Quality of life in oncologic patients after maxillectomy operations: clinical case series on different rehabilitation protocols.

OBJECTIVE: The study's purpose was to compare the quality of life (QoL) in oncologic patients treated with different rehabilitation protocols following maxillary tumor resections. PATIENTS AND METHODS: The patients were divided into three groups. Group A: 18 Patients with maxillary obturator prosthesis. Group B: 17 Patients with simultaneous autologous tissue reconstruction. Group C: 12 Patients with prosthesis on zygomatic implants. The post-operative QoL was compared using standard questionnaires, investigating items like pain, mood, social relations, and specific functions that could potentially compromise the post-operative QoL. A secondary analysis compared reconstructed vs. non-reconstructed patients. RESULTS: Most questionnaire items did not show significant differences among groups. Statistically significant outcomes were found in two parameters (social contact and sexuality), in which patients treated with zygomatic implants had the best satisfaction, and patients with obturator prostheses showed the lowest satisfaction. Patients belonging to the non-reconstructed group showed better moods than those in the reconstructed group, while taste problem complaints and pain were lower in the reconstructed group. CONCLUSIONS: Although the type of reconstruction procedure depends on the type of maxillectomy to be performed and on the general health situation of each patient, the impact of the rehabilitation protocol on the patients' QoL should be accounted for when planning the treatment.

A novel guided zygomatic implant surgery system compared to free hand: A human cadaver study on accuracy.

OBJECTIVES: The aim of this human cadaver study was to compare the accuracy of guided versus free-hand zygomatic implant placement. For the guided implant placement laser sintered titanium templates were used. METHODS: Forty zygomatic implants were placed in ten cadavers heads. For each case two implants were inserted using the guided protocol (Ezgoma guide, Noris Medical, Israel) and the related surgical kit and the other two by using a free hand approach. Post-operative computed tomography (CT) scans were carried out to assess the deviations between planned and inserted implants. The accuracy was measured by overlaying the post-operative CT scan (with the final position of the achieved implants) with the pre-operative CT scan (with the planned implants). RESULTS: The difference of the mean between planned and placed zygomatic implants by using surgical guides or free hand were statistically significant for all the variables evaluated: angular deviation (1.19°±0.40° and 4.92°±1.71°, p<0.001), linear distance deviation at coronal point (0.88 mm±0.33 mm and 2.04 mm±0.56 mm, p<0.001), at apical point (0.79 mm±0.23 mm and 3.23 mm±1.43 mm, p<0.001) and at apical depth (0.35 mm±0.25 mm and 1.02 mm±0.61 mm, p<0.001). CONCLUSIONS: The proposed guided surgery system exhibited a higher accuracy for all the investigated variables, when compared to the free hand technique.

Clinical outcomes of fully and partially threaded zygomatic implants in a cohort of patients with minimum 7.5-year follow-up.

OBJECTIVE: The aim of this retrospective case series report was to evaluate the results of oral rehabilitation with extra-sinus zygomatic implant surgery with a minimum follow-up of 7.5 years. PATIENTS AND METHODS: A total of 35 patients with 87 zygomatic implants were included. The mean follow-up period of the patients was 93 months. The zygomatic implant survival and complications were evaluated as criteria for success. RESULTS: There were no implant failures. Overall success rate without complications for zygomatic implant was 88.5%. Complications developed in 4 patients (1 cutaneous fistula and 3 mucositis). According to the results on an implant basis, patients with previously failed conventional implants had greater probability of complications. Patients with quad zygomatic implants had higher incidence of complications than those with two zygomatic implants. Fully threaded implant design was associated with higher incidence of mucositis than partially threaded design. No relation was found between implant success and smoking, prosthesis type, and antagonist dentition. When conducting the analysis using the patient as unit, only the antagonist dentition showed significant difference, the worst outcome being associated with the Toronto resin prosthesis. CONCLUSIONS: Zygomatic implants can be considered as a safe alternative to conventional implant insertions and bone grafting procedures in oral rehabilitation of patients with severely atrophic maxillary bone.

Treatment of medication-related osteonecrosis of the jaw (MRONJ). A systematic review.

OBJECTIVE: Medication-related osteonecrosis of the jaw (MRONJ) is a severe drug-related side effect mostly seen in the maxillofacial region of patients under current or previous treatment with antiresorptive and/or angiogenic agents. There is a wide range of treatment options explained in literature for the management of this condition, from conservative treatments to surgical procedures of various levels of invasiveness, which are sometimes supplemented with adjunctive therapies. The present systematic review aimed at evaluating the treatment options of MRONJ in terms of successful outcomes. MATERIALS AND METHODS: Medline, Scopus, and Cochrane databases were searched. The search was limited to clinical studies involving human subjects with at least 3 cases. There was no other limitation for language, publication date, and study design for the articles to be included. A hand search of the bibliographies of identified articles was also performed. The evaluation criterion was an improvement in the healing of the treated site after treatment procedures. RESULTS: After evaluation of the full text of the articles, 118 articles were selected for evaluation (15 platelet concentrates, 4 teriparatide, 10 laser therapy, 3 hyperbaric oxygen, 2 ozone applications, 9 conservative protocols, and 75 surgical interventions articles). The evaluated articles reported positive improvements in healing/staging of the osteonecrosis sites. CONCLUSIONS: Due to the low evidence level and the limited sample size of the studies included, the results of this review must be cautiously interpreted. However, they can be suggestive for evaluating the possible benefits of these treatment options in MRONJ management. Further prospective comparative studies with a large sample size are urgently needed to confirm the results.

A new spiral dental implant: a tool for oral rehabilitation of difficult cases.

Spiral dental implant (SDI) is an implant with a conical internal helix that confers the characteristic of self-drilling, self-tapping, and self-bone condensing. These proprieties offer better control during insertion of SDI giving a high primary stabilization, even in poor quality bone. A shorter diameter of SDI results in reduced drilling during insertion and consequently less trauma and minimal bone loss. To address the research purpose, the investigators designed a retrospective cohort study. The study population was composed of 25 patients, 11 males and 14 females that have been treated by Dr. Balan with 187 SDI positioned in mandible and into maxilla bone. The implants were placed during the years 2013 to 2014 in Dr. Balan clinic. All patients underwent the same surgical protocol. Several variables are investigated: demographic (age and gender), anatomic (upper/lower jaws and tooth site), implant (length and diameter and type) variables, edentulism (partial or total), and comorbid status of health (i.e.: hypothyroidism, parodontitis, hypertension, diabetes, presence of cancer, heart disease, hepatitis and rheumatologic disease). Pearson Chi-Square test was used to investigate variables and p < 0.05 was considered statistically significant. Statistically it has been shown that females have a higher possibility of unsuccessful respect of male, with a "p value" of 0.014. Another important impact factor for success of implant insertion has been represented by concomitants pathologies: cancer represents the most negative high factor risk with a percentage of unsuccessful of 50%, followed by heart disease (15%), and diabetes (3.7%). SDIs are reliable tools for difficult cases of oral rehabilitation. They have a higher success and survival rate, which means stable results over time. No differences were detected among SDI lengths, implant/crown ratio. In addition, the insertion of SDIs in banked bone can be performed without adverse effects. Finally, flapless and computer tomography-planned surgery does not significantly increase the clinical outcome of SDIs in complex rehabilitation. Cancer represents the most important variable to consider when a patient wants to do oral rehabilitation because of its high risk of unsuccessful.

Surgiplanner: a new method for one step oral rehabilitation of severe atrophic maxilla.

The implant-prosthetic rehabilitation of edentulous upper jaws has always been complex for surgeons and dentists. The lack of bone in both vertical and horizontal dimension does not allow the correct insertion of dental implants. In addition, patients with edentulous upper and lower arch have a loss of vertical dimension of the face and an aged expression. Many surgical techniques have been proposed to increase the bone volume, height and thickness, such as the Le Fort I osteotomy, the bone grafts and the placement of dental implants. Planning these surgical procedures is difficult, because it is not possible to reproduce the movements of osteotomized bone segments in three planes of space. This article describes the treatment of severe atrophy maxilla with a new approach using a new instrument named "Surgiplanner". Surgiplanner is a method that, only using a computerized axial tomography (CAT), allows to obtain a totally predetermined therapeutic result from both an aesthetic and functional point of view, with surgery of severe resorbed jaws. Surgiplanner allows repositioning of segment of the skeleton of the patient's face in a predetermined and controlled way for the best implant-supported oral rehabilitation.

A new surgical and technical approach in zygomatic implantology.

PURPOSE: Different surgical approaches for zygomatic implantology using new designed implants are reported. MATERIAL AND METHODS: The surgical technique is described and two cases reported. The zygomatic fixture has a complete extrasinus path in order to preserve the sinus membrane and to avoid any post-surgical sinus sequelae. RESULTS: The surgical procedure allows an optimal position of the implant and consequently an ideal emergence of the fixture on the alveolar crest. CONCLUSION: The surgical procedures and the zygomatic implant design reduce remarkably the serious post-operative sequelae due to the intrasinus path of the zygomatic fixtures.

Aneurismal bone cyst: a conservative surgical technique. A case report treated with a small access osteotomy.

BACKGROUND: Aneurismal bone cysts (ABCs) are benign, non-neoplastic, expansive, and locally destructive lesions that may occur rarely. They are well defined and usually occur in the long bones, pelvis and vertebrae. According to the 2005 World Health Organization (WHO) histological classification of odontogenic tumours, ABC is classified as a bone-related lesion as ossyfing fibroma, fibrous dysplasia, osseous dysplasia, central giant cell lesion (granuloma-CGCL), cherubism and simple bone cyst (SBC). ABCs, as CGCLs and SBCs may arise as a consequence of an earlier trauma causing an overflow of blood into the bone, though a number of pathogenic theories have been put forward. The aim of this study is to present an unusual case of aneurismal bone cyst and to compare the different possibilities of surgical treatment after review of the literature. CASE REPORT: ABC was localised in the posterior right region of the mandible in an 11-year-old boy, and removed by a surgical procedure involving a small access osteotomy of the mandibular ramus with removal of the cortical bone in order to enucleate the whole lesion, the wisdom tooth and to preserve the healthy bone.