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A CLINICAL CASE OF ORBITAL RECONSTRUCTION M. Maglione, D. Sossi, E. Salvador, R. Rizzo Oral surgery, University Of Trieste, Trieste, Italy Objective: Blowout fractures of orbital bone may be cause of important facial asymmetry . Significant complications can occur as a result of these injuries, including enophthalmos, persistent diplopia, vertical dystopia, and restriction gaze. Recommendation for surgical fracture repair depend on a combination of clinical and imaging studies to evaluate the muscle and the nerve entrapment and periorbital tissue herniation. There are many techniques and biomaterials for reconstructing the original bony contour and restoration of proper orbital volume. Often a second surgery intervention may be required to solve the clinical case. Methods: A male 21 -year-old patient suffered frontal anterior cranial vault injuries and facial pan trauma. A first surgical intervention was performed to fracture reduction of frontal bone and zygomatic suture, supraorbital reconstruction with frozen bone, orbital floor reconstruction with durapatch membrane and reduction of maxillo-zygomatic process on the left. Reduction of frontal bone and zygomatic fracture, orbital floor and medial orbital frame reconstruction on the right. Than the patient’s anatomy was assessed in multiplanar (axial, coronal, sagittal) and 3D computed tomography. Stock titanium mesh was then preformed to the stereolitographic model to reproduce optimal orbital contour. A second surgical intervention was performed after 6 months to resolve left diplopia and the facial asymmetry of the patient. The orbital floor on the left was 7,4mm deeper than contralateral one. An orbital floor reconstruction with iliac crest graft bone was performed. A 1,5cm length and 1,2 deep graft bone was shaped and fixed with titanium mesh plate and screws. Result: Preoperative computer modeling provides useful guide for and presumably more accurate reconstruction of complex orbital injuries. Conclusions: The combined use bone grafts of titanium mesh plate could be an effective technique for the orbital floor reconstruction in severe asymmetry.

Orbital floor blowout fractures may cause severe facial asymmetry, particularly when combined with panfacial fractures with wide bone defects. Surgical repair recommendations depend on multi-disciplinary clinical evaluation and digital imaging to assess the amount of soft tissues herniation, the infraorbital nerve and rectum inferioris muscle entrapments, the ocular bulbus dislocation, and the ocular diplopia. A second surgery intervention may be required particularly when the orbital floor fracture is combined with skull and panfacial fractures in severely traumatized patients when the first surgical stage has been focused more on life saving than on craniofacial reconstruction. Preoperative multiplanar CT scans with 3D image reconstructions permit 3D printing modelling to achieve useful guide datas to combine bone grafts and titanium meshes in an effective and low expensive technique for orbital floor reconstruction when severe facial asymmetry occurs.

Aim To assess by micro-computed tomography (μCT) the quality of fillings in canals shaped with Reciproc considering the effects of filling technique and post insertion. Methodology The canals of 60 single-rooted teeth were instrumented with Reciproc R40 and randomly assigned to four groups (n = 15): G1, single point; G2, as G1 + DT Light Post; G3, continuous wave of condensation; G4, as G3 + DT Light Post. The filling voids were quantified by μCT. Data were statistically analysed by non-parametric test (p Results Filling greater than 96% of the entire canal volume was observed in all groups. The volume of internal voids was greater in G3 than in G4 (p Conclusions Our findings support the use of simplified techniques of canal shaping, filling with matching taper points and post cementation.

Aim To evaluate the 6-month outcome of endodontic treatment of periapical lesions with integrated systems by clinical examination and digital subtraction radiography (DSR). Methodology Eighty-four patients with chronic periapical pathosis were randomly allocated to two groups and received endodontic treatment with Revo-S/One Step Obturator (G1, n = 41) or GTX/GTX Obturator (G2, n = 43). Six months later, clinical examination and DSR analysis were performed. Non-parametric statistical methods were used (p Results Total healing, partial healing and failure occurred in 48.4%, 48.4% and 3.2% of cases in G1, in 50.0%, 43.8% and 6.2% of cases in G2, respectively. No significant difference was detected. Conclusions The integrated endodontic techniques allowed for a high 6-month success rate in both groups in accordance with literature data.

RiassuntoObiettiviValutare la guarigione di lesioni periapicali dopo sei mesi dal trattamento con sistemi integrati di strumentazione e otturazione canalare.Materiali e metodiSessanta pazienti con lesione periapicale sono stati assegnati a gruppi di trattamento (n=30) con sistema RevoS+One Step Obturator (G1) o con GTX+GTX Obturator (G2). La guarigione è stata valutata a sei mesi clinicamente e con Digital Subtraction Radiography (test non parametrici, p0,05).ConclusioniIl successo a sei mesi è alto e in linea coi dati della letteratura. Le tecniche semplificate considerate sono efficaci nel trattamento di lesioni periapicali.SummaryAimTo assess the healing of periapical lesions six months after the treatment with integrated systems for root canal shaping and filling.MethodologySixty patients with periapical lesion were randomly assigned to two treatment groups (n=30) with RevoS+One Step Obturator (G1) or GTX+GTX Obturator (G2). Healing was assessed by clinical examination and Digital Subtraction Radiography after six months (non-parametric tests, p0.05).ConclusionsThe six-month success was high and consistent with previously reported findings. The considered simplified techniques are effective for the treatment of periapical lesions.

RiassuntoObiettiviValutare il sigillo e la qualità dell’otturazione in canali sagomati con Reciproc in relazione a tecnica d’otturazione e inserimento del perno.Materiali e metodiSono stati analizzati con fluid filtration e microtomografia 44 denti estrattitrattati con Reciproc R40 e distinti in 4 gruppi test (n=10): G1, cono singolo; G2, come G1+perno; G3, System B; G4, come G3+perno (test parametrici e non, p