Treatment options of periapical cysts of deciduous teeth: report of a case and systematic review of the literature.

AIM: Periapical cysts of primary teeth are pathologic entities which are seldom encountered in the clinical practice. Most frequently, these lesions arise in correspondence with primary teeth presenting previous pulp therapy, severe carious lesions, or a history of previous trauma. The aim of the present study is to systematically review the treatment modalities of periapical cysts of the deciduous, along with the reporting of a clinical case. MATERIALS: A case of periapical cyst treated with marsupialization occurring in an 11-year-old patient is described. A literature search was devised to retrieve studies reporting the treatment of periapical cysts, and involved papers published in the Cochrane Oral Health Group specialist trials, MEDLINE via PubMed, and EMBASE up to March 2023. A total of 39 articles were retrieved. Following title and abstract analysis, 27 articles were selected for full-text analysis, with the final inclusion of 24 articles. CONCLUSION: Periapical cysts of primary teeth present an overall good prognosis irrespective of the treatment option adopted. The performance of a prompt diagnosis appears of utmost importance, as the extraction of the primary teeth involved implies the management of the residual space for the correct positioning of the corresponding permanent teeth.

[Chronic Inflammatory Polyradiculopathy Post-Covid-19 and the Role of Therapeutic Apheresis: A Clinical Case].

There is a strong correlation between SARS-CoV-2 and the onset of autoimmune neurological disease with atypical clinical presentation, characterized by limited response to medical therapy, likely caused by the underlying mechanism of the virus itself. In situations like these, after the failure of pharmacological therapy, therapeutic apheresis, including immunoadsorption, can be pursued. Treatments with IMMUSORBA TR-350 columns have proven to be particularly effective in managing refractory forms of post-Covid-19 nephropathies, leading to complete recovery of disability and elimination of neurological signs and symptoms. We discuss the case of a patient with chronic inflammatory polyradiculopathy post-Covid-19, resistant to medical therapy, effectively treated with immunoadsorption.

Osteonecrosis of the jaw: a rare but possible side effect in thyroid cancer patients treated with tyrosine-kinase inhibitors and bisphosphonates.

Osteonecrosis of the jaw (ONJ) is a rare but very serious disease that can affect both jaws. It is defined as exposed bone in the maxillofacial region that does not heal within 8 weeks after a health care provider identification. ONJ can occur spontaneously or can be due to drugs like bisphosphonates (BPS) and anti-RANK agents, in patients with no history of external radiation therapy in the craniofacial region. Although in phase 3 trials of tyrosine kinase inhibitors (TKIs) used in thyroid cancer (TC) the ONJ was not reported among the most common side effects, several papers reported the association between ONJ and TKIs, both when they are used alone and in combination with a bisphosphonate. The appearance of an ONJ in a patient with metastatic radio-iodine refractory differentiated TC, treated with zoledronic acid and sorafenib, has put us in front of an important clinical challenge: when a ONJ occurred during TKIs treatment, it really worsens the patients' quality of life. We should consider that in the case of ONJ a TKI discontinuation becomes necessary, and this could lead to a progression of neoplastic disease. The most important aim of this review is to aware the endocrinologists/oncologists dealing with TC to pay attention to this possible side effect of BPS and TKIs, especially when they are used in association. To significantly reduced the risk of ONJ, both preventive measures before initiating not only antiresorptive therapy but also antiangiogenic agents, and regular dental examinations during the treatment should always be proposed.

COVID-19 Transmission in Dental Practice: Brief Review of Preventive Measures in Italy.

The outbreak and diffusion of SARS-CoV-2, responsible for the coronavirus disease (COVID-19), has caused an emergency in the health system worldwide. After a first development in Wuhan, China, the virus spread in other countries, with Italy registering the second highest number of cases in Europe on the 7th of April 2020 (135,586 in total). The World Health Organization declared the pandemic diffusion of COVID-19, and restrictive measures to limit contagion have been taken in several countries. The virus has a predominantly respiratory transmission through aerosol and droplets. The importance of infection control is therefore crucial in limiting the effects of virus diffusion. We aim to discuss the risks related to dental practice and current recommendations for dental practitioners. A literature search was performed to retrieve articles on the management of COVID-19 diffusion in dental practice. The documented clinical experience, the measures of professional prevention, and the actual Italian situation were reported and described. Four articles were retrieved from the literature search. Among the eligible articles, 3 reported measures to contrast COVID-19 diffusion. The infection management protocols suggested were reviewed. Finally, recommendations based on the Italian experience in terms of patient triage, patients' entrance into the practice, dental treatment, and after-treatment management are reported and discussed. COVID-19 is a major emergency worldwide, which should not be underestimated. Due to the rapidly evolving situation, further assessment of the implications of COVID-19 outbreak in dental practice is needed.

Interdental plaque reduction after use of different devices in young subjects with intact papilla: A randomized clinical trial.

OBJECTIVES: To determine the efficacy of 4 different oral hygiene regimens involving adjunctive interdental cleaning devices in unsupervised young subjects with intact interdental papilla. MATERIAL AND METHODS: Sixty periodontally healthy subjects were randomly allocated to 4 groups following different oral hygiene regimens (T-7): use of manual toothbrush alone; manual toothbrush plus dental floss; manual toothbrush plus interdental brushes; and manual toothbrush plus rubber interdental picks. Oral hygiene instructions (OHI) were given. One week after (T0), professional supragingival scaling and polishing was performed, and subjects were then reseen every 2 weeks (T14 and T28). At T-7, T0, T14 and T28, full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS) and angulated bleeding index (AngBI) were taken. RESULTS: During the first week (T-7/T0 unclean phase), FMPS decreased significantly in all groups except the group using dental floss. At T28, a significant decrease in FMPS (P < .001, all groups) and FMBS (P < .05, all groups except the group using flossing P < .001) was noted. Interdental FMPS showed significantly lower values in subjects treated with interdental brushes or rubber interdental picks vs toothbrushing alone (P < .05). The use of interdental picks was associated with reduced interdental FMBS when compared to flossing (P < .05). CONCLUSION: In young subjects, with no interdental attachment loss, toothbrushing or toothbrushing and adjunctive interdental cleaning devices such as dental floss, interdental brushes or interdental rubber picks can significantly reduce both plaque and gingival inflammation. Use of interdental brushes or rubber picks reduces more interdental plaque in comparison with toothbrushing alone.

Systemic Inflammation after Third Molar Removal: A Case-Control Study.

Third molar extraction is one of the most frequent interventions in dentistry. Nevertheless, there is scarce evidence on the host response of individuals with impacted or semi-impacted third molars and the possible effects of surgical removal. A case-control study of 40 patients was designed to evaluate 1) the differences in biomarkers of systemic inflammation, vascular function, and metabolism (high-sensitive C-reactive protein, lipids, fibrinogen, oxidative stress, and endothelial function analysis) and 2) the acute and short-term effects of surgical removal in patients with bilateral impacted or semi-impacted third molars compared to controls with no third molars. Patients undergoing third molar extraction exhibited greater levels of systemic inflammation, oxidative stress, and triglycerides than controls. Raised white blood cell counts as well as peaks of serum levels of C-reactive protein and fibrinogen were noticed in the first postoperative week. Three months after the extraction, all markers returned to baseline values. Malondialdehyde, an indicator of oxidative stress indicator, was significantly reduced after third molar removal. Semi-impacted or impacted third molars are associated with higher systemic inflammation, and their removal may represent a useful human model to study acute inflammation and determine beneficial systemic effects ( ClinicalTrials.gov NCT03048175).

Conservative surgical management of patients with bisphosphonate-related osteonecrosis of the jaws: a series of 120 patients.

We evaluated retrospectively the efficacy of local resection for patients who presented with bisphosphonate-related osteonecrosis of the jaw (BRONJ). We studied 120 subjects with who required local resection of 129 BRONJ lesions that had not responded to medical treatment. The primary outcomes were improvement of the clinical stage of BRONJ and resolution of disease, and the secondary outcome was the influence of the surgeon's experience on the healing of the lesions. Age, sex, underlying diseases, smoking, and coexisting conditions were recorded. Logistic regression analysis was used to isolate factors that could potentially affect the outcome. Most of the lesions (n=107, 84%) improved postoperatively, 20 showed no change, and one got worse. One patient died. Stratification indicated complete healing and total resolution of disease for all 26 stage I lesions, improvement for 67 of the 77 stage II lesions, and for 14 of the 25 stage III lesions. The disease resolved in 67 of the 69 stage II lesions, and 14 of the stage III cases. Logistic regression indicated that smoking and the stage of disease could affect the outcome. Analysis of the surgeons' learning curve showed that performance improved significantly over time. Complete healing after local resection increased from 40% to 80% over a period of eight years (p<0.001). We conclude that local resection may be the treatment of choice in BRONJ stages I and II. Stage III might be better treated with either resection or clinical monitoring according to the condition of the patient.

Risk factors influencing BRONJ staging in patients receiving intravenous bisphosphonates: a multivariate analysis.

The objective of this study was to determine, retrospectively, the influence of various risk factors on the staging of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in a population attending a department of dentistry and oral surgery in Italy. Data were collected from the electronic and paper medical records of 90 patients receiving intravenous bisphosphonates. Two experienced and calibrated examiners used the American Association of Oral and Maxillofacial Surgeons updated 2009 classification to record the stage of BRONJ lesions. Multivariate ordinal logistic regression was performed to determine individual risk factors negatively affecting BRONJ staging. The factors associated with a worse BRONJ staging were high bisphosphonate cumulative dose (odds ratio (OR) 1.70, 95% confidence interval (CI) 1.02-2.82; P=0.04), smoking (OR 1.80, 95% CI 1.03-2.80; P=0.04), steroid intake (OR 1.70, 95% CI 1.00-2.87; P=0.05), and a maxillary location of the lesion (OR 3.50, 95% CI 1.81-6.77; P<0.01). Tooth extraction was the event that most negatively influenced BRONJ staging (OR 1.60, 95% CI 1.00-2.81; P=0.05), in comparison to other events such as prosthetic trauma, implant treatment, oro-dental infection, and periodontal disease. Certain clinical and medical risk factors may determine a more severe staging of BRONJ lesions. Future studies are necessary to confirm these findings.

Early enteral feeding with human milk for VLBW infants.

In a NICU early enteral feeding is usually possible only when the newborn clinical conditions permit it. Because of the frequent need of umbilical/central catheters, they usually start with parenteral feeding and/or with minimal enteral feeding (trophic feeding). This kind of management is even more frequent in VLBWIs, in which the risk of NEC is very high. In this work we describe a model of early enteral exclusive feeding (EEEF) based on the use of banking human milk followed by mother milk. In the Centre of Neonatology of Trento, as in other Centers, the newborns weighing less than 750g or with a GE< 27 weeks, are treated with parenteral nutrition and minimal enteral feeding. The newborn weighing 750-1249g and with GE > 26 weeks define a group in which we find critical neonates, who can not be treated with enteral feeding, and neonates whose clinical conditions permit EEEF. In particular, in a period of 16 years (1994-2009) in Trento, 308 newborns weighing 750-1249 g and GE > than 26 weeks were admitted. The 90,9 % has been treated with prenatal steroids, the 91,9 % was inborn, the 96,1% survived. In the 59,1 % of the cases (175) we gave EEEF. We could continue with a complete EEEF in the 40,2 % of the total (119 cases). The characteristics of these neonates and our centre management, based mainly on early use of banking human milk and mother milk, are detailed described.

Rupture of a left internal jugular vein. A rare case.

A 60-year-old woman with neurofibromatosis type 1 presented with a nonpainful swelling in the left laterocervical region that had suddenly arisen after mild exertion the previous evening. Computed tomography with and without contrast enhancement revealed a rupture of the wall of the left internal jugular vein, with a diffuse subcutaneous hematoma. Postoperative histopathologic examination reported diffuse proliferation of plexiform neurofibromatous tissue within the vessel wall.

Electrothermal bipolar energy-based device in laparoscopic right colectomy: our experience.

AIM: Aim of the present study was to evaluate effectiveness of bipolar electrothermal energy in laparoscopic right colectomy, both for vascular pedicle ligature and dissecting manoeuvres. METHODS: Eighty-nine consecutive unselected patients underwent laparoscopic right colectomy between 2003 and 2006. All procedures were performed or supervised by the same surgical team (two staff of surgeons). Forty-four laparoscopic right colectomy were carried out with ultrasonic coagulating shears (UCS), (group 1) and forty-five by means of electrothermal bipolar atlas (EBA), (group 2). Intraoperative bleeding and postoperative blood loss, operating time, complication and hospital stay have been investigated within two groups. RESULTS: No mortality and no major intraoperative were reported in both series. A conversion to open surgery occurred in one case in both groups. A duodenal perforation occurred in UCS group as major postoperative complication. Comparing 1 and 2 series statistically significant differences were found concerning mean operating time (122.7 vs 98.4) and blood loss (220 vs 115 mL), with a P value <0.05. CONCLUSIONS: Both UCS and EBA devices were safe and effective in performing laparoscopic right colectomy. However, EBA did allow a statistically significant shorter operative time and bleeding/blood loss, tracing back its effectiveness in vessel sealing and dissection.

Evaluation of tumour-infiltrating CD4+CD25+FOXP3+ regulatory T cells in human cutaneous benign and atypical naevi, melanomas and melanoma metastases.

BACKGROUND: CD4+CD25+FOXP3+ regulatory T cells (Tregs) are thought to induce immunotolerance in melanoma. They have not yet been investigated in the entire spectrum of melanocytic cutaneous lesions within a tumour site. OBJECTIVES: To evaluate CD4+CD25+FOXP3+ Tregs among tumour-infiltrating lymphocytes in cutaneous melanocytic lesions. METHODS: We analysed 128 lesions (10 benign junctional common naevi, 10 benign compound common naevi, 10 compound Spitz naevi, 10 junctional atypical naevi, 20 compound atypical naevi, 20 radial growth phase melanomas, 30 vertical growth phase melanomas and 18 melanoma metastases). Tregs were identified by CD25-FOXP3 double immunostains. RESULTS: This study indicates that CD4+/CD25+FOXP3+ Tregs are present in all groups of lesions. Junctional atypical naevi, compound atypical naevi and radial growth phase melanomas showed the highest percentages of CD4+CD25+FOXP3+ Tregs (junctional atypical naevi vs. junctional common naevi, compound common naevi, compound Spitz naevi, melanoma metastases: P < 0.0001; junctional atypical naevi vs. vertical growth phase melanomas: P = 0.001; compound atypical naevi vs. junctional common naevi, compound common naevi: P < 0.0001; compound atypical naevi vs. compound Spitz naevi, melanoma metastases: P = 0.002; compound atypical naevi vs. vertical growth phase melanomas: P = 0.02; radial growth phase melanomas vs. junctional common naevi, compound common naevi, compound Spitz naevi, melanoma metastases: P < 0.0001; radial growth phase melanomas vs. vertical growth phase melanomas: P = 0.008). CONCLUSIONS: The strong prevalence of CD25+FOXP3+ Tregs both in junctional and compound atypical naevi and radial growth phase melanomas, suggests that they induce immunotolerance early during melanoma genesis, favouring melanoma growth. Their evaluation within a tumour site could be useful for prognostic and therapeutic purposes.

Hepatic resections by means of electrothermal bipolar vessel device (EBVS) LigaSure V: early experience.

BACKGROUND: Many techniques and devices are available for performing liver resection, such as clamp crushing, Cavitron Ultrasonic Surgical Aspirator (CUSA), Hydrojet and dissecting sealer, ultrasonic shears, and, more recently, electrothermal bipolar vessel sealing system (EBVS). In this prospective trial we sought to evaluate the impact of EBVS on hepatic resections. METHODS: From March 2004 to December 2005, 24 patients from our consecutive liver resection series were enrolled in the present study. There were 17 males and 7 females with a mean age of 59.6 years (range = 41-80) who had colonic cancer metastases (18), hepatocarcinoma (3), angioma (2), and intrahepatic lithisasis (1). Patients were prospectively randomized to undergo liver resection via EBVS LigaSure V (12 patients, group A) or ultrasonic shears harmonic scalpel (HS) (12 patients, group B). Hepatic procedures did not differ significantly between the two groups and were as follows: right hepatectomy (2), left hepatectomy (1), bisegmentectomy (14), and segmentectomy (7). RESULTS: There was no mortality in either group. The mean operative time was 136.7 min (range = 90-210) in group A and 187.9 min (range = 130-360) in group B. The Pringle maneuver was done in five patients in group A [mean time = 11.4 min (range = 6-12)] and in four patients in group B [mean time = 16 min (range = 9-26)]. The mean blood loss, total bile salts, and hemoglobin concentration from drained fluid on the second postoperative day were 205.8 vs. 506.7 ml, 0.6 vs. 1.1 mmol/L, and 1.0 vs. 2.1 g/L (p < 0.05) for groups A and B, respectively. Mean postoperative hospital stay was 6.1 vs. 7.8 days. In group B a patient who underwent right hepatectomy for colon cancer metastases had transient hepatic failure. No patients received blood transfusions in group A, while two or more blood units were administered in two cases in group B. CONCLUSIONS: In the present study EBVS proved to be safe and effective for liver resection. By means of this device, statistically significant benefits concerning blood loss, total bile salts, and hemoglobin postoperative leakage were found.

Laparoscopic cecopexy for cecal volvulus after laparoscopy. Case report and a review of the literature.

Cecal volvulus is a rare cause of large bowel obstruction. Surgical therapy depends on visceral circulatory conditions at diagnosis. Possible options include endoscopic decompression, detorsion, cecopexy with or without cecostomy, right colectomy with immediate or delayed anastomosis. The present paper describes a case of cecal volvulus in a 40-year-old woman after laparoscopic removal of a pelvic mass successfully treated by laparoscopic cecopexy.

[Appendicectomy: laparoscopic or ''open approach''?]. / Appendicectomia: intervento laparoscopico o "a cielo aperto"?

AIM: The aim of our study was to evaluate the advantages and disadvantages of open appendectomy versus laparoscopic appendectomy in the surgical treatment of acute appendicitis. We have compared the following items: operating time, postoperative pain, length of hospital stay, postoperative complications and costs. METHODS: The study was conducted on 435 patients admitted in our Department from December 1993 to December 2003 with diagnosis of acute appendicitis: 339 (77.9%) cases were operated with laparoscopic approach (LA group) and 96 (22.1%) cases with open approach (OA group) according to personal experience of surgeons on laparoscopic technique and patient's anthropometrical conformation. RESULTS: Mean operative time in LA group was 50 minutes (range 25-195) and 65 minutes (range 35-160) for OA group. In 15 patients (4.4%), the operation had to be converted to open approach. The morbidity was observed in 4.4% of patients for the LA group and 14.6% for the OA group. Hospital stay was faster for patients having laparoscopic appendectomy (2.5 days vs 3.5 days). Pain in the 1st and 2nd postoperative days, evaluated on the use of pain medication, was less in patient in LA group whereas the costs were higher in the LA group than in OA group. CONCLUSIONS: In our experience the laparoscopic approach to acute appendicitis can be considered safe and effective with diagnostic and therapeutic value. It significantly offers all the advantages of mini-invasive surgery reported in literature.