The impact of fibromyalgia syndrome on obstructive sleep apnea syndrome in terms of pain threshold, daytime symptoms, anxiety, depression, disease severity, and sleep quality: a polysomnographic study.

BACKGROUND: Current studies have focused on the association of fibromyalgia syndrome (FMS) and obsctructive sleep apnea syndrome (OSAS). Results of these studies on the effect of this association have been inconsistent. The current study aimed to investigate the effect of FMS on OSAS regarding sleep quality, pressure pain threshold, fatigue, daytime symptoms, anxiety, and depression, and also to determine the relationship between OSAS severity and FMS. METHODS: In a cross-sectional design, patients diagnosed with OSAS were evaluated in two groups comparing those with and those without FMS. Data on demographics, headache, morning fatigue, and chronic pain duration were collected. Questionnaires including the Fatigue Severity Scale (FSS), Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were completed. Pressure pain threshold, tender points, and polysomnographic data were recorded. RESULTS: Of 69 patients, 27 were diagnosed with FMS + OSAS and 42 were diagnosed as OSAS only. Statistically significant differences were found between the two groups in VAS, pain duration, morning fatigue, headache, BAI, tender point count, FIQ and FSS scores, and algometer measurements. All polysomnografic data were compared, and no statistically significant differences were found between the two groups. There were no statistically significant differences in the algometer, BDI, BAI, FIQ, and FSS scores when analyzed according to the severity of OSAS. CONCLUSION: The findings suggest that FMS has no effect on polysomnographic parameters of OSAS. Headache, daytime fatigue, anxiety, depression, pain duration, and pain intensity are higher while the pressure pain threshold is lower when FMS is present. No correlation was found between OSAS severity and FMS, fatigue, pressure pain threshold, depression, and anxiety. CLINICAL TRIAL REGISTRATION NUMBER: NCT05367167/date: April 8, 2022.

Replantation After Dental Avulsion: A Scoping Review and Proposal of a Flow Chart.

AIM: Dental avulsion, the complete displacement of a tooth from its socket, is a severe dental trauma with a prevalence of 0.5% to 16% of all dental injuries. Replantation of avulsed teeth is common, yet recent studies show high failure rates and unpredictable long-term outcomes. This review examines clinical variables influencing intentional dental replantation decisions and proposes a treatment flow chart. A comprehensive literature search was conducted in PubMed-Medline, Scopus, WoS, and Cochrane databases using the keywords "tooth avulsion," "tooth replantation," and "tooth ankylosis." Inclusion criteria encompassed studies from January 2018 to February 2024. From 752 identified articles, 9 systematic reviews including 3 meta-analyses were selected for this scoping review. Immediate replantation is the gold standard for avulsed teeth, yet delayed replantation is more common in practice, impacting survival rates. Adherence to guidelines from the International Association on Dental Traumatology improves outcomes, especially in paediatric patients. Factors such as multiple caries, severe periodontal disease, advanced age, psychological conditions, immunodeficiency, and lack of cooperation are contraindications for replantation. Despite the high failure rate, replantation remains recommended in literature due to its potential advantages over prosthetic implants. This review highlights the complexities in decision-making for dental replantation, emphasising the need for a comprehensive approach considering individual clinical cases. A proposed treatment flow chart aims to support clinicians in predicting prognosis and making informed decisions. The review also underscores the link between dental trauma, poor oral health, and potential neglect in children, highlighting the importance of preventive measures and parental awareness.

Interdisciplinary management of orofacial lesions in early childhood: paediatric alert system at University of Verona.

BACKGROUND: Orofacial trauma (OFT) occurs frequently in children and requires thorough evaluation not only by paediatric dentists but also by all specialists involved in emergency services, particularly in cases involving children under 3 years of age, given their inability to directly participate in clinical-anamnestic evaluations. Addressing early childhood orofacial trauma resulting from maltreatment, this study explores the key role played by various healthcare professionals, including paediatric dentists, general dentists, maxillofacial surgeons, dental hygienists, and paediatricians, in the optimal management of these cases. In the event of trauma due to suspected or confirmed mistreatment, it is essential that all healthcare workers involved have precise knowledge of the appropriate course of action from both a clinical and legal point of view, guaranteeing maximum protection for the young patient. This is particularly significant as cases of mistreatment with apparently minor consequences can degenerate into situations of irreparable severity. The latest guidelines from the International Association of Dental Traumatology (IADT) in 2020 continue to emphasise the potential correlation between OFT and cases of abuse or violence. Recent recommendations in the literature highlight the importance of facilitating mandatory reporting of incidents to relevant authorities and improving information sharing between dental healthcare professionals and child welfare services. A new flow diagram, called Paediatric Orofacial Trauma Alert (P.O.T.A.), has been proposed at the University of Verona. This tool is specifically designed to assist specialists dealing with early childhood orofacial trauma cases by assisting them in identifying potential cases of maltreatment. In this innovative approach, the collaborative efforts of general dentists, paediatric dentists, maxillofacial surgeons, dental hygienists and paediatricians play a vital role in cases of abuse. In addition to restoring the oral health of young patients, these professionals can activate a vast network of contacts, ensuring not only optimal oral health care but also providing comprehensive support to victims. The objective is to safeguard not only the physical but also the psychological well-being of these vulnerable subjects.

Maternal mental health and children oral health: a literature review.

AIM: Recently, serious considerations regarding mental health conditions and their impact on the whole organism have been made. This area is still quite unknown within the dental community, despite the potential impact these conditions can have on both oral care and health. Previous studies have concluded that both pregnant women and mothers have been found to be particularly sensitive to the risk of developing mental disorders such as anxiety and major depression. There is a very high possibility for the children of these mothers to experience neglect and disregard due to of the development of these conditions, which will negatively affect their behavioural and physical growth as a result. This impact stretches into oral health as well, as these children have been reported to be more inclined to develop early childhood caries, bruxism, and after-birth enamel defects, in addition to illnesses like diabetes and disabilities. MATERIALS: A literature search was conducted in Pubmed, Medline, and Scopus for the keywords 'maternal depression', 'oral health' and 'children', combined with 'AND' or 'OR' Boolean Operators. CONCLUSION: The results of the present literature suggest a strong connection between maternal mental disorders and poor children's oral care, and as a result, dental professionals should be extremely careful when treating and communicating with these patients.

Preventive oral hygiene and ventilator-associated pneumonia in paediatric intensive care unit.

AIM: Data indicate a tendency towards an increased incidence through the last decades of various forms of pneumonia. Among these, nosocomial pneumonia in patients who have been on mechanical ventilation support (increased after the Covid-19 pandemic) is a condition that must be addressed as soon as possible to avoid complications. Current literature lacks an in-depth analysis of the potential correlation between ventilator-associated pneumonia and poor oral hygiene, especially in children. The aim of this literature review is to investigate if improving oral hygiene could affect the onset of nosocomial pneumonia in children. METHODS: A search was performed in Pubmed, Medline, and Scopus for the keywords: oral care, children, neonates, ventilator-associated pneumonia, combined with 'AND' or 'OR' Boolean Operators. CONCLUSION: The relevant papers retrieved in the scientific literature emphasised the importante of good oral care bundles to mitigate the bacteria proliferation in the bloodstream, and to prevent the development of ventilator-associated pneumonia.

Functional endoscopic sinus surgery for the treatment of Aspergillus mycetomas of the maxillary sinus.

AIM: The proper treatment for Aspergillus mycetoma (AM) of the maxillary sinus is a complete removal of the sinus fungal masses and improvement of aeration for the involved sinuses. We report our experience in the treatment of AM of the maxillary sinus by functional endoscopic sinus surgery (FESS). METHODS: Thirteen immunocompetent patients with AM underwent FESS under general anesthesia. Mycotic concretions were endonasally removed through the enlarged maxillary natural ostium. Care was taken to avoid any removal of the maxillary sinus mucosa. Only in one case complete removal could not be achieved and therefore we opened the maxillary sinus via the canine fossa and cleared it of fungal masses. Follow-up has ranged from 6 months to 4 years after surgery. Patients were all closely followed postoperatively with serial endoscopic examinations in order to verify the maintenance of opening of the maxillary natural ostium. RESULTS: Histological examination was positive for Aspergillus in all the patients. Postoperative radiographs and endoscopic examinations revealed maintenance of the antrostomy performed during FESS without mucosal degeneration and no evidence of recurrence. All patients were free of symptoms after a mean follow-up of 31 months. None of the patients required a second procedure. CONCLUSION: Surgical treatment of AM with FESS appears a reliable and safe surgical treatment. Sinus physiology is preserved in the event of a future bone reconstruction for prosthetic purposes.

Femoral nerve palsy after mandibular reconstruction with microvascular iliac flap: a complication under anticoagulation therapy.

Pharmacological prophylaxis and intervention are used extensively in head and neck reconstructions with microvascular flaps. There is no universally accepted protocol, but the microvascular surgery literature recommends intraoperative anticoagulation with heparin. Here is reported a case of iliacus haematoma with subsequent femoral nerve palsy after the harvest of a microvascular iliac flap for mandibular reconstruction in a patient who had been treated with heparin. The association between femoral nerve palsy and anticoagulant therapy has been well described. It remains unclear as to why the iliacus muscle is particularly vulnerable to intramuscular haemorrhage. Femoral nerve neuropathy is also an uncommon but recognized complication after abdominopelvic surgery. Iliacus haematoma secondary to microvascular surgery has not been previously reported. This case illustrates the need to be aware of this type of complication and its clinical manifestations for patients under anticoagulant therapy in the perioperative period during microvascular reconstructions.

Ultrasonic bone cutting for surgically assisted rapid maxillary expansion (SARME) under local anaesthesia.

Ultrasonic bone-cutting surgery has been recently introduced as a feasible alternative to the conventional tools of cranio-maxillo-facial surgery, due to its technical characteristics of precision and safety. The device used is unique in that the cutting action occurs when the tool is employed on mineralized tissues, but stops on soft tissues. This technical note illustrates the use of Piezosurgery for all osteotomies of surgically assisted rapid maxillary expansion (SARME). The procedure, including pterygo-maxillary detachment, can be completed under local anaesthesia. Other advantages include minimal risk of jeopardizing critical anatomic structures (e.g. palatine artery), minimal intraoperative bleeding and postoperative swelling, and minimal thermal damage to bone surfaces. Narrow and rectilinear osteotomies can be easily performed with varying vibrating scalpels, at the cost of a longer operative time.

Ultrasound bone cutting for surgically assisted rapid maxillary expansion under local anesthesia. Preliminary results.

Surgically assisted rapid maxillary expansion (SARME) is a well-established therapy for correction of maxillary transverse deficiency in adults, when consolidation of sutures has just been completed. It can be performed either under general or under local anesthesia and it can be accomplished with many surgical techniques. One of the most critical steps of SARME is the detachment of the pterygo-maxillary junction, due to the risks connected to such procedure. When required to obtain specific expansion patterns, the pterygo-maxillary separation has been suggested until now only for interventions under general anesthesia, due to the dangerousness and the rawness of this surgical step in awake patients. The authors introduce the use of an ultrasonic bone-cutting device to perform all osteotomic steps of SARME under local anesthesia on an outpatient basis, including pterygo-maxillary detachment. This ultrasonic device is unique in that the osteotomic action occurs only when the tool is employed on mineralized tissues, while it stops on soft tissues. It works in a linear pattern of vibration and it allows precise osteotomies without producing any heat damage to osteotomic surfaces and without any dangerous hammer-related stroke. Due to its precision and safety, this device named Piezosurgery, allows patients to undergo all the steps of SARME under local anesthesia, also without hospitalization.

Resorbable plates in maxillary fixation. A 5-year experience.

AIM: Metallic plates and screws have become the routine way of stabilizing the facial skeleton; however, there are many disadvantages in the use of metallic devices. Fixation systems made of biocompatible absorbable material, with appropriate load-bearing properties and sufficient degradation rate can overcome these disadvantages. Recently, resorbable materials were tested in maxillary, mandibular and chin osteotomies. Despite a lot of reports on the use of resorbable bone fixation devices in cranio-maxillo-facial application are now available, their use in preprosthetic surgery has yet to be adequately documented. The Authors report their 5-year experience in the employment of resorbable fixation in surgery of the superior maxilla, involving orthognathic and preprosthetic procedures of the upper jaws. The surgical technique is described and usefulness and advantages are discussed. METHODS: Plates and screws were composed of an 82% poly-L-lactic acid/18% polyglycolic acid copolymer (PLLA-PGA); 50 orthognathic and 5 preprosthetic procedures of upper jaws were involved, performing Le Fort I osteotomies in all cases. RESULTS: Our operations were were carried out without complications. Follow-up ranged from 6 months to 5 years. One patient developed a localized buccal space infection which resolved after a course of antibiotics given orally. CONCLUSIONS: Resorbable fixation should be considered adequate for fixation in maxillary surgery.

Bone biological plate for stabilization of maxillary inferior repositioning.

AIM: Inferior repositioning of the maxilla to correct vertical maxillary deficiency has been one of the more unstable orthognathic procedures performed. Different surgical techniques have been proposed to stabilize downward movement of the maxilla. The aim of this study was to evaluate the skeletal stability of maxillary anterior downgrafting using bone biological plates in association to bone plates and bone graft for skeletal stabilization. METHODS: The records of 6 patients were evaluated cephalometrically, analyzing the presurgical, immediate postsurgical and long-term follow-up radiographs. All patients had one-piece Le Fort I osteotomy with anterior downgraft of at least 2 mm at point A. Any horizontal movement of the maxilla concomitant with the downgraft was no more than 5 mm. Rigid fixation with titanium miniplates and screws and with bone biological plate was used to stabilize the maxilla. In the sample of 6 patients, 3 underwent one-jaw (maxilla only) surgery and 3 two-jaw surgery. RESULTS: The mean surgical inferior downgrafting at point A was 5+/-1.4 mm (P<0.001) with a relapse of 0.16+/-1. 63 mm (3.2% of surgical movement). The mean surgical inferior downgrafting at the anterior nasal spine (ANS) was 5.66+/-1.36 mm (P<0.001) with a relapse of 0.41+/-1.56 mm (7.32% of surgical movement). Relapse in the vertical dimension failed to reach any statistical significance for all maxillary landmarks. CONCLUSIONS: Anterior downgrafting of the maxilla with this fixation method seems to be a stable and predictable procedure. The use of bone biological plates seems to substantially improve skeletal stability even if further investigations with a more consistent sample of patients is required.

Lack of correlation between salivary Streptococcus mutans and lactobacilli counts and caries in IDDM children.

In a previous clinical study regarding the incidence of caries and the periodontal health, a group of young patients with various levels of glyco-metabolic control was studied and the results showed that the decayed-missing-filled teeth (DMFT) index was higher in insulin dependent diabetes mellitus (IDDM) type 1 patients with a poor glyco-metabolic balance than in a control group or in IDDM patients with sufficient glyco-metabolic balance. In light of these results, the purpose of this study was to find an explanation for these clinical observations by searching at a microbiological level. The results indicate that salivary counts of Streptococcus mutans and lactobacilli were higher in patients with active caries whether or not they be diabetic, than in people with no active caries, but the count of S. mutans was not directly correlated to the DMFT index. No significant alterations were found in salivary flow, pH, buffer capacity and glucose concentration in all the groups in this study. We conclude that the salivary count of S. mutans is not sufficient alone to account for the higher susceptibility to active caries of young IDDM patients with poor glyco-metabolic control.

[The diagnosis and treatment of traumatic root fractures of the coronal third in the mature permanent anterior teeth]. / Considerazioni sulla diagnosi e trattamento delle fratture radicolari traumatiche del terzo coronale nei denti frontali permanenti maturi.

Diagnostic and treatment implications of traumatic root fractures in the coronal third of permanent anterior teeth are reported. A review of the literature imposes a reevaluation of the treatment of these fractures. The teeth with root fractures should not be extracted and endodontic therapy should not be performed unless there is evidence of a pulp necrosis. The authors suggest trying a conservative treatment by repositioning, fixation and relief of occlusion of the teeth with fractures. The fixation is maintained over six months to improve the possibility of recovery. The clinical cases presented prove the long-term prognosis is good even if the location of fracture is near the gingival crevice. The conservative treatment doesn't preclude in case of failure, endodontic, orthodontic and prosthetic therapy. Moreover, according to the authors, conservative treatment represents the most simple, immediate and physiologic solution of functional aesthetic and psychologic problems, especially in young patients.

Traumatic crown fractures in permanent incisors with immature roots: a follow-up study.

A follow-up study of crown fractured permanent incisors with incomplete root formation was carried out in a group of patients, aged 6-12 years, over a 5-year period in the Dental Clinic of the University of Verona, Italy. The number of injured patients was 55, representing 84 injured incisors. All patients were followed clinically and radiographically using a standardized follow-up protocol. The most common type of trauma was fracture of enamel and dentine without pulpal exposure (80%) and the most common type of treatment was restoration with the acid-etch composite resin technique (46%). Bonding of the crown fragment was performed in 10 instances (12%). At the 5-year-control all teeth with fracture of the enamel had no pulp complications. Four of 67 teeth (6%) with fracture of the enamel and dentine without pulpal involvement showed pulp necrosis and 1 tooth showed pulp obliteration (1.5%). Eight of 14 teeth (57%) with fractures of the enamel and dentine with pulp involvement showed pulp necrosis. Aesthetically 36 of the restored teeth were deemed satisfactory (43%). In 9 teeth the bonded fragment had to be rebonded. 14 teeth were considered unsatisfactorily restored due to wear of the composite (17%). 34 restored teeth had to be retreated because of a new trauma (40%). In one tooth a previous bonded fragment had to be rebonded. These results confirmed that crown fractures without pulp involvement in permanent incisors with incomplete root formation hav a low percentage of pulp complications, while 60% of the teeth with crown fractures with pulp involvement had pulp complications.

Traumatic injuries to permanent incisors.

The prevalence of traumatic injuries to permanent incisors and their distribution according to type and some clinical factors, were analysed in a total population of 2798 patients, aged 6-21 years, examined over a 5-year period in the Dental Clinic of the University of Verona, Italy. The material consisted of case histories and radiograms taken during the examination of injured teeth. The number of injured patients was 178 (131 males and 47 females), the number of injured incisors was 326. The prevalence of injuries was 7.3%. A very large number of dental injuries occurred to children aged between 6 and 13 years. The ratio of boys to girls was 2.7:1. Most frequent causes of injuries were falls and traffic accidents. Most injuries involved two teeth. About 80% of the teeth were maxillary central incisors. The most common type of injury was non complicated crown fracture. In 87 cases (48%) there was an associated injury to soft tissue. Alveolar fractures occurred in 22 cases (12%). Traumas involving periodontal ligament constituted nearly 40% of the total. This study noted the following points: 1) preventive education programs should be instituted in the region, directed at parents and school teachers, to inform them about the problems of dental trauma and to obtain cooperative attitude to treatment and good motivation in controls; 2) the necessity to unify the diagnostic and therapeutic protocol to provide reliable information in clinical investigations, to permit valid comparison with other studies and to improve the long-term prognosis of many cases.

[Clinical evaluation of a posterior photopolymerizing composite: results 4 years after application]. / Valutazione clinica di un composito fotopolimerizzabile per posteriori: risultati a distanza di 4 anni dalla applicazione.

The aim of this study was to examine clinical results of class I and class II composite restorations of forty two posterior teeth, considering pulpal vitality, dentinal sensitivity, marginal integrity, contact areas, color, gingival irritation and secondary decay. The restorations were evaluated over a four-year period. The results are considered satisfactory both from a chemical-physical and biological point of view. The Authors wish to outline the importance to improve the operative technique to minimize the disadvantages of these materials and to obtain better results. The Authors propose to carry out a later control to confirm these results.

[Histologic changes in human periodontal tissue after transplantation of teeth with completely formed roots]. / Quadri istologici dell'evoluzione dei tessuti parodontali nell'umano dopo trapianti di denti a radice completamente formata.

Authors present the histological evolution of the periodontal tissues after complete-root teeth transplantation in human. They point out that there is a great distinction between the histological and clinical results. It is difficult to obtain the neoformation of a normal periodontal ligament. In spite of the histological failure, they obtained a good clinical result: there fore the complete-root tooth transplantation must be considered an acceptable surgical procedure.

[Clinico-therapeutic considerations in a serious case of amelogenesis imperfecta]. / Considerazioni clinico-terapeutiche in un grave caso di amelogenesi imperfetta.

The Authors present a case of a young female patient affected with a serious hypoplasic form of Amelogenesis Imperfecta, involving all the teeth which has been completely restabilished using composite resin. The therapy used has been developed thanks to the chemical-physical qualities of last generation of composites, which allow the compete reconstruction of teeth. Such a therapy has not to be considered definitive, however it has been used as a temporary solution, waiting for final prosthetic rehabilitation. The Authors estimate that such a temporary long term treatment, that utilize composite resins, represent the ideal therapeutical choice thanks to its characteristics of endurance, cost and benefice. In our opinion this therapy prevents tooth deterioration, secures a better mastication, a partial reduction of the teeth sensibility, facilitates teeth cleaning and solves the esthetical problems with great psychological advantage.