Consensus paper on postural dysfunction: recommendations for prevention, diagnosis and therapy.

Good fundamentals of posture and balance are essential for the efficient performance of both simple daily tasks and more complex movement patterns. In particular, postural balance is the ability to keep the body in equilibrium and to regain balance after the shift of body segments: postural control mechanisms of integration of the visual, vestibular and foot afferential channels contribute to this. This document provides recommendations based on scientific evidence, clinical practice, and consensus between experts concerning the prevention, diagnosis, and treatment of postural dysfunction at the three stages of life as the developmental age, adult age, and old age > 65 years and follows the "National Guidelines on Classification and Measuring of Posture and its Dysfunctions" per the Italian Ministry of Health (December 2017). The paper answers four main questions: i) "Which measures can be adopted to prevent postural dysfunctions?" ii) "What can we do in order to make a correct diagnosis of postural dysfunction?" iii) "What are the correct treatment programs for postural dysfunctions?" iv) Which professional competencies and experiences are useful for preventing, diagnosing and treating postural dysfunctions? By the Consensus of the Experts and the scientific evidence, emerge that the approach to postural dysfunctions requires a multidisciplinary and interdisciplinary team. Furthermore, rehabilitation treatment interventions must be specific to the age groups that have been indicated, to consider the integration of the main systems and subsystems of postural control that change with age.

Comparative molecular analysis of bacterial species associated with periodontal disease.

Periodontal disease is an inflammatory disorder affecting the supporting teeth structures, including gingiva, periodontal ligament and alveolar bone, causing loss of connective tissue, reabsorption of alveolar bone and formation of periodontal pockets. The aim of this study is to find a correlation between bacterial growth and periodontal disease. Fifty-seven patients aged between 21 and 65 years, median age 46 years, were enrolled. According to gingival pocket depth, ranging from 3 to 7 mm, patients were divided into two groups: the first (30 patients, 53%) with deep pockets ³ 5 mm and the second (27 patients, 47%) less than 5 mm. The samples taken were processed for microbiological analysis by absolute quantitative real-time Taq-Man technique. Patients affected by periodontal disease were 32 (56%) and patients with gingival bleeding were 35 (61%). This data showed that the presence, the type and the bacterial load in gingival pockets were strongly correlated with gingival depth, periodontal disease and gingival bleeding. Quantitative microbiological analysis is a key point to improve patient compliance, allowing to choose the specific antibiotic treatment. avoiding antibiotic resistance and ensuring the successful outcome of therapy for periodontal disease.

Alkaline phosphatase level in gingival crevicular fluid during treatment with Quad-Helix.

The aim of this work is to assess the level of the human alkaline phosphatase enzyme (ALP) during palatal expansion with Quad-Helix (QH) appliance. A total of twenty-two orthodontic patients characterized by contraction of the upper jaw, that needed application of a QH in order to treat their condition, were included in this study. Gingival crevicular fluid (GCF) was collected at four different times: before cementation (T0), after two weeks (T1), after four weeks (T2) and after one year (T3) from application of QH. In each patient maxillary first molars, right (UM-right) and left (UM-left), which were connected with bands to QH, were used for testing; first lower molars were used as Controls (LM-right, LM-left). Data show that ALP level in tension sites was proportional to the average increase of the inter-molar distance; on the contrary, the enzymatic level in compression sites was characterized by an inverse trend. The only exception to this phenomenon was recorded after one year (T3), when the increase of ALP level in both sites of tension and compression was ascribed to a mild inflammation due to bacterial plaque accumulation. The level of ALP in control sites was constant for the whole period of observation. The described ALP fluctuations in accordance with the inter-molar distance increment, shows that the main action of QH on bone remodelling was exerted during the fourth week (T2); for this reason, the monitoring of this enzyme could be used as a marker of effective function of the QH appliance.

Third Class Resolver: a retrospective analysis.

AIM: To evaluate the use of Third Class Resolver (TCR), a new fixed and functional orthopaedic appliance for the treatment of skeletal Class III malocclusion in adolescents and young adults. MATERIALS AND METHODS: Study design: Retrospective analysis. Twenty subjects, 10 females and 10 males, affected by Class III malocclusion were treated with a new fixed orthopaedic appliance: the Third Class Resolver (TCR). The mean age was 7 years at the beginning of treatment and 9 years at the end of treatment. The mean treatment time was 6 months. Digital cephalometric superimpositions on lateral radiographs taken at the start and end of treatment were assessed. The cephalometric values were statistically analysed. RESULTS: Cephalometric analysis of changes during treatment shows a statistically significant increase of ANB angle (mean 1°) (P = 0.045); increase of Witts Index (mean 3.5 mm) (P = 0.003); decrease of Maxillo-Mandibular angle (MM) (mean -2.3°) (P = 0.047); increase of Upper incisor-Maxilla Plane angle (angle mean 10.5°) (P = 0.02); increase of the distance between Upper Incisor and A-Pg line (mean 2.4 mm) (P = 0.021); increase of the mandibular branch length (mean 4.8 mm) (P = 0.004). CONCLUSION: TCR can be used fully for treatment of Class III malocclusions.

Second Class Resolver: a retrospective analysis.

AIM: To evaluate the use of Second Class Resolver (SCR), a new fixed orthopaedic appliance, for the treatment of skeletal Class II malocclusion in growing subjects. MATERIALS AND METHODS: Design Retrospective analysis. Forty subjects were treated with Second Class Resolver (SCR). The mean age was 8 years at the beginning of treatment and 10 years at the end of treatment. Digital cephalometric superimpositions on lateral radiographs taken at start and end of treatment were assessed. The cephalometric values were statistically analysed. RESULTS: Cephalometric analysis of changes during treatment shows reduction of ANB angle (mean 2°); reduction of Witts Index (mean 3 mm); reduction of Maxillo-Mandibular angle (MM) (mean 1°); reduction of SNA (angle mean 3°); reduction of gonial angle (mean 1.8°); increase of the mandibular branch length (mean 5 mm); increase of mandibular body (mean 2.9°). CONCLUSION: The Second Class Resolver can be beneficially used for the treatment of Class II malocclusion.

X-ray diagnosis of the pressure induced Mott nonmetal-metal transition.

The evolution of the K-edge x-ray absorption near-edge spectroscopy (XANES) spectrum is investigated for an aluminum plasma expanding from the solid density down to 0.5 g/cm{3}, with temperatures lying from 5 down to 2 eV. The dense plasma is generated by nanosecond laser-induced shock compression. These conditions correspond to the density-temperature region where a metal-nonmetal transition occurs as the density decreases. This transition is directly observed in XANES spectra measurements through the progressive formation of a preedge structure for densities around 1.6 g/cm{3}. Ab initio calculations based on density functional theory and a jellium model have been efficiently tested through direct comparison with the experimental measurements and show that this preedge corresponds to the relocalization of the 3p atomic orbital as the system evolves from a dense plasma toward a partially ionized atomic fluid.

Electronic structure investigation of highly compressed aluminum with K edge absorption spectroscopy.

The electronic structure evolution of highly compressed aluminum has been investigated using time resolved K edge x-ray absorption spectroscopy. A long laser pulse (500 ps, I(L)≈8×10(13) W/cm(2)) was used to create a uniform shock. A second ps pulse (I(L)≈10(17) W/cm(2)) generated an ultrashort broadband x-ray source near the Al K edge. The main target was designed to probe aluminum at reshocked conditions up to now unexplored (3 times the solid density and temperatures around 8 eV). The hydrodynamical conditions were obtained using rear side visible diagnostics. Data were compared to ab initio and dense plasma calculations, indicating potential improvements in either description. This comparison shows that x-ray-absorption near-edge structure measurements provide a unique capability to probe matter at these extreme conditions and severally constrains theoretical approaches currently used.

Three-dimensional tomographic mapping related to primary stability and structural miniscrew characteristics.

OBJECTIVES: To evaluate the maxilla, mandible, and cortical plates on computerized tomographic (CT) scans to achieve accurate three-dimensional bone thickness measurements. SETTING AND SAMPLE POPULATION: We selected the CT scans of 25 subjects (among 102), aged 18-58 years (10 men, 15 women), with nearly complete dentition. MATERIAL AND METHODS: We performed interradicular and bucco-lingual (including cortical plate thickness) measurements in dental areas distal to the canines in both alveolar arches, at three levels (5, 8, and 11 mm) from the alveolar ridge. RESULTS: The mean thicknesses of the cortical plates in the maxilla were 1.10 mm buccally and 1.27 mm on the palatal side (p < 0.05). In the mandible, cortical plates were 2.23 mm buccally and 2.02 mm lingually. Mandibular buccal and lingual cortical plates became thicker distally in the second and third molar areas. There was considerable variation in cortical thickness (from 0.25 to 5.50 mm). Based on interradicular distances, only 13% of measured sites in the maxilla were suitable for miniscrew insertion (≥3.3 mm), but 63% of sites were suitable in the mandible. CONCLUSION: This study showed considerable individual variation in bone thickness. Our data suggested that the palatal/lingual side may provide greater primary stability for miniscrews. The palatal area, between the second upper bicuspid and the first molar, appeared to be the most suitable area for tapered 7- to 9-mm miniscrews, starting at 1.5-2 mm from the alveolar crest.

Identification of COL6A1 as a differentially expressed gene in human astrocytomas.

Diffuse infiltrating gliomas are the most common tumors of the central nervous system. Gliomas are classified by the WHO according to their histopathological and clinical characteristics into four classes: grade I (pilocytic astrocytoma), grade II (diffuse astrocytoma), grade III (anaplastic astrocytoma), and grade IV (glioblastoma multiforme). Several genes have already been correlated with astrocytomas, but many others are yet to be uncovered. By analyzing the public SAGE data from 21 patients, comprising low malignant grade astrocytomas and glioblastomas, we found COL6A1 to be differentially expressed, confirming this finding by real time RT-PCR in 66 surgical samples. To the best of our knowledge, COL6A1 has never been described in gliomas. The expression of this gene has significantly different means when normal glia is compared with low-grade astrocytomas (grades I and II) and high-grade astrocytomas (grades III and IV), with a tendency to be greater in higher grade samples, thus rendering it a powerful tumor marker.

An electromyographic evaluation of bilateral symmetry of masticatory, neck and trunk muscles activity in patients wearing a positioner.

This study was designed to investigate the attitude of a positioner (Finition) or an Hawley's retention appliance to create a symmetric function of the masticatory, neck and trunk muscles during the orthodontic retention phase. Sixteen patients (18.5 +/- 2.2 years) were included in the sample. All the patients received an orthodontic therapy for the treatment of an Angle's class I malocclusion and skeletal class I, for a period of 2 years. After removal of orthodontic brackets, eight patients wore a teeth positioner (group I) as retention appliance and eight subjects wore an Hawley's appliance as upper retention (group II). Surface electromyographic (sEMG) activity was recorded from the bilateral anterior temporal, posterior temporal, masseter, sternocleidomastoid (SCM), upper and lower trapezius and cervical muscles at mandibular rest position and during maximal voluntary clenching (MVC) at T0, i.e. soon after the removal of orthodontic brackets and at T1, i.e. after 3 months of retention treatment. No significant difference was observed between the two groups at T0. At T1, at mandibular rest position, the group I showed a significantly lower sEMG activity of anterior temporal and SCM muscles compared with the group II. During MVC, at T1, the group I showed a significantly lower sEMG activity of the SCM and posterior cervicals, compared with the group II. The positioner seems to show a relevant effect on the sEMG activity of masticatory, neck and trunk muscles.

Enamel surface after debracketing of orthodontic brackets bonded with flowable orthodontic composite. A comparison with a traditional orthodontic composite resin.

AIM: Flowable composites showed acceptable shear bond strength for bonding orthodontic brackets, but it still lacks evidence if the routine clean-up of this type of composites from enamel surface after debracketing is susceptible of more difficult procedure, due to their fluidity, and, consequently, more enamel lesions, compared with traditional orthodontic composites. Thus, this in vitro study investigated this point. METHODS: Stainless steel brackets were bonded to 60 extracted human premolars using: 1) a new flowable composite (Denfil Flow) (group I; N=20); 2) a traditional flowable composite (Dyract Flow) (group II; N:20); 3) Transbond XT adhesive (group III; N=20). Twenty untreated teeth were the control group. After a routine debonding procedure, the adhesive remnant index (ARI) was calculated in each tooth. After the following clean-up procedure, enamel cracks (measurements about their frequency, their position in the tooth crown and their direction) were evaluated using fiber-optic transillumination. Finally, enamel surfaces were analyzed with scanning electron microscope to quantify enamel lesions RESULTS: A significantly higher frequency of enamel cracks, (from 65% to 80%), mostly in the cervical third of tooth crown (from 65% to 80%) and vertical (from 75% to 80%), were observed in the three study groups, compared with the control group (P<0.05), without difference among the three study groups. The index of enamel lesions was significantly higher in the three study groups, compared with control group (P<0.05), without significant differences among the three study groups. CONCLUSION: Flowable composites seem to show no relevant differences in terms of enamel lesions and cracks compared with traditional composites.

The analysis of walking in subjects with and without temporomandibular joint disorders. A cross-sectional analysis.

AIM: The aim of this study was to determine if stomatognathic functions correlate with alterations in walking function, that are detectable through the analysis of walking. METHODS: The study enrolled 24 Caucasian adult females (mean age 27.9+/-4.5), asymptomatic for temporomandibular and muscular disorders and 20 Caucasian adult females with temporomandibular joint disorders (TMDs). The analysis of walking was performed under three different experimental conditions: 1) mandibular rest position (RP); 2) habitual dental occlusion (DO); 3) cotton rolls between the upper and the lower dental arches (CRs). RESULTS: The mean pressure during walking, measured as g/cm(2), on the theoretical barycentre, the percentage of loading on the left and the right feet (measured as %) and the loading surface, measured as mm(2), under the right and the left feet, were recorded as posturographic parameters. Generally, no difference was found in any of these parameters in the mean pressure during walking in the different considered conditions; only when two cotton rolls were positioned between the dental arches the load pressure was found to be significantly higher in the TMD patients than in the control subjects (P<0.05). In addition, in the same condition, TMD subjects showed a significantly smaller loading surface than control subjects, both under the right and the left feet. CONCLUSION: TMDs seem to be associated to detectable alterations of the walking function.

Role of the friction free distalize appliance (2FDA)PAT in the molar distalization: photoelastic analysis and alkaline-phosphatase (ALP) activity on first molar and bicuspid.

Maxillary molar distalization is an increasingly popular option for the resolution of Class II malocclusions. This study describes the effects of one particular molar distalizing appliance, the Friction Free Distalize Appliance (2FDA), in a sample of 20 consecutively treated and growing patients to verify the osteoblastic activity in the compression and traction sites of both the molars and the bicuspids when used as the anchorage teeth. The 2FDA appliances were constructed utilizing a Nickel Titanium open coil spring of 200 gr force in order to distalize the maxillary first molar. The reaction force was controlled utilizing the principle of low/free friction. The results show that the resin around the root of the bicuspid did not discolour at all, which indicates an absence of a force load. On the other hand, on the molar, the resin around the root of the molar became discoloured due to the fact that an orthodontic force was involved with the tooth. To better understand whether the quantity of force that reached the tooth was able to produce osteoblastic recruitment in the sites of tension of the molar and the bicuspid, we quantified an enzyme, the alkaline phosphatase (ALP), present. This measurement allowed us to verify a regular increase of the ALP on the site of molar traction. We also elaborated a mathematical model to evaluate the quantity of force of reaction that produces the device on the bicuspid. Such force results as being 8.34 grams which equals half the pressure of the capillaries of the parodontal ligament (18 grams). The 2FDA appliance compares favourably with other intra-oral distalization devices for the resolution of patients with Class II malocclusions, and is the only distalizing appliance that does not determine osteoclastic/osteoblastic recruitment on the anchorage tooth.

Modification of condyle anatomy following a monolateral bite rise: a histological study in rat.

The aim of this study is to evaluate the histologic modifications of rat articular capsules, after compression and strain. Fifty adults Sprague Dawley rats were used in this study. The rats were divided into 3 groups: a dysfunction group, treatment group and a Control group. In the rats in the first two groups an occlusion hump, made of composite and less than 0.5 mm high, was applied to the upper right molar. The rats were anesthetized with an intraperitoneal injection of benzodiazepine (0.5-1 mg for 100 g. of body weight). The composite used consisted of a hollow, plastic cylinder 0.5 mm high, spread over the whole occlusal surface of the right upper molar. The dysfunction group therapy wore the occlusion hump for a week, at the end of which the animals in this group were killed and their temporomandibular joint removed. In the treatment group a second occlusion hump was applied to the left upper molar, in order to obtain a distraction of the previously compressed temporomandibular joint. The rats of the second group wore the second occlusion hump for one week. The rats were then killed with an intraperitoneal injection of Tanax, and the block sections, containing the temporo-mandibolar joint, were retrieved with a diamond disk, and surrounding tissues were washed in saline solution and immediately fixed in 4 percent formalin for 4 days. In the control group, no treatment was applied. In the first group, bone resorption was observed in the left temporomandibular joint; no osteoclast were, however, present. No other tissue alterations were present. Newly formed bone undergoing remodelling was intensely stained with acid fuchsin. In the second and third groups, no bone remodelling areas were observed. In conclusion, the compression of the temporomandibular joint determined a remodelling of the bone structure of the condyle.

A multi-biomarker analysis of DNA damage in automobile painters.

The genotoxic effects associated with automobile painting were analyzed using a panel of biomarkers. Chromosomal aberrations (CAs), sister chromatid exchange (SCE), and micronuclei were evaluated in 25 car painters (12 smokers, 13 nonsmokers) working in different automobile paint-shops in Italy and in 37 control subjects. The controls were healthy blood donors (14 smokers, 23 non-smokers) that were matched with the experimental population for gender and age. Air samples were analyzed regularly at the work places, and elevated concentrations of benzene and toluene were detected consistently. The exposed group had higher frequencies of CAs (both chromosome- and chromatid-type), micronuclei, and SCE (P < 0.5 - P < 0.001). Furthermore, exposed and control subjects were also genotyped for GSTM1 and GSTT1 polymorphism. No significant associations were detected between the biomarker responses and either the GSTM1 or GSTT1 genotype of the subjects, but the small sample size does not allow definite conclusions on the relationship between the genetic polymorphism and the biomarkers. The results indicate that automobile painters have increased levels of clastogenic and possible aneugenic damage and that smoking may be a confounding factor for the responses.

Influence of knee pathology on body posture and muscle activity of head, neck and trunk muscles.

AIM: The aim of the study was to evaluate the effects that an anterior cruciate ligament (ACL) injury of the knee has on postural control and activity of neck, head and trunk muscles in order to investigate the existence of connections between the masticatory system and body posture. METHODS: Surface electromyographic (sEMG) activity of the muscles and their asymmetry index, at mandibular rest position, and during maximal voluntary clenching (MVC), and posturometric and stabilometric measurements of 25 patients (mean age 28+/-9 years) having undergone ACL injury of the left knee were compared with a control non-pathologic group. RESULTS: At rest, the patients showed a higher sEMG activity of the anterior temporalis, masseter, sternocleidomastoid and lower trapezius, compared with the control subjects (P<0.05). At MVC, the patients showed a lower sEMG activity of the right anterior temporalis and masseter and a higher sEMG activity of the lower trapezius, compared with the control subjects. For the stabilometric measurements, all the subjects showed a significant reduction in the Center of Pressure (CoP) path length during the test with eyes open and cotton rolls, compared with the test with eyes closed and mandibular rest position (P<0.05). In addition, the patients showed a significant displacement of the CoP in a forward direction (P<0.05) and to the righ side (P<0.05), compared with the control-subjects during each test. CONCLUSIONS: ACL injury appears to be associated to a change in the sEMG activity of head, neck and trunk muscles and to a change in the position of the CoP of the body. Cotton rolls seem to improve the stability of the subject.

Gender assessment through three-dimensional analysis of maxillary sinuses by means of cone beam computed tomography.

OBJECTIVE: The availability of a low dose radiation technology such as Cone Beam Computed Tomography (CBCT) in dental practice has increased the number of scans available for forensic purposes. Moreover, specific software allows for three-dimensional (3D) characterization of the maxillary sinuses. This study was performed to determine whether sinus maxillary volumes can be useful to identify gender after validating the use of the Dolphin software as a tool for volumetric estimation of maxillary sinus volumes. PATIENTS AND METHODS: The validation was performed by four different operators measuring the volume of six phantoms, where the real volume was already known. The maxillary sinus volumes of 52 patients (26 males and 26 females) mean age 24.3 were calculated and compared between genders and sagittal skeletal class subdivision. The measurements for patients and phantoms were based on CBCT scans (ILUMA™) processed by Dolphin 3D software. RESULTS: No statistical difference was observed between the real volume and the volume measurements performed by the operators. No statistical difference was found in patient's maxillary sinus volumes between gender. CONCLUSIONS: Based on our results, it is not possible to support the use of maxillary sinuses to discern sexual difference in corpse identification.

Strong antioxidant activity of ellagic acid in mammalian cells in vitro revealed by the comet assay.

Oxidative stress due to oxygen and various radical species is associated with the induction of DNA single- and double-strand breaks and is considered to be a first step in several human degenerative diseases, cancer and ageing. Naturally occurring antioxidants are being extensively analysed for their ability to protect DNA against such injury. We studied three naturally occuring compounds, Ascorbic Acid, Melatonin and Ellagic acid, for their ability to modulate DNA damage produced by two strong radical oxygen inducers (H2O2 and Bleomycin) in cultured CHO cells. The alkaline Comet assay was used to measure DNA damage and a cytofluorimetric analysis was performed to reveal the intracellular oxidative species. The data showed a marked reduction of H2O2- and Bleomycin-induced DNA damage exerted by Ellagic Acid. On the contrary Ascorbic acid and Melatonin appeared to induce a slight increase in DNA damage per se. In combined treatments, they caused a slight reduction of H2O2-induced damage, but they did not efficiently modulate the Bleomycin-induced one. The Dichlorofluorescein diacetate (DCFH-DA) cytofluorimetric test confirmed the strong scavenging action exerted by Ellagic Acid.

Effects of topical diclofenac (DHEP plaster) on skin, subcutis and muscle pain thresholds in subjects without spontaneous pain.

The aim of this study was to determine whether topical application of diclofenac hydroxyethylpyrrolidine (DHEP) modifies somatic pain sensitivity in subjects without spontaneous pain. Twenty male subjects (aged 19-40 years), who had not reported any pain for at least 1 month, underwent measurement of pain thresholds to bilateral electrical stimulation in the quadriceps muscle and overlying subcutis and skin. Following the double-blind study design, one diclofenac adhesive plaster (13 x 10 cm; 180 mg DHEP) was then applied over one quadriceps while a matched placebo plaster was placed contralaterally. Each subject was given two other plasters (diclofenac and placebo) and instructed to substitute those over the quadriceps after 12 h and to wear them for a further 12 h. Thirty minutes after removal of the second plasters, thresholds. were remeasured in all subjects as on the previous day. Thresholds at the first evaluation were within normal range in nine subjects (group 1) and below normal in muscle (hyperalgesia) in the remaining 11 (group 2). No significant changes were observed in skin or subcutis thresholds after diclofenac or placebo treatment in either group. In contrast, muscle thresholds significantly increased after diclofenac compared with placebo treatment (group 1: p < 0.05; group 2: p < 0.007); the increase was significantly higher in group 2 than in group 1 (p < 0.002). Topical application of diclofenac had a selective hypoalgesic effect on muscles, which was more pronounced in the case of hyperalgesia. These results suggest that the preparation is particularly effective in the treatment of algogenic conditions of deep somatic tissues.

Clinical and experimental study of TMJ distraction: preliminary results.

A physiotherapeutic approach, with manual maneuvers and/or distraction appliances, is indicated in the treatment of temporomandibular joint disorders (TMDs) to prevent the progressive fibrosis of the muscle fibers. In this article, the authors report preliminary results of experimental and clinical studies conducted to assess the real effect of distraction in temporomandibular joint disorders. The experimental invivo studies confirmed the structural alteration due to compression and distraction on the capsular and condylar tissues. Clinical cases are reported to show the increase of the intraarticular vertical dimension, with a forward and downward movement of the condyles in a more physiologic condition.