THE USE OF THE OPERATING MICROSCOPE IN DENTAL PRACTISE: POSTURAL ANALYSIS AND CLINICAL EVALUATION

THE USE OF OPERATING MICROSCOPE IN DENTAL PRACTISE: POSTURAL ANALYSIS AND CLINICAL EVALUATION Abstract Author: Alberto Pispero Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Universit\ue0 degli Studi di Milano The study is in collaboration with Politecnico di Milano, Dipartimento di Ingegneria Elettronica, prof. Marco Marcon Study design: randomized controlled clinical trial. Setting of the clinical trial: Dental Clinic G. Vogel, via Beldiletto ASST Santi Carlo e Paolo Ospedale. Dr. Alberto Pispero, the surgeon for all the interventions; Prof. Giovanni Lodi is the head of research. PURPOSE The study investigates the effectiveness of microscope in dental practice in terms of posture improvement for the operator and clinical advantages for the patients. We carried out 4 studies: 1. Postural assessment in dentistry based on multiple markers tracking 2. The use of magnifying instrument for the extraction of lower third molar: Postural assessment 3. The use of magnifying instrument for the extraction of lower third molar: Clinical assessment 4. The influence of dental loupes on the quality of adhesive removal in orthodontic debonding: in vitro study. Background Attention and awareness towards MSDs in the dental profession has increased considerably in last years. From recent literature reviews, it is learned that prevalence of MSDs in dentists is 64-93%. Use of magnification systems improves the operator's visual capabilities, improves posture, and helps to prevent the onset of back and neck disorders. Moreover, the goal of dental treatment is to preserve tissues with minimally invasive prosthetics, conservatives and endodontics therapies, and to reconstruct periodontal soft and hard tissues performing microsurgery treatments in order to get the best aesthetic results and the least pain and complications. Over time, the degree of precision required immediately calls for magnification. METHODS Study 1: First, we conducted a study (study 1) on posture assessment to find an innovative method of postural analysis. In order to do that we worked with Politecnico of Milano. We presented a novel approach for upper limb posture assessment based on the tracking of a set of planar markers placed on the clothes of the worker. Thanks to this non-invasive approach, we were able to follow the 3D position and orientation of all the limbs involved in a speci\ufb01c activity during the job execution. Data will be evaluated through the index RULA (rapid upper limb assesment) to define whether there is a change in exposure to the risk of MSDs (Muskolo - skeletal - disease). Study 2: We used the method mentioned above in a randomized controlled three arms clinical trial where the surgeons performed 90 intervention. It was evaluated dentist posture during extraction of third lower molars depending on whether the operator performs the intervention by the use of surgical loupes or surgical microscope systems or performs a naked eyes surgery. Static and dynamic operator\u2019s posture has been monitored by markers positioned on a slim fit t-shirt and high definition cameras acquired data in real time (study 2). Study 3: To evaluate whether the use magnifying system, could influence the postoperative course of a patient after extraction of a lower third molar. Each patient will be recalled for follow-up visits at 7 days. During this session will be carried out the removal of stitches and data will be recorded as follows: VAS pain and trismus, number of painkillers taken, control photographs, Posse Scale. These data were analyzed considering type of magnification and difficulty of extraction (study 3). Study 4: In order to investigate the effect of using different magnifying systems for removal of composite residues and in the prevention of iatrogenic enamel damage we conducted an in vitro study. 27 permanent extracted teeth were used, The teeth were randomized into 3 groups named. Each tooth was photographed and scanned with the intraoral scanner CS3600-Carestream before bracket placement (T0), post bracket positioning (T1), after removal of bracket (T2) and after debonding (T3). RESULTS Study 1: The analysis that we performed can be easily integrated into classical ergonomics assessment tools like RULA providing an objective methodology that does not involve an operator in a subjective interpretation of the monitored job. Study 2: From step 1 to step 8 in RULA worksheet, we put the same score in all cases, in the same way in steps 11, 13 and 14. By the use of magnification system, the operator\u2019s posture didn\u2019t change in terms of leg positioning or arm raising and wrist twist. We verified that despite the big range between neck bending, from 40 to 3 degrees, the final RULA score is the same for all interventions. Study 3: From the results obtained it is clear that the methods taken into consideration, the operating microscope, the surgical loupes with coaxial illumination and the naked eye, do not have a statistically significant influence on pain intensity (VAS), quality of life (PoSSe) or the number of painkillers taken by patients. The complexity of the magnifying system does not increase the duration of the operating time Study 4: There is a statistically significant difference between the procedures performed with the naked eye and those performed with surgical loupes. This result can be explained by greater attention and accuracy in removing the residual composite from the operator when using magnification systems. Microscope and surgical loupes were slower but got the best results in removal of composite remnants. Intraoral scanner that we used to evaluate the teeth surfaces does not appear useful to discriminate damage to the enamel. CONCLUSION We developed a new approach for posture assessment, precise and accurate, and we have had 3d data of the whole body, which can discriminate differences of one degree. We need long term studies conducted on many dentists (male and female) and a new method of posture data analysis to define the correlation between upper limbs posture and WMSDs accurately. We wanted to test magnification systems in fields of dentistry different from endodontics in which microscope is generally used. Even if data had no statistical significance, on the other hand microscope didn't affect the operating time. Despite common perceptions, the use of the microscope in oral surgery didn't slow down the intervention. We decided to test the microscope potential in debonding. In our research, the procedures performed without a magnification system are on average faster than those performed with the aid of a magnification. This result can be explained by greater attention and accuracy in removing the residual composite from the operator when using magnification systems. Microscope and surgical loupes were slower but got the best results in removal of composite remnants

Dental treatment of a rare case of pyoderma gangrenosum with aggressive periodontal disease

Background and Overview: Pyoderma gangrenosum (PG) is a rare neutrophil-mediated autoinflammatory dermatosis that can involve the oral mucosa. Dental surgery is a potential triggering factor for the onset of PG lesions. The authors describe and discuss the dental management of a rare case of aggressive periodontitis in a patient with PG, from multiple tooth extractions to prosthetic rehabilitation, including administration of systemic steroid prophylaxis before surgery to prevent the potential onset of PG-related lesions. Case Description: A 22-year-old man who had a diagnosis of PG and who had aggressive periodontal disease underwent dental extractions, gingivoplastic surgery, and prosthetic rehabilitation. The patient received 8 milligrams of betamethasone intramuscularly 20 minutes before the oral surgery. The tissues healed perfectly, and no adverse effects were reported. Conclusions and Practical Implications: For minor oral surgery, prophylactic corticosteroids might help reduce the risk of developing PG-related lesions. The clinician should plan the prosthetic devices to be as atraumatic as possible

Do soft tissue augmentation techniques provide stable and favorable peri-implant conditions in the medium and long term? A systematic review

To review the available literature on the medium- and long-term effects of soft tissue augmentation (STA) at implant sites and to explore the effects of the different approaches on clinical-, patient-reported, and health-related parameters. Materials and Methods A comprehensive electronic and manual search was performed to identify prospective clinical studies that assessed the medium- and long-term (≥36 months) outcomes following STA, including number of sites maintaining peri-implant health and number of sites developing peri-implant disease, incidence of complications, stability of the clinical, volumetric, and radiographic parameters, and patient-reported outcome measures (PROMs). Results Fifteen studies were included in the qualitative analysis. STA was performed with either a bilaminar- or an apically positioned flap (APF) approach, in combination with autogenous grafts (free gingival graft [FGG] and connective tissue graft [CTG]) or substitutes (acellular dermal matrix [ADM] and xenogeneic cross-linked collagen matrix [CCM]). An overall high survival rate was observed. Most of the augmented implant sites maintained peri-implant health in the medium and long term, with the incidence of peri-implant mucositis and peri-implantitis ranging from 0% to 50% and from 0% to 7.14%, respectively. The position of the soft tissue margin following APF + FGG and bilaminar approaches involving CTG or CCM was found to be stable over time. No substantial changes were reported for plaque score/index, bleeding on probing/bleeding index, and probing depth between early time points and following visits. CTG-based STA procedures resulted in a stable or increased dimension of keratinized mucosa width (KMW) and mucosal thickness (MT)/volumetric outcomes over time, when compared with early follow-ups. Most of the included studies described stable marginal bone levels at the grafted implant sites over time. No substantial changes for patient-reported outcomes and professionally assessed esthetic results were reported at different time points.Conclusions Implants that received STA showed overall high survival rate and relatively low incidence of peri-implantitis in the medium and long term. Augmented sites seem to maintain the level of soft tissue margin and marginal bone over time, while non-augmented implants may exhibit apical shift of the soft tissue margin. The overall favorable early outcomes obtained with STA are maintained in the medium and long term, with an increase in KMW and MT that may be expected over time at CTG-augmented sites

Trattamento ambulatoriale della sialolitiasi sottomandibolare

The Authors present a short review of the literature about submandibular sialolithiasis, including stone formation, clinical manifestations and instrumental diagnosis. In particular the paper deals with the outpatient surgical treatment of stones obstructing the anterior portion of Warthon's duct. According to the literature, surgical excision is still the most effective technique; endoscopy and lithotripsy may be an indicated alternative when a surgical excision will cause excessive tissue loss. A case of submandibular sialolithiasis treated with Warthon's duct isolation and stone excision followed by surgical modification of duct is also reported

Posture assessment in dentistry for different visual aids using 2d markers

Attention and awareness towards musculoskeletal disorders (MSDs) in the dental profession has increased considerably in the last few years. From recent literature reviews, it appears that the prevalence of MSDs in dentists concerns between 64 and 93%. In our clinical trial, we have assessed the dentist posture during the extraction of 90 third lower molars depending on whether the operator performs the intervention by the use of the operating microscope, surgical loupes, or with the naked eye. In particular, we analyzed the evolution of the body posture during different interventions evaluating the impact of visual aids with respect to naked eye interventions. The presented posture assessment approach is based on 3D acquisitions of the upper body, based on planar markers, which allows us to discriminate spatial displacements up to 2 mm in translation and 1 degree in rotation. We found a significant reduction of neck bending in interventions using visual aids, in particular for those performed with the microscope. We further investigated the impact of different postures on MSD risk using a widely adopted evaluation tool for ergonomic investigations of work-places, named (RULA) Rapid Upper Limb Assessment. The analysis performed in this clinical trial is based on a 3D marker tracker that is able to follow a surgeon’s upper limbs during interventions. The method highlighted pros and cons of different approaches

Cancro e precancro orale: un aggiornamento per l\u2019odontoiatra

Il cancro del cavo orale rappresenta approsimativamente il 3% delle lesioni maligne che ogni anno vengono diagnosticate al mondo. Queste lesioni si pensa che progrediscano da lesioni potenzialmente maligne, partendo da tessuto displastico e sviluppando un carcinoma invasivo. Malgrado la buona accessibilit\ue0 al cavo orale durante una visita odontoiatrica, alcune lesioni maligne vengono diagnosticate negli stadi avanzati della malattia. Per prevenire la trasformazione maligna delle lesioni precancerose al cavo orale si rendono necessarie visite seriate e l\u2019utilizzo di tecniche di diagnosi precoce.Cancers of the oral cavity account for approximately 3% of malignancies diagnosed annually in the word. Cancers of the oral cavity are thought to progress from premalignant/precancerous lesions, beginning as dysplastic tissue and developing into invasive squamous cell carcinoma. Despite the general accessibility of the oral cavity during visit, many malignancies are not diagnosed until late stages of disease. To prevent malignant transformation of these oral precursor lesions, multiple screening and detection techniques for secondary prevention have been developed to address this problem

Influenza dei sistemi ingrandenti nella rimozione dell adesivo nel debonding ortodontico

Bracket bonding has been a major advance in orthodontic treatment. However, the method of debonding can lead to different problems such as enamel fractures, enamel loss and enamel scratching. This clinical investigation aims to investigate the influence of the use of different magnifying systems on enamel damage and the presence of composite residues during the debonding procedure, analyzing the dental surface with the intraoral scanner. To achieve the aforementioned purpose the authors used the ARI index, which allowed us a first post removal bracket evaluation, evaluating both composite remnants after debonding and enamel damage coming from an unfavorable breakouts. MATERIALS AND METHODS Twenty-seven human teeth were used in this study to evaluate ad hesive removal with and without the use of magnifying systems. Each tooth has been photo graphed and scanned with the intraoral scanner CS3600-Carestream at the baseline (T0), after bracket positioning (T1), after debonding (T2) and after clean up (T3). All tooth scans were saved in STL format (Standard Tessellation Language) and exported to MeshLab software to determine the changes on the enamel surface where the brackets were positioned. RESULTS The evaluation of differential images, obtained by digital sub traction computed by the Mesh Lab software, showed statistical ly significant difference (p = 0.0022) between the proce dures performed with the naked eye and those performed with magnification systems, while there does not seem to be significant difference between the two different magnifying systems (p = 0.8745). CONCLUSIONS Careful adhesive removal and efficient methods of restoring the enamel surface as much as possible to its pre-treatment state is essential. From the results obtained it is possible to demonstrate that working with magnification and better illumination results in fewer composite remnants on the enamel sur faces. CLINICAL SIGNIFICANCE The use of magnification sys tems is not an absolute guaran tee to perform a dental therapy correctly. A deep knowledge of the technique and materials al lows to reach high quality standards. The use of magnification systems with coaxial lighting can provide the clinician a tool that can improve visibility, as well as the ability to discriminate between different structures, thanks to a better visual, reducing the risk of damage to anatomical structures