LA GESTIONE ENDODONTICA DEL PAZIENTE CHE ASSUME FARMACI DELLA CLASSE DEI BISFOSFONATI: LINEE GUIDA ALLA LUCE DELLA RECENTE LETTERATURA SCIENTIFICA

La comparsa in letteratura di alcune case reports sulle complicanze che il trattamento endodontico non appropriato poteva sortire in pazienti che erano in trattamento con farmaci bifosfonati per la cura di supporto a patologie oncologiche ha reso opportuno l'approfondimento di questo argomento. Sono stati dunque analizzati gli articoli disponibili su Med-Line digitando le parole chiave: bisphosphonate and osteonecrosis. Dagli articoli revisionati e dall'esperienza degli Autori sono state delineate alcune linee guida per il trattamento dei pazienti che devono assumere farmaci della categoria dei bisfosfonati, dividendoli in tre categorie: 1) pazienti che devono iniziare la terapia 2) pazienti gi\ue0 in terapia ma senza sintomi 3) pazienti gi\ue0 in terapia che manifestano sintomi correlati con l'assunzione di questi farmaci. Appare quindi che per prevenire l'insorgenza di questa nuova entit\ue0 patologica, l'osteonecrosi associata all'uso dei bisfosfonati, sia importante la collaborazione fra i vari specialisti che trattano questi difficili pazienti per evitare che l'ignaro endodontista causi involontariamente il manifestarsi di tale patologia

GESTIONE E PREVENZIONE DELLA LITE. COMPLICANZE ED ERRORI IN CHIRURGIA ORALE

From a medico-legal point of view is very important to distinguish the occurrence of an unpredictable complication and a technical error. In the first case the doctor is not guilty but as the complication occurs he should be aware of \u201cwhat\u2019s going on\u201d and make the correct diagnosis and the adequate therapy. The authors analyze cases in which a lesion of the inferior alveolar nerve occurs and when it can be considered malpractice of the surgeon and when it can be considered only an unpredictable complication. Moreover they analyze the importance of the preoperative pharmacological anamnesis since are not rare abnormal bleeding in patients treated with oral anticoagulants and osteonecrosis in patients under biphosphonate therapy

PLANNING IN CRANIOFACIAL DO PROCEDURES USING SIMPLANT CMF SOFTWARE AND RAPID PROTOTYPING MODELS

Objective: Aim of this research is to define a more accurate way of planning Distraction Osteogenesis procedures in craniofacial surgery using a new software (Simplant CMF - Materialise) and Rapid Prototiping Skeletal Models. Materials & Methods: 3 pts. affected by cranio-maxillo-facial abnormalities have been submitted before surgery to CT Scan. CT data have been reconstructed in a 3D way. Utilizing Simplant CMF software osteotomies have been simulated and different distraction vectors have been simulated in a 3D virtual enviroment. At the end of each hard tissues simulation it was possible to preview the soft tissue final result. We later printed Rapid Prototiping Models from the same CT data and pre-operatively we reproduced surgery on the models and we pre-plated the distractor device in a proper way. Results: This planning procedure allows to choose the best aesthetic and functional surgical plan. In Crouzon patient it was decided to add bone graft in the nasal and orbital area, in the pre-prosthetic patient it was possible to precisely decide the distraction vector useful for the future dental implant position; in the micrognathia patient it was decided to increase the sagittal distraction movement more than the preliminary orthodontic plan for aesthetic issue. Final decision seemed to be more defined and time was saved during surgery for the pre-bending of the distractor fixation plate. Conclusions: Preliminary results bring us to conclude that Planning in Craniofacial DO procedures using Simplant CMF Software and Rapid Prototiping Models could improve the quality and the final surgical result