Osteotomy in Genioplasty by Piezosurgery.

BACKGROUND: The chin is the most prominent and median sector of the lower third of the face giving harmony to nose and lips. The authors present the application of piezoelectric scalpel for the correction of different chin deformities. The distinctive characteristics of this device allow us to avoid or reduce the immediate genioplasty complications. METHODS: Fifty-five patients with defective chin have been treated from January 2006 to April 2008. Intraoral chinplasty was performed during the correction of dentofacial dysmorphisms or associated with nasal surgery. The authors used a piezoelectric cutting device to perform different osteotomies and if necessary, interpositional graft was used to stabilize bony segments. RESULTS: Piezosurgery has been associated with a fewer number of postoperative complications, especially as regard intraoperative bleeding, nerve injuries (immediate and late), hematomas and seromas, and asymmetry (immediate and early). The mean time for completing the complete procedure of genioplasty with piezosurgery was almost the same compared with the saw and drill. CONCLUSIONS: Chinplasty represents one of the most common ancillary procedures and may be associated with corrective surgery of dentofacial dysmorphisms. Mental nerve injuries, asymmetries, intraoperative bleeding are the main immediate complications of genioplasty. Distinctive characteristics of ultrasonic piezoelectric osteotomy are selective cut of mineralized structure with less risk of vascular and nervous damage (microvibrations), intraoperative precision (thin cutting scalpel and no macrovibrations), blood free site (cavitation effect). In our experience, piezoelectric scalpel, compared with saw and drill, enables us to reduce or avoid immediate complications of chin surgery, helping the surgeon to reach patients' satisfaction. LEVEL OF EVIDENCE: IV.

Nonsurgical Rhinoplasty With the Novel Hyaluronic Acid Filler VYC-25L: Results Using a Nasal Grid Approach.

BACKGROUND: Nonsurgical aesthetic treatment of the nose is becoming increasingly popular. VYC-25L is a novel hyaluronic acid product with the high G' and cohesivity required of a nasal filler. OBJECTIVES: The authors sought to assess the safety and efficacy of VYC-25L for treatment of the nose utilizing a previously published, grid-based protocol. METHODS: This was a retrospective, single-center analysis of data from adult patients undergoing treatment of the nose with VYC-25L between February and April 2019 utilizing the grid system as the reference for injection quantity and sequencing. Specific procedures included correction of inadequate projection, deep glabella treatment, correction of a nasal hump, and adjustment of the nasolabial angle and columella. Patients were followed-up for 6 to 9 months. RESULTS: A total of 61 patients were included in the analysis (mean age, 32 ±â€…3 years; n = 45 females [74%]). At 2 weeks posttreatment, a high degree of defect correction was confirmed based on independent evaluation, with all patients scoring 9 or 10 on a 10-point visual analog scale. Fifty-nine of 61 patients (97%) self-assessed the degree of correction as "adequate." Results were stable at 3- and 6-month follow-up visits. Complications recorded were bruising (n = 15, 25%), asymmetry (n = 2, 3%), and hematoma (n = 1, 2%). All resolved rapidly. There were no cases of infection, bumps, or skin necrosis. CONCLUSIONS: VYC-25L is safe and efficacious for treatment of the nose, with high levels of patient satisfaction. It has potential to be a valuable tool in nonsurgical rhinoplasty.

Resin Infiltration in Dental Fluorosis Treatment-1-Year Follow-Up.

Background and objective: Dental fluorosis is a disease affecting dental hard tissues featured with white or yellowish lesions. Several treatments are proposed in the literature, some even invasive. This clinical study aimed to evaluate the effectiveness of resin infiltration in terms of lesions resolution, trend of sensitive teeth and satisfaction of patients over time. Methods and material: 200 fluorosis lesions were treated using ICON infiltrating resin (DMG, Hamburg, Germany). Parameters related to patients were collected by a questionnaire and analyzed aesthetic dissatisfaction about lesions, Shiff Air Index Sensitive Scale, sensitive teeth after treatment, the satisfaction of duration of treatment. The same operator measured dimensions of lesions Tooth Surface Index of Fluorosis (TSIF) and numbers of etching cycles needed for treating lesions. Statistical analysis was performed. The follow-up was of 1-year a measurement were performed at baseline (t0), immediately after the treatment (t1) and every three months during the observation period. Results: All lesions disappeared after one treatment. Pain or sensitive teeth were reported inside the 72 h and they disappeared after. Statistical analysis showed highly statistically correlation between etching cycles and the dimension of lesions and TSIF at the time-points evaluated as well as for pain during treatment, whereas a statistical significance was not noticed where etching cycles were correlated to sensitive teeth after 72 h. Overall, the treatment was found to be statistically significantly associated with differences in answers of aesthetic dissatisfaction between t0 and t1 and those collected between t1 and t2. Between t2 and t3 and between t3 and t4 no statistical differences were found in answers of patients about dissatisfaction, indicating the stability of the results. Conclusions: The ICON resin infiltration technique was found to be effective in lesions resolution with steady results.

The skin rejuvenation associated treatment-Fraxel laser, Microbotox, and low G prime hyaluronic acid: preliminary results.

Minimally invasive facial rejuvenation procedures reached an all-time high in the 2016. This reveals a growing interest in a smoother, younger, and tighter look accessible using the esthetic medicine tools like botulinum toxin and dermal filler injections, laser, and microdermabrasion. Forty-five patients from 35 to 52 years old (medium age 43.8), 38 women and 7 men underwent 5 sessions of Fraxel laser, 1 session of very low G prime HA, and Microbotox injection treatments from January 2016 and January 2017, were included in this study. In this study, we demonstrated that the usage of three treatments together, like mBTX, Volite, and Fractional laser, have a better result despite every single technique alone. The clinical result showed 98% (44 patients, 6 males, 38 females) of the patients had a smoother skin surface, brighter, more hydrated, and elastic skin; 68% of our patients (31 patients, 5 males, 26 females) showed less skin defects and staining as well as less small wrinkles, thanks to Fraxel laser treatment; 98% (44 patients, 6 males, 38 females) showed tighter skin with less sebaceous gland secretion. The aim of this study was to demonstrate that the combination of three techniques acts better and faster than single treatment to contrast facial aging and to improve skin texture and quality.

Platelet-Rich Plasma in Treatment of Temporomandibular Joint Dysfunctions: Narrative Review.

BACKGROUND: The aims of this narrative review were to examine up-to-date literature in order to evaluate the effectiveness of arthrocentesis or injections with platelet-rich plasma in temporomandibular affections and to compare them to arthrocentesis alone or with hyaluronic acid (HA) or to hyaluronic acid injections. METHODS: The search of international literature was made on the PMC, PubMed and Cochrane databases, including all full-length text of studies on humans focused on osteoarthritis and disc displacements and their treatment with platelet-rich plasma arthrocentesis or injections. All design studies were included in the review and they were examined for three different outcomes: pain, joint sound and mandibular motion. English papers were only selected. RESULTS: Even though the low number of studies in this field, arthrocentesis with platelet-rich plasma and platelet-rich plasma injections in temporomandibular disorders' management were found to be effective in reducing pain and joint sound as well as in improving mandibular motion in a maximum follow-up of 24 months. CONCLUSION: Comparison to arthrocentesis alone or to HA use in arthrocentesis or by injections provided encouraging results in terms of the effectiveness of platelet-rich plasma use.

Face Treatment Using Nonsurgical Mini-Invasive Techniques as Postsurgical Procedure for Traumatic Injury.

BACKGROUND: Facial trauma can cause major psychological damage and compromise a patient's quality of life. Unfortunately, surgery cannot always solve this problem or provide an acceptable result. OBJECTIVES: Treatment with injectables may provide a solution that is minimally invasive and better accepted by patients as a means to improve poor outcomes after facial trauma. METHODS: This retrospective study involved 50 patients (29 men, 21 women) who underwent primary surgery to treat facial trauma between January 2015 and January 2017. Based on the facial area affected by poor outcomes (upper face, midface, and lower face), patients underwent ≥1 aesthetic medicine treatments with hyaluronic acid dermal fillers and botulinum toxin injections. To evaluate patient satisfaction and the effect of the treatment on quality of life, patients were asked to complete 2 questionnaires, POSAS and FACE-Q, prior to treatment and 90 days after the last treatment session. RESULTS: Questionnaire scores indicated improvements in aesthetic and psychological metrics, perceived both by the patient and the observer. CONCLUSIONS: Minimally invasive aesthetic treatments represent a valuable adjunct to surgical procedures for improving facial aesthetics after injury and consequently the quality of life of patients affected by facial trauma.

Osteotomy in Genioplasty by Piezosurgery.

BACKGROUND: The chin is the most prominent and median sector of the lower third of the face giving harmony to nose and lips. The authors present the application of piezoelectric scalpel for the correction of different chin deformities. The distinctive characteristics of this device allow the authors to avoid or reduce the immediate genioplasty complications. METHODS: Fifty-five patients of defective chin have been treated from January 2006 to April 2008. Intraoral genioplasty was performed during the correction of dentofacial dysmorphisms or associated with nasal surgery. The authors used a piezoelectric cutting device to perform different osteotomies and if necessary, interpositional graft was used to stabilize bony segments. RESULTS: Piezosurgery has been associated with a fewer number of postoperative complications, especially as regard intraoperative bleeding, nerve injuries (immediate and late), hematomas and seromas, asymmetry (immediate and early). The mean time for completing the complete procedure of genioplasty with piezosurgery was almost the same compared with the saw and drill. CONCLUSION: Genioplasty represents one of the most common ancillary procedures and may be associated with corrective surgery of dentofacial dysmorphisms. Mental nerve injuries, asymmetries, intraoperative bleeding are the main immediate complications of genioplasty. Distinctive characteristics of ultrasonic piezoelectric osteotomy are selective cut of mineralized structure with less risk of vascular and nervous damage (microvibrations), intraoperative precision (thin cutting scalpel and no macrovibrations), blood free site (cavitation effect). In the authors' experience, piezoelectric scalpel, compared with saw and drill, enables them to reduce or avoid immediate complications of chin surgery, helping the surgeon to reach patients' satisfaction.

Acute mercury exposition of virgin, pregnant, and lactating rats: Histopathological kidney and liver evaluations.

This work investigated the effects of mercury chloride (HgCl2 ) acute exposure on virgin, pregnant and lactating rats by determination of renal and hepatic morphological and ultrastructural parameters and the expression of oxidative stress and stress tolerance markers, due to kidney and liver are the organs that more accumulate inorganic mercury. Adult Wistar rats virgin (90 days old), pregnant (18th gestation day) and lactating (7th lactation day) were injected once with HgCl2 (5 mg/kg) or saline (controls). We observed that HgCl2 exposure of virgin rats caused significant inflammatory infiltration and severe morphological variations, like glomeruli atrophy, dilatation of Bowman's capsule, tubular degeneration and hepatocytes alteration. Moreover, virgin rats presented mitochondrial modification, important oxidative stress and increase in stress tolerance proteins at both kidney and liver level, compared with virgin controls. In detail, virgin rats exposed to HgCl2 presented significantly elevated level of inducible nitric oxide synthase, heat shock protein 27 and glucose regulated proteins 75 expressions at both renal tubular and hepatocytes level, respect untreated virgin rats. Interestingly, pregnant and lactating rats exposed to HgCl2 presented weak renal and liver morphological alterations, showing weak inflammatory infiltration and no significant difference in structural mitochondrial transmembrane protein, oxidative stress markers and stress tolerance proteins expressions respect controls (virgin, pregnant and lactating rats). Although, both control and HgCl2 -exposed pregnant and lactating rats showed renal glomeruli greater in diameter respect virgin rats. In conclusion, we believe that virgin rats are more sensitive to HgCl2 toxicity respect pregnant and lactating rats. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 1500-1512, 2017.

Chin Microgenia: A Clinical Comparative Study.

BACKGROUND: The aesthetic relevance of the chin and its relatively simple correction through different approaches make genioplasty one of the most performed aesthetic procedures of the face. Sliding genioplasty is extremely rewarding, particularly when performed as an adjunction to rhinoplasty, rhytidectomy, or jaw surgery. In the scientific literature, many different surgical techniques are described, but the biological implications and the economical impact can shape the surgeon's decision on which can be the best treatment: surgical correction with osteotomy, chin implants, or with fillers. OBJECTIVE: The authors propose a decision making protocol for correcting chin microgenia based on a revision of 345 treated cases. METHODS: A retrospective review of 345 cases of chin microgenia was undertaken to understand the proper preoperative assessment and therapeutic planning. A total of 135 patients were treated with surgical sliding genioplasty (group A): 60 patients (group B) have been grafted with alloplastic implants and the remaining 150 patients (group C) with hyaluronic acid. We recorded clinical indications, complications, and long-term aesthetic results at 3-year follow-up. RESULTS: The analysis of the results based on the entity of the chin's sagittal defect, the chin soft-tissue thickness, the patient's age, and self-judgment allows for simplified treatment planning for sagittal chin deformities showing a greater predictability and a more stable long-term aesthetic result regarding sliding genioplasty compared to alloplastic implant placement and fillers. CONCLUSIONS: Our proposal for a simple and versatile protocol of chin microgenia aims to simplify the therapeutic indications for a predictable and a stable long-term aesthetic result. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Eagle syndrome surgical treatment with piezosurgery.

INTRODUCTION: Eagle syndrome (ES) is an uncommon complication of styloid process elongation with stylohyoideal complex symptomatic calcification. It is an uncommon condition (4% of the population) that is symptomatic in only 4% of the cases. Eagle syndrome is usually an acquired condition that can be related to tonsillectomy or to a neck trauma. A type of ES is the styloid-carotid syndrome, a consequence of the irritation of pericarotid sympathetic fibers and compression on the carotid artery. Clinical manifestations are found most frequently after head turning and neck compression. Although conservative treatment (analgesics, anticonvulsants, antidepressants, local infiltration with steroids, or anesthetic agents) have been used, surgical treatment is often the only effective treatment in symptomatic cases. MATERIALS AND METHODS: We present the case of a 55-year-old patient, successfully treated under endotracheal anesthesia. The cranial portion of the calcified styloid process was shortened through an external approach, using a piezoelectric cutting device (Piezosurgery Medical II; Mectron Medical Technology, Carasco, Italy) with MT1-10 insert, pump level 4, vibration level 7. RESULTS: No major postoperative complications such as nerve damage, hematoma, or wound dehiscence occurred. After 6 months, the patient was completely recovered. Two years after the surgery, the patient did not refer any symptoms related to ES. CONCLUSIONS: The transcervical surgical approach in patients with ES seems to be safe and effective, despite the remarkable risk for transient marginal mandibular nerve palsy. This risk can be decreased by the use of the piezoelectric device for its distinctive characteristics--such as precision, selective cut action, and bloodless cut.

Surgical treatment of unilateral condylar hyperplasia with piezosurgery.

INTRODUCTION: Unilateral condylar hyperplasia (UCH) is a disorder of unknown etiology mainly seen in growing patients, which results in facial asymmetry. High condylectomy alone or in association with orthognathic surgery can improve the occlusion and the facial aesthetics. MATERIALS AND METHODS: Between 2005 and 2012, a total of 5 patients underwent high condylectomy for UCH using a piezoelectric cutting device. All patients were treated postoperatively with functional rehabilitation. RESULTS: The long-term follow-up showed that all patients had a satisfactory temporomandibular joint articular function associated with stable occlusion without any recurrence of further condylar growth. CONCLUSIONS: High condylectomy in the surgical treatment of unilateral UCH seems to be the procedure of choice in growing patients. The use of a piezoelectric cutting device allows a safe and less invasive high condylectomy.

Topical Agents in Biofilm Disaggregation: A Systematic Review and Meta-Analysis.

Background: to evaluate the effectiveness of different topical agents in biofilm disaggregation during non-surgical periodontal therapy. Methods: the search strategy was conducted according to the PRISMA 2020 on Pubmed, Cochrane Library, Scopus, and Web of Science, and it was registered in PROSPERO, ID: CRD42023474232. It included studies comparing non-surgical periodontal therapy (NSPT) with and without the application of topical agents for biofilm disruption. A risk of bias analysis, a qualitative analysis, and a quantitative analysis were performed. Results: out of 1583 records, 11 articles were included: 10 randomized clinical trials and one retrospective analysis. The total number of participants considered in the 11 articles included in the study was 386. The primary outcomes were probing pocket depth (PPD), clinical attachment level (CAL), and bleeding indices. The secondary outcomes were plaque indices, gingival recessions, and microbiological parameters. The meta-analysis revealed the following: [Weighted mean difference (WMD): -0.37; 95% confidence interval (CI) (-0.62, -0.12), heterogeneity I2: 79%, statistical significance p = 0.004]. Conclusions: the meta-analysis of probing pocket depth reduction (PPD) between baseline and follow-up at 3-6 months showed a statistically significant result in favor of sulfonated phenolics gel. The scientific evidence is still limited and heterogeneous; further randomized clinical trials are required.

The Impact of Standing Electric Scooters on Maxillofacial Fractures: An Italian Multi-Centric Epidemiological Study.

Objectives: This study aimed to determine the impact of standing electric scooters on maxillofacial on the Italian territory. Methods: The authors analyzed the epidemiology of the injuries to define electric mobility's impact on maxillofacial surgery practice. For this retrospective cohort study, data were collected by unifying the standing e-scooter-related fractures database from 10 Italian maxillofacial surgery departments. The reference period considered was from January 2020 to December 2023. The main data considered included age, gender, type of access, time slot of admission, type of admission, alcohol level, helmet use, dynamics of the accident, and area of the fracture. Results: A total of 79 patients were enrolled. The average age of the participants was approximately 31 years. The blood alcohol level was found to be above the Italian norm in 15 cases (19%). Only one patient wore a helmet. The most affected facial third was the middle one with 36 cases (45.5%), followed by the lower one (31, 39.3%). The most recurrent patterns were fractures of the orbito-malar-zygomatic complex (15, 19%), followed by multifocal (bifocal, trifocal) fractures of the mandible (14, 17.5%). Conclusions: This study demonstrated how maxillofacial fractures related to the use of electric scooters are associated with complex patterns, associated with a high rate of post-surgical aftermaths.

Piezosurgery versus conventional osteotomy in orthognathic surgery: a paradigm shift in treatment.

The aim of the study was to compare in a randomized controlled clinical trial the use of the piezoelectric osteotomy as an alternative to the conventional approach in terms of surgery time, intraoperative blood loss, cut quality, nerve injury, and costs.One hundred ten patients who had orthognathic surgery procedures with bimaxillary osteotomy were divided into 2 groups: group A was treated with a piezosurgery device, and group B, with a reciprocating saw and bur.The piezosurgical bone osteotomy permitted individualized cut designs. The surgical time in group A was reduced, with a mean for the mandibular osteotomy (1 side) between 3 minutes 31 seconds and 5 minutes 2 seconds, whereas in group B, the surgical time was between 7 minutes 23 seconds and 10 minutes 22 seconds. The surgical time in group A for the Le Fort I osteotomy was between 5 minutes 17 seconds and 7 minutes 55 seconds in group A and between 8 minutes 38 seconds and 15 minutes 11 seconds in group B. All patients in group A had a low blood loss (<300 mL) versus patients of group B who had a medium to high blood loss (medium loss: 400 mL, high loss: >500 mL). Inferior alveolar nerve sensation was retained in 98.2% of group A versus 92.7% in group B at 6 months postoperative testing.Piezoelectric osteotomy reduced surgical time, blood loss, and inferior alveolar nerve injury in bimaxillary osteotomy. Absence of macrovibrations makes the instrument more manageable and easy to use and allows greater intraoperative control with higher safety in cutting in difficult anatomical regions.

Fracture strength and ribbond fibers: In vitro analysis of mod restorations.

Background: Ribbond fibers are supposed to be a reinforcing material in restoration of compromised teeth. This study aims to compare MOD restorations with and without Ribbond Fiber in terms of fracture strength under axial loading; to identify the minimum depth of MOD cavities to use Ribbond Fiber (to improve the fracture strength under axial load. Material and Methods: 20 upper and lower molars extracted intact were used for the experiment. The teeth were prepared with 2 types of cavities and then divided into 4 groups: 1) 5 mm deep MOD cavities with residual interaxial dentin restored without Ribbond; 2) 5 mm deep MOD cavities with residual interaxial dentin restored with Ribbond; 3) 5 mm deep MOD cavities without residual interaxial dentin, restored without Ribbond; 4) 5 mm deep MOD cavities without residual interaxial dentin restored with Ribbond. The restored teeth were then subjected to thermal cycling and their fracture strength was evaluated using an Instron device. The Mann-Whitney statistical test was used to compare fracture strength among groups. Finally, a descriptive analysis of the verified fractures was performed. Results: There was a statistically significant difference between groups 1 and 2 (P = 0.0090) in the loading force required for a fracture. In contrast, there was no statistically significant difference between groups 3 and 4 (P = 0.7540). Groups 1 and 2 had the fewest non-restorable fractures, in contrast to groups 3 and 4. Conclusions: Ribbond fiber application in MOD cavities seems to be more effective in terms of strengthening where cavities have interaxial dentinal tissue. Key words:Ribbond fibers, fracture strenght, direct dental restorations.

Six-Month Soft Tissues Healing after Lower Third Molar Extraction: Comparison of Two Different Access Flaps.

BACKGROUND: As specific flap designs performed for lower third molar extractions usually influence periodontal healing of the adjacent first and second molars, this study aimed to evaluate the periodontal conditions of these sites after 6 months post-surgery. METHODS: Forty patients, aged 14-30 years, were included. Surgical extraction of the lower third molar was performed through a flap with papilla detachment (a modified envelope technique with detachment of gingival papilla between the first and second molars) or a trapezoidal flap (characterized by mesial- and distal-releasing incisions). Periodontal parameters at the first and second molar sites were assessed for visible plaque index, bleeding on probing, recession, probing pocket depth, and clinical attachment loss before surgery (T0), one month (T1), and six months after extraction (T2). RESULTS: No statistical differences were found for the plaque and bleeding indexes between the two flaps at each observation time and considering both time intervals. For recession, no statistical differences were found between the two flaps considering the final time interval. For probing pocket depth at the second molar site, both techniques registered a significant increase between T0 and T1, followed by a decrease up to T2. For clinical attachment loss, mean values assessed for the first and second molar sites demonstrated evidently increased values between T0 and T1, followed by moderate decreases up to T2. CONCLUSIONS: Considering short (T1) and mid-term (T2) follow-ups, a specific flap design does not seem to particularly influence periodontal healing six months after surgery.

Influence of Surgical Technique on Post-Operative Complications in the Extraction of the Lower Third Molar: A Retrospective Study.

The surgical extraction of the impacted third molar is frequently associated with several complications. The purpose of this study is to assess how two different surgical protocols affect post-operative complications during the extraction of the lower impacted third molars. In order to compare and evaluate two different techniques (triangular flap vs. envelope flap), and the relative post-extraction complications, two groups of 150 patients each underwent to surgical impacted third molar extraction and 60 days of follow-up. The complication rate in the two groups was 14.00% in group A and 17.33% in group B. There was a strong association between smoking (OR: 2.8) and the use of oral contraceptives (OR: 1.75) with complications. The age- and sex-related incidence of complications in hard tissue healing has great variability in the literature; the analysis performed on our data did not show a statistically significant association between them. Even though related to a higher incidence of transient changes in sensitivity, it was found that the envelope flap saw a lower percentage of complications. There is still no clarity on which is the best protocol for the extraction of the lower impacted third molar, and the choice often depends on the surgeon's experience.

Outcomes of a Pharmacological Protocol with Pentoxifylline and Tocopherol for the Management of Medication-Related Osteonecrosis of the Jaws (MRONJ): A Randomized Study on 202 Osteoporosis Patients.

Medication-related osteonecrosis of the jaws (MRONJ) is a challenging situation in clinics. Previous studies have shown that pentoxifylline combined with tocopherol proved to be beneficial in patients with osteoradionecrosis, due to their antioxidant and antifibrotic properties. The aim of this randomized study was to evaluate the effect of pentoxifylline and tocopherol in patients that had developed MRONJ after tooth extractions. The study population consisted of 202 Stage I MRONJ female patients with an average age of 66.4 ± 8.3 years, who were divided into two groups. The test group (n = 108) received a pharmacological protocol with pentoxifylline and tocopherol (2 months pre-operatively and 6 months post-operatively). The control group (n = 94) had sequestrectomy operations without any pharmacological preparation. The main outcomes were clinical healing of the mucosa after 1 month, and clinical and radiographic healing of the bone lesion at 6 months. In the test group all patients had mucosal healing and there was only one relapse within 6 months. In the control group, in 17% of the patients the mucosa did not heal, 71% of the patients relapsed within two months, and 7% developed infectious complications (such as abscess or phlegmon). After 6 months, the control group patients with persisting issues were prescribed pentoxifylline and tocopherol, as in the test group. At a subsequent follow-up, all those patients healed completely. Patients were monitored for a period of 7.8 ± 0.3 years, during which no relapse or additional problems were reported. As a conclusion, pentoxifylline and tocopherol protocol seems to be beneficial in the management of MRONJ patients.

Application of the "All-on-Four" concept and guided surgery in a mandible treated with a free vascularized fibula flap.

In this article, we describe the first case in the literature in which 3D computer-assisted treatment planning and guided surgery enabled a patient affected by extreme paraphysiologic mandibular bone atrophy to be treated with a free vascularized fibula flap and, after a period of healing, the flapless installation of 4 immediately loaded dental implants. The computer-fabricated surgical guide allowed placement of the implants according to the "All-on-Four" concept in a proper spatial preplanned position and by tilting 1 implant, avoiding an area of bone discontinuity. Additionally, this technique allowed the production of a prefabricated temporary prosthesis, delivered after implant insertion, which could be immediately loaded. The use of a fibula flap makes it possible to create greater bone thickness while computer-assisted treatment planning and guided surgery provide several advantages over the traditional technique.

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.