Paediatric oral surgery: endoscopic approach in ameloblastic fibroma management. A preliminary report.

AIM: Ameloblastic fibroma (AF) is a rare benign odontogenic tumor of slow-growing behaviour characterised by proliferation of both epithelial and mesenchymal odontogenic tissues. Treatment of AF is usually conservative by means of enucleation, curettage and long term follow-up. CASE REPORT: This report describes a case of AF in a 12-year-old boy. Examination of the oral cavity revealed absence of tooth 3.7 and mild swelling in the same mandibular area. Orthopantomography and Cone Beam Computed Tomography (CBCT) showed a wide multilocular radiolucent lesion at the left mandibular angle, extending from the first molar to the lower part of the mandibular branch; agenesis of tooth 3.7 and displacement of tooth 3.8. Surgical excision was performed under general anaesthesia. A fiberscope was used to perform a more conservative bone removal and extraction of tooth 3.8. Furthermore, an accurate curettage of the bone site was performed. The histological investigation showed an AF pattern: an epithelial cell component arranged in nests and tubules immersed in a stroma of low differentiated mesenchymal tissue. No sign of recurrence has been observed during the 6-month follow-up period. CONCLUSION: Although AF is a rare tumor, it is more prevalent in children's jaw. A new intra-operative visual technique could provide a conservative treatment by minimising bone deformities and permitting an accurate bone curettage.

An experimental in vivo procedure for the standardised assessment of sealants retention over time.

AIM: The elaboration of an experimental system to obtain reproducible and comparable photographs of the occlusal surface to monitor sealants retention. MATERIALS AND METHODS: An intraoral camera connected to a computer was used to obtain photos of the occlusal surfaces. A specific software was utilized to perform measurements on archived pictures. An experimental two-part system, consisting of a dental arch support and a camera support, connected to each other through holes and pins, was made to obtain a standardised and reproducible placement of the camera in the mouth. In the first part, to test the degree of reliability of the procedure and the percentage of image distortion, 120 first molars were sealed and for each molar ten photographs were taken, using the intraoral camera connected with the dental arch support, the camera support and the dedicated software. In the second part, 165 first molars were sealed and photographed, as above described, immediately after sealing (T0), 6 months (T1) and 1 year later (T2). With the software, the sealed areas were measured. The comparison of the selected sealed areas between T0 and T1, T0 and T2, T1 and T2 determined the percentage of sealant loss. RESULTS: In the first part, the experimental procedure showed a reliability of 96.85%. In the second part, the difference in the rate of lost sealant between T0-T1 and T1-T2 was statistically significant (p <0.001). STATISTICS: ANOVA analysis was made. CONCLUSIONS: Photographs, obtained through the experimental two-part system, allowing a reproducible positioning of the intraoral camera in oral cavity, could represent a standardised and useful method to monitor sealants retention over time.

New approach in paediatric dentistry: ultrasonic nondestructive evaluation of restorative dental materials. Experimental study.

AIM: The ultrasonic inspection is a non invasive method which is very developed in the industrial field, for the non-destructive evaluation of materials, and in the medical field, for the ultrasound diagnostic analysis. In paediatric dentistry the most widely used non- destructive evaluation is the X-ray technique. Radiographs are valuable aids in the oral health care of infants, children, adolescents, allowing dentists to diagnose and treat oral diseases that cannot be detected during a visual clinical examination. The aim of this in vitro study was to analyse the ultrasonic non-destructive evaluation (UT-NDE) technique to inspect both dental materials internal structure and the form and position of internal defects in order to obtain a diagnostic method, free of ionising radiations, in paediatric dentistry. Moreover the ultrasonic inspection (UT) could be a rapid method of diagnosis in uncooperative paediatric patients. MATERIALS AND METHODS: Study Design: Experimental samples were manufactured with the characteristics of a large composite or glass ionomer cement paediatric dental restoration, in terms of either size or operative technique used. Characteristics of the common restorations were analysed and reproduced in vitro, using the same operative conditions, also adding operative defects into some samples. All the samples were subjected to an innovative UT test using the pulse echo immersion scanning technique. Both C-scans and full volume scans were carried out during the experimental programme. To enhance the data obtained from the UT scan, a digital system (Ecus Inspection software) for signal detection, archiving, processing and displaying was used. RESULTS: UT images showed the presence of internal defects in the dental materials. It was also possible to inspect very thin discontinuity such as the one represented by the fluid resin. STATISTICS: In order to execute the statistical analysis, the values of electric voltage measured in five higher white points and in five higher grey points of the pictures pixels, were measured for each sample. Then, the average values and the standardised data were calculated. CONCLUSION: n In conclusion, the ultrasonic test could be a diagnostic non-invasive method in paediatric patients, capable to evaluate the quality of the restorative teeth filling, showing internal little defects. In vivo application of this diagnostic method should be developed.

SEM investigation on casein phosphopeptides capability in contrasting cola drinks enamel erosion: an in vitro preliminary study.

AIM: Erosion of dental hard tissues induced by acidic dietary components is a high-prevalence finding, especially among children and adolescents. Acidic soft drinks are frequently implicated in dental erosion. The aim of this in vitro study was to assess if CPP-ACP preparation is capable of reducing enamel erosion caused by a cola-type drink. MATERIALS AND METHODS: Twenty-five sound human permanent premolars, extracted for orthodontic reasons in patients of 12-16 years old, were used. The roots were removed and the crowns were sectioned in order to obtain 3 enamel sections from each tooth. The specimens were immersed in: (A) cola-type drink; (B) cola-type drink plus CPP-ACP; (C) deionised water (control) for: 48 h, 24 h, 12 h, 6 h and 3 h, respectively. pH values were constantly monitored. Statistical analysis was performed using ANOVA. The enamel samples were evaluated for surface changes using scanning electron microscopy (SEM). RESULTS: Specimens subjected to cola-type drink (treatment A) showed wide areas of enamel dissolution, while the treatment B specimens showed a few areas of little enamel erosion, different from control samples. Adding CPP-ACP to the cola-type drinks influenced pH levels of the solutions, but always in the acidity range. CONCLUSION: CPP-ACP provides protection against dental erosion from cola-type drinks in vitro. Therefore, further studies are necessary to evaluate if adding casein phosphopeptide-stabilised amorphous calcium phosphate complex to acidic cola drinks could reduce their erosive potential in vivo as well.

Carcinogen hemoglobin adducts, urinary mutagenicity, and metabolic phenotype in active and passive cigarette smokers.

In 100 healthy volunteers, we have studied the relationship between the type (air- or flue-cured) and number of cigarettes smoked and different biomarkers relevant to the risk of bladder cancer, including the levels of 4-aminobiphenyl (ABP) hemoglobin adduct (a marker of internal dose), urinary mutagenicity in Salmonella typhimurium TA98, and the N-acetylation phenotype (a marker of susceptibility). ABP is a potent bladder carcinogen that is N-acetylated as an overall detoxification step. Levels of the ABP hemoglobin adduct were higher in smokers of black tobacco (air-cured) than in smokers of blond tobacco (flue-cured), confirming our earlier study. In addition, "slow" acetylators had higher levels of the ABP hemoglobin adduct for the same type and quantity of cigarettes smoked. Urinary mutagenicity was also associated with quantity of cigarettes but not with the acetylation phenotype. Convex dose-response relationships were found between the amount smoked and ABP hemoglobin adduct levels or urinary mutagenicity. In 15 nonsmokers who reported exposure to environmental tobacco smoke, ABP hemoglobin adduct levels, unlike urinary mutagenicity, were found to be an aspecific exposure indicator.

Acetylation phenotype, carcinogen-hemoglobin adducts, and cigarette smoking.

Levels of 4-aminobiphenyl-hemoglobin adducts in smokers of blonde (flue-cured) and black (air-cured) tobacco have been found to be proportional to bladder cancer risk. In addition, risk of bladder cancer due to exposure to occupational carcinogens is elevated in genetically determined slow acetylators. In this study of normal male volunteers, 4-aminobiphenyl-hemoglobin adducts were found to be related to both the quantity and the type of tobacco smoked, as well as to the acetylator phenotype (independently of smoking habits). The demonstration that both the genetically determined slow acetylator phenotype and tobacco smoking are independently associated with levels of the carcinogen 4-aminobiphenyl in adducted hemoglobin suggests a single mechanism to explain the contribution of genetic susceptibility and environmental exposure in bladder carcinogenesis.