Efficacy of Pulsed Electromagnetic Field Therapy for Pain Management After Impacted Mandibular Third Molar Surgery. A Randomized Clinical Trial.

BACKGROUND: Postoperative pain and swelling associated with the removal of the third molar (M3) adversely affect the patient's quality of life. PURPOSE: The study aims to measure pain reduction and analgesic use in patients treated with pulsed electromagnetic field (PEMF) therapy following M3 removal and compares it to patients who did not receive PEMF. STUDY DESIGN, SETTING, SAMPLE: The single-center study was designed as a randomized, prospective, controlled, double-blinded trial on a sample of patients with impacted mandibular M3 ascertained by x-ray orthopantomography and computed tomography. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLES: The predictor variable is postoperative pain management. It was assigned randomly to each subject who received either PEMF or standard therapy. MAIN OUTCOME VARIABLES: The pain was quantified using a 100 mm visual analog scale and the number of analgesics taken. Each subject kept a daily clinical diary for 7 days, recording the amount of pain using the visual analog scale and the number of analgesic tablets taken. COVARIATES: The study covariates were age, sex, tobacco use, and Pell and Gregory's classification of M3s. ANALYSES: Student's t test was used, placing the statistical significance for P value < .05. The primary planned analysis was a 2-group, continuity-corrected, χ2 test of equality of proportions. RESULTS: The study sample included 90 patients, 47 men and 43 women, with an average age of 32.43 ± 8.80 years. PEMF was statistically associated with improved pain reduction (2.08 vs 5.04 with a P value = .0002) and consumption of fewer analgesics than the control group (2.6 vs 5.8 with a P value = .0062). CONCLUSIONS AND RELEVANCE: The study's results attest to the effectiveness of PEMF therapy in pain control after M3 surgery.

Percutaneous Reduction of Isolated Zygomatic Arch Fractures: A 5-Year Experience.

PURPOSE: We evaluated the outcomes and differences in surgical time and hospitalization length for patients with an isolated zygomatic arch (ZA) fracture treated by percutaneous wire reduction with external fixation. PATIENTS AND METHODS: We designed and developed a retrospective study of patients with isolated ZA fractures treated from 2014 to 2019. The predictor variable was the operative treatment, represented by percutaneous reduction with external fixation. The primary outcome variables were the surgical time and hospitalization length. Other variables, including functional and esthetic results (evaluated by clinical and radiologic assessments) and the rate of immediate and delayed complications during a 6-month minimum follow-up period, were considered. Descriptive statistics were computed and compared with the international reported data. RESULTS: A total of 15 patients met specific inclusion and exclusion criteria. The 15 fractures were grouped using the classification reported by Kim et al as type 1A (n = 9) and type 1B (n = 6). No significant differences were found between the 2 groups, except for the fracture type. The operative treatment was performed with the patient under general anesthesia (n = 12) or local anesthesia with sedation (n = 3). Only 1 patient developed a complication (early hematoma). No other cases of early or delayed complications were reported. Two patients required a traditional surgical operation with the Gilles approach. The average hospitalization length and surgical time were 0.8 night and 18.4 minutes for the type 1A group and 0.7 night and 19.0 minutes for the type 1B group, respectively. Optimal esthetic and functional outcomes were obtained for all 15 patients. CONCLUSIONS: The results of the present study suggest that optimal esthetic and functional results can be obtained, minimizing the effect on soft tissues and patient discomfort, with a short surgical time and low rate of complications.

Can Surgical Management Improve Resolution of Medication-Related Osteonecrosis of the Jaw at Early Stages? A Prospective Cohort Study.

PURPOSE: There is no clarity on which protocol is proper to use in the management of medication-related osteonecrosis of the jaw (MRONJ) at early stages (ie, stages 1 and 2) to halt disease progression. The aim of this study was to evaluate the success of surgical treatment in terms of time to mucosal integrity and downstaging in patients with MRONJ at early stages. MATERIALS AND METHODS: The study was implemented as a prospective, single-center cohort study. The sample included patients who presented at Magna Graecia University of Catanzaro with a clinical diagnosis of MRONJ and underwent surgical treatment. The primary predictor variables were gender, age, medical history, drug administration, MRONJ localization, trigger factors, and stage. The outcome variables were 1) time to mucosal integrity after surgery with time-to-event analysis and 2) time to downstaging of MRONJ lesions. Descriptive, bivariate, and regression statistics were performed. RESULTS: The study sample included 129 MRONJ patients (90 women and 39 men; mean age, 71.2 ± 12.7 years), of whom 57 had stage 1 and 72 had stage 2. The mean time to achieve mucosal integrity was 71.6 ± 67.7 days, considering the survival probability always to be 93% or greater. The mean time to achieve downstaging of the lesion was 43.6 ± 38.4 days. Patients older than 70 years, those affected by osteometabolic disorders, and those treated with oral antiresorptive therapy showed a significantly shorter time to mucosal healing and downstaging (P < .05). In patients with stage 2 MRONJ, we recorded a significantly longer time to mucosal integrity (56.4 ± 54.5 days) but shorter time to lesion downstaging (33.6 ± 9.9 days) than in patients with stage 1 MRONJ (P < .05). CONCLUSIONS: Surgical treatment of patients in the early stages of MRONJ guarantees benefits in outcomes such as mucosal integrity and lesion downstaging, improvement in quality of life, and faster reuptake of medication therapy, especially for oncologic patients.

The Influence of Socioeconomic Factors on the Epidemiology of Maxillofacial Fractures in Southern Italy.

Maxillofacial fractures represent a serious public health problem. Their epidemiology is extremely variable and its analysis is crucial to establish effective treatment and prevention of these injuries. The aim of this multicentric retrospective study was to analyze causes, demographics, incidence, characteristics of 987 patients diagnosed with maxillofacial trauma between 2011 and 2015 at Complex Operative Unit of Maxillofacial Surgery of Federico II University of Naples and Magna Graecia University of Catanzaro, Italy; 657 male and 310 female patients were admitted in the study. The most frequently observed fracture involved the mandible (399 patients, 35.4%), followed by zygomatic complex (337 patients, 29.9%), orbital walls (160 patients, 14.2%), and nasal bones (129 patients, 11.4%). The most frequent cause of fracture was assaults (30.4%), followed by road traffic injuries (27.2%), falls (23.2%), sport accidents (15.4%), and others causes (2.6%). Significant variations of etiology have been detected between the 2 hospitals in relationship with different migration flow trends and cultural and socioeconomic features. Epidemiological analysis of maxillofacial fractures is crucial to identify the trauma burden and to help in developing a more efficient system to plan resource allocation and to deliver care and preventive measures establishing clinical and research priorities for effective treatment and prevention of these injuries.

Classical Orbital Floor Post-Traumatic Reconstruction vs. Customized Reconstruction with the Support of "In-House" 3D-Printed Models: A Retrospective Study with an Analysis of Volumetric Measurement.

BACKGROUND: Orbital floor fractures (OFFs) represent an interesting chapter in maxillofacial surgery, and one of the main challenges in orbit reconstruction is shaping and cutting the precise contour of the implants due to its complex anatomy. OBJECTIVE: The aim of the retrospective study was to demonstrate, through pre- and postoperative volumetric measurements of the orbit, how the use of a preformed titanium mesh based on the stereolithographic model produced with 3D printers ("In-House" reconstruction) provides a better reconstruction volumetric compared to the intraoperatively shaped titanium mesh. MATERIALS AND METHODS: The patients with OFF enrolled in this study were divided into two groups according to the inclusion criteria. In Group 1 (G1), patients surgically treated for OFF were divided into two subgroups: G1a, patients undergoing orbital floor reconstruction with an intraoperatively shaped mesh, and G1b, patients undergoing orbital floor reconstruction with a preoperative mesh shaped on a 3D-printed stereolithographic model. Group 2 (G2) consisted of patients treated for other traumatic pathologies (mandible fractures and middle face fractures not involving orbit). Pre- and postoperative orbital volumetric measurements were performed on both G1 and G2. The patients of both groups were subjected to the measurement of orbital volume using Osirix software (Pixmeo SARL, CH-1233 Bernex, Switzerland) on the new CT examination. Both descriptive (using central tendency indices such as mean and range) and regressive (using the Bravais-Pearson index, calculated using the GraphPad program) statistical analyses were performed on the recorded data. RESULTS: From 1 January 2017 to 31 December 2021, of the 176 patients treated for OFF at the "Magna Graecia" University Hospital of Catanzaro 10 fulfilled the study's inclusion criteria: 5 were assigned to G1a and 5 to G1b, with a total of 30 volumetric measurements. In G2, we included 10 patients, with a total of 20 volumetric measurements. From the volumetric measurements and statistical analysis carried out, it emerged that the average of the volumetric differences of the healthy orbits was ±0.6351 cm3, the standard deviation of the volumetric differences was ±0.3383, and the relationship between the treated orbit and the healthy orbit was linear; therefore, the treated orbital volumes tend to approach the healthy ones after surgical treatment. CONCLUSION: This study demonstrates that if the volume is restored within the range of the standardized mean, the diplopia is completely recovered already after surgery or after one month. For orbital volumes that do not fall within this range, functional recovery could occur within 6 months or be lacking. The restoration of the orbital volume using pre-modeled networks on the patient's anatomical model, printed internally in 3D, allows for more accurate reconstructions of the orbital floor in less time, with clinical advantages also in terms of surgical timing.

Bi-layered collagen nano-structured membrane prototype (collagen matrix 10826(®)) for oral soft tissue regeneration: an "in vitro" study.

AIM: To evaluate fundamental cell functions, such as adhesion, IL-6 production and proliferation of human gingival keratinocytes cultured on a newly engineered collagen matrix (CM-10826) and to assess the degree of specific biocompatibility of this new device. MATERIALS AND METHODS: Primary cultures of human keratinocytes were derived "in vitro" from biopsies of independent donors. Their true epithelial origin was ensured by the expression of cytokeratin 14. Adhesion, proliferation and production of IL-6 cytokine was then measured in the presence or absence of CM-10826 activity or of its relevant components. RESULTS: Functional tests revealed that keratinocytes adhered to CM-10826 and up-regulated their basal IL-6 production. The type of keratinocytes used expressed cytokeratin 14. Proliferation experiments demonstrated that the best cellular response was observed in the presence of Collagen I, the main component of CM-10826. No undesired effects were observed as for keratinocyte viability, morphology or differentiation. CONCLUSIONS: Our results demonstrate that CM-10826 has a favourable biological effect on the "in vitro" response of gingival keratinocytes in terms of IL-6 production, cell growth and adhesion. These findings may encourage a possible use of this collagen membrane as a tissue which, alone, may substitute for autologous gingival grafts thereby overcoming the limitations of autologous tissue.

A rare case of secondary ameloblastic carcinoma in a young Man.

Ameloblastic carcinoma is a rare and aggressive malignant odontogenic tumour that can arise de novo or from a preexisting benign lesion. It most frequently involves the mandible, and its clinical course is aggressive with extensive local destruction. Although rare, these lesions have been known to metastasize, mostly to regional lymph nodes or lungs. Surgical therapy, eventually followed by radiotherapy, is the treatment modality most frequently used, while the role of chemotherapy remains unclear. Here we present a case of secondary ameloblastic carcinoma of the mandible in a 33-year-old male patient with typical aggressiveness and extensive local destruction and metastasis with a follow-up period of 93 months. KEY WORDS: Ameloblastic Carcinoma, Head and Neck Cancer, Maxillofacial Surgery, Oncological Surgery.

Unusual presentation of pulmonary adenocarcinoma metastases in the mandibular condyle: A case report.

INTRODUCTION: Mandibular bone metastases should be suspected in all patients with temporomandibular joint disorder symptoms and lung cancer history. The purpose of this report is to present a case of metastasis to the mandibular condyle following pulmonary adenocarcinoma. CASE PRESENTATION: In December 2020, a 71-year-old patient was evaluated by the Department of Maxillofacial Surgery for the presence of a large osteolytic lesion in the left mandibular condyle. There were no changes to the face or occlusion, and mandibular movements were preserved. After surgical removal, histology revealed pulmonary adenocarcinoma metastasis. DISCUSSION: To date, only 7 cases of condylar metastases are described by lung cancer. This pathology's clinical and radiological features are almost always shaded and not specific. CONCLUSION: This study also focuses on rare conditions, such as metastases to the mandibular condyle. It also stresses the importance of a multidisciplinary approach both in the diagnostic and therapeutic process.

Design and Simulate Intracranial Support to Guide Maxillo Surgery: A Study Based on Bioengineering.

BACKGROUND: Intraoperative navigation allows for the creation of a real-time relationship between the anatomy imagined during diagnosis/planning and the site of surgical interest. This procedure takes place by identifying and registering trustworthy anatomical markers on planning images and using a point locator during the operation. The locator is calibrated in the workspace by placing a Dynamic Reference Frame (DRF) sensor. OBJECTIVE: This study aims to calculate the localization accuracy of an electromagnetic locator of neuro-maxillofacial surgery, moving the standard sensor position to a different position more suitable for maxillofacial surgery. MATERIALS AND METHODS: The upper dental arch was chosen as an alternative fixed point for the positioning of the sensor. The prototype of a bite support device was designed and generated via 3D printing. CT images of a skull phantom with 10 anatomical landmarks were acquired. The testing procedure consisted of 10 measurements for each position of the sensor: precisely 10 measurements with the sensor placed on the forehead and 10 measurements with the sensor placed on the bite support device. It also evaluated the localization error by comparing the two procedures. RESULTS: The localization error, when the sensor was placed on the bite support device, was lower in the sphere located on the temporal bone. It was the same in the spheres located on the maxillary bone. The test analysis of the data of the new device showed that it is reliable; the tests are reproducible and can be considered as accurate as the traditional ones. In addition, the sensor mounted on this device has proven to be slightly superior in terms of accuracy and accuracy in areas such as the middle third of the face and jaw. DISCUSSION AND CONCLUSION: The realization of the bite support device allowed the sensor to change position concerning its natural site. This procedure allows us to explore structures, such as the frontal site, which were initially difficult to approach with neuronavigation and improves the approach to midface structures, already studied with neuronavigation. The new calibration, with the position of the sensor on the support device in the same reference points sphere, highlighted the reduction in the location error. We can say that the support proposed in this study lays the foundations for a new navigation approach for patients in maxillofacial surgery, by changing the position of the sensor. It has strong points in improving the localization error for some reference points without determining disadvantages both in the calibration and in the surgical impediment.

Mandibular reconstruction using fresh frozen bone allograft after conservative enucleation of a mandibular odontogenic myxoma.

The purpose of this article was to report the clinical, radiographic, and histological findings about a case of a young woman affected by a mandibular odontogenic myxoma. Conservative tumor resection was followed by immediate reconstructive treatment using fresh-frozen human bone graft, instead of autologous bone graft, as material for bone regeneration. Odontogenic myxoma, according to the World Health Organization, is classified as a benign tumor of mesenchymal origin whether or not containing odontogenic epithelium. Radiological and histological examination of the lesion confirmed the presence of an odontogenic myxoma, which was 21.2 mm high and 47.6 mm long; the lesion underwent biopsy evaluation before enucleation. According to literature and with the aim of a patient free of disease, conservative enucleation of the lesion was performed. The residual bone defect was filled with fresh-frozen bone allograft. At 6 months after surgery, no evidence of major complications was observed; the computed tomography scan revealed effective bone regeneration through the grafted area. The use of fresh-frozen bone allograft, thanks to its osteoinductive and osteoconductive properties, may represent an optional choice for reconstruction of bone defects after jaw tumor removal.

Jaw angiosarcoma. First case, with massive intraosseous localization, described in Italian literature.

Angiosarcoma (AS) is a rare non-epithelial malignant neoplasm arising from neoplastic vascular degeneration of endothelial cells. It usually occurs in soft tissue and skin. The incidence, according to American authors, is 1% of all soft tissue sarcomas. About 50% of AS is localized in head and neck region (scalp and face skin) and represents less than 1% of all malignancies of this district; the primitive intra- oral localization is rare, even rarer intraosseous development of AS in jaw bones. The Authors report a case of a mandibular intraosseus angiosarcoma with different peculiarities: the rarity of the location and mode of occurrence; in addition they have focused on clinical-histopathological and immunohistochemical charateristics.

An unusual localization of intraosseus schwannoma: mandibular localization and new pathogenetic prospectives.

AIM: The aim of the study is to give an explanation on the Intra-osseous Schwanoma etio-pathogenesis, based on the isto-pathological findings presented by the Authors. MATERIAL OF STUDY: In a 40 years old patient with pain on the territory innervated by the third right trigeminal branch, OPT showed a like ground-glass area that involved the mandible with the mandibular canal disappearance and dental roots resorption. They removed the lesion with preservation of the vascular-neural beam on which the lesion were extremely attached; the histological examination confirmed the diagnosis of intra-osseous Schwannoma. Immunohistochemically the Schwannoma labelled with antibodies to S-100, Vimentin, Osteopontin and Osteonectin. RESULST: The clinical and radiological follow-up after one year since the surgery, using OPT showed an improvement of bone formation and the disappearance of the pain. DISCUSSION: Schwannoma rarely presents as an intraosseous mass, comprising less than 1% of all bone tumors with a strong predilection for the mandible. Data like the expression of osteopontin are believed to be distinctive feature of other schwannian cell tumors such as the granular cell tumor. Such data might explain the prevalence of mandibular location among the rare intraosseous schwannomas and might point out that the calcified shwannoma of the skull is similar to an hamartomatous lesion.

Unique and rare bone metastases from occult primary cancer. Our experience.

AIM: The aim of our study is to describe the rare location of metastasis cancers (kidney and prostate) in the jaw bones (maxillary branch and the condyle); this is the first and the only sign of disease. MATERIAL OF STUDY: Two patients referred to us for a swelling in his left preauricolar region with a moderate pain. They underwent a radiologic and bioptic examinations that showed a metastasis which could arise from a primary prostatic and renal adenocarcinoma. The patients underwent surgical treatment (Subtotal-emimandibulectomy and reconstruction with metallic endoprosthesis). RESULTS: The final follow up for the first patient was acceptable and without any motor or sensory deficit. The patient also underwent chemotherapy for his primary tumour and radiotherapy of his mandibular condyle metastasis during the preoperative stage. The final follow-up of the second patient was performer two years after the surgery and it did not show any recurrence and after about 18 months from surgery has performed dentistry rehabilitation. The patient had a chemotherapy treatment with the administration of bisphosphonates for the presence of skeletal metastases. DISCUSSION AND CONCLUSION: Just 1% of carcinomas metastasizes in jaw bones. The low rate is linked to the low active bone marrow content in jaw bones of adult patients. For the prostatic and breast adenocarcinomas the neoplastic embolis reaches the skeleton directly, passing through the vertebral venous system (Batson's hypothesis). Early diagnosis made the treatment both of the primary tumour and of its recurrence (single metastasis) more effective.

A rare case of mandibular dentinogenic ghost cell tumor: Histopathological, clinical and surgical management.

Dentinogenic ghost cell tumor (DGCT) is a rare benign tumorous form of calcifying odontogenic cyst (COC) characterized by the presence of ghost cells but it seems to have more aggressive behavior. It represents 11.5% of COCs. In this work, we report a case of a 60-year-old male patient with DGCT in the posterior region of the right mandible treated with surgical enucleation.

Management in oral and maxillofacial surgery during the COVID-19 pandemic: Our experience.

A novel ß-coronavirus (2019-nCOV), identified in Wuhan City in late December 2019, is generating a rapid and tragic health emergency in Italy due to the need to provide assistance to an uncontrollable number of infected patients and, at the same time, treat all the non-deferrable oncological and traumatic maxillofacial conditions. This article summarises the clinical and surgical experience of Maxillofacial Surgery Unit of "Magna Graecia" University (Catanzaro -Italy) during the COVID-19 pandemic and would like to provide a number of recommendations that should facilitate the scheduling process of surgical activities during the COVID-19 pandemic and reduce the risk of infection among healthcare professionals.

Telemedicine in Oral and Maxillo-Facial Surgery: An Effective Alternative in Post COVID-19 Pandemic.

The aim of this work was to demonstrate the advantages of using telemedicine (TM) in the management of the outpatients with maxillofacial surgical pathologies during the COVID-19 pandemic. The study was conducted at the MaxilloFacial Surgery Unit of "Magna Graecia" University of Catanzaro, on two different groups of patients: a group of follow-up patients (A1: patients in oncological follow-up after surgical treatment performed before the COVID-19 pandemic; A2: suffering from chronic lesions such as precancerous lesions), and a group B of patients with first urgent visits (B1: patients with suspected oncological pathology; B2: patients with suspected urgent disease such as medication-related osteonecrosis of the jaws (MRONJ), odontogenic abscesses, temporomandibular joint (TMJ) dislocation, etc.). Participation in the study required possession of a smartphone with Internet access, e-mail and the use of a messaging service (WhatsApp or Telegram) to send photos and messages; completion by the patient of a COVID-19 screening questionnaire; submission of a satisfaction questionnaire by the doctors and patients. A total of 90 patients were included in this study. A high percentage of satisfaction emerged from the analysis of the satisfaction questionnaires of both patients and doctors.TM thus represents an excellent opportunity to improve accessibility to oncological and non-management activities, reducing the risk of Covid-19 dissemination and should be promoted and implemented in the post-pandemic era.

Mini-retromandibular transparotid approach to subcondylar fractures of the mandible A single Center clinical experience.

AIM: We evaluated the safety and efficacy using a mini-retromandibular transparotid approach to reduce and rigidly fix displaced mandibular condylar neck fractures. MATERIAL OF STUDY: Retrospective evaluation of patients who underwent surgical reduction of condylar fracture from January 2012 to December 2014 at the Department of Cranio Maxillo-Facial Surgery of the University Hospital of Catanzaro, Italy. All the patients were clinically assessed for signs/symptoms of infection, signs of Frey's syndrome or salivary fistula, facial nerve palsy ,postoperative scar, TMJ function, and occlusion with range of mouth opening and deviation. RESULTS: The sample was composed of 15 patients. Good results were achieved in all patients and with an average follow- up of 20 months. No major intraoperative or postoperative complication remained at 6 months of postoperative follow- up. DISCUSSION: Management of condylar fractures is still one of the most controversial topics in maxillofacial surgery. Regarding our experience with the mini-retromandibular approach, we evaluate the advantages in comparison with other extra-oral approaches. Advantages include the shorter working distance from the skin incision to the condyle with direct alignment of the fractured segments, less conspicuous facial surgical scarring with good cosmetic result, short operation time, with a low risk of postoperative complications and possible injuries of the facial nerve. CONCLUSIONS: According to our results, we believe that the mini-retro-mandibular approach is a viable and safe approach for the surgical treatment of condylar fractures, with a relatively low risk of postoperative complications. KEY WORDS: Condylar fracture, Extraoral approach, Mini-retromandibular access.

Jaw bones regeneration using mesenchymal stem cells. A single-center experience.

PURPOSE: Mesenchymal stem cells (MSC), which are multipotent stromal cells, are considered to be a promising resource in tissue engineering and tissue regeneration. MSCs have been used to generate new maxillary bone with clinically successful results. The aim of this study was to determine the role of MSC in bone regeneration procedures in patients with benign maxillary lesions. METHODS: A study was conducted on five patients treated for maxillary bone defects resulting from biopsy of benign lesions at the University Hospital of Magna Græcia, Catanzaro, Italy from January 2015 to October 2016. MSC from autologous bone marrow were used for bone regeneration. The bone mineral density was compared, using the Hounsfield scale, before and after treatment. Follow-up was monthly for six months, and the patients underwent a computed tomography scan of the maxilla at 6 months. RESULTS: Five patients, who underwent biopsy of osteolytic odontogenic benign tumors, were included in the study. There were no intraoperative or postoperative complications. The mean volume of the newly formed bone was 2.44cm3 (range 2,0-3,1) and the mean bone density was 1137 Hounsfield Units (range 898-1355). CONCLUSIONS: Bone regeneration with MSC from autologous bone marrow appears to be a valid treatment option for maxillary bone defects. KEY WORDS: Bone regeneration, Mesenchymal stem cells, BM-MSC, Upper jaw, Mandible.

Effects of cold therapy in the treatment of mandibular angle fractures: hilotherm system vs ice bag.

AIM: To evaluate the effectiveness of Hilotherm, a recently introduced cooling system, in controlling postoperative edema and pain and to compare the results with those obtained with conventional cryotherapy. MATERIAL OF STUDY: The investigators selected 40 patients with unilateral angle fracture of the jaw and divided them into two groups, cryotherapy with ice bag (A group), and Hilotherapy system (B Group); both groups with the same drug treatment. Facial swelling was preoperatively quantified measuring skin segments (called α, ß, γ and δ), pain and patient satisfaction were measured for each with questionnaires. RESULTS: Data analysis showed better decrease of soft tissue edema and better pain control with Hilotherapy system in post-surgical treatment. DISCUSSION: The cooling procedures described are ice packs, gel packs or cold compresses. An alternative to conventional cooling methods is Hilotherapy (HilothermGmbH, Ludwigsburg, Germany) a water-circulating cooling device that permits continuous cooling through a face polyurethane preshaped mask. CONCLUSIONS: The results of this study suggest that Hilotherm is the better method for patient's postoperative edema and pain management when compared to conventional cooling probably due to possibility of mean temperature control and to greater patient's compliance. KEY WORDS: Cold therapy, Cooling methods, Mandibular fractures.

Postextractive implants in aesthetic areas: evaluation of perimplant bone remodeling over time.

AIM: The aim of this research was to assess peri-implant bone remodeling of post-extractive implants over 2 years. MATERIAL AND METHODS: 30 patients meeting pre-established inclusion criteria were enrolled for the study. One implant for each patient was inserted in the post-extraction sockets according to a defined surgical protocol (atramautic extraction, curettage of extraction socket, implant insertion, grafting with collagenated cortico-cancellous porcine bone, and a trimmed collagen membrane to completely cover the socket, suture). A temporary adhesive bridge, with an adequate profile, was bonded to the adjacent teeth. X-ray evaluation with a standardized stent was carried out at different times. Measurements were obtained from the implant edge to the bone peak. The values obtained at time 0 and at 2 years were compared by t-student test. RESULT: Our results showed that after one year 73% of patient had 0 mm of bone reabsorption, 20% of patient had 0 mm ≤ x ≤ 0.5mm, 7% of patient had 0.5 mm ≤ x ≤ 2 mm of bone reabsorption. After two years 62% of patient had 0 mm of bone reabsorption, 24% had 0 mm ≤ x ≤ 0.5mm, 14% had 0.5 mm ≤ x ≤ 2 mm. CONCLUSIONS: The results showed no significant differences in bone reabsorption in most patients over 2 years.