Giuseppe Pantaleo

La responsabilità professionale in odontoiatria: analisi di una casistica interdipartimentale

Riasunto Obiettivi L’incremento degli addebiti di responsabilita professionale in ambito sanitario, unitamente alla diffusione di dati espressivi di una differente distribuzione percentuale dei settori odontoiatrici coinvolti nel contenzioso, ha indotto gli autori a condurre un’analisi conoscitiva del fenomeno attraverso lo studio di una casistica interdipartimentale di accertata responsabilita professionale odontoiatrica in ambito civilistico. Materiali e metodi E stata condotta un’analisi descrittiva di tipo poliparametrico su un campione costituito da 436 casi di errata condotta odontoiatrica accertata, promossi da soggetti di eta compresa tra 14 e 70 anni. Risultati Il settore odontoiatrico in cui e piu frequentemente ravvisato un errore tecnico-deontologico e quello protesico e implantoprotesico, seguito da quelli endodontico- conservativo e ortognatodontico. Nella maggioranza dei casi si e accertata la carenza della documentazione sanitaria descrittiva dello stato anteriore, in assenza di un modulo di consenso informato al trattamento odontoiatrico. Il danno ha riguardato piu frequentemente strutture dentarie, concretizzandosi in un danno permanente alla persona ≤ 4% in oltre due terzi dei casi, con un importo del danno emergente quasi sempre (97%) Conclusioni Gli autori propongono un decalogo comportamentale al fine di ridurre i possibili addebiti di responsabilita professionale o, comunque, utile a documentare la corretta condotta tecnico- deontologica.

Intraoral epimucosal fixation for reducible maxillary fractures of the jaws; surgical considerations in comparison to current techniques.

Fractures of the jaw are often treated with rigid and stable internal fixation using plates or miniplates. Early surgery for jaw fractures is the optimal treatment; however, if a late treatment is begun, often the adoption of other protocols is needed. When the jaw fracture has one free bone fragment with 2 full-thickness lesions of mucoperiosteal soft tissues both on the buccal and palatal sides, the risk of resorption or necrosis is very high after elevating a mucoperiosteal flap for rigid fixation. For this reason, we developed an intraoral epimucosal fixation technique using self-locking screws and plates. Substantial advantages of this new technique, in comparison with other commonly used fixation techniques, consisted in the prevention of bone resorption or necrosis by safe and simple screw insertion procedure after manipulation of the fracture for reduction in closed surgery. Major indications for epimucosal fixation in closed surgery are the presence of jaw fractures without dislocation or reducible jaw fractures by manipulation particularly in edentulous patients.

On the comparison of age determination methods based on dental development radiographic studies in a sample of Italian population

Abstract Objectives This study investigated the degree of reliability, complexity of use and possibility of further refinement of eight radiographic methods for the age determination of subjects in the growth phase, applied on a sample of Italian population. Materials and methods Each considered method was tested on a sample of 178 digitized panoramic radiographs (97 males and 81 females, aged 5 to 22 years). The obtained data were processed by statistical analysis. Results The overall Absolute Mean Error (AME) was on average equal to 0.89 years; within this error range fell approximately 61% of the subjects in our sample. The overall average of AME plus 1 standard deviation (SD) was equal to approximately 1.70 years, in the context of which fell about 84.5% of the sample investigated. Conclusions The statistical analysis of the data obtained by applying on our sample the considered methods showed, for each of them, the level of reliability in terms of absolute error with the relative SD (i.e., exact match between the age determined by the evaluators and the actual age, in terms of absolute value).

Transcrestal Sinus Lift Procedure Approaching Atrophic Maxillary Ridge: A 60-Month Clinical and Radiological Follow-Up Evaluation

Aim. The aim of this study was to assess the success and the survival rate of dental implants placed in augmented bone after sinus lifting procedures. Material and Methods. 31 patients were mainly enrolled for a residual upper jaw crest thickness of 3 mm. CBCT scans were performed before and after the augmentation technique and at the follow-up appointments, at 3, 6, 12, 24, and up to 60 months. The follow-up examination included cumulative survival rate of implants, peri-implant marginal bone loss, and the height of sinus floor augmentation. Results. This retrospective study on 31 patients and 45 implants later inserted in a less than 3 mm crest showed excellent survival rates (99.5%), one implant was lost before loading due to an acute infection after 24 days, and two implants did not osteointegrate and were removed after 3 months. The radiological evaluation showed an average bone loss of 0.25 mm (±0.78 mm) at the first follow-up appointment (3 months) up to 0.30 mm (±1.28 mm) after 60-month follow-up. Conclusion. In this study it was reported how even in less than 3 mm thick crest a transcrestal technique can predictably be used with a long-term clinical and radiological outcome, giving patients excellent stability of the grafted material and healthy clinical results.

Bone and soft tissue non-Hodgkin lymphoma of the maxillofacial area: Report of two cases, literature review and new therapeutic strategies

Primary mandibular non-Hodgkin lymphoma (NHL) and soft tissues NHL of the maxillofacial are extremely rare representing a minimal percentage of the head and neck tumors. Two cases of bone and soft tissue maxillofacial NHL are reported. Clinical, radiological and pathological features are described and the therapeutic procedures are discussed accordingly. Mandibular radiologic features have been carefully analyzed and discussed to achieve an early and accurate diagnosis avoiding improper dental therapies.

Clinical and Spectrophotometric Evaluation of LED and Laser Activated Teeth Bleaching

Background: Auxiliary power sources (LED and laser) are used in in-office teeth bleaching techniques to accelerate the redox reaction of the whitening gel to increase ease of use, to improve comfort and safety, and to decrease the procedure time. Objective: The aim this study is to evaluate the efficiency of the teeth whitening procedures performed with hydrogen peroxide and carbamide peroxide, LED or Laser activated. Method: 18 patients, affected by exogenous dyschromia, were treated with a bleaching agent composed by 35% hydrogen peroxide and 10% carbamide peroxide. They were divided into two groups: in the first group the bleaching agent was activated by a LED lamp; in the second group it was activated by a Laser diode lamp. Both groups were subjected to 3 bleaching cycle of 15’ each. The chromatic evaluations were performed before and after one week from the treatment, using a chromatic scale and a spectrophotometer. The mean value of pre, post bleaching and follow-up were analyzed using a T-test, with results statistically significant for P<0,05. Results: Results showed that the variations in brightness, chroma and hue are significantly influenced by the interaction between the whitening agent and the original colour of the teeth. Laser-activation has marginally improved the bleaching effectiveness. All patients treated with laser activation complained an increase in dental sensitivity. Conclusion: The use of laser-activating systems did not improve the efficacy of bleaching.

Ridge Expansion by Flapless Split Crest and Immediate Implant Placement: Evolution of the Technique

AbstractVarious treatment strategies and techniques have been proposed to perform alveolar bone augmentation; most common are guided bone regeneration, split crest, and autologous bone grafting. All of these techniques are reported to possess bone regenerative properties of osteoinduction and osteoconduction in relation to regenerated bone survival. Split crest resulted to be one of the most reliable bone augmentation techniques. In this study, we describe a new flapless-modified split crest technique on 4 patients to optimize the bone regeneration with bone augmentation implant insertion in 1 single stage. The rationale of this technique is to obtain a proper buccal cortex expansion preserving its vascular supply and avoiding periosteal elevation for better cortical bone preservation. The main advantages of this technique consist in a single surgical stage without donor sites, vascular periosteal preservation of vestibular cortical walls, preservation of alveolar bone height avoiding bone loss after implant kit drilling, and preservation of proper cortical thickness on both sides, thereby saving periosteal nourishment on the vestibular side. Indication for this technique could be extended to almost every implant insertion for alveolar height saving at drilling time for implant insertion, because of the alveolar crest shape.

Chin Wing Osteotomy for Bilateral Goldenhar Syndrome Treated by ''Chin Wing Mentoplasty'': Aesthetic, Functional, and Histological Considerations

AbstractVarious treatment strategies have been proposed to perform the aesthetic surgical correction of asymmetric deformities of the mandible. These techniques range from relatively simple to complex procedures including bimaxillary surgery associated with complex mandibular osteotomies. The authors describe a patient with grade III Goldenhar syndrome, treated by a “chin wing” mentoplasty as described by Triaca. These situations are classically treated with a bilateral sagittal splint osteotomy (BSSO) in combination with mentoplasty. However, because of a good occlusion with Angles class I relation, slight imbalance of the occlusal plane with good function of the mouth opening, the patient refused to be treated with a BSSO, hence, a chin wing mentoplasty was performed. Size and stability of bone regeneration were evaluated by histological examination and dynamic-volume computed tomography (CT). Mature bone in the grafted areas was detected by histology and CT scan with stable results and a significant increase of facial aesthetics 1 year after surgery. The authors also demonstrated that the chin wing technique provided a little but significant breathing improvement as detected on CT scans and lateral X-ray cephalograms by measuring the breathing area. Chin wing mentoplasty is a moderately invasive technique that is able to improve the aesthetics of the face and patient breathing.

Platelet-rich fibrin (PRF) in implant dentistry in combination with new bone regenerative technique in elderly patients

Highlights • PRF in association with a new split crest augmentation technique was analyzed.• Ten patients five with the new technique and five by traditional one were treated.• All cases were successful and all implants achieved osteointegration.• Main advantages with this technique are soft tissues healing and bone regenerative properties.

New Technique for Mandibular Symphyseal Distraction by a Double-Level Anchorage and Fixation System: Advantages and Results.

Introduction:A surgical technique to widen the mandible is the mandibular midline distraction: the most common indications for mandibular midline distraction are severe mandibular anterior crowding, severe mandibular transverse deficiency, uni- or bilateral crossbite, impacted anterior teeth with inadequate space, and tipped teeth. Commonly used distraction devices can be divided into 2 systems: bone-borne distraction system appliance, dental-borne distraction systems. Each system has peculiar advantages, disadvantages, and different indications. To combine advantages of both systems we developed a new technique adopting an immediate basal bone widening with fixation after osteotomy and a dental borne rigid lingual system for distraction. Aim:The aim of this work is to show a new technique for symphysis mandibular distraction based on a double-level anchorage and fixation system on clinical patients showing final results and advantages. Methods:Two patients affected by dento-alveolar and basal bone maxillary and mandibular transversal collapse even in association with other skeletal malocclusion were selected. Patients were clinically and radiographically studied and analyzed at different times before and after surgery. Dental and basal bone measurements were performed clinically and radiographically. Results:The results were optimal with perfect dental arches alignment followed by closing of the open bites with multiple-segmented surgery in a second surgical time. No misalignment of the 2 mandibular halves was noticed during the distraction procedure. Discussion:Dental-bone discrepancies correction is mandatory before orthodontic treatment alignment. Transversal jaw expansion can be achieved safely and stably by distraction of both maxillae for the combination of osteogenesis and histogenesis with augmentation of both bone and soft tissue. Bone-borne distraction will result in more stable results; dental-borne devices will result in more simple and aesthetically rewarding procedures. Hybrid techniques usually show mixed results depending on the characteristics of the device. For this reason we developed a combination of both the aforementioned systems which is not a hybrid system but the combination of an immediate expansion of the symphysis and fixation by 1 miniplate with only 2 screws acting like hinges during distraction, combined with a lingual distraction system at the alveolar bone level. Conclusions:Bone-borne distraction systems result in more efficient basal bone mandibular widening with increased stability for dental results. For dental-borne appliance the advantages consist in no second surgery need for their removal, no transmucosal hardware emergence and better aesthetic, especially when lingual devices were used. Our technique combines advantages of both procedures.