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.

New 3D printed polymers in orthodontics: a scoping review.

AIM: The aim of this scoping review is to assess the application of new 3D printed polymeric materials in orthodontics, including polyamide-12 (PA-12) and Shape Memory Polymers (SMPs). METHODS: A search for articles published until January 2023 was carried out using PubMed, Scopus, Web of Knowledge, Lilacs, Opengrey, Embase and Cochrane Library databases and by applying the search terms (orthodontic* OR paediatric* OR paedodontic*) AND ("3D printed" OR "three-dimensional printed") AND (polymer* OR material* OR resin* OR technopolymer*). Additional records were also screened through hand or electronic search. No restriction in terms of language or publication period was applied. CONCLUSION: Due to their mechanical, aesthetic and biocompatibility characteristics, PA12 and SMPs can be used in orthodontic practice. However, additional studies should be performed to evaluate the clinical efficiency of these recent materials.

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.

ZeroExpander: Metal-free automatic palatal expansion for special-needs patients.

AIM: The aim of this paper is to illustrate a new concept for approaching maxillary expansion in paediatric orthodontics with a metal-free fixed automatic appliance in special-needs patients. CASE REPORTS: The ZeroExpander is a complete CAD-CAT full digital and automatic metal-free fixed device. It is designed to expand the maxilla in a pre-programmed automatic way using deciduous teeth as anchorage. Two cases of growing patients with a narrow upper arch are illustrated to present this innovative system, one in complete deciduous dentition and the second in mixed dentition. Both patients were successfully treated with palatal expansion. In the first case we present the use of PEEK, and in the second one the use of PA12. CONCLUSION: The ZeroExpander, fabricated using metal-free technopolymers and anchored on deciduous teeth, proved to be comfortable and efficient in treating palatal transverse deficiency, without the need of any compliance, even in young patients who must periodically undergo MRI.

State-of-the-art on MIH. Part. 2 MIH clinical management using ozone.

MIH is still a challenge in paediatric dentistry, due to the high sensitivity caused to the first permanent molars, that can greatly reduce the cooperation either for home oral hygiene or for in-office treatment. In this contest the use of ozone emphasises the ART technique (Atraumatic Restorative Treatment) and introduces modern "no aerosol" concept.

The Two by Four appliance: a nationwide cross-sectional survey.

AIM: The aim of the study was to investigate how widespread is the use of the 2 x 4 appliance among Italian general dentists and specialists in orthodontics, as well as the type of treatment employed and length of use. MATERIALS AND METHODS: We conducted a nationwide cross-sectional survey from July 14, 2016 to January 12, 2017 using an online questionnaire of 8 multiple choice questions, created by the SurveyMonkey® Company, on a population of Italian dentists and specialists in orthodontics affiliated with the Italian Society of Paediatric Dentistry (SIOI). This was made to assess how many clinicians knew and used this device in their clinical practice. We included 200 Italian dentists, 99 specialists in orthodontics and 101 general dentists of a mean age of 45 ± 15 years. RESULTS: Results show that 93.94% of orthodontists have knowledge of and use this device in their clinical practice, while only 51.49% of the general dentists have knowledge of and use it (p<0.001). The 51.92% of dentists and the 52.13% of orthodontists used the 2x4 appliance to treat both space management and incorrect overjet. Most of general dentists and orthodontists combined the 2x4 appliance with pre-adjusted brackets and accessory components such as coil springs and power chains. While most of dentists (45.90%) used the 2x4 in association with appliances for space management, most of specialists (46.15%) applied the 2×4 in combination with both appliances for space management and high-pull headgear. Statistically significant differences were found also for the answers to the question "what is the average time of treatment?" among general dentists: the 32.79% used the 2 x 4 for less than 6 months of treatment, and the 67.21% used the 2 x 4 for more than 6 months of treatment. On the other hand 49.46% of orthodontists used the 2 x 4 for less than 6 months of treatment, and 50.54% of them for more than 6 months of treatment (p=0.041). CONCLUSIONS: We conclude that the 2 x 4 appliance is widespread among orthodontists and about half of the general dentists, 93.94% and 51.49% (p<0.001) respectively. We found that 67.21% of general dentists used the 2 x 4 for a more than 6 months of treatment. As far as the orthodontists, 49.46% used the device for less than 6 months of treatment and 50.54% of them for more than 6 months of treatment. These differences were statistically significant (p=0.041).

A new method for deep caries treatment in primary teeth using ozone: a retrospective study.

AIM: The aim of this study was to assess the effectiveness of a new protocol for deep caries treatment in deciduous teeth based on: 1) the incomplete removal of carious dentin tissue; 2) the use of new technology (ozone) for the disinfection of carious dentine; 3) the creation of a peripheral seal in healthy tissue for bonding procedures with rubber dam isolation. MATERIALS AND METHODS: From a personal database, authors selected 50 consecutive patients (28 males, 22 females; mean age 5.8 ± 1.7 years) in whom this new protocol was applied on posterior deciduous molars, for a total of 94 restorations. RESULTS: Regular follow- ups were performed at 3, 6 and 12 months by a second operator, who was asked to rate each restoration as success or failure. The success rate at 12 months was 93,62% (n. 88/94 restorations), similar to that reported in the literature for pulpotomy. CONCLUSION: The deciduous teeth considered for this study, if treated conventionally, would have probably been subjected to pulpotomy, because of the extension of the carious lesions. The proposed protocol, through the use of ozone, proved to be an excellent alternative, with the fundamental advantage of saving dental tissue and preventing the invasion of the pulp chamber.

IRAK1 variant is protective for orthodontic-induced external apical root resorption.

OBJECTIVE: Interleukin-1 beta (IL1B) pathway is a key player in orthodontic-induced external apical root resorption (EARR). The aim of this work was to identify the genes related to the IL1 pathway as possible candidate genes for EARR, which might be included in an integrative predictive model of this complex phenotype. MATERIALS AND METHODS: Using a stepwise multiple linear regression model, 195 patients who had undergone orthodontic treatment were assessed for clinical and genetic factors associated with %EARRmax (maximum %EARR value obtained for each patient). The four maxillary incisors and the two maxillary canines were assessed. Three functional single nucleotide polymorphisms (SNPs) were genotyped: rs1143634 in IL1B gene, rs315952 in IL1RN gene, and rs1059703 in X-linked IRAK1 gene. RESULTS: The model showed that four of the nine clinical variables and one SNP explained 30% of the %EARRmax variability. The most significant unique contributions to the model were gender (P = 0.001), treatment duration (P < 0.001), premolar extractions (P = 0.003), Hyrax appliance (P < 0.001), and homozygosity/hemizygosity for variant C from IRAK1 gene (P = 0.018), which proved to be a protective factor. CONCLUSION: IRAK1 polymorphism is proposed as a protective variant for EARR.

Classical aversive conditioning induces increased expression of mature-BDNF in the hippocampus and amygdala of pigeons.

The expression of brain-derived neurotrophic factor (BDNF), which is found in the pro-BDNF, truncated-BDNF and mature-BDNF isoforms, changes with learning. Mature-BDNF shows a peak of late expression in the hippocampus that is involved in the persistence of aversive memory in rodents. However, the role of BDNF in the hippocampal synaptic mechanisms involved in the classical conditioning aversive memory in birds still needs clarification. This study investigated the late expression of BDNF in the hippocampus and amygdala of pigeons trained with tone-shock conditioning and the effects of intra-hippocampal infusion of anisomycin (Ani) in these changes. Seven days after implantation of intra-hippocampal microcannulae, adult pigeons trained with three tone-shock pairings were assigned to one of three groups: Conditioning and Ani (CondANI), Conditioning and saline vehicle (CondSAL) and Conditioning only (Cond). NAIVE group had no treatment or conditioning. Homogenates of tissues from the hippocampus and amygdala, obtained 12h after training, were used to determine the content of mature-BDNF, truncated-BDNF and pro-BDNF using Western blotting. Higher values for mature-BDNF than for truncated- and pro-BDNF content were seen in the hippocampus of Cond and CondSAL birds, but not in the hippocampus of CondANI or NAIVE birds (p<0.05). The values of mature-BDNF in the amygdala of all the three conditioned groups were higher than those observed for truncated- and pro-BDNF (p<0.05), which indicates that the activation of this protein in the amygdala was not affected by the infusion of Ani in the hippocampus. The data indicate that the tone-shock conditioning induced the activation of molecular pathways of BDNF in the hippocampus and amygdala of the pigeons. The decreases in the content of truncated- and pro-BDNF isoforms found in conditioned pigeons may suggest cleavage mechanisms induced by the training. Our data confirm previous observations of rodent studies and extend these observations to pigeons, revealing that, in spite of the anatomical differences between the hippocampus of rodents and pigeons, there are functional and molecular mechanisms that are conservative between the species.

Non-contact atomic force microscopy study of hydroxyl groups on the spinel MgAl2O4(100) surface.

Atom-resolved non-contact atomic force microscopy (NC-AFM) studies of the magnesium aluminate (MgAl(2)O(4)) surface have revealed that, contrary to expectations, the (100) surface is terminated by an aluminum and oxygen layer. Theoretical studies have suggested that hydrogen plays a strong role in stabilizing this surface through the formation of surface hydroxyl groups, but the previous studies did not discuss in depth the possible H configurations, the diffusion behaviour of hydrogen atoms and how the signature of adsorbed H is reflected in atom-resolved NC-AFM images. In this work, we combine first principles calculations with simulated and experimental NC-AFM images to investigate the role of hydrogen on the MgAl(2)O(4)(100) surface. By means of surface energy calculations based on density functional theory, we show that the presence of hydrogen adsorbed on the surface as hydroxyl groups is strongly predicted by surface stability considerations at all relevant partial pressures of H(2) and O(2). We then address the question of how such adsorbed hydrogen atoms are reflected in simulated NC-AFM images for the most stable surface hydroxyl groups, and compare with experimental atom-resolved NC-AFM data. In the appendices we provide details of the methods used to simulate NC-AFM using first principles methods and a virtual AFM.

Overdose of Vinblastine in place of Vinorelbine during IGEV chemotherapy.

Any class of drugs is susceptible to errors, in case of antineoplastic agents the medication errors may cause severe and life-threatening toxicity due to very limited therapeutic index with toxic events even at therapeutic dosage, to complexity of regimens and the particular vulnerable population. We report herein a case of Vinblastine (VBL) accidental overdose, the cause of mistake, the toxic effect and the salvage therapy adopted in a young lady suffering of Hodgkin relapse during IGEV chemotherapy.

The role of the tip in non-contact atomic force microscopy dissipation images of ionic surfaces.

In this paper we use simulations to investigate the role of the tip in nc-AFM measurements of dissipated energy. Using a virtual AFM we simulate the experiment focusing on the atomic scale energy dissipation on an NaCl(100) flat surface. The non-conservative interaction was treated with the theory of dynamic response and all the calculations were carried out using an atomistic model; several sets of tips were tested using ionic crystals (NaCl, KBr, MgO), each in different configurations (ideal, vacant, divacant, doped). Using an MgO-doped tip we were able to calculate a dissipation signal comparable to what is typically measured in experiments. It was not possible to see any dissipation with ideal tips, although they still have a significant interaction with the surface and give atomic contrast in the frequency shift signal. The effect of the scanning speed on measured frequency shift and dissipation is also calculated and discussed.

Post-transplant lymphoproliferative disorders in liver transplanted patients: a single-centre experience.

Post-transplant lymphoproliferative disorder (PTLD) is a life-threatening complication after solid organ transplantation. Reduction of immunosuppression (RI) is accepted as a first step treatment with a long-term complete response rate observed in 23-50% of patients. Chemotherapy for diseases refractory to RI is based on small cohorts treated with different regimens. This paper reports on 10 consecutive cases of PTLD after liver transplantation. The median time from transplantation to PTLD diagnosis was 5 years. PTLD was frequently extranodal involving the transplanted liver. Seven monomorphic PTLD, 2 polymorphic and one Hodgkin disease were observed. Epstein Barr virus was present in tumour tissue only in one case. Initial therapy included RI in all patients. Chemotherapy was used in eight patients. No treatment-related mortality was observed and no patient developed graft rejection during chemotherapy. At a median follow-up period of 25 months, 6 of the 10 patients were alive and without evidence of disease.

Post-transplant lymphoproliferative disorders after heart or kidney transplantation at a single centre: presentation and response to treatment.

Post-transplant lymphoproliferative disorders (PTLD) is a serious complication after solid organ transplantation. Reduction of immunosuppression (RI) alone is not able to control the disease. We report a prospective analysis of 30 patients with PTLD after heart or kidney transplantation. Only 5 of 30 patients, treated solely with RI, obtained a complete response. Five patients were treated heterogeneously; in the remaining 20, the efficacy and safety of a weekly anthracycline-based chemotherapy were assessed. Sixteen patients obtained a complete remission. One death was related to treatment. With a median follow-up of 36 months, 3-year overall survival was 63.3% and 57% for the entire group and the chemotherapy-treated group, respectively. Moreover, 4 second neoplasms were observed in the chemotherapeutic group. In this study, we demonstrated that most PTLD need other treatment than RI and a weekly regimen is manageable and has a favourable impact on long-term survival.

Mode-locking optimization with a real-time feedback system in a Nd:yttrium lithium fluoride laser cavity.

We present a control system, which allows an automatic optimization of the pulse train stability in a mode-locked laser cavity. In order to obtain real-time corrections, we chose a closed loop approach. The control variable is the cavity length, mechanically adjusted by gear system acting on the rear cavity mirror, and the controlled variable is the envelope modulation of the mode-locked pulse train. Such automatic control system maintains the amplitude of the mode-locking pulse train stable within a few percent rms during the working time of the laser. Full implementation of the system on an Nd:yttrium lithium fluoride actively mode-locked laser is presented.

Hugoniot data of plastic foams obtained from laser-driven shocks.

In this paper we present Hugoniot data for plastic foams obtained with laser-driven shocks. Relative equation-of-state data for foams were obtained using Al as a reference material. The diagnostics consisted in the detection of shock breakout from double layer Al/foam targets. The foams [poly(4-methyl-1-pentene) with density 130 > rho > 60 mg/cm3] were produced at the Institute of Laser Engineering of Osaka University. The experiment was performed using the Prague PALS iodine laser working at 0.44 microm wavelength and irradiances up to a few 10(14) W/cm2. Pressures as high as 3.6 Mbar (previously unreached for such low-density materials) where generated in the foams. Samples with four different values of initial density were used, in order to explore a wider region of the phase diagram. Shock acceleration when the shock crosses the Al/foam interface was also measured.