Reconstruction of the upper jaw bone volume with advanced atrophy in the implant-prosthetic rehabilitation by autogenous bone graft from the iliac crest

Catedra de Chirurgie Oro-Maxilo-Facială și Implantologie Orală ”Arsenie Guţan”, IP USMF „Nicolae Testemiţanu”, Departamentul de Chirurgie Cranio-Maxilo-Facială și Implantologie Orală, UMF ”Iuliu Haţieganu”Rezumat. Cauzele și condiţiile pierderilor dentare condiţionează modificarea crestelor alveolare. Defectul crestei alveolare pune, de multe ori, medicul chirurg în dificultate atunci când se preconizează înserarea unui implant în crestele alveolare resorbite. Un spaţiu interarcadic mărit rezultă o lungime și formă coronară similară, ceea ce produce, în reconstrucţia protetică finală, un raport corono-radicular nefavorabil, aspect inestetic și poate crea dificultăţi de igienă orală și un pronostic nefavorabil pe termen îndelungat. Recoltarea grefei osoase de la nivelul crestei iliace este metoda de elecţie pentru defectele ce necesită cantităţi mari de os autogen, datorită riscului limitat și a unei abordări simple. În acest studiu au participat 8 pacienţi cu recoltarea grefei din creasta iliacă prin metoda convenţională și cea minimal invazivă. În urma acestui studiu putem afirma că morbiditatea în metoda minimal invazivă de recoltare de creastă iliacă este mai mică și reprezintă o tehnică potrivită în crearea ofertei osoase a maxilarului superior cu atrofie avansată, unde este neceasară o cantitate considerabilă de os autogen.Summary The causes and conditions of dental loss influences the alteration of alveolar ridges. Defects of the alveolar ridge often places the surgeon in difficulty when inserting an implant into the resorbed alveolar ridges. An enlarged space between dental arches results a similar coronary length and shape, which causes, in the final prosthetic reconstruction, an unfavorable corono-radicular ratio, an unaesthetic aspect and may create difficulties in oral hygiene and unfavorable longterm prognosis. Bone graft harvesting of iliac crest is the method of choice for defects requiring large amounts of autogenous bone due to limited risk and a simple approach. In this study attended 8 patients which were harvested from the iliac crest graft by conventional and minimally invasive methods. As a result of this study, we can afirm that morbidity in the minimal invasive method of iliac crest harvesting is lower and is a suitable technique for creating bone volume of the upper jaw with advanced atrophy where is needed a considerable amount of autogenous bone

The Presence of Periodontitis in Patients with Von Willebrand Disease: A Systematic Review

The aim of this systematic review and meta-analysis was to analyze the available evidence on the assessment of periodontal disease in patients with von Willebrand disease (VWD). An electronic search in three databases (PubMed, Web of Science, and Scopus) was conducted by three independent reviewers to identify cross-sectional, cohort, and clinical trial studies. Studies considered eligible for this review were evaluated according to the quality and risk assessment tool proposed by the CLARITY Group at McMaster University. In order to analyze the possible correlation of VWD patients and periodontitis and their susceptibility to bleeding during the periodontal screening phase, periodontal parameters evaluated were probing pocket depth (PPD), bleeding on probing (BOP), gingival bleeding index (GBI), and periodontal inflamed surface area (PISA). After a screening of 562 articles, three articles were selected for the qualitative analysis. Within the limitation of our review, VWD patients are not more susceptible to periodontitis as compared with non-VWD patients. Nevertheless, bleeding on probing and gingival index needs to be carefully taken into consideration during periodontal screening of VWD due to the possible presence of false positives

Un procedeu original de construcţie şi utilizare a lamboului nazogenian

Introduction. The classical naso-labial fl ap used for the reconstruction of tongue and oral floor presents multiple drawbacks. As an alternative to the classical one we present an original procedure of preparation of the naso-labial fl ap evaluated after seven years of use. Material and Method. The procedure we used was fi rst applied in the Oral and Maxillofacial Surgery Clinic in Cluj-Napoca seven years ago on patients suffering from tongue and/or oral floor malignancies in order to reconstruct these anatomical areas after the excision of the tumours in oncological safe limits. Most of its preparation procedure was made according to the classical method with some modifi cations in the preparation of its base. In order to enhance its covering area and functional availability and to eliminate some drawbacks, the route to the receptor area was changed. The submandibular course was used instead of the transbuccal one. Results. In all 21 patients who underwent surgery, a considerable enhancement of fl ap covering availability was obtained. It was able to cover defects ranging from the posterior limits of the tongue and oral fl oor to the tongue tip even beyond the midline. Unlike in the classical method there was no need to perform tooth extractions in dentulous patients. It is a one step procedure. Thus, the second step of the classical method was eliminated. Conclusions. The naso-labial fl ap with submandibular course offers covering and functional availability superior than the classical one with transbuccal route. It preserves and reconstructs the perimandibular anatomical sites. It also shortens the surgical treatment period of tongue and oral floor malignancies

Coronavirus (SARS-CoV-2) Pandemic: Future Challenges for Dental Practitioners

In the context of the SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) pandemic, the medical system has been subjected to many changes. Face-to-face treatments have been suspended for a period of time. After the lockdown, dentists have to be aware of the modalities to protect themselves and their patients in order not to get infected. Dental practitioners are potentially exposed to a high degree of contamination with SARS-CoV-2 while performing dental procedures that produce aerosols. It should also be noted that the airways, namely the oral cavity and nostrils, are the access pathways for SARS-CoV-2. In order to protect themselves and their patients, they have to use full personal protective equipment. Relevant data regarding this pandemic are under evaluation and are still under test. In this article, we made a synthesis about the way in which SARS-CoV-2 spreads, how to diagnose a novel corona virus infection, what the possible treatments are, and which protective personal equipment we can use to stop its spreading

Cross-sectional imaging and cytologic investigations in the preoperative diagnosis of parotid gland tumors – An updated literature review

An accurate preoperative diagnosis of parotid tumors is essential for the selection and planning of surgical treatment. Various modern cross-sectional imaging and cytologic investigations can support the differential diagnosis of parotid tumors. The aim of this study was to achieve a comprehensive and updated review of modern imaging and cytologic investigations used in parotid tumor diagnosis, based on the latest literature data. This literature review could serve as a guide for clinicians in selecting different types of investigations for the preoperative differential diagnosis of parotid tumors. Magnetic resonance imaging (MRI) with its dynamic and advanced sequences is the first-line imaging investigation used in differentiating parotid tumors. Computed tomography (CT) and positron emission tomography (PET)-CT provide limited indications in differentiating parotid tumors. Fine needle aspiration biopsy and core needle biopsy can contribute with satisfactory results to the cytological diagnosis of parotid tumors. Dynamic MRI with its dynamic contrast-enhanced and diffusion-weighted sequences provides the best accuracy for the preoperative differential diagnosis of parotid tumors. CT allows the best evaluation of bone invasion, being useful when MRI cannot be performed, and PET-CT has value in the follow-up of cancer patients. The dual cytological and imaging approach is the safest method for an accurate differential diagnosis of parotid tumors

Efficiency of Hyaluronic Acid in Infrabony Defects: A Systematic Review of Human Clinical Trials

Background and objectives: The aim of this systematic review was to assess the electronic literature about the benefits of using hyaluronic acid (HA) in the surgical periodontal treatment of infrabony defects. Materials and methods: This review was conducted under the PRISMA guidelines. The electronic search was conducted on PubMed, Scopus, Web of Science, and Cochrane databases until February 2022. The inclusion criteria consisted of human clinical trials that reported the use of HA in open-flap debridement (OFD) for infrabony defects. The assessment of risk of bias was performed using the Cochrane risk of bias tool. Statistical analysis was performed using Review Manager. Results: Overall, three RCTs were found eligible for the statistical analysis. Probing depth (PD) reduction and clinical attachment level (CAL) gain in the HA test group presented WMs of −1.11 mm (95% CI −2.38 to 0.16 mm; p = 0.09) and −1.38 mm (95% CI −2.26 to −0.49 mm; p = 0.002), respectively. However, the heterogeneity of the RCTs was high, and the risk of bias, in general, was low. Conclusions: The use of hyaluronic acid seems to have beneficial effects in periodontal surgery using OFD, in terms of PD and CAL. To draw a clear conclusion, more adapted and well-designed clinical trials are needed to assess the advantage of this product in comparison with other products

A Naso-Orbito-Ethmoid (NOE) Fracture Associated with Bilateral Anterior and Posterior Frontal Sinus Wall Fractures Caused by a Horse Kick—Case Report and Short Literature Review

Naso-orbito-ethmoid (NOE) fractures associated with anterior and posterior frontal sinus wall fractures are among the most challenging cranio-maxillofacial injuries. These represent a major emergency, having a potentially severe clinical picture, with intracranial hemorrhage, cerebrospinal fluid (CSF) leak, meningeal lesions, pneumocephalus, contusion or laceration of the brain matter, coma, and in some cases death. In this article, we present the case of a 30-year-old patient with the diagnosis of NOE fracture associated with bilateral anterior and posterior frontal sinus wall fractures caused by a horse kick, with a fulminant post-traumatic alteration of the neurological status and major impairment of the midface bone architecture. Despite the severity and complexity of the case, early initiation of correct treatment both in terms of intensive care and cranio-maxillofacial surgery led to the successful rehabilitation of the neurological status, as well as to the reconstruction and redimensioning of midface architecture and, not least, to the restoration of the patient’s physiognomy

Clinical Outcomes of Enamel Matrix Derivate Used in Surgical and Non-Surgical Treatment of Peri-Implantitis: A Systematic Review of Clinical Studies

Background and objectives: The aim of this systematic review was to assess the available evidence of using enamel matrix derivate in the treatment of peri-implantitis. Materials and methods: Three electronic databases (PubMed, Scopus, and Web of Science) were searched until August 2022 to identify relevant articles. The inclusion criteria consisted in human clinical studies that reported the use of enamel matrix derivate (EMD) in surgical and non-surgical treatment of peri-implantitis. The risk of bias was assessed using Cochrane risk of bias tool for randomized clinical trials (RCTs) and for non-RCTs ROBINS-I tool. Results: Clinical studies included were published between 2012 and 2022 and consisted of two randomized clinical trials (RCTs) for non-surgical therapy and two RCTs, three prospective cohort studies, and one retrospective case series in surgical therapy. Due to the heterogeneity of patients’ characteristics and assessment of peri-implant therapy, statistical analysis could not be achieved. Conclusions: The use of EMD indicated a positive effect on both surgical and non-surgical therapy. However, the available literature is scarce, with low evidence in non-surgical approach and modest evidence in surgical approach using EMD. More RCTs with standardize protocols are necessary to evaluate the efficacy of using EMD in both therapies

Bacterial and inflammatory behavior of implants in the early healing phase of chronic periodontitis

To assess the pattern of early bacterial colonization at implants and teeth in patients with a history of chronic periodontitis compared with a group of healthy subjects. Furthermore, the presence of host-derived markers at teeth and implants in the two subject groups was determined

Substantial Improvements in Facial Morphology through Surgical-Orthodontic Treatment: A Case Report and Literature Review

Background and Objectives: The long face type is associated with excessive vertical facial growth and most often with anterior open bite. In many cases of anterior open bite of high severity associated with bimaxillary dento-alveolar protrusion, lips are unable to form an adequate seal at rest. This leads to many issues, including facial dysmorphism. The aim of this study was to describe the case of a 15 year old girl who addressed the orthodontist in November 2015, having complaints related to the skeletal and dental open bite. Case Description: A 15.7 year old patient required a consultation with the orthodontic service for impaired dento-facial aesthetics at rest, smile and speech due to an exaggerated superior protrusion of the upper frontal teeth, labial incompetence with excessive gingival exposure at rest and smile associated with upper and lower anterior teeth crowding. The orthodontic diagnostic consisted of skeletal open bite with a hyperleptoprosop morphological facial type, high degree of hyperdivergence, bimaxillary dento-alveolar protrusion, 7 mm skeletal open-bite, 3 mm vertical inocclusion of the anterior teeth, skeletal class II relationships, bilateral half cusp class II molar and canine relationships, labial incompetence, highly increased interlabial gap, facial asymmetry, excessive gingival exposure of 7 mm at smiling and bimaxillary anterior crowding. Because the patient initially refused orthognathic surgery, prior to starting the orthodontic treatment, the patient was recommended to receive a bilateral extraction of the first upper premolars. Key objectives of pre-surgical orthodontic treatment were to achieve a retroclined position of the upper incisors under their normal inclination for the planned upward maxillary rotation, to maintain slightly lower incisor proclination. The orthognathic surgery consisted of Le Fort I impaction osteotomy with 8 mm anterior impactation, bilateral sagittal split osteotomy, and mandibular repositioning using occlusal splint. Conclusions: At the end of the orthodontic-surgical treatment, the patient presented significant improvement in dento-facial aesthetics, and optimal skeletal, muscular and dental balance