Oral Rehabilitation Of Patient Research Articles

Treatment of partial mandibular edentious patients using a partially removable prostheses with extracoronal attachments

The management of uni- or bi-terminal edentulous cases in patients who cannot undergo implant-prosthetic treatment is complex and challenging, often requiring a multidisciplinary approach. Correct diagnosis, paraclinical investigations (retroalveolar radiographs, CBCT, blood tests), and a well-elaborated treatment protocol are usually necessary to achieve a predictable and successful outcome. The objective of complete rehabilitation of an arch includes identifying the cause, preventing, and conserving the remaining dental structure. This case study presents an interdisciplinary endo-prosthetic management through endodontic retreatment followed by the realization of a removable prosthesis restoration with extracoronal attachments. The prosthetic restoration yielded excellent functional and aesthetic results. Background. Oral rehabilitation of patients who cannot benefit from implant-prosthetic treatment. Case report. Restoration of the mandible using removable prostheses with extracoronal attachments. Conclusions. Removable prosthetic restorations remain a treatment solution in the era of implant prosthetics.

Factors Affecting Complete Oral Rehabilitation in Patients With Vascularized Free Fibula Flap Mandibular Reconstruction: A 10-Year Retrospective Study.

The fibula is the preferred bone flap for mandibular reconstructions due to its many advantages, including the possibility to insert dental implants. All patients who received a mandibular reconstruction with a vascularized free fibula flap at the Uppsala University Hospital between 2009 and 2019 were retrospectively examined regarding the proportion of implant insertion and factors that affected implant outcome. Forty-one patients had 42 fibula flap reconstructions. Eleven patients (27%) received dental implants and 8 (20%) completed dental rehabilitation. Patient death and cancer recurrence were the main reasons for not receiving implants. The survival rates of implants placed in irradiated and nonirradiated fibulas were 15% and 76%, respectively. Less than 20% of reconstructed patients received an implant-supported prosthesis. Implants placed in an irradiated fibula should be considered at high risk for implant loss.

Three-piece digital complete denture obturator with a heptagonal key assembly for a patient with a total maxillectomy: A dental technique

Digital workflows have been used in the oral rehabilitation of patients with maxillofacial defects. However, dental techniques for fabricating a denture obturator for patients with a total maxillectomy are lacking. This technical report describes the use of digital technology to produce a milled complete denture obturator using an intraoral scanner, a computer-aided design software program, and computer-aided manufacturing. The limited size of the milled polymethylmethacrylate disk was resolved by separating the prosthesis into 3 pieces: the obturator base, denture base, and artificial teeth.

Effects of tongue lesions and palatal coverage on oral sensory functions

Statement of problemOral stereognosis (OS) plays a significant role in the oral rehabilitation of patients with edentulism, as it influences their adaptation to new prostheses. Because of the essentially tactile characteristic of oral sensory perception, the tongue and palate appear to have a crucial function in OS. However, little is known about the influence of tongue lesions on OS and sensorial function. In addition, controversies remain regarding the role of the palate. PurposeThe purpose of this clinical study was to evaluate whether tongue lesions and palatal coverage are disruptive to OS and gustatory function. Material and methodsSeventy participants (mean age=30.7 ±6.7 years) were divided into a tongue lesion group (experimental; n=35) and a control group (n=35). The tongue lesion group included participants with geographic, fissured, or hairy tongue. OS was evaluated with the oral stereognosis ability (OSA) test. Gustatory function was assessed with exposure to flavored solutions. After completing the above tests, the participants received a palate covering device, and then OS and gustatory function were immediately reevaluated. Data were analyzed with the Mann-Whitney and Wilcoxon tests (α=.05). ResultsOSA and gustatory function scores did not differ among the tongue lesion and control groups with and without palatal coverage (all P>.05). After palatal coverage, the tongue lesion group took more time to perform the OSA test than the control group (P<.05). ConclusionsNeither the presence of tongue lesions nor palatal coverage influenced OS or gustatory function. The OSA test response times were longer for the tongue lesion group after they had received palatal coverage.

PROSTHETIC REHABILITATION OF A RESORBED MAXILLA WITH AN INDIVIDUAL TITANIUM IMPLANT USING SELECTIVE LASER MELTING (SLM) TECHNOLOGIES. CASE REPORT

The purpose of presented case report was to show the outcome of prosthetic rehabilitation of a resorbed maxilla with an individual titanium maxillary implant using virtual 3D surgical planning and fabrication using Selective Laser Melting (SLM) technology. Oral rehabilitation in patients with severe atrophy using a custom titanium subperiosteal implant could be a solution with great potential to solve the well-known problems of traditional implantology. It is also very important to have enough experience with implants in general to reach the skill level to perform custom subperiosteal titanium implants using SLM laser growth technology.

Recreation of Aesthetic Smile by Restoring Form, Function and Aesthetics: A Prosthodontic Approach: A Case Report

Smile designing primarily involves an enhancement towards appealing and elegant smile through appropriate dental restorations. Todayrsquos modern society gives a lot of precedence to a beautiful and healthy smile making it crucial for dental specialists to devise a comprehensive plan for fulfilling patientrsquos desires. Oral rehabilitation of patients in need of an appealing smile necessitates an integrative approach that involves a modification not only in the soft tissue architecture but also in the form and configuration of teeth. This clinical report describes a successful interdisciplinary approach for the treatment of an aesthetically and functionally compromised anterior dentition of a young female patient. Treatment plan included extraction of teeth with poor prognosis intentional root canal treatment and crown lengthening of maxillary and mandibular anterior teeth followed by conventional porcelain-fused-to metal fixed prosthesis. The final treatment outcome not only restored satisfactory function and aesthetics of the patient but also led to an improvement in the quality of life with a positive mind set towards her appearance.nbsp

Clinical outcomes of fully and partially threaded zygomatic implants in a cohort of patients with minimum 7.5-year follow-up.

The aim of this retrospective case series report was to evaluate the results of oral rehabilitation with extra-sinus zygomatic implant surgery with a minimum follow-up of 7.5 years. A total of 35 patients with 87 zygomatic implants were included. The mean follow-up period of the patients was 93 months. The zygomatic implant survival and complications were evaluated as criteria for success. There were no implant failures. Overall success rate without complications for zygomatic implant was 88.5%. Complications developed in 4 patients (1 cutaneous fistula and 3 mucositis). According to the results on an implant basis, patients with previously failed conventional implants had greater probability of complications. Patients with quad zygomatic implants had higher incidence of complications than those with two zygomatic implants. Fully threaded implant design was associated with higher incidence of mucositis than partially threaded design. No relation was found between implant success and smoking, prosthesis type, and antagonist dentition. When conducting the analysis using the patient as unit, only the antagonist dentition showed significant difference, the worst outcome being associated with the Toronto resin prosthesis. Zygomatic implants can be considered as a safe alternative to conventional implant insertions and bone grafting procedures in oral rehabilitation of patients with severely atrophic maxillary bone.

Survival rate and complication-free survival rate of implant-retained prostheses in the oral rehabilitation of patients with head and neck cancer: A retrospective evaluation of a cohort from a regional service

Statement of problemLiterature reporting on the prosthetic survival and complications of implant-retained prostheses in patients with head and neck cancer is sparse. PurposeThe purpose of this retrospective study was to present the survival rates and complication-free survival rates of both fixed and removable implant-retained oral prostheses in patients with head and neck cancer while also reporting on the frequency and causes of failure and complications for each prosthesis type. Material and methodsA retrospective analysis of the prosthetic survival rates and complication-free survival rates of implant-retained oral prostheses and the frequency and causes of failure and complications in patients with head and neck cancer treated in a regional unit from 2012 to 2017 was performed. Differences in categorical and continuous data were assessed for statistical significance by using the Pearson chi-square test, Fisher exact test, t test, and analysis of variance as appropriate. Cox proportional hazard regression models were fitted to evaluate the association between prostheses type, clinical and medical factors, and the outcomes of survival and complication-free survival. Descriptive statistics were used to analyze the frequency and type of prosthetic complications. ResultsThe sample was composed of 153 patients diagnosed with head and neck cancer who had completed implant-retained prosthodontic rehabilitation and had been provided with 221 prostheses. The 5-year survival rate was 87% for maxillary fixed prostheses, 79% for mandibular fixed, 66% for maxillary removable, and 50% for mandibular removable. Hazard ratios were calculated showing that the 5-year survival rate of a mandibular removable prosthesis (HR=5.1; 95% CI 1.60-16.25) (P=.006) was greater than that of a maxillary fixed prosthesis (HR=1.0). The 5-year complication-free survival rate was highest for mandibular fixed prostheses (62%), followed by maxillary fixed (58%), maxillary removable (36%), and mandibular removable prostheses (29%). Hazard ratios showed that the 5-year survival rate of maxillary removable (HR=1.91; 95% CI 1.01-3.66) (P=.048) and mandibular removable prosthesis (HR=2.29; 95% CI 1.23-4.25) (P=.009) was greater than that of a maxillary fixed prosthesis (HR=1.0). Variables of radiotherapy, grafting, age, and sex and their influence on the survival rate and complication-free survival rate were assessed but were not statistically significant. ConclusionsThis evaluation indicated that fixed implant-retained prostheses had a higher 5-year survival rate and 5-year complication-free survival rate than removable implant-retained prostheses in patients with head and neck cancer.

Oral health in patients with neurodegenerative and cerebrovascular disease: a retrospective study

Purpose This retrospective study investigates oral health and oral care in patients with neurodegenerative and cerebrovascular diseases (CVDs) treated in a dental facility for people with disabilities. Methods Oral health indices decayed, missing, and filled teeth (DMFT), periodontal screening index (PSI), treatment spectrum, and oral hygiene were evaluated in 152 patients with multiple sclerosis, Parkinson’s disease, dementia, and CVD and 30 controls. Regression analyses identified group differences and influencing factors on DMFT. Results Patients with neurodegenerative or CVD had a significantly higher DMFT (21.2 ± 5.8 vs. 18.3 ± 5.9), more decayed teeth (4.3 ± 4.8 vs. 1 ± 1.9), fewer filled teeth (7.9 ± 5.5 vs. 11 ± 5.6), and a higher number of surgical (39.5% vs. 20%) treatments but significantly less conservative (49.3% vs. 73.3%) and prosthetic (15.1% vs. 56.7%) treatments than the control group (p< 0.05). The frequency of toothbrushing and the use of an electric toothbrush were related to lower DMFT in patients with neurodegenerative and CVD. Smoking was associated with higher DMFT. Conclusions Poor oral health was found in all individuals with disabilities, suggesting that limitations in oral care attributed to aging and neurological disorders negatively affect oral health. Oral rehabilitation of patients with disabilities requires awareness of oral health limitations and early intervention through dental care. Implications for rehabilitation Poor oral health and oral hygiene is common among older people with disabilities. To optimize oral rehabilitation of patients with disabilities, early intervention, individualized treatment plans and an adapted time frame for dental treatment are required. Education of dentists, caregivers, and family members is essential for oral rehabilitation and improvement of oral hygiene in patients with disabilities.

Pathways for the rehabilitation of resection defects in the maxilla.

Oral rehabilitation of head and neck cancer patients is an integral component of the care pathway. Maxillectomy procedures can cause significant defects, such as oronasal fistulas, loss of support for the cheek and lip, aesthetic defects in the middle third of the face and functional impairments. Orofacial rehabilitation plays a fundamental role in restoring aesthetics and functional capabilities, such as speech, mastication and deglutition.Rehabilitation of maxillectomy patients poses a challenge for both clinicians and patients. This paper utilises case examples to demonstrate the treatment options for the oral rehabilitation of these patients. We will summarise the treatment pathways for conventional obturators, delayed (secondary) implant retained fixed rehabilitation following composite free flap and early rehabilitation using a zygomatic implant perforated flap technique. This paper aims to highlight the challenges in treatment planning and the importance of a multidisciplinary approach in improving patient outcomes.

Conservative Dental Management of a Patient With Amelogenesis Imperfecta Under Oral Sedation: A Case Report

Amelogenesis imperfecta (AI) is a rare hereditary developmental disease that has a significant effect on the enamel structure. Both primary and permanent dentition could be affected by this condition. The pivotal characteristics are loss of the tooth structure, wear of enamel, and exposed dentinal areas at the occlusal surface of posterior teeth. AI may be inherited in autosomal dominant, autosomal recessive, or X‐linked types. Treatments of AI cases should be initiated in childhood and continue into adolescence. Considering that AI is a rare and heterogeneous condition, the dental team faces various difficulties regarding choosing the appropriate treatment plan. The oral rehabilitation of patients with AI is a challenging condition that needs a multidisciplinary approach. Many treatment options have been reported for solving cosmetic and restorative problems in AI cases. The conservative treatment plan in this hypoplastic-hypomature AI case included esthetic rehabilitation with a sequential method, innovative non-invasive pulp-therapy methods, and dental restorations under oral sedation. The written consent for the treatments was obtained after consultation with the child and his parents.

Interdisciplinary dental management of patient with oligodontia and maxillary hypoplasia: a case report

BackgroundThe craniofacial developmental abnormality can significantly complicate the oral rehabilitation of patients with oligodontia. This case report describes an interdisciplinary approach that took 7 years to successfully treat a young patient with non-syndromic oligodontia and midface deficiency.Case presentationA 14-year-old patient with complex oral and maxillofacial conditions and diagnosis of oligodontia presented to our clinic. In addition to 4 retained deciduous teeth and congenitally missing 10 permanent teeth, dentofacial findings included maxillary and malar deficiency with a concave facial profile, Angle Class III malocclusion, and poor dental esthetics. The interdisciplinary treatment included pre-surgical orthodontic decompensation, high Le Fort I maxillary osteotomy, postsurgical orthodontic therapy, osseous ridge augmentation using recombinant human bone morphogenetic protein-2 (rhBMP-2), interim removable partial denture, dental implant installation, interim implant prostheses, and final prosthetic rehabilitation.ConclusionsThe successful treatment of patients with oligodontia and complex dentofacial abnormalities requires the close and orderly collaboration among orthodontist, oral maxillofacial surgeon, and prosthodontist. Within the limitations of this case report, presented interdisciplinary approaches may optimize the oral rehabilitation outcome in patients with similar clinical challenges. A prospective clinical investigation is desired to verify the benefit of presented interdisciplinary approach.

Major indications and current clinical findings of zygomatic implant: a systematic review

Introduction: The lack of bone in the alveolar crest represents a major problem in aesthetic recovery in patients who have suffered dentoalveolar trauma, traumatic extractions, congenital tooth absence pathologies involving maxilla and mandible, and the possibility of deformity. In this sense, the zygomatic implant (ZI) is an alternative when there is bone loss. Objective: It was to carry out a systematic review of the main clinical outcomes of ZI, emphasizing the main indications. Methods: The present study followed the PRISMA rules. The search strategy was performed in the PubMed, Scielo, Cochrane Library, Web of Science and Scopus, and Google Scholar databases, following the rules of the word PICOS (Patient; Intervention; Control; Outcomes; Study Design). The Cochrane Instrument was used to assess the risk of bias of the included studies. Results and Conclusion: A total of 82 articles were found involving zygomatic implantation and the evolution of the technique. Initially, the duplication of articles was excluded. A total of 54 articles were fully evaluated and 33 were included in this study. Based on the clinical results of the last five years, some studies have broadened clinical understanding based on comparative studies to show the success rate of ZI. Even if more complications were reported for ZI that resolved spontaneously or could be handled, ZI proved to be a better modality of rehabilitation for severely atrophic jaws. Furthermore, zygomatic surgery proved to be a viable and safe alternative to conventional treatment modalities for oral rehabilitation of patients with ectodermal dysplasia syndrome. Also, there was greater accuracy and drastically reduced risk of perioperative/postoperative complications using the dynamic navigation system compared to the freehand placement of implants. Finally, guided surgery for the placement of ZI using specially designed metal jigs that must be supported by bone showed the placement of a made-to-measure provisional prosthesis, reducing surgery time, simplifying the procedure, and optimizing the result.

CLINICAL CASE OF DENTINE DYSPLASIA TYPE I

Developmental dental hard tissues disorders are rarely diagnosed both in children and adults, and their treatment is a problem for dentist. Despite the fact that molecular genetics studies allow to discriminate some dentine disorders, pathogenesis of radicular dentin dysplasia is still obscure. Type I dentin dysplasia is characterized by normal or slightly coloured crowns with no roots or only rudimentary roots, reduced pulp space in permanent teeth and incomplete or total obliteration of the pulp chambers, and periapical radiolucent areas or cysts which might result in premature loss of tooth. Fortunately, teeth demonstrate higher resistance to caries than normal teeth do.&#x0D; Dentin dysplasia type II is characterized by yellow, brown, grey, translucent primary teeth with complete pulpal obliteration. Permanent teeth are normal or might be slightly coloured. Roots are normal in size, but pulp chamber has pulp stones. A third type of dentine dysplasia or focal odontoblastic dysplasia has radiographic aspects of the other two types of disease.&#x0D; Also dentine dysplasia type I has subtypes Ia, Ib, Ic and Id. Dentine dysplasia Ia is characterized by complete obliteration of the pulp, disorder of root development, and many periapical radiolucent areas. A single small horizontally oriented and half-moon shaped pulp is presented in case of dentine dysplasia Ib, roots have a few millimetres length and frequent periapical radiolucencies. Dentine dysplasia Ic is characterized by the presence of two horizontal or vertical semicircle-shaped pulpal remnants which surround dentine in pulp chamber. Also teeth have shortened roots and variable periapical radiolucencies. Dentine dysplasia Id is characterized by the distinct pulp chambers with pulp stones in the coronal third of the root canal; periapical radiolucencies are possible as well. Aim of this study was to analyse clinical case of dentine dysplasia in 8,5-year-old boy.&#x0D; A 8,5-year old boy patient with parents came to a dental office due to caries cavity in tooth 62. Shape of tooth crowns was not changed and teeth with no signs of mobility; white lines and spots on teeth are were detected. Based on age, the decision of orthopantomogram was made to evaluate status of primary and permanent teeth. The image showed almost obliterated pulp chamber in both erupted and developing teeth and considerably shortened, blunted and malformed roots without a visible lumen of root canals in primary teeth. Periapical lesions were found about roots of primary molars and follicles of teeth 12 and 14 without caries lesions.&#x0D; Patient's medical history revealed no disturbance in general health. Clinical examination of the patient's mother did not show dental hard tissues disorders, but radiograph examination revealed such disorder in the orthopantomogram. Thus, history, clinical and radiographic findings revealed this case as dentine dysplasia type I subtype 1c inherited from mother.&#x0D; Oral rehabilitation of patients with dentine dysplasia type I require effective prevention and a complex approach. Thus, meticulous oral hygiene measures and dietary instructions, regular check-ups twice a year were established for this patient; orthodontic consultation was recommended. Varnish «Ftoplen-LC» was applied on the permanent teeth 3 times. To prevent early exfoliation, plan of preventive measures was developed included application of fluoride varnish twice a year and fissure sealing in the premolars in 9-10 years and in the second premolars in 12-13 years.&#x0D; Treatment of dentine dysplasia I type that depends on patient age and severity of disease may include also filling of carious teeth, orthodontic, surgical and orthodontic treatment. In this regard, dentist has to know developmental dental hard tissues disorders and select measures to prolong the retention of affected teeth maintaining them as long as possible.

Overdenture: An alternative treatment for oral rehabilitation in patients with early childhood caries

Oral rehabilitation in child is an odontopediatric challenge once the restorative treatament needs to be done in quick procedures and few visits for maintain cooperative child behaviour. With these objectives in mind, the present report describes an oral rehabilitation using fixed prosthesis (overdenture) in a 3-year-old boy who had early childhood caries and whose dental roots had been endodontically treated. The use of this device is a good aesthetic and functional solution for early teeth lost. Thus, this treatment approach allowed a harmonic dental maintenance in relation to other structures of the stomatognathic system, thus supporting the maxillary development and guiding the eruption of the permanent teeth, in addition to increasing patient and family satisfaction.

"Three-in-one" patient-specific surgical guides for simultaneous dental implants in fibula flap jaw reconstruction: A prospective case series.

Conventional freehand immediate placement of dental implants is technically challenging in the jaw reconstructive surgery. Computer-aided surgery might be the best solution, however, there has not been any standard approach to ensure the accuracy and efficiency of simultaneous dental implants in fibula flap jaw reconstruction. We aim to evaluate the clinical outcome of simultaneous dental implant in fibula flap using the "three-in-one" patient-specific surgical guide (3-in-1-PSSG) in an open-label, prospective, single-arm, and single-center clinical trial. A novel computer-aided designed and three-dimensional (3D) printed 3-in-1-PSSG, which contains functions of fibula segmentation, surgical plate positioning and implant placement, was used to facilitate the reconstructive surgery and simultaneous dental implant placement. The intraoperative success of dental implant placement, implant survival rate and accuracy of dental implant placement were reported. From November 2018 to June 2020, 15 consecutive patients with 48 dental implants were enrolled in this study. Fifteen 3-in-1-PSSGs were fabricated with a mean number of dental implants per guide of 3.2 ± 1.5. The intraoperative success rate of this approach was 14 out of 15. With an average follow-up period of 40 weeks, the overall implant survival rate was 83.3% (40/48). Eight implants were removed due to two fibula flap failures. The mean deviation at the implant platform and implant apex were 2.8 mm (interquartile range [IQR]: 1.9-3.4) and 3.2 mm (IQR: 2.0-4.6), and the angular deviation was 2.5° (IQR: 1.1-6.8). Our preliminary data indicated that the 3D printed 3-in-1-PSSG facilitated simultaneous dental implant in fibula flap jaw reconstruction with a favorable intraoperative success and short-term clinical outcome. It might be a viable alternative to allow one-step immediate oral rehabilitation in patients underwent jaw reconstruction with free flaps. Long-term results with a larger sample size are warranted.

Dental implant-based oral rehabilitation in patients reconstructed with free fibula flaps: Clinical study with a follow-up 3 to 6 years.

Oral rehabilitation of patients after maxillofacial reconstructive surgery represents a challenge and stable prosthetic retention can be achieved with the use of dental implants. This retrospective report aimed to evaluate implant-based oral rehabilitation following maxillofacial reconstruction with free fibula flaps. A total of 14 patients who had reconstruction with fibula flaps either by CAD/CAM or conventional surgery were included in this study. A total of 56 implants (40 in flaps, 16 in native bone) were evaluated. Follow-up after reconstructive surgery ranged between 3.25 and 6.3 years. Follow-up after implant surgery ranged between 1.5 and 3.8 years. Overall survival rate was 85.7% in free fibula flaps and 85.6% in dental implants. Eight implants were lost in three patients and all of these failures were in dental implants inserted in free flaps. According to the results on patient basis, the implant survival was not influenced by any variable. The maxillofacial reconstruction with free fibula flap and oral rehabilitation with implant-supported prostheses after ablative surgery can be considered as an effective and safe procedure with successful aesthetic and functional outcomes.

Osteogenic Potential of Bovine Bone Graft in Combination with Laser Photobiomodulation: An Ex Vivo Demonstrative Study in Wistar Rats by Cross-Linked Studies Based on Synchrotron Microtomography and Histology.

Background: Alveolar bone defects are usually the main concern when planning implant treatments for the appropriate oral rehabilitation of patients. To improve local conditions and achieve implant treatments, there are several methods used for increasing bone volume, among which one of the most successful, versatile, and effective is considered to be guided bone regeneration. The aim of this demonstrative study was to propose an innovative analysis protocol for the evaluation of the effect of photobiomodulation on the bone regeneration process, using rat calvarial defects of 5 mm in diameter, filled with xenograft, covered with collagen membrane, and then exposed to laser radiation. Methods: The animals were sacrificed at different points in time (i.e., after 14, 21, and 30 days). Samples of identical dimensions were harvested in order to compare the results obtained after different periods of healing. The analysis was performed by cross-linking the information obtained using histology and high-resolution synchrotron-based tomography on the same samples. A comparison was made with both the negative control (NC) group (with a bone defect which was left for spontaneous healing), and the positive control (PC) group (in which the bone defects were filled with xenografts and collagen membrane without receiving laser treatment). Results: We demonstrated that using photobiomodulation provides a better healing effect than when receiving only the support of the biomaterial. This effect has been evident for short times treatments, i.e., during the first 14 days after surgery. Conclusion: The proposed analysis protocol was effective in detecting the presence of higher quantities of bone volumes under remodeling after photobiomodulation with respect to the exclusive bone regeneration guided by the xenograft.

Meta analysis of oral rehabilitation in patients with maxillofacial defects -a systemic review

Meta analysis of oral rehabilitation in patients with maxillofacial defects -a systemic review

Oral Rehabilitation of Patients with Angle Class III Malocclusion and Teeth Loss through a Multidisciplinary Approach, Including Orthognathic Surgery and Implant Prosthetic Rehabilitation

Oral Rehabilitation of Patients with Angle Class III Malocclusion and Teeth Loss through a Multidisciplinary Approach, Including Orthognathic Surgery and Implant Prosthetic Rehabilitation