Importance of CBCT in the management plan of upper canine with internal resorption

Abstract Aim Internal root resorption is a particular medical condition which requires the clinician to a treatment as early as possible to avoid complications such as excessive loss of mineralized tissues and periodontal communications. Methodology This article describes the diagnosis and treatment of a case of internal resorption of an upper canine in a patient of 21 years. The presence of pain and swelling periodontal gum showed an interest, a sign of the presence of a perforation. Result and conclusions Accurate diagnosis associated with the three-dimensional evaluation of the internal fault (CBCT examination) have allowed a conservative treatment who has allowed the recovery of the tooth

Ludwig's angina: a case report with a 5-year follow-up

Aim: Ludwig's angina is a rare aggressive infection, often of dental origin, characterized by a rapid spread of cellulitis in the submandibular and sublingual spaces. Ludwig's angina is potentially fatal, if it obstructs the airways and if it is not treated with appropriate antibiotic therapy. Summary: The case report describes the diagnosis and the management of a Ludwig's angina caused by an endodontic infection in a 16 years-old female patient. The infection has been caused by a decay of the second lower right molar. After hospitalization and systemic antibiotic therapy, in accordance with the patient and the parents endodontic and restorative treatments of the tooth were performed. After 3 and 5 years, the radiological examination revealed no periapical lesions around right lower second molar and the presence of lamina dura. Key learning points: This aggressive infection may often be undervalued and this may cause dangerous consequences to the patient's life. The infection can be prevented by periodic dental care and interventions, which can avoid odontogenic infections. In the case of Ludwig's angina, early diagnosis is fundamental to save the patient's life. After the initial antibiotic therapy and once the life of the patient is no longer at risk, an appropriate endodontic therapy can be considered a valid therapy for this disease. Riassunto: Obiettivi: L'angina di Ludwig è un'infezione aggressiva, spesso di origine odontogena, caratterizzata da una raccolta cellulitica a rapida evoluzione che coinvolge gli spazi sotto-mandibolare e sotto-linguale. Essa può ostruire le vie respiratorie ed essere potenzialmente fatale se non tempestivamente trattata con cure antibiotiche appropriate. Riassunto: In questo articolo viene descritto un caso di diagnosi e trattamento di un'angina di Ludwig causata da un'infezione odontogena in una ragazza di 16 anni. L'infezione é stata causata da una carie a carico del secondo molare inferiore di destra. Dopo il ricovero ospedaliero ed una terapia antibiotica sistemica parenterale, con il consenso dei genitori abbiamo è stata eseguita una terapia endodontica e la successiva ricostruzione con materiali adesivi dell'elemento dentario in questione. Dopo 3 e 5 anni gli esami radiografici mostrano assenza di lesioni periapicali e la presenza della lamina dura. Punti chiave di apprendimento: Questa infezione aggressiva è spesso sottovalutata e ciò può causare conseguenze gravi per la vita del paziente. Tali infezioni possono essere prevenute con controlli periodici del cavo orale. In caso di angina di Ludwig una diagnosi tempestiva è fondamentale per salvare la vita del paziente. Dopo l'iniziale terapia antibiotica ed aver messo in sicurezza la salute generale del paziente, la terapia endodontica può essere considerata una valida alternativa per questa patologia. Keywords: Ludwig's angina, Endodontic therapy, Endodontic infection, CBCT, Management infection, Parole chiave: Angina di Ludwig, Terapia endodontica, Infezione endodontica, CBCT, Gestione dell'infezion

Le perforazioni radicolari iatrogene: classificazione e possibilità di trattamento ortogrado

RiassuntoObiettivoScopo dell'articolo è descrivere le principali classificazioni delle perforazioni iatrogene e valutare le più attuali tecniche di trattamento per via ortograda.Materiali e metodiLe perforazioni di tipo iatrogeno della radice sono per definizione tragitti artificiali che mettono in comunicazione l'endodonto con le strutture parodontali di sostegno del dente. La causa di tali comunicazioni è legata ad errori commessi dall'operatore durante le diverse fasi del trattamento endodontico. Le perforazioni possono essere classificate in relazione alla loro posizione e alla loro dimensione.RisultatiGrazie al supporto di sistemi ingrandenti quali il microscopio operatorio e l'impiego di materiali per la riparazione come il mineral trioxide aggregate, oggi è possibile migliorare la prognosi di questi trattamenti.ConclusioniLa posizione della perforazione in relazione all'attacco epiteliale e alla cresta ossea è importante per stabilire una corretta prognosi. L'applicazione di protocolli operativi rigorosi con l'impiego del mineral trioxide aggregate consentono di migliorare la prognosi di elementi con perforazione radicolare.SummaryObjectiveAim of this paper is to describe iatrogenic perforations of the root canal system, to classify them and to evaluate the methods and techniques available to treat them.Materials and methodsIatrogenic perforations of the root canal system are defined as artificial communications between the endodontic environment and the periodontal tissue surrounding the dental root. Often, some procedural errors related to the operative techniques employed during the endodontic treatment may lead to misshaping or, in the worst cases, perforation. These communications might be divided into several classes and are classified according to the site, dimension and location of the perforation.ResultsDue to technical supports like magnification loups or operative microscope the dentist might have the advantage to locate and seal the perforation with some new biocompatibile materials such as mineral trioxide aggregate, making this separative procedure more predictable than in the past.ConclusionsThe perforation position related to epithelial junction and bony crest is strategic from a clinical point of view in order to establish a correct prognosis. A clear operative protocol and the use of proper sealing materials could both lead to a better prognosis for all treatable root canal perforations

Inpatients’ and outpatients’ satisfaction: The mediating role of perceived quality of physical and social environment

This study analyses the processes through which the physical environment of health care settings impacts on patients' well-being. Specifically, we investigate the mediating role of perceptions of the physical and social environments, and if this process is moderated by patients' status, that is, if the objective physical environment impacts inpatients' and outpatients' satisfaction by different social-psychological processes. Patients (N=206) evaluated the physical and social environments of the care unit where they were receiving treatment, and its objective physical conditions were independently evaluated by two architects. Results showed that the objective environmental quality affects satisfaction through perceptions of environmental quality, and that patients' status moderates this relationship. For inpatients, it is the perception of quality of the social environment that mediates the relationship between objective environmental quality and satisfaction, whereas for outpatients it is the perception of quality of the physical environment. This moderated mediation is discussed in terms of differences on patients' experiences of health care environments

Patient-reported outcome measures in patients with familial cerebral cavernous malformations: results from the Treat_CCM trial

BackgroundThe Phase 1/2 Treat_CCM randomized controlled trial for people with familial cerebral cavernous malformations (FCCMs) confirmed the safety of propranolol and suggested beneficial effects on intracerebral hemorrhage or new focal neurological deficits, but the effects on patient-reported outcome measures have not been reported.MethodsParticipants completed self-reported questionnaires at baseline, 1 and 2 years. Depression was assessed with the Beck Depression Inventory-II (BDI-2); Anxiety with the State–Trait Anxiety Inventory X1 and X2 (STAI X-1 and STAI X-2); and Quality of Life with the Short Form 36 (SF-36), split into the physical and mental component scales (PCS and MCS). Differences between treatment groups and the general population were assessed. Change over time by treatment was assessed by means of mixed models.ResultsIn total, 71 participants (48 propranolol and 23 standard care) were enrolled, of whom 61 (73%) completed questionnaires at baseline and 2-year FU. At baseline, no differences between treatment groups for any of the questionnaires were present. Twenty (31.7%) patients were considered depressed at baseline, while this proportion was lower in the propranolol group after 2 years (28.6% vs. 55.5%, p = 0.047). The STAI X-1 and X-2 scores were stable over time. PCS was lower in FCCM patients as compared with the general Italian population, while the MCS was similar to the general population. No effect of propranolol was found for both PCS and MCS.ConclusionDepression is common among patients with FCCM. Patients randomized to propranolol had a lower proportion of participants with depression after 2 years.Clinical trial registration: https://clinicaltrials.gov/, identifier (NCT03589014)

An index-based checkpointing algorithm for autonomous distributed systems

This paper presents an index-based checkpointing algorithm for distributed systems with the aim of reducing the total number of checkpoints while ensuring that each checkpoint belongs to at least one consistent global checkpoint (or recovery line). The algorithm is based on an equivalence relation defined between pairs of successive checkpoints of a process which allows us, in some cases, to advance the recovery line of the computation without forcing checkpoints in other processes. The algorithm is well-suited for autonomous and heterogeneous environments, where each process does not know any private information about other processes and private information of the same type of distinct processes is not related (e.g., clock granularity, local checkpointing strategy, etc.). We also present a simulation study which compares the checkpointing-recovery overhead of this algorithm to the ones of previous solutions. © 1999 IEEE

An index-based checkpointing algorithm for autonomous distributed systems

This paper presents an index-based checkpointing algorithm for distributed systems with the aim of reducing the total number of checkpoints while ensuring that each checkpoint belongs to at least one consistent global checkpoint (or recovery line). The algorithm is based on an equivalence relation de ned between pairs of successive checkpoints of a process which allows, in some cases, to advance the recovery line of the computation without forcing checkpoints in other processes. The algorithm is well suited for autonomous and heterogeneous environments where each process does not know any private information about other processes and private information of the same type of distinct processes is not related (e.g., clock granularity, localcheckpointing strategy, etc.). We also present asimulation study which compares the checkpointing-recovery overhead of this algorithm to the ones of previous solutions

Post-Operative Endodontic Pain Management: An Overview of Systematic Reviews on Post-Operatively Administered Oral Medications and Integrated Evidence-Based Clinical Recommendations

Endodontic treatment comprises the overall management of pre-, intra- and post-operative symptoms, including post-operative endodontic pain, considered as a complication susceptible of chronicization. Post-operative pain is very common and highly unpreventable and has a multi-factorial etiology and a potential pathogenic link to the acute inflammation of the periapical area, secondary to localized chemical, mechanical, host and/or microbial damage occurring during endodontic treatment. Considering the multitude of heterogeneous technical and pharmacological approaches proposed to control post-operative endodontic pain, the present study primarily comprised an overview of systematic reviews of systematic reviews of randomized clinical trials, summarizing findings on post-operatively administered oral medications for post-operative endodontic pain control, in order to note the most effective type and dosage of such drugs. Secondarily, a narrative review of the current evidence on technical solutions to be observed during endodontic treatment procedures, to control post-operative pain, was conducted to provide integrated evidence-based clinical recommendations for optimal post-operative endodontic pain management