Minimally Invasive Treatment of Stress Urinary Incontinence in Women: A Prospective Comparative Analysis between Bulking Agent and Single-Incision Sling.

INTRODUCTION: The study aims to compare the efficacy and safety of bulking agents and single-incision slings in the treatment of urinary incontinence in 159 patients during a 29-month follow-up period. MATERIAL AND METHODS: Of the 159 patients suffering from stress urinary incontinence, 64 were treated with bulking agents (PAHG Bulkamid®) and 75 with a single-incision sling (Altis®). The ICIQ-UI-SF (Incontinence Questionnaire-Urine Incontinence-Short Form), PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaires short form), FSFI (Female Sexual Function Index), FSDS (Female Sexual Distress Scale), and PGI-I (Patient Global Improvement Index) were used to assess efficiency and quality of life. RESULTS: The bulking agents showed high efficacy and safety during the 29-month follow-up. Post-operative complications were recorded in both groups, with only two significant differences. The Bulkamid group experienced no pain, while 10.8% of the ALTIS group experienced groin pain and 5% experienced de novo urgency. Furthermore, patients treated with bulking agents experienced reduced nicturia (0.78 vs. 0.92 in patients treated with single-incision slings.). In both groups, we noticed a significant improvement in QoL (quality of life), with a halved ICIQ-UI-SF (International Consultation on Incontinence Questionnaire-Urine Incontinence-Short Form) score which was completed to assess the impact of urine symptoms. After 24 months of therapy, the Bulkamid group saw a decrease from 14.58 ± 5.11 at baseline to 5.67 ± 1.90 (p < 0.0001), whereas the ALTIS group experience a decrease from 13.75 ± 5.89 to 5.83 ± 1.78. Similarly, we observed an improvement in sexual function, with the number of sexually active patients increasing from 29 to 44 (56.4%) in the Bulkamid group (p = 0.041) and from 31 to 51 (61.7%) in the ALTIS group (p = 0.034). According to the most recent statistics, the PISQ-12, FSFI, and FSDS scores all demonstrated an improvement in women's sexual function. CONCLUSIONS: In terms of efficacy and safety, bulking agents had notable results over the 29-month follow-up period. Furthermore, the patients treated with bulking agents reported a lower incidence of postoperative complications and a no discernible difference in terms of quality of life and sexual activity compared to the ones treated with single-incision slings. Bulking agents can be considered a very reliable therapeutic option based on accurate patient selection.

TOT in combination with solifenacin or intravaginal prasterone in postmenopausal women with mixed urinary incontinence: A retrospective analysis in 112 patients.

OBJECTIVES: The aim of this study was to compare the efficacy of the transobturator tape (TOT) procedure combined with solifenacin (TOT-S) or prasterone (TOT-P) in postmenopausal women affected by mixed urinary incontinence (MUI) with a predominant stress urinary incontinence component. METHODS: This is a retrospective analysis including 112 patients: 60 patients of the TOT-S group and 52 patients of the TOT-P group. Physical examination, 3-day voiding diary, urodynamic tests, and Vaginal Health Index (VHI) were compared at the beginning of the analysis and after 12 weeks of follow-up (FU). Specific questionnaires were administered to indagate the impact on women's quality of life and sexual function. RESULTS: After 12 weeks of FU, the detrusor's peak flow pressure was significantly different between the two groups (p = .02). Detrusor overactivity decreased only in the TOT-P group (p = .05). At the end of FU, 58 patients (96.7%) of the TOT-S group and 50 patients (96.2%) of the TOT-P group were dry at the stress test. A significative group difference was observed in urge urinary incontinence (24 h) (p = .01) but not in the mean number of voids (24 h) and urgent micturition events (24 h). VHI improved only in the TOT-P group (12.57 ± 3.80 vs. 19.75 ± 4.13, p < .0001). The questionnaires and Patient Global Index of Improvement (PGI-I) scores showed comparable improvements, while the Female Sexual Function Index improved especially in the TOT-P group (p < .001). CONCLUSIONS: In postmenopausal women with MUI, TOT-P demonstrated the same effectiveness as TOT-S in reducing urinary symptoms. In addition, TOT-P increased VHI and sexual function scores compared with TOT-S.

Italian multicenter mid-term analysis of laparoscopic lateral suspension in women with pelvic organ prolapse: clinical, sexual and Quality of Life assessment after surgical intervention.

BACKGROUND: The aim of this study was to evaluate effectiveness and safety of laparoscopic lateral suspension in women affected by high grade uterine prolapse associated to anterior defect. The secondary endpoint is to evaluate mid-term impact on Quality of Life and sexual function. METHODS: A multicenter retrospective study on women undergoing laparoscopic lateral suspension for uterine prolapse ≥III stage was performed. We included 174 women, but due to exclusion criteria, 134 patients were enrolled for this study. Preoperative evaluation consisted of an urogynecological interview, clinical exam, 3-day voiding diary and urodynamic testing; the prolapse Quality of Life Questionnaire was used to quantify the impact of prolapse symptoms on Quality of Life and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form, the Female Sexual Function Index and the Female Sexual Distress Scale were administered to evaluate sexual function before surgical intervention and at median follow-up of 3.8 years. RESULTS: We included 134 women with uterine prolapse ≥III stage. All patients underwent laparoscopic lateral suspension, 8 also posterior colporrhaphy and 5 also transobturator tape insertion. POP-Q classification score for anterior and apical compartment showed a significant average decrease. The surveys administered to patients showed an improvement in Quality of Life, an increase in the number of monthly intercourses and a significant improvement in sexual life after surgery. CONCLUSIONS: Laparoscopic lateral suspension for pelvic organ prolapse correction is a safe and effective technique for uterine and anterior associated defect. Quality of Life and sexual function significantly improved after surgery.

Type 2 diabetes mellitus impairs the maturation of endothelial progenitor cells and increases the number of circulating endothelial cells in peripheral blood.

Type 2 diabetes mellitus (T2DM) is associated with endothelial dysfunction, which leads to vascular complications. Endothelial progenitor cells (EPCs) are thought to be a subset of cells derived from the bone marrow that play a crucial role in the neovascularization of ischemic tissue and in the maintenance of endothelial cell integrity. In contrast, circulating endothelial cells (CECs) are of endothelial origin and become detached from the intima of blood vessels in response to pathological stimuli. The study investigated the effects of T2DM on subpopulations of EPCs and CECs in peripheral blood, as compared with the effects on unacylated (UAG) and acylated (AG) ghrelin levels, which have been shown recently to play an important role in endothelial dysfunction associated with diabetes. Using the high-performance flow cytometer FACSCanto, and UAG/AG ghrelin enzyme immunoassay kits, we analyzed whole peripheral blood samples from: (i) diabetic patients with a history of disease of less than 1 year and no clinical evidence of angiopathy, (ii) diabetic patients with long-standing disease with vascular complications, and (iii) healthy donors. We found that T2DM did not affect bone-marrow mobilization, but it altered the UAG/AG profile and decreased the number of highly differentiated EPCs (late EPCs) greatly. In addition, T2DM increased the number of CECs, together with the number of activated CECs. Our results suggest that: (i) the endothelial damage could be due mainly to altered maturation/commitment of EPCs, rather than a simple decrease in their production in the bone marrow; and (ii) EPC subpopulations and ghrelin levels could be useful markers to assess endothelial damage in diabetes.

In vitro evaluation of the frictional forces between brackets and archwire with three passive self-ligating brackets.

The aim of this in vitro study was to evaluate the frictional forces between bracket and archwire that included three passive self-ligating brackets (Damon SL2 SDS). The brackets were individually bonded to a brass mount using a preformed 0.021 x 0.025 inch stainless steel wire jig in order to exclude adverse tipping or torsion. The central bracket was positioned 1 mm higher than the others, in order that the three brackets were vertically unaligned. Thirty-six similar set-ups including in total 108 brackets were investigated using the same wire: copper (nickel-titanium) 0.014 inches. A testing machine was designed and constructed to measure the frictional forces between the wire and the three-bracket set-up. Twelve set-ups were tested to measure kinetic frictional forces between the wire and unaligned passive self-ligating brackets used in the closed position. The frictional properties of two sets of 12 three-bracket set-ups (control) were tested and measured with an open slide and conventional ligation. A stainless steel ligature wire was used in the former, while elastomeric modules were employed in the latter. One-way analysis of variance showed a significant effect of ligation mode on the frictional properties of the three-bracket set-ups (P < 0.001). Post hoc pairwise comparison showed that the frictional forces arising from passive self-ligation were significantly lower (P < 0.01) than those resulting from elastic ligation. The same result was achieved when comparing self-ligation and metallic ligation (P < 0.01). No significant difference was found when comparing elastic and metallic ligation.

Cervicofacial emphysema secondary to facebow injury: a case report.

AIM: To report the clinical case of a child with facial and periorbital emphysema caused by an orthodontic device. CASE REPORT: An 11-year-old child presented to our clinic showing moderate swelling of the left facial area. Based on his dental history, physical findings, and instrument examinations, the diagnosis of cervicofacial emphysema was established, caused by disengagement of the facebow. One week later, all swelling and crepitus had disappeared without complications. Most patients who develop subcutaneous emphysema after a dental procedure have only moderate local swelling, which normally resolves spontaneously and without complications within a week. However the spread of large amounts of air into the deeper spaces may cause life-threatening sequelae. CONCLUSIONS: Orthodontists should be aware that the use of extraoral traction applied via a facebow can cause soft tissue injures and emphysema of the cervicofacial region. It is important to avoid misdiagnosis and to appropriately inform patient and parents about this condition.

Effectiveness and compliance of an oscillating-rotating toothbrush in patients with dental implants: a randomized clinical trial.

BACKGROUND: The aim of this randomized clinical trial was to assess the efficacy of an oscillating-rotating toothbrush in reducing plaque and inflammation around dental implants. METHODS: Eighty patients presenting dental implants were enrolled in this study and assigned randomly to two different groups: 40 patients in the test group and 40 in the control one. Each patient in the test group received an oscillating-rotating toothbrush while in the control group patients kept using the manual toothbrush. Furthermore, the test group received a special toothbrush head designed for dental implants and another one for natural teeth. Domiciliary oral hygiene instructions were given to both groups. Periodontal parameters like plaque index (PI), bleeding on probing (BoP), and probing pocket depth (PPD) were recorded at the baseline and after 1 and 3 months. RESULTS: At the end of the study, the difference of plaque and bleeding indices with the baseline was statistically significant for both test and control groups (P < 0.0001). Implant sites showed higher values of both BoP and PI when compared to the natural teeth. In the second part of the study, comparing the 1-3-month period, the oscillating-rotating toothbrush was effective in reducing new plaque formation (P < 0.0001) and bleeding (P < 0.0001) both at the implant sites and the dental sites comparing to manual ones (P > 0.05). No significant differences were appreciated concerning the PPD. CONCLUSIONS: The oscillating-rotating toothbrush can be successfully used for the plaque and bleeding control of the peri-implant tissues.

Pulmonary phagocyte depression induced by an acid or alkaline solution in a rat model of peritonitis.

BACKGROUND: Peritonitis is a surgical problem with a high mortality rate attributable to various complications, including respiratory infection. This complication is more common under certain conditions reflective of the origin of peritonitis, suggesting that the composition of the peritoneal fluid exerts an influence on the intensity of the macrophage and peritoneal response. To establish a correlation among macrophage function, absorption of bacteria from the peritoneal cavity, and the pH of the peritoneal fluid, we carried out this study. METHODS: Thirty female Wistar rats were divided into three equal groups, all of which received infusions of 0.9% saline by parietal puncture. In group A (control), the saline pH was 7.0; in group B, it was 2.5; and in group C, it was 8.5. After 40 min, 0.25 mL of a suspension containing 10(11) colony-forming units of (99m)Tc-labeled Escherichia coli was infused by the same route. After another 40 min, samples of vena caval blood, spleen, liver, and lung were removed; the radioactivity was counted; bacterial absorption was determined; and the proportional radioactivity/g of tissue was calculated. The values were compared among the groups by the Student t-test, with the level of significance set at p < 0.05. RESULTS: There was significantly greater bacterial absorption in group B than in group C (p = 0.004) but no differences in the numbers of bacteria in the liver and spleen. Bacteria were significantly more numerous in the peripheral blood in group B than in groups A and C (p = 0.04 for both). Pulmonary phagocytosis was significantly reduced in group B compared with group A (p = 0.008) and group C (p = 0.005). CONCLUSION: Peritonitis associated with acidic conditions in the peritoneal cavity is correlated with a reduction in pulmonary phagocytosis and an increase in the numbers of nonphagocytized bacteria in the peripheral blood, possibly representing a direct or indirect cause of the higher incidence of pneumonia and sepsis in these individuals.

Measuring effectiveness of orthognathic surgery by electromyography: a restrospective clinical study.

BACKGROUND: This study investigates retrospectively if the initial electromyography (EMG) status of patients who underwent orthognathic surgery correlates with the extent of postsurgical EMG functional recovery. METHODS: Clinical records concerning 20 patients who underwent Le Fort I and/or sagittal osteotomy of the mandibular ramus to correct skeletal dental class III malocclusions were retrieved and presurgical and postsurgical EMG data were analyzed and compared. Additionally, postsurgical EMG recovery was compared with that of a set of healthy, not surgically treated class I patients, with no sign of disorders affecting the temporomandibular joint (TMJ). Finally, the effect of six independent variables (age, sex, time from surgery, extent of segment re-positioning, malocclusion class, upper jaw repositioning) on muscular recovery was investigated by means of correlation analysis. RESULTS: A significant increase of the average EMG activity after orthognathic corrective surgery was observed (P=0.01). The postsurgical increase of EMG values showed a negative correlation trend with those collected before surgery (r=-0.38, clenching on teeth; r=-0.33, clenching on cotton rolls). None of the independent variables had any effect on the postsurgical outcome. CONCLUSIONS: Orthognathic surgery improves the muscular activity of patients who present skeletal dental class III malocclusions. This improvement can be objectively assessed with EMG measurements. Patients who benefit more from orthognathic surgery seem to be those displaying the lowest presurgical EMG activity.

CBCT evaluation of the tridimensional relationship between impacted lower third molar and the inferior alveolar nerve position.

BACKGROUND: The aim of this study is to evaluate if the statistical significant relations between the measures taken exists or not and to show how the 3D reconstruction could be help the oral surgeon in all those instances in which it may have a direct impact on the planning of the surgical steps. METHODS: Thanks to use of NobelClinician™ Software it was possible to analyze 200 mandibular tomography computerized, random selected, and create a 3D reconstruction of mandibular bone, point out dental structure of wisdom tooth and the way of IAN. Statistical analysis was performed using the Statistical Package for Social Sciences. One way ANOVA test was used to measure the association between each independent variable and the outcome variable, followed by the post-hoc least significant difference (LSD) test for intergroup differences. RESULTS: Two independent variables were significant predictors for risk to have the distance 0 mm from IAN to apex: "Ramus relationship/space available" and "depth". CONCLUSIONS: The 3D reconstruction software provide surgeons with an additional planning tool, offering: immediate and neat visualization of the noble structures that have to be respected and their localization in the three spatial planes; the exact morphology of the relevant root apex; a 360° view of the relationship between the IAN and the third molar and the exact point in which the root is in relationship with the canal.

Risk indicators related to peri-implant disease: an observational retrospective cohort study.

PURPOSE: The aim of the present study was to retrospectively investigate the influence of potential risk indicators on the development of peri-implant disease. METHODS: Overall, 103 patients referred for implant treatment from 2000 to 2012 were randomly enrolled. The study sample consisted of 421 conventional-length (>6 mm) non-turned titanium implants that were evaluated clinically and radiographically according to pre-established clinical and patient-related parameters by a single investigator. A non-parametric Mann-Whitney U test or Kruskal-Wallis rank test and a logistic regression model were used for the statistical analysis of the recorded data at the implant level. RESULTS: The diagnosis of peri-implant mucositis and peri-implantitis was made for 173 (41.1%) and 19 (4.5%) implants, respectively. Age (≥65 years), patient adherence (professional hygiene recalls <2/year) and the presence of plaque were associated with higher peri-implant probing-depth values and bleeding-on-probing scores. The logistic regression analysis indicated that age (P=0.001), patient adherence (P=0.03), the absence of keratinized tissue (P=0.03), implants placed in pristine bone (P=0.04), and the presence of peri-implant soft-tissue recession (P=0.000) were strongly associated with the event of peri-implantitis. CONCLUSIONS: Within the limitations of this study, patients aged ≥65 years and non-adherent subjects were more prone to develop peri-implant disease. Therefore, early diagnosis and a systematic maintenance-care program are essential for maintaining peri-implant tissue health, especially in older patients.

Histological Features and Biocompatibility of Bone and Soft Tissue Substitutes in the Atrophic Alveolar Ridge Reconstruction.

The reconstruction of the atrophic alveolar ridges for implant placement is today a common procedure in dentistry daily practice. The surgical reconstruction provides for the optimization of the supporting bone for the implants and a restoration of the amount of keratinized gingiva for esthetic and functional reasons. In the past, tissue regeneration has been performed with autogenous bone and free gingival or connective tissue grafts. Nowadays, bone substitutes and specific collagen matrix allow for a complete restoration of the atrophic ridge without invasive harvesting procedures. A maxillary reconstruction of an atrophic ridge by means of tissue substitutes and its histological features are then presented.

Use of a Collagen Matrix as a Substitute for Free Mucosal Grafts in Pre-Prosthetic Surgery: 1 Year Results From a Clinical Prospective Study on 15 Patients.

BACKGROUND: The presence of keratinized tissue around dental implants is more than desirable either from a functional and aesthetic point of view, making soft tissue grafting a common practice in implant rehabilitation. Autogenous soft tissue grafting procedures are usually associated with high morbidity. Aim of this study was to assess the efficacy of a xenogeneic collagen matrix as a substitute for soft tissue grafting around dental implants. METHODS: 15 consecutive patients underwent a vestibuloplasty and grafting, both in the mandible and the maxilla, with a collagen matrix. RESULTS: The primary endpoint was to evaluate the resorption of the graft along with the re-epithelization grafted area. The percentage of the resorption was 44,4%, with a mean gain in vestibular height of 3 mm. Secondary endpoints evaluated the clinical appearance, the hemostatic effect and the post-operative pain. All subjects referred minimal pain with no bleeding. No adverse reaction nor infection were noted. CONCLUSION: This study showed that the used collagen matrix can find major interest in those patients who need a greater aesthetic outcome as the matrix has a perfect integration with the surrounding tissues. Furthermore it is strongly recommended for those patients who can bear little pain. CLINICAL SIGNIFICANCE: Post-operative morbidity of autologous grafts is the biggest concern of this type of surgery. The possibility to use a soft tissue substitute is a great achievement as morbidity decreases and bigger areas can be treated in a single surgery. The present study showed the efficacy of a collagen matrix as this kind of substitute.

[Efficacy of the povidine-iodine irrigation in healing of colonic anastomosis in rats]. / Efeito do uso de povidine-iodine na cicatrização de anastomoses de cólon direito de ratos.

BACKGROUND: Anastomotic leakage is a major cause of mortality in colorectal surgery. Several methods have been evaluated in order to prevent anastomotic leakage, and was postulate that povidone-iodine irrigation of colon before anastomosis can improve anastomotic healing, prevent adhesion formation, and may be beneficial in patients undergoing gastrointestinal surgery. AIM: To evaluates the efficacy of this agent in healing of colonic anastomosis in rats. MATERIAL AND METHODS: Twenty Wistar rats were divided into two groups: Group A (n = 10), cleaning of anastomotic borders with saline solution, and group B (n = 10), cleaning of anastomotic borders with 5% povidone-iodine. The animals were submitted to laparotomy, section of colon and treatment according previously described. After anastomosis, the animals were observed, and killed in 7th postoperative day. Blood samples were collected to serum albumin measurement and anastomosis observed macroscopically in relation to presence of fistula, adhesion and dilatation. A 6 cm colonic segment with the anastomosis at the center was excised bursting pressure was determined. RESULT: There was no fistula in any animal in both groups, and there was no difference in relation to obstruction, presence of adhesion or bursting pressure when compared group A and B. CONCLUSION: The use of povidone-iodine was not able to improve anastomotic healing in rats.

Osseointegrated implants in vertical ridge augmentation with a nonresorbable membrane: a retrospective study of 75 implants with 1 to 6 years of follow-up.

The aim of this study was to retrospectively evaluate 75 implants inserted in vertically augmented bone at the time of or prior to implant placement after 1 to 6 years of prosthetic loading. The study included 21 patients (29 surgical sites). The vertical procedure was performed combining a titanium-reinforced expanded polytetrafluoroethylene membrane with autograft (7 sites), allograft (5 sites), or auto-xenograft (17 sites). Healing was uneventful in 24 surgical sites. Three sites showed premature exposure, and two sites presented an abscess. Two implants were lost, for a cumulative survival rate of 93.6%. Mean bone remodeling at 1, 2, 3, 4, 5, and 6 years was 0.34, 0.72, 1.04, 0.84, 0.56, and 0.61 mm, respectively. The implant success rate was higher with a simultaneous approach (82.5%) compared with a staged approach (66.8%). Implants surrounded by keratinized mucosa revealed a higher success rate (82.1%) than those without it (58.4%).

Twelve-Year Retrospective Follow-Up of Machined Implants in the Posterior Maxilla: Radiographic and Peri-Implant Outcome.

PURPOSE: To retrospectively evaluate the survival rate of machined implants in sinus-lifted posterior maxilla after 12 years, with special reference to radiographic outcome and peri-implantitis. MATERIALS AND METHODS: From 37 possible candidates, 29 patients with 59 implants were evaluated. Implants were placed in the posterior maxilla in combination with a sinus elevation procedure (27 patients) or 6 months after sinus elevation (2 patients). Marginal bone level changes were radiographically evaluated at baseline and 1, 7, and 12 years post-loading. Probing depth was measured; presence/absence of plaque and bleeding on probing were recorded. RESULTS: Four out of 59 implants failed in 4 out of 29 patients (cumulative survival rate = 93.2%). The mean bone loss was 0.78 mm (± 0.88) after 12 years. Changes in the mean bone level were statistically significant between baseline and all the other follow-up intervals (p < .001). Statistically significant differences could be demonstrated for the first- to 12th-year interval (p < .05) and for the seventh- to 12th-year interval (p < 0.001). No statistically significant differences could be demonstrated at the first- to seventh-year interval (p = .32). The mean overall probing depth was 2.9 ± 0.66 mm. Probing depth was moderately correlated with the marginal bone changes at 7 year and after 12 year follow up (p = .05). No signs of peri-implantitis were reported during the 12-year follow-up period. CONCLUSIONS: This follow-up demonstrates a very good prognosis when implants with machined surfaces are used. The frequencies of implant failures were very small. Within the limits of the results from this study, the risk of peri-implantitis in the posterior maxilla might be considered a minor problem when implants with machined surfaces are used.

A Retrospective Evaluation of 192 Implants Placed in Augmented Bone: Long-Term Follow-Up Study.

The purpose of the present study was to assess the cumulative survival rate (CSR) of 192 implants placed in association with guided bone regeneration (GBR) procedures to evaluate the long-term predictability of this technique. Moreover, the Kaplan Meier survival analysis was applied to the data in order to evaluate predictors of implant failures, including the source of the graft, the type of membrane, and the timing of implant placement. The CSR of the sample was 95.6% over a mean follow-up period of 78 months (range, 1-175 months). Considering the source of graft, a 95.0%, 93.3%, and 97.7% CSR was obtained for demineralized bovine bone mineral (DBBM), autologous, and 1:1 ratio mixture of autologous and DBBM grafts,, respectively. The CSR referred to bioabsorbable membranes was 96.5%, whereas 94.6% was the CSR reported for nonresorbable membranes. The CSR of simultaneous surgeries was 96.8%, whereas staged surgeries showed a CSR of 94.5%. According to the data, implants placed in conjunction with GBR procedures presented a satisfying survival rate even in the long term. All the procedures performed with different bone grafts and type of membranes guaranteed optimal results both in one- and two-stage approaches. No statistically significant differences could be detected among the groups; indeed, the use of DBBM associated with resorbable membranes may be suggested to reduce patients' morbidity and treatment time. Therefore, the dental implants placed in association with bone regenerative procedures presented safe and predictable long-term clinical results.

Evaluation of postoperative discomfort after impacted mandibular third molar surgery using three different types of flap.

OBJECTIVE: The surgical extraction of an impacted third molar involves a wide range of consequences such as trismus, swelling, and pain, as well as more significant complications, temporary or permanent, that can manifest altered sensitivity of the tongue or lips. The purpose of this prospective study was to evaluate the effects of three different flaps on postoperative discomfort considering trismus, edema, and pain, after the extraction of impacted third molars. The data derived from the analysis of the surgical trials performed at the Oral Surgery Unit, Department of Surgical, Reconstructive and Diagnostic Sciences, IRCCS Policlinico, University of Milan, directed by Professor F. Santoro, MD. METHOD AND MATERIALS: This study, developed over 2 years, involved 238 patients for a total of 238 extractions of impacted mandibular third molars. The 238 surgeries were performed on 114 men and 124 women: 54 avulsions were performed with the elevation of an envelope flap (Group 1), 48 avulsions through the elevation of a triangular flap (Group 2), and the remaining 136 avulsions were performed using a trapezoidal flap (Group 3). RESULTS: Trismus was significantly reduced (P < .05) in patients treated with envelope flap, as was the swelling perceived by the patient (P < .05). Pain was closely related to the elevation of a mucoperiosteal flap and osteotomy. Our study does not reveal statistically significant differences between the three types of flap used; however, the number of analgesic tablets taken was lower in cases of elevation of a less traumatic flap (envelope and triangular flaps). CONCLUSION: The data collected in this study indicate the envelope flap as the most suitable for the reduction of the expression of postoperative complications such as swelling and trismus.

Survival of post-treatment canine-to-canine lingual retainers with fiber-reinforced composite resin: a retrospective study.

The aim of the study is to evaluate the long term results of ribbond retainer after orthodontic treatment. One hundred and thirty patients who were orthodontically treated satisfied the inclusion criteria of having received a semipermanent retention were treated with FRC lingual retainers (Ribbond (®)). It was performed a follow up evaluation after 2 years average from the retainer application and any complication or failure was recorded. Data from 119 remaining patients that met the inclusion criteria were analyzed and no instances of loosening were observed. It may be concluded that orthodontic canine-to-canine FRC retainers provide aneffective means of retaining realigned anterior teeth for at least two years.

Do ultrasonic dental scalers interfere with implantable cardioverter defibrillators? An in vivo investigation.

OBJECTIVES: To test the in vivo effects of an ultrasonic dental scaler on various implanted cardioverter defibrillator (ICD) models. METHODS: 12 consecutive patients with ICDs had continuous both electrocardiogram monitoring and device interrogation to detect interferences during the use of an ultrasonic dental scaler. RESULTS: No interferences were detected by any ICD. Evaluation of the electrocardiograms for each patient failed to show any abnormalities in pacing during testing. CONCLUSION: The results of this study suggest that the routinary clinic use of piezoelectric dental scalers do not interfere with the functioning of any of the tested ICDs. CLINICAL SIGNIFICANCE: Ultrasonic dental scalers have been suspected of electromagnetic interference (EMI) with the normal functioning of ICDs and the use of this type of equipment for patients with these devices has been controversial. This is the first in vivo study to investigate EMI of ICD activity during the operation with ultrasonic dental scaler.