Francesca Angiero

Long-term survival of endodontically treated, maxillary anterior teeth restored with either tapered or parallel-sided glass-fiber posts and full-ceramic crown coverage

OBJECTIVES This retrospective study investigated the clinical effectiveness over up to 8 years of parallel-sided and of tapered glass-fiber posts, in combination with either hybrid composite or dual-cure composite resin core material, in endodontically treated, maxillary anterior teeth covered with full-ceramic crowns. METHODS The study population comprised 192 patients and 526 endodontically treated teeth, with various degrees of hard-tissue loss, restored by the post-and-core technique. Four groups were defined based on post shape and core build-up materials, and within each group post-and-core restorations were assigned randomly with respect to root morphology. Inclusion criteria were symptom-free endodontic therapy, root-canal treatment with a minimum apical seal of 4mm, application of rubber dam, need for post-and-core complex because of coronal tooth loss, and tooth with at least one residual coronal wall. Survival rate of the post-and-core restorations was determined using Kaplan-Meier statistical analysis. RESULTS The restorations were examined clinically and radiologically; mean observation period was 5.3 years. The overall survival rate of glass-fiber post-and-core restorations was 98.5%. The survival rate for parallel-sided posts was 98.6% and for tapered posts was 96.8%. Survival rates for core build-up materials were 100% for dual-cure composite and 96.8% for hybrid light-cure composite. CONCLUSIONS For both glass-fiber post designs and for both core build-up materials, clinical performance was satisfactory. Survival was higher for teeth retaining four and three coronal walls.

Intracellular ATP level increases in lymphocytes irradiated with infrared laser light of wavelength 904 nm.

OBJECTIVE Red and near-infrared laser irradiation is reported to have a range of biological effects on cultured cells and different tissues, leading to the hypothesis that laser light can affect energy metabolism. Increased adenosine triphosphate (ATP) synthesis has been reported in cultured cells and rat brain tissue after irradiation at 632.8 nm and 830 nm, respectively. This study investigated whether diode pulsed laser irradiation enhances ATP production in lymphocytes. MATERIALS AND METHODS Aliquots (500 microL) of an extract of cultured lymphocytes of the Molt-4 cell line were irradiated with diode laser light (lambda = 904 nm, pulsed mode, 6 kHz frequency) with an average emission power of 10 mW for 60 min. A Spectra Physics M404 power meter was used to measure light intensity. Controls were treated similarly but not irradiated. The amount of ATP was measured by the luciferin-luciferase bioluminescent assay. RESULTS The amount of ATP in irradiated cell cultures was 10.79 +/- 0.15 microg/L (SD; n = 10), and in non-irradiated cell cultures it was 8.81 +/- 0.13 microg/L (SD; n = 10). The average percentage increase of irradiated versus control cell cultures was about 22.4% +/- 0.56% SD (p < 0.001). CONCLUSION This significant increase is probably due to laser irradiation; it cannot be attributed to any thermal effect, as the temperature during irradiation was maintained at 37.0 degrees +/- 0.5 degrees C. Thus the therapeutic effects of the biostimulating power of this type of laser are identified and its indications may be expanded.

HER FAMILY RECEPTORS EXPRESSION IN SQUAMOUS CELL CARCINOMA OF THE TONGUE: STUDY OF THE POSSIBLE PROGNOSTIC AND BIOLOGICAL SIGNIFICANCE

OBJECTIVES The squamous cell carcinoma of the tongue (SCCT) is biologically and epidemiologically distinct from other oral cavity cancers and is associated with lower overall survival rates. The role of HER family members (HER-1, HER-2/neu, HER-3 and HER-4) in the pathogenesis and progression of head and neck squamous cell carcinomas has been demonstrated but no report have focused on SCCT. This study investigated, the expression of all members of the HER family, in a series of SCCT and studied the possible prognostic value and correlation with various clinico-pathological parameters. METHODS HER-1, HER-2/neu, HER-3 and HER-4 expression was analysed by semi-quantitative immunohistochemical staining on paraffin embedded tissue specimens from 40 patients who underwent surgery for SCCT between 1996 and 2006. RESULTS HER-1 was overexpressed in 26 cases (65%), HER-2/neu in two (5%), HER-3 in 19 (48%) and HER-4 in three cases (8%). No significant correlation was found between clinicopathological variables and expression of HER-1 and HER-2/neu. HER-3 overexpression was significantly related to nodal stage, age (>or=64 years) and decreased overall survival (P <or= 0.05). HER-4 overexpression was significantly associated with low histological grade including when it was coexpressed with HER-3 but in this case the prognosis was worse (P < 0.05). CONCLUSIONS These results suggest that HER-1 and HER-2/neu when determined with stringent criteria are not useful indicators of prognosis in SCCT. Only HER-3 overexpression may help in identifying SCCT with greater malignant potential also when it is coexpressed with HER-4. Instead, as in other malignancies, HER-4 could play a protective role in SCCT.

Head and Neck Hemangiomas in Pediatric Patients Treated with Endolesional 980-nm Diode Laser

PURPOSE In pediatric patients with hemangiomas, vascular malformations, or lymphovenous malformations, therapeutic decisions frequently pose a challenge to surgeons, dermatologists, radiologists, and pathologists. We analyze the value of an interdisciplinary approach, and treatment of hemangiomas with an endolesional 980-nm diode laser. PATIENTS AND METHODS Between 2000 and 2008 we provided interdisciplinary consultation for patients with hemangiomas, lymphangiomas, and vascular anomalies. We treated 250 patients with a 980-nm diode laser. In patients with hemangiomas and venous malformations, clinical diagnosis was confirmed by color Doppler flow imaging and magnetic resonance imaging; angiography was employed for patients with arteriovenous malformations. All patients were either treated by laser surgery or treated conservatively depending on lesion size and behavior. RESULTS Two hundred fifty pediatric patients were treated; these included 160 patients with hemangiomas, 50 with vascular malformations, and 40 with lymphatic malformation. The treatment results were analyzed by evaluating the decrease in lesion size and the lesions complete clinical disappearance. All patients had resolution except 38 for whom there was a reduction in lesion size that required a new session. CONCLUSIONS The interdisciplinary approach increases diagnostic accuracy, and subsequently improves individual treatment for pediatric patients with hemangioma, lymphangioma, and vascular anomalies. The diode laser was found to be useful in the treatment of lesions in pediatric patients in terms of aesthetic results and resolution.

Mandibular condylar hyperplasia: clinical, histopathological, and treatment considerations.

Abstract Condylar hyperplasia is a rare disorder characterized by an increased volume of the condyle, ramus, and mandibular body leading to facial asymmetry. We present three cases of condylar hyperplasia: two women and one man, age range 27 to 34. Clinically, all three patients showed a deviation of the mandible to the opposite side and a protruded position of the chin, hypertrophy of the lower border of the mandible, combined with an elongation of the mandibular ramus, open-bite on the deformed side, and cross-bite on the opposite side. In all three cases, scintigraphy showed an increased uptake. Radiography and CT scanning confirmed the clinical diagnosis and patients were subjected to surgery, comprising high condylectomy on the affected side with access in the pre-tragus area. The surgical piece sent to the Institute of Pathological Anatomy for histological examination revealed a nonuniform picture, in terms of both the depth of cartilage islands and the thickness of the fibrous layer covering the joint surface. Common to all three cases, however, was the apparent evolution of fibrous tissue to cartilage, and of this to compact bone tissue. At two-four years, all cases have maintained a good occlusal response. The asymmetric deformity of the mandible resulting from the rare condition of hemimandibular hyperplasia is presented and the clinical, histopathological and therapeutic aspects discussed.

Treatment of hemangioma of the head and neck with diode laser and forced dehydration with induced photocoagulation.

OBJECTIVE The aim of this study was to investigate the efficacy of treating oral hemangiomas using forced dehydration with induced photocoagulation (FDIP) via diode laser. METHODS One-hundred sixty patients were treated between 1999 and 2006 (76 men, 46%; 84 women, 54%). In 136 cases we used FDIP to treat hemangioma, and in 24 cases complete surgical excision was performed. One-hundred thirty-four lesions had a surface area <2 x 2 cm2, whereas only two had large lesions measuring 2.5 x 2 cm2. RESULTS In 136 patients with hemangiomas treated with FDIP, 134 cases (98.53%) showed complete remission, one case (0.735%) did not show complete remission, and one case (0.735%) displayed tumor growth. There were no adverse effects and all patients were carefully followed-up until complete healing was documented, along with any complications. CONCLUSIONS Our findings suggest that FDIP is a useful and effective treatment for benign oral vascular lesions. FDIP treatment of these oral lesions is clinically significant because it provides effective management, avoids recurrence, and shortens healing time. We believe that the use of this method by medical and dental specialists should be supported.

Decontamination of Root Canals with the Gallium-Aluminum-Arsenide Laser: An in Vitro Study

OBJECTIVES In this in vitro study, we investigated the bactericidal effects on root canals of 810-nm diode laser irradiation, alone or combined with sodium hypochlorite and citric acid irrigation. MATERIALS AND METHODS One hundred sixteen single-rooted human teeth extracted for periodontal reasons were randomly divided into four experimental groups. The canal of each tooth was prepared with a conventional step-back technique and a pure culture of vancomycin-resistant Enterococcus faecalis grown in brain heart infusion broth was used to contaminate the root canal. The specimens were incubated at 37 degrees C for 15 d in a test tube filled with agar, adding fresh bacterial suspension every 48 h, and sent them for microbiological analysis and bacterial count. Subsequently they were divided into four groups: in group A, 29 teeth were irrigated with 2 mL of 10% citric acid solution; in group B, 29 teeth were irrigated with 2 mL 5.25% sodium hypochlorite (NaOCl) solution; in group C, 29 teeth were irradiated with 810-nm laser energy via a 200-microm optic fiber at 2.5 W power in pulsed mode (10 msec on and 10 msec off) for 5 sec; and in group D, 29 teeth were irrigated with NaOCl, irradiated with the laser, then irrigated with citric acid, and irradiated with the laser, followed again by NaOCl irrigation and laser irradiation. All the samples were again sent for microbiological analysis and bacterial count. RESULTS Group A had a bactericidal effect of 0.041 log mean CFU, that of group B was 3.381 log mean CFU, and that of group C was 1.459 log mean CFU, whereas group D showed the best results, with a bactericidal effect of 7.178 log mean CFU. CONCLUSIONS The use of NaOCl, citric acid, and diode laser energy together have a synergistic effect, increasing treatment efficacy and leading to significantly better decontamination of the root canal.

Comparative analysis of c-erbB-2 (HER-2/neu) in squamous cell carcinoma of the tongue: does over-expression exist? And what is its correlation with traditional diagnostic parameters?

OBJECTIVES Over-expression of the proto-oncogene c-erbB-2 (HER-2/neu) has been shown to be a prognostic marker in many kinds of cancer, whereas conflicting data exist about the prevalence of HER-2/neu over-expression in squamous cell carcinoma (SCC) of the tongue. The status of Her-2/neu was evaluated in a series of SCC of the tongue to verify the frequency of over-expression of HER-2/neu and evaluate the correlation with traditional diagnostic parameters of this neoplasm. METHOD Fourty patients with SCC of the tongue were investigated for over-expression of the protein through immunohistochemistry using CB11 antibody, the Hercep Test kit and FISH. RESULTS Data obtained using the Hercep Test differ from published reports concerning the over-expression of Her-2/neu and there was no correlation between levels of expression of Her-2/neu and other clinico-pathological and/or prognostic parameters. Of the 40 specimens, using CB11 we obtained results in line with published reports; however, with the Hercep Test we found only 1 positive case (2.5%) (score 3+). CONCLUSION These data, confirmed by FISH, suggest that Her-2/neu is not a suitable marker that could play a primary role in the clinical-therapeutic management of SCC of the tongue.

Apicoectomies with the erbium laser: a complementary technique for retrograde endodontic treatment.

OBJECTIVE The purpose of this study was to evaluate the efficacy of erbium lasers for retrograde endodontic treatment, in terms of clinical outcome and therapeutic success. BACKGROUND DATA Apicoectomy with retrograde filling is a well-established surgical procedure to treat teeth affected by persistent periapical lesions. The apical root end is generally removed with burs, and the adjacent periapical tissue curetted, or alternatively treated with ultrasound or laser. METHODS Between 2000 and 2010, 65 apicoectomies were performed on necrotic teeth that presented apical lesions (29 men, 36 women). The lasers used in the study were the erbium:yttrium-aluminum-garnet (Er:YAG) laser, wavelength 2940 nm, and the erbium,chromium-doped:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser, wavelength 2780 nm. RESULTS Of the 65 teeth in the study, failure only occurred in 9 CASES, MANIFESTING AFTER DIFFERENT TIMES. THE REMAINING PATIENTS, 86.15%, experienced no complications, and their treatment followed a positive course. CONCLUSIONS Laser-assisted surgery increases the range of therapeutic approaches in the sphere of retrograde endodontic treatment. The results of this study show that the erbium laser, used for apicoectomy, results in a high success rate with considerable benefit in terms of clinical outcome and therapeutic success.

Diagnostic Implications of L1, p16, and Ki-67 Proteins and HPV DNA in Low-grade Cervical Intraepithelial Neoplasia

The expressions of p16, Ki-67, and L1 proteins and human papillomavirus DNA were investigated using polymerase chain reaction (HPV/PCR) and catalyzed signal-amplified colorimetric DNA in situ hybridization (CSAC/ISH) as potential molecular markers for the diagnosis and transforming potential of low cervical intraepithelial neoplasia (CIN1). Ki-67 and p16 protein expression increased linearly from control cases to more dysplastic cases (CIN1, CIN2, and CIN3), peaking in squamous cell carcinoma cases (P<0.05). In contrast, L1 expression was inversely correlated with malignant transformation. Patients with CIN1 were divided into 4 groups: L1–p16+, L1+p16–, L1–p16–, and L1+p16+, and the immunohistochemical results were combined with HPV/PCR, L1/PCR, and high-risk E6/E7 genome and CSAC/ISH data. Malignant transformation correlated with L1–p16+ patients (100% of CIN2, CIN3, and squamous cell carcinoma cases) and was evident in approximately 23% of CIN1 cases. In addition, the presence of HPV/DNA+ was evident in 52% of CIN1 cases, and within the L1–p16+ group. In 4 of 7 cases, the high-risk E6/E7 HPV genome was present and in 1 case it was integrated into the host DNA, as confirmed using CSAC/ISH. In patients with CIN1, investigating the presence of HPV/DNA using PCR and the presence of the high-risk E6/E7 genome is necessary to distinguish high-risk oncogenic patient groups from low-risk groups. This study highlights the importance of combining immunohistochemical analysis with HPV/PCR and CSAC/ISH to identify patients with CIN1 with a risk of neoplastic progression.