS

  Sleep efficiency was <90% in 16/18 patients, and it was significantly reduced when compared with controls. Reduced sleep efficiency was associated with abnormal respiratory events (5/18 patients) and/or periodic limb movements (11/18 patients). The Periodic Limb Movement Index was significantly increased in DM1 versus controls. A significantly lower mean MSLT sleep latency was detected in DM1 versus controls, but it did not reach pathological levels.

CONCLUSIONS

  Our controlled study demonstrated sleep alterations in unselected consecutive DM1 patients. Periodic limb movements in sleep are commonly associated with sleep disturbance in adult-onset DM1, and it may represent a marker of CNS neurodegenerative processes in DM1.

Two typologies of endodontic instrument handle are here investigated for tactility modifications

AIM

The purpose of this comparative study was to evaluate possible modifications of tactility (deep and discriminative tactile sensitivity) using manual endodontic instruments equipped with traditional handles compared with innovative silicone handle versions.

METHODS

Sixteen subjects were selected and supplied with resin Endo-Training-Block simulators, latex gloves and manual endodontic instruments with diameters ranging from 10 to 40 mm. All instruments had traditional and silicon handles. The investigation of deep and discriminative tactile sensitivity was performed at 0, 15, 30, and 45 minutes of the manual instrumentation with an esthesiometer. We obtain each of our data from the median of three consecutive measurements. The results were then statistically analyzed thanks to the ANOVA test: P=0.003 for subjects, P<0.001 for time factor, and P=0.010 for sensitivity-time interaction.

RESULTS

We observed a better tactility with silicone handle instruments, comparing the two kinds of handle (regardless of the finger tested) as well as singly analyzing the thumb and index finger.

CONCLUSION

Despite the sample limited extension, the loss of deep cutaneous and discrimination sensitivity seems to be reduced using silicone handles, most likely favoring an improvement of the working performance.

[Cardiac resynchronization therapy: is there always a need for the adjunctive ICD therapy?]

Chronic postinfarction patients with an ejection fraction ≤ 30% and heart failure patients in NYHA classes II and III with an ejection fraction ≤ 35% due to ischemic or dilated cardiomyopathy meet current indications for ICD therapy. There is significant overlap with patients in NYHA class III also exhibiting a wide QRS complex (>120 ms), who commonly benefit from resynchronization therapy. Although a combination of ICD and CRT seems reasonable in many patients, one should be aware of subtle distinctions regarding selection criteria for either therapy. There is no clear ICD indication for heart failure patients in NYHA class IV or even III, taking subclass analysis of SCD-HeFT [4] into account. Uncertainty still exists for the subacute postinfarction phase (4 weeks to 6 months), whereas the early postinfarction phase should clearly not be considered for ICD evaluation. No randomized data exist for heart failure due to other etiologies. CRT, on the other hand, is not only helpful regarding symptom relief and quality of life, but also with respect to life expectancy. The additive value of adjunctive ICD therapy has not yet been proven in a randomized comparison. Finally, particularly in elderly patients, quality of life might seem more desirable than prevention of sudden cardiac death. Thus, combination of ICD and CRT is not always a "must". Instead, ICD guidelines still leave room for a patient specific decision, with "stand-alone" CRT still providing a very helpful, prognostically significant therapy.