Periodontal Alteration of the Microcirculation and Hypercholesterolemia: A Possible Correlation?

OBJECTIVE: We evaluated the morphological and parametric characteristics of the periodontal microcirculation in patients diagnosed as having hypercholesterolemia and high levels of low-density lipoprotein (LDL). METHODS: Forty patients were recruited, 20 of whom were affected by hypercholesterolemia and 20 of whom were considered healthy. A videocapillaroscopic examination was carried out on the periodontal mucosa in the proximity of the frenulum (II, V sextant). RESULTS: The difference between the parameters of the hypercholesterolemia group and the control group was evaluated with the Mann-Whitney U-test for non-parametric ordinal data; the level of significance being P < 0.05. The videocapillaroscopy documented extremely significant differences between the two groups, regarding the following parameters: total diameter of the loop (P = 0.0017), diameter of the afferent loops (P = 0.0004), diameter of the efferent loops (P = 0.00008) and periodontal density (P = 0.0001). CONCLUSIONS: The capillaroscopic examination revealed a morphological alteration of the periodontal microcirculation in patients with hypercholesterolemia, which is an expression of peripheral vascular phlogosis

IN VIVO EVALUATION OF PERIODONTAL MICROCIRCULATORY CHANGES ASSOCIATED WITH ENDODONTIC TREATMENT

The purpose of this study was to investigate in vivo the gingival microcirculatory changes associated with endodontic treatment using the continuous wave of condensation technique. MATERIALS AND METHODS: Twenty necrotic one canal roots of 20 cooperative patients of both sexes, aged between 20 and 43 years, were selected. All patients were examined by capillaroscopy before, immediately after endodontic treatment, and after 7 days. The last examination was carried out by the same operator, and repeated twice for each examined area: masticatory, buccal and labial mucosa corresponding to the endodontically treated root. All canals were prepared using a simultaneous technique with Ni-Ti files (MTwo files). RESULTS: The images of the masticatory mucosa after root canal obturation showed evident micro-areas of extravasation, with significant bleeding and angio-morphological alterations due to heat. One hour after the endodontic treatment evident extravasation was observed, but a decrease of all altered parameters, was present. After seven days from treatment, in the periodontal tissues, a complete healing was observed. The in vivo evaluation of the vascular pattern during root canal obturation with System B showed that the high temperature in the canal determines visible effects on the vasculature of adjacent sites. It was found that microangiotectonic alterations decrease up to a complete healing after 7 days from treatment. CONCLUSION: All the changes in microcirculation, due to thermal shock of periodontal tissues, are reversible

PATHOLOGICAL GAMBLING: AN ASSOCIATION WITH ALEXITHYMIA, PERSONALITY DISORDERS AND CLINICAL SYNDROMES

Pathological gambling (PG) is a disorder recently conceptualized as a behavioural addiction, because of its neurobiological, neurophysiological and psychological features (American Psychiatric Association. Diagnostic and statistical manual of mental disorders - 5th ed., 2013; Potenza et al., 2012). PG represents both a social and a sanitary cost, in terms of pharmacological and psychological therapies. The aim of this study was to examine the correlation between personality disorders, clinical syndromes and alexithymia levels in a group of pathological gamblers. Furthermore this study aimed at highlighting a relationship between PG and alexithymia, over and above the relationship between personality disorders, clinical syndromes and PG. Sixty treatment- seeking pathological gamblers and 60 healthy controls were included in the study. Psychological assessment included the South Oaks Gambling Screen (SOGS), the Millon Clinical Multiaxial Inventory (MCMI-III) and the Toronto Alexithymia Scale (TAS-20). Pathological gamblers displayed Axis I disorders, such as anxiety, somatoform symptoms, bipolar symptoms, dysthymia, thought disorders and major depression, as well as Axis II disorders such as depressive, antisocial, sadistic, passive-aggressive, self-defeating and paranoid disorders, and greater alexithymia levels. Alexithymia was detected in PG independently from the presence of other psychiatric disorders. Our data show that comorbid psychiatric disorders have been evidentiated in PG. Interestingly alexithymia is related to PG indipendently from other psychopathological disorders, representing a relevant feature, helpful for assessing PG diagnosis and for orienting to the correct therapeutical strategy. REFERENCES American Psychiatric Association. 2013. American Psychiatric Publishing Potenza et al.,2012Psychoph219(2):469-49

Mastectomy with immediate breast reconstruction during "phase 1" COVID-19 emergency: An Italian experience.

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Tooth-implant connection in removable denture

When the patient cannot be rehabilitated with a fixed denture, or when he does not succeed in adapting to a traditional removable denture, a possible alternative solution consists in the use of a limited number of implants, placed in strategic positions in the arches of the patient, and subsequently connected to their residual teeth. The aim of this review is to evaluate the progress made on connections between teeth and implants in removable denture, to analyze their advantages and disadvantages and to compare the survival rate, both of the teeth and of the implants used as abutments, present in the various studies taken into examination, with the aim of being able to evaluate the effectiveness of this rehabilitative option. The concept of preserving residual teeth, even if these are unfavorably distributed, and inserting a minimum number of implants in strategic positions, thanks to which an area of favorable support for the denture can be created, seems reasonable; this will guarantee a better adaptation of the patient to the denture, as well as an improvement in the quality of life. The study of articles present in literature suggests that the survival rate of the implants in removable dentures, supported by teeth and implants through traditional systems of anchorage, appears to be quite high. However, further studies with a higher level of evidence, more representative test subjects and a longer follow-up period are necessary, in order to confirm the validity of this rehabilitative solution

The Effects of Low-frequency Vibration on Aligner Treatment Duration: A Clinical Trial

Objectives: The aim of this study was to investigate the effectiveness of an orthodontic tooth movement acceleration device (AcceleDent, OrthoAccel Technologies, Houston, Texas) when used during an aligner treatment. Materials and Methods: Adult patients who began an aligner treatment (Lineo, Micerium Lab, Avegno, Italy) were allocated to two treatment groups. The first one (Group A), with a 7-day aligner change regimen, used the AcceleDent device for 20 min per day, whereas the second one (Group B) changed the aligners every 14 days and did not use any device. The registered outcomes were the possibility of completing the treatment, the number of aligners needed and treatment duration in the two groups. Moreover, we assessed patients’ perception of pain during the first week of treatment. Results: Twenty-four patients were allocated to Group A or B depending on the acceptance of AcceleDent use. Patients which used AcceleDent (Group A) completed the treatment using each aligner for fewer days than those belonging to Group B (9.0 ± 1.0 and 15.4 ± 1.2 days, respectively) (P &lt; 0.001). As a secondary outcome, a significant difference was found in pain perception during the first week of treatment between the two groups (P &lt; 0.05). Conclusions: This controlled clinical trial shows that is possible to apply a 7-day change regimen together with AcceleDent use and successfully complete an aligner treatment with a significant saving of time when compared to a standard 14-days change regimen. Finally, the use of this device allowed reduction in pain perception during the orthodontic treatmen

ATTI S.I.D.O.

Introduction The first clinical use of rapid maxillary expansion (RME) was described over a century ago by Emerson C. Angell in 1860.1 Since then, numerous appliances have been designed to apply orthopedic forces during expansion, thus limiting movement of teeth and maximizing skeletal displacement. However, a component of orthodontic effects following RME has been described by numerous authors. A relevant concern in this regard is represented by the possible periodontal consequences of RME because of risk of damage to the buccal cortical plate of alveolar bone in the correspondence of anchorage teeth and/or the development of recessions.Most investigations have analyzed the dentoskeletal effects of RME through bidimensional radiographic examination, which does not allow for exact identification of the thickness of the buccal and lingual bone plates because of the superimposition of many structures on different planes of space; Timms in 1982 used computed tomography (CT) for the first time in studying basal bone changes induced by RME. Scans obtained by CT, a noninvasive and reproducible technique, permit the clinician to quantify exactly the dentoalveolar modifications induced by orthopaedic forces. RME produced transverse effects in all patients, although dental, alveolar, and skeletal changes varied from subject to subject. These studies were undertaken before or after a very short period of retention. It should be noted that several authors reported that a retention period of at least 5 months is necessary to permit adequate mineralization of the midpalatal suture, in order to minimize the relapse tendency after rapid maxillary expansion. The aim of this preliminary study is to evaluate, in 2D and 3D, the dental and peri-odontal effects of rapid maxillary expansion (RME), using a modified rep with bands on the upper first molar and palatal support by mean of low-dose Cone Beam Computed Tomography (CBCT) with focused FOV protocol. Materials and Methods: We enrolled in this preliminary study 3 patients, age between 10 and 12 years in need of palatal expansion. (Aggiungere protocollo espansivo – quante attivazioni/die e per quanti giorni- più cenni sulle caratteristiche del REP modificato – assenza dei bracci anteriori) CBCT scans were taken before rapid palatal expansion (T0), at the end of the active expansion phase (t1) by mean of Scanora 3D (Soredex). It was used a low-dose CBCT protocol (90kV, 12.5 mA, 4,5sec) with a focused FOV (cm 7.5 x 10). Each radiographic dataset was analized by an expert user by mean of the open source medical software Osirix vers. 5.7.1. It was applied an MPR (MultiPlanarReconstruction) to each dataset and they were taken into account the following measures: Intermolar Width Coronal (IWC); Intermolar Width Apical (IWA); Interincisors Coronal Width (ICW); Interincisors Apical Width (IAW); Anterior Frontal Apical Suture Width (AFASW); Anterior Frontal Coronal Suture Width (AFCSW); Anterior Axial Suture Width (AASW); Posterior Axial Suture Width (PASW). It was also evaluated the morphology of the buccal and palatal bone around the first maxillary molar (but measure were not taken into account for the statistical analisys because of the extreme anatomical variations between a patient and another).    Results: The measures taken into account in this preliminary study showed a reduced increase in the suture opening, in comparison to the RME acticvation protocol (total expansion 6,25 mm). We noticed an average expansion of 3,68mm, at the crown of the first maxillary molar, and an average expansion of 1,96mm at the apical level. This difference is due to a vestibular tipping of the first molar, in accordance to the literature. (see the table 1 and 2) The suture opening was measured in the axial projection (spline plane parallel to the hard palate) and in the front projection (spline plane parallel to the central incisors axis). Both the measure revealed no notable differences between anterior and posterior, upper and lower. (see the table 1 and 2) The cortical bone vestibular to the first maxillary molar decreased (1mm or so) but we couldn’t measure it well because of the extreme anatomical variations (there are no fixed reference points to do the before/after measures). Conclusions: We applied, in this preliminary study, a new protocol of CBCT scanning using the most focused FOV possible (on the Scanora 3D) that still permitted us to see the upper jaw and the cortical vestibular bone. On the contrary of the so called “low dose CT” protocol we reduced the effective dose to the patient: only 40μSv in each dataset acquisition. This was obtained thanks to: a more sensitive sensor (the flat panel on the CBCT requires a lower radiation dose); the reduction of the exposed area with a focused FOV of 7,5x10 cm; the reduction of scan time. Moreover the resolution of the acquired x-ray images was better than the CT (100μm). This preliminary, less invasive, study showed some analogies and some differences with the literarure. On one side we have a 50% reduced dental expansion in comparison to the REP activation, in accordance to the literature. But on the other side we have a parallel suture opening (both on the axial and on the front projection), in disagreement with the literature

ETIOPATOGENESI DEL DOLORE MAXILLO-FACCIALE = Le possibili cause di dolore del distretto oro-facciale

Oral tissue damage and mucositis pain can be a significant problem for patients. The frequency and severity of these problems can vary significantly from patient to patient. Oral complications primarily are associated with discomfort and interference with oral function. Oral tissue damage and pain can result from a number of different processes. There are many types of pain and many locations to get pain. The body uses pain to tell the brain that something is wrong. Never ignore pain. Any type of pain symptom needs prompt professional medical advice for diagnosis of the underlying cause of the pain