Valutazione estetica del sorriso in pazienti con agenesia degli incisivi laterali mascellari: revisione della letteratura

Objectives

Our aim was to identify the aesthetic parameters of the smile that should be assessed in patients with missing maxillary lateral incisors, by means of a review of the most recent literature on this topic.

Materials and methods

Using the most common search engines, such as Pub Med and the Cochrane library, we selected articles published between 1995 and 2010, which were indexed with the following Keywords “congenitally missing lateral incisors”, “aesthetic aspects”, “long-term clinical results”, “smile arc”, and “soft-tissue aspects”. Of the 28 articles selected, 10 were eliminated because they had follow ups <5 years or referred to sponsored studies. The remaining 18 articles only 12 articles were analyzed to identify the aesthetic parameters to evaluate in smile assessment of patients with missing maxillary lateral incisors.

Results

The review showed that when upper incisors are missing, good aesthetic results can be obtained with the traditional space-opening approach or with orthodontic space closure and mesialization of the lateroposterior sectors. However, clinicians currently prefer the orthodontic space closure option.

Conclusions

Treatment options for patients with missing maxillary lateral incisors include either space closure approaches and those based on space reopening and insertion of implants. Both offer good results in terms of smile aesthetics.     

Valutazioni posturali in pazienti con crossbite posteriore monolaterale

Objectives

To evaluate the body posture and plantar arches of patients with posterior unilateral crossbite.

Materials and methods

We examined 24 patients: 12 with posterior unilateral crossbites (study group) and 12 with no orthodontic problems in the transversal plane (controls group). Each participant was subjected to a baropodometric evaluation with the eyes open and stabilometric evaluations with the eyes closed and open. These variables were evaluated: percentage of body weight distributed on each foot, length and velocity of oscillations from the body's center of pressure (COP) during testing with the eyes closed. Mean values and standard deviations were calculated for each variable. The Student's t-test was used to compare postural parameters of the two groups.

Results

The two groups differed significantly in terms of the length and velocity of sway.

Conclusions

Posterior unilateral crossbite seems to influence postural stability.     

Un ausilio all'igiene orale in pazienti diversamente abili

Objectives

The aim of the study is to prove that the use of a disposable gauze imbued with chlorhexidine 0.12% is a helpful aid to traditional oral hygiene procedures in disabled patients.

Materials and methods

The ability of disabled people during oral hygiene procedures was evaluated with a questionnaire. The patients were given instructions on how to use the gauze for their daily oral hygiene. It was also used a teaching aid set formed by an information brochure and a plastic model of the oral cavity. After 45 days their questionnaire was filled out to evaluate the improvement of oral hygiene performance.

Results

The use of a gauze in addition to correct dental hygiene procedures turned out to be an excellent way to improve the performance of dental hygiene procedures.

Conclusions

The results have shown the need to divulge the basis of dental prevention procedures within rehabilitation facilities.     

Prevenzione e igiene orale in pazienti in terapia ortodontico-chirurgica

Objectives

The aim of this work consists in presenting the results obtained from a qualitative and quantitative analysis of bacterial plaque in patients in orthodontic surgical treatment.

Materials and methods

Seventy-five patients of both sexes (aged 21–41 years) were studied. Samples of plaque were obtained from lingual surfaces of tooth 46 at the first appointment (T1), the day before surgical intervention (T2), during intermaxillary fixation (T3), at the removal of the orthodontic appliance (T4) and after one year from the removal of the fixed appliance (T5). Samples of plaque were evaluated quantitatively and qualitatively, analysing plaque index, total coccoid and bacillary forms and Gram positive and Gram negative forms for each sample.

Results

A slight decrease of the plaque index and total bacillary and coccoid forms between the first sample (T1) and the one taken the day before surgical intervention (T2) was recognised. During intermaxillary fixation (T3), a slight increase of the plaque index was evidenced. Between T3 and T4 another reduction of the plaque index (that reached 8%) was noticed. The plaque index was lower in T4 (8%) than in T2 (14%). From the fourth to the fifth sampling, performed after a year, there was a further general improvement of the plaque index: indeed, in 51 patients out of 75 (68%) the plaque index decreased, while in 24 patients there was a slight increase that did not exceed 10% compared with the previous sampling.

Conclusions

Patients in orthodontic surgical treatment, after a proper training, show a significant reduction of bacterial plaque between the first appointment and the following ones. Bacterial forms diminish. Also during intermaxillary fixation, when mechanical plaque control is compromised, it is possible to plan a plaque control through mouthwashes containing hydrolitic enzymes with destranasic activity.     

Sperimentazione clinica su pazienti affetti da xerostomia

Objectives

The aim of the study is to assess the importance of saliva and to investigate the problem of xerostomy also known as “dry mouth syndrome”.

Methods

In order to start the experiment a standard protocol has been created. This protocol allowed to examine patients with xerostomy through a standard and precise procedure. Xerostomy is caused by reduction of production of saliva. In spite of the fact that xerostomy is thought a rare trouble, it involves a number of patients with symptoms such as dry mouth for long time. The protocol consists of nine points to apply in the checking of patients. The sperimental protocol was applied and followed carefully during the three meetings with patients (first check up, check up after a month, and check up after three months).

Results and conclusions

Both objective and statistic analysis underlined a better xerostomy including an increase of salivary secretion and significative reduction of plaque and bleeding indexes.     

Terapia conservativa in pazienti con disordini temporomandibolari: risultati preliminari

Objectives

To evaluate the effect of conservative therapy for the treatment of patients with temporomandibular disorders (TMD).

Materials and methods

In this clinical, retrospective, before-and-after study, we reviewed clinical chart data and selected 28 outpatients with TMD. Inclusion criteria were TMD that was mainly functional and biomechanical in origin, treatment with conservative measures, availability of 3-month follow-up data. Conservative treatment consisted of one or more of the following: occlusal appliances, active physical therapy exercises, manual therapy, and stress management techniques. The following outcome measures were evaluated: craniofacial pain and mouth opening at base-line and after treatment at the 3-month follow-up.

Results

As a result of treatment, follow-up assessments revealed significant improvements in pain and mouth opening (t test for paired samples, p < 0.01).

Conclusions

Despite the limitations of this study, our findings indicate that conservative therapy may be useful in the treatment of patients with TMD. This conclusion is in line with international guidelines, which recommend noninvasive, reversible interventions for the initial treatment of TMD.     

Valutazione delle caratteristiche cranio-facciali in pazienti affetti da patologie neuromuscolari

Objectives

The objective of this study was to perform an epidemiological survey of craniofacial features in patients affected by neuromuscular diseases.

Materials and Methods

67 patients, aged 6 to 18 years (57 males and 10 females), affected by different neuromuscular diseases (Duchenne muscular dystrophy, Becker muscular dystrophy, spinal muscular atrophy, congenital myopathy, limb-girdle muscular dystrophy, congenital muscular dystrophy, congenital myotonic dystrophy, facioscapulohumeral dystrophy) were evaluated.

Results

High prevalence of particular craniofacial features (hyperdivergent facial morphology, increased lower third facial height, lip incompetence, asymmetry) and occlusal features (Class II or III dental occlusion, crossbite) was observed. Moreover, atypical swallowing, macroglossia, mouth breathing and phonological disorders were frequently evidenced.

Conclusions

Patients affected by neuromuscular diseases present with particular dysmorphic craniofacial features and dental malocclusion.     

Estrazioni dentarie in regime ambulatoriale in pazienti in terapia con anticoagulanti orali

ObjectivesEvaluation of post-extraction bleeding in patients on oral anticoagulant (vitamin K antagonist) therapy.Materials and methodsWe reviewed 256 consecutive outpatient extractions performed between 4 July 2008 and 27 July 2010 on patients receiving oral anticoagulants (OAC). The INR during the 48 hours before the procedure was never above the therapeutic range (< 3.5). A total of 311 teeth were extracted.ResultsThere were no major hemorrhagic complications severe enough to require hospitalization, transfusion, and/or adjustment of OAC therapy. There were 4 cases of late bleeding that required a second outpatient visit; all were controlled with simple local measures (intra-alveolar oxidized cellulose, sutures and compression). The incidence of post-extraction bleeding was unrelated to the INR, and our results were not significantly different from those of other studies that used different protocols for post-extraction hemostasis. About a quarter of subjects had INRs below the therapeutic level.ConclusionsThis retrospective study confirms that vitamin K antagonists do not need to be stopped before dental extractions. Unfortunately, in many countries this approach is not always used in clinical practice.     

Trattamento ortopedico in pazienti con III classe scheletrica: una revisione sistematica

Objectives

To evaluate the efficacy of orthopedic devices for maxillary protraction in patients with class III malocclusion, with reference to the indications for and timing of treatment and the short-term and long-term outcomes.

Materials and methods

This study is based on a review of the literature (CCTs, RCTs, reviews, metanalyses) published during the period from January 2000 to May 2011.

Results

Fifteen articles were selected for review on the basis of explicit criteria for inclusion and exclusion. The articles differed from one another in terms of the treatments assessed (devices, protocols, and timing).

Conclusions

Orthopedic maxillary protraction devices are indicated for correction of class III malocclusion in patients under 10 years old of age. They appear to be effective on the basis of short-term observations; no long-term outcomes have been reported thus far.     

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.     

Comunicazione oro-antrale e otturatore in pazienti con osteonecrosi dei mascellari. Caso clinico

ObjectivesThe obturator prosthesis is a valid aid in rehabilitation. It is normally used to correct small-to-medium defects of the palate left by surgical excision of tumors involving the oral cavity and part of the respiratory tract. Our aim was to implement a similar protocol for patients with osteonecrosis of the jaw (ONJ).Materials and methodsThis report describes the treatment of a patient with ONJ using self-molding thermoplastic material applied on an obturator.Results and conclusionsPlacement of an obturator with thermoplastic material allowed us to restore the patient's general health, which had been poor, and it also had positive effects on phonation.     

Associazione tra composti volatili solforati,malattia parodontale e reflusso gastroesofageo in pazienti con alitosi

Objectives

The aim of this research was to evaluate the correlation between three different kinds of Volatile Sulphur Compounds (VSC), periodontal disease and gastroesophageal reflux disease.

Materials and methods

In this study, we used a gas chromatograph capable of measuring levels of VSCs individually and displaying their concentration in a diagram expressed in nanograms/10 mL. 40 patients were selected on the basis of diagnosed periodontal diseases and the reported symptom of gastroesophageal reflux.

Results

Our results show that periodontal disease was linked to a high concentration of hydrogen sulphide, whereas gastroesophageal reflux was linked to high concentration of dimethyl sulfide.

Conclusions

Halitosis is a condition characterized by consistent foul-smelling breath that may indicate a wide range of local and systemic diseases, or may be due to specific eating habits. It may also be a diagnostic factor for psychiatric disorders. A gas chromatograph detecting sulphur gases in breath makes the diagnosis of halitosis easier and adds useful data for the diagnosis of periodontal disease and gastroesophageal reflux disease.     

Osteonecrosi dei mascellari e bisfosfonati: terapia e follow-up a lungo termine in 160 pazienti

ObjectivesOsteonecrosis of the jaw (ONJ) is a side effect of bisphosphonate therapy (BPT) that was first described in 2003. The etiology of BPT-associated ONJ (BRONJ) remains unknown, but the pathogenesis seems to be related to multiple local and general factors. Several groups of experts have developed prevention protocols to facilitate specialists involved in the multidisciplinary management of patients with BRONJ. This paper provides a concise review of the literature on BRONJ and describes our experience at the University of Parma with 160 patients who received BPT for neoplastic and non-neoplastic diseases.Materials and methods139 BRONJ sites in 160 patients were treated with 5 different approaches, as follows: Group 1, 28 sites treated with medical therapy alone; Group 2, 32 sites treated with medical therapy and Low-Level Laser Therapy (LLLT); Group 3, 17 sites treated with medical therapy and conventional surgery; Group 4, 33 sites treated with medical therapy, surgery, and traditional LLLT; and Group 5, 29 sites treated with medical therapy, laser-assisted surgery, and LLLT.Results and conclusionsIn terms of clinical improvement, statistically significant differences were found between the different treatment groups and those treated with medical therapy alone. The introduction of laser-assisted therapy and surgical approaches seem to produce better results in terms of complete healing.     

Posizionamento di impianti immediati o differiti in siti postestrattivi o in aree edentule in pazienti trattati con bifosfonati orali

Objectives

The purpose of this study is to evaluate postoperative healing after tooth extraction and implant positioning into extraction sockets, in patients undergoing oral bisphosphonate treatment.

Materials and methods

The surgical technique for implant positioning starts with the initial osteotomy of the site and follows the manufacturer's protocol. Fourteen patients were treated: they received a preventive therapy for the control of local and systemic infections; the surgery was minimally invasive.

Results and Conclusions

Fifty-one implants were positioned and evaluated for a follow up period of 36.2 months. Two maxillary implants were lost after 18 month from the prosthesis delivery.No post-surgical complications were observed and Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) didn’t occur in any case.