Alar cinch sutures in orthognathic surgery: scoping review and proposal of a classification.

Orthognathic surgery and the Le Fort I osteotomy result in noticeable alterations to the nasal/nasolabial anatomy. The alar base cinch technique is a surgical technique to control lateralization of the base of the nose and is well described in the literature. The aim of this scoping review was to identify every unique alar cinch suture technique reported in orthognathic surgery and to propose a classification for the different techniques described. A search was conducted in the PubMed, Cochrane Library, and Scopus electronic databases covering the period May 1980 to July 2020, which identified 10 articles that were eligible for this review. Among these, there were several proposals for modifications to the technique, and different studies to show the effectiveness of one type among all others. Despite observing multiple techniques and variations of these while performing this review, the lack of a classification for alar cinch suture was noticed. Therefore, we propose a classification of the alar cinch suture that includes four types, which cover all of the cinching techniques described. It is believed that the use of a standardized classification may be useful to avoid duplicate publishing of techniques and to set a standard for further studies.

Steam Sterilization of Equine Bone Block: Morphological and Collagen Analysis.

INTRODUCTION: The use of equine bone blocks is widely reported for bone augmentation techniques. The block must be shaped according to the form of the defect that should be regenerated. The shaping could be performed by hand before or during the surgery, in a sterile ambient, or using a CNC milling machine that could not be sterile. The aim of our study was to evaluate if a steam sterilization could provide a medical grade sterilization of the blocks and to evaluate if bone microstructure and collagen structures change after different steam sterilization protocols provided by mainstream autoclave. MATERIALS AND METHOD: Two blocks of equine bone were divided into 16 samples. 1 sample was used as control and not submitted to any treatment. 15 samples were infected with a Streptococcus faecalis bacterial culture. The samples were singularly packed, randomly divided into 3 groups, and submitted to autoclave sterilization on the same device. The groups were submitted to a sterilization cycle (Gr. A: 121°C, 1,16 bar for 20'; Gr. B:134°C, 2,16 bar for 4'; Gr. C: 134°C, 2,16 bar for 3.30 min.). 2 samples for each group were evaluated for the sterility. 3 samples for each group were observed at SEM to notice the macro- and microstructure modification and to confocal microscope to observe the collagen. RESULTS: All samples were sterile. The SEM evaluation showed, in all groups, a preserved morphological structure. Confocal microscope evaluation shows that the collagen structure appears to be more uniform and preserved in group C. CONCLUSION: Data show that autoclave steam sterilization could be reliable to obtain sterilization of equine bone blocks.

Standard and low-dose cone beam computer tomography protocol for orthognatodontic diagnosis: a comparative evaluation.

Considering the diagnostic capability offered by cone-beam computed tomography (CBCT), nowadays orthodontists often use this exam for treatment planning, especially in cases of impacted teeth, maxillary ipoplasia, orthognathic surgery etc. The aim of this study was to compare the radiation doses related to a conventional CBCT setting and that of a low dose protocol, usable in orthodontic practice. The absorbed organ doses were measured using an anthropomorphic phantom loaded with thermo-luminescent dosimeters related to sensitive organs (brain, bone marrow, salivary glands, thyroid, esophagus, oral mucosa, extrathoracic airways, lymph nodes). The device used was a MyRay Hyperion X9-11x5. The standard setting of the apparatus was 90 Kv, 36 mAs, CTDI/Vol 4.09 mGy, instead the low dose one was 90 Kv, 27 mAs, CTDI/Vol 2.89 mGy. Equivalent and effective doses have been calculated; the measurement of the effective doses was based on the ICRP recommendations. For the assessment of image quality, five readers, independent and experienced orthodontists, were asked to state if the images were sufficient enough to perform an orthodontic diagnosis. The lowest organ dose (5.01 microSv) was received by the esophagus during low dose CBCT acquisition. The highest mean organ dose instead (1227.67 microSv) was received by the salivary glands during conventional setting CBCT acquisition. Image quality has been considered sufficient for orthodontic diagnostic needs for both CBCT protocols. CBCT low dose setting should be preferred over the standard one in orthodontic practice, because it provides a significant lower radiation dose to the patients ensuring a good image quality. However, further studies are necessary to evaluate the opportunity of CBCT exams in orthodontic treatment planning.

Cyclic fatigue resistance of two nickel-titanium rotary instruments in interrupted rotation.

AIM: To investigate the influence of interrupted rotation on cyclic fatigue of two nickel-titanium rotary instruments. METHODOLOGY: Cyclic fatigue of 300 new ProTaper Next size X1; X2 and Mtwo size 10, .04 taper; size 15, .05 taper; size 20, .06 taper and size 25, .06 taper instruments was tested in continuous or interrupted rotation. Fifty files of the same brand and size were randomly assigned to five groups (n = 10). Group 1 instruments were tested in continuous rotation; groups 2 and 3 in paused rotation for 1 s every 10 or 20 s, respectively; groups 4 and 5 in interrupted rotation for 5 s every 10 or 20 s, respectively. Cyclic fatigue was expressed in time to fracture (TtF) in an artificial canal with 60° angle and 5 mm radius of curvature. The fracture surface was examined with a scanning electron microscope (SEM). Data were evaluated by two-way analysis of variance. RESULTS: Cyclic fatigue of groups 2 and 4 of ProTaper Next X2 and Mtwo size 25, .06 taper was significantly lower than that of group 1 of the same instruments (P < 0.01). ProTaper Next X2 had significantly reduced cyclic fatigue in groups 3 and 5 (P < 0.05). No differences were found by interrupting the rotation for 1 or 5 s in all instruments (P > 0.05). Fatigue of other instruments was not affected by interrupted rotation (P > 0.05). CONCLUSIONS: Interrupted rotation reduced cyclic fatigue resistance of ProTaper Next X2 and Mtwo size 25, .06 taper, especially when a higher number of interruptions was performed.

Traumatic Pseudoaneurysm of the Internal Maxillary Artery: A Rare Life-Threatening Hemorrhage as a Complication of Maxillofacial Fractures.

Pseudoaneurysm of the internal maxillary artery due to a traumatic event is a rare condition. Pseudoaneurysms are usually directly produced by arteries break with extravasation of blood. The compressed perivascular tissue forms the wall of aneurysmal sac. Then, this sac gradually expands and can be damaged. It is rare to see pseudoaneurysms of IMA. They are usually associated with fracture of the neck of the mandible. To the best of our knowledge the pseudoaneurysm of the internal maxillary artery related to maxillofacial trauma is an event extremely rare in the literature and if not quickly managed can lead to the patient's death. This case underlines how the close cooperation between surgeons and radiologists results in a quick diagnosis and management of such pathological events.

Transcrestal Sinus Lift Procedure Approaching Atrophic Maxillary Ridge: A 60-Month Clinical and Radiological Follow-Up Evaluation.

Aim. The aim of this study was to assess the success and the survival rate of dental implants placed in augmented bone after sinus lifting procedures. Material and Methods. 31 patients were mainly enrolled for a residual upper jaw crest thickness of 3 mm. CBCT scans were performed before and after the augmentation technique and at the follow-up appointments, at 3, 6, 12, 24, and up to 60 months. The follow-up examination included cumulative survival rate of implants, peri-implant marginal bone loss, and the height of sinus floor augmentation. Results. This retrospective study on 31 patients and 45 implants later inserted in a less than 3 mm crest showed excellent survival rates (99.5%), one implant was lost before loading due to an acute infection after 24 days, and two implants did not osteointegrate and were removed after 3 months. The radiological evaluation showed an average bone loss of 0.25 mm (±0.78 mm) at the first follow-up appointment (3 months) up to 0.30 mm (±1.28 mm) after 60-month follow-up. Conclusion. In this study it was reported how even in less than 3 mm thick crest a transcrestal technique can predictably be used with a long-term clinical and radiological outcome, giving patients excellent stability of the grafted material and healthy clinical results.

Flowable resin and marginal gap on tooth third medial cavity involving enamel and radicular cementum: a SEM evaluation of two restoration techniques.

PURPOSE: The aim of this study is to investigate the presence and the extent of a possible marginal gap after the interposition of a flowable composite between the composite restoration and the dental structures (enamel and cementum). This technique is also used to eliminate the infiltration in a zone of the cavity preparation that is frequently at a risk of secondary decay. MATERIALS AND METHODS: Fifteen human premolars extracted for orthodontic reasons were used for the study. A cavity with mesial and distal margin in enamel and cementum was realized in every tooth. The cavities were then restored with an adhesive system (ScotchBond 3MÔ) and composite (Filtek Supreme 3MÔ); and, a fine layer of flowable composite was applied in the distal margin of each cavity. Scanning electron microscopy (SEM) in secondary electron imaging (S.E.I.) modality was used for the study and identifying the marginal gaps in the composite restorations. Data was investigated on the mesial and distal margin of each cavity at the restoration-enamel interface, and at the restoration-cementum interface. The interfaces were divided in four groups: Group A (enamel/composite); Group B (enamel/flow/composite); Group C (cementum/composite); and, Group D (cementum/flow/composite). RESULTS: By the comparison of the gap's average width found in each group, it is evidenced that the average width of the gap increases when the interface moves from the coronal to the radicular end (Group A 0,1 ± 0,4 µm Vs Group C 12,3 ± 11,6 µm; Group B 0,2 ± 0,8 µm Vs Group D 2,8 ± 6,6 µm). Correlating the measurements of the marginal gap's average width among the Group A and Group B, no significant variations were obtained; and instead, on comparing Group C with Group D, the gap's average width decreases. CONCLUSION: The interposition of a low elastic modulus composite between the adhesive layer and the composite resin allows an improvement of the cementum-restoration interface by the means of a lower shrinkage stress during polymerization.

TLR4 and NOD2/CARD15 genetic polymorphisms and their possible role in gastric carcinogenesis.

UNLABELLED: The aim of this study was to evaluate the role of TLR4 and NOD2/CARD15 genes in gastric carcinogenesis. PATIENTS AND METHODS: We investigated the allelic frequencies of TLR4 (D299G and T399I) and NOD2/CARD15 (R702W, G908R, and L1007finsC) SNPs in 87 asymptomatic serologically H. pylori-positive individuals (Group I), in 63 patients with antrum-predominant gastritis (Group II) and in 60 patients with corpus-predominant gastritis or pangastritis (Group III). RESULTS: There was significant difference in allelic frequencies of TLR4 D299G SNP in Group II (p=0.02; OR 2.97) as well as in Group III (p=0.001; OR 4.80). Significant difference of T399I SNP allele frequency was only found in Group III (p=0.009; OR 3.73). The allele frequencies of NOD2/CARD15 G908R and of L1007insC SNP were higher in Group III (p=0.003, OR 5.18; p=0.03; OR 3.66, respectively). CONCLUSION: TLR4 and NOD2/CARD15 genes are associated with high risk Group III patients and, therefore, they appear to play a role in gastric carcinogenesis.

Acute visual loss and chorioretinal infarction after photodynamic therapy combined with intravitreal triamcinolone.

PURPOSE: To report acute visual loss associated with dynamic vascular changes after photodynamic therapy (PDT) combined with intravitreal triamcinolone (IVTA) for the treatment of occult choroidal neovascularization (CNV). METHODS: An 86-year-old woman complained of visual loss in her left eye. Angiographic examination showed a serous pigment epithelium detachment complicated by CNV. She underwent combined treatment with IVTA (4 mg) followed by standard verteporfin PDT administered after a 5-day interval. RESULTS: The patient developed vision loss 1 day after PDT. Ophthalmoscopic examination disclosed an acute serous neurosensory retinal detachment. Fluorescein angiography showed a large area of early hypofluorescence in correspondence to and extending beyond the photodynamic spot. Neurosensory retinal vessels involvement with dilation of the retinal arterioles and capillary nonperfusion were also revealed. Indocyanine green angiography showed choroidal infarction within the collateral choroid included in the area of light exposure, with associated nonperfusion of medium and large choroidal vessels being revealed. Five days after PDT, spontaneous severe bleeding with breakthrough into the vitreous occurred, in addition to an RPE tear. CONCLUSIONS: Acute loss of vision associated with vascular changes in retinal and choroidal circulation represents an uncommon but serious complication following combined PDT and IVTA. These risks should be carefully considered in combination therapies.

Supernumerary and supplemental teeth: case report.

AIM: This is to report the case of a ten year old child affected by a numeric dental anomaly showing the pathologic condition characterised by the simultaneous presence of supernumerary and supplemental teeth. The anomaly was analysed to plan the best surgical and orthodontic treatments. CASE REPORT: Dental history, clinical and instrumental examinations were made to perform a correct orthodontic examination and diagnosis. A young patient was affected by numeric dental anomaly in the upper jaw. We observed a high number of teeth, specifically two normally formed supplemental lateral permanent incisors and an unerupted mesiodens placed between the upper central incisors. Firstly, the supplemental lateral teeth were extracted. This surgical therapy and the application of a space maintainer were made to permit the eruption of the permanent canines. Then the mesiodens also underwent surgical treatment (i.e. extraction). Eventually, physiologic eruption of permanent teeth was allowed by the planned surgical-orthodontic treatment. DISCUSSION: Aim of the surgical-orthodontic treatment was extraction of the unerupted supernumerary teeth to obtain the physiologic eruption of the permanent ones. Orthodontic treatment is important to solve malocclusions and maintaining the space for the eruption of permanent teeth. CONCLUSION: Aesthetics and function are two important parameters in modern dentistry. All clinicians should try to make a correct and rational diagnosis for both simple and complex dental pathologies. Particularly in young children, invasive and surgical disinclusive techniques can be substituted by interceptive orthodontic treatments.

Mechanical behavior of quartz fiber reinforced epoxy resins for teeth restoration.

In this work composite materials, based on quartz fibers and epoxy resins, were employed with the aim to restore damaged teeth. The composite materials were chosen because they show biomechanical features very similar to that of the dentine, the main constituent of the tooth. Extracted teeth were rebuilt with two different restorative procedures: in the first, the composite material was pre-formed in a conical trunk shape abutment (PA) and then bonded to a fiber quartz post with a dental bonder. In the second rebuilt system the abutment was prepared by cross linking the resin on the fiber quartz post with a halogen lamp (CRA). The restored teeth were then mechanically tested and observed with a Scanning Electron Microscope (SEM) with the aim to study the interaction between the reconstructive materials. Wetting and roughness measurements were also carried out in order to study the interface adhesion between the post and the abutments. Characterization analysis evidenced that the CRA restorative procedure improves the adhesion between the substitutive materials and shows higher fracture strength than the PA ones. Anyway both the rebuilt systems are able to support the masticator load. An explanation of the interfacial post-abutment interaction phenomenon is discussed.

Is there any relationship between photodynamic therapy for exudative age-related macular degeneration and choroidal neovascolarization recurrence? A rationale for combined treatments.

PURPOSE: Photodynamic therapy (PDT) is the treatment of choice for subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (ARMD). Interpretation of PDT mechanism of action is not yet fully understood and causes of CNV recurrences are unclear. The authors have conducted a retrospective analysis of fluorescein and indocyanine green angiographies in patients treated with multiple PDT in order to identify risk factors for recurrence. METHODS: A total of 342 eyes of 342 patients (207 women and 135 men) with ARMD and subfoveal CNV were treated with at least two PDT. Angiographic (fluorescein and indocyanine green) features of recurrences were confronted to pretreatment examinations in all patients. RESULTS: Post-PDT angiographies showed in all eyes a dark circle corresponding to the laser spot even 1 year after treatment. Persistence or progressive regrowth of CNV developed in an area adjacent or corresponding to the original lesion, without any specific relationship with the location of fluorescein and indocyanine green late leakage or with presence of abnormal fluorescence due to pigment abnormalities. At the 3-month angiographic follow-up, 23 patients (6.7%) showed a recurrent CNV resembling shape and dimension of the laser spot used for the PDT treatment. CONCLUSIONS: The authors failed to identify angiographic signs helpful to predict the risk of CNV persistence or recurrence. PDT leaves minor but persistent changes in the choroidal vasculature within the treatment area. In some cases, the recurrent CNV seems to be related to the laser spot of the PDT.

Identification of the microorganisms responsible for periodontopathy by Multiplex RT-PCR.

The aim of our research was to identify by bacterial genomic DNA analysis the prevalence of five different species of periodontopathogenic bacteria present in the subgingival biofilm, specifically: Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Bacterioides forsytus (Bf), Treponema denticola (Td). For the analysis we used the systematic Multiplex-PCR-microdent kit with species-specific primers. We studied a group of 48 subjects, 18 males and 30 females, from 18 to 78 years of age. The initial clinical screening enabled us to select, among the group analysed, 24 subjects with signs of active periodontopathy (Group A) and 24 patients without identifiable clinical evidence of the disease used as the control group (Group B). Within the two experimental groups (A and B), the test was found to be positive in 75% of subjects from group A, whereas the test was found to be negative in all the subjects from group B. Our research shows that the Multiplex-PCR system is reliable. Furthermore, the sensitivity and simplicity of this technique, as well as the decrease in working times and the possibility of identifying non-culturable bacteria, since the presence of viable organisms is not essential, make this technique indicated for the simultaneous identification of periodontopathogenic bacteria and might, in perspective, provide a more effective clinical alternative to the techniques of bacterial typing of the subgingival plaque.

Retinal abnormalities associated with a mutation of the nucleotide 683 in von Hippel-Lindau disease.

BACKGROUND: von Hippel-Lindau disease (VHL) is a hereditary cancer syndrome in which affected individuals are at risk of developing tumors in multiple organs, including eyes, cerebellum, spinal cord, kidneys, inner ear, adrenal glands and pancreas. METHODS: We performed a fundus examination and fluorescein and indocyanine green (ICG) angiography in both eyes of a young woman affected by VHL with bilateral pheochromocytoma, retinal angioma, retinal microaneurysms and unusual alterations of the deep retinal layers. A molecular analysis of the VHL gene was carried out. RESULTS: Ophthalmoscopy disclosed in her right eye a small retinal hemangioma, some microaneurysms in both eyes at the posterior pole and multiple, small, whitish, dome-shaped lesions scattered in the retinal pigment epithelium (RPE) of the posterior retina. Fluorescein angiograms revealed in the early phase multiple hyperfluorescent spots that showed progressive discoloration in the late phase of angiography. Some of these spots were ophthalmoscopically undetectable. The late phase of ICG angiography showed some small hyperfluorescent points located at the level of the RPE, and some of them corresponded to the hyperfluorescent spots seen on fluorescein angiography. The molecular analysis revealed the presence of a "missense" mutation of the VHL gene at nucleotide 683. CONCLUSIONS: Alterations in the RPE have never been observed in the VHL syndrome. We describe an unusual case of VHL with a capillary hemangioma associated to diffuse alterations with the RPE of the posterior retina. The possibility exists that these lesions form part of the eye modifications in VHL.

Kinesiographic investigations in children with increased nasal airways resistance.

The aim of this study is to evaluate by means of the kinesiographic test, how the muscular alteration, linked with mouth breathing, modifies mandibular dynamics. From a sample of children aged between 8-11 years, on the basis of increased nasal airways resistance measured with the forced oscillation technique, we selected a group of 14 subjects. These children underwent kinesiographic examination (K-System Biotronic) and they were compared to a control group. Certainly, the speeds reduction in the pathological group emerged as the most significant data. The mastication tracings on the frontal plane, in the group with increased nasal airways resistance, moreover appeared to be reduced in width, elongated in shape and sometimes irregularly square, compared to the bell shape typical of subjects without any dysfunctional pathologies. Considering that each subject responds in a personal manner to an increase of the nasal resistances, due to the extremely variable individual adaptability, the kinesiographic test, together with the electromyographic one, in our opinion, can assist anamnesis, clinical examination and other instrumental investigations, in the identification of those subjects in which the increase of the nasal airways resistance interferes with muscular function, laying the basis for possible modifications in the craniofacial growth.

[Restoration of dentoperiodontal unit in cervical carious lesions]. / Il ripristino dell'unita' dento parodontale nelle lesioni cariose cervicali.

The Authors study the issues of conservative periodontal treatment in therapy of carious lesions adjacent gingivae. They say again with one accord with others Authors the importance of the attainment of the extrasulcular cavity margins. They show the resolution of some cases.

[Bad habits and dysgnathia: epidemiological study]. / Abitudini viziate e disgnazie: indagine epidemiologica.

The authors refer about an epidemiological survey in 651 children in the school-age. The aim of study is to investigate about the frequency of the bad habits and the pathogenetic relations between these and the development of the dento-maxillo-facial deformities. They point out an incidence of these bad habits in the 35,48% with a predominance of mouth breathers (45,45%). After they discuss the necessity of an early detection of anomalous neuromuscular attitudes.

[Epidemiological study of the frequency of caries and malocclusion in school-age children]. / Studio epidemiologico sulla frequenza della carie e delle malocclusioni in eta' scolare.

The authors have made an epidemiological survey on a population in the school-age group, with the aim to evaluate the right incidence of the decay and dysgnathias and about the possible ethiopatogenetic relationship between these two pathologies. The results are very close to other similar researches.