Aims. To measure the friction force generated during sliding mechanics with conventional, self-ligating (Damon 3 mx, Smart Clip, and Time 3) and low-friction (Synergy) brackets using different archwire diameters and ligating systems in the presence of apical and buccal malalignments of the canine. Methods. An experimental setup reproducing the right buccal segment of the maxillary arch was designed to measure the friction force generated at the bracket/wire and wire/ligature interfaces of different brackets. A complete factorial plan was drawn up and a three-way analysis of variance (ANOVA) was carried out to investigate whether the following factors affect the values of friction force: (i) degree of malalignment, (ii) diameter of the orthodontic wire, and (iii) bracket/ligature combination. Tukey post hoc test was also conducted to evaluate any statistically significant differences between the bracket/ligature combinations analyzed. Results. ANOVA showed that all the above factors affect the friction force values. The friction force released during sliding mechanics with conventional brackets is about 5-6 times higher than that released with the other investigated brackets. A quasilinear increase of the frictional forces was observed for increasing amounts of apical and buccal malalignments. Conclusion. The Synergy bracket with silicone ligature placed around the inner tie-wings appears to yield the best performance.

Objectives. Odontomas are the most common odontogenic tumors of the oral cavity. They account for 22-67% of all maxillary tumors with an increased prevalence in children and adolescents. They are asymptomatic and are generally diagnosed by radiographic examination. The chosen treatment is surgical excision of the lesion followed by a histo- pathological examination. The aim of this study is to show confocal laser scanning microscopic features in a case of compound odontoma not easily evident when using an optical traditional microscopy. Methods. A case of bilateral mandibular compound odontoma in young patient is presented. Radiographic analysis revealed two symmetrical radio-opaque masses with a surrounding thin radio-transparent halo, up to the first lower premolars. Surgical excision of the lesion under general anesthesia was performed. The specimens were fixed in a buffered solution of 10% formalin, embedded in paraffin, cut in 3 μm thick serial sections, stained with hematoxylineosin, observed by optical microscope and by Confocal Laser Scanning Microscope (CLSM). Results. Control at 2 weeks showed excellent healing of the tissues. Follow-up at 6 months showed the absence of recurrence and the eruption of the previously retained teeth. CLSM analysis in autofluorescence underlined a different fluorescence of soft and hard tissues showing different intensity of emission in autofluorescence due to different degrees of calcification. The odontogenetic components appeared strongly autofluorescent and presented foci of ectomesenchymal dentinogenetic multifocal differentiation that cause irregularities in the shape and structure of the tissue. Conclusions. Odontomas are frequent in childhood and are often responsible for dental retention. CLSM allows a careful histo-morphological analysis of odontomas and other odontogenic tumors. The morpho-structural organization of the cellular component is also observed with the possibility of three-dimensional reconstruction. References • Crincoli V, Scivetti M, Di Bisceglie MB, Lucchese A, Favia G. Complex odontoma: confocal laser scanning microscopy analysis of a case. Minerva Stomatol. 2007 Nov-Dec;56(11-12):611-20. • Da Silva LF, David L, Ribeiro D, Felino A. Odontomas: a clinico-pathologic study in a Portuguese population. Quintessence Int 2009; 40(1):61-72. • Tamme T, Soots M, Kulla A, Karu K, Hanstein S-M, Sokk A, et al. Odontogenic tumours, a collaborative retrospective study of 75 cases covering more than 25 years from Estonia. J Cranio-Maxillofacial Surgery 2004; 32:161-5.

Dental implants placement in the anterior mandible with flap or flapless technique is a routine procedure and is considered to be safe. However, serious life-threatening complications may occur. We report the first case of massive lingual and sublingual haematoma following postextractive implant placement in the anterior mandible with flapless technique. A 45-year-old female patient underwent placement of four immediately postextractive implants in the anterior mandible using flapless technique. During the procedure, the patient referred intense acute pain and worsening sign of airway obstruction, dysphagia, dyspnea, and speech difficulties. Bimanual compression of the mouth floor, lingual surface of the mandible, and submental skin was maintained for approximately 25 minutes in order to stop the bleeding. Computerized tomography highlighted the massive lingual and sublingual haematoma. The symptoms and signs had almost completely resolved in the next 48 hours. The prevention of these complications is mandatory with clinical and CT analyses, in order to highlight mandibular atrophy and to select carefully the correct length and angulation of bone drilling and to keep more attention to the flapless technique considering the elevation of a lingual mucoperiosteal flap to access the mandibular contour intraoperatively and to protect the sublingual soft tissues and vasculature in high risk cases.

BACKGROUND: Many authors have considered dental implants to be unrelated to increased risk of medication-related osteonecrosis of the jaw (MRONJ). Nevertheless, more recently, more cases of peri-implant MRONJ (PI-MRONJ) have been described, thus becoming a challenging health problem. Also, metastatic cancer deposits are not infrequently found at peri-implant sites and this may represent an additional complication for such treatments. We present the case of a breast cancer patient with PI-MRONJ, presenting a clinically and radiologically undetected metastasis within the necrotic bone, and highlight the necessity of an accurate histopathological analysis. CASE REPORT: A 66-year-old female patient, who had received intravenous bisphosphonates for bone breast cancer metastases, came to our attention for a non-implant surgery-triggered PI-MRONJ. After surgical resection of the necrotic bone, conventional and immunohistochemical examinations were performed, which showed breast cancer deposits within the necrotic bone. CONCLUSIONS: Cancer patients with metastatic disease, who are undergoing bisphosphonate treatment, may develop unusual complications, including MRONJ, which is a site at risk for hosting additional metastatic deposits that may be clinically and radiologically overlooked. Such risk is increased by previous or concomitant implant procedures. Consequently, clinicians should be prudent when performing implant surgery in cancer patients with advanced-stage disease and consider the possible occurrence of peri-implant metastases while planning adequate treatments in such patients.

Medication-related osteonecrosis of the jaw (MRONJ) is a well-recognized severe complication of bisphosphonate (BPs) treatment in patients with osteoporosis or metastatic cancer. Microbiological infection has been hypothesized as a contributing factor to bisphosphonate related osteonecrosis of the jaw (BRONJ). Despite infection being present in BRONJ patients, there is no clear data as to whether infection plays a role in the pathophysiology. Moreover, microbial cultures have not been helpful in directing therapy because specific pathogens have not been identified. The objective of this study was to determine the bacterial colonization of jawbone and identify the bacterial phylotypes associated with BRONJ. Twenty oncologic patients, aged 48-87 years (average age 70.65 ± 8.86 years) with BRONJ were enrolled in this study and underwent three different microbiological samplings. Overall, 60 samples were obtained from oral mucosa, necrotic bone fragments and fistula drainage. The same procedure was performed for the laboratory culture of all these specimens. No significant differences regarding either gram+ and gram– species (Chi-squared= 0.1642; p = 0.6854) or aerobes and anaerobes bacteria (Chi-squared= 3.084; p = 0.0791) were found. Compared to other sampling techniques, the oral swab allowed to obtain valuable microbial data in order to recognize pathogens responsible for the infection and to outline a focused antimicrobial therapy.

Hereditary Haemorrhagic Telangiectasia (HHT) is a muco-cutaneous inherited disease. Symptoms are epistaxis, visceral arterio-venous malformations, multiple muco-cutaneous telangiectasia with the risk of number increasing enlargement, bleeding, and super-infection. The aim of this work is to show the dual Diode Laser efficacy in preventive treatment of Early Lesions (EL < 2mm) and therapeutic treatment of Advanced Lesions (AL > 2mm). 21 patients affected by HHT with 822 muco-cutaneous telangiectatic nodules have been treated in several sessions with local anaesthesia and cooling of treated sites. EL preventive treatment consists of single Laser impulse (fibre 320) in ultrapulsed mode (2 mm single point spot). AL therapeutic treatment consists of repeated Laser impulses in pulsed mode (on 200ms / off 400ms). According to the results, Diode Laser used in pulsed and ultra-pulsed mode is very effective as noninvasive treatment both in early and advanced oral and perioral telangiectasia. © 2014 Copyright SPIE

The objective of this study was to assess frequency and extension of the defects affecting the dentin-post interface after using different combinations of irrigants and sealers. The experimental work was conducted on single-rooted teeth extracted for orthodontic reasons. The specimens were divided into different groups, according to irrigant and endodontic cement utilized, and endodontically instrumented. After fiberglass posts cementation, cross sections were obtained at apical, middle and coronal level of the root and submitted to quantitative analyses. Different types of defects were found: bubbles, bonding defects, polymerization defect, and cement residues. The percent extension of each defect and its frequency were related to the specific irrigant/sealer combination and to the root level. Detachments of the material from dentin were found only at apical and middle levels. Chlorhexidine digluconate seems to have more beneficial effects if compared to sodium hypochlorite: samples prepared with chlorhexidine digluconate showed a higher performance, with roots including null to few defects. In detail, samples treated with chlorhexidine digluconate and Pulp Canal Sealer showed the lowest frequency and the smallest dimension of defects.

This study investigated the prevalence of the signs and symptoms of temporomandibular disorders (TMD) in a population of children and adolescents. TMD signs and symptoms were recorded in 1,134 subjects (593 males and 541 females; age range 5-15 years), divided into various groups according to the: (i) Angle dental class; (ii) presence and type of crossbite; (iii) gender; and (iv) age (ages 5-11 and 12-15 years). The percentages of signs and symptoms were compared using the χ2-test to determine the differences among the groups for the rates of TMD symptoms, bruxism, joint sounds, deviation during opening, reduced opening/lateral/protrusive movements, and myofascial pain. Subjects who were 12-15 years old showed a significantly higher prevalence of myofascial pain than those who were 5-11 years old (χ2 = 4.263; p<0.05). Females showed a significantly higher prevalence of myofascial pain than males (χ2 = 3.882; p<0.05). Subjects with posterior, unilateral crossbite showed a significantly higher prevalence of TMD symptoms (χ2 = 33.877; p<0.001) and reduction of functional movements (χ2 = 10.800; p<0.05) than those with no crossbite, or with anterior or posterior bilateral crossbite. TMD's signs and symptoms seem to be associated to some definite characteristics of the patient, such as female gender, young age, and presence of posterior unilateral crossbite.

Psoriasis is a chronic, remitting and relapsing inflammatory disorder, involving the skin, nails, scalp and mucous membranes, that impairs patients' quality of life to varying degrees. Psoriatic arthritis is a chronic seronegative, inflammatory arthritis, usually preceded by psoriasis. Temporomandibular disorders is a generic term referred to clinical conditions involving the jaw muscles and temporomandibular joint. The aim of this study was to assess symptoms and signs of temporomandibular disorders in psoriasis patients with and without psoriatic arthritis.