A Teledentistry System for the Second Opinion

In this paper we present a teledentistry system aimed to the Second Opinion task. It make use of a particular camera called intra-oral camera, also called dental camera, in order to perform the photo shooting and real-time video of the inner part of the mouth. The pictures acquired by the Operator with such a device are sent to the Oral Medicine Expert (OME) by means of a current File Transfer Protocol (FTP) service and the real-time video is channeled into a video streaming thanks to the VideoLan client/server (VLC) application. It is composed by a HTML5 web-pages generated by PHP and allows to perform the Second Opinion both when Operator and OME are logged and when one of them is offline

Prevenzione e management odontoiatrico dei pazienti oncologici a rischio di osteonecrosi delle ossa mascellari da farmaci

non disponibil

L\u2019odontoiatria a misura del paziente con patologia osteometabolica a rischio di osteonecrosi delle ossa mascellari da farmaci.

L\u2019osteonecrosi delle ossa mascellari (ONJ) da farmaci \ue8 una severa patologia odontoiatrica, recentemente defi nita come \uabuna reazione avversa farmacocorrelata, caratterizzata dalla progressiva distruzione e necrosi dell\u2019osso mandibolare e/o mascellare di soggetti esposti al trattamento con farmaci per cui sia accertato un aumentato rischio di malattia, in assenza di un pregresso trattamento radiante\ubb1-3. I pazienti osteometabolici a rischio di sviluppare l\u2019ONJ sono quelli sottoposti a terapia con bisfosfonati (in particolare aminobisfosfonati o Nitrogen-containing BisPhosphonate/NBP) e, pi\uf9 recentemente, con denosumab (anticorpo monoclonale anti-RANKL)4. Tali farmaci antiriassorbitivi caratterizzati da una prevalente azione inibitoria sul metabolismo dell\u2019osso, sono ampiamente prescritti per la cura di patologie osteometaboliche, prevalentemente osteoporosi primaria o secondaria, oltre che per la prevenzione e il trattamento di lesioni scheletriche in pazienti con patologia onco-ematologica1,5-7

Osteonecrosis of the jaw after adjuvant endocrine therapy plus alendronate in a breast cancer patient

Background. Bisphosphonates-associated osteonecrosis of the jaws (BRONJ) is a serious complication, which has been defined by Bedogni et al. (1) as an adverse drug reaction consisting of progressive destruction and death of bone that affects the mandible and/or maxilla of patients exposed to the treatment with nitrogen-containing bisphosphonates (NBPs) in absence of a previous radiation treatment. Generally, IV NBPs have a strong association with BRONJ than oral NBPs as evidenced by the higher incidence of BRONJ (0-10%) in patients treated with IV drugs than in patients in oral therapy (<1%). Objectives. The aim of this study was to report a clinical case of BRONJ in an oncologic patient who has been treated with anastrozole and oral NBPs for secondary osteoporosis. Case report. In February 2014 a 75-year-old woman was referred because of history of pain in the left posterior mandibular region and hypoesthesia/anesthesia of the homolateral inferior lip and chin. In the anamnesis, she had referred to be in therapy with alendronate since 2004, for a history of severe osteoporosis and, in multimodal chemotherapy and anastrazole since 2010 for a diagnosis of breast cancer. Furthermore, left lower molar extraction was performed on March 2013. Clinical examination revealed swelling of the extraoral soft tissue in the left emimandible; intraorally, the presence of a mucosal fistula on the left mandibular angle was identified. CT was performed and BRONJ diagnosis was defined with a stage 2A according to Bedogni et al. Conclusions. Administration of NBP is indicated to treat also osteoporosis anastrazole-induced in oncological patients, showing that patients with hormone receptor-positive early-stage breast cancer taking oral BP could represent a subset in which it would be useful to apply BRONJ prevention protocols

Leucocyte-and platelet-rich fibrin block: Its use for the treatment of a large cyst with implant-based rehabilitation

The management of critical-size bone defects is still demanding. Recently, autologous platelet concentrates in combination with bone substitute have been applied and reported in a few studies. Our aim is to report the healing of a critical-size alveolar bone defect treated with a new bone regeneration technique by means of L-PRF and L-PRF blocks. A 45-year-old woman presented a large cystic lesion; the extraction of three teeth, a cyst removal procedure, and bone regeneration procedures with L-PRF and L-PRF blocks were planned. The L-PRF block was prepared by mixing a bone substitute with a piece of L-PRF membrane and liquid fibrinogen. Additionally, after bone healing an implant-based rehabilitation was optimally performed. On the basis of the positive results, in terms of bone healing and tissue regeneration in a large bone defect, the application of LPRF and L-PRF blocks, in agreement with the scarce literature, is suggested as a feasible procedure in selected cases

Effect of hormone replacement therapy on vasomotor function of the coronary microcirculation in post-menopausal women with medically treated cardiovascular risk factors

Aims The aim of this study was to evaluate the effect of hormone replacement therapy (HRT) on coronary vasomotor function in post-menopausal women (PM) with medically treated cardiovascular risk factors (RFs) in a cross-sectional and a longitudinal follow-up (FU) study. Methods and results Myocardial blood flow (MBF) response to cold pressor testing (CPT) and during pharmacologically induced hyperaemia was measured with positron emission tomography in pre-menopausal women (CON), in PM with HRT and without HRT, and repeated in PM after a mean FU of 24 ± 14 months. When compared with CON at baseline, the endothelium-related change in MBF (ΔMBF) to CPT progressively declined in PM with HRT and without HRT (0.35 ± 0.23 vs. 0.24 ± 0.20 and 0.16 ± 0.12 mL/g/min; P = 0.171 and P = 0.021). In PM without HRT and in those with HRT at baseline but with discontinuation of HRT during FU, the endothelium-related ΔMBF to CPT was significantly less at FU than at baseline (0.05 ± 0.19 vs. 0.16 ± 0.12 and −0.03 ± 0.14 vs. 0.25 ± 0.18 mL/g/min; P = 0.023 and P = 0.001), whereas no significant change was observed in PM with HRT (0.19 ± 0.22 vs. 0.23 ± 0.22 mL/g/min; P = 0.453). Impaired hyperaemic MBFs when compared with CON were not significantly altered from those at baseline exam. Conclusion Long-term administration of oestrogen may contribute to maintain endothelium-dependent coronary function in PM with medically treated cardiovascular RF

Tilt measurements at Vulcano Island

A network of tiltmeters has been operational on Vulcano Island for numerous years. At present, the network comprises five functioning borehole stations, four of which are installed at 8-10 m and allow recording very stable, high precision signals with very low noise. We report observations over the last 12 years that illustrate impulsive variations linked to seismicity and long-term (several years) trends in the signals. We suggest a relationship between tilt changes correlated to the strongest regional seismic events and site acceleration; long-term tilt variations analyzed in combination with other ground deformation data seem to represent the evidence of a contraction of the La Fossa cone. We also analyzed how the tilt device has the capability to detect possible magma migrations; we considered previous studies that have imaged spatially well-defined levels of magma accumulation beneath La Fossa, and Vulcanello; we concluded that the Vulcano tilt network should be capable of detecting the upward migration of small magma volumes. Finally, we show that no evidence of changes are visible on tilt signals during anomalous degassing episodes (linked to a building up input of magmatic fluids) at the La Fossa thereby evidencing that no magma migration occurred during such events

Immune-mediated desquamative gingivitis and optical coherence tomography diagnostic patterns: Clinical implication from a systematic review

Desquamative Gingivitis (DG) comprises heterogeneous clinical manifestations of numerous immune-mediated muco-cutaneous diseases. Optical Coherence Tomography (OCT) has been proposed as a valuable diagnostic support even if, to date, there are no standardized OCT-diagnostic patterns applicable to DGs. A systematic review was performed to detect existing data on in vivo OCT diagnostic patterns of the most common immune-mediated DGs (i.e., pemphigus vulgaris, mucous membrane pemphigoid and oral lichen planus). It has been found that OCT exhibits specific patterns that address the diagnosis of DG by pemphigus vulgaris (i.e., intraepithelial unilocular blister, reduced epithelial thickness, presence of acantholytic cells in the blister) and by mucous membrane pemphigoid (i.e., subepithelial multilocular blister, presence of inflammatory infiltrate), but not by oral lichen planus. These patterns could offer an attractive diagnostic OCT framework to support the clinical preliminary assessment and monitoring of these complex pathological conditions

Platelet-Rich Plasma (PRP) in Dental Extraction of Patients at Risk of Bisphosphonate-Related Osteonecrosis of the Jaws: A Two-Year Longitudinal Study

Dental extraction has often been described as the main trigger event of osteonecrosis of the jaws (ONJ). This longitudinal hospital-based study aimed to evaluate the outcome at 2 years of a standardized medical-surgical protocol for dental extraction, combined with platelet rich-plasma (PRP) application, compared with conventional protocol not combined with PRP or any other autologous platelet concentrate in cancer (ONC) and osteometabolic (OST) patients, at risk of bisphosphonate (BP)-related ONJ. Twenty patients were consecutively recruited: six received BPs for cancer skeletal-related events (34.17 ± 19.97 months), while fourteen received BPs for metabolic bone disease (74.5 ± 34.73 months). These patients underwent a standardized protocol for dental extraction, combined with autologous PRP application in the post-extraction socket. A total of 63 dental extractions were performed (24 and 39 in ONC and OST groups, respectively). As controls, historical cases, derived from the literature and including 171 ONC and 734 OST patients, were considered. The outcome of the surgical treatment was successful in all patients treated with PRP: two years after extraction, no patient had clinical or radiological signs of ONJ. When this datum was compared with historical controls, no statistically significant differences were found (p &gt; 0.1). The combination of a standardized medical-surgical protocol with PRP application may contribute to limit the occurrence of BP-related ONJ, in both ONC and OST patients. Additional prospective studies with a larger patient sample are necessary to confirm this datum