Diagnosis and treatment of dens invaginatus with open apex in a young adult patient by using cone-beam computed tomography and operative microscope.

BACKGROUND: Dens invaginatus is a developmental anomaly that can affect both deciduous and permanent dentition. The anomaly is caused by the invagination of the enamel organ into the dental papilla prior to the calcification of the dental tissues. The treatment option changes according to the classification, from the simple filling of the invaginated enamel area to root canal treatment with or without retrograde surgery, intentional re-implantation, or the extraction of the affected tooth. CASE REPORT: In this study we report a case of a maxillary lateral incisor invaginatus in a young adult patient. The periapical endoral X-ray showed the presence of a periapical radiolucency in tooth 22, that had a structure similar to a tooth inside it and an immature apex. Cold thermal testing showed that it was not a vital tooth. CBCT confirmed the diagnosis of Oehler Class II dens invaginatus. The treatment plan involved root canal treatment of both the "true" and the "invaginated" canal using calcium hydroxide-based intermediate medication. Then, after removing the hard internal structure with the aid of an operative microscope, MTA was used to close the immature apex. Finally, the large endodontic space was filled with self-etching, self-adhesive, dual curing resin cement. The patient was included in a follow-up programme to monitor and verify the complete healing of the periapical bone of the affected tooth. CONCLUSION: The use of technology and of special materials allowed an adequate management and resolution of the case reported.

Effectiveness of a new method of disinfecting the root canal, using Er, Cr:YSGG laser to kill Enterococcus faecalis in an infected tooth model.

Some lasers have demonstrated to provide effective disinfection when used as adjunctive device to the conventional treatment. The aim of this in vitro study was to determine the effectiveness of the erbium, chromium:yttrium scandium gallium garnet (Er, Cr:YSGG) laser by measuring its bactericidal effect inside the root canal experimentally colonized with Enterococcus faecalis. The laser was tested at different irradiation times (30 and 60 s) and energy of impulses (75 and 25 mJ). A total of 52 single-rooted extracted human teeth were endodontically prepared with rotary instrumentation. All were sterilized and inoculated with a suspension of E. faecalis (105 bacteria/ml). The teeth were randomized into three treatment (group 1, group 2, and group 3) and one control groups. In all groups, teeth were chemically irrigated with 5.25% sodium hypochlorite and 17% ethylenediaminetetraacetic acid. Groups 1 and 2 were also irradiated at 30 and 60 s, respectively, with an Er, Cr:YSGG laser at 75 mJ. Teeth of group 3 were treated with laser for 60 s at 25 mJ. Samples were processed to detect the presence of E. faecalis. For all groups, a bactericidal effect was observed. The use of laser at 75 mJ with an irradiation time of 30 and 60 s eliminated a percentage of 92.3 and 100% of E. faecalis, respectively. In the control group, a reduction of 92.3% was observed. Lower percentage of reduction (46.1%) was obtained in teeth treated with laser at 25 mJ for 60 s. No statistical differences were observed between the groups (P = 0.543, Fisher's exact test). The results indicated a bactericidal effect of Er, Cr:YSGG laser irradiation at the settings used in this study. The highest bactericidal effect of this laser was observed at 60 s of irradiation time, using an energy pulse of 75 mJ.

In vivo evaluation of periodontal microcirculatory changes associated with endodontic treatment.

AIM: The purpose of this study was to investigate in vivo the gingival microcirculatory changes associated with endodontic treatment using the continuous wave of condensation technique. MATERIALS AND METHODS: Twenty necrotic one canal roots of 20 cooperative patients of both sexes, aged between 20 and 43 years, were selected. All patients were examined by capillaroscopy before, immediately after endodontic treatment, and after 7 days. The last examination was carried out by the same operator, and repeated twice for each examined area: masticatory, buccal and labial mucosa corresponding to the endodontically treated root. All canals were prepared using a simultaneous technique with Ni-Ti files (MTwo files). RESULTS: The images of the masticatory mucosa after root canal obturation showed evident micro-areas of extravasation, with significant bleeding and angio-morphological alterations due to heat. One hour after the endodontic treatment evident extravasation was observed, but a decrease of all altered parameters, was present. After seven days from treatment, in the periodontal tissues, a complete healing was observed. The in vivo evaluation of the vascular pattern during root canal obturation with System B showed that the high temperature in the canal determines visible effects on the vasculature of adjacent sites. It was found that microangiotectonic alterations decrease up to a complete healing after 7 days from treatment. CONCLUSION: All the changes in microcirculation, due to thermal shock of periodontal tissues, are reversible.

Driving h-osteoblast adhesion and proliferation on titania: peptide hydrogels decorated with growth factors and adhesive conjugates.

Hydrogels from self-assembling ionic complementary peptides have been receiving much interest from the scientific community as mimetics of the extracellular matrix that can offer three-dimensional support for cell growth or become vehicles for the delivery of stem cells or drugs. These scaffolds have also been proposed as bone substitutes for small defects as they promote beneficial effects on human osteoblasts. In order to develop a novel bioactive titanium implant, we propose the introduction of a layer of ionic-complementary self-assembling peptides (EAbuK) on Ti whose surface has been previously sandblasted and acid etched. The peptide layer is anchored to the metal by covalent functionalization of titania with self-assembling sequences. The peptide layer has also been enriched by the insulin-like growth factor-1 incorporated to the layer and/or a conjugate obtained by chemoselective ligation between EAbuK and a sequence of 25 residues containing four GRGDSP motifs per chain. X-ray photoelectron spectroscopy studies confirmed a change in the surface composition in agreement with the proposed decorations. An evaluation of the contact angle showed a substantial change in wettability induced by the peptide layer. The human osteoblast adhesion and proliferation assays showed an increase in adhesion for the surfaces enriched with conjugate at a concentration of 3.8 × 10(-7)m and an enhanced proliferation for samples enriched with insulin-like growth factor-1 at the highest concentration tested (2.1 × 10(-5)m).

Endocrine evaluation after an intra-articular therapeutic dosage of dexamethasone in horses.

This study investigated whether a single intra-articular administration (IA) of dexamethasone (DEX) in horses at therapeutic dosage could exert a systemic effect by influencing the hypothalamic-pituitary-adrenal axis activity as a consequence of (limited) absorption and systemic distribution. The results indicated that DEX was detectable in urine collected 12-48 h after IA administration and that injection was accompanied by a reduced urine excretion of cortisol, 6ß-hydroxycortisol (6ßOHF) and two other metabolites of cortisol lasting up to 48 h post-DEX administration. The systemic effects in horses treated with DEX by IA route are similar to those that typically occur with short-term treatment including the reduction in urinary cortisol concentration.

Kinetics and intrapulmonary disposition of tilmicosin after single and repeated oral bolus administrations to rabbits.

Tilmicosin (TIM, Pulmotil) was administered to eight rabbits by oral gavage at a dose of 12.5 mg/kg body weight for 2, 5, and 7 days, and its plasma kinetics and intrapulmonary disposition were investigated. TIM concentrations in plasma samples collected after days 1 and 6 of treatment were measured by high-performance liquid chromatography with ultraviolet detection. The pharmacokinetic parameters, obtained by non-compartmental analysis of TIM plasma concentrations, did not show any significant variations between days 1 and 6. From the second day of treatment, TIM concentrations attained in lung tissue and pulmonary alveolar macrophages (PAM) exceeded those in plasma by 7- and 400-fold, respectively, and high levels were maintained in lung tissues during the entire treatment duration. After the first day of withdrawal, a fast decline in TIM levels in both plasma and lung tissue was observed, but in PAM, much higher concentrations were maintained after 3 days of TIM withdrawal.

Boldenone, boldione, and milk replacers in the diet of veal calves: the effects of phytosterol content on the urinary excretion of boldenone metabolites.

Twenty-six veal calves were split into two groups and fed two milk replacers with a different content of phytosterols for 26 days; then, 14 calves (7 animals from each diet) were kept as controls and 12 calves (6 per diet) received daily, per os, a combination of 17beta-boldenone (17beta-Bol) and androsta-1,4-dien-3,17-dione (ADD) for 38 days. The urinary elimination of 17 alpha-/17beta-boldenone conjugates (17 alpha/beta-Bol) and androsta-1,4-dien-3,17-dione (ADD) was followed by liquid chromatography-tandem mass spectrometry from all of the animals until slaughtering. In urine from treated animals, 17 alpha-Bol concentrations, despite a great variability, were greater than 17beta-Bol, both detected always as conjugates. At days 1, 2, and 3, the mean urine concentration of 17 alpha-Bol was higher than 12 ng/mL. A remarkable decrease was observed during the following days, but the 17 alpha-Bol concentration was still higher than the attention level of 2 ng/mL in 58% of the samples; the concentration of 17beta-Bol was around the action level of 1 ng/mL; two days after treatment withdrawal, no 17beta-Bol was detected in the urine. In urine from control animals, the 17 alpha-Bol concentration was strictly related to the phytosterol content of the diet, while, in urine from treated animals, the much higher 17 alpha-Bol levels were not modified by the production from diet precursors. The results confirmed that a 17 alpha-Bol level higher than 2 ng/mL should be considered as evidence of suspected illegal treatment and that the urinary excretion of 17beta-Bol is due to exogenous administration of 17beta-Bol. The discontinuous rate of elimination of both 17 alpha- and 17beta-Bol, despite the daily administration of 17beta-Bol plus ADD, indicates the necessity for further research to detect other urinary boldenone metabolites to strength surveillance strategy.

An in vitro study on metabolism of 17beta-boldenone and boldione using cattle liver and kidney subcellular fractions.

17Beta-boldenone (17beta-BOLD) and Boldione (ADD) are steroid compounds with androgenic activity, likely to be used as growth promoters in cattle. Different studies still on-going aiming to distinguish between "natural" occurrence or illegal BOLD source had already indicated that their metabolism in cattle is of relevant significance. To identify metabolites as in vivo markers to support the thesis of exogenous administration, a further approach to the in vitro biotransformation of 17beta-BOLD and ADD was performed using different subcellular fractions obtained from both liver and kidney of untreated cattle. Polar and non-polar metabolites obtained from incubated parent compounds were formerly separated by high performance liquid chromatography (HPLC) elution and successively identified by liquid chromatography tandem mass spectrometry (LC-MS/MS) detection. The bovine liver was the target tissue of the main metabolic reaction transforming 17beta-BOLD to ADD and vice versa. The presence of 6beta-hydroxy-17beta-BOLD, produced from both compounds when NADPH was added as cofactors to liver post mitochondrial and microsomal fractions suggests that cytochrome P450-dependent enzymes could be involved in the biotransformation, as it occurs for 6beta-hydroxylation of 17beta-testosterone. The results indicated that the urinary excretion profile in vivo of 6beta-hydroxy-17beta-BOLD and 16alpha-hydroxy-17beta-BOLD could be studied together with 17alpha- and 17beta-BOLD as putative markers of BOLD treatment in cattle.

Illicit treatments in cattle and urinary 6beta-hydroxycortisol/cortisol ratio.

Dexamethasone (DXM) is often illegally used as a growth promoter. To identify indirect biomarkers of illicit treatments, the urinary ratio between 6beta-hydroxycortisol (6beta-OHF) and cortisol (F) was measured in urines obtained from bulls experimentally treated per os and intramuscularly (i.m.) with different DXM dosages. Dexamethasone, given per os at low doses elicited an early and lasting significant reduction of 6beta-OHF/F. No significant variations were seen in urines from bulls given DXM intramuscularly. These results suggest 6beta-OHF/F as a rapid, non-invasive, screening test for oral, low-dose, long-term corticosteroid treatment in cattle. Further studies are required to go deep inside the biochemical and molecular events underlying such an effect.

Composite of low contraction and rapid polymerization. A study of marginal infiltration.

The aim of this work consists in a comparative biomorphological analysis of the properties of infiltration and of adhesion to dental tissues of two different composits (Tetric Ceram and Inten-S) with different modalities of of application of halogen light. The results have given evidence that there was found to be no significant difference between the two groups examined.

[The effect of instrumentation on original apical foramen shape using steel vs niti rotatory: computerized analysis]. / Analisi computerizzata della morfologia del forame apicale dopo preparazione canalare con strumenti in acciaio ed in nickel titanio.

BACKGROUND: A fundamental requirement to obtain a correct endodontic preparation depends on the respect, during cleaning and shaping, of the original morphology of the apical foramen, (AF), so that the filling material will form a complete seal. METHODS: In our previous studies, in order to verify if this presumption was respected using rotary NiTi instruments with cutting tip, we instrumented extracted teeth characterised by a different degree of root curvatures. Using a standardized system to replace the sample, the original shape of the apical foramen of each tooth was recorded using a computerised technique and then compared to the shape after instrumentation. The data showed differences on AF shapes depending on the degree of root canal curvatures. In fact, the teeth with straight canals showed the least alterations on the original AF shape; on the contrary, the teeth with curved canals showed apical foramen enlargement or transportation. Therefore, in the current study we aimed to compare the in vitro effects of stainless steel, (Flexofile, Dentsply Maillefer, Baillaigues, Switzerland), vs NiTi safe cutting tip (Quantec SC, (Tycom Dental, Irvine CA, U:S.A.), vs NiTi non cutting tip, (Quantec LX, Tycom Dental, Irvine CA, U:S.A.), instrumentation on original apical foramen shape. We used NiTi instruments according to standard technique suggested by Tycom, and hand steel files, to instrument the apical third, according to the Crown-Down technique. Working length was fixed at -0.5 from AF. RESULTS AND CONCLUSIONS: Our results suggested that in the presence of accentuated canal curves rotary Niti, with cutting tip, cause significantly more enlargement of the AF area. At the same time, we also observed that NiTi rotary files, with both cutting and non-cutting tip, cause eccentric enlargement of AF in curved canals. Therefore, NiTi engine-driven instruments should be used carefully in the presence of accentuated canal curves to avoid enlargement or transportation of AF, probably because rotary NiTi files may slip out of operative control, leaving a mark on the foramen shape. In the presence of severe curves, we suggest modifying the operative sequences by alternating rotary NiTi with hand NiTi or stainless steel instruments, especially in the preparation of apical third.

[S.E.M. analysis of composite resin surfaces applied to chemically and chemo-mechanically treated dentin]. / Analisi, al S.E.M., delle superfici di resina composita applicata su dentina sottoposta a trattamento chimico o chemio-meccanico.

The authors evaluated, at scanning electron microscope (S.E.M.), the morphological aspects of composite resin surfaces applied on dentin subjected, "in vitro", to chemical or chemo-mechanical treatments. S.E.M. photographs of dentinal surfaces of composite, applied on dentin treated with acid agents or Caridex, showed extensive penetration of resin tags into dentinal tubules and their deep adaptation to rough and winding dentinal surfaces. The obtained results have been evaluated in the light of recent advances in biocompatibility and long-term stability of composite fillings, in particular, to setting up new materials and methods in cavities preparation and treatment.

Lack of correlation between HLA-B35 resistance against herpes labialis and antibody titers to HSV-1.

To investigate whether genetic factors linked to the human leukocyte antigens (HLA) might influence individual resistance to recurrent herpes labialis (RHL), we studied the frequencies of HLA-A, -B, and -C antigens in a sample of Sicilian population. The frequency of HLA-B35 was significantly decreased in the patient group (p corrected = 0.018). Consequently, the relative risk of development of RHL in a subject positive for HLA-B35 was 20 times smaller than in a subject who does not bear B35. Furthermore, a study was made of the possible relationship between the presence of HLA-B35 antigen and antibody titers to herpes simplex virus type 1 (HSV-1) in 62 persons affected or not by RHL. Significantly elevated titers to HSV-1 were found in the diseased group (p less than 0.001), but the geometric mean of antibody titers in HLA-B35 positive subjects was not different from that of B35 negative subjects either of RHL-affected or in healthy persons. These data are in a good agreement with the hypothesis that humoral immune responses play a marginal role in the protection from HSV-1 recurrences.

[Scanning electron microscopy evaluation of wear of turbine rotary instruments]. / Valutazione al microscopio a scansione dell'usura di strumenti rotanti montati su turbina.

A wear test was conducted to evaluate carbide and diamond dental burs, in air turbines at 400,000 r.p.m., by using a dentine-enamel substrate. There is less variability within each bur type. All of the burs showed a decreased ability to make a standard cut with succeeding trials. Generally, a linear dulling rate was observed with a progressive reduction of cutting effectiveness, except for middle grain burs, that showed better characteristics among tested burs.

[Recent advances in diagnosis of Sjogren's syndrome]. / Recenti acquisizioni nella diagnosi della sindrome di Sjogren.

In this paper the authors review the classification and the clinical features of primary and secondary Sjogren's syndrome. Particular attention in focused on differential diagnosis, on clinical examination of the patients with chronic xerostomia and on its functional and pathological sequelae: rampant dental caries and oral candidiasis. Advanced in diagnostic procedures are described: salivary flow rate, salivary gland scintigraphy, parotid and submandibular scialography, Schirmer's test, Rose Bengal staining, minor salivary gland biopsy and serum immunological examinations. The relationships between scintigraphic and histologic result are discussed. The clinical features and the course of the disease provide further insight into the immunological pathogenesis of this syndrome.

[Plasmacellular neoplasms of the head and neck: clinical status and personal experience]. / Le neoplasie plasmacellulari nel distretto oro-facciale: contributo all'inquadramento clinico ed esperienze personali.

In this review, the authors examine the diagnostic, prognostic and therapeutic advances in clinical management of Solitary Plasmacytoma of bone, Extramedullary Plasmacytoma and their relationship to multiple myeloma. The clinical differences among these tumors are the subject of continued studies. Oral symptoms and signs of the neoplasias are relatively common. The literature is reviewed with respect to the prevalence of oral and maxillofacial manifestations and the presence of such manifestations as the first sign and/or symptom of disease. The case of a young adult patient, with a kappa-light-chain positive extramedullary plasmacytoma of the maxillary sinus is presented. The reported case illustrates the necessity of a multidisciplinary approach using relevant immuno-hematologic, radiographic and histologic investigations in the differential diagnosis of these tumors. Factors influencing the prognosis of these neoplastic lesions are also discussed.