Clinical insights on Tolosa Hunt syndrome: a multidisciplinary approach on neurological-related symptomatology in maxillofacial region

Background Tolosa–Hunt syndrome (THS) related neurological symptoms are described in literature as “unilateral”, “recurrent”, “episodic”, “intense”, “severe”, “lancinating” or “stabbing” pain on the upper face and forehead and may be misdiagnosed due to the similarity of few symptoms and a significant number of common characteristics between both conditions. Aims The aim of this brief report is to indicate some important clinical insights related to Tolosa Hunt syndrome, and to give a frank account on the multidisciplinary approach on neurological-related symptomatology in maxillofacial region. Methods We analysed a selection of patients with such clinical picture. To better describe the proper management of clinical cases, we report a 50-year-old female reporting an history of two years of recurrent, severe stabbing pain around the right eye, prominence of her cheek and forehead. Her general dentist first mistakenly diagnosed toothache and, thus, it was subsequently misdiagnosed the trigeminal neuropathy (TN). Results Reported exemplificative case presented a mild ptosis, diplopia of the right eye, corneal reflex loss, paresthesia and hyperesthesia of upper part of left side of face. Magnetic resonance imaging (MRI) findings were suggestive of THS. Complete resolution of symptoms was achieved with oral Prednisolone and constant monitoring of symptoms. Conclusion THS may be added to the long list of differential diagnosis of TN and general dentist and oral surgeons should be informed about such rare causes of facial pain through continued medical education programs

In Situ Growth of Mg-Fe Layered Double Hydroxides (LDH) Film on Titanium Dental Implant Substrates for pH Regulation in Oral Environments

Layered double hydroxides (LDHs) consist of two-dimensional, positively charged lamellar structures with the ability to host various anions in the interlayer spaces, which grants them unique properties and tunable characteristics. LDHs, a class of versatile inorganic compounds, have recently emerged as promising candidates for enhancing osseointegration. A suitable alkaline microenvironment is thought to be beneficial for stimulating osteoblasts’ differentiation (responsible for bone matrix formation) while suppressing osteoclast generation (responsible for bone matrix disintegration). LDHs are prone to adjusting their alkalinity and thus offering us the chance to study how pH affects cellular behavior. LDHs can indeed modulate the local pH, inflammatory responses, and oxidative stress levels, factors that profoundly influence the behavior of osteogenic cells and their interactions with the implant surface. Herein, we deposited Mg–Fe LDH films on titanium substrates for dental implants. The modified Ti substrates was more alkaline in comparison to the bare ones, with a pH higher than 8 after hydrolysis in an aqueous environment

Hybrid Funnel Technique: A Novel Approach for Implant Site Preparation: A Pilot Study.

(1) Background: Different techniques and tools have been developed for implant site preparation. In this clinical scenario, Hybrid Funnel Technique (HFT), a novel osteotomy procedure, has been proposed. (2) Aim: The aim of this retrospective observational study was to consider the different responses to compression of the histological bony compartments (cancellus and cortical). HFT involves the use of multiple drills for the cortical layer preparation and of an osteotome for the osteocompaction of the cancellous bone. (3) Materials and Methods: Following computer-supported implant planning and guided surgery, 10 osteotomies with HFT were performed and 10 implants with the same length and diameter were placed in seven healthy and no daily smoking patients. Periapical X-ray and intraoral photographs were performed at baseline and after 12 months of follow-up to evaluate marginal bone level (MBL) changes and aesthetic results obtained from implant prosthetic rehabilitation. (4) Results: At 1 year of follow-up, 100% of the implants were successfully integrated, MBL change mean value was 0.17 mm ± 0.21. No differences in terms of MBL were noted between thin and thick biotypes. Pink esthetic score (PES) and white esthetic score (WES), assessed one year after definitive restoration placement, were 7.5 ± 2.3 and 8.5 ± 1.1, respectively. (5) Conclusions: Based on the findings of this preliminary clinical study, HFT has led to stability of peri-implant tissues and could represent a reliable technique for surgical preparation of the implant site

A Review on Risk Management of Coronavirus Disease 19 (COVID-19) Infection in Dental Practice: Focus on Prosthodontics and All-Ceramic Materials.

Background: A novel β-coronavirus infection (COVID-19) was first detected in Wuhan city, spreading rapidly to other countries and leading to a pandemic. Dental professionals and patients are exposed to a high risk of COVID-19 infection, particularly in the prosthodontic practice, because of the bio-aerosol produced during teeth preparation with dental handpieces and the strict contact with oral fluids during impression making. This paper aimed to provide an overview to limit the risk of transmission of COVID-19 infections during prosthetic procedures in dental offices. Methods: An electronic search was conducted on the electronic databases of PubMed/Medline, Google Scholar, Embase, Scopus, Dynamed, and Open Grey with the following queries: (COVID-19) AND/OR (SARS-CoV-2) AND/OR (Coronavirus) AND/OR (contaminated surface) AND/OR (cross-infection) AND/OR (Prosthodontics) AND/OR (dental ceramic) AND/OR (glass-ceramic). A manual search was performed as well. Results: From the 1023 collected records, 32 papers were included. Conclusions: Dental offices are at high risk of spreading SARS-CoV-2 infection due to the close contact with patients and continuous exposure to saliva during dental procedures. Therefore, pre-check triages via telephone, decontamination, the disinfection of impressions, the sterilization of scanner tips, and the use of specific personal protective equipment, dental high-speed handpieces with dedicated anti-retraction valves, and effective mouthwashes are strongly recommended

Clinical insights on Tolosa Hunt syndrome: A multidisciplinary approach on neurological-related symptomatology in maxillofacial region

BackgroundTolosa–Hunt syndrome (THS) related neurological symptoms are described in literature as “unilateral”, “recurrent”, “episodic”, “intense”, “severe”, “lancinating” or “stabbing” pain on the upper face and forehead and may be misdiagnosed due to the similarity of few symptoms and a significant number of common characteristics between both conditions.AimsThe aim of this brief report is to indicate some important clinical insights related to Tolosa Hunt syndrome, and to give a frank account on the multidisciplinary approach on neurological-related symptomatology in maxillofacial region.Methods We analysed a selection of patients with such clinical picture. To better describe the proper management of clinical cases, we report a 50-year-old female reporting an history of two years of recurrent, severe stabbing pain around the right eye, prominence of her cheek and forehead. Her general dentist first mistakenly diagnosed toothache and, thus, it was subsequently misdiagnosed the trigeminal neuropathy (TN). Results Reported exemplificative case presented a mild ptosis, diplopia of the right eye, corneal reflex loss, paresthesia and hyperesthesia of upper part of left side of face. Magnetic resonance imaging (MRI) findings were suggestive of THS. Complete resolution of symptoms was achieved with oral Prednisolone and constant monitoring of symptoms.ConclusionTHS may be added to the long list of differential diagnosis of TN and general dentist and oral surgeons should be informed about such rare causes of facial pain through continued medical education programs

Evidences of a New Psychobiotic Formulation on Body Composition and Anxiety

Background. Gut microbiota is implied in obesity, because of its ability to harvest energy from diet, and in the regulation of behavior. Given the link between gut microbiota, body composition, obesity, and anxiety, the aim of this study was to evaluate the effects of a new psychobiotic formulation. Methods. Eligible patients were randomly divided into three groups: psychobiotics oral suspension group (POSG); dietary treatment group (DTG); combined treatment group (CTG). All subjects underwent body composition and psychological profile evaluation. Results. Significant changes in body composition parameters in each group were relieved after all treatments. Hamilton anxiety rating scale (HAM-A) highlighted a significant reduction of the total score for all study population after treatments in POSG (p=0.01) and CTG (p=0.04). A reduction of HAM-A total score in anxious subjects in POSG or CTG and a significant reduction of positive subjects for HAM-A in POSG (p=0.03) and in CDG (p=0.01) were shown. Discussion. Three-week intake of selected POS represents a good approach to solve problems related to obesity and behavior disorders. However, new clinical trials need to be performed on a larger population and for a longer period of treatment before definitive conclusions can be made. This trial is registered with NCT01890070

Management of Uncommon Secondary Trigeminal neuralgia related to a rare Arnold Chiari type I malformation

BackgroundTrigeminal neuralgia (TN) may sometimes present secondary to an intra-cranial cause. Arnold Chiari Malformation (ACM) is downward herniation of the cerebellar tonsils through the foramen magnum that may be a cause of TN like pain in very rare cases.AimsThe aim of this brief report is to suggest the proper management of uncommon secondary trigeminal neuralgia related to a rare Arnold Chiari type I malformation.Methods A male patient presented electric shock like stabbing pain on the right side of the face for more than ten years. The symptoms were typical of trigeminal neuralgia except that there was loss of corneal reflex on the right side and the patient also complained of gait & sleep disturbances. Complex and multilevel diagnosis was made. Results A multiplanar imaging through brain acquiring T1/T2W1 revealed ACM Type I Malformation with caudal displacement of cerebellar tonsils through foramen magnum.ConclusionDental surgeons and oral and Maxillofacial Surgeons should exclude intra-cranial causes by Magnetic Resonance Imaging(MRI) in patients of TN presenting with loss of corneal reflex, gait and sleep disturbances due to night time pain episodes

Clinical decision-making review on magnetic attachments versus mechanical attachments in dental prosthetics

BackgroundConventional dentures in edentulous patients show some limitations due to the lack of retention, support and stability thus resulting in difficulty to chew. The modern implantology allows to use different implant overdentures and different attachment systems. The selection of the attachment by practitioners is mainly influenced by the clinical experience or technical preferences. AimsThe aim of the present review is to provide an adequate background to the clinicians, in order to select the prosthetic attachments according to the current literature. The mechanical attachments have been compared to the magnetic devices, with the aim to guide the decision of the practitioners. Methods Articles topics selection was based on the use of magnetic attachments in dentistry and the comparison between them and mechanical connectors. The databases used were PubMed/MEDLINE, Google Scholar and ISI Web of Science. A critical evaluation of the selected paper has been made to choose the ones that matched the inclusion criteria.Results Nowadays, few studies have compared different attachments in a manner useful for clinical decision-making. The main problem limiting long-term durability of magnetic attachments in the oral fluid is the poor corrosion resistance of permanent magnets and the consequent leaching of cytotoxic ions. ConclusionMagnetic attachments in comparison with other attaching systems can be useful in patients with special needs, in patients with limited interocclusal space, or in patients with neuromuscular limitations, thanks to the automatic reseating properties. However, it’s important to highlight that the mechanical attachments still represent the best choice in common conditions requiring dental prostheses

Autogenous Dentin Particulate Graft for Alveolar Ridge Augmentation with and without Use of Collagen Membrane: Preliminary Histological Analysis on Humans

(1) Background: The phenomenon of ankylosis of the dental elements has led clinicians to think that properly treated dentin and cement may be a potential graft for alveolar ridge augmentation. Currently, there are no studies in the literature able to histomorphometrically compare the healing patterns of an autogenous dentin particulate graft with the association, or not, of resorbable membranes. The aim of this pilot study is to histologically compare bone after an alveolar ridge augmentation using an autogenous dentin particulate graft with and without a resorbable collagen membrane. (2) Methods: this clinical trial enrolled six patients with defects requiring bone augmentation. Two procedures were performed in all six adult human patients in order to perform a study–control study: in Group 1, a ridge augmentation procedure with an autogenous dentin particulate graft and a resorbable collagen membrane was performed, and, in Group 2, an alveolar ridge preservation without a membrane was performed at the same time (T0). At 4 months, a biopsy of the bone tissues was performed using a 4 mm trephine bur in order to perform a histomorphometric analysis. (3) Results: The histomorphometric analysis demonstrated that Group 1 presented 45% of bone volume, 38% of vital bone, and 7% of residual graft. On the contrary, membrane-free regenerative procedures demonstrated 37% of bone volume, 9% of vital bone, and 27% of non-resorbed graft. In all cases, the regenerated bone allowed the insertion of implants with a standard platform, and no early failures were recorded. (4) Conclusions: Autogenous dentin particulate grafts seem to work best when paired with a membrane

Protocollo clinico per il trattamento di inclusioni multiple al mascellare superiore

Scopo del lavoro è quello di dimostrare l’importanza di un approccio terapeutico di tipo intercettivo e descrivere le corrette fasi di trattamento in un caso di doppia inclusione mascellare di un incisivo laterale e di un canino in seguito alla presenza di un odontoma composto in una paziente in dentizione mista con evidente asimmetria mandibolare di tipo funzionale. La sequenza terapeutica è stata: escissione chirurgica dell’odontoma, trazione ortodontica sequenziale degli elementi ritenuti, risoluzione della asimmetria occlusale mediante ripristino dei corretti diametri traversi del mascellare superiore, finalizzazione e mantenimento a distanza dei risultati ottenuti