Maxillary functional orthopedics (MFO), officially introduced in 1936th in the orthodontic world by Andresen and Haulp as valid alternative in the treatment of malocclusions, has always been subject to profound passion by both followers and opponents.
In the middle of last century the idea of being able to intervene positively or negatively influencing the growth of the jaw was strongly denied in the light of the belief that there was a growth program exclusively determined by genetics and virtually no influenced by the environment and function.
The 28 year old patient came into our office complaining of tooth sensitivity. When doing the anamnesis, she denied any history of dental or facial trauma. But she declared that she has been eating lemons 2 times a day for the past 12 years. On examination, we found no TMJ, muscle or periodontal problems.
As part of our protocol, we requested a panoramic x-ray and did facial and dental photos, on which we discussed the dental problems with the patient. Although her only chief complaint was tooth sensitivity, after seeing the facial photos she realized that her issues are also related to esthetics.
The clinical case we present here regards a 25-year old girl who underwent an extremely severe car accident in which she was the only one survivor out of 4 passengers of the same age.
The need to work under dry conditions, free of saliva, has been recognized for centuries, and the idea of using a sheet of rubber to isolate the tooth dates exactly 153 years! The introduction of this notion is attributed to a young American dentist from New York, Sanford Christie Barnum, who in 1864 demonstrated for the first time the advantages of isolating the tooth with a rubber sheet.
I’m doctor Loris Prosper a dentist and a dental technician. I love our beautiful work since I started doing it, more than 45 years ago. My area of expertise is fixed prosthodontic in aesthetic area that, in my opinion, should respect biology, preserve teeth and soft tissue health and respond to minimal invasive criteria since we make irreversible procedure when we prepare the abutment. It is only a short while I’ve published the book :”Bioestetics in the Oral Reabilitation “ Quintessence Publishing , that collects my expertise and my researches. Since the beginning of my practice my mission was to teach all the technical expertise and the tricks I’ve been acquiring through experience and mistakes.
Much contemporary literature mainly focuses on abstractions not linked to daily practice of either general either specialist dental practitioner.
A serious car accident caused severe damage, both systemically as well as to the oral cavity of a young 17 year old female (Fig. 1). The loss of teeth, hard tissue and soft tissue in the fifth sextant resulted in a critical esthetic-functional deficit.
The patient’s request was to restore the compromised zone with a prosthetic rehabilitation that would be as similar as possible to the area prior to the trauma, avoiding solutions that foresee the presence of artificial gingiva .
The required vertical bone regeneration exemplifies one of the most complex procedures, mainly with regards to the correct management of the soft tissue compromised by the injury.
Following an accurate clinical-radiographic assessment of the skeletal maturity, a complex therapeutic strategy was undertaken (Figs. 2, 3).
Patients affected by dental wear often are treated only when their dentation becomes extremely compromised.
However, when pathologies such as dental erosion, and/or parafunctional habits are not intercepted at an early stage, full mouth rehabilitations, mostly implementing crowns, are often considered. Thanks to improved adhesive techniques, the indications for crowns have decreased and a more conservative approach can be nowadays proposed to protect the remaining tooth structure.
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.
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.