Intravescical prostatic protrusion is a predictor of alpha blockers response: results from an observational study.

BACKGROUND: To investigate the efficacy of tamsulosin in patients with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE) with intravesical prostatic protrusion (IPP). Ultrasound measurement of the IPP has been previously described as an effective instrument for the evaluation of benign prostatic obstruction (BPO) and could help in clarifying the role of alpha-blockers in patients with (BPE). METHODS: Patients with BPE and LUTS were enrolled in this observational study. Intravesical prostatic protrusion was graded as grade 1 (< 5 ml), 2 (5 < IPP < 10 ml) and 3 (> 10 ml). Patients were treated with tamsulosin for twelve weeks. Evaluation was performed before and at the end of treatment by means of International Prostate Symptom Score (IPSS) and uroflowmetry. Patients were considered responders if a reduction of IPSS > 3 points was reported. RESULTS: One hundred forty-two patients were enrolled. Twelve patients were excluded because of incomplete data. Fifty patients showed an IPP grade 1 (group A), 52 a grade 2 (group B) and 28 a grade 3 (group C). Treatment success was obtained in 82%, 38,5% and 7,1% of patients respectively; these differences (group A vs B-C and group B vs C) were highly significant. The odd ratio to obtain a treatment success was of 59 and 8.1 in group A and group B respectively, in comparison to group C. After a multivariate regression, the relationship between IPP grade and treatment success remained significant. Improvement of uroflowmetry parameters has been reported in all the groups especially in patients with a low grade IPP (p value = 0,016 group A vs group B; p value = 0,005 group A vs group C). Prostate volume seems not to influence this relationship. CONCLUSIONS: Intravesical prostatic protrusion has found to be significantly and inversely correlated with treatment success in patients with LUTS and BPE under alpha-blockers therapy. Alpha blockers odd ratio of success is 59 times higher in patients with a low grade IPP in comparison to patients with a high grade.

The use of oxybutynin in patients treated by means of botulinum neurotoxin A for neurogenic detrusor overactivity: an observational study.

STUDY DESIGN: This is an observational prospective noncontrolled study. We enrolled 105 patients affected by neurogenic detrusor overactivity (NDO) who underwent botulinum neurotoxin A (BONT-A) intradetrusor injection and were followed-up for 270 days. OBJECTIVES: To investigate the use of oxybutynin after BONT-A administration in NDO patients. SETTING: Careggi University Hospital in Florence and Tor Vergata University Hospital in Rome. METHODS: Prospective data from two Italian centers were collected in 1 year. Patients showing limited efficacy but good tolerability and adherence to oxybutynin 5 mg three times a day (t.i.d.). were enrolled in the study. Patients received BONT-A intradetrusor injection (onabotulinumtoxinA, 300 U) with a trigone-sparing technique, and the use of oxybutynin was registered at every visit. RESULTS: 105 patients were included. At visit 1, only 30 patients (28.6%) used oxybutynin t.i.d., whereas 47 (45,2%) used a lower dosage and 28 (26.7%) stopped the therapy. At visit 2, 77.3% of patients who had reduced oxybutynin intake, maintained the dosage decided at visit 1. At visit 3, 51.9% returned to oxybutynin t.i.d.; 44.8% were on a reduced dosage and only 3 (2.9%) were not taking the drug. At visit 4, only 37.5% of patients were taking less than oxybutynin t.i.d. CONCLUSION: This study provides some important insights on the use of oral antimuscarinics in patients treated by means of BONT-A intradetrusor administration for NDO; in particular, it suggests that, after an initial reduction in the use of oxybutynin, patients tend to increase the dosage of this drug during the follow-up after the BONT-A treatment.

Immediate dentin sealing in indirect restorations of dental fractures in paediatric dentistry.

AIM: At present, two different clinical procedures to ensure the adherence of indirect tooth restorations to the dental tissues are available: a traditional method based on a delayed dentin sealing (DDS) and an innovative approach that contemplates an immediate dentin sealing (IDS). In this study the authors highlight the advantages of the latter method (IDS), decribing the operating phases of this procedure used in paediatric dentistry to perform indirect restorations of dental fractures. MATERIALS AND METHODS: The operating phases of indirect composite restorations of dental fractures in paediatric patients are described, introducing an innovative procedure that recommends the immediate application of the dental adhesive (IDS) on the exposed dentin before the subsequent operating phases of tooth preparation, dental impression and adhesive cementation of the restoration. RESULTS: The immediate application of the dental adhesive (IDS) on the freshly cut exposed dentin, before taking the dental impression, protects the dental pulp from bacterial contamination and prevents post-operative sensitivity. At the same time, this procedure provides an ideal substrate for formation of a hybrid layer with excellent adhesion properties. CONCLUSION: Both methods (DDS and IDS) allow the formation of an adequate hybrid layer to seal the dentin in the interdiffusion area, although SEM images of samples treated with the two methods reveal clear ultrastructural differences between the different interfaces.

Atypical deglutition: diagnosis and interceptive treatment. A clinical study.

AIM: The aim of this study was to evaluate the early treatment of atypical deglutition, by analysing the efficacy of the eruptive guide appliance Habit Corrector™. MATERIALS AND METHODS: The pre- and post-treatment (T1 and T2) cephalometric data of 2 groups of patients (G1 and G2), both consisting of 25 patients each and treated with Habit Corrector™, were compared. The first group included 10 males and 15 females, aged between 4 and 7 years old, with average age 6.17 years, and therefore undergoing the last phase of primary dentition and the first phase of mixed dentition. The second group included 12 males and 13 females, aged between 8 and 12 years old, with average age 9.19 years old, undergoing the second phase of mixed dentition. The overall duration of the treatment was 12 months. RESULTS: The results showed significant differences between the two groups, with respect to overbite, overjet, molar relation, inclination of the upper and lower incisors, position of the jaw. A significant variation between the two groups at T2 was registered for the maxillomandibular relationships: the increase in the growth and degree of mandibular protrusion was of 4.66° in G1 and 2.44° in G2. Significant changes were registered for the position or growth of the upper jaw; the upper facial height almost remained unaltered, with 53.34° for G1 and with 53.96° for G2. A significant variation occurred with the increase in the sagittal relationship between the molars, improved in G1 by 3.14 mm and in G2 by 2.61 mm. A significant decrease of overjet was registered in G1 by 1.94 mm and in G2 by 0.76 m and an increase of overbite in G1 by 3.14 mm and in G2 by 0.88 mm. The inclination of the maxillary and mandibular incisors improved, with an inter-incisive angle of 123° in G1 and 124.2° in G2. CONCLUSION: The clinical results obtained suggest that early intervention in atypical deglutition with Habit Corrector™ is able to produce significant results in primary dentition and in the first phase of mixed dentition, rather than in the late phase of mixed dentition.

Oral lesions in paediatric patients with graft-versus-host disease.

AIM: This work aims at assessing and describing the most frequent clinical manifestations of the Graft-versus- Host Disease (GvHD) in the oral and maxillofacial region in paediatric patients affected by neoplastic or non neoplastic haematologic disorders who undergo specific haematopoietic stem cell transplantation (HSCT) protocols, with a view to detecting the potential pathological modifications that are recognised as the cause of a possible altered harmonious development of the child. MATERIALS AND METHODS: Thirty-eight paediatric patients aged between 3 and 13 years, coming from the haematological department of Tor Vergata University (Roma, Italy) and affected by GvHD, assessed on the basis of their medical history and accurate clinical and instrumental exams, after having received haematopoietic stem cell transplantation for neoplastic or non neoplastic haematologic disorders, were enrolled in this study. The aim of this work was to assess oral conditions, detect possible oral pathological manifestations and evaluate their incidence both locally and in terms of clinical severity, as well as to mitigate associated symptoms. This was done to prevent and eliminate any oral interference in the systemic treatment protocol. DISCUSSION AND CONCLUSION: In line with the data presented in the literature, clinical GvHD manifestations seem to mainly involve the oral and maxillofacial region from an early phase also in paediatric patients. As a consequence, a timely diagnosis and a multidisciplinary treatment programme are essential for the early detection of the oral signs of potential systemic complications, to improve the quality of life of these young patients, as well as to prevent any potential alterations of dentoskeletal development and growth in the child.

MIH: epidemiologic clinic study in paediatric patient.

The Molar Incisor Hypomineralization (MIH) is a qualitative and quantitative defect of the enamel structure of the first permanent molars, which may vary from 1 to 4 with involvement of maxillary and jaw permanent incisors. AIM.: Aim of this study is that to evaluate, among 1500 paediatric patients chosen at random aged between 0 and 14 years, afferent by the Paediatric Dentistry of the Azienda Ospedialiera Policlinico Tor Vergata of Rome from 1996 to 2011, the incidents and the prevalence of the MIH distribution, and furthermore to ascertain the possible relationship with the data described in the literature. RESULTS AND DISCUSSION.: From the sample of 1500 paediatric patients, the number of those affections from MIH has turned out to be pairs to 110 (7.3%) aged between 4 and 15 years, and an average age equal to 9.7. The incidence of the hypoplastic defects is greater in the elements of the permanents series in which the functional class mainly interested is that of the first molars, with a percentage of 39.8%. Regarding the elements of the deciduous series affections from hypoplasia, they turn out to be in all in number of 20 represented in 80% of the cases from the seconds molars while in the remaining 20% of the cases the items involved are the central incisors. About the percentage of elements involved in the MIH: the molars, involved with a frequency of 56%, turn out to be more hit regarding incisors (44%). As reported in the literature, it can be asserted that the MIH can hit in equal measure both the male sex that feminine one. CONCLUSIONS.: MIH represents a condition quite frequent in the paediatric population. In managing this anomaly takes an essential role in the early diagnosis and in the differential one. The study done underlined the importance of a correct application of the therapeutic protocol which, starting from a careful diagnosis and articulating themselves in the execution of preventive treatments and in severe cases restorative and prosthetic, has the aim to certify the functionality and the aesthetic of the dental elements affected by MIH.

Fluoride supplements in pregnancy, effectiveness in the prevention of dental caries in a group of children.

UNLABELLED: This clinical, retrospective study intends to evaluate whether the systemic administration of fluoride during pregnancy can reduce caries incidence in a group of paediatric patients, compared to a control group.84 patients were selected out of a sample of 2000 children (3-15 years of age) and then divided in two groups: TEST Group: 34 patients (16M - 18F, mean age 9.23), whose mothers had taken fluoride during pregnancy; CONTROL GROUP: 50 patients (23M - 27F, mean age 9) whose mothers had not taken fluoride.Patients underwent a clinical and radiographic inspection to assess the dfs/DFS value as caries index (decayed or filled surfaces for deciduous or permanent teeth). RESULTS: DFS/DFS VALUE: TEST Group: 3.41, CONTROL group 2.49. The TEST group was further divided in individuals who were administered fluoride only during pregnancy (33%) with a dfs/DFS of 3.14 and individuals who were administered fluoride also after birth (67%) with a dfs/DFS of 3. Caries index (dfs/DFS) did not show any significant differences between the test and control groups. Fluoride administration during pregnancy and postpartum does not seem to have a significant impact on the reduction of caries incidence. More preventive strategies should be investigated to contrast the multifactorial etiology of children caries.

Cervical vertebral maturation and dental age in coeliac patients.

AIM: The aim of the study was to evaluate the cervical vertebral maturation and dental age, in group of patients with coelic disease (CD), in comparison with a control group of healthy subjects. METHODS: At the Paediatric Dentistry Unit of PTV Hospital, "Tor Vergata" University of Rome, 120 female patients, age range 12.0-12.9 years were recruited. Among them, 60 subjects (Group 1) were affected by CD, while the control group (Group 2) consisted of 60 healthy subjects, sex and age-matched. The Group 1 was subdivided, according to the period of CD diagnosis, in Group A (early diagnosis) and Group B (late diagnosis). The skeletal age was determined by assessing the cervical vertebral maturation, while the dental age has been determined using the method codified by Demirjiyan. STATISTICS.: The analyses were performed using the SPSS software (version 16; SPSS Inc., Chicago IL, USA). In all the assessments a significant level of alpha = 0.05 was considered. RESULTS: There are no statistically significant differences between Group 1 and Group 2 as for chronological age (p=0.122). Instead, from the assessment of skeletal-dental age, there are statistically significant differences between Group 1 - Group 2 (p<0.001) and Group A - Group B (p<0.001). The statistical analysis carried out to assess the differences between chronological and skeletal-dental age within the single groups, show a statistically significant difference in Group 1 (p<0.001) and in Group B (p<0.001), while there are no statistically significant differences in Group 2 (p=0.538) and in Group A (p=0.475). A correlation between skeletal and dental age was registered; for Groups 1-2 and for Groups A-B the Pearson coefficient was respectively equal to 0.967 and 0.969, with p<0.001. Through the analysis of data it is possible to assess that the percentage of subjects with skeletal and dental age delay corresponds to 20% in healthy subjects, 56.7% in coeliac subjects, 23% in coeliac subjects with early diagnosis and 90% in coeliac subjects with late diagnosis. From the comparison between Group 2 and Group A there are no statistically significant differences (p=0.951). Conclusions. The skeletal age and dental age delay may be two predictive indexes for a CD diagnosis. The dental age and cervical vertebral maturity can be assessed with a low cost, non invasive, easy to perform exam carried out through the routine radiographic examinations such as orthopanoramic and lateral teleradiography.

Analysis of clinical efficacy of interceptive treatment of Class II division 2 malocclusion in a pair of twins through the use of two modified removable appliances.

UNLABELLED: The interceptive therapeutic approach of a functional type is indicated for the treatment of Class II Division 2 mandibular retrusion with deep bite, where improvement is required not only in occlusal relationships but also in skeletal and aesthetic parameters. PURPOSE: The aim of this study is to assess, in two identical twins suffering from the same malocclusion, the effectiveness and clinical stability of functional interceptive Class II division 2 treatment during puberty by mandibular retro-positioning associated with deep bite, and to compare skeletal changes and dental and dental-alveolar changes induced by the application of two different modified removable appliances: Clark's Twin block and Bergersen's Occlus-o-guide. RESULTS: The results show that both devices allowed for circumvention of the pre-functional therapy phase aimed at correcting the upper labial segment, and for the conversion of the Class II division 1 incisor relationship, they were able to promote significant and obvious clinical effects. CONCLUSIONS: The study shows that Class II Division 2 functional type interceptive treatment of mandibular retrusion with deep bite conducted in the puberal phase through clinical use of modified Bergersen's Occlus-o-guide(®) allowed for simultaneous resolution of the skeletal, dental-alveolar and dental problems in one step, while that using modified Clark's Twin-block still requires a second phase of treatment necessary to resolve the alignment, levelling, inter-cuspidation of the arches, optimization of the dental overjet and overbite parameters and to the stabilization of the basal Class I.