Search

COVID-19 is the disease supported by SARS-CoV-2 infection, which causes a severe form of pneumonia. Due to the pathophysiological characteristics of the COVID-19 syndrome, the particular transmissibility of SARS-CoV-2, and the high globalization of our era, the epidemic emergency from China has spread rapidly all over the world. Human-to-human transmission seems to occur mainly through close contact with symptomatic people affected by COVID-19, and the main way of contagion is via the inhalation of respiratory droplets, for example when patients talk, sneeze or cough. The ability of the virus to survive outside living organisms, in aerosol or on fomites has also been recognized. The dental practitioners are particularly exposed to a high risk of SARS-CoV-2 infection because they cannot always respect the interpersonal distance of more than a meter and are exposed to saliva, blood, and other body fluids during surgical procedures. Moreover, many dental surgeries can generate aerosol, and the risk of airborne infection is to be considered higher. The aim of this paper is to provide practical advice for dentists based on the recent literature, which may be useful in reducing the risk of spreading COVID-19 during clinical practice.

This paper outlines the main operating framework of a Debt Agency (DA) for the management of the Eurozone sovereign debts. The framework leverages on the potential irredeemable nature of sovereign debts in order to build a common bond. Structurally filtering liquidity risk, the DA can price the Member States' installments by referring only to their fundamental risk. The common bond issued by the DA then avoids mutualisation by design, hence it can be directly bought by the ECB. Thanks to its structural intertemporal sustainability, the DA framework sketched here can serve as a benchmark for institutional and political decisions.

OBJECTIVES To evaluate the oral health-related quality of life (OHRQoL) of patients with burning mouth syndrome (BMS) by comparing the Oral Health Impact Profile-14 (OHIP-14) and Geriatric Oral Health Assessment Index (GOHAI) tests, assessing their dependence with pain, anxiety and depression and, secondly, to analyse the changes in time after treatment with psychotropic drugs. METHODS Twenty-six patients and 26 controls were included. The GOHAI, OHIP-14, visual analogue scale (VAS) and the Hamilton Rating Scales for Depression and Anxiety (HAM-D and HAM-A) were performed at baseline (time 0) and after 6 months of treatment (time 1). Descriptive statistics, the Mann-Whitney non-parametric test for two independent samples and the Wilcoxon non-parametric test for two paired samples were used. RESULTS The scores from all outcome measurements were statistically significantly different between the cases and controls (P

BACKGROUND Pemphigus vulgaris patients with exclusive oral involvement (OPV) treated with conventional immunosuppressive therapy may be non-responders or experience severe side effects and/or relapses. In such cases, rituximab could be used as an adjuvant in recalcitrant OPV patients. METHODS A retrospective single-center study on patients with oral pemphigus vulgaris treated with RTX at a dose of 375 mg/m2 was performed, evaluating the complete clinical and immunological remission, side effects of RTX, and possible correlation between anti-desmoglein (Dsg) 3 antibodies and clinical remission. RESULTS We treated 10 OPV patients, of which 60% had a moderate and 40% mild disease severity before therapy with RTX. Complete clinical remission (CCR) was achieved in 100% of OPV patients, of which 20% developed side effects and 20% experienced a relapse in a mean time of 15.2 ± 10.2 weeks. The mean time for CCR was achieved in 19.8 ± 10.3 weeks, whereas the duration of the CCR consisted in 37.4 ± 33.5 weeks. OPV patients underwent a mean follow-up of 57.2 ± 37.7 weeks. In all patients, the mean of pemphigus disease area index (PDAI) decreased from 20.3 ± 14.1 to 0.4 ± 0.0, whereas the mean Dsg3 value dropped from 157.1 ± 40.6 to 67.0 ± 26.6 after therapy with RTX. However, no correlation was found between PDAI and anti-Dsg3 antibodies before and after therapy with RTX (P > .05). CONCLUSIONS RTX represents a valid and safe alternative as an adjuvant in OPV patients with low rate of relapses and side effects.

Keynes' project for an International Clearing Union does not respond only to the economic and political needs of the particular historical moment in which it was conceived, i.e. the establishment of an international money really complementary to national currencies. With that project, in fact, Keynes conceives a new kind money, whose positive character is to be un-hoardable. The non-hoardability of the bancor raises the issue of the nature of what is commonly known as 'liquidity', and allows not only to distinguish the liquidity that is proper to money from liquidity in general, but also to refine the concept of liquidity in itself. And finally, it allows to think about the very possibility of other forms of monetary complementarity, notably at different local levels.

Aim: The aim of this study is to evaluate in vitro, using artificial lateral canals, the rate of dissolution of the pulp tissue through different protocols of canal irrigation. Materials and Methods: One hundred artificial canals provided with lateral canals have been used. Each lateral canal was filled with pulp tissue and calibrated to 0.002 mg. All canals were irrigated using five different protocols. Five groups have been used for the experiment: Group A, distilled water (control); Group B, preheated NaOCl; Group C, NaOCl heated inside the canal; Group D, NaOCl ultrasonically activated; and Group E, NaOCl heated inside the canal with ultrasonic activation. All samples were weighed through professional microbalance in three different phases: before insertion of the pulp tissue into the lateral canal, after insertion of the pulp tissue and, finally, after different protocols of irrigation. A statistical analysis with Kruskal–Wallis test and Mann–Whitney test was performed. Results: The partial dissolution of the pulp tissue inside the artificial lateral canal occurs only using the protocol with NaOCl heated inside the canal with ultrasonic activation. Other irrigation protocols are not able to dissolve the pulp tissue. Discussion and Conclusions: The main objective of endodontic therapy is the removal of damaged tissues and bacteria. Modern literature highlights that it is impossible to remove all the pulp tissues and bacteria from the whole endodontic space. Hence, to achieve excellence and get positive results in the short and long term, it is necessary to use techniques and technologies that may increase the degree of root canal detersion.

Aim The aim of present study was to compare cyclic fatigue resistance of three modern Ni–Ti instruments used with continuous rotation. Materials and methods For this study 3 groups of rotating instruments with continuous rotation (HyFlex EDM, Twisted File Adaptive, Revo S SU) have been used, each group consisted of 20 files. The various groups were subjected to cyclic fatigue testing through an artificial metal device. A statistical analysis with Kruskal–Wallis test and Mann–Whitney test was performed. Results There were statistically significant differences between the three groups. The HyFlex EDM instruments have a fracture resistance slightly higher than the Twisted file and far higher than Revo S SU. Conclusions Modern Ni–Ti alloys increase resistance of the rotating instruments to cyclic fatigue.

This study compares the effect of the modified early warning score (MEWS) versus a new early warning system (Niguarda MEWS) for detecting instability and criticality in hospital medical departments. A retrospective observational study was conducted in the Internal Medicine ward of Niguarda Ca’ Granda Hospital in Milan between November 2013 and October 2014. MEWS and Niguarda-MEWS were gathered using: systolic blood pressure, respiratory frequency, heart rate, temperature, level of consciousness, oxygen saturation, creatinine level, hematocrit level and age. In order to determine if the patient was critical or not the MEWS criticality cut-off value chosen was 3, while in the Niguarda MEWS it was 6. The primary outcome was the correlation between the critical level of the two scores and in-hospital mortality. The secondary endpoint was the correlation between a specific disease and the two scores. In the study, 471 patients were included, using both the MEWS and the Niguarda MEWS score at admittance: 33.4% of patients turned out to be critically ill using the former, 40.98% when using the latter. Therefore, the specificity of scores was 70% for MEWS and 73% for Niguarda MEWS, the sensitivity 58% for MEWS and 63% for Niguarda MEWS, Niguarda MEWS area under the curve (AUC): 0.736, MEWS AUC: 0.670. For the secondary outcome, the new score is higher for genitourinary and respiratory diseases. Niguarda-MEWS could be an optimal tool to detect criticality and instability in order to address the patient to the right level of care.

Most common techniques for alveolar bone augmentation are guided bone regeneration (GBR) and autologous bone grafting. GBR studies demonstrated long-term reabsorption using heterologous bone graft. A general consensus has been achieved in implant surgery for a minimal amount of 2 mm of healthy bone around the implant. A current height loss of about 3-4 mm will result in proper deeper implant insertion when alveolar bone expansion is not planned because of the dome shape of the alveolar crest. To manage this situation a split crest technique has been proposed for alveolar bone expansion and the implants’ insertion in one stage surgery. Platelet-rich fibrin (PRF) is a healing biomaterial with a great potential for bone and soft tissue regeneration without inflammatory reactions, and may be used alone or in combination with bone grafts, promoting hemostasis, bone growth, and maturation. Aim The aim of this study was to demonstrate the clinical effectiveness of PRF combined with a new split crest flapless modified technique in 5 patients vs. 5 control patients. Materials and methods Ten patients with horizontal alveolar crests deficiency were treated in this study, divided into 2 groups: Group 1 (test) of 5 patients treated by the flapless split crest new procedure; Group 2 (control) of 5 patients treated by traditional technique with deeper insertion of smaller implants without split crest. The follow-up was performed with x-ray orthopantomography and intraoral radiographs at T0 (before surgery), T1 (operation time), T2 (3 months) and T3 (6 months) post-operation. Results All cases were successful; there were no problems at surgery and post-operative times. All implants succeeded osteointegration and all patients underwent uneventful prosthetic rehabilitation. Mean height bone loss was 1 mm, measured as bone-implant most coronal contact (Δ-BIC), and occurred at immediate T2 post-operative time (3 months). No alveolar bone height loss was detected at implant insertion time, which was instead identified in the control group because of deeper implant insertion. Conclusion This modified split crest technique combined with PRF appears to be reliable, safe, and to improve the clinical outcome of patients with horizontal alveolar crests deficiency compared to traditional implanting techniques by avoiding alveolar height-loss related to deeper insertion of smaller implants.

This study investigated the effect of ultrasonic activation of intracanal-heated sodium hypochlorite (NaOCl) on its dentinal tubular penetration and root canal cleanliness in vitro. In experiment 1, mandibular premolars were randomly allocated to three groups (n = 8): group A, ultrasonic activation; group B, ultrasonic activation of intracanal-heated NaOCl and group C, syringe-and-needle irrigation. Penetration of the fluorescent-labelled NaOCl was investigated using light microscopy. In experiment 2, mandibular premolars were randomly allocated to group B or C (n = 10), for histological analysis of the remaining pulp tissue and debris. Data were statistically analysed using Kruskal-Wallis and Mann-Whitney tests (P = 0.05). The highest penetration of NaOCl was observed in group B, followed by group A (P < 0.05). Group B showed significantly less amount of debris than group C (P < 0.05). Dentinal tubule penetration of NaOCl and root canal cleanliness were significantly improved by ultrasonic activation of intracanal-heated NaOCl.

Increased left ventricular mass (LVM) is often present in metabolic syndrome (MS), also in the setting of well-controlled blood pressure (BP). Aim of the present study was to evaluate the efficacy of a nutraceutical combination of berberine, red yeast rice extract and policosanol (Armolipid Plus™, AP) in reducing LVM in patients with MS and left ventricular hypertrophy (LVH).In this multicenter, randomized, double-blind, placebo-controlled trial, 158 patients with MS (IDF criteria) and LVH (LVM48 g/mOne-hundred-and-forty-five patients (AP n = 74, placebo n = 71) completed the study. A significant percentage reduction in LVM was observed in AP group vs baseline (-2.7%, p 0.0001), and compared to placebo (-4.1%, p 0.0001), and remained significant after adjustment for age, sex, baseline systolic BP and BMI and their changes during the study period. The proportion of subjects showing LVM reduction was higher in AP group than in the placebo group (57% vs 28%, adjusted p = 0.007). Treatment with AP was associated with improvement of lipid profile.24-week of treatment with AP is associated with a significant reduction in LVM in subjects with MS and LVH, in addition to favourable effects on lipid profile, and could represent an effective strategy aiming at reducing the associated cardiovascular risk. The trial was registered at clinicaltrials.gov with ID NCT02295176.

Summary Objective CR4056 is a selective imidazoline-2 (I2) receptor ligand with potent analgesic activity in animal pain models. This proof-of-concept study tested CR4056 efficacy and safety in patients with knee osteoarthritis (OA) and different phenotypes. Design This is a multicenter, randomized, double-blind, placebo-controlled trial. Knee OA patients with moderate to severe pain received CR4056 (women 100 mg bid; men 200 mg bid) or placebo (both genders) for 14 days. The primary outcome was the change in WOMAC pain score (0–100 scale) compared to placebo, analyzed in the intention-to-treat population and pre-defined OA phenotypes. Results 213 patients were treated with CR4056 (92 women; 52 men) or placebo (69 overall). After 14 days, median WOMAC pain improvements were 10 points on placebo and 14, 20 and 16 in women, men, and pooled CR4056 groups (P = 0.184, 0.030 and 0.070 vs placebo, respectively). Pre-specified subgroup analysis in the metabolic OA phenotype (BMI ≥ 27.5 kg/m2, N = 156) showed statistically significant differences in all CR4056-treated groups vs placebo of 12–18 points. Conversely, there were too few patients with a neuropathic or inflammatory phenotype for a meaningful analysis. CR4056 was well tolerated; the most common adverse event was mild headache. Conclusions Although the primary endpoint was met in males only, this exploratory phase 2 trial shows that CR4056 might be an effective analgesic against knee OA pain, especially in overweight patients representing the metabolic OA phenotype. These findings, along with the broad-spectrum analgesic activity of CR4056 in animal models, warrant further clinical investigation in OA and other pain conditions. Clinical trial registration number EudraCT 2015-001136-37.

Background Nutraceuticals represent a new therapeutic frontier in the treatment of metabolic syndrom (MetS) and related cardiovascular risk factors. The aim of this study was to evaluate the potential beneficial effects of Armolipid Plus (AP) (berberine 500 mg, red yest rice, monacolin K 3 mg and policosanol 10 mg) on insulin resistance, lipid profile, particularly on small and dense LDL cholesterol (sdLDL-C), representing the most atherogenic components, as well as its effects on high sensitivity C-reactive protein, a notable marker of cardiovascular risk, blood pressure and cardiac remodeling in subjects affected by MetS, with left ventricular hypertrophy. Methods The study was a prospective, multi-center, randomized, double blind, placebo-controlled trial. One hundred and fifty eight patients, aged between 28 and 76 years old, were enrolled and randomized to receive either one tablet of AP or placebo (PL) once daily for 24 weeks. Anthropometric and vital parameters, total cholesterol (tot-C), low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglyceridemia (TG), non-HDL cholesterol (NHDL-C) and sdLDL-C were evaluated. Results After 24 weeks of treatment, the analysis performed on 141 subjects (71 in AP arm and 70 in PL arm), showed a significant improvement of lipid profile in the AP group, with reduction in tot-C (− 13.2 mg/dl), LDL-C (− 13.9 mg/dl) and NHDL-C (− 15.3 mg/dl) and increase in HDL-C (+ 2.0 mg/dl). These changes were equally significant compared with placebo (tot-C: AP − 13.2 mg/dL vs PL + 2.7 mg/dL, p

Aim Today, thanks to modern technologies as operative microscope, ultrasonic tips, devices to activate irrigation and tridimensional obturation performed with thermo plasticized gutta-percha, excellent results could be obtained. Materials and methods In this study, we present 5 patients with the presence of periapical lesions in molars and incisors with history of pain. Modern endodontic technologies were used. The rationale of using these technologies was to obtain a chemo-mechanical cleansing and obturation of the entire endodontic system and to gain the lesion resolution with a non-surgical approach. Results A success rate of 100% was obtained. Radiographs and clinical examinations were done until 10 years. All the cases highlighted the success achieved in the short and long term through the complete resolution of the lesions and therefore the reconstitution of the lamina dura. Conclusions The positive results highlighted by these clinical cases demonstrate how the use of modern technologies is essential to avoid iatrogenic damage and to gain safe and reproducible results.

One of the most widespread implications of the Great Financial Crisis has been the increase in bankruptcies across advanced economies. The traditional approach to the problem of insolvencies is constrained by deeply ingrained concepts of money and credit and by the institutions in which those concepts are embodied, according to which the only way to discharge a debt is a payment in money. This paper deals with a peculiar project elaborated within the Italian Ministry of Justice to address the problem of the growing amount of uncollectibles involved in bankruptcy procedures. The project entails a new form of articulation between money and credit, which overturns the traditional logic of liquidation by transforming creditors of bankruptcy procedures, passively waiting to be paid, into active operators, capable of sustaining demand. This goal is pursued by converting part of their credits into purchasing power that can be immediately spent in the auctions for the assets of bankrupt companies, thereby increasing the efficiency of bankruptcy procedures, accelerating the reallocation of assets and maximising the satisfaction of creditors. The projects may be seen as a complementary currency characterised by a functional, and not by a territorial, delimitation. It incorporates some of the features that have been recently experimented with, with varying degree of success, within both the official and alternative monetary systems: endogenous money creation, targeted loans and demurrage. The present paper aims at illustrating the theoretical underpinnings of the project and its implication for the question of devising an alternative to current financial institutions.

BACKGROUND Participants with functional gut disorders develop gas retention and symptoms in response to intestinal gas loads that are well tolerated by healthy subjects. To determine the role of cholecystokinin (CCK1 ) receptors on gas transit and tolerance in women with functional gut disorders. METHODS In 12 healthy women, and 24 women with functional gut disorders (12 dyspepsia and 12 constipation-predominant irritable bowel syndrome) gas was infused into the jejunum at 12 mL/min for 3 h with simultaneous duodenal lipid infusion (intralipid 1 kcal/min), while measuring anal gas evacuation and abdominal symptoms on a 0-6 score scale. Triple-blind paired studies during iv infusion of dexloxiglumide (2.5 mg/kg bolus plus 5 mg/kg h continuous infusion), a selective CCK1 inhibitor, or saline (control) were performed in random order. RESULTS During saline infusion participants with functional gut disorders developed significantly greater gas retention and abdominal symptoms than healthy subjects (394 ± 40 mL vs 265 ± 35 mL and 2.8 ± 0.3 vs 1.9 ± 0.4 highest abdominal symptom score, respectively; P

COVID-19 has severely impacted dentists, who are at a great risk of infection. This study aimed to investigate if dentists are anxious about returning to their daily activities, and what the perception of the risk is for dentists and orthodontists regarding orthodontic procedures. An online questionnaire, including the Patient Health Questionnaire-4 (PHQ-4), was sent to Italian dentists during the final days of the lockdown with items about anxiety, fear, distress, perceived risk for operators, and concerns about orthodontic patients caused by working during the COVID-19 outbreak. Data were analyzed with a chi-square test and logistic regression analysis. The level of significance was set as p &lt, 0.05. A total of 349 dentists completed the survey, including 183 orthodontists. Returning to their daily work activity was a source of anxiety for 192 participants and this was associated with the level of distress (odds ratio (OR) = 3.7, p &lt, 0.001). Most of the orthodontists (67.6%) thought that they would increase the number of working hours during the week (OR = 1.8, p = 0.007). Italian dentists were mostly scared to return to their daily activities because they considered their jobs a high risk to them and their families. Dentists with an exclusive/prevailing orthodontic activity were forced to increase their working day during the week.

Background:MTX is the first line treatment in early RA. There is robust evidence from cohort studies, but less from RCTs, that a “window of opportunity” exists over 12-16 weeks symptom duration. CR6086 is a selective prostaglandin EP4 receptor antagonist, with an immunomodulatory profile.Objectives:To test efficacy and safety of CR6086 added to MTX in early RA, DMARD-naïve patients.Methods:Patients with RA (ACR/EULAR 2010 criteria), < 1 year from symptom onset and naïve to DMARDs were randomized to oral CR6086 30, 90, 180mg, or placebo bid and oral MTX (20mg weekly) for 13 weeks (NCT03163966). Primary endpoint was the ACR20 response rate: 240 patients were needed to detect a difference among groups, with 50% responders on placebo and 70% on the 90mg CR6086 target dose. Pairwise comparisons of proportions were performed, with nonresponder imputation for withdrawals. A subgroup of patients underwent dynamic contrast-enhanced (DCE) MRI for quantification of synovitis at MCP and wrist joints, evaluated as DEMRIQ-ME and DEMRIQ-vol.Results:The ITT population included all 244 randomized patients receiving at least one dose of study drugs (59 CR6086 30mg/MTX, 60 CR6086 90mg/MTX, 63 CR6086 180mg/MTX, 62 placebo/MTX). Safety was good with no increased rate of infections or other disorders; however, there were more minor upper GI adverse events (AEs) with CR6086, and increased dropouts due to AEs with the 180mg dose (9/63, 14.3% vs 1.7-3.4% in other groups). There were more ACR20 responders with MTX monotherapy than predicted (59.7%) and thus the 10.3% difference with the 90mg target dose (70.0%) was not significant. The low 30mg dose was no better than placebo (55.9%), while the high 180mg dose did not provide additional benefit compared with 90mg (74.0% net of dropouts). CR6086 90mg and 180mg induced a significant improvement in MRI, compared with placebo (Fig. 1). In a post-hoc analysis in patients < 6 months from symptom onset (ACR definition of early RA: 98/244, 40.2%), MTX monotherapy exerted a large 76% ACR20 response rate that precluded potentiation. Conversely, in patients of 6-12 months disease duration (146/244, 59.8%) ACR20 responders were 48.6% with MTX monotherapy vs 68.4% with 90mg, i.e. a 19.8% difference as postulated, with proportional differences in secondary endpoints (Tab. 1).Conclusion:There was no benefit demonstrated for CR6086 added to MTX in the study cohort as a whole. However, in a post-hoc analysis, enhanced responses were observed with CR6086 90mg bid added to MTX in patients >6 months disease duration. This generated the hypothesis that addition of CR6086 90mg bid may benefit in RA patients initiating MTX after the window of opportunity, to be tested in further studies.Table 1.Patient characteristics & pregnancy outcomesSymptom onset (principal analysis)Symptom onset 6-12 months(post-hoc analysis)*Placebo+MTX(N=62)CR6086 90mg+MTX(N=60)Placebo+MTX(N=37)CR6086 90mg+MTX(N=38)ACR20, %59.7%70.0%48.6%68.4%ACR50, %33.9%38.3%29.7%39.5%ACR70, %17.7%23.3%10.8%28.9%DAS28 (CRP) 12.9%20.0%8.1%18.4%CDAI ≤2.8, %8.1%11.7%5.4%15.8%SDAI ≤3.3, %6.5%10.0%2.7%15.8%Boolean-based remission, %6.5%6.7%2.7%10.5%*In patients with symptom onset Figure 1.Change in MRI (DEMRIQ-ME#) after 13 weeksDisclosure of Interests:Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Ivanova Delina2 Delina: None declared, Minodora Mazur: None declared, Massimo D’Amato Employee of: Rottapharm Biotech, GIAMPAOLO GIACOVELLI Employee of: Rottapharm Biotech, Federica Girolami Employee of: Rottapharm Biotech, Marek Krogulec: None declared, René Østgård: None declared, Asger Reinstrup Bihlet Shareholder of: Nordic Bioscience A/S., Olga Kubassova Shareholder of: IAG, Image Analysis Group, Consultant of: Novartis, Takeda, Lilly, Employee of: IAG, Image Analysis Group, Lucio Rovati Shareholder of: Rottapharm Biotech, Employee of: Rottapharm Biotech, Peter C. Taylor Grant/research support from: Celgene, Eli Lilly and Company, Galapagos, and Gilead, Consultant of: AbbVie, Biogen, Eli Lilly and Company, Fresenius, Galapagos, Gilead, GlaxoSmithKline, Janssen, Nordic Pharma, Pfizer Roche, and UCB

Background Many techniques have been evolved for the purpose of managing discoloured non-vital tooth such as dental bleaching, restorative and prosthetic treatment. In order to achieve better control on the patients, in-office and intra-coronal bleaching procedures were introduced in clinical practice. Such techniques usually use higher whitening agent concentrations activated by means of heat or light sources, resulting in improved color stability in the long term. The aim of this study was to evaluate the color stability, after 25 years, of endodontically-treated teeth subjected to in-office and walking bleach dental treatments with carbamide peroxide. Methods A population of patients with a single endodontic treatment on an incisor teeth was recruited. All the teeth selected for the study were subjected to both in-office intra-coronal dental bleaching and walking bleach technique with 10% carbamide peroxide gel. The patients were recalled at follow-up every 12 months for a total observational period of 25 years. Results After 25 years of clinical service on 40 patients, an optimal tooth color stability in relation to adjacent teeth was evidenced in 34 patients, while 6 patients were classified as failures, since a color mismatch of two or more shades were noticed. Consequently, a success rate of 85% was reported after 25 years. Conclusions Ten percent carbamide peroxide proved to be an effective dental whitening agent in the long-term for endodontically-treated.

BACKGROUND: Physical attractiveness is dependent on facial appearance. The facial profile plays a crucial role in facial attractiveness and can be improved with orthodontic treatment. The aesthetic assessment of facial appearance may be influenced by the cultural background and education of the assessor and dependent upon the experience level of dental professionals. This study aimed to evaluate how the sagittal jaw relationship in Class I and Class II individuals affects facial attractiveness, and whether the assessor’s professional education and background affect the perception of facial attractiveness. METHODS: Facial silhouettes simulating mandibular retrusion, maxillary protrusion, mandibular retrusion combined with maxillary protrusion, bimaxillary protrusion and severe bimaxillary protrusion in class I and class II patients were assessed by five groups of people with different backgrounds and education levels (i.e., 23 expert orthodontists, 21 orthodontists, 15 maxillofacial surgeons, 19 orthodontic patients and 28 laypeople). RESULTS: Straight facial profiles were judged to be more attractive than convex profiles due to severe mandibular retrusion and to mandibular retrusion combined with maxillary protrusion (all P

Background. Patients with inflammatory bowel diseases could experience mouth and teeth disorders and alterations in psychological mood. Vice versa, the psychological status may influence the presence of oral diseases. Aim. To evaluate in inflammatory bowel disease patients the prevalence of sleep bruxism and its correlation with the presence of oral diseases, quality of sleep, and psychological disturbances. Methods. Patients were consecutively recruited in our clinic and examined for temporomandibular disorders, dental enamel disorders, sleep bruxism, and recurrent aphthous stomatitis by two dentists. Patients also underwent Pittsburgh Sleep Quality Index and Beck Depression Inventory Scale questionnaires. Results. 47 patients and 46 controls were included. Sleep bruxism and enamel wear disorders were more frequent in Crohn’s disease patients when compared with ulcerative colitis patients and controls (p=0.03 and p=0.02, resp.). Among groups, no differences were noted for enamel hypoplasia, temporomandibular disorders, recurrent aphthous stomatitis, depression, and quality of sleep. We found a positive correlation between bruxism and temporomandibular disorders (Spearman 0.6, p<0.001) and between bruxism and pathological sleep (Pittsburgh Sleep Quality Index > 5) (Spearman 0.3, p<0.005). Conclusion. Bruxism and enamel wear disorders should be routinely searched in Crohn’s disease patients. Moreover, the attention of healthcare givers to sleep disturbances should be addressed to all inflammatory bowel disease patients.

Aim:The aim of this study was to evaluate the efficacy of the IG-file, a new instrument designed for apical diameter gauging.Materials and Methods:After shaping with F1 Universal Protaper, 60 roots were randomly divided into two groups and assigned to two operators, One Expert in Endodontics (EO) and One Unexpert (UO).In each sample, after canal curvatures have been detected, the apical diameters were measured with the IG-file and the K-NiTi. The results were compared with the reference value obtained by retrograde apical gauging. The data were statistically analyzed.Results:Among 60 samples, 10% of errors were recorded when the IG-files were used; in the K-NiTi group the incorrect measurements were 70%.In both groups (expert and unexpert) the IG-file measurements were more accurate than the K-NiTi (90vs33 and 90vs26,7). The differences were statistically significant.In curved canals, the difference between measurement rates performed with both instruments was statistically significant (85,7% IG-filevs28,6% K-NiTi) as well as for the samples without curvatures (92,3% IG filevs30,8% NiTi file).In root canals without curvatures overestimation errors in K-NiTi file group are more frequent than underestimation errors. This difference was statistically significant.Conclusion:A proper gauging of the apical diameter has a key role in endodontic therapy; an incorrect measurement can lead to clinical failures. This “in vitro” study highlights that IG-file improves measurement accuracy independently from clinician experience. Furthermore, in curved canals, the IG-file is more accurate than K-NiTi.

Mucous membrane pemphigoid (MMP) is a heterogeneous group of rare, systemic, autoimmune subepidermal inflammatory disease that affects mucous membranes and the eye. In its most severe forms, this disease needs systemic therapy, usually based on steroids and immunosuppressant agents. In unresponsive cases or in the presence of contraindications or severe side effects due to conventional systemic corticosteroid and/or immunosuppressant therapy, a therapy shift to high-dose intravenous immunoglobulins (IVIg) has been recommended in other reports. This new therapy has proven to be effective in stopping ocular pemphigoid, but the data regarding the long-term effect on the disease activity or reactivation are extremely scarce, so the novel scientific aim of this study was to evaluate the clinical outcomes after a 9-year follow-up in 12 eyes (6 patients) affected by MMP with ocular involvement, successfully treated with IVIg therapy, as previously described in our report published in 2008. The evaluation of ocular and extraocular disease progression was performed at the end of IVIg therapy and at the end of the follow-up period. After 9 years, all the eyes enrolled showed a long-lasting remission of ocular and oral symptoms with a significant steroid-sparing effect. In conclusion, the IVIg has to be considered as a safe and successful alternative therapy in patients with severe ocular mucous membrane pemphigoid; furthermore, this kind of therapy seems to be effective in maintaining the clinical remission by the time.

Background: There are a lot of techniques to obturate the root canals, but lateral condensation of gutta-percha is the most used one. An important aspect of thermafil is the error margin tolerated by the manufacturer in the production of plastic carriers. In literature, there is no evidence about discrepancy percentage between different carriers. It is demonstrated that the error margin of gutta-percha is 0.5% and is 0.2% for metal files (ISO standards). Objective: The aim of this study was to evaluate the real dimensions of thermafil plastic carriers observed by the stereo microscope measuring the dimensional discrepancy between them. Methods: For this study, 80 new thermafil (Dentsply Maillefer) have been selected. 40 thermafil 0.25 and 40 thermafil 0.30. Through 60X stereo microscope, the dimensions of the plastic carrier tips have been measured. The dimensions of the plastic carrier were also measured after a heating cycle. ZL GAL 11TUSM (Zetaline stereo evolution) microscope was used to observe the samples. Measurements were made through a dedicated software (Image Focus). All samples were analysed at 60X. Results: A non-parametric paired test (Wilcoxon test) was used to compare baseline and after heating values; p-values ≤ 0.05 were assumed to be statistically significant. Conclusion: The samples we measured showed a mean value of the diameters in Thermafil 25 that was 0.27 mm, for Thermafil 30 the mean value was 0.33 mm. We have measured a dimensional variable of 8% in the 25 group while in group 30 the maximum possible variation found was 4%, that’s why we propose a new protocol of obturation with thermafil. We can also conclude that a single heating process does not affect clinically the plastic carrier dimensions.

Background The Oral Behaviours Checklist (OBC) is a valid 21-item instrument quantifying the self-reported frequency of oral behaviours. An Italian version (OBC-It) has been released recently. Anxiety and oral behaviours are known to be associated in individuals with oro-facial pain due to temporomandibular disorders (TMD). However, information about this relationship in pain-free individuals is still limited. Objectives The aim of this study was to test the reliability of the OBC-It and its reduced version (OBC-It 6), focusing on tooth clenching-related wake-time oral behaviours, and the effect of patient instructions on reliability. A second aim was to test the association between trait anxiety and oral behaviours in pain-free individuals. Methods Two hundred and eighty-two TMD-free students, divided into 2 groups (Group A, n = 139, mean age ± SD = 22.6 ± 5.4 years; Group B, n = 143, 23.7 ± 4.2 years), filled in the State-Trait Anxiety Inventory and the OBC-It. Group B received instructions about the OBC-It, while Group A did not. After 2 weeks, both groups filled in the OBC-It again. However, Group B was further divided into 2 subgroups, B1 and B2 . The first received the same instructions again, while B2 did not. Results The test-retest reliability of the OBC-It (A: ICC = .87; B1 : ICC = .94; B2 : ICC = .95) and OBC-It 6 (A: ICC = .85; B1 : ICC = .89; B2 : ICC = .93) was excellent in all groups. Trait anxiety was weakly associated with OBC-It only in women (R2 = .043, P = .021). Conclusions The OBC-It is a reliable tool but further subjects' instructions might be needed. Trait anxiety has a limited effect on oral behaviours in TMD-free subjects.

Pour cette première édition, Génie naturel ! Génie humain ?, le paysagiste-jardinier-écrivain Gilles Clément sera entouré de personnalités pour tenter de définir ce qui lie l’humain à son milieu, comment il l’habite, le façonne et interagit avec la nature au-delà de son territoire Le Jardin Planétaire, le Jardin en Mouvement, le Tiers-Paysage… ces concepts qu'a développés Gilles Clément vont au-delà des clôtures de jardin, des limites de territoire ou des horizons de paysages. Ces idées font aussi référence à des notions bien plus globales. Comment ont et vont-elles continuer à influencer notre vision de la société ?

Background:Prosthetic precision can be affected by several variables, such as restorative materials, manufacturing procedures, framework design, cementation techniques and aging. Marginal adaptation is critical for long-term longevity and clinical success of dental restorations. Marginal misfit may lead to cement exposure to oral fluids, resulting in microleakage and cement dissolution. As a consequence, marginal discrepancies enhance percolation of bacteria, food and oral debris, potentially causing secondary caries, endodontic inflammation and periodontal disease.Objective:The aim of the presentin vitrostudy was to evaluate the marginal and internal adaptation of zirconia and lithium disilicate single crowns, produced with different manufacturing procedures.Methods:Forty-five intact human maxillary premolars were prepared for single crowns by means of standardized preparations. All-ceramic crowns were fabricated with either CAD-CAM or heat-pressing procedures (CAD-CAM zirconia, CAD-CAM lithium disilicate, heat-pressed lithium disilicate) and cemented onto the teeth with a universal resin cement. Non-destructive micro-CT scanning was used to achieve the marginal and internal gaps in the coronal and sagittal planes; then, precision of fit measurements were calculated in a dedicated software and the results were statistically analyzed.Results:The heat-pressed lithium disilicate crowns were significantly less accurate at the prosthetic margins (ppp>0.05); nevertheless CAD-CAM zirconia copings presented the best marginal fit among the experimental groups. As to the thickness of the cement layer, reduced amounts of luting agent were noticed at the finishing line, whereas a thicker layer was reported at the occlusal level.Conclusion:Within the limitations of the presentin vitroinvestigation, the following conclusions can be drawn: the recorded marginal gaps were within the clinical acceptability irrespective of both the restorative material and the manufacturing procedures; the CAD-CAM processing techniques for both zirconia and lithium disilicate produced more consistent marginal gaps than the heat-pressing procedures; the tested universal resin cement can be safely used with both restorative materials.

Aesthetic of the face is greatly changed in relation to common standards of the past. Modern concepts of beauty from popular models of beautiful faces to actors show a biprotrusive asset with high tension for soft tissues. Facial symmetry has been proposed as a marker of developmental stability that may be important in human mate choice. Any deviation from perfect symmetry can be considered a reflection of imperfect development. The goal of maxillofacial surgery should be to give the best results for both aesthetic and functional aspects. Following these new concepts of aesthetic of the face, new surgical procedure by osteodistraction techniques will lead to a very natural final result by harmonizing the face. The aim of this study was to detect aesthetic results on 10 patients operated for skeletal discrepancies by maxillary distraction and jaw repositioning compared with other 10 patients operated by conventional techniques on a 5-point scale by Likert.

(1) Background: Celiac disease (CD) patients can be affected by mouth and tooth disorders, which are influenced by their gluten-free diet. The aim of our research was to evaluate the pathological conditions of the stomatognathic system observed in celiac patients on a gluten-free diet. (2) Methods: we consecutively recruited celiac patients on a gluten-free diet at our celiac center, as well as healthy volunteers. Two dentists examined all patients/controls and checked them for any mouth disorder. (3) Results: Forty-nine patients affected by celiac disease (age at test 31.8 ± 11.58, time on GFD 8.73 ± 7.7) and 51 healthy volunteers (age at test 30.5 ± 8.7) were included. Recurrent aphthous stomatitis was reported in 26 patients (53.0%) and in 13 (25.5%) controls (p = 0.005). Dental enamel disorders were reported in 7 patients (14.3%) and in 0 controls (p = 0.002), with none having geographic tongue. We found non-specific tooth wear, characterized by loss of the mineralized tissue of the teeth, in 9 patients (18.3%) and in 3 (5.9%) controls (p = 0.05). (4) Conclusion: Recurrent aphthous stomatitis and enamel hypoplasia are “risk indicators” that may suggest that an individual has CD. We detected a high prevalence of non-specific tooth wear that can be caused by several factors such as malocclusion, sleep bruxism, parafunctional activity, and age.

Introduction Numb chin syndrome (NCS) or mental neuropathy (MN) is a disorder characterized by sensory neuropathy on the distribution of the inferior alveolar nerve or mental nerve. The most frequent causes are of odontogenic origin (infections, wrong therapies). Other etiologies are related to primary tumor, metastasis, osteoradionecrosis and medication-related osteonecrosis of the jaw (MRONJ). The aim of this study is to highlight the clinical importance of NCS as one of the first symptoms of cancer or as consequence of drug therapy. Materials and methods The present study was conducted from 2010 to 2016 by recruiting patients who present NCS as one of the symptoms, having excluded those in which it depends on a clear odontogenic cause, on systemic degenerative diseases or metabolic disorders. Data collection included suspected diagnosis at the time of presentation of the symptom, final diagnosis, mandibular localization, treatment performed and diagnostic delay between the first medical examination and the definitive diagnosis. Results This study included 29 patients in which NCS had not a clear odontogenic cause. NCS was the first symptom of malignancy in 11 cases and the clinical sign of metastasis in 4 cases. In a single patient, it was the first symptom of an immune-mediated disease. In the remaining 13 patients, NCS represented the symptom of MRONJ. Conclusion NCS can be the first symptom of malignancy, especially in patients with a previous history of cancer, but also a prodromal sign of MRONJ. It should be recognized in order to require deeper examinations for early diagnosis of the disease.

Necrotizing fasciitis (NF) of odontogenic origin affecting the head and neck region is a rare but serious clinical condition, which, if diagnosed late, can lead to a fatal outcome. The early diagnosis of necrotizing fasciitis can be difficult. Delay in diagnosis leads to increase in the area of necrosis with a resulting increase in cosmetic deformity and life-threatening complication. In this study, we present two cases of elderly patients with aggressive NF affecting the neck and anterior mediastinum, which were of odontogenic origin. In the two patients selected necrotic skin and soft tissue were removed and wide exposure was achieved with debridement of the neck at the level of the affected layer of superficial cervical fascia. Saline solution was used as irrigation to treat the patients with acute necrotizing fasciitis. Difficulties in managing this condition with NF extent to deep anterior mediastinum is related to clavicle osteotomy or thoracotomy need with high surgical risks. In our technique, by gentle suction in anterior mediastinum, necrotic tissue resection was possible without any osteotomy need. Suctioning resection technique associated with hyperbaric, metabolic rebalance, and amino acid support in association with three types antibiotic therapy are fundamental points for correct therapy strategy, leading to full recovery and healing of NF patients even if in very unfavorable conditions. Multidisciplinary approach is paramount for proper treatment of this disease.

One of the major causes of the 2007 global economic crisis was the weak perception of the real risk of it actually occuring. This was due to a ‘financial optimism’ that created the illusion of a sustainable and never-ending prosperity. ‘Liquid markets’ boost growth, but they also prepare the ground for crisis. From where does this short-circuit arise? According to Keynes, it arises from a tacit decision about the role of time in the formation of expectations. This decision shifts the ‘precariousness of the basis of knowledge’ from the facts that happen in time to the precariousness of a ‘convention’, that is the convention that leads financial calculations and expectations. This tacit move from to a real precariousness to an ideological-theoretical one deserves to be made explicit and to be investigated.

Aims and Objectives: The lack of information among the population regarding the existence of oral squamous cell carcinoma (OSCC) and the lack of attention and expertise in examining the oral cavity of dentists and clinicians still remain very worrying and could explain the high incidence of OSCC. The aim of this study is to evaluate the level of awareness of OSCC among 600 participants from Southern Italy. Materials and Methods: A 13-question survey was prepared and distributed to 600 participants divided into two subgroups, the first one of 300 patients referring to the Department of Neuroscience, Reproductive, and Odontostomatological Sciences, University Federico II of Naples, for the treatment of dental pathologies, and the second one of 300 patients referring to the Department of Internal Medicine of the Second University of Naples for the diagnosis and treatment of cardiovascular diseases. Statistical analysis consisted in the calculation of percentages related to the answers given by patients. Comparison of percentages was after performed between the two subgroups. Result: Only 175 participants (29.1%) knew about the existence of pathologies which can affect the oral mucosa, and only 46 (7.6%) were aware that carcinoma can arise in the oral cavity; 345 (57,5%) stated that they had periodical dental visits, at least once a year but none of them stated they had a visit for the identification of oral carcinomas. Conclusion: The data acquired must be taken into consideration to outline essential socio-healthcare educational projects on carcinoma and its risk factors, training programs to increase dentists and clinicians' competences, and to evaluate the feasibility and effectiveness of oral carcinoma screening programs.

Providing here our aims and project background, we note that intravenous silibinin (SIL) is a potent antiviral agent against hepatitis C virus (HCV) genotype-1. In this proof of concept case-study we tested: (i) whether interferon-alfa (IFN)-free treatment with SIL plus ribavirin (RBV) can achieve sustained virological response (SVR); (ii) whether SIL is safe and feasible for prolonged duration of treatment and (iii) whether mathematical modelling of early on-treatment HCV kinetics can guide duration of therapy to achieve SVR. With our method, a 44 year-old female HCV-(genotype-1)-infected patient who developed severe psychiatric adverse events to a previous course of pegIFN+RBV, initiated combination treatment with 1200 mg/day of SIL, 1200 mg/day of RBV and 6000 u/day vitamin D. Blood samples were collected frequently till week 4, thereafter every 1-12 weeks until the end of therapy. The standard biphasic mathematical model with time-varying SIL effectiveness was used to predict the duration of therapy to achieve SVR. Our results show that, based on modelling the observed viral kinetics during the first 3 weeks of treatment, SVR was predicted to be achieved within 34 weeks of therapy. Provided with this information, the patient agreed to complete 34 weeks of treatment. IFN-free treatment with SIL+RBV wasmore » feasible, safe and achieved SVR (week-33). In conclusion, we report, for the first time, the use of real-time mathematical modelling of HCV kinetics to individualize duration of IFN-free therapy and to empower a patient to participate in shared decision making regarding length of treatment. SIL-based individualized therapy provides a treatment option for patients who do not respond to or cannot receive other HCV agents and should be further validated.« less