Description of late onset neutropenia in indolent lymphoma patients treated with bendamustine plus rituximab.

Bendamustine (B) associated with rituximab (R) is widely described in literature for the management of patients with chronic lymphoid leukaemia (CLL) and indolent non-Hodgkin lymphoma. Safety data regarding late hematotoxicity such as late onset neutropenia (LON) are scarce. The aim of our study was to assess the incidence and to identify risk factors for LON in patients with indolent non-Hodgkin lymphoma and CLL treated with B and R (B-R). One hundred forty five patients were treated with B-R as first or second line. Patients with neutropenia prior induction treatment, treated beyond second line and relapsing within 3 months after the end of induction treatment, were excluded. Patients receiving at least 1 cycle of B-R and having LON during follow-up period were included and considered as eligible for toxicity assessment. A complete blood count was performed 4 weeks after the last cycle of induction treatment and thereafter every 3 months for 1 year. Thirty six patients were identified in our cohort (incidence of 25%), mostly affected by CLL (n = 11) and follicular lymphoma (FL) (n = 15). During follow-up, 84 events of LON were recorded, 61% and 39% were of grades 1/2 and 3/4, respectively. No episode of febrile neutropenia was documented. Amongst 13 of the 15 patients with FL undergoing R maintenance, 8 had treatment discontinuation because of LON. Median time for LON (grade > 2) and time to recovery (grade < 3) were of 11.2 and 17.3 weeks, respectively. One year after B-R induction, LON persisted in 4 patients. The risk of LON was increased both in patients with FL or CLL and performance status >1. The LON in B-R treated patients is clinically relevant. Close clinical and biological follow-up and treatment prophylaxis (eg, valaciclovir and cotrimoxazole) especially for FL patients undergoing maintenance with R monotherapy seems relevant.

Dental injuries in young athletes, a five-year follow-up study.

AIM: The aim of this study is to produce a clinical therapy protocol for a group of 20 athletes between the ages of 8 and 14, who all suffered traumas affecting hard dental and periodontal tissues. MATERIALS AND METHODS: This study involves a group of 20 athletes (10 male and 10 female) who had suffered dental traumas of varying severity. In order to collect the data, two classification systems were used: one for hard tissue traumas and another for periodontal lesions. The athletes were subdivided into lesion groups, treated depending on the type of lesions and then followed-up over a period of 5 years. A statistical analysis was carried out to study the association between type of lesions, types of sports and the number of teeth involved. RESULTS: We found that recovery time ranged from 3 to 5 days for uncomplicated fractures and up to 14 days for luxations. Only four complications were registered during the follow-up period and these were most likely due to the severity of the trauma. Out of the 20 athletes, 16 had begun and maintained the habit of using mouth protection devices when practicing their sport. The statistical analysis focused on the possible association between the risk levels of a sport and the typical lesions and complications that usually occur. Due to their high frequency, the two types of lesions taken into account in our study were complicated fractures (FP) and luxated/fractured teeth (LF). The average number of teeth involved varied according to the sport's risk level (medium or high) with averages of 1.6 teeth involved for medium-risk sports and 2.0 teeth for high-risk sports. CONCLUSIONS: What emerged in particular was the regular progress in the recovery time needed for the injuries sustained, with few complications or delays in rehabilitation; we also noted that the numerous athletes who habitually used mouthguards while competing during the recovery period did not suffer any recurrences of injuries or further complications. Regarding the results of our statistical analysis, no association was found between the sport's risk, the types of lesions and the occurrence of complications. In addition, analysis of the average number of teeth involved showed that there is no statistical evidence to reject the hypothesis that the ratios remain the same in the two groups.

Uncovering and autonomous eruption of palatally impacted canines.

BACKGROUND: The palatal impaction of maxillary canine is a quite common yet challenging clinical condition that orthodontists have to face in the everyday practice. The purpose of this report is to describe and discuss a case involving the uncovering of an upper canine and it subsequent spontaneous eruption. CASE REPORT: The diagnostic and therapeutic protocol of a case with a palatally impacted canine is presented. The upper right canine was uncovered with an open surgical approach. Removal of the attached gingiva and bone covering the crown enhanced the tooth spontaneous eruption, while the first levelling and aligning phase of the treatment was performed. This approach results in a shorter overall treatment time. This protocol produced an aesthetic, healthy and functional result, which was stable at the two-year post-treatment follow-up.

Single tooth anaesthesia: a new approach to the paediatric patient. A clinical experimental study.

AIM: The objective of this study is to assess the efficacy of the STA Wand System with respect to pain and fear reduction in paediatric patients and by using the Single Tooth Anaesthesia (STA) technique. MATERIALS AND METHODS: Patients included children and teenagers between 6 and 17 years of age, who required the administration of local anaesthesia prior to expected treatments. Local anaesthesia was performed by means of the electronic STA Wand System (Milestone scientific., Inc.) adopting the Single Tooth Anaesthesia (STA) technique. Pre- and post-anaesthesia, the patients were asked to complete the Wong-Baker faces image scale and the provider filled in the Frankl Scale. RESULTS: All treatments were completed successfully and no collaboration issues were recorded. Frankl's assessment showed that 91% of patients regarded dental experience positively. The efficacy of the computer-assisted anaesthesia was at 100% when treating primary teeth, and 70% for procedures on permanent teeth. Almost the totality of treated patients (94%) gave a positive evaluation after having tried the device with STA technique. Only 6% of the patients assessed the procedure negatively. CONCLUSIONS: The STA technique allows for absence of anticipatory anxiety, absence of physical pain, no anaesthetic effects in the perioral tissues and a controllable, lower dosage of the anaesthetic liquid.

Aneurismal bone cyst: a conservative surgical technique. A case report treated with a small access osteotomy.

BACKGROUND: Aneurismal bone cysts (ABCs) are benign, non-neoplastic, expansive, and locally destructive lesions that may occur rarely. They are well defined and usually occur in the long bones, pelvis and vertebrae. According to the 2005 World Health Organization (WHO) histological classification of odontogenic tumours, ABC is classified as a bone-related lesion as ossyfing fibroma, fibrous dysplasia, osseous dysplasia, central giant cell lesion (granuloma-CGCL), cherubism and simple bone cyst (SBC). ABCs, as CGCLs and SBCs may arise as a consequence of an earlier trauma causing an overflow of blood into the bone, though a number of pathogenic theories have been put forward. The aim of this study is to present an unusual case of aneurismal bone cyst and to compare the different possibilities of surgical treatment after review of the literature. CASE REPORT: ABC was localised in the posterior right region of the mandible in an 11-year-old boy, and removed by a surgical procedure involving a small access osteotomy of the mandibular ramus with removal of the cortical bone in order to enucleate the whole lesion, the wisdom tooth and to preserve the healthy bone.

Post-traumatic rehabilitation of anterior teeth with laminates composite veneers in children. Report of two cases.

BACKGROUND: When treating children, a conservative and minimally invasive approach is mandatory. In dental traumas with partial coronal destruction, veneers represent the fastest and most effective method to rehabilitate front teeth of a young patient, since these no- or minimal-preparation restorations were proved to have predictable results without reducing the enamel layer. Indirect additive anterior composite restorations, besides being quick and minimally invasive, have to be considered a good treatment option for rehabilitating children, because they are inexpensive and repairable over time. Current laboratory techniques, associated with a strict clinical protocol, satisfy patients' restorative and aesthetic needs in few appointments and in a short time. CASE REPORT: The cases reported describe the minimally invasive treatment of two lateral incisors with nano-hybrid resin composite veneers after traumatic events. The patient satisfaction and good integration of indirect restorations confirmed the success of this rehabilitation.

Is a new sonic toothbrush more effective in plaque removal than a manual toothbrush?

AIM: Powered or manual toothbrushes are daily-used instrument in the Western area for the control and removal of bacterial biofilm. Among powered-toothbrushes, sonic technology has shown to produce fluid turbulent activity that might assist in plaque removal; however, limited knowledge is available in-vivo. The objectives of this study were to compare the plaque removal efficacy of two different toothbrushes in a population not familiar with sonic technology, and to collect and analyse data regarding oral hygiene habits. The null-hypothesis was that a sonic toothbrush is able to remove a superior amount of plaque compared to the manual type. MATERIALS AND METHODS: Forty young adult patients were enrolled in the study. A single-cohort crossover clinical trial was designed. For each patient, three appointments were scheduled: the first (T0) was used for oral care education and explanations of toothbrushes techniques, for a preliminary professional hygiene session, and for delivery of a questionnaire; at one week (T1), plaque evaluation was performed (Turesky modification of the Quigley and Hein index) at baseline and after asking patients to brush with the randomly selected manual or sonic device. At the last appointment (week 3, T2), the same plaque evaluations of T1 were repeated asking patients to brush with the other toothbrush. Entire mouth indexes were calculated and mean reductions in whole mouth plaque scores were obtained (pre-brushing minus post-brushing values) for the two tested toothbrushes. Multiple ANOVA tests (p = 0.05 ) were used 1) to compare plaque levels between male and female subjects at baseline and post-brushing, regardless the type of toothbrush, and 2) to differentiate between mean reductions in whole mouth plaque scores according to the type of toothbrush (manual versus sonic). The study population was subjected to descriptive statistical analysis; potential relationships between socio-demographic variables and obtained plaque scores were evaluated (Mann-Whitney and Kruskal-Wallis tests). RESULTS: Full-mouth plaque levels were reduced at post-brushing sessions, regardless the device, by approximately 62% (p<0.0001). Mean plaque index reductions for manual and sonic toothbrush were of 1.05 ± 0.22 and 1.19 ± 0.37, respectively. A statistically significant difference was found between the two devices (p = 0.0342). The powered sonic toothbrush removed about 10% more plaque than the manual type. From the collected questionnaire financial data, willingness to pay (WTP) values expressing economic efforts of patients for the purchase of toothbrushes were of Euros 4.83 ± 3.86 and of Euros 54.75 ± 36, for the manual and sonic devices, respectively. CONCLUSION: Within the limitations of the study, in subjects without any previous experience of a similar technology, the single use of the sonic toothbrush showed a significantly greater plaque reduction compared to the manual traditional toothbrush (null-hypothesis accepted).

Treatment of traumatic dental injuries: evaluation of knowledge among Italian dentists.

AIM: The aim of this study was to evaluate the degree of knowledge in the management of different scenarios of dental trauma in a population of Italian dentists. MATERIALS AND METHODS: A closed-ended questionnaire consisting of 5 clinical cases of common traumatic dental injuries was asked to be filled out by dentists in the area of Milan, Italy. A total of 500 questionnaires were collected; after a descriptive analysis of the population, results of correct answers were expressed in frequency distribution and computed in percentages. To examine possible associations between the level of knowledge for each question (number/percentage of correct answers) and independent variables of the population (sex, number of years after graduation, attendance of dental trauma courses, type of clinical activity) appropriate correlation tests were performed (Pearson chi-square, or Fisher's exact; level of significance = 0.05) for identification of statistically significant differences. RESULTS: More than 75% of participants answered correctly to the questions regarding crown fracture and extrusive luxation injuries; only 40% of dentists responded correctly about the duration and type of splinting following avulsion; 60% of participants incorrectly chose immediate invasive therapies (tooth extraction or endodontic procedures) for horizontal middle-root fracture. There was a trend towards slightly better knowledge (in 7 out of 9 questions) for dentists 1) working in hospitals and 2) who had attended a post-graduate course in traumatology. CONCLUSION: The level of knowledge in the group of dentists considered was heterogeneous; problems in the management of traumatic dental injuries were restricted to specific clinical cases and topics.

Large buccal bifurcation cyst in a child: a case report and literature review.

BACKGROUND: WHO defines the mandibular buccal bifurcation cyst as a cyst occurring near the cervical margin of the lateral aspect of a root as a consequence of inflammatory process in a periodontal pocket. The pathogenesis of these cysts is still debated, but they are most likely originated from reduced enamel epithelium or from inflammatory proliferation of epithelial cell rests of Malassez that come from the superficial mucosa of a tooth in eruption. The aim of this article was to describe a case of large buccal bifurcation cyst of a permanent mandibular first molar. CASE REPORT: A 6-year-old boy was referred to Department of Oral Riabilitation of the Istituto Stomatologico Italiano, University of Milan, Italy, with the complaint of hard swelling over the buccal gingiva and a deep probing depth located on the buccal aspect. Radiograph revealed a well-defined semilunar-shaped radiolucency, marked by a fine radiopaque line on the buccal aspect of the partially-erupted lower right first molar and it was large enough to include a small part of the crown of the second right molar. As reported in the literature the treatment of choice is enucleation and curettage of the lesion without extraction of the vital involved tooth. This procedure has shown excellent results in both the short- and long-term. The definitive diagnosis of paradental cysts can be assessed by histopathologic analysis.

Second order root control of self-ligating brackets and traditional brackets: a "typodont" study.

AIM: Aim of the study was to evaluate if self-ligating brackets (SLB) and conventional brackets (CB) have the same degree of second order root control in closing extraction spaces. METHODS: Two resin models, left and right sides of an upper arch, with two wells in the premolar area, were used. Wells have been filled with wax and resin premolars with anatomic root structure were placed in them. Resin premolars were bonded with CB and SLB. We performed 20 pairwise runs: CB on one side against SLB on the other side. We tested 0.018 and 0.016x0.022 stainless steel arches. Models were put in warm water to allow teeth to move in the softened wax by the force excerpted by NiTi coils. Root control in the second order was evaluated with the aid of metallic markers on the roots and digital radiographies taken before and after each run. RESULTS: On 0.018 wires CB moved 4.0 mm (SD 1.06 mm), mean root control angle was 14.8° (SD 9.15°), while SLB moved 4.1 mm (SD 1.33 mm), mean angle in the second order was 11.8° (SD 5.01°). On 0.016x0.022 wires CB moved 3.6 mm (SD 1.24 mm), mean angle in the second order was 9.7° (SD 5.48°) while SLB moved 3.4 mm (SD 1.05 mm), mean angle was 10.7° (SD 3.92°). CONCLUSION: It seems that, on typodont, CB and SLB are equally efficient in moving teeth crowns and have the same degree of second order root control, both when 0.018 and 0.016x0.022 stainless steel wires are used.

Involving citizen scientists in monitoring arthropod vectors of human and zoonotic diseases: The case of Mosquito Alert in Italy.

Citizen science has been particularly effective in gathering reliable, timely, large-scale data on the presence and distributions of animal species, including mosquito vectors of human and zoonotic pathogens. This involves the participation of citizen scientists in research projects, with success strongly dependent on the capacity to disseminate project information and engage citizen scientists to contribute their time. Mosquito Alert is a citizen science that aids in the system surveillances of vector mosquitoes. It involves citizen scientists providing expert-validated photos of targeted mosquitoes, along with records of bites and breeding sites. Since 2020 the system has been disseminated throughout Europe. This article uses models to analyze the effect of promotion activities carried out by the Mosquito Alert ITALIA team from October 2020 to December 2022 on the number of citizen scientists recruited and engaged in the project, and their performance in mosquito identification. Results show a high level of citizen scientist recruitment (N > 18.000; 37 % of overall European participants). This was achieved mostly through articles generated by ad hoc press releases detailing the app's goals and functioning. Press releases were more effective when carried out at the beginning and end of the mosquito season and when mosquito's public health significance was emphasized. Despite the high number of records received (N > 20.000), only 30 % of registered participants sent records, and the probability of a participant sending a record dropped off quickly over time after first registering. Among participants who contributed, ∼50 % sent 1 record, ∼30 % ≥3 and 4 % >10 records. Participants showed good capacity to identify mosquitoes and improve identification skills with app usage. The results will be valuable for anyone interested in evaluating citizen science, as participation and engagement are seldom quantitatively assessed. Our results are also useful for designing dissemination and education strategies in citizen science projects associated with arthropod vector monitoring.

Behavior of endosseous one-piece yttrium stabilized zirconia dental implants placed in posterior areas.

AIM: Considering that zirconia dental implants are indicated for the rehabilitation of highly esthetic areas, the aim of this work was to investigate the functional behavior of these implants positioned in the posterior regions of the jaws. METHODS: The study included 6 patients with 14 zirconia implants positioned in posterior (molar) areas of the jaws. Immediately after surgery, all implants were restored with temporary crowns or bridges. Clinical radiographic evaluation was performed 6 months after surgery and subsequently every year. At these follow-up visits, periodontal indexes were recorded and peri-apical radiographs were taken in order to calculate marginal bone loss. RESULTS: The success and survival rates were 100%. The modified bleeding index (mBI) and modified plaque index (mPLI) were respectively equal to 0.57±0.51 and 0.29 ± 0.47 at 4-year follow-up. The overall mean probing depth of the implants was 3.13±0.87 mm. The mean marginal bone loss was +0.665 mm 4 years after surgery. CONCLUSION: Considering the limits of our study, as regards to the data concerning peri-implant tissue health, marginal bone loss and survival and success rates of zirconium implants placed in posterior areas, we can conclude that the data reported are very encouraging although the number of implants observed is still limited.

Treatment of seriously compromised teeth: decision- making criteria and treatment options.

The aim of this article was to describe the case of a patient who presented to our attention with severe periodontal disease, complicated by furcation involvement on elements 16 and 17. In addition, the radiographic exam revealed the presence of a deep intrabony defect distal to tooth 15. Surgical therapy is performed after the resolution of the endodontic component of the intra-bony defect on the element 15 and consists on osteoplasty and ostectomy on 16, guided tissue regeneration (GTR) on 15, extraction of 17 and bi-laminar connective tissue graft for the coverage of the recession on tooth 13. The patient is visited monthly and 9 months after surgery, the definitive metal-ceramic crown is delivered and adapted to tooth 16. At 18 months, the patient's periodontal situation is re-evaluated and the pocket depth results healthy (probing depth of tooth 15=2 mm). The surgical practices reported in this work allowed for functional and esthetic rehabilitation of periodontally compromised teeth. The RSR and the GTR represent conservative surgery that allow the preservation of compromised dental elements and if properly performed, guarantee excellent survival rates of the elements in the arch. For these reasons, when it is possible, the RSR and the GTR are a valid alternative to implantology and are to be considered as the first therapeutic option in the treatment plan.

Evaluation of the prevalence of dental agenesis through the use of orthopantomography in a sample of subjects residing in Lombardy and Piedmont regions.

AIM: Dental agenesis is one of the most frequent dental anomalies, with a prevalence varying from 1.6% to 36.5%, depending on the populations studied. The patient's age at diagnosis, sex, and ethnic differences are considered possible influenting factors that can explain such a wide range of prevalence. The objective of the study was to define the frequency of dental agenesis in a sample of subjects living in Piedmont and Lombardy regions of Italy. MATERIALS: X-rays, already taken for other diagnostic purposes, were collected. Orthopantomographies belonging to subjects born after 1995 and aged between 7.9 and 16.9 years were selected. It was assessed the presence of each tooth, except for third molars since they are frequently absent due to their variability. If a tooth was missing and the patient had additional radiographs, the other radiographs were evaluated to confirm the diagnosis or to rule out a delayed calcification or the presence of a malposition tooth. Results: Orthopantomographies were collected from 1,020 subjects and 98 of them presented agenesis, with a prevalence of 5% for females and 4.61% for males. The most affected teeth were 35 and 45, followed by 12 and 22. The lower arch was more frequently involved by agenesis: there were 107 teeth absent in the mandibular arch and 83 in the maxillary arch.

Caries prevalence and molar incisor hypomineralisation (MIH) in children. Is there an association? A systematic review.

AIM: Molar incisor hypomeralisation (MIH) is a dental condition clinically characterised by the presence of morphological and qualitative enamel defects involving the occlusal and/or incisal third of one or more permanent molars or incisors. Its worldwide prevalence ranges between 2.4 and 40%. Several harmful conditions, such as genetic or medical problems during pregnancy, may act together and increase the risk of MIH. The main objective of this systematic review is to assess whether there is a correlation between MIH and dental caries in mixed or permanent dentition. METHODS: An electronic search was performed on PubMed (Medline), Scopus and Cochrane Library for articles published from August 2022 to April 2023. Cohort, cross-sectional, retrospective and prospective studies were included. In vitro and animal studies, as well as clinical cases and systematic reviews, were excluded. Studies not differentiating between mixed and permanent dentition were excluded. The observed variables were DMFT (Decayed Missed Filled Teeth) score, DMFS (Decayed Missed Filled Surface) and DMF scores related to FPM (First Permanent Molar) and the clinical prevalence of MIH. CONCLUSION: DMFT, DMFS and DMFT on FPM scores are significantly different between the group of patients with MIH and the control group. The available evidence supports a correlation between MIH lesions and caries. Caries indexes scores increase proportionally to the severity of MIH.

BAYPAN study: a double-blind phase III randomized trial comparing gemcitabine plus sorafenib and gemcitabine plus placebo in patients with advanced pancreatic cancer.

BACKGROUND: Sorafenib is an oral anticancer agent targeting Ras-dependent signaling and angiogenic pathways. A phase I trial demonstrated that the combination of gemcitabine and sorafenib was well tolerated and had activity in advanced pancreatic cancer (APC) patients. The BAYPAN study was a multicentric, placebo-controlled, double-blind, randomized phase III trial comparing gemcitabine/sorafenib and gemcitabine/placebo in the treatment of APC. PATIENTS AND METHODS: The patient eligibility criteria were locally advanced or metastatic pancreatic adenocarcinoma, no prior therapy for advanced disease and a performance status of zero to two. The primary end point was progression-free survival (PFS). The patients received gemcitabine 1000 mg/m(2) i.v., weekly seven times followed by 1 rest week, then weekly three times every 4 weeks plus sorafenib 200 mg or placebo, two tablets p.o., twice daily continuously. RESULTS: Between December 2006 and September 2009, 104 patients were enrolled on the study (52 pts in each arm) and 102 patients were treated. The median and the 6-month PFS were 5.7 months and 48% for gemcitabine/placebo and 3.8 months and 33% for gemcitabine/sorafenib (P = 0.902, stratified log-rank test), respectively. The median overall survivals were 9.2 and 8 months, respectively (P = 0.231, log-rank test). The overall response rates were similar (19 and 23%, respectively). CONCLUSION: The addition of sorafenib to gemcitabine does not improve PFS in APC patients.

Esthetics in the edentulous: clinical steps for recovering of maxillary anterior teeth harmony.

Smile designing for edentulous patients has not been much investigated; the selection of artificial teeth is a task that follows multiple consequential steps such as choosing their form, size, material, color and disposition. Even if smile designing is thought to involve some artistic abilities, specific techniques or suggestions have been proposed in the literature to perform each step of the selection of artificial teeth, keeping in mind the importance of consultation and understanding of the patient preferences. This article will focus on the recovering of maxillary anterior teeth harmony in an edentulous patient; a clinical case report will show the rationale process of anterior teeth selection, supported by scientific guidelines found in the literature.

Cone Beam Computed Tomography evaluation of midpalatal suture maturation according to age and sex: A systematic review.

AIM: To systematically review and analyse the available evidence and assess if a correlation exists in children and young adults between the chronological age and the degree of midpalatal suture maturation as assessed according to the method proposed by Angelieri et al. [2013]. METHODS: A search was performed in Medline/Pubmed, Scopus, and Web of Science during October 2020 for published studies analysing midpalatal suture maturation through cone beam tomography according to the method proposed by Angelieri et al. [2013]. The review was performed according to the PRISMA protocol and the articles were selected according to the established inclusion and exclusion criteria. To assess the quality of reporting, the STROBE checklist was applied. CONCLUSION: The high variability of the maturational stages in the studied cohorts, highlights the poor correlation between suture maturation and chronological age in both genders, especially in young adults. According to our findings until the age of 14, the high prevalence of stages related to sutural opening does not justify CBCT assessment of the MPS and supports the use of a conventional protocol for maxillary expansion.

In vivo early plaque formation on zirconia and feldspathic ceramic.

AIM: Zirconia is a ceramic material with optimal aesthetic and mechanical properties that make it adapt to esthetic recontructions in narrow spaces. Aim of this split mouth clinical trial is to compare amount and structure of early plaque coated to zirconia and feldspathic ceramic. METHODS: Four patients were included in this study. A removable acrylic device was manufactured for each subject and equipped on the lingual surface in correspondence to molar teeth with eight specimens. Four zirconia samples were positioned on the right side (test) of the device, and 4 feldspathic ceramic samples were positioned on the left side (control). One test and one control samples were harvested from each device at 6, 12, 24 and 36 hours after oral environment exposition. A total of four samples for each group were collected at each timepoint; three of these were used for reverse transcription polymerase chain reaction analysis to evaluate the bacteria plaque amount; the remaining sample was used for scanning electron microscopy analysis to observe the bacteria plaque structure. RESULTS: No significant differences were detected in terms of bacteria amount between test and control group at each timepoint. At scanning electron microscopy evaluation especially at 36 hou, bacteria plaque structure coated to zirconia surface appeared less uniform and compact compared to feldspathic ceramic. CONCLUSION: Zirconia material may be considered adapt to prosthetic reconstructions that require high mechanical and aesthetic properties and that are exposed to the oral environment.

Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature.

PURPOSE: This narrative review intends to summarize the most important and relevant data on diagnosis and treatment of pediatric forearm fractures and to describe the characteristics and advantage of each therapeutic option. METHODS: We conducted a literature research considering peer-reviewed papers (mainly clinical trials or scientific reviews) using the string "forearm fracture AND epidemiology" or "forearm fracture AND diagnosis or " forearm fracture AND treatment" or "forearm fracture AND casting" or "forearm fracture AND surgery". Studies were identified by searching electronic databases (MEDLINE and PubMed) till April 2020 and reference lists of retrieved articles. Only English-language articles were included in the review. RESULTS: Conservative management with cast immobilization is a safe and successful treatment option in pediatric forearm fractures. Surgical indication is recommended when an acceptable reduction cannot be obtained with closed reduction and casting. Surgical treatment options are intramedullary nail, plating and hybrid fixation. CONCLUSIONS: There is not a unique consensus about fracture management and treatment. Further studies are necessary to create univocal guidelines about optimal treatment, considering new techniques and available technologies.