Decontamination using a desiccant with air powder abrasion followed by biphasic calcium sulfate grafting: a new treatment for peri-implantitis.

Peri-implantitis is characterized by inflammation and crestal bone loss in the tissues surrounding implants. Contamination by deleterious bacteria in the peri-implant microenvironment is believed to be a major factor in the etiology of peri-implantitis. Prior to any therapeutic regenerative treatment, adequate decontamination of the peri-implant microenvironment must occur. Herein we present a novel approach to the treatment of peri-implantitis that incorporates the use of a topical desiccant (HYBENX), along with air powder abrasives as a means of decontamination, followed by the application of biphasic calcium sulfate combined with inorganic bovine bone material to augment the intrabony defect. We highlight the case of a 62-year-old man presenting peri-implantitis at two neighboring implants in positions 12 and 13, who underwent access flap surgery, followed by our procedure. After an uneventful 2-year healing period, both implants showed an absence of bleeding on probing, near complete regeneration of the missing bone, probing pocket depth reduction, and clinical attachment gain. While we observed a slight mucosal recession, there was no reduction in keratinized tissue. Based on the results described within, we conclude that the use of HYBENX and air powder abrasives, followed by bone defect grafting, represents a viable option in the treatment of peri-implantitis

Lingual frenectomy: a comparison between the conventional surgical and laser procedure.

Aim: Ankyloglossia, commonly known as tongue-tie, is a congenital oral anomaly characterized by a short lingual frenulum that may contribute to feeding, speech and mechanical problems. The purpose of this study is to compare the advantages of laser vis-à-vis conventional frenectomy in both intra- and post-surgical phases. Methods: This study took into consideration two patients, who were respectively 9 and 10-year-old. The first one underwent a common surgical procedure. A Nd:Yap laser device with a micropulsed wavelength of 1340 nm and power of 8 watts was used for the second. The postsurgical discomfort and healing characteristics were evaluated. Results: The results indicated that the Nd:Yap laser has the following advantages when compared to the conventional frenectomy: 1) soft tissue cutting was efficient, with no bleeding, giving a clear operative field; 2) there was no need to use sutures; 3) the surgery was less time-consuming; 4) there was no postsurgical infection and no need for analgesics or antibiotics; 5) wound contraction and scarring were decreased or eliminated; 6) despite the initial slowness of the healing process, the complete and final recovery was faster. Conclusion: Considering the above elements, it is possible to assert that the laser frenectomy has a series of unquestionable advantages if compared to the conventional surgical technique

Reduction of precocious peri-implant resorption cone

Aim: After implant-insertion, bone tissue, newly-formed on peri-implant crest, undergoes to a mild marginal osseous readjustment due to build-up of inflammatory cell tissue (ICT). The present study verifies the possibility to limit bone resorption by placing implant fixtures 0.5 mm outside cortical bone edge. Methods: A clinically-controlled randomized study on 100 implants has been performed to compare early resorption process of implant fixtures placed 0.5 mm outside cortical bone edge with implant-fixtures inserted according to juxtacortical bone conventional protocols. Results: After 6 months, bone implant level was higher with emersion approach (-1.01\ub10.54 mm, mean\ub1SD) than with submerged treatment (-1.56\ub10.5 mm) (P<0.001). Conclusion: Factors to achieve an excellent result at mean-long term seem to be very good, even though the latter have to be confirmed by follow-up

Second Vascularized Fibula Flap and Osteotomy to Correct Malocclusion

For alveolar bone augmentation, a further reconstructive procedure is possible with a new revascularized fibula flap fixed onto the surface of the first fibula, placed as reconstruction of the basal bone of the mandible. Two consecutive vascularized free flaps are reported in a small series of patients affected by recurrent squamous cell carcinoma. A second fibula vascularized flap is reliable for simultaneous augmentation in symphysis, parasymphysis, and the premolar area over a previous fibula flap: implant-borne dental rehabilitation becomes practicable to improve quality of speech and diet. Malocclusion and asymmetric facial contour may follow reconstruction of the jaws with vascularized fibula flap for an inaccurate insetting procedure. The misaligned reconstructed jaw may influence the implant placement, resulting in occlusal overload that may impair the long-term survival of implant-supported prostheses. Correction of malocclusion after fibula graft may be obtained by secondary osteotomies. We described the use of a Le Fort osteotomy to correct malocclusion after fibula flap reconstruction of the maxilla. The ideal dental relationships of the osteotomized and moved jaw can be established by using a surgical acrylic splint, which is secured to the opposing dentition. The peroneal vessels can be ligated on this occasion, enabling the osteotomized jaw to move with more ease and thus proceed according to the planning

Delayed correction of orbital-maxillo-zygomatic complex fractures with stereolitographic models

Introduction: The etiology of post-traumatic orbital deformities is most frequently due to impossibility of an immediate surgical treatment because of any systemic pathology that may represent a life risk. It may be possible to achieve a suitable surgical result pursuing the following aims: restoration of the threedimensional structure of the orbit, soft tissue correction and eventually restoration of lost tissues with autologous or similar ones. In the correction of post-traumatic orbital sequelae, many surgical options exist: osteotomies, reconstructive and camou- \ufb02age techniques using alloplastic material or bone grafts and soft tissues restoration. The aim of this study is to evaluate if the use of stereolithographic models in the pre-operative planning allows an accurate evaluation of the orbital defect or alteration and makes the surgical planning and intraoperative steps easier and more predictable. Material and Methods: Five patients affected by post-traumatic orbital sequelae, both aesthetic and functional, were surgically treated. In order to achieve an accurate pre-operative diagnosis, conventional X-rays, TC multi-slice with three-dimensional reconstructions and then the fabrication of custom stereolithographic models were performed. Results and Conclusions: The use of stereolithographic models in the preoperative planning allows an accurate evaluation of the volumetric orbital defect or alteration; it makes the surgical planning easier because many choices, usually made during surgery, can be done during the aforementioned planning. We refer to timing and modality of the osteotomies, reallignament of bony segments after osteotomy, pre or intraoperative moulding of the osteo-synthesis plates and pre-fabrication, using a template, of autologous or alloplastic grafts

Cleft lip rhinoplasty

The secondary cleft lip nasal deformity presents an extreme challenge to the facial plastic surgeon. The deformity is complex and involves all tissue layers, including skeletal platform, inner lining, osseocartilaginous structure, and overlying skin. It is often the characteristic cleft nasal deformity that is noticeable to the observer after a well performed cleft lip repair. Secondary repair of the cleft lip nasal defect requires an understanding of the pathological nasal anatomy associated with congenital clefting. The basic cleft nasal deformity is characteristic and defendant upon the original extent of clefting of the lip. However, the secondary nasal defect varies greatly and is a result of: 1) the original malformation, 2) any interim surgery performed, and 3) growth of the nose and face. The cleft surgeon must therefore have a treatment philosophy and technique flexible enough to reconstruct a variable range of associated nasal problems. This chapter describes the pathological anatomy associated with cleft deformities, and describes approaches and techniques designed to improve form and function of the cleft nose

Cosmetic procedures in orthognathic surgery

Purpose: Orthognathic surgery produces cosmetic and functional effects, and patients should be evaluatedfor additional cosmetic improvements beyond those possible with orthognathic surgery. Soft tissue procedurescan be performed on an outpatient basis in an office environment and can be combined withorthognathics and delayed in a second stage.Methods: Systematic accurate facial evaluation is necessary to focus on cosmetic soft tissue problems.Features that make the patient look unattractive, old, tired, out of shape, weak, or sad must be identified byaccurate clinical analysis and 3-dimensional planning. Then it will be possible to select the treatment planaccording to the patient\u2019s input, prioritizing the additional cosmetic improvements that can be added toprimary surgery.Results: It is particularly important to review the results and the patient\u2019s satisfaction by clinical examination,a questionnaire, and with 3-dimenisonal pictures, and to understand if the treatment options have beenaccurately chosen and their lasting effect on follow-up. The treatment sequence is analyzed, and if there areresidual defects, a secondary cosmetic procedure can be planned to complete the result.Conclusions: The surgeon\u2019s goal must be the simultaneous treatment of malocclusions and facial estheticdisharmonies, and orthognathic surgical procedures and facial cosmetics must be performed simultaneously,if possible. Residual defects must be treated after at least 6 to 12 months