The flap recovery on the impacted lower third molar surgery comparing 3 different flap designs: a clinical study.

AIM: The purpose of the study was to analyze the healing of the deep and superficial lower first and second molars periodontium, after the surgical extraction of the contiguous impacted third molar, comparing 3 mucoperiosteal flap designs. MATERIALS AND METHODS: 150 patients which had to undergo a impacted lower third molar surgery were enrolled in this study. They were checked from day 0 to day 90, in order to focus on the recovery quality of the soft tissues around the lower second molar, comparing 3 different flap designs. RESULTS: No intraoperatory incident happened. The complete recovery of the periodontium around the second molar has been shown in each patient after 90 days from surgery and each adverse reaction happened within the sixth week after surgery. Only 2 slight gengival recessions 0,5 mm have been find out. CONCLUSIONS: The impacted third molar surgery is an operation that, if rightly programmed and performed, is relatively safe. Besides, the correct handling and management of periodontium around the second molar and the choice of the flap type to be used support a correct recovery on the second molar periodontium, avoiding any long-term damage. CLINICAL SIGNIFICANCE: This study wanted to analyze the healing of the deep and superficial lower second molar periodontium, after the impacted lower third molar surgery. In order to improve the surgical technique used for lower third molar germectomies, we wanted to compare 3 different kind of flap designs.

Graded porous polyurethane foam: a potential scaffold for oro-maxillary bone regeneration.

Bone tissue engineering applications demand for biomaterials offering a substrate for cell adhesion, migration, and proliferation, while inferring suitable mechanical properties to the construct. In the present study, polyurethane (PU) foams were synthesized to develop a graded porous material-characterized by a dense shell and a porous core-for the treatment of oro-maxillary bone defects. Foam was synthesized via a one-pot reaction starting from a polyisocyanate and a biocompatible polyester diol, using water as a foaming agent. Different foaming conditions were examined, with the aim of creating a dense/porous functional graded material that would perform at the same time as an osteoconductive scaffold for bone defect regeneration and as a membrane-barrier to gingival tissue ingrowth. The obtained PU was characterized in terms of morphological and mechanical properties. Biocompatibility assessment was performed in combination with bone-marrow-derived human mesenchymal stromal cells (hBMSCs). Our findings confirm that the material is potentially suitable for guided bone regeneration applications.

Piezosurgery vs High Speed Rotary Handpiece: a comparison between the two techniques in the impacted third molar surgery.

OBJECTIVE: The aim of the Study was to compare the impacted third molar surgical technique by means of the high speed rotary handpiece with the piezoelectric one. MATERIALS AND METHODS: 192 patients have been selected among those who had to undergo a third molar surgical extraction. These patients' surgeries have been performed by means of one of the techniques, randomly chosen. Each patient has undergone the same analgesic therapy (paracetamol 1000 mg tablets). Each surgery has been performed by the same surgeon. The patients were asked to fill in a questionnaire concerning the postoperative pain ("happy face pain" rating scale). RESULTS: The average duration of the surgeries performed by means of the high speed rotary handpiece was 32 minutes, while the duration of the ones performed by means of the piezoelectric handpiece was much longer (54 minutes). The postoperative pain values were almost equal. CONCLUSIONS: In conclusion, the osteotomy performed by means of the traditional technique still represents the gold standard in the impacted third molar surgery. The piezoelectric technique may be an effective choice, especially for the less skilled surgeons, in order to guarantee the protection of the delicate locoregional anatomical structures.

Medical waste to energy: experimental study.

OBJECTIVE: Although waste is traditionally assessed as a pollutant which needs to be reduced or lessened, its management is certainly necessary. Nowadays, biological fuel cells, through the direct conversion of organic matter to electricity using biocatalysts, represent a technology able to produce sustainable energy by means of waste treatment. This study aims to propose a mean to generate energy from blood and saliva, that are common risk-infectious medical waste. MATERIALS AND METHODS: Material employed (purchased by Sigma-Aldrich) were: Glucose oxidase (GOx), Nafion perfluorinated resin solution at 5% in a mixture of lower aliphatic alcohols and water, Polyethylene oxide. Stock solutions of D (+) glucose were prepared in a 0.1 M phosphate buffer solution and stored at 4 °C for at least 24 h before use. Carbon cloth electrode ELAT HT 140 E-W with a platinum loading of 5 gm-2 was purchased by E-Tek. Electrospun Nafion fibers were obtained as follows. Scanning electron microscopy was used to characterize the electrode morphologies. RESULTS: In order to develop an effective immobilization strategy of GOx on the electrode surface, Nafion fibers (a fully fluorinated ion conducting polymer used as a membrane material in enzymatic fuel cells - EFC) were selected as immobilizing polymer matrix. In this work, exploiting the nafion fibers capability of being able to cathalize Gox activity, we have tried to produce an enzymatic fuel cell which could produce energy from the blood and the saliva within medical-dental waste. CONCLUSIONS: Medical waste refers to all those materials produced by the interaction among doctor and patient, such as blood and saliva. During our research we will try to complete an EFC prototype able to produce energy from blood and saliva inside the risk-infectious medical waste in order to contribute to the energy requirements of a consulting room.

Podoplanin in the development and progression of oral cavity cancer: a preliminary study.

OBJECTIVE.: Podoplanin is a mucin-like glycoprotein that is important in lymphangiogenesis but not in blood vessel formation. The aim of this preliminary study is to determine the role of podoplanin in the development and progression of head and neck cancer. MATERIAL AND METHODS.: Podoplanin over expression was analyzed in 20 patients with oral cancer, by immunohistochemical analysis. RESULT.: Podoplanin is not expressed in normal oral epithelial cells but was found in some hyperplastic and dysplastic lesions. Podoplanin high expression was found in 9 of 20 patients and was more frequent in cancers with lymph node metastasis, particularly in oral cavity cancers. In our preliminary study, patients who showed high levels of podoplanin had a statistically greater rate of lymph node metastasis (P<0,001); patients with lymph node metastasis and high-level podoplanin showed a shorter disease-specific survival (P = 0,004) than other patients. CONCLUSION.: The results of our preliminary study have provided interesting and encouraging data. We have observed that podoplanin expression increases in the early stages of tumourigenesis and it seems to be associated with a higher risk of head and neck cancer. While in squamous cell carcinoma podoplanin expression diminishes during tumour progression. These data support a role for podoplanin expression in the initiation but not in the progression of cancer. So we can conclude that podoplanin is involved in oral oncogenesis and can be a predictor for lymph node metastasis in asymptomatic patients. Histology and podoplanin analysis can be very useful to predict the risk of development, invasion and metastatic progression of a tumour in patients with oral cancer.

Origin of microsatellite instability in gastric cancer.

Microsatellite instability (MSI) is observed in 13-44% of gastric carcinoma. The etiology of MSI in gastric carcinoma has not been clearly defined. To assess the role of mismatch repair in the development of MSI in gastric cancer, expression of hMSH2 and hMLH1 was explored. We examined 117 gastric carcinomas for MSI and observed instability at one or more loci in 19 (16%) of these tumors. Of the 19 tumors with MSI, nine exhibited low-rate MSI (MSI-L) with instability at <17% of loci, whereas the remaining 10 exhibited high-rate MSI (MSI-H) with instability at >33% of loci examined. Immunohistochemical staining for hMLH1 and hMSH2 was performed on eight of the tumors with MSI-H, five with MSI-L, and 15 tumors without MSI. All eight tumors with MSI-H showed loss of staining for either hMLH1 (n = 5) or hMSH2 (n = 3). In contrast, tumors with MSI-L or without MSI all showed normal hMSH2 and hMLH1 protein expression patterns. Moreover, all eight of the tumors with MSI-H also showed instability at BAT-26, whereas none of the MSI-L tumors or tumors without instability showed instability at BAT-26. These findings suggest that the majority of high-level MSI in gastric cancer is associated with defects of the mismatch repair pathway. Although larger studies are needed, BAT-26 appears to be a sensitive and specific marker for the MSI-H phenotype in gastric carcinoma.

Characterization of the APC gene in sporadic gastric adenocarcinomas.

The prominent role of the APC gene in colorectal tumor development is well established. However, its role in tumorigenesis in other tissues is not clear. Hence, DNA from 30 primary sporadic gastric adenocarcinomas was obtained from patients living in a high risk area of the world (North-Central Italy) in order to further define APC's role in gastric tumorigenesis. We thoroughly examined that region of APC which is commonly mutated in colorectal tumors using proven sensitive methods. The IVS protein assay and DNA sequence analysis of APC codons 686 through 1693 revealed no intragenic mutations. However, allelic loss of loci near APC was detected in 7 (28%) of 25 informative gastric adenocarcinomas using two 5q dinucleotide repeat markers for LOH analysis. These results suggest that genetic alteration of a region of APC commonly mutated in colorectal cancer is not a common event during sporadic gastric tumor development, at least in patients from North-Central Italy. Further analysis of chromosome 5q might identify another gene to be significantly altered in these gastric cancers.

Acute intestinal obstruction from a granuloma due to Schistosoma hematobium in the appendix.

A case of acute intestinal obstruction due to a granuloma caused by Schistosoma haematobium in the appendix is presented. The patient came from a pure S. haematobium area and only S. haematobium eggs were identified. The granuloma turned the appendix into a cingulum that caused an intestinal strangulation.