Associated orthodontic, surgical and hematological management of Cooley s anemia. Report of a case.

Cooley s anaemia or b-thalassaemia or mediterranean anaemia is a blood disease characterised by malformation of the skull and long bones, which confers a typical appearance on the patient. The complete development of facial abnormalities can be prevented by an intensive blood transfusion programme or by bone-marrow-transplantation. At the present time these therapeutic strategies would be able to help these patients grow and develop, live a prolonged life and avoid bad surgical RESULTS. The aim of this study was to evaluate the feasibility of orthodontic and maxillofacial surgical corrective treatment associated with an appropriate transfusion therapy in a b-thalassemic patient. The patient enrolled in the study was affected by major b-thalassemia and diagnosis was performed as an infant. She was referred to our centre at puberty for dento-maxillofacial disorders. Clinical, haematological and radiographic evaluation permitted a complete diagnosis. She received a combined haematological, orthodontic and maxillofacial surgical treatment. Controls for evaluating the statement of results obtained were performed at different times after the end of the therapy and have shown that the therapeutic objectives had been achieved and maintained. At the present time, complete diagnostic and therapeutic haematological strategies cannot be carried out on a large scale, especially in countries where health resources are limited. This objective reason, associated with possible low patient compliance, explains why we still encounter severe facial deformities resulting from erythroid hyperplasia. Our results suggest that this facial disfigurement requires surgical and orthodontic correction by consolidated surgical-orthodontic techniques performed according to the appropriate anaemia therapy. Although this is a preliminary study, initial encouraging results show no relapse three years after the end of the therapy.

Gingival lesions in a patient with dermochondrocorneal dystrophy (François syndrome). A case report.

This report is concerned with gingival manifestations associated with a case of dermochondrocorneal dystrophy (DCCD) or François syndrome occurring in a 42-year-old woman. Our Department treated this patient for 15 years. Oral examination of this case revealed a diffuse enlargement and severe inflammation of the attached gingiva. Systemic findings were similar to those reported in the literature for patients with DCCD. Firm papules 3 mm wide, localized on the face and on the dorsal surface of the hands, were associated with corneal involvement and progressive and severe articular disorder. Because they recurred after surgical ablation, the gingival lesions became an important problem in the management of the patient. After 10 years of unsuccessful treatment limited to scaling, oral hygiene control and mouth rinses with 0.2% chlorexidine solution, the patient was submitted to extraction of the remaining teeth, remodelling osteoplasty and cutaneous graft. An acrylic full denture was inserted. In a follow-up of 7 years, good results for the oral health of the patient were seen.

Computed tomography and magnetic resonance imaging in the management of coronoid process hyperplasia: review of five cases.

OBJECTIVE: To describe the imaging features of primary bilateral coronoid hyperplasia, with particular reference to the use of CT and MRI. MATERIALS: A series of five cases is reviewed. RESULTS: The correct diagnosis was achieved with panoramic radiography alone or with the addition of CT. MRI did not provide additional pre-operative information; it was useful in the postoperative assessment of poor functional recovery in order to determine the presence of haematoma and/or fibrosis. CONCLUSIONS: Although panoramic radiography alone can demonstrate this condition, CT has an important role in diagnosis and is useful for an adequate surgical planning by allowing assessment of the size of impingement of the coronoid processes. MRI is useful for evaluating postoperative complications involving soft tissue.

Tissue culture of adult human osteoblasts isolated from jaw bones.

Shreds of biopsied adult human jaw bones were divided into four groups that were each incubated together with borosilicate glass chips in one of four variants of DMEM expansion medium (i.e., with a high or low calcium complement and with or without sodium ascorbate added). The outgrown bone cells were propagated in secondary cultures kept in the same DMEM expansion medium variants prior to being transferred to a beta-glycerophosphate-enriched high-Ca2+ and ascorbate-containing DMEM mineralisation medium. In this latter medium the proliferation rates and the simultaneous expression of alkaline phosphatase by the four distinct groups of osteoblasts were assessed during 7 days of staying in vitro via biochemical methods. Human osteoblasts previously expanded in high-Ca2+ ascorbate-added DMEM medium were found to initially express a quite high alkaline phosphatase activity that subsequently declined, while their proliferative activity remained rather low. Conversely, osteoblasts formerly expanded in low-Ca2+ ascorbate-devoid DMEM medium exhibited minimal levels of alkaline phosphatase activity while simultaneously maximally proliferating in the mineralisation medium. Moreover, a mixture (1:1 v/v) of the DMEM mineralisation medium with Ham's medium (in which the aminoacid proline abounds) was found to accelerate, in comparison to DMEM alone, the intracellular type I procollagen synthesis, the extracellular assembly of type I collagen fibrils, and the calcification of the extracellular matrix by the human osteoblasts. Hence, the presence or absence of calcium and/or ascorbate in the expansion medium and of proline in mineralisation medium can significantly modulate the progression of human jaw bone cells from an undifferentiated highly proliferating condition to the mature osteoblastic phenotype.

Disinfection and sterilization in dentistry. Use of potentiated glutaraldehyde (DIBA-GLAXO) in the water systems of dentistry units: analysis of microbiological activity, physico-chemical compatibility and residues in washing water.

Glutaraldehyde is a potent sterilizing agent with a very broad-spectrum of biocidal activity including Gram-positive and -negative bacteria, spores and viruses such as HBV and HIV (the aetiological agents responsible for hepatitis B and AIDS, respectively). The aim of this study was to evaluate, in experimental conditions simulating the operative risk in dental practice, a 2% potentiated acid glutaraldehyde-based product (DIBA-GLAXO) not only in the disinfection and sterilization of the water circuits of dental units, but also with regard to physico-chemical compatibility, as well as from the toxicological viewpoint. DIBA, in the dental unit disinfection cycle, proved capable of destroying the bacterial cultures of all 16 pathogens used to contaminate artificially the water circuits of the unit handpieces. When the contamination was produced using bacterial spores, 5 hours of contact were sufficient to obtain sterility. The residual concentrations of glutaraldehyde in the circuit washing water, after optimization of the washing process, may be regarded as safe for the patient. Lastly, the product analysed was found to be compatible with the mechanical components of dental unit water circuits. No corrosion phenomena were observed even after total immersion in DIBA for a period equivalent to approximately 20,000 disinfection cycles.

Is the Melkersson-Rosenthal syndrome related to the exposure to food additives? A case report.

We present a case of Melkersson-Rosenthal syndrome that occurred in an adult patient who experienced intolerance to the food additives sodium benzoate and tartrazine. The main symptoms were the facial swelling, hypertrophy of the gums, and a typical infiltration of lymphocytes and plasma cells around the small vessels observed in the biopsy of the gums. No involvement of facial nerves was present, and other disorders of granulomatosis have been excluded. All clinical manifestations went into remission once the food additives were excluded from the usual diet.

[Maxillary neurilemmoma. A case report]. / Neurilemmome du maxillaire. Description d'un cas.

Histopathology was the only means of diagnosing a rare case of neurilemmoma of the molar region of maxilla.

[Indications for the treatment of bone rarefactions of endodontic origin]. / Indicazioni al trattamento delle rarefazioni ossee di origine endodontica.

Bone rarefactions arising from dental lesions are commonly thought to be sustained by the microbiol component or by the toxins spread out into the surrounding bone by the disintegrated pulp. In thise case endodontic therapy is the only one capable of obtaining a full recovery. In our opinion the most suitable endodontic procedure is that described by Schilder: with his technique infact a great deal of substantial results can be achieved. Bone rarefactions are to be surgically treated only when endodontic therapy does not guarantee the complete removal of microrganisms and that of the tissue debris arising from the disintegrating pulp possibly located in the root's area. This event may occur in the following circumstances: 1) fracture of endodontic instruments; 2) partial filling with cement or any other not removable material; 3) misleading endodontic therapy (distored roads or circular steps); 4) a peculiar anatomy of the dental rost such as that resulting when the apex bears a drop or a trumpet-like appearance; 5) bent roots, very hardly treated; 6) when a dry root's dent cannot be obtained because of the presence of large and continually secreting cysts. Bone rarefactions should then be treated by surgical procedures such as apicectomy backward filling of the root's canal and root's apex locking with direct view of the apex. Apicectomy should only be visualized asd a surgical transport of the apex from a point where the apex is open to an other where is apex is completely filled up by the endodontic treatment. Surgical procedure of the backward filling of the root's canal should be followed only when the root's canal unapproachability does not allow any endodontic treatment such as that suggested by Schilder. Finally surgical procedure to fill up the root's canal with direct view of the apex results from the combination of two surgical treatments: 1) the filling up of the root's canal (Schilder procedure), and 2) the modelling of the root's canal up to a point where the last one is hermetically sealed. This result can be achieved removing the apex when it bears a drop or trumpet-like appearance or the transported apex foramen. It can also be obtained by removing the wounded apex or the radicular canal when it is unapproachable along the 2 or 3 distal mms. and finally ad dry root's canal when it remains wet by the continuous secretion of the liquid material endowed in the cystic cavity.

[Lateral mandibular deviations]. / Le laterodeviazioni mandibolari.

The mandibular laterodeviation is one of the most evident malformations of the face, because it alters the lower third of the face. Etiologically it can be classified into: Static laterodeviations caused by teeth; Static laterodeviations caused by skeleton change: by monolateral hypertrophy (condyle, condyle and neck of the condyle, half mandible hypertrophy); by monolateral hypertrophy (congenital pathological); Dinamic laterodeviations functional. The midline displacement with posterior monolateral cross bite is caused by width discrepancy between the upper and lower dental arch resulting in a lateral shifting of the mandible. This laterodeviation is also called "laterale forced bite" or "articular cross bite". Articular cross bite is generally corrected by orthodontics during the interceptive period when the growth of the jaws is still present. In the author's opinion the orthognathic surgery is absolutely necessary for adult dental laterodeviation already stabilized. The skeletal laterodeviation must always be treated by orthognathic surgery. It is the author's practice to use the sagittal bilateral osteotomy at the angle and ramus level whose lines of osteotomy at the angle are different from one another depending on the displacement and rotation which one must do to the mandible to get contact surfaces which are larger enough to ensure proper union because the two mandibular halves have different lengths and different angles. This kind of operation normalizes the occlusion and is sometime sufficient to harmonize the oval of the lower third of the face. In the anterior part of the chin is still laterodeviated one continues with a wedge shaped osteotomy at the tip of the chin in order to reposition the tip to the midline and with an additional osteotomy at the hypertrophied angle level. If laterodeviation is joined by other bone malformations in can be considered a symptom which is more or less marked. In this case, therefore, laterodeviation is a part of a complex malformatin of the jaws: mandibular prognathism and/or maxillary retrognathism and/or maxillary prognathism. Consequently the operation must be single or combined. In these cases, one uses combined operations on the lower and upper jaws, so as to correct the various jaw malformations at the same time. The surgical methods used to correct laterodeviations of pathological origin are only directed to harmonize the edge of the mandible because only people with occlusion within the norm were seen by the author. The surgical methods are different depending on the complexity of the malformation. At the end laterodeviation on a functional basis are treated by the operation established by Köle which consists of a dermofibrotic flap, cut in front of the tragus, and then passed in front of the condyle in the space of the sigmoidal incisure and fixed to the mucous membrane of the internal wall of the cheek. Many well recorded cases have been presented.