"All on short" prosthetic-implant supported rehabilitations

Objectives. Short implants are increasing their popularity among clinicians who want to fulfill the constant demanding of fixed prosthetic solutions in edentulous jaws. The aim of this report was to propose a new possibility to project and realize an occlusal guided implant cross-arch prosthesis supported by ultra-short implants, describing it presented an edentulous mandible case report. Methods. A 61-year-old, Caucasian, female patient who attended the dental clinic of the University of L’Aquila presented with edentulous posterior inferior jaw and periodontitis and periimplantitis processes in the anterior mandible. The remaining tooth and the affected implant were removed. Six 4-mm-long implants were placed to support a cross-arch metal-resin prosthesis. Results. At 1-year follow-up clinical and radiological assessment showed a good osseointegration of the fixtures and the patient was satisfied with the prosthesis solution. Conclusion. The method, even if it requires further validation, seems to be a valid aid in solving lower edentulous clinical cases, and appears less complex and with more indications of other proposals presented in the current clinical literature. Our case report differs from the current technique All-on-Four, which uses four implants in the mandible to support overdenture prosthesis, assuring a very promising clinical resul

Self-bone graft and simultaneous application of implants in the upper jawbone. (Fit lock technique).

The implant-supported rehabilitation ofposterosuperior sectors may be sometimes conditioned by the pneumatization of the para-nasal sinuses, which decreases the possibility of implant placement when the bone height is < or = 4 mm. (prerequisite for primary stabilization). Sinus lift surgery with simultaneous application of implants is the procedure which provides the best chance of success compared to the application of the filling material only. There are many surgical techniques which combine autogenous bone grafting (ilium crest, calvaria,fibula) with implant placement. The objective of this report is to present a new technique which aims to minimize invasive bone grafting and patient morbidity. The authors performed a longitudinal study on 21 cases with a 94.5\% success rate, exemplified by one clinical case. The advantages of this technique are: 1) Functional and anatomical recovery of the jaw cavity. 2) Simultaneous application of implants when the bone is < or = 4mm. 3) Reduction of surgical times. 4) Reduced patient morbidity. 5) Local anesthesia

Subjects with temporomandibular joint disc displacement and body posture assessment via rasterstereography: a pilot case-control study

Objective: The possible relationship between temporomandibular disorders (TMDs) and body posture is still controversial. Rasterstereography has been introduced as a radiation-free, reliable and non-invasive method to analyze three-dimensional spinal posture. The aim of this case-control study is to evaluate, through rasterstereography, body posture parameters in a group of patients with reducible unilateral dislocation of the articular disc, compared to healthy volunteers. Patients and methods: Rasterstereographic recordings obtained were compared between the two groups with a paired t-student test. Furthermore, the relationship between Rasterstereographic recordings and clinical data in the TMD group were analyzed by means of multiple regression analysis. Results: Only lateral deviation was statistically significant different between the two groups (rms VPDM Control group 40% &gt; TMD group, p=0.02; 43% control group VPDM max &gt; TMD group, p&lt;0.02). In the TMD group, a significant relationship (p&lt;0.05) was found out between lateral and rotational deviations of the column and muscular pain, therefore suggesting a possible overactivity of the masticatory muscles, especially of lateral pterygoids' bilaterally and the left masseter. Conclusions: Patients with reducible unilateral disc displacement showed limited postural alterations compared to healthy volunteers, only lateral deviations (VPDM rms and VPDM-max) were statistically significant (Π&lt;0.05) between the two groups

Mechanical influence of tissue culture plates and extracellular matrix on mesenchymal stem cell behavior: A topical review

Tissue engineering applications need a continuous development of new biomaterials able to generate an ideal cell-extracellular matrix interaction. The stem cell fate is regulated by several factors, such as growth factors or transcription factors. The most recent literature has reported several publications able to demonstrate that environmental factors also contribute to the regulation of stem cell behavior, leading to the opinion that the environment plays the major role in the cell differentiation. The interaction between mesenchymal stem cells (MSCs) and extracellular environment has been widely described, and it has a crucial role in regulating the cell phenotype. In our laboratory (Tecnologica Research Institute, Crotone, Italy), we have recently studied how several physical factors influence the distribution and the morphology of MSCs isolated from dental pulp, and how they are able to regulate stem cell differentiation. Mechanical and geometrical factors are only a small part of the environmental factors able to influence stem cell behavior, however, this influence should be properly known: in fact, this assumption must be clearly considered during those studies involving MSCs; furthermore, these interactions should be considered as an important bias that involves an high number of studies on the MSCs, since in worldwide laboratories the scientists mostly use tissue culture plates for their experiments

Longitudinal epidemiological analysis of three decades of TMD populations

OBJECTIVES This study aims to compare the epidemiological data of three cohorts of dysfunctional patients attending to the Clinical Gnathology Service of Policlinico Umberto I University Hospital - Sapienza University of Rome, in order to highlight the salient characteristics of Temporomandibular disorders (TMD) and patients who are affected, and understand their evolution over time. MATERIALS AND METHODS A homogeneous population of 387 dysfunctional patients, belonging to three different decades, consecutively extracted from the medical records in the archive, which contained all their personal, anamnestic and clinical data, was selected. All patients were divided into three homogeneous groups of 129 subjects: GI (1990-1993), GII (2000-2003) and GIII (2010-2013). A descriptive statistical analysis of all the clinical and anamnestic data was performed. RESULTS The female gender (F) is far more interested in the development of TMD, although the study groups of more recent times shows an increasing trend in the incidence on the male one (M): in GI, the patients of M and F sex are respectively 14.84% and 85.16%; in GII are 15.50% and 84.50%; in GIII are 20.16% and 79.84%. Regarding the age, in all three groups the most affected range is between 16 and 40 years: 80% in GI, the 68.26% in GII and the 62.02% in GIII. However, the highest age groups, from 41 to 70 years and over, shows a progressive increase in incidence, from the 90s (GI) to today (GIII): the 17.27% in GI; the 30,16% in GII; the 37.20% in GIII. The most frequent TMDs are the joint diseases (GI: 85%; GII: 54.3%; GIII: 51.2%). The disc displacement with reduction (DDWR) is present in the 44.89% of GI patients, the 40.31% of GII, and the 34.11% of GIII. The disc displacement without reduction (DDWoR) is present in the 40.15% of GI patients, the 13.96% of GII, and in the 17.06% of GIII. GIII shows an increased incidence of muscular pathologies (37.2%) compared to previous decades (GI: 10.2%; GII: 35.6%). The parafunctions are a datum of remarkable incidence in all the study groups, especially in GIII. Clenching is present in the 17.05% of GI, in the 30.23% of GII, and in the 62.8% of GIII. Bruxism is present in the 14.96% of GI, in the 11.63% of GII, and in the 35.66% of GIII. Joint pain is the symptom with higher incidence in all analyzed groups, being reported by the 74.42% of GI, the 79.07% of GII and the 69.77% of GIII. This symptom, whether present on the right, on the left or bilaterally, is mostly referred as moderate/severe by patients of GI, GII and GIII, and shows no remarkable discrepancies between the different decades. Headache is a symptom mostly referred as bilateral, and is the comorbidity most reported all three groups: 45.74% in GI, 57.36% in GII, and 66.67% in GIII. Neck pain occurs mostly bilaterally and is reported by a higher percentage of GIII patients (61.24%), compared to GII (41.87%). CONCLUSIONS The TMD patient, compared to the past, is on average less young and afflicted by painful and chronic diseases, almost constantly accompanied by painful symptoms associated with the purely articular or muscular one, such as headache and neck pain. These features make the dysfunctional patient more complex to be examined, so the specialist need to train properly in order to have a valid diagnostic and therapeutic expertise. CLINICAL SIGNIFICANCE The dysfunctional patient has changed over time several characteristics that must be considered in clinical practice

self bone graft and simultaneous application of implants in upper jawbone

The implant supported rehabilitation of upper back sectors, sometimes, is conditioned to the pneumatization of the jawbone and so, reducing the possibility to apply the implants when the bone portion is inferior to 4 mm (important condition for the primary stability). The great rise of the jawbone and the simultaneous application of implants is, surely, the condition to have the best success guarantees compared to the only application of filling material. The surgical technologies used in the self bone grafts are various (Ilium crest, calvaria, fibula) and so also for implant applications. In this article we want to put in evidence a new technology in order to reduce at the minimum the invasive surgery of the removal and the patient morbidity. 1. Functional and anatomical recovery of the jaw cavity. 2. Immediate application of implants with a thickness of remaining bone in fervor to 4 mm. 3. Reduction of surgical times. 4. Reduced morbidity of the patient. 5. Local an anesthesia

Implant stability in different techniques of surgical sites preparation: an in vitro study

In the last few decades the implantology has achieved excellent results in the prosthetic rehabilitation of the partially or totally edentulous patients. The clinicians, given the pressing demand by patients, must deal with the situations in which the lack of the availability and sometimes the low quality of the bone can lead to the treatment failure. Although the manufacturers recommend to follow codified surgical protocols, alternative techniques of preparation, apt to ensure a better primary implant stability, have been developed. The aim of this study was to determine in vitro, by using the resonance frequency (Osstell mentor), which technique of implant site preparation (piezo surgery, conventional, under-preparation, bone compaction, osteodistraction) is able to improve implant stability of type IV cancellous bone. 10 pig ribs were prepared, and a surgical pre-drilled and calibrated guide for proper implant placement was used. On each rib, 5 implant sites were prepared, one for each technique. One-way ANOVA did not show statistically significant differences among the “implant stability quotient” (ISQ) values of the 5 techniques utilized. Thus, in light of these results, in the clinical practice of the type IV bone one technique is replaceable with the others, as none of them improves implant stability. The choice should instead be directed to the technique that accelerates the healing process and the osseointegration

“RA.DI.CA.” splint for the management of the mandibular functional limitation: A retrospective study on patients with anterior disc displacement without reduction

The study aimed at assessing the effectiveness of the RA.DI.CA. splint in the management of temporomandibular joint disc displacement without reduction (ADDwoR) and jaw functional limitation. The authors developed a retrospective clinical study. A total of 2739 medical records were screened. One hundred and forty-one patients with chronic unilateral disc displacement without reduction and jaw limitation, treated with a multifunctional RA.DI.CA. splint, were enrolled. Temporomandibular pain, headache, familiar pain, neck pain, and emotional strain, maximum spontaneous mouth opening, and lateral excursions were evaluated at baseline (T0), after therapy (T1), and during the follow-up (T2). Descriptive statistical analysis was performed. Wilcoxon test assessed changes in symptomatology and functional aspects before and after treatment and between T1 and T2, with p &lt; 0.05. Ninety-nine patients (70%) declared themselves “healed” from jaw functional limitation with no residual painful symptoms, 31 (22%) improved their symptoms and jaw function, 11 (8%) reported no changes compared to T0 and no one worsened. As for all parameters analyzed, the comparison between the ones before and after treatment was statistically significant (p &lt;0.05). The RA.DI.CA. splint proved to be highly performing and promoting functional and symptomatologic recovery, also in the medium and long term, through the restoration of the functional disc-condyle relationship and the healing of joint tissues