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

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

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

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

Endodontic retreatment and bioceramics: A case report.

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

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

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

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

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

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

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

The Effect of a Physical Training with the Use of an Exoskeleton on Depression Levels in Institutionalized Elderly Patients: A Pilot Study.

CONTEXT: The Human Body Posturizer (HBP) is an exoskeleton used in the neurorehabilitation. The HBP may improve motor control by stimulating the pre-frontal cortex, a brain region involved also in the inhibitory modulation of the amygdala whose hyperactivity is involved in the mechanisms of depression. OBJECTIVE: The aim of the study was to investigate in institutionalized elderly patients the effects on depression of a physical training with the use of the HBP compared to a traditional training. DESIGN: Randomized controlled trial. PARTICIPANTS: 20 institutionalized patients (mean age = 88, ds = ± 5, 3 males) with moderate depression levels. INTERVENTION: The participants were randomly assigned to: a) HBP Group, which carried out physical training using the HBP; b) Excercise Group, which carried out a training without the use of the orthosis. The training was conducted for 6 months (3 sessions each week), with the same kind of exercises with or without the HBP according to the assignment group. MEASUREMENTS: Participants were evaluated at baseline using the Tinetti balance and Gait scale, the Mini Mental State Examination and the Geriatric Handicap Scale. The Geriatric Depression Scale was administered to the participants before and after the period of training. RESULTS: The two groups were homogeneous for age, baseline motor ability (risk falls), handicap score, cognitive functioning and depression levels. After 6 months of exercise training a significant reduction in depression levels was reported only in the HBP Group (p <.01). CONCLUSIONS: A positive effect of the HBP in the modulation of mood in institutionalized elderly subjects was found. It is possible to hypothesis that a traditional training without the HBP may require more time to achieve significant results. Clinical implications will be discussed.

Oral health and implant therapy in Parkinson's patients: review.

Parkinson's Disease (PD) is one of the most frequent neurodegenerative diseases, second only to Alzheimer's disease. It is a progressive disease that inevitably leads the patient to death, in most cases for pneumonia ab ingestis. It affects 120 people out of 100,000 and more frequently affects men than women. The main symptoms are divided into motor, non-motor and behavioral ones. The main motors symptoms are tremor, bradykinesia and postural instability. Non-motor symptoms include autonomic nervous dysfunction (orthostatic hypotension, cardiac arrhythmia, sexual dysfunction, excessive sweating due to hypothalamic dysfunction, constipation), insomnia, OSAS, and olfactory dysfunction. Behavioral symptoms are depression, dementia and psychosis. The purpose of this study is to evaluate, through a systematic review of literature, the oral health status of the Parkinson's patient compared with the general population with particular reference to the incidence of caries and periodontal disease, the patient's management during dental interventions and the possibility of rehabilitating the patient with implanted therapy.

Combined orthodontic-surgical approach in the treatment of impacted maxillary canines: three clinical cases.

Impaction of maxillary canine is a relatively frequent orthodontic anomaly which could represent fuctional and aesthetic problems for patients. Nowadays, the conventional technique to impacted canines consists of a combined orthodontic and surgical approach, aimed to guide cuspids at the center of the alveolar ridge in a stable position and surrounded by healthy hard and soft tissues. This article presents three cases studies with different combined surgical-orthodontic approaches for the treatment of infraosseous impacted canines. An impacted maxillary canine could be guided, after adequate space is created orthodontically, to the center of the ridge through an orthodontic traction directly applied to the crown of impacted cuspid. Several surgical techniques have been proposed to expose the crown of impacted tooth. Location (buccal or palatal side) of impactation and depth influence surgical approach in order to obtain best aesthetic and functional results.

Full digital workflow for implant-prosthetic rehabilitations: a case report.

OBJECTIVES: The aim of the present study was to describe a proof of concept digital workflow for the implant-prosthetic treatment in partially edentate patients and evaluate its clinical performance. METHODS: A 55-year-old woman with a Kennedy class III bilateral edentulism in the mandible has been selected for a computer guided implantology according with the Smart Fusion® protocol (NobelBiocare, Kloten, Switzerland). After the template-guided implant placement, an immediate loading of the implants has been performed. QuickTemp conical temporary abutments were selected to deliver immediately prefabricated cement-retained provisionals. Two months after an impression was taken with an intraoral digital scanner (3Shape Trios3, Copenhagen, Denmark). The provisional restoration optical scanning was used to transfer the functionalized prosthetic contour to be duplicated into the definitive porcelain fused to zirconia restoration cemented on customized titanium abutments. RESULTS: A satisfying esthetic and functional result has been achieved. No biological and mechanical complications were recorded. CONCLUSIONS: The investigated fully digital implant-prosthetic protocol provided a smooth, complication free and time effective treatment alternative to the conventional workflow. Besides the fully digital workflow allowed the surgical and prosthetic decision making and the communication within the dental team and with the patient. Further improvements heading to a direct match between the intraoral scan and the CBCT are strongly advised in order to create the so-called virtual patient.

FEM and Von Mises analyses of different dental implant shapes for masticatory loading distribution.

The rehabilitation of edentulous patients is today a challenge for the clinicians. The healthy of the hard and soft issue may be considered a fundamental element for having long-term results. The dental implant progresses about the predictable and safe results made this technique chosen from a large group of practitioners. However some problems related intra-operative and postoperative conditions may create discomfort on the patients and consequently to the clinician. The unfavourable results are often related to the bone tissue quality but sometime the dental implant shape and the prosthesis framework may undergo to technical difficulties. The purpose of this work is, through the use of appropriate FEM models, to analyse the effect of all these parameters in the construction of a prosthesis type "Toronto", evaluating all the surgical and prosthetic components in order to direct the choices made by the surgeon and to optimize the distribution of loads reducing the patient's discomfort and having a long term clinical success.

Simplified type 3 implant placement, after alveolar ridge preservation: a case study.

Alveolar ridge, after tooth extraction, could reduce its volume up to 50% in buccal-lingual width in the first twelve months and residual dimensions could interfere with correct three dimensional placement of implants and influence negatively treatment outcomes with regard to function and aesthetic aspects. Over the last decades, several approaches have been proposed and tested in order to prevent ridge volumetric contraction and provide maximum bone availability for implant procedure. This article presents a case study with a single anterior tooth replacement, illustrating socket seal technique followed by a type 3 timing implant placement. Immediately after tooth extraction, residual socket was grafted using Deproteinized Bovine Bone Mineral and a free gingival punch harvested from palate. After 3 months, a root-form titanium implant was inserted without additional regenerative procedures. Follow-up examination revealed favourable preservation of soft tissue width and height in the aesthetic area. Socket seal approach maximizes soft tissue healing, preserving ridge envelope and the subsequent implant placement, furthermore, results simplified, as any augmentation techniques are required. Clinical advantages of this method include predictable preservation of the soft tissues, favourable healing features, easy handling of graft materials and a positive benefit-cost ratio.

Oral health-related quality of life in partially edentulous patients before and after implant therapy: a 2-year longitudinal study.

OBJECTIVES: The aim of this study was to measure the Oral Health-Related Quality of Life (OHRQoL) before and after a prosthodontic implant therapy so to determine the physical and psychological impact of implant-supported fixed partial dentures (IFPD) rehabilitation among edentulous patients. METHODS: 50 partially edentulous patients aged 40-70 years, treated with IFPD, completed the OHRQoL questionnaire before the implant surgery (Time 0) and 2 years after their whole implant-prosthetic rehabilitation (Time 1). The questionnaire was proposed in a short version of Oral Health Impact Profile (OHIP-14, range 0-56) and analyzed through the 'additive method'. We evaluated statistical mean, standard deviation, median, variance and mode of all OHIP-14 domains and the statistical significance about oral changes at Time 0 and Time 1 using the Chi-square test (p-values < 0.05). RESULTS: Patients reported significant changes in mean OHIP scores (Time 0: 2.15; Time 1: 0.65; p < 0.01). The most prevalently affected domain was "functional limitation", followed by "psychological discomfort" and "physical pain". There were no significant differences dependent on age, gender and antagonistic teeth (p > 0.05). Patients with I and IV Kennedy's class edentulism showed better improvement (p < 0.05). CONCLUSIONS: Preoperative and post-treatment assessments of OHRQoL exhibited significant differences. The IFPD treatment had a positive effect on the OHRQoL, which improved better in patients with I and IV Kennedy's edentulous class.

Clinical assessment of submerged vs non-submerged implants placed in pristine bone.

The medium-long term success of osseointegrated dental implants is evaluated on the basis of the degree of osseointegration over time, assessed by radiographic or instrumental analysis (ISQ). Over the years, the question has always been which surgical technique can provide a better performance in the medium-long term and, thanks to literature studies, it has been evidenced that there are no differences between "one stage" and "two stage" interventions. The purpose of this study is to evaluate clinical and radiographic parameters, referring to interventions for the insertion of dental implants characterized by a new kind of implant surface (Synthegra® GEASS, Udine). The prospective study, not randomized and controlled, referred to the insertion of 18 implants on 9 patients with mono or bilateral edentulism, with measurements at 1, 3, 6 and 12 months and an overall follow-up at 3 years, in order to evaluate the different degree of crestal bone resorption using the submerged and transmucosal surgical technique. The results of our study show that there are no differences in the resorption of the two surgical techniques, with an average bone resorption of 2,05±0,16 mm, comparable with values reported in literature.

Prevalence, distribution, and differential diagnosis of nasopalatine duct cysts.

UNLABELLED: INTRODUCTION.: Nasopalatine duct cysts (NPDCs) are the most common developmental epithelial non-odontogenic cysts of the maxillae. Their origin, however, is still a source of considerable debate. AIMS.: The aim of this investigation is to describe and discuss the etiology, differential diagnosis, clinic-pathological characteristics as well as to report the relative frequency and distribution of nasopalatine duct cysts in population (NPDCs) with a literature's review on the topic. METHODS: The retrospective study was carried out using 36 clinical cases, with histopatological confirmation for NPDC, radiographs and oral photographs. Data included age and gender of the patient, radiographic findings, etiological factors, treatment, and prognosis of NPDC. Few surgical consideration are discussed. RESULTS: The study results report a clear male predilection with a 3:1 ratio. No statistically significant correlation was observed between the size of the lesion and patient's gender. Lesions were usually asymptomatic. All cysts were located in the anterior maxillary midline region. Panoramic X-rays and computed tomography was used to identify the lesion. Surgical treatment was performed under local anesthesia including the dissection and removal of the cyst, adopting a usually palatine approach, with an enveloping flap from 1.4 to 2.4. CONCLUSIONS: The etiology of NPDC is unclear and a male predilection was observed. Simple surgical resection is recommended, followed by clinical and radiological control to ensure correct resolution of the case.

Cemento-ossyfying fibroma juvenile of the oral cavity.

OBJECTIVES: Fibro-osseous neoplasm remains somewhat controversial, and differing concept have been advanced regarding their nature and the proper terminology for them. Cemento-ossyfying fibroma juvenile (JOF) is a rare type of fibro-osseous tumor as also been included under the "umbrella" of cemento-ossyfying fibroma. The JOF is most often seen in patients who are between 5 and 15 years of age. With this work we emphasize the importance of a correct diagnostic approach. MATERIAL AND METHODS.: The case describes a form of cemento-ossyfying fibroma hight active and aggressive like JOF. The patient thirteen older showed from 2004 to 2008 three times the palatal lesion, it was performed with a incisional biopsy and excisional biopsy. The tumor were fixed in 10% buffered formalin embedded in paraffin cut into thick sections and stained with ematoxylineosin. RESULTS: The incisional biopsy was inadequate to formulate a correct diagnosis. The histological exams have showed for three times different aspects. CONCLUSION: Some authors in the past have suggested different classification. The COFs show different clinical, histological and radiographical patterns.

The evaluation of disphagic syndrome, in patients with previously acquired brain damages.

Recently clinical studies have proved without doubts that in patients affect by neurological diseases, like stroke, parkinsonism syndromes and others neurodegenerative pathologies, there is a very elevated incidence of swallowing disorders even severe. The disease can show up in a full blown way, with clinical evident signs like suffocation or frequent and sudden cough, at the moment in which the patient tries to feed or to drink; or it can appear in a less clear way, through an unable protection of the low airway and with possible pathologies ab ingestis. The first signals are represented by frequent resulting of cough reflex at nutrition or hydratation. Important is to assess the validity of this reflection, monitoring the amount of food reflux in the mouth after swallowing, which then could be perceived like foreign body and be aspired. The main diagnostic tests are the pHmetry in 24h, ultrasound, esophagography, videofluoroscopy, endoscopic examination and scintigraphy. Through the FEES (Fiberoptic Endoscopic Evaluation of Swallowing) we can then identify the time of swallowing deficit. Early diagnosis of Dysphagia Syndrome is important to improve living condition and survival of patients.

Expression of thyrotropin and thyroid hormone receptors in adipose tissue of patients with morbid obesity and/or type 2 diabetes: effects of weight loss.

OBJECTIVE: Increased thyroid-stimulating hormone (TSH) and FT(3) levels are often found in clinically euthyroid obese individuals. Information on thyroid gene expression in human adipose tissue is scarce. The objective of this study was to measure the expression of the TSH receptor (TSHR) and the thyroid hormone receptor (TRalpha1) genes in subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) in obese individuals and to test the effect of weight loss on these genes. STUDY DESIGN AND PARTICIPANTS: This study is a prospective study involving 107 obese (body mass index (BMI)=46+/-8 kg m(-2), 52 with type 2 diabetes or impaired glucose tolerance) and 12 lean nondiabetic participants. A total of 27 obese patients were restudied 1 year after gastric bypass surgery. Total RNA was extracted from SAT and VAT obtained at baseline from all participants, and from SAT in obese patients post surgery. RESULTS: Circulating TSH and FT(3) levels were 170 and 36%, respectively, higher in obese patients than in controls. In SAT, TSHR and TRalpha1 were reduced in the obese by 67 and 33%, respectively, regardless of glucose tolerance. A similar trend was found in VAT. Post surgery, a BMI decrease of 33% was associated with a decrease in TSH and FT(3) levels and with a 150 and 70% increase in SAT of TSHR and TRalpha1, respectively. CONCLUSION: In both subcutaneous and visceral fat, the thyroid gene expression (especially TSHR) is reduced in obesity. The reversal of these changes with major weight loss and the reciprocal changes in plasma TSH and FT(3) levels suggest a role for adipocytes in the regulation of TSH and thyroid hormones.

Pattern of expression of adiponectin receptors in human liver and its relation to nonalcoholic steatohepatitis.

BACKGROUND: Adiponectin has antisteatosis-anti-inflammatory properties and its circulating levels are reduced in nonalcoholic steatohepatitis (NASH). METHODS: To assess the role of adiponectin in NASH, we measured expression of adiponectin gene (APM1) and receptors (AdipoR1/AdipoR2) in liver and subcutaneous and visceral fat in subjects with biopsy-proven NASH or pure steatosis (PS). In 103 subjects undergoing gastric bypass or elective abdominal surgery (17 with normal liver histology (C), 52 with PS, and 34 with NASH), RNA was extracted from tissue samples, and quantification of APM1, AdipoR1, and AdipoR2 was carried out by real-time polymerase chain reaction. RESULTS: In NASH vs C, circulating adiponectin levels (3.6[2.4] vs 5.3[4.3] microg/ml, median[interquartile range], p < 0.05) and adiponectin concentrations, APM1, AdipoR1, and AdipoR2 expression in visceral fat were all reduced (p < or = 0.03). These differences disappeared when adjusting for obesity. In contrast, liver AdipoR1 (1.40 [0.46] vs 1.00 [0.32] of controls) and AdipoR2 expression (1.20 [0.41] vs 0.78 [0.43]) were increased in NASH, and group differences were statistically significant (p < 0.0001 for AdipoR1 and p = 0.0001 for AdipoR2). Results for PS were generally intermediate between NASH and C. Liver receptor expression was reciprocally related to circulating adiponectin (rho = -0.42, p < 0.003 for AdipoR1 and rho = -0.26, p < 0.009 for AdipoR2). In multivariate models adjusting for sex, age, fasting plasma glucose, and obesity, liver enzymes levels were directly related to both AdipoR1 and AdipoR2 expression in liver. CONCLUSION: In obese patients with NASH, adiponectin receptors are underexpressed in visceral fat-as a likely correlate of obesity-but overexpressed in liver, possibly as a compensatory response to hypoadiponectinemia, and positively associated with liver damage.

Microsurgery flap in endodontic surgery: case report.

In periodontal plastic surgery it is increasingly more evident the relavance of the protection of the gingival marginal anatomy through the realization of a conservative flap. Minimizing the recession of the treated tissue. A correct healing always needs to take into account the diameter and type of the suture and the time of removal from the wound.