L'abolitio criminis "parziale" tra vincoli costituzionali e aporie processuali

Il saggio affronta la problematica della successione di norme penali nel tempo analizzando la giurisprudenza successiva alla sentenza delle Sezioni Unite del 2003 (Giordano). Si mette in evidenza come, al di l\ue0 di una conformit\ue0 apparente alle indicazioni delle Sezioni Unite a favore del criterio strutturale, la giurisprudenza, nei "casi difficili", continui ad utilizzare un criterio sostanzialistico, assimilabile alla teoria della continuit\ue0 del tipo di illecito. Si mette inoltre in evidenza come le statuizioni della Sentenza Giordano pongano rilevanti aporie processuali, relative soprattutto al riconoscimento degli effetti dell''aboilitio criminis "parziale", in relazioni ai processi pendenti nel giudizio di Cassazione, nonch\ue8 ai fatti passati in giudicato

CLINICAL APPLICATION OF AUTOLOGOUSPLATELET RICH PLASMA (P.R.P.) IN THEEXTRACTION OF THIRD IMPACTEDMANDIBULAR MOLAR

The impacted third molar surgery has various limits; one of these limit is the type of surgery applied, often demolitive for the patientswith long term consequeses in the post-op period. Aim of our study is to get a better healing of soft and hard tissues with theapplications of PRP in this type of surgery. 5 patients were included in the study with these requests: the impacted or semiimpacted third molar were on both side; the acceptance of PRP tecnique on one side (considered as the case) the extraction ofthe other impacted molar as the controll side to our case; both teeth were extracted on the same day, both sockets were closedby hermetically suturing the flap; on one socket it has been inserted the platelet gel on the other side nothing. Pre operativemesurements were: 1. probing depth of both the seventh (3.7-4.7); 2. ortopantomography (OPT). Post operative measurementsincluded: 1. probing depth two months after surgery; 2. OPT at one weeek, one month, two month.One week after surgery patiens were aked about the post-op through a questionary on the course of the week, in specific theywere asked to assess a score from one to three on swelling and pain of the two side. One week after a clinician who was out of thestudy (not the surgeon) evaluated the eventual bacterial sovrainfections, the dehicence of the flaps, the eventual collateral effectsgiven by the application of PRP giving a score from one to three to the type of healing. Periodontal healing was evaluated on bothside after 2 months after surgery in all the cases treated the initial P.D. was 2-3mms on both sides. It showed an improvement inthe sites treated with P.R.P. Swelling (perceived by the patients during the course of the fist week) was not reduced by theapplication of PRP gel, while there has been a reduction in the pain in comparison with the control side reffered by the patients.Clinical evaluation realized a week after the extractions showed a better healing on the PRP side vs the controll side (total score12 vs 8) where three patients from five realized a primary closure with no bacterial sovrainfection or dehiscence of the flap vs oneprimary closure on the controll side. Bone healing measured by digital OPT did not show a real improvement on PRP side after twomonths in the cases analyze

Medication-related osteonecrosis of the jaw: clinical and practical guidelines

Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse drug reaction, consisting of progressive bone destruction in the maxillofacial region of patients. ONJ can be caused by two pharmacological agents: Antiresorptive (including bisphosphonates (BPs) and receptor activator of nuclear factor kappa-B ligand inhibitors) and antiangiogenic. MRONJ pathophysiology is not completely elucidated. There are several suggested hypothesis that could explain its unique localization to the jaws: Inflammation or infection, microtrauma, altered bone remodeling or over suppression of bone resorption, angiogenesis inhibition, soft tissue BPs toxicity, peculiar biofilm of the oral cavity, terminal vascularization of the mandible, suppression of immunity, or Vitamin D deficiency. Dental screening and adequate treatment are fundamental to reduce the risk of osteonecrosis in patients under antiresorptive or antiangiogenic therapy, or before initiating the administration. The treatment of MRONJ is generally difficult and the optimal therapy strategy is still to be established. For this reason, prevention is even more important. It is suggested that a multidisciplinary team approach including a dentist, an oncologist, and a maxillofacial surgeon to evaluate and decide the best therapy for the patient. The choice between a conservative treatment and surgery is not easy, and it should be made on a case by case basis. However, the initial approach should be as conservative as possible. The most important goals of treatment for patients with established MRONJ are primarily the control of infection, bone necrosis progression, and pain. The aim of this paper is to represent the current knowledge about MRONJ, its preventive measures and management strategies

Up to a quarter of patients with osteonecrosis of the jaw associated with antiresorptive agents remain undiagnosed

Recent data suggest that the traditional definition of bisphosphonate-associated osteonecrosis of the jaw (ONJ) may exclude patients who present with the non-exposed variant of the condition. To test the hypothesis that a proportion of patients with ONJ remain undiagnosed because their symptoms do not conform to the traditional case definition, we did a secondary analysis of data from MISSION (Multicentre study on phenotype, definition and classification of osteonecrosis of the jaws associated with bisphosphonates), a cross-sectional study of a large population of patients with bisphosphonate-associated ONJ who were recruited in 13 European centres. Patients with exposed and non-exposed ONJ were included. The main aim was to quantify the proportion of those who, according to the traditional case definition, would not be diagnosed with ONJ because they had no exposed necrotic bone. Data analysis included descriptive statistics, median regression, and Fisher's exact test. A total of 886 consecutive patients were recruited and 799 were studied after data cleaning (removal or correction of inaccurate data). Of these, 607 (76%) were diagnosed according to the traditional definition. Diagnosis in the remaining 192 (24%) could not be adjudicated, as they had several abnormal features relating to the jaws but no visible necrotic bone. The groups were similar for most of the phenotypic variables tested. To our knowledge this is the first study in a large population that shows that use of the traditional definition may result in one quarter of patients remaining undiagnosed. Those not considered to have ONJ had the non-exposed variant. These findings show the importance of adding this description to the traditional case definition

Staging of osteonecrosis of the jaw requires computed tomography for accurate definition of the extent of bony disease

Management of osteonecrosis of the jaw associated with antiresorptive agents is challenging, and outcomes are unpredictable. The severity of disease is the main guide to management, and can help to predict prognosis. Most available staging systems for osteonecrosis, including the widely-used American Association of Oral and Maxillofacial Surgeons (AAOMS) system, classify severity on the basis of clinical and radiographic findings. However, clinical inspection and radiography are limited in their ability to identify the extent of necrotic bone disease compared with computed tomography (CT). We have organised a large multicentre retrospective study (known as MISSION) to investigate the agreement between the AAOMS staging system and the extent of osteonecrosis of the jaw (focal compared with diffuse involvement of bone) as detected on CT. We studied 799 patients with detailed clinical phenotyping who had CT images taken. Features of diffuse bone disease were identified on CT within all AAOMS stages (20%, 8%, 48%, and 24% of patients in stages 0, 1, 2, and 3, respectively). Of the patients classified as stage 0, 110/192 (57%) had diffuse disease on CT, and about 1 in 3 with CT evidence of diffuse bone disease was misclassified by the AAOMS system as having stages 0 and 1 osteonecrosis. In addition, more than a third of patients with AAOMS stage 2 (142/405, 35%) had focal bone disease on CT. We conclude that the AAOMS staging system does not correctly identify the extent of bony disease in patients with osteonecrosis of the jaw