Evaluation of factors influencing accuracy of virtual surgical planning in orthognatic surgery

Three-dimensional virtual surgical planning has become routine practice in orthognatic and reconstructive surgery for the possibility to realize presurgical evaluation of intraoperative bones movements, the prediction of postoperative results and the high level of accuracy. Thanks to surface superimposition between 3D planned and 3D postoperative model of maxillo-facial skeleton, a medium discrepancy less than 1 mm was found in scientific literature, considering 15 different points of maxillofacial skeleton. In our study we decided to evaluate different factors that could invalidate that result in the same cohort of patients, such as sex, kind of dentofacial deformity, asymmetry, type of surgical approach and entity of maxillo-mandibular movements (more or less than 1 mm). We found out no significant differences among groups. We can state that virtual surgical planning and 3D surgical splints are a valid means of diagnosis, treatment and predictivity regardless factors that could influence post-operative results. In conclusion, virtual surgical planning and 3D surgical splints facilitated diagnosis, treatment planning and accuracy regardless of sex, dentofacial deformity class, surgery techniques, entity of advancement and asymmetry.

Collagenated heterologous cortico-cancelleus bone mix stimulated dental pulp derived stem cells

Collagenated heretologous cortico-cancelleus bone mix (CHCCBM) is largely employed in maxillary and dental surgery for regeneration procedures, and is similar to human bone from chemical and physical point of view and promotes osteogenesis. In order to get more inside how this biomaterial induces osteoblast gene expression to promote bone formation, the mRNA levels of bone related genes were compared in human osteoblasts and dental pulp stem cells, using real time RT-PCR. The obtained results demonstrated that CHCCBM enhance stem cells differentiation and deposition of matrix by the activation of osteoblast related genes SP7, FOSL1 and SPP1.

Retrospective study on forty-eight fixtures inserted in upper jaw

It is generally accepted that maxilla has a less bone quality than mandible and this fact makes implant rehabilitation more complex. Recently a new type of spiral implants has been introduced in the global market. Since few reports are available a retrospective study was performed. A total of 48 two-piece spiral implants were inserted, 21in female and 27 in males. The median age was 58 ± 8. Implants replaced 10 incisors, 9 cuspids, 25 premolars and 4 molars. Implant' length was 10 mm, 11.5 mm and 13 mm in 13, 24, and 11 cases, respectively. Implant diameter was 3.3 mm, 3.75 mm and 4.2 mm in 25, 17 and 6 cases, respectively. One implant was lost, survival rate (SVR) = 97.91%. Then peri-implant bone resorption was used to investigate success rate (SCR). The mean bone resorption was 0.3 mm after an average period of 1 year follow up. In conclusion the implants studied are reliable devices for oral rehabilitation with a very high SCR and SVR.

Bimaxillary orthognathic surgery with a conventional saw compared with the piezoelectric technique: a longitudinal clinical study

The only cutting technique used for osteotomies in orthognathic surgery for many years has been a saw, but recently piezoelectric surgery has been introduced as a possible alternative. The aim of this study was to find out if piezoelectric surgery can be more comfortable for patients having orthognathic surgery. A total of 25 patients with dentofacial deformities (seven male and 18 female), were treated from January 2016 to September 2017. In 11 patients, osteotomies were made using a conventional saw, while in 14 a piezoelectric device was used. The variables assessed were: operating time, postoperative swelling, postoperative pain, and cutaneous sensitivity of the upper and lower lips. The duration of operation for the piezosurgery group was significantly longer than that for controls, but the patients had less swelling at all follow-up visits, and the difference was significant at the 30-day follow-up (p=0.045). Those who had piezosurgery had significantly less pain at the three-day follow up (p=0.035). There was a significant difference in cutaneous sensitivity only for the right side of the upper lip and only at the one-day follow-up. We conclude that piezoelectric surgery offers some advantages in lessening swelling and the perception of pain after orthognathic surgery, but further investigations are required.

Free flap loss caused by heparin-induced thrombocytopenia and thrombosis (HITT): a case report and literature review

Heparin-induced thrombocytopenia and thrombosis (HITT) represents a dramatic condition that is difficult to diagnose because of nuanced clinical presentation. Therefore, in every case of microvascular thrombosis during heparin-therapy prompt suspicion about HITT is necessary to avoid flap necrosis. We present a case of HITT which, as the 8 other articles reviewed, clearly shows that HITT is difficult to diagnose and complex to manage. Microvascular reconstruction is the first choice in head and neck reconstruction; unfortunately, dramatic outcomes in free flap surgery due to unpredictable thrombotic events are still reported in the English literature. More knowledge is required about HITT and reaching a consensus about thrombotic prevention in microsurgery could be helpful. Furthermore, a careful anamnesis can help minimise unexpected situations.