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Seconda fase chirurgica: valutazione della mucosa peri-implantare in relazione alle diverse sistematiche implantari
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A new method to evaluate volumetric changes in sinus augmentation procedure
No full textBackground
In sinus augmentation procedure, the assessment of volume changes of grafted materials is important both in the clinical practice and in dental research to evaluate the features of filling materials.
Purpose
In this study, we assessed the repeatability of a new method proposed to evaluate volumetric changes following sinus lift augmentation procedure.
Materials and Methods
In 10 patients, maxillary sinus augmentation procedure with simultaneous implant placement was performed. Maxillary cone beam computer tomographies were taken 1 week after surgery (T1) and 6 months after surgery (T2). At each evaluation the gap inside the implant between the fixture and the bottom of the screw was used as reference point (Rp), and a standardized volume of interest (VOI) centered on the Rp was selected. Masks were chosen to select the graft and bone tissue within the VOI; the volume at T1, T2, and the difference of volume between T1 and T2 were computed. Expert and non-expert operators performed the analysis. Method errors were computed.
Results
The error of the method was 1% for both intra-operator and inter-operator measurements. Tissue contraction at T2 was 19 ± 4% of the total initial volume.
Conclusions
The standardization of the method allows to obtain repeatable measurements
La gestione di un caso complesso implantare : dall’analisi preoperatoria alla realizzazione della protesi definitiva
No full textUna programmazione pre-chirurgica scorretta e una gestione del sito implantare altrettanto
poco curata possono portare a inconvenienti quali risultati finali poco predicibili dal punto
di vista funzionale e anche estetico. In questi casi sempre più frequentemente ci si trova
di fronte alla gestione di casi complessi in cui ci si deve confrontare con impianti di diverse
tipologie posizionati in tempi diversi. Nell’ambito del trattamento implanto-protesico, queste
situazioni, ancor più di altre, richiedono la corretta gestione dell’intero piano di trattamento,
cercando di ovviare agli inconvenienti affinché si ottenga un risultato estetico e funzionale
ottimale, soprattutto nelle zone ad alta esigenza estetica. La presenza di problemi a livello
dei tessuti peri-implantari spesso provocano una serie di deficit dei tessuti duri e molli, che
devono essere risolti attraverso delle manovre di rigenerativa tissutale e aumento dei tessuti
molli. Diverse sono le metodiche descritte in letteratura inerenti le procedure di incremento
dei tessuti duri pre-implantari in caso di atrofie alveolo mascellari1,2. In alcuni casi tali procedure
prevedono l’utilizzo di membrane non-riassorbibili rinforzate in titanio per l’aumento verticale
della cresta edentula. Anche la gestione dei tessuti molli è ben documentata in letteratura;
infatti, mediante l’utilizzo di tecniche di chirurgia muco-gengivale è possibile incrementare lo
spessore di gengiva cheratinizzata peri-implantare migliorando l’estetica e la salute dei tessuti
molli. Tali metodiche comprendono anche l’utilizzo di innesti epitelio-connettivali prelevati dal
palato3,4. Il caso clinico preso in esame descrive l’analisi, la programmazione e l’esecuzione
di un piano di trattamento complesso. Dall’iniziale situazione implanto-protesica presente
sono stati eseguiti sia interventi di rigenerativa ossea tramite GBR in zona retro-mascellare e
l’inserimento dilazionato di 3 impianti, che interventi con tecniche di chirurgia plastica periimplantare
per l’aumento della quantità di mucosa cheratinizzata durante la seconda fase
chirurgica sia nei nuovi siti implantari che nei vecchi. L’unione delle due tecniche ha permesso
l’ottenimento di un’architettura tissutale armonica e di un’adeguata presenza di gengiva
cheratinizzata e la risoluzione in modo soddisfacente della riabilitazione implanto-protesicaAn incorrect pre-surgery programmation and a wrong management of the implant
site could cause many disadvantages like unpredictable aesthetic and functional final
results. In this cases increasingly we have to manage complex situations in which
different kind of implant are inserted in different time. This situation, in an implantprosthetic
treatment, need the right management of the whole treatment plane,
trying to avoid drawbacks, with the aim to obtain the best functional and aesthetic
result, overall in the aesthetic area. Presence of peri-implant tissue problems, often
could cause some deficit of hard and soft tissues that need regenerative techniques to
eliminate these defect. There are some different kind of techniques described in literature to
improve hard tissues1,2. Some of these provide the use of non-resorbable reinforced titanium
membranes to facilitate the vertical growing of the edentulous ridge.
The management of soft tissues is also well described in literature. With the use of mucous
gum surgery techniques, is possible to improve the thickness of the keratinized gingiva,
improving the health and the aesthetic of soft tissues. These techniques also include the use
of epithelial connective tissue graft taken from the palate3,4. This clinical case describes the
analysis, programming and execution of a complex treatment plan. From the initial
implant-prosthetic situation, both bone regenerative responses with GBR in the back
jaw area, insertion of 3 implants and peri-implant plastic surgery, to increase the quality
of the keratinized mucosa, were performed, both in the new and old implant site.
The union of the two techniques allowed us to obtain a tissue harmonic architecture
and an appropriate presence of keratinized gingiva with the good resolution of the implant-prosthetic rehabilitation
Analysis of the major species-specific insertion of Toxoplasma gondii ferredoxin-NADP(+) reductase by protein engineering
No full textSlow orthodontic teeth extrusion to enhance hard and soft peridontal tissue quality before implant positioning in esthethic area
No full textApproaching bone defects of jaws treatments, hard and soft tissue augmentation could be considered as a goal for clinicians when performing dental implant placement. The increase in patients who want cosmetic treatment puts practitioners in an awkward position when choosing the best therapy to obtain the most desirable results.
A private dentist referred a young patient to the Department of Implantology in Milan in order to place implants in the upper jaw. Radiographic evaluation of the two upper anterior incisors confirmed that the teeth had a poor prognosis The anterior ridge volume was clinically analyzed and several therapeutic choices were evaluated. Rapid extractions and immediate implant positioning were not considered due to the vertical and horizontal components of the bone defect. Therefore, the surgical team decided on increasing the bone volume by using slow orthodontic teeth extrusion technique.
After 3 months of orthodontic treatment, the angular intra-bony defects of 1.1 tooth was completely healed. Implant guided positioning, associated with a small bone graft, showed optimal results at the time of healing screw placement. The soft tissue conditioning was obtained by a provisional acrylic crown. The final application of two integral ceramic crowns showed excellent aesthetic results. Radiographic investigation at a 24 month follow-up confirmed the integration of the dental implants and the recovery of the bone defects.
Several safe surgical techniques are available today for reconstructing atrophic jaws. However, the same technique applied on the posterior area did not give the same predictable results as in the anterior areas of the jaw
Individual skeletal models and preoperative simulation in advanced osseointegration : a case report
No full textThis article presents a new diagnostic and simulative method, PSM LAB-MACHINE, with the aim of the anatomic reproduction of skeletal components of the facial skeleton. The importance of surgical predetermination with the possibility of simulating the planned surgical strategies is here evaluated. The described clinical case demonstrates the importance of planning in the reconstructive surgery of the maxillofacial district, using solid structures as individual skeletal models. The usefulness of a solid structure as skeletal replica for the effectiveness of modeling corticocancellous bone grafts from the iliac crest with an impressive reduction of the work times is highlighted. The high precision of adaptation of grafts to the donor site after modeling is notable
Hard and soft tissue augmentation in implant surgery: a case report
No full textCorrect pre- and postimplant hard and soft tissue management is prerequisite to achieving optimal esthetic and functional outcomes after implant-prosthesis treatment. Various different methods for preimplant hard tissue augmentation in alveolus maxillary atrophy are described. In some cases, non-resorbable titanium-reinforced membranes are employed for vertical augmentation of the edentulous crest. Also well documented is soft tissue management through mucus-gingival surgery techniques that increase the thickness of peri-implant keratinized gingiva, enhancing soft tissue esthetic and health. These methods also include the use of epithelial-connectival grafts collected from the palate. Here we present a clinical case of severe bone vertical resorption in edentulous areas treated with two vertical ridge augmentations by means of non-resorbable membranes in the retromandibular area and deferred insertion of six implants. Peri-implant plastic surgery techniques to improve the quantity of keratinized mucosa during the second surgery phase are also discussed. Combination of the two techniques resulted in harmonic tissue architecture and adequate presence of keratinized gingiva
Innesto di tessuto molle nel sito postestrattivo mediante l'utilizzo della tecnica CPT, Clot Preservation Technique
No full textLa letteratura descrive diverse tecniche di preservazione
dell’alveolo post-estrattivo in caso di inserimento dilazionato degli impianti. Diversi autori, indicano l’utilizzo di biomateriali come una delle tecniche per la preservazione della cresta alveolare (1-3). Quando la quantità
di osso residuo non è sufficiente per avere una buona guarigione, un’alternativa può essere l’utilizzo di un innesto epitelio-connettivale. Sono tre le ragioni per cui si può scegliere un innesto libero. Primo: nel caso in cui si renda necessario ottenere un’adeguata quantità di tessuti molli a favorire eventuali manovre di ricostruzione ossea con l’utilizzo di biomateriale e membrane. Secondo: l’innesto
tissutale permette una corretta protezione del coagulo a favore di una buona guarigione dell’alveolo post-estrattivo.
Terzo: impedisce il collasso dei tessuti molli proteggendo il coagulo nella sua funzione riparatrice. In questo case report viene analizzata la guarigione di un alveolo post-estrattivo trattato solo con un innesto epi-
telio-connettivale. Su un paziente di 30 anni è stato utilizzato un innesto epitelio-connettivale dopo l’estrazione per motivi parodontali di un elemento dentale in area estetica. Dopo 2 mesi dall’estrazione e dal posizionamento dell’in
nesto libero, è stato inserito un impianto endosseo.
Successivamente al periodo di osteointegrazione, sono state eseguite prima la protesi provvisoria e poi la protesi in ceramica integrale. Il successo clinico ottenuto al momento dell’inserimento dell’impianto, con l’ottima guarigione dei tessuti duri e molli pre-implantari, ha permesso una chirurgia rigenerativa più semplice.
Nonostante i limiti rappresentati dalla presentazione di un
singolo case report, il risultato clinico finale è soddisfacente. Lo sviluppo di studi più approfonditi potrà permettere una maggiore ripetibilità e predicibilità dei risultati
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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