Utilizzo di Mineral Trioxide Aggregate nella riparazione di perforazioni della forcazione: due casi clinici

Aims: Mineral Trioxide Aggregate (MTA), a Portland Cement-like materi- al, developed in 1993 by M. Torabine- jad, has been suggested in the treat- ment of furcal perforation. The aim of this study is to describe two case reports of teeth with furcal perforation treated with mineral trioxide aggre- gate. Clinical cases: two molars with a furcal perforation, due to decay and iatro- genic mistake, respectively, were treated with Mineral Trioxide Aggregate during the conventional retreatment. Clinical and radiological controls show the healing of periodontal tissues. Conclusions: the MTA seems to be the best material in the treatment of furcal perforation. Its excellent action may be connected with highly reduced quantity of liquid and bacterial leak- age, and this clinical condition seems to allow the healing of periodontal tissues

Cyclin dependent kinase 4 and 6 inhibitors as novel therapeutic agents for targeted treatment of malignant mesothelioma

Malignant Mesothelioma (MM) is a rare and aggressive form of tumour that affects the lining of the internal organs for which current treatments have not been proven to be very effective. P16(INK4A) tumour suppressor encoding CDKN2A gene is often downregulated in MM. This protein is a cyclin dependent kinase 4 and 6 inhibitor, that normally phosphorylates RB1, which has to be un-phosphorylated in order to block cell-cycle at G1 in normal cells. Adding CDK inhibitor molecules to MM in pre-clinical studies has been proven to restore the normal function of p16(INK4A), blocking thereby MM cell cycle at G1. Future randomised phase III studies with CDK4/6 inhibitors in MM carrying relevant CDK4/6, cyclin D1/3 or p16 aberrations will be warranted

Arginine-Based Toothpaste Induces Calcium-Phosphates Deposits on Dentin Surface and Tubules

Objective: To test the ability of a calcium carbonate-containing toothpaste for dentinal hypersensitivity to occlude the exposed open tubules of dentin surface. Method: Dentine slices (0.9±0.1 thick) and crown segments (1.5±0.3 cm thick) from human third molars were used. Elmex Sensitive Professional toothpaste (GABA Int AG, Therwill, Switzerland) containing as main active ingredients arginine (8%), sodium monofluorophosphate (1450 ppm Fˉ) and calcium carbonate, was applied (3 min) on coronal dentin surface. Fluid flow/permeation through the dentin thickness (i.e. permeability or hydraulic conductance, Lp in microliters/min) was evaluated using a digital fluid flow-meter after smear layer formation, after EDTA treatment, after Elmex toothpaste treatment (t=0) and after soaking for 1, 7, 28 days in simulated body fluid (HBSS). Tubules occlusion, elemental analysis and mineral content were studied by ESEM-EDX. Toothpaste penetration inside dentinal tubules was analyzed by laser confocal microscopy using calcein as tracer. Result: Lp of EDTA-treated dentin significantly decreased after treatment with Elmex toothpaste (-73,32% at t=0) and after soaking in HBSS the Lp values further decreased (-77,69% at 24h, -78,18% at 7d, -83,01% at 28d). After 24h and 7d in HBSS, ESEM on Elmex-treated dentin showed the presence of precipitates on dentin surface and in the dentinal tubules; EDX revealed N (from arginine) and F (from monofluorophosphate) of the toothpaste. Lp remained significantly lower (-78,18%) than EDTA- treated control dentin. After 28d in HBSS, a calcium phosphate layer was detected on dentin surface so tubules were not visible. EDX detected F and no N. No CaP deposits were found on EDTA-treated dentin soaked in HBSS. Confocal microscopy showed an average penetration depth of the toothpaste into the dentinal tubules of ~85 microns. Conclusion: Elmex sensitive toothpaste can reduce the fluid movement into the exposed dentinal tubules and favour the formation of calcium phosphate minerals

L'anatomia endodontica dei secondi molari superiori: ricerca ex vivo

Aim: of the present study was to deter- mine anatomic complexities which can be seen in maxillary second molars, with a specific attention to the presence of MB2 (second mesio-buccal) canals. Methodology: 50 maxillary second molars, which had been extracted for periodontal reasons, were selected for the study, following strict exclusion cri- teria. After determining the different roots, only the mesio-buccal one was examined. Location and number of canals were determined (i) after a normal access cavity, (ii) after a wider removal of dentine from the chamber floor, and (iii) after sectioning the root 4 mm be- low the cementum-enamel junction. Data were collected and analyzed. Results: MB2 canals were present in 44% of the examined teeth (20% of ca- ses showed Weine 2 configuration, while the remaining 24% showed Weine 3 configuration). It was possible to estabilish patency in MB2 canals only in 28% of cases. Conclusions: MB2 canals are often present in maxillary second molars, being individuated in nearly half cases. This possibility and the presence of an indipendent apex make the research of MB2 canals mandatory during the endodontic treatment

Would the combination of everolimus with endocrine-therapy help in FGFR2 positive serous endometrial cancer?

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Arginine-calcium carbonate professional treatment for tubules occlusion in hypersensitive dentin

Objective: To test the tubules occlusion of an arginine-based professional treatment for hypersensitive dentin. Method: Dentin segments/discs were prepared from erupted sound molars. Elmex sensitive professional desensitizing paste (GABA Int. by Colgate Oral Pharmaceuticals, Dallas, USA) containing arginine 8% and calcium carbonate was applied on EDTA-treated dentin for 20s at 1000rpm using a prophy cup, following the manufacturer directions. The excess was removed using a microbrush then the dentin disc was gently rinsed and immersed in 20mL of simulated body fluid (Hank\u2019s Balanced Salt Solution, HBSS) at 37\ub0C. After 24h, 7 and 28d the dentin surface was analyzed by ESEM-EDX to evaluate the tubules occlusion and the mineral content. Elmex paste mixed with calcein solution 1% was used to evaluate its penetration depth into the tubules by confocal microscopy. Result: After 24h in HBSS, ESEM-EDX analyses on Elmex-treated dentin showed the presence of precipitates on dentin surface and in the dentinal tubules, relevant amount of N(16-19 wt%, demonstrating the presence of arginine and Ca/P molar ratio 653.0. Confocal microscopy showed a penetration of the paste into the dentinal tubules to a mean depth of approx 50 microns (maximum depth penetration 100 microns). ESEM showed the presence of many tubules still obturated by material after 7d in HBSS; EDX found N (approx 19 wt%) and Ca/P molar ratio was 2.43. After 28d in HBSS a coating of calcium phosphate deposits covered the dentin surface so tubules were not visible; EDX detected N (6-7 wt%) and showed a Ca/P molar ratio of 2.14. Conclusion: Elmex sensitive professional paste can obturate the dentinal tubules and adhere to the dentin surface. Evidences of mineralizing properties have been found by the deposition of calcium and phosphate-containing minerals within the dentinal tubules and the formation of a calcium phosphate protective layer on the dentin surface

HyFlex EDM rotary Ni-Ti prototypes: the effect of an innovative machining technology on Ni-Ti wear

Aim. HyFlex EDM files were recently introduced pre- senting an innovative electro discharge machining (EDM) process of fabrication. The aim of this study was to evalua- te the surface and microstructural alterations of new and in vitro used HyFlex EDM Ni-Ti rotary prototypes. Methods. The surface and microstructural characteristi- cs of 15 new HyFlex EDM instruments were analyzed by ESEM equipped with energy dispersive x-ray spectropho- tometry (EDS) and optical metallographic imaging. Instru- ments were subjected to instrumentation tests on severely curved root canals (ranging between 50° and 70°) of ex- tracted multi-rooted teeth. Once that canal patency was verified with a #10 K-file, the working length was determi- ned by subtracting 1mm. HyFlex EDM files were used with a 16:1 reduction handpiece X-Smart (Dentsply Maillefer, Baillagues, Switzerland) following the manufacture’s direc- tion, at 500 rpm and 2.5Ncm, with slightly apical pressure and pecking motion. The operative sequence was: 25/12 at 2/3 of the WL, 10/05 and 25/08 at WL. Irrigation was per- formed at every change of instrument, with a total amount of3mlof5%NaOCland3mlof10%EDTA(Ogna,Mug- giò, Italy). Each instrument was used in 10 curved canals, washed in an ultrasonic bath containing detergent for 10 min and then autoclaved at 134°C. Surface and microstruc- tural characterizations were repeated on used instruments at same points and with same angulations to compare the pre- and postoperative micrographs, in order to verify the appearance of fractures, unwinding, microcracks, blade di- sruption and tip deformation. Results. Surface and microstructural characteriza- tion of new instruments revealed the typical features of a NiTi ED-Machined alloy with an irregular and “craters-like” surface. High magnification microgra- phs disclosed a non-uniform structure were pits, po- res and voids caused the peculiar aspect of a “rough- spark-machined” surface. No fractures were registered during instrumentation of curved canals. Surface and microstructural characterization of used files revealed no wear and no degradation of the 25.12 and 25.08 files. The tip segment was confirmed as the most me- chanically stressed portion of 10.05 prototypes. All the instruments, after several uses, well-preserved the “craters-like” irregular surface without cutting edge al- terations. The metallographic inspection on the cross section of brand new HyFlex EDM files showed an homogeneous martensitic phase. The microstructure appeared uniform from the surface to the bulk, and no microcracks or defect were identified, even at high optical magnification (1000X). Conclusion. Unaltered spark-machined surface and low microstructural degradation are the main features of recently introduced HyFlex EDM. Caution would be re- commended regarding reuse of small HyFlex EDM files. Instruments exhibited a safe in vitro use in presence of severely curved canals

Role of targeted agents in neuroendocrine tumors: Results from a meta-analysis

5noBACKGROUND: Several randomized phase III trials in neuroendocrine tumors (NETs) showed the clinical role of new targeted agents and their impact on tumor response and outcome of whose patients affected by advanced NET. In this study, we summarize the available clinical data related to clinical efficacy of targeted therapies in the treatment of advanced NETs. METHODS: A meta-analysis of randomized studies in accordance with the PRISMA guidelines was performed after searching the databases of PubMed, the Cochrane Library, and the ASCO University Meeting for relevant publications. RESULTS: One thousand 9 hundred and 8 cases were included in the meta-analysis; among these, 1012 were in the experimental arm and 896 were in the control arm. The pooled analysis of the use of target agents in NETs revealed significantly increased of progression free survival compared to control group (hazard ratio = 0.59, 95% CI:0.42-0.84; P = 0.003). Subgroup analysis of patients according to tumor site showed a difference in favor of pancreatic neuroendocrine tumors. Moreover, targeted therapies improved the overall survival (hazard ratio = 0.79, 95%CI: 0.63-0.98; P = 0.03), and response rate (hazard ratio = 3.33, 95% CI 2.02-5.49; P < 0.00001) in all types of NETs. CONCLUSION: Our analysis supports the routine use of targeted agents for treatment of neuroendocrine tumors with particular regards to the pancreatic neuroendocrine tumorspartially_openembargoed_20171001Roviello, Giandomenico; Zanotti, Laura; Venturini, Sergio; Bottini, Alberto; Generali, DanieleRoviello, Giandomenico; Zanotti, Laura; Venturini, Sergio; Bottini, Alberto; Generali, Daniel