Presurgical Phase Research Articles

Implant Rehabilitation of Central Incisor: A Staged Approach

The aim of this report is to demonstrate the outcome of implant rehabilitation in the anterior maxilla. Aesthetics in implantology results from the correct execution of many rehabilitation phases: presurgical planning, surgical and prosthetic phases, and case management. In the presurgical phase, preexisting anatomical conditions and prosthetic evaluations influence the choice of regenerative techniques. Correct presurgical planning, in order to realize surgical and prosthetic procedures, is the most important phase to obtain an aesthetic result. Only a successful anatomical correction of hard and soft tissues is able to assure a satisfying therapeutic achievement involving many operative steps and the rigorous observance of recovery timing. A guided bone regeneration technique with a staged approach was used in conjunction with implant replacement.

Surgical crown lengthening: a 12-month study - radiographic results

ObjectiveThe purpose of this study was to perform a radiographic follow-up evaluation after a 12-month healing period, following crown lengthening surgery.Material and methodsTwenty-three periodontally healthy subjects (mean age 32.5 years) that required crown lengthening surgery in premolars were recruited. In a total of 30 premolars, full thickness flaps, osseous resection, and flap suturing were performed. The restorative margin was defined in the pre-surgical phase and maintained unaltered during the healing period, serving as a reference point. Standardized bitewing radiographs were taken before and after osseous reduction, and at 2, 3, 6, and 12-month healing periods.ResultsIntact lamina dura was observed at both mesial and distal alveolar crests only from the 3rd month. At 12-months, all alveolar crests presented lamina dura. The overall mean distance from the restorative margin to the alveolar crest achieved after osseous resection was 3.28±0.87 mm at mesial and 2.81±0.51 mm at distal sites. No significant radiographic changes in the bone crest were observed during a 12-month healing period.ConclusionThe findings of this study suggest that the radiographic proximal bone level observed on bitewing radiographs following crown lengthening surgery can be used as a reference to predict the future level of the healed alveolar crest.

Three-Dimensional Reconstruction and Image Processing in Mandibular Distraction Planning

Mandible or facial bone reconstruction is a serious challenge in craniomaxillofacial surgery. Careful presurgical planning or availability of objective methods to evaluate the three-dimensional (3-D) shape of the patient mandible is necessary to achieve predictable outcomes. The aim of this paper is to apply 3-D techniques of volumetric reconstruction and image processing for planning distraction osteogenesis of the mandible, involving the use of 3-D modeling. To accomplish this task, suitable two-dimensional (2-D)-to-3-D image processing is used in order to obtain a 3-D model of the mandible from standard 2-D computed tomography images. The goal of this paper is to provide the surgeon with a 3-D model of the patient mandible, where it would be possible to find, in the presurgical phase, the exact point of implant with respect to the patient's anatomy and to build a custom-made prosthesis that properly fits the bone surface of the patient for correct control of the vector during the progressive traction of the bone segments

Depression and Anxiety in Mastectomy Cases

The present research evaluated depression and anxiety in patients undergoing mastectomy during their pre-surgical and post surgical phases. A Pre-Post Research Design was used. Sample consisted of 50 married mastectomy patients, selected from the Surgery Department of Mayo Hospital, Hameed Latif Hospital and Jinnah Hospital of Lahore, Pakistan. Each subject was individually administered Depression Scale and Anxiety Check-List twice; that is: 1–7 days before and 1–7 days after surgery. The mastectomy patients showed greater depression and anxiety ( t = 1.68; df = 48; * p < 0.05) in the pre-surgical phase as compared to their post surgical phase probably due to the emphasis on body image and long-term psychosocial and sexual conflicts associated with the loss of this organ.

Clinical application of surgical fixation screws in implant prosthodontics—Part II: Indexing implant position

The accurate transfer of intraoral implant position to the definitive cast in situations of immediate implant loading in completely edentulous patients is an important step and may be difficult to achieve with common transfer and impression methods. Intraoral fixed points of reference accurately transferred to the definitive cast are necessary to provide precise and stable placement of radiographic and surgical templates during the presurgical diagnostic phase, during implant placement, and during fabrication of an immediate provisional restoration. This article describes a technique using surgical microfixation screws to provide fixed reference points and transfer the position of the conventional implants to the definitive cast.

Aneurysmal bone cysts: treatment with direct percutaneous Ethibloc injection: long-term results.

To assess the efficacy and long-term results of Ethibloc treatment in aneurysmal bone cysts (ABC). Thirteen patients with ABC were treated with direct percutaneous Ethibloc injection. Four patients had only one injection and the other nine patients from two to four injections. No severe complications were observed; in two patients a local leakage of Ethibloc from the cyst into the soft tissues occurred but it was temporary and the consequent inflammation self-healed without residua and sequelae. Imaging follow-up lasted from 6 to 67 months and included conventional radiology (CR) and magnetic resonance imaging (MRI), both used in the presurgical phase. All images demonstrated a remarkable shrinkage of the cystic lesion and bone cortex thickening. In all patients, circumscribed areas of lucency persisted at radiography, corresponding to residual cystic areas without fluid-fluid levels at MRI. Pain, which was present in all the patients before treatment, was relieved within a month. According to our experience, direct percutaneous Ethibloc injection is effective in the treatment of ABC and can be recommended as the first-choice treatment. Due to its higher sensitivity MRI must be included either in the pretreatment phase to study the multilocular structure or in the imaging follow-up to evaluate the efficacy of Ethibloc in persistently non-responsive areas.

Équilibre musculaire et chirurgie orthognathique

Few studies have been written about the effects of orthodontic preparation and of the consequences of surgical movements on mandibular motricity. The aim of this preliminary report is to evaluate the modifications of muscular activity between the pre-surgical phase and its evolution during the year after surgery, together with the skeletal modifications found. The muscular activity of six patients with serious vertical discrepancies requiring rehabilitation of the lower facial height has been studied using electromyographical recordings. A longitudinal study of the EMG data has been established in order to discover a muscular adaptation method towards physiological equilibrium following the realization of a new facial diagram. The reduction of the lower facial height obtained through a surgical procedure including a maxillary impaction, appears to indicate that, at rest, the masseter muscles activity tends to normalize, whereas that of the temporal muscles may sometimes increase. During maximal contraction, facial hyper-divergence reduction would lead to a sharp decrease in temporal and masseter muscular activity which would subsequently return to normal. The increase in vertical dimension would also cause significant changes in muscular tonus depending on the sagittal direction of the associated mandibular osteotomy. It would take longer to achieve muscular activity stability. These few results show: The existence of significant modifications following orthognathic surgery, possible reduction of high rest muscular activities, often revealing a cranio mandibular dysfunction, after vertical typology rehabilitation. The electromyographic recordings during treatment then enable to perfect the therapeutic re-evaluation of these major vertical discrepancies.

Diagnosis and Treatment Planning for the Surgical-Orthodontic Patient

Contemporary orthognathic surgery has made it possible to reposition either or both jaws in one piece or as segmental osteotomies. This has provided the patient, who has a severe dentofacial problem, with the option of having all components of their malocclusion and facial aesthetic concerns addressed. The close collaboration between the orthodontist and the surgeon provides a comprehensive diagnosis and treatment plan to be generated. The goal of the presurgical phase of orthodontics is to remove the dental compensations and allow optimum surgical correction of the jaw discrepancy. A short phase of orthodontic treatment postoperatively is usually necessary to detail the final occlusion. A systematic approach to diagnosis and treatment planning is discussed in the context of the problem-oriented approach. The application of this approach is illustrated in a case report of the combined orthodontic-surgical treatment of a patient who benefited from a two-jaw surgical procedure with pre- and postoperative orthodontic treatment. The principles of presurgical orthodontic treatment are discussed and should avoid any counterproductive tooth movements that can be part of the surgical correction. Tooth movements done as part of the postoperative treatment should avoid compromising the surgical outcome. Illustrations of the cephalometric prediction tracing and its application to the diagnosis and treatment plan of the patient discussed in the case report is an important aspect in providing the dentofacial patient with a representation of the expected treatment outcome.

Diagnosis and Treatment Planning for the Surgical-Orthodontic Patient

Contemporary orthognathic surgery has made it possible to reposition either or both jaws in one piece or as segmental osteotomies. This has provided the patient, who has a severe dentofacial problem, with the option of having all components of their malocclusion and facial aesthetic concerns addressed. The close collaboration between the orthodontist and the surgeon provides a comprehensive diagnosis and treatment plan to be generated. The goal of the presurgical phase of orthodontics is to remove the dental compensations and allow optimum surgical correction of the jaw discrepancy. A short phase of orthodontic treatment postoperatively is usually necessary to detail the final occlusion. A systematic approach to diagnosis and treatment planning is discussed in the context of the problem-oriented approach. The application of this approach is illustrated in a case report of the combined orthodontic-surgical treatment of a patient who benefited from a two-jaw surgical procedure with pre- and postoperative orthodontic treatment. The principles of presurgical orthodontic treatment are discussed and should avoid any counterproductive tooth movements that can be part of the surgical correction. Tooth movements done as part of the postoperative treatment should avoid compromising the surgical outcome. Illustrations of the cephalometric prediction tracing and its application to the diagnosis and treatment plan of the patient discussed in the case report is an important aspect in providing the dentofacial patient with a representation of the expected treatment outcome.

Bacterial Penetration of the Pocket Tissues in Juvenile/ Postjuvenile Periodontitis after the Presurgical Oral Hygiene Phase

Previous ultrastructural investigations of untreated sites of both adult and juvenile periodontitis have shown bacteria within the periodontal soft tissues. In the present study biopsies of the soft tissue walls of deep pockets from seven patients with juvenile (JP) or postjuvenile periodontitis (PJP) were removed at the end of the presurgical oral hygiene phase of treatment and examined in the transmission electron microscope. Bacteria were sparse, regardless of the level of tissue breakdown, both on the surface and within the superficial layers of the epithelium, deep to the basement membrane and throughout the underlying connective tissue. Of the 140 blocks from 20 biopsies, only two revealed intratissue accumulations of microorganisms. The organisms observed were gram-positive or gram-negative and appeared to be exclusively coccoid or rod-shaped. It is suggested that the reduced tissue content of bacteria reflects the establishment of adequate oral hygiene. Evidently either the tissue content of bacteria is less than has been reported previously or the host response is able to cope with residual bacteria that have penetrated the soft tissue.