Dental implants in patients with ectodermal dysplasia: a computer guided quad zygomatic case report and literature review / Implantes dentales en pacientes con displasia ectodérmica: Reporte de caso y revisión de literatura

Abstract Ectodermal dysplasia (ED) is a genetic disorder affecting anatomical structures with an ectodermal origin. The consequent alveolar bone anomalies and lack of teeth require a multidisciplinary approach to rehabilitate patients function and esthetics. To avoid bone grafting procedures the application of zygomatic implants was suggested for the upper jaw treatment. The advancements in three-dimensional (3D) radiology and the introduction of digital implant planning software could enhance the approach to zygomatic implants in ED patients. The present case report describes the quad zygomatic implant treatment of the edentulous maxilla of an ED patient by means of computer guided implant surgery. The patient reported previous failure of bone grafting procedures in the upper jaw. The implants were immediately loaded with a screw-retained complete-arch resin prosthesis. The patient was followed up for 1 year with no biological nor mechanical complications reported, but a slight bone resorption in the anterior zone was observed. Zygomatic implants could be a potential alternative treatment to bone grafting in upper jaw and the digital implant planning could enhance the surgical procedure.

Resumen La displasia ectodérmica (DE) es una enfermedad genética que afecta las estructuras anatómicas de origen ectodérmico. Las consiguientes anomalías del hueso alveolar y la anodoncia requieren un planteamiento multidisciplinario para rehabilitar la función y la estética de los pacientes. Para evitar procedimientos de injerto óseo se sugirió la aplicación de implantes cigomáticos para el tratamiento del maxilar superior. Los avances en radiología tridimensional (3D) y la introducción de software de planificación de implantes digitales podrían mejorar el enfoque de los implantes cigomáticos en los pacientes con displasia ectodérmica. El presente reporte de caso describe el tratamiento con implantes cigomáticos en el maxilar superior edéntulo de un paciente con displasia ectodérmica mediante cirugía de implantes guiada por ordenador. El paciente refirió fracaso de procedimientos de injerto óseo en el maxilar superior. Los implantes se cargaron inmediatamente con una prótesis de resina de arcada completa. El paciente ha sido incluido en un programa de control postoperatorio por 1 año, sin reportarse complicaciones ni biológicas ni mecánicas, siendo el único problema encontrado una ligera reabsorción ósea en la zona anterior. Los implantes cigomáticos podrían ser un posible tratamiento alternativo al injerto óseo en el maxilar superior y la planificación de implantes digitales podría mejorar el procedimiento quirúrgico.

Surgical Excision of Unusual Sacked Neck and Mediastinum Abscess of Odontogenic Origin.

The most common cause of neck infections is odontogenic abscesses that can often be life-threatening and require a surgical drain associated with antibiotic therapy. We present a case of the surgical management of an odontogenic sack-shaped and walled abscess arising from elements 3.6, 3.7 and 3.8 that reached the laterocervical spaces and anterior mediastinum in a 28-year-old healthy woman. Typical signs and symptoms of cervical complications of dental origin are fever, a neck mass, lymphadenopathy, trismus and odynophagia. The gold standard treatment in these situations is a multidisciplinary approach involving an oral surgeon, ENT specialist and thoracic surgeon to drain the infected material. To the best of our knowledge, this is the first described case report of a dental abscess enclosed in a sack in the deep space of the neck and in the anterior space of the mediastinum.

Influence of Implant Scanbody Wear on the Accuracy of Digital Impression for Complete-Arch: A Randomized In Vitro Trial.

The aim of this study was to evaluate the influence of implant scanbody (ISB) wear on the accuracy of digital impression for complete-arch. A polymethylmethacrylate (PMMA) edentulous mandibular model with four internal hexagonal interlocking conical connections was scanned with an extraoral optical scanner to achieve a reference file. Four cylindrical polyetheretherketone (PEEK) ISBs were scanned 30 times with IOS, and the test files were aligned to the reference file with a best-fit algorithm. For each analog linear (ΔX, ΔY and ΔZ-axis) and angular deviations (ΔANGLE) were assessed. Euclidean distance (ΔEUC) was calculated from the linear deviation, reporting a mean of 82 µm (SD 61) ranging from 8 to 347 µm. ΔANGLE error mean was 0.33° (SD 0.20), ranging from 0.02 to 0.92°. From a multivariate analysis, when ΔEUC was considered as a response variable, a significant influence of ISB wear by scan number in interaction to position for implant 3.6 was identified (p < 0.0001); when ΔANGLE was considered as a response variable, a significant effect of position 3.6 was recorded ((p < 0.0001). The obtained results showed that the ISB wear negatively influenced the accuracy of IOS, suggesting that ISB base wear could be detrimental for the seating of ISBs on angulated implants.

Minimally Invasive Intraoral Approach to Submandibular Lodge.

The purpose of this study is to describe the Minimally Invasive Intraoral Approach (MIIA) performed on selected cases of abscesses and neck phlegmons of odontogenic origin when the infection has not spread beyond the inferior mandibular margin. This technique allows us to avoid cervicotomy by a direct approach to the abscess, draining it through the oral cavity. If the limits have already been crossed, then cervicotomy is necessary. The aim of the study is to show the surgical outcomes that we have achieved during a time span of two years, and to show the effectiveness of the MIIA and its results. We selected 66 patients with abscesses and neck phlegmons, from January 2018 to June 2020. Among these cases, five patients were excluded as it was not possible to recover medical records from database. The MIIA technique has been performed on 16 patients (26.2%) when a successful dental extraction and drainage of the submandibular lodge were accomplished. The patients who underwent the MIIA surgery have all perfectly healed and did not suffer from relapses during the follow-up. The results show the achievement of excellent healing, underlining the lower impact required by MIIA when compared to a more traditional approach through cervicotomy.

Surgical and orthodontic rapid palatal expansion in adults using a modified palatal partial osteotomy technique (ppot): Technique description and clinical experience.

Transversal hypoplasia of the upper maxilla is a frequent condition between malocclusions. The rapid maxillary expansion (RME) is an already consolidated technique for these types of defects. This case report analyzes the outcome of a novel surgical technique that we named TOPP (Partial Palatal osteotomy technique) aiming to provide scientifically proven data over the percentage of relapse and the long-term stability of this type of surgical assisted palatal expansion. A 24 year old male patient with a hyperdivergent class III, presenting the absence of 1.1 due to a teenage trauma and a transversal contraction of the upper arch was selected for the surgery. The mucoperiosteal flap was performed at a palatal level with a paramarginal arch shape (from region 1.4 to 2.4) due to preserve the nasal-incisal vascular bundle and the mucoperiosteum was detached from the floor of the nose. A horizontal osteotomy was performed at 4-5 mm above the roots apexes; a sagittal osteotomy in a posterior direction was done at the level of the midline to divide the mesiopalatine suture and separate the maxilla in two halves. The only bony attachment that remained was represented by the perpendicular lamina of the palatal bone. The TOPP technique showed that it is possible to have a better control of both the intercanine and intermolar expansion, that is more difficult in the case of a conventional SARME. Other goals were a greater view and access to the site and the reduction of the risk of damaging the palatine fibromucosa. The incision of the archform paramarginal flap improves certainly the conditions of the palatal fibromucosa in the post operative and allows the reduction of the soft tissues' elastic return. Key words:Rapid maxillary expansion, orthognatic surgery, maxillary osteotomy.

Chronic maxillary sinusitis of dental origin and oroantral fistula: The results of combined surgical approach in an Italian university hospital.

Unilateral chronic maxillary sinusitis is a possible complication of odontogenic disease or dental treatment and is mainly due to the development of an oroantral fistula (OAF). The management of chronic maxillary sinusitis of dental origin (CMSDO) requires a combined treatment via endoscopic sinus surgery (ESS) and intraoral surgical treatment of the odontogenic source. The aim of this study is to present the results of our university hospital unit in the treatment and follow-up of a case series of 34 patients treated with a combined surgical approach for CMSDO due to OAF. All patients were treated with ESS combined with an intraoral approach. No intraoperative or immediate postoperative complications were observed; nasal synechia was found in 3 patients (8.82%). The overall success rate after the primary intervention was 94.12%; recurrence was observed in 2 cases (5.88%), both were suffering from diabetes mellitus and were tobacco smokers. Our results confirm that simultaneous surgery with a combination of an intraoral and endoscopic approach can be considered the best strategy for the long-term restoration of normal sinonasal homeostasis in selected patients with chronic odontogenic sinusitis and OAF, guaranteeing an effective treatment with minimal complications in the short and long term.

Left-sided IVC in left renal cell carcinoma.

AIM: Congenital anomalies of the inferior vena cava (IVC) are very rare and extremely diverse, reflecting the complexity of the embryological development of these structures. The variants must be differentiated from pathology, particularly lymphadenopathy, on imaging studies as their presence can affect surgical and interventional procedures in retroperitoneum. We describe two patients with renal cell carcinoma of left kidney and left IVC. CASE REPORT: First patient was taken up for left radical nephroureterectomy. During surgery the existence of a transposed left IVC was demonstrated. The second case is a fifty-four-year-old man; abdomen and pelvic CT-scan with coronal maximum intensity projection reconstruction showed a 7 cm heterogeneously enhancing neoformation involving the left kidney with intraparenchymal hematoma and a transposed left IVC. CONCLUSIONS: Preoperative detection of congenital IVC anomalies can prevent morbidity. Once diagnosed, appropriate care must be taken during the operation to expose and define the anatomic anomaly and protect it from injury.