Beyond the Clinic: why new bioactive restorative materials have really changed Paediatric Dentistry.

BACKGROUND: The aim of this paper is to remind how evidence-based paediatric dentistry should not only consider the best available scientific evidence relating to the patient's oral conditions but it should also consider the patient's needs beyond the clinic. In a child-family-oriented approach, the best restorative treatment for a primary tooth could not be the proper one for the child as a whole. Preservation of dental tissues as much as possible, without involving the pulp, is called minimal intervention dentistry (MID) and it is closely related to "selective caries removal" and "bioactive restorative materials". To preserve the vitality of a tooth as much as possible, many tools are available on the market (i.e. silver diamine fluoride, ozone) and this could play an important role in a "tailored fit treatment plan" mindset. CONCLUSION: Minimally invasive direct restorative strategies in paediatric dentistry, is a predictable evidence-based-restorative option for the treatment of vital primary teeth with no need of local anaesthesia and absolute isolation. Beyond the clinical aspect, the clinician expertise is crucial to evaluate the required materials and tools, not only to perform a minimal invasive paediatric dentistry in a safe, efficient and child-friendly way, but for the wellness of all parties involved. In this life-related paradigm new bioactive restorative materials are among the main protagonists.

Child/family-oriented approach: the teeth come after.

BACKGROUND: The aim of this paper is to promote reflection on the dentist's approach to the dental care of young patients, considering not only their oral care needs, but also the management of their behaviour, that is intrinsic to their life needs and to those of their families. CASE REPORT: This approach to dental care management stems from a thorough evaluation of the patient, the reason for dental visit, whether the child had previous dental visit(s), which might not have been positive, the family involvement and the emotional characteristics of the child and their parents. We should design a progressive customized path, sometimes starting only from secondary prevention in order to "comfortably" avoid the worsening of a given clinical condition, stimulate a concomitant positive behavioural response of all parties involved, until the child and their family are ready to take the next step, in terms of integrated restorative dentistry and/or paediatric orthodontics, where and when needed. CONCLUSION: "The teeth come after" means that dental and oral care of the children may not be achievable goals unless we first address their wellbeing and that of their families, and that sometimes "the perfect is the enemy of the good", especially when we incorrectly consider only the clinical outcome. In this scenario, psychological skills and clinical feelings, comfort techniques, technologies, new materials and a more "medical less" surgical approaches are the bases for a child/family-oriented approach.

DOP Dentistry: digitally embracing orthodontics and paediatric dentistry.

AIM: The aim of this paper is to illustrate the concept of DOP Dentistry (Digital Ortho Paediatric Dentistry) in daily practice. CASE REPORT: DOP Dentistry is a new concept introduced by the authors to express the perfect integration between two disciplines that for a long time have been separated: paediatric dentistry and paediatric orthodontics. In modern dentistry it is increasingly important for the paediatric dentist to have skills and abilities that embrace both of these disciplines. To these we have to add a third element, represented by new digital technologies, as well as new bioactive ionic resin composites and biocompatible technopolymers to perform fully digital, integrated paediatric orthodontic treatments. CONCLUSION: Based on the DOP Dentistry concept, that definitely changes the paradigm of taking care of children, new and fascinating scenarios open up, that will lead us to a more integrated management of our little patients, their needs and those of their family with a new, more ergonomic, efficient and tailor-made approach.

Face Scan for Ceph 3D: a green way for diagnosis in children.

BACKGROUND: The aim of this paper is to illustrate how new opportunities offered by technology and diagnostic imaging can more easily create a 3D integration of soft tissue Face Scan and IOS (intra oral scan) for orthodontic evaluation in children. CASE REPORT: Through TrueDepth technology, a software commonly used for digital devices such as smartphones and tablets, the authors illustrate the acquisition of facial scans by means of different applications, and their integration with IOS to perform diagnostic evaluations and treatment planning at zero biological cost for patients. CONCLUSION: TrueDepth technology is both accurate and easy to use for all clinicians, even those less accustomed to digital innovations. In the past, stereophotogrammetric systems and devices were used, and they are the gold standard for three-dimensional acquisitions. However, there is a major drawback associated with this technology as it is expensive and non-portable. Truedepth technology is an effective substitute, as smartphone applications are portable, cheaper, and more accessible, giving each orthodontist the ability to take advantage of the benefits of facial scanning in their daily practice.

Spa-Inspired Oral Care: A new approach in paediatric dentistry.

BACKGROUND: The aim of this paper is to illustrate a different way to take care of our little patients, starting from creating child-oriented environmental conditions and proceeding using a specific comfort technique in paediatric dentistry. CASE REPORT: This concept of treatment arises from the inseparable relationship between body and psyche. It starts with instructions aimed at informing parents or caregivers not to prepare the child for the visit but to explain the child that he/she will be taken care in new ways. This is accomplished by approaching the child in an original setting without the traditional dental chair, and that can be the same dedicated room in which we will be able to provide the first care, as a part of a customised treatment, which does not consider only the clinical outcomes. CONCLUSION: Spa-inspired oral care is the name we chose to describe this new way to treat our little patients, putting them at ease with a dedicated environment, characterised not only by drawings hung on the walls, but also by lights, music, videos and scents. Importance is also given to the choice of words, the dental team appearance, and instruments that allow the application of treatment and comfort techniques tailored to them, where 'how' can be more important than 'what'.

Fully digital fixed orthodontic prosthesis: use of PEEK technopolymer in cases of early loss of primary incisors.

BACKGROUND: The aim of this paper is to illustrate a new, fully digital approach to temporary rehabilitation in the case of premature loss of deciduous incisors, using a metal-free fixed orthodontic prosthesis made of polyether ether ketone (PEEK). CASE REPORT: Clinical report: Technopolymer Orthodontic Prosthesis (TOP) is a complete CAD-CAT (Computer Aided Design-Computed Aided Technofacturing) fixed device that can be used to rehabilitate the mouth of very young patients, both from an aesthetic and functional point of view as well as maintaining space and controlling growth. The appliance is customised, designed to be cemented with adhesive technique, using deciduous teeth as anchorage. Two cases of patients in deciduous dentition with early loss of incisors are illustrated to present this procedure. In the first case the patient lost 2 central incisors and in the second one 3 lower incisors were lost due to trauma. CONCLUSION: TOP, made by metal-free technopolymer and cemented on deciduous teeth, proved to be comfortable, aesthetic, easy to apply and efficient in rehabilitating smile and mastication in case of trauma or premature loss of deciduous incisors.

Congenital mesoblastic nephroma: report of a Case with review of the most significant literature.

AIMS AND BACKGROUND: Congenital mesoblastic nephroma (CMN) is a rare pediatric tumor of the kidney with the highest peak of incidence during the first 3 postnatal months. It has previously been confused with Wilms' tumor (which, on the contrary, is rare during the first six months of age and is still considered a histogenetic congener). CMN almost always has a favourable prognosis. Therefore, CMN needs to be correctly diagnosed and differentiated from other pediatric renal neoplasms. Two morphological subtypes are currently distinguished histologically: the classical or leiomyomatous type and the atypical or cellular type. Mixed forms with a combination of the two patterns are also on record. Recurrence and even tumor-related death have been described in the literature and always related to the atypical form or to the mixed form, particularly in patients aged more than 3 months and in those cases in which the surgical removal was not complete. Opinions concerning post-surgical clinical management, especially in regard to adjuvant therapy, are not unanimous. METHODS: A case of CMN, predominantly of the classical histological subtype diagnosed in a baby with a follow-up of 6 years, is herein presented. The tumor was discovered at birth and surgically removed after one month. Since the tumor showed a high mitotic index (one of the characteristics of the cellular subtype) and the perirenal fat was focally involved with the tumor, the possibility of giving adjuvant chemotherapy was considered. Flow cytometric analysis was also performed which showed a diploid DNA content of neoplastic cells. RESULTS: The tumor was completely removed, surgical margins were free histologically, and no clear-cut histological features of the atypical subtype were noted. Flow cytometrically, it showed the euploid DNA content. Consequently no additional therapy was given. Six years after surgery the patient is developing well and is free of disease. He has regular follow-up examinations. CONCLUSIONS: CMN almost always pursues a benign clinical course if diagnosed under three months of age and if totally surgically excised independent of histological type. Criteria for management of atypical cases are not unanimous in regard to the benefit of additional therapy after surgery.

[Techniques for the diagnosis of kidney diseases. Is there a role for the immunoperoxidase method in the evaluation of immunologic glomerulopathy on biopsy specimens, including those in paraffin? Our experience: preliminary results]. / Tecniche di diagnostica nella patologia renale. Esiste un ruolo per la metodica di immunoperossidasi nella valutazione delle glomerulopatie immunologiche su biopsie incluse in paraffina? La nostra esperienza: primi risultati.

Firstly an extensive summary of the diagnostic power and limits in renal glomerular pathology of light microscopy even corroborated by all the special histochemical stains is made. Secondly a complete list of all those renal glomerular diseases in which electron microscopy is unanimously considered necessary for the diagnosis is given as well as the main and most updated references pertinent to those rare and recently recognized pathological entities in which EM proved as a fundamental diagnostic tool are provided. Thirdly the authors focus on the importance of immunohistochemistry (IIC) in the diagnosis of immune-mediated renal glomerular diseases. The advantages and disadvantages of immunofluorescence microscopy (IF) and immunoperoxidase method (I-perox) are respectively discussed. The value of I-perox staining method applied to sections from paraffin blocks is emphasized and some technical suggestions in order to optimize results are given. Among the latter the choice of the used fixative for the purpose of preserving antigenicity of immunoglobulins and complement fractions, the timing of tissue fixation as well as the quantitation of enzymatic pretreatment relative to the duration of fixation, and the repeated washings with phosphate-buffer saline to minimize background staining. Ultimately the authors report on their preliminary personal results with the use of I-perox staining on sections from paraffin embedded renal core biopsies. Although if is their favourite diagnostic microscopy for evaluating renal immunopathology the authors underline I-perox method as a helpful tool to rely on at least in those circumstances when frozen material for IF is not available due to the scarcity of core biopsy, when glomeruli are absent in frozen sections, or when due to a technical lab accident the frozen tissue devoted to IF has been ruined or lost, and the only available material is the one which lies embedded in paraffin. The LSAB ("labelled streptavidin biotin") complex and PAP ("peroxidase-antiperoxidase") working procedures are provided in detail.

[Inflammatory pseudotumor of the breast. Report of a case and review of the literature]. / Lo pseudotumore infiammatorio della mammella. Osservazione di un caso e revisione della letteratura.

Inflammatory pseudotumor (IPT) truly represents an enigmatic entity. A tumor-like lesion known with many synonyms according to the various patronymic authors who named it on the basis of the different observed morphological appearances. Among these names plasma cell granuloma, plasma cell/histiocytoma complex, xanthomatous pseudotumor, xanthoma, fibrous xanthoma, histiocytoma, xanthogranuloma, inflammatory myofibroblastic tumor, inflammatory myofibrohistiocytic proliferation are just the most renown. The enigma consists in the fact that it can easily be misunderstood as a sarcoma with a marked inflammatory component just as reciprocally an inflammatory sarcoma can be misinterpreted as an IPT. As it was not enough some authors believe that some so-called IPT actually represent or may evolve into a true neoplastic process. For this reason a big debate has been raised concerning the biologic behaviour of this entity and a sense of scepticism often surrounds pathological diagnoses termed under this rubric. The predominant pattern is that of a plasma cell infiltration with a definitely histiocytic component and mostly bland spindle shaped cells which occasionally can look somewhat atypical, and can form fascicles in some areas. Anyway putting apart diagnostic misinterpretations, IPT pathogenetically is intended as the result of an inflammatory process mediated locally by an inappropriate production of monokines. It has been described in many different anatomic visceral and somatic sites, from the classical ones such as soft tissues and retroperitoneum to the most unusual such as nervous system and its covering to the most recently observed such as skin or lymph nodes or salivary glands. Breast is definitely an exoteric site of location of such kind of lesion. Only one case has previously been described. This case regards a lady aged 38 years which was locally treated by surgical excision: this case aside the standard microscopic examination was also studied immunohistochemically including proliferation markers (Ki-67/MIB-1) and on flow cytometry which are helpful means to confidently diagnose such entity. The differential diagnoses and diagnostic difficulties concerning the correct interpretation of this lesion are dealt with.