Elastodontic Appliances for the Interception of Malocclusion in Children: A Systematic Narrative Hybrid Review.

BACKGROUND: Interceptive orthodontic treatment aims to eliminate factors that prevent the harmonious development of the maxillary and mandibular arches during childhood, and elastodontic appliances (EAs) represent a group of devices with an increasingly important role. This systematic narrative hybrid review (HR) aims to provide an overview of the clinical indications for the use of EAs according to the available evidence and to identify potential research areas for unexplored applications. MATERIALS AND METHODS: To assess the available literature on the subject, selective database searches were performed between July 2023 and September 2023. With the assistance of a health sciences librarian, a search strategy that utilized terms related to elastodontic therapy was developed. Embase, Scopus, PubMed, and Web of Science were the databases used. RESULTS: The current literature addressing the usability of EAs is scarce and mostly limited to case reports and case series. After 2168 citations were found through the searches, 13 studies were ultimately included. In this regard, information about the clinical use and effectiveness of EAs are reported in a narrative form, defining specific domains of the application that are clinically oriented, including sagittal and transversal discrepancies, atypical swallowing, teeth malposition, two-phase orthodontics and a lack of teeth retention. CONCLUSIONS: Within the intrinsic quality limitation of the available literature, it seems that EAs may represent a promising treatment alternative for managing mild-to-moderate malocclusion in children as an adjuvant therapy to the interruption of spoiled habits.

The older patient with cardiovascular disease: background and clinical implications of the comprehensive geriatric assessment.

Principles and processes of comprehensive geriatric assessment (CGA) are increasingly being applied to subspecialties and subspecialty conditions, including cardiovascular patients (i.e., infective endocarditis; considerations of surgery or transcatheter aortic valve replacement, TAVR, for patients with aortic stenosis; vascular surgery) and postoperative mortality risk. In cardiovascular field CGA has mainly the aim to define ideal management according to the different typology of older adult patients (e.g., robust versus intermediate versus physical and cognitively disabled versus end-stage or dying), allowing physicians to select different therapeutic goals according to life expectancy; Aspect to be valued are by CGA are global health status and patient's decision-making capacity: CGA allows the individualized treatment definition and optimize the preprocedure condition.

Teleorthodontics: Where Are We Going? From Skepticism to the Clinical Applications of a New Medical Communication and Management System.

Teleorthodontics represents the orthodontic care system involving remote management of orthodontic treatment. Despite skepticism, there are several advantages of including teleorthodontics in the clinical orthodontic practice. In the present review, we discuss the lights and shadows of this new communication healthcare system and its applications in the field of orthodontics that is destined to change the future of our clinical practice. For this purpose, we have provided a point-to-point analysis based on data from the most valuable scientific evidence on this topic. The information and data discussed in the present paper were obtained from the most relevant studies evaluating the performance of teleorthodontics and remote monitoring systems in clinical practice.

Evaluation of the accuracy of orthodontic models prototyped with entry-level LCD-based 3D printers: a study using surface-based superimposition and deviation analysis.

OBJECTIVES: The objective of this study was to evaluate the accuracy of dental models prototyped via entry-level liquid crystal display (LCD) 3D printers. MATERIALS AND METHODS: Identical prototyped models were generated from a master digital file testing two entry-level LCD-based 3D printers and using one professional-grade 3D printer as gold standard (GS), with 50-µm and 100-µm layer thickness. Each 3D-printed model was scanned, and a specific 3D technology was used to perform surface-based superimposition and deviation analysis to evaluate trueness and precision. The distances between surface points of two superimposed models were converted to root mean square (RMS) and statistically analyzed. RESULTS: The RMS values detected were significantly higher in dental models prototyped with entry-level compared to the SLA printer (p < 0.001), in terms of trueness (50 µm: GS 0.075 mm, LCD1 0.192 mm, LCD2 0.179 mm; 100 µm: GS 0.066 mm, LCD1 0.209 mm, LCD2 0.199 mm) and precision (50 µm: GS 0.028 mm, LCD1 0.075 mm, LCD2 0.085 mm; 100 µm: GS 0.039 mm, LCD1 0.096 mm, LCD2 0.101 mm). No significant differences were found between the values of RMS of both entry-level 3D printers (p > 0.05). Layer thickness did not affect either the trueness or precision of the 3D-printed models (p > 0.05). CONCLUSION: Entry-level LCD-based 3D printers are not as accurate as professional-grade 3D printer, but still close to orthodontics clinical threshold values. CLINICAL RELEVANCE: Clinicians should evaluate the intended application of 3D-printed orthodontic models before using entry-level 3D printers.

Hypertension in the elderly: why one size does not fit all.

Over recent years, managing hypertension in older people has gained increasing attention, with reference to very old, frailer individuals. In these patients, hypertension treatment may be challenging due to a higher risk of hypotension-related adverse events which commonly overlaps with a higher cardiovascular risk. Additionally, frailer older adults rarely satisfy inclusion criteria of randomized clinical trials, which determines a substantial lack of scientific data. Although limited, available evidence suggests that the association between blood pressure and adverse outcomes significantly varies at advanced age according to frailty status. In particular, the negative prognostic impact of hypertension seems to attenuate or even revert in individuals with older biological age, e.g., patients with disability, cognitive impairment, and poor physical performance. Consequently, "one size does not fit all" and personalized treatment strategies are needed, customized to individuals' frailty and functional status. Similar to other cardiovascular diseases, hypertension management in older people should be characterized by a geriatric approach based on biological rather than chronological age and a geriatric comprehensive evaluation including frailty assessment is required to provide the most appropriate treatment, tailored to patients' prognosis and health care goals. The aim of this review was to illustrate the importance of a patient-centered geriatric approach to hypertension management in older people with the final purpose to promote a wider implementation of frailty assessment in routine practice.

Severe aortic stenosis and transcatheter aortic valve replacement in elderly patients: utility vs. futility.

Recently, transcatheter aortic valve replacement (TAVR) has emerged as established standard treatment for symptomatic severe aortic stenosis, providing an effective, less-invasive alternative to open cardiac surgery for inoperable or high-risk older patients. In order to assess the anticipated benefit of aortic replacement, considerable interest now lies in better identifying factors likely to predict outcome. In the elderly population frailty and medical comorbidities have been shown to significantly predict mortality, functional recovery and quality of life after transcatheter aortic valve replacement. Scientific literature focused on the three items will be discussed. High likelihood of futility is described in patients with severe chronic lung, kidney, liver disease and/or frailty. The addition of frailty components to conventional risk prediction has been shown to result in improved discrimination for death and disability following the procedure and identifies those individuals least likely to derive benefit. Several dedicated risk score have been proposed to provide new insights into predicted "futile" outcome. However, assessment of frailty according to a limited number of variables is not sufficient, while a multi-dimensional geriatric assessment significantly improves risk prediction. A multidisciplinary heart team that includes geriatricians can allow the customization of therapeutic interventions in elderly patients to optimise care and avoid futility.

Analysis of Earlier Temporomandibular Joint Disorders in JIA Patients: A Clinical Report.

The aim of this study was to analyse the structural characteristics of the temporo-mandibular joint (TMJ) and the dysfunctional consequences induced by disease in subjects with juvenile idiopathic arthritis (JIA). The study was conducted in 25 patients with JIA (median age (IQR), 13.9 (10.9-15.3)) and 26 healthy controls (median age (IQR), 14.3 (11.6-17.2)) years. All enrolled patients were subjected to anamnestic evaluation, laboratory parameters, JIA subclass, and type of therapy for the disease. A clinical-gnathological evaluation, anamnestic and dysfunctional index (Ai and Di), and magnetic resonance imaging of TMJs were performed in all patients. The test group showed a significant reduction (p < 0.001) regarding the clinical findings such as maximal mouth opening, left and rightward laterotrusion and protrusion, and a significant difference in the reported symptoms (TMJ sounds, reduced mouth opening and pain), and Ai and Di (p < 0.001) compared to healthy patients. Correlation analysis showed a significant correlation between the median duration of disease and the maximum mouth opening and between visual analogue scale (VAS) score and maximum mouth opening, leftward laterotrusion, rightward laterotrusion, and protrusion. The results obtained in this study suggest that patients with JIA presented a cohort of symptoms in TMJs in comparison with healthy controls. Moreover, a careful TMJs evaluation and an early diagnosis of TMJs dysfunction and regular follow-ups are recommended in order to prevent and reduce functional and chewing problems in patients with JIA.

Dietary Factors Affecting the Prevalence and Impact of Periodontal Disease.

In the last few decades, growing evidence have shown a possible impact of diet and nutrients on oral health. This review aims to describe, in the light of current knowledge, the role of diet, nutrients, and micronutrients in periodontal health and periodontal diseases. A variety of macronutrients and micronutrients could have an impact on periodontal health. The balanced intake of unprocessed complex carbohydrates, vegetable proteins, omega-3 fatty acids, minerals, and vitamins positively affects periodontal inflammation. On the other way, refined carbohydrates, non-vegetable proteins, proinflammatory saturated fatty acids and an unbalanced supply of vitamins and minerals may increase periodontal inflammation. This review will discuss the current evidence that shows how a healthy and balanced diet has anti-inflammatory and protective effects on periodontal health. Therefore, it appears that adopting a correct lifestyle and diet should be encouraged in patients with oral and periodontal disease.

Class II Skeletal Malocclusion and Prevalence of Temporomandibular Disorders. An Epidemiological Pilot Study on Growing Subjects.

The purpose of our work is to evaluate the correlation between skeletal Class II malocclusion and temporomandibular disorders, by assessing potential different frequency scores compared with Class I and Class III skeletal malocclusion, and to evaluate associated etiological and risk factors. Fifty-five subjects were examined, 35 females and 20 males, with a mean age of 18 ± 1.3 years, divided into two groups: those with TMD and those without TMD, and prevalence was evaluated in the two groups of Class II subjects. Symptoms and more frequent signs were also examined in the TMD group. Regarding Group A (subjects with the presence of TMD), we found that 48% have a Class II, 16% have Class I, and 28% have Class III. In the totality of the group A sample, only 8% were male subjects. In Group B (subjects without TMD), we found that 40% were females, with 26.7% in Class I, 10% in Class II, and 3.3% in Class III; the male subjects in this group (60%) were distributed with 33.3% in Class I, 16.7% in Class II, and 10% in Class III. Class II malocclusion is not a causal factor of TMD but may be considered a predisposing factor.

The Emerging Role of microRNA in Periodontitis: Pathophysiology, Clinical Potential and Future Molecular Perspectives.

During the last few decades, it has been established that messenger ribonucleic acid (mRNA) transcription does not inevitably lead to protein translation, but there are numerous processes involved in post-transcriptional regulation, which is a continuously developing field of research. MicroRNAs (miRNAs) are a group of small non-coding RNAs, which negatively regulate protein expression and are implicated in several physiological and pathological mechanisms. Aberrant expression of miRNAs triggers dysregulation of multiple cellular processes involved in innate and adaptive immune responses. For many years, it was thought that miRNAs acted only within the cell in which they were synthesised, but, recently, they have been found outside cells bound to lipids and proteins, or enclosed in extracellular vesicles, namely exosomes. They can circulate throughout the body, transferring information between cells and altering gene expression in the recipient cells, as they can fuse with and be internalised by the recipient cells. Numerous studies on miRNAs have been conducted in order to identify possible biomarkers that can be used in the diagnosis of periodontal disease. However, as therapeutic agents, single miRNAs can target several genes and influence multiple regulatory networks. The aim of this review was to examine the molecular role of miRNAs and exosomes in the pathophysiology of periodontal disease and to evaluate possible clinical and future implications for a personalised therapeutical approach.

Prevalence of Early Childhood Caries in Southern Italy: An Epidemiological Study.

The purpose of this study was to assess the prevalence of Early Childhood Caries (ECC) and oral habits among preschool children from a southern Italian cohort. The survey population consisted of 300 subjects randomly selected among children attending two kindergartens in Catania, Italy. The prevalence of ECC and oral habits were clinically evaluated. During the clinical evaluation, the oral hygiene of children was also assessed. Parents were also interviewed using a brief and simple online questionnaire aimed at investigating eating and oral hygiene habits. The selected sample age ranged between 3 and 5 years. The prevalence of ECC was 9.34%, and the most affected teeth were primary molars. Moreover, the prevalence of oral habits was 44.66%. Only two-thirds of the sample brush their teeth at least once per day. The prevalence of ECC among Sicilian children (9.33%) seems suitable with the rest of the country. The results of the present study evidenced that oral habits showed a high prevalence among preschool children. The level of oral hygiene among preschool children is still not sufficient.

Impact of Matrix Metalloproteinase-9 during Periodontitis and Cardiovascular Diseases.

Matrix metalloproteinase-9 (MMP-9) has been shown to play a key role in endothelial function and perhaps pivotal in the correlation between periodontal disease and cardiovascular disease (CVD). For the study, the impact of MMP-9 of periodontitis and CVD on serum and saliva concentrations was analyzed. For the study patients with periodontitis (n = 31), CVD (n = 31), periodontitis + CVD (n = 31), and healthy patients (n = 31) were enrolled. Clinical and demographic characteristics as well as serum and salivary MMP-9 were evaluated. MMP-9 concentrations in serum and saliva were statistically elevated in patients with CVD (p < 0.01) and in patients with periodontitis plus CVD (p < 0.001) compared to patients with periodontitis and healthy subjects. Multivariate regression analysis showed that c-reactive protein (hs-CRP) was the only significant predictor for MMP-9 serum (p < 0.001), whereas hs-CRP (p < 0.001) and total cholesterol (p = 0.029) were the statistically significant salivary MMP-9 predictors. This study evidenced that patients with CVD and periodontitis + CVD presented elevated MMP-9 concentrations in serum and saliva compared to patients with periodontitis and healthy subjects. Furthermore, hs-CRP was a negative predictor of serum and salivary MMP-9.

New Materials for Orthodontic Interceptive Treatment in Primary to Late Mixed Dentition. A Retrospective Study Using Elastodontic Devices.

The aim of this study was to assess the skeletal and dentoalveolar changes obtained after 1 year of treatment with elastodontic appliances (EA) in a retrospective cohort of children reporting early signs of malocclusion. Also, a detailed description of the tested EAs was reported. The study sample included 20 subjects, 8 males and 12 females, with a mean age of 8.4 ± 0.6 years, and a control group consisting of 20 subjects, 9 males and 11 females, with a mean age of 8.1 ± 0.8 years. All subjects in the treated group received the AMCOP second class (SC) (Ortho Protec, Bari, Italy) device. Digital impressions were taken along with a digital bite registration in centric relation before treatment (T0) and after 1 year (T1). Lateral cephalograms were also taken at T0 and T1 and cephalometric analysis was performed to assess the skeletal sagittal changes of the maxilla and the mandible (sella, nasion, A point angle, SNA^; sella, nasion, B point angle, SNB^; and A point-nasion-B point angle, ANB^) as well as the changes of the inter-incisors angle (IIA^). In the treated group, the distribution of subjects according to the presence of crowding and the pattern of malocclusion changed at T1. In the same group, there was an increase of subjects showing no signs of crowding and a class I occlusal relationship, while in the control group, there was a small increase of subjects developing dental crowding and featuring a worse sagittal relationship (class II) compared to pre-treatment condition. A statistically significant reduction of the overjet and overbite was recorded in the treated group between T0 and T1 (p < 0.05); in the control group, a slight increase in the overjet and overbite was detected at T1, being this increment significanct only for the latter parameter. In the tested group, no significant differences were found between SNA^ values detected at T0 and T1 (p > 0.05), instead the SNB^, ANB^, and IIA^ showed a significant increase after 1 year of treatment (p < 0.05). From a clinical perspective, all clinical goals were reached since patients showed remarkable improvements in overjet, overbite, crowding, and the sagittal molar relationship. Within the limitations of the present study, EAs could be effectively used for the interceptive orthodontic in growing patients.

Association of Systemic Sclerosis and Periodontitis with Vitamin D Levels.

The aim of the present study was to analyze the association among systemic sclerosis (SSc), periodontitis (PT); we also evaluated the impact of PT and SSc on vitamin D levels. Moreover, we tested the association with potential confounders. A total of 38 patients with SSc, 40 subjects with PT, 41 subjects with both PT and SSc, and 41 healthy controls were included in the study. The median vitamin D levels in PT subject were 19.1 (17.6-26.8) ng/mL, while SSc + PT group had vitamin d levels of 15.9 (14.7-16.9) ng/mL, significantly lower with respect to SSc patients (21.1 (15.4-22.9) ng/mL) and to healthy subjects (30.5 (28.8-32.3) ng/mL) (p < 0.001). In all subjects, vitamin D was negatively associated with c-reactive protein (CRP) (p < 0.001) and with probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and plaque score (PI) (p < 0.001 for all parameters) and positively related to the number of teeth (p < 0.001). Moreover, univariate regression analysis demonstrated an association among high low-density lipoproteins (LDL) cholesterol (p = 0.021), CRP (p = 0.014), and PT (p < 0.001) and reduced levels of vitamin D. The multivariate regression analysis showed that PT (p = 0.011) and CRP (p = 0.031) were both predictors of vitamin D levels. Subjects with PT and SSc plus PT had significant lower vitamin D values with respect to SSc and to healthy subjects. In addition, PT seems negatively associated with levels of vitamin D in all analyzed patients.

Comparison between Additive and Subtractive CAD-CAM Technique to Produce Orthognathic Surgical Splints: A Personalized Approach.

The present study aimed to evaluate the accuracy of digitally designed surgical splints generated with milling technology (material subtractive procedure) and with 3D printing technology (material additive procedure) through a customized approach in the planning of surgical orthognathic splints. Cone beam computed tomography (CBCT) examinations and scanned dental models of 10 subjects who had required surgical treatment of skeletal malocclusion were included. Simulation of the orthognathic surgery was performed according to dento-skeletal and aesthetic characteristics of the subjects and the visual treatment objective (VTO), using Dolphin3D software (Dolphin Imaging, version 11.0, Chatsworth, CA, USA). Afterward, the Appliance Designer software (3Shape A/S, Copenhagen, Denmark) was used to digitally design the surgical splints that were generated twice using laser stereolithography technology (DWS 0.29D, DWS, Vicenza, Italy) and milling technology (Sirona inLab MC X5). Finally, each physical splint was digitalized using a desktop scanner (D500 3D, 3Shape A/S, Copenhagen, Denmark) in order to perform deviation analysis using the original project as a reference. The relative percentage of matching (trueness) was calculated (Geomagic Control X software (3D Systems, version 2018.1.1, 3D Systems, Rock Hill, SC, USA). An Independent Student's t-test was used to statistically analyze the data. The milled splints showed a lower value of root to mean square (RMS) relative to the original project (0.20 mm ± 0.018) compared to the prototyped splints (0.31 ± 0.021) (p < 0.001). According to the present findings, surgical splints generated with milling technology present higher trueness compared with 3D printing technology.

Association among serum and salivary A. actinomycetemcomitans specific immunoglobulin antibodies and periodontitis.

BACKGROUND: The aim of this study was to assess the association between serum and salivary Immunoglobulin (Ig) Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) specific antibodies in healthy controls (HC) and periodontitis (PT) patients. Furthermore, the objectives were to determine whether PT influenced serum A. actinomycetemcomitans specific antibodies and whether serum or salivary antibodies against A. actinomycetemcomitans IgG were mediated by serum high-sensitivity c-reactive protein (hs-CRP). METHODS: Fifty-three patients with periodontitis and 48 HC were enrolled in the present study. Patients were regularly examined and characterized by clinical, salivary and blood samples analyses. A. actinomycetemcomitans IgA and IgG antibodies and hs-CRP were evaluated using a commercially available kit. The Spearman Correlation Test and Jonckheere-Terpstra Test were applied in order to assess the interdependence between serum A. actinomycetemcomitans IgG antibodies and clinical periodontal parameters. To evaluate the dependence of the serum and salivary A. actinomycetemcomitans IgG levels from possible confounders, univariate and multivariable linear regression analyses were performed. RESULTS: Compared to HC, patients with PT had significantly higher IgA [serum: PT, 1.89 (1.2-2.2) EU vs HC, 1.37 (0.9-1.8) EU (p = 0.022); saliva: PT, 1.67 (1.4-2.1) EU vs HC, 1.42 (0.9-1.6) EU (p = 0.019)] and A. actinomycetemcomitans IgG levels [serum: PT, 2.96 (2.1-3.7) EU vs HC, 2.18 (1.8-2.1) EU (p < 0.001); saliva, PT, 2.19 (1.8-2.5) EU vs HC, 1.84 (1.4-2) EU (p = 0.028)]. In PT patients, serum A. actinomycetemcomitans IgG were associated with a proportional extent of PT and tooth loss (P-trend value< 0.001). The univariate regression analysis demonstrated that PT (p = 0.013) and high hs-CRP (p < 0.001) had a significant negative effect on serum and salivary A. actinomycetemcomitans IgG levels. The multivariate regression analysis showed that PT (p = 0.033), hs-CRP (p = 0.014) and BMI (p = 0.017) were significant negative predictors of serum A. actinomycetemcomitans IgG while hs-CRP (p < 0.001) and BMI (P = 0.025) were significant negative predictors of salivary A. actinomycetemcomitans IgG. CONCLUSIONS: PT patients presented a significantly higher serum and salivary A. actinomycetemcomitans IgA and IgG compared to HC. There was a significant increase in serum A. actinomycetemcomitans IgG when patients presented a progressive extent of PT. Moreover, PT and hs-CRP were significant negative predictors of increased salivary and serum A. actinomycetemcomitans IgG levels. TRIAL REGISTRATION: The study was retrospectively registered at clinicaltrials.gov ( NCT04417322 ).

Craniomandibular Disorders in Pregnant Women: An Epidemiological Survey.

Temporomandibular joint (TMJ) disorder has been reported to be 1.5 to two times more common in women than men. Such a gender-based difference could be attributed to behavioral, hormonal, anatomical, and psychological characteristics. Physiological hormonal differences between genders could be one of the possible explanations for the higher incidence of temporomandibular disorder (TMD) in women. As the plasma level of certain female hormones increases during gestation, it could be assumed that there is a higher prevalence of dysfunctional signs and symptoms in pregnant women. We performed an epidemiological survey based on screening for TMD in a group of 108 pregnant women and found that 72% of young women reported significant signs of TMJ disorders, 9% of the young women reported mild signs of TMJ disorders, and 19% of the included subjects reported no signs or symptoms of TMD. The presence of estrogen receptors in the temporomandibular joint of female baboons could be the basis of an explanation for the increased prevalence of dysfunction in young women reported in the literature and the high feedback we have seen of joint noises in pregnant women. On the basis of the present findings, it could be assumed that gestation period could represent a risk factor for craniomandibular dysfunctions.

Three-dimensional computerized tomographic orbital volume and aperture width evaluation: a study in patients treated with rapid maxillary expansion.

OBJECTIVE: The purpose of this study was to assess the influence of rapid maxillary expansion (RME) on orbital volume and aperture width measurements by using freeware software with DICOM data from low-dose-protocol multidetector computerized tomography (MDCT). STUDY DESIGN: The subjects consisted of 30 patients (12 male, 18 females) treated with a Hyrax Palatal Expander, activated 3 times per day (0.25 mm per turn of the screw) for an average of 18 days. Low-dose MDCT was performed immediately before (T1) and after (T2) treatment. DICOM data was exported into the open-source OsiriX Medical Imaging software (www.osirix-viewer.com), the data reoriented to a standard projection, and then orbital volumetric and maximum aperture measurements performed. RESULTS: Orbital mean volumes increased significantly from 18.81 ± 1.23 cm(3) (T1) to 19.53 ± 1.26 cm(3) (T2). Orbital aperture width also increased significantly from 36.02 ± 1.24 mm (T1) to 37.11 ± 1.01 mm (T1). CONCLUSIONS: RME produces small but significant increases in orbital dimensions. However, RME does not produce drastic changes of the normal architecture of the orbital bones and is unlikely to alter the normal anatomy of the face.

Tumor necrosis factor-related apoptosis-inducing ligand expression correlates to temporomandibular joint disk degeneration.

This study investigated if tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) immunohistochemical expression in human temporomandibular joint (TMJ)-degenerated disks correlates to the degree of tissue damage to elucidate the possible involvement of this apoptotic pathway in TMJ disk degeneration. Twenty-one TMJ displaced disk from 12 patients were affected by anterior disk displacement with reduction and 9 by anterior disk displacement without reduction processed immunohistochemically with TRAIL antibody. Histopathologic grading of the disk degeneration was carried out in each specimen. The mean histopathologic score of the TMJ degenerated disks was 4.77±1.26 (minimum, 2; maximum, 7). Immunolabeling for TRAIL was detected in the cytoplasm of the TMJ disk cells in every sample, although with different patterns of reactivity. The degree of TRAIL immunostaining was correlated to the histopathologic degeneration score obtained from the sample (Spearman ρ=0.617). Therefore, cell loss due to the involvement of TRAIL apoptotic pathway seems, in part, responsible for TMJ disk degeneration.

Atlanto-occipital ligament calcification: a novel sign in nevoid basal cell carcinoma syndrome.

BACKGROUND: The nevoid basal cell carcinoma syndrome (NBCCS), first described by Gorlin and Goltz in 1960, is a hereditary autosomal dominant disease with high penetrance and variable expressivity. Almost 70% of patients with NBCCS have some degree of craniofacial anomaly. Among these, the presence of ectopic calcification have been reported but Atlanto-occipital ligament calcification has never been described. Therefore this investigation was carried out to determine the prevalence of atlanto-occipital ligament calcification on lateral x-ray of NBCCS patients aiming to assess the effectiveness of this sign in NBCCS diagnosis. PATIENTS AND METHODS: Lateral and frontal cephalometric radiographs of 18 patients (11 males and 7 females), aged 8-61 years, with the diagnosis of NBCCS were evaluated for the presence of intracranial calcifications (diaphragma sellae and falx cerebri) and or calcification of the atlanto-occipital ligament. RESULTS: A total of 11 patients presented calcification of atlanto-occipital ligament to various degrees and in three cases this represented the only sign of ectopic calcification. When compared to the other two sites of ossification, atlanto-occipital ligament calcification had a similar prevalence. CONCLUSION: The calcification of the atlanto-occipital ligament should be considered in addition to the other major criteria for NBCCS diagnosis.