ORAL and Implantology最新文献

Mandibular implant placement (MIP) has been accepted and widely used for decades all over the world, and has reached a very high level of therapeutic reliability. MIP is used mostly in elderly edentulous patients who lost their teeth when dentistry was not oriented to fixed or removable prosthetic. Notwithstanding this, every year cases of severe complications during MIP due to haemorrhage causing life-threatening airway's obstruction are reported. These severe complications of MIP need immediate therapy, usually with hospitalization, and may be potentially fatal. A 56-year-old man presented to the private practice requesting the placement of two dental implants at 41 and 31 previously lost for periodontal disease. Two implants of 3.3 mm of diameter, and 10 mm of length were inserted replacing teeth 31 and 41. Two hours after surgery and home delivery, the patient came to the emergency room complaining of dyspnoea and edema at the floor of the mouth. The maxillo-facial surgeon decided to perform tracheostomy and haemostasis under general anaesthesia. Two weeks after demission a complete healing was performed. This is important for dental practitioners to avoid severe bleeding complications during the MIP in the interforaminal region, especially on the midline. Moreover, when mandibles are severely atrophic, practitioners should be aware of this fact and the possible implications. The evaluation of these data is essential in the correct preoperative planning of implant procedures in the mandible, and with the increasing demand for MIP, the variations of the lingual foramen of the mandible should receive more attention.

Background: The Obstructive Sleep Apnea Syndrome (OSAS) is a clinical picture characterized by partial or complete obstruction of the upper airway during sleep, associated with a reduction of oxygen saturation in the blood.The most common symptoms are: apnea sleep, snoring, headache, sleepiness, reduced concentration and memory, irritability, increased blood pressure and dry mouth.

Materials and methods: It was examinated a not-smoker man of 54 years that suffers of roncophaty. He did physical examination, rhinoscopyexam, faringoscopy, rhinofibrolaringoscopy, gnathological evaluation and polysomnographic examination performed with multichannel polygraphy (VitalNight). From the performed examinations, it has been diagnosed a moderate form of obstructive apnea sleep syndrome. He was treated with a mandibular advancement device and it was repeated the polysomnographic exam.

Results: Comparing the results of the polysonographic examination performed before and after the treatment, the patient's clinical picture clearly improved. It has shown a clear reduction of obstructive apneas, hypopneas and snoring.

Conclusions: The use of a mandibular advancement device is certainly a valuable aid in the treatment of moderate type OSAS. The quality of diurnal life is also improved as shown with Sleepness Epworth Scale.

Different implant-abutment connections have been developed in the effort of reducing mechanical and biological failure. The most frequent complications are screw loosening, abutment or implant fracture and marginal bone loss due to overload and bacterial micro-leakage. Ideal connection should work as a one-piece implant avoiding the formation of a micro-gap at the implant-abutment interface. Different in vitro and in vivo researches have been published to compare the implant-abutment connections actually available: external hexagon, internal hexagon and conical finding different amount of micro-gap, micro-leakage and marginal bone loss. The aim of this article is to describe, according to the most recent literature, different kind of fixture-abutment connections and their clinical and mechanical advantages or disadvantages.

Background: The purpose of the study is to evaluate the effectiveness of Low-Level Laser Therapy in reducing joint and muscle pain in patients with acute and chronic temporomandibular dysfunction.

Materials and methods: The study was conducted on a sample of 180 patients. The sample was divided into two groups according to the time of onset of the disease: acute TMD (<6 months) and chronic TMD (> 6 months). The treatment for all patients provided for the irradiation with Diode Laser Wiser Doctor Smile with tip plane wave at wavelength of 830 nm, continuous beam to 40nW diameter and radius of 6 mm. The irradiated areas were the joint area, temporal, masseter and pterygoid. The irradiation time for each zone was 60s.The protocol adopted consisted of two weekly treatment for six weeks. Pain assessment was performed using the Visual Analog Scale (VAS), in which different scores (s) depending accused of pain by the patient: s0 no pain, s1-3 mild pain, s4-6 moderate pain, s7-9 severe pain and s10 excessive pain. The pain monitoring was performed before treatment, after 15 days and after one month.

Results: The sample included 80 patients with acute TMD and 100 with chronic TMD. The sample belonging to acute TMD group before treatment, was distributed as follows: 0% in s0; 12,5% in s1-3; 31.3% in s4-6; 53.6% in s7-9 and 2.5% in s10. After 15 days the distribution was was as follows: 6.25% in s0; 47.5% in s1-3; 20% in s4-6; 26.3% in s7-9 and 0% in s10. After 30 days the sample was well distributed: 35% in s0; 45% in 1-3; 10% in s4-6; 10% in s7-9 and 0% in s10. The sample belonging to the chronic TMD group, at time zero, was as follows: 0% at s0; 48% in S1-3; 35% in s4-6; 15% in s7-9 and 2% in s10. After 15 days the distribution was: 29% in s0; 28% in S1-3; 33% in s4-6; 10% in s7-9 and 0% in s10. After 30 days the sample was well distributed: 45% in s0; 36% in S1-3; 15% in s4-6; 4% in s7-9 and 0% in s10.

Conclusions: The Low-Level-Laser-Therapy is a valuable tool that can significantly decrease the perception of pain in patients with temporomandibular joint dysfunction, acute and chronic.

Objective: The objective is to present a clinical case of a 38-year-old male with a maxillary unicystic ameloblastoma treated by means of tumor block resection followed by chin-harvested graft placement in order to place two dental implants for esthetic and functional rehabilitation.

Methods: Ameloblastoma is a benign odontogenic tumor characterized by local aggression and a high rate of recurrence; the latter partly depends on how it is treated. Complete resection of the tumor, which usually prevents recurrence, produces bone defects of varying size that must be reconstructed later on. In most cases this is done using bone grafts and implant-supported prostheses. Grafts harvested from the chin are relatively easy to obtain and enjoy a fairly uneventful post-operative with few complications; they are suitable for cases in which the defect generated by resection is of small size.

Results: Functional and esthetic rehabilitation and the tumor has not relapsed during a 7-year follow-up.

Conclusion: Tumor block resection followed by chin-harvested graft placement and dental implants is a safe treatment for patients with unicystic ameloblastoma.

Objectives: This prospective cohort study aimed to investigate effectiveness of Computerized Local Anesthesia (CLA) on oral implantology through estimation of pain and discomfort and total quantity of injected anesthetic.

Methods: Forty-five consecutive patients whose treatment plan included immediate or late dental implants were included in this study. The main inclusion criteria comprised: previous implant intervention under conventional anesthesia (CA) during the past 3 years and no previous treatment of pain relief. All patients reported on a 0-10 scale on previous experience with CA, and new experience with CLA. The same CLA system, namely Single Tooth Anesthesia (STA) was used for all patients with half of the quantity normally used for CA. Data on quantity of anesthetic and reported ratings were collected and described. Potential associations and determinant variables were analysed through correlation analysis and regression models.

Results: Out of 45 patients, 27 received post-extractive implant surgery whereas the rest 18 implant surgery on healed sites. The reported pain from STA (mean 1.6, SD 0.7) showed important difference as compared to CA (7.9, SD 1.2; z=5.873; p<0.0001). The comfort perceived during the STA ranged from 7 to 10 (mean 9.5, SD 0.79). A second injection with half of the initial dose was necessary in three cases only.

Conclusions: STA system proved to be effective during interventions of dental implantology, by markedly reducing patients' pain and discomfort and the total quantity of necessary anesthetic.

The dental unit waters are divided in two different groups, because of their chemical and microbial composition proprieties: in the first there is the "incoming dental unit water", drinking water that arrived directly in the dental chair unit through the municipal water system; in the second there is the "waste water", that represents the whole dental unit waste water. Regarding the lack of a complete systematic review on the quality of dental unit wastewater, the aim of the current research was to systematically study the incoming dental unit water and the waste one, focusing the attention on the problem of the wastewater contamination and its regulations.

Materials and methods: A systematic literature review of the last 17 years was conducted on the topic of dental unit wastewater. Italian and English were the languages chosen for the papers research.Studies were searched in PubMed, Medline and Cochrane, with regard to inclusion criteria.

Results: The investigation and analysis of the two papers group revealed the presence of many information and scientific studies on the incoming dental unit water contamination, in contrast not much in literature about dental unit waste-water.

Conclusions: The results revealed that dental unit wastewater is a problem underestimated by the scientific community, with the exception of dental amalgam wastes.In Italy there is a sentence of "Corte di Cassazione Penale, sez III, sentenza 17 gennaio 2013, n 2340" that regularized dental wastewaters as industrial ones, so they are inadequate to be disposed as domestic waters; but, at the same time, there isn't a specific law that regulates this king of waste.

Purpose: This study evaluated the effects of different dowel space (DS) diameters on pull-out bond strength of a cylindrical post, of threaded steel, to dentin.

Materials and methods: Forty-five extracted human teeth were divided in 3 groups with DSs, with the same depth (6 mm), differing for the diameter (i.e. 1.5 mm, Group 1; 1.75 mm, Group 2; 2.00 mm, Group 3). Both the diameter of the post (1.3 mm) and the composite resin cement (Panavia 21) were the same for all the samples. The samples were submitted to pull-out test by means an Universal Testing Machine (Mod. 1193, Instron) (1KN load cell, crosshead speed 0.5 mm/min).

Results: The mean values of the bond strength (BS) were: Group 1, 442±128.3N; Group 2, 411.3±111N; Group 3, 448.7±142.29N. While the calculated average shear bond strengths (SBSs) were: Group 1, 14.7±4.27MPa; Group 2, 11.6±3.14MPa; Group 3, 11±3.5MPa. ANOVA test showed not significative differences, among the groups, concerning the BS: Group 1 vs Group 2 (p = 0.490); Group 1 vs Group 3 (p = 0.894); Group 2 vs Group 3 (p = 0.431). Significative differences were observed, among the groups, concerning the SBS for Group 1 vs Group 2 (p = 0.032) and Group 1 vs Group 3 (p = 0.014). While a not significative difference was found, concerning this parameter, for Group 2 vs Group 3 (p = 0.641).

Conclusion: The cement thickness can influence the SBS of the adhesively luted posts, in our setting, the best values were obtained with a thickness of 100 μm.

Objectives: Short implants are increasing their popularity among clinicians who want to fulfill the constant demanding of fixed prosthetic solutions in edentulous jaws. The aim of this report was to propose a new possibility to project and realize an occlusal guided implant cross-arch prosthesis supported by ultra-short implants, describing it presented an edentulous mandible case report.

Methods: A 61-year-old, Caucasian, female patient who attended the dental clinic of the University of L'Aquila presented with edentulous posterior inferior jaw and periodontitis and periimplantitis processes in the anterior mandible. The remaining tooth and the affected implant were removed. Six 4-mm-long implants were placed to support a cross-arch metal-resin prosthesis.

Results: At 1-year follow-up clinical and radiological assessment showed a good osseointegration of the fixtures and the patient was satisfied with the prosthesis solution.

Conclusion: The method, even if it requires further validation, seems to be a valid aid in solving lower edentulous clinical cases, and appears less complex and with more indications of other proposals presented in the current clinical literature. Our case report differs from the current technique All-on-Four, which uses four implants in the mandible to support over-denture prosthesis, assuring a very promising clinical result.

Objectives: The aim of the study was to assess the depth and quality of the post-space reading, using an IOS without scan-post, compared to a traditional silicon technique.

Methods: Six extracted bicuspids were decoronated and endodontically treated. After having prepared the space for the posts, a structure in pink acrylic resin was created with two resin elements. At the center of the structure one sample was put at a time. Digital and traditional impressions were taken for each sample.Digital impressions were developed through the Computer-aided design (CAD) software in order to integrate the scanner results into a three-dimensional grid to make the measurements. A K-file was used to measure the length of the post-space of each sample obtained through the traditional silicon impression and subsequently the measurement results were reported on a millimeter gauge. Furthermore, an assessment of the width of the entrances of the post-spaces was carried out.

Results: The mean reading depth discrepancy expressed in percentages (19.58%) indicates that the digital impression with current technologies fails to impress clearly the post-space. Standard deviation of the data expressed in percentage is 13.89, suggesting that the values were not similar to each other. In two cases the digital technique has achieved less than 10% difference compared to the traditional technique, but there have been also cases in which the variation in depth has reached almost 40%.The samples that showed the minor discrepancy between the two techniques expressed the widest post-space entrance.

Conclusions: In this in vitro study, the application of the IOS for the post-space reading in order to deliver an anatomic post has been proven to be still not reliable, as there are still depth reading limitations for the narrow root channels. In fact, in this type of channels it is difficult to reach with the light beam of the IOS the deepest areas of the post-space, with a consequent incomplete post-space reading.