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The objective of this study was to evaluate the feasibility and reproducibility of a new diagnostic approach through the flow injection of green indocyanine such as the intraoperative and perioperative vascularization in the reconstruction of various anatomical areas with pedunculated or microsurgical free flaps, the identification of the sentinel lymph node in the latero cervical emptying or the assessment of the quality of anastomoses in organ transplantation. The study involved ten patients who underwent reconstructive procedures with different surgical approaches for reconstructive surgery of head and neck. An intraoperative check was performed in several stages to assess the real perfusion status of the treated area. Indocyanine green was used in all the patients in association with an intraoperative imaging diagnostic system. Indocyanine green showed in all the cases a full highlight of central and peripheral vascularization. Furthermore, this imaging system allowed a satisfactory and rapid intraoperative evaluation of the vascular tree and a high sensitivity in detection of the sentinel lymph node in latero cervical emptying. Despite the limited sample, the results suggest that the intraoperative administration of indocyanine green may represent a valid evaluating system for reconstructed flap perfusion and for sentinel lymph node identification in oncological surgery.
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Orthodontic retention is the maintenance of the teeth in their ideal position from an aesthetic and functional point of view. The aim of this work is to illustrate the different orthodontic retainers. For this study we proceeded with a research of the abstract concerning this topic from the scientific archive “Pubmed” using terms relating to orthodontic retainers: 40 articles were selected from the research. In addition, 4 textbooks related to this topic have also been consulted. 7 fixed and 10 removable retainers have been identified. The most used retainers are the bonded ones for the lower arch and the Hawley and/or vacuum-formed ones for the upper one. Although numerous studies relating to orthodontic retention have been performed, there is no definitive evidence to identify the best type of orthodontic retainer.
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Photometric analysis is a facial aesthetics evaluation method which is useful for diagnosis and treatment planning. This system is increasingly applied since there is growing attention to aesthetic improvement and occlusal correction as objectives of orthodontic treatment. Ten articles regarding aesthetic analysis on photos were identified through scientific archives and analysed. The diagnostic rationale, the scientific reliability and the methods used were identified to help clinicians in their practice. Photometric analysis represents an effective, reliable and cheap system for the analysis of craniofacial morphology of the face profile. This analysis can be achieved in subjective or objective ways; the latter modality provides greater reproducibility of the results as well as a good assessment of the harmony between the external craniofacial structures, including soft tissue contribution; it also provides repeatable and reliable measurements, thus enabling a rapid acquisition of the facial image, with long-term durability. Through facial profile photometric analysis it is possible to obtain proportionality, angular and linear measurements. These measures are useful as parameters for an optimal definition of the conditions of normality, harmony and profile balance.
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Nowadays, the best possible approach in respect to the patient is that tailored on the “person”, intended as the result of the balance between the patient’s requirements and expectations, the latter being influenced by contemporary society’s over-information without a proper preparation. It is therefore possible to obtain an efficient and effective treatment by recovering the doctor-patient relationship, which is fundamental to guarantee the respect of the therapist’s pragmatic and common-sense guidance whilst satisfying the patient’s needs. The reported case serves as an example of this choice, combining the psychological support with a valuable minimally invasive surgical implant-prosthetic rehabilitation.
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Rapid palatal expansion can determine an improvement of the sagittal relationship between maxilla and mandible. The purpose of this study was to evaluate the skeletal and dentoalveolar effects of the upper and lower jaws on the sagittal plane in subjects treated with acrylic-splint rapid palatal expander before growth peak. 36 patients aged 6-10 years with a cervical vertebral maturation stage of CS1 or CS2 were selected. Skeletal and dentoalveolar variables on the cephalometric traces of the lateral teleradiographs were measured before (T0) and at the end (T1) of the orthodontic treatment. The same variables were measured in a subgroup (20 subjects) of the same sample, characterized by a skeletal Class II malocclusion (ANB ≥ 4°) at T0. Statistics used was paired samples t-test. The p-value was considered statistically significant for P<0.05. In the whole sample ANB showed a significant decrease (-0.96±1.75°). Pg-OLp and Co-OLp + Pg-OLp increased of 4.25±6.07 mm and 4.89±6.65 mm respectively. FMA angle showed a significant decrease (-1.26±2.47°). In the subgroup with skeletal Class II malocclusion the results were similar, but it was also registered a significant increase of SNB (1.37±2.14°). In addition to the correction of the cross-bite, the treatment with acrylic-splint rapid palatal expander determined an improvement of the dento-basal discrepancy in the maxilla, an improvement of the skeletal maxillo-mandibular relationships, an anterior repositioning and length increase of the mandible and a facial height reduction.
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Background: Type VI Osteogenesis Imperfecta (OI) is caused by homozygous or compound heterozygous null mutations in SERPINF1 gene, coding for pigment-epithelium derived factor (PEDF). Null SERPINF1 mutant patients appear healthy at birth and free from fractures until after 6 months of age, suggesting a protective effect of circulating maternal PEDF during fetal development. Moreover, unaffected asymptomatic heterozygotes parents, have PEDF circulating levels of about 1 μg/mL, lower than normal concentrations and sufficient for a normal bone metabolism/development. This study aims to evaluate efficacy and safety of plasma administration and provide a minimum amount of PEDF similar to the levels found in heterozygotes in patients affected by type VI OI. Materials and methods: Ten patients (5-18 yrs old) were eligible for the study. Pharmaceutical grade plasma (Plasmasafe) (12-15 mL/Kg) was administered e.v. every month for 6 months. At baseline, before each plasma transfusion, and 6 months after the last plasma transfusion, PEDF, bone metabolic markers (Ca, P, 25-OH Vitamin D, PTH, bone ALP, osteocalcin, P1NP, DKK1, sclerostin, b CTX), iron and ferritin were determined. PEDF, DKK1, Sclerostin and P1NP were repeated 1, 2 and 7 days after first plasma administration to see the effective bloodstream increase and evaluate the short-term response. Results: Of the initial 10 patients, only 4 completed the study. PEDF (5 patients) showed an increase from <0.045 μg/mL before infusion to 1,357 ± 0.27 μg/mL at day 1, returning to<0.045 μg/mL from day 2 and thereafter. We found a significant decrease in DKK1 (p=0.05) and a non-significant increase in P1NP levels the day after the first transfusion, with a rapid return to previous levels. Biochemical markers of bone turnover and BMD did not show significant changes during the study. Conclusions: Plasma infusion at doses and intervals used in our study produced only a slight and not lasting increase in PEDF circulating levels, not useful to modify bone metabolic markers and BMD. The slight decrease in DKK1 could be an acute effect due to the administration of PEDF, confirming the relationship between PEDF and the Wnt/β-catenin signaling pathway.
