Publications by authors named "Patrizia Defabianis"

20 Publications

  • Page 1 of 1

An Innovative Strategy for Oral Biofilm Control in Early Childhood Based on a Resveratrol-Cyclodextrin Nanotechnology Approach.

Materials (Basel) 2021 Jul 7;14(14). Epub 2021 Jul 7.

Department of Surgical Sciences, C.I.R. Dental School, University of Turin, 10126 Turin, Italy.

The purpose of this randomized controlled study was to evaluate the clinical efficacy of a novel oral spray containing resveratrol (RV) in controlling bacterial biofilm and gingival inflammation in early childhood. RV, a natural polyphenol, known for its anti-inflammatory and anti-infective activities, was included in a nanovector of 2-hydroxypropyl-beta-cyclodextrins (HPβCD) to improve its bioavailability. A total of 64 children between two and five years of age with plaque-induced gingivitis were randomly included in two equal groups. Both groups were enrolled in a mechanical plaque control program for a period of four weeks, while the test group was also instructed to use the RV-HPβCD mouthwash (in spray formulation) once daily, after toothbrushing. All children underwent three oral hygiene motivation sessions, 14 days apart, during which the full-mouth presence of bacterial plaque, gingival inflammation, dental stain and salivary pH were recorded. At two-week appointment, they also received professional plaque removal. The use of RV-based oral spray significantly reduced the amount of dental plaque and the percentage of bleeding sites and improved salivary pH compared to the control group at both two- and four-week examinations. Based on these promising results, the local delivery of RV-HPβCD via oral spray could enhance the control of dental biofilm in early childhood, when antiseptic mouthwashes are not recommended.
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http://dx.doi.org/10.3390/ma14143801DOI Listing
July 2021

Evaluation of Biodentine in Pulpotomies of Primary Teeth with Different Stages of Root Resorption Using a Novel Composite Outcome Score.

Materials (Basel) 2021 Apr 24;14(9). Epub 2021 Apr 24.

Department of Surgical Sciences, C.I.R. Dental School, Section of Pediatric Dentistry, University of Turin, 10126 Turin, Italy.

This study aimed to assess the success of pulpotomy in primary molars using Biodentine, new-developed tri-calcium, di-calcium-based silicate cement, at 6 and 12 months. The hypothesis was that stages of root resorption could influence the treatment success. A novel composite score was used based on five clinical and radiographic outcomes: soft-tissue pathology, pain to percussion, pathologic mobility, radiolucency and pathologic root resorption. Patients' compliance and intraoperative pain experience were recorded using the Frankl scale and the Wong-Baker scale. A total of 22 primary molars, 9 in stage S (stability) and 13 in stage R (resorption) were submitted to pulpotomy using Biodentine and restored with composite resin. The success rate was 92.3% in the R group compared to 100% in the S group at both 6 and 12 months ( = 0.850). There was no statistically significant effect of type of molar, tooth position and type of carious lesions on the composite outcome (all > 0.05). Overall, 73% of the children experienced no or mild/moderate pain and 77% had a cooperative attitude. Children younger than 7 years old experienced more pain ( = 0.04). Biodentine is a promising biomaterial for pulpotomy of primary teeth regardless of the stage of root resorption.
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http://dx.doi.org/10.3390/ma14092179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8123062PMC
April 2021

SALIVARY GLANDS INVOLVEMENT: A NEW INDICATOR OF JUVENILE IDIOPATHIC OLIGOARTICULAR ARTHRITIS (Preliminary results).

Rheumatology (Oxford) 2021 Jan 6. Epub 2021 Jan 6.

Department of Surgical Sciences, C.I.R. Dental School-Section of Periodontology, University of Turin, Turin, Italy.

Objective: Early diagnosis is critical to reduce long-term disability in patients with juvenile idiopathic arthritis (JIA) by ensuring prompt treatment. The aim of this cross-sectional study was to evaluate the salivary gland function in JIA, addressing specifically oligoarticular (JIA1) and polyarticular (JIA2) subtypes, compared with healthy controls. This may contribute to the identification of salivary risk indicators of the disease that may help diagnosis at an early stage or even before the onset of other clinical evidences.

Methods: Twenty-eight patients with JIA1, 28 patients with JIA2, according to the International League of Associations for Rheumatology criteria, and 28 healthy controls (C) were included in the study. Exclusion criteria were any concurrent medical condition. Data on medication, dietary and oral hygiene habits were collected using a questionnaire. All patients underwent oral examination and saliva measurement.

Results: : While stimulated salivary flow rate (SFR) was significantly lower in JIA1 compared with JIA2 and C (p < 0.001), both salivary buffer capacity and pH were similar in the two JIA groups but statistically different from C (p = 0.002 and p = 0.010, respectively). Children with very low SFR (< 3.5 ml) exhibited a 16-fold higher likelihood of being affected by JIA1 rather than JIA2 (p = 0.003), while no association was observed between low flow rate and JIA subtype (p = 0.744).

Conclusion: These preliminary data suggest impairment of salivary gland function as a risk indicator for JIA1 with no association with dietary habits and drug intake.
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http://dx.doi.org/10.1093/rheumatology/keaa891DOI Listing
January 2021

Italian guidelines for the prevention and management of dental trauma in children.

Ital J Pediatr 2019 Dec 4;45(1):157. Epub 2019 Dec 4.

Department of Pediatrics, Pugliese-Ciaccio Hospital of Catanzaro, Viale Papa Pio X, 83, 88100, Catanzaro, Italy.

Dental trauma is a frequent occurrence in children and adolescent and a correct diagnosis and treatment are essential for a favourable long-term prognosis. The present Guidelines aim to formulate evidence-based recommendations to assist dentists, paediatricians, surgeons, teachers, school and sport staff, parents in the prevention and first aid of dental trauma in children and to provide a careful assessment of the medico-legal implications, reviewing the first draft of the guidelines published in 2012. A multidisciplinary panel on the behalf of the Italian Ministry of Health and in collaboration with the WHO Collaborating Centre for Epidemiology and Community Dentistry of Milan, developed this document. The following four queries were postulated: 1) Which kind of precautions the health personnel, parents, sports and educational personnel must activate in order to prevent the dental trauma damage? 2) How an orofacial trauma in paediatric patients should be managed either in the Emergency Care Unit and/or in private dental office? 3) What criteria should be adopted by a dentist private practitioner to fill in a certificate in cases of dental and/or tempomandibular joint trauma occurring in children and adolescents? 4) What are the elements that should lead clinicians to suspect a non-accidental dental trauma? A systematic review and analysis of the scientific literature published in English, Italian and French from 2007 to 2017 regarding dental trauma in children and adolescents aged 0-18 years was performed, and about 100 papers were analysed and included. The following four domains were analysed and discussed: Dental Trauma Prevention Strategies and Health Education, First aid in orofacial and dental trauma, Certificate of the dental trauma, Oral and dental signs of child abuse and neglect. Twenty-eight recommendations were draw up and codified by the panel according to the Methodological handbook, produced by the Istituto Superiore di Sanità, in order to guide physicians in the prevention and first aid of dental trauma in children and adolescents. In addition, a careful assessment of the medico-legal implications is reported in this document.
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http://dx.doi.org/10.1186/s13052-019-0734-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894327PMC
December 2019

Correction to: Best practice management guidelines for fibrous dysplasia/McCune-Albright syndrome: a consensus statement from the FD/MAS international consortium.

Orphanet J Rare Dis 2019 Nov 21;14(1):267. Epub 2019 Nov 21.

Skeletal Disorders and Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, Bethesda, MD, USA.

The original version of this article [1] unfortunately included an error to an author's name. Paul Arundel was inadvertently presented as Paul Arunde.
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http://dx.doi.org/10.1186/s13023-019-1255-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868680PMC
November 2019

Best practice management guidelines for fibrous dysplasia/McCune-Albright syndrome: a consensus statement from the FD/MAS international consortium.

Orphanet J Rare Dis 2019 06 13;14(1):139. Epub 2019 Jun 13.

Skeletal Disorders and Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, Bethesda, MD, USA.

Fibrous Dysplasia / McCune Albright syndrome (FD/MAS) represents a wide spectrum of diseases due to somatic gain-of-function mutations of the GNAS gene. The mutation leads to overactivity in the target tissues and to a wide phenotype of clinical features that vary in severity and age of onset. The rarity of the disease and its variable presentation to multiple specialities often leads to misdiagnosis and inappropriate variability in investigations and treatments. To address this, our international consortium of clinicians, researchers, and patients' advocates has developed pragmatic clinical guidelines for best clinical practice for the definition, diagnosis, staging, treatment and monitoring for FD/MAS to empower patients and support clinical teams in both general and specialised healthcare settings. With the lack of strong evidence to inform care, the guidelines were developed based on review of published literature, long-standing extensive experience of authors, input from other healthcare professionals involved in the care of FD/MAS patients and feedback from patients and patient groups across the globe. This has led to the formulation of a set of statements to inform healthcare professionals, patients, their families, carers and patient groups of the best practice of care. It is anticipated the implementation of these recommendations will lead to improvement in the care of patients with FD/MAS internationally.
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http://dx.doi.org/10.1186/s13023-019-1102-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567644PMC
June 2019

Standardizing Terminology and Assessment for Orofacial Conditions in Juvenile Idiopathic Arthritis: International, Multidisciplinary Consensus-based Recommendations.

J Rheumatol 2019 05 15;46(5):518-522. Epub 2019 Jan 15.

From the Department of Dentistry and Oral Health, Aarhus University; Department of Oral and Maxillofacial Surgery, Aarhus University Hospital; Department of Orthodontics, Aarhus University; Department of Pediatrics, Aarhus University Hospital; Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital; Section of Oral Surgery and Oral Pathology, Aarhus University, Aarhus, Denmark; Harvard School of Dental Medicine and Harvard Medical School; Department of Plastic and Oral Surgery, Boston Children's Hospital; Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts; Oral and Maxillofacial Surgery and Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia; University of Alabama at Birmingham, Birmingham, Alabama; Perelman School of Medicine, University of Pennsylvania; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Seattle Children's Hospital, Seattle, Washington, USA; Department of Neuroscience, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples Federica II, Naples; Dental School, Section of Paediatric Dentistry, University of Turin, Turin, Italy; Department of Orthodontics and Pediatric Dentistry, UZB, University Center for Dental Medicine, Basel; Department of Diagnostic Imaging, University Children's Hospital Zurich, Switzerland; Department of Pediatrics, University of North Norway and Department of Clinical Medicine, UiT the Arctic University of Norway, Tromso; Section of Orthodontics, Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo; Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital North Norway; The Public Dental Service Competence Centre of North Norway; Department of Clinical Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromso, Norway; Department of Orthodontics, Faculty of Dentistry, Rigas Stradins University, Riga, Latvia; Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Department of Pediatrics, Cumming School of Medicine, University of Calgary; Alberta Children's Hospital, Calgary, Alberta, Canada; Malmo University, Faculty of Odontology, Orofacial Pain Unit, Malmo and Skane University Hospital, Specialized Pain Rehabilitation, Lund, Sweden; Department of Ear and Oral Diseases, Tampere University Hospital; Faculty of Medicine and Life Sciences, University of Tampere; Institute of Dentistry and University of Eastern Finland, Kuopio, Finland.

Objective: To propose multidisciplinary, consensus-based, standardization of operational terminology and method of assessment for temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA).

Methods: Using a sequential expert group-defined terminology and methods-of-assessment approach by (1) establishment of task force, (2) item generation, (3) working group consensus, (4) external expert content validity testing, and (5) multidisciplinary group of experts final Delphi survey consensus.

Results: Seven standardized operational terms were defined: and CONCLUSION: Definition of 7 operational standardized terms provides an optimal platform for communication across healthcare providers involved in JIA-TMJ arthritis management.
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http://dx.doi.org/10.3899/jrheum.180785DOI Listing
May 2019

Multicenter randomized, double-blind controlled trial to evaluate the efficacy of laser therapy for the treatment of severe oral mucositis induced by chemotherapy in children: laMPO RCT.

Pediatr Blood Cancer 2018 08 4;65(8):e27098. Epub 2018 May 4.

Pediatric Hemato-Oncology Unit, IRCCS materno infantile Burlo Garofolo, Trieste, Italy.

Objectives: To demonstrate the efficacy of laser photobiomodulation (PBM) compared to that of placebo on severe oral mucositis (OM) in pediatric oncology patients. The primary objective was the reduction of OM grade (World Health Organization [WHO] scale) 7 days after starting PBM. Secondary objectives were reduction of pain, analgesic consumption, and incidence of side effects.

Methods: One hundred and one children with WHO grade > 2 chemotherapy-induced OM were enrolled in eight Italian hospitals. Patients were randomized to either PBM or sham treatment for four consecutive days (days +1 to +4). On days +4, +7, and +11, OM grade, pain (following a 0-10 numeric pain rating scale, NRS) and need for analgesics were evaluated by an operator blinded to treatment.

Results: Fifty-one patients were allocated to the PBM group, and 50 were allocated to the sham group. In total, 93.7% of PBM patients and 72% of sham patients had OM grade < 3 WHO on day +7 (P = 0.01). A significant reduction of pain was registered on day +7 in the PBM versus sham group (NRS 1 [0-3] vs. 2.5 [1-5], P < 0.006). Reduced use of analgesics was reported in the PBM group, although it was not statistically significant. No significant adverse events attributable to treatment were recorded.

Conclusions: PBM is a safe, feasible, and effective treatment for children affected by chemotherapy-induced OM, as it accelerates mucosal recovery and reduces pain.
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http://dx.doi.org/10.1002/pbc.27098DOI Listing
August 2018

Preliminary study in a new protocol for the treatment of oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT) and chemotherapy (CT).

Lasers Med Sci 2017 Aug 29;32(6):1423-1428. Epub 2017 Jun 29.

Section of Paediatric Dentistry CIR-Dental School, University of Turin, Turin, Italy.

Oral mucositis (OM) is a debilitating and serious side effect in patients undergoing hematopoietic stem cell transplantation (HSCT) and chemotherapy (CT). Laser therapy is becoming a promising treatment option in these patients, avoiding the necessity of enteral/parenteral nutrition. The aim of this study was to evaluate the efficacy of laser therapy in patients affected by oral mucositis induced by chemotherapy and HSCT. Sixteen onco-hematological pediatric patients receiving chemotherapy and hematopoietic stem cell transplantation, affected by oral mucositis, were enrolled in this study. They were divided in two randomized groups: the laser group and the placebo-control group. Patients in the laser group were treated with HPLT (970 ± 15 nm, 3.2 W (50%), 35-6000 Hz, 240 s) for four consecutive days, once a day; and placebo group underwent sham treatment. The assessment of mucositis was recorded through WHO Oral Mucositis Grading Objective Scale, and pain was evaluated through Visual Analogue Scale (VAS). Patients were monitored and evaluated 3, 7, and 11 days after the first day of laser therapy. Once OM was diagnosed, the patients had mucositis grading assessments before laser or sham application at day 3, 7, and 11 after first application. All patients of laser group demonstrated improvement in pain sensation from day 3 after first application of laser (p < 0.05), ulcerations reduced their dimensions and erythema disappeared. The patients of placebo group had improvement from day 7. In laser group, all mucositis were fully resolved from day 7 (p < 0.05). Oral mucositis negatively impacts on nutritional intake, oral hygiene, and quality of life. Laser therapy appears to be a safe and innovative approach in the management of oral mucositis. In this preliminary study, HPLT encourages to consider laser therapy as a part of onco-hematological protocol, providing to decrease pain and duration of OM induced by CT and HSCT. Further researches will be needed, especially randomized, controlled clinical trials with a large number of enrolled patients and a long term of follow-up to confirm the efficacy of laser therapy in prevention and control of OM in onco-hematological pediatric patients.
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http://dx.doi.org/10.1007/s10103-017-2266-yDOI Listing
August 2017

Odontoiatric perspectives and osteonecrosis of the jaw as a possible adverse effect of bisphosphonates therapy in fibrous dysplasia and McCune-Albright syndrome.

J Pediatr Endocrinol Metab 2016 Mar;29(3):333-6

Background: McCune-Albright syndrome (MAS) is characterized by the triad of polyostotic bone fibrous dysplasia (PFD), endocrine disorders, and café-au-lait skin pigmentation. Ninety percent of MAS patients have fibrous dysplasia (FD) craniofacial lesions. Osteonecrosis of the jaw (ONJ) has been described as an adverse side effect of bisphosphonate therapy. The aim of the study was to investigate evidence of clinical and/or radiological signs of ONJ in FD/MAS pediatric patients due to bisphosphonate therapy and describe odontoiatric tools in this population.

Methods: Thirteen FD/MAS patients were enrolled. All patients during pediatric age have been treated with pamidronate infusions. They underwent complete oral clinical examination. Ortopantomography and/or CT were evaluated in all cases.

Results And Conclusions: No patient developed ONJ. None of them showed radiological signs different from jaw FD. In spite of the low number of patients enrolled, results confirm that, in this population, ONJ can be ruled out as a chronic adverse side effect of bisphosphonate therapy.
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http://dx.doi.org/10.1515/jpem-2015-0300DOI Listing
March 2016

Professional oral hygiene as a therapeutic option for pediatric patients with plasma cell gingivitis: preliminary results of a prospective case series.

J Periodontol 2011 Dec 12;82(12):1670-5. Epub 2011 May 12.

Department of Biomedical Science and Human Oncology, Oral Medicine Section, Lingotto Dental School, University of Turin, Italy.

Background: Plasma cell gingivitis (PCG) is a rare, benign inflammatory condition of unclear etiology with no definitive standard of care ever reported to our knowledge. The aim of this case series is to ascertain the clinical efficacy of professional oral hygiene and periodontal therapy in younger individuals with a histologically confirmed diagnosis of PCG.

Methods: All patients received non-surgical periodontal therapy, including oral hygiene instructions, and thorough supragingival scaling and polishing with the removal of all deposits and staining combined with the use of antimicrobials in a 9-week cohort study. Clinical outcome variables were recorded at baseline and 4 weeks after the intervention and included, as periodontal parameters, full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), the clinical extension of gingival involvement, and patient-related outcomes (visual analog score of pain).

Results: A total of 11 patients (six males and five females; mean age: 11 ± 0.86 years) were recruited. Four weeks after finishing the oral hygiene and periodontal therapy protocol, a statistically significant reduction was observed for FMPS (P = 0.000), FMBS (P = 0.000), reported pain (P = 0.003) and clinical gingival involvement (P = 0.003).

Conclusion: Standard, professional oral hygiene procedures and non-surgical periodontal therapy including antimicrobials were associated with a marked improvement of clinical and patient-related outcomes in pediatric cases of PCG.
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http://dx.doi.org/10.1902/jop.2011.100663DOI Listing
December 2011

Absence of soluble CD14 in saliva of young patients with dental caries.

Eur J Oral Sci 2007 Apr;115(2):93-6

Department of Genetics, Biology, and Biochemistry, University of Torino, Italy.

It is generally accepted that salivary components are important for dental health, but to date no clear correlation has been found between one or more of these components and the outcome of dental caries. The identification of salivary factors preventing, favoring or signaling dental caries might help to control the disease. In the present study, western blotting analysis of whole saliva from 20 healthy caries-free children showed the presence of the soluble form of CD14, a bacterial pattern-recognition receptor for many bacterial components that is involved in the innate immune response. The identity of the protein was confirmed through N-terminal sequencing by Edman degradation, and by partial sequencing with mass spectrometry of tryptic peptides. Conversely, CD14 was completely absent in the saliva of 20 age-matched patients affected by two to eight carious lesions, but appeared in their saliva a few weeks after dental restoration. These results suggest that the absence of salivary soluble CD14 could represent an useful index of caries activity, and might be used to detect early carious lesions not visible by oral inspection.
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http://dx.doi.org/10.1111/j.1600-0722.2007.00437.xDOI Listing
April 2007

TMJ internal derangement treatment in the growing patient: effect of functional appliance therapy on condyle and fossa relocation.

J Clin Pediatr Dent 2004 ;29(1):11-8

Department of Odontostomatology, St John the Baptiste Hospital, University of Torino, Italy.

New biodynamic factors seem to be involved on condyle and fossa remodeling and relocation, conditioning to mandibular growth direction, size and morphology. The understanding of the mechanism of action is critical for treatment of TMJ dysfunction in children and youths for those who hope to treat and retain the achieved correction during growth. The purpose of this article is to describe a specific, non-muscular hypothesis that explains the way the condyle modifies and the fossa remodels and relocates to achieved a new therapeutic, stable position, creating an anatomical base for long-term retention of the results. A case report of a young patient will be illustrated and available clinical data will be discussed.
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http://dx.doi.org/10.17796/jcpd.29.1.4qr12w616237567tDOI Listing
December 2004

The importance of early recognition of condylar fractures in children: a study of 2 cases.

J Orofac Pain 2004 ;18(3):253-60

Department of Odontostomatology, St John the Baptist Hospital, University of Torino, Torino, Italy.

Maxillofacial fractures in general and mandibular fractures in particular seem to be less common in children than in adults; however, this finding might be influenced by the fact that condylar fractures in children are often undiagnosed and so the true incidence is likely to be higher than that reported in literature. Traumatic lesions of the temporomandibular joint often are overlooked as they can apparently occur with relatively little pain, few clinical signs, and insufficient reaction by the child to alert an adult to the seriousness of the injury. Only 1 to 2 years later, when growth disturbances appear, are they perceived as a problem, but by that time, the dysplastic growth pattern has stabilized and will continue over a period of years. The problem is frequently underestimated because of the difficulties inherent in pediatric pain assessment. The fact that the mechanisms of pain perception in children differ somewhat from adult pain perception mechanisms is one factor that can make pediatric pain assessment difficult. This paper outlines 2 case reports that draw attention to pain in children in the case of temporomandibular joint injury. The inability to assess pain adequately may lead to a delay in diagnosis and treatment and possibly result in future growth disturbances and facial asymmetries.
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December 2004

Scleroderma: a case report of possible cause of restricted movement of the temporomandibular joint with effects on facial development.

J Clin Pediatr Dent 2003 ;28(1):33-8

Department of Odontostomatology, St. John the Baptiste Hospital, University of Torino, Italy.

Scleroderma is a rare abnormality in which fibrosis of the skin, subcutaneous tissues and muscle may occur. All forms of scleroderma are rare in childhood: the most common form is localized scleroderma. Localized scleroderma is often benign, but may cause significant deformity, if it occurs on the face or extends across joint surfaces. Structural changes may occur in the osseous tissue and result in mandibular joint restriction (pseudoankylosis) and facial and occlusal disharmonies. This article describes a case of facial linear scleroderma in a nine-year-old child and the treatment performed to minimize consequences on occlusion and face development. Available clinical data will be illustrated.
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http://dx.doi.org/10.17796/jcpd.28.1.607q556111778521DOI Listing
December 2003

Biology and mechanics of facial asymmetries in children and youths.

Funct Orthod 2003 Spring-Summer;20(1-2):32-9

Dept. of Odontostomatology, St. John The Baptiste Hospital, University of Torino, Corso Montevecchio 62, 10128 Torino, Italy.

There is a need for further knowledge about the normal and abnormal growth patterns of bones and teeth. Genetic make-up, as well as various types of diseases and injuries such as trauma, inflammation, radiation and chemicals may affect skeletal and dental growth sites, thereby causing faulty growth. The degree of the subsequent deformity depends not only on the type, intensity, extent and chronology of the noxious agent, but also on the site and its particular involvement in growth activity. The knowledge of what happens to the stomatognathic system when some of its parts are altered is very important. Dentists are challenged to visualize the entire system in all its relationships: they must visualize the dynamics of how the system works. The relationship of the maxilla to the mandible and the mechanics of the stomatognathic system must be considered as a whole when considering the occlusion. The aim of this paper is to focus attention on the biologic basis of facial asymmetries and the functional reasons for their stabilization.
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December 2003

Post-traumatic TMJ internal derangement: impact on facial growth (findings in a pediatric age group).

J Clin Pediatr Dent 2003 ;27(4):297-303

Department of Odontostomatology, St. John the Baptiste Hospital, University of Torino, Italy.

Many clinical studies have shown how jaw injuries sustained during impact trauma to the face or mandible are the single most important cause of TMJ subsequent internal derangement. Proper function of the masticatory system is certainly the most influential variable in the TMJ remodelling; once a TMJ is internally deranged, adaptative or degenerative osteocartilagineous processes take place in the mandible, temporal bones and muscles. To evaluate relationships between consequences of post-traumatic TMJ internal derangement and disturbed facial skeleton growth in children, 25 patients (16 boys 9 girls), 14 year of age or younger, were selected out of a group of 74 and analysed. They all had been treated by physiotherapy and had undergone combined clinical and radiographic examination for five years. Symptoms included either individually or in various combination, pain, mechanical TMJ dysfunction and facial skeletal abnormalities, such as mandibular retrognathia and lower facial asymmetry manifested by chin deviation from the midline. Seventeen patients were found to have at least one abnormal and internally deranged TMJ on imaging studies; in twelve of them a mandibular asymmetry with chin deviation from the midline to the smaller or more degenerated TMJ was evident. Of the eight retrognathic patients, five were found to have bilateral TMJ derangement. In three patients both TMJ(s) were normal with normal facial structure. These data suggest that TMJ derangement in children may potentially have an impact on facial growth and lead to the development of retrognathia, with or without asymmetry, in many cases.
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http://dx.doi.org/10.17796/jcpd.27.4.2782236161p3p467DOI Listing
October 2003

TMJ fractures in children and adolescents: treatment guidelines.

J Clin Pediatr Dent 2003 ;27(3):191-9

Department of Odontostomatology, St. John The Baptiste Hospital, University of Torino, Italy.

TMJ fractures must be focused not only as a cause of direct damage to osseous structures, but also of future disturbances of dentofacial development. Treatment is aimed at restoring normal joint function, occlusion and symmetry. Any disturbance of condylar cartilage will result in alteration of mandibular development. The subsequent deformity of jaw and face will depend not only on the type, intensity extent and chronology of the noxious agent, but also on the particular time of occurrence and growth activity. Thus the effect will be more decided if the disturbance occurs early in life, during childhood, when growth activity is greater and mandibular shape and size have not been assumed yet. This report will include basic information on both prevention and first aid in these types of injuries. The correct application of these precautions immediately following the trauma should improve the short and long-term outcome. Information on diagnosis and treatment of lesions of the bone and soft tissues, which may coexist with dental trauma, a critical first step in the overall management of traumatized patients, will be given. Follow-up procedures of these patients will be illustrated. The guidelines described in this paper for the treatment of traumatic TMJ fractures in children and youths are based on our clinical experience. They are intended as an aid to practioners in the management and treatment of these traumas, by professional must always use professional judgement. There are no guarantees of any positive results associated with the use of these guidelines, although it is felt that time and proper treatment will maximize the chances of success.
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July 2003

TMJ fractures in children: importance of functional activation of muscles in preventing mandibular asymmetries and facial maldevelopment.

Funct Orthod 2002 ;19(2):34-42

Dept. of Odontostomatology, St. John the Baptiste Hospital, University of Torino (Italy), Corso Montevecchio 62, 10128 Torino, Italy.

Normal development of the mandible as well as some portions of the upper jaw and face are related to good function of the masticatory apparatus: the integrity and interaction of bony and soft-tissue structures may be highly disturbed by injury of the TM joints and result in facial and occlusal disharmonies. When the neuromuscular system is in harmony, the mandibular muscles collectively exert their effect on both position and movement of the jaw and the loading of forces on the TM joints is optimal and balanced. Unfortunately, TMJ fractures may alter completely this balance with loss of the support to the mandible against the temporal component and loss of the functional effect of the lateral pterygoid muscle on the mandible. Disturbances in the harmonious interplay of the masticatory muscles may result in facial alteration and asymmetries. If not treated, the dysplastic patterns of growth continues and worsens during the years.
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October 2002

Treatment of condylar fractures in children and youths: the clinical value of the occlusal plane orientation and correlation with facial development (case reports).

J Clin Pediatr Dent 2002 ;26(3):243-50

Department of Odontostomatology, St. John the Baptist Hospital, University of Torino, Italy.

The relative position of the plane of occlusion to the cranial base determines the direction of the forces generated in the cranium during occlusal function. When the plane of occlusion is level and when the neuromuscular system is in harmony, the vectors of forces created by the closing muscles are directed to the central area of the cranium in a symmetrically balanced way. Unfortunately, TMJ fractures may alter completely this balance with loss of the support to the mandible against the temporal component and loss of the functional effect of the lateral pterygoid muscle on the mandible. Changes in orientation of the occlusal plane may result in facial alteration and asymmetries. In our experience, the restoration of a plan of occlusion orthogonally aligned to the forces of occlusion for a correct transfer of forces through the maxilla to the rest of the cranial bones is essential to allow proper face development. Two, quite similar cases of unilateral, dislocated condylar fracture treated in a different way, will be reported to demonstrate how this can occur. Available clinical data will be illustrated.
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http://dx.doi.org/10.17796/jcpd.26.3.8477pr3g41362532DOI Listing
August 2002
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