Umberto Garagiola

Ten-point 3D cephalometric analysis using low-dosage cone beam computed tomography

OBJECTIVE The aim of this study was to combine the huge amount of information of low dose Cone Beam CT with a cephalometric simplified protocol thanks to the latest informatics aids. Lateral cephalograms are two-dimensional (2-D) radiographs that are used to represent three-dimensional (3-D) structures. Cephalograms have inherent limitations as a result of distortion, super imposition and differential magnification of the craniofacial complex. This may lead to errors of identification and reduced measurement accuracy. The advantages of CBCT over conventional CT include low radiation exposure, imaging quality improvement, potentially better access, high spatial resolution and lower cost. MATERIALS AND METHODS This study assessed cephalometric 2D and 3D measurements and the analysis of CBCT cephalograms of the volume and centroid of the maxilla and mandible, in 10 clinical cases. RESULTS With a few exceptions the linear and angular cephalometric measurements obtained from CBCT and from conventional cephalograms did not differ statistically (p>0.01). There was a correlation between the variation in the skeletal malocclusion and growth direction of the jaws, and the variation in the spatial position (x, y, z) of the centroids and their volumes (p<0.01). CONCLUSIONS The 3D cephalometric analysis is easier to interpret than 2D cephalometric analysis. In contrast to those made on projective radiographies, the angular and linear measurements detected on 3D become real, moreover the fewest points to select and the automatic measurements made by the computer drastically reduced human error, for a much more reliable reproducible and repeatable diagnosis.

Osseointegration and guided bone regeneration in ectodermal dysplasia patients.

Dental and surgical implant treatment for patients affected by ectodermal dysplasia syndrome can be very complicated. The guided bone regeneration (GBR) membrane technique together with bone grafting is used to facilitate the placement of osseointegrated implants in a prosthetically guided position. Two groups with the same bony anatomical features were assessed. The first consisted of 13 ectodermal dysplasia patients in whom 66 implants with bone grafts and membranes were inserted. In the second control group, 120 implants with GBR were placed in 20 patients. The implants were assessed at the second stage of surgery, and at a follow-up after 1, 2, and 3 years of functional loading. There was no statistically significant difference in the osseointegration rate between the two groups. Despite the anatomical defects associated with the decreased occlusal vertical dimension and the reduced edentulous alveolar ridges, both in height and width, osseointegrated implants together with GBR and bone grafts can be used successfully in patients with ectodermal dysplasia syndrome.

Temporary lip paresthesia during orthodontic molar distalization: Report of a case

Lip paresthesia during mandibular molar orthodontic distalization is rare. When it occurs, it is often related to excessive dimensions of the mandibular second molar roots. In this clinical report, we describe a patient who developed lip paresthesia during orthodontic treatment. The paresthesia was relieved by immediate interruption of the forces applied to the mandibular second molars and pharmacologic therapy. Before fixed orthodontic treatment proceeds in patients with large tooth roots, it is important to diagnose the relationship between the roots and the mandibular canal to prevent nerve numbness and damage.

Temporomandibular disorders due to improper surgical treatment of mandibular fracture: clinical report.

Abstract: A case of mandibular fracture surgically consolidated in a wrong position resulting in craniomandibular disorders is reported. The inadequate surgical alignment of the healed bony segments caused a malocclusion. This changed the original neuromuscular system such that compensatory mechanisms began to change the whole balance of the organism. The patient presented a mandibular crossbite, an asymmetry of the face, and extensive alteration of muscular, articular, and postural function. The bony malunion and malocclusion were treated using an interdisciplinary surgical-orthodontic treatment for correcting functional disorders and aesthetic deformity. Electromyography and computerized mandibular scanning were used to evaluate improvement of the muscular activity, during rest and function, and of the mandibular kinesiology. Timing of surgical treatment and adequate fixation and immobilization of fracture segments are very important to avoid complications such as infection, delayed union, nonunion, malunion, skeletal discrepancies, nerve injury, and (rarely) ankylosis. The surgical approach should be based on the general criteria of traumatologic therapy, restoring the original bone shape and the right occlusal relations as soon as possible.

Surgery-first orthognathic approach vs traditional orthognathic approach: Oral health-related quality of life assessed with 2 questionnaires

Introduction The purposes of the study were to investigate and evaluate the differences detected by the patients between the traditional orthognathic approach and the surgery‐first one in terms of level of satisfaction and quality of life. Methods A total of 30 patients who underwent orthognathic surgery for correction of malocclusions were selected and included in this study. Fifteen patients were treated with the conventional orthognathic surgery approach, and 15 patients with the surgery‐first approach. Variables were assessed through the Orthognathic Quality of Life Questionnaire and the Oral Health Impact Profile questionnaire and analyzed with 2‐way repeated‐measures analysis of variance. Results The results showed significant differences in terms of the Orthognathic Quality of Life Questionnaire (P <0.001) and the Oral Health Impact Profile (P <0.001) scores within groups between the first and last administrations of both questionnaires. Differences in the control group between first and second administrations were also significant. Questionnaire scores showed an immediate increase of quality of life after surgery in the surgery‐first group and an initial worsening during orthodontic treatment in the traditional approach group followed by postoperative improvement. Conclusions This study showed that the worsening of the facial profile during the traditional orthognathic surgery approach decompensation phase has a negative impact on the perception of patients’ quality of life. Surgeons should consider the possibility of a surgery‐first approach to prevent this occurrence. HighlightsBenefits of traditional orthognathic surgery and surgery‐first approach were studied.Self‐esteem, body image, level of satisfaction, and quality of life were compared.The results showed significant benefits with the surgery‐first approach.

Mentolabial angle and aesthetics: a quantitative investigation of idealized and normative values

BackgroundThis study is a quantitative evaluation of the influence of the mentolabial angle on perceived attractiveness and threshold values of desire for surgery.MethodsThe mentolabial angle of an idealized silhouette male Caucasian profile image was altered incrementally between 84° and 162°. Images were rated on a Likert scale by pretreatment orthognathic patients (n = 75), lay people (n = 75) and clinicians (n = 35).ResultsA mentolabial angle of approximately 107° to 118° was deemed the most attractive, with a range of up to 140° deemed acceptable. Angles above or below this range were perceived as unattractive, and anything outside the range of below 98° or above 162° was deemed very unattractive. A deep mentolabial angle (84°) or an almost flat angle (162°) was deemed the least attractive.In terms of threshold values of desire for surgery, for all groups, a threshold value of ≥162° and ≤84° indicated a preference for surgery, although clinicians were least likely to suggest surgery. The clinician group was the most consistent, and for many of the images, there was some variation in agreement between clinicians and lay people as to whether surgery is required. There was even more variability in the assessments for the patient group.ConclusionsIt is recommended that in orthognathic and genioplasty planning, the range of normal variability of the mentolabial angle, in terms of observer acceptance, is taken into account as well as threshold values of desire for surgery. The importance of using patients as observers in attractiveness research is stressed.

Orthodontic treatment of an unerupted mandibular canine tooth in a patient with mixed dentition: a case report

BackgroundThe aim of this case report was to describe the surgical–orthodontic treatment of an unerupted mandibular canine tooth in a 9-year-old girl.Case presentationA 9-year-old white girl presented with an unerupted right mandibular canine tooth. Combined surgical–orthodontic treatment was performed to correct dental impaction and to achieve good aesthetic and functional results.ConclusionOrthodontic treatment achieved all of the required objectives.

Nasofrontal Angle and Nasal Dorsal Aesthetics: A Quantitative Investigation of Idealized and Normative Values

This study is a quantitative evaluation of the influence of the lower component of the nasofrontal angle on perceived attractiveness and threshold values of desire for rhinoplasty. The nasofrontal angle of an idealized silhouette male Caucasian profile image was altered incrementally between 106 and 148 degrees. Images were rated on a Likert scale by pretreatment patients (n = 75), laypeople (n = 75), and clinicians (n = 35). The results demonstrated that a nasofrontal angle of approximately 130 degrees is ideal, corresponding to a lower component of 60 degrees, with a range of 127 to 142 degrees deemed acceptable. Angles above or below this range are perceived as unattractive, and anything outside the range of 118 to 145 degrees is deemed very unattractive. Reduced nasofrontal angles, simulating a nasal hump deformity, of less than 115 degrees were deemed the least attractive. In terms of threshold values of desire for surgery, for all groups a threshold value of 148 degrees indicated a preference for surgery: for patients, the threshold value was 121 degrees or less; for lay people, the threshold value was 124 degrees or less; and similarly for clinicians, the threshold value was 118 degrees or less. Clinicians were the least critical, and patients appeared to be less critical than lay people. This stresses the importance of using patients as observers, as well as laypeople and clinicians, in facial attractiveness research. From the results of this study, it is recommended that in rhinoplasty planning, the range of normal variability of the nasofrontal angle, in terms of observer acceptance, is taken into account as well as the threshold values of desire for surgery.

The Medical Legal Aspects of Surgery First and a New Model of Consent Form

AbstractThe introduction of “surgery first” has resulted in a new requirement to compare and resolve medical legal problems which previously did not exist in traditional orthognathic surgery. The first issue relates to the relationship between the doctor and the patient and, in particular, the need to create a new informed consent form for surgery first. The second problem that has arisen with the arrival of surgery first concerns the relationship between health workers, namely the surgeon, and the orthodontist. The authors of this article propose a new template for informed consent specifically created for surgery first and also a model for the new working relationship between surgeons and orthodontists which will facilitate and improve co-operation between them. This will improve results, and guarantee a greater level of protection for the surgeon. It will also enable the identification the individual responsibilities of each person.

Diode laser surgery in the treatment of oral proliferative verrucous leukoplakia associated with HPV-16 infection

BackgroundProliferative verrucous leukoplakia (PVL) is an oral potentially malignant disorder, characterized by multifocal expression, progressive clinical evolution, and a high rate of malignant transformation. Evidence-based information regarding optimal PVL management is lacking, due to the paucity of data. The present report describes a case of PVL associated with HPV-16 infection and epithelial dysplasia treated by diode laser surgery, and the outcome of disease clinical remission over a 2-year follow-up period.Case reportA 61-year-old Caucasian male with oral verrucous hyperkeratosis presented for diagnosis. The lesions were localized on the maxillary gingiva and palatal alveolar ridge. Multiple biopsy specimens have been taken by mapping the keratotic lesion area. Microscopic examination was compatible with a diagnosis of PVL with focal mild dysplasia, localized in the right maxillary gingiva. Polymerase chain reaction (PCR) was done for human papillomavirus (HPV) detection which revealed presence of HPV DNA, and the genotype revealed HPV 16 in the sample. The PVL in the right gingival area was treated on an outpatient basis by excision with a diode laser. This approach resulted in good clinical response and decreased morbidity over a 2-year follow-up period.ConclusionsThis case illustrates the benefit of a conservative approach by diode laser treatment than wide surgical excision for management of the PVL lesions associated with mild dysplasia and HPV-16 infection.