RESUMO
SUMMARY: Objective. The purpose of the study was to describe the characteristics of patients experiencing hypersensitivity reactions (HRs) to iodinated contrast media (ICM) in a large Italian population and to investigate potential risks factors in order to obtain a risk stratification, helpful in the management of these patients. Methods. Data of 407 patients investigated in 9 Italian Allergy Centers for suspected HRs to ICM were analyzed and compared with a control group of 152 subjects that tolerated one or more ICM-enhanced examinations. The univariate and multivariate logistic regression model was used to evaluate associated factors. Results. The mean age of reactive patients was 61 years and 60% were female; 67% of patients reported immediate reactions and 35% experienced the reaction, more frequently with immediate onset, at the first examination in life. Iomeprol, iopromide and iodixanol were the most frequent culprit agents and 20% of patients showed a positive skin test result. Previous adverse reactions to ICM were reported by 15.6% of patients, whereas 35% of subjects experienced the reaction, more frequently immediate, after the first ICM-enhanced examination in their life. The multivariate analysis showed that male gender and age > 65 were associated with ICM reactions as protective factors [ORadja = 0.51; 95% CI: 0.33-0.77 and ORadja = 0.60; 95% CI: 0.39-0.92 respectively]. Cardio-vascular disease [ORadja = 2.06; 95% CI: 1.22-3.50)], respiratory allergy [ORadja = 2.30; 95% CI: 1.09-4.83)] and adverse drug reactions [ORadja = 1.99; 95% CI: 1.05-3.77)] were identified as risk factors for ICM reactions. Food allergy was not significantly associated with reactions [ORadja = 1.51; 5% CI: 0.41-5.56]. Conclusions. This is the largest study on Italian patients experiencing hypersensitivity reactions to ICM. Most results are in line with other studies, showing some association with factors that could influence the incidence of hypersensitivity reactions but not allowing an easy risk stratification.
Assuntos
Meios de Contraste , Hipersensibilidade a Drogas , Meios de Contraste/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Testes CutâneosRESUMO
Water is used in petroleum oil refineries in significant volumes for cooling, steam generation and processing of raw materials. Effective water management is required at refineries to ensure their efficient and responsible operation with respect to the water environment. However, ascertaining the potential environmental risks associated with discharge of refinery effluents to receiving waters is challenging because of their compositional complexity. Recent European research and regulatory initiatives propose a more holistic approach including biological effect methods to assess complex effluents and surface water quality. The study presented here investigated potential effects of effluent composition, particularly hydrocarbons, on aquatic toxicity and was a component of a larger study assessing contaminant removal during refinery wastewater treatment (Hjort et al 2021). The evaluation of effects utilised a novel combination of mechanistic toxicity modelling based on the exposure composition, measured bioavailable hydrocarbons using biomimetic solid phase microextraction (BE-SPME), and bioassays. The results indicate that in the refinery effluent assessments measured bioavailable hydrocarbons using BE-SPME was correlated with the responses in standard bioassays. It confirms that bioassays are providing relevant data and that BE-SPME measurement, combined with knowledge of other known non-hydrocarbon toxic constituents, provide key tools for toxicity identification. Overall, the results indicate that oil refinery effluents treated in accordance to the EU Industrial Emissions Directive requirements have low to negligible toxicity to aquatic organisms and their receiving environments. Low-cost, animal-free BE-SPME represents a compelling tool for rapid effluent characterization.
Assuntos
Petróleo , Poluentes Químicos da Água , Bioensaio , Disponibilidade Biológica , Indústria de Petróleo e Gás , Petróleo/análise , Petróleo/toxicidade , Águas Residuárias/análise , Poluentes Químicos da Água/análise , Poluentes Químicos da Água/toxicidadeRESUMO
OBJECTIVE: The aim of the study was to assess the psychological impact of COVID-19 pandemic on subjects with temporomandibular disorders (TMD), as for symptomatology and presence of parafunctions and sleep disorders. PATIENTS AND METHODS: Two hundred fourteen subjects completed an online questionnaire, including Perceived Stress Scale (PSS), a temporomandibular screening and a specific item about the impact of such event on the psycho-physical side. Non-parametric tests - Mann-Whitney and Kruskal-Wallis - were performed to compare sex and age groups, as for PSS and "COVID-19 pandemic impact score (CpIS)", and the groups Improved/stationary and Worsened in symptomatology as for the "CpIS". Data of subjects undergoing gnathological therapy and not were compared, using Chi-squared test. Orofacial symptomatology values before and during pandemic were compared. The level of statistical significance was set at p<0.05. RESULTS: The most prevalent category of perceived stress was the one of "moderate stress". Participants on average attributed to the pandemic a medium-low impact. The reported symptomatology actually showed a significant negative trend only as for neck pain. The intensity of orofacial symptomatology during pandemic was lower than before. Differences between age groups were statistically significant, as for CpIS. Subjects belonging to the group Worsened in one or more fields examined - TMD symptoms, comorbidities, sleep disturbances and fatigue - reported a significantly higher CpIS (p<0.0001). Awake and sleep bruxism, dental grinding, alteration in the quality and quantity of sleep and fatigue increased. Gnathological therapy was not a protective factor. CONCLUSIONS: The most evident fact during pandemic was the increase of parafunctions and sleep disorders. The trend of symptoms was more variable and complex.
Assuntos
COVID-19/psicologia , Transtornos do Sono-Vigília/psicologia , Estresse Psicológico/psicologia , Transtornos da Articulação Temporomandibular/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Inquéritos e Questionários , Adulto JovemRESUMO
Methods: A questionnaire of 36 questions was developed and administered to assess socio-occupational characteristics, knowledge of Healthcare-associated infections, attitudes and barriers encountered in compliance with hygiene standards, self-analysis of professional behaviour, and proposals for new interventions. Variables were evaluated by univariate analysis, and multivariable logistic regression models were constructed to identify predictors of adequate knowledge, positive attitude and appropriate professional behaviour. Background: Healthcare-associated infections are the main complications of hospitalization. A bottom-up approach, where the Healthcare workers involved play a key role, can be adopted to limit the Healthcare-associated infections burden. To this end, a survey was conducted in the main intensive care unit of Umberto I Teaching Hospital of Rome, where an active surveillance system has been in place since April 2016. Results: Overall, 79/89 Healthcare workers completed the questionnaire. Multivariate analysis showed that Healthcare workers, who participated in ward meetings to share active surveillance reports, were more likely to have adequate knowledge (aOR=4.21, 95% CI: 1.36-13.07). Only job type seemed to be a predictor of adequate behaviour, since nurses and physicians were more likely to show adequate behaviour than residents in training (aOR=0.21, 95% CI: 0.06-0.74). Direct observation of compliance with standard hygiene precautions and the identification of 'local champions' to manage Healthcare-associated infections' issues were the most requested interventions. Conclusions: Our study suggests that the training of healthcare professionals is a key factor in preventing and containing the spreading of Healthcare-associated infections. Moreover, by encouraging greater Healthcare workers' involvement, we conclude that a bottom-up approach is likely to improve Healthcare-associated infections' prevention and management.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Estudos Transversais , Hospitais de Ensino , Humanos , Unidades de Terapia Intensiva , Cidade de Roma/epidemiologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Ehlers-Danlos syndromes (EDS) are inherited connective tissue disorders, requiring specific care along with a multidisciplinary approach by an expert medical staff, as for both the diagnosis and the treatment management. Chronic generalized pain and musculoskeletal dysfunctions due to joint hypermobility are common traits. Temporomandibular disorders (TMDs) are among the most frequent complaints. The authors report the diagnostic and therapeutic management of an EDS subject. CASE PRESENTATION: A 33-year old woman with Ehlers-Danlos syndrome, hypermobile type, was clinically evalu-ated and treated. She underwent a gnathological therapy with an anterior repositioning splint and proprioception ex-ercises, and a physical rehabilitation through an osteopathic manipulation treatment (OMT). Technology - surface Elec-tromyography (sEMG) of masticatory muscles, T-scan and stabilometric platform- supported diagnostic and therapeutic phases, giving objective and quantifiable information on the patient's assessment before and after treatments. CONCLUSION: According to a targeted therapeutic strategy, both the gnathological and the osteopathic therapy proved to be effective in improving patient's symptomatology and functionality, as confirmed by digital findings.
Assuntos
Dor Crônica/terapia , Síndrome de Ehlers-Danlos/terapia , Transtornos da Articulação Temporomandibular/terapia , Adulto , Síndrome de Ehlers-Danlos/diagnóstico , Feminino , Humanos , Instabilidade Articular/etiologiaRESUMO
BACKGROUND: Many studies have shown that low health literacy (HL) is associated with several adverse outcomes. In this study, we systematically reviewed the prevalence of low HL in Europe. METHODS: PubMed, Embase, and Scopus were searched. Cross-sectional studies conducted in the European Union (EU), published from 2000, investigating the prevalence of low HL in adults using a reliable tool, were included. Quality was assessed with the Newcastle-Ottawa Scale. Inverse-variance random effects methods were used to produce pooled prevalence estimates. A meta-regression analysis was performed to assess the association between low HL and the characteristics of the studies. RESULTS: The pooled prevalence of low HL ranged from of 27% (95% CI: 18-38%) to 48% (95% CI: 41-55%), depending on the literacy assessment method applied. Southern, Western, and Eastern EU countries had lower HL compared to northern Europe (ß: 0.87, 95% CI: 0.40-1.35; ß: 0.59, 95% CI: 0.25-0.93; and ß: 0.72, 95% CI: 0.06-1.37, respectively). The assessment method significantly influenced the pooled estimate: compared to word recognition items, using self-reported comprehensions items (ß: 0.61, 95% CI: 0.15-1.08), reading or numeracy comprehensions items (ß: 0.77, 95% CI: 0.24-1.31), or a mixed method (ß: 0.66, 95% CI: 0.01-1.33) found higher rates of low HL. Refugees had the lowest HL (ß: 1.59, 95% CI: 0.26-2.92). Finally, lower quality studies reported higher rates of low HL (ß: 0.56, 95% CI: 0.06-1.07). DISCUSSION: We found that low HL is a public health challenge throughout Europe, where one in every three to almost one in every two Europeans may not be able to understand essential health-related material. Additional research is needed to investigate the underlying causes and to develop remedies. PROSPERO REGISTRATION: CRD42019133377.
Assuntos
Letramento em Saúde , Adulto , Estudos Transversais , Europa (Continente)/epidemiologia , União Europeia , Humanos , PrevalênciaRESUMO
OBJECTIVE: The possible relationship between temporomandibular disorders (TMDs) and body posture is still controversial. Rasterstereography has been introduced as a radiation-free, reliable and non-invasive method to analyze three-dimensional spinal posture. The aim of this case-control study is to evaluate, through rasterstereography, body posture parameters in a group of patients with reducible unilateral dislocation of the articular disc, compared to healthy volunteers. PATIENTS AND METHODS: Rasterstereographic recordings obtained were compared between the two groups with a paired t-student test. Furthermore, the relationship between Rasterstereographic recordings and clinical data in the TMD group were analyzed by means of multiple regression analysis. RESULTS: Only lateral deviation was statistically significant different between the two groups (rms VPDM Control group 40% > TMD group, p=0.02; 43% control group VPDM max > TMD group, p<0.02). In the TMD group, a significant relationship (p<0.05) was found out between lateral and rotational deviations of the column and muscular pain, therefore suggesting a possible overactivity of the masticatory muscles, especially of lateral pterygoids' bilaterally and the left masseter. CONCLUSIONS: Patients with reducible unilateral disc displacement showed limited postural alterations compared to healthy volunteers, only lateral deviations (VPDM rms and VPDM-max) were statistically significant (Å <0.05) between the two groups.
Assuntos
Diagnóstico por Imagem/métodos , Mialgia/diagnóstico por imagem , Postura , Coluna Vertebral/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Adulto JovemRESUMO
OBJECTIVE: Surface Electromyography of masticatory muscles (sEMG) is used as a tool to support diagnosis and treatment of Temporomandibular disorders (TMDs). The study aimed at examining jaw muscles pattern in individuals with temporomandibular joint disc displacement with reduction (TMJ/DDR). This sort of subjects was supposed to have a different muscular pattern compared to the control group. MATERIALS AND METHODS: Sixty-four women with unilateral TMJ/DDR and forty TMD-free women underwent a sEMG assessment of masticatory muscles. Descriptive statistics were performed. Student T-Test assessed differences between the two groups. Statistical significance was set at ρ < 0.05. RESULT: The t-test showed statistically significant results only in BAR and SMI scores (ρ value < 0,0001). The other measurements did not differ between the two groups. BAR index values of all healthy subjects were within the reference range. Almost the entire TMJ/DDR group had BAR index out of reference range and anteriorly placed. CONCLUSION: Women with TMJ/DDR showed an altered recruitment of the jaw muscles, with significant difference between the activity of the couple of temporalis and the one of masseters, compared to the control group. A lower chewing efficiency was found in the DDR group compared to the control one.
Assuntos
Eletromiografia , Disco da Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/fisiopatologia , Adulto , Eletromiografia/métodos , Feminino , Humanos , Músculo Masseter/fisiopatologia , Mastigação , Músculos da Mastigação/fisiopatologia , Pessoa de Meia-Idade , Músculo Temporal/fisiopatologia , Transtornos da Articulação Temporomandibular/diagnósticoRESUMO
BACKGROUND: Healthcare-associated infections (HAIs), or nosocomial infections, represent a significant burden in terms of mortality, morbidity, length of stay and costs for patients hospitalized in intensive care units (ICUs). Surveillance systems are recommended by national and international institutions to gather data on HAIs in order to develop and evaluate interventions that reduce the risk of HAIs. STUDY DESIGN: Here we describe the methodology and the results of the surveillance system implemented in the ICU of the Policlinico Umberto I, a large teaching hospital in Rome, from April 2016 to October 2018. METHODS: The multimodal infection surveillance system integrates four different approaches: i) active surveillance of inpatients; ii) environmental microbiological surveillance; iii) surveillance of isolated microorganisms; and iv) behavioral surveillance of healthcare personnel. Data were collected on catheter-related bloodstream infections, ventilation-associated pneumonia, catheter-associated urinary tract infections and primary bloodstream infections that developed in patients after 48 h in the ICU. For environmental surveillance 14 points were selected for sampling (i.e. bed edges, medication carts, PC keyboards, sink faucets). The system of active surveillance of HAIs also included surveillance of microorganisms, consisting of the molecular genotyping of bacterial isolates by pulsed-field gel electrophoresis (PFGE). From 1 November 2016, monitoring of compliance with guidelines for hand hygiene (HH) and proper glove or gown use by healthcare personnel was included in the surveillance system. After the first six months (baseline phase), a multimodal intervention to improve adherence to guidelines by healthcare personnel was conducted with the ICU staff. RESULTS: Overall, 773 patients were included in the active surveillance. The overall incidence rate of device-related HAIs was 14.1 (95% CI: 12.2-16.3) per 1000 patient-days. The monthly device-related HAI incident rate showed a decreasing trend over time, with peaks of incidence becoming progressively lower. The most common bacterial isolates were Klebsiella pneumoniae (20.7%), Acinetobacter baumannii (17.2%), Pseudomonas aeruginosa (13.4%) and Staphylococcus aureus (5.4%). Acinetobacter baumannii and Klebsiella pneumoniae showed the highest proportion of isolates with a multidrug-resistant profile. A total of 819 environmental samples were collected, from which 305 bacterial isolates were retrieved. The most frequent bacterial isolates were Acinetobacter baumannii (27.2%), Staphylococcus aureus (12.1%), Enterococcus faecalis (11.1%), Klebsiella pneumoniae (5.2%) and Pseudomonas aeruginosa (4.7%). All Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae environmental isolates were at least multidrug-resistant. Genotyping showed a limited number of major PFGE patterns for both clinical and environmental isolates of Klebsiella pneumoniae and Acinetobacter baumannii. Behavioral compliance rates significantly improved from baseline to post-intervention phase. CONCLUSIONS: By integrating information gathered from active surveillance, environmental microbiological surveillance, surveillance of bacterial isolates and behavioral surveillance of healthcare personnel, the multimodal infection surveillance system returned a precise and detailed view of the infectious risk and microbial ecology of the ICU.
Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Infecção Hospitalar/epidemiologia , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Infecções Urinárias/epidemiologia , Adulto , Idoso , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/prevenção & controle , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Feminino , Fidelidade a Diretrizes , Hospitais de Ensino , Humanos , Incidência , Unidades de Terapia Intensiva , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Recursos Humanos em Hospital/normas , Pneumonia Associada à Ventilação Mecânica/microbiologia , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Guias de Prática Clínica como Assunto , Infecções Urinárias/microbiologia , Infecções Urinárias/prevenção & controleRESUMO
OBJECTIVE: The aim of this study was to evaluate functionality and clinical application of a novel immediate device in the treatment of temporomandibular disorders (TMDs). To address the research purpose, authors developed and implemented a randomized control clinical trial. PATIENTS AND METHODS: Eighty patients were enrolled in this study and were randomly divided into two subgroups based on the treatment applied: patient group (PG) and control group (CG). The CG was not subjected to any kind of treatment, even placebo, in order to be able to assess the spontaneous development of the pathology over time. The PG was treated applying the novel device for a maximum of three months. The following parameters were evaluated at baseline (T0) and at the end of therapy (T1): presence/absence of articular noises, painful symptomatology (articular pains, muscle pains, headache, cervicalgia), parafunctional habits and duration of symptoms. The x2-index of association was performed, with a p-value < 0.05 considered as statistically significant. RESULTS: No patient in the PG worsened its symptomatology. Thirteen patients (33%) declared themselves cured from their symptoms and were included in a monitoring protocol. Twenty-seven patients (67%) improved their symptoms and were treated with other conservative conventional methods to complete the therapeutic cycle. Therefore, 100% of PG obtained benefits from the application of the new therapeutic approach. In contrast, among patients of CG, eighteen subjects (45%) worsened their symptoms, while eighteen (45%) were defined as stationaries compared to T0 and only four (10%) were defined as improved. CONCLUSIONS: The device presented the following advantages: immediacy of use, reduction of waiting times for its application, good tolerability and comfort and specificity in the execution of tongue rehabilitation exercises.
Assuntos
Dor Facial/terapia , Placas Oclusais , Transtornos da Articulação Temporomandibular/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The numbers of potential neurotoxicants in the environment are raising and pose a great risk for humans and the environment. Currently neurotoxicity assessment is mostly performed to predict and prevent harm to human populations. Despite all the efforts invested in the last years in developing novel in vitro or in silico test systems, in vivo tests with rodents are still the only accepted test for neurotoxicity risk assessment in Europe. Despite an increasing number of reports of species showing altered behaviour, neurotoxicity assessment for species in the environment is not required and therefore mostly not performed. Considering the increasing numbers of environmental contaminants with potential neurotoxic potential, eco-neurotoxicity should be also considered in risk assessment. In order to do so novel test systems are needed that can cope with species differences within ecosystems. In the field, online-biomonitoring systems using behavioural information could be used to detect neurotoxic effects and effect-directed analyses could be applied to identify the neurotoxicants causing the effect. Additionally, toxic pressure calculations in combination with mixture modelling could use environmental chemical monitoring data to predict adverse effects and prioritize pollutants for laboratory testing. Cheminformatics based on computational toxicological data from in vitro and in vivo studies could help to identify potential neurotoxicants. An array of in vitro assays covering different modes of action could be applied to screen compounds for neurotoxicity. The selection of in vitro assays could be guided by AOPs relevant for eco-neurotoxicity. In order to be able to perform risk assessment for eco-neurotoxicity, methods need to focus on the most sensitive species in an ecosystem. A test battery using species from different trophic levels might be the best approach. To implement eco-neurotoxicity assessment into European risk assessment, cheminformatics and in vitro screening tests could be used as first approach to identify eco-neurotoxic pollutants. In a second step, a small species test battery could be applied to assess the risks of ecosystems.
RESUMO
BACKGROUND: The attainment of a good primary stability is a necessary condition to ensure the success of osseointegration in implantology. In type IV cancellous bone, however, it is possible that a reduced primary stability can lead to an increased rate of failure. The aim of this study was therefore to determine, with the help of the resonance frequency (Osstell mentor), which technique of implant site preparation (piezo surgery, conventional, under-preparation, bone compaction, osteodistraction) and macro-geometry is able to improve implant stability in type IV cancellous bone. MATERIAL AND METHODS: 10 pig ribs were prepared with a surgical pre-drilled guide, calibrated for a correct implant positioning. On each rib, 5 implant sites (one for each technique) were prepared. Successively, 50 conical implants (Tekka Global D) were inserted and measured with the resonance frequency to evaluate the primary stability. Data collected were analyzed by analysis of variance (ANOVA) to test whether the Implant Stability Quotient (ISQ) values of the five techniques were significantly different. RESULTS: The results showed that no significant differences among the ISQ values of the five techniques used were found. Also, no significant differences in the macro-geometry of the two types of compared implants were observed. However, the macro-geometry of Tekka implants, characterized by a double condensing thread, seems to provide greater ISQ values than those of single thread implants when using the same technique. CONCLUSIONS: In light of these preliminary data, it is conceivable that in cases of reduced stability, such as those occurring with a type IV bone, all means ameliorating the primary stability and accelerating the osseointegration can be utilized.
Assuntos
Implantação Dentária/métodos , Osseointegração , Cuidados Pré-Operatórios/métodos , Animais , Técnicas In Vitro , SuínosRESUMO
OBJECTIVES: Short implants are increasing their popularity among clinicians who want to fulfill the constant demanding of fixed prosthetic solutions in edentulous jaws. The aim of this report was to propose a new possibility to project and realize an occlusal guided implant cross-arch prosthesis supported by ultra-short implants, describing it presented an edentulous mandible case report. METHODS: A 61-year-old, Caucasian, female patient who attended the dental clinic of the University of L'Aquila presented with edentulous posterior inferior jaw and periodontitis and periimplantitis processes in the anterior mandible. The remaining tooth and the affected implant were removed. Six 4-mm-long implants were placed to support a cross-arch metal-resin prosthesis. RESULTS: At 1-year follow-up clinical and radiological assessment showed a good osseointegration of the fixtures and the patient was satisfied with the prosthesis solution. CONCLUSION: The method, even if it requires further validation, seems to be a valid aid in solving lower edentulous clinical cases, and appears less complex and with more indications of other proposals presented in the current clinical literature. Our case report differs from the current technique All-on-Four, which uses four implants in the mandible to support over-denture prosthesis, assuring a very promising clinical result.
RESUMO
OBJECTIVE: In the last few decades the implantology has achieved excellent results in the prosthetic rehabilitation of the partially or totally edentulous patients. The clinicians, given the pressing demand by patients, must deal with the situations in which the lack of the availability and sometimes the low quality of the bone can lead to the treatment failure. Although the manufacturers recommend to follow codified surgical protocols, alternative techniques of preparation, apt to ensure a better primary implant stability, have been developed. The aim of this study was to determine in vitro, by using the resonance frequency (Osstell mentor), which technique of implant site preparation (piezo surgery, conventional, under-preparation, bone compaction, osteodistraction) is able to improve implant stability of type IV cancellous bone. METHODS: 10 pig ribs were prepared, and a surgical pre-drilled and calibrated guide for proper implant placement was used. On each rib, 5 implant sites were prepared, one for each technique. RESULTS: One-way ANOVA did not show statistically significant differences among the "implant stability quotient" (ISQ) values of the 5 techniques utilized. CONCLUSIONS: Thus, in light of these results, in the clinical practice of the type IV bone one technique is replaceable with the others, as none of them improves implant stability. The choice should instead be directed to the technique that accelerates the healing process and the osseointegration.
RESUMO
Temporomandibular disorders (TMD) are functional diseases of the masticatory system; their symptoms are clicking, difficulty opening the mouth wide, ear pain, facial pain and headaches. The relationships among distress, emotional factors and TMD are well known. It was shown that patients with TMD have little awareness of their inner states and emotions, and it was found that those reporting oro-facial pain presented higher alexithymia than did asymptomatic people. Other authors confirmed that alexithymia was higher in the painful TMD group than controls. This study was aimed to evaluate whether alexithymia and its components can be considered as predisposing factors for pain severity, poor health and greater social difficulties in patients with TMD. One hundred thirty-three patients received a diagnosis of TMD and completed the 20-item Toronto Alexithymia Scale. Multiple stepwise regressions showed that alexithymia and age explained 10% of the pain and 31% of poor health and also that alexithymia explained 7% of social difficulty. A direct comparison of patients with TMD based on alexithymia revealed a higher presence of pain in alexithymic patients with TMD than in those characterised by moderate or no alexithymia. In conclusion, alexithymia partly predicts pain, poor health and social difficulties in patients with TMD. Furthermore, alexithymic patients have more pain than those with moderate or low alexithymia.
Assuntos
Sintomas Afetivos/epidemiologia , Dor Facial/epidemiologia , Nível de Saúde , Comportamento Social , Síndrome da Disfunção da Articulação Temporomandibular/epidemiologia , Adulto , Sintomas Afetivos/psicologia , Fatores Etários , Estudos de Casos e Controles , Dor Facial/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Síndrome da Disfunção da Articulação Temporomandibular/psicologiaRESUMO
Among the various treatment options currently indicated to deal with temporomandibular joint disorders (TMD) an important role is played by occlusal devices, which can be used in an individualized or universal manner. A new universal occlusal appliance device was designed and patented at the Clinical Gnathology Service of the Sapienza University of Rome. To assess its validity and efficacy a preliminary study on a sample of 50 patients was carried out. Patients were selected from a cohort of 158 according to the RDC-TMD (SPEC) criteria and randomly assigned to two groups, the patient group (PG), treated with the device, and a control group (CG) without any treatment. The two groups were evaluated by comparing four VAS pain scores: muscular, migraine, cervical and temporomandibular joint (TMJ). On the whole, all VAS pain scores in the PG showed a marked and statistically significant improvement after treatment, decreasing to about 50-80 percent, while the control group remained stable. The best improvement was achieved in muscular pain. Age did not affect neither the initial scores, nor the pain response to the treatment. The pain scores tended to slightly increase with time of application (one, two or three months), but this trend was significant only for cervical pain. Overall the results are favourable to the application of this new occlusion device. However, the data should be considered preliminary and require further verification in time and on a higher sample of patients of both sexes.
Assuntos
Placas Oclusais , Transtornos da Articulação Temporomandibular/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escala Visual AnalógicaRESUMO
Among the various treatment options currently indicated for the temporomandibular joint disorders (TMD) tackle an important role is played by occlusal devices which can be used in an individualized and or universal.At the Service of Clinical Gnathology of the Head-Neck Department of the Umberto I Polyclinic at the Sapienza University of Rome, has been tested a new universal occlusal appliance, invented and patented by dott. Rampello.To assess the applicability and efficacy was carried out a preliminary study on a sample of 50 patients selected according to the criteria RDC-TMD and divided in random into two groups, the patient group (PG), treated with the device, and a control group (CG) does not undergo any treatment.The two groups were evaluated according to an analysis of segmentation by comparing the clinical data. Were considered some aspects of the application of the device using a self-evaluation questionnaire administered to the PG.CONSIDERATIONS DERIVED FROM THIS INITIAL APPLICATION ARE: none of the 25 patients in the sample PG has worsened the initial situation. 6 patients (24%) were healed and were included in a protocol of regular six-monthly visits. 16 patients (64%) have improved and incorporated into treatment to complete the treatment cycle. 3 patients (12%) were stationary and subjected to a diagnostic reassessment.The patients in the CG have all been included in the multidisciplinary treatment program.The findings of our preliminary study are favorable to this new device occlusion, however, requires further verification in time and on a sample of patients numeroso.
RESUMO
OBJECTIVE: Aims of the study were to assess the stabilometric pattern in a TMD population with migraine and to evaluate the role of static stabilometry as an important tool in the clinical practice to quantify postural analysis in TMD and migraine patients. MATERIALS AND METHODS: We recruited 3 samples. The first one with TMD and headache symptom; the second one consisted in a migraneurs population and the third one was a healthy group. All subjects submitted to a stomathognatic visit for diagnosis of TMD in according to international RDC/TMD criteria, a neurological visit to make diagnosis of primary headache (IHS criteria, 2004) and stabilometric tests (1.open eyes, 2.closed eyes, 3. hyperextended head, 4.with cotton rolls). RESULTS: We found that TMD patients showed an high percentage of migraine diagnosis (90%) and that TMD patients with migraine presented a muscular involvement in the neck district, more than healthy controls. CONCLUSIONS: We showed that there is a strong association between TMD and migraine and an increase of myogenous tension in the neck area is frequent in TMDs, particularly when they are associated with migraine. We suggest that stabilometry could represent a valid tool in the postural approach of TMD and migraine patients.
RESUMO
AIM: The purpose of this study is to evaluate the condylar position and its variation in patients with temporomandibular joint (TMJ) disorders before and after therapy with occlusal gnathologic devices. METHODS: Twenty-five TMJ of 25 patients with temporomandibular joint disorder were examined by linear measurement of the anterior, posterior and superior joint space between the condyle and glenoid fossa through cephalometric analysis on X-ray tomography of the TMJ and by calculating the condylar position with the Pullinger and Hollender method. RESULTS: The average condylar position in the TMJ with DTM was posterior with a mean value of 22.2% and a range from 14.3% to 36%. The condylar position of 25 TMJs was: anterior 0(0%); centric 8(32%) and posterior 17(68%). After therapy with occlusal gnathologic devices the average condylar position was centric with a mean value of 0.6% and a range from 5.3% to 6.6%. The condylar position of 25 TMJs was: anterior 2(8%); centric 22(88%) and posterior 1 (14%). CONCLUSIONS: The hypothesis can be advanced that joint pathology is the consequence of the alteration of the condyle position and therefore of the mandibular movement and vice versa. Therapy with occlusal devices makes it possible to modify the condylar position by increasing the condylar capability to recapture the joint disc.
Assuntos
Côndilo Mandibular/patologia , Transtornos da Articulação Temporomandibular/etiologia , Transtornos da Articulação Temporomandibular/patologia , Adolescente , Adulto , Idoso , Cefalometria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/terapiaRESUMO
AIM: Clinical evidences about therapeutic effectiveness of splint therapy and modern concept concerning the etiopathogenesis of temporomandibular disorders (TMD) lead to a review of the therapeutic approach accepted until the middle 90s for the solution of this derangement of the stomathognatic system. Aim of this study is to produce a long term follow-up of a sample of TMD patients, to estimate the validity and utility of the present therapeutic procedures. METHODS: After diagnostical classification of the patients observed, they have been included in a therapeutic protocol. The outcomes obtained (46 patients at the 1st control in 1994 and 38 patients at the last control in 2001) are re-examined with an average follow-up of 10 years. RESULTS: The results obtained showed the efficacy of the therapeutic procedures carried out (36 healed, 9 improved and 1 worsened at the 1994 check-up: on the whole, a successful result in 98% of cases; 17 healed, 21 improved and 8 lost at the 2001 check-up: on the whole, a successful result in 100% of cases), but at present their application has to be reviewed according to a more conservative and careful therapeutic approach, based on the evaluation of some fundamental parameters. CONCLUSION: The rehabilitative occlusal therapy, in its various aspects, is successful in the long term treatment of TDMs, as long as it is used only when it is possible to determine a correct indication.