A Full Computerized Workflow for Planning Surgically Assisted Rapid Palatal Expansion and Orthognathic Surgery in a Skeletal Class III Patient.

In the present case report, we present and discuss the digital workflow involved in the orthodontic/orthognathic combined treatment of a skeletal malocclusion correction in a 17-year-old male patient affected by a skeletal class III, facial asymmetry, sagittal and transversal deficiency of the medium third of the skull, dental crowding, and bilateral cross-bite. The first stage of the treatment involved surgically assisted rapid palatal expansion and occlusal decompensation, using fixed self-ligating appliance. An orthodontic software package (i.e., Dolphin 3D Surgery module) was used to perform virtual treatment objective evaluation by integrating data from cone beam computer tomography acquisition, intraoral scan, and extraoral photographs. The software allowed a comprehensive evaluation of skeletal, dento-alveolar, and soft-tissue disharmonies, qualitative and quantitative simulation of surgical procedure according to skeletal and aesthetic objectives, and, consequently, the treatment of the malocclusion. Using a specific function of the software, the surgical splint was designed according to the pre-programmed skeletal movements, and subsequently, the physical splint was generated with a three-dimensional (3D) printing technology. Once a proper occlusal decompensation was reached, a Le Fort I osteotomy of the maxilla and a bilateral sagittal surgical osteotomy of the mandible were executed to restore proper skeletal relations. The whole treatment time was 8 months. The orthodontic/orthognathic combined treatment allowed to correct the skeletal and the dental imbalance, as well as the improvement of facial aesthetics. Accordingly, the treatment objectives planned in the virtual environment were achieved. Virtual planning offers new possibilities for visualizing the relationship between dental arches and surrounding bone and soft structures in a single virtual 3D model, allowing the specialists to simulate different surgical and orthodontic procedures to achieve the best possible result for the patient and providing an accurate and predictable outcome in the treatment of challenging malocclusions.

Correlation Between Maxillary Canine Impaction and Facial Biotype.

AIM: The etiology of teeth impaction is still not fully understood, despite that cofactors have been considered important to develop such a clinical picture. The aim of the authors' paper was to investigate about facial biotype, about the values of inclination of the upper cuspid axis to the perpendicular to Frankfort-horizontal plane and about the distance "d" of the canine cuspid to occlusal plane: each factor was statistically compared. The authors also performed a comparative analysis on the radicular length of the left and right lateral incisors of subjects with impacted maxillary canine. METHODS: The authors recruited with "cluster sampling" randomization more than 30 patients, then refined to 25 after the application of exclusion criteria. Specific values were carried out by x-rays: the authors calculated both the α and ß angles, the intermaxillary angle, the distance "d" and the inclination of upper cuspid axis to the perpendicular-to-Frankfort-horizontal plane. Spearman rank correlation coefficient or Spearman rho (ρ) was used as statistical methods. RESULTS: The authors' results assessed that the inclination of the upper cuspid axis to the perpendicular-to-Frankfort-horizontal plane showed a statistically significant inverse correlation with the intermaxillary angle. CONCLUSION: The authors' data clearly indicate that hyperdivergence is a key-factor that will certainly support the eruption path of canine cuspid: in this light, the treatment of tooth impaction in hyperdivergent subjects can be considered as predictive for a good prognosis.

Eradication of hairy mouth after oncological resection of the tongue and floor mouth using a diode laser 808 nm. Postoperative pain assessment using thermal infrared imaging.

OBJECTIVES: Vascularized soft tissue flaps are often harvested from hair-bearing areas, such as the radial forearm or anterolateral thigh, making their use in oral reconstruction problematic due to postoperative hair growth. The presence of intact hair follicles in free tissue transfer and continued hair growth at the recipient site can result in difficulties with oral hygiene, intraoral irritation, food trapping, and patient distress. This study was to evaluate the intraoral efficacy and safety of a diode laser 808 nm when used for hair removal. MATERIALS AND METHODS: Sixteen male patients, between 2010 and 2017, were referred for intraoral hair eradication with a history of squamous cell carcinoma of the tongue or floor mouth resection. An 808 nm diode laser (Stark 808, Plume s.r.l., Rome, Italy) was used to remove the intraoral hair. Each patient received a total of six treatments at 4-week intervals. Perifollicular pain was quantified by the physician using visual analog scales. Follow-up visits were scheduled at 1, 4, and 6 days to check the state of the tissues. The recall program included assessments of VAS, erythema, and perifollicular temperature. Patients were followed up for long-term assessments at 6 and 12 months after the final treatment session. RESULTS: All patients presented well with no occurrence of symptoms, indicating possible perifollicular inflammation. Based on the VAS scores, very mild discomfort during laser irradiation was recorded in all patients, with average pain score of 10.98 ± 1.42. No pain or discomfort was recorded 1, 4, and 6 days after the procedure. After the third pulse of light was applied, the average temperature with standard deviation of the hair tip with both the dark and light skin was 74.4 ± 11.7°C. The difference in temperature before the procedure (basal measurement 37.5 ± 2.8°C) and immediately after laser irradiation was 36.9 ± 3.7°C. The difference in temperature disappeared after 0.29 seconds, and no temperature increase was recorded on days 1, 4, or 6. In all the patients, the hair clearance between baseline and the 6th treatment, the 6-month follow-up, and the 12-month follow-up rated as significant P < 0.05. The mean percentage of hair reduction was 97.3% at 12 months. CONCLUSION: In conclusion, the clinical findings demonstrate the safety and efficacy of the 808 nm diode laser system for intraoral hair removal Lasers Surg. Med. 51:516-521, 2019. © 2019 Wiley Periodicals, Inc.

Preliminary Study to Evaluate Marginal Bone Loss in Cases of 2- and 3-Implant-Supported Fixed Partial Prostheses of the Posterior Mandible.

PURPOSE: The purpose of this study was to evaluate, by radiographic examinations, the marginal bone resorption around implants in cases of 2 and 3 implant-supported fixed partial prostheses (FPPs) at the posterior mandible. METHODS: A retrospective study of 41 patients (23 males, 18 females) of an average age of 67 years (range, 53-85), with 2 and 3 implants-supported FPPs in the posterior mandible that were treated during 2006 to 2015. The mean follow-up time was 6.32 years (range, 2-10). Twenty-four patients had FPPs on 2 implants (a total of 48 implants). Seventeen patients had FPPs on 3 implants (a total of 51 implants). Clinical and radiographic follow-up examinations were performed. All radiographs were analyzed for changes in marginal bone height surrounding the implants. RESULTS: The mean marginal bone loss around the most mesial implant was slightly higher in the 2-implant group (0.833 mm) compared with the 3-implant group (0.431 mm). The correlation between the mean marginal bone loss around the most mesial implant and the number of implants was of borderline value (P = 0.055). CONCLUSIONS: Considering the limitations of this preliminary study, the authors found that the mesial implant in the 2-implant group is more susceptible to marginal bone loss.

Bilateral Hyperplasia of the Coronoid Process in Pediatric Patients: What is the Gold Standard for Treatment?

OBJECTIVES: The aim of this systematic review of the literature is to describe treatment options for bilateral coronoid process hyperplasia in pediatric patients, to describe etiologic and diagnostic correlations with the treatment, and to evaluate long-term follow-up treatment outcomes. METHODS: A systematic revision of the literature was performed in the Medline, PubMed, Cochrane library, and Embase database up to December 5, 2017. Predetermined Medical Subject Heading keywords were used: "bilateral" or "monolateral" and "coronoid" or "coronoid process" and "hyperplasia" and "temporomandibular joint" or "tmj" and "ankylosis" or "trismus" and "treatment." Results were recorded following PRISMA guidelines. RESULTS: The systematic research produced 1459 results excluding duplicates. Two additional studies from "Grey literature" were also considered. After application of inclusion and exclusion criteria, 38 articles were selected for a qualitative synthesis. Data regarding sex and age of presentation were collected and summarized in a study flow diagram. CONCLUSION: It is possible to conclude that early diagnosis is fundamental to restore stomatognathic multifunction. There is lack of longitudinal studies presenting long-term follow-up to determine treatment stability. Coronoidectomy might be considered gold standard treatment for this pathologic condition.

Auto-Fluorescence and Histopathologic Evaluation of Medication-Related Osteonecrosis of the Jaws: Perspectives for Treatment.

Auto-fluorescence (AF) of healthy bone tissue has recently been described. Loss of AF (LAF) has, on the contrary, been reported in necrotic bone. Further, the use of LAF as a possible guidance to distinguish viable from necrotic bone during surgical treatment of osteonecrosis has been proposed. The aim of this study is to detail 8 patients of medication-related osteonecrosis of the jaws treated through an AF-guided surgical resection. The authors also provide the histopathologic description of hypo-fluorescent and hyper-fluorescent bone in each patient. After removal of necrotic bone block, Er:YAG laser was used for vaporizing further necrotic bone, up to the detection of strongly hyper-fluorescent bone. Samples of hyper-fluorescent bone were collected around areas of necrosis. Histopathologic evaluation revealed viable bone tissue in all hyper-fluorescent specimens. On the basis of these data, AF-guided surgical resection could be effective in highlighting surgical margins of necrotic bone tissue and it might have some utility in a range of applications of bone surgery.

Growth Factors Release From Concentrated Growth Factors: Effect of ß-Tricalcium Phosphate Addition.

BACKGROUND: Platelet concentrates represent a new approach to improve tissue regeneration and can be used alone or together with autogenous bone, recombinant human growth factors, and/or other biomaterials, to enhance tissue regeneration. Among platelet concentrates, concentrated growth factors (CGFs) exhibit an interesting clinical and biotechnological application potential. OBJECTIVE: The aim of this study was to evaluate the in vitro release of 4 growth factors (bone morphogenetic proteins [BMP] -2, BMP-7, transforming growth factor [TGF] -ß1, and insulin-like growth factor [IGF] -1) by the enzyme-linked immunosorbent assay (ELISA) technique, in CGFs mixed or not with ß-tricalcium phosphate (ß-TCP), using or not the Round-up device, at different times. METHODS: CGFs were obtained from healthy volunteers, mixed or not with ß-TCP, using or not the Round-up device. The release of 4 growth factors from these CGFs was then measured at 5 hours, 1, 3, 6, and 8 days, using the ELISA assay. RESULTS: Comparison of the results obtained with those achieved for CGFs alone showed that BMP2 and BMP-7 release, significantly increased in CGFs mixed with Round-up and ß-TCP, TGF-ß1 release was similar to CGFs alone, whereas IG-1 release was lower compared with CGFs alone. CONCLUSION: The present data suggest that ß-TCP addition to CGF could enhance and improve tissue regeneration, especially bone regeneration, increasing the release of some growth factors that play an important role in osteogenesis.

Short Implants: Analysis of 69 Implants Loaded in Mandible Compared With Longer Implants.

OBJECTIVES: In the last decade, several studies have reported that short implants achieve excellent results with a 2-stage technique. According to the literature, short dental implants have often been used for the replacement of teeth. METHODS AND MATERIALS: A total of 69 short implants (Bone System) were inserted in the posterior mandibular area (41 in males, 28 in females, with a median age of 55 years and an age ranging from 41 to 70 years). RESULTS: Mean loss of bone levels at 1 year was 0.20 ±â€Š0.03 mm, mean changes in bone levels for periods longer than 1 year was 0.07 mm. Survival rate (SRR) of short implants was 98.5%. CONCLUSION: This study showed no complications in short implants and they could represent predictable solutions for the rehabilitation of atrophic posterior mandible to avoid complementary surgical procedures.

Assessment of Atlanto-Axial and Mandibular Rotation by Cone Beam Computed Tomography.

The cranial portion of the vertebral segment together with the atlanto-occipital joint represents a very complex area. Since this system could be influenced by different atlas and mandibular position, the aim of this work was to assess atlanto-axial and mandibular rotation. Scanora 3-dimensional cone bean computed tomography images from 205 patients without signs or symptoms of temporomandibular disorder were evaluated. Using a digitalized images analyzer, the axial rotations of atlas and mandible rotation were calculated, measuring the angle with respect to the frontal plane. The same direction for the axial rotation of the mandible and for the atlanto-axial rotation (consistent group) was observed in 80.98% of the patients; opposite directions (inconsistent group) were observed in 19.02%. Among the consistent group, the left rotation was observed in 71.08% of the patients and the right rotation in 28.92%. Absolute values showed a more marked rotation for atlas than mandible and higher values for the left rotation were reported for both.Taking together these data represents important starting points for the knowledge of atlas and mandible relationship and its functional and clinical implication.

Prosthetic Complications Affecting Single-Tooth Morse-Taper Connection Implants.

PURPOSE: To evaluate the long-term cumulative implant survival rate (CISR%) and cumulative implant-crown success rate (CICSR%) of single-tooth Morse-taper connection implants, with particular attention to documenting the incidence of prosthetic complications. METHODS: The customized records of all patients who had been treated with single-tooth Morse-taper connection implants in 2 dental centers during the period between January 2002 and December 2012 were revisited. These records included patient-related (gender, age at surgery, smoking, bruxism), implant-related (date of insertion, site/location, and length/diameter of the implant, previous/concomitant bone regeneration), and restoration-related (date of delivery of the provisional and final crown) information. In addition, these records contained information about any implant failure and biologic and/or prosthetic complication that occurred during the follow-up period as well as the radiographic documentation. The follow-up period comprised between 5 and 15 years. The main outcomes were CISR% and CICSR%, with the latter being defined as the condition in which no complication had affected the surviving implant-supported crown during the entire follow-up. Life-table analysis was used for the analysis of CISR% and CICSR%. Peri-implant marginal bone resorption (PIMBR) at 5, 10, and 15 years was a secondary outcome of this study. RESULTS: In total, 578 patients who had received 612 implants were included in this study. The overall CISR% at 15 years was 94.8% (94.2% maxilla, 95.3% mandible). Among the surviving crowns, the overall CICSR% at 15 years was 94.5% (93.1% and 94.9% for anterior and posterior crowns, respectively), and the incidence of prosthetic complications was low (1.5%). The PIMBL amounted to 0.38 ±â€Š0.29 mm, 0.49 ±â€Š0.35 mm, and 0.94 ±â€Š0.58 mm at the 5-, 10-, and 15-year follow-ups, respectively. CONCLUSION: Morse-taper connection implants represent a reliable treatment procedure for the restoration of single-tooth gaps in the long term, with high CISR% (94.8%) at 15 years, a very low incidence of complications, and a high CICSR% (94.5%).

Upper Eyelid Blepharoplasty With Voltaic Arc Dermabrasion.

The aging to the upper eyelid complex includes skin laxity, resulting in rhytids, orbicularis oculi hypertrophy, and pseudohermitian of orbital fat and nowadays a high number of patients seeking cosmetic surgery. Excess and laxity of upper eyelid skin affect more than 90% of women, the impact of these problems on the patient's self-esteem can become important enough to affect quality of life in psychological and sociocultural terms.The aim of the study was to evaluate the clinical efficacy of blepharoplasty with an electrosurgical technology for treatment of skin laxity of upper eyelid, which produced a lid retraction and an elevation of the upper lid without complications.This retrospective evaluation was conducted from October 2008 to July 2015, where 80 patients (56 female and 24 male) were treated for excess and laxity of upper eyelid skin with voltaic arc dermabrasion.The outcome was that all patients displayed some aspects of tissue contraction that stretched the lax skin of the upper eyelids, resulting in cosmetic improvement.In conclusion this technique was predictable and useful to remove the laxity of upper eyelid skin minimal recurrence rates, and acceptable aesthetics.

Diode Laser Clinical Efficacy and Mini-Invasivity in Surgical Exposure of Impacted Teeth.

The gold standard to arrange impacted teeth in the dental arch is represented by a surgical approach followed by orthodontic traction force application. In the literature, many surgical approaches are proposed to reach such a scope. The aim of the present study is to demonstrate how laser technique could positively assist surgical approaches.Study population was composed by 16 patients undergoing orthodontic treatment of 20 impacted teeth. In 10 patients (population A) surgical exposure of the impacted teeth was performed using a 980 nm diode laser, while in the other 10 patients (population B), surgical incision was performed using a traditional lancet.Only 3 patients of the population A needed local anesthesia for surgical procedure while the remaining 7 patients reported only faint pain during surgery. Two patients referred postsurgical pain (numerical rating scale average value = 2) and needed to take analgesics. None of the patients showed other postsurgical side effects (bleeding, edema).All population B patients needed infiltrative anesthesia and referred postsurgical pain (numerical rating scale average value >4) treated with analgesics. Moreover, in such population, 4 patients referred lips edema while 4 showed bleeding and 6 needed surgical sutures of soft tissues.The lack of side effects of laser surgical approach to expose impacted teeth must persuade dental practitioners to choose such a clinical approach to closed surgical approach every time it is possible.

Predictive variables derived from panoramic radiographs for impacted maxillary cuspids treated with easy cuspid system.

The aim of the current study was to find, by means of panoramic radiographs, a viable statistical method to forecast the duration of orthodontic traction of impacted maxillary cuspids. The treatment sample consisted of 51 palatal impacted cuspids (19 unilateral and 32 bilateral) in 35 patients (aged between 10.5 and 17.5 y) with a cervical vertebral maturation between cervical stage 1 and 4. Each patient underwent the same combined surgical-orthodontic technique. Anamnestic data as well as pretreatment panoramic radiograph and cephalogram with European Board of Orthodontics analysis were recorded for each case. Eight radiographic indicators were derived from panoramic films to define the reliable position of the impacted cuspid. Multiple regression analysis was used. All cuspids were successfully treated with an average traction time of 99 days (range, 33-188 d). The pretreatment radiographic features assessed on the panoramic radiographs did not significantly affect the duration of traction. The formula based on α angle, d1 distance, and S sector forecasted an average traction time of 123 days (range, 63-210 d), which is longer than the real time. No relevant correlations were found between orthodontic traction time and pretreatment radiograph parameters derived from panoramic film at the beginning of the treatment. The classic formula elaborated by Crescini could not be applied to the patients of this study, who were treated with the Easy Cuspid method.

A simple score for evaluation of the complexity of third-molar extractions.

OBJECTIVES: This article proposes a simple preoperative score to evaluate the complexity of tooth extractions of the third mandibular molar and to estimate the time involved. STUDY DESIGN: We consider 11 factors (demographic, anatomic, and radiologic) that favor the surgery and that can be identified through standard clinical and radiologic examinations. The number of favorable factors (NFF) relative to each patient constitutes his/her score. The analysis of 1500 extractions performed by various surgeons with experience from 2 to 25 years evidences a quadratic inverse correlation between NFF and the time required for the surgery. RESULTS: The shape of the time distribution suggests the existence of 3 major classes of patients characterized by time of 4 to 10 minutes, 11 to 20 minutes, and 21 to 40 minutes. The corresponding NFF brackets, as identified by their frequency distributions and validated by the receiver operating characteristic curve method, are 5 to 11 (mean [SD], 6.8 [1.6]), 2 to 4 (3.3 [1.3]), and 0 to 1 (0.8 [1.0]), respectively. CONCLUSIONS: Our results show the good performance of this score as a predictor of the surgical time and its applicability in daily practice regardless of operator experience, background, and level of surgical ability.

Patient-based assessment of tooth extraction with ultrasonic dental surgery.

BACKGROUND: The aim of this study was to compare the postoperative period and healing of 2 methods used for simple tooth extraction: traditional and ultrasonic bone surgery. The clinical healing of the sockets and psychologic acceptance of the ultrasonic bone surgery were also evaluated. METHODS: Two hundred patients requiring bilateral maxillary or mandibular extractions were enrolled. The extractions of the 2 teeth were performed in the same surgical session. The extraction on 1 side was performed using traditional surgery (control site), whereas ultrasonic surgery was used on the other side (test site). The patients were clinically screened at 1, 7, 14, and 21 days. RESULTS: A total of 200 patients (115 women and 85 men), with a mean age of 54.8 years (range, 40-65 y), provided 400 extraction sites. The time required to perform the tooth extractions was longer at the test site than at the control site, although this difference did not reach statistical significance. CONCLUSIONS: The piezoelectric extraction technique also provided the best surgical healing results, as evidenced by the integrity of the alveolar walls and surrounding soft tissues. In addition, the patients responded positively to ultrasonic surgery and preferred it to traditional surgery for both the surgical and postsurgical phases. CLINICAL IMPLICATION: Our preliminary study showed that Piezosurgery is an excellent tool for reducing the risk for complications and for improving the clinical healing and postoperative period in particular. The use of ultrasound reduces trauma to the adjacent bone and soft tissues during the tooth extraction.

Cephalometric evaluation of ocular protrusion at stages of growth.

The sagittal relationships between the orbital globe and the ocular orbit have great importance in aesthetic and functional evaluations. These relationships are useful in diagnosis and treatment of some malformations in which the orbital volume is reduced such as craniostenosis. The aim of the present study was the cephalometric evaluation of the ocular protrusion at different growth stages. Ninety-two patients with negative history of craniosynostosis, severe myopia, and skeletal class I were selected for the present study. Lateral teleradiography x-ray was performed for all the patients, and 5 groups were carried out based on the dentition phase. Cephalometric analyses were performed on the lateral teleradiography x-ray. Mean values of ocular protrusion (B-Or post) for females and males were found and digitized for the 5 groups tested. All other sagittal and vertical measurements were successfully computed by the trained operator. B-Or post showed values between -14.93 mm and -16.90 mm among the groups. The cephalometric analysis proposed in the present study allowed to successfully evaluate sagittal and vertical relationship of the orbital globe and the orbital cavity in growing patients. Moreover, the B-Or post maintained its value during growth in the present study.

Intercurrent infectious diseases in post-stem cell transplant patients: paranasal sinusitis.

Improvements in treatments available for oncohematologic diseases have made it possible to treat patients at more advanced stages of the disease and thus at greater risk of fungal, bacterial, and viral infections; these may be extensive and have aggressive evolution. In particular, chemotherapy at high doses and allogenic bone marrow transplant expose patients to an increased risk of infection, especially because of the period of aplasia and the condition of immune depression subsequent to the procedure. We presented a case of a 15-year-old adolescent girl diagnosed with combined relapse of acute lymphoblastic leukemia 2 years after completion of first-line chemotherapy that, at 120 days after transplant, erosive lesions of the palatal mucosa at the left hemipalate in the area adjacent to tooth 2.7 were detected, of approximately 2 mm in size. These gave rise to an orosinus communication. Various therapeutic possibilities are examined. These cases are not frequent. Diseases and their related complications require an in-depth knowledge, on the part of the stomatologist, to recognize the early signs of involvement of the oral cavity and, on the part of the oral surgeon, to decide the most appropriate therapeutic strategy.

Saldino-Mainzer syndrome: nephronophthisis, retinitis pigmentosa, and cone-shaped epiphyses.

Saldino-Mainzer syndrome is part of a group disorders, the conorenal syndromes, that are characterized by cone-shaped epiphyses with chronic renal disease in childhood and are variously associated with retinitis pigmentosa, cerebral ataxia, and/or abnormalities of the proximal epiphyses and femur metaphyses. Saldino-Mainzer syndrome usually has sporadic presentation. The present report shows the unusual findings of a 23-year-old woman, affected by the Saldino-Mainzer syndrome and has undergone kidney transplantation, highlights the possible association with maxillofacial and cephalometric abnormalities.