A pilot study on the use of the super dimension navigation system for optimal cryobiopsy location in interstitial lung disease diagnostics.

BACKGROUND: Transbronchial cryobiopsies has become increasingly important in the diagnostic workup for interstitial lung diseases. The rate of complications and mortality are low compared to surgical lung biopsies, but the diagnostic yield is not as high. The reason for the lower diagnostic yield could in some cases be explained by biopsies taken too centrally or in less affected areas. In this pilot study we examined the feasibility of using the electromagnetic navigation system, superDimension (SD), when performing cryobiopsies to increase the diagnostic yield. METHODS: Electromagnetic navigation bronchoscopy and cryobiopsies were performed using SD. An electromagnetic board placed on the back of the patient and a position sensor at the tip of the navigational probe created a real-time 3D reconstruction of previously acquired computer tomography images. The procedure was performed with the patients in general anesthesia using a rigid bronchoscope when performed in Florence and with a flexible bronchoscope through an orotracheal tube when performed in Aarhus. RESULTS: In total, 18 patients were included. Five patients were excluded, partly due to technical difficulties. Disposable 1.7 mm cryoprobes were used in Aarhus, and reusable 1.9 mm probes in Florence. Pneumothorax was detected in three (23%), mild hemorrhage was seen in one (8%) and moderate hemorrhage in six (46%). The biopsies contributed to the diagnosis in 11 of the patients (85%). CONCLUSION: Using superDimension electromagnetic navigation system when performing cryobiopsies is feasible. A larger prospective trial is necessary to homogenize the technique between centres and to evaluate diagnostic advantage and complications.

Prevalence of molar incisor hypomineralization among school children in Rome, Italy.

Molar incisor hypomineralization (MIH) is a highly prevalent condition associated with increased caries experience, dental pain and treatment need. Aim of this study was to determine the prevalence and severity of MIH in a group of 7-8 years old primary school children living in Rome, Italy; and to assess the association with caries experience and possible perinatal risk factors. A survey has been conducted in the city of Rome, between April 2019 and March 2020 with a total of 49 primary schools and 176 2nd grade primary school classes and a total of 3611 children being involved. Of these, a subset of 346 children of 21 primary schools was selected for the epidemiological investigation. The prevalence of MIH was of 18.2%, with girls showing twice the probability of being subject to a mild-severe condition. Molar location was present in 71.4%, while location on both molar plus incisor was present in 28.6% of cases. The mean DMFT was 0.44 ± 0.78, "D" was 0.17 ± 0.58; the mean dmft was 1.7 ± 2.56, "d" was 1.32 ± 2.21. Female gender, caries experience, insufficient oral hygiene were risk factors. The incidence of MIH is increasing in the pediatric population. Knowledge about diagnosis and treatment options should be disseminated among dental professionals.

Bisphosphonate-related osteonecrosis of the jaws and dental surgery procedures in children and young people with osteogenesis imperfecta: A systematic review.

BACKGROUND: Bisphosphonates (BPs) contrast the bone fragility and improve bone density in some metastatic cancers and bone diseases, such as Osteogenesis Imperfecta (OI). BPs use has been associated with osteonecrosis of the jaws (BRONJs) in adults needing for invasive dental procedures. AIM: To conduct a systematic review on BRONJ occurrence after dental surgery in paediatric population under BPs therapy for OI, so as to identify the pre-surgical protocols adopted. DESIGN: According to PRISMA guidelines, Pubmed, Web of Science (WoS) and Cochrane were investigated on September 2018, and re-checked on July 2019. Inclusion criteria were English-language papers on children/young adults (until 24 years old) reporting dental/oral surgery procedures. RESULTS: Totally, 60 articles were found. After title/abstract reviews and duplicates exclusion, 22 eligible titles underwent full-text evaluation. Finally, 10 studies were included. CONCLUSIONS: The lack of BRONJ occurrence in paediatric population suffering OI and treated with BPs, was confirmed, but the reasons are still debated, being the BPs therapies and the surgical strategies various and not standardized. Longitudinal studies should evaluate what happens to those former children once adult, to evaluate the delayed BRONJs onset associated with the occurrence of comorbidities during the adulthood.

Using of modified rapid palate expander with miniscrews in a patient affected by ectodermic dysplasia.

OBJECTIVES: To show the orthodontic treatment in a 8-year-old patient affected by Ectodermal Dysplasia (hypohidrotic type) and presenting multiple agenesiae, contraction of the maxilla and skeletal Class III malocclusion. STUDY DESIGN: Because of both oligodontia of primary and secondary dentition and no good retention and anchoring, a hybrid modified rapid palatal expander (RPE) was used. It presented dental anchoring with two bands on first upper molars and skeletal anchoring with two miniscrews in the anterior palate. The project included the use of a CBTC for the bone examination and precise silicon dental impression for the insertion of miniscrews. RESULTS: The procedure was successful and the patient solved the expansion in few days, so RPE has been embedded throughout 6 months in order to develop the bone at the median suture. CONCLUSIONS: This case report can be considered as a valid example for approaching patients affected by Ectodermal Dysplasia with multiple agenesiae and palatal contraction because of the difficult retention.

Obstructive sleep apnea syndrome in the pediatric age: the role of the dentist.

OBJECTIVE: Sleep disordered breathing in children designates a wide spectrum of respiratory disorders characterized by partial or complete obstruction of the upper airways. It ranges from primary snoring, its mildest clinical manifestation, to obstructive sleep apnea syndrome (OSAS): complete obstruction of the upper airways with cessation of airflow. The aim of this paper is to highlight the roles of the pediatric dentist and the orthodontist in the therapeutic approach to pediatric OSAS as a "sentinel" who can detect early signs of the disease for immediate referral to the otolaryngologist and as an active participant in therapy. MATERIALS AND METHODS: A literature review has been performed on the following topics: pediatric OSAS, orthodontic clinical aspects of pediatric OSAS, orthodontic therapy of pediatric OSAS, mandibular advancement devices and functional orthodontic devices in OSAS treatment. RESULTS: The role of the dentist in pediatric OSAS is essential to correct orthodontic alterations that may favor the development of the condition. Orthodontic treatment aims at reducing the severity of OSAS by increasing the airspace and improving airflow through orthopedic expansion of the upper jaw and mandibular advancement. Rapid palatal expanders and mandibular advancement devices are successfully used in the treatment of OSAS. CONCLUSIONS: Scientific evidence of a strong association between craniofacial growth and OSAS; the pediatric dentist and the orthodontist participate as sentinels, observing and identifying conditions requiring referral to the otolaryngologist and playing a pivotal role in the orthodontic treatment phase.

Late radiation-associated dysphagia in head and neck cancer patients: evidence, research and management.

In head and neck cancer (HNC) scenario, newer radiotherapy (RT) techniques, such as intensity modulated RT (IMRT), aim to reduce acute and late toxicity without impair tumor response and loco-regional control rates. However, late radiation-associated dysphagia (RAD) remains a major clinical problem and has gained a growing importance in the last few years, especially due to human papilloma virus (HPV)-related HNC favorable prognosis. The aim of this review was to provide clinical information about late RAD. The main anatomical structures involved in swallowing were described, in order to define potential organ at risk and available radiation-dose constraints in IMRT plan. Finally, possible rehabilitation strategies were proposed. This is expected to represent an opportunity for improved multidisciplinary management in HNC patients.

Craniofacial morphology and airflow in children with primary snoring.

OBJECTIVE: Sleep-disordered breathing (SDB) is among the most common diseases and includes a group of pathological conditions that form a severity continuum from primary snoring (PS) to obstructive sleep apnea (OSA). SDB presents a multifactorial etiology and in children, it is often linked to adenotonsillar hypertrophy, which may lead to an alteration of the breathing pattern. Therefore, several studies hinted at the existence of a correlation between SDB and the alteration of craniofacial growth. However, these studies concentrated on the most severe forms of SDB and little evidence still exists for the mildest form of SDB, namely PS. This preliminary study investigates the association between nasal airflow, measured through rhinomanometry, and cephalometric parameters in a sample of young children with PS. PATIENTS AND METHODS: A sample of 30 children with habitual snoring aged between 5 and 8 years was selected by a SDB validated questionnaire at the Pediatric Allergology and Immunology Center of "Sapienza" University of Rome, Italy. To assess the degree of nasal obstruction, all children underwent anterior active rhinomanometry while nocturnal pulse oximetry and polysomnography were used to characterize the SDB. Cephalometric analysis was used to evaluate relevant orthodontic parameters associated to the sagittal and vertical craniofacial development and to the position of the hyoid bone. RESULTS: We found a statistically significant association between the Frankfurt mandibular angle (FMA), which measures the total facial vertical divergence, and the severity of the airflow's obstruction (p = 0.014). CONCLUSIONS: The present study supports the association between the level of nasal obstruction in children with PS and the alteration of cephalometric parameters associated with the vertical craniofacial growth, thus placing the evaluation of craniofacial parameters in the growth period in a privileged position to determine an early diagnosis of a possible insurgence of sleep disorders.

Er:YAG laser for brackets bonding: a SEM study after debonding.

BACKGROUND: The introduction of Er:YAG laser in dentistry for ablation of hard tissues advocated an alternative method of enamel etching for orthodontics purpose. MATERIALS AND METHODS: 55 extracted human third molars were inserted in acrylic resin blocks and divided into five groups of 11 teeth. Group 1 was treated with 37% orthophosphoric acid for 30 seconds. Group 2 was treated with laser irradiation (Er:YAG Fidelius III, Fotona, Slovenia) at 80 mJ and 4 Hz. Group 3 underwent laser treatment (80 mJ, 4 Hz), followed by 37% orthophosphoric acid for 30 seconds. The teeth in Group 4 were treated with laser at 40 mJ and 10 Hz. The teeth in Group 5 were treated with laser (40 mJ, 10 Hz), followed by 37% orthophosphoric acid for 30 seconds. The adhesive remnant index was determined after debonding. RESULTS: Kruskas-Wallis test showed that location parameters (median and mean) are significantly different between Groups 2 and 4 when compared with control group; on the contrary no significant difference was detected between Groups 3 and 5 with the controls. CONCLUSION: The use of Er:YAG laser alone, as in Groups 2 and 4, showed no significant advantages over phosphoric acid in the bonding procedure for orthodontics brackets.

Collaboration Spotting for oral medicine.

AIM: The goal of the Collaboration Spotting project is to create an automatic system to collect information about publications and patents related to a given technology, to identify the key players involved, and to highlight collaborations and related technologies. The collected information can be visualized in a web browser as interactive graphical maps showing in an intuitive way the players and their collaborations (Sociogram) and the relations among the technologies (Technogram). We propose to use the system to study technologies related to oral medicine. METHODS: In order to create a sociogram, we create a logical filter based on a set of keywords related to the technology under study. This filter is used to extract a list of publications from the Web of Science™ database. The list is validated by an expert in the technology and sent to CERN where it is inserted in the Collaboration Spotting database. Here, an automatic software system uses the data to generate the final maps. RESULTS: We studied a set of recent technologies related to bone regeneration procedures of oro-maxillo-facial critical size defects, namely the use of porous hydroxyapatite (HA) as a bone substitute alone (bone graft) or as a tridimensional support (scaffold) for insemination and differentiation ex vivo of mesenchymal stem cells. We produced the sociograms for these technologies and the resulting maps are now accessible on-line. CONCLUSION: The Collaboration Spotting system allows the automatic creation of interactive maps to show the current and historical state of research on a specific technology. These maps are an ideal tool both for researchers who want to assess the state-of-the-art in a given technology, and for research organizations who want to evaluate their contribution to the technological development in a given field. We demonstrated that the system can be used in oral medicine as is produced the maps for an initial set of technologies in this field. We now plan to enlarge the set of mapped technologies in order to make the Collaboration Spotting system a useful reference tool for oral medicine research.

Collaboration spotting for dental science.

AIM: The goal of the Collaboration Spotting project is to create an automatic system to collect information about publications and patents related to a given technology, to identify the key players involved, and to highlight collaborations and related technologies. The collected information can be visualized in a web browser as interactive graphical maps showing in an intuitive way the players and their collaborations (Sociogram) and the relations among the technologies (Technogram). We propose to use the system to study technologies related to Dental Science. METHODS: In order to create a Sociogram, we create a logical filter based on a set of keywords related to the technology under study. This filter is used to extract a list of publications from the Web of Science™ database. The list is validated by an expert in the technology and sent to CERN where it is inserted in the Collaboration Spotting database. Here, an automatic software system uses the data to generate the final maps. RESULTS: We studied a set of recent technologies related to bone regeneration procedures of oro--maxillo--facial critical size defects, namely the use of Porous HydroxyApatite (HA) as a bone substitute alone (bone graft) or as a tridimensional support (scaffold) for insemination and differentiation ex--vivo of Mesenchymal Stem Cells. We produced the Sociograms for these technologies and the resulting maps are now accessible on--line. CONCLUSION: The Collaboration Spotting system allows the automatic creation of interactive maps to show the current and historical state of research on a specific technology. These maps are an ideal tool both for researchers who want to assess the state--of--the--art in a given technology, and for research organizations who want to evaluate their contribution to the technological development in a given field. We demonstrated that the system can be used for Dental Science and produced the maps for an initial set of technologies in this field. We now plan to enlarge the set of mapped technologies in order to make the Collaboration Spotting system a useful reference tool for Dental Science research.

Occlusal trauma in mixed dentition: literature review.

AIM: Controversy over the relationship between occlusion and the progression of periodontal destruction has been ongoing since the beginning of scientific studies of dental diseases. This paper reviews the literature and explores the relationship between trauma from occlusion with periodontal disease in children, presenting recommendations for clinical practice based on the available evidence.

Effects of interceptive orthodontics on orbicular muscle activity: a surface electromyographic study in children.

The purpose of this study was to assess by surface electromyography (sEMG) the changes in upper and lower orbicular oris (OO) muscles produced by a preformed functional device in subjects with Class II, division 1 malocclusion, deep bite, and labial incompetence. Twenty-eight subjects were selected: 13 subjects (mean age 9 ± 1.5 years) with Class II malocclusion, deep bite, and labial incompetence were treated with a preformed functional device, while 15 subjects (mean age 9.5 ± 0.8 years) with normal occlusion were used as control. Inclusion criteria for both groups were: presence of mixed dentition, no previous orthodontic treatment, and absence of speech disturbance. sEMG recordings were taken at the time of the first visit (T0), and after 3 (T1) and 6 months (T2) for the treated group, and at T0 and T2 for the control group. The sEMG recording was performed at rest, and while kissing, swallowing, opening the mouth, clenching the teeth, and during protrusion of the mandible, by placing electrodes at the area of muscle contraction. At T0, except during swallowing, the treated group always showed a lower sEMG activity of the lower OO muscle with respect to the control group, with significant differences at rest and during mandibular protrusion (p<0.05). In the treated group, a significant increase in muscle tone was observed for the lower OO muscle from T0 to T1, but only at rest. The upper OO muscle showed a significant increase during the protrusion of the mandible from T1 to T2. No significant change was observed in the control group during the follow-up. Muscular contractility of treated patients at T2 reached the same values as that of the control group at T2. Interceptive orthodontics seems to improve the form and function of the orofacial muscle structure. Improvement in muscle contraction after treatment was demonstrated by sEMG.

Noonan syndrome: A case report.

AIM: Noonan syndrome is a rare genetic alteration; the responsible gene is located on the long arm of chromosome 12. CASE REPORT: The authors examined a caucasic girl of eight years with Noonan syndrome. The patient had systemic problems, such as: otitis, heart trouble, language disturbances and asymmetry of the lower limbs. Light mental delay was also found. She had the bad habit of sucking the lower lip. The treatment plan was extraction of some teeth, sealing of first molars and orthodontic treatment with functional appliance.

[Clinical and radiographic association between tooth agenesis and systemic pathology on a group of children from U.O.C. of paediatric dentistry of Sapienza University, Rome]. / Rilevamento dell'associazione clinico-radiografica tra agene- sie dentarie e patologie sistemiche in un campione pediatrico afferente presso la U.O.C. di Odontoiatria Pediatrica della Sapienza Università di Roma.

The aim of this work is to identify the association between tooth agenesis and systemic pathologies in paediatric patients. The Authors used clinical case-history and orthopanoramic rx of paediatric patients between 5 and 12 years old, gone to U.O.C. of Paediatric Dentistry, from genuary 2006 to genuary 2009. It resulted that 9.1% of 1190 children presented tooth agenesis and in this group the Authors put in evidence a percentage of 41.5% with syndromes or orofacial diseases.

Evaluation of customer satisfaction at the Department of Paediatric Dentistry of "Sapienza" University of Rome.

AIM: Healthcare facility management requires the optimisation of the quality of services offered. METHODS: The Authors adopted a questionnaire as a means to assess customer satisfaction and needs. The Questionnaire has been designed to address adults, i.e., parents or guardians of children attending the Paediatric unit as patients. To estimate their degree of satisfaction, either regarding the environment where children are treated or about the direct interactions between the parents and the structure (waiting room, waiting time, treatment time and time needed to make the payments, costs, etc.), the questionnaire was submitted to a sample of approximately 600 customers, between March and June of 2005. RESULTS: On one hand results provide a pleasant confirmation on customers' perception of the service, especially regarding the direct relationship between the parties; on the other, they highlight aspects that could be improved (waiting room, optimisation of waiting time), distinguishing between factors that need extra funding to be implemented, and those that, instead, could be simply improved through a better and more efficient organisation of labour and time. CONCLUSION: The present analysis and previous experiences confirm that appraisal of the degree of customers' satisfaction by means of questionnaires is a valid and necessary instrument for the quality improvement of a healthcare service. Doing so, economic and human resources can be more efficiently allocated.

Malignant infantile osteopetrosis: dental effects in paediatric patients. Case reports.

AIM: Malignant Infantile Osteopetrosis is a hereditary pathology caused due to osteoclastic cells which are incapable of carrying out their functions and hence do not resorb osseous tissue where required. Thus the consequence is that during growth phase, the medullary cavities and nervous tissue cavities do not undergo sufficient growth and the corresponding organs do not develop adequately. The aim of this study is to outline the role of the pediatric dentist who has to carry out protocols of primary, secondary, tertiary prevention intervening at many levels. Clinical features and dental effects are described. Two case reports are presented in this study. CONCLUSION: Oral problems of osteopetrosis are delayed tooth eruption, absence of some teeth, malformed teeth, enamel hypoplasia, disturbed dentinogenesis, hypomineralisation of enamel and dentin, propensity for tooth decay, defects of the periodontal membrane, thickened lamina dura, mandibular protrusion, and the presence of odontomas. Tooth removal should be limited as it may induce bone fractures and osteomyelitis. The role of the pediatric dentist is defined.

Case report: clinical management of hypoplastic amelogenesis imperfecta.

BACKGROUND: The fundamental therapeutic problems related to amelogenesis imperfecta treatment are governed by the need to effect primary prevention interventions, reducing the risk of calculus accumulation and caries. There are also aesthetic and functional rehabilitative needs. Clinical management rehabilitation techniques vary depending on the AI type, but usually require restoration of affected teeth. Where orthodontic problems also exist, these should be corrected prior to the final restorative treatment. CASE REPORT: The use of composite resins in aesthetic restoration of permanent anterior and posterior teeth as affected by hypoplastic AI type is described. This case illustrates a patient who suffered from less attrition than those of the hypomineralized varieties. The therapeutic choice has allowed the correction of vertical dimension without the use of preformed crowns.

Rare compound odontoma of the mandible in a 7-year-old child: case report.

BACKGROUND: A compound odontoma is a mixed tumor of odontogenic origin, in which both ectodermal and mesenchymal cells exhibit complete differentiation, resulting in the formation of tooth structures. It occurs with equal frequency in both sexes, and is often initially asymptomatic. CASE REPORT: A 7-year-old boy was recently examined in our Department for management of a compound odontoma. Surgical treatment was invasive because of the size of the lesion, but it was possible to use interceptive orthodontic treatment to restore the dental arch.

Expression profiling of ductal carcinoma in situ by laser capture microdissection and high-density oligonucleotide arrays.

Gene expression profiling through the use of nucleic acid arrays is a powerful method for the molecular classification of human neoplasms. Laser capture microdissection is an equally useful technique to selectively isolate defined cell populations from heterogeneous histological tissue sections. In this report, we demonstrate how a modest use of laser capture microdissection is sufficient to isolate nanogram quantities of high-quality RNA. Together with the use of several internal standards and microcapillary electrophoresis of input RNA, two rounds of linear molecular amplification have been used to generate sufficient quantities of labeled target for hybridization to high-density oligonucleotide expression arrays. Results demonstrate that the technique is reproducible, generates only modest biasing of the original transcript population, and is comparable to the sensitivity achieved with standard methodology. Using this approach, we have compared the expression profiles of nonmalignant human breast epithelium and adjacent ductal carcinoma in situ lesions from breast cancer patients. Several genes, previously implicated in human breast cancer progression, demonstrate differential expression among the microdissected cell populations.

Sperm factor induces intracellular free calcium oscillations by stimulating the phosphoinositide pathway.

Injection of a porcine cytosolic sperm factor (SF) or of a porcine testicular extract into mammalian eggs triggers oscillations of intracellular free calcium ([Ca(2+)](i)) similar to those initiated by fertilization. To elucidate whether SF activates the phosphoinositide (PI) pathway, mouse eggs or SF were incubated with U73122, an inhibitor of events leading to phospholipase C (PLC) activation and/or of PLC itself. In both cases, U73122 blocked the ability of SF to induce [Ca(2+)](i) oscillations, although it did not inhibit Ca(2+) release caused by injection of inositol 1,4,5-triphosphate (IP(3)). The inactive analogue, U73343, had no effect on SF-induced Ca(2+) responses. To determine at the single cell level whether SF triggers IP(3) production concomitantly with a [Ca(2+)](i) rise, SF was injected into Xenopus oocytes and IP(3) concentration was determined using a biological detector cell combined with capillary electrophoresis. Injection of SF induced a significant increase in [Ca(2+)](i) and IP(3) production in these oocytes. Using ammonium sulfate precipitation, chromatographic fractionation, and Western blotting, we determined whether PLCgamma1, PLCgamma2, or PLCdelta4 and/or its splice variants, which are present in sperm and testis, are responsible for the Ca(2+) activity in the extracts. Our results revealed that active fractions do not contain PLCgamma1, PLCgamma2, or PLCdelta4 and/or its splice variants, which were present in inactive fractions. We also tested whether IP(3) could be the sensitizing stimulus of the Ca(2+)-induced Ca(2+) release mechanism, which is an important feature of fertilized and SF-injected eggs. Eggs injected with adenophostin A, an IP(3) receptor agonist, showed enhanced Ca(2+) responses to CaCl(2) injections. Thus, SF, and probably sperm, induces [Ca(2+)](i) rises by persistently stimulating IP(3) production, which in turn results in long-lasting sensitization of Ca(2+)-induced Ca(2+) release. Whether SF is itself a PLC or whether it acts upstream of the egg's PLCs remains to be elucidated.