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Objectives: The purpose of this case report is to illustrate the consequences of dental surgical extractions in patients who are receiving or have received IV bisphosphonate. Materials and methods: A 52-year old man suffering from multiple myeloma was treated with Zometa for one year. At the end of the therapy he underwent some surgical extractions that caused two areas of mandibular osteonecrosis after a few months. The authors obtained the patient's informed consent to report his medical data and pictures. Results: The two necrotic areas were treated in different ways and the treatments are still in progress. After 5 months, a slight improvement has been observed in the exposed bone areas. Conclusions: In the management of the osteonecrosis of the jaw it is important to assess the cost-benefit ratio, trying to improve health expectations and perspectives in a patient who is already affected by a systemic disease. © 2010 Elsevier Srl. All rights reserved.

The philosophy of Dentistry Science at University of Milan-Bicocca foresee clinical/operative criteria into Preventive and Therapeutical Dentistry activities. This philosophical formulation determined a planning on different areas of intervention such as Surgical, Pedo-orthodontic and Oral Hygiene Sciences carried out within teaching, research, clinical activities and management. In particular, within Oral Hygiene Science, it has been established a Territorial Preventive Dentistry Coordination (TPDC) which, also thanks to technological systems, allows to connect all the Oral Hygiene Centres of the University Hospital of Monza and Brianza among each others. The structures connected to each others are St. Gerardo Hospital in Monza, the Don Gnocchi Institute in Milan, the FERB in Bergamo and the "Il Sole" Association. St. Gerardo Hospital treats patients of all ages range and usually, the most perfomed dental services are scalings (22,24%) and control examinations (24,36%); at FERB's are control examinations (27,30%), orthodontic support measures (21,27%) and furrow sealing (17,92%), since the target of patients is mostly paediatric; at Don Gnocchi's Institute are implant (31,80%) and surgical support measures (23,02%), because the target is mostly geriatric, as well as at Il Sole's Association where performances are mainly implant (29,81%) and surgical support measures (18,27%). The TPDC helps all the Oral Hygiene Centres to gather and compare all their information, in order to improve diagnostic, therapeutical and prognostic techniques.

This paper discusses current approaches in the treatment of oral cancer. MATERIALS AND METHODS. The mainstays of treatment in early stage of oral cancer are either radiotherapy or surgery. Advanced diseases are treated either by surgery with postoperative radiotherapy or by definitive radiotherapy, with surgery as last option if necessary. In recurrent and metastatic disease, chemotherapy is the standard treatment option and is generally used with palliative intent. Surgical treatment of malignant tumours in the oral cavity often results in an unfavourable anatomic situation for prosthodontic rehabilitation. Many of these problems can be, at least partially, solved by the use of endosseous oral implants. RESULTS. Although disease responds well at early stage, the risk of a second primary cancer is high, with a development rate of about 4% per year. For non-metastatic locally advanced disease, there is a relatively high risk of tumour recurrence (locoregionally or at distance), despite the use of post-operative radiotherapy after resection. The prognosis for patients with recurrent /metastatic disease remains poor. Oral rehabilitation needs a thorough pre-surgical examination and multidisciplinary consultation for a well-established treatment planning. CONCLUSIONS. At early stage, the goal of the treatment is to maintain a favourable efficacy/toxicity ratio and to reduce the incidence of second primary tumours. The immediate aim of the treatment in advanced stage should be to increase survival, locoregional control and organ preservation and to reduce both the formation of distant metastases and the incidence of severe acute treatment induced toxicities, particularly mucositis. In recurrent and metastatic disease, the goal is to improve response rates to chemotherapy and, wherever possible, to prolong survival without reducing quality of life. The development of endosseous implants and bone grafting has allowed to increase the possibilities of oromandibular reconstruction in patients with oral cancer.

Dental hygienist becomes integral part of numerous operating protocols, which are actuated to codify and improve clinical activity and scientific research of University Hospital. A purpose of dental hygienist is carrying out with dentistry personnel a succession of specific preventive-therapeutic programs, devoted to different kinds of patients, improving conditions of mouth and organism health of these ones. One of these protocols is that applied to dental treatment and prevention of old patients resident in Don Gnocchi Foundation, Palazzolo Institute. This Institute, share of University Hospital of Monza and Brianza, houses inside 822 old people, with average age of 89, who join the current study from November 2006. At first personnel checks autonomy levels and cooperation for all the patients and at the same time they notices conditions of oral health, with possible presence of removable prosthesis, partial or total and also levels of plaque, blood index and parodontal probing. Every day Hygienist shows all the patients how to carry out personal hygienÈs and their own prosthesis cleaning's manoeuvres. He executes directly these ones on patients partially cooperating or absolutely not cooperating. After these surveys staff picks up same data and levels of prosthesis cleaning. In the end of protocol (6 months) the same personnel carries out for the second time all the surveys and compares those with previous ones. All the surveys show improvements in prosthesis cleaning, blood index and plaque levels. There isn't any effectiveness in this operative protocol without hygiene and prevention activities done by dental hygienist in OPHR with cooperation of other medical specialists.

In diversi lavori presenti in letteratura, è stato evidenziato che l’acqua in circolo nei riuniti odontoiatrici può raggiungere una concentrazione batterica di gran lunga superiore a quella consentita per legge nell’acqua potabile. Le ragioni ritenute responsabili di questo fenomeno sono la contaminazione diretta dei circuiti idrici da parte di batteri provenienti dalla rete dell’acqua potabile o aspirati, per refl usso o capillarità, dalla superfi cie esterna della testina dei manipoli. Lo scopo di questo lavoro è di valutare, con analisi microbiologiche in vivo, le capacità di controllo della contaminazione batterica delle linee idriche dei riuniti odontoiatrici off erte da un sistema combinato basato su cicli periodici di disinfezione e immissione in continuo di perossido di idrogeno a 300 e 600 ppm all’interno delle linee idriche. I risultati ottenuti hanno evidenziato che il sistema adottato consente - con una concentrazione di 600 ppm di perossido di idrogeno erogato in continuo nei circuiti idrici del riunito testato, combinata con un ciclo di disinfezione quotidiano - di portare la carica batterica contaminante al di sotto della soglia di rilevabilità dei test culturali microbiologici adottati. Different papers showed that bacterial contamination od dental unit waterlines can reach much higher concentrations than allowed for potable water, according to European Community Standards. Reasons for that are recognized in direct contamination from bacteria present in potable water that supplies dental units or aspirated from the outer surface of dental hand pieces. Data obtained show that a daily disinfection cycle in combination with concentrations of 600 ppm of hydrogen peroxide continuously supplied in dental unit waterlines allowe to reduce bacterial contamination under the level of sensitivity of the adopted microbiological assay.

Dentist and Dental Higyenist cooperation is strategical for an appropriate treatment of the pedo-orthodontic patient. In our University this kind of synergy was applied to caries prevention and to the initial identification of dental-maxillo-facial malformations in childhood. At the same time only a team approach allowed us to correctly treat complex cases such as hemato-oncological patients.

Aim: dentists both as clinical practice and research increased progressively their interest in leukemia, because the oral complications are common during the outcome of the disease, dental management is complex, and the mouth is a potential source of morbidity. Dental Clinic of University of Milan-Bicocca has prepared, in collaboration with the Hematologic Pediatric Department, guidelines for dental treatment of children affected by leukemia. Dentists, who take care of leukemic children, have several roles: diagnostic, preventive, therapeutic and supportive role. Diagnostic role: head and neck signs resulting from leukemic infiltrates include cervical lymphadenopathy, oral bleeding, gingival infiltrates, oral infections, and oral ulcers. Thrombocytopenia and anemia manifest in pallor of the mucosa, petechiae, and ecchymoses, as well as gingival bleeding. Spontaneous gingival bleeding is common when the platelet count falls below 20.000/mm3. Preventive role: dental treatment to eliminate potential sources of oral infection, such as teeth with caries, pulpitis, moderate to severe periodontal disease, is accompanied by a significant reduction in the rate of septicemia. The early diagnosis of oral infection is mandatory because oral disease is considered a true source of potentially life-threatening infection from gram-positive and gram-negative bacilli. The oral flora is the most likely sources of septicemia in 50% of cases. Therapeutic role: it is dentists' duty to develop screening evaluation and remove sources of infection before chemotherapy has started, following subsequent guidelines: complete oral examination, removal of orthodontic brackets, conservative therapy, professional hygiene, resolution of inflammation, extraction of compromised teeth, even if platelet transfusion and intravenous combinated antibiotics may be required before. The use of absorbable gelatin or collagen sponges, topical thrombin, or the placement of microfibrillar collagen held in place by packing or splints are helpful. Supportive role: as survival rate of children with cancer increased significantly during the past decades, late effects of antineoplastic therapy become important to be forwarded. Children with acute lymphoblastic leukemia received brain radiation and chemotherapy to prevent a relapse. Craniofacial deformities and dental anomalies are quite common in children who receive this therapy, expecially before age 5. The most common abnormalities reported in children were deficient mandibular development, dental agenesis, arrested root development, microdontia, and enamel dysplasia. Conclusions: Leukemic children need special care. Appropriate oral hygiene and health should be manteined and restored before development of irreversible dental damage: only a close cooperation among pediatric hematoncologists, pediatric dental surgeons, and dental hygienists could guarantee these. In the last 5 years we have treated 317 leukemic children and have made 5292 dental care. Our experience suggests that even if detrimental impact of antineoplastic therapy on oral cavity is unavoidable, it could be diminished with an adequate and correct preventive or curative therapy contributing to a better quality of life of children treated for leukemia.

Invasive cervical resorption is a relatively un common form of external root resorption which has been a source of interest and academic debate by clinicians and researches for over a century. Tooth resorption is a condition associated with either a physiological or a pathological process resulting in loss of dentin, cementum or bone (1,2). This condition has been variously labeled, but because of its invasive nature of the term seems more appropriate to invasive cervical resorption. Although the etiology of this conditions remains obscure, knowledge of potential predisposing factors is important in assessing patients at risk. It is seen in most cases a late complication of traumatic injuries of teeth, but it may also occur after orthodontic movement, tooth bleaching, scaling, chronic inflammation of the pulp and periodontal tissue, root planing and a wide variety of traumatic conditions. The diagnosis of resorption into internal and external resorption is usually based on clinico-radiographic finding, internal resorption is comparatively more destructive and results in loss of tooth structure without the deposition of any hard tissue. It is most commonly found in the cervical region, and clinically presents asymptomatically. Usually, the coronal pulp is necrotic, the resorptive defect creates a clinically obvious pinkish color (“pink spot”) in the crown. The same resorptive process can occur in other tooth locations: in erupting teeth in may arise trough an enamel defect in the tooth crown and may be termed invasive coronal resorption, while a more apical source may be termed invasive radicular resorption. In root canal that leads to resorption of the aetiology is not known for which it was defined by the term idiopathic. Radiographically the lesion presents as a circumscribed in continuous expansion. Invasive cervical resorption has and continues to be misdiagnosed as a form of internal resorption, a misunderstanding that could possibly be attributed to the descriptions of internal resorption by Gaskill in 1984 and by Mummery in 1920 which included teeth showing “pink spot”. Currently, the etiology of invasive cervical resorption is poorly understood and this may explain some of the diversity in terminology. A basic question to be answered by researches is whether this process is purely inflammatory in nature, more probably activated by sulcural microorganisms, o alternatively a type of benign proliferative fibrovascular or fibro-osseus disorder in which microorganisms play a secondary role as an invading pathogen as demonstrated by studies of recently acquired. The classification in the diagram below shows the types of dental resorption in the regions.

Low-level laser therapy (LLLT) has been reported to enhance wound healing. Activation of fibroblasts has a potential for early wound healing in oral cavity. The aim of this study was to determine adequate energy doses using specific parameters of LLLT to produce biostimulatory effects on human fibroblasts culture. Materials and Method: cells were seeded on multiwell plates and exposed to a 980 nm diode laser with energy doses of 0,5, 1, 2, 4, 5, 7, 17, 50 J/cm2. Cell metabolism was evaluate by using 3-(4, 5-dimethylithiazol-2-yl)-2, 5-diphenyl tetrazolium bromide (MTT). Cell proliferation was measured by sulforhodamine B (SRB) assay. Data were analyzed by variance test with statistical significance of 5% . Results: irradiation of the fibroblasts with 2, 4 and 5 J/cm2 resulted in significant increase in cell metabolism compared with non-irradiated group (P˂ 0,05), 2 J/cm2 was found to be an optimal energy density. Cell proliferation was significantly stimulated at 2 J/cm2 . Conclusions: LLLT stimulates cell metabolism and proliferation of fibroblasts in vitro.

SURGICAL-RADIOGRAPHIC PART:The aim of the present retrospective chart review was to determine the relationship between nonvascularized osseous graft remodeling and the three-dimensional (3D) features of grafts and recipient sites, the anatomical recipient regions and different graft procedures. 18 iliac crest were onlay-positioned in the mandible or maxilla or used in sinus lift procedures. CT scans, taken before implant positioning and after 1 year, revealed a mean volume resorption of 40%. For iliac crest grafts, the average resorption was 36% when the onlay was positioned in the anterior maxilla, 77% when it was positioned in the posterior mandible and 17% in sinus lift procedures. GENIC PART: This part of the study aims to identify and rank genes involved in osseous augmentation or bone remodeling to obtain groups with more numerous predicted associations called the leader gene clusters. An iterative search (consisting of a consecutive expansion-filtering loop) was performed for which only genes involved in a specific process were identified. For each gene, predicted associations with all other involved genes were obtained from a Web-available database (Search Tool for the Retrieval of Interacting Genes/Proteins) and the weighted number of links (WNL), given by the sum of only high-confidence predicted associations (results with a score > or =0.9), allowing gene ranking. A total of 161 genes potentially involved in bone-volume augmentation and 128 genes connected with the bone-remodeling phenomenon were identified.

The aim of our study was to evaluate the properties of the laser-modified titanium surface, that are its skills of promoting a faster differentiation of human Mesenchymal Stem Cells (hMSCs) into osteoblasts and a more stable connection between differentiated cells and titanium comparing to the machined and the sand-blasted surfaces. Furthermore, we wanted to evaluate if titanium alone was a sufficient factor able to induce the differentiation towards the osteogenic lineage. Materials and methods: we harvested stem cells from an individual (after his consensus) and cultivated them into dishes with titanium disks presenting three different surfaces: machined (M), sand-blasted (S) and laser-modified (L). In the test group cells were cultivated in an osteogenic medium, while in the control group cells were seeded in a standard DMEM. Evaluations of the degree of differentiation were made with Alizarin coloration after 28, 38, 42, 49, 56 and 63 days of induction. Results: no signs of differentiation were evident in the control group, while in the test group there was a statistically significant differentiation evident since the fourth week. Laser-modified and sand-blasted surfaces showed similar values, greater than the machined surface. Discussion: the differentiation reached its peak on the sixth week for the laser-modified surface, and on the seventh week for the other two surfaces. After the peak, the differentiation had a slow decrease for the laser-modified surface and a rapid decrease for the other two. Conclusions: titanium alone can’t be considered a sufficient factor able to induce differentiation of human Mesenchymal Stem Cells into osteoblasts. Moreover, laser-modified induces a faster differentiation of stem cells and a more stable connection between osteoblasts and titanium.