The piezoelectric osteotomy technique compared to the one with rotary instruments in the surgery of included third molars. A clinical study.

AIM: The purpose of this study is to compare surgical times, the saving of bonytissues, the postoperative course of the extraction of included third molars in patients treated with piezoelectric surgery compared to those treated with conventional rotary instruments. METHODS: The study included 140 patients with upper and lower third molars included. 70 of them were treated with osteotomy using conventional rotary instruments (Group 1) and 70 more with osteotomy through piezosurgery Mectron® (GROUP 2). The treatment protocol was the same for both groups. The time of surgery and the saving of bonytissues in the intra-operative have been estimated; moreover, 24-48-72 hours and 7 days after the surgery, two other parameters have been estimated: facial swelling and trismus. The swelling, trismus and the saving of bony tissues were assessed by a surgery gauge. RESULTS: The average surgical time was 15 minutes in Group 1 and 20 minutes in Group 2. The savings of bonytissues was greater in Group 2 than in group 1 by 2.7 mm. The average facial swelling was 6.23 mm for group 1 and 2.86 mm for group 2 24 hours after the surgery, of 5.22 mm for group 1 and 1.76 mm for group 2 48 hours after the intervention, of 3.75 mm for Group 1 and 0.85 for group 2 72 hours after the surgery, of 0.86 mm for group 1 and 0.12 for group 2. The average trismus was of 14.76 mm in Group 1 and 11.15 mm in Group 2. Statistical analysis showed a significant reduction of swelling, trismus and a bigger saving of bony tissues in Group 2 and a reduction in surgical time in Group 1. CONCLUSION: The osteotomy technique with a piezoelectric instrument has produced a significant reduction in facial swelling, trismus and a bigger saving of bony tissues than with conventional rotary instruments. A slight lengthening in terms of surgical time has been recorded, compared to the use of conventional rotary instruments.

Orofacial pain evaluation in children.

AIM: Pain evaluation in children and its diagnosis are problems not always easy to solve. Children, because of their immaturity, are not always able to well communicate or to describe the clear characteristics of the disease by which they are affected. Moreover, they are often unable to report the real intensity of the pain they experience. These problems are related to their immature, not fully evolved psyche. Such problems can create difficulties to the physician who is called to examine and evaluate the origin of orofacial pain, as well as hesitation regarding when it could be necessary to start a drug therapy. Aim of this work is to propose the basic tools for the evaluation and measurement of pain that are better suitable for children, as these instruments can be used together with an accurate anamnesis and a meticulous examination, in order to formulate a precise differential diagnosis among the pathologies that affect the head and neck. A list of the most common painful diseases affecting this area is also presented. METHODS: A systematic literature review about the methods for evaluation and measurement of pain in children was conducted. The commonly used scales of measurement were examined: VAS, VSN, CAS, FPS and the Oucher SCALE. The different pathologies of head and neck and their characteristics are described and the possible causes of orofacial pain have been divided into extracranial and intracranial, in order to easily direct diagnosis. RESULTS: Orofacial pain in children is an issue of great interest in consideration of its high frequency in paediatric dentistry. Its measurement and evaluation is possible despite the small compliance of paediatric patients. Thanks to the modern technique and knowledge this evaluation can be realistic and reproducible. CONCLUSION: Evaluation scales of pain are suitable at any age and skill of the child and, together with a careful anamnesis and a proper clinical examination, allow the clinician to conduct a precise differential diagnosis of the pain so as to set the ideal therapy for the little patient.

Identification of latex UDP glucose pyrophosphorylase (Hev b UDPGP) as a novel cause of latex fruit allergy syndrome.

Based on a recently published unusual ase of food allergy in a latex-allergic patients, the present study identifies Hev b UDPGP as a novel allergen in natural rubber latex able to cause latex-fruit allergy syndrome and as a novel, potential pan-allergen in vegetable foods.

Ex vivo expansion of bone marrow stromal cells by platelet-rich plasma: a promising strategy in maxillo-facial surgery.

The aim of our study is to evaluate in vitro the response of bone marrow stromal cells (BMSCs) to platelet-rich plasma (PRP), in order to clarify the potential role of their combined use in a preclinical phase preceding BMSCs transplantation for bone repair and regeneration procedures. The incubation of BMSCs with PRP promoted a remarkable, dose- and time- dependent, growth stimulation, that was paralleled to a strong increase in the quantity of type I collagen and to a significant decrease in the activity of the early osteoblastic differentiation marker, alkaline phosphatase (AP). Once PRP was removed and osteogenic inducers were added, AP returned to levels comparable to the control, while the late phenotypic markers, osteocalcin and matrix calcification, were enhanced to higher levels than in controls. Our data demonstrate that PRP induces a remarkable ex vivo enrichment of BMSCs maintaining their differentiative potential. Thus PRP represents a valid preclinical tool for obtaining an effective, rapid and safe ex vivo expansion of BMSCs prior to their clinical utilization in bone engineering.

Amphiphilic and hydrophilic forms of choline-O-acetyltransferase in cholinergic nerve endings of the Torpedo.

In the purely cholinergic nerve endings isolated (i.e. synaptosomes) from the electric organ of the fish Torpedo, the enzyme choline acetyltransferase was found to exist not solely in its well-known soluble form but also in a form which is non-ionically bound to the plasma membrane; this activity could not be solubilized in solutions of high ionic strength (0.5 M NaCl). The non-ionic detergent Triton X-114 was used to solubilize synaptosomes isolated from either the electric organ of Torpedo or rat brain. This detergent allows to separate hydrophilic from amphiphilic proteins of cells or subcellular fractions. Twelve per cent of the synaptosomal choline acetyltransferase partitioned as amphiphilic and 80-97% as hydrophilic activity. The percentage of amphiphilic activity present in synaptosomes was significantly higher than that of the form of activity (4.4%) extracted from samples containing only the soluble form of choline acetyltransferase but was significantly lower than the percentage of amphiphilic enzyme present in preparations of synaptosomal plasma membrane (20-22%) which were enriched in the non-ionically membrane-bound form of choline acetyltransferase. These results indicate that the soluble and the non-ionically membrane-bound enzymes differ in their capacity to interact with non-ionic detergents. The preparations of synaptosomal plasma membranes contained significantly higher proportions of detergent-insoluble choline acetyltransferase activity than did the whole synaptosomes; the difference was more striking for the Torpedo than for the rat enzyme. This detergent-insoluble activity was not due to aggregates of the enzyme. Some properties of the hydrophilic and amphiphilic choline acetyltransferase of Torpedo were analyzed. The two forms of the enzyme did not exhibit different affinities for their substrates; they were found to differ with respect to their sensitivity to inhibition by increasing concentrations of the two products of the reaction, acetylcholine and coenzyme A and heat inactivation at 45 degrees C. Most probably the hydrophilic and amphiphilic activities correspond to what was referred to as soluble and non-ionically membrane-bound choline acetyltransferase, respectively. The amphiphilic form may be an integral enzyme of the plasma membrane of cholinergic nerve endings or may be tightly bound to a specific protein in this membrane which may act as a "receptor" for choline acetyltransferase.

Biocompatibility studies on glass ionomer cements by primary cultures of human osteoblasts.

Glass ionomer cements (GICs) are materials largely employed in the dental field that have been considered recently as cements in orthopaedic surgery for their proven osteogenic features. The aim of this study was to compare the response of cultured human osteoblastic cells to a number of commercial glass ionomer cements in order to provide indications useful for the further development of formulations that have potential for use as cements or implants in repair and replacement of bone tissue. The GICs tested were: Ketac-Fil Aplicap, lonocem lonocap 1,0, GC Fuji II, GC Fuji II LC and Vitremer 3M. Several features such as plating efficiency, adhesion and morphology of the cells were studied, as well as the only specific biochemical parameter of osteoblastic phenotype, namely osteocalcin production. In addition, the colonisation of materials by osteoblastic cells was verified by means of scanning electron microscopy. Altogether, the results obtained indicate that four of the five glass ionomer cements tested are biocompatible, showing vital cells adhering to the materials, proliferating and expressing the biochemical markers of osteoblastic phenotype, whereas Vitremer 3M, although currently employed in the dental field, exhibits a great cytotoxicity toward the cells. The adverse reaction of this GIC can be attributed to the leaching of at least two components of the polyacidic phase evidenced by protonic magnetic resonance analysis (PMR), namely 2-hydroxyethylmethacrylate (HEMA), and an unidentified acidic species. The addition of pure HEMA at the same concentrations found by means of PMR to cultures of osteoblastic cells resulted in a complete cell death. Our results also show that in vitro methods employing primary cultures of human cells specific to the implant sites of prostheses are appropriate and suitable tools for evaluating biocompatibility of materials. Furthermore, this kind of approach can provide indications useful in the design of novel materials as well as in improving the characteristics of the formulations already available.

Neoadjuvant chemotherapy with ifosfamide, cisplatin, and vinorelbine in advanced squamous cell carcinoma of the cervix.

A phase II trial was performed to assess the efficacy and toxicity of a combination of ifosfamide (IFX), cisplatin (CDDP), and vinorelbine (VNB) as neoadjuvant chemotherapy (NAC) for untreated advanced cervical carcinoma (ACC). Between October 1995 and February 1998, 40 patients were entered in this study. Their median age was 43 years (range: 23-74 years). International Federation of Gynecology and Obstetrics stages were: IIB, 23; IIIB, 13; and IVA, 4. Therapy consisted of: IFX 2,000 mg/m2 1-hour (H) IV infusion days 1 to 3; 2-mercaptoethanesulfonic acid sodium salt (mesna) 400 mg/m2 IV bolus H 0 and 4, and 800 mg/m2 by mouth H 8, days 1 to 3; VNB 25 mg/m2 20-minute IV infusion days 1 and 8; and CDDP 75 mg/m2 IV day 3. Cycles were repeated every 28 days for a total of three courses. Both staging and response (R) assessment were performed by a multidisciplinary team. An objective response (OR) was observed in 24 of 40 patients (60%; 95% confidence interval, 45-75%). Four patients achieved complete response (CR) (10%); 20 partial response (50%); 12 patients stable disease (30%); and 4 progressive disease (10%). Eight of 24 patients (33%) with OR underwent radical surgery, and histologic CRs were recorded in 2 of them. The remaining patients received definitive radiotherapy after NAC. The dose-limiting toxicity was myelosuppression. Leukopenia occurred in 32 patients (80%) and was grade III or IV in 14 patients (36%). Peripheral neuropathy occurred in 9 patients (22%), whereas myalgias occurred in 10 (25%). Constipation was observed in 9 patients (23%); emesis occurred in 35 patients (88%). There were no therapy-related deaths. These results indicate that IFX/CDDP/VNB is an active combination for ACC with moderate toxicity. Implementation of this regimen in a multimodal therapy protocol deserves further study.

[Clinical applications compared in implantology]. / Applicazioni cliniche a confronto in implantologia.

On the basis of their own experience and of orientation reported by literature, the authors display how important it is for professional men who practise implantology or who approach it, to have the possibility of knowing several implantologic systems. Indeed, what we want to demonstrate is, that in different situations of edentulous, in relation to the quantity and the quality of the available bones, to the gnotologic situation and to the aesthetic functional result they aim to, corresponds the choice of one or several implantologic systems. In that sense the basic research occupies a role of vital importance, because only through the knowledge of chemical, chemical-physical and biomechanical characteristics it is possible to recognize some essential chemical entities for an implantologic approach. Thus the several diagnostic instrumental means available enable the surgeon to make an exact clinical diagnosis. The TAC, in this case, assumes a determinant role, because, in addition to supplying exact dimensional and qualitative informations, also occupies an important medico-legal aspect. The resolution of some forms of edentulous programmed like that, will subsequently be illustrated. Finally, a control hypothesis is proposed for the rearrangement, of peri-implant bone. On this account, the SPECT (single photon emission computerized tomography), through a semi-quantitative research, could provide some specific indications about the osteotropic implantation activity.

[Maxillary sinus surgical lift. Summers' technique versus lateral surgical approach]. / Sollevamento chirurgico del seno mascellare. Tecnica di Summers vs approccio chirurgico laterale.

BACKGROUND: After an extensive review of the literature regarding maxillary sinus lift procedures, the authors report the results of a retrospective study carried out by the Institute of Oral and Maxillofacial Surgery at the Second University of Naples. METHODS: A group of 9 patients aged between 18 and 50 years old, including two females, were enrolled in this study. At the preliminary evaluation, the sites to be analysed showed a bone height between the residual crest and the sinusal membrane not exceeding 8 mm. All patients responded positively to specific preimplantation requisites. Commercially pure titanium fixtures were used as well as demineralised freeze-dried bovine bone and autologous bone graft from the retromolar region. RESULTS: All patients were followed for at least 15 months and no clinical check-ups were missed during that time. No implant was lost and no cases of spire exposure were reported. Postoperative vertical bone resorption was within normal values. CONCLUSIONS: Summers technique and its variations with bone grafts of various kinds represents a valid aid for edentulous maxillary rehabilitation with scarce osseous resources in the postero-superior sectors. It offers a number of advantages compared to the traditional technique using an invasive lateral approach and is more acceptable to patients. However, in spite of this positive experience, the follow-up in the literature still appears to be too short. The authors, are therefore cautious in expressing their absolute preference for Summers technique and stress the need to wait for further long-term results.

[The characteristics and properties of calcium phosphates in biomaterial formulations used in dentistry. 1]. / Caratteristiche e proprietà di alcuni fosfati di calcio presenti nella formulazione di biomateriali impiegati in odontostomatologia. Nota 1.

In this work we present the features and the properties of natural and synthetic apatites, which we use in an experimental study of various commercial products composed by calcium phosphate. After having considered the general concepts of biomaterials and biocompatibility, we describe non biological tests used for the characterization of these products. Biomaterials used in this study are: reabsorbable Dac Blu, non reabsorbable Dac Blu, non reabsorbable atomized Dac Blu, non reabsorbable thin Dac Blu, reabsorbable Biocoral 450, Calcitite 2040-12, Orthogel, Apagen, BTF 65, Calcitite 4060-2 Osprogel, Bio-oss, Biostite, Osprovit, Merck Hydroxiapatite. Tests used are: X-ray fluorescence (XRF), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), thermogravimetric and thermodifferential analysis (TG, DTG, DTA), scanner-ing electron microscopy (SEM) morphological analysis. Last but not least, we underline the particular features of these tests whose interpretation allows a more precise definition of the bioactivity of a biocompatible material.

[The thermal analysis of mineral-based biomaterials used in dentistry. 5]. / Analisi termiche di biomateriali a base minerale utilizzati in odontostomatologia. Nota 5.

In this study the following commercial products were thermo-analysed (TG, DTG, DTA): reabsorbable Dac Blu, non reabsorbable Dac Blu, non reabsorbable atomized Dac Blu, non reabsorbable thin Dac Blu, reabsorbable Biocoral 450, non reabsorbable thin Dac Blu, reabsorbable Biocoral 450, Calcitite 2040-12, Orthogel, Apagen, BTF 65, Calcitite 4060-2, Osprogel, Bio-Oss, Biostite, Osprovit, Merck Hydroxiapatite. The apparatus utilized was a Setaram TAG 24, in a symmetrical set up, which gave the TG, DTG and DTA analysis simultaneously. The analysis of all the materials were performed in correct operative conditions. The thermo analyses gave useful information about the thermal stability of the samples. The TG analysis gave the data relative to the percentage of weight loss due to the volatile substances in the samples (H2Oass C, OH-, CO2). The DTG graph made it possible to establish the presence of carbonate apatite and/or hydroxyapatite or the absence of both the substances. Finally, DTA and DTG analyses allowed show the presence of various organic substances. These data were very useful to characterize the examined materials and confirmed the extreme importance and sensibility of this method.

A diagnostic trap for the dermatopathologist: granulomatous reactions from cutaneous microimplants for cosmetic purposes.

We present a case of late granulomatous reactions from silicone that first appeared in a site different from that of the injection causing an incorrect diagnosis of liposarcoma in the beginning. The histological picture was a cystic-macrophagic granuloma in both the injection site (upper lip) and the migrating site (paranasal regions). We think that the foreign body has undergone an antigravity migration from the upper lip to the right paranasal region. To our knowledge, such a phenomenon has not been yet reported in literature.

New abutment for a screw-retained, implant-supported crown.

The 1-piece, implant-supported abutment and crown, colloquially described as the UCLA abutment, commonly is used to fabricate single, screw-retained crowns. This abutment was designed to allow attachment of the crown directly to the implant and requires a waxing and casting procedure by a laboratory technician. A new prefabricated abutment has been developed that uses a similar approach but does not require the waxing and casting process. The PDQ abutment is made from a metal-ceramic alloy that is custom contoured by grinding to support a porcelain veneer. Porcelain then is fired to the contoured abutment to develop the 1-piece artificial crown. This article describes the use of the PDQ abutment.

[Infectious endocarditis in dentistry practice: recent controversies and modes of the use of antibiotic prophylaxis]. / L'endocardite infettiva nella pratica odontostomatologica: recenti controversie e modalità di applicazione dell profilassi antibiotica.

A survey by questionnaire to assess the daily practice of the antibiotic prophylaxis of infective endocarditis by physicians attending post-graduate schools of the Institutes of Oral Surgery and Stomatology (Group A n = 83) and Cardiology (Group B n = 46) of the Second University of Naples has been conducted. They were asked about dental procedure and cardiopathies that require prophylaxis for infective endocarditis, the relationship between infective endocarditis and rheumatic disease and the provision of antibiotic. Extraction of tooth and dental and oral surgery have been reported as the most risky procedures. Moreover provision of antibiotic prophylaxis was suggested to patients not at risk (pacemaker or coronary artery bypass), and was not suggested in high risk conditions (mitral valve prolapse with regurgitation and hypertrophic cardiomyopathy). Most of the 50-60% practitioners usually start the prophylaxis 24-48 hours before the procedure and prolong it for 48-72 hours. These results underline the need for improvement of the knowledge for the antibiotic prophylaxis of infective endocarditis.