A new challenge in dentistry – Complex Oral Surgery in the Office

A new challenge in dentistry – Complex Oral Surgery in the Office

ITALIAN VERSION

Root canal therapy of a molar tooth was a sophisticated treatment 50 years ago: the extraction was the rule.

Endodontics of a molar tooth is still a sophisticated treatment today, but it has become a normal dental procedure in any dental office.

What has changed? Tools, techniques, mentality of the dentist and patient needs.

Dentists today are used to working in very narrow spaces.

Progress in some surgical disciplines, such as periodontology and implantology, has been extraordinary.

Oral surgery, however, was excluded: the tools and techniques for the extraction of wisdom teeth are the same as 50 years ago, even in the video clips we see today on the Internet.

The contrast is even more striking when we consider that dentists safely perform sinus lift procedures in their offices, while referring cases of cysts to hospitals. Yet, the elevation of the sinus membrane requires greater skill than the detachment of a cyst wall.

A new challenge in dentistry – Complex Oral Surgery in the Office ultima modifica: 2016-04-08T15:40:30+00:00 da Roberto Barone

Maxillary sinus surgery: lateral approach. The state of the Art

Maxillary sinus surgery: lateral approach. The state of the Art

 

ITALIAN VERSION

 

Introduction

The physiological resorption of alveolar process in the corono-apical and vestibular-palatal direction following tooth loss often does not allow the positioning of implants in the posterior part of the upper jaw without an adequate bone reconstruction. The functional load exerted on the residual crest which transforms into compression force favors centripetal and cranio-caudal bone resorption (Cawood et al. 1988) with consequent reduction in size of the alveolar process associated with a progressive pneumatization of the maxillary sinus.

Among the pre-implant surgical procedures for bone reconstruction, the maxillary sinus surgery has been shown to have a high clinical predictability (Wallace et al. 2003,Del Fabbro et al. 2004-2008-2012-2013 a-b, Pjetursson et al. 2008, Testori et al. 2012). Historically in cases of bone atrophy where the residual bone is less than 4 mm, the lateral approach was utilized.

Maxillary sinus surgery: lateral approach. The state of the Art ultima modifica: 2016-01-11T11:19:14+00:00 da Tiziano Testori

Digital Smile Design interdisciplinary approach

Digital Smile Design interdisciplinary approach

The “Excellence in Prosthodontics” award winning case

 

ITALIAN VERSION

 

Summary:

Limitations in treatment planning are unpredictable due to poor communication between operator – patient, interdisciplinary team, lab technician and clinical factors overlooked by the lack of information .

Tools such as photographys , videos and computer are essential for communication with the patient to create expectations through prototypes that can result in a temporary restoration that will help us see the functional , biological, mechanical and aesthetic performance of the same and future the final restoration.

Digital Smile Design interdisciplinary approach ultima modifica: 2015-12-03T11:04:19+00:00 da Ernesto Guzman

Rehabilitation of maxillary edentulism by means of computer-guided implant surgery and provisional prosthesis with immediate loading

Rehabilitation of maxillary edentulism by means of computer-guided implant surgery and provisional prosthesis with immediate loading

ITALIAN VERSION

 

Computer-guided implantology and immediate loading with CAD-CAM screw-retained full-arch temporary prosthesis

 

A 41 year-old female patient presented with multiple missing teeth at both dental arches and a few remaining elements, among which fractured and non vital teeth. Moreover, the patient, in good general health but with poor oral hygiene, presented with reduced vertical dimension of occlusion (VDO), insufficient labial support and prosthetic space limited by macroglossia. The patient lamented severe functional problems, related both to mastication and speech, as well as serious esthetic concerns, since the maxillary teeth were not visible at all both at rest and during function.

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Rehabilitation of maxillary edentulism by means of computer-guided implant surgery and provisional prosthesis with immediate loading ultima modifica: 2015-10-12T15:26:04+00:00 da Fabio Cozzolino

“Fence Technique”: an innovative reconstruction procedure

“Fence Technique”: an innovative reconstruction procedure

 

ITALIAN VERSION

 

Edentulism was defined as a pathological condition by the World Health Organization in 1990. The discomfort and inconvenience that this condition can generate in terms of aesthetics, function, as well as psychologically, can be so debilitating as to consider edentulism a social handicap.

Due to the gradual increase in the average age of the population, today there are more and more people in their seventies who are enjoying overall good health and intrapersonal relationships. Their expectations have significantly increased as well, and as patients are no longer satisfied with traditional removable dentures; explicit requests are now frequently made for fixed prosthetic solutions with a high level of aesthetics and correct function.

One such example is this patient who came to our observation in 2009 complaining of severe discomfort from a functional and aesthetic perspective (Fig. 1). His dentures were worn and unstable, causing frequent lacerations and sores on the gingival tissues and oral mucosa. The patient reported that this condition was causing psychological problems and lowering his self-esteem, therefore his desire was to solve this complex situation , if possible, with a fixed prosthesis. The assessment of the patient’s systemic risk profile pointed out that his general health conditions were good and that he would classify as ASA class I (Owens et al. 1978).

The evaluation of local risk factors showed the presence of few dental elements (that were in fact compromised) and a particularly marked atrophy of both the upper and lower jaw. The severe bone deficit could have been related also to infrequent readjustment of the prosthesis.

 

“Fence Technique”: an innovative reconstruction procedure ultima modifica: 2015-07-02T16:55:53+00:00 da Mauro Merli

The Self-Adjusting-File (SAF) Technique

The Self-Adjusting-File (SAF) Technique

ITALIAN VERSION

Introduction

 

In 1993 the first  endodontic files, made from a nickel-titanium (NiTi) alloy,  were introduced to the dental market and definitely contributed to a radical change in the operative approach to endodontic treatment   [1]. Compared to  previous stainless steel  files, they were much more flexible,  effective and better performing in shaping   root canals. Furthermore, in recent years, advances in knowledge and technology  have  brought about  several  interesting changes in these alloys, which were made increasingly resistant to  torsional load and, therefore, safer to use.This has led to the manufacturing of  a “single file” ,  which  enables dental practitioners to shape the full length of the root canal using a single  instrument, such as  Wave One ® (Maillefer- Dentsply , Ballaugues, Switzerland) or Reciproc ® (VDW, Munich, Germany) [2].Despite these structural improvements, the file design has remained unchanged :  a solid body with more or less sharpened blades, which cut the canal from different angles and  collect treatment debris in their flutes. This suggests that, despite the different endodontic  variations recurrent in nature, we do nothing but imprint the instrument shape inside the canal, regardless  canal anatomy ; this apparently allows us  to use similar procedures with either round-shaped  and oval- shaped canals ,  as well as with  more or less tightly curved canals.From the studies carried out by  Paqué [3,] analyzing  MicroCT  sections, it is clear  that instrumentation with conventional Ni-Ti tools   does not allow  us to accomplish  a proper cleaning of the whole root canal system (fig.1). In fact, these instruments, due to their  shape, cannot contact the entire surface  of root  walls, thus  leaving within a certain amount of unremoved tissue, which also reduces the quality of subsequent obturation ,  as  highlighted by De Deus (Fig2) [4.5].

The Self-Adjusting-File (SAF) Technique ultima modifica: 2015-06-01T15:49:55+00:00 da Francesco Bellucci

The Conservative Restoration In Critical Areas

The Conservative Restoration In Critical Areas

 

ITALIAN VERSION

 

A young patient presented to the Author with a traumatic coronal fracture of tooth 21, localized at cervical level at about 1 mm from the cementum-enamel junction.

A standardized periapical radiograph was taken and a careful treatment plan was designed. A multidisciplinary approach was chosen, based on endodontic treatment, temporary conservative restoration, orthodontic treatment and prosthetic rehabilitation of the tooth.

CERUTTI zerodonto .002

 

The Conservative Restoration In Critical Areas ultima modifica: 2015-02-16T14:49:23+00:00 da Antonio Cerutti

Invisible Orthodontics: a case report of severe open bite

Invisible Orthodontics: a case report of severe open bite

  ITALIAN VERSION

 

 

‪Many adult patients require aligned teeth to improve their aesthetics, as dental exposure and smile are fundamental for the beauty of the face.

For this reason, the orthodontic treatment plan is the result of a careful radiographic examination and related cephalometric tracing, a detailed examination of the dental casts and related space analysis, but also an accurate aesthetic facial analysis.

We want to focus our attention on the exposure of the maxillary incisors with lips at rest. This is critical, for example, when we treat a case with overbite alterations, both in excess and in defect.

The clinical case we introduce is an example of treatment in case of anterior open bite. The patient asked for a fixed invisible lingual orthodontic therapy without brackets, to completely hide the presence of the device without phonetic distortions and tongue irritations.

Ortopantomography, Latero-Lateral Teleradiography, cephalometric study, cephalometric values chart :

Invisible Orthodontics: a case report of severe open bite ultima modifica: 2015-01-21T15:30:33+00:00 da Anna Mariniello

Complex prosthetic rehabilitation due to severe dental wear

Complex prosthetic rehabilitation due to severe dental wear

 ITALIAN VERSION

 

In collaboration with Dr. Leonardo Bacherini

Several factors affect the life of a tooth and, consequently, different causes can lead to dental wear. Unfortunately, their effects are cumulative and irreversible and, despite its main cause, tooth wear starts immediately after tooth eruption. As a consequence, clinicians have to diagnose such a condition early, particularly when dental wear occurs suddenly and progressively in young patients. The processes causing tooth wear are attrition, erosion, abrasion, demastication, abfraction and non-carious cervical lesions.

 

Patient’s expectations

  • Remote pathological anamnesis: bulimia during youth
  • Recent pathological anamnesis: gastro-esophageal reflux disease (GERD)
  • Non smoker
  • Dental anamnesis: the patient complained about severe sensitivity on all teeth and wanted to improve the esthetics of her smile; the teeth were short and abraded

Complex prosthetic rehabilitation due to severe dental wear ultima modifica: 2014-11-18T13:45:24+00:00 da Mauro Fradeani

Localized Management of Sinus Floor

Localized Management of Sinus Floor

 

ITALIAN VERSION

OBJECTIVES

The Localized Management of Sinus Floor is a surgical technique for transcrestal maxillary sinus floor elevation. Its aim is to create a surgical site for implants by displacing a portion of native residual below bone within the cavity of the maxillary sinus. This particular type of bone is usually found below the sinus floor and, through this technique, is displaced vertically in order to create a new implant alveolar portion. In the final configuration of the surgically created alveolus, the coronal portion of the crest must give primary implant stability. This will be completed by the coronal bone portion – pushed laterally and internally of the sinus cavity – from which, a sort of closed “tent” formed by the sinus membrane, will keep the cavity closed. The latter will be filled by blood produced by the alveolar walls.

Tissue repair of the peri-implant alveolus is totally entrusted to the physiological mechanism of bone repair on the site chosen for the implant osteotomy. 3-4-13-14

The goal is to change the height of available bone by creating an osteotomy tunnel starting from the crestal position and extending, initially transversally and medially, in a direction parallel to the palatine vault. This way, the osteotomy tunnel pushes the spongy bone against the floor of the maxillary sinus and avoids loss of the precious calcified structure.

The initially transverse direction (and not vertical, according to the normal prosthetic axis) is essential to:

1. Increase the height of native bone, interfacing the implant to improve primary stability;

2. Use the higher portion of the sinus floor which is normally found towards the medial side of the sinus cavity.

Preparation of the surgical field

According to the protocol, the preparation of the soft tissues is made with a partial thickness technique that has the objective to leave a thin layer of connective tissue which:

1. Ensures the integrity of the periosteum;

2. Allows to easily read the underlying bony anatomy.

The protection of the periosteum is critical, of course, to maintain the integrity of the blood supply15. Also the layer of connective tissue, and the interposed periosteum between tissue and bone, will be fundamental to promote the peri-implant tissue secondary intention healing. This is one of the main issues of the protocol.

This preparation enables to firmly anchor the keratinized tissue – using the sub-periosteal sutures – in an apical and vestibular position. This residual displaced tissue, previously covering the crest, has been displaced vestibularly14.

The flap preparation begins with a palatally beveled incision which slides along the bone plane, starting from the palatal angle of the crest, exactly where the palatal structure crosses the horizontal portion of the edentulous ridge. This has the aim of exposing the crest and displacing vestibularly the keratinized crestal residual tissue to the future implant emergency. This crestal tissue is the same one which has been previously moved from the palatal aspect of the surgical field. Fig. 01/05

SONY DSC

Localized Management of Sinus Floor ultima modifica: 2014-07-15T14:46:00+00:00 da Giovanni Battista Bruschi