Poly-D,L-lactic acid (PDLLA) is increasingly used as a collagen-stimulating injectable with a favorable safety profile. However, reports of nodules associated with PDLLA remain limited, particularly in anatomically sensitive areas such as the neck. We report a case of early, asymptomatic cervical nodules occurring after PDLLA injection, characterized clinically and by high-resolution ultrasound. The case is discussed in the context of injection technique, anatomical considerations, and real-world procedural factors that may predispose to product accumulation. This report highlights that early nodules following PDLLA injection may reflect technical deposition rather than inflammatory or granulomatous reactions. Awareness of neck anatomy, careful handling of PDLLA suspensions, and the use of ultrasound can aid in accurate diagnosis and prevention of similar events.
EU regulation requires that cosmetic products be safe and that claims not mislead consumers. It does not require that claims be compositionally grounded. A product marketed as "barrier-restoring" need not contain barrier lipids at any particular concentration. Practitioners who want to check whether formulation composition supports a declared function have no standardised procedure for doing so from the label alone. To develop a structured, label-based methodology - the Multi-Vector Functional Mapping (MVFM) - for analysing cosmetic formulations from their INCI composition without laboratory data or proprietary tools. The MVFM locates the first regulated preservative or fragrance marker in the INCI list and uses its position as a segmentation boundary. Ingredients above that boundary are scored on three functional vectors - Hydration (H), Lipid (L), Structural (S) - on a 0–3 scale. Three commercial products with different declared functions were used as a test case. Segmentation worked without ambiguity in all three products. Products A and C returned vector profiles consistent with their label claims. Product B - marketed as anti-aging - scored H=4, L=7, S=6: a lipid-dominant profile more consistent with a texture-focused cream than with a bioactive-driven anti-aging formula. Two fragrance allergens regulated under Commission Regulation (EU) 2023/1545 were identified in the functional zone of Product B. The MVFM converts the INCI list into a reproducible functional profile. Three products tested by one evaluator show it functions as designed. Larger-scale validation and inter-rater reliability testing remain to be done.
This pilot study aimed to evaluate hygienic–sanitary conditions and microbiological contamination in indoor environments of primary schools in Albania. Fifty primary schools enrolling 9-year-old students were randomly selected from six districts in Albania. Hygienic–sanitary and infrastructural conditions were assessed using five standardized survey instruments. Air and surface samples were collected and analyzed for bacterial, fungal, and yeast contamination. Environmental parameters, including temperature, relative humidity, and ventilation efficiency, were systematically monitored. A substantial proportion of schools did not comply with recommended hygiene and ventilation standards, particularly in restrooms and common indoor areas. Potentially pathogenic microorganisms were predominantly detected in environments with elevated humidity and inadequate cleaning practices. The study reveals significant deficiencies in indoor environmental quality in Albanian primary schools and highlights the need for infrastructural improvements and the implementation of sustainable hygiene and environmental monitoring protocols to reduce microbiological risks and protect children’s health.
Products with CBD are gaining ground in the cosmetic and massage cream market. However, the growing trend towards natural and effective pain relief and CBD-containing creams underscores the importance of making a well-informed product choice. By examining the organoleptic properties of these creams, we can obtain valuable insights into their performance and acceptance, contributing to a more informed market. To investigate the sensory profile of Physiorelax® CBD compared to three other CBD-infused topical massage creams, all aimed at providing natural relief for muscle and joint pain. An initial group of 20 panellists trained in sensory panel methodology since 2018 was convened to evaluate the four products. The presentation of the creams was randomised and blinded. Organoleptic characteristics were assessed using quantitative scores. The four creams exhibited a comparable sensory profile overall, with Physiorelax® CBD standing out in certain aspects related to appearance and pick-up characteristics. Physiorelax® CBD showed higher scores compared to Fisiocrem® Cannabis in integrity of shape (*P=0.006; *P=0.003 after 10 seconds), firmness (*P=0.006), and stickiness (*P=0.033). It also differs in initial glossiness (in terms of visible shine observed in the cream before application) compared to Cannaben® (*P=0.005), Alivium® CBD (*P<0.005), and Fisiocrem® Cannabis (*P=0.02), with a median of 70 (Alivium® CBD median of 50; Cannaben® and Fisiocrem® Cannabis median of 75). Physiorelax® CBD excels in some sensory characteristics of application compared to the other topical products tested. With a 1% CBD concentration and a blend of anti-inflammatory and analgesic natural ingredients, Physiorelax® CBD stands out as a strong option from a sensory and formulation perspective, showing properties that may be of interest for topical musculoskeletal products. However, no conclusions on clinical effectiveness can be inferred from this study.
Scars following mastectomy can lead to chronic pain, restricted mobility, and psychological distress. Intralesional injections with non-crosslinked hyaluronic acid (HA) may offer a minimally invasive solution to improve scar quality and function. A 56-year-old woman presented with a painful, retractile scar after right mastectomy with intraoperative radiotherapy. She experienced movement limitation and was considered a candidate for lipofilling. Two intralesional treatments were performed with Neauvia Hydro Deluxe (non-crosslinked HA + 0.01% CaHA). The patient reported improved tissue pliability, reduced pain, and enhanced mobility. Objective findings included improvements in the POSAS and reductions in pigmentation, vascularity, and scar thickness. The Global Aesthetic Improvement Scale (GAIS) rated the result as “very much improved.” This case highlights the potential of non-crosslinked HA for improving scar quality and reducing pain post-mastectomy, providing an alternative or adjunct to surgical revision.
Microbiological contamination of indoor air in school environments represents a significant public health issue, particularly for children, who are more susceptible to respiratory diseases and allergic conditions. The aim of this study was to evaluate levels of exposure to microbiological air pollution in primary schools in Albania and to contribute to protecting students’ health and to standardizing indoor air quality monitoring in educational settings. A cross-sectional study was conducted using both active and passive air sampling techniques. Air samples were cultured on selective media, including Plate Count Agar (PCA), Czapek Agar, Meat-Peptone Agar (MPA), and Potato Dextrose Agar (PDA). Sampling was performed in 29 primary schools across five Albanian districts: Fier, Kukës, Malësi e Madhe, Korçë, and Vlorë. Total microbial and fungal loads were analyzed and compared among different school environments and districts. The findings demonstrated considerable variability in total microbial and fungal concentrations among districts and indoor school areas. The predominant fungal genera identified were Aspergillus spp., Penicillium spp., Mucor spp., and Cladosporium spp. Higher fungal contamination levels were observed in schools located in areas with dense vegetation, while local climatic conditions appeared to influence the distribution of microbial contaminants. Indoor air quality in school environments requires continuous monitoring, as prolonged exposure to microbiological contaminants may adversely affect students’ respiratory health. The results emphasize the need for preventive strategies and for establishing national guidelines for indoor air quality management in primary schools.
Facial aging involves bone resorption, fat compartment deflation, ligament laxity, and soft-tissue biomechanical changes. Conventional hyaluronic acid (HA) filler techniques may not address these changes comprehensively and can risk overcorrection or impaired facial dynamics. Vector-based injection approaches have therefore gained interest, though standardized protocols remain limited. To describe the BEFly Vector Lift, a vector-guided, multilayer facial volumization technique using two PEGDE-cross-linked HA fillers, and to report short-term clinical outcomes in a single patient. A 47-year-old female patient (Fitzpatrick skin type IV) with mild-to-moderate mid- and lower-face volume loss was treated in a single session. Deep juxta-osseous support was performed using a high-density PEGDE-HA filler (28 mg/mL, 2 mL total), followed by subcutaneous volumization using a CaHA-enriched PEGDE-HA filler (26 mg/mL, 3 mL total). Outcomes were assessed using static and dynamic clinical photography, patient-reported satisfaction, and safety monitoring over 30 days. No validated outcome scales were used. At 30-day follow-up, contour improvement was noted in the malar, mandibular, and mentonian regions on photographic comparison. Facial expressiveness appeared preserved. Treatment was well tolerated; adverse events were limited to mild transient edema. In this single case, the BEFly Vector Lift produced short-term contour improvement with preserved expressiveness and acceptable tolerability. The findings are preliminary and based on qualitative assessment. Studies with validated outcome measures, longer follow-up, and larger cohorts are needed.
Skin hyperpigmentation disorders are common, chronic, and often refractory to monotherapy. Multimodal strategies addressing pigmentation, dermal quality, and epidermal barrier simultaneously may improve outcomes. To evaluate the efficacy and safety of a combined protocol using accelerated non-ablative fractional diode laser therapy (LaserMe®), injectable non-cross-linked calcium hydroxyapatite-hyaluronic acid (CaHA-HA), and adjunctive topical retinoid and ascorbic acid in patients with facial hyperpigmentation. Five participants with Fitzpatrick skin types I-IV (including melasma, post-inflammatory hyperpigmentation, age-related pigmentation, and photodamage-associated dyschromia) were enrolled in a prospective, open-label pilot study. The protocol included three laser sessions over four weeks, injectable CaHA-HA at weeks 0 and 4, daily stabilised ascorbic acid, alternate-night retinoid application, and broad-spectrum SPF 50 photoprotection. The primary outcome was the change in pigmentation severity assessed by the modified Melasma Area and Severity Index (mMASI). Secondary outcomes included transepidermal water loss (TEWL), standardised photographic assessment, and safety evaluation over 12 weeks. All participants demonstrated clinically meaningful improvement in pigmentation by week 12. Mean mMASI scores decreased from 14.0 at baseline to 7.0 at week 12, representing a 50.4% mean reduction. Four of five participants showed improved TEWL values, with mean TEWL decreasing from 19.0 to 14.4 g/m²/h. No serious adverse events occurred; mild transient erythema, swelling, and bruising resolved spontaneously. This pilot study suggests that a combined laser-injectable-topical protocol is safe, well-tolerated, and associated with consistent improvements in pigmentation severity and epidermal barrier function. Larger randomised controlled trials are warranted to confirm these findings.
Acne vulgaris affects approximately 80% of individuals between the ages of 11 and 30 and often results in persistent acne scarring that can negatively impact psychosocial well-being, leading to anxiety and reduced self-esteem. This study aimed to evaluate the safety and clinical outcomes associated with the use of PEG-crosslinked hyaluronic acid with calcium hydroxyapatite in patients with facial acne scars. Twenty healthy female volunteers (aged 18–42) underwent a single session combining subcision with a 22G cannula and the simultaneous administration of 2 mL of PEG-crosslinked hyaluronic acid with calcium hydroxyapatite. Participants with recent retinoid use, excessive tanning, or relevant medical conditions were excluded. Skin elasticity, scar depth, and scar diameter were measured at baseline and on days 28 and 90 after treatment. Significant improvements in skin texture and a visible reduction in acne scars were observed. Cutometric analysis demonstrated increased skin elasticity, while high-frequency ultrasound imaging showed an average 21% reduction in scar diameter and a 61% reduction in scar depth by day 90. No adverse effects were reported. A single session combining subcision with a 22G cannula and the simultaneous administration of PEG-crosslinked hyaluronic acid and calcium hydroxyapatite was shown to be safe and to be associated with clinically and instrumentally observed improvements. The filler provides temporary volumization of atrophic or thinned facial soft tissues, resulting in visible aesthetic improvement and favorable patient-reported outcomes. These findings support the potential role of this minimally invasive approach in the management of patients with acne scars.
This proof-of-concept article introduces the “Dual Core Concept”, a novel facial rejuvenation model integrating complementary mechanical, biological, and metabolic processes within a single synergistic framework. The concept focuses on Neauvia Stimulate, a PEG-crosslinked hyaluronic acid (PEG-HA) filler enriched with calcium hydroxyapatite (CaHA), which intrinsically embodies two “cores”: the mechanical core providing immediate structural lift and the biological core inducing progressive dermal regeneration. To reinforce deep anatomical support, Neauvia Intense may be used concomitantly as a structural scaffold, optimizing the environment for superficial and mid-fat layer regeneration. Drawing on histological, clinical, and biochemical evidence, this model illustrates the evolution of aesthetic medicine from volumetric correction toward physiological bio-regeneration, emphasizing precise anatomical targeting and the “less-is-more” principle of natural tissue restoration. This integrative approach represents a paradigm shift from static correction to functional, multi-layered rejuvenation aligned with the physiology of facial tissues.
Pain management in endodontics is a critical aspect of dental care, as the fear of endodontic pain often influences patient behavior and treatment outcomes. This narrative review examines the mechanisms, classification, and management strategies for pain associated with endodontic procedures, focusing on preoperative, intraoperative, and postoperative stages. Preoperative pain, often caused by irreversible pulpitis or periapical infections, is exacerbated by inflammatory mediators like prostaglandins, which lower pain thresholds and hinder anesthetic efficacy. Intraoperative pain arises from difficulties in achieving adequate anesthesia, particularly in cases of pulpitis, while postoperative pain, peaking within 24 hours, is linked to inflammatory responses in periapical tissues. A range of pharmacological options is discussed, including NSAIDs, paracetamol, corticosteroids, and opioids, alongside their mechanisms of action, efficacy, and side effects. NSAIDs remain the first-line treatment due to their anti-inflammatory and analgesic properties, with ibuprofen demonstrating rapid and effective pain relief. Corticosteroids are highlighted for their ability to enhance anesthetic success and reduce inflammation, particularly in severe cases. Opioids and gabapentinoids are reserved for more severe or neuropathic pain, with cautious use due to potential dependency risks. The aim of this review is to emphasize the importance of tailored analgesic strategies that address the specific pain phase, patient characteristics, and procedural requirements. This comprehensive approach not only alleviates pain but also enhances the overall effectiveness of endodontic treatment, ensuring better patient outcomes and satisfaction.
Orthodontic treatment, especially fixed orthodontic treatment, increases the amount of plaque in the oral cavity due to the difficulty in brushing because of the presence of brackets. The aim of this systematic review was to compare different types of toothbrushes, that is, sonic, roto-oscillating, and manual, to determine the best method for removing plaque during treatment with fixed orthodontics. The review was conducted using the PubMed and Cochrane Library databases. The 2020 PRISMA guidelines were used for this study. Nine studies between 2013 and 2023 were included, two of which considered sonic toothbrushes in relation to others, and seven investigated roto-oscillating toothbrushes with other types. The aim of this study was to observe how plaque indices change based on the device used. Each study used a distinct method of instruction and follow-up. According to statistical data and plaque percentages, the best device appears to be a roto-oscillating toothbrush combined with an orthodontic brush head. However, it remains essential that patients, throughout the treatment, are motivated to have good oral hygiene at home and follow up to ensure the treatment is effective.
Peri-implantitis is a growing concern as dental implants become increasingly popular. This review paper aims to present the current understanding of peri-implant disease and provide insights into its management and prevention. The study followed PRISMA guidelines and conducted an extensive electronic search for relevant articles. Only systematic reviews published in Q1 and Q2 journals were considered. Eighteen systematic reviews have been selected from the 63 initial studies. The prevalence of peri-implantitis is estimated at around 19.53% of patients with implants and 12.53% of implants placed. Specific bacteria and MMP-8 levels have been associated with peri-implantitis, highlighting potential diagnostic markers. The review emphasized the need for consensus in research to accurately estimate the epidemiological parameters of peri-implantitis. Additionally, the adjunctive use of local antibiotics showed promising results in improving probing pocket depth and bleeding on probing compared to surgical treatment alone. Overall, this paper provides a comprehensive overview of the current knowledge on peri-implantitis and emphasizes the importance of precise diagnostic markers and effective treatment modalities.
This retrospective study aims to assess the clinical efficacy and quality of life outcomes in patients with temporomandibular joint disorders (TMDs) who underwent arthrocentesis combined with hyaluronic acid (HA) injection. A total of 30 patients diagnosed with TMDs were treated with single-needle arthrocentesis followed by intra-articular HA injection. Clinical evaluations included spontaneous mouth opening, pain assessment, and patient-reported outcome measures using a modified quality of life questionnaire adapted from the SF-36. Pre- and post-treatment measurements were compared using paired Student’s t-tests. Post-treatment, 70% of patients showed improved mouth opening (mean increase: 1.5 mm; SD: 3.9), although the change did not reach statistical significance (p = 0.056). Pain levels decreased markedly, with 40% of patients reporting complete pain relief and 50% reporting only mild discomfort. Significant improvements were also observed in chewing function, recreational activity, and overall quality of life. Arthrocentesis with HA injection appears to be a safe, minimally invasive, and clinically effective treatment option for patients with TMDs, particularly those with early to moderate joint degeneration. Improvements in both objective and subjective outcomes support its role as a valuable therapeutic approach in cases unresponsive to conservative management.
The aim of the present study is to conduct a descriptive epidemiological analysis of clinical and histopathological data related to the treatment of squamous cell carcinoma of the oral cavity in a population of elderly patients. To address the research inquiries, a population of patients diagnosed with oral cancer at the Maxillofacial Unit of Verona University between 1997 and 2017 was considered. To create the descriptive statistics of the sample population, the following parameters were collected: sex, age, site of the tumor, frequency and type of surgical reconstruction, frequency of pathological staging (pTNM), postoperative hospitalization duration, disease recurrence, overall survival, disease-specific survival, and disease-free survival. Three hundred eighty-six patients met the inclusion criteria; the population was divided into two groups: patients aged <75 years and patients aged ≥75 years. The male-to-female ratio in the overall population was 1.41:1. In the entire sample, the primary site of localization of disease was found to be the tongue. A total of 37.3% of patients underwent microvascular flap reconstruction. Reconstruction with a pedicled flap was used in 27.7% of patients under 75 years old and in 11% of patients over 75 years old. Minor reconstructions using local flaps were performed in 14% of cases. Globally, the average length of postoperative hospital stay (LOS) was 15.8 days for patients aged <75 years and 14.5 days for patients aged ≥75 years. Cancer recurrence was registered in 50% of patients under 75 years and 45% of patients over 75 years. Overall survival in patients aged <75 years was 74%, 65,7%, 50.3% at 3, 5, and 10 years, respectively. Overall survival in patients aged ≥75 years was 63.6%, 50.1%, and 23.2% at 3, 5, and 10 years, respectively. The findings of the present study show that squamous cell carcinoma of the oral cavity in patients aged 75 years or older is a relatively frequent pathology that has been increasing in recent decades, likely due to the progressive aging of the general population. The disease is more prevalent in women, who have greater longevity, and in this subgroup, cancer primarily affects the gingiva. Age alone was not found to be a determining factor, whereas the difference observed in overall survival highlights the importance of comorbidities in elderly patients, which must be carefully evaluated and managed before initiating any therapeutic pathway. Finally, the results of this study emphasize the importance of early diagnosis to ensure that patients receive the most appropriate treatment while minimizing invasiveness.
The aim of this literature review is to outline bleeding complications in orthognathic surgery, to define their clinical presentation in terms of timing and frequency, and to eventually highlight indications for prevention and management. This literature review was conducted in accordance with the PRISMA guidelines for systematic reviews. To fulfill the research enquiries, two electronic databases (PubMed and Scopus) were searched using the PICO protocol and relevant keywords related to bleeding in orthognathic surgery. A total of 130 scientific articles written in English were retrieved from PubMed and Scopus, without any time limitation. After removing duplicates and excluding ineligible records, 22 papers were excluded. Finally, 25 articles were included in the study. Vascular complications following orthognathic surgery, although rare, can lead to severe and potentially life-threatening outcomes. A thorough knowledge of the maxillofacial district vascular anatomy and intraoperative awareness is key to managing these complications effectively, such as maintaining a high suspicion during the postoperative period, due to the variability in clinical presentation and timing.
In the context of oral cavity cancer surgery, free flap reconstruction is considered the standard procedure. However, mechanical trauma resulting from occlusion can lead to complications such as ulcers and necrosis. This case series investigates the application of custom-made occlusal splints in three patients undergoing free flap reconstruction for oral cavity squamous cell carcinoma, with the aim of preventing complications and supporting rehabilitation. This retrospective case series comprises three patients who underwent free flap reconstruction at a tertiary care referral hospital. Each patient received a preoperative maxillofacial and orthodontic assessment, followed by the application of a custom-made occlusal splint immediately postoperatively to protect the flap and facilitate rehabilitation. Reconstructing the oral cavity presents significant challenges due to its intricate anatomy and the associated risks of flap failure and infections. The use of custom-made splints has demonstrated potential in mitigating occlusal trauma and facilitating recovery. Despite their promise, the application of custom-made oral splints remains insufficiently explored. Further research is needed to assess their potential in reducing complications and improving recovery outcomes. It is essential to validate their efficacy, optimize their usage, and integrate them into clinical guidelines for oral cavity reconstruction.
This systematic review evaluates the effectiveness of various bone biomaterials and barriers used in Guided Bone Regeneration (GBR) procedures performed simultaneously with implant placement. The study aims to compare bone augmentation outcomes achieved with different materials and assess the incidence of barrier exposure. From an initial pool of 881 publications two independent reviewers selected 30 studies to be included in the final analysis. The review revealed significant data heterogeneity, allowing for only three meta-analyses on pairs of studies. Results: Despite this limitation, key findings emerged: all evaluated biomaterials (autologous, homologous, heterologous, engineered, and synthetic) and barriers (collagen, expanded polytetrafluoroethylene (PTFE), polyelectrolyte complex (PEG), poly (lactic-co-glycolic acid) (PLGA), and titanium mesh) were effective in achieving positive bone regeneration outcomes. Among the meta-analyses, collagen membranes showed a statistically significant superiority over PTFE membranes, while no significant differences were observed between heterologous and engineered bone or between collagen and PEG membranes. Barrier exposure was consistently associated with reduced bone augmentation. While this review confirms the suitability of various biomaterials and membranes in GBR procedures it emphasizes the need for additional high-quality comparative studies to address current data gaps and better inform clinical decision-making. From the results of the current literature review it appears that GBR outcomes are independent from the specific materials used, and the right biomaterials to be employed should be balanced based on the surgeon’s preferences and specific clinical scenarios.
The human oral mucosa exhibits a wide array of color variations, influenced by both genetic and environmental factors. These variations range from physiological differences in individuals with lighter or darker skin tones to pathological changes caused by trauma, inflammation, hormonal fluctuations, and exposure to pharmacological agents. Pigmented lesions in the oral cavity present a diagnostic challenge due to their diverse etiologies, which include benign conditions such as melanotic macules and smoker’s melanosis, as well as more serious pathologies like oral melanoma and systemic disorders such as Addison’s disease and Peutz-Jeghers Syndrome. The differential diagnosis is further complicated by multifactorial causes, including both endogenous factors, such as nevi, and exogenous ones, such as amalgam tattoos. This review provides a comprehensive examination of the causes, diagnostic challenges, and clinical management of oral mucosal pigmentation. It underscores the importance of distinguishing between physiological and pathological states, highlighting the need for a detailed understanding of the underlying mechanisms and careful diagnostic evaluation in clinical practice.
Oral candidiasis is a common condition in immunocompromised patients, such as those with HIV and diabetes. It manifests in acute forms, for example, pseudomembranous candidiasis and erythematous candidiasis, as well as in chronic forms, including chronic hyperplastic candidiasis and prosthesis-induced candidiasis. The aim of this article is to provide an overview of oral candidiasis manifestations and treatment, and to highlight the importance of appropriate management of the disease in immunocompromised patients. The authors conducted a literature review on oral candidiasis to summarize clinical information and treatment indications. Median rhomboid glossitis, once considered a congenital malformation, is now recognized as a form of chronic candidiasis. Angular cheilitis is often caused by mixed infections with Candida and Staphylococcus aureus, particularly in the elderly population. Antifungal agents used in treatment include polyenes (nystatin and amphotericin B) and azoles (fluconazole and itraconazole), which act by inhibiting ergosterol biosynthesis in fungi. Antiretroviral therapy showed beneficial effects in reducing oral candidiasis in HIV-positive patients. In patients undergoing radiation therapy for oral carcinoma, the risk of candidiasis is increased, requiring preventive measures, such as proper oral hygiene and local antifungal therapies. Early diagnosis and targeted treatment are essential for managing oral candidiasis, especially in at-risk patients. A personalized therapeutic approach is crucial for reducing complications and preventing the malignant progression of such an unpleasant infection.
