Surgical decision making in coronally located vertical root fracture.

AIM: The purpose of this study was to present an intrasurgical decision making in teeth showing clinical signs and symptoms of incomplete vertical root fracture. METHODS: Sixteen patients with one tooth in which an incomplete vertical root fracture was diagnosed, involving only the buccal side, underwent a flap elevation procedure to visualize the pattern of bone loss and assess the type of root fracture. If the intraoperative diagnosis confirmed the presurgical one, a new root fracture repair technique was used. If the intraoperative diagnosis consisted of a complete or multiple fracture, the tooth was extracted and a postextraction implant insertion procedure was performed, in combination with the use of plasma rich in growth factors in order to enhance implant osseointegration. RESULTS: A total of nine vertical root fracture repair procedures were performed. The mean patient follow-up was 22.5 months. All patients reported full satisfaction for mastication function and phonetics. One patient was not satisfied for the esthetic result. A total of seven implants were immediately inserted in fresh postextraction sockets, and loaded four months later. The mean patient follow-up was 25.2 months. Overall implant success and survival was 100% after one year of functional loading. All patients reported full satisfaction for mastication function, phonetics and esthetics. CONCLUSIONS: Intraoperative diagnosis allowed to choose an appropriate surgical approach that led to excellent results in terms of clinical outcomes and patient satisfaction.

TUNEL - an efficient prognosis predictor of salivary malignancies.

Biological markers are necessary for predicting prognosis of salivary malignancies and better understanding the pathogenesis of salivary cancer. We analysed terminal deoxynucleotidyl transferase (TdT)-mediated biotinylated deoxyuridine-triphosphate (dUTP)-biotin nick-end labelling (TUNEL), p53 and Ki67 expression in 66 patients with malignant salivary tumours by immonohistochemistry, and correlated the data with survival, disease-free survival, tumour grade, stage, and local and distant metastasis. TUNEL efficiently predicted poor prognosis in salivary malignancies. The 5-year (5Y) survival probability dropped significantly with the level of TUNEL staining (from 83% in negatively stained tumours to 57 and 24% in TUNEL positively stained levels 1 and 2, respectively), (P=0.042). Extensive Ki67 staining (in addition to TUNEL) reduced the 5Y-survival rate even further and addition of positively stained p53 dropped the 5Y-survival rate to 0. The correlation rates between TUNEL and Ki67 was 58% (P=0.0001), and between TUNEL and p53 it was 50% (P=0.035). Concurrently, TUNEL correlated with metastasis, extracapsular spread, grade and stage. The correlation between TUNEL, p53 and Ki67 staining and survival probabilities, and the pathological grade, stage and metastasis spread of salivary malignancies makes this a highly effective tool in patient follow-up and prognosis.

[A new tricortical implant].

We wish to introduce a new type of implant intended for use in the posterior maxilla when only 8 mm or less of the resorbed alveolar ridge is present, without the need for sinus lift procedures or ridge augmentation. The implant is called "Excalibur" and will be available in varying lengths with either an internal or external hex. The implant is supported at three points in the cortical bone due to the use of an apically positioned screw, which passes through the implant and the buccal and palatal cortices at 90 degrees to the long axis of the implant. The bicortical screw is inserted via a minimal full thickness flap or through a small incision in the gingiva at the proposed point of placement. The additional stability provided by this screw allows for immediate loading at the time of implant placement. In comparative tests with regular implants, the "Excalibur" was found to be far more resistant to forces applied to the implant resulting in far less stress on the neck of the implant, which was shown on the finite element modeling. Two clinical cases are presented: 1) Excalibur implants were placed in the posterior maxilla and four months after the surgical procedure the permanent prosthetic rehabilitation was completed. 2) Excalibur implants were placed at the time of extraction, with an immediate temporary acrylic bridge. Permanent prosthetic rehabilitation was begun four months later.

Use of the 'shark-fin' osteotome in separation of the pterygomaxillary junction in Le Fort I osteotomy: a clinical and computerized tomography study.

Le Fort I osteotomy fails in many cases to completely separate the pterygomaxillary junction and often results in fractures of the pterygoid bone and the tuberosity, which subsequently can cause complications. The objectives of this study were to describe the specifically developed Laster 'shark-fin' osteotome and to compare its use to other methods of pterygomaxillary dysjunction. Pterygomaxillary dysjunction was performed in 10 adult patients requiring Le Fort I osteotomy. In one randomly chosen side of the maxilla, the Obwegeser osteotome was used, while the Laster 'shark-fin' osteotome was used on the opposite side. A postoperative computerized tomography of the separation at the pterygomaxillary junctions revealed that in all sites treated with the Laster 'shark-fin' osteotome, a complete or almost complete separation was obtained, whereas the use of the Obwegeser osteotome resulted in five sites with fractures of the maxillary tuberosity and three with high-level fractures of the pterygoid plates (P<0.001). Comparing these findings with the literature, we concluded that the Laster 'shark-fin' osteotome is preferable for separating the pterygomaxillary junction in Le Fort I osteotomy.

Fixation of a frontozygomatic fracture with a shape-memory staple.

A simple method using a staple was successfully used to treat a 74-year-old lady with a fractured frontozygomatic suture.

Complete bony fusion of the mandible to the zygomatic complex and maxillary tuberosity: case report and review.

Congenital craniofacial disorders represent approximately 20% of all birth defects. One of these disorders is syngnathia, of which only 24 cases have been reported since 1936. Twenty cases involved fusion of the alveolar processes of the maxilla and mandible. Only four are similar to the presented case, which includes bony fusion of the ascending ramus of the mandible to the zygomatic complex and the posterior part of the maxilla. This case report will present details from the 23rd week of gestation to 8 months of age when the infant underwent the first attempt to free the syngnathia. The literature is discussed and a causative mechanism and new classification are proposed.