Critical investigation of the pre-surgical anatomic factors that influence the aesthetic result in post-extractive implantology and immediate prosthetic.

The aesthetic goals of implant dentistry should be similar to those of conventional prostheses. In implant-prosthetic rehabilitations of the anterior sectors, the quantity and quality of hard and soft tissue play a fundamental role in achieving the desired aesthetics and in integrating the restoration in a complete and harmonious way into the existing anterior dentition. Post-extraction implantology is a treatment option for implant therapy after the extraction of a single tooth in the anterior jaw. This article presents some key factors to analyze and follow in order to achieve a predictable and acceptable aesthetic result. The creation of a predictable peri-implant aesthetics requires adequate preservation of the bone and soft tissues around the teeth that will be extracted and a correct positioning of the 3D implant. Furthermore, aesthetic success requires the creation of a correct transmucosal path, during the provisional prosthetic phases, which must be replicated and maintained with the definitive crowns.

Guided sinus lift: virtual planning of surgical templates for lateral access.

The sinus lift with lateral approach is a regenerative technique nowadays considered predictable to increase the height of bone in the atrophic posterior maxilla. Knowledge of sinus anatomy and evaluation of risk factors are the basis of regenerative and rehabilitative surgical success. The positioning and size of the lateral antrostomy represent critical factors in the execution of regenerative surgery, due to the difficulty in transferring radiological information to the lateral wall of the maxillary sinus even for skilled surgeons. The knowhow of guided implant surgery in recent years is also finding use in planning and precisely delineating the lateral access to the maxillary sinus using CBCT imaging and dimensional reconstruction software, through the realization of surgical guides with 3D printing, as shown in the presented case.

Endodontic retreatment and bioceramics: A case report.

The success rate in endodontic retreatment can be significantly boosted by using materials that guarantee both intimate adhesion to the canal walls and long-term stability. Bioceramic cements used in root filling show interesting properties including extraordinary sealing capacities, antimicrobial activity that stimulates periapical healing and the continuous production of hydroxyopathitis for a long time. This case report deals with the application of bioceramic cement in endodontic retreatment. The Bioroot RCS (Septodont), thanks to its ability to firmly adhere both to the gutta-percha and to the walls of the canal and to definitively seal the apical third, can allow to obtain extraordinary healing in a relatively short time by exploiting its antimicrobial abilities. However, further studies are needed to assess the effectiveness of this technique over the long term.

Computer-guided implant surgery: analysis of dynamic navigation systems and digital accuracy.

After the static computer-guided implant surgery, borns the concept of "navigated implantology" (NI) that offers significant advantages in the treatment planning and help clinicians to perform successful implant rehabilitation. NI allows an optimal final location, to avoid the risk of damaging the noble anatomical structures near the site and allows the achievement of satisfactory aesthetics. The aim of this study is analyze three different systems: the RoboDent® system (Berlin, Germany, 2001), today not for sale, was the first implant navigation system introduced on the market and made the history of dynamic surgery; X-Guide (Nobel Biocare, 2017), a dynamic computer assisted system that uses the principles of stereoscopic triangulation by optical video cameras. And last, the Navident® dynamic navigation system (Toronto, Canada, 2015), produced by the Canadian company ClaroNav, evolved from the Navient brand used in orthopaedic surgery, neurosurgery and otolaryngology, sharing the motion tracking technology. Dynamic computer assisted surgery systems allow more accurate implant placement when based on an accurate 3D CT-based image data and an implant planning software which minimizes errors and simplify the surgical technique.

MRI findings of working and non-working TMJ during unilateral molar clenching on hard bolus.

The aim of this study is to evaluate with MRI the TMJs behavior during one-side clenching on a hard bolus. The sample consisted of 13 patients. an MRI of TMJ using a 1.5 Tesla superconducting magnet and a dedicated surface coil was performed in all patients. Parasagittal scans of the TMJ (perpendicular to the long axis of the condyles) were made with the mouth closed, open and with a plastic thickness 10 mm high, 15 mm wide and 20 mm long always interposed between the molars of the left side; TSE T2W and DPW sequences were used. The working condyle is always positioned behind the non-working contralateral condyle and the morphology of the retrodiscal tissue upper lamina was curvilinear in all TMJs examined. This work confirmed that, during clenching on a unilateral hard bolus, the working condyle translates less than the balancing one and that the condyle-disc ratios are substantially the same in both sides. The study of the retrodiscal tissue imaging in the different functional phases, suggest that it does not exert any pulling force towards the disc.

Appearance of normal MRI anatomy of the lingual nerve using steady-state free precession sequences at 3-T.

The aim of this study is to assess the value of SSFP MRI sequence in depicting the normal anatomy of the lingual nerve (LN), particularly in the molar region, in order to help the periodontists, dentists and oral surgeons in their daily practice. The study group included 24 patients who were to undergo MR study for a reason unrelated to our purpose. All imaging was performed by using a 3.0T system with a head and neck multiarray coil. The evaluation criteria included image quality factors such as the identification of the LN, its demarcation and its contrast to surrounding tissues on a five-point scale. The LN is clearly visible throughout its course from its origin from the mandibular nerve (MN) to the mylohyoid muscle. In edentulous patients, the LN could be damaged during surgical procedures especially it during the dissection and retraction of a lingual flap and, above all, during the suture due to a direct trauma caused by the needle or indirectly during tying the knot.

Oral rehabilitation of edentulous jaws with one-piece implants: a case series.

The popularity of one piece implants has increased considerably between patients and dentists. The advantages of one-piece immediate loading for rehabilitation of edentulous mandibles is to reduce the number of interventions and timing of prosthetic. These parameters can be better controlled with a one-piece implant. Twenty-one patients with one-piece implants inserted in totally edentulous mandibles were considered for this retrospective study. Inclusion criteria were: Good oral hygiene, absence of lesions of the oral mucosa, no smoking or smoking less than 20 cigarettes a day, drinking less than 2 glasses of wine a day, good general health no pregnancy. Twenty-one (12 females 9 males) patients were enrolled in this retrospective study. The mean follow-up was 1 years. A total 84 one-piece implants (Biohorizon, Italy) were inserted in edentulous mandible. Implants diameter was 3.0 mm in all fixtures. Implants length was equal and longer than 12 mm in 44 and 40 fixtures respectively. 48 were inserted in females 36 in males (range 33-67; mean age 58.3). One-piece immediate loading implants has no difference in survival rate respect to two-piece implant and delayed loading for rehabilitation of totally edentulous mandibles. In conclusion one-piece immediate loading implant is a reliable device for mandible rehabilitation.

Complications in sinus lift.

Prosthetic rehabilitation of atrophic maxillary implants often requires grafting owing to vertical and transversal bone deficiency. The use of this procedure in order to insert implants was introduced by Tatum and published as a clinical study by Boyne and James. It can be performed via a lateral or crestal approach. This surgery is now widespread, with good results in terms of bone augmentation and implant osseointegration. Nevertheless, there is a small proportion of patients who have infectious complications with an incidence ranging from 3.5% to 10.5%. We observe that maxillary sinus augmentation is a successful preprosthetic technique for augmentation of the edentulous posterior maxilla. Preoperative assessment of the anatomy of the sinus reduces the rate of complications considerably.

The effectiveness of endodontic sealers and endodontic medicaments on the elimination of enterococcus faecalis: an in vitro study.

The aim of this study was to investigate the efficacy of endodontic sealers and endodontic medicaments: Aureoseal (OGNA), MTA (DENTSPLY), calcium hydroxide (CH) (Endoidrox OGNA) and iodoformic paste (OGNA) against Enterococcus faecalis. Thirty-six Biomeraux plates (18 MH and 18 DCO) were inoculated with the experimental suspensions. The E. faecalis broth culture suspensions were prepared and adjusted to no. 0.5-0.7 McFarland standard. In each agar plate, three cavities were created, each measuring 4mm in depth and 7mm in diameter, and then completely filled with the product to be tested. To investigate the root canal sealers' antimicrobial activity, the agar diffusion method is used. The diameters of the zones of microbial inhibition were measured in millimeters around the plate. The results showed that the antimicrobial activity of Aureoseal was superior to those of MTA, iodoformic paste and calcium hydroxide for the microorganisms tested. The study confirmed the resistance of Enterococcus faecalis to endodontic sealers. Aureoseal and Calcium hydroxide showed the best results in inhibition test suggesting to employ them in clinical cases.

Application of the radiosurgery assisted gingival displacement technique in the aesthetic area: a case report.

The use of digital tools offers a new perspective to daily clinical activities even though sometimes different clinical approaches are necessary. This case report of a maxillary anterior rehabilitation demonstrates the application of a gingival displacement technique to enhance the recording of subgingival finish line by means of an intraoral optical scanner (IOS). The temporary restoration was used as a guide for the radiosurgery tip in order to displace the gingiva in a guided and mini-invasive approach. It was then possible to create the space between the tooth structure and the soft tissues for the light beam of the IOS to properly detect the finish lines of the dental preparation. Six single porcelain fused to zirconia crowns were delivered. This technique could be considered as a solution of complex cases with subgingival dental preparation to be detected by means of an IOS.

Clinical fitting of a cast metal post and core obtained by means of an intraoral optical scanning (IOS) and digital workflow.

Customization of post-and-cores using computer-aided-design and computer-aided-manufacturing (CAD-CAM) requires the scanning of a pattern and the subsequent digital design. This case report describes the production of a CAD-CAM customized post-and-core designed from an intraoral scan and milled from a metal block. The use of an intraoral scanner (IOS) for post-endodontic rehabilitation could lead to a faster and more efficient CAD-CAM customized post-and-core realization. The use of a high resistance material such as metal is paramount in cases with high loss of coronal structure. The patient has been treated with bisphosphonate (BP) for years. The risk of osteonecrosis of the jaw after extraction was high.

Two-way relationship between diabetes and periodontal disease: a reality or a paradigm?

Diabetes mellitus (DM) and periodontal disease (PD) are both chronic diseases. From one side, DM have an adverse effect on PD, and on the other side PD may influence DM. Systemic therapy of DM with glycaemic control, affects the progress of PD. Reversely treatment of PD combined with the administration of systemic antibiotics seems to have a double effect on diabetic patients reducing the periodontal infection and improving the glycaemic control. Inflammation, altered host responses, altered tissue homeostasis are common characteristic of both DM and PD. The potential common pathophysiologic pathways of direct or reverse relationship of DM and PD are still unknown and further in vitro and in vivo studies are needed to explore this relationship.

Why patients with cardiovascular risks go to dentists. Is there sufficient evidence of influence of periodontal therapy on cardiovascular disease?

Cardiovascular disease (CVD) is a common cause of death, representing 29% of the mortality all over the word. Estimates for 2006 show that CVD is one of the world's main cause of death, with 17.1 million death per year. More than 70 million Americans have been diagnosed with various forms of CVD, including high blood pressure, coronary artery disease (acute myocardial infarction and angina pectoris), disorders of peripheral arteries etc. There is strong evidence that periodontal disease (PD) is associated with an increased risk of CVD. In addiction many patients with CVD are also affected by PD, which can be mild or severe. The aim of this manuscript is to investigate the effects of periodontal therapy on the management of CVD. 34 randomised controlled trials and reviews were included in this manuscript to test the effects of different periodontal therapies for patients with CVD. In conclusion, we may affirm that there is some lack of knowledge on relations between PD and CVD, however there is sufficient evidence to justify a periodontal treatment to prevent CVD, in fact PD is very prevalent in middle-aged population and can have a significant impact on the cardiovascular function.

Antiresorptive drug-related osteonecrosis of the jaws, literature review and 5 years of experience.

PURPOSE: Bisphosphonate drug therapy provides benefits in the case of osteoporosis and carcinomas metastasizing to the bones, but it exposes patients to important side effects. The aim of this study was to investigate the incidence and the appropriate surgical treatment of bone lesions and fractures due to antiresorptive drug-related osteonecrosis of the jaws (ARONJ). METHODS: Patients presenting with osteonecrosis lesions of the jaw, who were referred to the Maxillo-Facial unit of the University of L'Aquila, were considered for inclusion. Grade of the lesion and treatment choice was recorded for each patient. Descriptive statistics were calculated and the data were analysed with Chi-squared tests. A representative case of a fracture reduction with a supra-periostal approach is reported. RESULTS: Among the 165 patients with ARONJ lesions, 112 were female and 53 were male. In total, 115 patients received intra-venous bisphosphonate therapy and 50 received oral bisphosphonate therapy. Five stage 2 lesions, three stage 2 lesions and two stage 3 lesions were not a consequence of dental procedures. Eighteen surgical bone excisions were performed and four pathological fractures were reduced. In one case (the reported one), the combined use of platelet-rich plasma and the supra-periostal approach leads to a successful 1-year follow-up. CONCLUSIONS: ARONJ lesions are a type of pathological bone disease affecting the jawbones. The pathology pathway remains a controversial and frequently discussed topic. A surgically conservative strategy seems to be the best way to assure a comfortable quality of life to those patients negatively affected by this condition.

Healing of the post extractive socket: technique for conservation of alveolar crest by a coronal seal.

The first aim of the following experimental study was to assess bone changes in the horizontal and vertical dimension when using different socket preservation procedures. The second objective of our work was also to compare two clinical methods of coronal seal's management: an experimental group was treated using the natural extracted tooth; another experimental group saw the use of a provisional resin preformed as a seal technique. In twelve patients a premolar tooth was extracted without elevation of a mucoperiosteal flap and the patients were randomly distributed into four groups. The first and second group was considered as a control groups: in the first, the extraction socket was left with its blood clot and interrupted sutures were applied; In the second, the extraction socket was filled with BioOss Collagen (Geistlich Biomaterials, Wolhusen, Switzerland) and a free gingival graft was sutured to cover the socket. The third and fourth groups was considered as a test group. In the third group, after tooth extraction, for aesthetic reasons, the root of the natural dental element is cut to allow immediate temporary prosthesis. In the fourth group, as in group 3, the patient is discharged through a temporary restoration performed or by the dental technician or directly to the chair. Standardized photographs were taken eight months after tooth extraction. Five competent observers analyzed the esthetic outcome according to the PES. To assess the level of bone healing at the extraction site, the following parameters were evaluated: 1) changes in soft tissue and 2) changes in bone level. As for soft tissues, they were assessed using the PES score by two assessments, four weeks apart. The overall scores of the four treatment groups revealed PES values of 8.47 (SD 2.08, group 3), 6.62 (SD 3.24, group 4). The differences between groups 1 and 2 and were statistically significant (P=0.015 and P=0.047). The single parameter analysis displayed a certain range of fluctuation and heterogeneity. As regards hard tissue, during the 6-month period, bone remodeling occurred in all four experimental groups with different percentages. The mean vertical loss of the buccal bone plate for the Tx 1 group was -2 ± 0.2 mm. The Tx 2 group showed vertical loss of - 0.34 ± 0.2 mm. The Tx 3 group demonstrated - 0.3 mm of mean vertical loss and the 4 groups demonstrated -0.46 of mean vertical loss. The horizontal dimension of the alveolar process was 13.5 ± 0.1 mm, 7.6 ± 0.1 mm e 6.7 ± 0.1 mm at the three different levels for the Tx 1 group. The Tx 2 group depicted bone dimensions of 14.4 ± 0.2 mm, 13.7 ± 0.3 mm e 13.4 ± 0.1 mm. The horizontal dimension of the Tx 3 - Tx 4 group was 13.7 ± 0.3 mm, 13.1 ± 0.1 mm e 13 ± 0.1 mm and 13.5 ± 0.1 mm, 13.2 ± 0.1 mm e 12.9 ± 0.1 mm. The findings from the present study disclose that incorporation of coronal seals define a particular respect to the buccal bone plate.

Pathogenesis of chronic rhinosinusitis in patients affected by ß-thalassemia major and sickle cell anaemia post allogenic bone marrow transplant.

OBJECTIVES: Sickle cell anemia (SCA) and ß -thalassemia major are well-recognized beta-globin gene disorders of red blood cells associated to mortality and morbidity included bone morbidities due to ineffective erythropoiesis and bone marrow expansion, which affect every part of the skeleton. While there are an abundance of described disease manifestations of the head and neck, the manner of paranasal sinuses involvement and its relations to ß-thalassemia and SCA process was not studied yet. Therefore, the aim of this study was to investigate a possible increased risk of rhinosinusitis and the real pathogenetic mechanism of it, comparing these two hematological diseases using msCT, gold standard for paranasal sinuses evaluation. METHODS: A retrospective analysis of 90 patients affected by ß-thalassemia major or SCA (respectively 59 and 31) underwent allogeneic bone marrow transplantation (BMT), and 44 control subjects was performed. Both patient categories and control group have been subjected to hematological and radiological evaluation using 64-multidetector-row CT scanner without contrast injection. RESULTS: Statistical analysis reveals that patients of the two study groups exhibit a significantly increased risk of sinusitis in comparison with the normal controls (RR: 3.55 for ß-thalassemic pediatric subjects; RR: 3.35 for SCA pediatric subjects). A significant difference (p < 0,5) was found between the ß -thalassemic patients on the one side, and SCA and control group on the other side, with regard to the evaluation of the typical anatomic alteration of maxillary sinus: ß-thalassemic children had significant increase in the bone thickness of anterior and lateral sinus walls and significant reduction in volume and density compared to SCA patients and control group, with normal conditions of these parameters. CONCLUSIONS: In these hematological patients, there is an increased incidence of sinonasal infections due their therapy-induced immunosuppression post transplantation. In ß-thalassemic patients, furthermore, the specific anatomical variants play an important confounding factor in radiological interpretation of CT images. Therefore, a cranio-facial CT scan evaluation could be a useful tool in the management of upper airway infections after BMT and should be a routinely exams in order to avoid useless surgical or antibiotic approaches.

A new system of implant abutment connection: how to improve a two piece implant system sealing.

PURPOSE: Implant dentistry has become one of the most successful dentistry techniques for replacing missing teeth. The success rate of implant dentistry is above 80%. However, peri-implantitis is a later complication of implant dentistry that if untreated, can lead to implant loss. One of the hypotized causes of peri-implantis is the bacterial leakage at the level of implant-abutment connection. Bacterial leakage is favored to the presence of a micro gap at the implant-abutment interface, allowing microorganisms to penetrate and colonize the inner part of the implant leading to biofilm accumulation and consequently to peri-implantitis development. MATERIALS AND METHODS: To identify the capability of the implant to protect the internal space from the external environment, the passage of genetically modified Escherichia coli across implant-abutment interface was evaluated. Implants were immerged in a bacterial culture for twenty-four hours and then bacteria amount was measured inside implant-abutment interface with Real-time PCR. RESULTS: Bacteria were detected inside all studied implants, with a median percentage of 9%. CONCLUSIONS: The reported results are better to those of previous studies carried out on different implant systems. Until now, none implant-abutment system has been proven to seal the gap between implant and abutment.

3D X-ray microscopic analysys on a prosthetically loaded implant with platform-switching and conical connection: a case report.

The histological and histomorphometrical examination were the gold standard in the qualitative and quantitative analyses of the peri-implant tissue around the implant. In recent years, the field of microscopy has witnessed a considerable enhancement of the performance of microscopes that have very high resolution performance and allowing very sophisticated analysis even larger than traditional preparations. The possibility to have an affordable analyses of whole implant with the surrounding different tissues (soft and hard tissues) without the traditional pre-treatment necessary for the histological analysis may represent a goal to describe material properties and behaviors or simply to visualize structural details. The aim of the present study were to evaluate a 3D X-ray microscopic analysis of peri-implant tissue compared to a traditional histological and histomorphometrical analysis of the peri-implant tissues around an implant with a conical connection associated with platform-switching in order to assess the validity of the new analysis technique.

Treatment of severe atrophic maxilla with zygomatic implants: a case series.

Treatment of severe maxillary atrophy with implants has achieved important successes in recent years. The limit of implant insertion is related to inadequate bone quantity (i.e. height and width). Alveolar bone grafting, sinus lifting and major grafting via Le Fort I osteotomy have used in the past to restore bone volume prior of implant insertion. However successes do not always occur and a second stage surgery is necessary in most cases. Immediate loading cannot be performed in all grafted bone. In recent years a new treatment approach has been proposed by using zygomatic implants. This new technique can provide a better stability to the prosthesis and less morbidity for patient. Here a cases series of eighteen patients rehabilitated with zygomatic together with standard implants and immediate loading is reported.

Radiological and clinical difficulties in the management of chronic maxillary sinusitis in ß Thalassemic paediatric patients.

INTRODUCTION: Beta thalassemia is a blood dyscrasia that caused a marked expansion of active marrow spaces and extramedullary haematopoiesis results. In these patients various alterations and abnormalities affects different body areas, including increased risk of sinusitis. The marrow expansion in the facial bones results in delay in pneumatisation of the sinuses, overgrowth of the maxillae, and forward displacement of the upper incisors with skeletal deformities. In current literature, maxillary sinuses are not deeply evaluated by CT scan studies in these kind of patients. The aim of our study was to investigate the presence of maxillary sinuses abnormalities by the use of CT in patients with beta-thalassemia major and to compare these findings with a control group free from this disease. MATERIALS AND METHODS: A retrospective analysis of 22 paediatric patients with beta-thalassemia major and 22 control subjects without sinonasal diseases was performed. CT was done using a 64-multidetector-row CT scanner without contrast injection, obtained in axial plane using thin-slice technique. Evaluated parameters were: bone thickness of the lateral and anterior wall, density and volume of the maxillary sinuses. RESULTS: Significant difference was found between the study group and control group in the evaluation of all the parameters examined. The maxillary sinus of ß thalassemic patients was smaller respect of controls, the bone was more dense and thick in the side and anterior wall. Beta-thalassemic patients have a relative risk of 2.87 to develop a maxillary sinusitis. DISCUSSION: In these patients there is an increased incidence of sinonasal infections due to the abnormal development of cranio facial skeleton. These bone alterations might confuse the physicians and lead to an increased rate of sinusitis diagnoses.