Robot-assisted rehabilitation of people with breast cancer developing upper limb lymphedema: protocol of a randomized controlled trial with a 6-month follow‐up

Upper limb lymphedema (ULLy) is an external (and/or internal) manifestation of lymphatic system insufficiency and deranged lymph transport for more than 3 months and frequently affects people as a consequence of breast cancer (BC). ULLy is often underestimated despite diminished motor skills, mood, and cognitive-behavioral complaints negatively condition the health-related quality of life (HRQoL) of persons. BC can also metastasize to the jawbone, further impacting on the HRQoL. In time, the implementation of robot-assisted rehabilitation (RR) for neurological diseases has grown to improve HRQoL and pain. This study aims to evaluate the effectiveness of a RR program in the treatment of individuals who develop an ULLy; as a further analysis, the study will assess the effectiveness of the same program in people with jawbone metastases from BC who will also develop ULLy. A randomized, parallel-group superiority-controlled trial will be conducted. 44 participants will be randomly allocated to either the experimental (receiving a RR program) or the control group (regular rehabilitation). Both groups will follow individual-based programs three times a week for 10 weeks. The main outcome measure will be the Lymphedema Quality of Life Questionnaire. Secondary outcomes will be a pain intensity numerical rating scale and the Cranio-Facial Pain Disability Inventory. Evaluations are before and after training and 6 months later. Findings may provide evidence on the effectiveness of a RR program on inducing improvements in the HRQoL and pain of individuals with ULLy due to BC. People with ULLy and jawbone metastases from BC are expected for similar or higher improvements as per the same comparisons above. This trial might contribute towards defining guidelines for good clinical rehabilitation routines and might be used as a basis for health authorities' endorsements.Trial registration OSF REGISTRIES, osf-registrations-jz7ax-v1 . Registered on 26 June 2023

SILVIO PALAZZI (1892-1979), A PIONEER OF MODERN ITALIAN DENTISTRY

Non è facile analizzare una figura complessa come quella di Silvio Palazzi (1892-1979) (fig.1). Senza dubbio fu uno dei personaggi di maggior spicco nel panorama odontostomatologico italiano per circa un cinquantennio, uno dei protagonisti della trasformazione dell’Odontoiatria pionieristica a in quella scientifica, un precursore ed un uomo con una mentalità aperta, dotato di una visione lungimirante. Personalità eclettica, versatile, da certi punti di vista addirittura geniale ma anche imprevedibile, fu al centro della vita accademica e professionale dell’Odontoiatria italiana; pochi possono vantare un’attività didattica, clinica, scientifica come la sua. Divenuto, in età giovanissima, direttore di una clinica che era ancora poco più che un ambulatorio seppe portarla ad un livello di eccellenza che non aveva riscontri in Italia (fig. 2) e che poteva essere paragonato a quello delle grandi cliniche odontoiatriche europee.Fu autore di un “Trattato di Odontologia” (fig. 3 e 4) che ebbe sette edizioni, sui cui si formarono intere generazioni di dentisti, e di oltre cinquecento pubblicazioni scientifiche tutti i campi dell’Odontostomatologia; predilesse particolarmente le indagini istologiche ed istochimiche, come spesso ricordava, per avere avuto una preparazione impostata in tal senso dalla sua frequenza presso l’istituto di Patologia Generale di Pavia diretto da Camillo Golgi (1843-1926, Premio Nobel per la Medicina nel 1906). In campo clinico ogni settore della Odontoiatria lo vide attento ed appassionato cultore, in particolare dell’Endodonzia e della Parodontologia. Inoltre, fu un pioniere dell’Implantologia quando questa branca riscuoteva più critiche che successi ed iniziò le ricerche sull’azione profilattica del fluoro quando molti erano contrari. Si batté assiduamente per una differente legislazione odontoiatrica: fu un convinto sostenitore di un Corso di Laurea apposito per la preparazione del futuro odontoiatra, già sin dagli anni Cinquanta: poiché questo progetto sembrava di difficile realizzazione, propose se non altro l’obbligo di una specializzazione post-laurea per garantire una formazione idonea. Accanto a ciò, per il suo modo di porsi spesso aggressivo e polemico si alienò l’amicizia di molti colleghi e si creò numerosi nemici. Certamente fu un personaggio che non può passare inosservato e che merita, ad oltre quaranta anni di distanza dalla morte, una attenta valutazione storica.It is not easy to analyse a complex figure like Silvio Palazzi (1892-1979). Without a doubt, he was one of the most prominent figures in the Italian odontostomatology scene for about fifty years and one of the absolute protagonists of the transition of Italian dentistry from the pioneering era to the scientific. He was certainly a precursor and a man with an open mind, endowed with a broad vision. Palazzi had an eclectic, versatile personality, from certain points of view even brilliant but also unpredictable and difficult to understand. He was at the centre of Italian dentistry’s academic and professional life; few can boast of a didactic, clinical, scientific activity like his. Having become, at a young age, the director of a clinic that was still little more than a dental practice, he was able to make it grow, revitalise it, bring it to a level of excellence that had no comparison in Italy but that could be compared to that of the great European dental clinics. He was the author of a “Treaty of Odontology” (which had seven editions) on which entire generations of dentists were formed, and he wrote over five hundred scientific publications in all the fields of Odontostomatology. He particularly favoured histological and histochemical investigations, as he often recalled, for having been trained in this sense by his attendance at the Institute of General Pathology of Pavia directed by Camillo Golgi (1843-1926, Nobel Prize for Medicine in 1906). In the clinical field, every sector of the dental discipline saw him as an attentive and passionate scholar, in particular of Endodontics and Periodontology. Furthermore, he was a pioneer of implantology when this branch received more criticism than success and began research on the prophylactic ac-tion of fluoride when many were against it. He fought assiduously for a different Italian den-tal legislation: he was a convinced supporter of a special Degree Course for the preparation of the future dentists, already in the Fifties. Since this project seemed difficult to carry out, he proposed, if nothing else, the requirement of a post-graduate specialisation to guarantee suitable training to dental practitioners. Despite this, due to his often aggressive and argu-mentative attitude, he lost the friendship of many colleagues and created numerous enemies. Certainly, he was a character who cannot go unnoticed and who, forty years after his death, deserves a careful historical evaluation

Opening and closure forces of sliding mechanisms of different self-ligating brackets

Self-ligating brackets engage the wire by means of a slide mechanism. Forces that have to be applied to open and close the sliding mechanism of brackets are still unknown. Objective The aim of this study was to measure and compare the opening and closure forces of different self-ligating brackets. Material and Methods Three different stainless steel self-ligating brackets (Carriere LX, Ortho Organizers; F1000, Leone; Damon Q, Ormco) were tested. For each different bracket, 20 maxillary right central incisors and 20 mandibular right central incisors were used. Opening and closure forces were measured using an Instron Universal Testing Machine. Statistical analysis was performed and ANOVA and Tukey tests were carried out. Results Opening forces were registered between 1.1 N and 5.6 N, whereas closure forces were recorded between 1.57 N and 4.87 N. Significant differences were detected among the different brackets and between the two prescriptions tested. Conclusion The knowledge of different opening and closure forces of self-ligating brackets can help the orthodontist in the clinical management of these devices

Effect of fluoride application on shear bond strength of brackets bonded with a resin-modified glass-ionomer

PURPOSE: The purpose of this study was to assess the effect of fluoride application at 3 different steps of the bonding process on the shear bond strength and bond failure site of a resin-modified glass ionomer cement. MATERIAL: Sixty stainless steel brackets were bonded to bovine incisors with Fuji Ortho LC (GC Europe, Leuven, Belgium) under 4 different enamel conditions: (1) uncontaminated enamel, (2) enamel precleaned with fluoride-containing prophylaxis paste, (3) 1.1% acidulated phosphate fluoride (APF) gel applied immediately before conditioning, and (4) 1.1% APF gel applied immediately before bonding. After bonding, all samples were stored in distilled water for 24 hours and subsequently tested in shear mode on a universal testing machine. RESULTS: No significant differences were found between groups 1 (uncontaminated enamel) and 2 (fluoride application during prophylaxis). Both groups showed significantly greater shear bond strength values than groups 3 (fluoride application before conditioning) and 4 (fluoride application before bonding). Groups 3 and 4 did not differ significantly. Moreover, no significant differences in debond locations were found among the 4 groups. CONCLUSIONS: Fluoride application during initial prophylaxis does not affect the bond strength values of Fuji Ortho LC, whereas it significantly lowers bond strength values when applied before both conditioning and bonding

Disinclusion of unerupted teeth by mean of self-ligating brackets: effect of blood contamination on shear bond strength

Objectives: The aim of this study was to assess the effect of blood contamination on the shear bond strength and failure site of three different orthodontic self-ligating brackets. Study Design: 240 bovine permanent mandibular incisors were randomly divided into 12 groups of 20 specimens each. Orthodontic self-ligating brackets were tested under four different enamel surface conditions: a) dry, b) blood contamination before priming, c) blood contamination after priming, d) blood contamination before and after priming. Brackets were bonded to the teeth and subsequently tested using a Instron universal testing machine. Shear bond strength values and adhesive failure rate were recorded. Statistical analysis was performed using ANOVA and Tukey tests (strength values), and Chi squared test (ARI Scores). Results: Non-contaminated enamel surfaces showed highest bond strengths for all self ligating brackets. Under blood-contamination shear bond strengths lowered for all brackets tested. Groups contaminated before and after primer application showed the lowest shear bond strength. Significant differences in debond locations were found among the groups under the various enamel surface conditions. Conclusions: Blood contamination of enamel during the bonding procedure lowers bond strength values of self ligating brackets, expecially when contamination occur in different times of the bonding procedure

Microleakage in Class II composite restorations with margins below the CEJ: in vitro evaluation of different restorative techniques

Objectives: The purpose of this in vitro study was to evaluate the microleakage in "deep" Class II composite restorations with gingival cavosurface margin below the CEJ (cemento-enamel junction) and restored with different techniques. Study Design: Fifty human teeth were used. In each tooth two standardized Class II slot cavities (on mesial and on distal surfaces) were prepared: the buccolingual extension of the cavities was 4 mm; the gingival wall was located in dentin/cementum (2 mm beyond the CEJ). The prepared teeth were randomly assigned to 5 experimental groups (of 10 specimens and 20 cavities each) and restored. Group 1: Filtek TM Supreme XTE Flowable (3MESPE) + Universal Filtek Supreme XTE (3MESPE), Group 2: GrandioSO Heavy Flow (Voco) + GrandioSo (Voco), Group 3: SDRTm (Dentsply Caulk) + Esthet-X® HD (Dentsply Caulk), Group 4: SonicFill (Kerr), Group 5: Grandio (Voco). After thermocycling, the specimens were immersed in a 0.5% basic fuchsine dye solution and incubated at 37°C for 24 hours. The teeth were subsequently sectioned mesiodistally. All specimens were examined at 25× in a stereomicroscope and standardized digital images were obtained. Dye penetration was measured from gingival margins. Results: The results demonstrated no significant leakage differences between Group 4 and Group 5, that both showed significantly higher frequency distribution of Score 0. Group 2 and Group 3 showed a significant prevalence of Score 1, whereas Group 1 showed significantly higher frequency of Score 2. Conclusions: None of the restorative techniques tested completely eliminated microleakage dye penetration in dentin margins; marginal adaptation in Class II composite restorations with gingival wall below the CEJ varied in both substrates and from different restorative techniques used

Shear bond strength of one-step self-etch adhesives to dentin : evaluation of NaOCl pretreatment

The aim of this study was to evaluate the influence of dentin pretreatment with NaOCl on shear bond strength of four one-step self-etch adhesives with different pH values. Bovine permanent incisors were used. Four one-step self-etch adhesives were tested: Adper? Easy Bond, Futurabond NR, G-aenial Bond, Clearfil S3 Bond. One two-step self-etch adhesive (Clearfil SE Bond) was used as control. Group 1- no pretreatment; group 2- pretratment with 5,25 % NaOCl; group 3- pretreatment with 37 % H3PO4 etching and 5,25 % NaOCl. A hybrid composite resin was inserted into the dentin surface. The specimens were tested in a universal testing machine. The examiners evaluated the fractured surfaces in optical microscope to determine failure modes, quantified with adhesive remnant index (ARI). Dentin pretreatment variably influenced bond strength values of the different adhesive systems. When no dentin pretreatment was applied, no significant differences were found (P >.05) among four adhesives tested. No significant differences were recorded when comparing NaOCl pretreatment with H3PO4 + NaOCl pretreatment for all adhesive tested (P >.05) except Clearfil S3 Bond that showed higher shear bond strength values when H3PO4 was applied. Frequencies of ARI scores were calculated. The influence of dentin pretreatment with NaOCl depends on the composition of each adhesive system used. There was no difference in bond strength values among self-etch adhesives with different pH values

Clinical evaluation of bond failures and survival between mandibular canine-to-canine retainers made of flexible spiral wire and fiber-reinforced composite

Objectives: The purpose of this longitudinal prospective randomized study was to evaluate the clinical reliability of two different types of postorthodontic treatment retainers: a silanised-treated glass fibers-reinforced resin composite (FRC) and a directly bonded multistranded stainless steel wire. The hypothesis of the study was to assess if significant differences are present between failure rates of the two retainers. Study Design: This prospective study was based on an assessment of 87 patients (35 men and 52 women),with an average age of 24 years who required a lower arch fixed retainer after orthodontic treatment. Patients were divided in two groups. Assignment was carried out with random tables. A follow-up examination was carried out once a month. The number, cause, and date of single bond adhesive failures were recorded for both retainers over 12 months. Teeth that were rebonded after failure were not included in the success analysis. Statistical analysis was performed by means of a Fisher's exact test, Kaplan-Meier survival estimates, and log rank test. Results: Bond failure rate was significantly higher (P=0.0392) for multistranded metallic wire than for FRC. Conclusions: Glass fiber-reinforced resin composite retainers and multistranded metallic wires showed no significant difference in single bond failure rates over a one-year follow up

Imaging Software Programs for Reliable Mathematical Measurements in Orthodontics

Aim: To evaluate the reliability of linear and angular measurements taken using different software programs in orthodontics. Materials and Methods: A sample of four software programs from different manufacturers, namely MicroDicom viewer, Photoshop® CS3, AutoCAD®, and Image-Pro®, were used for measuring the geometric features of four types of miniscrews from different manufacturers. Each miniscrew type presented a group: Group I, Tomas® (Dentaurum, Ispringen, Germany); Group II, HUBIT® (HUBIT, Gyeonggi-do, Korea); Group III, AbsoAnchor® (Dentos, Daegu, Korea); and Group IV, Creative (Creative, Zhejiang, China). Measurements of apical face angle, thread angle, lead angle, flank, pitch depth, and width were taken on 45 × magnification scanning electron microscope images of the shafts of the miniscrews. One assessor measured the seven geometric features for the four types of miniscrews using the four software programs twice in two sessions separated by a three week interval. Results: Pairwise comparisons, for each of the four miniscrew groups, showed that the only common result observed was the significant difference (p < 0.001) between measurements of flank taken by the four software programs. When measurements of the four types of miniscrews were pooled into one group, a high degree of intra-rater reliability (ICC range from 0.9 to 1.0) for all the seven geometric features was found with all the four software programs. The paired t-test showed insignificant difference (at p ≤ 0.05) between the first and second measurements, except for a few measurements including pitch width measured by Image-Pro® (p = 0.012), MicroDicom (p = 0.023), and Photoshop® (p = 0.001). Conclusions: Results did not give absolute superiority to one software program over the others and suggested an assessor effect. Assessor estimates could have been affected, among other factors, by the design of the miniscrews and the technical features of the software programs

3D Evaluation of Upper Airway Morphological Changes in Growing Patients with Class II Malocclusion Using Sander Bite Jumping Appliance

Class II malocclusion due to mandibular retrognathia is associated with a posterior positioning of the tongue and the hyoid bone, reducing the oropharyngeal volume. This could be a contributing factor to the development of respiratory and cardiovascular problems. This study evaluates the oropharyngeal volume variation in 13 patients with class II malocclusion undergoing functional orthopedic treatment with Sander Bite Jumping Appliance (SBJ). CBCT scans were performed before treatment (T0) and approximately after 12.5 months (T1): the retropalatal volume and retroglossal volume were quantified in mm(3) using a segmentation software. At T1, the retropalatal volume increased in 2523 +/- 2088 mm(3), and the retroglossal volume increased in 2258 +/- 1717 mm(3). Both values were statistically significant (p &lt; 0.05). This widening of the airways may allow prevention and treatment of sleep-disordered breathing, including obstructive sleep apnea syndrome