Oral complications of head and neck radiotherapy: prevalence and management.

AIM: The aim of the study was to evaluate the short-term and long-term toxicity caused by radiation treatment in the head and neck with the technique of intensity-modulated radiotherapy (IMRT). METHODS: We selected 20 patients, 18 men and 2 women aged between 21 and 71 years, undergoing radiation therapy (IMRT) in head and neck. Patients were visited during radiotherapy and followed for six months after the end of the therapy. We assessed the presence of: mucositis, xerostomia, dysgeusia, dysphagia, pain, trismus and, in the case of late-onset complications, radiation cavities. RESULTS: Acute toxicity: in 20 patients, 18 reported mucositis, 19 xerostomia, 17, dysgeusia, 15 dysphagia, 18 had pain and 3 patients had trismus. Tardive toxicity: in 14 patients, 5 reported mucositis, 11 xerostomia, 6 dysgeusia, 2 dysphagia, 3 had pain, 4 trismus and in 4 patients were found radiation cavities. CONCLUSION: Acute complications with higher prevalence were xerostomia (19 of 20 patients), dysgeusia of 2nd grade (11 patients of 20), mucositis of 1st grade and pain of 1st grade (10 patients of 20). Among the late complications it was noted a maintenance of the high prevalence of xerostomia (11 patients of 14) and an increase in prevalence of trismus (4 patients of 14) against a reduction of all other complications. The presence of radiation cavities in 4 patients of 14 was also recorded.

Combined orthodontic-surgical approach in the treatment of impacted maxillary canines: three clinical cases.

Impaction of maxillary canine is a relatively frequent orthodontic anomaly which could represent fuctional and aesthetic problems for patients. Nowadays, the conventional technique to impacted canines consists of a combined orthodontic and surgical approach, aimed to guide cuspids at the center of the alveolar ridge in a stable position and surrounded by healthy hard and soft tissues. This article presents three cases studies with different combined surgical-orthodontic approaches for the treatment of infraosseous impacted canines. An impacted maxillary canine could be guided, after adequate space is created orthodontically, to the center of the ridge through an orthodontic traction directly applied to the crown of impacted cuspid. Several surgical techniques have been proposed to expose the crown of impacted tooth. Location (buccal or palatal side) of impactation and depth influence surgical approach in order to obtain best aesthetic and functional results.

Full digital workflow for implant-prosthetic rehabilitations: a case report.

OBJECTIVES: The aim of the present study was to describe a proof of concept digital workflow for the implant-prosthetic treatment in partially edentate patients and evaluate its clinical performance. METHODS: A 55-year-old woman with a Kennedy class III bilateral edentulism in the mandible has been selected for a computer guided implantology according with the Smart Fusion® protocol (NobelBiocare, Kloten, Switzerland). After the template-guided implant placement, an immediate loading of the implants has been performed. QuickTemp conical temporary abutments were selected to deliver immediately prefabricated cement-retained provisionals. Two months after an impression was taken with an intraoral digital scanner (3Shape Trios3, Copenhagen, Denmark). The provisional restoration optical scanning was used to transfer the functionalized prosthetic contour to be duplicated into the definitive porcelain fused to zirconia restoration cemented on customized titanium abutments. RESULTS: A satisfying esthetic and functional result has been achieved. No biological and mechanical complications were recorded. CONCLUSIONS: The investigated fully digital implant-prosthetic protocol provided a smooth, complication free and time effective treatment alternative to the conventional workflow. Besides the fully digital workflow allowed the surgical and prosthetic decision making and the communication within the dental team and with the patient. Further improvements heading to a direct match between the intraoral scan and the CBCT are strongly advised in order to create the so-called virtual patient.

CEREC CAD/CAM Chairside System.

PURPOSE: The aim of this paper was to describe the CEREC 3 chairside system, providing the clinicians a detailed analysis of the whole digital workflow. Benefits and limitations of this technology compared with the conventional prosthetic work-flow were also highlighted and discussed. MATERIALS AND METHODS: Clinical procedures (tooth preparation, impression taking, adhesive luting), operational components and their capabilities as well as restorative materials used with CEREC 3 chairside system were reported. RESULTS: The CEREC system has shown many positive aspects that make easier, faster and less expensive the prosthetic workflow. The operator-dependent errors are minimized compared to the conventional prosthetic protocol. Furthermore, a better acceptance level for the impression procedure has shown by the patients. The only drawback could be the subgingival placement of the margins compared with the supra/juxta gingival margins, since more time was required for the impression taking as well as the adhesive luting phase. The biocopy project seemed to be the best tool to obtain functionalized surfaces and keep unchanged gnathological data. Material selection was related to type of restoration. CONCLUSIONS: The evidence of our clinical practice suggests that CEREC 3 chairside system allows to produce highly aesthetic and reliable restorations in a single visit, while minimizing costs and patient discomfort during prosthetic treatment. However improvements in materials and technologies are needed in order to overcome the actual drawbacks.

Simplified type 3 implant placement, after alveolar ridge preservation: a case study.

Alveolar ridge, after tooth extraction, could reduce its volume up to 50% in buccal-lingual width in the first twelve months and residual dimensions could interfere with correct three dimensional placement of implants and influence negatively treatment outcomes with regard to function and aesthetic aspects. Over the last decades, several approaches have been proposed and tested in order to prevent ridge volumetric contraction and provide maximum bone availability for implant procedure. This article presents a case study with a single anterior tooth replacement, illustrating socket seal technique followed by a type 3 timing implant placement. Immediately after tooth extraction, residual socket was grafted using Deproteinized Bovine Bone Mineral and a free gingival punch harvested from palate. After 3 months, a root-form titanium implant was inserted without additional regenerative procedures. Follow-up examination revealed favourable preservation of soft tissue width and height in the aesthetic area. Socket seal approach maximizes soft tissue healing, preserving ridge envelope and the subsequent implant placement, furthermore, results simplified, as any augmentation techniques are required. Clinical advantages of this method include predictable preservation of the soft tissues, favourable healing features, easy handling of graft materials and a positive benefit-cost ratio.

Prevalence of hepatitis C virus among users attending a voluntary testing centre in Rio Grande, southern Brazil: predictive factors and hepatitis C virus genotypes.

We estimated the prevalence of hepatitis C (HCV) infection and associated risk factors in 750 individuals attending the Voluntary Counseling and Testing Center of Rio Grande (VCT/RG), in Southern Brazil, and identified viral genotypes. Demographic data and risk factors for HCV transmission were also collected and analysed. Anti-HCV antibody-positive individuals were tested for HCV-RNA and genotyped by sequencing the 5' untranslated region of the viral genome. Prevalence estimates of anti-HCV and HCV-RNA were 6% and 5.5%, respectively. We identified genotypes 1 (67%), 2 (2%) and 3 (31%); the latter was more prevalent than in other regions of Brazil. Anti-HCV prevalence in VCT/RG users was similar to previous reports. Age, previous blood transfusion, sexual orientation and injecting drug use were independent predictors of HCV infection. The presence of multiple risk factors was also associated with a higher risk for HCV infection. HCV genotype was not associated with any variable analysed in this study.

Characterization of S3Pvac anti-cysticercosis vaccine components: implications for the development of an anti-cestodiasis vaccine.

BACKGROUND: Cysticercosis and hydatidosis seriously affect human health and are responsible for considerable economic loss in animal husbandry in non-developed and developed countries. S3Pvac and EG95 are the only field trial-tested vaccine candidates against cysticercosis and hydatidosis, respectively. S3Pvac is composed of three peptides (KETc1, GK1 and KETc12), originally identified in a Taenia crassiceps cDNA library. S3Pvac synthetically and recombinantly expressed is effective against experimentally and naturally acquired cysticercosis. METHODOLOGY/PRINCIPAL FINDINGS: In this study, the homologous sequences of two of the S3Pvac peptides, GK1 and KETc1, were identified and further characterized in Taenia crassiceps WFU, Taenia solium, Taenia saginata, Echinococcus granulosus and Echinococcus multilocularis. Comparisons of the nucleotide and amino acid sequences coding for KETc1 and GK1 revealed significant homologies in these species. The predicted secondary structure of GK1 is almost identical between the species, while some differences were observed in the C terminal region of KETc1 according to 3D modeling. A KETc1 variant with a deletion of three C-terminal amino acids protected to the same extent against experimental murine cysticercosis as the entire peptide. On the contrary, immunization with the truncated GK1 failed to induce protection. Immunolocalization studies revealed the non stage-specificity of the two S3Pvac epitopes and their persistence in the larval tegument of all species and in Taenia adult tapeworms. CONCLUSIONS/SIGNIFICANCE: These results indicate that GK1 and KETc1 may be considered candidates to be included in the formulation of a multivalent and multistage vaccine against these cestodiases because of their enhancing effects on other available vaccine candidates.

Oral focal mucinosis: case report.

Oral focal mucinosis (OFM) is an uncommon disease of unknown aetiology. It is considered to be the oral counterpart of cutaneous focal mucinosis and cutaneous myxoid cyst and it is characterized by a focal myxoid degeneration of the connective tissue. A preoperative diagnosis is almost impossible, and the clinical suspicion, usually made by exclusion, must be confirmed by a bioptic examination followed by histological observations.The Authors report a case of focal oral mucinosis diagnosed and treated in a male adult patient.

Clinical and histological study of a xenogenic bone substitute used as a filler in postextractive alveolus.

AIM: The development of oral implant techniques and the demand for the treatment of increasingly complex cases have drawn the attention of researchers and clinicians towards those systems and materials able to promote bone regeneration. The aim of this paper is to evaluate the clinical behavior and in particular the resorption times of the material used as a filler in postextractive alveolus with the intent of preserving the ridge volume, a prerequisite for successive insertion of osteointegrated fixtures. METHODS: A group of 12 patients, aged between 30-40 years, have been selected at the Oral Surgery Unit of the San Giovanni Calibita Hospital in Rome. They all required an endosseous implant following the loss of a dental element due to radicular fracture of periodontal pathology. The grafting material used is OsteoBiol Putty, an antigen-free bone paste composed of 80% granulated mix and 20% pure collagen. RESULTS: The results emerging from the histological analysis show that 3 months after insertion of this osteoconductive material in the receiving site it can no longer be detected in the samples collected and it has been completely substituted by trabecular bone tissue. CONCLUSIONS: The conclusion is drawn that the heterologous material used in this study shows excellent manageability allowing the operator to easily and accurately remove and shape it in the receiving site.

Bilateral anesthesia into Spix's spine. Ten years' experience.

AIM: This study examines 10.112 cases in 10 years of bilateral block anaesthesia to Spix's spine. The aim of this study is therefore to eliminate any doubt about executing a bilateral anaesthesia to Spix's spine for the extraction, in inclusion and impacted of the inferior wisdom teeth. METHODS: A retrospective study was carried out on 10,112 operations (59% females, 41% males,) regarding the removal of the lower 3 molar teeth undertaken in the past 10 years. Locoregional anaesthesia and standard instruments and protocol were applied to all operations. The anaesthetic used was mepicavina at 2% with epinefrine 1:100,000 with a 4 x 25 mm, 27 Gauge needle. In order to completely anaesthetize the areas subject to surgery a quantity of approximately 3-ml on each side was injected. Local anaesthetics used were the same throughout the study; all the patients were in good health and not undergoing any pharmaceutical treatment. RESULTS: The onset of complications was 3 times less when using local anaesthesia (LA) compared to general anaesthesia (GA). It was also proven that local anaesthesia was advantageous, as the operation time was considerably less (24 min for LA and 46 min for GA). CONCLUSIONS: The paper shows that LA offers a significant reduction in complications, psychological advantages for the patients and facilitation of the operational position too, so that GA is to be preferred only for non-cooperative patients.

Spatiotemporal patterns of expression of neurotrophins and neurotrophin receptors in mice suggest functional roles in testicular and epididymal morphogenesis.

Several reports have established that the action of neurotrophins is not restricted to the nervous system but can affect a broad range of non-neuronal cells. Nerve growth factor (NGF) is present in adult testis and has been suggested as a potential regulator of meiosis in rat seminiferous epithelium. Here we present an extensive immunohistochemical study on neurotrophins and their receptors (p75 and trk) in the developing mouse testis and epididymis, and in fetal human testis. During the early steps of testicular and epididymal organization in the mouse, strong p75 immunoreactivity is detectable in the gonadal ridge in the mesenchyme that is excluded from the evolving testicular cords, and in the mesenchymal cells of the mesonephros. Later in organogenesis, most of the p75-positive interstitial cells of the testis coexpress neurotrophin-3 (NT-3) and the truncated trk B receptor in a developmentally regulated pattern. Our Western blot data confirm the expression of these molecules. These findings suggest that neurotrophin receptors play a role in early inductive events during critical periods of testicular and epididymal development. During fetal and postnatal histogenesis, an increasing number of NT-3- and p75-positive mesenchymal cells start to express alpha-smooth muscle isoactin, suggesting a role for the so-called neurotrophic system in the differentiation of testicular myoid cells and epididymal smooth muscle cells. In the testis of an 18-wk gestational-age human fetus, immunohistochemical analysis has shown intense immunoreactivity of mesenchymal cells to antibodies for neurotrophin receptors p75, trk A, and trk C, and their ligands NGF and NT-3. In addition, we found that in the human fetal testis, the interstitial cells that are differentiating into peritubular myoid cells are associated with a dense network of nerve fibers. Our data suggest that neurotrophins and their receptors are involved in a multifunctional system that regulates cell differentiation and innervation in the developing testis and epididymis.

Non-specific hyperreactivity before and after nasal specific immunotherapy.

BACKGROUND: Specific local immunotherapy (SLIT) improves symptom scores for allergic rhinitis during treatment and after its conclusion, as confirmed by non-specific tests. However, the duration of clinical and instrumental improvement after discontinuing SLIT is unknown. OBJECTIVE: To evaluate the changes in the non-specific reaction time of patients with allergy to Dermatophagoides pteronissinus before and during 3 years of SLIT, and 6, 12, 18, and 24 months after discontinuing SLIT. MATERIAL AND METHODS: Sixteen patients were diagnosed by clinical history, positive skin test for D. pteronissinus, RAST, nasal provocation test (NPT) specific for D. pteronissinus, NPT with cold water solution. SLIT was administered by nasal spray. Patients were evaluated before, at 6, 12, 24, and 36 months of SLIT, and 6, 12, and 18 months after discontinuing SLIT. At the beginning of SLIT, the allergen concentration used was similar to that used in NPT. Maintenance doses were administered 3 times a week for 1 year and 2 times a week for 2 years. All patients kept a symptom diary. RESULTS: After the first year of SLIT, total nasal resistance (TNR) decreased sharply. TNR then remained constant at the end of the second year and decreased at the end of the third year of treatment. Discontinuation of SLIT did not produce evident variations in average TNR at 6 or 12 months, but 3/16 patients at 6 months and 9/16 patients at 12 months complained of symptomatic deterioration. The most evident deterioration was noted at the 18-month post-SLIT visit, in which TNR values were similar to those recorded at the onset of treatment. Positive response to stimulation and increased TNR were found after SLIT in 8/16 patients at 6 months, 13/16 at 12 months, 12/13 at 18 months, and 7/7 at 24 months. The symptom score indicated the return of symptoms. Twelve months after discontinuing SLIT, the patients complained about increased secretion and itching. The initial non-specific hyperreactivity, which had been present in all patients, was not evident in 68.7% after 3 years of SLIT, but persisted in a milder form in 31.3%. CONCLUSION: SLIT successfully reduced symptoms of D. pteronissinus sensitivity. Non-specific hyperreactivity was absent at the end of SLIT, but returned by 6 months after discontinuing SLIT. Therefore, SLIT did not maintain the clinical results achieved at the beginning of treatment for more than 12 months.

Magnetic polarity fractions in magnetotactic bacterial populations near the geomagnetic equator.

The relative numbers of North-seeking and South-seeking polarity types in natural populations of magnetotactic bacteria were determined at sites on the coast of Brazil. These sites were South of the geomagnetic equator and had upward geomagnetic inclinations of 1-12 degrees . For upward inclinations >6 degrees , South-seeking cells predominated over North-seeking cells by more than a factor of 10. For upward inclinations <6 degrees , the fraction of North-seeking cells in the population increased with decreasing geomagnetic inclination, approaching 0.5 at the geomagnetic equator. We present a simple statistical model of a stochastic process that qualitatively accounts for the dynamics of the two polarity types in a magnetotactic bacterial population as a function of the geomagnetic field inclination.