Antonio D'Addona

Calcification of the stylohyoid ligament: incidence and morphoquantitative evaluations.

To study the incidence of calcification of the stylohyoid ligament, 286 orthopantomographs were analyzed. All patients had no symptoms. The total incidence of calcification was noted to be high, at 84.4%. The number and the length of calcifications increased with age, and there was no relationship to sex or mandibular size. The phenomenon is often evident bilaterally. The variety of results reported in the references depends on different criteria in radiographic evaluation and in patient selection.

The Thickness of Facial Alveolar Bone Overlying Healthy Maxillary Anterior Teeth

BACKGROUND A facial bone (<2 mm) overlying maxillary anterior teeth may be prone to resorptive processes after extraction and immediate implant placement. A thin bone contributes to risk of bone fenestration, dehiscence, and soft-tissue recession. This study measures the distance between the cemento-enamel junction (CEJ) and alveolar bone crest and the thickness of facial alveolar bone at points 1 to 5 mm from the bone crest for the six maxillary anterior teeth. METHODS Sixty-six tomographic scans (31 males and 35 females; aged 17 to 69 years; mean age: 39.9 years) of intact anterior maxilla were randomly selected and evaluated by two calibrated and independent examiners (MG and TP). RESULTS A high variation of CEJ-bone crest (0.8 to 7.2 mm) was detected. A significantly larger CEJ-bone crest was measured in smokers (P <0.05) and patients who were ≥50 years old (P <0.05). The average bone thickness at 3 mm from the CEJ for the maxillary right central incisor was 1.41 mm and for the maxillary left central incisor was 1.45 mm. For the maxillary right and left lateral incisors, the crestal bone thickness averaged 1.73 and 1.59 mm, respectively. For the maxillary right and left canines, the crestal bone thickness averaged 1.47 and 1.60 mm, respectively. CONCLUSIONS The present study supports the finding of a predominantly thin facial bone overlying the six maxillary anterior teeth. Therefore, it is essential to make informed treatment decisions based on thorough site evaluation before immediate implant placement.

Human Bone Repair After Mandibular Symphysis Block Harvesting: A Clinical and Tomographic Study

BACKGROUND There are limited data on the healing potential of osseous defects in the human mandible. Animal model studies have shown that defect fill is size dependent. METHODS Twenty patients who had autogenous block transplants harvested from the mandibular symphysis were included in the study. Computerized tomography (CT) scans were carried out at an average of 26.7 months after augmentation to assess bone healing. Subgroups were compared on the basis of bone volume harvested, healing time, incision design, symphysis midline preservation, age, and gender. Percentage bone fill was calculated by comparing the preoperative and postoperative CT scans using a computer software program. RESULTS CT scan analysis showed a significant percentage (74.5% +/- 10.36%) of bone fill at an average of 26.7 +/- 22.3 months (range, 4 to 72 months). Healing time and bone volume harvested were significant variables influencing the osteogenic potential of mandibular donor-site defects. Defects <0.5 cc with a healing period of 34.2 months showed 81% +/- 7.4% bone fill, whereas those >0.5 cc and 7.2 months of healing had a repair of 63.8% +/- 12.2% (P <0.05; 95% CI, 2.46 to 31.93). A positive trend in bone fill was observed for subgroups receiving sulcular incisions (80%) and midline preservation (77.5%). CONCLUSIONS The osteogenic potential of human osseous repair in the mandibular symphysis is size and time dependent. The process of osteogenesis of repair in humans seems to be multifactorial. Such factors as preservation of the periosteum and symphysis cortical midline may positively influence defect fill allowing for reharvesting.

Fourier Analysis of Cephalometric Shapes

Craniofacial growth and development involve both size and shape variations. Shape variations can be assessed independently from size using mathematical methods such as the Fourier series. A method for the reconstruction of outlines starting from selected landmarks and for their Fourier analysis has been developed and applied to analyze the age differences in shape in the tracings of the Bolton standards (lateral view) from 1 to 18 years of age. The size-independent shape of the Bolton standard at 18 years was larger at the chin, at the gonion, and in the anterior cranial base than the shape at 1 year of age. Conversely, the younger shape was larger in the middle part of face, corresponding roughly to the maxillary bone, than the older shape. When standardized for size, growth thus seemed to modify craniofacial shape with progressive lengthening and narrowing. This shape effect was largely overwhelmed by the very evident size increments, and it could be measured only using the proper mathematical methods.

Periodontopathogen and Epstein-Barr Virus Contamination Affects Transplanted Bone Volume in Sinus Augmentation

BACKGROUND Bone microbial contamination can impair osteogenesis. Human herpesviruses-associated vasculitis can cause vascular damage within the osseous graft and host. This study is conducted to substantiate specific contamination and assess the impact 6 months after sinus augmentation. METHODS Culture- and polymerase chain reaction (PCR)-based identification were done on harvested bone particles and unstimulated whole saliva in a group of 30 patients undergoing maxillary sinus augmentation. Patients were divided into two groups: those with and those without a history of periodontitis. Radiographic evaluation was done to assess and compare bone healing and volume gain at baseline and 6 months post-transplantation. RESULTS Seventeen patients had a history of periodontitis, and 13 did not. Ten showed culture- and PCR-negative results and belonged to the periodontally healthy group. The 17 patients with periodontitis showed culture- or PCR-positive results for the targeted periodontal pathogens. Patients with periodontitis were 2.3 times more likely to have positive salivary Epstein-Barr virus type 1 (EBV-1) than those with no history of periodontitis. The likelihood of having moderate to pronounced bone volume loss 6 months postaugmentation was 7.5 times greater in those patients presenting contamination with ≥3 specific pathogens (Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, or Prevotella intermedia) versus those with only one (P <0.05). The odds ratio (OR) of pronounced volume loss was 16.3 times higher in those contaminated with a combination of salivary EBV-1 and ≥3 of the previously mentioned species versus only EBV-1 (P <0.05). Individuals showing positive salivary EBV-1 had bone bacterial contamination associated 57% of the time. The OR of having bone microbial contamination in patients with a history of periodontitis was 37.5 times higher than in individuals without periodontitis. CONCLUSIONS This study confirms contamination of bone, harvested intraorally, with key periodontopathogens in individuals undergoing sinus augmentation. Specific microbial contamination can impair osteogenesis. Saliva may act as a vehicle to transport EBV and other pathogens into the sinus. Increased bone volume loss seems to be associated with the occurrence of specific periodontal anaerobic species, salivary EBV-1, or the combination of both.

Examination of periodontal pathogens in stenotic valve specimens and in whole blood samples in patients affected by aortic valve stenosis and chronic periodontitis

Periodontitis may be a risk factor for atherosclerosis and coronary heart disease. The influence of periodontal pathogens in cardiovascular diseases needs further investigation. Therefore, the aims of this clinical study are: to test the presence of periodontal bacteria DNA in aortic valves and to assess the concomitant presence of the same periodontal bacteria DNA in whole blood samples in patients affected by aortic valve stenosis and chronic periodontitis. Nineteen consecutive patients (12 males and 7 females, age: 49–85 years) were enrolled in this study after having been subjected to a complete periodontal evaluation to confirm the diagnosis of chronic periodontitis. All patients were scheduled for aortic valve replacement surgery. After clinical and microbial periodontal examination, the aortic valve tissue specimens were obtained by excision during valve replacement surgery and the patients were subjected to the whole blood sampling before the surgery. The polymerase chain reaction technology was used to detect the putative periodontal pathogens Tannerella forshytia, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Fusobacterium nucleatum, Campylobacter rectus, Eikenella corrodens and Treponema denticola. Neither the 19 aortic valve specimens nor the blood samples were positive for the genoma of the selected periodontal pathogens. The selected periodontal pathogens did not colonize the aortic valve of patients affected by stenosis and bacterial genoma was not present in whole blood samples. A high blood pressure at the aortic valve may prevent the adhesion and proliferation of bacterial colonies.

Interobserver variability of dynamic MR imaging of the temporomandibular joint

PurposeThis study investigated the interobserver variability of dynamic magnetic resonance (MR) imaging of the temporomandibular joint (TMJ).Materials and methodsSixty-two patients with internal derangement of the TMJ (124 TMJs) were investigated with a 1.5-T MR imaging system during physiological opening and closing of the mouth. Two readers evaluated independently the quality of the dynamic examination (Q: nondiagnostic, diagnostic, optimal), condylar motion (CM: limited, suboptimal, optimal), condylar orientation (CO: in-plane, through-plane shift), disc visibility and movement (DV: visible, nonvisible; DM: normal, reducing, nonreducing dislocation) and joint effusion (JE: present, absent). For each TMJ, the condylar path was measured by tracing the position of the condyle in the frames of the dynamic acquisition. Agreement between the two readers was assessed with Cohen’s Kappa and the Bland-Altman method.ResultsInterobserver agreement was almost perfect for Q (nondiagnostic, diagnostic, optimal: 0.8%, 4.9%, 94.3%; κ=1), CM (limited, suboptimal, optimal: 14%, 26.4%, 59.5%; κ=0.84) and DV (visible, nonvisible: 100%, 0%). Substantial agreement was found for DM (normal, reducing, nonreducing: 66.1%, 14.8%, 19.1%; κ=0.64) and JE (present, absent: 41.3%, 58.7%; κ=0.67). Moderate agreement was found for CO (in-plane, through-plane shift: 94.2%, 5.8%; κ=0.41). As for the condylar path, the means of the percentage differences and limits of agreement (LA) were −3% (LA: −34.5%, 28.3%) on the right and −1.2% (LA: −35%, 32.6%) on the left.ConclusionsIn dynamic imaging of the TMJ, qualitative assessment of condyle-disc movement and joint effusion is minimally dependent on the reader’s evaluation. Measurement of the condylar pathway shows an interobserver variability of ±30%.RiassuntoObiettivoScopo del nostro lavoro è stato valutare la variabilità inter-osservatore della risonanza magnetica (RM) dinamica dell’articolazione temporo-mandibolare (ATM).Materiali e metodiSessantadue pazienti con disfunzione condilo-meniscale (124 ATM) sono stati studiati con tecnica RM dinamica dell’ATM su apparecchio da 1,5 T durante movimento fisiologico di apertura e chiusura buccale. Due lettori hanno valutato indipendentemente la qualità dell’esame (Q: non diagnostico, diagnostico, ottimale), il movimento condilare (MC: limitato, subottimale, ottimale), l’orientamento condilare (OC: nel piano, fuori dal piano), visibilità e movimento del disco (VD: visibile, non visibile; M: normale, dislocazione ridotta, dislocazione non ridotta) e il fluido articolare (F: presente, assente). Per ogni ATM, è stato inoltre misurato il percorso condilare demarcando la posizione del condilo nei frame dell’acquisizione dinamica. È stata stimata la concordanza tra i due osservatori (κ di Cohen, Bland-Altman).RisultatiLa concordanza è risultata ottimale per Q (non diagnostico, diagnostico, ottimale: 0,8%, 4,9%, 94,3%; κ=1), MC (limitato, subottimale, ottimale: 14%, 26,4%, 59,5%; κ=0,84) e VD (visibile, non visibile: 100%, 0%), buona per M (normale, dislocazione riducibile, non riducibile: 66,1%, 14,8%, 19,1%; κ=0,64) e V (presente, assente: 41,3%, 58,7%; κ=0,67), moderata per OC (nel piano, fuori dal piano: 94,2%, 5,8%; κ=0,41). Per il percorso condilare, la media delle differenze percentualizzate ed i limiti di concordanza (LC) sono risultati −3%, (LC: −34,5%, 28,3%) a destra e −1,2% (LC: −35%, 32,6%) a sinistra.ConclusioniLa valutazione qualitativa del movimento condilo-meniscale e della presenza di fluido intraarticolare nell’imaging dinamico dell’ATM è solo minimamente dipendente dalla stima dell’osservatore, mentre la misurazione del tracciato condilare presenta una variabilità inter-osservatore pari a ±30%.

Soft and Hard Tissue Management in Implant Therapy—Part I: Surgical Concepts

Implant therapy has become a reliable and predictable treatment alternative for the replacement of missing teeth with conventional removable and fixed partial dentures. Recently though, in the pursuit for improved esthetics, the literature has dedicated a considerable amount of its research on the successful maintenance and regeneration of the surrounding gingiva and bone, which are lost following extraction of a tooth. Thoroughly analyzing the anatomic situation and well-planned treatment has become a requirement, because incorrectly planned and positioned implants may jeopardize long-term esthetic and functional prognosis. In addition, many types of biocompatible materials, autogenous hard and soft tissue grafts, and different surgical techniques have been developed, and their viability has been investigated. As a result, implant specialists have gained a greater understanding of the dynamics and anatomical and biological concepts of the periodontium and peri-implant tissues both at the surgical and prosthetic phases of treatment, which contributes to better soft and hard tissue management (SHTM). This may further contribute to achieving a superior final result which is obtained by having a harmonious soft tissue profile, a correctly placed and contoured final restoration, and the reestablishment of masticatory function and phonetics.

Soft and Hard Tissue Management in Implant Therapy—Part II: Prosthetic Concepts

The ongoing pursuit of aesthetic excellence in the field of implant therapy has incorporated prosthetic concepts in the early treatment-planning phase, as well as the previously discussed surgical concepts. The literature has addressed these prosthetic and laboratory approaches required to enhance and perfect the soft and hard tissue management (SHTM). After surgically providing an acceptable hard tissue architecture and adequate timing of loading of the implant, the prosthetic phase is responsible for the soft tissue modeling, through correctly planned and executed procedures, which induce a satisfactory soft tissue profile by considering the microvasculature, the abutment connection and positioning, and the implementation of an adequate provisional phase. The objectives are the modeling of the soft tissues through the use of a conforming periorestorative interface which will produce desired and stable results.