The neuropathic origin of a case of unilateral burning mouth syndrome, previously diagnosed as psychogenic, was ascertained by intra-oral mucosa biopsy, which showed a severe sensory fibers damage, probably caused by maxillary anesthetic block and dental surgery.

Background: Stroke is the third leading cause of death in the world after cardiovascular disease and cancer. This study aimed to investigate the oro-dental status and removable denture conditions in stroke survivors. Methods: At the Department of Vascular Disease of the Neurological Clinic of the Polyclinic Hospital of Bari, from January 2003 to May 2008, 189 consecutive patients were examined who had had a stroke, to select removable denture wearers. The oro-dental examination was performed in a period between 12 and 60 months after the stroke and among these 189 patients, 60 were wearing a removable denture, but only 33 participated in our research. All the patients gave written informed consent. Results: It was observed that in 42.4%, removable dentures needed to be remade, in 27.3%, they needed to be rebased and in 30.3%, they were adequate. Conclusion: The role of oral health providers is fundamental in order to maintain good oral health and to avoid oral diseases in stroke patients. They should, indeed, monitor these patients with a regular follow-up after 1 month and every 3–4 months.

Endocanalar posts are necessary to build up and retain coronal restorations but they do not reinforce dental roots. It was observed that the dislodgement of post-retained restorations commonly occurs after several years of function and long-term retention may be influenced by various factors such as temperature changes. Temperature changes, in fact, produce micrometric deformations of post and surrounding tissues/materials that may generate high stress concentrations at the interface thus leading to failure. In this study we present an optical system based on the projection moiré technique that has been utilized to monitor the displacement field of endocanalar glass-fibre posts subjected to temperature changes. Measurements were performed on forty samples and the average displacement values registered at the apical and middle region were determined for six different temperature levels. A total of 480 displacement measurements was hence performed. The values of the standard deviation computed for each of the tested temperatures over the forty samples appear reasonably small which proves the robustness and the reliability of the proposed optical technique. The possible implications for the use of the system in the applicative context were discussed.

This study analyses the expansive capacities of the new low friction binding system,compared with the conventional elastomeric binding system. Methods. 12 young people aged between 11 and 14 have been counted among the patients, who have skeletal malocclusion of Class II or III and with slight to moderate crowding of teeth,with no need of tooth extraction.The participants have been divided into two groups of 6: the first group has been treated with conventional elastomeric bindings,the second with low friction bindings,always using 0.14 NiTi arches and conventional stainless steel brackets.All the patients have been submitted to periodical check-ups Results. After 90 days the changes of the following parameters have been evaluated: intercanine distance, interpremolar and intermolar distance, dental arch length and perimeter. It has been found that the patients with low friction bindings show a greater increase of the interpremolar distance,while the patients with elastomeric bindings show a greater increase of the intermolar distance and of the dental arch length and perimeter;the latters have also showed a slightly greater increase of the intercanine distance. Discussion. As low friction dental braces do not alter the biological bone-periodontium-teeth system,they would allow a physiological movement of the teeth with the bone and a remodelling of the arch dimension.

Aim. The scope of this experimental study was to verify the validity of the ADPI proposed by Kim,confronting it with the ANB angle and Wits' index.Furthermore,it was intended to consider the correlation between these three parameters and the variations of the vertical scheletral rapports using as indicator Schudy's intermaxillary angle. Methods. We have analised the lateral-side x-rays from 50 subjects between the ages of 7 to 14.After having carried out the cephalometric tracing and,to evaluate the error,we have applied Dalberg's equation.The values from the various APDI measures were studied and elaborated to obtain the average and the standard deviation. Confronting the APDI values with the ANB angle we were able to evaluate the correlation matrix between ANB,Wits and APDI.The following phase was the analysis of the regression between the intermaxillary angle and the respective values of ANB,Wits and APDI. Results. These studies have bought us to recognise a high level of correlation between APDI and the other two parameters. Conclusions. The use of APDI should not substitute the traditional measures because it is reductive and risky,because of this one should resort to the practice of "2 out of 3" using the three forms of cephalometric tracing. Where two parameters are discordant it is always better to consider a third in order to arrive at a more correct diagnosis.

Objective: Cri du Chat Syndrome (CCS) is a rare chromosomal disorder resulting from deletion of the short arm of chromosome 5, characterized by distinctive catlike cry since born due to typical larynx (small and narrow) and epiglottis anomalies. We report on still unreported clinic-pathological features CCS: diffuse Gingival Fibromatosis (GF) with Confocal Laser Scanning Microscopic (CLSM) examination.Case Presentation: A 21-year-old female, affected by CCS showed diffuse GF on the palatal gingiva in the molar region (linked to dental dislocation and malocclusion), which was surgically removed by Diode Laser, formalin-fixed, stained with hematoxylin-eosin and picrosirius red and analyzed at CLSM Nikon E-600 with double Laser inducing fluorescence (green and red).Results: Microscopically, the lesion consisted in large parallel collagenous fibers, abundant blood vessels with plump endothelial cells and chronic inflammatory reaction, and large polygonal cells in the vascular interstitial spaces, with large nuclei, resembling undifferentiated totipotent mesenchymal cells (stem-like cells). At CLSM large and variably oriented collagenous fibers displayed intense fluorescence due to cross-linking between such fibers, which generally characterize fibromatosis, and the vascular structures. The latter showed lower fluorescence intensity, and were surrounded by loose collagenous fibers and trapezoidal large mesenchymal cells.Conclusions: GF seems a characteristic feature of CCS, with typical fluorescent pattern at CLSM, in which purported totipotent mesenchymal cells may play a pathogenetic role.

OBJECTIVE: This case report describes a patient with nocturnal bruxism and related neck pain treated with botulinum toxin type A (BTX-A). CLINICAL FEATURES: The patient was a 27-year-old man with nocturnal bruxism and difficulty in active mouth opening and chewing and neck pain at rest. His numeric pain score was 7 of 10. Surface electromyography of the temporalis and masseter muscles showed typical signs of hyperactivity, characterized by compound muscle action potential amplitude alterations. INTERVENTION AND OUTCOME: After clinical evaluation, he was treated with BTX-A to reduce masseter and temporalis muscle hyperactivity. After 3 days of treatment with BTX-A, with each masseter muscle injected with a dose of about 40 mouse units with a dilution of 1 mL and with temporal muscle bilaterally injected with 25 mouse units with the same dilution, a decrease in bruxism symptoms was reported. Neck pain also decreased after the first treatment (visual analog scale of 2/10) and then resolved completely. After 4 weeks, electromyography showed the reduction of muscle hyperactivity with a decrease in the amplitude of the motor action potential. The same reduction in signs and symptoms was still present at assessment 3 months posttreatment. CONCLUSION: These findings suggest that BTX-A may be a therapeutic option for the treatment of bruxism and related disorders.

Objective: We report on the clinic-pathological features of Familial Tumoral Calcinosis (FTC), a rare disease of early childhood and adulthood, caused by mutations in fibroblast growth factor 23 and GalNAc transferase 3. It is a bone metabolism disorder with abnormal phosphate and calcium (calcinosis) deposits around the joints, in visceral and soft tissues. Case Presentation: A 17 year-old girl complaining for long-standing night leg pain, resistant to FANS therapy, had been diagnosed with osteogenesis imperfecta and was therefore undergoing bisphosphonates therapy. She was referred to our Dental Clinic for diffuse dental anomalies, maxillary hypoplasia and tooth roots inclusions and underwent combined surgical and orthodontic treatment. The surgical samples were used for conventional and Confocal Laser Scanning Microscopic (Nikon E-600) (CLSM) examination. Results: Microscopically several metaplastic micro and macro-calcificationin soft and periodontal tissue location were detected, along with a typical islands of homogenous, non tubular, dentino-osteoid calcified structures in dentinal tissues. Also, dentinal dysplasia with osteoid-like material, without incremental lines but with strong basophilia, intermingled with remnants of mature mucous connective tissue, was demonstrated. The diagnosis of FTC was confirmed by genetic analysis. Conclusions: CLSM helps to demonstrate distinct odontoblast and osteoblast anomalies in FTC that lead to the accumulation of atypical calcified tissues, responsible for the several clinical signs detected in the patient and formerly attributed to osteogenesis imperfecta.

Introduction: M.I.D. (mini dental implants) Atlas endosseous implants are single-phase titanium alloy Grade 5 with variable diameter (1,8-2,2-2,4 mm), so that they can be used even in severe bone atrophies. The entry is performed in the interforaminale area with flapless tecnique.The main indication is the stabilization of lower overdentures, very unstable due to various factors such us movements of the tongue and transverse and vertical bone atrophy in the presence of D1 or D2 bone density. M.I.D. for overdenture can be of two types: mini implants with metal ring with a Teflon cap to be fixed in the prosthesis and mini-implants with a ball held in a soft silicone (Tuf-Link) positioned in the undercut run directly in removable dentures (Atlas, Dentatus). Case report: Male patient, aged 56, carrier of lower total dentures has a severe mandibular bone atrophy with excessive instability of the prosthetis. After careful clinical and radiographic assessment, we proceeded to the insertion of Atlas 4 MID 2.4 mm in diameter with flapless technique. The excellent primary stability has allowed the immediate loading of implants by applying the silicone retentive "Tuf-Link " in removal denture. Control at 12 months shows the stability of the prosthesis, the successful osteintegration and the integrity of implants due to the careful management of occlusal loads. Conclusions: Implant System Atlas Implant System has proven to be a microinvasive, atraumatic, reliable and highly predictable

Lymphatic Malformation (LM) according to ISSVA Classification, is a rare benign disorder with unknown aetiology. LM may grow slowly over years or develop rapidly over the course of days becoming a bulky lump, infected or bleeding. We propose our three steps Diode Laser protocol for LM management, based on its persistent vascular blood component. 1. Histological and cytological examination, to evaluate the vascular blood component (10-40%), shows mature lymphocytes with red blood cells and endothelial cells. 2. Diode Laser Photocoagulation (DLP) in pulsed mode (on 100ms / off 400ms) at 10W and 800nm with a 300μm fibre kept 2-3mm from the tissues, to reduce the lesion. 3. Diode Laser surgical excision in pulsed mode (on 50ms / off 200ms) at 8W and 800nm with a 300 μm fibre in close contact with tissues, and histological intraoperative margins control on frozen sections. Even if it has inconstant results (lesions decreasing rate is 10% to 40% proportionally to vascular blood component), DLP simplifies the last and the most important step. Use of Diode Laser also in surgical excision reduces intra and postoperatory complications.

Fibromyalgia (FM) is a rheumatic disease which affects fibrous tissues and muscles; it is characterized by chronic pain and it is often associated with craniomandibular disorders (CMD). 31 patients were assessed from March 2012 to October 2012 through the administration of specific questionnaires and following neurologic and gnatologic assessment. A relevant corre-lation between FM and CMD emerges from the present study, as 80.6% of our patients report CMD symptoms with high prevalence of myofascial pain (84%). Multivariate regression analysis revealed that the patients in the present study did not differ in score of quality of life questionnaires from patients with fibromyalgia. The neuropathic pain diagnostic question-naire (DN4) scores were positively affected by belonging to group II of Research Diagnostic Criteria of Temporomandibular Disorders (RDC/ TDM) classification, suggesting the possibility of a neuropathic component in chronic pain in this CMD group, as already speculated in our study on the correlation between burning mouth syndrome and CMD and by other au-thors in studies on chronic low back pain. However, further clinic and instrumental studies are needed in order to test this as-sumption.

Objectives: The aim of this study was to carry out clinical and radiographic outcomes of bone healing using a new medical device, a sterile gel formulation of sodium hyaluronate and amino acids Gly-Leu-Pro-Lys (AMINOGAM®) in treatment of third stage bisphosphonates-related osteonecrosis of the jaws (BRONJ). Materials and methods: We selected 32 third stage BRONJ patients divided in two groups according to systemic pathology: - Neoplatic diseases group that includes 21 patients; - Non-neoplastic diseases group of 11 patients. According to AAOMS guidelines, all patients suspended biphosphonate therapy three-six months before the surgery and were subjected to antibiotic therapy: three courses of 1g ceftriaxone intramuscular injection/die and 250mg metronidazolo oral tablet two times/die for 8 days with 10 days rest between each course. Surgical treatment provides local anesthesia without vasoconstrictor, segmental resection, Piezosurgery osteoplasty, intracavitary intraoperative use of gel to fill up residual bone defect and a first application upon the stitches (sandwich technique). Our procedure includes using of gel 4 times/die till to complete mucosal healing. Finally a clinical and radiographic follow-up by orthopantomograph and CT examinations at 3, 6, 12 and 24 months was carried out. Results: Clinical outcomes showed complete hard and soft tissue healing in all post-surgical sites, with a difference between two groups: neoplastic deseases group needed a longer soft wound healing time of 5 days compared to non-neoplastic diseases group. Radiographic outcomes show radiolucent areas decreasing due to gel direct osteoinductive effect with a faster osteoregeneration time in non-neoplastic deseases group: 15% difference between ossification level at 3 and 6 months. Gel preparation of sodium hyaluronate and amino acids enhances angiogenesis, fibroblast and osteoblast proliferation, collagen biosynthesis and production of growth factors as evidenced by MTT test and alkaline phosphatase histochemical staining. In vivo and in vitro studies have suggested that hyaluronic acid plays important roles in bone wound healing by enhancement of osteoblast differentiation through the down-regulation of BMP-2 antagonists. Lysine and proline regulate collagen matrix synthesis during osteogenesis. Conclusions: Sodium hyaluronate and amino acids gel formulation decreases postoperative pain, swelling and infective complications after surgery by surgical wound mechanical protectection. This new medical device is biocompatible, extremely cheap, safe and useful in all surgical procedure in order to obtain a faster healing of oral hard and soft tissues, specially in BRONJ that are often prone to difficult, slow and complicate recovery.