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Caries and periodontal diseases are highly neglected disease affecting millions of Italian children; both diseases are preventable and the combination of high prevalence, high morbidity and a relative lack of attention of the Italian National Health Service make caries and periodontal disease a significant public health problem. To date none studies reported epidemiological data of 6–7-year-old-italian-children-population.The aim of this survey was to describe the dental and periodontal health status in 6- and 7-year-old schoolchildren from Palermo and to evaluate the association between socioeconomic determinants and behavioural habits. A sample of 2701 children aged 6 and 7 from the selected public schools in all the eight districts of the town received a clinical intraoral examination carried out by trained dentists. Parents were asked to fill in a questionnaire investigating children’s eating habits, oral health related behaviours and socioeconomic determinants of the household.The percentage of 6- and 7-year-old schoolchildren with at least one carious lesion was found to be 66.5%. A higher mother’s and father’s educational level were a protective factor for carious lesions; conversely, a paternal unemployment was found to be a risk factor. Living in II and VII districts was a risk factor for all stages of carious lesions.Key words: Dental caries; Schoolchildren; Oral health-related determinants; Caries risk factors; ICDAS II; Caries epidemiology; Deprivation index; Oral health promotion; Dental sealants; Di.Chir.On.S 2021

Drug-related osteonecrosis of the jaw (MRONJ) is a potentially serious and debilitating drug-related complication. In the literature, there are many studies that evaluate therapeutic treatments to support those already existing for MRONJ.The aim of this work was to report a case of severe osteonecrosis, related to bisphosphonates treated with Photodynamic therapy (PDT), Low level laser therapy (LLLT) and a surgery with new platelet-rich plasma preparation. The main biological effects of LLLT are wound healing, collagen synthesis, nerve regeneration, stimulation of endorphin release and immune system modulation. PDT is a new technique for the treatment of inflammatory, infectious, ulcerative, tumor and pre-tumor lesions, able to selectively destroy the altered cells. The preparation of Bio-Plasma® with Pure Growth Factors, associated with the use of fibrin enriched with poor Plasma is able to provide a perfect healing. The excellent results obtained, combined with the absence of short- and long-term complications, constitute a good perspective for the outpatient use of Bio-Plasma® with Pure Growth Factors. Therefore, LLLT and PDT associated with the use of fibrin enriched with poor Plasma, are important tools to contribute to healing and improvement of patient's quality of life.

AbstractBackground: Mandible reconstruction using vascularized free fibula flaps (FFF) is now considered the state of the art, however, those including disarticulation resections and hence reconstruction of the temporomandibular joint (TMJ) are still challenging for most maxillofacial surgeons as the available literature reports are scarce. Most reports focused on the clinical outcomes, and few focused on the spatial deviations of the neocondyle. Several modifications and methods have been reported to support the fibula and improve the functional outcomes of the TMJ.Objective: The aim of this systematic review is to investigate different functional and morphological outcomes following TMJ reconstruction with FFF after disarticulation resections and correlates with the different modification and factors. Materials and Methods: An online search will be done to check all articles reporting TMJ reconstruction using FFF and advocating different outcomes. prospective clinical study was to introduce three modified techniques simultaneously with mandible reconstruction of the TMJ with vascularized free fibula flap (FFF) for dynamic mandible reconstruction and evaluate the different outcomes of such modifications in comparison to the conventional technique.

Osteonecrosis of the jaw (ONJ) is an adverse drug reaction described as the progressive destruction and death of bone that affects the mandible and maxilla of patients exposed to the treatment with medications known to increase the risk of disease, in the absence of a previous radiation treatment.Tooth extraction often precedes the manifestation of ONJ; indeed, it is sometimes called trigger event and it have also been considered as risk factors for the onset of ONJ.As a consequence, some of the guidelines recommend avoiding tooth extractions in patients at risk of ONJ; however, a growing body of evidence indicates that dental/periodontal infection prior to extraction, rather than dental extraction may represent the main local risk factor for ONJ.Ten patients at risk of ONJ have undergone tooth extractions. They were identified and included in our retrospective monocentric clinical investigation. Patients underwent tooth extractions with standardized procedures (PROMaF protocol), and bone biopsies were taken.Extractions were performed due to symptomatic, non-restorable teeth in patient at risk of ONJ; histological findings of ONJ were observed in all samples.This outcome may highlight that the proof of non‐exposed ONJ might be the histopathologic confirmation of necrotic bone, as stated by European task force on MRONJ. Additionally, alveolar biopsy should possibly be taken in every case of suspected ONJ, which needs an proper and prompt management for successful healing.

Medication-related osteonecrosis of the jaw (MRONJ) is on the rise among patients taking long-term antiresorptive drugs. The primary goal of treatment in osteonecrosis of the jaws (ONJ) should be to improve the patient's quality of life by managing pain and infections, preventing the development of new lesions and slowing the progression of the disease. In recent years, the use of the laser for MRONJ treatment has spread, thanks to the practical administration and the widely reported beneficial effects on tissue healing. This literature overview sought to clarify whether low-level laser therapy (LLLT) has positive effects on the treatment of osteonecrosis of the jaw. Our results show that treatment modalities, including LLLT, were associated with superior outcomes in terms of cure or improvement of antiresorptive drugs-related osteonecrosis of jaw lesions compared to conventional surgical and / or conservative drug therapy alone. It can be concluded that combined treatment with antibiotics, minimally invasive surgery (including laser surgery) and LLLT in the early stages of the disease should be the gold standard for management to MRONJ.

The present retrospective study we compared 507 sites of MRONJ occurred in 394 patients to highlight possible differences between cancer and non-cancer patients with stage III MRONJ.Five hundred and seven sites of MRONJ were observed between January 2004 and March 2021 at the Center of Oral Medicine and Laser Surgery of the Academic Hospital of University of Parma. Patients were sub-classified in two groups: Group A (cancer) consisted in 293 affected patients and Group B (non-cancer) in 100 patients with MRONJ.Both Group A and B were evaluated on: gender, mean age, underlying pathology and MRONJ stage.This retrospective analysis highlighted no main differences between cancer and non-cancer patients with stage III MRONJ: both groups presented with similar percentage of advanced stage of MRONJ.Contrary to general belief: osteometabolic patients are not to be considered "safe" from serious complications rather than cancer patients.

Nowadays the multidisciplinary team (MDT) plays a critical role in the treatment of patients with osteonecrosis of the oral cavity, in particular for the reconstructive-rehabilitation phase of complex cases. Among the objectives of the MDT we find the improvement of the quality of life of patients, the restoration of the anatomical defect following surgery, as well as the planning of an aesthetic-functional rehabilitation.The experience of the MDT composed of professionals belonging to the Medicine and Oral Pathology Outpatient Clinic of the Maggiore Hospital of Trieste and to the Department of Otolaryngology of the S. Maria degli Angeli Hospital in Pordenone is presented in relation to surgical-prosthetic rehabilitation in a patient with drug-induced osteonecrosis.The patient, suffering from right maxillary osteonecrosis induced by therapy with Zoledronic Acid, underwent a demolitive surgical intervention of right maxillectomy. At the same time, reconstruction was carried out using a microvascularized fibula flap and insertion of 5 implants. Subsequently, the patient was rehabilitated with a fixed prosthesis on implants.The rehabilitation of the treated patient allowed the resumption of functional activities such as chewing and phonation, guaranteeing the patient a good quality of life. Last but not least, it has allowed us to obtain a good result also from an aesthetic point of view.There are numerous studies in literature which confirm the success of planning by the MDT in treating MRONJ hat demonstrate how an effective and dynamic MDT positively influences the patient's therapeutic and rehabilitative path. The MDT must therefore be able to formulate a personalized therapeutic and rehabilitation plan for the individual patient.