Somatosensory tinnitus and temporomandibular disorders: A common association.

BACKGROUND: Although the association between tinnitus and temporo-mandibular disorders (TMD) has been frequently reported, their rate of association in the literature shows a great variability. OBJECTIVE: We aimed to investigate the prevalence of TMD in patients with somatosensory tinnitus and, vice versa, the occurrence of somatosensory tinnitus in patients with TMD. METHODS: The study included patients with somatosensory tinnitus (audiological group) and patients with TMD (stomatological group), evaluated at the audiologic and stomatologic clinics of the Policlinic Hospital of Milan, Italy. Common causes of tinnitus, such as hearing and neurological disorders, were excluded. A cervicogenic somatic tinnitus was also ruled out. Different TMD symptoms, including joint noise and joint pain, were considered. The collected data were analysed using descriptive statistical methods, and the Pearson's Chi-squared test was performed to study the prevalence of the different symptoms by clinical groups. RESULTS: Audiological group included 47 patients with somatosensory tinnitus. Overall, TMD was diagnosed in 46 patients (97.8%), including TMJ noise in 37 (78.7%), clenching in 41 (87.2%) and pain in 7 (14.8%) patients. Stomatological group included 50 patients with TMD, including joint noise in 32 (64.0%), clenching in 28 (56.0%) and TMJ pain in 42 (84.0%) patients. A somatosensory tinnitus was diagnosed in 12 (24.0%) patients. CONCLUSION: Our study showed a high prevalence of TMD in patients with tinnitus, as well as a not uncommon occurrence of tinnitus in patients presenting with TMD. The distribution of TMD symptoms, such as joint noise, and joint pain was different between the two groups.

Evaluation of Arthrocentesis with hyaluronic acid injections for management of temporomandibular disorders: a systematic review and case series.

Although arthrocentesis is an accepted safe treatment modality for the management of temporomandibular disorders (TMD) in symptomatic patients, the benefit of hyaluronic acid (HA) injections remains uncertain. The aim of this study was to evaluate whether intra-articular HA injections adjunctive to arthrocentesis can be more effective than other medications for the improvement of TMD associated symptoms. Additionally, the impact of HA injections on quality of life of TMD patients was assessed with SF-36® questionnaire in a cohort of patients. An electronic search of Medline, Scopus and Cochrane databases was performed up to March 2020. The following search terms were used: "arthrocentesis", "hyaluronic acid", "intra-articular injections", "visco-supplementation", "temporomandibular disorders". Prospective and retrospective studies that reported the application of HA injections compared to other intra-articular drugs for the treatment of temporomandibular disorders were included. Systematic or narrative reviews and pre-clinical studies were excluded. Additionally, a retrospective clinical study was performed for evaluation of changes in quality of life before and after arthrocentesis with HA injections. In the systematic review, the initial search yielded 1327 articles. After screening of the titles, abstracts, and full texts, 29 studies were selected (26 randomized studies, 2 controlled clinical trials, 1 retrospective report). In the clinical study, 12 patients were included. Intra-articular injections of HA and other medications together with arthrocentesis seemed to be beneficial for improvement of functional symptoms of TMD and pain. The case series also supported the efficacy of HA injections showing an improvement of quality of life of these patients. However, from literature review, it was impossible to identify an optimum drug or a protocol for predictably improving the pain and/or functional symptoms of temporomandibular problems, due to different etiologies, diversity of treatment modalities and conflicting results. In conclusion, there is no consensus in the literature that HA injections shows better results in comparison with other treatment modalities. According to the results of the present clinical study, HA injections with/without arthrocentesis seems to be beneficial in terms of clinical symptoms and quality of life of the TMD patients.

Evaluation of factors influencing accuracy of virtual surgical planning in orthognatic surgery.

Three-dimensional virtual surgical planning has become routine practice in orthognatic and reconstructive surgery for the possibility to realize presurgical evaluation of intraoperative bones movements, the prediction of postoperative results and the high level of accuracy. Thanks to surface superimposition between 3D planned and 3D postoperative model of maxillo-facial skeleton, a medium discrepancy less than 1 mm was found in scientific literature, considering 15 different points of maxillofacial skeleton. In our study we decided to evaluate different factors that could invalidate that result in the same cohort of patients, such as sex, kind of dentofacial deformity, asymmetry, type of surgical approach and entity of maxillo-mandibular movements (more or less than 1 mm). We found out no significant differences among groups. We can state that virtual surgical planning and 3D surgical splints are a valid means of diagnosis, treatment and predictivity regardless factors that could influence post-operative results. In conclusion, virtual surgical planning and 3D surgical splints facilitated diagnosis, treatment planning and accuracy regardless of sex, dentofacial deformity class, surgery techniques, entity of advancement and asymmetry.

Predictive role of gnathological techniques for the treatment of persistent idiopathic facial pain (PIFP).

INTRODUCTION/BACKGROUND: Persistent idiopathic craniofacial pain (PIFP) is a heterogeneous group of pain syndromes whose main characteristic is the daily presence of persistent pain for at least 3 months. The pathophysiology of PIFP is still not entirely known and probably related to biological and psychological factors. Although PIFP has been attributed to the central neuron activity, the importance of masticatory muscles as a possible pathogenic mechanism was recently demonstrated. The main purpose of our paper was to identify the physiological rest position of the mandible with minimal tonus of both the elevator and depressor muscles and the neuromuscular trajectory of mouth closing obtained by transcutaneous electrical stimulation (TENS) and maintained with the use of an occlusal device, known as orthotic. MATERIALS AND METHODS: The VAS scale for facial pain and the migraine disability assessment score (MIDAS) index for patient quality of life were evaluated at the beginning of the study for the 38 subjects that came to our attention. Our research included two phases. The first phase consisted of kinesiographic and electromyographic (EMG) examinations of the masticatory muscles and a 45-min application of TENS in order to deprogram the muscular activity. Kinesio-electromyographic examinations were repeated in the second phase. The main evaluated parameter was jaw deflection or deviation on the sagittal and frontal planes before and after TENS during patient tooth occlusion. Patients that showed a significant modification of this parameter were treated with orthotics for 12 months. RESULTS: The results of a 12-month follow-up show a sharp reduction of the VAS (pre-orthotic 9.05, range 8-10, SD 0.8; post-orthotic 5.87, range 1-5, SD 0.7) and an improvement in the quality of life (MIDAS). CONCLUSIONS: Our study demonstrated the usefulness of TENS as a screening method for the application of orthotics. This non-invasive and/or non-painful procedure could be a useful complementary treatment in this patient population. The results of the study also confirm the role of masticatory muscle dynamics as a possible pathogenic mechanism in patients with PIFP.

The role of electrophysiological investigations of masticatory muscles in patients with persistent idiopathic facial pain.

INTRODUCTION: The authors tried to establish whether there is any electrophysiological difference of masticatory muscle activity between patients with persistent idiopathic facial pain (PIFP) and healthy subjects. METHODS: Twenty-eight PIFP patients (6 men and 22 women, mean age 40 years) and 28 normal subjects (12 men and 16 women, mean age 40 years) underwent EMG of temporal and masseter muscles before and after transcutaneous electric nerve stimulation (TENS). RESULTS: After TENS stimulation, the mean amplitude difference was found to be smaller than the baseline before TENS in the PIFP patients compared with healthy subjects. CONCLUSIONS: The peculiar behavior of masticatory muscles after TENS could be relevant in order to explain the well-known improvement of pain reported by some PIFP patients after orthosis positioning.

Minimally-invasive osteotome sinus floor elevation combined with short implants and platelet-rich plasma for edentulous atrophic posterior maxilla: a five-year follow-up prospective study.

The aim of this study was to investigate the success of the combination of short implants, osteotome sinus floor elevation technique (OSFE) and pure platelet rich plasma (P-PRP), for the rehabilitation of atrophic posterior maxilla. Fifty-one patients were included in this study, receiving a total of 88 short implants in three different lengths (6.5 mm, 7.5 mm, 8.5 mm), depending on the residual bone height level. A total of 39 standard implants were also inserted when judged necessary, and splinted with one or more short implants in order to support a fixed prosthesis. Data were recorded in a one-year and five- year follow-ups. No statistically significant difference was found between short implants with different length, nor between short and standard length implants in terms of both bone level change and bone height. Based on the present results, the use of short implants combined with OSFE technique for the rehabilitation of atrophic posterior maxilla can be recommended.

Augmentation of the atrophic maxillary sinus floor: graft stiffness, implant shape and length.

This study investigates the characteristics of load transmission to bone of alternative treatments for posterior maxilla edentulism with relatively limited available bone volume. Implant shape (conical and cylindrical), augmentation technique and the effect of bone-graft stiffness were taken into consideration. The finite element models of the atrophic sinus implanted with short implant were compared to two grafted-sinus models implanted with longer implants, engaged bicortically. Bone-graft stiffness was varied to describe different stages of graft-maturation (from short-term to long-term). Stress and load distributions due to axial and bending loads were compared on the bony structures. In the short-term, axial force is supported almost equally by the cortical layers and the trabecular core, while a bending load is mainly supported by the crestal cortical layer and secondarily by the cortical floor, the bone-graft supported a negligible load. Bicortical engagement produces higher load transfer to the cortical floor under axial load. In the long-term, as the stiffness of the bone-graft increases, the load is transferred progressively towards the grafted region, progressively unloading other structures, particularly the internal cortical layer.

Analyze my face.

Plastic surgery is gaining more and more popularity, while stigma and popular myths about it are gradually decreasing. Analyze My Face conjunctly deals with the two main problems of facial plastic surgery: the excessive rate of dissatisfaction, which results in high revision requests and negative psychological side-effects and the “diagnosis by procedure” approach, which leads to erroneous measurements. This new and innovative method of Digital Facial Analysis is a direct non-expensive online service that provides professional and documented in-depth consultation to patients before they decide to undergo any type of facial intervention. The paper thoroughly explains the scientific method with which professionals provide customers with a facial assessment based on specific parameters which will be discussed (height, width, proportions, direction of facial growth, the way they assess each facial area in detail (eyes, mouth, cartilage), and the motivations for which they suggest to correct eventual defects through precise measurements, indicators and suggested interventions. Long-term evaluation of stability of surgical results and patient satisfaction achieved with digital facial analysis has not yet been established and needs further research. However, it is important to underline that the AMF approach tends to consider exclusively possible and feasible procedures that do not compromise functionality and that do not put patients in danger of serious damage. Problems or deformities that cannot be treated are always indicated. AMF aims to maximize professionality by giving practitioners an additional tool to aid their work, give unbiased opinions and look at the overall picture. It also aims to help patients by soothing their way into the complicated world of aesthetic surgery.

Use of the orbital fat pad in eyelid reconstruction.

Eyelid reconstruction, though challenging, can produce a functional, esthetically pleasing lid. This should preferably be accomplished with a one-stage procedure, using robust, well-vascularized tissues similar to those being replaced, with minimal associated donor morbidity. According to the experience with Bichat pedicled flap in oral reconstruction, the authors propose the use of pedicle infraorbital fat pad for repair of conjunctival defect. Seven patients underwent eyelid reconstruction of full-thickness oncological or post-traumatic defects. In all cases, the reconstruction involved an orbital fat pad flap for the posterior lamella in addition to local flaps for the anterior lamella. All of the flaps survived. The transferred fat flap had a complete epithelization, histologically documented. No tumor relapse occurred in oncological cases. The results have been satisfactory both for clinical evaluation and for the patients. Reconstruction of the palpebral inner lamella with the orbital fat pad is a simple and low-morbidity procedure that has good morphological and functional results.

Parry Romberg Syndrome and linear facial scleroderma: management in pediatric population.

Among all different types of cutaneous scleroderma, Parry Romberg syndrome and linear scleroderma "en coup de sabre" typically involve the visage. Gradual degeneration of the tissues, from the skin up to the bone, is the stigmata of the diseases and the range of clinical manifestations is wide. They typically start during childhood and slowly progress before stabilizing. Considering the gravity of the associated deformity and its impact on facial function and appearance, we strongly advocate a prompt intervention that however must be tailored on paediatric patients. There is not a general consensus on hemifacial atrophy treatment, but autologous fat grafting has been proved to be a suitable technique, due to its low morbidity, repeatability and efficacy in correcting volume defects and in improving skin texture. Following the same concept of safeness and non-invasiveness we propose 3D stereophotogrammetric acquisitions as a possible tool for the pre- and post-surgical follow up, indispensable to evaluate the surgical results. We present our case series composed of 8 paediatric patients, aged between 11 and 17 years, who underwent several lipofilling procedures, from 2012 to 2016. Starting from 2015, 3D stereophotgrammetric data has been obtained.

Bilateral coronoid hyperplasia: a report of six cases.

Bilateral coronoid process hyperplasia is a rare condition defined as an abnormal elongation of the mandibular coronoid process, formed of histologically normal bone. Coronoid process hyperplasia usually develops progressively, and the clinical symptoms are often similar to those of temporomandibular joint disorders (TMD). Therefore, it is often misdiagnosed as TMD initially. From 2013 to 2016, six patients were referred to our maxillofacial surgery unit by their dentist, to evaluate mouth opening with suspected TMJ disorder. Average age was 30 years No hypertrophy of the masseter muscles was found and the patient had no history of pain and/or dysfunction of the temporomandibular joint. Average maximal incisal opening was 16.3 mm. (Rance 13-20 mm). At the end of surgery the average mouth opening achieved was of 40.3 mm. After 6 months from surgery an average mouth opening of 41 mm was obtained, with no recidivism in the coronoid process growth or decrease in the mouth opening. The only successful treatment to restore the mouth opening caused by coronoid process hyperplasia is surgical correction of coronoid-malar interference by coronoidectomy or coronoidotomy. Commencement of physiotherapy is recommended to begin between three days and one week after surgery. We also recommend the use of the TeraBite®, a simple manual physiotherapy device.

Oral melanoma with osteocartilagineous differentiation: a case report and literature review.

Osteocartilagineous differentiation within malignant melanoma is a rare occurrence with several implications for diagnosis. Most of the reported cases have occurred in acral lentiginous malignant melanomas. In this paper, the authors describe the clinical, morphological, immunohistochemical features and surgical treatment of a case of primary oral mucosal melanoma with osteocartilaginous differentiation and they review the existing literature. The clinical history of a 67-year-old man affected of oral malignant melanoma was described from the first presentation to the second recurrence. FISH analysis on primary lesion and on relapses showed positive results both in epithelioid and in osteocondroblastic areas. Because of the scarcity of literature in osteogenic melanoma, histological identification may be problematic and prognostic factors and therapeutic protocols are nor well established. Immunohistochemical and molecular techniques can help to diagnosis this rare lesion.

Bidirectional flux of fluids and microbiota at implant-abutment connection of FMD Storm implant system: an in vitro stud y using RT-PCR.

The purpose of the present microbiological study was to evaluate bacterial leakage at implant-abutment connection level of a new type of implant (Storm implant (FMD, Falappa Medical Devices®, Rome, Italy) using Real-Time Polymerase Chain Reaction (RT-PCR). This implant presents a polygonal external implantabutment connection with a geometry that provides a hex on which engage complementary abutments. To identify the capability of the implant to protect the internal space from the external environment, the passage of genetically modified Escherichia coli across implant-abutment interface was evaluated. Four Storm implants (FMD, Falappa Medical Devices®, Rome, Italy) were immerged in a bacterial culture for 24 h and bacteria amount was measured inside implant-abutment interface with Real-time PCR. Bacteria were detected inside all studied implants, with a median percentage of 15% for P. gingivalis and 14% for T. forsythia. Our results are similar to those reported in the English literature. Additional studies are needed to explore the relationship in terms of microbiota between the internal implant and implant-prosthetic connection. In addition, the dynamics of internal colonization needs to be thoroughly documented in longitudinal in vivo studies. As a result, microbial leakage along the implant abutment interface was acceptable and considered the most probable explanation for peri-implantitis.

Bacterial colonization of the implant-abutment interface of conical connection with an internal octagon: an in vitro study using real-time PCR.

Bacterial leakage at the implant-abutment connection of a two-piece implant system is considered the main cause of peri-implantitis. Prevention of bacterial leakage at the implant-abutment connection is mandatory for reducing inflammation process around implant neck and achieving bone stability. Micro-cavities at implant-abutment connection level can favour bacterial leakage, even in modern two-piece implant systems. The conical connection with an internal octagon (CCIO) is considered to be more stable mechanically and allows a more tight link between implant and abutment. As P. gingivalis and T. forsythia penetration might have clinical relevance, it was the purpose of this investigation to evaluate molecular leakage of these two bacteria in a new two-implant system with an internal conical implant-abutment connection with internal octagon (Shiner XT, FMD Falappa Medical Devices S.p.A. Rome, Italy). To verify the ability of the implant in protecting the internal space from the external environment, the passage of genetically modified Escherichia c oli across implant-abutment interface was evaluated. Four Shiner XT implants (FMD, Falappa Medical Devices®, Rome, Italy) were immerged in a bacterial culture for 24 h and bacteria amount was measured inside implant-abutment interface with Real-time PCR. Bacteria were detected inside all studied implants, with a median percentage of 6% for P. gingivalis and 5% for T. forsythia. Other comparable studies about the tightness of the tested implant system reported similar results. The gap size at the implant-abutment connection of CCIOs was measured by other authors discovering a gap size of 1­2µm of the AstraTech system and of 4µm for the Ankylos system. Bacterial leakage along implant-abutment connection of cylindrical and tapered implants, Shiner XT, (FMD Falappa Medical Devices S.p.A. Rome, Italy) showed better results compared to other implants. Additional studies are needed to explore the relationship in terms of microbiota of the CCIO. In addition, the dynamics of internal colonization needs to be thoroughly documented in longitudinal in vivo studies.

Replica-guided trauma surgery.

The aim of this study is to present a new approach to the surgical treatment of fractures of the middle third of the face, based on the use of resorbable materials and stereolithographic models. From 2009 to 2014, we treated 10 cases of orbitozygomatic trauma mostly as secondary surgery. For each case, an anatomical replica had been produced simulating the expected result and was then used to contour the resorbable plates on its surface, even before the beginning of the surgical procedure itself. The plates and meshes already bended act as a guide to bony reduction procedure. No complications occurred: all patients healed well, without inflammatory reactions. The results obtained corresponded to the expected results. This technique has been employed for primary or secondary treatment of fracturesof the middle third facial, where it is not always easy to understand the displacement of bony segments and where the use of resorbables plates could be particularly beneficial, as they do not interfere with the maxillofacial skeleton physiology and avoid the necessity to remove plates and screws. Combined use of stereolithographic model and resorbable materials allow a new surgical approach based on the realization of the surgical procedure on the model, then transferred from the patient to the model, thanks to plates and meshes. This technique helps to overcome many of the limits of the conventional technique: the need of minimal surgical access, in order to minimize facial scarring and the vasculo-nervous structures that cross the head and neck district and the obligation to restore not only the morphology but also the biological functions.

Nasal reconstruction: our experience.

The nose is a critically important aesthetic and functional portion of the face. We can explore nasal defects following trauma or tumor resections. Reconstructive techniques based on primary closure, skin graft, local flap, regional flap and microvascular free tissue transfer provides an algorithmic framework applicable to any reconstructive problem. From 2010 to 2016, 33 patients were treated with nasal reconstruction. Malignant tumor resection was the main cause of nasal defect. The most common tumor resected was BCC (basal cell carcinoma) followed by SCC (squamous cell carcinoma). Recurrence of malignant tumor were also treated. As described in the literature, we used the most common reconstructive techniques to handle post-resection defects. Most of the defects involved the dorsum and the ala of the nose, only rarely had the skeleton been affected by the resection. When the cartilage had been sacrificed, a graft from the septum or from the ear flap was harvested. All patients resulted in optimal reconstruction. In any case, a second surgery was needed. All the surgical procedures were performed in one single stage except for the paramedian forehead flap that required a second stage for division and inset of the flap. All donor sites did not show functional and aesthetic damage. All patients resulted in a morpho-functional restoration of the area affected by the resection with a high success rate. Following the algorithm when restoring the anatomical subunit is the base purpose has determined satisfactory results.

Genetic effects of BIOPAD® on fibroblast primary culture.

BIOPAD® is an ivory-white soft sponge, made exclusively of lyophilized type I native heterologous collagen extracted from horse flexor tendon, gelatine free, that keeps its native structure specific to the body's skin tissue. BIOPAD® is an active dressing, playing an active role in all stages of wound healing process, stimulating granulation tissue growth and enhancing regeneration tissues. It ensures balance between absorption and humidity at wound surface, gaseous exchange of soft tissues during healing process, barrier to prevent bacterial infections and it is completely non-adherent. The use of BIOPAD® is painless for the patient and does not require removal or change of dressing. In this work, we evaluated the effect of BIOPAD® on fibroblasts behavior in term of cell viability, survival and growth and collagen production. The expression levels of some adhesion and traction-resistance related genes (ELN, DSP, FN1, FBN1, ITGB1, ITGA1, ITGA5, ITGA2, COL1A1, COL3A1) were analyzed using real time Reverse Transcription-Polymerase Chain Reaction (real time RT-PCR). All genes, except for ELN, DSP, ITGB1 and ITGA1 are up-regulated after 48 h of treatment. Altogether, our results point out the good potential of BIOPAD® as a biocompatible and regenerative tool in medicine.

Cone-morse implant connection system significantly reduces bacterial leakage between implant and abutment: an in vitro study.

Osseointegrated implants are very popular dental treatments today in the world. In osseointegrated implants, the occlusal forces are transmitted from prosthesis through an abutment to a dental implant. The abutment is connected to the implant by mean of a screw. A screw is the most used mean for connecting an implant to an abutment. Frequently the screws break and are lost. There is an alternative to screw retained abutment systems: the cone-morse connection (CMC). The CMC, thanks to the absence of the abutment screw, guarantees no micro-gaps, no micro-movements, and a reduction of bacterial leakage between implant and abutment. As P. gingivalis and T. forsythia penetration might have clinical relevance, it was the purpose of this investigation to evaluate molecular leakage of these two bacteria in a new CMC implants systems (Leone Spa®, Florence, Italy). To identify the capability of the implant to protect the internal space from the external environment, the passage of genetically modified Escherichia coli across implant-abutment interface was evaluated. Four cone-morse Leone implants (Leone® Spa, Florence, Italy) were immerged in a bacterial culture for 24 h and bacteria amount was then measured inside implant-abutment interface with Real-time PCR. Bacteria were detected inside all studied implants, with a median percentage of 3% for P. gingivalis and 4% for T. forsythia. Cone-morse connection implant system has very low bacterial leakage percentage and is similar to one-piece implants.

Genetic effects of Vicryl® on fibroblast primary culture.

Vicryl® (polyglactin 910) is an absorbable, synthetic, usually braided suture, indicated for soft tissue approximation and ligation. Vicryl® has a special coating for minimizing friction, easing passage through tissue and easy knot tie down. It is synthetic for minimal tissue reaction. Fibroblasts are the main cells of connective tissue that synthesize extracellular matrix. In this work, we tried to judge the action of Vicryl® on fibroblasts behaviour. We evaluated the expression levels of some adhesion and traction-resistance related genes (ELN, DSP, FN1, FBN1, ITGB1, ITGA1, ITGA5, ITGA2, COL1A1, COL3A1) by using real time Reverse Transcription-Polymerase Chain Reaction (real time RT-PCR). All but 2 genes resulted up-regulated after 48 h of treatment. Our preliminary results point out the potential of Vicryl® as a biocompatible and regenerative tool in medicine.

Effect of platelet reach plasma on fibroblast primary culture: gene expression evaluation.

To correct skin imperfections, aesthetic medicine today makes use of injectable dermal fillers that allow filling skin by increasing the volume of soft tissue. Currently, there are many fillers usable for their excellent biocompatibility and low allergic reactions that ensure good results and good compliance. Among these, the most widely used filler is Human Plasma, obtained by centrifugation from patient blood and processed through cycles of centrifugation and heating, until it becomes a gel. In this work, we evaluated the effect of the Plasma on fibroblasts behavior in terms of cell viability, survival, growth and collagen production. To this aim, the expression levels of some adhesion and traction-resistance related genes (COL11A1, ELN, GDF6, IGF1, DSP, ELANE, HAS1, HYAL1, COL1A1 and COL3A1) were analyzed using real time Reverse Transcription-Polymerase Chain Reaction (real time RT-PCR). All genes, except for COL1A1, COL3A1 and COL11A1, were up-regulated after 24 h of treatment. Altogether, our results point out the good potential of Plasma. In particular, we appreciated an up-regulation in some of the most important genes involved in bio-revitalization, such as elastin and hyaluronic acid.