Interdisziplinäres Konzept zur Diagnostik und Therapie gefäßreicher Fehlbildungen im Gesichts- und Halsbereich

Purpose. In patients with extended vascular anomalies in the head and neck, therapeutic decisions may pose a challenge to maxillofacial surgeons, dermatologists, and interventional radiologists. We analyzed the value of an interdisciplinary classification and treatment concept. Patients and methods. The classification distinguishes hemangiomas and vascular malformations. Whereas hemangiomas are endothelial proliferations, vascular malformations are considered to be developmental anomalies, which are further classified into high-flow or low-flow lesions and according to the vascular channels into capillary, venous, or lymphatic malformations. Since 2000 we have provided interdisciplinary consultation for patients with vascular anomalies. In patients with hemangiomas and venous malformations, the clinical diagnosis is confirmed by color-coded duplex sonography and magnetic resonance imaging; angiography is performed as part of the treatment planning for patients with arteriovenous malformations. Patients with hemangiomas are treated surgically by cryosurgery or laser surgery or conservatively according to lesion size and behavior. In patients with venous malformations, percutaneous sclerotherapy is combined with surgical reduction; patients with arteriovenous malformations undergo transarterial embolization prior to surgical excision of the nidus. Results. A total of 73 patients attended the interdisciplinary consultation. This group included 53 patients with facial hemangiomas, 7 with venous malformations, 2 with capillary malformations, 5 with lymphatic malformations, and 6 with high-flow arteriovenous malformations. Conclusions. The interdisciplinary protocol increases diagnostic accuracy and helps to establish individual treatment plans for patients with extended vascular anomalies.     

Inquadramento diagnostico e clinico delle asimmetrie scheletriche di interesse ortodontico

Objectives

The aim of this paper is to provide the tools to differentiate physiological and pathological asymmetry and to recognize the severity of the malocclusion.

Materials and methods

On the basis of a survey of literature, a classification of craniofacial asymmetries is provided with particular reference to the aetiology and diagnosis of the skeletal mandibular asymmetry.

Results and Conclusions

The aetiology of mandibular asymmetries is multifactorial including genetic, environmental and congenital influences. Clinical examination, X-ray analysis and dental casts play an essential role in the correct diagnosis of skeletal anomalies and understanding the degree of skeletal asymmetry.The early diagnosis allows the clinician to bring the developmental process to a harmonious growth.     

The Use of Cone-beam Computed Tomography in the Preservation of Pulp Vitality in a Maxillary Canine with Type 3 Dens Invaginatus and an Associated Periradicular Lesion

Introduction

Dens invaginatus type 3 is an anomaly characterized by an invagination of enamel and dentin that can extend up to the root apex. It may pose treatment challenges when nonsurgical root canal therapy is deemed necessary. Conventional diagnostic aids such as periapical radiographs play an important role in the assessment of complex root canal morphologies. However, these modalities may sometimes yield insufficient diagnostic information. Cone-beam computed tomographic imaging produces 3-dimensional digital images and provides the clinician with a more in-depth understanding of the true morphology of the root canal system.

Methods

This case report describes the diagnosis and conservative treatment of an unusual case of a maxillary canine with an infected type 3 dens invaginatus and an associated periradicular lesion in which the vitality of the surrounding pulp was maintained. Mineral trioxide aggregate was used to fill the entire invagination, whereas the circular true root canal system around the invagination with vital pulp was left untreated.

Results

At the 1-year follow-up examination, clinical and radiographic findings showed that a diligent nonsurgical endodontic treatment can result in satisfactory periradicular healing and complete root formation.

Conclusions

The use of cone-beam computed tomographic imaging as an auxiliary tool for both diagnosis and planning the treatment of these anomalies is highlighted.     

La frequenza delle anomalie dentarie nei pazienti affetti da cheilognatopalatoschisi

Objectives

The purpose of this study was to investigate dental abnormalities in children with cleft lip and palate (CLP) in order to identify the most prevalent anomalies and the teeth most frequently affected.

Materials and methods

We analyzed orthopanoramics X-rays (OPT), computed tomography Dental Scans, clinical records, and dental casts from 18 consecutive patients (10 boys, 8 girls; mean age 11.2 years, range: 6 to 18), with CLP (complete or incomplete, mono- or bilateral) and recorded the presence of the following anomalies: supernumerary teeth, agenesis, shape and size anomalies, ectopic and dystopic eruptions, rotations and retained teeth.

Results

The most frequent abnormalities were: agenesis (prevalence: 22.5%), ectopic and dystopic eruption (19.3%), rotations (17.7%), shape and size anomalies (16.1%), and retained teeth (14.5%). The most frequently affected teeth were the lateral (45.1%) and central incisors (32.2%), the cuspids (14.5%), and the second bicuspid (6.4%). Lateral incisors were usually missing (39.2%) or retained (21.4%), while central incisors were more often rotated (50%) or deformed (25%). The cuspids were ectopic (66.6%) or retained (23%), while the bicuspids were missing (25%), retained (25%), or presented alterations in number (25%) or shape/size (25%).

Conclusions

Each subject presented at least one dental anomaly. This high frequency indicates that identification of these anomalies is fundamental for appropriate management of cleft lip and palate.     

Experimental periodontitis promotes transient vascular inflammation and endothelial dysfunction

Objectives

This study aimed to evaluate the systemic inflammatory response and cardiovascular changes induced by experimental periodontitis in rats.

Design

Experimental periodontitis was induced by placing a cotton ligature around the cervix of both sides of mandibular first molars and maxillary second molars in each male rat. Sham-operated rats had the ligature removed immediately after the procedure. Seven, 14 or 28 days after procedure, the effects of acetylcholine, sodium nitroprusside and phenylephrine were evaluated on blood pressure, aortic rings and isolated and perfused mesenteric bed. The blood was obtained for plasma Interleukin-6 (IL-6), C-reactive protein (CRP) and lipid evaluation. The mesenteric vessels were obtained to evaluate superoxide production and nitric oxide synthase 3 (NOS-3) expression.

Results

Ligature induced periodontitis reduced endothelium-dependent vasodilatation, a hallmark of endothelial dysfunction. This effect was associated with an increase in systemic inflammatory markers (IL-6 and CRP), worsens on lipid profile, increased vascular superoxide production and reduced NOS-3 expression. It is interesting to note that many of these effects were transitory.

Conclusion

Periodontitis induced a transient systemic and vascular inflammation which leads to endothelial dysfunction, an initial step for cardiovascular diseases. Moreover, the animal model of periodontitis used here may represent a valuable tool for studying the relationship between periodontitis and endothelial dysfunction.     

Misdiagnosis of a Nasopalatine Duct Cyst: A Case Report

Introduction

Nonendodontic lesions misdiagnosed as pathoses of endodontic origin are often referenced in the literature. One of the most frequent nonodontogenic cysts of the oral cavity, the nasopalatine duct cyst (NPDC), can be misdiagnosed as endodontic in nature.

Methods

A case is presented in which a patent NPDC was originally diagnosed as a sinus tract with subsequent endodontic nonsurgical retreatment and eventual extraction before endodontic consultation.

Results

After surgical treatment, a histopathologic diagnosis of an NPDC was confirmed.

Conclusions

If diagnosed incorrectly, inappropriate endodontic treatment of a NPDC may be initiated to include unnecessary extraction. An increased understanding of anatomy, the use of appropriate diagnostic tests to include cone-beam computed tomography imaging, and key examination techniques to distinguish endodontic lesions from nonendodontic pathoses are imperative for an accurate differential diagnosis and appropriate treatment outcome.     

Multiple Radiopaque Mandibular Lesions in a Patient with Apert Syndrome

Introduction

Apert syndrome (acrocephalosyndactyly) is a rare congenital malformation characterized by craniosynostosis, craniofacial anomalies, and symmetric syndactyly of the hands and feet. Oral manifestations usually include bifid uvula, a Byzantine arch palate associated with lateral swellings of the palatine processes, severe maxillary dental crowding associated with teeth malposition, severe open bite, dental caries, and gingival and periodontal disorders. Florid osseous dysplasia is an asymptomatic lesion mostly encountered during casual dental radiographic examinations as multiple sclerotic masses in 2 or more quadrants, usually in tooth-bearing regions.

Methods

A 32-year-old woman diagnosed with Apert syndrome was seen in our department for a routine dental examination. Radiographic evaluation showed multiple radiopaque lesions in the mandible. All teeth with radiopaque lesions gave positive responses to vitality tests, and the patient did not report any symptoms. Based on the clinical and radiographic findings, the diagnosis of florid osseous dysplasia in a patient with Apert syndrome was made. Because there were no signs of an intraoral infectious process or endodontic needs, the patient was followed during revisions for Apert syndrome, and the only treatment provided was conservative management of the many carious lesions observed during the clinical examination.

Conclusions

To our knowledge, this is the first study reporting the occurrence of florid osseous dysplasia in a patient with Apert syndrome. Conservative management should be performed in asymptomatic cases. Although rare, our case report highlights the importance of florid osseous dysplasia as a condition that may mimic lesions with an endodontic origin in patients with Apert syndrome.     

Il ruolo dell’igienista dentale nel trattamento laser dell’ipersensibilità dentinale

Objectives

The aim of the study is to assess and compare the desensitizing effects of Er:Yag laser and CO₂ laser with fluoride gel in the treatment of dentine hypersensitivity.

Materials and methods

The 15 patients selected are affected by hypersensitivity in the upper premolar; they have been treated randomly with Er:Yag laser, CO₂ laser, fluoride gel, and placebo. The pain was evaluated before the treatment by using the Visual Analogue Scale (VAS) and by air emission from a standard air-water syringe.

Results

There were statistically significant differences between the group treated with lasers and fluoride gel versus the group treated with placebo. There were no statistically significant differences between the groups treated with Er:Yag and CO₂ laser and the groups treated with fluoride gel and placebo.

Conclusions

Er:Yag and CO₂ lasers together with fluoride gel are useful in the treatment of dentine hypersensitivity.     

Effects of Fam83h overexpression on enamel and dentine formation

Objective

The aim of this study was to determine if FAM83H over-expression causes dentine or enamel malformations.

Materials and methods

The full-length mouse Fam83h cDNA was inserted into the pCAGIG vector between a β-actin promoter and β-globin enhancer for ubiquitous expression in transgenic mice. Recombinant mouse FAM83H was expressed and used to generate polyclonal antibodies. Western blots showed enhanced expression of the Fam83h transgene. The effects of transgene expression on tooth development were assessed by microhardness measurements of enamel and dentine. Total thickness of incisor enamel at the level of the alveolar crest was measured and decussating rod patterns were visualized by scanning electron microscopy (SEM).

Results

Three transgenic mouse lines were selected based upon their transgene expression levels. There was no statistically significant difference in the Vickers microhardness values of enamel or dentine between the transgenic lines or between the transgenic lines and wild type mice. No statistically significant differences in enamel thickness were observed between the transgenic lines and the wild type mice. SEM analysis revealed no apparent differences in the enamel crystal and rod morphologies.

Conclusion

Our findings demonstrate that over-expression of FAM83H in mice does not produce a phenotype in dentine or enamel.     

Does dental disease presence equate to treatment need among care home residents?

Objectives

This study aimed to explore the relationship between dental disease, complexity and dental treatment needs of care home residents.

Methods

Survey of residents in care homes in Wales. Random sample of participants from a random selection of care homes across Wales, UK. Data collection involved questionnaires and dental examinations.

Results

Data were collected from 655 care home residents in 213 care homes. Half of all residents reported good or very good oral health but most had dental treatment needs. 73% of dentate residents had active caries, of those, 53% required restorations and 37% needed extractions. All were deemed to require dental examination. 60% of dentate residents and 50% of edentate residents had case complexity, which influenced the delivery of care.

Conclusions

There is significant unmet dental treatment need amongst care home residents. Dental disease presence alone is a poor indicator of the need for care and does not account for case complexity or the shift towards a patient centred rather than disease focussed approach to care. Measures for treatment needs and complexity are required when undertaking assessments of oral health needs in care homes.

Clinical Significance

Traditional oral health surveys measuring dental disease do not necessarily equate to treatments required for care home residents and do not reflect the complexity and difficulties involved in delivering dental care. This survey highlights dental needs in care homes, and the difficulties involved in delivering care to address these needs.     

Histologic Study of a Human Immature Permanent Premolar with Chronic Apical Abscess after Revascularization/Revitalization

Introduction

Histologic studies of teeth from animal models of revascularization/revitalization are available; however, specimens from human studies are lacking. The nature of tissues formed in the canal of human revascularized/revitalized teeth was not well established.

Methods

An immature mandibular premolar with infected necrotic pulp and a chronic apical abscess was treated with revascularization/revitalization procedures. At both the 18-month and 2-year follow-up visits, radiographic examination showed complete resolution of the periapical lesion, narrowing of the root apex without root lengthening, and minimal thickening of the canal walls. The revascularized/revitalized tooth was removed because of orthodontic treatment and processed for histologic examination.

Results

The large canal space of revascularized/revitalized tooth was not empty and filled with fibrous connective tissue. The apical closure was caused by cementum deposition without dentin. Some cementum-like tissue was formed on the canal dentin walls. Inflammatory cells were observed in the coronal and middle third of revascularized/revitalized tissue.

Conclusions

In the present case, the tissue formed in the canal of a human revascularized/revitalized tooth was soft connective tissue similar to that in the periodontal ligament and cementum-like or bone-like hard tissue, which is comparable with the histology observed in the canals of teeth from animal models of revascularization/revitalization.     

Orthokeratinized Odontogenic Cysts Presenting as a Periapical Lesion: Report of a Case and Literature Review

Introduction

Inflammatory cysts, granulomas, abscesses, and fibrous scars represent most periapical radiolucencies. However, other less common lesions, such as orthokeratinized odontogenic cysts (OOCs), can be found at this region, and they deserve to be discussed because the prognosis for an OOC is different from that expected for the ordinary inflammatory periapical diseases.

Methods

An interesting case of OOC associated with a nonvital tooth in a 40-year-old woman is described. After a previous clinical diagnosis of a radicular cyst, the tooth was extracted, and the lesion was enucleated and submitted to microscopy examination.

Results

Because of the detection of an orthokeratinized epithelium lining, a diagnosis of OOC was concluded. After 2 years of periodic follow-up, no signs of recurrence were detected.

Conclusions

The presence of keratin in radicular lesions must be carefully evaluated to eliminate the diagnosis of lesions with more aggressive behavior, such as an OOC or even a keratocystic odontogenic tumor. Hence, histopathologic examination is mandatory to confirm the type of lesion and to differentiate other pathologic conditions, therefore establishing patients' prognoses precisely.     

Effectiveness of non-conventional methods for accelerated orthodontic tooth movement: A systematic review and meta-analysis

Objectives

To assess the available evidence on the effectiveness of accelerated orthodontic tooth movement through surgical and non-surgical approaches in orthodontic patients.

Methods

Randomized controlled trials and controlled clinical trials were identified through electronic and hand searches (last update: March 2014). Orthognathic surgery, distraction osteogenesis, and pharmacological approaches were excluded. Risk of bias was assessed using the Cochrane risk of bias tool.

Results

Eighteen trials involving 354 participants were included for qualitative and quantitative synthesis. Eight trials reported on low-intensity laser, one on photobiomodulation, one on pulsed electromagnetic fields, seven on corticotomy, and one on interseptal bone reduction. Two studies on corticotomy and two on low-intensity laser, which had low or unclear risk of bias, were mathematically combined using the random effects model. Higher canine retraction rate was evident with corticotomy during the first month of therapy (WMD = 0.73; 95% CI: 0.28, 1.19, p < 0.01) and with low-intensity laser (WMD = 0.42 mm/month; 95% CI: 0.26, 0.57, p < 0.001) in a period longer than 3 months. The quality of evidence supporting the interventions is moderate for laser therapy and low for corticotomy intervention.

Conclusions

There is some evidence that low laser therapy and corticotomy are effective, whereas the evidence is weak for interseptal bone reduction and very weak for photobiomodulation and pulsed electromagnetic fields. Overall, the results should be interpreted with caution given the small number, quality, and heterogeneity of the included studies. Further research is required in this field with additional attention to application protocols, adverse effects, and cost-benefit analysis.

Clinical significance

From the qualitative and quantitative synthesis of the studies, it could be concluded that there is some evidence that low laser therapy and corticotomy are associated with accelerated orthodontic tooth movement, while further investigation is required before routine application.     

In vitro biocompatibility of CoCrMo dental alloys fabricated by selective laser melting

Objective

Selective laser melting (SLM) is increasingly used for the fabrication of customized dental components made of metal alloys such as CoCrMo. The main aim of the present study is to elucidate the influence of the non-equilibrium microstructure obtained by SLM on corrosion susceptibility and extent of metal release (measure of biocompatibility).

Methods

A multi-analytical approach has been employed by combining microscopic and bulk compositional tools with electrochemical techniques and chemical analyses of metals in biologically relevant fluids for three differently SLM fabricated CoCrMo alloys and one cast CoCrMo alloy used for comparison.

Results

Rapid cooling and strong temperature gradients during laser melting resulted in the formation of a fine cellular structure with cell boundaries enriched in Mo (Co depleted), and suppression of carbide precipitation and formation of a martensitic ? (hcp) phase at the surface. These features were shown to decrease the corrosion and metal release susceptibility of the SLM alloys compared with the cast alloy. Unique textures formed in the pattern of the melting pools of the three different laser melted CoCrMo alloys predominantly explain observed small, though significant, differences. The susceptibility for corrosion and metal release increased with an increased number (area) of laser melt pool boundaries.

Significance

This study shows that integrative and interdisciplinary studies of microstructural characteristics, corrosion, and metal release are essential to assess and consider during the design and fabrication of CoCrMo dental components of optimal biocompatibility. The reason is that the extent of metal release from CoCrMo is dependent on fabrication procedures.     

Differences between the human eye and the spectrophotometer in the shade matching of tooth colour

Objectives

The aim of this work was to assess the agreement between instrumental and visual colour matching.

Methods

Shade selection with the 3DMaster Toothguide (Vita-Zahnfabrik) was performed for 1361 maxillary central incisors and compared with the shade obtained with the EasyShade Compact (Vita-Zahnfabrik) spectrophotometer.

Results

We observed a greater correlation between the objective method and the subjective one in the colour dimension of lightness (Kappa 0.6587), followed by hue (Kappa 0.4337) and finally chroma (Kappa 0.3578).

Conclusion

The colour dimension in which the greatest agreement is seen between the operator and the spectrophotometer is value or lightness.

Clinical significance

This study reveals differences between the measurement of colour via spectrophotometry and the visual shade selection method. According to our results, there is better agreement in the value or lightness colour dimension, which is the most important one in the choice of tooth colour.     

Tipologie di cementi nel fissaggio di corone in zirconia-ceramica: revisione della letteratura

Objectives

The purpose of this article is to present a review of the literature about surface treatments and methods of cementation of zirconia.

Materials and methods

We undertook a review of international literature considering dental journals as well as international PubMed database.

Results and conclusions

The sandblasting is considered the best treatment for zirconia, which is followed by using auto-curing or dual-curing resin cements. The choice of the type of material used is in accordance with the clinical conditions.     

A new method to assess the accuracy of a Cone Beam Computed Tomography scanner by using a non-contact reverse engineering technique

Aim

Today Cone Beam Computed Tomography (CBCT) has become an important image technique for dento-maxilla facial applications. In the paper a new method to assess the geometric accuracy of these systems was proposed. It uses a free form benchmark model and a non-contact Reverse Engineering (RE) system.

Method

The test geometry chosen for this study was designed in such a way that it simulated human spongy bone, cortical bone, gingiva and teeth and it composed of removable free form parts. It was acquired with a high-resolution laser scanner (D700 Scanner – 3Shape, Denmark). The reference 3D surface models obtained with the laser scanner was compared with the 3D models that were created from a CBCT system (Scanora 3D – Soderex, Finland) and from a traditional Multi-Slice Computed Tomography (MSCT) scanner (LightSpeed VCT 64 Slice – General Electric, USA) at different reconstruction settings, using an iterative closest point algorithm (ICP) in Geomagic^® software.

Results

The comparison between the different pairs of CAD models clearly shows that there is a good overlap between the models.

Conclusions

Although the results obtained in this study could lead to increase the use of CBCT for an increasing number of dental procedures, the publication of the European Commission guidelines represents a baseline on which the clinicians should rely heavily when considering the use of CBCT in their practice.

Clinical Significance

The results of this research show that the accuracy of CBCT 3D models is comparable to MSCT 3D models.     

Maxillary Premolar with 4 Separate Canals

Introduction

Recognition of anatomic variations is a challenge for clinicians regardless of which tooth is treated. Maxillary premolars usually have 2 root canals, but the presence of 3 distinct root canals has been reported in 1%–6% of cases.

Methods and Results

This report describes the case of a maxillary right second premolar with 4 separate canals: 1 mesial, 1 palatal, and 2 distal canals. This was confirmed by using cone-beam computed tomography and was successfully treated with rotary files and obturated by using a warm vertical compaction technique.

Conclusions

The clinical significance of the present case is that this is the first report of 3 roots and 4 separate canals in a maxillary premolar. Precise knowledge of root canal morphology and its variation is also underlined. Cone-beam computed tomography examination and the operating microscope are excellent tools for identifying and managing these complex root canal systems.     

10-Year Follow-up of Calcifying Odontogenic Cyst in the Periapical Region of Vital Maxillary Central Incisor

Introduction

Radiographic images may lead to misinterpretations of lesions of endodontic and nonendodontic origin. This report describes a case of a 10-year follow-up of a calcifying odontogenic cyst (COC) in the periapical region of a vital maxillary central incisor in a 9-year-old boy.

Methods

The patient revealed a history of a swelling in the periapical area of tooth #9. The patient denied any dental trauma or history of pain. Clinical examination revealed no mobility, but there was discrete discomfort when horizontal pressure was applied. Pulp vitality was present in all maxillary anterior teeth. Radiographs revealed an oval radiolucent lesion in the periapical region of maxillary central incisor. The therapeutic option was enucleation of the periapical lesion and histologic examination of the specimen. Microscopic findings suggested the diagnosis of a COC.

Results

At a follow-up visit 10 years after surgery, panoramic and periapical radiographs showed new bone formation; the patient did not have any pain, and pulp vitality was maintained in all teeth in this area.

Conclusions

A COC should be part of the differential diagnosis of other jaw lesions, such as apical periodontitis. The definitive diagnosis of a COC can only be made after microscopic evaluation of the specimen. The follow-up is a helpful reference because it confirms the survival of pulp tissue and no recurrence of the COC.     

Root Resorption Caused by Jaw Infiltration of Multiple Myeloma: Report of a Case and Literature Review

Introduction

Infiltration of the maxillofacial region by multiple myeloma is common and typically appears as punched out osteolytic lesions of the jaws. Although swelling, bone pain, and tooth mobility are characteristic clinical symptoms, root resorption is rare in conjunction with myeloma nests.

Methods

A case of a 67-year-old man with multiple myeloma is presented. Root resorption of the second mandibular premolar and the first and second molars on the right side, with consecutive tooth mobility, was the initial manifestation of the disease and was primarily detected on a periapical radiograph. The treating dentist referred the patient to the department for further examination, which revealed multiple myeloma. The patient received tandem high-dose chemotherapy and autologous stem cell transplantation as standard myeloma treatment. Intravenous bisphosphonates were administered to curb the osteolytic lesions.

Results

No signs of bisphosphonate-related osteonecrosis of the jaw were observed until the end of the follow-up period.

Conclusions

Only 5 reports of myeloma-associated root resorption have been reported in the literature. In all cases, mandibular premolars or molars were involved, and the patients exhibited extensive involvement of the jaw by myeloma. This report highlights the importance of correct interpretation of clinical signs and radiographs by dental specialists in the diagnostic algorithm of systemic diseases. Furthermore, this is an example for the inevitable part of bisphosphonates in the treatment of osteolytic processes.