Dynamic Navigation for Dental Implant Placement.

In modern implantology, the application of surgical navigation systems is becoming increasingly important. In addition to static surgical navigation methods, a guide-independent dynamic navigation implant placement procedure is becoming more widespread. The procedure is based on computer-guided dental implant placement utilizing optical control. This work aims to demonstrate the technical steps of a new dynamic computer-aided implant surgery (DCAIS) system (design, calibration, surgery) and check the accuracy of the results. Based on cone-beam computed tomography (CBCT) scans, the exact positions of implants are determined with dedicated software. The first step of the operation is the calibration of the navigation system, which can be performed in two ways: 1) based on CBCT images taken with a marker or 2) based on CBCT images without markers. Implants are inserted with the aid of real-time navigation according to the preoperative plans. The accuracy of the interventions can be evaluated based on postoperative CBCT images. The preoperative images containing the planned positions of the implants and postoperative CBCT images were compared based on the angulation (degree), platform, and apical deviation (mm) of the implants. To evaluate the data, we calculated the standard deviation (SD), mean, and standard error of the mean (SEM) of deviations within planned and performed implant positions. Differences between the two calibration methods were compared based on this data. Based on the interventions performed so far, the use of DCAIS allows for high-precision implant placement. A calibration system that does not require labeled CBCT recording allows for surgical intervention with similar accuracy as a system that uses labeling. The accuracy of the intervention can be improved by training.

Cherubism in three siblings. / A cherubismus elofordulása három testvérben.

Összefoglaló. A cherubismus ritka, autoszomális dominánsan öröklodo megbetegedés. A fibroossealis elváltozások csoportjába tartozik. Jellemzoje az állcsontok szimmetrikus duzzanata, a típusos radiológiai elváltozások és az SH3BP2-gén mutációja. Szövettanilag nem különül el az óriássejtes granulomától. A csontelváltozások és a fibroticus szövet felszaporodása pubertás elott kezdodik, ezután stagnálás vagy visszafejlodés következik be. A magyar orvosi irodalomban a szerzok elsoként tárgyalják három testvér kórtörténete alapján a cherubismust. A diagnózist a hasonló klinikai tünetek, a típusos kórlefolyás, a szinte azonos radiológiai kép, a szövettan és a genetikai elváltozások biztosítják. A testvérek és az anya csíravonalában kimutatott azonos mutáció akkor is megfelel egy dominánsan öröklodo szindrómának (például cherubismusnak), ha a betegség az anyában klinikailag nem manifesztálódott, de genetikailag igen. A szerzok összefoglalják a kórkép kezelési lehetoségeit: a sebészi (excochleatio, ,,decountouring", esetleg reszekció) és a gyógyszeres (biszfoszfonát, kalcitonin, szteroid stb.) terápiát. Egyezik a véleményük azokéval, akik azon az állásponton vannak, hogy a beavatkozásokkal várni kell, és meg kell figyelni a betegeket a várható regresszió miatt. Saját eseteikben csak a növekvo tumorrész excochleatióját végezték, foleg kozmetikai okok és a szövettan biztosítása érdekében. Orv Hetil. 2022; 163(11): 446-452. Summary. Cherubism is a rare autosomal, dominant bone disorder, characterised by symmetrical expansion of the jaws along the typical radiological and genetic (SH3BP2 mutation) features. It belongs to the heterogenous group of fibro-osseous lesions. Its histology is the same as that of giant-cell granuloma. The bone lesions and fibrous tissue expansion increase before puberty and regress thereafter. For the first time in Hungarian medical literature, the authors discuss the condition of cherubism in the case of three siblings. The diagnosis of these three siblings is supported by the clinical, radiological, microscopic and genetic data. In all three, the bone lesions and fibrous tissue expansion increased before puberty and stabilized thereafter. The radiological results and the molecular findings were nearly identical. The identical mutation shown in the germ lines of the three siblings and the mother correspond to a dominantly inherited syndrome (e.g., cherubism) even if the condition did not manifest in the mother. The authors summarize the treatment options of the disease: surgical (excochleation, decountouring, in rare case resection) and drug (bisphosphonate, calcitonin, steroid, etc.) therapy. They agree with those who are of the opinion that interventions should wait and the patients should be observed ("wait and see") for the expected regression. In their own cases, only excochleation of the growing tumor was performed, mainly for cosmetic reasons and to secure the tissue. Orv Hetil. 2022; 163(11): 446-452.

[Dental and oral surgical treatment of the mentally retarded in Hungary: the situation in the past, currently and hopes for the future]. / A szellemi fogyatékosok fogászati-szájsebészeti ellátásának múltja, jelene és remélt jövoje Magyarországon.

Introduction: Dental care for mentally disabled people poses a growing challenge for healthcare. In Hungary, the number of mentally disabled people needing special dental care is ca. 100 000. Aim: The aim of our retrospective analysis is to provide a summary of the demographic data and the treatment outcomes of patients with mental disorders treated at the Department of the Oral and Maxillofacial Surgery of the Semmelweis University in the past five years. Method: Dental care for patients with a severe level of mental disability can be carried out in general anaesthesia only. At Semmelweis University, in the Oral and Maxillofacial Department, 1717 mentally disabled adults received dental care during the past five years. (Patients included people with a mild, medium or severe level of mental disability, patients with Down's syndrome, autism, epilepsy or panic disorder.) Results: The single biggest achievement seems to be the fact that the issue of acute dental care and oral surgery has basically been settled. A workable relationship has been forged with foundations and organizations dealing with the problems of these patients. It has been realized, however, that in the case of mentally disabled patients there is an enormous need for prevention and ongoing care. Conclusions: Up to now no survey has been carried out in Hungary with the aim of objectively revealing the dental care needs of these patients. Internationally, however, several surveys have been published. It can be stated on the basis of these that both caries frequency and the presence of parodontal diseases increase in correlation with age and the level of disability. Oral hygiene is insufficient, patients or their caretakers do not get proper information, only a few of them receive adequate training and they are not motivated to keep up oral health. Dental care, except for tending acute cases, is not satisfactory. For the sake of prevention, cooperation is needed with non-governmental organizations, foundations, special education teachers and psychiatrists specialized in this field. Orv Hetil. 2019; 160(35): 1380-1386.

[Chronic, nonbacterial, multicentric osteomyelitis in the mandible]. / Krónikus, nem bakteriális, multicentrikus osteomyelitis a mandibulában.

Chronic nonbacterial osteomyelitis is a sterile inflammatory osteitis that most commonly develops in the long bones, but it can occur in any bone. Mandibular lesions are found in 1.5-3% of disease foci in patients and it is poorly characterized in the maxillofacial surgery literature due to the use of inconsistent terminology. The purpose of this study was to present the clinical experience of chronic nonbacterial multicentric osteomyelitis and a collection of research and information of the disease. This is a retrospective study of 2 cases with mandibular lesions radiographically consistent with osteomyelitis without infection. Medical records were reviewed for history, clinical features, imaging and pathology. The study included 2 patients (2 females, age of 17 and 43 years). Both reported mandibular pain and swelling, radiographic finding of multifocal intraosseal inflammatory lesions. Computed tomography scans typically showed expansion of the affected mandible with sclerosis of the medullary space, small foci of poorly defined lytic destruction with lamellated periosteal reaction. Both patients showed a long ineffective antibiotic therapy and recurrent flare-ups of inflammation. After the proper course of treatment (nonsteroid and steroid therapy), a long painless period was reached. Chronic multicentric nonbacterial osteomyelitis has been reported to be uncommon in the mandible, but it may be more common with correct diagnosis, typified by recurrent pain and swelling with characteristic pathologic and radiologic features. The current treatment modalities include nonsteroidal anti-inflammatory drugs or steroids. Orv Hetil. 2018; 159(43): 1761-1766.