Management of the exposure of a dense PTFE (d-PTFE) membrane in guided bone regeneration (GBR): a case report.

Guided bone regeneration (GBR) is a well-established and generally predictable method for repairing alveolar ridge defects and preparing edentulous sites for implant placement. Standard GBR involves filling the space underneath a membrane with autogenous bone or a mixture composed of autogenous bone particles and allogeneic bone tissue or heterologous biomaterials. The use of a barrier membrane for GBR has sometimes been associated with complications, however - reportedly involving exposure, infection, and collapse - and the non-resorbable types of membrane seem to be involved more often than the resorbable solutions. Such complications may be severe enough to defeat the object of the GBR procedure. A non-resorbable high-density polytetrafluoroethylene (d-PTFE) membrane has recently been designed specifically for use in bone-augmentation procedures that seems to assure a good bone regeneration process even when the membrane is exposed to the oral cavity. This case report describes an exposure of a d-PTFE membrane occurring after a maxillary GBR procedure and how it was overcome successfully, enabling implants insertion.

Improvement of the fatigue resistance of NiTi endodontic files by surface and bulk modifications.

AIM: To assess the failure mechanism of rotary NiTi instruments by chemical, structural and morphological analyses to provide a rational explanation of the effects of surface and bulk treatments on their resistance to fatigue fracture. METHODOLOGY: Thermal treatment (350-500 °C) was performed on electropolished (EP) and non-electropolished (Non-EP) NiTi endodontic instruments. Bulk and surface chemical composition and crystallographic structures were determined by energy-dispersive X-ray spectroscopy, X-ray photoelectron spectroscopy (XPS) and X-ray diffraction (XRD) to evaluate the effects of thermal treatment and electropolishing on the NiTi alloy. Fatigue tests of all instruments were performed. Surface morphology before and after the tests, and fractured section were analysed using scanning electron microscopy to determine crack extensions. Results were analysed statistically using analysis of variance (anova) and post hoc Student-Newman-Keuls test. RESULTS: Before thermal treatment, significant differences (P < 0.05) in fatigue resistance between EP and Non-EP instruments (the number of revolutions to failure, N(f) , was 385 and 160, respectively) were attributed to differences in the surface morphology of the instruments. SEM analysis of the fracture surfaces indicated that flexural fatigue fractures occurred in two steps: first by a slow growth of initial cracks and then rapid rupture of the remaining material. Thermal treatment did not affect the surface morphology but resulted in significant changes in the instrument bulk with the appearance of an R-phase and an improved fatigue resistance; indeed after treatment at 500 °C, N(f) increased up to 829 and 474 for EP and Non-EP instruments, respectively. CONCLUSIONS: Both thermal treatment and electropolishing improved the resistance of NiTi rotary instruments against fatigue fracture.

Wear of nickel-titanium endodontic instruments evaluated by scanning electron microscopy: effect of ion implantation.

The present work analyzes possible increases in resistance to wear of nickel-titanium endodontic instruments that have undergone a process of ionic implantation. ProFile .04 taper #25 instruments were subjected to ionic implantation with bands of nitrogen ions of 250 KeV, currents in the order of 10 microA/cm2, and doses of 2 x 10(17) ions/ cm2. The instruments were used to make preparations in acrylic endodontic training blocks. Scanning electron microscopic investigations showed that after 60 s of work inside the endodontic training blocks nonionic implanted control instruments showed small modifications in their blades, and their tips showed the first signs of wear. After 240 s the control instruments showed consistent signs of wear and frequent changes to their surfaces. After 240 s of use the ionic-implanted instruments did not present any significant changes in the micromorphology of their surfaces. The implanted instruments did not manifest the typical signs of wear and did not show the surface changes that quickly affect the working life of untreated endodontic instruments manufactured from nickel-titanium.

Defects in GT rotary instruments after use: an SEM study.

Used rotary nickel-titanium instruments require frequent replacement. This laboratory study evaluated defects of GT Rotary instruments before and after usage. The instruments were fixed into custom-made holders and photographed in an SEM at x 260 to x 12,000 magnification at preset points. Instrument sizes 20 with 1.0, 0.8, and 0.6 taper and instrument sizes 35 with 1.2 taper were used in 12 canals. The used instruments were cleaned and then reexamined in an SEM as before. The presence of 11 types of conditions was scored from the pre- and postusage photographs. No instruments fracturing or plastic deformation was observed during the test. The presence of debris, pitting, and scraping changed significantly. Imperfections were found on used GT Rotary instruments and the presence of defects (pitting, scraping, and blunt-cutting edges) increased in all of the instruments. The behavior of GT Rotary instruments with usage seems to be different, compared with that found in other instruments.

The effect of surface treatments of nickel-titanium files on wear and cutting efficiency.

OBJECTIVES: This study was designed to verify whether nitridation treatment of the cutting surfaces resulted in surface or subsurface changes that produced an increase in the resistance to wear in nickel titanium (NiTi) endodontic files. STUDY DESIGN: Some experimental samples were exposed to ionic implantation by using 150 keV of nitrogen ions and doses of 1 x 10(17) ions per cm(2). Other samples were exposed to thermal nitridation processes performed for 480 minutes at 500 degrees C temperature. Control samples were not exposed to any process. The chemical composition of the surface layers of each sample was determined by means of x-ray photoelectron spectroscopy. The cutting efficiency was tested on an endotraining bloc. RESULTS: The experimental instruments showed in-depth distributions of chemical composition that were different from those seen in the control group; thermal-nitridated instruments demonstrated a surface ratio of nickel to titanium of 0.5. Implanted samples had a higher N/Ti ratio (1.2); this ratio may be due to the presence of a layer of titanium nitride. Samples in the experimental groups showed an increase in cutting ability as compared with the controls. CONCLUSIONS: Thermal nitridation and nitrogen-ionic implantation treatment of nickel-titanium files produced a higher wear resistance and an increased cutting capacity.

[Thermoelastic analysis of nickel-titanium endodontic files]. / Analisi termoelastica di lime endodontiche in nichel-titanio.

BACKGROUND: Technological progress in the endodontic field has allowed the creation of innovative nickel-titanium endodontic instruments, made with a superelastic alloy with a reduced modulus of elasticity. The elastic properties of the NiTi alloy can undergo significant variations in connection with mechanical movements and cyclic fatigue induced on the instruments caused by their repeated usage, especially in canals which are anatomically difficult to shape. The state of tension of the instrument determines a deformation of the geometry of the files and, therefore, a modification in their properties. Similarly to mechanical stress, thermal treatments can influence the properties of the alloy. The aim of the study is to subject the NiTi alloy to repeated thermomechanical cycles, examining the influence of the mechanical and thermal stress on the temperature at the beginning and end of the martensite transformation, on the increase of recovery of deformation during the cooling phase and on the change in the internal structure of the material. METHODS: The instruments (30 ProFile Maillefer) were subdivided into 5 groups: Group I, composed of 6 new ProFiles submitted to 14 sterilization cycles in an autoclave for 30 minutes each; Group II, formed by 6 unused ProFiles subjected to one sterilization cycle in an autoclave; Group III made up of 6 new ProFiles used as controls; Group IV made up of 6 ProFiles submitted to clinical use on endodontic simulators in plexiglas for a total time of 240 seconds; Group V consisting of 6 ProFiles used on endodontic simulators for a total time of 480 seconds. All the above mentioned samples were tested using a thermomechanic dynamic analyzer (DMTA) produced by Rheometric Scientific. RESULTS: The files from Group III (control) show an elastic deformation curve typical of nickel-titanium instruments. The samples from Groups IV and V subjected to sequential use on endodontic simulators evidenced modifications in their elastic behaviour compared to the control instruments. The operative use caused modifications in the original properties of the alloy, with a reduction in elasticity proportional to the number of uses. The instruments that underwent 14 cycles of sterilization in the autoclave (I group) present dynamic analysis curves which are different compared to the new unsterilized ProFiles. After 14 cycles there is a modification in the response of the instruments to thermodynamic stress. CONCLUSIONS: Both the samples undergoing repeated mechanical stress on Plexiglas endodontic simulators and those sterilized in the autoclave at thermodynamic analysis show significant modification in modulus of elasti- city. The different taper does not influence the experimental results, there not being any significant differences found in the elastic behaviour between ProFiles.

[Von Recklinghausen osteitis fibrosa cystica. A clinical case]. / Osteite fibroso cistica di Von Recklinghausen. Caso clinico.

In Recklinghausen's disease the skeleton lesions are often the first signal of the pathology. The main clinical manifestations are represented by bony lesions which appear as multicystic lesions with loss of the hard lamina and skull malformation and asymmetry. In this disease there is a relevant osteoclastic activity which prevails over the osteoblastic one associated to the fibrous substitution of the marrow, sometimes producing micro or macro cysts. The typical alteration consists of an increase along the endosteal and trabecular surfaces in the number of osteoclasts which can be found in small reabsorption gaps. This is the cause of a cortical and trabecular reduction which can appear as interrupted. Histologic lesions consist in the replacement of bone tissue with fibrous and osteoid tissue. These bony lesions are not characteristic of the disease but to be distinguished from other pathologies such as for example Paget's disease and other forms of fibrous dysplasia (Gardner's syndrome, Leontiasis ossea). A case personally observed is described: a women, 29 years old, suffering from Recklinghausen's disease with face and skull asymmetry, condyles and glenoid cavity deformation, abnormal face reduction. Observing the planigraphy on the right side of the temporomandibular articulation, flattened glenoid cavity and condyles with irregular outlines can be noticed, aplastic coronoid cuts, altered jaw. The patient was submitted to surgery for dental extraction followed by a biopsy which showed some regressive alterations on cellular level of the bony structure.

Effect of sterilization on the cutting efficiency of rotary nickel-titanium endodontic files.

OBJECTIVE: Nickel-titanium instruments that offer greater flexibility than instruments made of other metallic materials have been developed. This study evaluated the behavior in vitro of nickel-titanium rotary instruments under repeated sterilization cycles. STUDY DESIGN: To investigate changes in cutting ability and superficial alterations, 36 ProFile instruments, 18 with a taper of .04 and 18 with a taper of .06, were exposed to different sterilization cycles. Samples were divided into 3 groups of 12 files each. The 12 group A samples were exposed to 14 cycles of sterilization for 30 minutes; the 12 group B samples were exposed to 7 cycles of sterilization for 30 minutes; the 12 group C samples were not sterilized and served as a control group. Chemical compositions of the near surface layers of samples of each group were determined by means of Auger spectroscopy. RESULTS: The instruments that underwent the greatest number of sterilizations (group A) showed in-depth distributions of chemical composition that were different from those seen in the control group; this was the result of greater amounts of titanium oxide on the surfaces of the sterilized instruments. The files of group A showed a decrease in cutting efficiency in comparison with those of the control group. CONCLUSIONS: On the basis of this research on nickel-titanium files, we determined that repeated sterilizations under autoclave alter the superficial structure of such instruments.

[Comparison of different finishing methods for composites and compomers. Profilometric analysis]. / Differenti metodiche di rifinitura di compositi e compomeri. Analisi al profilometro.

BACKGROUND: Reconstructions with aesthetical materials neither finished nor polished can be extremely irregular and wrinkled. For this reason they represent an ideal basis for the growing of pigmentation which come from food remainings and the nestle of bacteria on the plaque. The finishing of aesthetical materials is a fundamental step in conservative dentistry. The finishing session regarding the aesthetical restorations should be considered and planned at the moment of their insertion in the prepared hollows. The finishing should not be considered an option, but the conclusion of all the conservative treatment. Purpose of the search is to examine and assess, through a technical equipment measuring the superficial wrinkledness of the materials, the action of 4 systems of finishing and polishing on two aesthetical materials widely used in the daily practice by dental surgeons: a compomer (Compoglass, Vivadent) and a composite (Spectrum, Dentsply). METHODS: For each of these two materials some little slabs model have been prepared, choosing the universal colour in the colorimetric scale. The two types of filling materials have been compared with 4 systems of finishing and polishing: Sof-Lex Pop-on (3M), Enhance system (Dentsply), Hawe Micro Disc (Howe Neos), Heawe Gommini Polisher (Heawe Neos). The total working time did not overcome 1 minute. The little slabs have been obtained, pressing the resin between two slides used in microscopy. In the hope to guarantee in the different samples, a uniform thickness, we have used a technical device. On each covering slide we have put a weight of 0.5 kg for 5 minutes. The thickness of the little slabs obtained was 2 mm. Thus, pressed between the two slides, the aesthetical material has been photopolymerized according to the time suggested by Manufacturing Industries. The sizes concerning the wrinkledness of samples subjected to different treatments have been carried out using a pointed profilometer with high sensitivity. (Tencor-P10). This instrument used in the National Laboratory of Catania, called INFN, is able to graphitize the wrinkledness of a surface "survbeying" it with a diamond ultramicrometric point. RESULTS: All tested systems gradually produce the upper layers of the materials less suitable to resist the assault of plaque bacteria as time passed. The 3M coarse and medium grain Disks are very abrasive and for this reason the surface of the materials is ill-shaped. Those disks with fine and extra fine grain, smooth the tracks left by previous disks. As they have been always used according to their decreasing granulometry, the disks are used only for removing small composite pieces in excess and to improve micromorphology of the restauration. The "Gommini" are less abrasive than Disks. In a few minutes and often with only one step they produce a much regular and polished fillings surface. CONCLUSIONS: The "Gommini" have a preference when the last photopolymerization has left a regular layer, with a very good micromorphology. Actually, "Gommini" do not remove much material, but they continue to smooth the outline of the reconstruction. Disks are not classified as being of first quality in the finishing of composites and compomers.

[Evaluation of two root canal preparation and obturation methods: the Mc Spadden method and the use of ProFile-Thermafil]. / Valutazione delle preparazioni e otturazioni canalari realizzate secondo Mc Spadden e con i ProFile-Thermafil.

BACKGROUND: In endodontic field different instruments and techniques have been suggested for the preparation and filling or radicular bent canals. The purpose of this study is to compare two different cleaning and canal filling methods: preparation and filling technique, according to Mc Spadden's method, instrument technique and the closing of the canal system according to ProFile-Thermafil method. METHODS: In this study ten molars divided into two groups of five elements each were used. The five molars of the first group were prepared according to the "crown-down" technique with nickel-titanium instruments by NT Engine Files Quantec 2000 series. The 18 canals found out in the five molars have been filled with Pac Mac and gutta-percha preheated. The five molars of the second group have 17 radicular canals which, firstly, have been cleaned with ProFile .04 and .06 taper fitted to a manipulator at 220 revolutions per minute and then filled by Thermafil n. 30 with plastic carrier. All ten molars were X-rayed first, during and after the treatment. All teeth were soaked into polymerised resin, dissected into three different points and observed through Optical Microscope. RESULTS: Both cleaning techniques succeed in being efficient in bent canals. The instruments made by Mc Spadden highlight a greater preservation of canal dentine than the ProFile. In samples of the first group there is an excellent adaptation of multiphase gutta-percha to the canal walls and a correct relationship between the filling material and the apical foramen. In filling with Thermafil the adaptation of gutta-percha inside the radicular canal shows outstanding differences in relation to sections taken into account. Actually, while in portion of the crown the filling can be considered satisfactory towards the canal walls, in apical sections there is a decrease in the quantity of gutta-percha step by step, while a contact of plastic carrier with dentine walls is highlighted. CONCLUSIONS: Wheter in the shaping or in the canal filling phase, the two methods are efficient and conservative towards dental structure at the same time. These methods, have an outstanding reduction in dental weakening and in times of the endodontic treatment performance.

[Non-Hodgkin lymphoma of the maxilla. Report of a case]. / Linfoma non Hodgkin del mascellare superiore. Caso clinico.

Lymphomas are primitive neoplasias of the lympho-reticular system and are classified into two principal categories: Hodgkin's lymphoma (HL) and Non-Hodgkin's Lymphoma (NHL) each classified into low, medium and high grades, according to their clinical and cytological characteristics. The treatment and prognosis of such neoplasias vary according to the distribution of the illness and to the moment of initial diagnosis. In NHL, treatment depends prevalently on the histological subtype. Over the last few years it has been possible to associate to defined nosographic entities a characteristic phenotype, and to formulate a phenotypical classification of chronic lymphoproliferating illnesses. The classification of the Working Formulation subdivides lymphomas into groups of increasing malignancy. In histological sections, non-Hodgkins lymphomas are relatively homogeneous, uniformly cellular and dominated by malign lymphocytes. The symptomatology of NHL can vary according to the different location. The clinical manifestation of NHL can be in the form of swelling or ulceration. In contrast with lymphonodal lymphoma, in which the spread through blood to distant lymphonodal regions or extra lymphonodal areas is rapid, the extra lymphonodal ones show a clinical course of illness comparable with those of carcinomas. The authors present the case of a 89 year-old patient with an ulcerated, non painful swelling in the upper right alveolar maxillary region, showing slow development, soft consistency and indefinite edges; this lesion did not affected the normal physiological functions of the stomatognathic apparatus, thus explaining why the patient had noticed the appearance of the process two years prior to the visit but had not reported it. The pathological case-history shows traumas at the site of the lesions due to dentures. At the moment of the visit, the ortopathomographic examination of the upper and lower dental arch shows the presence of a lesion in the right maxillary region, radiographically opaque, with ill-defined margins and signs of continuity with the homolateral maxillary sinus.

[The role of cell adhesion molecules in the formation of periapical granulomas]. / Ruolo delle molecole di adesione cellulare nella formazione dei granulomi periapicali.

Cell adhesion molecules (CAMs) are cell surface proteins involved in the binding of cells, usually leukocytes, to each other, to endothelial cells, or to extracellular matrix. Specific signals produced in response to wounding and infection control the expression and activation of certain of these adhesion molecules. The interactions and responses then initiated by binding of these CAMs to their receptors/ligands play important roles in the mediation of the inflammatory and immune reactions that consult one line of the body's defense against these insults. Most of the CAMs characterized so far fall into three general families of proteins: the immunoglobulin (Ig) superfamily, the integrin family, or the selectine family. Recent studies have indicated that selectins (E,L,P) are implicated in cell trafficking, an important aspect of inflammation-related process. Regulation of white blood cell trafficking from the blood vascular compartment to regions of pathogenic exposure is one of the most important functions of the immune system. The distinct phases of leukocyte migration include: rolling, activation, firm adhesion, transendothelial migration and subendothelial migration. The selectins have been implicated in the first step of this cascade. An inflammatory response is first evoked in the pulpal tissue in an attempt to neutralize the injurious agent and to dispose of damaged tissue and cells. The pulpal vessels dilate and blood flow to the tooth increases. At the same time, permeability of the vessels increases allowing leakage of fluid and leukocytes into the tissue.

[Cell communication in the development of the oral cavity]. / La comunicazione cellulare nello sviluppo della cavità orale.

The cadherins are a family of a calcium-dependent cell adhesion molecules that are regulated both spatially and temporally during development. Epithelial cadherin (E-cadherin) is present in the epithelial cells in both the embryo and yolk sac during organogenesis. In many studies, the presence of E-cadherin was analyzed during normal and disturbed craniofacial development with respect to palate and tooth formation. E-cadherin was present in epithelia of both ectodermal and endodermal origin. The expression level of E-cadherin increased with age and differentiation. The expression pattern of E-cadherin implies that this molecule has a role during normal development of the epithelia of the cranio-facial complex. Morphogenesis and cell differentiation in the developing tooth are controlled by a series of reciprocal interactions between the epithelial and mesenchymal tissues. The exact molecular mechanisms operating in these interactions are unknown at present, but both structural components of the extracellular matrix (ECM) and diffusible growth factors have been suggested to be involved. In this review article we summarize our findings on the distribution patterns of three ECM molecules and two cell surface receptors during tooth morphogenesis through bud, cap, and bell stages of development. The examined molecules include fibronectina and tenascin, which all represent components of the mesenchymal ECM, the cell surface proteoglycan, syndecan, which functions as a receptor for interstitial matrix. Based on the observed changes in distribution patterns and on experimental evidence, roles are suggested for these molecules in epithelial-mesenchymal interactions during tooth development. C-Cam is a cell surface glycoprotein that is involved in cell adhesion and may play a role in histogenesis and organogenesis. It is a member of the carcinoembryonic antigen (CEA) gene family, which is a subfamily of the immunoglobulin gene superfamily. The presence of C-CAM in all proliferating craniofacial epithelia indicates that this molecule may play an important role in development.

[Changes in the biological and immunologic parameters in the oral cavity of the aged. Review]. / Modificazioni dei parametri biologici ed immunologici nel cavo orale dell'anziano. Review.

Senescence is the effect of the immune system incapacity to see "self" and "non-self"; timo-involution induced down-regulation of immunoregulatory -T and B-lymphocytes. Immunosenescence mutations in oral cavity are examined. Even the oral ecosystem presents disorders in quality and quantity of the bacterial plaque and a different immune response. Age senescence is particularly evident in the masticatory apparatus, in fact the dental tissues have remarkable morpho-structural physiological changes; the epithelial, connective and osseous tissues of the periodontium have structural age changes related to the collagen synthesis and physical properties, with an increase of the stroma and a decrease of cell population. The osseous tissue presents cellular atrophy, sclerosis, osteoporosis and is undergoing a continuous structural remodelling; the oral mucous membranes show a thinning of epithelium and an increase of the stroma related to the parenchyma. Specific individual changes could be appraised in the involution of stomatognathic apparatus, more than an indefinite reduction of the performances.

[Oral lesions in systemic lupus erythematosus. I. The etiopathogenic aspects of lupus erythematosus]. / Lesioni orali nel lupus eritematoso sistemico. Nota I: Aspetti etiopatogenetici del lupus eritematoso.

The authors investigate lupus erythematosus systemicus, characterized by the multiform etiology and autoimmune pathogenesis. Cutaneous lesions, large confluent areas of erythema, poikilodermatous lesions, atrophy and necrotizing vasculitis (leukocytoclastic vasculitis) occur in patients with lupus erythematosus (SLE). Ulcerative lesions are an ACR (American College of Rheumatology), (formerly ARA), criterion for the diagnosis of SLE. These lesions are suspected of being caused by a mechanism involving circulating immune complexes and neutrophils. This observation further supports previous evidence that all oral lesions in SLE result from vacuolar degeneration of basal keratinocytes. Immunopathologic study of lupus erythematosus shows the correlation between HLA-dr positive keratinocytes or Langerhans cells and epidermotropic T cells and the immunobiological significance of the antigen-antibody system in LES.

[Oral lesions in systemic lupus erythematosus. II. The clinical and therapeutic aspects of lupus erythematosus]. / Lesioni orali nel lupus eritematoso sistemico. Nota II: Aspetti clinici e terapeutici del lupus eritematoso.

The authors describe the most common clinical characteristics and main parameters of SLE. They describe the currently most therapeutic protocol with particular reference to circulating immune complex study on patients with SLE, and they examine different prospects of applicability and of prognostic result. The aim of this paper is to provide an outline of the clinical diagnosis and the immunobiological significance of the nucleoprotein autoantibodies and of the Ro/SSA antigen-antibody system and the relationship between circulating anti Ro/SSa antibody levels and skin disease activity in SLE.

[SEM (Scanning Electron Microscopy) study of the deterioration of ProFile .04 and .06]. / Studio al SEM sul deterioramento dei proFile .04 e .06.

BACKGROUND: The ProFile are endodontic instruments made by a special nickel-titanium alloy. They have to work on constant rotation at a speed of 350 revolutions per minute. The purpose of the study is to assess, through SEM research, a possible deterioration of different ProFile conicity. METHODS: Sixteen dental elements pulled out for period dental reasons have been used as samples to assess the progressive deterioration of .04 and .06 ProFile conicity. Eight molars and eight premolars with a total of 36 radicular canals were examined. The types of ProFile tested were 8: they were respectively 4 with .04 conicity and 4 with .06 conicity. Before being used, all instruments are previously studied through SEM. The tested ProFile with .04 conicity had a diameter of 15, 25, 30 and 45. Those with .06 conicity had a diameter of 20, 25, 30 and 35. Each tested ProFile was introduced inside a radicular canal and was turned for 180 seconds with a constant rotation of 200 revolutions per minute. After this first step, the alterations produced by the instrument could be observed through SEM. Afterwards, the same ProFile has worked again inside another radicular canal with the same time and the same number of turns, before being observed again through SEM. We have continued using this method up to the break of the instrument. RESULTS: The instruments with .04 conicity and smaller diameter are subject to a faster deterioration, more visible at the point. After a working time of 180 seconds all the instruments have their distinct morphological alterations: after other 180 seconds it is possible to often observer an alteration to the pitch of the instrument. The breaking times are related to the diameter and conicity of ProFile tested. CONCLUSIONS: Endodontic nickel-titanium instruments, even if they represent a progress in the field of canal preparation, undergo some alterations in their shape if they are put under inevitable mechanical stress. The damages can be: break at the top of the instrument and loss of cutting abilities at the turns level.

[Recklinghausen neurofibromatosis. Report of a case]. / Neurofibromatosi di von Recklinghausen. Descrizione di un caso clinico.

Neurofibromatoses are genetic disorders of the nervous system that primarily affect the development and growth of neural cell tissues. These disorders produce other abnormalities such as skin changes and bone deformities. Neurofibromatoses occur in both sexes and in all races and ethnic groups. Scientists have classified these disorders as neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2). Other types of neurofibromatoses may exist, but are not yet identified. Nearly 50% of the cases shows a well definited familiarity for the disease, according to an autosomal dominant transmission, while the other 50% of patients shows a negative history of familiarity, according to a new chromosomal mutation interesting the same autosomal genes of the dominant transmission. Oral localization is more rare showing an incidence ranging from 4 to 7% in most series of different authors. The most frequent involvement site in oral neurofibromatosis is the tongue, followed by the oral mucosa and floor of the mouth; palate and maxillary-mandibular bones are a rare localization of the disease. In the present, the clinical, radiological, histopathological and therapeutical aspects of a clinical case of neurofibromatosis, presenting as mandibular tumor, are examined. The clinical case reported, a 37 year old man, was essentially characterized by a positive family history for the disease, a neurofibroma of the oral mucosa.

Another "new" form, the palagonia type of acrofacial dysostosis in a Sicilian family.

We described another previously apparently unreported form of acrofacial dysostosis (AFD) from Sicily, residing, coincidentally in the same small village as that with the recently delineated Catania AFD. In contra-distinction to the latter, the 4 patients with the Palagonia form of AFD are of normal intelligence, and instead of extensive caries have oligodontia (4), short stature (3), frizzy hair (pili torti) with aplasia cutis verticis (1), mild cutaneous syndactyly of digits 2-5 (4), attenuation of the 4th metacarpals (3/3), unilaterally cleft lip (1), and some vertebral anomalies such as a large atlas (1), mild scoliosis (1), small odontoid process, spina bifida occulta at S1 (1). Casually, this would appear to be an iceberg dominant disorder, with the proposita most severely affected. This could be an X-linked dominant, but more likely an autosomal dominant trait.

[Report of a case of maxillo-nasal dysplasia (Binder syndrome)]. / Presentazione di un caso di displasia maxillo-nasale (sindrome di Binder).

The case of a girl with Binder syndrome (maxillonasal-dysplasia) is reported. The girl has a peculiar face due to severely depressed nasal bridge, the nasofrontal angle is absent and the nose is hypoplastic with flattened alae and nasal tip; the upper lip has a convex contour with poorly developed philtrum. The premaxillary is hypoplastic. Lateral and postero-anterior cephalometric findings are presented.