The quality of life in orthognathic surgery: surgery first versus traditional orthognathic surgery evaluation.

BACKGROUND: This study aims to evaluate the differences in terms of Quality of life and the degree of satisfaction with the result obtained between the two groups of patients treated with the orthodontic first approach and surgery first approach, through administered questionnaires inserted in the post-operative phase. METHODS: A total of 40 patients who previously underwent orthognathic surgery were included in this study, 20 treated with the orthodontic first approach and 20 treated with the Surgery First Approach. The impact of orthognathic surgery on patients' quality of life was recorded through the administration of the OHIP-14 test, FACE-Q test scale and FACE-Q test. Comparison between the two groups was done using a nonparametric inferential statistical test, the Mann-Whitney U-test. RESULTS: The results showed no significant differences in terms of quality of life between the two groups. Patients treated with orthodontic first approach presented greater psychological distress and perceived their faces as unattractive. CONCLUSIONS: A worsening of the aesthetics of the face determined by the orthodontic approach before surgery, may not be decisive in the quality of life of patients, which will certainly be better after surgery. SFA and OFA determine in both cases a marked improvement in the patient's quality of life.

Virtual Orthodontic Surgical Planning to Improve the Accuracy of the Surgery-First Approach: A Prospective Evaluation.

PURPOSE: We developed an innovative computer-assisted method to increase the accuracy of the surgery-first (SF) approach by linking the virtual orthodontic planning (VOP) with the virtual surgical planning (VSP). MATERIALS AND METHODS: Fifteen consecutive patients were enrolled from 2013 to 2015. All 15 patients had initially undergone cone-beam computed tomography (CBCT; 15 × 15 field-of-view) and intraoral digital scanning of the dental arches. The DICOM (Digital Imaging and Communications in Medicine) data set and STL files were processed using the SimPlant O&O platform (Dentsply-Sirona, York, PA), which facilitates skeletal, dental, and soft tissue modeling and subsequent realization of the VOP/VSP. The VSP was reproduced using computer-aided design and computer-aided manufacturing surgical splints, and the VOP was realized via postoperative orthodontic treatment. At the end of treatment, all the patients underwent repeat CBCT and digital scanning of the dental arches, and the new data sets were compared with the original data sets to determine the deviations. To evaluate skeletal accuracy, we assessed all points within an arbitrary range of -2 to +2 mm. To evaluate dental accuracy, the arbitrary range was -0.8 to +0.8 mm. RESULTS: The average duration of orthodontic treatment was 17.9 months. The accuracy of maxillary treatment averaged 0.0702 ± 2.0724 mm and that of mandibular treatment, 0.2811 ± 1.9993 mm. The average upper and lower dental arch accuracy was -0.0029 ± 1.125 and -0.0147 ± 1.263 mm, respectively. The maxillary surgery accuracy was 75.3% and that of mandibular surgery 74.0%, both within the -2 to +2-mm range. The upper and lower arch accuracy was 58.86 and 51.53%, respectively, both within the -0.8 to +0.8-mm range. CONCLUSIONS: The use of the VOP/VSP improved the diagnostic and therapeutic SF preoperative planning. VOP contributed significantly in this context. The accuracy of skeletal repositioning was acceptable; however, the VSP should be rendered more reproducibly in the future to minimize the need for orthodontic compensation and to maximize the advantages of SF.

Infiltration of Autologous Growth Factors in Chronic Tendinopathies.

Achilles tendinopathy and patellar tendinopathy are among the most frequent diagnoses in sports medicine. Therapeutic treatment of the disease is difficult, particularly in chronic cases. In literature, several studies suggest the employment of Platelet-Rich Plasma as a therapeutic alternative in tendinopathies. The choice of employing this method is based on the activity of growth factors contained in platelets which activate, amplify, and optimize the healing process. We selected 14 patients affected by Achilles tendinopathy and 7 patients affected by patellar tendinopathy, with a two-year final follow-up. These patients underwent a cycle of three tendinous infiltrations, after clinical and instrumental evaluation carried out by means of specific questionnaires and repeated ultrasound scans. Ultrasound scans of 18 patients showed signs of reduction in insertional irregularities. The result is confirmed by complete functional recovery of the patients, with painful symptomatology disappearing. The patients showed a clear pain reduction, along with an enhanced VISA score after the 24-month follow-up, equal to 84.2 points on a scale of 0 to 100. In conclusion, the present study provides evidence to suggest that PRP infiltration is a valid option to patients with chronic tendinopathy who did not benefit from other treatments.

Laser evaporation versus laser excision of oral leukoplakia: A retrospective study with long-term follow-up.

OBJECTIVES: The study makes a comparison between two surgical approaches for the treatment of oral leukoplakia (OL) in terms of recurrence in a well-defined cohort of patients with a long-term follow-up period. METHODS: The cohort consisted of 77 OL patients divided into 2 groups. Group 1: 47 patients treated with laser evaporation using a Nd:YAG laser. Group 2: 30 patients treated with a CO2 laser for excision. Clinical and histological examinations were performed for the diagnosis of OL before treatment. We included OLs with or without dysplasia. The mean follow-up period was 60 ± 32.49 months. RESULTS: Of the 77 patients, 22 (28.5%) showed recurrence during the follow-up period. No significant difference was found between the two treatments (χ(2) = 2.6; p = 0.2). However, CO2 laser excision resulted in better results than the Nd:YAG laser evaporation, considering the non-homogeneous OLs (χ(2) = 3.9; p = 0.04) and OLs with mild dysplasia (χ(2) = 4.6; p = 0.03). DISCUSSION: The study makes a comparison between our results and articles from the literature, and suggests when each of the two surgical approaches is most appropriate.

Autologous platelet gel for tissue regeneration in degenerative disorders of the knee.

BACKGROUND: The refinement of the use of platelet-derived growth factors that has occurred over the last decade has led to a broadening of the fields of use, in particular for new treatments in orthopaedics aimed at improving tissue regeneration. MATERIALS AND METHODS: Twenty-seven patients, aged between 18 and 81 years, with a diagnosis of degenerative joint disease lasting for more than 1 year were treated. The patients were divided into two groups, one with arthritis of the knee, the other with degenerative cartilage disease of the knee. Both groups were treated with a therapeutic protocol consisting of a cycle of three infiltrations of platelet-rich plasma at weekly intervals.The extemporaneous preparation was made from a sample of about 8 mL of venous whole blood collected into a specific Fibrin Polymer 2 test-tube from RegenLab(®) and centrifuged before addition of calcium gluconate.During the initial pre-treatment evaluation, specific questionnaires were administered, the Numerical Rating Scale (NRS) for subjective measurement of pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); these assessments were repeated 7 days after the end of the treatment and at 6 months during the follow-up. RESULTS: The parameters evaluated improved in both groups after treatment and there was a further improvement after 6 months of follow-up; furthermore, there was a substantial decrease in pain right after the first infiltration. DISCUSSION: The patients were treated on an out-patient basis by a specifically created multidisciplinary team comprising a transfusion specialist, an orthopaedist and a radiologist, who collaborate in a symbiotic manner. The out-patient protocol exploits the regenerative properties of platelet-rich plasma, which is a low cost treatment; in practice, a diagnostic-therapeutic programme of lower intensity, but of high technical and professional quality is created. The strategy also reduces both the number of hospital services and the pharmacological support required, thereby optimising the use of health care resources.