Effect of pre-operatory low-level laser therapy on pain, swelling, and trismus associated with third-molar surgery

Background: The extraction of impacted third molars is commonly associated to pain, edema, trismus, limited jaw opening and movements. The aim of this retrospective study is to verify if pre-surgical low-level laser therapy (LLLT) associated with the extraction of impacted lower third molars could add benefits to the postoperative symptoms respect LLLT performed only after surgery. Material and Methods: Data from 45 patients subjected to a surgical extraction of lower third molars were pooled and divided into three groups. Patients that received only routine management were inserted in the control group. Group 1, were patients that received LLLT immediately after surgery and at 24 hours. In group 2 were included patients treated with LLLT immediately before the extraction and immediately after the end of the procedure. Data were analyzed using linear regression and descriptive statistics. Results: Both laser-treated groups were characterized by minor events of post-surgery complications of pain, edema, trismus. The use of NSAIDs in the first 24 hours was significantly inferior in Group 2. Conclusions: Pre-surgical LLLT treatment seems to increase the analgesic effect of LLLT. However, trismus and edema were reduced in both laser treated groups, independently from the period of irradiation (AU)

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Quality measurement and benchmarking of HPV vaccination services: a new approach.

BACKGROUND: A new measurement process based upon a well-defined mathematical model was applied to evaluate the quality of human papillomavirus (HPV) vaccination centers in 3 of 12 Local Health Units (ASLs) within the Lazio Region of Italy. The quality aspects considered for evaluation were communicational efficiency, organizational efficiency and comfort. RESULTS: The overall maximum achievable value was 86.10%, while the HPV vaccination quality scores for ASL1, ASL2 and ASL3 were 73.07%, 71.08%, and 67.21%, respectively. CONCLUSIONS: With this new approach it is possible to represent the probabilistic reasoning of a stakeholder who evaluates the quality of a healthcare provider. All ASLs had margins for improvements and optimal quality results can be assessed in terms of better performance conditions, confirming the relationship between the resulting quality scores and HPV vaccination coverage. METHODS: The measurement process was structured into three steps and involved four stakeholder categories: doctors, nurses, parents and vaccinated women. In Step 1, questionnaires were administered to collect different stakeholders' points of view (i.e., subjective data) that were elaborated to obtain the best and worst performance conditions when delivering a healthcare service. Step 2 of the process involved the gathering of performance data during the service delivery (i.e., objective data collection). Step 3 of the process involved the elaboration of all data: subjective data from step 1 are used to define a "standard" to test objective data from step 2. This entire process led to the creation of a set of scorecards. Benchmarking is presented as a result of the probabilistic meaning of the evaluated scores.

[Epidemiology of third molar extractions: the experience of the S.G.C. Fatebenefratelli Hospital in Rome (Italy)]. / L'epidemiologia degli interventi sui terzi molari:l'esperienza dell'Ospedale S.G.C. Fatebenefratelli di Roma.

The extraction of third molars (wisdom teeth) is one of the main surgical procedures performed in dentistry. The aim of this study was to describe the characteristics of patients undergoing the procedure in the SGC Fatebenefratelli Hospital, a large hospital in Rome (Italy), where about 20% of all third molar extractions in the Lazio Region are performed. Hospital discharge forms were analysed for patients discharged in the years 2010 and 2011 with a Diagnosis Related Group (DRG) code 169, used for the procedure. Study results indicate that the extraction of third molars is a relevant public health issue considering its frequency and associated yearly costs at the national level. The appropriateness of third molar extraction, especially when performed prophylactically in young persons, should be further explored.

Fabrication and characterization of biomimetic ceramic/polymer composite materials for dental restoration.

OBJECTIVE: Conventional dental composites with randomly dispersed inorganic particles within a polymer matrix fail to recapitulate the aligned and anisotropic structure of the dentin and enamel. The aim of the study was to produce a biomimetic composite consisting of a ceramic preform with graded and continuously aligned open pores, infiltrated with epoxy resin. METHODS: The freeze casting technique was used to obtain the hierarchically structured architecture of the ceramic preforms. Optical and scanning electron microscopy (SEM) and differential thermal analysis and thermogravimetry (TG-DTA) were used to characterize the samples. Three point bending test and compression test were also performed. RESULTS: All analysis confirmed that the biomimetic composite was characterized by a multi-level hierarchical structure along the freezing direction. In the bottom layers close to the cooling plate (up to 2mm thick), a randomly packed ceramic with closed pores were formed, which resulted in incomplete infiltration with resin and resultant poor mechanical propertiesof the composite. Above 2mm, all ceramic samples showed an aligned structure with an increasing lamellae spacing (wavelength) and a decreasing wall thickness. Mechanical tests showed that the properties of the composites made from ceramic preforms above 2mm from cooling plate are similar to those of the dentin. SIGNIFICANCE: The fabrication processing reported in this work offers a viable route for the fabrication of biomimetic composites, which could be potentially used in a range of dental restorations to compete with the current dental composites and ceramics.

Cyclic nucleotide phosphodiesterase activity in stem cells of human periodontal ligament (PDL-MSCs) before and after osteogenic induction.

OBJECTIVE: The aim of this work was to evaluate both the level of endogenous cyclic nucleotides cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cAMP) and phosphodiesterase activity in mesenchymal stem cells (MSCs) before and during the osteogenic induction. STUDY DESIGN: Samples were organized into control (nondifferentiated) and test groups which were analyzed at 3 different time points: 1, 2, and 4 weeks. Periodontal ligament MSCs were isolated and then expanded in an MSCM medium while cyclic nucleotide levels and phosphodiesterase activity were assessed. RESULTS: cAMP and cGMP levels were markedly higher in the first week than in the following stages. Similarly, PDE activity increased during the first week and reached the peak in the second week. CONCLUSIONS: This work validates that cAMP, cGMP, and PDE activities are important factors in the first phase of the osteogenic induction of a human stem cell.

Effect of low-level laser therapy after extraction of impacted lower third molars.

The aim of this study is to evaluate the effectiveness of the low-level laser therapy (LLLT) in the control of pain, swelling, and trismus associated with surgical removal of impacted lower third molars. Thirty patients were randomized into two treatment groups, each with 15 patients-group test (LLLT) and a group control (no-LLLT)-and were told to avoid any analgesics 12 h before the procedure. In group test, the 980-nm diode-laser (G-Laser 25 Galbiati, Italy) was applied, using a 600-µm handpiece, intraorally (lingual and vestibular) at 1 cm from the involved area and extraoral at the insertion point of the masseter muscle immediately after surgery and at 24 h. The group control received only routine management. Parameters used for LLLT were: continuous mode, at 300 mW (0.3 W) for a total of 180 s (60 s × 3) (0.3 W × 180 s=54 J). Group test showed improvement in the interincisal opening and remarkable reduction of trismus, swelling and intensity of pain on the first and the seventh postoperative days. Although LLLT has been reported to prevent swelling and trismus following the removal of impacted third molars, some of these studies reported a positive laser effect while others did not. All references to the use of laser therapy in the postoperative management of third molar surgery employ different methodologies and, in some, explanations as to selection of their respective radiation parameters are not given. This study has demonstrated that LLLT, with these parameters, is useful for the reduction of postoperative discomfort after third-molar surgery.

[Application of the QuavaTAR model to vaccination services in Latium, Italy]. / Sistema di misura della qualità QuaVaTar: dal modello matematico all'applicazione nei servizi vaccinali del Lazio.

Definition, categorization, and measuring of Quality have become increasingly important concerns in the era of managed care and cost containment. Most attempts to develop quality indicators have been based on outcome measures. The Donabedian model of Structure-Process-Outcome has been universally accepted and used as the basis for much of the work addressing quality and outcomes. Adequate indicators for vaccination services are scant therefore are applied to this setting a new quality measurement process based on a probabilistic approach called MQS (Misure di Qualità in Sanità-Quality Measures in Healthcare), developed by our working group since 2005 in several hospital settings. This new application, called "Quality in Vaccination Theory and Research"(QuaVaTAR), was used to measure the efficiency of the vaccination centers of three Local Health Units (ASL RM B, RM F, RM H) in Lazio Region (Italy). The measure method combines the evidences obtained from the supplied services (objective measurements) and the judgments of the services' stakeholders collected by an "ad hoc" questionnaire (subjective measurements). The subjective evaluations were expressed with a number (between 0-100) representing a personal judgment on the organizational and the communicational efficiency and the comfort of the "ideal" vaccination center. The objective measurements were collected in performance grids on the same points investigated with the questionnaire. Combining objective and subjective measures we obtained "Quality Scores", useful to make improvements in the vaccination centers and to compare different services.

Endoscopic palliation of esophageal cancer.

Endoscopic palliation is the most suitable approach to improve quality of life in patients with esophageal cancer since diagnosis is often made at an advanced stage, when radical treatment is unfeasible. Endoscopy offers several techniques to palliate dysphagia either by stenting the stenosis or by reducing the tumor mass with thermoablation. A small number of randomized controlled trials is available to compare the efficacy of different techniques and the ideal palliation has not been defined as yet. Recently, the development of self-expandable covered metal stents has rapidly gained ground in the endoscopy units throughout the world as a simple, single step procedure for palliation of dysphagia.

[Application of quality standards to activities at the Advanced School of Hygiene and Preventive Medicine of Rome (Tor Vergata University): early results]. / Applicazione del sistema qualità alle attività della Scuola di Specializzazione in Igiene e Medicina Preventiva dell'Università di Roma Tor Vergata: risultati preliminari.

In the academic year 2001-2002, experts from the Advanced School of Hygiene and Preventive Medicine of Rome (Tor Vergata University) have tested a quality approach based on the ISO standards 9000:2000. In so doing, they have questioned the school's didactic organization itself. In order to assess such approach, students were given pre-course and post-course schedules, reflecting 38% and 61% of correct answers respectively. The popularity rating was set at 8.3 out of 10, and the survey has shown that quality standards can well be applied to the activities of the school.