Valutazione delle anomalie dentarie in soggetti con differenti tipi di schisi orofacciali

Background and aim: Subjects with nonsyndromic cleft lip and/or palate (CLP) present high frequency of hypodontia, both inside and outside the cleft region, which may represent a complicating factor for the dental management. Our aim was to evaluate the prevalence of tooth agenesis in a large sample of cleft subjects and to evaluate the relation with gender, cleft type and sidedness. Materials and methods: Tooth agenesis was identified from serial panoramic radiographs of 293 subjects (123 female, 170 male) with unilateral (66%), bilateral CLP (17%) and isolated cleft palate (17%). Association between tooth agenesis and the different variables was assessed by chi-square test and Poisson regression model (P<0.05). Odds Ratio (OR) was calculated for the different cleft types. Results: A hypodontia prevalence of 50,17% (excluding third molars) was found for the overall cleft group. A considerably higher incidence of missing teeth was found in the maxilla compared with the mandible. The highest rates of agenesis were observed in the anterior region on the cleft sides. Upper lateral incisor and upper and lower second premolars were missing most frequently. Bilateral CLP showed a statistically significant difference in the prevalence of agenesis (P<0,001) and a higher risk of simultaneous agenesis of both maxillary incisors (OR=47). Conclusions: There is a high prevalence of tooth agenesis associated with orofacial clefts. Missing maxillary lateral incisors and second premolars were found more frequently, and occurred mainly in the cleft area

Cyst-like periapical lesion healing in an orthodontic patient: A case report with five-year follow-up

Abstract Aim To report the orthodontic movement of two central incisors through the healing site of a maxillary cyst-like lesion of endodontic origin after nonsurgical treatment. Case summary This report shows the treatment of a 18-year old patient, male, with a Class II division 2 malocclusion. He came to our attention seeking for orthodontic treatment. Radiographic examinations revealed a large cyst-like lesion in the maxillary anterior area, extending from the mesial surface of tooth 12 to the distal surface of tooth 21. The two upper incisors were nonresponsive to pulp sensitivity tests. Endodontic treatment was performed first. One week after root canal treatment had been completed with gutta-percha fillings, orthodontic treatment was started while the bone lesion healing was still underway. At the end of the orthodontic treatment, incisor retroclination was corrected, periapical lesion healing was completed and there were no signs of root resorption. The five-year follow-up revealed that occlusal relationship and dental alignment were kept stable and excellent radiographic resolution of the periapical lesion was obtained

Effect of pH on in vitro biocompatibility of orthodontic miniscrew implants

BACKGROUND: Although the clinical use of miniscrews has been investigated on a large scale, little is known about their biocompatibility. Since low pH can affect corrosion resistance, the aim of this study was to evaluate the cytotoxic effect of orthodontic miniscrews in different pH conditions. METHODS: Four orthodontic miniscrews of stainless steel and grade IV and grade V titanium were immersed in a pH 7 and pH 4 saline solution for 1, 7, 14, 21, 28, and 84 days. Human osteogenic sarcoma cells (U2OS), permanent human keratinocytes (HaCat), and primary human gingival fibroblasts (HGF) were exposed to eluates, and the mitochondrial dehydrogenase activity was measured after 24 h to assess the cytoxicity. The results were analyzed using the Mann-Whitney U test (P < 0.05). RESULTS: When exposed to pH 7-conditioned eluates, the cell lines showed an even greater viability than untreated cells. On the contrary, the results revealed a statistically significant decrease in U2OS, HaCat, and HGF viability after exposure to eluates obtained at pH 4. Among the cell lines tested, HGF showed the most significant decrease of mitochondrial activity. Interestingly, grade V titanium miniscrews caused highest toxic effects when immersed at pH 4. CONCLUSIONS: The results suggested that at pH 7, all the miniscrews are biocompatible while the eluates obtained at pH 4 showed significant cytotoxicity response. Moreover, different cell lines can produce different responses to miniscrew eluates

Biocompatibility of Orthodontic Resins: In vitro Evaluation of Monomer Leaching and Cytotoxic Effects

The aim of this study was to investigate the effect of orthodontic resins on cell survival and to evaluate monomer leaching both before and after resin polymerization. Materials and methods: 3T3 mouse fibroblasts were exposed to three cured and uncured orthodontic resins. Cellular viability was assessed by Alamar Blue assay after 24, 48 and 72 h. High Performance Liquid Chromatography was used to measure the amount of monomers released by the tested samples. Data were analyzed by means of ANOVA and Tukey's test (p<0.05). All tested materials exerted a cytotoxic response. Cytotoxicity tests showed that the uncured samples were more cytotoxic than the polymerized ones. A time-dependent reduction in cellular viability was found. Monomer release analyses indicated a higher elution of Triethylene Glycol Dimethacrylate (TEGDMA) compared to Bisphenol A Glycidyl Methacrylate. TEGDMA release was higher in the uncured samples and showed a time-dependent pattern. Our results showed the role of resin curing in determining the cytotoxic effect of orthodontic resins and suggested that the differences in the chemical composition of resin matrix appeared to be much more related to the decrease in cell viability than the amount of monomer leaching from orthodontic resins. Clinicians should pay greater attention to resin curing after bracket placement in order to reduce the potentially dangerous effect of monomer release

Ligneous periodontal lesions in a young child with severe plasminogen deficiency: a case report

BACKGROUND: Ligneous periodontitis or gingivitis is a rare periodontal disorder, secondary to plasminogen deficiency, characterised by nodular gingival enlargements and progressive destructive membranous periodontal disease. CASE REPORT: We describe the early and successful dental management of a case of ligneous gingivitis secondary to plasminogen deficiency in a 6-year- old girl. The patient was referred because of a nodular asymptomatic gingival hypertrophy with ulceration around the eruption site of tooth 36, without any detectable tooth mobility. After non-surgical management of the lesion and strict follow-up, the first molar erupted completely, with no signs of bone and periodontal disease. CONCLUSION: Ulcerated periodontal lesions could represent the ?rst signs of plasminogen deficiency. The early treatment is essential in preventing infections and the onset of a destructive periodontitis. The paediatric dentist may play a key role in early diagnosis and treatment

How did the Introduction of Biosimilar Filgrastim Influence the Prescribing Pattern of Granulocyte Colony-Stimulating Factors? Results from a Multicentre, Population-Based Study, from Five Italian Centres in the Years 2009\u20132014

Background Granulocyte colony-stimulating factors (G-CSFs) are biological products for which the main indication of use is chemotherapy-induced neutropenia. Biosimilars of G-CSFs have been available in Europe since 2007. Objective The objective of this study was to investigate the prescribing pattern of G-CSFs in five Italian centres using different healthcare policy interventions to promote the use of biosimilars in routine care. Methods This retrospective, population-based drug utilization study was conducted during the years 2009\u20132014 using the administrative databases of the Caserta, Treviso and Palermo Local Health Units (LHUs) and the Tuscany and Umbria regions. G-CSF users were characterized and the prevalence of use, proportion of biosimilar users and switching pattern of different G-CSFs were evaluated over time and across centres. Results Overall, 30,247 patients were treated with G-CSFs in the years 2009\u20132014, of which 29,083 (96.2 %) were na\uefve users. The overall prevalence of G-CSF use increased from 0.8 per 1000 inhabitants in 2009 to 1.1 per 1000 in 2014. An increase in the proportion of the use of the biosimilar filgrastim by the total G-CSF users was observed in all centres: from 0.2 % (2009) to 66.2 % (2014). However, heterogeneity across different centres was reported, with the largest increase in Treviso LHU (from 0 to 89.1 % from 2009 to 2014). During the first year of treatment, switching between different G-CSFs was frequent (20.3 %). Conclusions Heterogeneity in the use of G-CSF and, in particular, biosimilar filgrastim across different Italian centres was observed, probably due to different regional healthcare policy interventions. During the first year of treatment, switching between different G-CSFs was frequent. Considering the impact of biological drugs on pharmaceutical expenses, it is necessary to harmonize healthcare policies promoting the use of biological drugs with the lowest cost

In Search of Predictors of Switching Between Erythropoiesis-Stimulating Agents in Clinical Practice: A Multi-Regional Cohort Study

Background and objectives: Switching between different erythropoiesis-stimulating agents (ESAs) during the first year of therapy is frequent (15\u201320%), much more so toward reference products than biosimilars. The objectives of this study were to investigate the frequency and identify the potential predictors of switching between biosimilar and originator ESAs during the first year of treatment in patients with chronic kidney disease (CKD), or chemotherapy-related anemia from six large Italian geographic areas in the years 2009\u20132015. Methods: A retrospective cohort study was conducted using six Italian regional claims databases ( 65 13\ua0million inhabitants) during 2009\u20132015. Among incident epoetin users, the frequency of single, multiple, and backward switch during the first year of treatment was evaluated. Using frailty Cox models, potential predictors of first switch were identified. All analyses were stratified by the main indications for use. Results: Among 102,240 incident epoetin users, 15,853 (15.5%) switched to another epoetin during the first year of therapy; only 18% of these switched to biosimilars. Single switch was more common (62.2% of the switchers) than multiple (23.5%) or backward switch (14.3%). In cancer, the cumulative number of transfusions and iron preparations dispensed, as well as hyperparathyroidism, were predictors of switching. In CKD, the cumulative number of transfusions, number of vitamin A/D preparations dispensed, and CKD severity increased the probability of switching. Conclusions: Switching between ESAs was frequent in both CKD and cancer patients. The number of cumulative transfusions and severity of disease seemed to affect the switch

Effectiveness and Safety of Switching Originator and Biosimilar Epoetins in Patients with Chronic Kidney Disease in a Large-Scale Italian Cohort Study

Introduction: Real-world data on the comparative effectiveness and safety of switching among different epoetins (including originators and biosimilars) are limited. In light of current debate about interchangeability, prescribers, some patient groups and decision makers are calling for additional post-marketing evidence on the clinical effects of switching between originator and biosimilar epoetins in chronic kidney disease (CKD) patients. Objective: The objective of this study was to evaluate the effectiveness and safety of switching versus non-switching and of switching from originator/biosimilar epoetin alpha (ESA\ua0\u3b1) to any other epoetin in CKD patients. Methods: An observational, record-linkage, multi-database, retrospective cohort study was carried out in four Italian geographical areas. All subjects with at least one ESA\ua0\u3b1 dispensing between 1 January 2009 and 31 December 2015 were retrieved. Switching was defined as any transition between originator/biosimilar ESA\ua0\u3b1 to any other epoetin in a series of two consecutive prescriptions up to 2\ua0years. Switchers were matched 1:1 with non-switchers by baseline propensity score and by duration of ESA\ua0\u3b1 treatment. Switchers and non-switchers were followed up from switching date to a maximum of 1\ua0year. Lack of effectiveness and safety of switching versus non-switching were evaluated through Cox regression models (hazard ratio [HR], 95% confidence interval [CI]). A direct comparison between the two switcher categories (switchers from originator/biosimilar ESA\ua0\u3b1 to any other epoetin) was also performed. Results: Overall, 14,400 incident users of ESA\ua0\u3b1 for anaemia due to CKD (61.4% originator, 38.6% biosimilar) were available for analysis. During the follow-up, we found no differences on effectiveness (HR 1.02, 95% CI 0.79\u20131.31 originators; HR 1.16, 95% CI 0.75\u20131.79 biosimilars) and safety outcomes (HR 1.08, 95% CI 0.77\u20131.50 originators; HR 1.20, 95% CI 0.66\u20132.21 biosimilars) between switchers and non-switchers of ESA\ua0\u3b1. Cumulative probabilities of recording an adverse event, either in terms of lack of effectiveness or safety issue, were the same for two switching categories Conclusions: In this large-scale Italian observational multi-database study, switching versus non-switching as well as switching from biosimilar/originator ESA\ua0\u3b1 to any other epoetin in CKD patients is not associated with any effectiveness and safety outcomes