Management of temporomandibular joint ankylosis: a case report of joint replacement with piezoelectric surgery.

AIM: Temporomandibular joint (TMJ) ankylosis is a joint disorder which refers to bone or fibrous adhesion of the anatomic joint components and the ensuing loss of function. This report describes the management of a case of bilateral TMJ ankylosis in a 20-year-old patient with prosthetic replacement with the aid of a piezoelectric instrument (MECTRON (R). METHODS: The right ankylotic mass was surgically removed and replaced by a custom-made prosthesis based on data obtained from three-dimensional computed tomography (CT) reconstruction of the skull of the patient using a stereolithography model. RESULTS: At six months postoperative, the opening of the mouth was stable at 36 mm and imaging studies (CT and magnetic resonance imaging [MRI]) showed a great condylar prosthesis and surrounding tissues in addition to partial remodeling of the left TMJ. CONCLUSION: In this patient, despite the bilateral ankylosis, it was sufficient to intervene only on the right TMJ, which presented a serious bone block, with mobilization since surgery gradually restored the anatomical and functional conditions of the left TMJ compatible with normal activities of mastication and speech.

The piezoelectric osteotomy technique compared to the one with rotary instruments in the surgery of included third molars. A clinical study.

AIM: The purpose of this study is to compare surgical times, the saving of bonytissues, the postoperative course of the extraction of included third molars in patients treated with piezoelectric surgery compared to those treated with conventional rotary instruments. METHODS: The study included 140 patients with upper and lower third molars included. 70 of them were treated with osteotomy using conventional rotary instruments (Group 1) and 70 more with osteotomy through piezosurgery Mectron® (GROUP 2). The treatment protocol was the same for both groups. The time of surgery and the saving of bonytissues in the intra-operative have been estimated; moreover, 24-48-72 hours and 7 days after the surgery, two other parameters have been estimated: facial swelling and trismus. The swelling, trismus and the saving of bony tissues were assessed by a surgery gauge. RESULTS: The average surgical time was 15 minutes in Group 1 and 20 minutes in Group 2. The savings of bonytissues was greater in Group 2 than in group 1 by 2.7 mm. The average facial swelling was 6.23 mm for group 1 and 2.86 mm for group 2 24 hours after the surgery, of 5.22 mm for group 1 and 1.76 mm for group 2 48 hours after the intervention, of 3.75 mm for Group 1 and 0.85 for group 2 72 hours after the surgery, of 0.86 mm for group 1 and 0.12 for group 2. The average trismus was of 14.76 mm in Group 1 and 11.15 mm in Group 2. Statistical analysis showed a significant reduction of swelling, trismus and a bigger saving of bony tissues in Group 2 and a reduction in surgical time in Group 1. CONCLUSION: The osteotomy technique with a piezoelectric instrument has produced a significant reduction in facial swelling, trismus and a bigger saving of bony tissues than with conventional rotary instruments. A slight lengthening in terms of surgical time has been recorded, compared to the use of conventional rotary instruments.

Benefits of piezoelectric surgery in oral and maxillofacial surgery. Review of literature.

Piezoelectric surgery is based on the use of ultrasound for the cutting of bones. It represents an innovative technique, as it offers the maxillofacial surgeon the opportunity of making precise bone cuts without damaging any soft tissue, minimizing the invasiveness of surgical procedure, and the opportunity of working in a field which is almost totally blood-free. It reduces the impact on soft tissues (vessels and nerves) which lie adjacent to the areas of treatment. Compared to traditional methods, it enables optimal healing because it reduces the postsurgery swelling and discomfort. In this article the authors realized a review of the literature.

Prevalence of retained/transmigrated permanent and persistence of primary teeth associated with odontomas in young children.

AIM: Odontomas are odontogenic tumours of the jaws; they are generally asymptomatic with an unknown aetiology. This study was conducted on non-syndromic children aged 9 to 14 years to explore the side effects deriving from the presence of these benign tumours, as retention, transmigration, ectopic eruption of permanent teeth and the permanence of primary teeth in the affected area. METHODS: Two hundred panoramic (OPT) and 92 Cone Beam Computed Tomography radiographs (CBCT) of patients (130 males and 70 females) were analysed from February 2018 to December 2019. Two hundred odontomas (145 compound and 55 complex type) and 800 teeth (160 primary and 640 permanent) were included. RESULTS: The prevalence of these tumours in both male and female subjects was 65% and 35%, respectively; the prevalence of compound odontomas in maxillary and mandibular bones was respectively 27.58% and 72.41%. The prevalence of complex odontomas in maxillary bones in female and male subjects was 37.5% and 62.5% respectively. It was observed the presence of a primary tooth in 81% of cases, the presence of retained teeth in 16.5% and a dental transmigration in the remaining 2.5% of cases in the compound type. Gender (p?=0.158) has no significant correlation. CONCLUSIONS: An early diagnosis and removal of odontomas in primary dentition is crucial in order to prevent later dental complications. Since the detection of odontomas is mainly an accidental radiological finding, the need for routine radiographic analysis should be highlighted.

Warthin's tumor distribution within the parotid gland. A feasible etiologic source from lymph nodal tissue.

AIM: Warthin's tumor (WT) is the second commonest parotid gland neoplasm after pleomorphic adenoma (PA). It mainly arises from the lower pole of the superficial parotid lobe (i.e., tail of gland), a site with the greatest distribution of intra-parotid lymph nodes, and its definitive etiopathogenesis is still unclear. The aim of this study was to support the strict topic and etiologic link hypothesised between this tumor and the intraparotid lymph nodes, as being massively present in the tail, by assessing the WT distribution within the parotid gland. METHODS: Seventy-one WTs excised from 64 patients were compared retrospectively with 134 PAs from 133 patients, as controls. In all sample, staging of parotid gland tumors was defined by sonography and magnetic resonance imaging. Furthermore, tumor localization, size, bilaterality and multifocality were assessed according to radiological, intraoperative and histopathological findings. RESULTS: WTs were mainly detected in the tail (73%), less in the superficial lobe (23%) and the deep one (4%). WT presented with bilateral and synchronous lesions in 10% of cases vs. 0.75% of controls. CONCLUSION: Since the tail has been well known to present the greatest distribution of intra-parotid lymph nodes, our clinical findings on WT parotid localization could suggest the possible origin of this tumor from epithelial salivary gland ductal inclusions, as being likely entrapped during embryogenesis within the intra-parotid lymph nodes, and could support the hypothesis of a heterotopy in the pathogenesis of WT. However, this suggestive hypothesis based only on clinical and "topographic" data should be confirmed by histopathological studies about the presence of the salivary ductal elements trapped within the intra-parotid lymph nodes.

The aesthetic and functional restoration in the case of partial edentulism in young patients.

The absence of teeth in youths can be due to congenital absence, traumas, caries and periodontitis. The loss of a tooth in growing patients can cause both aesthetic-functional and psychological problems, particularly if the teeth of the anterior region are involved. When there is the loss of a dental element in a teenager it is necessary to provide a quick suitable therapeutic solution, which will be different in comparison to an adult because of the changes related to the growth of the maxillary bones. The aim of this paper is the analysis of the several therapies which can be carried out on young patients with partial edentulism, paying particular attention to the conditions and the indications which allow an implant prosthesis restoration.

Radiotherapy for maxillo-facial hemangiomas in children. Dental and periodontal long term effects.

Vascular maxillo-facial malformations, common pathologies in children, represent 7% of all benign tumors. They are divided into vascular malformations and hemangiomas. In the 70s-80s radiotherapy was the most applied technique, but because of its misuse or overdose, it could lead to relevant and hard consequences for the impact on the salivar glands, periodontium and growing maxillo-facial nuclei. The authors describe the case of a 38-year-old man, who, during infancy, was submitted to radiotherapy for a hemangioma to his chin and cheek. He was under observation for an agressive periodontitis, followed by a serious facial asimmetry, located in his irradiated side. They describe the therapy and the results obtained, underlying the particular difficulties detected in operating on tissues hardly and often irreversibly injured by radiotherapy. On the basis of this clinical case and of the most up-dated knowledge, therapeutical alternatives such as embolization, cryotherapy, cortisonic systemic and intralesional therapy, the use of interferon gamma 2 and the use of the most recent laser, are analyzed, and advantages and disadvantages and the most appropriate indications are underlined.

Oculodentodigital dysplasia. A case report.

This report describes a rare case of oculodentodigital (ODD) dysplasia, an autosomic-dominant disease with alteration on the gene GJA1 of connexin 43 on the human chromosome 6q22-q23, highlighting the anomalies affecting face, eyes, teeth and limbs. The case described shows bilateral microphthalmia, microcornea, syndactyly and other phenotypic alterations characteristic of this syndrome, such as: nose of reduced size with hypoplasic wings, partial stenosis of the choanae, micrognathia, ogival palate and hypoplasia of the enamel. The authors emphasize the importance to know the principal features of ODD syndrome in order to make a correct diagnosis and the role of the dentist in the treatment of this pathology.

Localized osteodysplasia of the mandible in a seven-year-old child: a case report.

AIM: This report concerns the most recent knowledge on osteodysplasies, anomalies in the development of the bone tissue, that may concern one or more skeleton segments affecting children. CASE REPORT: The case of a 7-year-old patient is reported, whose left hemimandible showed a radio transparency with a size of 10 x 7 mm. After the usual preliminary diagnostic investigations, it was decided to carry out an ablation. The neoplastic formation was completely enucleated using a conservative operation technique.

Supernumerary teeth "mesiodens". Case report.

The supernumerary tooth is an anomaly of dental eruption that is not rare to find in the clinical practice. Among the supernumerary teeth the "mesiodens" is most frequent. The mesiodens is found in the region of the superior central incisors and it can be the cause of many complications. The aim of this work is the description of a rare symptomatic case of mesiodens and the diagnostic and therapeutic strategies to adopt when this dental anomaly occurs. In particular the authors suggest making radiographic examinations only in the family of patients with dental anomalies of number, thinking that the incidence of such anomalies is too low to justify mass radiographic examinations.

[A case of a carcinoma arising in lichen planus in a subject with diabetes mellitus and arterial hypertension (Grinspan's syndrome)]. / Su di un caso di carcinoma insorto su lichen planus in soggetto con diabete mellito ed ipertensione arteriosa (sindrome di Grinspan).

The authors describe a clinical case observed at the Inst of Oral & Maxillofacial Surgery characterized by three simultaneous symptoms: arterious hypertension, diabetes mellitus, oral erosive lichen planus. Grinspan & his co-workers observed this syndrome. The results of their research were exposed at the Congress on Dermatology in Buenos Aires, 1963. In 1965 in a repetitive study Grupper & Avul seemed confirm the existence of this symptomatological triad; therefore the authors defined this complex as "Grinspan's syndrome". Further researches conducted by other authors (Jolly, Powell. Howell e Rick) confirmed the association hypertension-diabetes-"erosive" lichen. However there were other worthwhile studies (Lozada-Nur, Christensen) which emphasized a not significant high frequency of patients with diabetes and high blood pressure and the oral sugar tolerance like random specimens of common people. Besides the authors notice that their clinical case is interesting not only because of their simultaneous presence of the three symptoms but also because of the bioptic appearance of a cancer likely appeared on a pre-existing inveterate lichenoid lesion.

[Tooth replantation after traumatic exarticulation. Present therapeutic orientations and future perspectives]. / Reimpianto dentale dopo exarticolazione traumatica. Orientamenti terapeutici attuali e prospettive future.

Replantation is a method in which an avulsed dental element is replaced into its alveolar socket. The dental traumatic exarticulation occurs in any age, but most frequently in the juvenile population. The aim of this paper is to rewiew the risks and benefits of tooth replantation and to discuss the present therapeutic orientations and future perspectives for avulsion management.

Nonsurgical treatment of a sublingual ranula in a ten-month-old baby.

A clinical case of nonsurgical treatment of a sublingual ranula in a ten-month-old baby is presented.

[Clinical applications compared in implantology]. / Applicazioni cliniche a confronto in implantologia.

On the basis of their own experience and of orientation reported by literature, the authors display how important it is for professional men who practise implantology or who approach it, to have the possibility of knowing several implantologic systems. Indeed, what we want to demonstrate is, that in different situations of edentulous, in relation to the quantity and the quality of the available bones, to the gnotologic situation and to the aesthetic functional result they aim to, corresponds the choice of one or several implantologic systems. In that sense the basic research occupies a role of vital importance, because only through the knowledge of chemical, chemical-physical and biomechanical characteristics it is possible to recognize some essential chemical entities for an implantologic approach. Thus the several diagnostic instrumental means available enable the surgeon to make an exact clinical diagnosis. The TAC, in this case, assumes a determinant role, because, in addition to supplying exact dimensional and qualitative informations, also occupies an important medico-legal aspect. The resolution of some forms of edentulous programmed like that, will subsequently be illustrated. Finally, a control hypothesis is proposed for the rearrangement, of peri-implant bone. On this account, the SPECT (single photon emission computerized tomography), through a semi-quantitative research, could provide some specific indications about the osteotropic implantation activity.

[The preoperative treatment of patients with heart valve prostheses undergoing oral and maxillofacial surgical interventions. Our protocol]. / Trattamento preoperatorio di pazienti portatori di protesi valvolari cardiache da sottoporre ad interventi di chirurgia orale e maxillo-facciale. Nostro protocollo.

The paper examines the prevention of hemorrhagic and bacterial endocarditis in patients with a prosthetic heart value and treated with oral anticoagulant therapy, undergoing oral and maxillo-facial surgery. The authors present a protocol personally adopted in hospital activity underlining the excellent results.

[Oral candidiasis following radiotherapy for neoplasms of the oromaxillofacial area]. / La candidosi orale conseguente a radioterapia per neoplasie del distretto oro-maxillo-facciale.

The authors report the clinical and histopathologic factors of oral candidiasis in patients treated with irradiation for head and neck cancer and predisposing antimycotic related treatments.

Metastases to the human mandible.

Two clinical cases are reported of mandibular swelling caused by metastatic jaw neoplasms. They analyse. The clinical characteristics of the swelling are analysed and all laboratory and radiographic tests performed are examined. It is concluded that metastatic localisations in the maxillofacial bone are very rare, but that the mandible is certainly the most frequent site. The authors also highlight the fact that the presence of metastatic lesions in the jaw may be the first symptom of the neoplastic disease.

[Pleomorphic adenoma of the parotid gland in childhood]. / Adenoma pleomorfo della ghiandola parotide in etá evolutiva.

BACKGROUND: The authors report the results of ten years' activity at the Pedodontic Surgery Unit in the Institute of Maxillofacial Surgery at the Second University of Naples and analyse the possibility of conservative treatment of pleomorphic adenoma in childhood. METHODS: The study includes 614 cases of salivary gland pathology. The authors illustrate the epidemiological, clinical and therapeutic characteristics of this type of lesion in childhood, emphasising that the data emerging from this study do not differ from the clinical and therapeutic management of pleomorphic adenoma in young patients reported in the literature. RESULTS: In particular, they emphasise that satisfactory therapeutic results can be achieved using conservative techniques, like conservative superficial parotidectomy. CONCLUSIONS: Conservative superficial parotidectomy has the advantage of being less radical and traumatic for a young patient, without provoking a significant increase in recidivation.

[Maxillary sinus surgical lift. Summers' technique versus lateral surgical approach]. / Sollevamento chirurgico del seno mascellare. Tecnica di Summers vs approccio chirurgico laterale.

BACKGROUND: After an extensive review of the literature regarding maxillary sinus lift procedures, the authors report the results of a retrospective study carried out by the Institute of Oral and Maxillofacial Surgery at the Second University of Naples. METHODS: A group of 9 patients aged between 18 and 50 years old, including two females, were enrolled in this study. At the preliminary evaluation, the sites to be analysed showed a bone height between the residual crest and the sinusal membrane not exceeding 8 mm. All patients responded positively to specific preimplantation requisites. Commercially pure titanium fixtures were used as well as demineralised freeze-dried bovine bone and autologous bone graft from the retromolar region. RESULTS: All patients were followed for at least 15 months and no clinical check-ups were missed during that time. No implant was lost and no cases of spire exposure were reported. Postoperative vertical bone resorption was within normal values. CONCLUSIONS: Summers technique and its variations with bone grafts of various kinds represents a valid aid for edentulous maxillary rehabilitation with scarce osseous resources in the postero-superior sectors. It offers a number of advantages compared to the traditional technique using an invasive lateral approach and is more acceptable to patients. However, in spite of this positive experience, the follow-up in the literature still appears to be too short. The authors, are therefore cautious in expressing their absolute preference for Summers technique and stress the need to wait for further long-term results.