Traumatic and surgical scars: successful treatment with a 1,565nm erbium-glass NAFL combined with IPL.

Scars are a very common condition of the general population and can have a profound impact on the psyche of the patient such as low self-esteem and feelings of psychosocial isolation. Various therapeutic approaches have been proposed for improving the clinical appearance of scars. Fractional mode of ablative and non-ablative lasers has become a novel strategy for the treatment of scars. A total of 43 patients (Fitzpatrick skin type II to IV), clinically diagnosed of surgical and post-traumatic scars from January 2015 to December 2016, were treated. Each treatment comprised of several passes over the scars with different devices, using a 1.565nm scanned erbium-doped fiber NAFL and an IPL. All patients noted subjective improvement in cosmesis and functionality after treatment, also with a decreased pain and an increased mobility on the underlying plans. Numerous therapeutic strategies for traumatic and surgical scars have been suggested to date, but no consistent treatment modality has been established yet. In our study, we have shown that there was a significant collagen remodelling with decrease of scar vascularity and significant improvement of pliability of scar after combined treatment with non-ablative fractional resurfacing and IPL resulting in a remarkable improvement in scar vascularity, pigmentation and height.

Malar region rejuvenation through non-invasive techniques: hyaluronic acid fillers and lipofilling.

Contour enhancements of the midface make up a dominant aspect of aesthetic surgery. The goal of midface rejuvenation is to decrease the prominence of grooves and creases as well as to provide volume to atrophied tissue. There are various options, including autologous tissue grafts, allogenic tissue grafts and alloplastic materials. In turn, patients’ needs have led to an increasing trend of less invasive treatments. In the present study, 82 implants were used for midface augmentation in 41 patients (38 women, 3 men) between January 2014 and January 2016. Twenty-five patients were treated with Hyaluronic acid implants while the remaining 16 patients were treated with lipofilling. For both groups and in all cases, good integration of the filled material was observed in the malar region, with no significant treatment complications and the last follow-up visit demonstrated good results and overall satisfaction. Hyaluronic acid fillers and lipofilling are therefore the ideal answer to patients who aim for a natural and immediate result with manageable complications, but, unlike Hyaluronic acid, autologous fat allows us to obtain a long-lasting effect over time, resulting the closest thing to an ideal facial filler.

Early and late adjustments of the photosynthetic traits and stomatal density in Quercus ilex L. grown in an ozone-enriched environment.

Quercus ilex L. seedlings were exposed in open-top chambers for one growing season to three levels of ozone (O3 ): charcoal filtered air, non-filtered air supplemented with +30% or +74% ambient air O3 . Key functional parameters related to photosynthetic performance and stomatal density were measured to evaluate the response mechanisms of Q. ilex to chronic O3 exposure, clarifying how ecophysiological traits are modulated during the season in an ozone-enriched environment. Dark respiration showed an early response to O3 exposure, increasing approximately 45% relative to charcoal-filtered air in both O3 enriched treatments. However, at the end of the growing season, maximum rate of assimilation (Amax ) and stomatal conductance (gs ) showed a decline (-13% and -36%, for Amax and gs , respectively) only in plants under higher O3 levels. Photosystem I functionality supported the capacity of Q. ilex to cope with oxidative stress by adjusting the energy flow partitioning inside the photosystems. The response to O3 was also characterised by increased stomatal density in both O3 enriched treatments relative to controls. Our results suggest that in order to improve the reliability of metrics for O3 risk assessment, the seasonal changes in the response of gs and photosynthetic machinery to O3 stress should be considered.

Computer-assisted implant surgery and immediate loading in edentulous ridges with dental fresh extraction sockets. Two years results of a prospective case series study.

INTRODUCTION: The two-stage surgical approach for implant placement first documented in 1977 by Brånemark, represents today the most used protocol for placing implants. AIM: Aim of this prospective case series study was to compare the clinical and radiological performance of 12 edentulous jaws treated with of a modified prosthetic and surgical protocol for 3D software planning, guided surgery, immediate loading of implants inserted in edentulous jaws and extraction sockets and restored with Cad-Cam Zirconia and titanium full arch frameworks. PATIENTS AND METHODS: This work was designed as a prospective case series study. Twelve patients have been consecutively rehabilitated with an immediately loaded implant supported fixed full prosthesis. A total of 72 implants, Nobel Replace Tapered Groovy; Nobel Biocare AB, Goteborg, Sweden) 26 of which were inserted in fresh extraction sockets, were inserted. Outcome measures were implants survival, radiographic marginal bone-levels and bone remodeling, soft tissue parameters and complications. RESULTS: All patients reached 24 months follow-up, and no patients dropped out from the study. The cumulative survival rate was 100%; after 24 months mean marginal bone remodelling value was: 1.35 ± 0.25, mean PPD value was 2.75 ± 0.40 mm and mean BOP value was 3.8% ± 1.8%. Only minor prosthetic complications were recorded. CONCLUSIONS: These data seem to validate this surgical and prosthetic protocol with valid results when applied in selected cases.

A retrospective analysis of the headache associated with temporomandibular joint disorder.

BACKGROUND: Headache is a common symptom, that can be extremely disabling, affecting 26 million of patients only in Italy. ICHD-II has reported two categories: "primary headaches" and "secondary headaches". Temporomandibular joint disorders can lead to a secondary headaches. AIM: We want to evaluate the prevalence and clinical features of headache among a series of patients having temporomandibular joint disorders and we illustrate the evolution of headache following medical treatament of temporomandibular joint (TMJ) disorders. MATERIALS AND METHODS: This is a retrospective study carried out on chart review of 426 consecutive patients with various degrees of temporomandibular disorders and treated with medical devices from 2007 to 2011. RESULTS: Headache was reported by 73 patients (17.14%). Headache was observed in 36 of 51 patients with lock and in 32 out of 130 patients with mandibular deflections (Table I). The remaining 5 patients with headache had articular noise. CONCLUSIONS: Headache is not a rare finding in a population with temporomandibular dysfunctions and is more often a tension-type rather than trigeminal headache.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ): 5 year experience in the treatment of 131 cases with ozone therapy.

BACKGROUND: Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) are the result of the assumption of such drugs. The most widely used molecules are pamidronate and zoledronic acid, which are pyrophosphate analogues and are usually given to patient with bone remodelling diseases. International literature reports showed an association between this therapy and avascular necrosis, thus leading to review the guidelines for their administer. AIM: The authors present their protocol based upon medical treatment, antibiotic and antimycotic, together with minimally invasive surgery and ozone therapy developed after a 5 year experience to assess the viability of this treatment. MATERIALS AND METHODS: In the last years researchers studied treatment protocols, both medical and surgical, for the management of BRONJ. Among these Ozone therapy is being adopted by several centers. From February 2004 and December 2010 a total number of 131 patients affected by BRONJ have been observed. Collected data include patients' age at the time of disorders, gender, presenting signs and symptoms, primary diagnosis, type and characteristics of the treatment performed, radiological findings and post-treatment results. CONCLUSIONS: At the present time there are no major guidelines in international literature for the treatment of BRONJ, the Authors then propose a therapeutic protocol based upon minimally invasive surgery, antibiotic and anti mycotic therapy with the adoption of ozone as regenerating factor for tissues. In 90% of the cases the results confirmed the procedure with successful outcomes.

Le Fort III osteotomic variants.

INTRODUCTION: Midface hypoplasia is a skeletal defect involving all three space planes, hence needing a three-dimensional repositioning. This research study shows two cases of cranio-facial dysostosis, on which two Le Fort III variants were performed. CASE REPORT: In the first case we report the performing the two types of osteotomy simultaneously. Le Fort I, however, has been performed without any pterygomaxillary disjunctions, thus accomplishing a complete midface mobilization without any variation of the occlusal ratios. In the second case a modified Le Fort III osteotomy has been performed with median disjunction; reduction of the transverse interdacryal diameters and of the pyriform opening. DISCUSSION: Among all osteotomic variants we would like to mention the one introduced by Obwegeser in 1969 where, in patients with acceptable dental occlusal ratios, Le Fort III and Le Fort I have been performed in conjunction. This technique allows a different midface and dental occlusion repositioning. CONCLUSIONS: In adult patients with permanent dentition and normal occlusal ratios this technique may be chosen for a midface advancement without compromising the dento-skeletal relations, in order to achieve the best functional and aesthetical results.