La cisti ossea solitaria: aspetti istologici, diagnostici e terapeutici.

Il termine «tumori odontogeni» include un ampio numero di lesioni, che si presentano però molto diverse tra loro in termini istopatologici, clinici, terapeutici e prognostici. L’ultima classificazione dell’OMS differenzia i tumori odontogeni distinguendo primariamente le lesioni maligne dalle lesioni benigne; all’interno di quest’ultimo gruppo differenzia le lesioni in base al tessuto proliferativo dominante. L’OMS riconosce un ulteriore gruppo di lesioni, incluse sotto il termine «altre lesioni ossee» e, tra queste, inserisce la cisti ossea solitaria, una lesione ossea che, per i suoi particolari aspetti istopatologici è spesso chiamata anche «pseudocisti». Nonostante questa lesione sia reperita raramente, essa deve essere considerata dal clinico in corso di diagnosi differenziale con le altre lesioni dei mascellari, poiché la terapia e la prognosi sono specifiche. Questo lavoro presenta la nuova classificazione delle lesioni neoplastiche dei tessuti duri e molli del distretto cranio-faciale secondo l’OMS e un caso clinico di due lesioni ossee solitarie della mandibola che, per l’insolita simmetria delle lesioni stesse, necessitano di attenta diagnosi differenziale al fine di distinguerle come lesioni primarie da lesioni infiammatorie o secondarie a patologie sistemiche. Il corretto iter diagnostico e l’approccio chirurgico alle lesioni hanno permesso di ottenere completa remissione delle lesioni nell’arco di 12 mesi. Il follow-up radiografico, protratto per 24 mesi, ha permesso di controllare la guarigione e l’assenza di recidive

Criteri di realizzazione delle dime radiologiche e chirurgiche per impianti osteointegrati

Obiettivi: Descrivere l’uso della dima sia in fase diagnostica sia come guida durante la fase chirurgica e le corrette procedure di laboratorio che garantiscono l’ef!cacia di tali dispositivi. Materiali e metodi: Sono descritti distintamente i passaggi per la realizzazione della dima radio- gra!ca e chirurgica, tenendo conto di alcuni utili criteri realizzativi. Ciascuna fase realizzativa è accompagnata da immagini esplicative. Vengono illustrati gli aspetti fondamentali per la realiz- zazione delle dime da parte dell’odontotecnico, aspetti che hanno diretti e immediati effetti e risvolti sull’ef!cacia e utilità della dima stessa durante il suo uso clinico. Alla !ne del lavoro sono presentati anche alcuni casi clinici esempli!cativi. Risultati e conclusioni: L’implantologia “prote- sicamente guidata” prevede il posizionamento degli impianti in zone in cui il restauro prote- sico dovrebbe essere idealmente posizionato. In quest’ottica l’uso delle dime radiologiche e chirurgiche ha un ruolo fondamentale. L’utilizzo delle dime, infatti, riduce i rischi connessi alla scorretta piani!cazione implantare e permette l’ottimizzazione della terapia implantare garan- tendo il posizionamento del numero adeguato di impianti. Inoltre è possibile piani!care pre- operatoriamente anche la dimensione e la lun- ghezza degli impianti stessi, riducendo anche il costo delle operazioni e dello stesso intervento

L’ansiolisi farmacologica nel paziente pediatrico

Sottoporsi a una procedura odontoiatrica crea livelli di stress e di ansia più o meno importanti nel- la maggior parte dei pazienti. Le procedure dentarie sono classificate come procedure associate a un basso livello di dolore, ma a un elevato livello di ansia. L’ansia per la pre- stazione odontoiatrica nel bambino si instaura a seguito della concomitanza di diversi fattori, personali ed esogeni, che vanno attentamente valutati. SCOPODELLAVOROQuesto lavoro ha l’obiettivo di descrivere i meccanismi neurofisio- logici di instaurazione dello stato ansioso e illustrare le strategie per ottenere ansiolisi. MATERIALI EMETODI Attra- verso la revisione della letteratura internazionale sono analizzati i metodi per ottenere ansiolisi, farmacologici e non farmacologici. RISULTATI ECONCLUSIONI Per ottenere an- siolisi nel paziente pediatrico, il ricorso a farmaci deve es- sere l’ultima opzione considerata, in quanto tutte le tecni- che psicologiche (metodi psicocomportamentali, art-the- rapy, videogame ecc.) devono essere tentate per primi da parte dell’odontoiatra. Se con tali metodi non è possibile ottenere collaborazione, e si deve ricorrere alla sedazione cosciente del paziente pediatrico, devono essere attenta- mente considerate le problematiche legate all’uso di far- maci nei pazienti pediatrici

Valutazione dell’apparato di sostegno di impianti singoli a supporto di protesi fissa: considerazioni cliniche.

AIM: Assessment of peri-implant tissues around single implant-supported single fixed crown restorations can follow different protocols. The aim of this study was to asses peri-implant hard and soft tissues according to clinical periodontal parameters, modified for implant standard, and to radiographic parameters, and to test correlations between clinical parameters and historical bone loss. METHODS: Forty-two Brànemarks implants (implant-supported single fixed crown restorations positioned between two natural teeth) inserted in 24 patients were assessed according to clinical and radiographic parameters, without removing the prosthetic crown. RESULTS: All implants were judged successful according to published criteria. Results of some clinical parameters differed between smokers and non-smokers. Radiographic measurements of peri-implant bone loss were in line with published data. Bone loss also correlated with the distance between adjacent teeth and implants. CONCLUSION: Radiographic parameters were found to be the most appropriate for evaluation of successful implants. While clinical parameters proved useful for distinguishing immediately between swollen and healthy tissues, they did not indicate a negative prognosis for osseointegration nor for potential complications affecting peri-implant soft tissues

Cisti Follicolare Mandibolare: Caso Clinico.

viene presentato un caso clinico di cisti follicolare a carico di terzo molare semi incluso. l'articolo descrive aspetti eziologici, patologici, clinici, diagnostici e terapeutici di questo tipo di neo formazione

A simplified composite outcome measure to assess the effect of periodontal regenerative treatment in intraosseous defects

Background To propose a novel composite outcome measure (COM) for periodontal regenerative treatment of intraosseous defects. Methods COM is based on the combination of clinically relevant clinical attachment level (CAL) gain (>= 3 mm) and pocket closure (post-surgery probing depth [PD] <= 4 mm). Treatment was regarded as successful when a clinically relevant CAL gain was associated with pocket closure, and failing when either clinically relevant CAL gain and pocket closure were not achieved. The effect of the different regenerative treatments was both collectively and separately evaluated according to COM in a defect cohort accessed by Single Flap Approach (SFA). Results In the entire study cohort, the procedure resulted in a 6-month CAL gain of 3.7 +/- 1.9 mm, which was clinically relevant in 71.8% of patients. Six-month residual PD was 3.7 +/- 1.1 mm, with pocket closure recorded in 79.6% of patients. COM revealed a successful treatment in 60 patients (58%), and a treatment failure in 7 patients (7%). Mean CAL gain was clinically relevant for each treatment, whereas the residual PD values were consistent with pocket closure for the majority of treatment options. However, when COM was used to rate the treatment outcome of each procedure, it appeared that a successful treatment ranged from 41.5% to 77.5%, whereas treatment failure varied from 3% to 15% for different treatments. Conclusions Compared to single probing measurements, COM seems (1) more accurate in capturing the overall benefit of the regenerative procedure and (2) to better identify which factor (CAL gain, residual pocket) mainly contributed to determine a treatment failure

Early childhood caries: case series and suggestions.

The early childhood caries (ECC) is a chronic illness common in children below 6 years. It is a syndrome characterized by presence of deciduous teeth multiple caries lesions. Scientific evidence indicate that ECC is an infectious and transmissible disease. Streptococcus mutans and other cariogenic bacteria are the microbiological agents in the disease. Prolonged contact between sugars in the liquids (like milk and juices) and cariogenic bacteria on the teeth increases caries risk. Lack of appropriate preventive measures can lead to multiple caries in susceptible infants. Ethiological aspects of ECC are investigated. After clinical case presentation, program of counseling, oral hygiene instruction, fluoride treatments, and restorative care effectiveness is described

A simplified composite outcome measure to assess the effect of periodontal regenerative treatment in intraosseous defects

Background: to propose a novel composite outcome measure (COM) for periodontal regenerative treatment of intraosseous defects. Methods: COM is based on the combination of clinically relevant CAL gain (≥ 3 mm) and pocket closure (post-surgery PD≤ 4 mm). Treatment was regarded as successful when a clinically relevant CAL gain was associated with pocket closure, and failing when either clinically relevant CAL gain and pocket closure were not achieved. The effect of the different regenerative treatments was both collectively and separately evaluated according to COM in a defect cohort accessed by Single Flap Approach (SFA). Results: In the entire study cohort, the procedure resulted in a 6-month CAL gain of 3.7±1.9 mm, which was clinically relevant in 71.8% of patients. Six-month residual PD was 3.7±1.1mm, with pocket closure recorded in 79.6% of patients. COM revealed a successful treatment in 60 patients (58%), and a treatment failure in 7 patients (7%). Mean CAL gain was clinically relevant for each treatment, whereas the residual PD values were consistent with pocket closure for the majority of treatment options. However, when COM was used to rate the treatment outcome of each procedure, it appeared that a successful treatment ranged from 41.5% to 77.5%, whereas treatment failure varied from 3% to 15% for different treatments. Conclusions: Compared to single probing measurements, COM seems 1) more accurate in capturing the overall benefit of the regenerative procedure and 2) to better identify which factor (CAL gain, residual pocket) mainly contributed to determine a treatment failure

Awareness of prevention and treatment of bisphosphonate-related osteonecrosis of the jaws among dental practitioners in Ferrara.

Objectives. The aim of this study was to assess the awareness of bisphosphonate-related osteonecrosis of the jaws (BRONJ) among dental practitioners from Ferrara (Italy) and to verify their knowledge about BRONJ primary and secondary prevention, early diagnosis and therapy. Methods. Within a period of 12 months two different questionnaires were created ad hoc, consisting of 27 questions and delivered as online and hard copy form to 310 dental practitioners. The online survey was carried out by the data processing platform Google Docs©. During local cultural meetings, developed periodically by cultural Association ANDI and AIO in Ferrara, printed questionnaires were delivered hand by hand to dental practitioners. Results. Total responsiveness was 37.3%. 7% of respondents had never treated patients taking BP medications. Among dentists who have been in contact with patients taking BP medications (93%), both oral or intravenous. Large part noticed BRONJ in patients taking BP medications (34.6%). Considering BRONJ onset, 21% lesions were related to dental extractions or trauma to the jaw bones. 70% of those observing BRONJ required x-ray of jaws for complete staging and diagnosis. After BRONJ diagnosis, 56% of respondents haven’t dealt with BRONJ patients anymore. 10.5% of respondents who diagnosed at least one lesion, decided to recommend drug holiday, local antiseptic and oral antibiotic therapy, analgesic/anti-inflammatory therapy and surgical debridement of necrotic bone. 36% of re- spondents chose clinical features and guidelines for the management of BRONJ from articles in scientific journals and national and international guidelines. 87% are interested in more information on the prevention and manage- ment of risk of BRONJ. Conclusions. The advantages of the online questionnaire are related to a larger pool of sampling and to the great congruence between answers provided. Considering different studies in literature, responsiveness to this question- naire achieved the highest percentage of responsiveness. The dual mode of administration of the questionnaire was useful to overcome digital bias