Transverse maxillary distraction with a bone-anchored appliance: dento-periodontal effects and clinical and radiological results.

In 29 adult patients presenting with maxillary deficiency, a bone-anchored palatal distractor (Surgi-Tec NV, Brugge, Belgium) was applied after osteotomy of the anterolateral walls of the maxillary sinuses, midpalatal suture, and, eventually, separation of the pterygomaxillary sutures. Expansion proceeded at a rate of 0.33-0.66 mm per day and the device was retained for 4-6 months for consolidation. Active orthodontic therapy was started after 8-10 weeks. The increment of arch width and the perimeter were evaluated using dental casts. Tooth thermal sensitivity and the periodontal side effects of treatment were monitored clinically after distraction, at device removal, and after 1 year. Bone healing was also investigated during the procedure using conventional radiological techniques. This experience confirms that transverse maxillary distraction is an effective technique in adult patients, leading to the formation of new bone. There were no noticeable intraoperative complications, but postsurgical periodontal side effects were documented. The procedure offers advantages over traditional teeth-borne appliances in terms of rapidity of treatment and the absence of mechanical forces acting on the teeth. Further evaluation is required to assess the long-term stability and periodontal consequences of this technique.

Hyperplasia of the mandibular coronoid process: long-term follow-up after coronoidotomy.

The aim of this study was to evaluate long-term results of treatment by intraoral coronoidotomy and prolonged physiotherapy in five patients with mandibular coronoid process hyperplasia. Five consecutive cases of coronoid process hyperplasia were studied (two unilateral and three bilateral) at the Department of Maxillo-facial Surgery of the University of Turin during the period 1985-1990. All patients were treated by intraoral coronoidotomy and given physiotherapy from the third postoperative day. This continued for an entire year. A clinical and radiological follow-up (average 39.4 months), in three cases over a 5-year period, was completed. Three months after the operation, all patients had achieved satisfactory improvement in mandibular interincisal opening. The mean value for mouth opening at the end of follow-up was 42 mm. Radiographic follow-up showed the presence of a coronoid process almost the size of the original, apparently united with the mandibular ascending ramus, with moderate dislocation and inclination posterior to the body of the zygomatic bone. The results of this study indicate that treatment of coronoid process hyperplasia by intraoral coronoidotomy, when combined with prolonged postoperative physiotherapy, gives satisfactory and stable long-term results in the correction of coronoid-malar interference.

[Case studies of galactography]. / Contributo casistico alla galattografia

A brief account of radiological examination in diseases of the breast is followed by a discussion on galactography. Its technique is not difficult, but requires diligence, attention and experience. Its indications essentially concern cases in which there is secretion from the nipple. Contraindications are mainly known or strongly suspected malignant tumours. Disorders affecting the milk ducts are described with reference to their radiological picture as observed in 91 cases, 40 of which were followed operatively and histologically and 18 with cytological examination of the secretion. The examination is seen as an alternative of choice in cases of mammary lesion with secreting nipple, particularly in the exact localisation of damage.

[Nephrangiotomography with iopamidol in renal insufficiency]. / La nefrangiotomografia con iopamidolo nelle insufficienze renali.

An account is given of a study of 118 patients, including 67 with renal failure of varying severity, examined nephrangiotomographically with the aid of both a non-ionic contrast medium (iopamidol) and a conventional medium (sodium diatrizoate and methylglucamine). It is shown that the advantages presented by rapid injection of the medium, and the obtaining of prompt vascular data, are accompanied by those offered by the non-ionic medium, since it induces reduced osmotic diuresis, which permits satisfactory visualisation of the excretory ducts, even in patients with very low glomerular filtration values.

[Potentiated peroral cholecystography and simultaneous multiple tomography with Synchroplan. A new approach to the study of bile duct pathology]. / Colecistografia perorale potenziata e tomografia multipla simultanea con Synchroplan. Nuovo protocollo di indagine nella patologia delle vie biliari.

Tomographic study of the bile ways following a second dose of oral contrast medium led in 60 patients to a considerable diagnostic gain. Oral cholecystographic examination failures fell and at the same time the field of indication for i.v. cholangiography was restricted.

[Sequential endovenous angiourography (AUS) with image subtraction for the study of the arterial phase of urography. Comparison with nephroangiotomography (NAT)]. / L'angiourografia sequenziale (AUS) endovenosa con sottrazione di immagine per lo studio della fase arteriosa dell'urografia. Confronto con la nefroangiotomografia (NAT).

Two urographical techniques employed in the endovenous study of renal arteries are compared. They are nephroangiotomography (NAT) using synchroplan and sequential angiourography (SAV) with image subtraction. 64 patients were studied, 32 with NAT and 32 with AVS. Both techniques were shown to be useful, but AVS through infrequently used was cleary more efficient than Nat in the study of the vascular arterial phase.

[Renal tubular damage after rapid intravenous contrast study with iopamidol]. / Il danno tubulare renale dopo contrastografia rapida endovenosa con iopamidolo.

Reference is made to results obtained in 53 nephropathics in the study of urinary elimination of alphaglycosidase and lysozyme before and after rapid contrastography with sodium and meglumine diatrizoate and with iopamidol. A statistically significant difference in alphaglycosidase was evident with both media, whereas no change was noted for lysozyme. As far as the evaluation of alphaglycosidase was concerned, the tubular alteration induced by each medium was the same in terms of statistical comparison of the mean differences before and after urography.

[The value of the basophil degranulation test on the study of hypersensitivity reactions to iodinated contrast media]. / Utilità del test di degranulazione dei basofili nello studio delle reazioni di ipersensibilità ai mezzi di contrasto iodati.

The ability of basophils and tissue mastocytes activated by sensitised IgE antibodies to release mediators in the presence of the specific antigen underlies immediate hypersensitivity reactions. This phenomenon can be explored by the in vitro basophil degranulation test adopted not only in experimental pathology, but in human allergological pathology and in the study of post-streptococcal and lupus glomerulonephritis. The test has been carried out to analyse sensitisation to iodate contrast media in 71 patients already submitted to contrastography, 37 of whom had given evidence of allergic reactions. All patients with a previous history of sensitisation presented, in vitro, a positive reaction (56 + 15.3% degranulation) in the presence of the contrast medium. Against this, none of the patients with negative test presented an allergic reaction during contrastography. Stress is laid on the practical importance of the test prior to performance of contrastography so as to predict possible sensitisation and select the most suitable medium.

The use of replicate resin models in the treatment of maxillary sinus augmentation patients.

The elevation of the floor of the maxillary sinus is becoming a routine surgical procedure to develop the site for dental implants. This delicate procedure is best performed with diagnostics of the highest magnitude. To this point, computer tomographic scans provide valuable information, especially when defining the location and extension of septae transversing the sinus. Additional useful information is provided by a replicate resin model that is constructed from a magneto-optical disk compatible with a personal computer. The image data is then converted to a DOS format. Bone structures of interest are thresholded in each slice based on single-pixel gray levels. Object profiles with linear interpolation and their elaboration generate the three-dimensional surface of the object. Finally, the physical resin model is fabricated.

[The role of the traditional radiological methods in conservative therapy and endodontics]. / Ruolo delle metodiche radiologiche tradizionali in terapia conservativa ed endodontica.

The traditional radiographic examinations used in restorative dentistry and endodontics are: intraoral radiograph performed in the beta-wing or the paralleling technique, the partial extraoral radiograph (rotational narrow beam), the panoramic radiography and the periapical radiographs with the bisecting technique which is particularly suitable for visualization of the apex. Radiology is a valuable diagnostic means to evaluate the extension of primary caries, to identify secondary and interproximal initial decays and if required let the therapist measure the biological width. Several factors influence the radiographic interpretation of caries: cervical burnout, mach band effect, internal and external resorption, restorative materials for fillings and sub-bases, abrasions and/or erosions. Radiology allows the diagnosis of developmental and acquired abnormalities of the teeth which can have an influence on the treatment itself. Examples are: variations in the shape of the crown and root, dens in dente, enamel hypoplasia, dentinogenesis imperfecta. Radiograms are of major importance in the evaluation of restorative dentistry results: precision of the margins, congruous contact points, fractures. Moreover, it provides the endodontic procedures with useful diagnostic data and permits the measurements during the treatment, supplying the immediate and long term checks too.

Primary impaction of primary teeth: a review and report of three cases.

Primary impaction of primary teeth is rare. Only ten cases have been found in the world literature. It affects almost always second molars and the finding is usually occasional. Three cases of this abnormality, two of the upper jaw and one of the mandible, are presented. The analysis of the characteristics of these cases and the cases in the literature, suggests that ankylosis has probably a leading role in the etiopathogenesis. The following criteria for a correct diagnosis is presented: 1) deep retention into the bone; 2) absence of caries, restorations and resorptions; 3) frequent passing of the corresponding permanent premolar; and possible retention of the corresponding adjacent tooth. More attention is recommended in the study of the lesion for the future.

[Radiological considerations of malpractice in dentistry]. / Considerazioni radiologiche sulla "malpractice" in odontoiatria.

Several branches of competence are needed to evaluate malpractice in dentistry: first a complete case history, secondly careful clinical observation and finally a correct procedure of radiographic documentation. This latter is able to prove existence of the treatment and its evolution, moreover it shows the bone, the dental components underneath the surface and the treatment becomes appraisable by different observers. In restorative dentistry, radiological findings allow us to demonstrate overcontoured restorations in approximal sites and, if necessary, identify the biological width. In endodontics the insufficient filling or the overfilling of the root channel can be demonstrated along with the material used for the filling and the presence of fractured instruments inside the channel. In prosthodontics, on the other hand, the quality of the abutments, fractured roots and/or prosthesis, symptoms of inadequate charge on the bone and overcontours with the subsequent periodontal damage can be seen. In orthodontics one can assess the appearance of infrabone pockets, reabsorptions and horizontal recessions. In extractive surgery it is again possible to identify through radiographic documentation small root fragments in the maxillary sinus (possible sinusitis associated) and maxillary fractures as a consequence of extractions. In the field of implantology, damage to noble structures due to inadequate case planning can be highlighted.

[Panoramic radiography using an intraoral tube. Method, anatomy, radiography and dosimetry]. / La radiografia panoramica con sorgente endorale. Tecnica, anatomia radiografica e dosimetria.

BACKGROUND: There are two techniques giving a panoramic view of the dental arch: orthopantomography and intraoral tube panoramic radiography. The last one is not very well known because images, with a characteristic and variable deformity if compared with orthopantomography are not useful for routinary use in dentistry. The poor radiographic and pathologic anatomy knowledge of intraoral tube panoramic radiography, and the slight improvements brought to the method particularly in order to reduce the dose, partly depend on the scant attention given to the method by investigators, and partly on the dyshomogeneous anatomic sites enlargement and overlapping with consequent deformity of all of them. With intraoral tube panoramic radiography, X-ray exposition is emitted using a miniaturized cylindrical source placed inside the oral cavity and the radiographic film is in contact with the skin of the face. Based on the orientation of the collimator and the inclination of the tube major axis in the oral cavity, a central technique (exposition of either superior or inferior dental arch) and a lateral technique (simultaneous exposition of the two hemiarches of the same side) are recognized. The aim of this study is to give a significative contribution to maxillo-facial characteristic appearance and dosimetry knowledge in intraoral tube panoramic radiography. METHODS: It consists of: a) a "laboratory" part concerning the evaluation of the enlargement, deformation and visibility of different structures, obtained by positioning about fifty different markers in different maxillary and mandibular anatomic sites, and b) an in vivo dosimetry part obtained with intraoral and extraoral termoluminiscent dosimeters. An original dispositive allowed the right positioning of the film and its adherence to the screen. Deformity characteristics are analitically described and discussed in relation with the different sites. RESULTS AND CONCLUSIONS: The use of intensifying screens allowed a good reduction of dose, (mean absorbed doses ranging from 25 microGy in the intraoral sites to 1936 microGy in the extraoral sites) without reducing the image quality thanks to the device performed "ad hoc".

["Empty cysts" of the jaws]. / Le "cisti vuote" dei mascellari.

BACKGROUND: The extensive use of orthopantomography contributed to the occasional discovery of the so called empty cysts (EC) also defined as traumatic or hemorrhagic, which are benign mainly asymptomatic lesions. There are different opinions on empty cysts (even on the proper term to define them) particularly regarding their epidemiology, etiopathology, and clinical and radiological aspect. The purpose of this study is to compare the literature and personal experience and to underline the peculiar aspects not only from a semantic point of view, but also from a more elaborate perspective. MATERIALS AND METHODS: Forty-five osteolytic lesions, which can be considered as empty cysts, taken out of a group of 30,000 patients in a period of 5 years have been examined retrospectively. Radiologic documentation included: orthopantomography, occlusal radiographs, intraoral periapical radiographs, intraoral tube panoramic radiographs and TC in 4 cases. Several parameters among which: trauma, symptoms, location, dimension and the radiological aspect of the lesion were taken into account. RESULTS: The authors concluded: trauma in 4 cases, location of 44 out of 45 empty cysts in the mandible, 67% of which distal to canines; displacement of adjacent teeth in four cases, without root resorbtion. The major axis of empty cysts varied from a minimum of 18 to a maximum of 80 mm. The morphology was oval or round, 37 cysts were monolocular, 8 were plurilocular. In 17 cases the authors noticed a reduction and a displacement of the corticals, but never discovered a pathological fracture. During the observed period an increase in growth of lesions was not found in the follow-up of 14 out of 44 patients. CONCLUSIONS: The personal data were compared to those of the literature where the authors found a larger incidence of patients with symptoms and a history of trauma and cementofibrousdysplasia. The authors suggested that the real incidence of empty cysts is higher than that of the literature. On the basis of personal experience empty cysts are very stable. Therefore, it is questionable if oral surgery should be avoided when radiological picture is certain.

[The surgical verification of the periodontal probe and endoral radiography in assessing the bone substance loss in periodontal disease. A proposal for optimizing the methods]. / Verifica chirurgica del sondaggio parodontale e della radiografia endorale nella valutazione della perdita di sostanza ossea nella malattia parodontale. Proposta di ottimizzazione delle metodiche.

It is difficult to compare levels of bone loss in periodontal disease measured by periodontal probe and X-ray and to verify them versus surgical techniques. In fact, there are relatively few published reports on the subject. To this purpose the Authors describe their personal experience using plates equipped with guide tracks and center-film boxes with personalized bites. The suitability of the two methods (probe, intraoral X-ray) to determine levels of bone loss similar to those revealed by surgical verification was assessed on the basis of an analysis of the respective bone loss in 44 sites surrounding 19 dental elements. This method, which is accurate but time-consuming, demonstrated an broadly analogous underestimate (approx. 20%) using both preoperative probe and X-ray techniques in comparison to the true level of bone loss measured during surgery.

Family studies and HLA typing in ankylosing spondylitis and sacroiliitis.

The families of 21 ankylosing spondylitis (AS) and 16 sacroiliitis (SI) patients were investigated and typed for HLA markers. The association of HLA B27 with AS was confirmed, but no strong evidence for the same or other HLA markers being associated with SI was found. Inheritance patterns in families were analyzed according to the multifactorial and monofactorial models. It is proposed that a major gene associated or interacting with the B27 product controls the susceptibility to AS, and that this gene behaves as a dominant with incomplete penetrance. The problem as to whether linkage disequilibrium maintained by selective pressure, or functional epistasis between the "disease gene" and the B27 antigen may be the acting mechanism of association, remains to be elucidated.

Radiochromic films for dental CT dosimetry: a feasibility study.

Dental CT dose evaluations are commonly performed using thermoluminescent dosimeters (TLD) inside anthropomorphic phantoms. Radiochromic films with good sensitivity in the X-ray diagnostic field have recently been developed and are commercially available as GAFCHROMIC XR-QA. There are potential advantages in the use of radiochromic films such as a more comprehensive dosimetry thanks to the adjustable size of the film samples. The purpose of this study was to investigate the feasibility of using radiochromic films for dental CT dose evaluations. Film samples were cut with a width of 5mm and a length of 25 mm (strips), the same size as the Alderson Rando anthropomorphic phantom holes used in this study. Dental CT dose measurements were performed using simultaneously both TLD and radiochromic strips in the same phantom sites. Two equipment types were considered for dental CT examinations: a 16 slice CT and a cone beam CT. Organ equivalent doses were then obtained averaging the measurements from the sites of the same organ and effective doses were calculated using ICRP 103 weighting factors. The entire procedure was repeated four times for each CT in order to compare also the repeatability of the two dosimeter types. A linear correlation was found between the absorbed dose evaluated with radiochromic films and with TLD, with slopes of 0.930 and 0.944 (correlation r>0.99). The maximum difference between the two dosimeter's measurements was 25%, whereas the average difference was 7%. The measurement repeatability was comparable for the two dosimeters at cumulative doses above 15 mGy (estimated uncertainty at 1 sigma level of about 5%), whereas below this threshold radiochromic films show a greater dispersion of data, of about 10% at 1 sigma level. We obtained, using respectively Gafchromic and TLD measurements, effective dose values of 107 µSv and 117 µSv (i.e. difference of 8.6%) for the cone beam CT and of 523 µSv and 562 µSv (i.e. difference of 7%) for the multislice CT. This study demonstrates the feasibility of radiochromic films for dental CT dosimetry, pointing out a good agreement with the results obtained using TLD, with potential advantages and the chance of a more extensive dose investigation.