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This study aims to describe pathologic fractures of the jaws due to cystic bone lesions. Their daily clinical practice findings are not very common, so their treatment can be challenging. In addition, endosseous benign lesions like a radicular, residual, solitary, aneurysmal cyst, and odontogenic keratocyst, might weaken the bone so that trauma, or usual chewing, could break it. We follow from the first clinical examination to the X-ray or CBCT examination and surgical management of our patients, reporting all procedures and results to explain our approach to these cases. We also reviewed the literature briefly to determine if our operative management is in line with the scientific community. Mandibular angle and body are common locations, while symphysis and condyle are less so. Young men are the most affected, and trauma is the most triggering event. Cyst enucleation, followed by fracture reduction and fixation, is the treatment of choice for our clinical team and the scientific community. We observe how impactful it is to approach the cavity of the cystic lesion from the fracture line as the surgical gold standard

Aim: The objectives of this study were three: 1) obtaining electronic microscopy images before and after a PRF pretreatment from three different implant surfaces, 2) evaluating the angle contact obtained wetting, with a blood drop, three different implant surfaces and 3) evaluating if the PRF pretreatment of the same implant surfaces, modifies their wettability. Methods: Six implant surface’s samples were selected: two machined, two blasted and two with laser treatment. Four images for implant surface were acquired by SEM (Scanning Electron Microscope) before and after a PRF pretreatment, respectively with 200x, 500x, 1000x and 2000x magnification. Afterwards the angle contact formed between three different implant surfaces and 10μl blood drop was calculated by optical microscope with 10x magnification. With other three samples, that were pretreated with PRF, the angle contact formed between the different implant surfaces and 10μl blood drop was evaluated by the same microscope. The pretreatment of the implant surfaces was made soaking the samples in the PRF and after drying them with sterile gauze. The entire procedure was performed five times in five different days to obtain five measurements for implant surface with and without the PRF pretreatment. The human blood, for the drops and for the PRF production, was drawn from the same volunteer for all the time. Results: The results obtained with SEM were poorly relevant. It was possible to observe only a few fibrin deposits on implant surfaces with PRF pretreatment. The results obtained with optical microscopy, evaluating different surfaces between them, were relevant: by using “non parametric” tests with software SPSS for Mac OS X (SPSS inc. Chicago, IL, USA) a significant wettability difference from different implant surfaces was observed. The average angle contact of the different surfaces were: for the machined surface 56.58 ± 12.83, for the sandblasted surface 76.45 ± 6.93 and for laser treated surface 51.02 ± 3.49. The results obtained, calculating the angle contact after PRF pretreatment of implant surfaces, were very interesting and satisfying. It was possible to observe an important wettability improvement of implant surfaces: machined surface had 33.67 ± 3.06, sandblasted surface had 38.84 ± 8.49 and laser treated surface had 32.88 ± 1.59. The statistical analysis highlighted a significant wettability difference from the same implant surface before and after PRF pretreatment but there was not significant angle contact difference between the different surfaces after PRF pretreatment; in fact the angle contact values were very similar Conclusions: Compelling evidence from our study lead us to suggest, according to scientific literature, that the machined surfaces have more wettability than sandblasted surfaces and a similar one compare to the laser treated surfaces. The PRF pretreatment have a positive effect on wettability of implant surfaces. This effect is independent from the kind of surface, probably because the wettability improvement is directly related to PRF proprieties and not to the characteristics of the implant surface even if the results with SEM were not significant; perhaps due to chemical changes on implant surfaces (not visible by microscopy) thanks to PRF pretreatment. So the PRF could be used as a helper to make the osseointegration process faster by using a rough surface, which stimulates the cell differentiation, with an optimal wettability, which allows to improve the cell adhesion.

Aim: The aim of the study is to evaluate and compare the intra- and post-operative bleeding during asimple dental extraction, among patients undergoing conventional Oral Anticoagulant Therapy (OAT) and patients assuming Direct Oral Anticoagulants (DOACs). Methods: Patients in chronic oral anticoagulant therapy (at least 6 months) with indication of a single dental extraction were enrolled and divided between OAT e DOACs group. All the participants were evaluated at four different time-points: T0 during the first examination, T1 during surgery, T2 thirty minutes after surgery and T3 the day of suture removal (seven days after surgery). At the different time-points anagraphic, medical history, local periodontal and dental variables were collected. The surgical protocol consisted in a simple dental extraction lead by the same surgeon (FB), in the least invasive procedure. Bleeding occurrence and biological complications were registered, according to Iwabuchi classification. Results: 15 patients (mean age 77,27±5,72) and 18 patients (mean age 75,94±12,18) were enrolled respectively in OAT e DOACs group. Overall 33 teeth were extracted within 20 minutes of surgical time (cut off that defined the simple extraction in our research protocol). The results of the present study showed no statistical difference between the two groups regarding the intraoperative bleeding and post-extraction bleeding complications. In detail, no intra-operative bleeding occurred, two patients for each group reported a post-operative bleeding managed with a single gauze compression during the week after the extraction, three patients of OAT group and one subject belonging to DOACs group needed more than two compressions in the week, and finally one patient for each group referred to our dental first aid. In these two cases, the urgency was managed with the local application of tranexamic acid and the complication could be attributable to high blood pressure values. Conclusion: Within the limits of the present study, apparently, patients assuming DOACs can be treated for simple oral surgery like patients undergoing OAT with INR index in therapeutic range. No discontinuation or changes of anticoagulation treatment with novel oral anticoagulants are possibly required. The adoption of local hemostasis techniques represents the most important precaution to prevent bleeding complications and to discriminate between bleeding caused by anticoagulation therapy and surgical technique. The patient education for the post-operative care of surgical site appears also strictly necessary.

Aim: The Platelet-Rich Plasma is a blood compound with high platelets density. By using immunotest ELISA. this study evaluates the activation and degranulation of the platelets during stocking procedure of the PRP, considering the role of the TGF-β1, a growth factor of the tissues, that is found in the α-platelet granules. Finally, to gain a better understanding of the quality and the quantity activationes state these datas are compared to the ones obtained with the cytofluorimetric analysis of the activation state of the platelets in the PRP. Methods: This study focuses on a sample of 19 patients (21-71 years-old), with no major deseases and waiting for an invasive oral-surgery. 24h before surgery each patient was sampled for 400ml of venous blood (+sodium citrate). Subsequently, the obtained blood sack was centrifugated to divided the erythrocytes from the plasma (900RPM, 13min, at 20°C). The plasma was then centrifugated (3300RPM, 15min) to respectively obtain the P.R.P. and the P.P.P. (Platelet- Poor Plasma). Thus, P.R.P. was then shaked to prevent platelet aggregation. Instead, from the P.P.P. were took the autologous-thrombin and cryoprecipitate. Finally, P.R.P. (5ml), cryoprecipitate (2ml), calcium-gluconate (1ml) and autologous-thrombin (2ml) were mixed in 10ml syringe; after gelification the compound was placed in the chirurgic site. Through test-ELISA were calculated the pg of TGF-β1 into P.R.P. and into compound after the gelification. Results: The results for the TGF-β1 obtained through test-ELISA are the following. 1) For the diluited solution SN (1:300) is has been extimated a release after 1 hour (h) of 22366.50 pgTGFβ/ml, after 6h of 30527.50 pgTGFβ/ml, after 24h of 19138.88 pgTGFβ/ ml and in post gel of 11791.63 pgTGFβ/ml. 2) For the diluited solution (1:150) is has been extimated a release after 1h of 15712.33 pgTGFβ/ml, after 6h of 26850.00 pgTGFβ/ml, after 24h of 29450.00 pgTGFβ/ ml and in post gel of 15321,43 pgTGFβ/ml. The TGF-β1 percentage released has been calculated using two formulas: (SN/SN+TOT) e (SN/TOT). The results using first formula were respectively after 1h of 7.6%, after 6h of 8.6% and after 24h of 20.5%. The results using second formula were after 1h of 8.4%, after 6h of 14.8% and after 24h of 19.9%. These results have been matched with the ones obtained through cytofluorimetric analysis of the samples marked with monoclonal antibodies. They reveal the following datas: for CD 42 the percentage of exposure are after 1h of 79.1%, after 6h of 90.2% after 24h of 87.6% and in post gel of 11.9%; for CD 62p is after 1h of 29.1%, after 6h of 32.4%, after 24h of 52.7%; for CD 63 is after 1h of 64.5%, after 6h of 67.1%, after 24h of 80.3%. Conclusion: From the cytofluorimetric analysis of the datas we state the procedure to produce P.R.P. it is satisfying since the gel has demostrated a high platelets density. When the activation and degranulation of the platelets rise (cytofluorimetric), the release of the TGF-β1 increases (ELISA), but only 20% of the total present in the platelets has been effectivly released in the first 24h. This implies that a great quantity of growth factors remains in the paltelets and is available in the chirurgic-site. Untill the 24h it has been observed an increasing of release of the TGF-β1, with a drop in the quantity once the gel was formed, bringing the levels close to the first hour.

L'attività ludica occupa uno spazio importante nella vita della popolazione giovanile. Gli autori indagano sull'attività ludica svolta dagli studenti della Scuola Secondaria di I grado di Messina e Catania.

Type of impaction and site of nerve are important risk factors of neurological damage following the lower third molar removal. The purpose of this study was to evaluate the peripheral damage of lingual and lower alveolar nerves in relation to tooth angulation and radiographic proximity to the alveolar canal.Sixty-seven consecutive patients (41 women and 26 men, mean age 29.97+/-14.35 years) underwent lower wisdom teeth extraction and were clinically evaluated over a one year period, checking any evidence of peripheral damage of the lower alveolar or lingual nerves. Tooth angulation and presence or absence of spongy bone between the mandibular canal and the root apex were considered; so, the patients were assigned twice to two groups: G1A (third molar in axis); G2A (third molar angulated); G1B (third molar apex adjacent to the mandibular canal); G2B (spongy bone between root apex and canal). The extraction was carried out according to a standardised technique without raising and retracting of a lingual flap. The follow-up checks were at one week, 1, 3, 6, 12 months and until any problem was solved. Statistical analysis was carried out using chi2 test.A total of two cases of temporary damage to the lingual nerve (1 case in G1A and 1 in G2A; 2 cases in G2B) and 3 cases to the lower alveolar nerve (3 cases in G2A; 1 in G1B and 2 in G2B) were discovered. No statistical differences were found. Symptoms cleared up within a maximum period of 5 months.Tooth angulation and proximity to lower alveolar canal were not related to alveolar or lingual damage; the conservative surgical technique seems to be an important factor in preventing neurological complications.

Trismus may represent an external sign of masticatory or lateral pharyngeal abscess that in rare cases is the consequence of pathogen action by micro-organisms introduced in deep tissues after inferior alveolar block. The case presented shows a buccal-masseteric mycotic abscess following restorative procedure involving inferior alveolar anesthesia on the same side. A 49-year-old woman was referred to the Dental Clinic (University of Trieste) complaining of a progressive inability to open her mouth since one week associated to a hemifacial edema in the right parotid region. The symptoms initially started one week before. Infection developed after restorative procedures performed 10 days before on the same side. Based on clinical signs and cultural exam findings, a buccal-masseteric mycotic abscess was found and magnetic resonance (MR) was performed to assess its localization and extension. Initial pharmacological therapy with piperacillin/tazobactam administered intravenously, was replaced by appropriate antimycotic therapy on the basis of sensitivity test to antibiotics. Infection resolution was obtained but complete absence of facial asymmetry occurred after 5 months only. Introduction of micro-organisms during anesthetic alveolar block is a documented source of infection and may occur after dental procedure involving inferior alveolar anesthesia. Complete medical history, cultural exam with sensitivity test to antibiotics and RM or computed tomography (CT) images, are necessary to perform an adequate treatment plan and to administer a correct therapy. Presence of trismus, accompanied by pain or facial edema after dental procedure or during dental or perioral infections has to be carefully considered by clinician to diagnose as soon as possible a deep spaces infection and to avoid serious or life-threatening complications.

Objectives To evaluate the level of knowledge of pregnant women and puerpers about oral health and prevention during and after gestation. Methods One hundred women aged 18–49 years (mean age 33±6 years) were included in this cross-sectional study. An anonymous questionnaire with 24 items related to oral health has been administered during or just after pregnancy. Firstly, answers have been analyzed on the full population and then subdividing the sample on the base of age ranges (G1: 18–25 years, G2: 26–35 years and G3: >35 years) and number of pregnancies (FP: first pregnancy; SP: second or more pregnancies). Parametric tests have been chosen for the statistical analysis; in particular, Anova test for independent samples was used to evaluate differences of baseline demographic characteristics among subgroups G1, G2, G3 while chi-square test was used for FP and SP subgroups. Anova test was also used to intercept differences on answers given to the questionnaire among G1, G2 and G3 group; for FP and SP group was used t-test. Results Level of information and knowledge of the full sample was medium-low and no significant differences have been observed between groups regarding awareness of the own level of the oral hygiene and knowledge of oral care. Conclusions Results of this survey underline the high necessity of educational programs regarding oral care in pregnant and puerpers women. A strict collaboration between medical figures (dentist, oral hygienist, gynecologist and obstetric) is strongly encouraged to spread the concept of prevention.

Purpose. Recent advances show that ultrasonic implant site osteotomy is related to a decreased trauma and a better postoperative healing of the surgical site when compared to traditional drilling techniques. The micrometric bone cutting control and the operative advantages related to the piezoelectric approach are also characterized by a learning curve for the clinician in surgical practice and an increased operative duration of the procedure. The aim of this investigation is to compare the operative time, the postoperative pain, and the amount of painkillers taken by the patient during the healing period. Methods. A total of 65 patients were treated at the Unit of Oral Surgery (Department of Medical Sciences, Surgery and Health, University of Trieste, Italy) using a split mouth model: 75 drill-inserted implants (G1) and 75 piezoelectric device-inserted implants (G2) were placed. The Visual Analogue Scale (VAS) was performed to evaluate the postoperative pain at 15 days from surgery. The operative time and frequency of intake of painkillers were measured. Results. The G1 and G2 groups showed a significant difference with a higher use of painkillers observed for G1. The G2 patients showed a lower level of pain (VAS) at all experimental times between 8 hours to 7 days (p<0.01) postsurgery. At 15 days, the pain levels were similar for both groups. No differences were found in site preparation duration between the study groups. Conclusions. The evidence supports the application of the piezoelectric approach compared to the drill’s osteotomy as a useful technique for implant site preparation. This trial is registered with NCT03978923.

Objective: To investigate the relationship between the presence of ectopic calcification in the elongation of the styloid process (SP) and its possible clinical manifestation (Eagle syndrome) in a population of kidney-transplant patients previously treated with hemodialysis. Methods: Digital orthopantomography of 92 kidney-transplanted patients and 68 control subjects were analyzed to measure the length of SPs. Calcium, phosphate, alkaline phosphatase, and parathyroid hormone (PTH) blood levels were also available for comparison. Results: The mean length of SPs was significantly different between groups, as were phosphate and PTH values. Discussion: Renal transplant patients who have been treated with hemodialysis present elongated SPs, presumably due to alterations in phosphate balance and PTH levels. Thus, in cases of orofacial pain in patients with a history of altered bone metabolism, particularly when due to renal insufficiency, Eagle syndrome should be suspected as the main cause of symptoms.

The authors describe four cases of suicide by hara-kiri. This very painful form of suicide consists of self-inflicting a wound in the abdomen using a sharp instrument. It was first reported in 988 A.D. in the East but has now become rare in both the East and West. These four cases occurred over a 40-year period in the Trieste and Bari medicolegal area. In two of our cases the victims were afflicted with mental illness, whereas the other two suffered from depression. In cases of death by hara-kiri, it is important to establish a differential diagnosis between suicide and homicide; the presence of trial wounds (inflicted by the victim as a form of practice to overcome any hesitation before stabbing the abdomen with the cutting weapon) can prove very helpful.

Objective To evaluate postextractive neurological complications after third molar extraction under general anesthesia and to identify correlations between the surgical procedure, the third molar-related pathology, and neurological involvement. Study design The clinical records of 183 patients were analyzed for a total of 408 third molars extracted at the Dental Clinic of Trieste (Italy). Individual effects of clinical data on the presence of paresthesia were evaluated by a logistic regression model. Results Neurological involvement was observed in 13 patients (6.1%). No permanent inferior alveolar nerve damage was found (0%) and only 1 patient presented a permanent lesion of the ipsilateral lingual nerve (0.3%). Pell and Gregory classification and surgical difficulty were not associated with the incidence or gravity of neurological lesions (P = NS). Among the pathologies associated with third molars, only the variable “abscess” presented a significant correlation with paresthesia (OR 6.86; 95% CI 1.21-38.8; P = .029). Conclusion The percentage of nerve injuries agrees with the literature data, inclusion class, and surgical technique seem not to influence paresthesia risk. Further studies are necessary to evaluate the role of infectious pathologies as a cofactor in the development of neurological lesions after oral surgery.

Descending Necrotizing Mediastinitis is a rare complication that can be secondary to dental infections or surgical procedures involving the oral region. Despite a prompt pharmacological therapy and surgical intervention, a delayed diagnosis is still responsible for a too high mortality rate (about 40%). We present a review of the current literature on Descending Necrotizing Mediastinitis, focusing on the evolution of its management from Pearse to today. In particular, recent patents focused on novel compositions and methods to prevent and treat oral infections.

The problem of the possibility of modifying blank cartridge dummy firearms to make them fire a real bullet has long been known, but the phenomenon has been constantly on the increase in the recent years. In Italy, there are no restrictions on the purchase of an inoffensive weapon. However, few modifications are frequently enough to transform the inoffensive weapon into a harmful one: a procedure is often undertaken to avoid the mandatory control and registration of firearms. We describe a case of suicide of a man in Trieste, Italy, in 2002, with a blank cartridge dummy pistol that had been modified to fire homemade bullets. Today the achievement of a proper control of the spread of firearms is a serious problem worldwide. In particular, this is true in the case of weapons the lethal nature of which can be masked to pass a superficial examination, with the aim of evading the security laws in all nations. For various reasons, individuals may become illicit holders of firearms of various types and natures, often made out of common objects produced for other purposes. These can be bought on the market or found at home, but after assembly and proper modifications, they can be transformed into true weapons, homemade guns that work perfectly and are potentially lethal. The situation is slightly different in the case of home-modified guns, in which the transformed object was already a weapon, but originally produced to fire blank cartridges, as a replica or a toy (such as air guns or gas guns, or other instruments like tear-gas pen guns and pellet guns), that are available on the market and can be easily modified to convert them into harmful weapons. These are peculiar events that demonstrate a particular manual skill and ingenuity of their inventors, and make extremely difficult to identify the weapon used, in case of its absence on the scene-of-crime, or the dynamics of the event.

The authors describe 3 cases of dismemberment. Numerous methods of hiding a body and thus erasing proof of murder have been devised. Those most frequently described in the literature include: burial of the body in an unusual or impervious place such as a wood, grotto or mountain; charring the body by wrapping it in a tire, for example, to fuel the fire until all traces of the crime have been erased and identification of the victim is difficult; and dropping the weighted-down body in the open sea or in a well in the hope that it will never be found. Dismemberment is in reality a relatively rare method whereby, after killing the victim, the murderer uses a very sharp cutting weapon (a saw, axe, etc.) to sever the limbs and cut the body into small pieces. The operation is generally carried out immediately after the crime, although more rarely a long time may pass between the 2 events. © 2006 Lippincott Williams & Wilkins, Inc.