Delayed acellular dermal matrix assisted prepectoral breast reconstruction: Preliminary results.

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update on one stage immediate breast reconstruction with definitive prosthesis after sparing mastectomies

Abstract Immediate breast reconstruction after skin and nipple-sparing mastectomies is commonly performed as a two-stage procedure; to overcome the paradox of traditional two-stage tissue expander/implant reconstruction used to create a tight muscular pocket that needs expansion to produce lower pole fullness, while losing the laxity of the mastectomy skin flaps, the authors conceived a subpectoral-subfascial pocket by elevating the major pectoral muscle in continuity with the superficial pectoralis fascia up to the inframammary fold. This alteration allowed for the immediate insertion of the definitive implant. The authors present their experience in 220 cases of immediate one-stage breast reconstructions with definitive prostheses in sparing mastectomies. Immediate and long-term local complications were evaluated. Immediate breast reconstruction with definitive anatomical silicone-filled implants can produce excellent cosmetic results (78.6%) with a low rate of complications (17.7%); these results allow for agreement between oncologic, aesthetic and economic purposes

Regenerative Strategy for Persistent Periprosthetic Leakage around Tracheoesophageal Puncture: Is It an Effective Long-Term Solution?

Autologous tissue-assisted regenerative procedures have been considered effective to close different types of fistula, including the leakage around tracheoesophageal puncture. The aim of this study was to retrospectively review 10 years of lipotransfer for persistent periprosthetic leakage in laryngectomized patients with voice prosthesis. Clinical records of patients who experienced periprosthetic leakage from December 2009 to December 2019 were reviewed. Patients receiving fat grafting were included. The leakage around the prosthesis was assessed with a methylene blue test. Twenty patients experiencing tracheoesophageal fistula enlargement were treated with fat grafting. At the one-month follow-up, all patients were considered improved with no leakage observed. At six months, a single injection was sufficient to solve 75% of cases (n 15), whereas 25% (n 5) required a second procedure. The overall success rate was 80% (n 16). Results remained stable for a follow-up of 5.54 � 3.97 years. Fat grafting performed around the voice prosthesis, thanks to its volumetric and regenerative properties, is a valid and lasting option to solve persistent periprosthetic leakage

Usefulness of an app in improving oral hygiene compliance in adolescent orthodontic patients

Objective: To evaluate the influence of an app-based approach in a protocol for domestic oral hygiene maintenance in a group of adolescent patients wearing fixed multibracket appliances. Materials and Methods: Eighty adolescent patients scheduled to start an orthodontic multibracket treatment were randomly divided into two groups of 40. Plaque index (PI), gingival index (GI), white spots (WS), and caries presence were recorded in all patients, and they were instructed regarding domestic oral hygiene maintenance on the day of braces application (t0) and every 3 months (t1, t2, t3, t4) during the first year of treatment. Study group (SG) patients were enrolled in a WhatsApp chat room-based competition and instructed to share monthly with the other participants two selfphotographs (selfies) showing their oral hygiene status. Results: SG patient participation in the chat room was regular and active throughout the observation period. At t3, t3, and t4, SG patients had significantly lower values of both PI and GI and a lower incidence of new WS and caries, compared with the control group. Conclusion: Integration of new "social" technologies in a standard oral hygiene motivation protocol is effective in improving compliance of adolescent patients and in improving their oral health status during orthodontic multibracket treatment

Maxillary fungus ball: zinc-oxide endodontic materials as a risk factor

open7openNICOLAI, Piero; MENSI, Magda; Marsili, F.; Piccioni, M.; SALGARELLO, Stefano Alessandro; GILBERTI, Maria Enrica; Apostoli, P.Nicolai, Piero; Mensi, Magda; Marsili, F.; Piccioni, M.; Salgarello, Stefano Alessandro; Gilberti, Maria Enrica; Apostoli, P

Early Healing Events around Titanium Implant Devices with Different Surface Microtopography: A Pilot Study in an In Vivo Rabbit Model

In the present pilot study, the authors morphologically investigated sandblasted, acid-etched surfaces (SLA) at very early experimental times. The tested devices were titanium plate-like implants with flattened wide lateral sides and jagged narrow sides. Because of these implant shape and placement site, the device gained a firm mechanical stability but the largest portion of the implant surface lacked direct contact with host bone and faced a wide peri-implant space rich in marrow tissue, intentionally created in order to study the interfacial interaction between metal surface and biological microenvironment. The insertion of titanium devices into the proximal tibia elicited a sequence of healing events. Newly formed bone proceeded through an early distance osteogenesis, common to both surfaces, and a delayed contact osteogenesis which seemed to follow different patterns at the two surfaces. In fact, SLA devices showed a more osteoconductive behavior retaining a less dense blood clot, which might be earlier and more easily replaced, and leading to a surface-conditioning layer which promotes osteogenic cell differentiation and appositional new bone deposition at the titanium surface. This model system is expected to provide a starting point for further investigations which clarify the early cellular and biomolecular events occurring at the metal surface

Long-term bond strength and endogenous enzymatic activity of a chlorhexidine-containing commercially available adhesive

10siObjectives: The aim of this study was to investigate, by the means of microtensile bond strength (μTBS) test, gelatin and in situ zymography, the influence of 0.2% CHX contained within a commercially available adhesive on long-term bond strength and endogenous enzymatic activity. Methods: Non-carious teeth were subjected to μTBS test (N = 15 for each group) and stressed until failure. μTBS was evaluated immediately and after 12-month storage in artificial saliva at 37 °C. Dentin powder was obtained from additional teeth (N = 7) for gelatin zymography, while for in situ zymography, 3 teeth for each group were selected. Gelatin and in situ zymography were performed in dentin powder and slices of dentin, respectively, to assess the ability of 0.2% CHX blended within the adhesive to inhibit endogenous enzymatic activity. Results: μTBS bond strength was higher in the CHX-containing groups, immediately as well as after aging. The bond strength significantly decreased after 12-month aging. The activation of endogenous MMPs was found to be related to the presence of CHX within the adhesive system and the bonding strategy employed. Conclusions: Under this perspective 0.2% CHX blended within Peak Universal adhesive monomer seems to in- crease immediate bond strength, to preserve bond strength over time and to efficiently inhibit endogenous enzymatic activity in dentin. Hence, blending the CHX in low concentrations within the adhesive could be recommended as a feasible technique in every-day clinical practice. Clinical significance: Using CHX-containing adhesives could be recommended due to several benefits: it seems to increase the longevity of the hybrid layer; the inhibitor appears to be efficiently delivered to the dentinal substrate and to inhibit endogenous enzymatic activity, without prolonging chair time.openopenMaravić, Tatjana; Comba, Allegra; Cunha, Sandra Ribeiro; Angeloni, Valeria; Cadenaro, Milena; Visinitini, Erika; Navarra, Chiara Ottavia; Salgarello, Stefano; Breschi, Lorenzo*; Mazzoni, AnnalisaMaravić, Tatjana; Comba, Allegra; Cunha, Sandra Ribeiro; Angeloni, Valeria; Cadenaro, Milena; Visinitini, Erika; Navarra, Chiara Ottavia; Salgarello, Stefano; Breschi, Lorenzo; Mazzoni, Annalis

Guided Zygomatic Implantology for Oral Cancer Rehabilitation: A Case Report

Oral rehabilitation after maxillary oncological resection is challenging. This case report presents the rehabilitation of a 65-year-old Caucasian male adenoid cystic carcinoma patient using a myo-cutaneous thigh flap, zygomatic implant placement, and an immediate fixed provisional prosthesis made with computer-aided technologies. The patient presented complaints of asymptomatic enlarged swelling of 5-mm on the right hard hemi-palate. There was an oro-antral communication deriving from a previous local excision. Preoperative radiographs showed the involvement of the right maxilla, maxillary sinus, and nose with a suspect involvement of the maxillary division of the trigeminal nerve. Treatment was planned through a fully digital workflow. A partial maxillectomy was performed endoscopically, and maxilla was reconstructed using an anterolateral thigh free flap. Two zygomatic implants were inserted simultaneously. A provisional fix full-arch prosthesis was manufactured preoperatively through a fully digital workflow and was placed in the operating room. Following post-operative radiotherapy, the patient received a final hybrid prosthesis. During the follow-up period of two years, the patient reported good function, aesthetics, and significant enhancement in quality of life. According to the results of this case, the protocol represented can be a promising alternative for oral cancer patients with large defects, and can lead to an improved quality of life

Effect of benzalkonium chloride on dentin bond strength and endogenous enzymatic activity

Objective: This in vitro study evaluated at baseline (T0) and over time (T12 months), the effect of a multi-mode universal adhesive compared with two experimental formulations blended with different concentrations of benzalkonium chloride (BAC), on bond strength and endogenous enzymatic activity. Methods and materials: Specimens were assigned to the following groups according to the adhesive protocol: G1) All-Bond Universal (ABU) self-etch (SE); G2) ABU + 0.5% BAC SE; G3) ABU + 1% methacrylate BAC SE; G4) ABU etch-and-rinse (E&R); G5) ABU + 0.5% BAC E&R; G6) ABU + 1% methacrylate BAC E&R. Gelatin zymography was performed on dentin powder obtained from eight human third molars. Endogenous enzymatic activity within the hybrid layer was examined using in situ zymography after 24 h (T0) or 1-year storage in artificial saliva (T12). Forty intact molars were prepared for microtensile bond strength test at T0 and T12. Results were statistically analyzed with three-way ANOVA (\u3b1 = 0.05). Results: Gelatin zymography assay and in situ zymography quantification analyses indicated that all the BAC-containing formulations decreased matrix metalloproteinase expression. However, in situ zymography showed a general trend of enzymatic activity increase after aging. Microtensile bond-strength testing showed decrease in bond strength over time in all the tested groups; performances of the 1% methacrylate BAC experimental groups were worse than the control. Conclusions: BAC-containing adhesives reduce endogenous enzymatic activity both immediately and over time. However, independently from the adhesive employed, increase in the gelatinolytic activity over time and decrease in bond strength was found (especially in the BAC + 1% methacrylate groups), probably due to impaired polymerization properties. Clinical significance: Adhesives containing protease inhibitors are practical and efficient tools in clinical practice for enhancement of the longevity of dental restorations. However, extensive investigation of the mechanical and adhesive properties of the material is necessary prior to their clinical use